Quispel Chantal, Lambregtse-van den Berg Mijke P, Steegers Eric A P, Hoogendijk Witte J G, Bonsel Gouke J
1 Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands 2 Division of Obstetrics & Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
1 Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands 3 Department of Child and Adolescent Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands.
Eur J Public Health. 2014 Dec;24(6):917-23. doi: 10.1093/eurpub/cku063. Epub 2014 Jun 25.
Urban residence contributes to disparities in preterm birth (PTB) and birth weight. As urban and rural pregnant populations differ in individual psychopathological, psychosocial and substance use (PPS) risks, we examined the extent to which PTB and birth weight depend on the (accumulative) effect of PPS risk factors and on demographic variation.
Follow-up study from 2010 to 2012 among 689 urban and 348 rural pregnant women. Urbanity was based on the population density per ZIP code. Women completed the validated Mind2Care instrument questionnaire, which includes the Edinburgh Depression Scale, and demographic, obstetric and PPS questions. Pregnancy outcomes were extracted from medical records. With regression analyses we assessed crude and adjusted associations between residence and birth outcomes, adjusted for available confounding or mediating factors.
PTB was significantly associated with segregation, maternal age (<25 and ≥ 35 years old), primiparity, smoking during pregnancy and the accumulation of risks, but not with residence (urban, 4%; rural, 7%; P = 0.16). Mean birth weight was significantly lower for urban babies (crude β: -174; P < 0.001). Adjusting for potential confounders and mediators, non-Western ethnicity, parity and smoking during pregnancy significantly decreased birth weight besides residence. The accumulative effect of PPS risk factors significantly decreased birth weight (β: -58 g per risk factor; P < 0.001).
PTB was not associated with residence. The lower birth weight of urban babies remains significant after adjusting for urban risks, such as non-Western ethnicity and the PPS risk factor smoking. The accumulation of multiple (moderate) PPS risks accounts partly for the urban effect.
城市居住环境导致早产（PTB）和出生体重存在差异。由于城市和农村孕妇群体在个体心理病理、心理社会和物质使用（PPS）风险方面存在差异，我们研究了早产和出生体重在多大程度上取决于PPS风险因素的（累积）效应以及人口统计学差异。
对2010年至2012年期间的689名城市孕妇和348名农村孕妇进行随访研究。城市程度基于每个邮政编码区域的人口密度。孕妇完成经过验证的Mind2Care仪器问卷，该问卷包括爱丁堡抑郁量表以及人口统计学、产科和PPS问题。从医疗记录中提取妊娠结局。通过回归分析，我们评估了居住地与出生结局之间的粗关联和调整后关联，并对可用的混杂或中介因素进行了调整。
早产与隔离、母亲年龄（<25岁和≥35岁）、初产、孕期吸烟以及风险累积显著相关，但与居住地无关（城市为4%；农村为7%；P = 0.16）。城市婴儿的平均出生体重显著较低（粗β值：-174；P < 0.001）。在调整潜在的混杂因素和中介因素后，除居住地外，非西方种族、产次和孕期吸烟显著降低了出生体重。PPS风险因素的累积效应显著降低了出生体重（β值：每个风险因素-58克；P < 0.001）。
早产与居住地无关。在调整城市风险因素（如非西方种族和PPS风险因素吸烟）后，城市婴儿较低的出生体重仍然显著。多种（中度）PPS风险的累积部分解释了城市效应。
