Antecedents of Preterm Delivery Among Adolescents: Relationship to Type of Prenatal Care

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Abstract
The objective of this study was to determine if the antecedents of preterm delivery differ significantly among adolescents who obtain prenatal care in a comprehensive, multidisciplinary, adolescent-oriented maternity program and adolescents who obtain prenatal care in other settings. We hypothesized that the preterm births of patients who obtain adolescent-oriented maternity care are less frequently antedated by preterm premature rupture of the placental membranes (PPROM) than are the preterm birth of adolescents who obtain prenatal care in other settings. Retrospective review was made of medical records from 84 consecutive preterm deliveries to < 19-year-old mothers; 26 who were cared for in an adolescent-oriented maternity program and 58 who were cared for in other settings. Chi-square and logistic regression analyses were used to compare the incidence of 3 common antecedents of preterm delivery (PPROM, medical complication culminating in preterm delivery, and unknown causes of premature delivery) in the 2 populations. Eleven (19%) of the 58 preterm births to non-adolescent-oriented maternity care patients were excluded from the analysis because they were teens who were transported to the hospital from outside the area specifically for treatment of preterm labor. Teens who obtained adolescent-oriented care were younger than were teens who obtained other types of maternity care (P = 0.001). Preterm births to younger teens were less often antedated by medical complications (odds ratio: 4-1; 95% confidence interval: 1.4-12.6). Contrary to the study hypothesis, the preterm births of adolescent-oriented maternity care patients were not less often antedated by PPROM; approximately one-third of the preterm deliveries in each group were antedated by PPROM. Preterm births to adolescent-oriented maternity care patients were, however, more often induced (38.5% vs. 14.9%; P = 0.04), primarily because of concerns about intrauterine growth retardation. In conclusion, the study hypothesis was not supported. The study results are important methodologically. Two additional factors which should be taken into account in efficacy studies of adolescent-oriented maternity programs were identified: transportation of high-risk obstetric patients and preterm induction of labor. Failure to control for these factors may account for some of the conflicting reports concerning the efficacy of adolescent-oriented maternity care programs.

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