Reime Birgit, Schücking Beate A, Wenzlaff Paul
Faculty of Nursing and Healthcare, University of Applied Sciences of the Saarland, Goebenstr, 40, 66117 Saarbrücken, Germany.
BMC Pregnancy Childbirth. 2008 Jan 31;8:4. doi: 10.1186/1471-2393-8-4.
Recently, attention has been focused on subsequent pregnancies among teenage mothers. Previous studies that compared the reproductive outcomes of teenage nulliparae and multiparae often did not consider the adolescents' reproductive histories. Thus, the authors compared the risks for adverse reproductive outcomes of adolescent nulliparae to teenagers who either have had an induced abortion or a previous birth.
In this retrospective cohort study we used perinatal data prospectively collected by obstetricians and midwives from 1990-1999 (participation rate 87-98% of all hospitals) in Lower Saxony, Germany. From the 9742 eligible births among adolescents, women with multiple births, >1 previous pregnancies, or a previous spontaneous miscarriage were deleted and 8857 women <19 years remained. Of these 8857 women, 7845 were nulliparous, 801 had one previous birth, and 211 had one previous induced abortion. The outcomes were stillbirths, neonatal mortality, perinatal mortality, preterm births, and very low birthweight. Bivariate and multivariable logistic regression models were conducted.
In bivariate logistic regression analyses, compared to nulliparous teenagers, adolescents with a previous birth had higher risks for perinatal [OR = 2.08, CI = 1.11,3.89] and neonatal [OR = 4.31, CI = 1.77,10.52] mortality and adolescents with a previous abortion had higher risks for stillbirths [OR = 3.31, CI = 1.01,10.88] and preterm births [OR = 2.21, CI = 1.07,4.58]. After adjusting for maternal nationality, partner status, smoking, prenatal care and pre-pregnancy BMI, adolescents with a previous birth were at higher risk for perinatal [OR = 2.35, CI = 1.14,4.86] and neonatal mortality [OR = 4.70, CI = 1.60,13.81] and adolescents with a previous abortion had a higher risk for very low birthweight infants [OR = 2.74, CI = 1.06,7.09] than nulliparous teenagers.
The results suggest that teenagers who give birth twice as adolescents have worse outcomes in their second pregnancy compared to those teenagers who are giving birth for the first time. The prevention of the second pregnancy during adolescence is an important public health objective and should be addressed by health care providers who attend the first birth or the abortion and the follow-up care. Also, health care workers should attempt to improve the pregnancy outcomes of subsequent teenage pregnancies by addressing modifiable risk factors, for example, supporting smoking cessation and utilization of prenatal care.
最近，青少年母亲的后续妊娠受到了关注。以往比较青少年初产妇和经产妇生殖结局的研究往往没有考虑青少年的生育史。因此，作者比较了青少年初产妇与有过人工流产或既往生育史的青少年发生不良生殖结局的风险。
在这项回顾性队列研究中，我们使用了德国下萨克森州的产科医生和助产士于1990年至1999年前瞻性收集的围产期数据（参与率为所有医院的87%-98%）。在9742例符合条件的青少年分娩中，删除了多胎妊娠、既往妊娠>1次或既往自然流产的妇女，剩余8857名年龄<19岁的妇女。在这8857名妇女中，7845名是初产妇，801名有过一次既往分娩，211名有过一次人工流产。结局指标为死产、新生儿死亡、围产期死亡、早产和极低出生体重。进行了双变量和多变量逻辑回归模型分析。
在双变量逻辑回归分析中，与初产青少年相比，有过既往分娩的青少年发生围产期[比值比（OR）=2.08，可信区间（CI）=1.11,3.89]和新生儿死亡[OR = 4.31，CI = 1.77,10.52]的风险更高，有过人工流产的青少年发生死产[OR = 3.31，CI = 1.01,10.88]和早产[OR = 2.21，CI = 1.07,4.58] 的风险更高。在调整了母亲国籍、伴侣状况、吸烟、产前护理和孕前体重指数后，有过既往分娩的青少年发生围产期[OR = 2.35，CI = 1.14,4.86]和新生儿死亡[OR = 4.70，CI = 1.60,13.81]的风险更高，有过人工流产的青少年出生极低体重儿的风险[OR = 2.74，CI = 1.06,7.09]高于初产青少年。
结果表明，与首次生育的青少年相比，青少年期生育两次的青少年在第二次妊娠中的结局更差。预防青少年期的第二次妊娠是一项重要的公共卫生目标，应由负责首次分娩或人工流产及后续护理的医疗保健人员来解决。此外，医护人员应通过处理可改变的风险因素，如支持戒烟和利用产前护理，来努力改善青少年后续妊娠的结局。
