A review of the risks and consequences of adolescent pregnancy

Investigating time to first birth among women of reproductive age in Bangladesh: a survival analysis of nationwide cross-sectional survey data

BACKGROUND

The birth of the first child is an important turning point in a woman's life as it is the starting point of the demanding responsibilities of motherhood and childcare. This study aimed to explore the waiting time and the significant indicators of time to the first birth of aged 15-49 years of ever-married women in Bangladesh.

METHODS

The study considered the most recent country-representative data collected from Bangladesh Demographic and Health Survey (BDHS) in 2017/18. The log-rank test was used to assess the statistical significance of the observed difference between waiting time to first birth and various socio-economic and demographic factors. The Cox proportional hazard model is applied to identify the influential factors for waiting time to first birth.

RESULTS

About 55% of the respondents' age at their first birth was less than 18 years. More than 21% of them were 20 years and above at their first birth. Findings revealed a higher mean age at first birth in urban areas than in rural areas. Also, in Dhaka and Sylhet region, women have a higher age at first than in other regions of Bangladesh. Results show that the place of residence, region, age at first marriage, age at first sex, respondent's education, employment status, contraceptive use, and mass media exposure were found to be statistically significant determinants of the age of respondents at the time of first birth. Findings also show that a woman from rural areas was likely to be 5% smaller in age at the time of first birth than their counterpart (aHR 1.05; 95% CI 1.01-1.10). The age at first birth of a woman in Chattogram was 24% shorter, while in Rangpur and Barishal, that age was increased by 14% and 8%, respectively. A woman with no education, primary, and secondary education had 28%, 38%, and 29%, respectively, shorter age at first birth than that of the higher educated women. Mass media unexposed women were shorter aged at first birth by 27% (aHR 1.27; 95% CI 1.10-1.47) compared to the women who were mass media exposed.

CONCLUSION

It is necessary to increase the age of mothers at first birth which may help to reduce the prevalence of child marriage in Bangladesh. The study findings will be helpful to the policymakers in identifying the gap and designing the programmes targeting the early timing of first birth to reduce child mortality as well as poor maternal outcomes which will be beneficial for achieving the Sustainable Development Goal-3 in Bangladesh.

Adolescent pregnancy is associated with child undernutrition: Systematic review and meta-analysis

Adolescent pregnancy is associated with poor fetal growth and development which, in turn, increases the risk of childhood wasting and underweight. However, evidence on how young maternal age affects childhood anthropometry beyond the neonatal period is limited. This systematic review and meta-analysis examined associations between adolescent pregnancy and child wasting and underweight and explored potential underlying social and biological factors. Peer-reviewed literature published in English since 1990 was systematically searched. Eligible studies presented data on wasting and/or underweight in children (≤59 months) born to adolescent mothers (10-19, or ≤24 years where applicable) from low- and middle-income countries. Data extraction used a predefined extraction sheet. Both meta-analysis and qualitative synthesis were performed. Of 92 identified studies, 57 were included in the meta-analysis. The meta-analysis showed that children born to adolescent versus adult mothers were at a higher risk of moderate (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.00-1.26 p = 0.04) and severe underweight (OR: 1.21, 95% CI: 1.08-1.35 p < 0.01). Associated risk of wasting was not statistically significant: (OR: 1.05, 95% CI: 0.98-1.12 p = 0.17); severe wasting (OR: 1.16, 95% CI: 0.68-1.96 p = 0.59). These findings were supported by the qualitative synthesis. Evidence on the potential role of biological/social factors was limited, but suggested an intermediary role of maternal nutritional status which warrants further exploration. Particularly in contexts where adolescent pregnancy remains common, interventions to both delay adolescent pregnancy and improve adolescent nutritional status could help reduce the risk of undernutrition in children and contribute to breaking the intergenerational cycle of malnutrition.

Development of pregnancy class with husband's assistance on the outcome of teenage pregnancy

Background

Teenage pregnancy is an international phenomenon without a definite solution to date. Globally, an estimated 16 million girls aged 15-19 give birth each year. Husbands need to play their assistance role in order to thwart the negative impact of the outcome of teenage pregnancy.

Research objective

To identify the effect of the development of Pregnancy Classes with the Husband's Assistance on the Outcome of Teenage Pregnancy in the Dayak community, Central Kalimantan.

Research methods

This was a quasi-experimental study with the posttest-only non-equivalent control group design involving the husband's assistance in pregnancy classes. The respondents were 60 individuals where 30 of them were given the pregnancy class assistance intervention while the other 30 were not given any intervention (control group).

Results and discussion

Pregnancy class with Assistance by the husband increases positive pregnancy outcomes 2.4 times compared to without the husband's assistance. Family support increases positive pregnancy outcomes 2.5 times compared to pregnant women without support from the family. Pregnant women that are highly motivated regarding antenatal care are likely to have positive pregnancy outcomes 5.4 times greater than pregnant women with low motivation. Based on the analysis, then the variables that have no effect are the history of antenatal care, frequency of antenatal care, and support from health workers.

Conclusions

Pregnancy class with husband's assistance affects positive outcomes of teenage pregnancy. Other factors with meaningful influence on pregnancy outcomes include family support and motivation to seek teenage antenatal care. Furthermore, other factors that have no influence include the teenager's age, history of antenatal care, frequency of antenatal care, and support from health workers. An intervention is needed that involves the husband/partner in the form of active assistance.

