The effect of acculturation on progesterone/estriol ratios and preterm birth in Hispanics

R. Jeanne Ruiz, George Saade, Charles E L Brown, Carolyn Nelson-Becker, Alai Tan, Sheryl Bishop, Radek Bukowski

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

OBJECTIVE: To examine the Hispanic acculturation paradox by identifying the effect of acculturation on serum progesterone and estriol levels, the progesterone/estriol ratio, and preterm birth. METHODS: We used an observational, prospective design with 468 self-identified, low-income, pregnant Hispanic women. We used the Language Proficiency Subscale (from the Bidimensional Acculturation Scale for Hispanics) to measure acculturation. We measured progesterone and estriol in maternal serum at 22-24 weeks of pregnancy. We defined preterm birth as birth before 37 weeks of gestation. Statistical analysis was by Wilcox-Mann-Whitney and Kruskal-Wallis tests, analysis of variance, t tests, logistic regression, and structural equation modeling. RESULTS: English proficiency had an adjusted odds ratio of 4.03 (95% confidence interval 1.44-11.25), P<.001, and the lowest quartile of the progesterone/estriol ratio had an adjusted odds ratio of 2.93 (95% confidence interval 1.25-6.89), P<.001, to predict preterm birth. English proficiency was associated with a decrease in progesterone/estriol ratio and an increase in preterm birth. In structural equation modeling, the progesterone/estriol ratio mediated the relationship between acculturation and preterm birth. CONCLUSION: Hispanic woman have four times the risk of a preterm birth if they are more acculturated (ie, proficient in English). These findings demonstrate another possible aspect of obstetric risk, that of acculturation. Further refinement of the risk of acculturation is essential to clarify how we can adjust our clinical care to prevent increasing preterm birth with the increasing Hispanic population.

Original languageEnglish (US)
Pages (from-to)309-316
Number of pages8
JournalObstetrics and Gynecology
Volume111
Issue number2 PART 1
DOIs
StatePublished - Feb 2008
Externally publishedYes

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Acculturation
Estriol
Premature Birth
Hispanic Americans
Progesterone
Odds Ratio
Confidence Intervals
Pregnancy
Serum
Obstetrics
Pregnant Women
Analysis of Variance
Language
Logistic Models
Mothers
Parturition
Population

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Ruiz, R. J., Saade, G., Brown, C. E. L., Nelson-Becker, C., Tan, A., Bishop, S., & Bukowski, R. (2008). The effect of acculturation on progesterone/estriol ratios and preterm birth in Hispanics. Obstetrics and Gynecology, 111(2 PART 1), 309-316. https://doi.org/10.1097/01.AOG.0000297896.00491.2c

The effect of acculturation on progesterone/estriol ratios and preterm birth in Hispanics. / Ruiz, R. Jeanne; Saade, George; Brown, Charles E L; Nelson-Becker, Carolyn; Tan, Alai; Bishop, Sheryl; Bukowski, Radek.

In: Obstetrics and Gynecology, Vol. 111, No. 2 PART 1, 02.2008, p. 309-316.

Research output: Contribution to journalArticle

Ruiz, RJ, Saade, G, Brown, CEL, Nelson-Becker, C, Tan, A, Bishop, S & Bukowski, R 2008, 'The effect of acculturation on progesterone/estriol ratios and preterm birth in Hispanics', Obstetrics and Gynecology, vol. 111, no. 2 PART 1, pp. 309-316. https://doi.org/10.1097/01.AOG.0000297896.00491.2c
Ruiz, R. Jeanne ; Saade, George ; Brown, Charles E L ; Nelson-Becker, Carolyn ; Tan, Alai ; Bishop, Sheryl ; Bukowski, Radek. / The effect of acculturation on progesterone/estriol ratios and preterm birth in Hispanics. In: Obstetrics and Gynecology. 2008 ; Vol. 111, No. 2 PART 1. pp. 309-316.
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N2 - OBJECTIVE: To examine the Hispanic acculturation paradox by identifying the effect of acculturation on serum progesterone and estriol levels, the progesterone/estriol ratio, and preterm birth. METHODS: We used an observational, prospective design with 468 self-identified, low-income, pregnant Hispanic women. We used the Language Proficiency Subscale (from the Bidimensional Acculturation Scale for Hispanics) to measure acculturation. We measured progesterone and estriol in maternal serum at 22-24 weeks of pregnancy. We defined preterm birth as birth before 37 weeks of gestation. Statistical analysis was by Wilcox-Mann-Whitney and Kruskal-Wallis tests, analysis of variance, t tests, logistic regression, and structural equation modeling. RESULTS: English proficiency had an adjusted odds ratio of 4.03 (95% confidence interval 1.44-11.25), P<.001, and the lowest quartile of the progesterone/estriol ratio had an adjusted odds ratio of 2.93 (95% confidence interval 1.25-6.89), P<.001, to predict preterm birth. English proficiency was associated with a decrease in progesterone/estriol ratio and an increase in preterm birth. In structural equation modeling, the progesterone/estriol ratio mediated the relationship between acculturation and preterm birth. CONCLUSION: Hispanic woman have four times the risk of a preterm birth if they are more acculturated (ie, proficient in English). These findings demonstrate another possible aspect of obstetric risk, that of acculturation. Further refinement of the risk of acculturation is essential to clarify how we can adjust our clinical care to prevent increasing preterm birth with the increasing Hispanic population.

AB - OBJECTIVE: To examine the Hispanic acculturation paradox by identifying the effect of acculturation on serum progesterone and estriol levels, the progesterone/estriol ratio, and preterm birth. METHODS: We used an observational, prospective design with 468 self-identified, low-income, pregnant Hispanic women. We used the Language Proficiency Subscale (from the Bidimensional Acculturation Scale for Hispanics) to measure acculturation. We measured progesterone and estriol in maternal serum at 22-24 weeks of pregnancy. We defined preterm birth as birth before 37 weeks of gestation. Statistical analysis was by Wilcox-Mann-Whitney and Kruskal-Wallis tests, analysis of variance, t tests, logistic regression, and structural equation modeling. RESULTS: English proficiency had an adjusted odds ratio of 4.03 (95% confidence interval 1.44-11.25), P<.001, and the lowest quartile of the progesterone/estriol ratio had an adjusted odds ratio of 2.93 (95% confidence interval 1.25-6.89), P<.001, to predict preterm birth. English proficiency was associated with a decrease in progesterone/estriol ratio and an increase in preterm birth. In structural equation modeling, the progesterone/estriol ratio mediated the relationship between acculturation and preterm birth. CONCLUSION: Hispanic woman have four times the risk of a preterm birth if they are more acculturated (ie, proficient in English). These findings demonstrate another possible aspect of obstetric risk, that of acculturation. Further refinement of the risk of acculturation is essential to clarify how we can adjust our clinical care to prevent increasing preterm birth with the increasing Hispanic population.

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