Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress
Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress
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DOI：
10.1007/s10995-018-2500-7
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发表时间：
2018-08-01
影响因子：
2.3
通讯作者：
Ahluwalia, Indu B.
中科院分区：
文献类型：
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作者：
Almeida, Joanna;Becares, Laia;Ahluwalia, Indu B.
在美国，低出生体重（LBW）和早产（PTB）的种族/民族不平等仍然存在。研究已经确定了许多不良出生结果的风险因素;然而，它们并不能完全解释PTB/LBW的发生或不平等。压力被认为是人种/种族LBW和PTB差异的一种解释。方法使用2012年至2013年21个州和一个城市（n = 15，915）的妊娠风险评估监测系统（PRAMS）数据，我们使用泊松回归估计急性，经济和关系压力与LBW和PTB之间的关联，并检查这些压力因素单独和同时对LBW和PTB种族/民族差异的贡献。结果调整年龄和种族/民族因素后，急性（p < 0.001）、经济（p < 0.001）和关系（p < 0.05）应激源与LBW风险增加相关，但只有急性（p < 0.05）和经济（p < 0.01）应激源增加PTB风险。在所有模型中，非西班牙裔黑人的LBW和PTB风险均高于非西班牙裔白人（IRR 1.87，95% CI 1.55，2.27和IRR 1.46，95% CI 1.18，1.79）。考虑到压力因素的影响，LBW和PTB的风险分别降低了17%和22%，但不能完全解释非西班牙裔黑人LBW和PTB的可能性增加。讨论本研究的结果表明，压力可能会增加LBW和PTB的风险。虽然压力源可能导致LBW和PTB的种族/民族差异，但它们并不能完全解释这些差异。减轻怀孕期间的压力可能有助于促进更健康的分娩结果，并减少LBW和PTB中的种族/民族不平等。
Introduction Racial/ethnic inequities in low birth weight (LBW) and preterm birth (PTB) persist in the United States. Research has identified numerous risk factors for adverse birth outcomes; however, they do not fully explain the occurrence of, or inequalities in PTB/LBW. Stress has been proposed as one explanation for differences in LBW and PTB by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2013 for 21 states and one city (n = 15,915) we used Poisson regression to estimate the association between acute, financial and relationship stressors and LBW and PTB, and to examine the contribution of these stressors individually and simultaneously to racial/ethnic differences in LBW and PTB. Results Adjusting for age and race/ethnicity, acute (p < 0.001), financial (p < 0.001) and relationship (p < 0.05) stressors were associated with increased risk of LBW, but only acute (p < 0.05) and financial (p < 0.01) stress increased risk of PTB. Across all models, non-Hispanic blacks had higher risk of LBW and PTB relative to non-Hispanic whites (IRR 1.87, 95% CI 1.55, 2.27 and IRR 1.46, 95% CI 1.18, 1.79). Accounting for the effects of stressors attenuated the risk of LBW and PTB by 17 and 22% respectively, but did not fully explain the increased likelihood of LBW and PTB among non-Hispanic blacks. Discussion Results of this study demonstrate that stress may increase the risk of LBW and PTB. While stressors may contribute to racial/ethnic differences in LBW and PTB, they do not fully explain them. Mitigating stress during pregnancy may help promote healthier birth outcomes and reduce racial/ethnic inequities in LBW and PTB.