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Digest

Teenagers and Young Adults Have Elevated Maternity-Related Risks

John Thomas, Guttmacher Institute

First published online:

| DOI: https://doi.org/10.1363/4420712_2

The maternity experiences of teenagers and young adults differ from those of older women in ways that may put them and their infants at heightened risk of adverse outcomes, according to findings from a nationally representative sample of Canadian women who had recently given birth.1 For example, 15–19‐year‐olds and 20–24‐year‐olds were more likely than those aged 25 or older to have experienced physical abuse in the past two years (odds ratios, 2.3–4.9), not taken a folic acid supplement in the three months before conceiving or after getting pregnant (2.1–6.2), smoked or used illicit drugs before or during pregnancy or the postpartum period (1.4–6.2), and initiated prenatal care after the first trimester (1.5–3.9).

While considerable research has been directed at the prevention of adolescent pregnancy, little attention has focused on the needs and experiences of pregnant and postpartum adolescents. In an effort to improve health care providers’ ability to care for these young women, this study analyzed data from the 2006 Maternity Experiences Survey of 6,421 women who had had a live, singleton birth and were living with their infant. The survey was conducted through telephone interviews, and most respondents were 5–9 months postpartum. Researchers compared the demographic and psychosocial characteristics, health behaviors and maternity experiences of adolescents (ages 15–19), young adults (20–24) and adults (25 or older). Weighted data represented the experiences of nearly 74,000 women; multivariate logistic regression analysis was used to calculate odds ratios comparing adolescents and young adults with adults, while controlling for education, parity and marital status.

Three percent of respondents were aged 15–19 when they gave birth; the mean age was 18 for adolescents, 22 for young adults and 31 for adults. Adolescents and young adults were more likely than adults to be single (odds ratios, 17.8 and 4.9, respectively) and to have only one child (13.3 and 2.7, respectively). The younger age‐groups were also more likely than the oldest one to have wanted to get pregnant later or not at all (6.2 and 2.5, respectively), and to have felt unhappy or neutral about getting pregnant (3.6 and 1.4, respectively).

Notably, adolescents and young adults had an elevated likelihood of having experienced physical abuse in the past two years (odds ratios, 4.9 and 2.3, respectively) and of having experienced multiple episodes (2.1–5.2). Among respondents who reported physical abuse, a majority in each subgroup said their partner had been the main perpetrator; 15–19‐year‐olds were more likely than women 25 or older to report that a family member had abused them (5.7). Furthermore, adolescents and young adults had an increased risk of having experienced three or more stressful life events in the year before the birth (3.2 and 2.8, respectively) and, as assessed with a standard screening tool, of having experienced symptoms of postpartum depression in the previous week (2.3 and 1.4, respectively).

Overall, adolescents and young adults reported riskier health behaviors both before and during pregnancy than older mothers. They were more likely to have not taken a folic acid supplement in the three months before conceiving (odds ratios, 6.2 and 3.4, respectively) or after getting pregnant (4.4 and 2.1, respectively), and they were more likely to report not knowing that folic acid could prevent some birth defects (5.7 and 3.2, respectively). In addition, adolescent and young adult respondents had an elevated risk of having smoked in the three months preceding pregnancy (1.4–2.7) or during pregnancy or the postpartum period (3.0–6.2). They were also more likely than women in the oldest age‐group to have lived with a smoker during their pregnancy (2.9–6.9) or to have used an illicit drug before getting pregnant (2.9–3.7).

Maternity experiences also varied by mothers’ age. Adolescents and young adults had an elevated risk of having initiated prenatal care after the first trimester (odds ratios, 3.9 and 1.5, respectively), and of not having attended any prenatal classes (2.2 for each). Adolescents had an increased likelihood of not intending to exclusively breast‐feed (1.6); both younger subgroups had elevated odds of not having initiated breast‐feeding and, among respondents who had started, of not having breast‐fed for three or more months (1.5–2.6 for each measure). Among women who had begun breast‐feeding, adolescents had an increased likelihood of not having breast‐fed exclusively for at least three months (2.0). In addition, adolescents and young adults had elevated odds of having placed infants in a position other than the recommended one for sleeping (i.e., on their backs; 1.4–1.5). Respondents aged 15–19 were more likely than those aged 25 or older to rate their own health and that of their infant as good, fair or poor, as opposed to excellent or very good (2.3 for each), as were 20–24‐year‐olds regarding their own health (1.5). Finally, both of the younger age‐groups had a reduced risk of having had a cesarean delivery (0.6 for each).

The investigators note several limitations of their study: The prevalence of adolescent pregnancy was lower than that found elsewhere, the relatively small number of adolescent respondents may have prevented the detection of some differences by age‐group, and the exclusion of adolescents who were not living with their infant may have introduced selection bias. Nonetheless, the researchers believe that, given the limited research "directed at understanding the needs of pregnant and postpartum adolescents or exploring the continuum of risk" across age‐groups, their study identified a number of important areas for future research. These include the high level of physical abuse among pregnant adolescents, teenagers’ late initiation of prenatal care, and their low rates of breast‐feeding and use of folic acid supplements.—J. Thomas