Department of Obstetrics and Gynaecology, Kätilöopisto Hospital, University of Helsinki and Helsinki University Central Hospital, PO Box 610, 00029-HUS, Helsinki, Finland.
Hum Reprod. 2012 Sep;27(9):2829-36. doi: 10.1093/humrep/des253. Epub 2012 Jul 9.
What are the current trends in teenage termination of pregnancy (TOP) and its risk factors?
The incidence of teenage TOP fluctuated substantially during the study period and the incidence of repeat TOP among adolescents increased markedly in the 2000s.
Teenage pregnancy is associated with difficulties in psychological, sexual and overall health. The proportion of teenage pregnancies resulting in termination varies by country and time, but only few countries have reliable statistics on TOPs.
STUDY DESIGN, SIZE, DURATION: This nationwide retrospective register study included all the TOPs (n= 52 968) and deliveries (n= 58 882) in Finland between 1987 and 2009 among girls <20 years of age at the beginning of pregnancy.
PARTICIPANTS/MATERIALS, SETTING, METHODS: The cohorts were divided into three subgroups; 13-15- (n= 6087), 16-17- (n= 18 826) and 18-19- (n= 28 055) year-olds.
After an initial steady decline, the incidence of teenage TOP increased by 44% between 1993 (8.0/1000) and 2003 (11.5/1000), and thereafter declined by 16% until 2009 (9.7/1000). The incidence was higher in older adolescents, but the trends were alike in all age groups. Early TOPs (performed at <56 days of gestation) more than tripled from 11 to 36% during the study period. However, the proportion of second-trimester TOPs remained steady at ≈ 7%. Young age [13-15 years: odds ratio (OR) 1.75 (95% confidence interval (CI) 1.57-1.94), 16-17 years: OR 1.13 (1.05-1.23), 18-19 years: OR 1 (reference category)] and non-use of contraception [(OR 11.16 (10.15-12.27)] were related to a higher risk of second-trimester TOP. The incidence of repeat TOP increased by 95% from 1.9/1000 to 3.7/1000 in 18-19-year-olds and by 120% from 0.5/1000 to 1.1/1000 in 16-17-year-olds between 1993 and 2009. Increasing age [13-15 years: OR 0.16 (95% CI 0.14-0.19), 16-17 years: OR 0.49 (0.45-0.52), 18-19 years 1 (Ref)], living in an urban area [rural: OR 0.62 (0.56-0.67), urban: OR 1 (Ref)] and having undergone a second-trimester TOP [OR 1.46 (1.31-1.63)] were risk factors for repeat TOP. The planned use of intrauterine contraception for post-abortal contraception increased from 2.6 to 6.2% and among girls with repeat TOP from 10 to 19%.
The retrospective nature of the study remains a limitation and the quality of the data is reliant on the accuracy of reporting. We were not able to link repeat TOPs of the same woman in our data set. However, the share of repeat abortions was moderate. WIDER IMPLICATIONS OF THE FINDINGS The rate of teenage TOP seems to rapidly reflect changes in national sexual and reproductive health services and policy. The rising rate of repeat TOP is alarming and may represent a sign of marginalization among these girls. All efforts to maintain a low rate of teenage pregnancy are welcomed.
青少年终止妊娠（TOP）的当前趋势及其危险因素是什么？
在研究期间，青少年 TOP 的发生率波动很大，并且在 21 世纪 00 年代，青少年重复 TOP 的发生率显著增加。
青少年怀孕与心理、性和整体健康方面的困难有关。不同国家和时间的青少年怀孕导致终止妊娠的比例不同，但只有少数几个国家有可靠的 TOP 统计数据。
研究设计、规模、持续时间：这项全国性回顾性登记研究包括芬兰所有在妊娠开始时年龄小于 20 岁的女孩（n=52968）在 1987 年至 2009 年间的 TOP（n=58882）和分娩（n=58882）。
参与者/材料、设置、方法：队列分为三组；13-15 岁（n=6087）、16-17 岁（n=18826）和 18-19 岁（n=28055）岁。
在最初的稳定下降之后，青少年 TOP 的发生率在 1993 年（8.0/1000）和 2003 年（11.5/1000）之间增加了 44%，此后直到 2009 年（9.7/1000）下降了 16%。年龄较大的青少年发生率较高，但所有年龄组的趋势都相似。在研究期间，早期 TOP（在妊娠 56 天内进行）增加了两倍多，从 11%增加到 36%。然而，第二个三个月的 TOP 比例保持稳定，约为 7%。年轻年龄[13-15 岁：优势比（OR）1.75（95%置信区间（CI）1.57-1.94），16-17 岁：OR 1.13（1.05-1.23），18-19 岁：OR 1（参考类别）]和不使用避孕措施[（OR 11.16（10.15-12.27）]与较高的第二个三个月 TOP 风险相关。18-19 岁青少年的重复 TOP 发生率增加了 95%，从 1.9/1000 增加到 3.7/1000，16-17 岁青少年的重复 TOP 发生率增加了 120%，从 0.5/1000 增加到 1.1/1000。年龄增加[13-15 岁：OR 0.16（95% CI 0.14-0.19），16-17 岁：OR 0.49（0.45-0.52），18-19 岁 1（参考）]、居住在城市地区[农村：OR 0.62（0.56-0.67），城市：OR 1（参考）]和进行第二个三个月的 TOP[OR 1.46（1.31-1.63）]是重复 TOP 的危险因素。为堕胎后避孕而计划使用宫内节育器的比例从 2.6%增加到 6.2%，而在有重复 TOP 的女孩中，这一比例从 10%增加到 19%。
研究的回顾性性质仍然是一个限制，数据的质量依赖于报告的准确性。我们无法在我们的数据集中链接同一妇女的重复 TOP。然而，重复堕胎的比例适中。
青少年 TOP 的发生率似乎迅速反映了国家性和生殖健康服务和政策的变化。重复 TOP 率上升令人担忧，这可能是这些女孩边缘化的迹象。欢迎所有努力保持青少年怀孕率低的措施。
