A comparison between adolescent mothers and adult mothers in terms of maternal and infant outcomes at follow-ups

Teenage parents and their children-position paper of the European academy of paediatrics and the European confederation of primary care paediatricians

Introduction

Teenage parenthood presents multifaceted implications, affecting adolescent parents, their children, and extended families. Despite a decrease in teenage pregnancy rates across Europe, the phenomenon continues to present significant challenges, impacting not only the adolescent parents but also their offspring and extended families.

Methods

A comprehensive literature review was conducted. Key factors influencing teenage pregnancies, including socioeconomic background, family structure, and access to sex education and contraception, were examined. This review was supplemented by expert opinions from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP).

Results

The triad of mother, father, and child presents individual distinct healthcare needs and vulnerabilities, highlighting the importance of specialized support and healthcare. This paper explores the psychological, social, and educational repercussions of teenage parenthood on both parents and their children, including higher risks of postpartum depression, school dropout, and repeat pregnancies. Furthermore, it underscores the critical role that paediatricians and primary care providers play in supporting these young families.

Discussion

The position paper advocates for comprehensive care for adolescent parents and their children. It recommends preventive measures such as proper sex education and access to contraception to reduce unplanned teenage pregnancies. Additionally, it emphasizes the need for specialized healthcare and support for teenage parents to address their unique challenges and improve outcomes for both parents and their children.

Positive Parenting and Sociodemographic Factors Related to the Development of Chilean Children Born to Adolescent Mothers

The lack of economic resources has a negative effect on the maternal role of younger mothers. In Chile, the majority of adolescent pregnancies occur in socially and economically vulnerable contexts. The current study aimed to examine the relationship between demographic variables within the family context and parenting behaviors among Chilean adolescent mothers (including affection, responsiveness, encouragement, and teaching). These factors were correlated with communication, problem-solving abilities, and personal-social development in typically developing infants. The study included a sample of 79 Chilean adolescent mother-child dyads with children aged 10 to 24 months. Communication, problem-solving, and personal-social development were assessed using the Ages and Stages Questionnaire-3, along with a demographic information questionnaire. The parenting behaviors mentioned above were observed using the Spanish version of Parenting Interactions with Children: Checklist of Observations Linked to Outcomes. The findings indicated that mothers in employment and those who had not dropped out of school had children with better problem-solving skills. Additionally, children residing with their fathers and female children performed better in communication, problem-solving, and personal-social development. Maternal responsiveness was associated with communication and problem-solving, while maternal encouragement was linked to improved problem-solving skills. Maternal teaching was connected to communication, problem-solving, and personal-social development. The study emphasized the significance of parenting and sociodemographic factors among adolescent mothers and their influence on their children's development.

Adolescent Mothers' Psychological Wellbeing during Pregnancy and Infant Emotional Health

OBJECTIVE

Although many studies have identified risk factors for adolescent pregnancy, much less is known about factors that support pregnant adolescents' psychological wellbeing and offspring outcomes. This study drew on strength-based frameworks to investigate family and neighborhood factors linked to social connectedness that predict psychological wellbeing during adolescent pregnancy and offspring outcomes.

METHOD

Participants included 135 adolescent mothers (ages 14-21; 90% Black American) assessed annually since childhood as part of a longitudinal study. During preadolescence (ages 11-13), data on contextual stressors and neighborhood support were gathered from participants' caregivers; participants also rated their perceived trust/attachment with caregivers before and during pregnancy. To assess changes in psychological wellbeing, adolescents reported positive and depressed mood before and during pregnancy. A path analysis model tested the prospective associations between family and neighborhood factors, psychological wellbeing during pregnancy, and offspring outcomes (birth outcomes; observed infant positive/negative emotions at age 3-months).

