Alexis Dunn Amore's additional information
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Alexis Dunn Amore PhD, CNM is a clinical associate professor. She is committed to advancing the health of those most vulnerable. Her clinical practice, teaching, research and service are focused on dismantling perinatal health disparities, addressing racism and bias in midwifery and nursing education, and developing initiatives to address the root causes of maternal mortality. Her work has improved the health of thousands of women through research and clinical practice as well as advocacy efforts on the state and national level. She is passionate about the community and works in collaboration with several community organizations to develop timely and innovative strategies to address disparities in health outcomes for black women during pregnancy, as well as initiatives to build social support and resilience in the birth community.
Amore has received active funding for her research in the past from the National Institutes of Health, and the American College of Nurse Midwives. She is currently funded as a Co-Investigator on a R01 study funded by NIH/NINR entitled “Biologic Mechanisms of Labor Dysfunction: A systems Biology approach“ for which she oversees the community advisory board and leads sessions with them to support the research process. She has published in a variety of journals including the Journal of Midwifery and Women’s Health, Biological Research for Nursing, and BMC Pregnancy and Childbirth. Additionally, she actively disseminates health-related information through mainstream and social media outlets and has been featured on NPR radio as well as television broadcasts for Fox 5 Atlanta.
Prior to joining the faculty at NYU Meyers, Amore worked as a tenure track assistant professor at the Nell Hodgson Woodruff School of Nursing at Emory University. She also worked as a certified nurse midwife at the Atlanta Birth Center. Additionally, she has several years working as a nurse midwife in a variety of hospital based and community settings.
She is a fellow in the American College of Nurse Midwives and the American Academy of Nursing in which she actively serves on several committees. She is also current Vice-President for the American College of Nurse Midwives through which she serves to uplift the profession of midwifery and to sure access of care people across the reproductive spectrum.
Amore earned her Bachelors of Science degree in Nursing in 2005 from the University of Tennessee, Knoxville. She earned her MSN Midwifery in 2009, post masters certificate in nursing education in 2010, and her PhD in Nursing in 2017 from Emory University.
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PhD, Nursing-Emory University (2017)Post-Master’s Certificate, Nursing Education-Emory University (2010)MSN, Nursing-Emory University (2009)BSN, Nursing-University of Tennessee Knoxville (2005)
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MidwiferyNursing education
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American Academy of NursingAmerican Nurses AssociationAmerican College of Nurse Midwives
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Faculty Honors Awards
Research Article of the Year, American College of Nurse Midwives (2022)Fellow (FAAN), American Academy of Nursing (2021)Emerging Leader in Health and Medicine Fellow, National Academy of Science and Medicine (2020)Excellence in Teaching Award, American College of Nurse Midwives (2020)Fellow (FACNM), American College of Nurse Midwives (2020)Nurse of the Year for Nursing Education, March of Dimes (2018) -
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Publications
Disparities by race/ethnicity in unplanned cesarean birth among healthy nulliparas: a secondary analysis of the nuMoM2b dataset
AbstractCarlson, N. S., Carlson, M. S., Erickson, E. N., Higgins, M., Britt, A. J., & Amore, A. D. (2023). BMC Pregnancy and Childbirth, 23(1). 10.1186/s12884-023-05667-6AbstractBackground: Racial disparities exist in maternal morbidity and mortality, with most of these events occurring in healthy pregnant people. A known driver of these outcomes is unplanned cesarean birth. Less understood is to what extent maternal presenting race/ethnicity is associated with unplanned cesarean birth in healthy laboring people, and if there are differences by race/ethnicity in intrapartum decision-making prior to cesarean birth. Methods: This secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset involved nulliparas with no significant health complications at pregnancy onset who had a trial of labor at ≥ 37 weeks with a singleton, non-anomalous fetus in cephalic presentation (N = 5,095). Logistic regression models were used to examine associations between participant-identified presenting race/ethnicity and unplanned cesarean birth. Participant-identified presenting race/ethnicity was used to capture the influence of racism on participant’s healthcare experiences. Results: Unplanned cesarean birth occurred in 19.6% of labors. Rates were significantly higher among Black- (24.1%) and Hispanic- (24.7%) compared to white-presenting participants (17.4%). In adjusted models, white participants had 0.57 (97.5% CI [0.45–0.73], p < 0.001) lower odds of unplanned cesarean birth compared to Black-presenting participants, while Hispanic-presenting had similar odds as Black-presenting people. The primary indication for cesarean birth among Black- and Hispanic- compared to white-presenting people was non-reassuring fetal heart rate in the setting of spontaneous labor onset. Conclusions: Among healthy nulliparas with a trial of labor, white-presenting compared to Black or Hispanic-presenting race/ethnicity was associated with decreased odds of unplanned cesarean birth, even after adjustment for pertinent clinical factors. Future research and interventions should consider how healthcare providers’ perception of maternal race/ethnicity may bias care decisions, leading to increased use of surgical birth in low-risk laboring people and racial disparities in birth outcomes.Maternal health equity in Georgia: a Delphi consensus approach to definition and research priorities
