Longitudinal health outcome and wellbeing of mother-infant pairs after adolescent pregnancy in Reunion Island, Indian Ocean

Mental health outcomes beyond the post-partum period among adolescent mothers: a systematic review and meta-analysis

Background

Adolescence is the most crucial part of life. The vulnerability of adolescent mothers is even more pronounced and can affect various health aspects. While they suffer from social and emotional stresses shortly after giving birth, the long-term effect after the post-partum period of adolescent pregnancy on the mental outcomes holds prime importance. Thus, this systematic review aims to ascertain the association between adolescent pregnancy on mental health outcomes.

Methods

The search strategy was run in June 2023 on databases including PubMed, CINAHL, Scopus, Psych Info, and Embase . Quality assessment of the studies was done using the National Institute of Health (NIH)'s National Heart, Lung and Blood Institute (NHLBI) tool for observational studies. For studies that measured similar outcomes, a meta-analysis was conducted.

Findings

The search strategy yielded 21 results from all databases and cross-referencing. Of these, all except for one (case-control) were cross-sectional and cohort studies. The pooled analysis found a significant association between adolescent pregnancy and depression (RR 1.34; 95% CI 1.05, 1.72, 6 studies, heterogeneity: Chi2 P 0.01; I2 = 60%); however, no association was found in anxiety (RR 1.05; 95% CI 0.26, 4.14, 2 studies; heterogeneity: Chi² P = 0.0003; I2 = 93%) and suicidal ideation (RR 3.21; 95% CI 0.17, 59.33; 3 studies; heterogeneity: Chi2 P < 0.00001; I2 = 98%).

Implication

These findings suggest that the mental health needs of adolescent mothers must be addressed and innovative and effective interventions that support and address the mental health needs of adolescent mothers are needed to improve their mental health.

Understanding barriers and motivations to Papillomavirus vaccination in a middle school in Reunion Island

BACKGROUND

In Reunion Island, papillomavirus (HPV) vaccination coverage is low. A study encouraging vaccination in middle school showed low rate of participation. The main objective of the study was to understand barriers and motivations to HPV vaccination in populations yet sensitized to its benefits.

METHODS

The study focused on population around the intervention school where a health promotion program was conducted during school year 2020-2021. Semi-structured face-to-face interviews among children, children's parents, school staff, general practitioners (GP) and association members were conducted. A qualitative study was adopted using a grounded theory approach to obtain an in-depth understanding of issues pertaining to HPV vaccination.

FINDINGS

A total of 19 school staff members, 20 parents of middle school children, 39 children, 5 GPs and 3 association members were interviewed in May 2021. Anti-vaccination attitudes included: fear of serious adverse effects (such as fertility) due to poor knowledge, fear of encouraging sexuality among teenagers, mistrust towards scientists and the pharmaceutical industry and the negative impact from social networks. However, we found that the influence of the school, GP's and 'story-telling' study testimonials were crucial to invert the balance and motivate children's vaccination.

INTERPRETATION

Reproductive adverse events related to the HPV vaccine may be strongly perceived amongst our population, either regarding fertility or negative fetal effects; though Reunion island has 5% of pregnancies among teenagers. It is crucial to lift this taboo related to sexuality and encourage dialogue between children and their close social network. This better understanding of barriers and motivations will help us increase the impact of school-based HPV vaccination, which will be introduced in September 2023 in whole France.

Prevalence and risk factors for gonococcal infection in Reunion Island

OBJECTIVE

To determine the prevalence and risk factors for gonococcal infection, and the resistance profile of Neisseria gonorrhoeae (NG) in Reunion Island.

PATIENTS AND METHODS

All patients who visited the four sexually transmitted infection (STI) clinics of Reunion Island between January 2017 and December 2018 were screened by multiplex polymerase chain reaction. Data on patient characteristics were collected using a self-administered questionnaire (reason for screening, marital status, risk-taking behaviors, place of birth, employment status, type of health care coverage, sexual orientation, number of sexual partners, occurrence of extra-marital relationships, history of STIs, and symptomatology. Precarity was defined as being unemployed and/or receiving universal health insurance).

