孕前肥胖对严重孕产妇发病率的种族和民族差异的贡献。

Contribution of Prepregnancy Obesity to Racial and Ethnic Disparities in Severe Maternal Morbidity.

机构信息

Université de Paris, U1153 Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, and the Maternity Unit, Notre Dame de Bon Secours-Paris Saint Joseph Hospital/University Hospital Department (DHU) Risks in Pregnancy, Paris Descartes University, Paris, France; the Department of Family Medicine and Community Health and the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; and the Department of Obstetrics & Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

出版信息

Obstet Gynecol. 2021 May 1;137(5):864-872. doi: 10.1097/AOG.0000000000004356.

DOI:10.1097/AOG.0000000000004356

PMID:33831920

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9725890/

Abstract

OBJECTIVE

To evaluate the role of prepregnancy obesity as a mediator in the association between race-ethnicity and severe maternal morbidity.

METHODS

We conducted an analysis on a population-based retrospective cohort study using 2010-2014 birth records linked with hospital discharge data in New York City. A multivariable logistic regression mediation model on a subgroup of the sample consisting of normal-weight and obese women (n=409,021) calculated the mediation effect of obesity in the association between maternal race-ethnicity and severe maternal morbidity, and the residual effect not mediated by obesity. A sensitivity analysis was conducted excluding the severe maternal morbidity cases due to blood transfusion.

RESULTS

Among 591,455 live births, we identified 15,158 cases of severe maternal morbidity (256.3/10,000 deliveries). The severe maternal morbidity rate among obese women was higher than that of normal-weight women (342 vs 216/10,000 deliveries). Black women had a severe maternal morbidity rate nearly three times higher than White women (420 vs 146/10,000 deliveries) and the severe maternal morbidity rate among Latinas was nearly twice that of White women (285/10,000 deliveries). Among women with normal or obese body mass index (BMI) only (n=409,021), Black race was strongly associated with severe maternal morbidity (adjusted odds ratio [aOR] 3.02, 95% CI 2.88-3.17) but the obesity-mediated effect represented only 3.2% of the total association (aOR 1.03, 95% CI 1.02-1.05). Latina ethnicity was also associated with severe maternal morbidity (aOR 2.01, 95% CI 1.90-2.12) and the obesity-mediated effect was similarly small: 3.4% of the total association (aOR 1.02, 95% CI 1.01-1.03). In a sensitivity analysis excluding blood transfusion, severe maternal morbidity cases found a higher mediation effect of obesity in the association with Black race and Latina ethnicity (15.3% and 15.2% of the total association, respectively).

CONCLUSION

Our findings indicate that prepregnancy obesity, a modifiable factor, is a limited driver of racial-ethnic disparities in overall severe maternal morbidity.

摘要

目的

评估孕前肥胖作为中介因素在种族和民族与严重孕产妇发病率之间的关联中的作用。

方法

我们使用纽约市 2010-2014 年出生记录和医院出院数据进行了一项基于人群的回顾性队列研究分析。在由正常体重和肥胖女性组成的样本亚组（n=409021）中，采用多变量逻辑回归中介模型计算肥胖在孕产妇种族和民族与严重孕产妇发病率之间关联中的中介效应以及肥胖无法解释的剩余效应。进行了一项敏感性分析，排除了因输血导致的严重孕产妇发病率病例。

结果

在 591455 例活产中，我们发现了 15158 例严重孕产妇发病率病例（256.3/10000 例分娩）。肥胖女性的严重孕产妇发病率高于正常体重女性（342 比 216/10000 例分娩）。黑人女性的严重孕产妇发病率几乎是白人女性的三倍（420 比 146/10000 例分娩），拉丁裔女性的严重孕产妇发病率几乎是白人女性的两倍（285/10000 例分娩）。在仅具有正常或肥胖体质指数（BMI）的女性中（n=409021），黑人种族与严重孕产妇发病率密切相关（调整后的优势比[aOR]3.02，95%CI 2.88-3.17），但肥胖介导的效应仅占总关联的 3.2%（aOR 1.03，95%CI 1.02-1.05）。拉丁裔民族也与严重孕产妇发病率相关（aOR 2.01，95%CI 1.90-2.12），肥胖介导的效应也相似：占总关联的 3.4%（aOR 1.02，95%CI 1.01-1.03）。在排除输血的敏感性分析中，严重孕产妇发病率病例发现肥胖在与黑人种族和拉丁裔民族相关联中的中介作用更高（分别占总关联的 15.3%和 15.2%）。