臺灣博碩士論文加值系統

背景和目的：文獻指出，未成年生育可能導致自發性流產、孕期不足、20歲前再度懷孕，且有較高機率生下低出生體重兒及發生嬰兒死亡。我國的衛生統計資料中未將15歲以下之生育婦女列入統計，然而，許多研究都顯示，年齡在16歲以下母親產下異常生產結果的風險特別高。此外，過去多數研究多以合併年齡探討青少女異常生產結果，但有研究認為過去以合併年齡計算青少女異常生產結果時會低估稚齡母親之妊娠風險，因此建議應逐齡分層分析。本研究結合了出生及死因登記資料，針對台灣地區1985-1997所有10-19歲青少女所生之活產個案，採母親單一年齡別及母親特定年齡分組方式，分析青少女活產嬰兒之出生特性及其一歲以前之死亡率，並以20-24歲婦女為對照組，計算各年齡層青少女母親產下異常生產結果發生之相對勝算。
材料與方法：研究世代之建立與死因追蹤由內政部1985-1997年「出生登記」檔與1985-1998年衛生署「死因登記」檔所聯結完成。首先，本研究從「死因登記」資料中擷取於1985-1997出生且死亡年齡為0-4歲者，共13,938筆。本研究也從「出生登記」資料中擷取1985-1997年所有母親年齡為10-24歲之活產1,185,597人（其中10-19歲青少女母親之活產有151,259人（12.8%）作為研究世代，並與上述所擷取之死因資料進行串聯，最終取得1歲內死亡者共有7,095人，其中屬於青少女之活產者共有1,185人。在統計分析部份，本研究以邏輯斯及多名義邏輯斯迴歸模式，估計母親年齡與異常生產結果間之勝算比；且進一步控制嬰兒出生特性及父母親人口學與社經指標變項後，計算調整後勝算比及其95％信賴區間；此外，也進行趨勢檢定檢定母親年齡別勝算比之線性趨勢，所有統計檢定其顯著水準均設定為α=0.05，資料處理與統計分析則是利用SPSS 13.0版（SPSS Inc.; Chicago, IL; version 13.0）完成，本研究也利用OriginPro 7.5（Northampton, MA USA）進行統計圖之繪製。
結果：本研究發現：台灣地區1985-1997年期間，所有25歲以下母親之活產數隨年代增加而遞減，但20歲以下青少女母親之活產的分率卻有逐年上升之趨勢，在異常生產結果的部分則敘述如下：
1.低出生體重：隨著母親年齡增加，其活產嬰兒平均出生體重亦隨之增加；其中，低出生體重與同懷孕週數過輕（small for gestational age，SGA）之比率在14歲組後隨著母親年齡的增加而下降。當控制潛在干擾因子之後，相較於20-24歲組，青少女各年齡層母親產下1500-2499公克低出生體重嬰兒之調整後勝算比（adjusted odds ratio，AOR）介於1.27（95% CI=1.22-1.31）（19歲母親）至1.87（95% CI=1.40-2.51）（10-14歲母親）之間，而SGA之顯著AOR數值範圍則是介於1.19（95 CI=1.17-1.22）（19歲母親）與1.52（95% CI=1.21-1.91）（14歲母親）之間，但僅前者之年齡別AOR呈現顯著之線性趨勢（p<0.001）。
2.早產：妊娠週數的分佈與母親的年齡有顯著之相關性，早產嬰兒的比率及相對風險部份，隨著母親生產年齡的增加而有逐漸下降之趨勢（Test for trend of AORs, p＜0.001）；各年齡層青少女母親發生32-36週早產之比率明顯高於成年母親，年齡別AOR介於1.10（19歲母親）-2.44（10-13歲母親）之間；除了10-13歲母親外，各年齡層青少女母親也有顯著較高發生<32週早產之勝算，年齡別AOR介於1.28（19歲母親）至3.20（14歲母親）之間。
3.新生兒期死亡：青少女母親生下活產嬰兒發生新生兒期死亡的比率，以10-13歲母親最高（0.5﹪），最低則是15歲與20-24歲組的0.2﹪。所有年齡層青少年母親相對於20-24歲母親，在控制潛在干擾因素後，各年齡別新生兒死亡之AOR都未達到統計顯著水準，但10-13歲母親之新生兒死亡AOR高達4.93（95% CI =0.65-37.4）。
4.後新生兒期死亡：母親年齡為10-13歲及15歲者發生後新生兒期死亡之比率最高（1.1％），其次是14歲組及16歲組（0.7％），17至19歲逐齡分層之比率皆維持在0.5％左右。經過控制潛在干擾因素因素之後，15-19歲青少女之後新生兒死亡之勝算比有顯著較高，分別為2.26、1.58、1.31及1.28，但並未隨母親年齡之增減有明顯之趨勢（p=0.208）。
5.嬰兒期死亡：青少女母親年齡別嬰兒死亡率，以10-13歲組母親其嬰兒之死亡率最高（1.6%），19歲母親最低（0.7%），在控制潛在干擾因素後，10-13歲母親年齡別嬰兒死亡AOR為4.06（95%=CI 1.27-13.0），年齡別AOR隨母親年齡增加而呈現顯著降低之線性趨勢（Test for trend of AORs, p＜0.001）。
6.按母親特定年齡分組之分析：合併母親生產年齡與異常生產結果之相關性分析發現，除了新生兒期死亡及源於週產期病變之嬰兒期死亡外，當以17歲為臨界年齡區分時，≦17歲母親在其餘異常生產後果上均呈現有明顯較高之勝算比。
結論：綜觀整個研究結果，相較於20-24歲成年母親，我國青少女明顯較於20-24歲母親容易產下低出生體重兒、SGA及早產兒，並且其所生嬰兒容易發生後新生兒期及嬰兒期之死亡。1985-1997之生育婦女研究世代中，雖然樣本數之限制致使某些AOR估計值並未達統計顯著性，但本研究數據傾向指出，母親年齡在10-16歲普遍有異常生產後果的較高勝算比，據此，吾人認為17歲以下的青少女母親發生異常生育後果之風險更為明顯；加強延後青少女懷孕之介入措施以及對青少女妊娠之加強照顧是降低青少女異常生產結果應同時並進之努力方向。

