Teenage pregnancy and motherhood: a review of the literature

Does Nubility Indicate More Than High Reproductive Value? Nubile Primiparas' Pregnancy Outcomes in Evolutionary Perspective

The idea that human males are most strongly attracted to traits that peak in women in the nubile age group raises the question of how well women in that age group contend with the potential hazards of a first pregnancy. Using data for 1.7 million first births from 1990 U.S. natality and mortality records, we compared outcomes for women with first births (primiparas) aged 16-20 years (when first births typically occur in forager and subsistence groups) with those aged 21-25 years. The younger primiparas had a much lower risk of potentially life-threatening complications of labor and delivery and, when evolutionarily novel risk factors were controlled, fetuses which were significantly more likely to survive despite lower birth weights. Thus, nubile primiparas were more likely to have a successful reproductive outcome defined in an evolutionarily relevant way (an infant of normal birth weight and gestation, surviving to one year, and delivered without a medically necessary cesarean delivery). This suggests that prior to the widespread availability of surgical deliveries, men who mated with women in the nubile age group would have reaped the benefit of having a reproductive partner more likely to have a successful first pregnancy.

Characteristics of positive-interaction parenting style among primiparous teenage, optimal age, and advanced age mothers in Canada

BACKGROUND

Positive-interaction parenting early in childhood is encouraged due to its association with behavioural development later in life. The objective of this study was to examine if the level of positive-interaction parenting style differs among teen, optimal age, and advanced age mothers in Canada, and to identify the characteristics associated with positive-interaction parenting style separately for each age group.

METHODS

This was a cross-sectional secondary analysis of the National Longitudinal Survey of Children and Youth. First-time mothers with children 0-23 months were grouped into: teen (15-19 years, N = 53,409), optimal age (20-34 years, N = 790,960), and advanced age (35 years and older, N = 106,536). The outcome was positive-interaction parenting style (Parenting Practices Scale); maternal socio-demographics, health, social, and child characteristics were considered for backward stepwise multiple linear regression modeling, stratified for each of the age groups.

RESULTS

Teen, optimal age, and advanced age mothers reported similar levels of positive- interaction parenting style. Covariates differed across the three age groups. Among optimal age mothers, being an ever-landed immigrant, childcare use, and being devoted to religion were found to decrease positive-interaction parenting style, whereas, higher education was found to increase positive-interaction parenting style. Teen mothers were not found to have any characteristics uniquely associated with positive-interaction parenting. Among advanced age mothers, social support was uniquely associated with an increase in positive-interaction parenting. Very good/excellent health was found to be positively associated with parenting in teens but negatively associated with parenting in advanced age mothers.

CONCLUSION

Characteristics associated with positive-interaction parenting varied among the three age groups. Findings may have public health implications through information dissemination to first-time mothers, clinicians, researchers, and public health facilities.

Observing Other Teachers Teach: The Effect on Adolescent Teaching Behavior

Low-income adolescents were instructed to observe videotapes of two teachers consistently modeling effective teaching of young children in a structured teaching task. Simultaneously the subjects incidentally observed systematic differences in the inquiry- and directive-oriented teaching styles and novel behavior being modeled. As a result of observation, the subjects imitated aspects of the incidentally observed inquiry teaching style modeled as well as important aspects of the effective teaching behavior they were instructed to observe. Factors affecting subjects' selective imitation of the two models' styles were examined. The most significant factors examined were subjects' perceptions of their own teaching style and their perceptions of the teaching models' effectiveness.

Mother—Child Interactions and Symbolic Play between Toddlers and Their Adolescent or Mentally Retarded Mothers

The present study investigated the symbolic play development and mother–child interactions between toddlers and their adolescent or mentally retarded mothers. Eighteen mother–child dyads were observed and videotaped playing with a standard set of toys for 20 minutes in their homes or day-care center three times over a 4-month period. Six mothers were adolescents, 6 mothers were mentally retarded and 6 mothers formed a “not-at-risk” sample drawn from local play groups. The levels of object and symbolic play as well as nonverbal and verbal maternal behaviors were coded for all children. Specific maternal behaviors were found to have different effects on the children's play. Mothers of children who engaged in a greater proportion of symbolic play appeared to become involved in their children's ongoing activities by verbally commenting requesting information, or suggesting a symbolic activity. Differences in maternal behaviors were found between the not-at-risk control group and the mentally retarded and adolescent mothers.