RESULTS

The prevalence of NG (n=4289) in the screened population was 2.8% (95% CI [2.3-3.3]). Minors were especially at-risk (4.4% (95% CI [2.6-7])) and especially girls (5.6% (95% CI [3.2-8.9])). The prevalence observed in the homosexual population was 4.0% [2.6-5.9]. Gonococcal infection was asymptomatic in 56 (69%) patients. For all infection sites, the main risk factors were male minors (P=0.019), individuals living in conditions of precarity (P=0.023), individuals co-infected with chlamydia (P<0.001) or syphilis (P<0.001), and individuals of foreign origin (P=0.006). No NG strain was resistant to ceftriaxone. Strains were resistant to penicillin G, ciprofloxacin, and azithromycin in 22% (20/91), 38% (35/91), and 1% (1/91) of cases, respectively.

CONCLUSION

The prevalence of NG in patients visiting STI clinics in Reunion Island is particularly high among minors. Prevention programs targeting this population should be reinforced and screening should be facilitated in school settings.

Impact of Age at Childbirth on Maternal Mental Health among Premenopausal Women: The 2010-2012 Korean National Health and Nutrition Examination Survey

OBJECTIVE

No reports have investigated the influence of age at first or last childbirth on maternal mental health. The aim of this study was to determine whether there is an association between age at first or last childbirth and the mental health of premenopausal women.

METHODS

The data used in this study were collected from the 2010 to 2012 Korea National Health and Nutrition Examination Surveys. A total of 3,370 premenopausal women were considered. The association between childbirth age and maternal mental health factors, including stress, depressed mood, and suicidal ideations were analyzed using multiple logistic regression analyses adjusted for confounding factors.

RESULTS

After adjusting confounding factors, younger maternal age at first childbirth was found to be associated with an increase in the prevalence of maternal depressed mood and suicidal ideations. Also, older maternal age at last childbirth was related to an increase in maternal stress, depressed mood and suicidal ideations.

CONCLUSION

Both younger first childbirth and older last childbirth maternal age may be risk factors for poor outcomes of premenopausal women's mental health. These data support the need for comprehensive mental health assessment for premenopausal women who either gave birth at an age too young or too old.

Management of pregnancy based on healthcare consumption of women who delivered in France in 2015: Contribution of the national health data system (SNDS)

OBJECTIVE

This study was designed to further our knowledge of the management of pregnant women based on the national health data system (SNDS).

MATERIAL AND METHODS

Women covered by the national health insurance general scheme or a local mutualist section, who delivered in 2015.

RESULTS

Among the 672,182 women included (mean age: 31 years, SD 5.3), 0.3% were under the age of 18 years, 4% lived in a French overseas department (<18 years: 21%), 17% had complementary universal health insurance coverage (<18 years: 75%), 1.2% presented a mental illness, 0.6% had a cancer, and 0.4% had cardiovascular disease. At least one outpatient visit with a gynaecologist or midwife was detected for 93% of women (first trimester (T1): 75%), specific or nonspecific pelvic ultrasound was performed in 98% (T1: 92%), blood glucose assay was performed in 78% (T1: 61%), and an oral glucose tolerance test was performed in 58%. Before delivery, 0.2% of women had at least one admission to the intensive care unit and 22% had at least one hospital stay (<18 years: 38%), for which the principal diagnoses were: false labour (4.5%), threatened preterm labour (2.5%), surveillance of high-risk pregnancy (2.6%), diabetes (2.6%), and hypertension (0.7%). The preterm delivery rate was 6.7% (<18 years: 14%, ≥40 years: 9%). Although 20% of deliveries were performed by caesarean section, 16% of vaginal deliveries required instrumental extraction.

DISCUSSION

SNDS data enrich the data derived from periodic national perinatal surveys, such as the poor follow-up of adolescent girls. These data can promote the elaboration and monitoring of annual indicators.

