Teenage pregnancy and fertility in New South Wales: an examination of fertility trends, abortion and birth outcomes

Maternal micronutrient restriction programs the body adiposity, adipocyte function and lipid metabolism in offspring: a review

Fetal growth is a complex process which depends both on the genetic makeup and intrauterine environment. Maternal nutrition during pregnancy is an important determinant of fetal growth. Adequate nutrient supply is required during pregnancy and lactation for the support of fetal/infant growth and development. Macro- and micronutrients are both important to sustain pregnancy and for appropriate growth of the fetus. While macronutrients provide energy and proteins for fetal growth, micronutrients play a major role in the metabolism of macronutrients, structural and cellular metabolism of the fetus. Discrepancies in maternal diet at different stages of foetal growth / offspring development can have pronounced influences on the health and well-being of the offspring. Indeed intrauterine growth restriction induced by nutrient insult can irreversibly modulate the endocrine/metabolic status of the fetus that leads to the development of adiposity and insulin resistance in its later life. Understanding the role of micronutrients during the development of fetus will provide insights into the probable underlying / associated mechanisms in the metabolic pathways of endocrine related complications. Keeping in view the modernized lifestyle and food habits that lead to the development of adiposity and world burden of obesity, this review focuses mainly on the role of maternal micronutrients in the foetal origins of adiposity.

Is young maternal age really a risk factor for adverse pregnancy outcome in a canadian tertiary referral hospital?

OBJECTIVE

To assess the risk of adverse pregnancy outcome among teenage mothers within a large tertiary referral center in Canada.

METHODS

All nulliparous singleton births in the McGill University Health Centre during 2001-2007 were retrieved using the "MOND" database. Patients were divided according to maternal age: <20 years (teenage), and between 20 and 39 years. Obstetric and neonatal complications were compared.

RESULTS

9744 nulliparous women were included; 250 (2.6%) were teenage and 9494 (97.4%) were 20-39 years old. Teenage mothers tended to deliver earlier (38.0 vs 39.2 weeks gestation, P < 0.001) and had higher rates of extreme prematurity (OR 4.5, 95% CI 2.5-8.1). Babies of teenage mothers had lower birth weights (3014 g vs 3326 g, P < 0.001), higher rates of NICU admission (OR 2.1, 95% CI 1.5-3.0), congenital anomalies (OR 1.8, 95% CI 1.2-2.6) and combined perinatal and neonatal mortality (OR 3.8, 95% CI 1.9-7.5). Logistic regression analysis showed an association between young maternal age and the risk to have at least one adverse outcome (P < 0.001).

CONCLUSIONS

Even within a large tertiary referral hospital, teenage mothers carry a greater risk of adverse pregnancy outcome, mainly due to preterm births.

Antecedents of teenage pregnancy from a 14-year follow-up study using data linkage

BACKGROUND

Many western nations continue to have high rates of teenage pregnancies and births, which can result in adverse outcomes for both mother and child. This study identified possible antecedents of teenage pregnancy using linked data from administrative sources to create a 14-year follow-up from a cross-sectional survey.

METHODS

Data were drawn from two sources - the 1993 Western Australian Child Health Survey (WACHS), a population-based representative sample of 2,736 children aged 4 to 16 years (1,374 girls); and administrative data relating to all their subsequent births and hospital admissions. We used weighted population estimates to examine differences between rates for teenage pregnancy, motherhood and abortion. We used Cox proportional hazards regression to model risk for teenage pregnancy.

RESULTS

There were 155 girls aged less than 20 years at the time of their first recorded pregnancy. Teenage pregnancy was significantly associated with: family type; highest school year completed by primary carer; combined carer income; whether the primary carer was a smoker; and whether the girl herself displayed aggressive and delinquent behaviours. An age-interaction analysis on the association with aggressive and delinquent behaviours found that while girls with aggressive and delinquent behaviours who were older at the time of the survey were at highest risk of teenage pregnancy, there was elevated risk for future teenage pregnancy across all ages.

