Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 y in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences. By the preschool years, racial/ethnic disparities in obesity prevalence are already present, suggesting that disparities in childhood obesity prevalence have their origins in the earliest stages of life. Several risk factors during pregnancy are associated with increased risk of offspring obesity, including excessive maternal gestational weight gain, gestational diabetes, smoking during pregnancy, antenatal depression, and biological stress. During infancy and early childhood, rapid infant weight gain, infant feeding practices, sleep duration, child's diet, physical activity, and sedentary practices are associated with the development of obesity. Studies have found substantial racial/ethnic differences in many of these early life risk factors for childhood obesity. It is possible that racial/ethnic differences in early life risk factors for obesity might contribute to the high prevalence of obesity among minority preschool-age children and beyond. Understanding these differences may help inform the design of clinical and public health interventions and policies to reduce the prevalence of childhood obesity and eliminate disparities among racial/ethnic minority children.

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The Complicated Inadequacy of Race and Ethnicity Data "Choose from the options below." This seemingly innocuous prompt embedded in countless daily medical registrations aims to capture race and ethnicity. Yet, as mothers of children with multiple racial and ethnic identities, a prompt that could take just moments sometimes becomes a weighted pause, reminding us of the intersectional reality of our families. How do we represent the Thai and non-Hispanic White; Cuban and Vietnamese; Colombian, non-Hispanic Black, and non-Hispanic White backgrounds, roots, and cultures that our children embody? Which box or boxes do we check off?Selecting every possibly relevant box might imply that our children are counted as their whole selves, described by each part within. But do we also try to anticipate their eventual self-determined identity that will coalesce with their socially assigned one, as both may contribute to their health status? 1 Or, we can reflex to "other," recognizing that any collection of small boxes will never equal the sum of their inherited legacies or gathered experiences, a critical acknowledgment as we seek to disentangle the drivers of disparate health outcomes. But, if we designate our children as "other," how will they be accurately ascribed risk in clinical practice or research?The weight of the pause and the many different approaches to these questions are not just informed by our own lived experiences and what we understand about the world. They are questions we ponder deeply because, in addition to mothers, we are physicianscientists. We know that our children-with their specific family ancestries-are unlikely to be meaningfully represented in our own result tables. By selecting "other," we relegate them to exclusion from many data analyses, decreasing not only their contribution to the advancement of health care systems research but also any benefit children like them might receive because we have obscured them into a box that is uninterpretable. By selecting their specific combinations of races and ethnicities among the options available, they are equally uninterpretable within the typically resultant multiracial category given the infinite combinations contained within.These are not outlier considerations for just our own children. The 2020 US Census has shown that when given the opportunity, there are many of us who view our family heritage in complex ways that do not fit neatly within a handful of boxes. As of 2020, "some other race" was the second most common racial category selected, an option chosen for 49.9 million people. 2 The multiracial population in the US increased by 276%, from 9 million in 2010 to 33.8 million in 2020. These large shifts likely represent a combination of real population change along with the improved methodologies to select options that reflect self-perceptions. But it also means

Neonatal patients and families from historically marginalized and discriminated communities have long been documented to have differential access to health care, disparate health care, and as a result, inequitable health outcomes. Fundamental to these processes is an understanding of what race and ethnicity represent for patients and how different levels of racism act as social determinants of health. The NICU presents a unique opportunity to intervene with regard to the detrimental ways in which structural, institutional, interpersonal, and internalized racism affect the health of newborn infants. The aim of this article is to provide neonatal clinicians with a foundational understanding of race, racism, and antiracism within medicine, as well as concrete ways in which health care professionals in the field of neonatology can contribute to antiracism and health equity in their professional careers.

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ImportanceAppreciation for the effects of neighborhood conditions and community factors on perinatal health is increasing. However, community-level indices specific to maternal health and associations with preterm birth (PTB) have not been assessed.ObjectiveTo examine the association of the Maternal Vulnerability Index (MVI), a novel county-level index designed to quantify maternal vulnerability to adverse health outcomes, with PTB.Design, Setting, and ParticipantsThis retrospective cohort study used US Vital Statistics data from January 1 to December 31, 2018. Participants included 3 659 099 singleton births at 22 plus 0/7 to 44 plus 6/7 weeks of gestation born in the US. Analyses were conducted from December 1, 2021, through March 31, 2023.ExposureThe MVI, a composite measure of 43 area-level indicators, categorized into 6 themes reflecting physical, social, and health care landscapes. Overall MVI and theme were stratified by quintile (very low to very high) by maternal county of residence.Main Outcomes and MeasuresThe primary outcome was PTB (gestational age <37 weeks). Secondary outcomes were PTB categories: extreme (gestational age ≤28 weeks), very (gestational age 29-31 weeks), moderate (gestational age 32-33 weeks), and late (gestational age 34-36 weeks). Multivariable logistic regression quantified associations of MVI, overall and by theme, with PTB, overall and by PTB category.ResultsAmong 3 659 099 births, 298 847 (8.2%) were preterm (male, 51.1%; female, 48.9%). Maternal race and ethnicity included 0.8% American Indian or Alaska Native, 6.8% Asian or Pacific Islander, 23.6% Hispanic, 14.5% non-Hispanic Black, 52.1% non-Hispanic White, and 2.2% with more than 1 race. Compared with full-term births, MVI was higher for PTBs across all themes. Very high MVI was associated with increased PTB in unadjusted (odds ratio [OR], 1.50 [95% CI, 1.45-1.56]) and adjusted (OR, 1.07 [95% CI, 1.01-1.13]) analyses. In adjusted analyses of PTB categories, MVI had the largest association with extreme PTB (adjusted OR, 1.18 [95% CI, 1.07-1.29]). Higher MVI in the themes of physical health, mental health and substance abuse, and general health care remained associated with PTB overall in adjusted models. While the physical health and socioeconomic determinant themes were associated with extreme PTB, physical health, mental health and substance abuse, and general health care themes were associated with late PTB.Conclusions and RelevanceThe findings of this cohort study suggest that MVI was associated with PTB even after adjustment for individual-level confounders. The MVI is a useful measure for county-level PTB risk that may have policy implications for counties working to lower preterm rates and improve perinatal outcomes.

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