The sex differences on neonatal mortality, estimated considering race and birth weight, have been known since the last century and they are negatively associated with gestational age. Notably, the male babies have major mortality and the worst postna­tal outcomes presenting a higher incidence of prematurity and congenital diseases.

Mothers of male babies have a higher rate of gestational diabetes mellitus, fetal macrosomia, and caesarean delivery and preterm births with a higher overall mortality rate.

Interestingly, prenatal drug exposure seems to affect differently male and female fetuses. For example, following maternal betamethasone for positive effects on survival in preterm neonates seems to be beneficial effect only male but this is not univocal datum. Vice versa, postnatal steroids seem to improve pulmonary outcomes more in females than in males. Additionally, maternal drug assumption can modify the infant microbiota. In particular, anti-asthmatic therapy lowered Lactobacilli in male while Bacteroidacæ are elevated in female. Post-hoc analysis on the use of indomethacin in preterm neonates to prevent IVH suggest a beneficial only in male neonates. Neonatal administration of caffeine produces sex dimorphic alteration in blood metaboloma. Neonatal abstinence syndrome due to prenatal opioid exposure has a higher frequency and severity in the male population, conversely female infants have more benzodiazepine deficiency symp­toms.

Interestingly, growing evidence shows that boys and girls respond differently to maternal nutrition, and maternal breastmilk composition differs based on fetal sex Additionally, maternal drug assumption can modify the infant microbiota. In particular, anti-asthmatic therapy lowered Lactobacilli in male while Bacteroidacæ were elevated in females.

Relevantly sex and gender differences are also observed in prenatal e neonatal programming, a concept, which highlights as certain events that occur during pregnancy and neonatal life may cause permanent effects that may change health trajectories across the lifespan. Some authors suggest that male embryos and fetuses are more sensible versus specific programming influences than female offspring. The early environmental life experience in utero and in the neonatal life is a major factor in shaping later life disease risk-including susceptibility to develop obesity, diabetes, cardiovascular disease, neurological and psychiatric diseases.

This Collection aims to improve the knowledge and underline the importance of sex-gender impact at the beginning of life. Eligible articles may include review, epidemiological, basic, clinical, and/or translational research articles. Topics include, but are not limited to, fetal and neonatal health, fetal and neonatal programming, genetics and epigenetics, nutrition, environmental factors, pregnancy-related diseases (e.g., pre-eclampsia, gestational diabetes), mechanisms, biomarkers, metabolomics and proteomics, therapies and drug abuse.

All submissions in this Collection undergo the journal’s standard peer review process. Similarly, all manuscripts authored by a Guest Editor(s) will be handled by the Editor-in-Chief. As an open access publication, this journal levies an article processing fee (details here). We recognize that many key stakeholders may not have access to such resources and are committed to supporting participation in this issue wherever resources are a barrier. For more information about what support may be available, please visit OA funding and support, or email OAfundingpolicy@springernature.com or the Editor-in-Chief.

The ongoing advancement of our understanding of how racism impacts health - both directly and structurally - is crucial for addressing the deep-rooted health inequities that persist globally. Structural racism shapes health outcomes among racialized populations, contributing to inequities in healthcare access and quality, and impacting social, political, or environmental determinants of health. Existing research also connects direct and visible manifestations of racism, such as major and everyday discrimination, to negative health outcomes. At the same time, racism does not operate in isolation. A growing body of research shows how it intersects with other systems of oppression—such as classism and patriarchy—and with broader social determinants of health, producing compounded and context-specific inequities. An intersectional lens is therefore essential to understand how overlapping structures of power and exclusion shape health and healthcare experiences. These insights are essential in conducting rigorous and thorough health research, guiding anti-racist health policy, and ultimately, ensuring equitable health for all.

Looking forward, research holds the potential to develop new methodologies and indices and unveil complexities in how racism manifests within healthcare systems and societal structures. By deepening our collective understanding, we can develop more effective interventions that target the root causes of health inequities.

We invite researchers to contribute to this special Collection on Racism and Health, focusing on advancing our understanding and addressing health inequities. Topics of interest include but are not limited to:

- Racism as a structural determinant of health

- Racism as a direct determinant of health

- Racialized health outcomes in different populations

- Intersectionality and inequities in health, healthcare access and quality

- Nexuses between social, political, and environmental determinants of health and systemic discrimination

- Anti-racist health policy frameworks and systems

- Impact of racism on mental health

- Health inequities in reproductive, maternal, and child health

- Obstetric and reproductive violence

- Community-based interventions for equitable health

- Decolonizing health research and global health epistemologies

We strongly encourage contributions from racialized scholars and authors with lived experience or expertise in addressing systemic discrimination in health research.

This Collection supports and amplifies research related to SDG 3, Good Health and Well-Being and SDG 10, Reduced Inequalities.

All submissions in this collection undergo the journal’s standard peer review process. Similarly, all manuscripts authored by a Guest Editor(s) will be handled by the Editor-in-Chief. As an open access publication, this journal levies an article processing fee (details here). We recognize that many key stakeholders may not have access to such resources and are committed to supporting participation in this issue wherever resources are a barrier. For more information about what support may be available, please visit OA funding and support, or email OAfundingpolicy@springernature.com or the Editor-in-Chief.