Institute of Child Health, University College London, London, UK.
Royal North Shore Hospital, The University of Sydney Northern Clinical School, Sydney, NSW, Australia.
Paediatr Perinat Epidemiol. 2020 Nov;34(6):645-654. doi: 10.1111/ppe.12685. Epub 2020 Apr 28.
Young maternal age is associated with lower birthweight and higher rates of preterm birth and childhood hospitalisations. Internationally, teen pregnancy rates vary widely, reflecting differences in social, welfare, and health care factors in different cultural contexts.
To determine whether the increased risk of adverse infant outcomes among teenage mothers varies by country, reflecting different national teenage birth rates and country-specific social/welfare policies, in Scotland (higher teenage pregnancy rates), England, New South Wales (NSW; Australia), Ontario (Canada), and Sweden (lower rates).
We used administrative hospital data capturing 3 002 749 singleton births surviving to postnatal discharge between 2010 and 2014 (2008-2012 for Sweden). We compared preterm birth (24-36 weeks' gestation), mortality within 12 months of postnatal discharge, unplanned hospital admissions, and emergency department visits within 12 months of postnatal discharge, for infants born to mothers aged 15-19, 20-24, 25-29, and 30-34 years.
Compared to births to women aged 30-34 years, risks of adverse outcomes among teenage mothers were higher in all countries, but the magnitude of effects was not related to country-specific rates of teenage births. Teenage mothers had between 1.2% (95% confidence interval [CI] 0.7, 1.7, Sweden) and 2.0% (95% CI 1.4, 2.5, NSW) more preterm births, and between 9.8 (95% CI 7.2, 12.4, England) and 19.7 (95% CI 8.7, 30.6, Scotland) more deaths per 10 000 infants, compared with mothers aged 30-34. Between 6.4% (95% CI 5.5, 7.4, NSW) and 25.4% (95% CI 24.7, 26.1, Ontario), more infants born to teenage mothers had unplanned hospital contacts compared with those born to mothers aged 30-34.
Regardless of country, infants born to teenage mothers had universally worse outcomes than those born to older mothers. This excess risk did not vary by national rates of livebirths to teenage mothers. Current mechanisms to support teenage mothers have not eliminated maternal age-related disparities in infant outcomes; further strategies to mitigate excess risk in all countries are needed.
年轻母亲的年龄与较低的出生体重和较高的早产率以及儿童住院率有关。国际上，青少年怀孕率差异很大，反映了不同文化背景下社会、福利和医疗保健因素的差异。
在苏格兰（青少年怀孕率较高）、英格兰、新南威尔士州（澳大利亚）、安大略省（加拿大）和瑞典（较低的比率），确定青少年母亲所生婴儿的不良结局风险是否因国家而异，反映不同国家青少年出生率和特定于国家的社会/福利政策的差异。
我们使用了行政医院数据，这些数据涵盖了 2010 年至 2014 年期间存活至产后出院的 3,002,749 例单胎分娩（瑞典为 2008-2012 年）。我们比较了母亲年龄为 15-19 岁、20-24 岁、25-29 岁和 30-34 岁的婴儿的早产（24-36 周妊娠）、产后 12 个月内的死亡率、无计划的住院治疗和产后 12 个月内的急诊就诊情况。
与 30-34 岁母亲所生婴儿相比，所有国家的青少年母亲所生婴儿发生不良结局的风险均较高，但影响的程度与特定国家的青少年出生率无关。青少年母亲的早产率比 30-34 岁母亲所生婴儿高 1.2%（95%置信区间为 0.7，1.7，瑞典）和 2.0%（95%置信区间为 1.4，2.5，新南威尔士州），死亡率高 9.8%（95%置信区间为 7.2，12.4，英格兰）和 19.7%（95%置信区间为 8.7，30.6，苏格兰）每 10,000 例婴儿中，与 30-34 岁母亲所生婴儿相比。与 30-34 岁母亲所生婴儿相比，在新南威尔士州（95%置信区间为 5.5，7.4，6.4%）和安大略省（95%置信区间为 24.7，26.1，25.4%），更多的青少年母亲所生婴儿有计划外的医院接触。
无论国家如何，青少年母亲所生婴儿的结局普遍比年龄较大的母亲所生婴儿差。这种额外的风险并不因全国青少年活产率的不同而有所不同。目前支持青少年母亲的机制并没有消除与母亲年龄相关的婴儿结局差异；所有国家都需要进一步采取策略来减轻这种过度风险。
