Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: A systematic review and meta‐analysis

Abstract

Background Adverse outcomes in adolescent pregnancies have been attributed to both biological immaturity and social determinants of health (SDOH). The present systematic review evaluated the evidence on the association between SDOH and adverse maternal and birth outcomes in adolescent mothers. Methods Comprehensive literature searches were conducted to identify observational studies evaluating the relationship between SDOH and adverse adolescent pregnancy outcomes. Study selection, risk of bias appraisal, and data extraction of study characteristics were independently performed by two reviewers. Pooled odds ratios (pOR) with 95% confidence intervals (95% CI) were calculated to assess the association between SDOH and adverse birth outcomes. Results Thirty‐one studies met the inclusion criteria. The most frequently evaluated SDOH was race while the most commonly reported maternal and birth outcomes were caesarean section and preterm birth (PTB), respectively. The risk of bias of included studies was fair on the Newcastle‐Ottawa Scale. Meta‐analyses of retrospective cohort studies showed that, compared to White adolescent mothers, African American teens had increased odds of PTB (pOR 1.67; 95% CI 1.59, 1.75) and low birthweight (pOR 1.53; 95% CI 1.45, 1.62). Rural residence was consistently linked with PTB while low maternal socio‐economic (SES) and illiteracy were found to increase the risk of adolescent maternal mortality and LBW infants. Conclusion Social determinants of health contribute to the risk of adverse pregnancy outcomes in adolescent mothers. African American race, rural residence, inadequate education, and low SES are markers for poor pregnancy outcomes in adolescent mothers. Further research needs to be done to understand the underlying causal pathways to inequalities in adolescent pregnancy outcomes.

Determinantes sociais da saúde de gestantes acompanhadas no pré-natal de alto risco

“…No tocante aos determinantes intermediários, quanto ao nível educacional, sabe-se que gestantes com maior escolaridade apresentam menor chance de desenvolver sintomas depressivos (17) , sendo considerado um fator de proteção à sua saúde. Em contrapartida, o baixo nível de escolaridade é uma barreira para o acesso a informações e é um preditor significativo de mortalidade (18) .…”

“…Com relação à renda familiar, quando baixa, associa-se a maior incidência de complicações obstétricas, não alcançando informações de qualidade e assistência multiprofissional (18) , ratificando a influência da camada econômica sobre o processo saúde-doença. Sobre a situação de moradia, verificamos que as gestantes residiam principalmente em casa própria.…”

Healthcare provider perspectives on inequities in access to care for patients with inherited bleeding disorders

“…While the influence of SDOH has been documented in a myriad of clinical contexts including adverse pregnancy outcomes [5], mental health disorders [6], infectious diseases [7], cardiovascular health [7], and more historically cancer screening [8,9], diabetes [10], HIV [11,12], prenatal care utilization [13], ambulatory care [14], as well as hospital-level care [15], the ways in which SDOH affect patients with inherited bleeding disorders remains unclear. Health inequities amongst this patient population may further be complicated by other factors related to bleeding disorders, including gender and degree of symptomatology.…”

Difference of Socioeconomic Factors among Mothers of Preterm and Full-Term Infant

“…Several factors are associated with preterm birth, including mother's age, pregnancy in adolescence or above 35 years, gestation of twins, chronic diseases and infections, socioeconomic and nutritional factors, race, short interval between pregnancies, and maternal anemia in the first semester of pregnancy. Other factors associated with the fetus, such as genetic diseases, are also associated with premature birth [1,6,7]. Indeed, most of the factors related to the etiology of prematurity are potentially preventable [8][9][10].…”