Abstract
There is limited data on the trends of childhood viable pregnancy and the risk of stillbirth in the United States. Our study assessed the trends in childhood viable pregnancy and associated stillbirth rates over the previous three decades, as well as the risk of stillbirth in these highly vulnerable child mothers aged 10-14 compared with teen mothers aged 15-19. We conducted a population-based retrospective cohort study that used birth datasets, fetal death datasets, and the US population census data: 1982-2017. To assess the association between various sociodemographic and maternal comorbidities and stillbirth, we generated adjusted hazard ratios (AHR) from Cox proportional hazards regression models. From 1982 to 2017, viable pregnancy rates declined among children (from 0.3/1000 to 0.06/1000 population) and teens (from 40.5/1000 in 1982 to 18.1/1000). Overall, there were declines in the stillbirth rates in both teens (15-19 years old) and child mothers aged 10-14 years, but the rate remained consistently higher among child mothers vs. teen mothers (14 per 1000 vs. 8 per 1000 viable pregnancies). Compared to teen mothers, childhood pregnancy was modestly associated with an elevated risk for stillbirth (AHR = 1.09; 95% CI = 1.05-1.12). Other factors significantly associated with increased risk of stillbirth included maternal race, preterm birth, arterial hypertension, diabetes, and eclampsia (P<0.0001).Conclusion: Childhood pregnancy may be a risk factor for stillbirth. This is the first study to assess the trends in childhood viable pregnancy and the associated stillbirth rates in the United States. These findings further underscore the need for sustained efforts and policies to prevent pregnancies in the early years of reproductive development. What is Known: • Childhood pregnancy, defined as pregnancy among 10-14 year-old females, may be associated with a number of pregnancy complications and adverse pregnancy outcomes, including preterm delivery, low birth weight, and infant mortality. • Structural disparities in socioeconomic status and access to healthcare place some teenagers at high risk of teen pregnancy. What is New: • Our study shows the trends in childhood pregnancy over the previous three decades; overall, there were declines in the stillbirth rates in both child mothers aged 10-14 years and teen (15-19 years old) mothers, but the rate remained consistently higher among child mothers. • Child mothers aged 10-14 were more likely to experience stillbirth than teenagers, and Black mothers had an increased risk of stillbirth than White mothers-all of which underscores the effects of structural health disparities.
Highlights
Teen pregnancy rate has decreased over the past two decades in the US, it still remains an important public health issue. [1] The teen pregnancy rate in the US is higher than in other industrialized western countries,[2] and disparities exist by race/ethnicity as well as geographic region. [3] In 2017, the overall rate of teen pregnancy among women aged 15–19 years old was 18.8 per 1,000 women, with Black and Hispanic teens having over twice the pregnancy rate of their White counterparts. [4] Pregnancy during the teenage years causes problems for the adolescent mother and creates issues for the child and the society at large
We found childhood pregnancy to be associated with greater risks for stillbirth compared to older teenagers (15-19 years)
The rate of childhood pregnancy had declined over time, it had remained stable since 2016 and was an important risk factor for stillbirth
Summary
Teen pregnancy rate has decreased over the past two decades in the US, it still remains an important public health issue. [1] The teen pregnancy rate in the US is higher than in other industrialized western countries,[2] and disparities exist by race/ethnicity as well as geographic region. [3] In 2017, the overall rate of teen pregnancy among women aged 15–19 years old was 18.8 per 1,000 women, with Black and Hispanic teens having over twice the pregnancy rate of their White counterparts. [4] Pregnancy during the teenage years causes problems for the adolescent mother and creates issues for the child and the society at large. Children born to teen mothers have increased risk of teen pregnancy, higher high school drop-out rates, greater chances of incarceration during their teenage years, and higher unemployment as young adults. Childhood pregnancy was previously defined as pregnancy at ≤ 14 years (1) and could be associated with a number of pregnancy complications and adverse pregnancy outcomes, including preterm delivery, low birth weight, [6,7,8] and infant mortality. [11] adverse pregnancy outcomes associated with low maternal age are attributed to health predictors, including poor socioeconomic status[12] and racial disparity. We examined the trends in childhood pregnancy over the previous three decades as well as the risk of stillbirth in these highly vulnerable mothers
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