Reviewing Publicly Available Reports on Child Health Disparities in Indigenous and Remote Communities of Australia

Developing programs that ensure a safe start to life for Indigenous children can lead to better health outcomes. To create effective strategies, governments must have accurate and up-to-date information. Accordingly, we reviewed the health disparities of Australian children in Indigenous and remote communities using publicly available reports. A thorough search was performed on Australian government and other organisational websites (including the Australian Bureau of Statistics [ABS] and the Australian Institute of Health and Welfare [AIHW]), electronic databases [MEDLINE] and grey literature sites for articles, documents and project reports related to Indigenous child health outcomes. The study showed Indigenous dwellings had higher rates of crowding when compared to non-Indigenous dwellings. Smoking during pregnancy, teenage motherhood, low birth weight and infant and child mortality were higher among Indigenous and remote communities. Childhood obesity (including central obesity) and inadequate fruit consumption rates were also higher in Indigenous children, but Indigenous children from remote and very remote areas had a lower rate of obesity. Indigenous children performed better in physical activity compared to non-Indigenous children. No difference was observed in vegetable consumption rates, substance-use disorders or mental health conditions between Indigenous and non-Indigenous children. Future interventions for Indigenous children should focus on modifiable risk factors, including unhealthy housing, perinatal adverse health outcomes, childhood obesity, poor dietary intake, physical inactivity and sedentary behaviours.

Exploring ambivalence toward pregnancy among young Inuit women

Ambivalence toward pregnancy is an important predictor of early pregnancy as documented in diverse Western societies. Inuit women from Nunavik, a northern region of Quebec, Canada, experience a high rate of early pregnancy, yet no study has explored their attitudes toward pregnancy. Grounded in a participatory approach, this study aimed to explore ambivalence toward pregnancy, among other pregnancy-related attitudes, and identify themes underlying ambivalence among young Inuit women from Nunavik. We conducted semi-structured interviews with 15 women aged 16 to 20 years, who became pregnant during the year preceding the interview. We used an inductive approach to analyse the data. Eleven participants were identified as ambivalent toward pregnancy while three were characterised as having a favourable attitude, and one as unfavourable. Four themes related to ambivalence were identified: the value of childbearing/motherhood; the use of contraceptives; the likelihood of becoming pregnant; and the ideal age to become pregnant. A better understanding of young women's attitudes toward pregnancy could contribute to the development of culturally relevant programmes to more effectively support adolescents, pregnant adolescents and young mothers, and to lead to better care.

Adolescent pregnancy: An important issue for paediatricians and primary care providers-A position paper from the European academy of paediatrics

Adolescent pregnancy and childbearing, remain a widespread health-related problem with potential short and long-term consequences. Comprehensive social, economic, environmental, structural, and cultural factors heavily impact on adolescents' sexual and reproductive health and early pregnancy. Health professionals can play a pivotal role in the prevention of unplanned pregnancy. Improved access to family planning, sexuality education in schools, community-based interventions, and policies contribute greatly to reduce the risk of adolescent pregnancy and the adoption of respectful and responsible sexual behaviour. Additionally, health care professionals can support pregnant adolescents in making decisions under these circumstances and provide adequate health care. This review highlights actions that can guide healthcare professionals in empowering young adolescents to become more aware and capable of making informed decisions about their sexual life, health, and future.

Adolescent Pregnancy in South Asia: A Systematic Review of Observational Studies

Adolescent pregnancy is a major health and social concern in South Asia. The aim of this study is to systematically review evidence on the factors associated with adolescent pregnancy in South Asia. This study was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Four electronic databases: EMBASE, PubMed, CINAHL, and Scopus were searched for relevant studies on factors associated with adolescent pregnancy in South Asia published in English between January 2000 and July 2022. The quality of the included studies was assessed using 12 criteria from The National Institute of Health (NIH) Study Quality Assessment Tools for observational studies. Of the 166 articles retrieved, only 15 studies met the eligibility criteria and were included in the final analysis. Consistent factors associated with adolescent pregnancy in South Asia were low maternal education, low socioeconomic status, rural residency, and ethnic minorities. To prevent adolescent pregnancy in South Asia, concerted effort towards promoting health equity by addressing the predisposing factors associated with adolescent pregnancy is essential. This systematic review was registered with PROSPERO [CRD42022340344].

Severe Adverse Maternal and Neonatal Outcomes in Adolescent Mother-Newborn Dyads: A Multicentre Study in Latin America

OBJECTIVES

To compare the risk of severe adverse maternal outcomes (SMO) and neonatal outcomes (SNO) and analyse their maternal correlates in adolescent mother-newborn and young mother-newborn dyads in secondary and tertiary care users in Latin America.

METHODS

We performed a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health database in 83 secondary and tertiary hospitals in seven countries in Latin America. We constructed a composite indicator of both SMO and SNO and estimated odds ratios (OR) comparing adolescent mothers (aged 12-19) with young mothers (aged 20-24). Our unit of analysis was the mother-newborn dyad.

RESULTS

We found that the combination of SMO and SNO was three times more likely in adolescent mother as compared to young mother dyads (OR 3.56; 95% CI 1.67-7.59). SNO either alone or in combination with SMO were more likely in adolescents aged 12 to 16 than in young women (OR 1.27 and 4.87, respectively).

CONCLUSIONS FOR PRACTICE

Adolescent mothers and their newborns are at an increased risk of severe adverse outcomes during child birth and in the first week postpartum compared to young mother dyads, especially young adolescents. Focusing on the dyad as a whole may facilitate a step towards integrated care which maximizes the health benefits of both mother and newborn. Continued efforts are needed to improve health care and prevention initiatives directed towards adolescent women and their newborns in Latin America.

Shedding light on attitudes towards pregnancy among Inuit adolescents from Nunavik

Better understanding attitudes toward pregnancy – a potent predictor of adolescent pregnancy – could help explain the high adolescent pregnancy rate in Nunavik, Canada. The objective of this study was to assess the distribution of different attitudes toward pregnancy and the factors associated with high pregnancy likelihood attitudes (HPLA; favourable, indifferent, and ambivalent), focusing on the perceived benefits of childbearing (BOC). T-tests, chi-square tests, and logistics regressions were performed based the answers of 159 Inuit women aged 16 to 20 years from the Qanuilirpitaa? survey. About 43% were ambivalent, 16% favourable, 5% indifferent, and 35% unfavourable toward pregnancy. Bivariate analysis indicate that the HPLA group was more likely to work, to report less frequent positive interactions, and to show a higher BOC score compared to others. Multivariate analysis show that an increased BOC score was associated with HPLA (OR = 1.09, 95% CI = 1.01 − 1.18). Perceiving that a baby would strengthen the relationship with the other parent (OR = 1.65, 95% CI = 1.15 − 2.37) and that it would help to access housing were individually associated with HPLA (OR = 1.45, 95% CI = 1.02 − 2.10). Findings provide evidence to support Inuit adolescents’ reproductive choices.

Equity in antenatal care visits among adolescent mothers: An analysis of 54 country levels trend and projection of coverage from 2000 to 2030

Background

Ensuring utilization of antenatal care (ANC) services by adolescent mothers (ages 10-19) is an enormous challenge in low-and middle-income countries (LMICs). This study provides the first comprehensive analysis of ANC visits among adolescent and adult mothers.

Methods

Using all available Demographic and Health Survey and Multiple Indicator Cluster Surveys between 2000 and 2019 in 54 LMICs, we estimated proportion of ANC visits among women. Bayesian hierarchical regression models were used to estimate trend, projection, and determinants of single and four ANC visits (ANC1 and ANC4) independently. Equity analysis were performed to assess the magnitude of wealth-based and urban-rural inequalities in access to ANC visits.

Results

Compared to women aged 36-49 years, coverage of ANC1 and ANC4 are expected to increase significantly for adolescent mothers and women aged 20-35 years. This increase was observed at the national level, as well as both urban and rural areas in most countries between 2000 and 2030. By 2030, the coverage of ANC1 is predicted to reach 80% or more in all countries except Angola, Central African Republic and Togo, whereas only 16 countries are predicted to reach 80% or more for ANC4. According to wealth quintile, the lowest inequalities with highest coverage of 80% or more ANC4 will be observed in Armenia, Cambodia, Dominican Republic, Ghana, Maldives, Indonesia, and Sao Tome and Principe in 2030. Determinant analysis found increased odds of receiving ANC visits during pregnancy for adolescent mothers with higher educational levels, frequency of listening/watching mass media, and various household socio-economic status factors.

Conclusions

This study calls for advanced, innovative and cost-effective approaches to increase ANC coverage among adolescent mothers, particularly in rural areas and/or in low socioeconomic groups.

Efficacy and Safety of Ferrous Bisglycinate and Folinic Acid in the Control of Iron Deficiency in Pregnant Women: A Randomized, Controlled Trial

Iron deficiency in pregnancy is a major public health problem that causes maternal complications. The objective of this randomized, controlled trial was to examine the bioavailability, efficacy, and safety of oral ferrous bisglycinate plus folinic acid supplementation in pregnant women with iron deficiency. Subjects (12−16 weeks of gestation, n = 120) were randomly allocated to receive oral iron as ferrous bisglycinate (equiv. iron 24 mg) in supplement form with folinic acid and multivitamins (test group, n = 60) or as ferrous fumarate (equiv. iron 66 mg iron, control group, n = 60) after breakfast daily. Iron absorption was assessed by measuring fasted serum iron levels at 1 and 2 h immediately after supplementation. Hematological biomarkers and iron status were assessed before intervention, and at 3 and 6 months. Side effects were monitored throughout the intervention. A significant increase in serum iron was seen in both groups (p < 0.001) during the bioavailability assessment; however, the test group increases were comparatively higher than the control values at each timepoint (p < 0.001). Similarly, both test and control groups demonstrated a statistically significant increases in hemoglobin (Hb) (p < 0.001), erythrocytes (p < 0.001), reticulocytes (p < 0.001), mean corpuscular volume (MCV) (p < 0.001), mean corpuscular hemoglobin (MCH) (p < 0.001), mean corpuscular hemoglobin concentration (MCHC) (p < 0.001), % transferrin saturation (p < 0.001), and ferritin (p < 0.001) at 3 and 6 months after supplementation. However, in all cases, the test group increases were numerically larger than the control group increases at each timepoint. The test intervention was also associated with significantly fewer reports of nausea, abdominal pain, bloating, constipation, or metallic taste (p < 0.001). In conclusion, ferrous bisglycinate with folinic acid as a multivitamin nutraceutical format is comparable to standard ferrous fumarate for the clinical management of iron deficiency during pregnancy, with comparatively better absorption, tolerability, and efficacy and with a lower elemental iron dosage.

Social Determinants of Health and Adverse Outcomes in Adolescent Pregnancies

The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.

Uncontrolled hypertension among tobacco-users: women of prime childbearing age at risk in India

BACKGROUND

Uncontrolled hypertension and tobacco use are two major public health issues that have implications for reproductive outcomes. This paper examines the association between tobacco-use status and uncontrolled hypertension among prime childbearing age (20-35) women in India.

METHODS

We used the India National Family Health Survey (NFHS-4) 2015-2016 to obtain data on hypertension status and tobacco use for 356,853 women aged 20-35. We estimated multivariate logistic regressions to obtain the adjusted odds ratio for tobacco users in favor of having uncontrolled hypertension. We examined the adjusted odds at different wealth index quintiles, at different educational attainment, and at different level of nutritional status measured by body mass index.

RESULTS

We found that the odds of having uncontrolled hypertension for the tobacco user women in India was 1.1 (95% CI: 1.01-1.19) times that of tobacco non-users at prime childbearing age. The odds were higher for tobacco-users at the poorest quintile (1.27, 95% CI: 1.14-1.42) and with no education (1.22, 95% CI: 1.10-1.34). The odds were also higher for tobacco-users who were overweight (1.88, 95% CI: 1.57-2.29) or obese (2.82, 95% CI: 1.88-4.24).

CONCLUSIONS

Our findings highlight the disproportionate dual risk of uncontrolled hypertension and tobacco use among lower-income women of prime childbearing age, identifying an opportunity for coordinated tobacco control and hypertension prevention initiatives to ensure better health of reproductive-age women in India.

Suicide risk and prematurity: A study with pregnant adolescents

OBJECTIVE

To verify the association between mood and anxiety disorders, and suicide risk during pregnancy and their relationship with premature birth in a population of pregnant adolescents attending prenatal care in the public health system of Pelotas, a southern city in Brazil.

METHODS

This was a cohort study with all pregnant adolescents attending antenatal public services in the urban area of Pelotas between October 2009 and May 2011. The first assessment occurred between the 20th and 22 nd week of pregnancy and the second occurred one month after delivery. We used the Mini International Neuropsychiatric Interview (MINI) to assess mood and anxiety disorders and suicide risk.

RESULTS

A total of 645 pregnant women aged between 12 and 19 years old were interviewed. An anxiety disorder was present in 9.1% of the pregnant adolescent, and 28.5% had a mood disorder. The prevalence of suicide risk was 12.6%, and 15.3% of the babies were born premature. A multivariate analysis adjusted for maternal education, number of previous pregnancies and previous preterm birth indicated that adolescents who had suicide risk during pregnancy were approximately twice as likely to give birth prematurely when compared to those who were not diagnosed with suicide risk (PR 1.79; CI 1.06-3.03).

CONCLUSION

Our findings suggest that pregnant adolescents who were at risk of suicide during pregnancy were more likely to have premature babies. It is important to pay attention to the mental health of this specific population to prevent obstetric complications and consequently improve the health of the children.

The association of maternal age with adverse neonatal outcomes in Lusaka, Zambia: a prospective cohort study

Background

Pregnancy among adolescents, whether intended or not, is a public health concern as it is generally considered high risk for both mothers and their newborns. In Zambia, where many women engage in early sexual behaviour or marry at a young age, 28.5% of girls aged 15–19 years were pregnant with their first child in the year 2013–2014. This study sought to explore associations between maternal age and neonatal outcomes among pregnant women in Lusaka, Zambia.

Methods

This was a secondary analysis of data nested within a larger population-based prospective cohort study which was implemented in three government health facilities-two first level hospitals and one clinic in Lusaka, Zambia. Women presenting to the study sites for antenatal care were enrolled into the study and followed up for collection of maternal and neonatal outcomes at 7, 28 and 42 days postpartum. The study’s primary outcomes were the incidence of maternal and newborn complications and factors associated with adverse neonatal outcomes. Statistical significance was evaluated at a significance level of P < 0.05.

Results

The study included 11,501 women, 15.6% of whom were adolescents aged 10–19 years. Generally, adolescence did not have statistically significant associations with poor maternal health outcomes. However, the risk of experiencing obstructed labour, premature rupture of membranes and postpartum hemorrhage was higher among adolescents than women aged 20–24 years while the risk of severe infection was lower and non-significant. Adolescents also had 1.36 times the odds of having a low birthweight baby (95% CI 1.12, 1.66) and were at risk of preterm birth (aOR = 1.40, 95% CI 1.06, 1.84). Their newborns were in need of bag and mask resuscitation at birth (aOR = 0.62, 95% CI 0.41, 0.93). Advanced maternal age was significantly associated with increased odds of hypertension/ pre-eclampsia (95% CI 1.54, 5.89) and preterm labour (aOR = 2.78, 95% CI 1.24, 6.21).

Conclusions

Adolescence is a risk factor for selected pregnancy outcomes in urban health facilities in Lusaka, Zambia. Health care workers should intensify the provision of targeted services to improve neonatal health outcomes.

Trial registration

Clinical trial number and URL: NCT03923023 (Retrospectively registered). Clinical trial registration date: April 22, 2019.

Inequality in fertility rate among adolescents: evidence from Timor-Leste demographic and health surveys 2009-2016

Background

Despite a decline in global adolescent birth rate, many countries in South East Asia still experience a slower pace decline in adolescent birth rates. Timor-Leste is one of the countries in the region with the highest adolescent birth rate and huge disparities between socio-economic subgroups. Hence, this study assessed the magnitude and trends in adolescent fertility rates within different socio-demographic subgroups in Timor-Leste.

Methods

Using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Timor-Leste Demographic and Health surveys (TLDHS) were analyzed between 2009 and 2016. We approached the inequality analysis in two steps. First, we disaggregated adolescent fertility rates by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio and Population Attributable Fraction. A 95% confidence interval was constructed for point estimates to measure statistical significance.

Results

We found large socio-economic and area-based inequalities over the last 7 years. Adolescent girls who were poor (Population Attributable Fraction: -54.87, 95% CI; − 57.73, − 52.02; Population Attributable Risk: -24.25, 95% CI; − 25.51, − 22.99), uneducated (Difference: 58.69, 95% CI; 31.19, 86.18; Population Attributable Fraction: -25.83, 95% CI; − 26.93, − 24.74), from rural areas (Ratio: 2.76, 95% CI; 1.91, 3.60; Population Attributable Risk: -23.10, 95% CI; − 24.12, − 22.09) and from the Oecussi region (Population Attributable Fraction: -53.37, 95% CI; − 56.07, − 50.67; Difference: 60.49, 95% CI; 29.57, 91.41) had higher chance of having more births than those who were rich, educated, urban residents and from the Dili region, respectively.

Conclusions

This study identified disproportionately higher burden of teenage birth among disadvantaged adolescents who are, poor, uneducated, rural residents and those living in regions such as Oecussi, Liquica and Manufahi, respectively. Policymakers should work to prevent child marriage and early fertility to ensure continuous education, reproductive health care and livelihood opportunities for adolescent girls. Specialized interventions should also be drawn to the subpopulation that had disproportionately higher adolescent childbirth.

