Adverse Birth Outcomes Among Nulliparous vs. Multiparous Women
Adverse Birth Outcomes Among Nulliparous vs. Multiparous Women
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DOI：
10.1177/003335491112600605
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发表时间：
2011-11-01
影响因子：
3.3
通讯作者：
Myers, Evan R.
中科院分区：
文献类型：
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作者：
Miranda, Marie Lynn;Edwards, Sharon E.;Myers, Evan R.
目标。先前的研究表明，未生育过的妇女（即没有生育过的妇女）比多产妇女（即至少有过一次生育过的妇女）出现不良分娩结果的风险更高。我们研究了不良结局发生率的部分差异是否可归因于妊娠结局不佳的未产妇与没有不良结局的未产妇在同一时间段内（通过选择或生育力差异）随后活产的可能性较小。方法。使用确定性匹配，我们将北卡罗来纳州详细出生记录中的未产妇与随后的出生联系起来。我们采用基于统计和模拟的分析来估计随后活产的未产妇与没有活产的未产妇之间的首次分娩结果率差异。我们的马尔可夫模拟重点关注早产 (PTB)。结果。在与二胎无关的未生育女性中，与有生育关系的女性相比，经母亲年龄调整的多种不良后果的发生率在统计上均较高。这些结果也适用于特定种族/民族的分析。模拟发现，如果一些有 PTB 风险的女性没有经历第二次生育，那么与 PTB 病史相关的 PTB 相对风险就会被低估。结论。观察到的未产妇和多产妇女之间不良后果发生率的差异部分归因于高危妇女随后没有活产，无论是出于选择还是由于生育力差异。
Objectives. Previous studies indicate that nulliparous women (i.e., women having no previous births) are at higher risk for adverse birth outcomes than multiparous women (i.e., women having had at least one previous birth). We examined whether part of the difference in adverse outcome rates is attributable to nulliparous women with poor pregnancy outcomes being less likely (through choice or fecundity differences) to have a subsequent live birth within the same time period as nulliparous women without adverse outcomes.Methods. Using deterministic matching, we linked nulliparous women from the North Carolina Detailed Birth Record to subsequent births. We employed statistical and simulation-based analyses to estimate first birth outcome rate differences between nulliparous women who did have a subsequent live birth vs. those who did not. Our Markov simulations focused on preterm birth (PTB).Results. Among nulliparous women who were not linked to a second birth, maternal age-adjusted rates of multiple adverse outcomes were all statistically higher compared with rates for linked women. These results also held in race/ethnicity-specific analyses. Simulations found that the relative risk of PTB associated with a history of PTB was underestimated if some women who would have been at risk for PTB did not experience a second birth.Conclusions. The observed differences in rates of adverse outcomes between nulliparous and multiparous women are partly attributable to higher-risk women not having a subsequent live birth, either by choice or due to fecundity differences.