CONCLUSIONS

Our findings suggest that interventions to reduce teenage pregnancy rates could be introduced during primary school years, including those that are focused on the prevention and management of aggressive and delinquent behaviour.

Birth outcomes for teenage women in New South Wales, 1998-2003

BACKGROUND

Pregnancy and childbirth in teenage women are associated with obstetric and social risks, and there is evidence that the birth rate among teenagers in rural and remote areas of Australia is not in decline. The combination of non-urban residence and young age at delivery might define a subgroup of women at special risk of adverse birth outcomes.

AIMS

To compare birth outcomes of New South Wales (NSW) teenagers residing in rural and remote areas with those living in larger centres with greater access to services.

METHODS

Outcomes for all singleton deliveries to teenage women living in NSW during the period 1998-2003 were reviewed. The women's place of residence was assigned an ARIA (Accessibility/Remoteness Index of Australia) classification according to remoteness and access to services. Analysis included obstetric factors (such as parity), and smoking status. Logistic regression analysis was undertaken to examine the impact of maternal factors on obstetric outcomes.

RESULTS

During the study period, 21 880 teenage women had singleton deliveries. Babies of teenage mothers in very remote areas had higher rates of preterm birth, small-for-gestational age and stillbirth. Rates of smoking were higher in more remote areas, and smoking correlated with preterm birth and stillbirth.

CONCLUSIONS

Teenagers living in remote areas of NSW face a higher risk of adverse pregnancy outcomes than their urban cousins.

Good outcome of teenage pregnancies in high-quality maternity care

BACKGROUND

Teenage pregnancies have been associated with fetal growth restriction, low birth weight, preterm birth and neonatal mortality. These could be due to biological immaturity, lifestyle factors or inadequate attendance to maternity care. The objective of this study was to assess the relationship between young age of the mother and pregnancy risk factors and adverse pregnancy outcome in conditions of high-quality maternity care used by almost the entire pregnant population.

METHODS

We analysed a population-based database of 26,967 singleton pregnancies during 1989-2001. Only 185 of these mothers were under 18 years old. Data were collected using a self-administered questionnaire at 20 weeks of pregnancy and clinical records of pregnancy, delivery and newborn child. The information covered maternal risk factors, pregnancy characteristics and obstetric outcomes. Odds ratios (ORs) for adverse pregnancy outcomes in teenage compared with older mothers were obtained from multiple logistic regression models.

RESULTS

Teenage mothers smoked, were unemployed and had anaemia or chorioamnionitis more often than older mothers. On the other hand, they were overweight and had maternal diabetes less often than adults. Teenage mothers had as many instrumented deliveries (OR 0.70; 95% confidence interval 0.39-1.27) but fewer Caesarean sections (0.62; 0.39-0.97) than adults. We found no evidence for increased risk of preterm delivery, fetal growth restriction, low birth weight, or fetal or perinatal death in teenage mothers.

CONCLUSIONS

These results suggest that increased risks for adverse pregnancy outcomes in teenage pregnancies can most probably be overcome by means of high-quality maternity care with complete coverage.

Teenage mothers: a pilot study

This paper presents the findings of a pilot study carried out in one regional center in Queensland, Australia. The study aimed to develop a snapshot image of teenage mothers. Of the thirty mothers who participated; just over half (16/30; 53%) reported using contraceptives, less than a third (8/30; 27%) used condoms to protect themselves from STDs and the majority (23/30; 77%) said their pregnancy was unplanned. Despite this, 16 (53%) attended prenatal classes, 16 (53%) breast-fed their infants and 27 (90%) were satisfied with motherhood. On average the fathers were almost four years older than the mother were (range 17 to 29 years), most fathers (23/30; 77%) were not teenagers themselves and only 11 (37%) were resident fathers following the birth of the baby. Exploratory analysis suggests that the fathers were significantly older than the teenage mothers were (t = -6.73, df 29, p = 0.0001). Although these preliminary results are similar to those reported in the American literature further research is needed to confirm if the findings presented are representative of teenage mothers in Australia. While we await the results of future studies, practitioners are encouraged to continue to educate young women about appropriate and safer sexual practices.

