Schieve L A, Handler A
Division of Epidemiology Science, School of Public Health, University of Illinois at Chicago, USA.
Obstet Gynecol. 1996 Sep;88(3):356-63. doi: 10.1016/0029-7844(96)00203-7.
To explore associations between race, preterm delivery, etiologic classification of preterm delivery, and perinatal mortality.
The study population consisted of 13,010 black and 19,007 white mother-infant pairs delivered at Chicago-area hospitals in 1988-1989 categorized as term or preterm births. Preterm births were further divided by severity and etiology. Black-white differences in perinatal mortality within groups were calculated and adjusted for birth weight and other potential confounding variables.
Black women were nearly twice as likely as whites to experience preterm (before 37 weeks' gestation) and very preterm (before 32 weeks' gestation) delivery associated with premature rupture of membranes (PROM) or classified as idiopathic. Although black infants were also found to have twice the perinatal mortality risk of white infants (relative risk [RR] 2.1, 95% confidence interval [CI] 1.7-2.5), the overall preterm perinatal mortality rates did not differ between black and white women (RR 1.0, 95% CI 0.8-1.2). However, among preterm births, perinatal mortality was not uniform within categories of medical etiology. The mortality risk was the same for black and white infants born preterm following polyhydramnios or placental complications (RR 1.1, 95% CI 0.6-1.9), the same for black and white infants born preterm after labor induction (RR 1.1, 95% CI 0.6-1.9), and higher for black infants classified as idiopathic preterm deliveries (RR 1.6, 95% CI 1.1-2.3). In contrast, mortality rates tended to be lower for black infants born preterm following PROM-amnionitis (RR 0.8, 95% CI 0.5-1.2). The idiopathic disparity was explained by a differential birth weight distribution (adjusted RR 1.1, 95% CI 0.7-1.9); however, the apparent survival benefit among black infants born preterm following PROM increased even further after adjustment for birth weight (adjusted RR 0.4, 95% CI 0.2-0.7).
Black infants born preterm after PROM appear to have a survival advantage compared with their white counterparts, an effect not observed within other etiologic categories of preterm delivery.
探讨种族、早产、早产的病因分类与围产期死亡率之间的关联。
研究人群包括1988 - 1989年在芝加哥地区医院分娩的13010对黑人母婴和19007对白人母婴，分为足月产或早产。早产进一步按严重程度和病因分类。计算并调整出生体重及其他潜在混杂变量后，得出各组内围产期死亡率的黑白差异。
黑人女性发生胎膜早破（PROM）相关早产（妊娠37周前）及极早产（妊娠32周前）的可能性几乎是白人女性的两倍，或被归类为特发性早产。尽管发现黑人婴儿围产期死亡风险是白人婴儿的两倍（相对风险[RR] 2.1，95%置信区间[CI] 1.7 - 2.5），但黑人与白人女性的总体早产围产期死亡率并无差异（RR 1.0，95% CI 0.8 - 1.2）。然而，在早产中，医学病因类别内的围产期死亡率并不一致。羊水过多或胎盘并发症后早产的黑人和白人婴儿死亡风险相同（RR 1.1，95% CI 0.6 - 1.9），引产术后早产的黑人和白人婴儿死亡风险相同（RR 1.1，95% CI 0.6 - 1.9），特发性早产分类中的黑人婴儿死亡风险更高（RR 1.6，95% CI 1.1 - 2.3）。相比之下，PROM - 羊膜炎后早产的黑人婴儿死亡率往往较低（RR 0.8，95% CI 0.5 - 1.2）。特发性差异可通过出生体重分布差异来解释（调整后RR 1.1，95% CI 0.7 - 1.9）；然而，在调整出生体重后，PROM后早产的黑人婴儿中明显的生存优势进一步增加（调整后RR 0.4，95% CI 0.2 - 0.7）。
与白人婴儿相比，PROM后早产的黑人婴儿似乎具有生存优势，这种效应在其他早产病因类别中未观察到。