Factors Affecting the Probability of School Dropout

The permanent records of 562 female adolescents enrolled in school-based programs for pregnant and parenting students in Colorado during the 1984-1985 through 1986-1987 school years were reviewed. The study compared students who graduated with those students who dropped out. The findings indicated that "completers " were more likely to be (a) better students, (b) 16 years of age or older, (c) enrolled in vocational classes, (d) show improved grades once in the special program, (e) fail to show a dramatic drop in their academic performance between grades 7 and 8, and (f) less frequently enrolled in special education classes. Five variables were significant predictors of group membership, predicting group membership with 76% accuracy.

Cognitive and Motor Development in Infants of Adolescent Mothers: A Longitudinal Analysis

A longitudinal study of cognitive and motor development among infants born to adolescent mothers was conducted with 58 adolescent mothers and a control group of 59 adult mothers. The experimental and control groups were matched on race (white/black), parity, prenatal care, and SES. Data were obtained on antepartum, delivery, and postpartum performance of the mothers, along with data on infant status within each maternal group. Additionally, infants from each maternal group were followed longitudinally over the first year of life. Measures of infant mental and motor development test performance on the Bayley Scales of Infant Development were obtained at six and 12 months of age. The HOME Inventory was also used to obtain ratings of the infant home environment at six and 12 months of age. No differences were observed in the incidence of infant or maternal complications between the adolescent and adult maternal groups. However, birthweight, cesarean section, and labor and delivery complications were significantly related to race, with black subjects experiencing less favorable outcomes on these variables. Infants born to adolescent mothers scored significantly lower on the Mental Development Index of the Bayley relative to controls. Black infants also performed significantly lower on this Index compared to white infants. Home environments of infants born to adolescents were found to be significantly less nurturant than those of controls, and the HOME ratings for black subjects were significantly lower than those for whites.

Depressive symptoms in black and Puerto Rican adolescent mothers in the first 3 years postpartum

While depressive symptoms in adolescent mothers may affect both their own and their babies' development, little research has focused on the mothers. Self-reported symptoms on the Beck Depression Inventory were collected at 1, 6, 12, and 28–36 months postpartum. Concurrent and reciprocal longitudinal relations among symptom levels, stressful life events, and social supports were investigated. Symptom levels declined over the four assessments, with changes in somatic, rather than cognitive affective, symptoms accounting for the decrease. Stressful life events and all sources of social supports predicted concurrent levels of depressive symptoms, but only social supports predicted declines in symptoms in the first year postpartum. Reciprocally, depressive symptoms tended (p = .06) to predict increases in stressful life events over time. Mothers were also categorized as reporting few (50%), intermittent (27.5%), or chronic (22.5%) symptoms in the first 12 months postpartum. Intermittently and chronically depressed mothers perceived their own mothers as less accepting than nondepressed mothers. Compared to nondepressed and intermittently depressed mothers, chronically depressed mothers also reported more stressful life events, were more likely to live alone, and experienced more moves by 28–36 months postpartum. The reciprocal causal relations among depressive symptoms, stress, and attachments to grandmothers and peers are discussed.

Early motherhood and subsequent life outcomes

BACKGROUND

Early motherhood has been linked with a number of adverse outcomes, including mental health difficulties and barriers to completing educational qualifications and workforce participation. The present study examined the extent to which these linkages could be explained by the influence of social, family, and background factors that were associated with early motherhood.

METHODS

Data were gathered as part of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children. Information was obtained on: (a) the history of pregnancy and parenthood for female participants over the period 15-21 years; (b) measures of DSM-IV mental disorders and suicidal behaviour over the interval 21-25 years; (c) measures of educational achievement over the interval 21-25 years; (d) measures of welfare dependence, workforce participation, and income over the interval 21-25 years; and (e) childhood, family and related confounding factors.

RESULTS

Early motherhood was associated with higher levels of mental health disorders, lower levels of educational achievement, higher levels of welfare dependence, lower levels of workforce participation, and lower income. Control for confounding factors reduced the associations between early motherhood and later mental health disorders to statistical non-significance. However, the associations between early motherhood and later educational achievement and economic circumstances persisted after control for potentially confounding factors.

CONCLUSIONS

The findings suggest that early motherhood puts young women at risk for educational underachievement and poorer economic circumstances. The linkages between early motherhood and later mental health difficulties can largely be accounted for by childhood, family, and related circumstances that occurred prior to parenthood.

Ecological analysis of teen birth rates: association with community income and income inequality

OBJECTIVES

To examine whether per capita income and income inequality are independently associated with teen birth rate in populous U.S. counties.

