Maternal Morbidity Predicted by an Intersectional Social Determinants of Health Phenotype: A Secondary Analysis of the NuMoM2b Dataset.
Maternal Morbidity Predicted by an Intersectional Social Determinants of Health Phenotype: A Secondary Analysis of the NuMoM2b Dataset.
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由健康表型的交叉社会决定因素预测的孕产妇发病率：对NuMoM2b数据集的二次分析。
DOI：
10.1007/s43032-022-00913-2
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发表时间：
2022-07
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--
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众所周知，产妇的种族、族裔和社会经济地位与一系列不良妊娠结局的风险增加有关，包括产妇发病率和死亡率。以前，研究人员试图确定的促成因素集中在母亲的行为和怀孕并发症。不太了解的是健康的社会决定因素（SDoH）在这些关键结果中观察到的种族/民族差异的贡献。在未产妊娠结局研究的二次分析中：监测准妈妈（nuMoM 2b）数据集，使用潜在混合模型构建健康、未产参与者组，其中头位非异常胎儿，基于SDoH变量进行分娩试验（N=5763）。主要结局是产后产妇发病率的综合评分。350人（6.1%）经历了产后孕产妇发病事件。使用SDoH变量的潜在类别分析显示了六组参与者，各组的产后孕产妇发病率范围为8.7%至4.5%（p<0.001）。两个SDoH组的孕产妇发病率最高。这些高风险群体由收入最低、压力最大的参与者和在美国生活时间最短的人组成。SDoH表型可预测MM结局，并确定了两组重要但不同的孕妇，他们最有可能发生孕产妇发病事件。
Maternal race, ethnicity and socio-economic position are known to be associated with increased risk for a range of poor pregnancy outcomes, including maternal morbidity and mortality. Previously, researchers seeking to identify the contributing factors focused on maternal behaviors and pregnancy complications. Less understood is the contribution of the social determinants of health (SDoH) in observed differences by race/ethnicity in these key outcomes. In this secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset, latent mixture modeling was used to construct groups of healthy, nulliparous participants with a non-anomalous fetus in a cephalic presentation having a trial of labor (N=5763) based on SDoH variables. The primary outcome was a composite score of postpartum maternal morbidity. A postpartum maternal morbidity event was experienced by 350 individuals (6.1%). Latent class analysis using SDoH variables revealed six groups of participants, with postpartum maternal morbidity rates ranging from 8.7% to 4.5% across groups (p<0.001). Two SDoH groups had the highest odds for maternal morbidity. These higher-risk groups were comprised of participants with the lowest income and highest stress and those who had lived in the U.S. for the shortest periods of time. SDoH phenotype predicted MM outcomes and identified two important, yet distinct groups of pregnant people who were the most likely have a maternal morbidity event.
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