Docheva Nikolina, Heimberger Sarah, Mueller Ariel, Bisson Courtney, Arenas Gabriel, Perdigao Joana Lopes, Kordik Abbe, Stewart Karie, Goodall Perpetua, Lengyel Ernst, Rana Sarosh
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, 5841 S. Maryland Ave, MC 2050, Chicago, IL, 60637, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Reprod Sci. 2023 Jul;30(7):2313-2323. doi: 10.1007/s43032-023-01174-3. Epub 2023 Jan 30.
The objective of the study is to evaluate whether rates of selected labor and delivery interventions and severe maternal morbidity (SMM) differ between Black and White pregnant patients. This retrospective observational cohort study included all Black or White pregnant patients who delivered at the University of Chicago Medical Center between January 2015 and December 2019. Data queried included demographic information, antepartum complications, preterm interventions, labor and delivery events, and neonatal outcomes. SMM was a composite outcome, including intensive care unit admission, blood transfusion, hysterectomy, eclampsia, cardiac arrest, or death. In total, 10,885 parturients (9001 Black and 1884 White) and 11,211 neonates (9254 born to Black and 1957 to White patients) were included in the study. Black patients were more likely to have preterm labor (3.51% vs. 1.86%, p = 0.0002) and no prenatal care (17.83% vs. 4.05%, p < 0.0001). There was no significant difference in the administration of magnesium sulfate for fetal neuroprotection (Black 44.78% vs. White 49.32%, p = 0.48) or antenatal corticosteroids (Black 67.83% vs. White 71.98%, p = 0.28) among those with preterm delivery. There was no significant difference in SMM (Black 2.24% vs. White 2.44%, p = 0.60), and SMM rates decreased over time (OR 0.79 per year, 95% CI: 0.72-0.87, p < 0.0001) for all patients. Black patients had more pregnancy complications, but their complications were addressed with similar rates of obstetrical interventions. In a high-resource setting, there was no difference in rates of SMM when compared to White patients.
本研究的目的是评估黑人与白人孕妇在选定的分娩干预措施发生率及严重孕产妇发病率（SMM）方面是否存在差异。这项回顾性观察性队列研究纳入了2015年1月至2019年12月期间在芝加哥大学医学中心分娩的所有黑人或白人孕妇。查询的数据包括人口统计学信息、产前并发症、早产干预措施、分娩事件及新生儿结局。SMM为综合结局，包括入住重症监护病房、输血、子宫切除术、子痫、心脏骤停或死亡。该研究共纳入10,885名产妇（9001名黑人产妇和1884名白人产妇）及11,211名新生儿（9254名黑人产妇所生和1957名白人产妇所生）。黑人患者更易发生早产（3.51%对1.86%，p = 0.0002）且未接受产前检查（17.83%对4.05%，p < 0.0001）。对于早产患者，在使用硫酸镁进行胎儿神经保护方面（黑人44.78%对白人49.32%，p = 0.48）或使用产前糖皮质激素方面（黑人67.83%对白人71.98%，p = 0.28）无显著差异。SMM无显著差异（黑人2.24%对白人2.44%，p = 0.60），且所有患者的SMM发生率随时间下降（每年OR为0.79，95%CI：0.72 - 0.87，p < 0.0001）。黑人患者有更多妊娠并发症，但针对其并发症采取产科干预措施的比例相似。在资源丰富的环境中，与白人患者相比，SMM发生率无差异。
