种族差异与不良妊娠结局和心理社会压力。
Racial Disparities in Adverse Pregnancy Outcomes and Psychosocial Stress.
机构信息
Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; and the Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, the University of California at Irvine, Irvine, California, the University of Utah Health Sciences Center, Salt Lake City, Utah, Columbia University, New York, New York, the University of Pittsburgh, Pittsburgh, Pennsylvania, the University of Pennsylvania, Philadelphia, Pennsylvania, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, Indiana University, Indianapolis, Indiana, and the University of Texas Medical Branch, Galveston, Texas.
出版信息
Obstet Gynecol. 2018 Feb;131(2):328-335. doi: 10.1097/AOG.0000000000002441.
OBJECTIVE
To assess the relationships between self-reported psychosocial stress and preterm birth, hypertensive disease of pregnancy, and small-for-gestational-age (SGA) birth and to assess the extent to which these relationships account for racial and ethnic disparities in these adverse outcomes.
METHODS
Self-reported measures of psychosocial stress (perceived stress, depression, racism, anxiety, resilience, and social support) were collected during pregnancy among a racially and ethnically diverse cohort of women enrolled in a prospective observational study of nulliparous women with singleton pregnancies, from eight clinical sites across the United States, between October 2010 and May 2014. The associations of preterm birth, hypertensive disease of pregnancy, and SGA birth with the self-reported measures of psychosocial stress as well as with race and ethnicity were evaluated.
RESULTS
The study included 9,470 women (60.4% non-Hispanic white, 13.8% non-Hispanic black, 16.7% Hispanic, 4.0% Asian, and 5.0% other). Non-Hispanic black women were significantly more likely to experience any preterm birth, hypertensive disease of pregnancy, and SGA birth than were non-Hispanic white women (12.2% vs 8.0%, 16.7% vs 13.4%, and 17.2% vs 8.6%, respectively; P<.05 for all). After adjusting for potentially confounding factors, including the six different psychosocial factors singly and in combination, non-Hispanic black women continued to be at greater risk of any preterm birth and SGA birth compared with non-Hispanic white women.
CONCLUSION
Among a large and geographically diverse cohort of nulliparous women with singleton gestations, non-Hispanic black women are most likely to experience preterm birth, hypertensive disease of pregnancy, and SGA birth. These disparities were not materially altered for preterm birth or SGA birth by adjustment for demographic differences and did not appear to be explained by differences in self-reported psychosocial factors.
目的
评估自我报告的心理社会压力与早产、妊娠高血压疾病和小于胎龄儿（SGA）之间的关系，并评估这些关系在多大程度上解释了这些不良结局在种族和族裔之间的差异。
方法
在一项针对美国 8 个临床站点的、纳入了 9470 名初产妇的、前瞻性观察研究中，在 2010 年 10 月至 2014 年 5 月期间，收集了自我报告的心理社会压力（感知压力、抑郁、种族主义、焦虑、韧性和社会支持）测量值。评估早产、妊娠高血压疾病和 SGA 出生与自我报告的心理社会压力以及与种族和族裔的关系。
结果
研究纳入了 9470 名女性（60.4%为非西班牙裔白人，13.8%为非西班牙裔黑人，16.7%为西班牙裔，4.0%为亚裔，5.0%为其他族裔）。与非西班牙裔白人女性相比，非西班牙裔黑人女性经历任何早产、妊娠高血压疾病和 SGA 出生的可能性显著更高（分别为 12.2%、16.7%和 17.2% vs 8.0%、13.4%和 8.6%；均<0.05）。在调整了潜在的混杂因素，包括六个不同的心理社会因素单独和组合后，非西班牙裔黑人女性与非西班牙裔白人女性相比，仍有更高的任何早产和 SGA 出生风险。
结论
在一个由大量、地理位置多样化的初产妇组成的队列中，非西班牙裔黑人女性最有可能经历早产、妊娠高血压疾病和 SGA 出生。这些差异在调整了人口统计学差异后，对于早产或 SGA 出生并没有明显改变，而且似乎也不能用自我报告的心理社会因素的差异来解释。
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