Wilson Roneé E, Alio Amina P, Kirby Russell S, Salihu Hamisu M
Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA.
Arch Gynecol Obstet. 2008 Sep;278(3):231-6. doi: 10.1007/s00404-007-0557-4. Epub 2008 Jan 24.
To determine the risk of intrapartum stillbirth among teen mothers.
The Missouri maternally linked data containing births from 1978 to 1997 were analyzed. The study group (teen mothers) was sub-divided into younger (<15 years) and older (15-19 years) teenagers. Women aged 20-24 were the referent category. We used Kaplan-Meier product-limit estimator to calculate the cumulative probability of death for each group and the Cox Proportional Hazards Regression models to obtain adjusted hazards ratios.
The rate of antepartum and intrapartum stillbirth among teenagers was 3.8 per 1,000 and 1.0 per 1,000, respectively, compared to 3.5 per 1,000 and 0.8 per 1,000 among the reference group. The adjusted risk of intrapartum stillbirth was more than 4 times as high among younger teens (adjusted hazard ratio [AHR] 4.3 [95% CI 4.0-4.7]) and 50% higher among older teens (AHR 1.5 [95% CI 1.2-1.8]). The risk of intrapartum stillbirth occurred in a dose-dependent fashion, with risk increasing as maternal age decreased (P < 0.01).
Teenagers are at an increased risk of stillbirth, with the greatest risk disparity occurring intrapartum, especially among younger teens. This new information is potentially useful for targeting intervention measures aimed at improving in utero fetal survival among pregnant women at the lower extreme of the maternal age spectrum.
确定青少年母亲分娩期死产的风险。
对密苏里州1978年至1997年的母婴关联数据进行分析。研究组（青少年母亲）分为年龄较小的（<15岁）和年龄较大的（15 - 19岁）青少年。20 - 24岁的女性为参照组。我们使用Kaplan - Meier乘积限估计量来计算每组的累积死亡概率，并使用Cox比例风险回归模型来获得调整后的风险比。
青少年产前和分娩期死产率分别为每1000例中有3.8例和1.0例，而参照组分别为每1000例中有3.5例和0.8例。年龄较小的青少年分娩期死产的调整风险高出4倍多（调整后风险比[AHR] 4.3 [95%置信区间4.0 - 4.7]），年龄较大的青少年高出50%（AHR 1.5 [95%置信区间1.2 - 1.8]）。分娩期死产风险呈剂量依赖性，随着母亲年龄降低风险增加（P < 0.01）。
青少年死产风险增加，分娩期风险差异最大，尤其是年龄较小的青少年。这一新信息可能有助于针对旨在提高低龄孕妇子宫内胎儿存活率的干预措施。