Background and Purposes: Previous studies suggested increased risks of spontaneous abortion, shorter gestation, pregnancy again by the age of 20, lower birth weight infants, and mortality during infancy are all associated with teenage pregnancy. The health statistics in Taiwan doesn’t include the information regarding the births of teenage mothers aged 14 or less. However, numerous previous studies frequently reported a particularly high risk of adverse birth outcomes among mothers aged 15 or less. Additionally, previous studies frequently treated all teenage mothers as a group, and this way of doing could overlook the risks of adverse birth outcomes associated with very young mothers. Therefore, some studies suggested a need for reporting age-specific risks of adverse birth outcomes for teenage pregnancies. This current study, using both birth and mortality registrations in Taiwan, collected all live births born to mothers aged 10-24 between 1985 and 1997, and investigated the birth characteristics and under 1 year mortality of these live births. We also calculated the relative odds of adverse birth outcomes by comparing between the live births of all teenage mothers and those born to adult mothers aged 20-24.
Materials and Methods: We used both birth (1985-1997, supervised by the Ministry of Interior) and mortality (1985-1998, supervised by the Department of Health) registrations to identify the study cohort and the deceased study subjects by his/her first birthday. We first identified, from mortality registration, 13,938 deaths at ages 0-4 who were born between 1985 and 1997. We also identified a total of 1,185,597 live births born to mothers aged 10-24 between 1985 and 1997 as the study cohort. Among those live births, 151,259 (12.8%) were born to teenage (10-19 years) mothers. Through linkage between the study cohort and the pre-identified mortality data, a total of 7,095 deaths at age of under 1 year old were noted for the study cohorts; and among them 1,185 were born to teenage mothers. In statistical analyses, we used logistic regression and multinomial logistic regression models to estimate the odds ratio (OR) of adverse birth outcomes associated with maternal age. After adjustment for birth characteristics and parental socioeconomic indicators that were considered as potential confounders in this study, we further calculated adjusted odds ratios (AORs) and the corresponding 95% confidence intervals (CIs). In addition, a test for linear trend of maternal age-specific AOR was also performed. The hypothesis testing carried out in this study used an -level of 0.05 as the level of significance. Data management and statistical analyses were performed with the SPSS ver. 13.0 (SPSS Inc.; Chicago, IL; version 13.0). We used OriginPro 7.5 (Northampton, MA USA) to construct statistical graphs.
Results: This study found that the number of live births born to mothers aged 25 or less decreased annually between 1985 and 1997 in Taiwan. But, the proportion of live births of teenage mothers increased over the study period. The following paragraphs outlined the results regarding various adverse birth outcomes.
