Sinha Sikha, Aggarwal Abha Rani, Osmond Clive, Fall Caroline Hd, Bhargava Santosh K, Sachdev Harshpal Singh
Sitaram Bhartia Institute of Science and Research, New Delhi, India; #University School of Medicine and Para-medical Health Sciences, Guru Gobind Singh Indraprastha University, Delhi, India; National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India; ‡MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; and ^Sunder Lal Jain Hospital, New Delhi, India. Correspondence to: Prof HPS Sachdev, Senior Consultant Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi 110 016, India.
Indian Pediatr. 2016 Oct 8;53(10):871-877. doi: 10.1007/s13312-016-0950-9. Epub 2016 Jul 10.
To evaluate the relationship between maternal age at child birth, and perinatal and under-five mortality.
Prospective birth cohort.
Urban community.
9169 pregnancies in the New Delhi Birth Cohort resulted in 8181 live births. These children were followed for survival status and anthropometric measurements at birth (+3 days), 3,6,9 and 12 months (7 days), and every 6 months thereafter until 21 years age. Information on maternal age at child birth and socio-demographic profile was also obtained.
Offspring mortality from 28 weeks gestation till 5 years age.
Offspring mortality (stillbirths - 5 years; n=328) had a U-shaped association with maternal age (P<0.001). Compared to the reference group (20-24 years), younger (≤19 years) and older (≥35 years) maternal ages were associated with a higher risk of offspring mortality (HR: 1.68; 95% CI 1.16, 2.43 and HR 1.48; 95% CI 1.01, 2.16, respectively). In young mothers, the increased risk persisted after adjustment for socio-economic confounders (maternal education, household income and wealth; HR 1.51; 95% CI 1.03, 2.20) and further for additional behavioral (place of delivery) and biological mediators (gestation and birthweight) (HR 2.14; 95% CI 1.25,3.64). Similar associations were documented for post-perinatal deaths but for perinatal mortality the higher risk was not statistically significant (P >0.05). In older mothers, the increased mortality risk was not statistically significant (P >0.05) after adjustment for socio-economic confounders.
Young motherhood is associated with an increased risk of post-perinatal mortality and measures to prevent early childbearing should be strengthened.
评估分娩时产妇年龄与围产期及五岁以下儿童死亡率之间的关系。
前瞻性出生队列研究。
城市社区。
新德里出生队列中的9169例妊娠分娩出8181例活产儿。对这些儿童进行随访，记录其出生时（出生后3天）、3、6、9和12个月（出生后7天）以及此后每6个月直至21岁的生存状况和人体测量数据。同时收集了产妇分娩时年龄及社会人口学特征信息。
妊娠28周直至5岁儿童的死亡率。
子代死亡率（死产至5岁；n = 328）与产妇年龄呈U型关联（P<0.001）。与参照组（20 - 24岁）相比，年龄较小（≤19岁）和较大（≥35岁）的产妇，其子代死亡风险更高（风险比：1.68；95%置信区间1.16, 2.43和风险比1.48；95%置信区间1.01, 2.16）。在年轻母亲中，经社会经济混杂因素（产妇教育程度、家庭收入和财富）调整后，死亡风险仍增加（风险比1.51；95%置信区间1.03, 2.20），进一步经其他行为因素（分娩地点）和生物学中介因素（孕周和出生体重）调整后（风险比2.14；95%置信区间1.25, 3.64）依然如此。围产期死亡后死亡的情况也有类似关联，但围产期死亡率升高的风险无统计学意义（P>0.05）。在年龄较大的母亲中，经社会经济混杂因素调整后，死亡风险增加无统计学意义（P>0.05）。
年轻母亲产后死亡风险增加，应加强预防早育的措施。
