台湾地区移民与本地出生女性剖宫产率与 VBAC 率：一项回顾性观察性研究 台湾地区移民女性剖宫产与 VBAC。
Cesarean and VBAC rates among immigrant vs. native-born women: a retrospective observational study from Taiwan Cesarean delivery and VBAC among immigrant women in Taiwan.
机构信息
Kaohsiung Municipal United Hospital, Department of Obstetrics & Gynecology, Kaohsiung, ROC, Taiwan.
出版信息
BMC Public Health. 2010 Sep 10;10:548. doi: 10.1186/1471-2458-10-548.
BACKGROUND
Cultural and ethnic roots impact women's fertility and delivery preferences This study investigated whether the likelihood of cesarean delivery, primary cesarean, and vaginal delivery after cesarean (VBAC) varies by maternal national origin.
METHODS
We conducted a nation-wide, population-based, observational study using secondary data from Taiwan. De-identified data were obtained on all 392,246 singleton live births (≥500 g; ≥20 weeks) born to native-born Taiwanese, Vietnamese and mainland Chinese-born mothers between January 1, 2006 and December 31, 2007 from Taiwan's nation-wide birth certificate data. Our analytic samples consisted of the following: for overall cesarean likelihood 392,246 births, primary cesarean 336,766 (excluding repeat cesarean and VBAC), and VBAC 55,480 births (excluding primary cesarean and vaginal births without previous cesarean). Our main outcome measures were the odds of cesarean delivery, primary cesarean delivery and VBAC for Vietnamese and Chinese immigrant mothers relative to Taiwanese mothers, using multiple regression analyses to adjust for maternal and neonatal characteristics, paternal age, institutional setting, and major obstetric complications.
RESULTS
Unadjusted overall cesarean, primary cesarean, and VBAC rates were 33.9%, 23.0% and 4.0% for Taiwanese, 27.6%, 20.1% and 5.0% for mainland Chinese, and 19.3%, 13.9 and 6.1% for Vietnamese respectively. Adjusted for confounders, Vietnamese mothers were less likely than native-born Taiwanese to have overall and primary cesarean delivery (OR = 0.59 and 0.58 respectively), followed by Chinese mothers (both ORs = 0.90 relative to native-born Taiwanese). Vietnamese mothers were most likely to have successful VBAC (OR = 1.58), followed by Chinese mothers (OR = 1.25).
CONCLUSION
Immigrant Vietnamese and Chinese mothers have lower odds of cesarean and higher VBAC odds than native-born Taiwanese, consistent with lower cesarean rates prevailing in their home countries (Vietnam 10.1%; mainland China 20%-50% rural and urban respectively).
背景
文化和民族根源影响着女性的生育和分娩偏好。本研究旨在调查产妇的原籍国是否会影响剖宫产、初次剖宫产和剖宫产后阴道分娩（VBAC）的可能性。
方法
我们进行了一项全国性、基于人群的观察性研究，使用了台湾全国出生证明数据中 2006 年 1 月 1 日至 2007 年 12 月 31 日期间出生的 392246 例单胎活产（≥500 克；≥20 周）的二次数据。我们的分析样本包括以下内容：总剖宫产可能性为 392246 例分娩，初次剖宫产 336766 例（不包括重复剖宫产和 VBAC），VBAC 55480 例（不包括初次剖宫产和无既往剖宫产的阴道分娩）。我们的主要结局指标是相对于台湾母亲，越南和中国移民母亲剖宫产、初次剖宫产和 VBAC 的可能性，使用多回归分析调整产妇和新生儿特征、父亲年龄、机构设置和主要产科并发症。
结果
未经调整的总剖宫产、初次剖宫产和 VBAC 率分别为台湾母亲 33.9%、23.0%和 4.0%，中国大陆母亲 27.6%、20.1%和 5.0%，越南母亲 19.3%、13.9%和 6.1%。调整混杂因素后，与本地出生的台湾母亲相比，越南母亲总剖宫产和初次剖宫产的可能性较小（OR = 0.59 和 0.58），其次是中国大陆母亲（OR 分别为 0.90 相对于本地出生的台湾母亲）。越南母亲 VBAC 成功率最高（OR = 1.58），其次是中国大陆母亲（OR = 1.25）。
结论
移民越南和中国母亲的剖宫产几率较低，VBAC 几率较高，与她们原籍国较低的剖宫产率一致（越南 10.1%；中国大陆分别为 20%-50%农村和城市）。
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