Adverse Perinatal and Neonatal Outcomes among Adolescent Pregnancies in the United States

 

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Abstract

Objective Despite a downward trend in recent years, adolescent pregnancies in the United States remain higher than any other western country. Adolescent pregnancies have been inconsistently associated with adverse perinatal outcomes. The objective of this study is to investigate the association between adolescent pregnancies and adverse perinatal and neonatal outcomes in the United States.

Study Design This is a retrospective cohort study of singleton births in the United States from 2014 to 2020 using national vital statistics data. Perinatal outcomes included gestational diabetes, gestational hypertension, preterm delivery <37 weeks (preterm birth [PTB]), cesarean delivery (CD), chorioamnionitis, small for gestational age (SGA), large for gestational age (LGA), and neonatal composite outcome. Chi-square tests were used to compare outcomes among adolescent (13–19 years) versus adult (20–29 years) pregnancies. Multivariable logistic regression models were used to examine association of adolescent pregnancies with perinatal outcomes. For each outcome, we utilized three models: unadjusted logistic regression, adjusted for demographics, and adjusted for demographics and medical comorbidities. Similar analyses were used to compare younger (13–17 years) and older (18–19 years) adolescent pregnancies to adults.

Results In a cohort of 14,014,078 pregnancies, we found that adolescents were at an increased risk of PTB (adjusted odds ratio [aOR]: 1.12, 99% confidence interval (CI): 1.12–1.13) and SGA (aOR: 1.02, 99% CI: 1.01–1.03) compared with adult pregnancies. We also found that multiparous adolescents with a prior history of CD were at an increased risk of CD, compared with adults. For all other outcomes, adult pregnancies were at higher risk for adverse outcomes in the adjusted models. When comparing birth outcomes among adolescents, we found that older adolescents are at an increased risk of PTB, whereas younger adolescents are at an increased risk of both PTB and SGA.

Conclusion After adjusting for confounders, our study demonstrates adolescents have an increased risk of PTB and SGA, compared with adults.

Key Points

• Adolescents as a whole subgroup have an increased risk of PTB and SGA compared with adults.

• Younger adolescents have a risk of PTB and SGA, whereas older adolescents have a risk of PTB only.

• Adverse birth outcomes in adults are gestational diabetes, chorioamnionitis, LGA, and worse neonatal composite score.

Note

All authors were involved in the design, analysis, and interpretation of the data reported in this study. This study was presented at the Society for Maternal-Fetal Medicine's 40th Annual Pregnancy Meeting 2020, Poster #242.

Publikationsverlauf

Eingereicht: 19. Dezember 2022

Angenommen: 30. Juni 2023

Accepted Manuscript online:
03. Juli 2023

Artikel online veröffentlicht:
04. August 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• References