RESULTS

Positive mood decreased from pre-pregnancy to pregnancy, whereas depressed mood remained stable. Adjusting for pre-pregnancy mood, perceived caregiver trust/attachment during pregnancy was associated with prenatal positive mood. Prenatal positive mood, in turn, reduced risk of preterm birth and indirectly predicted positive infant emotions via birth outcomes. Neighborhood support in preadolescence predicted lower prenatal depressed mood, but depressed mood did not predict infant outcomes beyond positive mood. Contextual life stress was not associated with prenatal mood after adjusting for family and neighborhood support.

CONCLUSIONS

Findings highlight changes in positive-valence emotions during adolescent pregnancy that may have unique associations with birth outcomes and offspring emotions.

Gender-common and gender-specific determinants of child dietary diversity in eight Asia Pacific countries

Background

Optimal child feeding practices contribute to reducing child undernutrition in low- and middle-income countries. Minimum dietary diversity (MDD) is a key indicator of complementary feeding quality for children aged 6-23 months. We aimed to examine the gender-common and gender-specific factors associated with the failure to meet MDD in eight Asia Pacific countries.

Methods

The study used data of children aged 6-23 months from the Demographic and Health Surveys (DHS) conducted in Afghanistan (n = 8410), Bangladesh (n = 2371), Nepal (n = 1478), Pakistan (n = 3490), Cambodia (n = 2182), Indonesia (n = 5133), Myanmar (n = 1379), and Timor-Leste (n = 2115). A total of 41 household, maternal, and child-level variables were examined for association with MDD using univariate and multivariable logistic regressions. All analyses accounted for the survey design and sampling weights.

Results

Being aged 6-11 months, not receiving Vitamin A supplementation, low maternal education, belonging to a low wealth quintile, and having two or more young children in the household were factors related to the failure to meet MDD among both male and female children. Mothers’ not watching TV or not being exposed to media at least once a week, delivery at home, young age, and engagement to non-agricultural work were only significant risk factors among female children. Non-professional delivery assistance, unsafe disposal of children’s stool, tolerant attitudes towards domestic violence, and rural residence were significant factors only among male children.

Conclusions

It is possible that male and female children in the region may consume food in various ways, because the factors for meeting MDD are not the same for different genders of children. It is advised to enhance dietary diversity in child nutrition programmes through gender-specific activities.

Maternal self-efficacy and emotional well-being in Chilean adolescent mothers: the relationship with their children's social-emotional development

Background

Low maternal self-efficacy and high levels of anxiety, depression, and stress can be triggered in adolescent mothers due to an incomplete development process that makes them physically or psychologically unprepared for the responsibilities of motherhood and parenting. These factors may be linked to difficulties with their children's social-emotional development. The present study aims to: (a) analyze the relationship between maternal self-efficacy and stress, depression, and anxiety levels in low-income adolescent mothers; (b) examine the relationship between maternal self-efficacy and well-being with children's social-emotional development; and (c) describe the effects of maternal self-efficacy on children's social-emotional development, mediated by maternal well-being.

Methods

A sample of 79 dyads comprising low-income Chilean adolescent mothers aged from 15 to 21 years old (M = 19.1, SD = 1.66) and their children aged 10 to 24 months (M = 15.5, SD = 4.2) participated in this research. A set of psychometric scales was used to measure maternal self-efficacy (Parental Evaluation Scale, EEP), the mothers' anxiety and depression (Hospital Anxiety and Depression Scale, HADS), maternal stress (Parental Stress Scale, PSS), and the children's social-emotional development (Ages and Stages Questionnaire Socio-emotional, ASQ-SE). Bivariate analyses and mediation models were employed to estimate and test the relevant relationships.

Results

A bivariate analysis showed that maternal self-efficacy was negatively related to the mother's anxiety, depression, and stress. Moreover, there was a significant relationship between maternal self-efficacy and maternal stress, and children's self-regulation and social-emotional development. Maternal self-efficacy, mediated by maternal anxiety, depression, and stress scores, had a significant effect on the development of children's self-regulation.

Conclusions

The results confirm the importance of adolescent mothers' emotional well-being and maternal self- efficacy with respect to their children's social-emotional development. This makes it necessary to have detailed information about how emotional and self-perception status influences a mother's role in the development of her children.

