青少年妊娠的不良母婴围产结局：中国河北的一项横断面研究。

The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China.

机构信息

Department of Obstetrics and Gynecology, Hebei General Hospital, Hebei Medical University, Shijiazhuang, Hebei, China.

Graduate School, Hebei North University, Zhangjiakou, Hebei, China.

出版信息

BMC Pregnancy Childbirth. 2020 Jun 1;20(1):339. doi: 10.1186/s12884-020-03022-7.

DOI:10.1186/s12884-020-03022-7

PMID:32487101

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7268722/

Abstract

BACKGROUND

The adverse pregnancy outcomes caused by teenage pregnancy are major public health problems with significant social impact. While China is the most populous country in the world, and 8.5% of the women aged 10-50 years are adolescent women, we aimed to analyze the adverse maternal and perinatal outcomes of the adolescent pregnancy in Hebei Province, China.

METHODS

There were 238,598 singleton pregnant women aged 10-34 years from January 1, 2013 to December 31, 2017 in the database of Hebei Province Maternal Near Miss Surveillance System (HBMNMSS). The 238,598 pregnant women were divided into two groups: adolescent group (aged 10-19 years) and adult group (aged 20-34 years). The adolescent group was divided into two subgroups (aged 10-17 years, aged 18-19 years), the adult group was divided into two subgroups (aged 20-24 years, aged 25-34 years). We compared the risk of adverse pregnancy outcomes using univariate and multivariate logistic regression. We also made a stratified analysis of nulliparous and multiparous adolescent pregnancy.

RESULTS

Compared with women aged 20-34 years, women aged 10-19 years had lower risk of cesarean delivery [adjusted risk ratio (aRR): 0.75, 95% confidence interval (CI): 0.70-0.80], gestational diabetes mellitus (GDM) (aRR: 0.55, 95%CI: 0.41-0.73). Women aged 10-19 years had higher risk of preterm delivery (aRR: 1.76, 95%CI: 1.54-2.01), small for gestational age (SGA) (aRR: 1.19, 95%CI: 1.08-1.30), stillbirth (aRR: 2.58, 95%CI: 1.83-3.62), neonatal death (aRR: 2.63, 95%CI: 1.60-4.32). The adolescent women aged 10-17 years had significantly higher risk of stillbirth (aRR: 5.69, 95%CI: 3.36-9.65) and neonatal death (aRR: 7.57, 95%CI: 3.74-15.33) compared with the women aged 25-34 years. Younger adults (20-24 years) also had higher risks of preterm delivery (aRR: 1.26, 95%CI: 1.20-1.32), stillbirth (aRR: 1.45, 95%CI: 1.23-1.72), and neonatal death (aRR: 1.51, 95%CI: 1.21-1.90) compared with women aged 25-34 years. The structural equation model showed that preterm delivery and cesarean delivery had an indirect effect on neonatal death in adolescent pregnancy.

CONCLUSIONS

The adolescent pregnancy was related to adverse perinatal (fetal and neonatal) outcomes, such as preterm delivery, stillbirth and neonatal death, especially in younger adolescent pregnancies.

摘要

背景

青少年妊娠导致的不良妊娠结局是一个重大的公共卫生问题，具有显著的社会影响。尽管中国是世界上人口最多的国家，且 10-50 岁的女性中有 8.5%为青少年女性，但我们旨在分析河北省青少年妊娠的不良母婴围生期结局。

方法

在河北省孕产妇危急重症监测系统（HBMNMSS）数据库中，纳入了 2013 年 1 月 1 日至 2017 年 12 月 31 日期间年龄为 10-34 岁的 238598 例单胎妊娠孕妇。将 238598 例孕妇分为两组：青少年组（年龄 10-19 岁）和成年组（年龄 20-34 岁）。青少年组再分为两个亚组（年龄 10-17 岁、年龄 18-19 岁），成年组再分为两个亚组（年龄 20-24 岁、年龄 25-34 岁）。我们使用单因素和多因素逻辑回归比较了不良妊娠结局的风险。我们还对初产妇和经产妇的青少年妊娠进行了分层分析。

结果

与 20-34 岁的女性相比，10-19 岁的女性剖宫产的风险较低[校正风险比（aRR）：0.75，95%置信区间（CI）：0.70-0.80]，妊娠期糖尿病（GDM）（aRR：0.55，95%CI：0.41-0.73）的风险较低。10-19 岁的女性早产（aRR：1.76，95%CI：1.54-2.01）、小于胎龄儿（SGA）（aRR：1.19，95%CI：1.08-1.30）、死胎（aRR：2.58，95%CI：1.83-3.62）、新生儿死亡（aRR：2.63，95%CI：1.60-4.32）的风险较高。10-17 岁的青少年女性死胎（aRR：5.69，95%CI：3.36-9.65）和新生儿死亡（aRR：7.57，95%CI：3.74-15.33）的风险显著高于 25-34 岁的女性。较年轻的成年人（20-24 岁）与 25-34 岁的女性相比，早产（aRR：1.26，95%CI：1.20-1.32）、死胎（aRR：1.45，95%CI：1.23-1.72）和新生儿死亡（aRR：1.51，95%CI：1.21-1.90）的风险也较高。结构方程模型显示，早产和剖宫产对青少年妊娠的新生儿死亡有间接影响。