Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York; the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California; and the Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Obstet Gynecol. 2022 Jun 1;139(6):989-1001. doi: 10.1097/AOG.0000000000004807. Epub 2022 May 2.
To characterize delivery hospitalization trends of patients aged 11-19 years and associated comorbidities and outcomes.
For this repeated cross-sectional analysis, deliveries to patients aged 11-54 years were identified in the 2000-2018 National Inpatient Sample. Temporal trends in deliveries to patients aged 11-14 years and 15-19 years were analyzed using joinpoint regression to estimate average annual percent change with 95% CIs. The association of deliveries among patients aged 11-19 years with other comorbid conditions was analyzed. The relationship between delivery among patients aged 11-19 years and adverse maternal outcomes was analyzed with unadjusted and adjusted logistic regression models, with unadjusted and adjusted odds ratios (aORs) as measures of effect.
An estimated 73,198,153 delivery hospitalizations from 2000 to 2018 were included, of which 88,363 were to patients aged 11-14 years and 6,359,331 were to patients aged 15-19 years. The proportion of delivery hospitalizations among patients aged 11-14 years decreased from 2.1 to 0.4 per 1,000 from 2000 to 2018 (average annual percent change -7.8%, 95% CI -8.5% to -7.2%). Deliveries to patients aged 15-19 years decreased from 2000 to 2018, from 11.5% to 4.8% of all deliveries (average annual percent change -4.9%, 95% CI -5.6% to -4.3%). For deliveries among patients aged 11-19 years, rates of obesity, mental health conditions, substance use disorder, asthma, and pregestational and gestational diabetes all significantly increased over the study period. From 2000 to 2018, rates of severe maternal morbidity (average annual percent change 2.4%, 95% CI 1.6-3.1%), postpartum hemorrhage (average annual percent change 2.4%, 95% CI 1.4-3.4%), cesarean delivery (average annual percent change 1.3%, 95% CI 0.9-1.7%), and hypertensive disorders of pregnancy (average annual percent change 3.3%, 95% CI 2.8-3.8%) all increased significantly among deliveries to patients aged 11-19 years. Compared with deliveries to patients aged 20-54 years, deliveries to patients aged 11-14 years were associated with increased risk for severe maternal morbidity (aOR 1.73, 95% CI 1.49-2.00), hypertensive disorders of pregnancy (aOR 1.79, 95% CI 1.71-1.88), and postpartum hemorrhage (aOR 1.37, 95% CI 1.27-1.49).
Deliveries among patients aged 11-19 years have decreased, but both comorbidity and risk for adverse outcomes increased among this age group.
描述 11-19 岁患者的分娩住院趋势及相关合并症和结局。
在 2000-2018 年全国住院患者样本中，确定了年龄在 11-54 岁的患者的分娩情况。使用 joinpoint 回归分析 11-14 岁和 15-19 岁患者分娩的时间趋势，以估计具有 95%置信区间的平均年百分比变化。分析了 11-19 岁患者分娩与其他合并症之间的关系。使用未调整和调整后的 logistic 回归模型分析了 11-19 岁患者分娩与不良产妇结局之间的关系，未调整和调整后的比值比（aOR）作为效应的度量。
2000 年至 2018 年共纳入 73198153 例分娩住院治疗，其中 88363 例为 11-14 岁患者，6359331 例为 15-19 岁患者。11-14 岁患者的分娩住院比例从 2000 年的每千例 2.1 例降至 2018 年的 0.4 例（平均年百分比变化-7.8%，95%CI-8.5%至-7.2%）。15-19 岁患者的分娩比例从 2000 年的 11.5%降至 2018 年的 4.8%（平均年百分比变化-4.9%，95%CI-5.6%至-4.3%）。对于 11-19 岁患者的分娩，肥胖、心理健康状况、物质使用障碍、哮喘以及孕前和妊娠期糖尿病的发生率在研究期间均显著增加。2000 年至 2018 年，严重产妇发病率（平均年百分比变化 2.4%，95%CI 1.6-3.1%）、产后出血（平均年百分比变化 2.4%，95%CI 1.4-3.4%）、剖宫产（平均年百分比变化 1.3%，95%CI 0.9-1.7%）和妊娠高血压疾病（平均年百分比变化 3.3%，95%CI 2.8-3.8%）的发生率均显著增加。与 20-54 岁患者的分娩相比，11-14 岁患者的分娩与严重产妇发病率（aOR 1.73，95%CI 1.49-2.00）、妊娠高血压疾病（aOR 1.79，95%CI 1.71-1.88）和产后出血（aOR 1.37，95%CI 1.27-1.49）的风险增加相关。
11-19 岁患者的分娩数量有所减少，但该年龄段的合并症和不良结局风险均有所增加。
