孕早期孕产妇心血管健康方面种族和民族差异的决定因素。
Determinants of Racial and Ethnic Differences in Maternal Cardiovascular Health in Early Pregnancy.
作者信息
Cameron Natalie A, Huang Xiaoning, Petito Lucia C, Ning Hongyan, Shah Nilay S, Yee Lynn M, Perak Amanda M, Haas David M, Mercer Brian M, Parry Samuel, Saade George R, Silver Robert M, Simhan Hyagriv N, Reddy Uma M, Varagic Jasmina, Licon Ernesto, Greenland Philip, Lloyd-Jones Donald M, Kershaw Kiarri N, Grobman William A, Khan Sadiya S
机构信息
Division of General Internal Medicine, Department of Medicine (N.A.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Preventive Medicine (N.A.C., X.H., L.C.P., H.N., N.S.S., A.M.P., P.G., D.M.L.-J., K.N.K., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL.
出版信息
Circ Cardiovasc Qual Outcomes. 2025 Mar;18(3):e011217. doi: 10.1161/CIRCOUTCOMES.124.011217. Epub 2025 Jan 14.
BACKGROUND
Suboptimal cardiovascular health (CVH) in pregnancy is associated with adverse maternal and offspring outcomes. To guide public health efforts to reduce disparities in maternal CVH, we determined the contribution of individual- and neighborhood-level factors to racial and ethnic differences in early pregnancy CVH.
METHODS
We included nulliparous individuals with singleton pregnancies who self-identified as Hispanic, non-Hispanic Black (NHB), or non-Hispanic White (NHW) and participated in the nuMoM2b cohort study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be). First-trimester CVH was quantified using 6 routinely assessed factors in pregnancy included in the American Heart Association Life's Essential 8 score (0-100 points), in which higher scores indicate better CVH. Oaxaca-Blinder decomposition evaluated the extent to which racial and ethnic differences in CVH were explained by differences in individual- and neighborhood-level factors (age, socioeconomic characteristics, psychosocial factors, nativity, perceived racial discrimination, and area deprivation index).
RESULTS
Among 9104 participants, the mean age was 26.8 years, 18.7% identified as Hispanic, 15.6% identified as NHB, and 65.8% identified as NHW. Mean (SD) CVH scores were 76.7 (14.1), 69.8 (15.1), and 79.9 (14.3) in the Hispanic, NHB, and NHW groups, respectively (<0.01). The individual- and neighborhood-level factors evaluated explained all differences in CVH between Hispanic and NHW groups and 82% of differences between NHW and NHB groups. Racial and ethnic differences in educational attainment explained the greatest proportion of differences in CVH. If mean years of education among the Hispanic (14.0 [2.5]) and NHB (13.4 [2.4]) groups were the same as the NHW (15.8 [2.4]) group, mean CVH scores would be higher by 2.98 points (95% CI, 2.59-3.37) in the Hispanic and 4.28 points (95% CI, 3.77-4.80) in NHB groups.
CONCLUSIONS
Racial and ethnic differences in early pregnancy CVH were largely explained by differences in individual- and neighborhood-level factors.
背景
孕期心血管健康（CVH）欠佳与不良的母婴结局相关。为指导公共卫生工作以减少孕产妇CVH方面的差异，我们确定了个体层面和社区层面因素对孕早期CVH种族和民族差异的影响。
方法
我们纳入了单胎妊娠的未生育个体，她们自我认定为西班牙裔、非西班牙裔黑人（NHB）或非西班牙裔白人（NHW），并参与了nuMoM2b队列研究（未生育妊娠结局研究：监测准妈妈）。孕早期CVH使用美国心脏协会生命基本8项评分（0 - 100分）中孕期常规评估的6个因素进行量化，分数越高表明CVH越好。Oaxaca - Blinder分解评估了个体层面和社区层面因素（年龄、社会经济特征、心理社会因素、出生地、感知到的种族歧视和地区贫困指数）的差异在多大程度上解释了CVH的种族和民族差异。
结果
在9104名参与者中，平均年龄为26.8岁，18.7%为西班牙裔，15.6%为NHB，65.8%为NHW。西班牙裔、NHB和NHW组的平均（标准差）CVH分数分别为76.7（14.1）、69.8（15.1）和79.9（14.3）（<0.01）。所评估的个体层面和社区层面因素解释了西班牙裔和NHW组之间CVH的所有差异以及NHW和NHB组之间82%的差异。教育程度的种族和民族差异解释了CVH差异的最大比例。如果西班牙裔（14.0 [2.5]）和NHB组（13.4 [2.4]）的平均受教育年限与NHW组（15.8 [2.4]）相同，西班牙裔组的平均CVH分数将提高2.98分（95% CI，2.59 - 3.37），NHB组将提高4.28分（95% CI，3.77 - 4.80）。
结论
孕早期CVH的种族和民族差异在很大程度上可由个体层面和社区层面因素的差异来解释。
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