Social networking sites: Can midwives and nurses working with adolescent mothers harness their potential value?

AIM

This paper aims to discuss social networking sites as potentially salutogenic, culturally relevant extensions to maternity care provision for adolescent mothers.

BACKGROUND

Studies report that online networking may enhance social capital, a concept linked to enhanced well-being, particularly for marginalized individuals. Improving outcomes for adolescent mothers is an ongoing global strategy; thus, this paper has relevance for all professionals involved in their care.

DESIGN

This is a discussion paper.

DATA SOURCES

This paper draws on the authors' research and is supported by literature and theory. Key terms and Boolean operators were used to identifiy English-language papers published in January 1995 to January 2019 in nine databases and Google Scholar databases.

IMPLICATIONS FOR NURSING

Despite limited evidence specific to adolescent mothers, contextual studies suggest that social networking sites may enhance well-being. Nurses and midwives need to understand adolescent mothers' use of online networks to aid development of innovative, health-enhancing care strategies using adolescent-familiar modalities.

CONCLUSION

This paper highlights the need for further research regarding the value of professional engagement in online networks to enhance an adolescent's transition to motherhood.

Maternal risk factors for birth asphyxia in low-resource communities. A systematic review of the literature

Birth asphyxia (BA) affects millions of newborns annually, especially in low-resource communities. Given that much of the attention to this point has focussed upon secondary prevention, we sought to inform the development of primary prevention strategies for BA in resource-limited settings by identifying maternal risk factors. To this end, we systematically reviewed the MEDLINE, PsychInfo, and EMBASE databases, and identified 38 relevant studies. Upon analysis, we found 12 maternal variables associated with BA, and thematically arranged them into 3 categories: sociodemographic factors (age, literacy, gravidity, parity), health care factors (antenatal care, delivery location), and health status (hypertension, pre-eclampsia, eclampsia, anaemia, antepartum haemorrhage, pyrexia). The factors with the greatest, and/or most consistent influence upon likelihood for BA were: young maternal age (<20 years), limited maternal literacy, insufficient antenatal care, non-hospital delivery, maternal hypertension, and anaemia. We hope our review will assist stakeholders guiding the development of BA-related policies and programmes.

Postpartum depression among women with pre-eclampsia and eclampsia in Tanzania; a call for integrative intervention

BACKGROUND

Postpartum depression (PPD) complicates maternal wellbeing, maternal-infant bonding, and cognitive function in children and woman's relationship with her partner. Clinical observations suggest a higher risk of postpartum depression among those women with pre-eclampsia and eclampsia compared to the general population. However, the evidence is inconsistent and not from settings similar to Tanzanian. This study aimed to determine the magnitude and risk factors for PPD among women diagnosed with pre-eclampsia or eclampsia at Muhimbili National Hospital (MNH), Tanzania.

METHODS

This cross-sectional study was conducted among 390 women who had pre-eclampsia or eclampsia during pregnancy attending postnatal care clinic at MNH. PPD was assessed using Edinburg postnatal depression scoring scale (EPDS). Face to face interviews was conducted and data was analysed using descriptive and logistic regression analysis to address the two respective objectives.

RESULTS

PPD was prevalent among 20.5% of women who had pre-eclampsia or eclampsia but varied with severity. Factors associated with PPD included young age (AOR = 10.13 95% CI 1.99-52.02), being a single mother (AOR = 3.18 95% CI 1.02-9.95), having a lower level of education (AOR = 3.83 95% CI 1.45-10.16), having a perinatal death (AOR = 5.14 95% CI 2.53-10.45), lack of family support (AOR = 7.06 95% CI 1.25-39.90), and experience of stressful event during pregnancy (AOR = 15.14 95% CI 2.38-96.19).

CONCLUSION

One in five women with pre-eclampsia or eclampsia had PPD and the magnitude increased with the severity of the disease condition. To address PPD, efforts should be done to screen and provide treatment to pregnant women presenting with pre-eclampsia or eclampsia, especially those with young age, low education level, single marital status, perinatal loss, lack of family support, and those reported to have a stressful event during pregnancy.

Trends in sociodemographic and health care factors in Portuguese and non-Portuguese mothers giving birth in Portugal, 1995-2014

BACKGROUND

Time-trend disparity in adverse pregnancy outcomes according to maternal nationality or immigration status has been well documented. In this study, we investigated time changes in individual-level risk factors for adverse pregnancy outcomes that have not been given the needed attention.

OBJECTIVE

To compare 20-year trends in sociodemographic, obstetric, health care factors, and adverse pregnancy outcomes in Portuguese and non-Portuguese women.

METHODS

We studied 2 105 497 livebirths from Portuguese national birth registry (1995-2014). We compared maternal sociodemographic characteristics (age, education, employment, and marital status), obstetric, and health care factors (parity, number of foetuses, place and type of delivery) in Portuguese and non-Portuguese at four periods (1995-1999, 2000-2004, 2005-09, and 2010-2014). Time-trend analysis using joinpoint regression method was performed to identify trends (joinpoints) and compare time changes in the prevalence of sociodemographic, obstetric, and health care factors expressed as annual percentage change (APC).

