Kawakita Tetsuya, Wilson Kathy, Grantz Katherine L, Landy Helain J, Huang Chun-Chih, Gomez-Lobo Veronica
Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC.
Obstetrics and Gynecology, Long Bearch Memorial Medical Group, Long Beach, California.
J Pediatr Adolesc Gynecol. 2016 Apr;29(2):130-6. doi: 10.1016/j.jpag.2015.08.006. Epub 2015 Aug 29.
To investigate the outcomes of adolescent pregnancy.
Retrospective cohort study from the Consortium on Safe Labor between 2002 and 2008.
Twelve clinical centers with 19 hospitals in the United States.
Nulliparous women (n = 43,537) younger than 25 years of age, including 1189 younger adolescents (age ≤ 15.9 years), 14,703 older adolescents (age 16-19.9 years), and 27,645 young adults (age 20-24.9 years).
Adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated, controlling for maternal characteristics and pregnancy complications (young adults as a reference group).
Maternal, neonatal outcomes, cesarean indications, and length of labor.
Younger adolescents had an increased risk of maternal anemia (aOR = 1.25; 95% CI, 1.07-1.45), preterm delivery at less than 37 weeks of gestation (aOR = 1.36; 95% CI, 1.14-1.62), postpartum hemorrhage (aOR = 1.46; 95% CI, 1.10-1.95), preeclampsia or hemolysis, increased liver enzyme levels, and low platelet syndrome (aOR = 1.44; 95% CI, 1.17-1.77) but had a decreased risk of cesarean delivery (aOR = 0.49; 95% CI, 0.42-0.59), chorioamnionitis (aOR = 0.63; 95% CI, 0.47-0.84), and neonatal intensive care unit admission (aOR = 0.80; 95% CI, 0.65-0.98). Older adolescents had an increased risk of maternal anemia (aOR = 1.15; 95% CI, 1.09-1.22), preterm delivery at less than 37 weeks of gestation (aOR = 1.16; 95% CI, 1.08-1.25), and blood transfusion (aOR = 1.21; 95% CI, 1.02-1.43), but had a decreased risk of cesarean delivery (aOR = 0.75; 95% CI, 0.71-0.79), chorioamnionitis (aOR = 0.83; 95% CI, 0.75-0.91), major perineal laceration (aOR = 0.82; 95% CI, 0.71-0.95), and neonatal intensive care unit admission (aOR = 0.89; 95% CI, 0.83-0.96). Older adolescents were less likely to have a cesarean delivery for failure to progress or cephalopelvic disproportion (aOR = 0.89; 95% CI, 0.81-0.98). For adolescents who entered spontaneous labor, the second stage of labor was shorter (P < .01).
Adolescents were less likely to have a cesarean delivery. Failure to progress or cephalopelvic disproportion occurred less frequently in older adolescents. Adolescents who entered spontaneous labor had a shorter second stage of labor.
调查青少年妊娠的结局。
2002年至2008年期间安全分娩联盟开展的回顾性队列研究。
美国12个临床中心的19家医院。
年龄小于25岁的未产妇（n = 43,537），包括1189名年龄较小的青少年（年龄≤15.9岁）、14,703名年龄较大的青少年（年龄16 - 19.9岁）和27,645名年轻成年人（年龄20 - 24.9岁）。
计算调整后的比值比（aOR）及95%置信区间（CI），并对产妇特征和妊娠并发症进行控制（以年轻成年人为参照组）。
产妇、新生儿结局、剖宫产指征及产程时长。
年龄较小的青少年患母体贫血（aOR = 1.25；95% CI，1.07 - 1.45）、妊娠小于37周早产（aOR = 1.36；95% CI，1.14 - 1.62）、产后出血（aOR = 1.46；95% CI，1.10 - 1.95）、先兆子痫或溶血、肝酶水平升高及血小板减少综合征（aOR = 1.44；95% CI，1.17 - 1.77）的风险增加，但剖宫产（aOR = 0.49；95% CI，0.42 - 0.59）、绒毛膜羊膜炎（aOR = 0.63；95% CI，0.47 - 0.84）及新生儿重症监护病房收治（aOR = 0.80；95% CI，0.65 - 0.98）的风险降低。年龄较大的青少年患母体贫血（aOR = 1.15；95% CI，1.09 - 1.22）、妊娠小于37周早产（aOR = 1.16；95% CI，1.08 - 1.25）及输血（aOR = 1.21；95% CI，1.02 - 1.43）的风险增加，但剖宫产（aOR = 0.75；95% CI，0.71 - 0.79）、绒毛膜羊膜炎（aOR = 0.83；95% CI，0.75 - 0.91）、会阴严重裂伤（aOR = 0.82；95% CI，0.71 - 0.95）及新生儿重症监护病房收治（aOR = 0.89；95% CI，0.83 - 0.96）的风险降低。年龄较大的青少年因产程无进展或头盆不称而行剖宫产的可能性较小（aOR = 0.89；95% CI，0.81 - 0.98）。对于自然发动分娩的青少年，第二产程较短（P < 0.01）。
青少年剖宫产的可能性较小。年龄较大的青少年产程无进展或头盆不称的情况较少见。自然发动分娩的青少年第二产程较短。