Effectiveness of interactive text messaging and structured psychosocial support groups on developmental milestones of children from adolescent pregnancies in Kenya: a quasi-experimental study (Preprint)

BACKGROUND

In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction.

OBJECTIVE

We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers' knowledge and practices as well as infant growth and development.

METHODS

This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups.

RESULTS

We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99).

CONCLUSIONS

An interactive text messaging platform improved adolescent mothers' knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents.

TRIAL REGISTRATION

Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse.

Breastfeeding challenges among Thai adolescent mothers: hidden breastfeeding discontinuation experiences

Purpose

The purpose of this study was to explore the experiences of adolescent mothers who wean their babies from breastfeeding before the first six months from the perspective of a psychosocial aspect in the Thai context.

Design/methodology/approach

A descriptive qualitative design was applied to this study to obtain meaningful data. The adolescent mothers for the primary study and nine supplementary participants were recruited from the largest university hospital in Bangkok, Thailand. Semi-structured in-depth interviews were conducted with 20 adolescent mothers. Descriptive statistics and content analysis were used for data analysis.

Findings

The average breastfeeding duration was 3.1 months while breastfeeding exclusively lasted 1.3 months. More than half of the adolescent mothers encountered breastfeeding problems at hospitalization including sore/cracked nipples (63.6%), one side breastfeeding (27.3%) and exhaustion (9.1%). According to the content analysis, (1) breastfeeding obstacles concealed by the adolescents' dependence and (2) repetitive emotional mistakes encountered were the two main themes that emerged.

Originality/value

The influence of key family members plays a vital role in breastfeeding and psychological outcomes. Therefore, family-adolescent support programs including support from the adolescents' mothers and grandmothers may improve breastfeeding outcomes, yield positive emotions and enhance maternal attachment. Moreover, healthcare professions are important mediators to convince adolescent mothers' key family members to reach an agreement and provide suitable support.

Children's dietary diversity and related factors in Rwanda and Burundi: A multilevel analysis using 2010 Demographic and Health Surveys

Background

One of the reported causes of high malnutrition rates in Burundi and Rwanda is children's inadequate dietary habits. The diet of children may be affected by individual characteristics and by the characteristics of the households and the communities in which they live. We used the minimum dietary diversity of children (MDD-C) indicator as a proxy of diet quality aiming at: 1) assess how much of the observed variation in MDD-C was attributed to community clustering, and 2) to identify the MDD-C associated factors.

Methods

Data was obtained from the 2010 Demographic and Health Surveys of Burundi and Rwanda, from which only children 6 to 23 months from rural areas were analysed. The MDD-C was calculated according to the 2007 WHO/UNICEF guidelines. We computed the intra-class coefficient to assess the percentage of variation attributed to the clustering effect of living in the same community. And then we applied two-level logit regressions to investigate the association between MDD-C and potential risk factors following the hierarchical survey structure of DHS.

Results

The MDD-C was 23% in rural Rwanda and 16% in rural Burundi, and a 29% of its variation in Rwanda and 17% in Burundi was attributable to community clustering. Increasing age and living standards were associated with higher MDD-C in both countries, and only in Burundi also increasing level of education of the mother's partner. In Rwanda alone, the increasing ages of the head of the household and of the mother at first birth were also positively associated with it. Despite the identification of an important proportion of the MDD-C variation due to clustering, we couldn't identify any community variable significantly associated with it.

Conclusions

We recommend further research using hierarchical models, and to integrate dietary diversity in holistic interventions which take into account both the household's and the community's characteristics the children live in.

