Carmichael Suzan L, Shaw Gary M, Song Jun, Abrams Barbara
California Research Division, March of Dimes Foundation, Oakland, California 94609, USA.
Birth Defects Res A Clin Mol Teratol. 2008 Nov;82(11):755-62. doi: 10.1002/bdra.20517.
Prevalences of NTDs are typically 50-100% greater among Hispanic women compared to non-Hispanic Whites. This article examines whether markers of acculturation such as "language preference" allow the identification of high-risk groups within the Hispanic population. It also examines whether known NTD risk factors explain observed differences in risk among Hispanic women who are more and less acculturated.
This population-based case-control study of deliveries in selected California counties from 1999-2003 included 337 NTD cases and 626 nonmalformed, liveborn controls.
Relative to less acculturated US-born Hispanic women (i.e., women who preferred reading and speaking Spanish), other subgroups (i.e., US-born Hispanic women who preferred English, foreign-born Hispanic women regardless of "language preference", and non-Hispanic White women) had approximately twofold increased risks of spina bifida. Only the less acculturated foreign-born women (i.e., women with a preference for Spanish) had substantially increased risk of anencephaly (OR 1.7; 95% CI 0.9, 3.4). Adjustment for several NTD risk factors (maternal intake of folic acid-containing supplements, dietary folate intake, body mass index, food insecurity, stressful life events, smoking, alcohol intake, education, income, and neighborhood education and poverty) resulted in modest or no reductions in most of the ORs.
The explanation for variability in NTD risks among Hispanic and non-Hispanic White women therefore likely extends beyond most known NTD risk factors.
与非西班牙裔白人女性相比，西班牙裔女性的神经管缺陷患病率通常要高出50%-100%。本文探讨诸如“语言偏好”等文化适应指标是否能在西班牙裔人群中识别出高危群体。同时还研究了已知的神经管缺陷风险因素能否解释文化适应程度不同的西班牙裔女性在风险上的差异。
这项基于人群的病例对照研究涵盖了1999年至2003年加利福尼亚州部分县的分娩情况，包括337例神经管缺陷病例和626例无畸形的活产对照。
相对于文化适应程度较低的美国出生的西班牙裔女性（即更喜欢阅读和说西班牙语的女性），其他亚组（即更喜欢英语的美国出生的西班牙裔女性、不论“语言偏好”的外国出生的西班牙裔女性以及非西班牙裔白人女性）脊柱裂风险增加了约两倍。只有文化适应程度较低的外国出生女性（即偏好西班牙语的女性）无脑儿风险大幅增加（比值比1.7；95%置信区间0.9，3.4）。对多个神经管缺陷风险因素（孕妇摄入含叶酸补充剂、膳食叶酸摄入量、体重指数、粮食不安全、生活压力事件、吸烟、饮酒、教育程度、收入以及邻里教育和贫困情况）进行调整后，大多数比值比仅有适度降低或未降低。
因此，西班牙裔和非西班牙裔白人女性神经管缺陷风险存在差异的原因可能超出了大多数已知的神经管缺陷风险因素。