A comparison of adult and teenage mother's self-esteem and satisfaction with social support

OBJECTIVE

To investigate the similarities and differences between teenage and adult mothers and their level of self-esteem and satisfaction with social support at six weeks and six months postpartum.

DESIGN

A two group comparative study.

SETTING

Maternal child health, immunisation and midwives' clinics in New South Wales, Australia.

PARTICIPANTS

173 adult mothers and 72 adolescent mothers who had experienced a normal pregnancy, labour and delivery and delivered a healthy baby near term.

MEASUREMENTS AND FINDINGS

Rosenberg's Self-esteem Scale, Brown's Support Behavior Inventory and a personal information form were used. Irrespective of age, breast-feeding rates and satisfaction with social support decreased significantly during the early months postpartum. Furthermore, a significant inverse relationship was noted between maternal age and satisfaction with support and a positive relationship was identified between maternal age and self-esteem.

KEY CONCLUSIONS AND CLINICAL IMPLICATIONS

Maternal self-esteem may be challenged by the demands of motherhood and dissatisfaction with social support could contribute to the decline in breast-feeding practices. Developing a postnatal support plan, including fathers in education programmes and offering courses and workshops designed to enhance self-esteem and parentcraft may assist mothers to assume baby care responsibilities and increase their satisfaction with support.

Trends in birth rates for teenagers in Queensland, 1988 to 1997: an analysis by economic disadvantage and geographic remoteness

OBJECTIVE

To investigate trends in the birth rate for teenagers in Queensland, stratified by geographic remoteness and economic disadvantage.

METHOD

This was an analysis of routine data for the period 1988 to 1997. The number of births were obtained from the Queensland Perinatal Data Collection. Population data (the denominators for the rates) were obtained from the Australian Bureau of Statistics. Economic disadvantage was based on place of usual residence of the mother. Because of differences in physical, social and psychological development, the data were analysed in three age groups: 13 to 14 years, 15 to 17 years and 18 to 19 years.

RESULTS

Birth rates to teenagers who live in disadvantaged areas were 2 to 4 times higher than the rates for all of Queensland and 10 to 20 times higher than the rates in affluent areas. The trend analysis showed that the rates are decreasing in urban-affluent areas (about 2.5% per year), while they have remained stable, but extremely high in disadvantaged-remote areas, and are increasing (about 5% per year) in disadvantaged-urban areas.

CONCLUSIONS

The relatively low and stable rates for all of Queensland have hidden marked variations in the trends for areas defined according to economic disadvantage and remoteness. The rates were especially high and showed no improvement over time in remote disadvantaged areas, which have a large indigenous population.

IMPLICATIONS

In some areas of Queensland births to teenagers is a pressing problem, especially because it can perpetuate a cycle of limited educational opportunities, social isolation and reliance on welfare.

The support needs of pregnant and parenting adolescents in rural communities

Pregnant adolescents and teenage mothers in rural communities face extraordinary difficulties accessing appropriate and adequate support services, despite having recognised specialist health needs and unique support requirements. The Australian Rural Health Research Institute at Charles Sturt University, Wagga Wagga, is currently engaged in a federally funded project aimed it significantly improving access to services for this disadvantaged and often neglected group, through the publication and wide dissemination of a resource booklet identifying successful aspects of service delivery across a range of rural support settings. Five existing health and welfare support services for pregnant or parenting adolescent: in rural Australia have been selected for inclusion in the booklet, which is being developed for community use. Assessment is being undertaken during visits to each of the services, and, following interviews with staff, referral agencies and consumers. This paper outlines the strengths, attributes and access difficulties associated with two contrasting service models involved in the project, and stresses the importance of improving access to services for rural adolescents. A framework for establishing innovative and effective new services is also presented.