METHODS

This study used 1990 U.S. Census data and National Center for Health Statistics birth data. Income inequality was measured with the 90:10 ratio, a ratio of percent of cumulative income held by the richest and poorest population deciles. Linear regression and analysis of variance were used to assess associations between county-level average income, income inequality, and teen birth rates among counties with population greater than 100,000.

RESULTS

Among teens aged 15-17, income inequality and per capita income were independently associated with birth rate; the mean birth rate was 54 per 1,000 in counties with low income and high income inequality, and 19 per 1,000 in counties with high income and low inequality. Among older teens (aged 18-19) only per capita income was significantly associated with birth rate.

CONCLUSIONS

Although teen childbearing is the result of individual behaviors, these findings suggest that community-level factors such as income and income inequality may contribute significantly to differences in teen birth rates.

Developmental and food profiles of infants born to adolescent and adult mothers

OBJECTIVE

To compare developmental markers and dietary intake of infants born to lower socioeconomic adolescent and adult mothers.

DESIGN

Sixty-one adolescent (age 14-18 years) and 60 adult (age 22-28 years) mothers met inclusion criteria of comparable socioeconomic status, age range, urban/rural residence, and distribution of infants by gender.

SAMPLE/SETTING

Adolescent subjects were recruited in last trimester and adult mothers postpartum. Interviews were conducted when infants were about 6 and 12 months of age. Data included age of occurrence for eight markers, age at adding complementary foods, two 24-h dietary recalls, and two measurements of growth.

RESULTS

Adolescent mothers reported a significantly earlier age at which the infant "holds a spoon by self" and "drinks alone from a trainer cup." Six other markers were not significantly different between groups. Adolescent mothers fed cereal significantly earlier than did adult mothers, but there were no significant differences for fruit, vegetables, and meat. At 12 months, infants of adolescents had intakes of vitamin D and iron which were < 100% of recommended allowances, as did infants of adult mothers for vitamin D, iron, and zinc. Dietary fat was significantly higher at 6 and 12 months and vitamin C was lower at 12 months for infants of adolescents compared to the adult group.

CONCLUSIONS

Compared to adult mothers, adolescent mothers reported earlier mean ages for developmental markers related to self-feeding, and introduced cereal earlier. In each group, selected nutrient intakes decreased from recommended amounts in the 6-12-month period. Fat intakes were significantly different between groups at 6 and 12 months.

The effects of childhood sexual abuse on minority adolescent mothers

OBJECTIVE

To examine the incidence and effects of childhood sexual abuse experiences on the lives of adolescent mothers who were Mexican American and African American. Specifically, the personality characteristics of the adolescent mothers who experienced sexual abuse as assessed using the Millon Adolescent Personality Inventory were compared with those of minority adolescent mothers who were not abused sexually.

DESIGN

An exploratory descriptive design.

SETTING

Four public agencies caring for adolescent mothers in two urban centers in Texas.

PARTICIPANTS

Mexican American and African American adolescent mothers (N = 124), ages 13-20 years.

MAIN OUTCOME MEASURES

The Millon Personality Inventory, the Life Event Scale-Adolescents, the Childhood Sexual Experience Survey, and a demographic data sheet.

RESULTS

Forty-four percent (n = 54) of the respondents reported childhood sexual abuse experience. Data from 111 subjects (two groups, abuse and nonabuse) were analyzed by MANCOVA techniques. Significant differences were found between the two groups when the effect of the Life Event Scale-Adolescents was controlled (Multivariate F[12, 97] = 3.055, p = 0.001). Univariate F tests (df1, 108) showed significant differences in self-concept (F = 18.434, p < 0.000), personal esteem (F = 8.819, p = 0.004), body comfort (F = 10.442, p = 0.002), sexual acceptance (F = 9.918, p = 0.002), peer security (F = 10.412, p = 0.002), family rapport (F = 9.801, p = 0.002), academic confidence (F = 5.764, p = 0.018), social conformity (F = 4.552, p = 0.035), scholastic achievement (F = 19.991, p < 0.000), and attendance consistency (F = 10.009, p = 0.002). The mothers in the abuse group had consistently poorer scores than those in the nonabuse group.

CONCLUSIONS

These findings suggest that childhood sexual abuse may be related to vulnerability for adolescent motherhood.

