Rising preterm birth rates, 1989-2004: changing demographics or changing obstetric practice?
Rising preterm birth rates, 1989-2004: changing demographics or changing obstetric practice?
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DOI：
10.1016/j.socscimed.2011.10.031
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发表时间：
2012-01
影响因子：
5.4
通讯作者：
Lauderdale, Diane S.
中科院分区：
文献类型：
--
作者：
VanderWeele, Tyler J.;Lantos, John D.;Lauderdale, Diane S.
美国的早产率高于大多数工业化国家，而且一直在稳步上升。一些人将这些趋势归因于人口结构的变化，更多的高龄母亲，更多的不孕不育，以及更多的多胞胎。其他人则认为产科的变化落后于这一趋势。我们试图确定，如果人口因素自以来没有改变，2004年的早产率会是多少。我们检查了1989年和2004年的完整美国出生证明文件，并使用Logistic回归模型估计了2004年的早产率(总体的、自发的和医学诱导的)，如果自1989年以来育龄妇女的母亲年龄、种族、出生、怀孕、婚姻状况和教育程度没有改变的话。从1989年到2004年，早产率从11.2%上升到12.8%，而药物诱导率上升了94%，从3.4%上升到6.6%，自然产率下降了21%，从7.8%下降到6.2%。如果2004年的人口因素与1989年一样，2004年的失业率将几乎相同。多胎生育的变化仅占医疗诱导率增加的16%。我们的分析表明，早产儿的增加更有可能主要是由于产科实践的变化，而不是生育人口结构的变化。进一步的研究应该检查产科实践中的这些变化对婴儿发病率和死亡率的影响程度。
Preterm birth rates are higher in the United States than in most industrialized countries, and have been rising steadily. Some attribute these trends to changing demographics, with more older mothers, more infertility, and more multiple births. Others suggest that changes in obstetrics are behind the trends. We sought to determine what the preterm birth rate in 2004 would have been if demographic factors had not changed since 1989. We examined complete US birth certificate files from 1989 and 2004 and used logistic regression models to estimate what the 2004 preterm birth rates (overall, spontaneous, and medically induced) would have been if maternal age, race, nativity, gravidity, marital status, and education among childbearing women had not changed since 1989. While the overall preterm births increased from 11.2% to 12.8% from 1989-2004, medically induced rates increased 94%, from 3.4% to 6.6%, and spontaneous rates declined by 21%, from 7.8% to 6.2%. Had demographic factors in 2004 been what they were in 1989, the 2004 rates would have been almost identical. Changes in multiple births accounted for only 16% of the increase in medically induced rates. Our analysis suggests that the increase in preterm births is more likely to be due primarily to changes in obstetric practice, rather than to changes in the demographics of childbearing. Further research should examine the degree to which these changes in obstetric practice affect infant morbidity and mortality.
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