Abstract
Preterm delivery (<37 weeks gestation) is the largest cause of child mortality worldwide. Marriage and pregnancy during adolescence have been associated with an increased risk of preterm delivery. We investigate independent associations of age at marriage and age at first pregnancy with preterm delivery in a cohort of women from rural lowland Nepal. We analyzed data from 17 974 women in the Low Birth Weight South Asia Trial. Logistic regression models tested associations of age at marriage and age at first pregnancy with preterm delivery, for primigravida (n =6 243) and multigravida (n =11 731) women. Models were adjusted for maternal education, maternal caste, and household asset score. Ninety percent of participants had married at <18 years and 58% had their first pregnancy at <18 years. 20% of participants delivered preterm. Primigravida participants married at ≤14 years had higher odds of preterm delivery than those married ≥18 years, when adjusting for study design (adjusted odds ratio (aOR) 1.45, 95% CI: 1.15-1.83), confounders (aOR 1.28: 1.01-1.62) and confounders + age at pregnancy (aOR 1.29: 1.00-1.68). Associations were insignificant for multigravida women. No significant associations were observed between age at first pregnancy and preterm delivery. In this population, early marriage, rather than pregnancy, is a risk factor for preterm delivery. We hypothesize that psychological stress, a driver of preterm delivery which is increased among those marrying young, rather than physiological immaturity, drives this association. Further research into the psychological consequences of child marriage in Nepal is needed.
Highlights
Preterm delivery refers to a delivery occurring before 37 weeks gestation (Althabe et al, 2012)
Green shading indicates the lowest level of association, and red shading indicates the highest. 54% of multigravida participants marrying at ages ≤14 years had their first pregnancy by the age of 15 years, 31% at ages 16–17 years, and 15% aged 18 years or older. 29% of primigravida participants marrying at ages ≤14 years had their first pregnancy by the age of 15 years, 31% at ages 16–17 years, and 40% aged 18 years or older
Our study found a significant association between marrying during early adolescence, at age ≤14 years, and the likelihood of preterm delivery
Summary
Preterm delivery refers to a delivery occurring before 37 weeks gestation (Althabe et al, 2012). Reducing preterm delivery rates is a vital component of reducing infant and child mortality and morbidity, contributing towards the United Nations Sustainable Development Goal (SDG) 3, which aims to end all preventable deaths under the age of five years by 2030 (United Nations, 2020). Prematurity has long-term consequences on the health and cognitive development of individuals into adulthood (Kajantie et al, 2010; MacKay et al, 2010; Markopoulou et al, 2019). This can cause families significant psychological and financial hardship (Moster et al, 2008; Rogers & Velten, 2011; Swamy et al, 2008)
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