The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes Alex Rogers

OBJECTIVES 1) To pose the question and explain its importance 2) To describe the methodology employed to answer question 3) To describe the results of the question 4) To critically appraise the results 5) To describe the implications of the results The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

Why Are We Interested? 1) Excess adverse infant outcomes in adolescents 2) Intergenerational cycle of deprivation The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

Infant mortality 50% higher in adolescent pregnancy compared with year old mothers LBW, SGA and Prematurity World Health Organisation (WHO) 40% council housing 40% council housing 70% rely on income support 70% rely on income support Teenage Pregnancy Associates The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

Intergenerational Cycle  Adverse Outcomes LOW SE STATUS TEENAGE PREGNANCY The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

Measuring Adverse Outcomes Low Birth Weight (<2500g) Low Birth Weight (<2500g) Small Size for Gestational Age (10 th percentile for birth weight) Small Size for Gestational Age (10 th percentile for birth weight) Prematurity Prematurity APGAR Score (Appearance, Pulse, Grimace, Activity, Respiration of newborn) APGAR Score (Appearance, Pulse, Grimace, Activity, Respiration of newborn) Infant Mortality Infant Mortality The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

Defining Adolescence Adolescent Childbearing*: Pregnancy in a female <20 years of age The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

What do we want to achieve?  Adverse infant outcomes Limit intergenerational cycle of deprivation BEST POSSIBLE START EQUAL FOOTING The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

MODIFYING RISK Need to know the risk factors Hence “The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes” The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

STUDY RETRIEVAL 4 major databases 4 major databases – EMBASE, MEDLINE, Cochrane Library and MIDIRS – EMBASE, MEDLINE, Cochrane Library and MIDIRS 883 articles returned 883 articles returned  Screened by title, abstract and eligibility criteria  Screened by title, abstract and eligibility criteria Limited to studies on UK and US populations Limited to studies on UK and US populations The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

Results – 11 Studies The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes Significant associations Adverse infant outcomes PATERNAL ABSENCE INADEQUATE PRENATAL CARE - US populations only POOR NUTRITIONAL STATUS - Folate - Iron - Selenium - Low weight gain & pre- pregnancy BMI YOUNG MATERNAL AGE SMOKING

RESULTS - STRENGTHS i.Dose-response relationship ii.Consistency iii.Originality iv.Objectivity The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

RESULTS - WEAKNESSES i.“Adolescent childbearing” ii.Quality of results iii.CONFOUNDERS - Alcohol, psychological stress, substance abuse iv. Generalisability – ethnicity The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

IMPLICATIONS Higher quality research: Higher quality research: - Prospective cohort studies FUTURE: Government policy making - Smoking - Smoking - Nutrition - Paternal involvement - Prenatal attendance The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

SUMMARY ↳ Risk factors for adverse birth outcomes identified ↳ Critical appraisal: moderate quality ↳ Improve research quality  government policy-making The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

ACKNOWLEDGEMENTS I would like to thank Professor Peter Donnelly for all his advice and support throughout this project. The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes

REFERENCES Alio AP, Mbah AK, Grunsten RA, Salihu HM. Teenage pregnancy and the influence of paternal involvement on fetal outcomes. J Pediatr Adolesc Gynecol 2011 Dec;24(6): Chang S-, O'Brien KO, Nathanson MS, Mancini J, Witter FR. Characteristics and risk factors for adverse birth outcomes in pregnant black adolescents. J Pediatr Aug 2003;143(2): Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol 2007 Apr;36(2): Cunnington AJ. What's so bad about teenage pregnancy?. The journal of family planning and reproductive health care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists 2001 Jan 2001;27(1): Delpisheh A. Attia E. Drammond S. Adolescent smoking in pregnancy and birth outcomes. Eur J Public Health April 2006;16(2): Gibbs CM, Wendt A, Peters S, Hogue CJ. The impact of early age at first childbirth on maternal and infant health. Paediatr Perinat Epidemiol 2012 July 2012;26(Improving maternal, newborn, and child health outcomes through better designed policies and programs that enhance the nutrition of women.): Delpisheh A, Kelly Y, Rizwan S, Attia E, Drammond S, Brabin BJ. Population attributable risk for adverse pregnancy outcomes related to smoking in adolescents and adults. Public Health 2007 Nov;121(11): Stevens-Simon C, Kaplan DW, McAnarney ER. Factors associated with preterm delivery among pregnant adolescents. J Adolesc Health 1993 Jun;14(4): Hack M, Klein NK, Taylor HG. Long-term developmental outcomes of low birth weight infants. Future Child 1995 Spring;5(1): The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes