medwireNews: Teen pregnancy could be a “readily identifiable marker for subsequent risk of premature mortality in early adulthood,” suggest the authors of a Canadian cohort study.
The incidence of all-cause death from age 12 onwards was 1.9 per 10,000 person–years among those without a pregnancy between the ages of 12 and 19 years, 4.1 per 10,000 person–years among those with one pregnancy in this age range, and 6.1 per 10,000 person–years among those with two or more pregnancies, say the investigators.
They collated information from 2,242,929 female teenagers, age 12 years between April 1991 and March 2021, residing in Ontario, Canada and eligible for the universal Ontario Health Insurance Plan. Of these, 7.3% had at least one pregnancy, at a median age of 18 years, 36.8% of teenagers gave birth (99.1% live births), 65.1% had an induced abortion, and 11.1% experienced miscarriage or ectopic pregnancy. The average age of participants at the end of follow-up was 25 years for those without a teen pregnancy and 31 years for those with a teen pregnancy.
The adjusted hazard ratio (AHR) for all-cause mortality was 1.51 for women with one teen pregnancy and 2.14 for those with two or more pregnancies, after taking into consideration comorbidity, education attainment, and other demographic factors. After further adjustment for adolescent mental health factors, the risk for all-cause mortality decreased slightly but remained significantly elevated for those who experienced one teen pregnancy and those with two or more teen pregnancies (AHRs=1.31 and 1.78, respectively).
Compared with no teen pregnancy, the AHR for premature death was 1.41 if the first teen pregnancy resulted in induced abortion and 2.10 if it ended in miscarriage or birth.
And when the AHR for premature mortality was examined by age at time of pregnancy, those pregnant before the age of 16 years had a higher risk of death than those aged 16–17 or 18–19 years (AHR=2.00, 1.74 and 1.56 versus no teen pregnancy, respectively), report Joel Ray (University of Toronto, Ontario, Canada) and colleagues in JAMA Network Open.
Furthermore, among women with versus without a teen pregnancy, the AHRs for premature death from noninjury, unintentional, and intentional injury were also significantly higher at 1.25, 2.06, and 2.02, respectively.
The study authors note that teens who experienced pregnancy were more likely to live in low-income neighborhoods with lower high school completion rates than those without teen pregnancy, and had a higher incidence of self-harm (5.0 vs 1.5%). However, there was no difference in other mental or physical comorbidities between the two groups.
Acknowledging that teen pregnancy could be a marker of adverse childhood experiences, such as sexual and emotional abuse, parental separation, family instability, or income decline, Ray and co-workers suggest that teen pregnancy could be a “time point for identifying some individuals at greater risk of premature mortality and morbidity to facilitate access to appropriate supports.”
They add that together, the age at first teen pregnancy, the total number of pregnancies, and the outcome of each pregnancy could guide the development of targeted strategies to prevent premature mortality.
In a related comment, Elizabeth Cook (Child Trends, Rockville, Maryland, USA) emphasizes the importance of strengthening structural policies, providing programs, and improving practices and systems to shift the burden of unintended teen pregnancy from an individual to a more system-focused approach.
She adds: “Better understanding the differences in premature death risk between adolescents who choose abortion and those who do not in Ray et al is important since having autonomy over one’s reproductive choices has been shown time and time again to be vital to one’s ability to thrive.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group.