AbstractHernandez, N. D., Aina, A. D., Baker, L. J., Blake, S. C., Dunn Amore, A. B., Franklin, C. G., Henderson, Z. T., Kramer, M. R., Jackson, F. M., Mosley, E., Nunally, L., & Sylvester, S. (2023). BMC Public Health, 23(1). 10.1186/s12889-023-15395-3AbstractBackground: Pregnancy-related mortality in the United States is the greatest among all high-income countries, and Georgia has one of the highest maternal mortality rates—almost twice the national rate. Furthermore, inequities exist in rates of pregnancy-related deaths. In Georgia, non-Hispanic Black women are nearly 3 times more likely to die from pregnancy-related complications than non-Hispanic White women. Unlike health equity, a clear definition of maternal health equity is lacking, overall and in Georgia specifically, but is needed to reach consensus and align stakeholders for action. Therefore, we used a modified Delphi method to define maternal health equity in Georgia and to determine research priorities based on gaps in understanding of maternal health in Georgia. Methods: Thirteen expert members of the Georgia Maternal Health Research for Action Steering Committee (GMHRA-SC) participated in an iterative, consensus-driven, modified Delphi study comprised of 3 rounds of anonymous surveys. In round 1 (web-based survey), experts generated open-ended concepts of maternal health equity and listed research priorities. In rounds 2 (web-based meeting) and 3 (web-based survey), the definition and research priorities suggested during round 1 were categorized into concepts for ranking based on relevance, importance, and feasibility. Final concepts were subjected to a conventional content analysis to identify general themes. Results: The consensus definition of maternal health equity created after undergoing the Delphi method is: maternal health equity is the ultimate goal and ongoing process of ensuring optimal perinatal experiences and outcomes for everyone as the result of practices and policies free of interpersonal or structural bias that tackle current and historical injustices, including social, structural, and political determinants of health impacting the perinatal period and life course. This definition highlights addressing the current and historical injustices manifested in the social determinants of health, and the structural and political structures that impact the perinatal experience. Conclusion: The maternal health equity definition and identified research priorities will guide the GMHRA-SC and the broader maternal health community for research, practice, and advocacy in Georgia.A Web-Based Intervention to Address Risk Factors for Maternal Morbidity and Mortality (MAMA LOVE): Development and Evaluation Study
AbstractAmore, A. D., Britt, A., Arconada Alvarez, S. J., & Greenleaf, M. N. (2023). JMIR Pediatrics and Parenting, 6. 10.2196/44615AbstractBackground: Maternal mortality in the United States is a public health crisis and national emergency. Missed or delayed recognition of preventable life-threatening symptoms and untimely treatment of preventable high-risk medical conditions have been cited as key contributors to the nation’s worsening mortality rates. Effective strategies are urgently needed to address this maternal health crisis, particularly for Black birthing populations. Morbidity and Mortality Assessment: Lifting Outcomes Via Education (MAMA LOVE) is a web-based platform that focuses on the identification of maternal morbidity and mortality risk factors. Objective: The purpose of this paper is to present the conceptualization, development, heuristics, and utility evaluation of the web-based maternal mortality risk assessment and educational tool MAMA LOVE. Methods: A user-centered design approach was used to gain feedback from clinical experts and potential end users to ensure that the tool would be effective among groups most at risk for maternal morbidity and mortality. A heuristic evaluation was conducted to evaluate usability and need within the current market. Algorithms describing key clinical, mental health, and social conditions were designed using digital canvas software (Miro) and incorporated into the final wireframes of the revised prototype. The completed version of MAMA LOVE was designed in Figma and built with the SurveyJS platform. Results: The creation of the MAMA LOVE tool followed three distinct phases: (1) the content development and creation of an initial prototype; (2) the feedback gathering and usability assessment of the prototype; and (3) the design, development, and testing of the final tool. The tool determines the corresponding course of action using the algorithm developed by the authors. A total of 38 issues were found in the heuristic evaluation of the web tool’s initial prototype. Conclusions: Maternal morbidity and mortality is a public health crisis needing immediate effective interventions. In the current market, there are few digital resources available that focus specifically on the identification of dangerous symptoms and risk factors. MAMA LOVE is a tool that can address that need by increasing knowledge and providing resources and information that can be shared with health care professionals.American College of Nurse-Midwives Clinical Bulletin Number 18: Induction of Labor
