Wallace Maeve E, Harville Emily W
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112-2715, USA.
J Pediatr Adolesc Gynecol. 2012 Oct;25(5):314-21. doi: 10.1016/j.jpag.2012.05.010. Epub 2012 Jul 24.
Pregnant adolescents experience elevated rates of adverse birth outcomes compared to older mothers. Positive deviance inquiry is the identification of uncommon behaviors and traits that result in better health outcomes for individuals in a population that shares similar risks. The purpose of our study was to utilize a positive deviance framework to identify sociodemographic and behavioral characteristics associated with a healthy birth outcome among adolescents.
This is a retrospective cohort study design.
We performed a secondary data analysis of vital records data from the State of Louisiana between January 1, 1995 and December 31, 2007.
Data included birth certificates from 35,013 Louisiana mothers age ≤19.
A healthy birth was defined as having an infant of weight between 2500 g and 4000 g, delivered vaginally without induction or instrumented delivery and in the absence of pregnancy, obstetric, or neonatal complications and anomalies.
Twenty-one percent of the study population was classified as positive deviants with healthy births. Multivariate log-linear regression was used to model predictors of healthy birth. Adolescents who were older, non-black, multiparous, non-smoking, married, gained a medium amount of weight, had a longer inter-pregnancy interval or received adequate prenatal care were most likely to experience a healthy pregnancy and birth. Ethnicity, alcohol use, father's information on the birth certificate and paternal characteristics did not significantly predict a positive birth outcome.
Characterizing positive deviant adolescents may help identify special populations for targeted intervention and important modifiable behaviors for the promotion of better birth outcomes in all young mothers.
与年龄较大的母亲相比，怀孕青少年出现不良分娩结局的几率更高。正向偏差探究是识别在具有相似风险的人群中能带来更好健康结局的罕见行为和特征。我们研究的目的是利用正向偏差框架来确定与青少年健康分娩结局相关的社会人口学和行为特征。
这是一项回顾性队列研究设计。
我们对1995年1月1日至2007年12月31日路易斯安那州的生命记录数据进行了二次数据分析。
数据包括35013名年龄≤19岁的路易斯安那州母亲的出生证明。
健康分娩定义为分娩出体重在2500克至4000克之间的婴儿，经阴道自然分娩，未使用引产或器械助产，且不存在妊娠、产科或新生儿并发症及异常情况。
研究人群中有21%被归类为具有健康分娩结局的正向偏差者。采用多变量对数线性回归对健康分娩的预测因素进行建模。年龄较大、非黑人、经产妇、不吸烟、已婚、体重增加适中、妊娠间隔较长或接受了充分产前护理的青少年最有可能经历健康的妊娠和分娩。种族、饮酒情况、出生证明上父亲的信息以及父亲的特征并不能显著预测良好的分娩结局。
对正向偏差青少年进行特征描述可能有助于识别需要进行针对性干预的特殊人群，以及有助于所有年轻母亲改善分娩结局的重要可改变行为。
