Obstetrical Intervention and the Singleton Preterm Birth Rate in the United States From 1991-2006
Obstetrical Intervention and the Singleton Preterm Birth Rate in the United States From 1991-2006
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DOI：
10.2105/ajph.2009.180570
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发表时间：
2010-11-01
影响因子：
12.7
通讯作者：
Zhang, Jun
中科院分区：
文献类型：
--
作者：
MacDorman, Marian F.;Declercq, Eugene;Zhang, Jun
目标.我们调查了1991年至2006年美国产科干预与早产的关系。我们评估了早产、剖宫产、引产和相关风险的变化。Logistic回归模型对风险调整后的早产产科干预的几率进行建模。从1991年到2006年，单胎早产的比例增加了13%。单胎早产的剖宫产率增加了47%，引产率翻了一番。2006年，51%的单胎早产是自然阴道分娩，而1991年为69%。调整人口统计学和医疗风险后，早产儿的母亲在2006年比1991年更有可能进行产科干预，比例为88%（95%置信区间[CI] = 1.87，1.90）。使用来自19个州的新出生证明数据，我们估计42%的单胎早产儿是通过引产或剖宫产分娩的，没有自然分娩。产科干预与1991年至2006年美国早产率的增加有关。公共卫生界可以在减少医疗上不必要的干预方面发挥核心作用。(Am J公共卫生。2010;100：2241-2247. doi：10.2105/AJPH.2009.180570）
Objectives. We examined the relationship between obstetrical intervention and preterm birth in the United States between 1991 and 2006.Methods. We assessed changes in preterm birth, cesarean delivery, labor induction, and associated risks. Logistic regression modeled the odds of preterm obstetrical intervention after risk adjustment.Results. From 1991 to 2006, the percentage of singleton preterm births increased 13%. The cesarean delivery rate for singleton preterm births increased 47%, and the rate of induced labor doubled. In 2006, 51% of singleton preterm births were spontaneous vaginal deliveries, compared with 69% in 1991. After adjustment for demographic and medical risks, the mother of a preterm infant was 88% (95% confidence interval [CI] = 1.87, 1.90) more likely to have an obstetrical intervention in 2006 than in 1991. Using new birth certificate data from 19 states, we estimated that 42% of singleton preterm infants were delivered via induction or cesarean birth without spontaneous onset of labor.Conclusions. Obstetrical interventions were related to the increase in the US preterm birth rate between 1991 and 2006. The public health community can play a central role in reducing medically unnecessary interventions. (Am J Public Health. 2010;100:2241-2247. doi:10.2105/AJPH.2009.180570)