• 1 Felice ME, Feinstein RA, Fisher MM. et al. Adolescent pregnancy–current trends and issues: 1998 American Academy of Pediatrics Committee on Adolescence, 1998-1999. Pediatrics 1999; 103 (02) 516-520
  PubMedGoogle Scholar
• 2 Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Mathews TJ. Births: final data for 2015. Natl Vital Stat Rep 2017; 66 (01) 1
  PubMedGoogle Scholar
• 3 Dangal G. Teenage pregnancy: complexities and challenges. Middle East 2008; 56: 1000
  PubMedGoogle Scholar
• 4 Maynard SDHRA. Kids Having Kids: Economic Costs & Social Consequences of Teen Pregnancy. The Urban Institute Press; 2008
  Google Scholar
• 5 Webb RT, Marshall CE, Abel KM. Teenage motherhood and risk of premature death: long-term follow-up in the ONS Longitudinal Study. Psychol Med 2011; 41 (09) 1867-1877
  CrossrefPubMedGoogle Scholar
• 6 Dinwiddie KJ, Schillerstrom TL, Schillerstrom JE. Postpartum depression in adolescent mothers. J Psychosom Obstet Gynaecol 2018; 39 (03) 168-175
  CrossrefPubMedGoogle Scholar
• 7 Gilbert W, Jandial D, Field N, Bigelow P, Danielsen B. Birth outcomes in teenage pregnancies. J Matern Fetal Neonatal Med 2004; 16 (05) 265-270
  CrossrefPubMedGoogle Scholar
• 8 Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med 1995; 332 (17) 1113-1117
  CrossrefPubMedGoogle Scholar
• 9 Gortzak-Uzan L, Hallak M, Press F, Katz M, Shoham-Vardi I. Teenage pregnancy: risk factors for adverse perinatal outcome. J Matern Fetal Med 2001; 10 (06) 393-397
  CrossrefPubMedGoogle Scholar
• 10 Igwegbe AO, Udigwe GO. Teenage pregnancy: still an obstetric risk. J Obstet Gynaecol 2001; 21 (05) 478-481
  CrossrefPubMedGoogle Scholar
• 11 Jolly MC, Sebire N, Harris J, Robinson S, Regan L. Obstetric risks of pregnancy in women less than 18 years old. Obstet Gynecol 2000; 96 (06) 962-966
  PubMedGoogle Scholar
• 12 Satin AJ, Leveno KJ, Sherman ML, Reedy NJ, Lowe TW, McIntire DD. Maternal youth and pregnancy outcomes: middle school versus high school age groups compared with women beyond the teen years. Am J Obstet Gynecol 1994; 171 (01) 184-187
  CrossrefPubMedGoogle Scholar
• 13 La-Orpipat T, Suwanrath C. Pregnancy outcomes of adolescent primigravida and risk of pregnancy-induced hypertension: a hospital-based study in Southern Thailand. J Obstet Gynaecol 2019; 39 (07) 934-940
  CrossrefPubMedGoogle Scholar
• 14 Bukulmez O, Deren O. Perinatal outcome in adolescent pregnancies: a case-control study from a Turkish university hospital. Eur J Obstet Gynecol Reprod Biol 2000; 88 (02) 207-212
  CrossrefPubMedGoogle Scholar
• 15 Lubarsky SL, Schiff E, Friedman SA, Mercer BM, Sibai BM. Obstetric characteristics among nulliparas under age 15. Obstet Gynecol 1994; 84 (03) 365-368
  PubMedGoogle Scholar
• 16 Olausson PM, Cnattingius S, Goldenberg RL. Determinants of poor pregnancy outcomes among teenagers in Sweden. Obstet Gynecol 1997; 89 (03) 451-457
  CrossrefPubMedGoogle Scholar
• 17 Ganchimeg T, Ota E, Morisaki N. et al; WHO Multicountry Survey on Maternal Newborn Health Research Network. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014; 121 (Suppl. 01) 40-48
  CrossrefPubMedGoogle Scholar
• 18 Pineles BL, Harris AD, Goodman KE. Adverse maternal and delivery outcomes in children and very young (age ≤13 years) US adolescents compared with older adolescents and adults. JAMA 2022; 328 (17) 1766-1768
  CrossrefPubMedGoogle Scholar
• 19 Kawakita T, Wilson K, Grantz KL, Landy HJ, Huang CC, Gomez-Lobo V. Adverse maternal and neonatal outcomes in adolescent pregnancy. J Pediatr Adolesc Gynecol 2016; 29 (02) 130-136
  CrossrefPubMedGoogle Scholar