RESULTS

The proportion of livebirths in non-Portuguese mothers increased between 1995 and 1999 (2.9%), 2000-2004 (6.3%), 2005-2009 (9.5%), and 2010-2014 (9.8%). The proportion of women aged ≥ 35 years among Portuguese mothers varied from 11.1% (1995-1999), 14.4% (2000-2004), 18.6% (2005-2009) to 25.5% (2010-2014); among non-Portuguese women, the corresponding proportions were 15.7% (1995-1999), 14.6% (2000-2004), 16.1% (2005-2009), and 19.0% (2010-2014), respectively. The rate of change in maternal age ≥ 35 years had 2 joinpoints in both Portuguese (APC = 6.5%, 95% confidence interval [CI] 6.2, 6.9; 2005-2014) and non-Portuguese (3.3%, 95% CI 2.5, 4.0; 2002-2014). Increase in caesarean rate was higher for non-Portuguese (24.0%-36.1%) than the Portuguese (30.6%-31.6%) between 1995 and 2014.

CONCLUSIONS

Sociodemographic, obstetric, and health care factors have divergent time trends and rate of change for Portuguese and non-Portuguese.

A survival analysis of the timing of onset of childbearing among young females in Nigeria: are predictors the same across regions?

Background

Early childbearing comes at high health costs to girls, the children they bear, their future life chances and the larger society. Nationally representative data suggest variation in onset of childbearing across regions and states of the country. Yet, there is need for strong evidence on how background characteristics explain time to first birth among young females across regions in Nigeria.

Methods

We analysed the 2013 DHS dataset using Kaplan Meier and Cox Regression. The outcome variable is age at onset of childbearing with location (rural/urban), education, religion, wealth index, region and having ever married/cohabited as covariates. Models were computed for national level analysis and the six regions of the country.

Results

The effect of marriage/cohabitation on time to first birth is strong and universal across the regions. Ever married girls had higher adjusted hazard ratios for starting childbearing than single girls, ranging from 5.35 in the South South to 44.62 in the North West (p < 0.001 in all models). Education also has significant effect on time to first birth across regions. The significance of state of residence, wealth, and religion varies across regions.

Conclusion

We conclude that the combinations of factors that explain onset of childbearing vary across regions. Therefore, context specific factors should be considered in program designs aimed at achieving a significant reduction in early childbearing and similar problems in Nigeria.

Risk Factors for Preeclampsia in a High-Risk Cohort of Women Served by a Nursing-based Home Visiting Program

This descriptive study aimed to identify the impact of psychosocial risk factors on pregnancy outcomes for high risk women in an urban setting. Women in this category tend to experience adverse pregnancy outcomes, like preeclampsia, at greater rates than low or medium risk women. A retrospective paper chart review of East Harlem women served by LSA Family Health Service (LSA) Maternal Outreach Program (MOP) was conducted. All women who enrolled in the MOP with a singleton pregnancy from January 2015 to December 2017, were eligible for inclusion in our analyses. Data were analyzed using SPSS (version 23). Of 379 total participants, 68.6% (n=203) were Hispanic/Latina women, 44.8% (n=163) were English only speakers, 67.4% (n=226) were identified as overweight/obese, 90.6% (n=328) were mothers over the age of 20 among those for whom data were available. Sixty-two percent (n=235) initiated prenatal care in their first trimester, and 71.5% (n=271) were referred to the MOP by a hospital or other healthcare provider. The percentage of preeclampsia among mothers was 26.9% (n=102). After adjustment for type of LSA services received, and race/ethnicity, there were no associations between psychosocial risk factors and preeclampsia diagnosis in this population. Further research is needed on the relationship between psychosocial risk factors and preeclampsia to identify potential areas of intervention and reduce the burden of disease.

Public Perception of Female Fertility: Initial Fertility, Peak Fertility, and Age-Related Infertility Among U.S. Adults

Perceptions of fertility are thought to impact reproductive behaviors, yet little is known about how lay people conceptualize the female fertility timeline. In this research, public perception of the female fertility timeline was assessed via a national survey of U.S. adults (N = 990) ranging in age from 18 to 89 years. Although there is no scientific consensus on the makeup of the female fertility timeline, results from this research indicate that the U.S. public posits fertility onset at (approximately) 13 years, peak fertility at 22, ideal first pregnancy age at 23, too late for pregnancy at 46, and infertility at 49. Regression analysis revealed that perceived peak fertility and ideal pregnancy age were positively correlated such that participants perceived the ideal pregnancy age as directly following peak fertility. Education was significantly related to fertility perceptions; those with more education perceived initial fertility to be lower and peak fertility and ideal pregnancy age to be higher. In other words, more highly educated individuals perceived fertility to manifest over a longer period of time as compared to individuals with less education. Black and Hispanic participants and participants with lower income perceived ideal first pregnancy age as significantly lower than did White participants and participants with higher income. These differences may suggest that the seeds of health disparities associated with phenomena such as adolescent pregnancy are lurking in fertility timeline perceptions.

Identification and Treatment of Adolescents With Perinatal Anxiety and Depression

Perinatal mood and anxiety disorders (PMAD) are the most common, yet under-diagnosed and undertreated complication of pregnancy, affecting up to 50% of pregnant and parenting teens. PMAD are a global health issue that can have devastating effects on the mental, physical, emotional, developmental health, and social life of the mother, infant, and family. Adolescents present with similar symptoms of PMAD as their adult counterparts, but also experience isolation from their peer group and lack of resources and coping strategies, as well as difficulty sleeping and lack of concentration and ability to focus. Nurses and nurse practitioners are in an ideal position to assess preexisting risk factors for PMAD. The current applied evidence-based article addresses the diagnosis of PMAD, provides a conceptual framework for understanding the intra- and interpersonal dynamics affecting teens with PMAD, and suggests a new screening tool to guide diagnosis. An easy to recall mnemonic for diagnosis and referral (SAIL AHEAD) is proposed. By using the SAIL AHEAD mnemonic, providers will impact adolescents' parenting success and resiliency, thereby enhancing their future success in life. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 23-29.].

Adolescent pregnancy: Maternal and fetal outcomes in patients with and without preeclampsia

OBJECTIVE

To determine the prevalence of preeclampsia (PE) in adolescents and to evaluate its association with risk factors for, and the occurrence of, adverse maternal and fetal outcomes.

