Disparities by race/ethnicity in unplanned cesarean birth among healthy nulliparas: a secondary analysis of the nuMoM2b dataset.
Disparities by race/ethnicity in unplanned cesarean birth among healthy nulliparas: a secondary analysis of the nuMoM2b dataset.
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DOI：
10.1186/s12884-023-05667-6
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发表时间：
2023-05-12
影响因子：
3.1
通讯作者：
中科院分区：
文献类型：
--
作者：
在产妇发病率和死亡率方面存在种族差异，其中大多数事件发生在健康的孕妇中。这些结果的一个已知驱动因素是计划外剖宫产。不太了解的是，在何种程度上产妇提出的种族/民族与计划外剖腹产在健康的劳动人民，如果有不同的种族/民族在分娩时的决策剖宫产前。未产妇妊娠结局研究的次要分析：监测准妈妈（nuMoM 2b）数据集涉及初产妇，在妊娠开始时没有显著的健康并发症，在≥ 37周时进行了分娩试验，单胎非异常胎儿头位（N = 5，095）。Logistic回归模型被用来检查参与者确定的呈现种族/民族和计划外剖宫产之间的关联。受试者确定的呈现种族/民族被用来捕捉种族主义对参与者的医疗保健经验的影响。19.6%的分娩者发生了计划外剖腹产。与白人参与者（17.4%）相比，黑人（24.1%）和西班牙裔（24.7%）的发病率显著较高。在调整后的模型中，白色受试者与黑人受试者相比，计划外剖宫产的几率低0.57（97.5%CI [0.45-0.73]，p < 0.001），而西班牙裔受试者与黑人受试者的几率相似。与白人相比，黑人和西班牙裔剖宫产的主要指征是在自然分娩开始的情况下不令人放心的胎心率。在健康的初产妇中，与黑人或西班牙裔相比，白人与计划外剖宫产的几率降低相关，即使在调整相关临床因素后。未来的研究和干预措施应考虑医疗保健提供者对产妇种族/民族的看法如何可能会使护理决策产生偏差，导致低风险劳动人群中手术分娩的使用增加，以及出生结局的种族差异。在线版本包含补充材料，可通过10.1186/s12884-023-05667-6获得。
Racial disparities exist in maternal morbidity and mortality, with most of these events occurring in healthy pregnant people. A known driver of these outcomes is unplanned cesarean birth. Less understood is to what extent maternal presenting race/ethnicity is associated with unplanned cesarean birth in healthy laboring people, and if there are differences by race/ethnicity in intrapartum decision-making prior to cesarean birth. This secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset involved nulliparas with no significant health complications at pregnancy onset who had a trial of labor at ≥ 37 weeks with a singleton, non-anomalous fetus in cephalic presentation (N = 5,095). Logistic regression models were used to examine associations between participant-identified presenting race/ethnicity and unplanned cesarean birth. Participant-identified presenting race/ethnicity was used to capture the influence of racism on participant’s healthcare experiences. Unplanned cesarean birth occurred in 19.6% of labors. Rates were significantly higher among Black- (24.1%) and Hispanic- (24.7%) compared to white-presenting participants (17.4%). In adjusted models, white participants had 0.57 (97.5% CI [0.45–0.73], p < 0.001) lower odds of unplanned cesarean birth compared to Black-presenting participants, while Hispanic-presenting had similar odds as Black-presenting people. The primary indication for cesarean birth among Black- and Hispanic- compared to white-presenting people was non-reassuring fetal heart rate in the setting of spontaneous labor onset. Among healthy nulliparas with a trial of labor, white-presenting compared to Black or Hispanic-presenting race/ethnicity was associated with decreased odds of unplanned cesarean birth, even after adjustment for pertinent clinical factors. Future research and interventions should consider how healthcare providers’ perception of maternal race/ethnicity may bias care decisions, leading to increased use of surgical birth in low-risk laboring people and racial disparities in birth outcomes. The online version contains supplementary material available at 10.1186/s12884-023-05667-6.
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影响因子：
7.6
作者：
BARON, RM;KENNY, DA
通讯作者：
KENNY, DA
影响因子：
2
作者：
Grobman WA;Crenshaw EG;Marsh DJ;McNeil RB;Pemberton VL;Haas DM;Debbink M;Mercer BM;Parry S;Reddy U;Saade G;Simhan H;Mukhtar F;Wing DA;Kershaw KN;NICHD nuMoM2b NHLBI nuMoM2b Heart Health Study Networks
通讯作者：
NICHD nuMoM2b NHLBI nuMoM2b Heart Health Study Networks
影响因子：
9.8
作者：
Kominiarek MA;Vanveldhuisen P;Hibbard J;Landy H;Haberman S;Learman L;Wilkins I;Bailit J;Branch W;Burkman R;Gonzalez-Quintero VH;Gregory K;Hatjis C;Hoffman M;Ramirez M;Reddy UM;Troendle J;Zhang J;Consortium on Safe Labor
通讯作者：
Consortium on Safe Labor
影响因子：
9.8
作者：
Haas, David M.;Parker, Corette B.;Wing, Deborah A.;Parry, Samuel;Grobman, William A.;Mercer, Brian M.;Simhan, Hyagriv N.;Hoffman, Matthew K.;Silver, Robert M.;Wadhwa, Pathik;Iams, Jay D.;Koch, Matthew A.;Caritis, Steve N.;Wapner, Ronald J.;Esplin, Sean;Elovitz, Michal A.;Foroud, Tatiana;Peaceman, Alan M.;Saade, George R.;Willinger, Marian;Reddy, Uma M.
通讯作者：
Reddy, Uma M.
影响因子：
5.4
作者：
Chae, David H.;Clouston, Sean;Kramer, Michael R.
通讯作者：
Kramer, Michael R.