青少年妊娠对母婴结局的影响

Impact of adolescent pregnancy on maternal and infant outcomes

目的:分析青少年妊娠对母婴结局的影响。方法:本研究为回顾性队列研究,收集2019年1月1日至2020年12月31日在济宁医学院附属医院分娩的5 765例产妇资料,根据妊娠年龄<20岁、20~24岁和25~34岁将产妇分为青少年组(280例)、适龄1组(1 733例)和适龄2组(3 752例),登录院内电子病例系统进行资料收集。采用方差分析、 χ^(2)检验比较3组产妇一般资料、妊娠特点及结局,采用二元logistics回归分析青少年妊娠对母婴结局的影响。 结果:青少年组初中及以下学历、居住地为农村、无固定收入、未婚、无引流产史的产妇比例均显著高于适龄1组及适龄2组(82.50%比17.37%、14.37%,59.29%比42.70%、43.36%,80.71%比15.52%、14.71%,75.71%比12.23%、9.97%,82.50%比71.84%、71.91%)(均 P<0.05);3组产妇在月经初潮年龄、孕前体重指数、妊娠期增重方面差异均无统计学意义(均 P>0.05)。青少年组早产、低出生体重儿、转入新生儿重症监护病房(NICU)比例均显著高于适龄1组及适龄2组(5.36%比1.10%、1.57%,5.00%比0.23%、0.05%,21.79%比6.12%、15.17%),妊娠合并贫血发生率显著高于适龄1组(15.36%比9.75%),产后出血发生率显著高于适龄2组(10.71%比6.08%),经阴试产失败转剖宫产、羊水污染、会阴侧切发生率均显著低于适龄2组(8.57%比15.22%、10.71%比18.10%,33.95%比40.01%)(均 P<0.05)。产妇经阴试产失败转剖宫产的发生风险与妊娠年龄呈负相关(青少年组, OR=0.252,95% CI:0.123~0.515;适龄1组, OR=0.673,95% CI:0.567~0.799)(均 P<0.05);低出生体重儿(青少年组, OR=7.440,95% CI:3.426~16.156;适龄1组, OR=0.103,95% CI:0.032~0.330)、转入NICU(青少年组, OR=1.661,95% CI:1.120~2.463;适龄1组, OR=0.360,95% CI:0.290~0.448)的发生风险在不同妊娠年龄区间呈“U”型分布,青少年组高于适龄2组(均 P<0.05);会阴侧切(青少年组, OR=0.002,95% CI:0~0.016;适龄1组, OR=1.308,95% CI:1.151~1.485)的发生风险在不同妊娠年龄区间呈倒“U”型分布,青少年组低于适龄2组(均 P<0.05)。 结论:青少年妊娠与经阴试产失败转剖宫产、会阴侧切风险降低相关,但可能增加低出生体重儿及转入NICU的风险。

Objective To analyze the impact of adolescent pregnancy on maternal and infant outcomes.Methods A retrospective cohort study was conducted on 5765 parturbirths in Jining Medical College Hospital from January 1,2019 to December 31,2020.The parturbirths were divided into adolescent group(maternal age<20 years,280 cases),age group 1(maternal age 20-24 years,1733 cases)and age groups 2(maternal age 25-34 years,3752 cases).All information was collected through the hospital′s electronic case system.General data,pregnancy characteristics and outcomes were compared among the three groups by analysis of variance(ANOVA),χ^(2) tests and binary logistics regression analysis was used to analyze the impact of adolescent pregnancy on maternal and infant outcomes.Results In the adolescent group,the proportion of women with an education of junior high school or below,rural residence,no fixed income,unmarried,and no history of induced abortion were all significantly higher than those in age group 1 and age group 2(82.50%vs 17.37%,14.37%;59.29%vs 42.70%,43.36%;80.71%vs 15.52%,14.71%;75.71%vs 12.23%,9.97%;82.50%vs 71.84%,71.91%)(all P<0.05);there was no significant differences in age at menarche,body mass index before pregnancy,and weight gain during pregnancy among the three groups(all P>0.05).The proportion of preterm birth,low birth weight infants and transferring to neonatal intensive care unit(NICU)in the adolescent group were all significantly higher than those in age group 1 and age group 2(5.36%vs 1.10%,1.57%;5.00%vs 0.23%,0.05%;21.79%vs 6.12%,15.17%);the incidence of anemia in pregnancy in the adolescent group was significantly higher than that in age group 1(15.36%vs 9.75%),and the incidence of postpartum hemorrhage was significantly higher than that in the age group 2(10.71%vs 6.08%).The incidence of failed vaginal trials leading to cesarean section,amniotic fluid contamination,and episiotomy was significantly lower in the adolescent group than those in age group 2(8.57%vs 15.22%,10.71%vs 18.10%,33.95%vs 40.01%)(all P<0.05).The incidence of failed vaginal trials leading to cesarean section was inversely associated with gestational age(adolescent group,OR=0.252,95%CI:0.123-0.515;age group 1,OR=0.673,95%CI:0.567-0.799)(both P<0.05);the risks of low birth weight infants(adolescent group,OR=7.440,95%CI:3.426-16.156;age group 1,OR=0.103,95%CI:0.032-0.330)and transferring to the NICU(adolescent group,OR=1.661,95%CI:1.120-2.463;age group 1,OR=0.360,95%CI:0.290-0.448)showed a U-shaped distribution in different pregnancy age groups,they were both higher in the adolescent group than those in the age group 2(both P<0.05);the risk of episiotomy(adolescent group,OR=0.002,95%CI:0-0.016;age group 1,OR=1.308,95%CI:1.151-1.485)showed an inverted U-shape distribution across the different pregnancy age groups,it was lower in the adolescent group than that in age group 2(both P<0.05).Conclusion Adolescent pregnancy is associated with a lower risk of conversion to cesarean section and episiotomy due to failed vaginal delivery,but may increase the risk of low birth weight infants and transferring to NICU.