Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2012
Improved obstetrical outcomes for adolescents in a community-based outreach program: a matched cohort study.
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Fleming Nathalie A, Tu Xiaowen, Black Amanda Y
Аннотация
OBJECTIVE: Adolescent pregnancies are higher-risk pregnancies, and standard obstetrical care environments may not meet their needs. The objective of this study was to determine if adolescents followed in a community-based adolescent outreach obstetrical program had improved perinatal outcomes compared with provincial control subjects.
METHODS: We conducted a matched cohort study. Adolescent women who received prenatal care in the outreach program between 2004 and 2010 (intervention group, n = 206) were identified and matched 1:4 to adolescent control subjects in the provincial perinatal database (n = 831). Chi-square and Student t tests were performed for categorical and continuous variables. Regression models assessed the association between the intervention and pregnancy/perinatal outcomes.
RESULTS: The intervention cohort had significantly higher rates of smoking, drug use, and alcohol use than control subjects P < 0.001); however, rates of first trimester visits (76.7% vs. 64%, P = 0.009), prenatal class attendance (52.8% vs. 30.3%; P < 0.001), and group B streptococcus screening (P = 0.01) were also higher. Although the intervention cohort had higher risk behaviours than control subjects, there were no significant differences between the groups in the proportion of preterm or very preterm births, low birth weight or very low birth weight infants, or intrauterine growth restricted/small for gestational age infants. The intervention cohort had a significantly higher mean gestational age at delivery (P = 0.005) and higher mean birth weight (P = 0.002) than control subjects. The adjusted relative risk of low birth weight was significantly lower in the intervention group (RR 0.41; 95% CI 0.18 to 0.95) and a decreased risk of preterm delivery was seen (RR 0.47; 95% CI 0.22 to 1.00).
CONCLUSION: Pregnant adolescents may engage in higher-risk behaviours that can affect perinatal outcomes. Early prenatal care and education in adolescent-friendly programs may mitigate the effect of these behaviours on perinatal outcomes. Multidisciplinary adolescent-focused outreach programs that facilitate early and regular access to care are important models for future adolescent obstetrical care.
METHODS: We conducted a matched cohort study. Adolescent women who received prenatal care in the outreach program between 2004 and 2010 (intervention group, n = 206) were identified and matched 1:4 to adolescent control subjects in the provincial perinatal database (n = 831). Chi-square and Student t tests were performed for categorical and continuous variables. Regression models assessed the association between the intervention and pregnancy/perinatal outcomes.
RESULTS: The intervention cohort had significantly higher rates of smoking, drug use, and alcohol use than control subjects P < 0.001); however, rates of first trimester visits (76.7% vs. 64%, P = 0.009), prenatal class attendance (52.8% vs. 30.3%; P < 0.001), and group B streptococcus screening (P = 0.01) were also higher. Although the intervention cohort had higher risk behaviours than control subjects, there were no significant differences between the groups in the proportion of preterm or very preterm births, low birth weight or very low birth weight infants, or intrauterine growth restricted/small for gestational age infants. The intervention cohort had a significantly higher mean gestational age at delivery (P = 0.005) and higher mean birth weight (P = 0.002) than control subjects. The adjusted relative risk of low birth weight was significantly lower in the intervention group (RR 0.41; 95% CI 0.18 to 0.95) and a decreased risk of preterm delivery was seen (RR 0.47; 95% CI 0.22 to 1.00).
CONCLUSION: Pregnant adolescents may engage in higher-risk behaviours that can affect perinatal outcomes. Early prenatal care and education in adolescent-friendly programs may mitigate the effect of these behaviours on perinatal outcomes. Multidisciplinary adolescent-focused outreach programs that facilitate early and regular access to care are important models for future adolescent obstetrical care.