低危初产妇中种族和民族差异与初次剖宫产及不良结局的关系。

Racial and Ethnic Disparities in Primary Cesarean Birth and Adverse Outcomes Among Low-Risk Nulliparous People.

机构信息

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, UTHealth Houston, Houston, Texas; and the Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, Rhode Island.

出版信息

Obstet Gynecol. 2022 Nov 1;140(5):842-852. doi: 10.1097/AOG.0000000000004953.

DOI:10.1097/AOG.0000000000004953

PMID:36201767

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10069716/

Abstract

OBJECTIVE

To compare trend of primary cesarean delivery rate and composite neonatal and maternal adverse outcomes in low-risk pregnancies among racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic.

METHODS

This population-based cohort study used U.S. vital statistics data (2015-2019) to evaluate low-risk, nulliparous patients with nonanomalous singletons who labored and delivered at 37-41 weeks of gestation. The primary outcome was the primary cesarean delivery rate. Secondary outcomes included composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, seizure, or death), and composite maternal adverse outcome (intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy), as well as infant death. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% CIs.

RESULTS

Among 4.3 million births, 60.6% identified as non-Hispanic White, 14.6% identified as non-Hispanic Black, and 24.8% identified as Hispanic. The rate of primary cesarean delivery was 18.5% (n=804,155). An increased risk for cesarean delivery was found in non-Hispanic Black (21.7%, aRR 1.24, 95% CI 1.23-1.25) and Hispanic (17.3%, aRR 1.09, 95% CI 1.09-1.10) individuals, compared with non-Hispanic White individuals (18.1%) after multivariable adjustment. There was an upward trend in the rate of primary cesarean delivery in all racial and ethnic groups ( P for linear trend<0.001 for all groups). However, the racial and ethnic disparity in the rate of primary cesarean delivery remained stable during the study period. The composite neonatal adverse outcome was lower in Hispanic individuals in all newborns (10.7 vs 8.3 per 1,000 live births, aRR 0.74, 95% CI 0.72-0.75), and in newborns delivered by primary cesarean delivery (18.5 vs 15.0 per 1,000 live births, aRR 0.73, 95% CI 0.70-0.76), compared with non-Hispanic White individuals.

CONCLUSION

Using a nationally representative sample in the United States, we found racial and ethnic disparities in the primary cesarean delivery rate in low-risk nulliparous patients, which persisted throughout the study period.

摘要

目的

比较不同种族和族裔的低危妊娠中初次剖宫产率和复合新生儿及产妇不良结局的趋势：非西班牙裔白人、非西班牙裔黑人和西班牙裔。

方法

本基于人群的队列研究使用了美国人口统计数据（2015-2019 年），评估了在 37-41 孕周分娩的低危、初产妇、非畸形单胎产妇。主要结局为初次剖宫产率。次要结局包括复合新生儿不良结局（5 分钟时 Apgar 评分低于 5 分、辅助通气超过 6 小时、抽搐或死亡）和复合产妇不良结局（重症监护病房入院、输血、子宫破裂或计划外子宫切除术），以及婴儿死亡。多变量泊松回归模型用于估计调整后的相对风险（aRR）和 95%置信区间（CI）。

结果

在 430 万例分娩中，60.6%为非西班牙裔白人，14.6%为非西班牙裔黑人，24.8%为西班牙裔。初次剖宫产率为 18.5%（n=804155）。与非西班牙裔白人（18.1%）相比，非西班牙裔黑人（21.7%，aRR 1.24，95%CI 1.23-1.25）和西班牙裔（17.3%，aRR 1.09，95%CI 1.09-1.10）人群初次剖宫产的风险增加，多变量调整后。所有种族和族裔群体的初次剖宫产率均呈上升趋势（所有组的线性趋势 P 值均<0.001）。然而，在研究期间，初次剖宫产率的种族和族裔差异保持稳定。与非西班牙裔白人相比，所有新生儿中西班牙裔个体的复合新生儿不良结局较低（每 1000 例活产 10.7 例 vs 8.3 例，aRR 0.74，95%CI 0.72-0.75），初次剖宫产分娩的新生儿中也较低（每 1000 例活产 18.5 例 vs 15.0 例，aRR 0.73，95%CI 0.70-0.76）。