Alexander G R, Cornely D A
Department of Maternal and Child Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205.
Am J Prev Med. 1987 Sep-Oct;3(5):254-61.
Distinct black-white differences in pregnancy outcome and prenatal care utilization have been a persistent feature of U.S. natality-related statistics. Using South Carolina and North Carolina live birth-infant death cohort files for 1978-1982, this study examines the extent to which variations in prenatal care utilization may be associated with racial disparities in pregnancy outcome within maternal sociomedical risk groups. After taking indicators of maternal risk into account (age-parity, education, marital status, complications of pregnancy and previous pregnancy terminations), birth weight and gestational age distributions and birth weight- and gestational age-specific neonatal mortality rates of blacks and whites were compared by level of prenatal care utilization. Distinct racial differences in birth weight and gestational age distributions were observed within equivalent maternal risk and prenatal care categories, with whites having an approximately 200-gram mean birth weight and five-day mean gestational age advantage compared to blacks. In this analysis of more than 650,000 cases, low-risk blacks adequately utilizing prenatal care had a lower mean birth weight (3,266 grams) and a higher neonatal mortality rate (6.6) than low-risk, inadequate-care whites (3,302 grams; 6.1).
妊娠结局和产前护理利用方面明显的黑白差异一直是美国出生相关统计数据的一个持续特征。本研究利用1978 - 1982年南卡罗来纳州和北卡罗来纳州的活产-婴儿死亡队列文件，考察了在孕产妇社会医学风险组内，产前护理利用的差异在多大程度上可能与妊娠结局的种族差异相关。在考虑了孕产妇风险指标（年龄-胎次、教育程度、婚姻状况、妊娠并发症和既往终止妊娠情况）后，按产前护理利用水平比较了黑人和白人的出生体重和孕周分布以及特定出生体重和孕周的新生儿死亡率。在同等的孕产妇风险和产前护理类别中，观察到出生体重和孕周分布存在明显的种族差异，与黑人相比，白人的平均出生体重约高200克，平均孕周长五天。在对超过65万例病例的分析中，充分利用产前护理的低风险黑人的平均出生体重（3266克）低于低风险、护理不足的白人（3302克），新生儿死亡率（6.6）高于后者（6.1）。
