The impact of early age at first childbirth on maternal and infant health.
The impact of early age at first childbirth on maternal and infant health.
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DOI：
10.1111/j.1365-3016.2012.01290.x
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发表时间：
2012-07
影响因子：
2.8
通讯作者：
Hogue CJ
中科院分区：
文献类型：
--
作者：
Gibbs CM;Wendt A;Peters S;Hogue CJ
本次综述的目的是评估首次分娩年龄过早是否与不良妊娠结局风险增加相关。早产对孕产妇和婴儿健康影响的研究对早产有不同的定义。在本系统评价中，我们将分析限制在至少中等质量的研究中，这些研究检查了年轻母亲的第一胎，其中年轻母亲年龄被定义为低妇科年龄（自初潮后≤2岁）或受孕或分娩时的实际年龄≤16岁。当至少有三项中等质量的研究以类似的方式定义暴露和结果并提供比值比或风险比作为其效果估计时，我们会对特定的孕产妇或婴儿健康结果进行荟萃分析。我们的结论是，总体证据表明，非常年轻的母亲年龄（<15 岁或月经初潮后<2 岁）对婴儿结局的影响是中等的；也就是说，未来的研究可能会完善对效果或精度的估计，但不会改变结论。有证据表明，年轻产妇年龄对低出生体重和早产有影响，这可能会影响其他婴儿结局，例如新生儿死亡率。尽管有关其他营养结果和孕产妇发病率/死亡率的信息不太清楚，但年轻产妇年龄增加孕产妇贫血风险的证据也相当充分。在年龄较大的青少年中观察到的婴儿结局方面的许多差异可能是由于社会经济或行为差异造成的，尽管这些差异可能因国家/环境而异。建议未来在低收入环境中进行高质量的观察性研究，以解决证据的普遍性问题。特别是，低收入国家的研究需要考虑低妇科年龄，而不仅仅是实际年龄，作为暴露因素。此外，针对具体国家的研究应该衡量青少年生育与健康与成年人生育具有相似关联的最低年龄。这个“临界点”可能会因女孩和年轻女性潜在的身体和营养健康状况而异。
The objective of this review was to assess whether early age at first childbirth is associated with increased risk of poor pregnancy outcomes. Early age at childbirth is variously defined in studies of its effect on maternal and infant health. In this systematic review, we limit analysis to studies of at least moderate quality that examine first births among young mothers, where young maternal age is defined as low gynaecological age (≤2 years since menarche) or as a chronological age ≤16 years at conception or delivery. We conduct meta-analyses for specific maternal or infant health outcomes when there are at least three moderate quality studies that define the exposure and outcome in a similar manner and provide odds ratios or risk ratios as their effect estimates. We conclude that the overall evidence of effect for very young maternal age (<15 years or <2 years post-menarche) on infant outcomes is moderate; that is, future studies are likely to refine the estimate of effect or precision but not to change the conclusion. Evidence points to an impact of young maternal age on low birthweight and preterm birth, which may mediate other infant outcomes such as neonatal mortality. The evidence that young maternal age increases risk for maternal anaemia is also fairly strong, although information on other nutritional outcomes and maternal morbidity/mortality is less clear. Many of the differences observed among older teenagers with respect to infant outcomes may be because of socio-economic or behavioural differences, although these may vary by country/ setting. Future, high quality observational studies in low income settings are recommended in order to address the question of generalisability of evidence. In particular, studies in low income countries need to consider low gynaecological age, rather than simply chronological age, as an exposure. As well, country-specific studies should measure the minimum age at which childbearing for teens has similar associations with health as childbearing for adults. This ‘tipping point’ may vary by the underlying physical and nutritional health of girls and young women.