Failed generating bibliography.AbstractAbstractInduction of labor is an increasingly common component of intrapartum care in the United States. This rise is fueled by a nationwide escalation in both medically indicated and elective inductions at or beyond term, supported by recent research showing some benefits of induction over expectant management. However, induction of labor medicalizes the birth experience and may lead to a complex cascade of interventions. The purpose of this Clinical Bulletin is twofold: (1) to guide clinicians on the use of person-centered decision-making when discussing induction of labor and (2) to review evidence-based practice recommendations for intrapartum midwifery care during labor induction.Discrimination is associated with poor sleep quality in pregnant Black American women
AbstractCohen, M. F., Corwin, E. J., Johnson, D. A., Amore, A. D., Brown, A. L., Barbee, N. R., Brennan, P. A., & Dunlop, A. L. (2022). Sleep Medicine, 100, 39-48. 10.1016/j.sleep.2022.07.015AbstractBackground: Heightened exposure to racial/ethnic discrimination is associated with poorer sleep health among non-pregnant adults. This relationship has received limited research attention among pregnant women, despite the importance of prenatal sleep quality for optimal maternal and child health outcomes. Methods: We utilized perinatal data from a sample of Black American women (n = 600) participating in a cohort study who reported their lifetime experiences of racial/ethnic discrimination and gendered racial stress during early pregnancy and reported on their sleep quality and depressive symptoms during early and mid-pregnancy. Hierarchical multiple linear regression models were fit to examine associations between lifetime experiences of racial/ethnic discrimination or gendered racial stress and sleep quality during early and mid-pregnancy. We also adjusted for women's concurrent depressive symptoms and tested whether the discrimination/sleep quality association varied by socioeconomic status. Results: Greater exposure to racial/ethnic discrimination was associated with poorer sleep quality during early (ΔR2 = 0.04, ΔF = 26.08, p < 0.001) and mid-pregnancy (ΔR2 = 0.02, ΔF = 9.88, p = 0.002). Similarly, greater gendered racial stress was associated with poorer sleep quality during early (ΔR2 = 0.10, ΔF = 65.72, p < 0.001) and mid-pregnancy (ΔR2 = 0.06, ΔF = 40.43, p < 0.001. These findings largely held after adjustment for concurrent prenatal depressive symptoms. Socioeconomic status did not modify the observed relationships. Conclusions: Efforts to decrease institutional and interpersonal experiences of racial/ethnic discrimination and gendered racism would benefit the sleep quality of pregnant Black American women, particularly during early pregnancy.Factors Associated with Vaginal Lactobacillus Predominance among African American Women Early in Pregnancy
AbstractWright, M. L., Dunlop, A. L., Dunn, A. B., Mitchell, R. M., Wissel, E. F., & Corwin, E. J. (2022). Journal of Women’s Health, 31(5), 682-689. 10.1089/jwh.2021.0148AbstractBackground: Vaginal Lactobacillus is considered protective of some adverse reproductive health outcomes, including preterm birth. However, factors that increase or decrease the likelihood of harboring Lactobacillus in the vaginal microbiome remain largely unknown. In this study, we sought to identify risk and protective factors associated with vaginal Lactobacillus predominance within a cohort of pregnant African American women. Materials and Methods: Vaginal microbiome samples were self-collected by African American women (N = 436) during their 8-14th week of pregnancy. Sociodemographic information and measures of health behaviors, including substance use, antibiotic exposure, sexual practices, frequency of vaginal intercourse, and the use of vaginal products, were collected through participant self-report. The V3-V4 region of the 16S rRNA gene was targeted for amplification and sequencing using Illumina HiSeq, with bacterial taxonomy assigned using the PECAN classifier. Univariate and a series of multivariate logistic regression models identified factors predictive of diverse vaginal microbiota or Lactobacillus predominance. Results: Participants who used marijuana in the past 30 days (aOR 1.80, 95% CI 1.08-2.98) were more likely to have diverse non-Lactobacillus-predominant vaginal microbiota, as were women not living with their partners (aOR 1.90, 95% CI 1.20-3.01). Cohabitating or marijuana usage were not associated with type of Lactobacillus (non-iners Lactobacillus vs. Lactobacillus iners) predominance (aOR 1.11, 95% CI 0.52-2.38 and aOR 0.56, 95% CI 0.21-1.47, respectively). Conclusions: Living with a partner is conducive to vaginal Lactobacillus predominance. As such, cohabitation may be in important covariate to consider in vaginal microbiome studies.Intergenerational Effects of Discrimination on Black American Children’s Sleep Health