School-Based Sexual and Reproductive Health Services for Prevention of Adolescent Pregnancy in the Hoima District, Uganda: Cluster Randomized Controlled Trial

Uganda has persistently had high adolescent pregnancy prevalence; 25% for the last 10 years. This protocol presents the design of a Cluster Randomized Controlled Trial (CRCT) to investigate the effectiveness of School-Based Sexual and Reproductive Health (SBSRH) interventions on prevention of pregnancy among school girls aged 15-19 years in the Hoima District, Uganda. 18 secondary schools (clusters) will be selected using cluster sampling and allocated 1:1 into control or intervention group stratified by geographical location. 1080 (60 each cluster) participants/girls aged 15-19 years will be selected using simple random sampling. The intervention group will receive tailored SRH information, in-school medical care and referral over 12 months. The control group will receive no intervention from the research team; however, they can access alternative services elsewhere if they wish. Data will be obtained at baseline, 6 months and 12 months. The outcomes are reduction in occurrence of pregnancy, utilization of SRH services and sexual behavioral change. To our knowledge, this is the first CRCT providing combined SRH interventions for prevention of adolescent pregnancy in Uganda. If effective, it could have great potential in preventing adolescent pregnancy. Trial Registration: Pan African Clinical Trial Registry (PACTR201810882140200) Registered on 16 October 2018.

Predicting postpartum depression among adolescent mothers: A systematic review of risk

BACKGROUND/AIMS

Postpartum depression (PPD) is a debilitating illness with negative consequences for affected mothers and their children (e.g., poor maternal-infant attachment, deficits in children's social, emotional, and cognitive development). While it is suggested that adolescent mothers are at increased risk of PPD, there is a paucity of research exploring factors that place adolescent mothers at risk. This systematic review aims to identify risk factors associated with adolescent PPD and appraise the quality of this evidence-base.

METHOD

A systematic review was conducted in May of 2018, using PsycINFO, EMBASE, MEDLINE, ASSIA, CINAHL, MIDIRS, and ProQuest Dissertations and Theses Global database, following PRISMA guidelines. Inclusion criteria included studies from developed countries; published after 1992; using a validated measure of PPD; with onset of illness within 12 months of childbirth, but which had persisted past two-weeks postpartum; adolescent mothers < 20 years of age; and risk factor(s) that occurred prior to birth.

RESULTS

Fourteen studies were included, ranging from weak-to-strong in quality. Results suggest several risk factors implicated in the onset of adolescent PPD, including prior depression, lack of familial social support, and socio-economic hardship.

CONCLUSIONS/LIMITATIONS

Awareness of risk factors for healthcare professionals working with pregnant adolescents is of high importance to better facilitate early identification and to provide support for adolescents at risk. Future research ought to consider employing prospective longitudinal designs, along with clearly defined, timely and validated measurements of risk factors and PPD. Limitations include only studies published in English and low agreement on the included studies selection bias.

Factors related to exclusive breastfeeding in Thai adolescent mothers: Concept mapping approach

The advantages of exclusive breastfeeding for the first 6 months are well-known. Unfortunately, adolescent mothers have lower rates of breastfeeding exclusivity and shorter duration of breastfeeding. There is limited evidence regarding exclusive breastfeeding determinants in adolescent mothers. The purpose of this study was to obtain adolescent mother-generated factors related to exclusive breastfeeding at 6 months. A mixed-methods design was conducted through concept mapping. Thirty adolescent mothers aged 15-19 years who had wide range of exclusive breastfeeding experiences brainstormed about specific factors. They then sorted and rated the statements into key clusters. Finally, half of the participants were involved in the interpretation of the mapping results and the creation of pathway diagrams. Data were analysed by multivariate statistics in the Concept System Global MAX program. The results showed that the adolescent mothers brainstormed about 104 statements on the factors related to exclusive breastfeeding at 6 months. These factors can be categorized into the following six key clusters: (a) breastfeeding advantages; (b) facilitating factors and necessary skills; (c) promotion and support needed; (d) community and social influence; (e) internal and external barriers; and (f) key problems in families. The pattern matching provided understanding of how key clusters are important to successful breastfeeding through comparing three groups of exclusive breastfeeding durations. Finally, the relationships of the stated factors were drawn in pathway diagrams. Exclusive breastfeeding experiences among Thai adolescent mothers showed complexity involving multilevel influences of social systems. The promotion of optimal breastfeeding should recognize the influences of both personal and environmental factors.

Attitude and practice of family planning methods among Roma women living in northern Turkey

Objective

This study aims to investigate the attitude and practice of family planning (FP) methods among Roma women living in northern Turkey.

Methods

A total of 120 Roma women living in northern Turkey participated in this descriptive study. Data were collected using a questionnaire. The scale of FP attitude was used.

Results

The mean age of participants was 28.9 ± 1.8. Among the participants, 37.5% (45/120) were primary school graduates, 70.8% (85/120) were unemployed, 73.4% (88/120) were in a consensual marriage and 94.2% (113/120) had children. The majority or 85.8% (103/120) of the participants stated that they used FP methods. Intrauterine device (57.4%, 69/120) and withdrawal method (22.3%, 27/120) were the most frequently used FP methods.

Conclusions

The rates at which Roma women use FP were high. Their attitudes towards FP tended to be negative and the methods used were primarily related to females.

Demographic Predictors of Family Functioning and Its Change Over the First 5 Years Postpartum: Findings From the Healthy Beginnings Trial

There are very few longitudinal studies examining family functioning in early childhood. This was a prospective cohort study to identify maternal sociodemographic factors associated with family functioning over the first 5 years postpartum, using data from the Healthy Beginnings Trial. Family functioning was measured using the General Functioning Subscale of the McMaster Family Assessment Device. A total of 667 first-time mothers participated, of which 369 remained at 5 years. Family functioning did not change significantly over the 5 years. Mothers being Australian born, being employed, and having a partner were predictors for healthy family functioning. Targeting support for immigrants, low-income and single-mother families may therefore improve family functioning.

Newborn Care Practices among Adolescent Mothers in Hoima District, Western Uganda

INTRODUCTION

Adolescent childbearing remains a major challenge to improving neonatal mortality especially in Sub Saharan countries which are still struggling with high neonatal mortality rates. We explored essential newborn care practices and associated factors among adolescent mothers in Western Uganda.

METHODS

Data were collected among 410 adolescent mothers with children aged one to six months in Hoima district. Three composite variables (appropriate neonatal breastfeeding, cord care and thermal protection) were derived by combining related practices from a list of recommended newborn care practices. Logistic regression analysis was conducted to identify factors independently associated with practice of essential newborn care.

RESULTS

Appropriate newborn feeding, optimal thermal protection and dry cord care were practiced by 60.5%, 67.2% and 31% of adolescent mothers respectively. Independent predictors' of cord care were: knowledge of cord care (AOR 5.34, 95% CI (1.51-18.84) and having delivered twins (AOR 0.04, 95% CI (0.01-0.22). The only predictor of thermal care was knowledge (AOR 25.15, 95% CI (7.01-90.20). Staying in a hospital for more than one day postpartum (AOR 2.45, 95%CI (1.23-4.86), knowledge of the correct time of breastfeeding initiation (AOR 14.71, 95% CI (5.20-41.58), predicted appropriate neonatal feeding, whereas; adolescent mothers who had had a caesarean delivery (AOR 0.19, 95% CI (I 0.04-0.96) and a male caretaker in the postnatal period (AOR 0.18, 95% CI (0.07-0.49) were less likely to practice the recommended newborn feeding.

CONCLUSION

Sub optimal essential newborn care practice was noted especially suboptimal cord care. Adolescent mothers should be a focus of strategies to improve maternal and neonatal health.

No widening socioeconomic gap within a general decline in Swedish breastfeeding

AIM

To study potential socioeconomic differences within the general decline in breastfeeding over time.

METHODS

Data was collected for 51 415 infants born 2004-2010 from the databases of statistics of the Preventive Child Health Care Services in Uppsala and Orebro counties in Sweden and socioeconomic indicators from Swedish national registers. Breastfeeding data (breastfed/not breastfed) from 1 week, 4 months and 6 months of age were used as the main outcome variables. Educational level of the mother was defined as the highest level on a three-grade scale, low, medium and high. Family type was defined as whether the mother was single or married/cohabiting. Family disposable income was divided into quartiles where quartile 1 included the 25% children in families with the lowest incomes. Analyses were conducted by logistic regression models using the methodology of generalized estimating equations (GEE). An exchangeable correlation structure was used to control for the dependence among infants with the same mother.

