Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
The Permanente Medical Group, Regional Offices, Kaiser Permanente Northern California, Oakland, California, USA.
J Womens Health (Larchmt). 2021 Jul;30(7):1028-1037. doi: 10.1089/jwh.2019.8171. Epub 2021 Feb 11.
While racial-ethnic disparities in cesarean delivery rates among nulliparous women delivering a term singleton in the vertex position (NTSV) exist, it remains unclear the extent to which potentially modifiable maternal cardiometabolic risk factors (obesity, maternal hyperglycemia and hypertensive disorders) underlie these disparities. We examined race-ethnicity and risk of NTSV cesarean deliveries and whether the associations were mediated by maternal cardiometabolic risk factors. A cohort study of 62,048 NTSV deliveries in Kaiser Permanente Northern California. The outcome was cesarean delivery. Black, Asian, and Hispanic women were at increased risk of having a NTSV cesarean delivery compared with White women (relative risks and 95% confidence intervals: 1.37 [1.28-1.45]; 1.11 [1.07-1.16]; 1.12 [1.07-1.16], respectively), independent of established risk factors and prenatal care utilization. The extent to which cardiometabolic risk factors mediated the associations between race-ethnicity (each group vs. White, in separate analyses) and NTSV cesarean delivery varied by race-ethnicity. Maternal overweight/obesity (body mass index ≥25.0) mediated the association between Black and Hispanic race-ethnicity and NTSV cesarean delivery (21.1% [15.8-26.4] and 24.7% [14.6-34.8, respectively), but not for Asian race. Maternal hyperglycemia (gestational diabetes mellitus or preexisting diabetes) mediated the association between Asian and Hispanic race and NTSV cesarean delivery (18.5% [9.8-27.2] and 9.8% [5.0-14.7], respectively), but not for Black race. Hypertensive disorders mediated 3.2% (0.70-5.8) of the association between Black race and cesarean delivery, but not for other race-ethnicities. Black, Asian, and Hispanic women are at increased risk for NTSV cesarean deliveries. Maternal cardiometabolic risk factors only partially mediate the associations between race-ethnicity and NSTV cesarean deliveries.
虽然在初产妇中，足月单胎头位（NTSV）剖宫产率存在种族和民族差异，但仍不清楚潜在可改变的产妇心脏代谢危险因素（肥胖、孕妇高血糖和高血压疾病）在多大程度上导致了这些差异。我们研究了种族和民族与 NTSV 剖宫产的关系，以及这些关联是否受产妇心脏代谢危险因素的影响。这是一项在 Kaiser Permanente 北加利福尼亚州进行的 NTSV 分娩队列研究。结果是剖宫产。与白人女性相比，黑人、亚洲人和西班牙裔女性 NTSV 剖宫产的风险增加（相对风险和 95%置信区间：1.37 [1.28-1.45]；1.11 [1.07-1.16]；1.12 [1.07-1.16]），独立于已确定的风险因素和产前保健的利用。产妇心脏代谢危险因素在多大程度上调节了种族和民族（每组与白人在单独的分析中进行比较）与 NTSV 剖宫产之间的关联因种族和民族而异。超重/肥胖（体重指数≥25.0）调节了黑人和西班牙裔种族与 NTSV 剖宫产的关联（分别为 21.1%[15.8-26.4]和 24.7%[14.6-34.8]），但与亚裔种族无关。孕妇高血糖（妊娠糖尿病或既往糖尿病）调节了亚裔和西班牙裔种族与 NTSV 剖宫产的关联（分别为 18.5%[9.8-27.2]和 9.8%[5.0-14.7]），但与黑人种族无关。高血压疾病调节了黑人种族与剖宫产之间 3.2%（0.70-5.8）的关联，但对其他种族和民族没有影响。黑人、亚洲人和西班牙裔女性 NTSV 剖宫产的风险增加。产妇心脏代谢危险因素仅部分调节了种族和民族与 NSTV 剖宫产之间的关系。