• 20 Malabarey OT, Balayla J, Klam SL, Shrim A, Abenhaim HA. Pregnancies in young adolescent mothers: a population-based study on 37 million births. J Pediatr Adolesc Gynecol 2012; 25 (02) 98-102
  CrossrefPubMedGoogle Scholar
• 21 Torvie AJ, Callegari LS, Schiff MA, Debiec KE. Labor and delivery outcomes among young adolescents. Am J Obstet Gynecol 2015; 213 (01) 95.e1-95.e8
  CrossrefPubMedGoogle Scholar
• 22 Hoque M, Hoque S. Comparison of perinatal and obstetrics outcomes among early adolescents, late adolescents and adult pregnant women from rural South Africa. East Afr J Public Health 2010; 7 (02) 171-176
  PubMedGoogle Scholar
• 23 Akseer N, Keats EC, Thurairajah P. et al; Global Young Women's Nutrition Investigators Group. Characteristics and birth outcomes of pregnant adolescents compared to older women: an analysis of individual level data from 140,000 mothers from 20 RCTs. EClinicalMedicine 2022; 45: 101309
  CrossrefPubMedGoogle Scholar
• 24 Centers for Disease Control and Prevention. (2023, July 21). Data Access - Vital Statistics Online. Centers for Disease Control and Prevention. Accessed July 20, 2023 at: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm
  PubMedGoogle Scholar
• 25 Talge NM, Mudd LM, Sikorskii A, Basso O. United States birth weight reference corrected for implausible gestational age estimates. Pediatrics 2014; 133 (05) 844-853
  CrossrefPubMedGoogle Scholar
• 26 Dowswell T, Carroli G, Duley L. et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev 2015; 2015 (07) CD000934
  CrossrefPubMedGoogle Scholar
• 27 Loto OM, Ezechi OC, Kalu BKE, Loto A, Ezechi L, Ogunniyi SO. Poor obstetric performance of teenagers: is it age- or quality of care-related?. J Obstet Gynaecol 2004; 24 (04) 395-398
  CrossrefPubMedGoogle Scholar
• 28 Sagili H, Pramya N, Prabhu K, Mascarenhas M, Reddi Rani P. Are teenage pregnancies at high risk? A comparison study in a developing country. Arch Gynecol Obstet 2012; 285 (03) 573-577
  CrossrefPubMedGoogle Scholar
• 29 Gupta N, Kiran U, Bhal K. Teenage pregnancies: obstetric characteristics and outcome. Eur J Obstet Gynecol Reprod Biol 2008; 137 (02) 165-171
  CrossrefPubMedGoogle Scholar
• 30 Chedraui P. Pregnancy among young adolescents: trends, risk factors and maternal-perinatal outcome. J Perinat Med 2008; 36 (03) 256-259
  CrossrefPubMedGoogle Scholar
• 31 Yadav S, Choudhary D, Narayan KC. et al. Adverse reproductive outcomes associated with teenage pregnancy. McGill J Med 2008; 11 (02) 141-144
  PubMedGoogle Scholar
• 32 Scholl TO, Hediger ML, Ances IG. Maternal growth during pregnancy and decreased infant birth weight. Am J Clin Nutr 1990; 51 (05) 790-793
  CrossrefPubMedGoogle Scholar
• 33 Chen X-K, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol 2007; 36 (02) 368-373
  CrossrefPubMedGoogle Scholar
• 34 Raatikainen K, Heiskanen N, Verkasalo PK, Heinonen S. Good outcome of teenage pregnancies in high-quality maternity care. Eur J Public Health 2006; 16 (02) 157-161
  CrossrefPubMedGoogle Scholar
• 35 Akinbami LJ, Schoendorf KC, Kiely JL. Risk of preterm birth in multiparous teenagers. Arch Pediatr Adolesc Med 2000; 154 (11) 1101-1107
  CrossrefPubMedGoogle Scholar
• 36 Smith GC, Pell JP. Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study. BMJ 2001; 323 (7311) 476
  CrossrefPubMedGoogle Scholar
• 37 Olausson PO, Cnattingius S, Haglund B. Does the increased risk of preterm delivery in teenagers persist in pregnancies after the teenage period?. BJOG 2001; 108 (07) 721-725
  CrossrefPubMedGoogle Scholar
• 38 Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and Meta-analysis. Reprod Health 2018; 15 (01) 195
  CrossrefPubMedGoogle Scholar
