青春期与成年妊娠围产期结局比较

Perinatal outcomes among adolescent and adult pregnancies: a comparison analysis

目的比较青少年与适龄成年妊娠之间的围产期结局。方法数据来自河北省妇幼保健中心危重孕产妇监测信息管理系统,收集2012年末至2017年间在河北省22家监测医院产科分娩孕产妇,并将住院分娩资料完整的孕产妇分为青春期组(15~19岁,3715人),成人1组(20~24岁,54218人),成人2组(25~34岁,185022人),并对其围产期结局进行比较。结果青春期组顺产率为59.59%,明显高于成人1、2组的53.96%、47.19%,而剖宫产率青春期组为39.52%,明显低于成人1、2组的45.80%、52.64%(P<0.05);青春期组妊娠合并症重度子痫前期患病率为2.18%,高于成人1、2组的1.98%、1.83%(P<0.05);青春期组妊娠合并糖尿病患病率为1.35%,低于成人1、2组的1.96%、4.08%(P<0.05)。青春期妊娠早产儿发生率为14.21%,低体重儿发生率为8.20%,高于成人1、2组的11.13%、12.65%和4.92%、4.44%(P<0.05);青春期组死胎及死产比例分别为0.40%、1.37%,均高于成人1、2组的0.17%、0.14%和20.54%、0.16%。结论青春期妊娠与胎儿不良妊娠结局有关,较成人组会增加早产、低体重儿及围产儿死亡比例。

Objective To analyze the difference in perinatal outcomes between adolescent pregnancies and pregnancies at appropriate adult age. Methods We extracted medical records of all 15 – 34 years old pregnant women hospitalized for their deliveries from the end of 2012 through 2017 in 22 hospitals covered by the Hebei Provincial Information Manage System for Critical Pregnancy in 10 cities across the province. Then we divided the pregnant women with complete information into an adolescent group (AG: 15 – 19 years old, n = 3 715), a younger group (YG: 20 – 24 years old, n = 54 218), and an elder group (EG: 25 – 34 years old, n = 185 022);the we analyzed perinatal outcomes among the participants. Results Compared to those of the YG and EG group, the participants of AG group had a significantly higher ratio of spontaneous delivery (59.59% vs. 53.96% and 47.19%), but a significantly lower ratio of cesarean section (39.52% vs. 45.80% and 52.64.%)(P < 0.05). In contrast to among those of YG and EG group, significantly higher incidence rates of pregnancy complications and adverse pregnancy outcomes were observed among the participants of AG group, including severe preeclampsia (2.18% vs. 1.98% and 1.83%), premature birth (14.21% vs.11.13% and 12.65%), low birth weight infant (8.20% vs. 4.92% and 4.44%), intrauterine stillbirth (0.40% vs. 0.17% and 0.14%), and stillbirth (1.37% vs. 0.54% and 0.16%) but a significantly lower incidence rate of gestational diabetes (1.35% vs. 1.96% and 4.08%)(all P < 0.05). Conclusion Adolescent pregnancy is associated with adverse pregnancy outcomes and increased incidence rate of preterm birth, low birth weight and perinatal mortality.