106. Pregnancy and Delivery Outcomes in Adolescent and Young Adult Mothers in the Military Health System

Abstract

We aim to examine risk factors in military-connected adolescent and young adult mothers after Affordable Care Act implementation that may predict adverse pregnancy and delivery outcomes. Dependent daughter (DD), active duty (AD) spouse, and AD service member (ADSM) mothers within the San Antonio Military Health System (SAMHS) ages 26 years and under at their initial prenatal visit between 2015-2019 were included. Data was collected retrospectively from Military Health System electronic inpatient and outpatient records. Demographic data included date and age at first prenatal visit, marital status, beneficiary status, sponsor’s rank (enlisted or officer) and estimated gestational age (EGA) at first prenatal visit and birth. Records were reviewed for preeclampsia, gestational diabetes mellitus (GDM), premature rupture of membranes (PROM), premature labor, substance use, sexually transmitted infection (STI), elective abortion, and pregnancy loss. Maternal and neonatal outcomes were compared to the demographic data. There were 4557 eligible mothers ranging from 13 to 26 years. Almost three-quarters of mothers were married. Median age at first prenatal visit was 20 years for unwed and 23 years for married mothers. DD, ADSM, and AD spouses made up 15.9%, 28.7%, and 55.3% of mothers, respectively. Eighty-six percent of mothers had an enlisted sponsor. A quarter of the eligible mothers had missing data. Age at initial prenatal visit was not significantly associated with preeclampsia (p=0.5266), premature labor (p=0.1755), PROM (p=0.3325), and pregnancy loss (p=0.4813). Beneficiary status was not significantly associated with preeclampsia (p=0.8775), premature labor, (p=0.3381), and PROM (p=0.4954). STI was significantly associated with younger mothers (p<0.001), DD (p<0.0001), presentation to care in the second or third trimester (p<0.0001), and enlisted rank (p=0.0005). Delayed entry to prenatal care was significantly associated with preeclampsia, GDM, substance use, STI (p<0.0001), DD, and younger age (p<0.0001). EGA at birth was significantly associated with age, beneficiary status, and initial prenatal visit trimester (p<0.0001). Initiation of prenatal care in the first trimester within the SAMHS in terms of timing remains consistent with nationally published data. Younger age and DD status are associated with delayed initiation of prenatal care. However, younger maternal age is not associated with certain adverse maternal pregnancy and delivery outcomes in military-connected mothers. This could indicate that universal access to healthcare may improve pregnancy and delivery outcomes in adolescent and young adult mothers.