Maravilla Joemer C, Betts Kim S, Couto E Cruz Camila, Alati Rosa
School of Public Health, The University of Queensland, Herston, Queensland, Australia.
School of Public Health, The University of Queensland, Herston, Queensland, Australia.
Am J Obstet Gynecol. 2017 Nov;217(5):527-545.e31. doi: 10.1016/j.ajog.2017.04.021. Epub 2017 Apr 19.
Existing evidence of predictors of repeated teenage pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation of protective and risk factors that are associated with repeated teenage pregnancy through a metaanalytical consensus.
We used PubMed, EMBASE, CINAHL, ProQuest, PsychINFO, ScienceDirect, Scopus, and Web of Science databases from 1997-2015 and the reference list of other relevant research papers and related reviews.
Eligibility criteria included (1) epidemiologic studies that analyzed factors associated with repeated pregnancy or birth among adolescents <20 years of age who were nulliparous or experienced at least 1 pregnancy, and (2) experimental studies with an observational component that was adjusted for the intervention.
We performed narrative synthesis of study characteristics, participant characteristics, study results, and quality assessment. We also conducted random-effects and quality-effects metaanalyses with meta-regression to obtain pooled odds ratios of identified factors and to determine sources of between-study heterogeneity.
Twenty-six eligible epidemiologic studies, most from the United States (n=24), showed >47 factors with no evidence of publication bias for each metaanalysis. Use of contraception (pooled odds ratio, 0.60; 95% confidence interval, 0.35-1.02), particularly long-acting reversible contraceptives (pooled odds ratio, 0.19; 95% confidence interval, 0.08-0.45), considerably reduced repeated teenage pregnancy risk. Among studies about contraception, the number of follow-up visits (adjusted coefficient, 0.72; P=.102) and country of study (unadjusted coefficient, 2.57; permuted P=.071) explained between-study heterogeneity. Education-related factors, which included higher level of education (pooled odds ratio, 0.74; 95% confidence interval, 0.60-0.91) and school continuation (pooled odds ratio, 0.53; 95% confidence interval, 0.33-0.84), were found to be protective. Conversely, depression (pooled odds ratio, 1.46; 95% confidence interval, 1.14-1.87), history of abortion (pooled odds ratio, 1.66; 95% confidence interval, 1.08-2.54), and relationship factors, such as partner support, increased the repeated teenage pregnancy risk.
Contraceptive use, educational factors, depression, and a history of abortion are the highly influential predictors of repeated teenage pregnancy. However, there is a lack of epidemiologic studies in low- and middle-income countries to measure the extent and characteristics of repeated teenage pregnancy across more varied settings.
现有关于青少年重复妊娠预测因素的证据尚未得到严格评估。本系统评价通过荟萃分析共识，对与青少年重复妊娠相关的保护因素和风险因素进行全面评估。
我们使用了1997年至2015年的PubMed、EMBASE、CINAHL、ProQuest、PsychINFO、ScienceDirect、Scopus和Web of Science数据库，以及其他相关研究论文和相关综述的参考文献列表。
纳入标准包括：（1）分析年龄＜20岁的未生育或至少经历过1次妊娠的青少年重复妊娠或分娩相关因素的流行病学研究；（2）具有经干预调整的观察性成分的实验研究。
我们对研究特征、参与者特征、研究结果和质量评估进行了叙述性综合。我们还进行了随机效应和质量效应荟萃分析，并进行了荟萃回归，以获得已识别因素的合并比值比，并确定研究间异质性的来源。
26项符合条件的流行病学研究，大多数来自美国（n = 24），每项荟萃分析显示有超过47个因素，且无发表偏倚的证据。使用避孕措施（合并比值比，0.60；95%置信区间，0.35 - 1.02），特别是长效可逆避孕措施（合并比值比，0.19；95%置信区间，0.08 - 0.45），可显著降低青少年重复妊娠风险。在关于避孕措施的研究中，随访次数（调整系数，0.72；P = 0.102）和研究国家（未调整系数，2.57；置换P = 0.071）解释了研究间的异质性。与教育相关的因素，包括较高的教育水平（合并比值比，0.74；95%置信区间，0.60 - 0.91）和继续上学（合并比值比，0.53；95%置信区间，0.33 - 0.84），被发现具有保护作用。相反，抑郁（合并比值比，1.46；95%置信区间，1.14 - 1.87）、流产史（合并比值比，1.66；95%置信区间，1.08 - 2.54）以及诸如伴侣支持等关系因素会增加青少年重复妊娠的风险。
避孕措施的使用、教育因素、抑郁和流产史是青少年重复妊娠的高度影响预测因素。然而，低收入和中等收入国家缺乏流行病学研究来衡量在更多样化环境中青少年重复妊娠的程度和特征。
