Amsterdam UMC, Location University of Amsterdam, Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Amsterdam UMC, Location University of Amsterdam, Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2023 Mar;282:94-100. doi: 10.1016/j.ejogrb.2023.01.019. Epub 2023 Jan 20.
Women of Black and other non-Western ethnicity and women who live in deprived neighborhoods are at increased risk for preterm birth (PTB). These women may live clustered in certain urban areas. If ethnicity reflects a biological rather than a socioeconomic risk factor, women should have a PTB risk independent of the urban area where they live. In this study we explored the association between urban living and the risk of PTB, combined with knowledge on ethnicity and neighborhood deprivation in these specific urban areas in the Netherlands.
National cohort study of 935,381 women (2014-2019) with a singleton pregnancy resulting in live birth between 24.0 and 42.6 weeks. Antepartum death and severe congenital anomalies were excluded. We performed logistic regression analysis and analyzed the impact of living in one of the four main urban areas on PTB. We adjusted for maternal age, parity and fetal gender. We tested for interaction between ethnicity, neighborhood deprivation index (NDI) and urban living.
Mean PTB rate among singleton pregnancies in The Netherlands is 5.1%. There was a strong ethnic difference in PTB risk, with the highest prevalence among South Asian women (7.9%) and African women (6.6%). In the most deprived neighborhoods the PTB risk was 5.7%. We found a significant interaction between ethnicity and urban living, and between NDI and urban living. South Asian and African women living in urban areas had the greatest risk of PTB, between 7.0% and 8.8%.
Ethnicity remains a fixed biological risk for PTB that cannot be fully explained by socioeconomic status or neighborhood deprivation. Independent of ethnicity and neighborhood deprivation, urban living has a great influence on the risk of preterm birth. Future studies and policies should focus on population-based interventions in those urban areas where South Asian and African ethnic groups live and where the preterm birth risk is the highest.
黑人及其他非西方族裔的女性和生活在贫困社区的女性，早产（PTB）的风险增加。这些女性可能集中居住在某些城市地区。如果族裔反映的是生物学而非社会经济风险因素，那么女性的 PTB 风险应与她们居住的城市地区无关。在这项研究中，我们探讨了城市居住与 PTB 风险之间的关联，同时考虑了荷兰这些特定城市地区的族裔和社区贫困程度方面的知识。
这是一项针对 935381 名女性（2014-2019 年）的全国队列研究，这些女性均怀有单胎妊娠，分娩时间在 24.0 至 42.6 周之间，且排除了产前死亡和严重先天性异常的情况。我们进行了逻辑回归分析，分析了居住在四个主要城市之一对 PTB 的影响。我们调整了母亲的年龄、产次和胎儿性别。我们还检验了族裔、社区剥夺指数（NDI）和城市居住之间的交互作用。
荷兰单胎妊娠的平均 PTB 发生率为 5.1%。族裔间 PTB 风险差异很大，南亚裔女性（7.9%）和非裔女性（6.6%）的 PTB 发生率最高。在最贫困的社区，PTB 风险为 5.7%。我们发现族裔和城市居住之间以及 NDI 和城市居住之间存在显著的交互作用。居住在城市地区的南亚裔和非裔女性的 PTB 风险最高，在 7.0%至 8.8%之间。
族裔仍然是 PTB 的一个固定生物学风险因素，不能完全用社会经济地位或社区贫困程度来解释。无论族裔和社区贫困程度如何，城市居住对早产风险都有很大影响。未来的研究和政策应侧重于在南亚裔和非裔群体聚居且 PTB 风险最高的城市地区开展基于人群的干预措施。
