Hospitalisation for non‐lethal self‐harm and premature mortality in the 3 years following adolescent pregnancy: Population‐based nationwide cohort study

Abstract

Objective To evaluate the risk of non‐lethal self‐harm and mortality related to adolescent pregnancy. Design Nationwide population‐based retrospective cohort. Setting Data were extracted from the French national health data system. Population We included all adolescents aged 12–18 years with an International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD‐10) code for pregnancy in 2013–2014. Methods Pregnant adolescents were compared with age‐matched non‐pregnant adolescents and with first‐time pregnant women aged 19–25 years. Main outcome measures Any hospitalisation for non‐lethal self‐harm and mortality during a 3‐year follow‐up period. Adjustment variables were age, a history of hospitalisation for physical diseases, psychiatric disorders, self‐harm and reimbursed psychotropic drugs. Cox proportional hazards regression models were used. Results In 2013–2014, 35 449 adolescent pregnancies were recorded in France. After adjustment, pregnant adolescents had an increased risk of subsequent hospitalisation for non‐lethal self‐harm in comparison with both non‐pregnant adolescents (n = 70 898) (1.3% vs 0.2%, HR 3.06, 95% CI 2.57–3.66) and pregnant young women (n = 233 406) (0.5%, HR 2.41, 95% CI 2.14–2.71). Rates of hospitalisation for non‐lethal self‐harm were lower during pregnancy and higher between 12 and 8 months pre‐delivery, 3–7 months postpartum and in the month following abortion. Mortality was significantly higher in pregnant adolescents (0.7‰) versus pregnant young women (0.4‰, HR 1.74, 95% CI 1.12–2.72), but not versus non‐pregnant adolescents (0.4‰, HR 1.61, 95% CI 0.92–2.83). Conclusions Adolescent pregnancy is associated with an increased risk of hospitalisation for non‐lethal self‐harm and premature death. Careful psychological evaluation and support should be systematically implemented for adolescents who are pregnant.

Teen Pregnancy and Risk of Premature Mortality

“…17 In a cohort study from France, the risk of hospitalization for nonlethal self-harm among teenagers was highest after induced abortion 3.5 [95% CI, 2.9-4.2]). 18 In the present study, teenagers whose pregnancy ended in an induced abortion were at somewhat higher risk of premature mortality, whereas the risk was even higher for those with a pregnancy that ended spontaneously in a birth or miscarriage. Together, the age at first teen pregnancy, the cumulative number of pregnancies, and the outcome of a teen pregnancy might each inform the targeting of strategies for the prevention of premature mortality among females.…”

“…The number of teen pregnancies between 12 and 19 years of age was treated as a time-varying exposure. Hazard ratios were adjusted for each woman's year of birth (as a continuous calendar year value [eg, 1985, 1986, 1987, etc]), number of comorbidity Aggregated Diagnosis Groups (ADGs) at 9 to 11 years of age (Յ2, 3-4, 5-6, or Ն7), area-level educational attainment less than high school (when the teenager was 12 In the separate Cox proportional hazards regression models of the nature of the pregnancy (no teen pregnancy and teen pregnancy ending spontaneously or not 16,18 ) and the age at teen pregnancy (no teen pregnancy, 12-15, 16-17, or 18-19 years), the earliest teen pregnancy was chosen as the index exposure event. In the assessment of the nature of the premature death (noninjury related, unintentional injury, or intentional injury), a cause-specific hazard model was used, censoring on the competing risk of the other causes of death.…”

“…11 For example, in a French population-based cohort study comparing pregnant adolescents aged 12 to 18 years with age-matched nonpregnant adolescents, the HR for subsequent hospitalization for nonlethal self-harm was 3.1 (95% CI, 2.6-3.7). 18 Hence, assessment of these and other prevalent outcomes should provide a powerful examination of important antecedent conditions that can compromise physical health and life expectancy. 26…”

Author reply

“…1 Their letter gives us the opportunity to clarify several issues in relation to our work. 2 The first issue is the definition of premature mortality, which in public health generally refers to deaths occurring before the average age of death in a given population. 3 By analogy, we felt that deaths among adolescent girls could be considered as premature mortality.…”

“…Individual written consent was not required. Karine Goueslard 1,2 Fabrice Jollant 3,4,5,6 Jonathan Cottenet 1,2 Sonia Bechraoui-Quantin 1,2,7 Patrick Rozenberg 8 Emmanuel Simon 7 Catherine Quantin…”