Wayne State University, Detroit, MI 48209, USA.
Paediatr Perinat Epidemiol. 2010 Nov;24(6):546-54. doi: 10.1111/j.1365-3016.2010.01148.x. Epub 2010 Aug 16.
Our objective was to examine how social and psychosocial factors may influence the risk of preterm birth. The design of the study was a hybrid retrospective and prospective cohort. African-American women residing in Baltimore, Maryland, were enrolled prenatally if they received care at one of three Johns Hopkins Medical Institution prenatal clinics (n=384) or enrolled post-partum if they delivered at Johns Hopkins Medical Institution with late, none or intermittent prenatal care (N=459). Preterm birth was defined as less than 37 weeks completed gestation. Interview data were collected on 832 enrolled women delivering singletons between March 2001 and July 2004. The preterm birth rate was 16.4%. In both unadjusted and adjusted models, exposure to racism over a woman's lifetime had no effect on risk of preterm birth in our sample. However, we found evidence of a three-way interaction between reported lifetime experiences of racism, depressive symptoms during pregnancy and stress during pregnancy on preterm birth risk. Racism scores above the median (more racism) were associated with an increased risk of preterm birth in three subgroups with the effect moderated by depressive symptoms and stress. Social and psychosocial factors may operate in a complex manner related to risk of preterm birth.
我们的目的是探讨社会和心理因素如何影响早产的风险。该研究的设计是混合回顾性和前瞻性队列研究。如果马里兰州巴尔的摩的三名约翰霍普金斯医疗机构产前诊所的妇女（n=384）接受了产前护理，或者如果她们在约翰霍普金斯医疗机构分娩但晚期、无产前护理或间歇性产前护理（N=459），那么她们就会被纳入研究。早产的定义是妊娠不足 37 周。2001 年 3 月至 2004 年 7 月期间，我们对 832 名分娩单胎的入组妇女进行了访谈。早产率为 16.4%。在未调整和调整模型中，女性一生中经历的种族主义对我们样本中早产的风险没有影响。然而，我们发现报告的一生中经历的种族主义、怀孕期间的抑郁症状和怀孕期间的压力之间存在三向相互作用，这与早产风险有关。种族主义评分高于中位数（更多的种族主义）与三个亚组的早产风险增加有关，而这种效果受到抑郁症状和压力的调节。社会和心理因素可能以与早产风险相关的复杂方式运作。
