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.
Prof. 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.
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PhD in Nursing, Nursing-Emory UniversityPost-Master’s Certificate in Nursing Education, Emory UniversityMSN in Midwifery, Nursing-Emory UniversityBSN in Nursing, University of Tennessee Knoxville
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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)Fellow (FACNM), American College of Nurse Midwives (2020)Excellence in Teaching Award, American College of Nurse Midwives (2020)Emerging Leader in Health and Medicine Fellow, National Academy of Science and Medicine (2020)Nurse of the Year for Nursing Education, March of Dimes (2018) -
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Publications
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). In International journal of environmental research and public health (Vols. 19, Issues 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). In Journal of Perinatal and Neonatal Nursing (Vols. 36, Issues 2, pp. 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.The Convergence of COVID-19 and Systemic Racism : An Evaluation of Current Evidence, Health System Changes, and Solutions Grounded in Reproductive Justice
AbstractBritt, A. J., Carlson, N. S., Joseph, N. T., & Amore, A. D. (2021). In Journal of Midwifery and Women's Health (Vols. 66, Issues 3, pp. 298-303). 10.1111/jmwh.13250Abstract~Review of Evidence-Based Methods for Successful Labor Induction
AbstractCarlson, N., Ellis, J., Page, K., Amore, A. D., & Phillippi, J. (2021). In Journal of Midwifery and Women's Health (Vols. 66, Issues 4, pp. 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
AbstractAmore, A. D., Wells, J. S., Chandler, R., Dunn, A., & Brewster, G. (2020). In Journal of Women's Health (Vols. 29, Issues 3, pp. 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.Complement Activation during Early Pregnancy and Clinical Predictors of Preterm Birth in African American Women
AbstractAmore, A. D., Dunn, A. B., Dunlop, A. L., Miller, A. H., Hogue, C. J., Crofton, J. M., & Corwin, E. J. (2019). In Journal of Perinatal and Neonatal Nursing (Vols. 33, Issues 4, pp. E15-E26). 10.1097/JPN.0000000000000443AbstractComplement activation is essential for select physiologic processes during pregnancy; however, excess activation has been associated with an increased risk for preterm birth (PTB). African American (AA) women experience disproportionately higher rates of inflammation-Associated PTB than other groups of women; thus, the purpose of this study was to explore the relationship between complement activation and perinatal outcomes among AA women. A plasma sample was collected between 8 and 14 weeks' gestation from a cohort of healthy AA women (N = 144) enrolled in a larger PTB cohort study. Medical record review was conducted to collect information on clinical factors (cervical length, health behaviors, gestational age at delivery). Multiple regression analysis was used to explore the relationships between complement marker (C3a/Bb) concentrations and the outcomes of interest after adjusting for baseline characteristics. C3a/Bb concentrations were not significant predictors of the gestational age at delivery, cervical length, or behavioral risk factors for PTB in this sample. Complement markers may not influence pregnancy outcomes among AA women in the same way as in predominantly white populations; however, more studies are needed to define complement dysregulation and the relationship with outcomes among AA women.Through the Microbial Looking Glass : Premature Labor, Preeclampsia, and Gestational Diabetes: A Scoping Review
AbstractAmore, A. D., Dunn, A. B., Hanson, L., Vandevusse, L., & Leslie, S. (2019). In Journal of Perinatal and Neonatal Nursing (Vols. 33, Issue 1, pp. 35-51). 10.1097/JPN.0000000000000375AbstractThe influence of microbial factors on adverse perinatal outcomes has become the focal point of recent investigations, with particular interest in the role of the microbiome and probiotic interventions. The purpose of this scoping review was to identify and critique the most recent evidence about these factors as they relate to pregnancies complicated by preeclampsia (PEC), preterm birth (PTB), and gestational diabetes mellitus (GDM). Four databases (PubMed, EMBASE, Web of Science, and Cochrane) were searched for articles published in English in the last 10 years with the concepts of the microbiome, probiotics, and PEC, PTB, or GDM. Forty-nine articles were eligible for full-text review. Five articles were excluded, leaving 44 articles that met all the eligibility criteria. The relationships between the microbiome and the risk for PEC, PTB, and GDM are not fully elucidated, although probiotic interventions seem beneficial in decreasing PEC and GDM risk. Probiotic interventions targeting bacterial vaginosis and elimination of infection in women at risk for PTB appear to be beneficial. More research is needed to understand the contributions of the microbiome to adverse perinatal outcomes. Probiotic interventions appear to be effective in reducing risk for select outcomes.Antepartum Care of Women Who Are Obese During Pregnancy : Systematic Review of the Current Evidence