Rheumatism and chronic fatigue, the two facets of post-chikungunya disease: the TELECHIK cohort study on Reunion island

Prolonged fatigue is increasingly reported among chikungunya virus (CHIKV)-infected populations. We investigated the relationships between CHIKV exposure, long-lasting rheumatic musculoskeletal pain (LRMSP) and chronic fatigue. 1094 participants (512 CHIKV seropositive and 582 seronegative) of the TELECHIK population-based cohort were analysed considering the duration of the manifestations throughout an average 2-year follow-up. Weighted prevalence rates and prevalence ratios for LRMSP, idiopathic chronic fatigue (ICF), and chronic fatigue syndrome (CFS)-like illness, both latter syndromes adapted from Centers for Disease Control (CDC)-1994/Fukuda criteria, were compared. Population attributable fractions (PAF) were estimated to assess the contribution of CHIKV infection to each of the three phenotypes. Among 362 adult subjects who had reported either rheumatic pain or fatigue at the onset of the infection, weighted prevalence rates of LRMSP, ICF and CFS-like illness were respectively of 32.9%, 38.7% and 23.9%, and of 8.7%, 8.5% and 7.4% among initially asymptomatic peers (P < 0.01, respectively). Each of the three outcomes was highly attributable to chikungunya (PAF of 43.2%, 36.2% and 41.0%, respectively). In the sub-cohort of CHIKV-infected subjects, LRMSP, ICF and CFS-like illness, which overlapped in 70%, accounted for 53% of the chronic manifestations. In addition to rheumatic disease, chronic fatigue could be considered in caring for patients with chronic chikungunya disease.

Linear association between maternal age and spontaneous breech presentation in singleton pregnancies after 32 weeks gestation

PURPOSE

To investigate the association between maternal age and spontaneous breech presentation.

MATERIAL AND METHODS

Fifteen-year observational study over (2001-2015). All consecutive singleton births delivered at the Centre Hospitalier Universitaire Sud Reunion's maternity. The only single exclusion criterion was uterine malformations (N = 123) women.

RESULTS

Of the 60,963 singleton births, there was a linear association (χ² for linear trend, p< 0.0001) between maternal age and spontaneous breech presentation. Overall rate of breech presentation was 2.7% in deliveries over 32 weeks gestation, while it was 1.9% in women aged 15 to 19 years and 4.0% in women aged 45+, with a linear progression for each 5-year age category. This linearity remained significant controlling for early prematurity (<33 weeks) and severe fetal malformations (χ² for linear trend = 64, p < 0.0001). Controlling in a multiple logistic regression model for other major risk factors gestational age, female sex, primiparity, maternal age remained significantly an independent risk factor, p < 0.0001.

CONCLUSION

Maternal age (x) is an independent factor for breech presentation in singleton pregnancies after 32 weeks gestation with a linear association that may be approximated at y = 0.1x. (y: incidence, percent).

Invasive Group B Streptococcal Disease in Non-pregnant Adults, Réunion Island, 2011

OBJECTIVES

While the prevalence of Group B streptococcus (GBS) colonization is important, little is known about invasive GBS (iGBS) disease in tropical areas. Our objective was to assess the burden of iGBS disease among non-pregnant adults.

METHODS

A prospective hospital-based study of all non-pregnant adult patients with iGBS disease was conducted between January and December 2011 in Saint Pierre, Réunion Island, to assess its cumulative incidence rate (CIR). Capsular serotyping and multilocus sequence typing were performed to characterize GBS isolates. Case-control study was done to identify risk factors.

RESULTS

The overall CIR of iGBS disease was 10.1 per 100,000. The CIR in elderly patients (≥ 65 yrs) was estimated at 40.6 per 100.000, and that of adults (15-64 years) at 6.7 per 100.000. Aboriginal origin in the Indian Ocean and overweight were both associated with iGBS disease. The most prominent clinical forms were osteo-articular and skin/soft tissue infections, as a consequence of diabetic foot. The serotypes were classic, type-Ia being the most prevalent. The hyper virulent ST-17 (CC17) was associated with type-III.

CONCLUSIONS

The incidence of iGBS disease found in Réunion island is twofold that usually reported. This burden is linked to overweight in aboriginal people from the Indian Ocean.