RESULTS

Breastfeeding rate in Sweden has declined gradually since the late 1990s. The results indicated that overall breastfeeding rates over the study period were influenced by socioeconomic status in a gradient manner but no widening socioeconomic gap was detected. Rather the interaction analyses showed a narrowing socioeconomic gap over the study period between high and low educational level and single versus cohabiting mothers at 4 months. The narrowing socioeconomic gap between the educational level categories was also detectable at 6 months.

CONCLUSION

No increase in socioeconomic gap was detected within the general decline in Swedish breastfeeding. However, there are reasons to maintain and strengthen the overall breastfeeding supportive measures including extended support for vulnerable groups.

Adolescent Pregnancy and Attained Height among Black South African Girls: Matched-Pair Prospective Study

IMPORTANCE

The impact of adolescent pregnancy on offspring birth outcomes has been widely studied, but less is known about its impact on the growth of the young mother herself.

OBJECTIVE

To determine the association between adolescent pregnancy and attained height.

DESIGN

Prospective birth cohort study.

SETTING

Cohort members followed from birth to age 20 y in Soweto, South Africa.

PARTICIPANT

From among 840 Black females with sufficient data, we identified 54 matched pairs, in which a girl who became pregnant before the age of 17 years was matched with a girl who did not have a pregnancy by age 20 y. Pairs were matched on age at menarche and height-for-age z scores in the year before the case became pregnant (mean 15.0 y).

MAIN OUTCOME MEASURES

The two groups were compared with respect to attained height, measured at mean age 18.5 y.

RESULTS

Mean age at conception was 15.9 years (range: 13.7 to 16.9 y). Mean height at matching was 159.4 cm in the adolescent pregnancy group and 159.3 cm in the comparison group (p = 0.3). Mean attained height was 160.4 cm in the adolescent pregnancy group and 160.3 cm in the comparison group (p = 0.7).

CONCLUSIONS

Among Black females in Soweto, South Africa, adolescent pregnancy was not associated with attained height.

Why Wait? Early Determinants of School Dropout in Preventive Pediatric Primary Care

Background

To answer the question of what bio-psychosocial determinants in infancy, early and middle childhood, and adolescence predict school drop-out in young adulthood, we approached the complex process towards school dropout as a multidimensional, life-course phenomenon. The aim is to find signs of heightened risks of school dropout as early as possible which will eventually help public health workers in reducing these risks.

Methods

In a case-control design, we used data from both the Preventive Pediatric Primary Care (PPPC) files (that contain information from birth onwards) and additional questionnaires filled out by 529 youngsters, aged 18–23 years, and living in the South-east of the Netherlands. We first conducted univariate logistic regression analyses with school-dropout as the dependent variable. Backward and forward stepwise analyses with the significant variables were done with variables pertaining to the 0 to 4 year period. Remaining significant variables were forced into the next model and subsequently variables pertaining to respectively the 4 to 8, 8 to 12 and 12 to 16 year period were introduced in a stepwise analysis. All analyses were cross-validated in an exploratory and confirmatory random half of the sample.

Results

One parent families and families with a non-Western background less often attended the health examinations of the PPPC and such less attendance was related to school dropout. The birth of a sibling (OR 0.63, 95% CI 0.43–0.93) in infancy and self-efficacy (OR 0.53, 95% CI 0.38–0.74) in adolescence decreased the odds of school dropout; externalizing behavior (OR 2.81, 95% CI 1.53–5.14) in middle childhood and (sickness) absence (OR 5.62, 95% CI 2.18–14.52) in adolescence increased the risks.

Conclusion

To prevent school dropout, PPPC professionals should not wait until imminent dropout, but should identify and tackle risk factors as early as possible and actively approach youngsters who withdraw from public health care.

