the relationship between adolescent childbearing and adverse infant outcomes alex rogers
TRANSCRIPT
The Relationship Between Adolescent Childbearing and
Adverse Infant Outcomes
Alex Rogers
The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes
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 20-29 year old mothers
LBW, SGA and Prematurity
World Health Organisation (WHO)
• 40% council housing
• 70% rely on income supportTeenage Pregnancy Associates
The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes
Intergenerational Cycle
Adverse Outcomes
LOW SE STATUS
TEENAGE PREGNANC
Y
The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes
Measuring Adverse Outcomes
• Low Birth Weight (<2500g)
• Small Size for Gestational Age(10th percentile for birth weight)
• Prematurity
• APGAR Score (Appearance, Pulse, Grimace, Activity, Respiration of newborn)
• 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
– EMBASE, MEDLINE, Cochrane Library and MIDIRS
• 883 articles returned
Screened by title, abstract and eligibility criteria
• Limited to studies on UK and US populations
The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes
Results – 11 Studies
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
The Relationship Between Adolescent Childbearing and Adverse Infant Outcomes
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:
- Prospective cohort studies
FUTURE: Government policy making
- 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):404-409.
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 2003 01 Aug 2003;143(2):250-257.
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):368-373.
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):36-41.
Delpisheh A. Attia E. Drammond S. Adolescent smoking in pregnancy and birth outcomes. Eur J Public Health April 2006;16(2):168-172.
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.):259-284.
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):861-868.
Stevens-Simon C, Kaplan DW, McAnarney ER. Factors associated with preterm delivery among pregnant adolescents. J Adolesc Health 1993 Jun;14(4):340-342.
Hack M, Klein NK, Taylor HG. Long-term developmental outcomes of low birth weight infants. Future Child 1995 Spring;5(1):176-196.