有或无辅助生殖情况下新生儿出生结局中的孕产妇种族和民族差异
Maternal Racial and Ethnic Disparities in Neonatal Birth Outcomes With and Without Assisted Reproduction.
作者信息
Crawford Sara, Joshi Nikhil, Boulet Sheree L, Bailey Marie A, Hood Maria-Elena, Manning Susan E, McKane Patricia, Kirby Russell S, Kissin Dmitry M, Jamieson Denise J
机构信息
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; the Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; the Florida Department of Health, Division of Public Health Statistics and Performance Management, Tallahassee, Florida; the Massachusetts Department of Public Health, Boston, Massachusetts; the Michigan Department of Health and Human Services, Lansing, Michigan; and the University of South Florida, Tampa, Florida.
出版信息
Obstet Gynecol. 2017 Jun;129(6):1022-1030. doi: 10.1097/AOG.0000000000002031.
OBJECTIVE
To explore disparities in prematurity and low birth weight (LBW) by maternal race and ethnicity among singletons conceived with and without assisted reproductive technology (ART).
METHODS
We performed a retrospective cohort study using resident birth certificate data from Florida, Massachusetts, and Michigan linked with data from the National ART Surveillance System from 2000 to 2010. There were 4,568,822 live births, of which 64,834 were conceived with ART. We compared maternal and ART cycle characteristics of singleton liveborn neonates using χ tests across maternal race and ethnicity groups. We used log binomial models to explore associations between maternal race and ethnicity and LBW and preterm birth by ART conception status.
RESULTS
The proportion of liveborn neonates conceived with ART differed by maternal race and ethnicity (P<.01). It was smallest among neonates of non-Hispanic black (0.3%) and Hispanic women (0.6%) as compared with neonates of non-Hispanic white (2.0%) and Asian or Pacific Islander women (1.9%). The percentages of LBW or preterm singletons were highest for neonates of non-Hispanic black women both for non-ART (11.3% and 12.4%) and ART (16.1% and 19.1%) -conceived neonates. After adjusting for maternal factors, the risks of LBW or preterm birth for singletons born to non-Hispanic black mothers were 2.12 [95% confidence interval (CI) 2.10-2.14] and 1.56 (95% CI 1.54-1.57) times higher for non-ART neonates and 1.87 (95% CI 1.57-2.23) and 1.56 (95% CI 1.34-1.83) times higher for ART neonates compared with neonates of non-Hispanic white women. The adjusted risk for LBW was also significantly higher for ART and non-ART singletons born to Hispanic (adjusted relative risk [RR] 1.26, 95% CI 1.09-1.47 and adjusted RR 1.15, 95% CI 1.13-1.16) and Asian or Pacific Islander (adjusted RR 1.39, 95% CI 1.16-1.65 and adjusted RR 1.55, 95% CI 1.52-1.58) women compared with non-Hispanic white women.
CONCLUSION
Disparities in adverse perinatal outcomes by maternal race and ethnicity persisted for neonates conceived with and without ART.
目的
探讨单胎妊娠中，使用和未使用辅助生殖技术（ART）的情况下，母亲种族和族裔与早产及低出生体重（LBW）之间的差异。
方法
我们进行了一项回顾性队列研究，使用了佛罗里达州、马萨诸塞州和密歇根州的居民出生证明数据，并将其与2000年至2010年国家ART监测系统的数据相链接。共有4,568,822例活产，其中64,834例是通过ART受孕的。我们使用χ检验比较了不同母亲种族和族裔组中单胎活产新生儿的母亲和ART周期特征。我们使用对数二项模型来探讨母亲种族和族裔与ART受孕状态下的LBW和早产之间的关联。
结果
通过ART受孕的活产新生儿比例因母亲种族和族裔而异（P<.01）。与非西班牙裔白人（2.0%）和亚洲或太平洋岛民女性（1.9%）的新生儿相比，非西班牙裔黑人（0.3%）和西班牙裔女性（0.6%）的新生儿中这一比例最小。非西班牙裔黑人女性的新生儿中，无论是否为ART受孕，低出生体重或早产单胎的百分比都是最高的（非ART受孕的为11.3%和12.4%，ART受孕的为16.1%和19.1%）。在调整了母亲因素后，非西班牙裔黑人母亲所生单胎新生儿发生低出生体重或早产的风险，对于非ART受孕的新生儿而言，比非西班牙裔白人女性的新生儿高2.12倍[95%置信区间（CI）2.10 - 2.14]和1.56倍（95% CI 1.54 - 1.57）；对于ART受孕的新生儿而言，比非西班牙裔白人女性的新生儿高1.87倍（95% CI 1.57 - 2.23）和1.56倍（95% CI 1.34 - 1.83）。与非西班牙裔白人女性相比，西班牙裔（调整相对风险[RR] 1.2
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