Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #820, Little Rock, AR, 72205-7199, USA.
Arkansas Children's Research Institute, Little Rock, AR, USA.
Matern Child Health J. 2019 Nov;23(11):1525-1535. doi: 10.1007/s10995-019-02775-8.
Objective Despite heterogeneity among Pacific Islanders, most studies aggregate them regardless of origin. Thus, limited information is available about perinatal outcomes among various subgroups of Pacific Islanders in the United States, including immigrants from the Republic of the Marshall Islands. We sought to evaluate perinatal outcomes among Marshallese women. Methods We conducted a cross-sectional study of women with at least one singleton live birth between 1997 and 2013 in two Arkansas counties using birth certificate data from the Arkansas Department of Health. Unadjusted and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated from modified Poisson regression models. Results Of the 91,662 singleton births in both counties during the study period, 2488 were to Marshallese women. In adjusted analyses, Marshallese women had higher prevalence of "other medical risk factors" (PR = 1.47; 95% CI 1.30, 1.65) than NH White women. Marshallese women had higher rates of precipitous labor and fetal distress during labor compared to NH White women (PR = 2.65; 95% CI 2.22, 3.17 and 1.89; 95% CI 1.62, 2.21, respectively). Marshallese were also more likely to have tocolysis (PR = 1.43; 95% CI 1.16, 1.76), forceps (PR = 1.68; 95% CI 1.16, 2.43) or vacuum (PR = 1.89; 95% CI 1.60, 2.22) used in delivery and cesarean section (PR = 1.13; 95% CI 1.01, 1.27). Marshallese infants had higher rates of anemia (PR = 3.10; 95% CI 2.01, 4.77), birth injury (PR = 2.13; 95% CI 1.50, 3.03), assisted ventilation < 30 min (PR = 2.11; 95% CI 1.64, 2.71), preterm birth (PR = 1.67; 95% CI 1.50, 1.83), and small-for-gestational age (PR = 1.25; 95% CI 1.12, 1.39) than NH White infants. Conclusions Marshallese women and infants had higher rates of adverse perinatal outcomes compared to their NH White counterparts. Additional studies are needed to determine if perinatal outcomes among the Marshallese differed from other Pacific Islander subgroups.
目的 尽管太平洋岛民存在异质性，但大多数研究都将他们归为一组，而不论其原籍如何。因此，在美国，关于太平洋岛民各亚群的围产期结局的信息有限，包括来自马绍尔群岛的移民。我们旨在评估马绍尔群岛妇女的围产期结局。
方法 我们使用阿肯色州卫生署的出生证明数据，对 1997 年至 2013 年间在阿肯色州的两个县至少有一次单胎活产的妇女进行了一项横断面研究。从修正泊松回归模型中计算未调整和调整后的患病率比（PR）和 95%置信区间（CI）。
结果 在研究期间，两个县的 91662 例单胎分娩中，有 2488 例是马绍尔群岛妇女。在调整分析中，马绍尔群岛妇女发生“其他医疗风险因素”的患病率更高（PR=1.47；95%CI 1.30，1.65）。与 NH 白种人妇女相比，马绍尔群岛妇女在分娩时出现急产和胎儿窘迫的比例更高（PR=2.65；95%CI 2.22，3.17 和 1.89；95%CI 1.62，2.21，分别）。马绍尔群岛妇女也更有可能需要催产素（PR=1.43；95%CI 1.16，1.76）、产钳（PR=1.68；95%CI 1.16，2.43）或真空（PR=1.89；95%CI 1.60，2.22）助产，以及剖宫产（PR=1.13；95%CI 1.01，1.27）。马绍尔群岛婴儿贫血（PR=3.10；95%CI 2.01，4.77）、出生损伤（PR=2.13；95%CI 1.50，3.03）、辅助通气<30 分钟（PR=2.11；95%CI 1.64，2.71）、早产（PR=1.67；95%CI 1.50，1.83）和小于胎龄儿（PR=1.25；95%CI 1.12，1.39）的发生率均高于 NH 白种婴儿。
结论 与 NH 白种人相比，马绍尔群岛妇女和婴儿的不良围产期结局发生率更高。需要进一步研究以确定马绍尔群岛的围产期结局是否与其他太平洋岛民亚群不同。
