Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
PLoS One. 2022 Jun 30;17(6):e0269158. doi: 10.1371/journal.pone.0269158. eCollection 2022.
Racial differences in adverse maternal and birth outcomes have been studied in other countries, however, there are few studies specific to the Canadian population. In this study, we sought to examine the inequities in adverse perinatal outcomes between Black and White pregnant people in Ontario, Canada.
We conducted a population-based retrospective cohort study that included all Black and White pregnant people who attended prenatal screening and had a singleton birth in any Ontario hospital (April 1st, 2012-March 31st, 2019). Poisson regression with robust error variance models were used to estimate the adjusted relative risks of adverse perinatal outcomes for Black people compared with White people while adjusting for covariates.
Among 412,120 eligible pregnant people, 10.1% were Black people and 89.9% were White people. Black people were at an increased risk of gestational diabetes mellitus, preeclampsia, placental abruption, preterm birth (<37, <34, <32 weeks), spontaneous preterm birth, all caesarean sections, emergency caesarean section, low birth weight (<2500g, <1500g), small-for-gestational-age (<10th percentile, <3rd percentile) neonates, 5-minute Apgar score <4 and <7, neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment but had lower risks of elective caesarean section, assisted vaginal delivery, episiotomy, 3rd and 4th degree perineal tears, macrosomia, large-for-gestational-age neonates, and arterial cord pH≤7.1, as compared with White people. No difference in risks of gestational hypertension and placenta previa were observed between Black and White people.
There are differences in several adverse perinatal outcomes between Black and White people within the Ontario health care system. Findings might have potential clinical and health policy implications, although more studies are needed to further understand the mechanisms.
在其他国家，已经有研究探讨了孕产妇和分娩结局的种族差异，但针对加拿大人群的研究较少。本研究旨在探讨加拿大安大略省黑人和白人孕妇不良围产结局的不平等现象。
我们开展了一项基于人群的回顾性队列研究，纳入了所有在安大略省任何一家医院进行产前筛查并单胎分娩的黑人和白人孕妇（2012 年 4 月 1 日至 2019 年 3 月 31 日）。采用泊松回归模型（稳健误差方差），在调整协变量后，估计黑人与白人相比不良围产结局的调整相对风险。
在 412120 名符合条件的孕妇中，10.1%为黑人，89.9%为白人。黑人发生妊娠期糖尿病、子痫前期、胎盘早剥、早产（<37 周、<34 周、<32 周）、自发性早产、所有剖宫产、急诊剖宫产、低出生体重（<2500g、<1500g）、小于胎龄儿（<第 10 百分位、<第 3 百分位）、新生儿 5 分钟 Apgar 评分<4 分和<7 分、新生儿重症监护病房收治和需要治疗的高胆红素血症的风险增加，但选择性剖宫产、经阴道助产、会阴切开术、3 度和 4 度会阴撕裂、巨大儿、大于胎龄儿和脐动脉血 pH 值≤7.1 的风险降低。黑人与白人之间，妊娠期高血压和前置胎盘的风险无差异。
在安大略省的医疗保健系统中，黑人与白人孕妇的某些不良围产结局存在差异。虽然还需要更多的研究来进一步了解其机制，但这些发现可能具有潜在的临床和卫生政策意义。