Individual differences in risk of child abuse by adolescent mothers: assessment in the perinatal period

Abuse risk potential and parenting attitudes of 66 adolescent mothers were examined during the perinatal period using self-report instruments. Approximately one-half of the sample was considered to be at significant risk. Specific risk factors included distress, rigidity in parenting attitudes, and inappropriate expectations of children. Younger adolescents were at greater risk of abuse, advocated the use of physical punishment more strongly, and reported greater unhappiness than older adolescents. Teens reporting limited social support were also at greater risk for abuse. Low acceptance of the pregnancy was related to abuse potential for parenting, but not pregnant, adolescents. A history of maltreatment was related to self-reported problems with family members but not to overall risk. Implications for the prevention of abuse among adolescent mothers are discussed.

Early onset psychopathology and the risk for teenage pregnancy among clinically referred girls

OBJECTIVE

To investigate whether early onset DSM-III depressive and conduct disorders and historical/familial variables increased the risk of teenage pregnancy among clinically referred girls, whose referral was unrelated to their reproductive status.

METHOD

The sample of 83 girls, 8 to 13 years old at study entry, were participating in a longitudinal investigation of childhood-onset psychiatric disorders. They were repeatedly evaluated during an interval of up to 12 years.

RESULTS

Twenty-nine girls had at least one pregnancy, and 25 had their first pregnancies as teenagers (< or = 18 years old). Several variables that predicted earlier age at first pregnancy in longitudinal univariate analyses became nonsignificant in the multivariate model. In the final model, childhood or adolescent onset conduct disorders (but not depressive disorders), and race were significantly associated with teenage pregnancy. Among the girls with conduct disorders, 54.8% became pregnant teenagers versus 12% of the rest, and 56% of the black adolescents versus 12% of the rest, had teenage pregnancies.

CONCLUSIONS

After adjusting for race, early onset conduct disorder represents a risk factor for teenage pregnancy among psychiatrically referred girls. The mechanisms may entail behavioral dysregulation, delay in social-cognitive development, and misinformation about reproductive issues. Such girls may benefit from therapeutic and educational interventions to delay childbearing.

Predictors of nurturant parenting in teen mothers living in three generational families

Direct and indirect effects of grandparents on maternal nurturance in teen mothers (TM) living in three-generational families were explored with path analytic techniques in a sample of 107 working-class families. Perceived support from the teen's mother, grandparents' nurturance toward the baby, and the presence of the grandfather as a father figure in the home were hypothesized as increasing TM nurturance. TM nurturance was found to be positively predicted by grandparent nurturance and negatively predicted by TM perceived support from her mother. The strongest predictor of TM nurturance was grandfather nurturance toward the baby.

The long term benefits of a comprehensive teenage pregnancy program

A comprehensive program was founded in 1982 to provide adolescents with prenatal and family planning care. The program's impact through its first five years of operation on medical aspects of pregnancy course and fetal outcome will be the subject of a separate report. This study examines subsequent maternal and infant health of the patients attending the program compared to a control group. Four hundred ninety-eight adolescents and their newborns attending the program's mother-baby family planning clinic from 1982 to 1989 (subject group) were compared to ninety-one adolescents and their newborns receiving postpartum family planning and pediatrics clinics from 1980 through 1989 (control group). Seventy-five percent of the subject group regularly attended mother-baby clinic, compared to 18% of the control group attending family planning and pediatric clinics (P less than or equal to .0001). The subject group experienced less maternal and infant morbidity, greater school attendance, graduation, employment, and contraceptive use than the control group (P less than or equal to .0001). Many parameters improved with each program year indicating continued wide acceptance of our program by area adolescents.

Successful contraceptive behavior among adolescent mothers: are there predictors?

Of 43 adolescent mothers who had been enrolled in a specialized program of prenatal care, 20 reported no subsequent unplanned pregnancy for 2 years. Descriptive statistics were used to identify differences between these nonrepeaters and 23 repeaters. The locus-of-control framework provided the theoretical basis for the study. The two study groups and those lost to follow-up were similar in demographic characteristics. School attendance, contraceptive knowledge, use of contraception, locus of control, and maternal support did not effectively differentiate the two groups. Program activities, including attendance at prenatal groups and nurse/social worker visits, also did not explain recidivism. Implications of these findings for health care providers and for further research are discussed.

