Childbearing during adolescence and offspring mortality: findings from three population-based cohorts in southern Brazil

BMC Public Health

Cesar G Victora²  Fernando C Barros¹  Alicia Matijasevich²  Ana MB Menezes²  Iná S Santos²  Aluísio JD Barros²  María C Restrepo-Méndez² 

[1] Postgraduate Course in Health and Behavior, Universidade Católica de Pelotas, Rua Félix da Cunha, 412 - 96010-000, Pelotas, Brazil;Postgraduate Programme in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 3° Piso, 96020-220, Pelotas, Brazil

关键词: cohort studies;    fetal mortality;    perinatal mortality;    neonatal mortality;    infant mortality;    pregnancy in adolescence;   

Others  :  1164155
DOI  :  10.1186/1471-2458-11-781

 received in 2011-06-06, accepted in 2011-10-10,  发布年份 2011

【 摘 要 】

Background

The role of young maternal age as a determinant of adverse child health outcomes is controversial, with existing studies providing conflicting results. This work assessed the association between adolescent childbearing and early offspring mortality in three birth cohort studies from the city of Pelotas in Southern Brazil.

Methods

All hospital births from 1982 (6,011), 1993 (5,304), and 2004 (4,287) were identified and these infants were followed up. Deaths were monitored through vital registration, visits to hospitals and cemeteries. The analyses were restricted to women younger than 30 years who delivered singletons (72%, 70% and 67% of the original cohorts, respectively). Maternal age was categorized into three groups (< 16, 16-19, and 20-29 years). Further analyses compared mothers aged 12-19 and 20-29 years. The outcome variables included fetal, perinatal, neonatal, postneonatal and infant mortality. Crude and adjusted odds ratios (ORs) were estimated with logistic regression models.

Results

There were no interactions between maternal age and cohort year. After adjustment for confounding, pooled ORs for mothers aged 12-19 years were 0.6 (95% CI = 0.4; 1.0) for fetal death, 0.9 (0.6; 1.3) for perinatal death, 1.0 (0.7; 1.6) for early neonatal death, 1.6 (0.7; 3.4) for late neonatal death, 1.8 (1.1; 2.9) for postneonatal death, and 1.6 (1.2; 2.1) for infant death, when compared to mothers aged 20-29 years. Further adjustment for mediating variables led to the disappearance of the excess of postneonatal mortality. The number of mothers younger than 16 years was not sufficient for most analyses.

Conclusion

The slightly increased odds of postneonatal mortality among children of adolescent mothers suggest that social and environmental factors may be more important than maternal biologic immaturity.

