Scholl T O, Hediger M L, Huang J, Johnson F E, Smith W, Ances I G
Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, Camden 08103.
Ann Epidemiol. 1992 Sep;2(5):565-75. doi: 10.1016/1047-2797(92)90001-7.
The influence of very young maternal age and parity on pregnancy outcome was examined in a cohort of nearly 900 adolescents and mature women from Camden, New Jersey. Young primigravid primiparas (aged 12 to 15 years) were compared with mature primigravid primiparas (18 to 29 years). Young multiparas (19 years or younger, with a first pregnancy at the age of 12 to 15 years) were compared with mature, multiparas (19 to 29 years old, with a first pregnancy at 18 years or older). After controlling for confounding factors, young primiparas were found to have a modest increase in preterm delivery, which was not statistically significant. However, low gynecologic age contributed disproportionately to the risk of preterm delivery in this group, with risk decreasing with each year from menarche (Cox's proportional hazard, 0.80; 95% confidence interval [CI], 0.68 to 0.94). Among multiparas, there were several statistical interactions associated with increased risk of small-for-gestational-age infants, including interactions between young age and low pre-pregnancy body mass (adjusted odds ratio [AOR], 5.74; 95% CI, 2.18 to 15.08), young age and a prior low-birth-weight infant (AOR, 10.58; 95% CI, 3.89 to 28.77), and young age and a prior preterm delivery (AOR, 5.52; 95% CI, 2.04 to 14.98). Thus, while chronologic age per se may not be a good predictor of pregnancy outcome, adolescents remain a high-risk group because of factors that are more common among them (e.g., biologic immaturity, inadequate prenatal care, poverty, minority status, low prepregnancy weight) and because factors associated with an early adolescent pregnancy, such as low gynecologic age, may continue to influence the outcome of subsequent pregnancies.
在一项对来自新泽西州卡姆登的近900名青少年和成年女性的队列研究中，研究了极年轻的产妇年龄和产次对妊娠结局的影响。将年轻初产妇（年龄在12至15岁之间）与成熟初产妇（18至29岁）进行比较。将年轻经产妇（19岁及以下，首次怀孕年龄在12至15岁之间）与成熟经产妇（19至29岁，首次怀孕年龄在18岁及以上）进行比较。在控制混杂因素后，发现年轻初产妇的早产率有适度增加，但无统计学意义。然而，低妇科年龄对该组早产风险的影响不成比例，风险从初潮起每年降低（Cox比例风险，0.80；95%置信区间[CI]，0.68至0.94）。在经产妇中，有几个与小于胎龄儿风险增加相关的统计学交互作用，包括年轻年龄与孕前低体重之间的交互作用（调整优势比[AOR]，5.74；95%CI，2.18至15.08）、年轻年龄与既往低出生体重儿之间的交互作用（AOR，10.58；95%CI，3.89至28.77）以及年轻年龄与既往早产之间的交互作用（AOR，5.52；95%CI，2.04至14.98）。因此，虽然实际年龄本身可能不是妊娠结局的良好预测指标，但青少年仍然是高危人群，这是因为他们中更常见的因素（如生物不成熟、产前护理不足、贫困、少数族裔身份、孕前体重低），以及与青少年早期怀孕相关的因素，如低妇科年龄，可能会继续影响后续妊娠的结局。