RESULTS

Of 3006 deliveries, 533 (17.7%) were from teenage mothers, with twenty-eight (5.3%) presenting PE; 17.8% of these cases were classed as severe. Vitamin and mineral supplementation was associated with the occurrence of PE (p=0.034). Puerperal complications and prematurity were more frequent in the PE group.

CONCLUSIONS

Prevalence of PE among adolescents was similar to the literature data and was associated with high rates of preterm birth and puerperal complications.

Long-acting reversible contraception in adolescents: a systematic review and meta-analysis

BACKGROUND

Among adolescent pregnancies, 75% are unintended. Greater use of highly-effective contraception can reduce unintended pregnancy. Although multiple studies discuss adolescent contraceptive use, there is no consensus regarding the use of long-acting reversible contraception as a first-line contraception option.

OBJECTIVE

We performed a systematic review of the medical literature to assess the continuation of long-acting reversible contraceptives among adolescents.

STUDY DESIGN

Ovid-MEDLINE, Cochrane databases, and Embase databases were searched using key words relevant to the provision of long-acting contraception to adolescents. Articles published from January 2002 through August 2016 were selected for inclusion based on specific key word searches and detailed review of bibliographies. For inclusion, articles must have provided data on method continuation, effectiveness, or satisfaction of at least 1 long-acting reversible contraceptive method in participants <25 years of age. Duration of follow-up had to be ≥6 months. Long-acting reversible contraceptive methods included intrauterine devices and the etonogestrel implant. Only studies in the English language were included. Guidelines, systematic reviews, and clinical reviews were examined for additional citations and relevant points for discussion. Of 1677 articles initially identified, 90 were selected for full review. Of these, 12 articles met criteria for inclusion. All studies selected for full review were extracted by multiple reviewers; inclusion was determined by consensus among authors. For studies with similar outcomes, forest plots of combined effect estimates were created using the random effects model. The meta-analysis of observational studies in epidemiology guidelines were followed. Primary outcomes measured were continuation of method at 12 months, and expulsion rates for intrauterine devices.

RESULTS

This review included 12 studies, including 6 retrospective cohort studies, 5 prospective observational studies, and 1 randomized controlled trial. The 12 studies included 4886 women age <25 years: 4131 intrauterine device users and 755 implant users. The 12-month continuation of any long-acting reversible contraceptive device was 84.0% (95% confidence interval, 79.0-89.0%). Intrauterine device continuation was 74.0% (95% confidence interval, 61.0-87.0%) and implant continuation was 84% (95% confidence interval, 77.0-91.0%). Among postpartum adolescents, the 12-month long-acting reversible contraceptive continuation rate was 84.0% (95% confidence interval, 71.0-97.0%). The pooled intrauterine device expulsion rate was 8.0% (95% confidence interval, 4.0-11.0%).

CONCLUSION

Adolescents and young women have high 12-month continuation of long-acting reversible contraceptive methods. Intrauterine devices and implants should be offered to all adolescents as first-line contraceptive options.

Depressive symptoms and gestational length among pregnant adolescents: Cluster randomized control trial of CenteringPregnancy® plus group prenatal care

OBJECTIVES

Depressive symptoms are associated with preterm birth among adults. Pregnant adolescents have high rates of depressive symptoms and low rates of treatment; however, few interventions have targeted this vulnerable group. Objectives are to: (a) examine impact of CenteringPregnancy® Plus group prenatal care on perinatal depressive symptoms compared to individual prenatal care; and (b) determine effects of depressive symptoms on gestational age and preterm birth among pregnant adolescents.

METHOD

This cluster-randomized controlled trial was conducted in 14 community health centers and hospitals in New York City. Clinical sites were randomized to receive standard individual prenatal care (n = 7) or CenteringPregnancy® Plus group prenatal care (n = 7). Pregnant adolescents (ages 14-21, N = 1,135) completed the Center for Epidemiologic Studies Depression Scale during pregnancy (second and third trimesters) and postpartum (6 and 12 months). Gestational age was obtained from medical records, based on ultrasound dating. Intention to treat analyses were used to examine objectives.

RESULTS

Adolescents at clinical sites randomized to CenteringPregnancy® Plus experienced greater reductions in perinatal depressive symptoms compared to those at clinical sites randomized to individual care (p = .003). Increased depressive symptoms from second to third pregnancy trimester were associated with shorter gestational age at delivery and preterm birth (<37 weeks gestation). Third trimester depressive symptoms were also associated with shorter gestational age and preterm birth. All p < .05.

CONCLUSIONS

Pregnant adolescents should be screened for depressive symptoms prior to third trimester. Group prenatal care may be an effective nonpharmacological option for reducing depressive symptoms among perinatal adolescents. (PsycINFO Database Record

Do children born to teenage parents have lower adult intelligence? A prospective birth cohort study

Teenage motherhood has been associated with a wide variety of negative offspring outcomes including poorer cognitive development. In the context of limitations of previous research, this paper assesses the contemporary relevance of this finding. In this study we investigate the long-term cognitive status (IQ) among 21 year adult offspring born to teenage parents using the Mater University Study of Pregnancy- a prospective birth cohort study, which recruited all pregnant mothers attending a large obstetrical hospital in Brisbane, Australia, from 1981 to 1983. The analyses were restricted to a sub-sample of 2643 mother-offspring pair. Offspring IQ was measured using the Peabody Picture Vocabulary Test at 21 year. Parental age was reported at first clinic visit. Offspring born to teenage mothers (<20 years) have -3.0 (95% Confidence Interval (CI): -4.3, -1.8) points lower IQ compared to children born to mothers ≥20 years and were more likely to have a low IQ (Odds Ratio (OR) 1.7; 95% CI: 1.3, 2.3). Adjustment for a range of confounding and mediating factors including parental socioeconomic status, maternal IQ, maternal smoking and binge drinking in pregnancy, birthweight, breastfeeding and parenting style attenuates the association, though the effect remains statistically significant (-1.4 IQ points; 95% CI: -2.8,-0.1). Similarly the risk of offspring having low IQ remained marginally significantly higher in those born to teenage mothers (OR 1.3; 95% CI: 1.0, 1.9). In contrast, teenage fatherhood is not associated with adult offspring IQ, when adjusted for maternal age. Although the reduction in IQ is quantitatively small, it is indicative of neurodevelopmental disadvantage experienced by the young adult offspring of teenage mothers. Our results suggest that public policy initiatives should be targeted not only at delaying childbearing in the population but also at supporting early life condition of children born to teenage mothers to minimize the risk for disadvantageous outcomes of the next generation.

