The Generation R Study Group, Erasmus MC Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands.
Eur J Epidemiol. 2011 Feb;26(2):165-80. doi: 10.1007/s10654-010-9542-5. Epub 2011 Jan 4.
Dutch' figures on perinatal mortality and morbidity are poor compared to EU-standards. Considerable within-country differences have been reported too, with decreased perinatal health in deprived urban areas. We investigated associations between perinatal risk factors and adverse perinatal outcomes in 7,359 pregnant women participating in population-based prospective cohort study, to establish the independent role, if any, for living within a deprived urban neighbourhood. Main outcome measures included perinatal death, intrauterine growth restriction (IUGR), prematurity, congenital malformations, Apgar at 5 min < 7, and pre-eclampsia. Information regarding individual risk factors was obtained from questionnaires, physical examinations, ultrasounds, biological samples, and medical records. The dichotomous Dutch deprivation indicator was additionally used to test for unexplained deprived urban area effects. Pregnancies from a deprived neighbourhood had an increased risk for perinatal death (RR 1.8, 95% CI [1.1; 3.1]). IUGR, prematurity, Apgar at 5 min < 7, and pre-eclampsia also showed higher prevalences (P < 0.05). Residing within a deprived neighbourhood was associated with increased prevalence of all measured risk factors. Regression analysis showed that the observed neighbourhood related differences in perinatal outcomes could be attributed to the increased risk factor prevalence only, without a separated role for living within a deprived neighbourhood. Women from a deprived neighbourhood had significantly more 'possibly avoidable' risk factors. To conclude, women from a socioeconomically deprived neighbourhood are at an increased risk for adverse pregnancy outcomes. Differences regarding possibly avoidable risk factors imply that preventive strategies may prove effective.
与欧盟标准相比，荷兰的围产儿死亡率和发病率数据较差。也有报道称，国内存在相当大的差异，贫困城市地区的围产儿健康状况下降。我们在一项基于人群的前瞻性队列研究中，调查了 7359 名孕妇的围产儿危险因素与不良围产儿结局之间的关系，以确定生活在贫困城市社区是否存在独立的作用。主要结局指标包括围产儿死亡、宫内生长受限（IUGR）、早产、先天性畸形、5 分钟 Apgar 评分<7 分和子痫前期。个体危险因素的信息通过问卷调查、体格检查、超声检查、生物样本和病历获得。此外，还使用二分类荷兰贫困指标来检验无法解释的贫困城市地区效应。来自贫困社区的妊娠有更高的围产儿死亡风险（RR 1.8，95%CI [1.1; 3.1]）。IUGR、早产、5 分钟 Apgar 评分<7 分和子痫前期的患病率也更高（P<0.05）。居住在贫困社区与所有测量的危险因素的患病率增加有关。回归分析表明，观察到的围产儿结局与社区相关的差异可以归因于危险因素患病率的增加，而与生活在贫困社区无关。来自贫困社区的女性有更多的“可能可以避免的”危险因素。总之，来自社会经济贫困社区的女性有更高的不良妊娠结局风险。可能可以避免的危险因素差异表明，预防策略可能有效。