• 39 Marvin-Dowle K, Kilner K, Burley VJ, Soltani H. Impact of adolescent age on maternal and neonatal outcomes in the Born in Bradford cohort. BMJ Open 2018; 8 (03) e016258
  CrossrefPubMedGoogle Scholar
• 40 Yakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review. Reprod Health 2018; 15 (01) 15
  CrossrefPubMedGoogle Scholar
• 41 Caughey AB, Stotland NE, Washington AE, Escobar GJ. Maternal ethnicity, paternal ethnicity, and parental ethnic discordance: predictors of preeclampsia. Obstet Gynecol 2005; 106 (01) 156-161
  CrossrefPubMedGoogle Scholar
• 42 Chen X-K, Wen SW, Krewski D, Fleming N, Yang Q, Walker MC. Paternal age and adverse birth outcomes: teenager or 40+, who is at risk?. Hum Reprod 2008; 23 (06) 1290-1296
  CrossrefPubMedGoogle Scholar
• 43 Howe CJ, Bailey ZD, Raifman JR, Jackson JW. Recommendations for using causal diagrams to study racial health disparities. Am J Epidemiol 2022; 191 (12) 1981-1989
  CrossrefPubMedGoogle Scholar
• 44 Alhusen JL, Bower KM, Epstein E, Sharps P. Racial discrimination and adverse birth outcomes: an integrative review. J Midwifery Womens Health 2016; 61 (06) 707-720
  CrossrefPubMedGoogle Scholar
• 45 Wadhwa PD, Entringer S, Buss C, Lu MC. The contribution of maternal stress to preterm birth: issues and considerations. Clin Perinatol 2011; 38 (03) 351-384
  CrossrefPubMedGoogle Scholar
• 46 Shapiro GD, Fraser WD, Frasch MG, Séguin JR. Psychosocial stress in pregnancy and preterm birth: associations and mechanisms. J Perinat Med 2013; 41 (06) 631-645
  CrossrefPubMedGoogle Scholar
• 47 Olajubu AO, Omoloye GO, Olajubu TO, Olowokere AE. Stress and resilience among pregnant teenagers in Ile-Ife, Nigeria. Eur J Midwifery 2021; 5: 9
  CrossrefPubMedGoogle Scholar
• 48 Hodgkinson S, Beers L, Southammakosane C, Lewin A. Addressing the mental health needs of pregnant and parenting adolescents. Pediatrics 2014; 133 (01) 114-122
  CrossrefPubMedGoogle Scholar
• 49 Szegda K, Bertone-Johnson ER, Pekow P. et al. Prenatal perceived stress and adverse birth outcomes among Puerto Rican women. J Womens Health (Larchmt) 2018; 27 (05) 699-708
  CrossrefPubMedGoogle Scholar
• 50 Traylor CS, Johnson JD, Kimmel MC, Manuck TA. Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. Am J Obstet Gynecol MFM 2020; 2 (04) 100229
  CrossrefPubMedGoogle Scholar
• 51 Loomans EM, van Dijk AE, Vrijkotte TGM. et al. Psychosocial stress during pregnancy is related to adverse birth outcomes: results from a large multi-ethnic community-based birth cohort. Eur J Public Health 2013; 23 (03) 485-491
  CrossrefPubMedGoogle Scholar
• 52 Fox CH. Cocaine use in pregnancy. J Am Board Fam Pract 1994; 7 (03) 225-228
  PubMedGoogle Scholar
• 53 LaBossier NJ, Hadland SE. Stimulant misuse among youth. Curr Probl Pediatr Adolesc Health Care 2022; 52 (09) 101265
  CrossrefPubMedGoogle Scholar
• 54 Scholl TO, Miller LK, Salmon RW, Cofsky MC, Shearer J. Prenatal care adequacy and the outcome of adolescent pregnancy: effects on weight gain, preterm delivery, and birth weight. Obstet Gynecol 1987; 69 (3 Pt 1): 312-316
  PubMedGoogle Scholar
• 55 Turner RJ, Grindstaff CF, Phillips N. Social support and outcome in teenage pregnancy. J Health Soc Behav 1990; 31 (01) 43-57
  CrossrefPubMedGoogle Scholar
• 56 Northam S, Knapp TR. The reliability and validity of birth certificates. J Obstet Gynecol Neonatal Nurs 2006; 35 (01) 3-12
  CrossrefPubMedGoogle Scholar
• 57 Ziogas C, Hillyer J, Saftlas AF, Spracklen CN. Validation of birth certificate and maternal recall of events in labor and delivery with medical records in the Iowa health in pregnancy study. BMC Pregnancy Childbirth 2022; 22 (01) 232
  CrossrefPubMedGoogle Scholar