美国 COVID-19 大流行期间的产妇健康:间断时间序列分析。

IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Epidemiology Pub Date : 2024-11-01 Epub Date: 2024-09-30 DOI:10.1097/EDE.0000000000001779
Kaitlyn Jackson, Deborah Karasek, Alison Gemmill, Daniel F Collin, Rita Hamad
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引用次数: 0

摘要

背景:COVID-19 大流行以及随后旨在遏制疾病传播和减少经济影响的政策应对措施对孕产妇健康产生了深远影响。据我们所知,除了早期的大流行之外,关于孕产妇健康趋势的持久性干扰的研究很少,对这些干扰如何影响孕产妇健康中预先存在的差异的理解也很有限:我们利用严谨的间断时间序列方法和美国国家卫生统计中心生命统计出生数据档案(2015-2021 年的所有活产婴儿,N = 24653848),估计了 COVID-19 大流行开始后(2020 年 3 月)孕产妇健康趋势的变化是否不同于基于之前存在的时间趋势的预测。结果包括妊娠糖尿病、妊娠高血压疾病、妊娠体重增加以及产前护理的充分性:结果:我们发现妊娠糖尿病(2020 年 12 月高峰:1.7 个百分点;95%CI:1.3,2.1)、妊娠高血压疾病(2021 年 1 月高峰:1.3 个百分点;95%CI:0.4,2.1)和妊娠体重增加(2021 年 3 月高峰:0.1 个标准差;95%CI:0.4,2.1)的发病率均有所上升:产前护理不足率有所下降(2021 年 1 月最低值:-0.4pp;95%CI:-0.7, -0.1)。不同亚群的主要差异包括黑人、西班牙裔和受教育程度较低人群的妊娠糖尿病发病率上升幅度更大且更持久:这些孕产妇健康模式可能不仅反映了 COVID-19 感染的影响,还反映了医疗服务、健康行为、远程工作、经济安全和孕产妇压力等方面的变化。对因果途径和长期趋势的进一步研究将为公共卫生和临床干预提供信息,以解决孕产妇疾病负担和差异问题。
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Maternal Health During the COVID-19 Pandemic in the United States: An Interrupted Time-series Analysis.

Background: The COVID-19 pandemic, and subsequent policy responses aimed at curbing disease spread and reducing economic fallout, had far-reaching consequences for maternal health. There has been little research to our knowledge on enduring disruptions to maternal health trends beyond the early pandemic and limited understanding of how these impacted pre-existing disparities in maternal health.

Methods: We leveraged rigorous interrupted time-series methods and US National Center for Health Statistics Vital Statistics Birth Data Files of all live births for 2015-2021 (N = 24,653,848). We estimated whether changes in maternal health trends after the onset of the COVID-19 pandemic (March 2020) differed from predictions based on pre-existing temporal trends. Outcomes included gestational diabetes, hypertensive disorders of pregnancy, gestational weight gain, and adequacy of prenatal care.

Results: We found an increased incidence of gestational diabetes (December 2020 peak: 1.7 percentage points (pp); 95% confidence interval [CI]: 1.3, 2.1), hypertensive disorders of pregnancy (January 2021 peak: 1.3 pp; 95% CI: 0.4, 2.1), and gestational weight gain (March 2021 peak: 0.1 standard deviation; 95% CI: 0.03, 0.1) and declines in inadequate prenatal care (January 2021 nadir: -0.4 pp; 95% CI: -0.7, -0.1). Key differences by subgroups included greater and more sustained increases in gestational diabetes among Black, Hispanic, and less educated individuals.

Conclusion: These patterns in maternal health likely reflect not only effects of COVID-19 infection but also changes in healthcare access, health behaviors, remote work, economic security, and maternal stress. Further research about causal pathways and longer-term trends will inform public health and clinical interventions to address maternal disease burden and disparities.

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来源期刊
Epidemiology
Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.70
自引率
3.70%
发文量
177
审稿时长
6-12 weeks
期刊介绍: Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
期刊最新文献
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