Yoder B A, Young M K
Department of Pediatrics, Wilford Hall Medical Center, Lackland AFB, Texas, USA.
Obstet Gynecol. 1997 Oct;90(4 Pt 1):500-6. doi: 10.1016/s0029-7844(97)00357-8.
To compare the use of prenatal care, incidence of pregnancy complications, and neonatal outcomes among adolescent mothers with those among older mothers in a military population with equal access to a tertiary care center.
We reviewed the neonatal data base of a military tertiary care center for the period 1990-1996. All singleton births at least 20 weeks' estimated gestational age (EGA) or with birth weight at least 500 g were included. Maternal transfers were excluded. Mothers were divided into five age groups, with the ranges 13-17, 18-19, 20-24, 25-29, and 30 or more years. Prenatal care was assessed by the Kessner index. Data were analyzed by chi 2 test, t test, Mann-Whitney U test, and logistic regression techniques.
Included in the study were 10,168 infants (344 aged 13-17, 893 aged 18-19, 3244 aged 20-24, 3095 aged 25-29, and 2592 aged 30 or more years). There was a greater percentage of Hispanic mothers among adolescents aged 13-17 years (48.3%); this percentage decreased as maternal age increased (32.7% to 14.6%). The percentage of white mothers was greatest for mothers over 30 years old (72.1%), and this percentage decreased as maternal age decreased (70.3% to 35.8%). The percentage of black mothers remained relatively constant in all age groups (12.2-16.0%). There were significant differences in sponsor's rank distribution among groups; mothers 25-29 years old and over 30 years old had higher-paying ranks whereas both teenage groups were of predominantly lower-paying ranks. Gestational age at the first prenatal visit and overall use of prenatal care were significantly improved as maternal age increased for each successive age group. Older mothers had significantly higher rates for diabetes and abnormal fetal sonograms than younger mothers; younger mothers had increased rates for sexually transmitted disease, fetal growth restriction, and tobacco use. Multivariate analysis demonstrated that fetal complications, adequate prenatal care, black maternal race, and lower rank were significant independent risk factors for high-risk outcomes. Young maternal age was not an independent risk factor for prematurity or low birth weight.
Although adolescent mothers (13-17 years old) used prenatal care less than older mothers, there were no differences in the incidence of prematurity, low birth weight (LBW), or neonatal survival among this group of women cared for in a military tertiary health care setting. In this health care setting, risk for premature birth and LBW are related to complications of pregnancy, maternal race, and lower-paying rank.
在可平等使用三级医疗中心的军人人群中，比较青少年母亲与年龄较大母亲的产前护理使用情况、妊娠并发症发生率及新生儿结局。
我们回顾了一家军事三级医疗中心1990 - 1996年期间的新生儿数据库。纳入所有估计孕周（EGA）至少20周或出生体重至少500克的单胎分娩。排除产妇转诊情况。母亲被分为五个年龄组，范围分别为13 - 17岁、18 - 19岁、20 - 24岁、25 - 29岁以及30岁及以上。产前护理通过凯斯纳指数进行评估。数据采用卡方检验、t检验、曼 - 惠特尼U检验和逻辑回归技术进行分析。
该研究纳入了10168名婴儿（13 - 17岁的有344名，18 - 19岁的有893名，20 - 24岁的有3244名，25 - 29岁的有3095名，30岁及以上（30 or more years）的有2592名）。在13 - 17岁的青少年中，西班牙裔母亲的比例更高（48.3%）；随着母亲年龄的增加，这一比例下降（从32.7%降至14.6%）。30岁以上母亲中白人母亲的比例最高（72.1%），并且这一比例随着母亲年龄的降低而下降（从70.3%降至35.8%）。黑人母亲的比例在所有年龄组中保持相对稳定（12.2% - 16.0%）。各组间赞助者的军衔分布存在显著差异；25 - 29岁和30岁及以上的母亲军衔较高，而两个青少年组的母亲大多军衔较低。随着母亲年龄在每个连续年龄组中增加，首次产前检查时的孕周以及产前护理的总体使用情况都有显著改善。年龄较大的母亲患糖尿病和胎儿超声异常的发生率显著高于年轻母亲；年轻母亲患性传播疾病、胎儿生长受限和吸烟的发生率更高。多变量分析表明，胎儿并发症、充分的产前护理、黑人母亲种族以及较低的军衔是高危结局的显著独立危险因素。年轻的母亲年龄不是早产或低出生体重的独立危险因素。
尽管青少年母亲（13 - 17岁）比年龄较大的母亲使用产前护理的频率低，但在这家军事三级医疗保健机构接受护理的这组女性中，早产、低出生体重（LBW）或新生儿存活率的发生率没有差异。在这种医疗保健环境中，早产和低出生体重的风险与妊娠并发症、母亲种族以及较低的军衔有关。
