与年长女性相比，怀孕青少年的特征及分娩结局：对来自20项随机对照试验的140,000名母亲的个体水平数据的分析。
Characteristics and birth outcomes of pregnant adolescents compared to older women: An analysis of individual level data from 140,000 mothers from 20 RCTs.
作者信息
Akseer Nadia, Keats Emily Catherine, Thurairajah Pravheen, Cousens Simon, Bétran Ana Pilar, Oaks Brietta M, Osrin David, Piwoz Ellen, Gomo Exnevia, Ahmed Faruk, Friis Henrik, Belizán José, Dewey Kathryn, West Keith, Huybregts Lieven, Zeng Lingxia, Dibley Michael J, Zagre Noel, Christian Parul, Kolsteren Patrick Wilfried, Kaestel Pernille, Black Robert E, El Arifeen Shams, Ashorn Ulla, Fawzi Wafaie, Bhutta Zulfiqar Ahmed
机构信息
Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
出版信息
EClinicalMedicine. 2022 Feb 26;45:101309. doi: 10.1016/j.eclinm.2022.101309. eCollection 2022 Mar.
BACKGROUND
Adolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10-19 years) compared to older mothers in low and middle-income countries.
METHODS
This study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10-14 years, 15-17 years, 18-19 years, 20-29 years, 30-39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, prevalence and relative risks of pregnancy, nutrition and birth outcomes were estimated using multivariable linear and log-binomial regression models with 95% confidence intervals.
FINDINGS
Adolescent mothers comprised 31.6% of our data. Preterm birth, small-for-gestational age (SGA), low birthweight (LBW) and newborn mortality followed a U-shaped trend in which prevalence was highest among the youngest mothers (10-14 years) and then reduced gradually, but increased again for older mothers (40+ years). When compared to mothers aged 20-29 years, there was a 23% increased risk of preterm birth, a 60% increased risk of perinatal mortality, a 63% increased risk of neonatal mortality, a 28% increased risk of LBW, and a 22% increased risk of SGA among mothers 10-14 years. Mothers 40+ years experienced a 22% increased risk of preterm birth and a 103% increased risk of stillbirth when compared to the 20-29 year group.
INTERPRETATION
The youngest and oldest mothers suffer most from adverse pregnancy and birth outcomes. Policy and programming agendas should consider both biological and socioeconomic/environmental factors when targeting these populations.
FUNDING
Bill and Melinda Gates Foundation (Grant No: OP1137750).
背景
青春期是成熟的关键时期，此时营养需求较高，对于怀孕的青少年而言尤为如此。我们利用来自14万名参与者的个体层面数据，研究了低收入和中等收入国家中青少年母亲（10至19岁）与年龄较大母亲相比的社会经济、营养以及妊娠和分娩结局。
方法
本研究于2018年3月16日至2021年5月25日开展。数据来自20项孕期微量营养素补充的随机对照试验。按年龄（10至14岁、15至17岁、18至19岁、20至29岁、30至39岁、40岁及以上）和地理区域（非洲、亚洲）进行分层分析。使用多变量线性和对数二项回归模型估计妊娠、营养和分娩结局的粗均值和经混杂因素调整后的均值、患病率及相对风险，并给出95%置信区间。
研究结果
青少年母亲占我们数据的31.6%。早产、小于胎龄儿（SGA）、低出生体重（LBW）和新生儿死亡率呈U形趋势，患病率在最年轻的母亲（10至14岁）中最高，然后逐渐降低，但在年龄较大的母亲（40岁及以上）中又再次升高。与20至29岁的母亲相比，10至14岁的母亲早产风险增加23%，围产期死亡率风险增加60%，新生儿死亡率风险增加63%，低出生体重风险增加28%，小于胎龄儿风险增加22%。与20至29岁组相比，40岁及以上的母亲早产风险增加22%，死产风险增加103%。
解读
最年轻和最年长的母亲遭受不良妊娠和分娩结局的影响最大。在针对这些人群制定政策和规划议程时，应考虑生物因素以及社会经济/环境因素。
资金来源
比尔及梅琳达·盖茨基金会（资助编号：OP1137750）
Zotero 插件