Sacramento County Public Health, Sacramento, CA, United States; College Of Social Work, The Ohio State University, Columbus Ohio, United States; Division of Social Work, California State University, Sacramento, CA, United States.
School of Nursing, California State University Sacramento, Sacramento, CA, United States.
J Pediatr Nurs. 2021 Jul-Aug;59:96-102. doi: 10.1016/j.pedn.2021.01.012. Epub 2021 Feb 12.
To examine the effectiveness of early and adequate prenatal care (PNC) in reducing racial disparities in pre-term birth (PTB) among low-income women.
This retrospective study examined birth records for 14,950 low-income Black and White women. The primary outcome of interest was racial disparities in PTB. Exposures of interest were first trimester entry into, and adequacy of, PNC. Maternal residential proximity to nearest PNC provider was calculated. Bivariate analyses were performed for PTB by race. Binary logistic regression was performed, controlling for maternal age, smoking status and racial segregation. Attributable risk of PTB for no or late entry into PNC, and percent difference by race was calculated.
We find that early and adequate PNC significantly decreases the risk of preterm birth, however, we find no evidence that this reduces racial disparities. Low income black females in a large metropolitan county have greater geographic access to and utilization of PNC than low-income white females, yet racial disparities in preterm birth remain. Attributable risk of PTB for no or late entry into PNC was lower for Black women (32.2%) than White women (39.4%).
Our findings suggest that adequate PNC alone does not reduce the marked racial disparities in preterm birth.
Public health agencies and health care providers need to look beyond access to care, to achieve racial equity in birth outcomes. Expansion of evidence-based, comprehensive nursing interventions shown to reduce preterm birth, such as the Nurse Family Partnership home visiting program, could contribute to these efforts.
探讨在低收入妇女中，早期充分的产前保健（PNC）在减少早产（PTB）种族差异方面的有效性。
本回顾性研究分析了 14950 名低收入黑人和白人妇女的分娩记录。主要研究结果为 PTB 的种族差异。感兴趣的暴露因素为第一孕期 PNC 的开始时间和充分性。计算了产妇到最近的 PNC 提供者的居住接近程度。对不同种族的 PTB 进行了双变量分析。进行了二元逻辑回归分析，控制了母亲年龄、吸烟状况和种族隔离。计算了无或晚期 PNC 进入导致的 PTB 的归因风险和种族差异百分比。
我们发现早期充分的 PNC 显著降低了早产的风险，但没有证据表明这可以减少种族差异。在一个大型大都市区县，低收入黑人女性在地理上更容易获得和利用 PNC，而低收入白人女性则不然，但早产的种族差异仍然存在。无或晚期 PNC 进入导致的 PTB 的归因风险黑人女性（32.2%）低于白人女性（39.4%）。
我们的研究结果表明，单纯的充分 PNC 并不能减少早产的显著种族差异。
公共卫生机构和医疗保健提供者需要超越获得医疗服务的范围，努力实现出生结局方面的种族公平。扩大经证实的、全面的护理干预措施，如母婴健康合作组织的家庭探访项目，可能有助于实现这些目标。
