Urquia Marcelo L, Ying Ivan, Glazier Richard H, Berger Howard, De Souza Leanne R, Ray Joel G
Centre for Research on Inner City Health, St. Michael's Hospital, Toronto ON; Institute for Clinical Evaluative Sciences, Toronto ON.
Department of Medicine, Schulich School of Medicine and Dentistry, London ON.
J Obstet Gynaecol Can. 2012 Apr;34(4):348-352. doi: 10.1016/S1701-2163(16)35215-X.
Research conducted outside Canada suggests that preeclampsia (PET) may be more common among certain ethnic groups. A limitation to prior studies is that they did not distinguish between immigrant and non-immigrant women; they also included women with mild PET arising near term, the clinical importance of which is debatable. We created the term "serious PET" to describe a diagnosis of severe PET, eclampsia, or any degree of PET with concomitant preterm delivery, fetal death, or maternal hospitalization of seven days or more, and evaluated its risk in association with world region of origin among recent immigrants to Ontario.
Using the federal Landed Immigrant Data System database (LIDS), we completed a population-based study of 118 849 women who immigrated to Ontario between 1985 and 2000. The LIDS was linked to the Canadian Institute for Health Information's Discharge Abstracts Database, thereby capturing all hospitalizations with subsequent delivery in Ontario between April 1, 2002, and March 31, 2009. Rates for serious PET were determined according to maternal world region of birth, and odds ratios were adjusted for maternal age, number of live births, multifetal pregnancy, diabetes mellitus status, level of formal education, place of residence, neighbourhood income quintile, duration of residence in Canada, and fiscal year of delivery.
Immigrant women from the Caribbean (6.8 per 1000; OR 3.34; 95% CI 2.25 to 4.96), Sub-Saharan Africa (6.8 per 1000; OR 3.14; 95% CI 2.04 to 4.83) and Hispanic America (5.9 per 1000; OR 3.11; 95% CI 1.97 to 4.88) were at highest risk of serious PET relative to immigrant women from industrialized nations. The ORs were either unchanged or higher when restricted to women without a prior live birth.
We identified immigrant groups at higher risk of serious PET, whose consequences would presumably include greater financial costs for hospital care and a negative impact on maternal and newborn well-being.
在加拿大以外开展的研究表明，子痫前期（PET）在某些种族群体中可能更为常见。既往研究的一个局限性在于，它们没有区分移民妇女和非移民妇女；这些研究还纳入了孕晚期出现的轻度PET患者，而其临床意义存在争议。我们创造了“严重PET”这一术语，用于描述重度PET、子痫、或任何程度的PET合并早产、胎儿死亡、或产妇住院7天及以上的诊断，并评估了安大略省近期移民中与原籍世界地区相关的严重PET风险。
利用联邦永久居民数据系统数据库（LIDS），我们对1985年至2000年间移民到安大略省的118849名妇女进行了一项基于人群的研究。LIDS与加拿大卫生信息研究所的出院摘要数据库相链接，从而获取了2002年4月1日至2009年3月31日期间安大略省所有随后分娩的住院信息。根据产妇的出生世界地区确定严重PET的发生率，并对产妇年龄、活产数、多胎妊娠、糖尿病状态、正规教育程度、居住地点、邻里收入五分位数、在加拿大的居住时间以及分娩财政年度进行比值比调整。
相对于来自工业化国家的移民妇女，来自加勒比地区（每1000人中有6.8例；比值比3.34；95%可信区间2.25至4.96）、撒哈拉以南非洲（每1000人中有6.8例；比值比3.14；95%可信区间2.04至4.83）和拉丁美洲（每1000人中有5.9例；比值比3.11；95%可信区间1.97至4.88）的移民妇女发生严重PET的风险最高。当仅限于无既往活产史的妇女时，比值比要么不变，要么更高。
我们确定了发生严重PET风险较高的移民群体，其后果可能包括更高的医院护理费用以及对孕产妇和新生儿健康的负面影响。
