Teen Pregnancy and Risk of Premature Mortality

Abstract

ImportanceUnintentional injury, suicide, and homicide are leading causes of death among young females. Teen pregnancy may be a marker of adverse life experiences.ObjectiveTo evaluate the risk of premature mortality from 12 years of age onward in association with number of teen pregnancies and age at pregnancy.Design, Setting, and ParticipantsThis population-based cohort study was conducted among all females alive at 12 years of age from April 1, 1991, to March 31, 2021, in Ontario, Canada (the most populous province, which has universal health care and data collection). The study period ended March 31, 2022.ExposuresThe main exposure was number of teen pregnancies between 12 and 19 years of age (0, 1, or ≥2). Secondary exposures included how the teen pregnancy ended (birth or miscarriage vs induced abortion) and age at first teen pregnancy.Main Outcomes and MeasuresThe main outcome was all-cause mortality starting at 12 years of age. Hazard ratios (HRs) were adjusted for year of birth, comorbidities at 9 to 11 years of age, and area-level education, income level, and rurality.ResultsOf 2 242 929 teenagers, 163 124 (7.3%) experienced a pregnancy at a median age of 18 years (IQR, 17-19 years). Of those with a teen pregnancy, 60 037 (36.8%) ended in a birth (of which 59 485 [99.1%] were live births), and 106 135 (65.1%) ended in induced abortion. The median age at the end of follow-up was 25 years (IQR, 18-32 years) for those without a teen pregnancy and 31 years (IQR, 25-36 years) for those with a teen pregnancy. There were 6030 deaths (1.9 per 10 000 person-years [95% CI, 1.9-2.0 per 10 000 person-years]) among those without a teen pregnancy, 701 deaths (4.1 per 10 000 person-years [95% CI, 3.8-4.5 per 10 000 person-years]) among those with 1 teen pregnancy, and 345 deaths (6.1 per 10 000 person-years [95% CI, 5.5-6.8 per 10 000 person-years]) among those with 2 or more teen pregnancies; adjusted HRs (AHRs) were 1.51 (95% CI, 1.39-1.63) for those with 1 pregnancy and 2.14 (95% CI, 1.92-2.39) for those with 2 or more pregnancies. Comparing those with vs without a teen pregnancy, the AHR for premature death was 1.25 (95% CI, 1.12-1.40) from noninjury, 2.06 (95% CI, 1.75-2.43) from unintentional injury, and 2.02 (95% CI, 1.54-2.65) from intentional injury.Conclusions and RelevanceIn this population-based cohort study of 2.2 million female teenagers, teen pregnancy was associated with future premature mortality. It should be assessed whether supports for female teenagers who experience a pregnancy can enhance the prevention of subsequent premature mortality in young and middle adulthood.

Knowledge, Attitude and Use of Contraceptive Among Secondary School Students in the Gambia

“…In spite of the gains made in reducing maternal deaths globally, WHO has ranked pregnancy related deaths as the second leading cause of death among teenagers aged 15-19 (WHO et al, 2013). A lot of factors could be attributed to this menace, such as unsafe abortion, hypertensive disorders, hemorrhage, sepsis and obstructive labor due to the size of pelvic (Ray et al, 2024).…”

Error in Commentary

“…In the Invited Commentary “Possible Individual-, System-, and Policy-Level Contributors to Teen Pregnancy and Risk of Premature Mortality,” 1 published March 14, 2024, there was an error describing the results of the study by Ray et al 2 In the first paragraph, the highest risk of premature death was among those whose pregnancies ended in livebirth, stillbirth, miscarriage, or ectopic pregnancy. This article has been corrected.…”