Dev Alka, Nagovich Justice, Maganti Srinija, Vitale Elaina, Blunt Heather, Allen Sophia E
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, 03756, USA.
Biomedical Libraries, Dartmouth College, Hanover, NH, USA.
Matern Health Neonatol Perinatol. 2024 Jun 3;10(1):11. doi: 10.1186/s40748-024-00181-9.
The risk of recurrent adverse birth outcomes has been reported worldwide, but there are limited estimates of these risks by social subgroups such as race and ethnicity in the United States. We assessed racial and ethnic disparities in the risk of recurrent adverse birth outcomes, including preterm birth, low birthweight, fetal growth restriction, small for gestational age, stillbirth, and neonatal mortality in the U.S.
We searched MEDLINE, CINAHL Complete, Web of Science, and Scopus from the date of inception to April 5, 2022. We identified 3,540 articles for a title and abstract review, of which 80 were selected for full-text review. Studies were included if they focused on the recurrence of any of the six outcomes listed in the objectives. Study quality was assessed using the NIH Study Quality Assessment Tool. Heterogeneity across studies was too large for meta-analysis, but race and ethnicity-stratified estimates and tests for homogeneity results were reported.
Six studies on recurrent preterm birth and small for gestational age were included. Pooled comparisons showed a higher risk of recurrent preterm birth and small for gestational age for all women. Stratified race comparisons showed a higher but heterogeneous risk of recurrence of preterm birth across Black and White women. Relative risks of recurrent preterm birth ranged from 2.02 [1.94, 2.11] to 2.86 [2.40, 3.39] for Black women and from 3.23 [3.07, 3.39] to 3.92 [3.35, 4.59] for White women. The evidence was weak for race and ethnicity stratification for Hispanic and Asian women for both outcomes.
Disparities exist in the recurrence of preterm birth, and race/ethnicity-concordant comparisons suggest race is an effect modifier for recurrent preterm birth for Black and White women. Due to the small number of studies, no conclusions could be made for small for gestational age or Hispanic and Asian groups. The results pose new research areas to better understand race-based differences in recurrent adverse birth outcomes.
复发性不良分娩结局的风险在全球范围内均有报道，但在美国，按种族和族裔等社会亚组对这些风险的估计有限。我们评估了美国复发性不良分娩结局风险中的种族和族裔差异，这些结局包括早产、低出生体重、胎儿生长受限、小于胎龄儿、死产和新生儿死亡。
我们检索了从创刊至2022年4月5日的MEDLINE、CINAHL Complete、Web of Science和Scopus数据库。我们筛选出3540篇文章进行标题和摘要审查，其中80篇被选作全文审查。纳入的研究需聚焦于目标中列出的六种结局中的任何一种的复发情况。使用美国国立卫生研究院研究质量评估工具对研究质量进行评估。由于各研究间的异质性过大，无法进行荟萃分析，但报告了按种族和族裔分层的估计值以及同质性结果检验。
纳入了六项关于复发性早产和小于胎龄儿的研究。汇总比较显示，所有女性复发性早产和小于胎龄儿的风险更高。按种族分层比较显示，黑人和白人女性早产复发风险更高，但存在异质性。黑人女性复发性早产的相对风险范围为2.02[1.94, 2.11]至2.86[2.40, 3.39]，白人女性为3.23[3.07, 3.39]至3.92[3.35, 4.59]。对于这两种结局，西班牙裔和亚裔女性按种族和族裔分层的证据不足。
早产复发存在差异，种族/族裔一致性比较表明，种族是黑人和白人女性复发性早产的效应修饰因素。由于研究数量较少，无法就小于胎龄儿或西班牙裔和亚裔群体得出结论。这些结果提出了新的研究领域，以更好地理解复发性不良分娩结局中基于种族的差异。
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