The health disparity in preterm birth (PTB) that exists in the United States (US) is a national crisis. Pregnant Black women have a 50% higher risk of PTB compared to pregnant White women in the US, and their infants are more than twice as likely to die. This disparity continues despite decades of research and tried intervention. Over ten years ago, the National Academy of Medicine identified Black women’s exposure to chronic stress as among the most important risk factors contributing to this health disparity and called for additional research as necessary. Although additional research has been conducted, the high rates of PTB among Black women have continued unabated. Thus, to address this significant critical need, we have brought together an exemplary team of researchers and clinicians with unique and complementary expertise. With this team, we will conduct a first of its kind clinic trial: testing the efficacy of a 10-week, live, culturally congruent music intervention compared to a similarly delivered 10-week sham control, to reduce the biological impact of chronic stress at the most fundamental level -- the molecules and metabolic pathways that are affected by stress. We further propose implementing the Music Characterization System (MCS) to identify the musical mechanisms underlying any benefit. Black women in the US often are exposed to chronic stress related to their race, sex, socioeconomic status, and social determinants of health including neighborhood and household food insecurity. Our study stems from our team’s previous research demonstrating that within a similar population of pregnant Black women, chronic stress was associated with changes in maternal metabolites and metabolic pathways linked to oxidative stress, energy production, and myelination, all potentially influencing pregnancy and newborn outcomes. This study also stems from our team’s rigorous research showing the power of live music to reduce stress and improve outcomes. Based on the National Institute of Minority Health and Health Disparities Research Framework, we will recruit 142 pregnant Black women during their 1st trimester of pregnancy and implement the Music Intervention or sham control beginning in the 2nd trimester. Women will collect saliva samples for later metabolomic analysis and complete surveys at the 1st, 5th, and 10th-week verbal or sham session. Birth outcomes will be determined from careful review of the labor and delivery record. Music is one of the earliest, most traditional art forms in human history, while metabolomics is one of the newest and most advanced technologies available in the world today. By combining the very old with the very new in this innovative study, we have the opportunity to identify a means by which the beneficial effects of live, culturally relevant music chosen by a pregnant woman and implemented therapeutically, can reduce the biological impact of the daily stressors to which she is exposed, and as a result, reduce one of the most persistent health disparities of our time, PTB.

Preterm birth occurs at unacceptably high rates in the United States, with Black women disproportionately affected. A long-recognized risk factor for preterm birth in this population is the relentless exposure to intersectional stress related to racial and sexual discrimination, poverty, and neighborhood disadvantage that Black women often experience from an early age. In this interdisciplinary study, we bring together experts in preterm birth, music therapy, and metabolomics to address this health disparity by testing the efficacy of a live, culturally based music intervention to reduce the production of metabolites and metabolic pathways associated with chronic stress and thereby improve birth outcomes.