1. Lower birth weight: The mean birth weight decreased with as maternal age increased. The incidence rates of lower birth weight and small for gestation (SGA) decreased monotonically as maternal age advanced among mothers aged 14 and older. After controlling for potential confounders, the teenage mother’s age-specific AOR of lower birth weight (1500-2499 g) ranged from 1.27 (95% CI=1.22-1.31) (for 19-year-old mothers) to 1.87 (95% CI=1.40-2.51) (for 10-14-year-old mothers) as compared to adult mothers aged 20-24. On the other hand, the AOR of SGA ranged from 1.19 (95% CI=1.17-1.22) (for 19-year-old mothers) to 1.52 (95% CI=1.21-1.91) (for 14-year-old mothers). Only the age-specific AORs of lower birth weight (1500-2499 g) showed a significant linear trend.
2. The distribution of gestational weeks is significantly associated with maternal age. The incidences and relative risk estimates of preterm birth decreased with an increase of maternal age (Test for trend of AORs, p<0.001). As compared to adult mothers, the risk of preterm birth with 32-36 weeks of gestation increased for all teenage mothers, and the AOR ranged from 1.10 (for 19-year-old mothers) to 2.44 (for 10-13-year-old mothers). Except for mothers aged 10-13, the teenage mothers of all ages had increased risks of preterm birth with a gestation of <32 weeks, with the lowest (1.28) and highest (3.20) AOR noted for 19-year-old mothers and 14-year-old mothers, respectively.
3. Neonatal mortality: The highest neonatal mortality rate (0.5%) was noted among the neonates born to mothers aged 10-13, and the lowest rate was 0.2% for births of adult mothers. As compared to the births of adult mothers, the births of teenage mothers of all ages were not suffering from a significantly increased risk of neonatal mortality. Nonetheless, there was a very high AOR (4.93, 95% CI=0.65-37.4) estimated for births born to very young mothers (10-13 years old).
4. Post-neonatal mortality rate: Mothers aged 10-13 or 15 years both had the highest risk of having post-neonatal mortality rate in their children (1.1%), followed by mothers aged 14 or 16 (0.7%). Mothers aged 17 to 19 had a similar figures at 0.5%. After controlling for potential confounders, the births of mothers aged 15-19 were at significantly elevated risk of developing post-neonatal mortality with an age-specific AOR of 2.26, 1.58, 1.31, and 1.28, respectively. However, the maternal age-specific AOR did not show a significant linear trend (p=0.208).
5. Infant mortality: While the 19-year-old mothers had the lowest infant mortality rate (0.7%), the highest infant mortality rate (1.6%) was noted for infants of very young mothers (10-13 years old). The AOR was estimated at 4.06 (95% CI=1.27-13.0) for mothers aged 10-13, then it started to significantly and linearly decline as maternal age increased (Test for trend of AORs, p<0.001).
6. Analysis based on maternal age groups: While age of teenage mothers was analyzed in groups and using 16 years as a cut-off point, we noted that mother ≦16 years of age had apparently higher odds ratios for all adverse birth outcomes except neonatal mortality and infant death from perinatal causes.
Conclusion: Overall, the teenage mothers were more likely than the adult mothers aged 20-24 to give births with increased risks of lower birth weight, SGA, and shorter gestation. Due to limited sample size and numbers of under 1 year death among the infants of teenage mothers aged 10-15, some estimated AOR were found to be insignificant. Despite that, our data tend to suggest that these very young mothers were especially vulnerable to such adverse birth outcome risks. Based on the findings from this study, we considered that the teenage mothers aged 15 or less are especially vulnerable to various adverse birth outcomes. The interventions that may avoid teenage pregnancy and the intensive care provided for teenage pregnancy and delivery should be seriously considered in order to reduce the risk of adverse birth outcomes associated teenage mothers.

中文摘要 IV
英文摘要 VIII
第一章　緒論 1
第一節　研究動機 1
第二節　研究目的 3
第三節　研究架構 4
第二章　文獻探討 5
第一節　青少女生育發生概況與趨勢 5
第二節　青少女母親之異常生產結果 7
第三節　不利青少女生產結果之相關因素 27
第三章 材料與方法 40
第一節　資料來源與處理 40
第二節　研究世代之擷取以及與死亡資料之串聯 43
第三節　資料分析 44
第四章　結果 48
第一節　研究樣本特性 48
第二節　異常出生結果及死亡率 53
第三節　單一年齡別異常出生結果部份之邏輯斯迴歸分析 55
第四節　按特定年齡分組異常出生結果部份之邏輯斯迴歸分析 60
第五章　討論 61
第一節　青少女生育發生概況與趨勢 61
第二節　青少女生產特性之討論 62
第三節　青少女母親之異常出生結果討論 63
第四節　本研究之優點與限制 72
第六章　結論與建議 76
第七章　參考文獻 78
第ㄧ節　中文部分 78
第二節　英文部分 82
表 90
圖 111
附表 128

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