Preterm birth, unplanned hospital contact, and mortality in infants born to teenage mothers in five countries: An administrative data cohort study.

Katie Harron,Alex Kopp,Anders Hjern,Maximiliane Verfuerden,Jane Ford,Ibinabo Ibiebele,Can Liu,Jan Van Der Meulen,Astrid Guttmann,Ruth Gilbert

doi:10.1111/ppe.12685

Abstract

BackgroundYoung maternal age is associated with lower birthweight and higher rates of preterm birth and childhood hospitalisations. Internationally, teen pregnancy rates vary widely, reflecting differences in social, welfare, and health care factors in different cultural contexts.ObjectivesTo determine whether the increased risk of adverse infant outcomes among teenage mothers varies by country, reflecting different national teenage birth rates and country‐specific social/welfare policies, in Scotland (higher teenage pregnancy rates), England, New South Wales (NSW; Australia), Ontario (Canada), and Sweden (lower rates).MethodsWe used administrative hospital data capturing 3 002 749 singleton births surviving to postnatal discharge between 2010 and 2014 (2008‐2012 for Sweden). We compared preterm birth (24‐36 weeks’ gestation), mortality within 12 months of postnatal discharge, unplanned hospital admissions, and emergency department visits within 12 months of postnatal discharge, for infants born to mothers aged 15‐19, 20‐24, 25‐29, and 30‐34 years.ResultsCompared to births to women aged 30‐34 years, risks of adverse outcomes among teenage mothers were higher in all countries, but the magnitude of effects was not related to country‐specific rates of teenage births. Teenage mothers had between 1.2% (95% confidence interval [CI] 0.7, 1.7, Sweden) and 2.0% (95% CI 1.4, 2.5, NSW) more preterm births, and between 9.8 (95% CI 7.2, 12.4, England) and 19.7 (95% CI 8.7, 30.6, Scotland) more deaths per 10 000 infants, compared with mothers aged 30‐34. Between 6.4% (95% CI 5.5, 7.4, NSW) and 25.4% (95% CI 24.7, 26.1, Ontario), more infants born to teenage mothers had unplanned hospital contacts compared with those born to mothers aged 30‐34.ConclusionsRegardless of country, infants born to teenage mothers had universally worse outcomes than those born to older mothers. This excess risk did not vary by national rates of livebirths to teenage mothers. Current mechanisms to support teenage mothers have not eliminated maternal age‐related disparities in infant outcomes; further strategies to mitigate excess risk in all countries are needed.

Highlights

Young maternal age is associated with lower birthweight and higher rates of preterm birth and childhood hospitalisations
Children born to teenage mothers have greater health care needs than those born to mothers in their 20s and older, and evidence suggests that social determinants explain much of the excess risk of adverse outcomes.[1,2,3]
We included singleton infants born to mothers aged

Summary

Introduction

Young maternal age is associated with lower birthweight and higher rates of preterm birth and childhood hospitalisations. A UK survey found that only 12% of teenage pregnancies were planned, compared with two-thirds of pregnancies in mothers aged 30-34 years.[4] The adverse circumstances associated with young maternal age and unplanned pregnancies (eg drug or alcohol abuse and smoking) are damaging to the health of the mother and baby. Such risky behaviours during pregnancy can lead to adverse neonatal outcomes, which in turn increase health care needs and use of health services throughout childhood and beyond. This suggests that as teenage pregnancy rates decline, teenagers who do give birth represent a more vulnerable group, with a higher concentration of individual risk factors such as mental health, conduct problems, or adversity.[10]

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