Teen pregnancy in Inuit communities - gaps still needed to be filled

Teen pregnancy is depicted around the world as an important cause of health disparities both for the child and the mother. Accordingly, much effort has been invested in its prevention and led to its decline in the northern hemisphere since the mid-1990s. Despite that, high rates are still observed in the circumpolar regions. As Inuit communities have granted better understanding of teenage pregnancy a priority for the coming years, this article comprehensively reviews this multidimensional issue. By depicting current prevalence, likely determinants and possible impacts documented among Inuit of Canada, Alaska and Greenland, and contrasting them to common knowledge that has emerged from other populations over the years, great gaps surface. In some regions, the number of pregnancies per number of Inuit women aged between 15 and 19 years has increased since the turn of the millennium, while statistics from others are either absent or difficult to compare. Only few likely determinants of teenage pregnancy such as low education and some household factors have actually been recognized among Inuit populations. Documented impacts of early pregnancy on Inuit women and their children are also limited compared to those from other populations. As a way to better address early pregnancy in the circumpolar context, the defence for additional scientific efforts and the provision of culturally adapted sexual health prevention programmes appear critical.

Health of adolescent refugees resettling in high-income countries

Adolescent refugees are a vulnerable population with complex healthcare needs that are distinct from younger and older age groups. Physical health problems are common in this cohort with communicable diseases being the focus of attention followed by an emphasis on nutritional deficiencies and other chronic disorders. Adolescent refugees have also often experienced multiple traumatic stressors and are at a heightened risk of developing mental health problems. Navigating these problems at the time of pubertal development adds further challenges and can exacerbate or lead to the emergence of health risk behaviours. Educational difficulties and acculturation issues further compound these issues. Adolescents who have had experiences in detention or are unaccompanied by parents are particularly at risk. Despite a constantly growing number of adolescent refugees resettling in high-income countries, knowledge regarding their specific healthcare needs is limited. Research data are largely extrapolated from studies conducted within paediatric and adult cohorts. Holistic management of the medical and psychological issues faced by this group is challenging and requires an awareness of the socioeconomic factors that can have an impact on effective healthcare delivery. Legal and ethical issues can further complicate their management and addressing these in a culturally appropriate manner is essential. Early identification and management of the healthcare issues faced by adolescent refugees resettling in high-income countries are key to improving long-term health outcomes and future healthcare burden. This review article aims to increase knowledge and awareness of these issues among paediatricians and other health professionals.

Gestational weight gain and preterm birth in obese women: a systematic review and meta-analysis

BACKGROUND

Prepregnant obesity is a global concern and gestational weight gain has been found to influence the risks of preterm birth.

OBJECTIVE

To assess the relationship between gestational weight gain and risk for preterm birth in obese women.

SEARCH STRATEGY

Four electronic databases were searched from 18 February through to 28 April 2015.

SELECTION CRITERIA

Primary research reporting preterm birth as an outcome in obese women and gestational weight gain as a variable that could be compared to the 2009 Institute of Medicine's recommendations.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trials for inclusion. The Newcastle Ottawa Scale was used to assess study bias.

MAIN RESULTS

Our search identified six studies meeting the inclusion criteria; five were conducted in the USA and one in Peru. Four studies with a total of 10 171 obese women were meta-analysed. Significant heterogeneity was found between studies in the pooled analysis. Results for indicated preterm birth in obese women with gestational weight gain above the Institute of Medicine's recommendations showed increased risk (adjusted odds ratio 1.54; 95% CI 1.09-2.16).

CONCLUSIONS

Available science on this topic is limited to special populations of obese pregnant women. Generalisable research is needed to assess the variation in risk for preterm birth in obese women by differences in gestational weight gain and class of obesity controlling for significant variables in the pathway to preterm birth. This research has the potential to illuminate new science impacting preterm birth and interventions for prevention.

Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers

OBJECTIVES

We compared an evidence-based model of group prenatal care to traditional individual prenatal care on birth, neonatal, and reproductive health outcomes.

METHODS

We performed a multisite cluster randomized controlled trial in 14 health centers in New York City (2008-2012). We analyzed 1148 pregnant women aged 14 to 21 years, at less than 24 weeks of gestation, and not at high obstetrical risk. We assessed outcomes via medical records and surveys.

RESULTS

In intention-to-treat analyses, women at intervention sites were significantly less likely to have infants small for gestational age (< 10th percentile; 11.0% vs 15.8%; odds ratio = 0.66; 95% confidence interval = 0.44, 0.99). In as-treated analyses, women with more group visits had better outcomes, including small for gestational age, gestational age, birth weight, days in neonatal intensive care unit, rapid repeat pregnancy, condom use, and unprotected sex (P = .030 to < .001). There were no associated risks.

CONCLUSIONS

CenteringPregnancy Plus group prenatal care resulted in more favorable birth, neonatal, and reproductive outcomes. Successful translation of clinical innovations to enhance care, improve outcomes, and reduce cost requires strategies that facilitate patient adherence and support organizational change.