Child development knowledge, childrearing attitudes, and social support among first- and second-time adolescent mothers

This paper compares the parenting characteristics of first- and second-time adolescent mothers. Using a case control design, immediately after delivery and at two months postpartum we administered a pretested questionnaire to 51 second-time adolescent mothers, 47 first-time adolescent mothers, and 25 second-time adult mothers. The questionnaire measured the subject's social support system, contraceptive use, and education level. Scales measuring stressful life events, knowledge of child development, and childrearing attitudes were included. The adolescent groups were similar except that significantly more second-time adolescent mothers dropped out of school (p less than or equal to 0.05). Greater maternal education and higher infant five-minute Apgar scores were associated with less negative childrearing attitudes immediately after the birth (p less than or equal to 0.05). At two months postpartum, the age of the father and the time he spent with the child were associated with positive childrearing attitudes (p less than or equal to 0.05). Increased paternal involvement and completion of high school may enhance adolescent attitudes toward childrearing and improve mother-child relations.

Factors in the Resolution of Adolescent Premarital Pregnancies

This article examines the effect of family background factors on first premarital pregnancy resolution for adolescents in the United States. Teenage fertility constitutes a sizable percentage of total fertility, and each outcome has a potentially different type of family structure associated with it. Not only are there marked racial/ethnic differences in the ways such pregnancies are resolved, but the effects of family structure, age at first conception, family size, and working mother also differ between blacks, whites, and Hispanics. Parental education is a highly significant predictor for all groups: the higher the level of education, the less likely the pregnancy will be carried to term.

Maternal psychological state and infant development with mothers under twenty: a research note

Data were used from a longitudinal study of mothers under 20 and their firstborn children to investigate some factors possibly associated with the developmental progress of the children at 21 mths of age. Developmental progress was considered as a function of whether other adults lived with the mother and child, whether it was a dual parent household, maternal age, aspects of maternal psychological state, child gender and cooperation. Child gender and cooperation and the woman's satisfaction with motherhood were related to children's developmental progress. Possible reasons for the observed interrelationships are discussed.

Teenage mothers and their children: risks and problems: a review

Adolescent mothers and their offspring are a high risk group broth physically and emotionally. Poverty, malnutrition, complications of pregnancy, emotional problems such as depression, drug and alcohol use, are all risks for the mother. Children are also at greater risk for physical, cognitive and emotional problems. It is therefore important to identify factors which influence outcome on adolescent mothers and their children in order to suggest interventions which will more positively affect the physical and psychological health of this increasing population.

A comparison of young teenage, older teenage, and adult mothers on determinants of parenting

A nonrandom socioeconomically homogeneous convenience sample of 150 young adolescent mothers, 260 older adolescent mothers, and 242 older mothers was analyzed according to their standing on key determinants of parenting. The results of a discriminant analysis showed that the young teen mothers differed from the older mothers in terms of knowledge of child development, punitive attitudes toward childrearing, and level of depression. Accuracy of classification was improved with the discriminant function for younger and older mothers, but decreased by 20% for older adolescents.

Correlates of depression according to maternal age

A convenience sample of 654 low-income, primarily single, head-of-household mothers participated in a study of the correlates of maternal depression as measured by the Center for Epidemiologic Studies of Depression (CES-D). Across three age groupings, the CES-D was positively correlated with punitive attitudes toward childrearing, inaccurate knowledge of child development, and insufficient social support. Social support was the best predictor of depression from a set of seven potential sociodemographic and psychological predictors. Objective measures of parenting behavior obtained with the Home Observation for Measurement of the Environment were not associated with depression.

Improving the life-course development of socially disadvantaged mothers: a randomized trial of nurse home visitation

We evaluated a comprehensive program of prenatal and postpartum nurse home visitation for socially disadvantaged women bearing first children. Eighty-five per cent of the participating women were either teenagers (less than 19 years at registration), unmarried, or of low socioeconomic status. Women were randomly assigned to either nurse home visitation or comparison services (free transportation for prenatal and well-child care and/or sensory and developmental screening for the child). During the first four years after delivery of their first child, in contrast to their counterparts in the comparison group, nurse-visited White women who had not graduated from high school when they registered in the study returned to school more rapidly; nurse-visited, poor, unmarried White women showed an 82 per cent increase in the number of months they were employed, had 43 per cent fewer subsequent pregnancies, and postponed the birth of second children an average of 12 months longer.

Sensitivity to infant development and behavior: a comparison of adolescent and adult single mothers

The relationship of adolescent mothers' knowledge of infant development and perceptions of infant behavior to stress experienced during pregnancy were examined using a comparison group of adults of similar marital status. Relationships with maternal age across groups also were examined. Adolescents underestimated developmental rate and perceived some infant behaviors less optimally, but did not differ in levels of stress. Stress was related to several parenting subscores. Some support for a linear relationship with maternal age was found. Results suggest the need for further research to determine how level of maturity affects translation of knowledge into maternal action.