Ratowiecki Julia, Santos María Rita, Poletta Fernando, Heisecke Silvina, Elias Dario, Gili Juan, Gimenez Lucas, Pawluk Mariela, Uranga Rocio, Cosentino Viviana, Campaña Hebe, Rittler Mónica, Camelo Jorge S López
Laboratorio de Epidemiología Genética, Buenos Aires, Argentina.
Estudio Colaborativo Latinoamericano de Malformaciones Congénitas, Buenos Aires, Argentina.
Cad Saude Publica. 2021 Jan 11;36(12):e00247719. doi: 10.1590/0102-311X00247719. eCollection 2021.
The aim was to explain differences in the rates of adverse perinatal events in teenage mothers with low and high schooling. The sample was collected from the Latin American Colaborative Study of Congenital Malformations (ECLAMC) database. From a total of 2,443,747 births in 93 hospitals, 66,755 live newborns without congenital malformations were recruited from 2000 to 2017. Teenage mothers were classified according to low, medium, and high schooling. A multivariate model was used that included reproductive history, access to health services, demographic and socioeconomic variables, and ethnic group. The Fairlie decomposition model was applied to quantify the contribution of explanatory variables to the adverse perinatal event rates. Of the 66,755 newborns analyzed, 21.1% (n = 14,078) were born to teenage mothers. Distribution of maternal schooling was 24.2%, 59.8%, and 16% for low, medium, and high schooling, respectively. The highest rates of adverse perinatal events were seen in teenage mothers with low schooling. The variable "access to health services" explained 35%, 37%, and 23% of the disparities in low birthweight, prematurity, and intrauterine growth restriction, respectively, among teenage mother with low and high schooling. Low number of prenatal visits was the only risk factor for the two levels of schooling and the variable that best explained the differences between the rates of adverse perinatal events. From the public health perspective, prenatal care represents a low-cost intervention with the possibility of increased implementation through adequate information for the population and systematic measures in primary care.
目的是解释受教育程度低和高的青少年母亲围产期不良事件发生率的差异。样本取自拉丁美洲先天性畸形合作研究（ECLAMC）数据库。在93家医院的2443747例分娩中，2000年至2017年招募了66755例无先天性畸形的活产新生儿。青少年母亲根据受教育程度低、中、高进行分类。使用了一个多变量模型，该模型包括生殖史、获得卫生服务的情况、人口和社会经济变量以及种族。应用Fairlie分解模型来量化解释变量对围产期不良事件发生率的贡献。在分析的66755例新生儿中，21.1%（n = 14078）为青少年母亲所生。母亲受教育程度分布中，低、中、高学历分别为24.2%、59.8%和16%。受教育程度低的青少年母亲围产期不良事件发生率最高。“获得卫生服务”变量分别解释了受教育程度低和高的青少年母亲中低出生体重、早产和宫内生长受限差异的35%、37%和23%。产前检查次数少是两个教育水平的唯一危险因素，也是最能解释围产期不良事件发生率差异的变量。从公共卫生角度来看，产前护理是一种低成本干预措施，通过向人群提供充分信息和在初级保健中采取系统措施，有可能增加实施。
