Individual-Level and Community-Level Predictors of Healthy Pregnancy Outcomes in Multigravid Black Women

被引：1

作者：

Barry, Valene Garr ^{[1
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Martin, Samantha L. ^{[1
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Schneider-Worthington, Camille ^{[1
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Zhao, Peinan ^{[1
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Woolfolk, Candice L. ^{[1
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Foraker, Randi ^{[1
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Davis, Kia L. ^{[1
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Kelly, Jeannie C. ^{[1
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Raghuraman, Nandini ^{[1
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England, Sarah K. ^{[1
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Carter, Ebony B. ^{[1
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机构：

[1] Washington Univ, Sch Med St Louis, Dept Obstet & Gynecol, Div Clin Res,Div Maternal Fetal Med, St Louis, MO USA

[2] Washington Univ, Ctr Reprod Hlth Sci, Sch Med St Louis, Dept Obstet & Gynecol,Div Gen Med Sci, St Louis, MO USA

[3] Washington Univ, Sch Med St Louis, Dept Surg, St Louis, MO USA

[4] Univ Alabama Birmingham, Dept Obstet & Gynecol, Div Maternal Fetal Med, Birmingham, AL USA

[5] Univ Alabama Birmingham, Sch Hlth Profess, Dept Nutr Sci, Birmingham, AL USA

[6] Univ North Carolina Chapel Hill, Dept Obstet & Gynecol, Div Maternal Fetal Med, Chapel Hill, NC USA

来源：

OBSTETRICS AND GYNECOLOGY | 2024年 / 144卷 / 02期

基金：

美国国家卫生研究院;

关键词：

LOW-BIRTH-WEIGHT; PRETERM BIRTH; INCOME INCONGRUITY; RISK; ASSOCIATION; DEPRIVATION; CONTEXT;

D O I：

10.1097/AOG.0000000000005634

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

Income, employment, and community factors significantly predict consecutive healthy pregnancies in multigravid Black women and may inform targeted maternal health initiatives to promote health equity. OBJECTIVE:To identify individual- and community-level factors that predict the odds of multigravid Black women having consecutive pregnancies without adverse pregnancy outcomes.METHODS:We conducted a secondary analysis of 515 multigravid Black women from a longitudinal observational study (2017-2019). We assessed the presence of adverse pregnancy outcomes (hypertensive disorders, gestational diabetes, preterm birth, fetal growth restriction, placental abruption, and pregnancy loss) for the index and prior pregnancies. We examined U.S. Census data, medical records, and surveys across multiple socioecologic domains: personal, behavioral, socioeconomic, and policy. We estimated adjusted odds ratios (aORs) and 95% CIs for the association between individual- and community-level factors and consecutive healthy pregnancies using hierarchical logistic regression models adjusted for maternal age, body mass index (BMI), gravidity, interpregnancy interval, and median household income.RESULTS:Among 515 multigravid Black women (age 27 +/- 5 years, BMI 31.4 +/- 8.9, gravidity 4 +/- 2), 38.4% had consecutive healthy pregnancies without adverse pregnancy outcomes. Individual-level factors associated with consecutive healthy pregnancies included normal glucose tolerance (aOR 3.9, 95% CI, 1.2-12.1); employment (aOR 1.9, 95% CI, 1.2-2.9); living in communities with favorable health indicators for diabetes, hypertension, and physical activity; and household income of $50,000 per year or more (aOR 3.5, 95% CI, 1.4-8.7). When individual and community factors were modeled together, only income and employment at the individual and community levels remained significant.CONCLUSION:Individual and community income and employment are associated with consecutive healthy pregnancies in a cohort of Black patients, emphasizing the need for comprehensive, multilevel systems interventions to reduce adverse pregnancy outcomes for Black women.

引用

页码：241 / 251

页数：11

共 42 条

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American College of Obstetricians and Gynecologists' Committee on Practice BulletinsObstetrics and the Society forMaternal-FetalMedicin, 2019, Obstet Gynecol, V133, pe97, DOI 10.1097/AOG.0000000000003070

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