Obstetric and neonatal outcomes of adolescent pregnancy

OBJECTIVE

We performed a retrospective study to evaluate adolescent pregnancies as for gestational complications, and prinatal outcomes.

METHODS

We evaluated 341 pregnants whose data we could reach regarding gestational, and perinatal complications.

RESULTS

In our study group anemia (35.4%), preeclampsia/eclampsia (1.45%), premature membrane rupture (1.4%), intrauterine growth retardation (3.81%), and instrumental delivery (0.3%) were seen in indicated incidence rates.

CONCLUSION

In our retrospective study, we found lower our complication rates in adolescent age group when compared with the adult age group, and other studies performed in adolescents. Since our hospital is a tertiary health care institute, and we monitorized our patients closely, our incidence rates can be better than those cited in the literature. As long as proper antenatal surveillance is employed, adolescent mothers do not seem to have increased risk for most of obstetric complications.

Unintended pregnancies among young women living in urban slums: evidence from a prospective study in Nairobi city, Kenya

BACKGROUND

Despite the significant proportion of young people residing in slum communities, little attention has been paid to the sexual and reproductive health (SRH) challenges they face during their transition to adulthood within this harsh environment. Little is known about the extent to which living in extreme environments, like slums, impact SRH outcomes, especially during this key developmental period. This paper aims to fill this research gap by examining the levels of and factors associated with unintended pregnancies among young women aged 15-22 in two informal settlements in Nairobi, Kenya.

METHODS

We use data from two waves of a 3-year prospective survey that collected information from adolescents living in the two slums in 2007-2010. In total, 849 young women aged 15-22 were considered for analysis. We employed Cox and logistic regression models to investigate factors associated with timing of pregnancy experience and unintended pregnancy among adolescents who were sexually active by Wave 1 or Wave 2.

FINDINGS

About two thirds of sexually experienced young women (69%) have ever been pregnant by Wave 2. For 41% of adolescents, the pregnancies were unintended, with 26% being mistimed and 15% unwanted. Multivariate analysis shows a significant association between a set of factors including age at first sex, schooling status, living arrangements and timing of pregnancy experience. In addition, marital status, schooling status, age at first sex and living arrangements are the only factors that are significantly associated with unintended pregnancy among the young women.

CONCLUSIONS

Overall, this study underscores the importance of looking at reproductive outcomes of early sexual initiation, the serious health risks early fertility entail, especially among out-of school girls, and sexual activity in general among young women living in slum settlements. This provides greater impetus for addressing reproductive behaviors among young women living in resource-poor settings such as slums.

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

OBJECTIVE

To evaluate longitudinal care needs and health service access among mother-infant pairs after adolescent pregnancy.

METHODS

In a case-control study, data were analyzed from primiparous adolescent and adult mother-infant pairs who delivered at Reunion Island University Hospital, France, between January 2004 and December 2006, and were followed-up from maternity discharge until December 2011. Infant outcomes were hospitalization during the first 2 years of life, hospital access for "non-medical" reasons, and neuropsychiatric care. Maternal outcomes were number of pregnancies and childbirths, rapid repeat pregnancy (RRP) rate, pregnancy morbidities, and use of health services.

RESULTS

Data from 476 cases and 476 controls were analyzed. Adolescent and control offspring did not differ in the measured outcomes. Adolescent and control mothers had, respectively, 2.4 ± 1.3 and 1.9 ± 1.1 pregnancies; 1.9 ± 0.8 and 1.6 ± 0.7 childbirths; and RRP rates of 7.6% and 2.7% (all P<0.001). Adolescents had less pregnancy-related pathologies at the index pregnancy and more frequently had natural deliveries (P<0.05). Younger mothers exhibited higher rates (19.7% versus 6.9%, P=0.001) of care for psychosocial reasons (suicide attempt, acute alcohol or drug intoxication, road accident, psychiatric problems, physical abuse).

CONCLUSION

Concerns arise from the long-term psychosocial risk among adolescent mothers.