Reproducing Inequity: Artificial Womb Technologies and Environmental Health Threats

Abstract: In September 2023, the FDA Pediatric Advisory Committee convened to establish regulatory and ethical standards for the first human trials of artificial womb technologies. These devices mimic in vivo placental oxygenation and substrate delivery to mitigate morbidity and mortality among extremely premature infants. When considering clinical efforts to address the complications of extreme prematurity, it is essential to recognize how environmental injustices play a role in racial disparities in preterm birth and create uterine environments that impede healthy human development. It is well established that environmental exposures during gestation contribute to adverse maternal-fetal outcomes––including stillbirth, fetal demise, extreme prematurity, and intrauterine growth restriction. Evidence suggests that exogenous stressors (including trauma, natural disasters, and poverty) during pregnancy may alter placental gene expression, contributing to genomic instability and varied disease processes. The implementation of new gestative technologies could perpetuate the very environmental injustices that warrant their use. Thus, clinicians and bioethicists ought to engage in discourse around the following: Will artificial womb technologies exacerbate existing racial disparities in health outcomes among extremely preterm neonates? How might artificial womb technologies obscure structural racism and reinforce environmental health injustices? And how might regulatory and ethical guidelines for the first human trials of artificial womb technologies address environmental health threats that exacerbate racial disparities in maternal-fetal health?

Faith Fletcher – Baylor College of Medicine