AbstractAmore, A. D., Carlson, N. S., Leslie, S. L., & Dunn, A. (2018). In Journal of Midwifery and Women's Health (Vols. 63, Issues 3, pp. 259-272). 10.1111/jmwh.12758AbstractIntroduction: Nearly 40% of US women of childbearing age are obese. Obesity during pregnancy is associated with multiple risks for both the woman and fetus, yet clinicians often feel unprepared to provide optimal antepartum care for this group of women. We collected and reviewed current evidence concerning antepartum care of women who are obese during pregnancy. Methods: We conducted a systematic review using PRISMA guidelines. Current evidence relating to the pregnancy care of women with a prepregnancy body mass index of 30kg/m2 or higher was identified using MEDLINE databases via PubMed, Embase, and Web of Science Core Collection between January 2012 and February 2018. Results: A total of 354 records were located after database searches, of which 63 met inclusion criteria. Topic areas for of included studies were: pregnancy risk and outcomes related to obesity, communication between women and health care providers, gestational weight gain and activity/diet, diabetic disorders, hypertensive disorders, obstructive sleep apnea, mental health, pregnancy imaging and measurement, late antepartum care, and preparation for labor and birth. Discussion: Midwives and other health care providers can provide better antepartum care to women who are obese during pregnancy by incorporating evidence from the most current clinical investigations.The Maternal Infant Microbiome : Considerations for Labor and Birth
AbstractAmore, A. D., Dunn, A. B., Jordan, S., Baker, B. J., & Carlson, N. S. (2017). In MCN The American Journal of Maternal/Child Nursing (Vols. 42, Issues 6, pp. 318-325). 10.1097/NMC.0000000000000373AbstractThe human microbiome plays a role in maintaining health, but is also thought to attenuate and exacerbate risk factors for adverse maternal-child health outcomes. The development of the microbiome begins in utero; however, factors related to the labor and birth environment have been shown to influence the initial colonization process of the newborn microbiome. This "seeding" or transfer of microbes from the mother to newborn may serve as an early inoculation process with implications for the long-term health outcomes of newborns. Studies have shown that there are distinct differences in the microbiome profiles of newborns born vaginally compared with those born by cesarean. Antibiotic exposure has been shown to alter the microbial profiles of women and may influence the gut microbial profiles of their newborns. Considering that the first major microbial colonization occurs at birth, it is essential that labor and birth nurses be aware of factors that may alter the composition of the microbiome during the labor and birth process. The implications of various activities and factors unique to the labor and birth environment that may influence the microbiome of women and newborns during the labor and birth process (e.g., route of birth, antibiotic use, nursing procedures) are presented with a focus on the role of labor nurses and the potential influence of nursing activities on this process.Maternal-Child Microbiome : Specimen Collection, Storage, and Implications for Research and Practice
AbstractAmore, A. D., Jordan, S., Baker, B., Dunn, A., Edwards, S., Ferranti, E., Mutic, A. D., Yang, I., & Rodriguez, J. (2017). In Nursing research (Vols. 66, Issues 2, pp. 175-183). 10.1097/NNR.0000000000000201AbstractBackground The maternal microbiome is a key contributor to the development and outcomes of pregnancy and the health status of both mother and infant. Significant advances are occurring in the science of the maternal and child microbiome and hold promise in improving outcomes related to pregnancy complications, child development, and chronic health conditions of mother and child. Objectives The purpose of this study was to review site-specific considerations in the collection and storage of maternal and child microbiome samples and its implications for nursing research and practice. Approach Microbiome sampling protocols were reviewed and synthesized. Precautions across sampling protocols were also noted. Results Oral, vaginal, gut, placental, and breast milk are viable sources for sampling the maternal and/or child microbiome. Prior to sampling, special considerations need to be addressed related to various factors including current medications, health status, and hygiene practices. Proper storage of samples will avoid degradation of cellular and DNA structures vital for analysis. Discussion Changes in the microbiome throughout the perinatal, postpartum, and childhood periods are dramatic and significant to outcomes of the pregnancy and the long-term health of mother and child. Proper sampling techniques are required to produce reliable results from which evidence-based practice recommendations will be built. Ethical and practical issues surrounding study design and protocol development must also be considered when researching vulnerable groups such as pregnant women and infants. Nurses hold the responsibility to both perform the research and to translate findings from microbiome investigations for clinical use. -