BALTIMORE, November 1, 2022 – Pregnant teens in the United States have long been known to face increased health risks and pregnancy complications, but a new study reveals for the first time that girls aged 13 years or younger who become pregnant face even greater risks. These very young girls are much more likely to experience preterm birth, cesarean section and intensive care unit (ICU) admission compared to older pregnant teens. Researchers from the University of Maryland School of Medicine (UMSOM) and the Perelman School of Medicine at the University of Pennsylvania conducted the study, which was published today in the Journal of the American Medical Association (JAMA).
Researchers reviewed more than 90,000 birth records of preteens, teens, and young pregnant women between the ages of 10 and 19. This is the first study of its kind to compare the differences between very young pregnant girls and those in their mid-teens. and those entering adulthood.
“Our study found that when it comes to childbirth, a pregnant child or very young adolescent is not just a ‘little’ adolescent,” said study corresponding author Katherine E. Goodman, JD , PhD, Assistant Professor of Epidemiology and Public Health at UMSOM. . “We found that children aged 10 to 13 had a 56% higher risk of preterm birth and a 32% higher risk of cesarean delivery compared to those aged 14 to 17.”
Results are based on all pregnant patients ages 10-19 who gave birth at hospitals in the Premier Healthcare database, a national resource that includes about a quarter of hospital discharges in the United States, as of January 2019. to May 2021. Anthony D. Harris, MD, MPH, professor of epidemiology and public health at UMSOM, is also a co-author of this study.
Premature delivery occurred in 18.5% of pregnant adolescents aged 10-13; 11.6% of 14 to 17 year olds; and 10.5% of young women aged 18-19. About 22% of the youngest gave birth by caesarean section, compared to 16.4% of adolescent girls aged 14 to 17 and 20.1% of young women aged 18 to 19.
The researchers considered factors that may have led to higher rates in the younger age group, such as race and ethnicity, type of insurance and obesity status. Still, they found that the youngest girls had significantly increased risks compared to teenage girls aged 14 to 17. In terms of total numbers, the vast majority of pregnancies – nearly 68,000 – occurred between the ages of 18 and 19. Teen pregnancies aged 14-17 The 17-year-old group totaled nearly 23,000, compared to just 206 pregnancies in the 10-13-year-old group. More than two-thirds of people in the youngest age group identified as black or Hispanic.
The study team consider the data they reviewed on ICU admissions to be preliminary and said the findings merit confirmation in future studies. However, they still found it remarkable that adolescents aged 10 to 13 experienced ICU admission rates three times higher than those aged 14 to 19.
“These complicated birth results are important. They can have lifelong consequences for both mother and child,” Dr Goodman said. “Mothers who give birth before term have a greater likelihood of developing hypertension and mental health problems, including postpartum depression and post-traumatic stress disorder. Infants born before term have a greater risk of neurodevelopmental and respiratory problems.
The findings take on particular significance as states consider whether to restrict access to reproductive health care based on the Supreme Court’s decision to overturn Roe v. Wade in June.
“The study results demonstrate the importance of a focus on pregnancy prevention and appropriate pregnancy care – with access to the full range of options, including abortion, if the pregnancy is unintended,” said study first author Beth L. Pineles, MD. , PhD, Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology at the University of Pennsylvania Perelman School of Medicine. “We were surprised by the magnitude of the effects, but they make sense because of the biological plausibility of the results and the improved birth outcomes in low- and middle-income countries that have been able to reduce infant pregnancies.”
“Fortunately, pregnancy in very young girls remains rare in the United States, but even one pregnancy in a preteen is too much,” said Mark T. Gladwin, MD, vice president of medical affairs, University of Maryland , Baltimore, and the John Z and Akiko K. Bowers Professor Emeritus and Dean of the University of Maryland School of Medicine. “Racial and ethnic disparities remain stark and point to an urgent health need that we as a nation must address to close the gap in health care inequity.”
About University of Maryland Medical School
Now in its third century, the University of Maryland Medical School was incorporated in 1807 as the first public medical school in the United States. It continues today to be one of the world’s fastest growing leading biomedical research enterprises – with 46 academic departments, centers, institutes and programs, and a faculty of more than 3,000 physicians, scientists and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a two-time distinguished recipient of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.3 billion, the School of Medicine works closely with the University of Maryland Medical Center and Medical System to provide intensive research, academic, and clinical care to nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments ranking highly among all medical schools in the nation for research funding. As one of seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents and fellows. The combined medical school and medical system (“University of Maryland Medicine”) has an annual budget of more than $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks first 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the last US News and World Report ranking of best medical schools, released in 2021, UM School of Medicine is ranked #9 among the 92 public medical schools in the United States and in the richest 15% (#27) out of 192 public and private American medical schools. The School of Medicine works locally, nationally and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu
Randomized clinical/controlled trial
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Adverse maternal and childbirth outcomes in very young American children and adolescents (age ≤ 13 years) compared with older adolescents and adults
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Conflict of Interest Statement
Dr. Harris said he received personal fees from UpToDate outside of the submitted work. Dr Goodman said he received grants from the Agency for Healthcare Research and Quality while conducting the study. No other disclosures were reported.
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