AbstractCohen, M. F., Dunlop, A. L., Johnson, D. A., Amore, A. D., Corwin, E. J., & Brennan, P. A. (2022). International Journal of Environmental Research and Public Health, 19(7). 10.3390/ijerph19074021AbstractGreater exposure to racial/ethnic discrimination among pregnant Black American women is associated with elevated prenatal depressive symptomatology, poorer prenatal sleep quality, and poorer child health outcomes. Given the transdiagnostic importance of early childhood sleep health, we examined associations between pregnant women’s lifetime exposure to racial/ethnic discrimination and their two-year-old children’s sleep health. We also examined women’s gendered racial stress as a predictor variable. In exploratory analyses, we examined prenatal sleep quality and prenatal depressive symptoms as potential mediators of the prior associations. We utilized data from a sample of Black American women and children (n = 205). Women self-reported their lifetime experiences of discrimination during early pregnancy, their sleep quality and depressive symptoms during mid-pregnancy, and their children’s sleep health at age two. Hierarchical linear multiple regression models were fit to examine direct associations between women’s experiences of discrimination and children’s sleep health. We tested our mediation hypotheses using a parallel mediator model. Higher levels of gendered racial stress, but not racial/ethnic discrimination, were directly associated with poorer sleep health in children. Higher levels of racial/ethnic discrimination were indirectly associated with poorer sleep health in children, via women’s prenatal depressive symptomatology, but not prenatal sleep quality. Clinical efforts to mitigate the effects of discrimination on Black American women may benefit women’s prenatal mental health and their children’s sleep health.Refocusing the Conduct of Maternal Mortality Research in Black Pregnant Populations: Ethical Considerations
AbstractAmore, A. D. (2022). Journal of Perinatal and Neonatal Nursing, 36(2), 131-137. 10.1097/JPN.0000000000000646AbstractIntroduction: Maternal morbidity and mortality rates are on the rise in the United States, particularly among Black populations. Recently, there has been an uptick in research funding to identify and address root causes, particularly among at-risk groups. However, given the historical trauma experienced by Black populations in research settings, novel approaches built firmly on ethical principles and grounded in a framework of reproductive justice are necessary to minimize harm and center the research process on maintaining the dignity and respect of research participants. Methods: Ethical principles as outlined by the American Nurses Association, Black Mamas Matter Alliance, and federal research guidelines are reviewed within the context of conducting maternal mortality-focused research. In addition, community developed research frameworks and methodologies are presented and discussed within the research context. Conclusions: Black pregnant people have reported mistreatment during clinical encounters; therefore, intentional protections to promote safety must be considered in the research setting. Ethical principles must be considered when designing and implementing research initiatives focused on addressing maternal mortality risk in Black communities.Review of Evidence-Based Methods for Successful Labor Induction
AbstractCarlson, N., Ellis, J., Page, K., Dunn Amore, A., & Phillippi, J. (2021). Journal of Midwifery and Women’s Health, 66(4), 459-469. 10.1111/jmwh.13238AbstractInduction of labor is increasingly a common component of the intrapartum care. Knowledge of the current evidence on methods of labor induction is an essential component of shared decision-making to determine which induction method meets an individual's health needs and personal preferences. This article provides a review of the current research evidence on labor induction methods, including cervical ripening techniques, and contraction stimulation techniques. Current evidence about expected duration of labor following induction, use of the Bishop score to guide induction, and guidance on the use of combination methods for labor induction are reviewed.The Vaginal Microbiome in U.S. Black Women: A Systematic Review
AbstractWells, J. S., Chandler, R., Dunn, A., & Brewster, G. (2020). Journal of Women’s Health, 29(3), 362-375. 10.1089/jwh.2019.7717AbstractBackground: Advancements in next-generation sequencing have allowed for a more complete understanding of the vaginal microbiome and its role in health and disease. The role of race/ethnicity in the composition of the vaginal microbiome and what is deemed normal/healthy microbiome is conflicting. Thus, the purpose of this review is to synthesize research that investigated the vaginal microbiome in Black women in the United States by using advanced 16S analysis. Methods: Searches of Pubmed, Google Scholar, and relevant journals for publications between January 2008 and July 2018 were conducted. Eligibility criteria were that the study: (1) used a molecular technique for sequencing of the vaginal microbiome, (2) reported the microbiome by race/ethnicity that included Black women, and (3) was conducted in the United States. Results: Our review selected 18 manuscripts that met the inclusion criteria for full review. Three themes emerged: the vaginal microbiome in healthy women versus women with bacterial vaginosis (BV); vaginal microbiome considerations in HIV; and vaginal microbiome considerations in preterm labor/birth. Overall, our review found that a majority of Black women (including HIV-positive women) have a Lactobacillus dominant group. Specifically, Lactobacillus iners was the most frequently reported Lactobacillus species. Non-Lactobacillus dominant groups were also reported to be found in healthy asymptomatic Black women. The vaginal microbiome's influence on preterm labor and/or birth among Black women was inconclusive and warrants further investigation. Conclusions: The role that the microbiome plays in health and disease among Black women warrants further research to better elucidate the definition of a healthy versus pathogenic microbiome. The wide variability in methods for BV diagnostics and defining preterm labor/birth are significant limitations that should be considered when conducting comparative studies.