文化适应与不良妊娠结局的关联。
Association of Acculturation With Adverse Pregnancy Outcomes.
机构信息
Northwestern University, Chicago, Illinois; the University of Utah Health and Intermountain Healthcare, Salt Lake City, Utah; Indiana University, Indianapolis, Indiana; the University of Pittsburgh, Pittsburgh, Pennsylvania; the University of California, Irvine, Irvine, California; the University of Pennsylvania, Philadelphia, Pennsylvania; Case Western Reserve University, Cleveland, Ohio; The Ohio State University, Columbus, Ohio; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Texas Medical Branch, Galveston, Galveston, Texas.
出版信息
Obstet Gynecol. 2020 Feb;135(2):301-309. doi: 10.1097/AOG.0000000000003659.
OBJECTIVE
To evaluate the relationship between acculturation and adverse pregnancy outcomes, and whether these relationships differ across racial or ethnic groups.
METHODS
This is a planned secondary analysis of the nuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study of 10,038 pregnant women at eight academic health care centers in the United States. Nulliparous pregnant women with singleton gestations were recruited between 6 0/7 and 13 6/7 weeks of gestation from October 2010-September 2013. Acculturation was defined by birthplace (United States vs non-United States), language used during study visits (English or Spanish), and self-rated English proficiency. The adverse pregnancy outcomes of interest were preterm birth (less than 37 weeks of gestation, both iatrogenic and spontaneous), preeclampsia or eclampsia, gestational hypertension, gestational diabetes, stillbirth, small for gestational age, and large for gestational age. Multivariable regression modeling was performed, as was an interaction analysis focusing on the relationship between acculturation and adverse pregnancy outcomes by maternal race or ethnicity.
RESULTS
Of the 10,006 women eligible for this analysis, 8,100 (80.9%) were classified as more acculturated (eg, born in the United States with high English proficiency), and 1,906 (19.1%) were classified as having less acculturation (eg, born or not born in the United States with low proficiency in English or use of Spanish as the preferred language during study visits). In multivariable logistic regression modeling, more acculturation was significantly associated with higher frequency of preterm birth (odds ratio [OR] 1.46, adjusted odds ratio [aOR] 1.50, 95% CI 1.16-1.95); spontaneous preterm birth (OR 1.54, aOR 1.62, 95% CI 1.14-2.24); preeclampsia or eclampsia (OR 1.39, aOR 1.31, 95% CI 1.03-1.67); preeclampsia without severe features (OR 1.44, aOR 1.43, 95% CI 1.03-2.01); and gestational hypertension (OR 1.68, aOR 1.48, 95% CI 1.22-1.79). These associations did not differ by self-described race or ethnicity.
CONCLUSION
In a large cohort of nulliparous women, more acculturation, regardless of self-described race or ethnicity, was associated with increased odds of several adverse pregnancy outcomes.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT01322529.
目的
评估文化适应与不良妊娠结局之间的关系，以及这些关系是否因种族或民族群体而异。
方法
这是 nuMoM2b 研究（Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be）的一项计划中的二次分析，这是一项在美国 8 个学术医疗中心进行的前瞻性观察性队列研究，共纳入了 10038 名单胎妊娠的孕妇。研究于 2010 年 10 月至 2013 年 9 月，在妊娠 6 0/7 周到 13 6/7 周期间招募了无生育史的孕妇。文化适应通过出生地（美国与非美国）、研究期间使用的语言（英语或西班牙语）和自我评估的英语熟练程度来定义。感兴趣的不良妊娠结局包括早产（少于 37 周，包括医源性和自发性早产）、子痫前期或子痫、妊娠高血压、妊娠糖尿病、死胎、胎儿小于胎龄和胎儿大于胎龄。进行了多变量回归建模，并进行了交互分析，重点关注文化适应与不良妊娠结局之间的关系，按产妇种族或族裔进行分层。
结果
在符合本分析条件的 10006 名妇女中，8100 名（80.9%）被归类为文化程度较高（例如，出生于美国且英语水平较高），1906 名（19.1%）被归类为文化程度较低（例如，出生于美国或非美国，英语水平较低或在研究期间使用西班牙语作为首选语言）。在多变量逻辑回归建模中，更高的文化适应程度与更高频率的早产（比值比[OR]1.46，调整比值比[aOR]1.50，95%置信区间[CI]1.16-1.95）、自发性早产（OR 1.54，aOR 1.62，95% CI 1.14-2.24）、子痫前期或子痫（OR 1.39，aOR 1.31，95% CI 1.03-1.67）、无严重特征的子痫前期（OR 1.44，aOR 1.43，95% CI 1.03-2.01）和妊娠高血压（OR 1.68，aOR 1.48，95% CI 1.22-1.79）显著相关。这些关联不因自我描述的种族或族裔而异。
结论
在一项大型的无生育史妇女队列中，无论自我描述的种族或族裔如何，更高的文化适应程度与几种不良妊娠结局的发生几率增加有关。
临床试验注册
ClinicalTrials.gov，NCT01322529。
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