Characteristics and birth outcomes of pregnant adolescents compared to older women: An analysis of individual level data from 140,000 mothers from 20 RCTs

Nadia Akseer; Emily Catherine Keats; Pravheen Thurairajah; Simon Cousens; Ana Pilar Bétran; Brietta M Oaks; David Osrin; Ellen Piwoz; Exnevia Gomo; Faruk Ahmed; Henrik Friis; José Belizán; Kathryn Dewey; Keith West; Lieven Huybregts; Lingxia Zeng; Michael J Dibley; Noel Zagre; Parul Christian; Patrick Wilfried Kolsteren; Pernille Kaestel; Robert E Black; Shams El Arifeen; Ulla Ashorn; Wafaie Fawzi; Zulfiqar Ahmed Bhutta; Global Young Women's Nutrition Investigators Group

doi:10.1016/j.eclinm.2022.101309

Characteristics and birth outcomes of pregnant adolescents compared to older women: An analysis of individual level data from 140,000 mothers from 20 RCTs

EClinicalMedicine. 2022 Feb 26:45:101309. doi: 10.1016/j.eclinm.2022.101309. eCollection 2022 Mar.

Authors

Nadia Akseer¹, Emily Catherine Keats¹, Pravheen Thurairajah¹, Simon Cousens², Ana Pilar Bétran³, Brietta M Oaks⁴, David Osrin⁵, Ellen Piwoz⁶, Exnevia Gomo⁷, Faruk Ahmed⁸, Henrik Friis⁹, José Belizán¹⁰, Kathryn Dewey¹¹, Keith West¹², Lieven Huybregts¹³, Lingxia Zeng¹⁴, Michael J Dibley¹⁵, Noel Zagre¹⁶, Parul Christian¹², Patrick Wilfried Kolsteren¹⁷, Pernille Kaestel⁹, Robert E Black¹², Shams El Arifeen¹⁸, Ulla Ashorn¹⁹, Wafaie Fawzi²⁰, Zulfiqar Ahmed Bhutta^{1

21

22}; Global Young Women's Nutrition Investigators Group

Affiliations

¹ Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada.
² London School of Hygiene and Tropical Medicine, London, United Kingdom.
³ World Health Organization, Switzerland.
⁴ University of Rhode Island, United States.
⁵ Institute for Global Health, University College London, United Kingdom.
⁶ The Bill and Melinda Gates Foundation, United States.
⁷ University of Zimbabwe, Zimbabwe.
⁸ Griffith University, Australia.
⁹ University of Copenhagen, Denmark.
¹⁰ UNC Chapel Hill, United States.
¹¹ University of California, Davis, United States.
¹² Johns Hopkins Bloomberg School of Public Health, United States.
¹³ International Food Policy Research Institute, United States.
¹⁴ School of Public Health, Xi'an Jiaotong University Health Science Centre, China.
¹⁵ The University of Sydney, Australia.
¹⁶ UNICEF Regional Office for West and Central Africa, Senegal.
¹⁷ Ghent University, Belgium.
¹⁸ ICDDRB, Bangladesh.
¹⁹ Faculty of Medicine and Health Technology, Tampere University, Finland.
²⁰ Harvard T.H. Chan School of Public Health, United States.
²¹ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
²² Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.

Abstract

Background: Adolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10-19 years) compared to older mothers in low and middle-income countries.

Methods: This study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10-14 years, 15-17 years, 18-19 years, 20-29 years, 30-39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, prevalence and relative risks of pregnancy, nutrition and birth outcomes were estimated using multivariable linear and log-binomial regression models with 95% confidence intervals.

Findings: Adolescent mothers comprised 31.6% of our data. Preterm birth, small-for-gestational age (SGA), low birthweight (LBW) and newborn mortality followed a U-shaped trend in which prevalence was highest among the youngest mothers (10-14 years) and then reduced gradually, but increased again for older mothers (40+ years). When compared to mothers aged 20-29 years, there was a 23% increased risk of preterm birth, a 60% increased risk of perinatal mortality, a 63% increased risk of neonatal mortality, a 28% increased risk of LBW, and a 22% increased risk of SGA among mothers 10-14 years. Mothers 40+ years experienced a 22% increased risk of preterm birth and a 103% increased risk of stillbirth when compared to the 20-29 year group.

Interpretation: The youngest and oldest mothers suffer most from adverse pregnancy and birth outcomes. Policy and programming agendas should consider both biological and socioeconomic/environmental factors when targeting these populations.

Funding: Bill and Melinda Gates Foundation (Grant No: OP1137750).

Keywords: Adolescence; Age; Birth outcomes; Determinants; Pregnancy.

Grants and funding

001/WHO_/World Health Organization/International