Ada M L, Hacker M R, Golen T H, Haviland M J, Shainker S A, Burris H H
Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Perinatol. 2017 Nov;37(11):1187-1191. doi: 10.1038/jp.2017.116. Epub 2017 Jul 27.
The objectives of this study were as follows: (i) to estimate the proportion of preterm deliveries at a tertiary perinatal center that were provider-initiated versus spontaneous before and after a 2009 policy to reduce elective early-term deliveries, and (ii)to evaluate whether shifts in type of preterm delivery varied by race/ethnicity.
We performed a retrospective cohort study of preterm deliveries over a 10-year period, 2004 to 2013, including detailed review of 929 of 5566 preterm deliveries, to designate each delivery as provider-initiated or spontaneous. We dichotomized the time period into early (2004 to 2009) and late (2010 to 2013). We used log-binomial regression to calculate adjusted risk ratios.
Of the 46 981 deliveries, 5566 (11.8%) were preterm, with a significant reduction in the overall incidence of preterm delivery from 12.3 to 11.2% (P=0.0003). Among the 929 preterm deliveries analyzed, there was a reduction in the proportion of provider-initiated deliveries from 48.3 to 41.8% that was not statistically significant. The proportion of provider-initiated preterm deliveries among Black, but not White, women declined from 50.8 to 39.7% (adjusted relative risk: 0.66; 95% confidence interval (CI): 0.45 to 0.97). This coincided with a larger reduction in overall preterm deliveries among Black women (16.2 to 12.8%) vs White women (12.3 to 11.2%) (P interaction=0.038). By 2013, the incidence of preterm deliveries had decreased for both Black (12.1%) and White women (11.4%), and the difference was no longer statistically significant (P=0.7).
We found a reduction in preterm deliveries after a policy targeted at reducing elective early-term deliveries in 2009 that coincided with reductions in the proportion of provider-initiated preterm deliveries, especially among Black women.
本研究的目的如下：（i）估计在一家三级围产期中心，2009年一项减少择期早产政策实施前后，由医疗服务提供者发起的早产与自然早产的比例；（ii）评估早产类型的变化是否因种族/族裔而异。
我们对2004年至2013年这10年间的早产情况进行了一项回顾性队列研究，包括对5566例早产中的929例进行详细审查，以确定每例分娩是由医疗服务提供者发起的还是自然发生的。我们将时间段分为早期（2004年至2009年）和晚期（2010年至2013年）。我们使用对数二项回归来计算调整后的风险比。
在46981例分娩中，5566例（11.8%）为早产，早产的总体发生率从12.3%显著降至11.2%（P = 0.0003）。在分析的929例早产中，由医疗服务提供者发起的分娩比例从48.3%降至41.8%，但差异无统计学意义。黑人女性（而非白人女性）中由医疗服务提供者发起的早产比例从50.8%降至39.7%（调整后的相对风险：0.66；95%置信区间（CI）：0.45至0.97）。这与黑人女性总体早产率的下降幅度（从16.2%降至12.8%）大于白人女性（从12.3%降至11.2%）相一致（P交互作用 = 0.038）。到2013年，黑人和白人女性的早产发生率均有所下降，黑人女性为12.1%，白人女性为11.4%，差异不再具有统计学意义（P = 0.7）。
我们发现，2009年一项旨在减少择期早产的政策实施后，早产率有所下降，同时由医疗服务提供者发起的早产比例也有所降低，尤其是在黑人女性中。