【 授权许可】

   
2011 Restrepo-Méndez et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]United Nations: Department of Economic and Social Affairs. Population Division. World Fertility Patterns. 2009.
• [2]Ministério da Saúde: Informações de Saúde. Estatísticas Vitais. Sistema de Informações de Nascidos Vivos. [http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinasc/cnv/nvuf.def] webcite 2011. Accessed January 23
• [3]Ministério da Saúde: Rede Interagencial de Informações Para Saúde. Indicadores e Dados Básicos. Brasil. [http://tabnet.datasus.gov.br/cgi/idb2009/a06.htm] webcite 2009. Accessed February 24, 2011
• [4]Barros FC, Matijasevich A, Requejo JH, Giugliani E, Maranhao AG, Monteiro CA, Barros AJD, Bustreo F, Merialdi M, Victora CG: Recent trends in maternal, newborn, and child health in Brazil: progress toward Millennium Development Goals 4 and 5. Am J Public Health 2010, 100(10):1877-89.
• [5]WHO: Global Health Observatory Database. Country statistics. Country summary of statistics. [http://apps.who.int/ghodata/?vid=3500&theme=country] webcite 2008. Accessed March 11, 2011
• [6]Victora CG, Aquino EML, Leal MdC, Monteiro CA, Barros FC, Szwarcwald CL: Maternal and Child Health in Brazil: progress and challenges. Lancet Series 2011.
• [7]Ministério da Saúde: Informações de Saúde. Estatísticas Vitais. Sistema de Informações de Mortalidade. [http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/inf10uf.def] webcite Accessed January 23, 2011
• [8]de Vienne CM, Creveuil C, Dreyfus M: Does young maternal age increase the risk of adverse obstetric, fetal and neonatal outcomes: a cohort study. Eur J Obstet Gynecol Reprod Biol 2009, 147(2):151-6.
• [9]Paranjothy S, Broughton H, Adappa R, Fone D: Teenage pregnancy: who suffers? Arch Dis Child 2009, 94(3):239-45.
• [10]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, 36(2):368-73.
• [11]Conde-Agudelo A, Belizan JM, Lammers C: Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. Am J Obstet Gynecol 2005, 192(2):342-9.
• [12]Gilbert W, Jandial D, Field N, Bigelow P, Danielsen B: Birth outcomes in teenage pregnancies. J Matern Fetal Neonatal Med 2004, 16(5):265-70.
• [13]Cunnington AJ: What's so bad about teenage pregnancy? J Fam Plann Reprod Health Care 2001, 27(1):36-41.
• [14]Letamo G, Majelantle RG: Health implications of early childbearing on pregnancy outcome in Botswana: insights from the institutional records. Soc Sci Med 2001, 52(1):45-52.
• [15]DuPlessis HM, Bell R, Richards T: Adolescent pregnancy: understanding the impact of age and race on outcomes. J Adolesc Health 1997, 20(3):187-97.
• [16]Reichman NE, Pagnini DL: Maternal age and birth outcomes: data from New Jersey. Fam Plann Perspect 1997, 29(6):268-72. 95
• [17]LeGrand TK, Mbacke CS: Teenage pregnancy and child health in the urban Sahel. Stud Fam Plann 1993, 24(3):137-49.
• [18]Haldre K, Rahu K, Karro H, Rahu M: Is a poor pregnancy outcome related to young maternal age? A study of teenagers in Estonia during the period of major socio-economic changes (from 1992 to 2002). Eur J Obstet Gynecol Reprod Biol 2007, 131(1):45-51.
• [19]Jolly MC, Sebire N, Harris J, Robinson S, Regan L: Obstetric risks of pregnancy in women less than 18 years old. Obstet Gynecol 2000, 96(6):962-6.
• [20]Oliveira EF, Gama SG, Silva CM: Teenage pregnancy and other risk factors for fetal and infant mortality in the city of Rio de Janeiro, Brazil. Cad Saude Publica 2010, 26(3):567-78.
• [21]Chen XK, Wen SW, Fleming N, Yang Q, Walker MC: Increased risks of neonatal and postneonatal mortality associated with teenage pregnancy had different explanations. J Clin Epidemiol 2008, 61(7):688-94.
• [22]Markovitz BP, Cook R, Flick LH, Leet TL: Socioeconomic factors and adolescent pregnancy outcomes: distinctions between neonatal and post-neonatal deaths? BMC Public Health 2005, 5:79. BioMed Central Full Text
• [23]Phipps MG, Blume JD, DeMonner SM: Young maternal age associated with increased risk of postneonatal death. Obstet Gynecol 2002, 100(3):481-6.
• [24]Alam N: Teenage motherhood and infant mortality in Bangladesh: maternal age-dependent effect of parity one. J Biosoc Sci 2000, 32(2):229-36.
• [25]Lawlor DA, Shaw M: Too much too young? Teenage pregnancy is not a public health problem. Int J Epidemiol 2002, 31(3):552-4.
• [26]Wilson RE, Alio AP, Kirby RS, Salihu HM: Young maternal age and risk of intrapartum stillbirth. Arch Gynecol Obstet 2008, 278(3):231-6.
• [27]Sharma V, Katz J, Mullany LC, Khatry SK, LeClerq SC, Shrestha SR, Darmstadt GL, Tielsch JM: Young maternal age and the risk of neonatal mortality in rural Nepal. Arch Pediatr Adolesc Med 2008, 162(9):828-35.
• [28]Salihu HM, Sharma PP, Ekundayo OJ, Kristensen S, Badewa AP, Kirby RS, Alexander GR: Childhood pregnancy (10-14 years old) and risk of stillbirth in singletons and twins. J Pediatr 2006, 148(4):522-6.
• [29]Olausson PO, Cnattingius S, Haglund B: Teenage pregnancies and risk of late fetal death and infant mortality. Br J Obstet Gynaecol 1999, 106(2):116-21.
• [30]Friede A, Baldwin W, Rhodes PH, Buehler JW, Strauss LT, Smith JC, Hogue CJR: Young maternal age and infant mortality: the role of low birth weight. Public Health Rep 1987, 102(2):192-9.
• [31]Santos IS, Barros AJ, Matijasevich A, Domingues MR, Barros FC, Victora CG: Cohort Profile: The 2004 Pelotas (Brazil) Birth Cohort Study. Int J Epidemiol 2010.
• [32]Victora CG, Hallal PC, Araujo CL, Menezes AM, Wells JC, Barros FC: Cohort profile: the 1993 Pelotas (Brazil) birth cohort study. Int J Epidemiol 2008, 37(4):704-9.
• [33]Victora CG, Barros FC: Cohort profile: the 1982 Pelotas (Brazil) birth cohort study. Int J Epidemiol 2006, 35(2):237-42.
• [34]Santos IS, Menezes AM, Mota DM, Albernaz EP, Barros AJ, Matijasevich A, Barros FC, Victora CG: Infant mortality in three population-based cohorts in Southern Brazil: trends and differentials. Cad Saude Publica 2008, 24(Suppl 3):S451-60.
• [35]Matijasevich A, Santos IS, Barros AJ, Menezes AM, Albernaz EP, Barros FC, Timm IK, Victora CG: Perinatal mortality in three population-based cohorts from Southern Brazil: trends and differences. Cad Saude Publica 2008, 24(Suppl 3):S399-408.
• [36]WHO: International Statistical Classification of Diseases and Related Health Problems (ICD-10). Geneva: World Health Organization; 1993.
• [37]Cowden AJ, Funkhouser E: Adolescent pregnancy, infant mortality, and source of payment for birth: Alabama residential live births, 1991-1994. J Adolesc Health 2001, 29(1):37-45.
• [38]Smith GC, Pell JP: Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study. BMJ 2001, 323(7311):476.
• [39]UNICEF: United Nations Children's Fund. State of the World's Children 2011: Adolescence - An Age of Opportunity. New York. 2011.
• [40]Gigante DP, Rasmussen KM, Victora CG: Pregnancy increases BMI in adolescents of a population-based birth cohort. J Nutr 2005, 135(1):74-80.