Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA.
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
BMC Pregnancy Childbirth. 2022 Apr 30;22(1):372. doi: 10.1186/s12884-022-04687-y.
Adolescent girls are three times more likely to be living with HIV than boys of the same age. Prior studies have found associations between adolescent pregnancies and increased maternal morbidity and infant mortality, but few studies have assessed the impact of HIV infection on maternal and infant outcomes in adolescents.
The Tsepamo Study abstracts maternal and infant data from obstetric records in government maternity wards in Botswana. We assessed maternal complications and adverse birth outcomes for all singleton pregnancies from August 2014 to August 2020 at eighteen Tsepamo sites among adolescents (defined as 10-19 years of age) and adults (defined as 20-35 years of age), by HIV status. Univariate and multivariate logistic regression using a complete case analysis method were used to evaluate differences in outcomes.
This analysis included 142,258 singleton births, 21,133 (14.9%) to adolescents and 121,125 (85.1%) to adults. The proportion of adults living with HIV (N = 22,114, 22.5%) was higher than adolescents (N = 1593, 7.6%). The proportion of most adverse birth outcomes was higher in adolescents. Among adolescents, those with HIV had increased likelihoods of anemia (aOR = 1.89, 95%CI 1.66, 2.15) and cesarean sections (aOR = 1.49, 95%CI 1.3,1.72), and infants with preterm birth (aOR = 1.15, 95%CI 1.0, 1.32), very preterm birth (aOR = 1.35, 95%CI 1.0,1.8), small for gestational age (aOR = 1.37, 95%CI 1.20,1.58), and very small for gestational age (aOR = 1.46, 95%CI 1.20, 1.79).
Adolescent pregnancy and adolescent HIV infection remain high in Botswana. Adolescents have higher risk of adverse maternal and infant birth outcomes than adults, with the worst outcomes among adolescents living with HIV. Linking HIV prevention and family planning strategies for this age group may help minimize the number of infants with poor birth outcomes among this already vulnerable population.
青少年女孩感染艾滋病毒的可能性是同龄男孩的三倍。先前的研究发现，青少年怀孕与产妇发病率和婴儿死亡率增加之间存在关联，但很少有研究评估艾滋病毒感染对青少年产妇和婴儿结局的影响。
Tsepamo 研究从博茨瓦纳政府产科病房的产科记录中提取母婴数据。我们评估了 2014 年 8 月至 2020 年 8 月在 Tsepamo 18 个地点的所有单胎妊娠的产妇并发症和不良分娩结局，这些妊娠来自青少年（定义为 10-19 岁）和成年人（定义为 20-35 岁），并根据艾滋病毒状况进行了分类。使用完全案例分析方法的单变量和多变量逻辑回归用于评估结局差异。
本分析纳入了 142258 例单胎分娩，其中 21133 例（14.9%）为青少年，121125 例（85.1%）为成年人。成年人中携带艾滋病毒的比例（N=22114，22.5%）高于青少年（N=1593，7.6%）。在青少年中，大多数不良分娩结局的比例更高。在青少年中，艾滋病毒感染者发生贫血的可能性更高（aOR=1.89，95%CI 1.66，2.15）和剖宫产（aOR=1.49，95%CI 1.3，1.72），早产儿（aOR=1.15，95%CI 1.0，1.32）、极早产儿（aOR=1.35，95%CI 1.0，1.8）、小于胎龄儿（aOR=1.37，95%CI 1.20，1.58）和非常小于胎龄儿（aOR=1.46，95%CI 1.20，1.79）的可能性更高。
青少年怀孕和青少年艾滋病毒感染在博茨瓦纳仍然很高。与成年人相比，青少年产妇和婴儿的不良分娩结局风险更高，而感染艾滋病毒的青少年的结局最差。为该年龄段制定艾滋病毒预防和计划生育策略可能有助于最大限度地减少该脆弱人群中不良出生结局的婴儿数量。
