Hitti Jane, Nugent Robert, Boutain Doris, Gardella Carolyn, Hillier Sharon L, Eschenbach David A
Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA.
Paediatr Perinat Epidemiol. 2007 Jul;21(4):330-7. doi: 10.1111/j.1365-3016.2007.00807.x.
The objective of this study was to examine the associations between lower genital tract infection, racial group and preterm birth in the Vaginal Infections and Prematurity Study, a large prospective cohort study conducted between 1984 and 1989. This analysis included 11 910 women enrolled at 23-26 weeks' gestation with equal representation from self-identified African American, Hispanic and white women. Subjects were screened for Chlamydia trachomatis, Trichomonas vaginalis and bacterial vaginosis at study entry, and their pregnancy outcomes were ascertained after delivery. The primary outcome of interest was preterm delivery of a low-birthweight infant (<37 weeks and <2500 g). The associations between lower genital tract infection and preterm delivery of a low-birthweight infant were examined within each racial group, with adjustment for potential confounders using multivariable logistic regression. In this cohort, 6.4% of African Americans, 3.8% of Hispanics, and 4.4% of whites had a preterm delivery of a low-birthweight infant (P < 0.001). Lower genital tract infection was significantly associated with preterm delivery of a low-birthweight infant among African Americans, but not among other racial groups. The proportion of preterm birth associated with lower genital tract infection was 21% among African Americans and 5% among whites. The increase in infection-associated preterm birth among African Americans appears to be related both to an increased prevalence of lower genital tract infection, and also to an increased risk of preterm delivery of a low-birthweight infant in the context of lower genital tract infection.
本研究的目的是在1984年至1989年进行的一项大型前瞻性队列研究——阴道感染与早产研究中，探讨下生殖道感染、种族与早产之间的关联。该分析纳入了11910名在妊娠23 - 26周时入组的女性，自我认定为非裔美国人、西班牙裔和白人的女性人数均等。研究开始时对受试者进行沙眼衣原体、阴道毛滴虫和细菌性阴道病筛查，并在分娩后确定其妊娠结局。主要关注的结局是低体重婴儿早产（<37周且<2500克）。在每个种族组内，使用多变量逻辑回归对潜在混杂因素进行调整后，研究下生殖道感染与低体重婴儿早产之间的关联。在该队列中，6.4%的非裔美国人、3.8%的西班牙裔和4.4%的白人有低体重婴儿早产（P<0.001）。下生殖道感染在非裔美国人中与低体重婴儿早产显著相关，但在其他种族组中并非如此。非裔美国人中与下生殖道感染相关的早产比例为21%，白人为5%。非裔美国人中感染相关早产的增加似乎既与下生殖道感染患病率增加有关，也与在下生殖道感染情况下低体重婴儿早产风险增加有关。
