From the Division of Epidemiology and Biostatistics School of Public Health, University of California, Berkeley, CA.
Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, CA.
Epidemiology. 2019 Sep;30(5):713-722. doi: 10.1097/EDE.0000000000001044.
Community violence is an understudied aspect of social context that may affect risk of preterm birth and small-for-gestational age (SGA).
We matched California mothers with live singleton births who were exposed to a homicide in their Census tract of residence in 2007-2011 to unexposed mothers within the same tract. We estimated risk differences with a weighted linear probability model, with weights corresponding to the matched data structure. We estimated the average treatment effect on the treated of homicide exposure on the risk of preterm birth and SGA during the preconception period and first and second trimester.
We found a small increase in risk of SGA associated with homicide exposure in the first trimester (0.14% [95% confidence interval (CI) = -0.01%, 0.30%]), but not for exposure during the preconception period (-0.01% [95% CI = -0.17%, 0.15%]) or the second trimester (-0.06% [95% CI = -0.23%, 0.11%]). Risk of preterm birth was not affected by homicide exposure. When women were exposed to homicides during all three exposure windows, there was a larger increase in risk of SGA (1.09% [95% CI = 0.15%, 2.03%]) but not preterm birth (0.14% [95% CI = -0.74%, 1.01%]). Exposure to three or more homicides was also associated with greater risk of SGA (0.78% [95% CI = 0.15%, 1.40%]). Negative controls indicated that residual confounding by temporal patterning was unlikely.
Homicide exposure during early pregnancy is associated with a small increased risk of SGA.
社区暴力是社会环境中一个研究不足的方面，可能会影响早产和小于胎龄儿（SGA）的风险。
我们将 2007-2011 年在居住的普查区内遭遇凶杀案的加利福尼亚母亲与同一普查区内未暴露于凶杀案的母亲进行匹配。我们使用加权线性概率模型估计风险差异，权重对应于匹配数据结构。我们估计了在受孕前、第一和第二孕期暴露于凶杀案对早产和 SGA 风险的平均处理效应。
我们发现，在第一孕期，凶杀暴露与 SGA 风险增加相关（0.14% [95%置信区间（CI）= -0.01%，0.30%]），但在受孕前（-0.01% [95% CI = -0.17%，0.15%]）或第二孕期（-0.06% [95% CI = -0.23%，0.11%]）暴露则不然。凶杀暴露对早产风险没有影响。当女性在所有三个暴露窗口都暴露于凶杀案时，SGA 的风险增加更大（1.09% [95% CI = 0.15%，2.03%]），但早产风险没有增加（0.14% [95% CI = -0.74%，1.01%]）。暴露于 3 次或更多次凶杀案也与 SGA 的风险增加相关（0.78% [95% CI = 0.15%，1.40%]）。阴性对照表明，时间模式的残余混杂不太可能。
妊娠早期暴露于凶杀案与 SGA 风险略有增加有关。
