新冠肺炎大流行对产科实践和种族差异的影响[ID: 1380285]

Malena Wheeler, H. Hong, G. Swamy, Tracy Truong, Shakthi Unnithan
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引用次数: 0

摘要

与白人产妇相比,黑人产妇发生剖宫产(CD)和妊娠期高血压(gHTN)的风险增加。在ARRIVE试验中,39周引产降低了低风险无产患者的CD和gHTN。我们的目的是确定在arrival和COVID-19大流行之后,引产、CD或gHTN的种族差异是否发生了变化。方法:我们进行了一项经irb批准的回顾性队列研究,使用了三个时间段的公开出生证明数据:到达前(2015年1月1日至2018年8月31日)、到达后(2018年9月1日至2020年2月29日)和到达后(2020年3月1日至2020年12月31日)。所有非西班牙裔黑人(NHB)或白人(NHW)未分娩的单胎妊娠患者,妊娠超过39周,无记录的高风险条件。采用经季节性和协变量调整的中断时间序列分析,按时间周期、种族和民族比较引产、gHTN和CD的几率。结果:共有471,351例NHB和2265,018例NHW出生记录纳入分析。分娩后,产妇的引产率在新生儿中有所上升。在《arrival》和COVID-19发表前后,非西班牙裔黑人患者被诱导的可能性低于白人患者。在调整后的ITS分析中,在所有三个时间段内,与NHW相比,NHB的引产(IOL)的几率较低,而妊娠期高血压和剖宫产的几率较高。结论:39周人工晶状体的种族差异可能导致妊娠高血压和剖宫产的种族差异。ARRIVE试验的结果表明,确保在第39周公平获得人工晶状体可能是减少产科种族差异的一种策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Effect of the ARRIVE Trial and the COVID-19 Pandemic on Obstetric Practice and Racial Disparities [ID: 1380285]
INTRODUCTION: Black birthing people are at increased risk for cesarean delivery (CD) and gestational hypertension (gHTN), compared to their White counterparts. In the ARRIVE trial, labor induction at 39 weeks decreased CD and gHTN in low-risk nulliparous patients. Our aim was to determine whether racial differences in labor induction, CD or gHTN changed after ARRIVE and the COVID-19 pandemic. METHODS: We conducted an IRB-approved, retrospective cohort study using publicly available birth certificate data from three time periods: pre-ARRIVE (January 1, 2015 to August 31, 2018), post-ARRIVE (September 1, 2018 to February 29, 2020), and post-COVID (March 1, 2020 to December 31, 2020). All non-Hispanic Black (NHB) or White (NHW) nulliparous patients with a singleton gestation who delivered at more than 39 weeks of gestation with no documented high-risk conditions were included. Odds of labor induction, gHTN, and CD were compared by time period and race and ethnicity using an interrupted time series analysis adjusted for seasonality and covariates. RESULTS: There were 471,351 NHB and 2,265,018 NHW birth records included in the analysis. Post ARRIVE, the rate of labor induction increased among NHB and NHW birthing people. Non-Hispanic Black patients were less likely to be induced than their White counterparts before and after the publication of ARRIVE and COVID-19. In the adjusted ITS analysis, the odds of induction of labor (IOL) were lower while the odds of gestational hypertension and cesarean birth were higher for NHB compared to NHW in all three time periods. CONCLUSION: It is plausible that the racial difference in 39-week IOL may contribute to racial disparities in gestational hypertension and cesarean delivery. The results of the ARRIVE trial suggest that ensuring equitable access to IOL in the 39th week may be one strategy to reduce obstetric racial disparities.
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