Adams M M, Read J A, Rawlings J S, Harlass F B, Sarno A P, Rhodes P H
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia.
Obstet Gynecol. 1993 Jan;81(1):65-71.
To examine black-white differences in preterm delivery in a healthy population who had unrestricted access to prenatal care.
We conducted a retrospective cohort study of 842 black and 1026 white enlisted servicewomen who delivered a singleton infant of 20 or more weeks' gestation from July 1, 1987 through September 30, 1990 at four Army Medical Centers in the United States. Data were collected by reviewing maternal and newborn records. We used logistic and proportional hazards regression models to analyze outcomes defined by length of gestation, cause of preterm delivery, and jointly by length and cause.
Black enlisted women had a cumulative probability of preterm delivery (13.5%) that was higher than that for white enlisted women (10.5%) (hazard ratio 1.31, 95% confidence interval [CI] 1.002-1.70). However, the ratio of black-to-white hazards was not uniform. Black-white differences were small and nonsignificant from 33-36 weeks' gestation, when most preterm deliveries occur. The differences were also small and nonsignificant for deliveries related to spontaneous rupture of membranes or idiopathic preterm labor, the most common causes of preterm delivery. The black-to-white hazard ratios were greatest for all deliveries before 33 weeks' gestation and for medically indicated preterm deliveries.
Efforts to reduce black-white differences in preterm delivery must go beyond providing prenatal care and eliminating recreational drug use. Future studies should consider black-white differences in environments during the mother's own development and in psychosocial and physical stresses during pregnancy.
在可不受限制地获得产前护理的健康人群中，研究早产方面的黑白差异。
我们对842名黑人及1026名白人现役女兵进行了一项回顾性队列研究，这些女兵于1987年7月1日至1990年9月30日在美国的四个陆军医疗中心分娩了单胎妊娠20周或以上的婴儿。通过查阅产妇和新生儿记录收集数据。我们使用逻辑回归模型和比例风险回归模型来分析由妊娠时长、早产原因以及妊娠时长和原因共同定义的结局。
黑人现役女兵的早产累积概率（13.5%）高于白人现役女兵（10.5%）（风险比1.31，95%置信区间[CI]1.002 - 1.70）。然而，黑白风险比并不一致。在妊娠33 - 36周时，黑白差异较小且无统计学意义，而大多数早产发生在此期间。对于与胎膜早破或特发性早产相关的分娩（早产最常见的原因），差异也较小且无统计学意义。在妊娠33周前的所有分娩以及医学指征性早产中，黑白风险比最大。
减少早产方面黑白差异的努力必须超越提供产前护理和消除消遣性药物使用。未来的研究应考虑母亲自身发育过程中的环境以及孕期心理社会和身体压力方面的黑白差异。
