MLHU - Health Status Resource

Teenage pregnancy and fertility

Teenage pregnancy and fertility
Key Findings: 

Trends in teen pregnancies are an indicator of young women’s sexual and reproductive health and their overall well-being.1, 2 To promote healthy sexuality among youth and prevent unplanned teen pregnancies, public health units in Ontario offer sexual health education and counselling services, low-cost contraception, and confidential and free sexual health clinic services.3 They also offer counselling services and supports to promote healthy pregnancies for teens who do become pregnant.3 Over time, the rate of teen pregnancies in Middlesex-London has decreased significantly. However, the percent of teenage mothers reporting mental health issues and substance use during pregnancy indicate that ongoing supports are needed for teens to ensure a healthy pregnancy for both the mother and baby.

The Healthy Pregnancy topic contains data for the overall Middlesex-London population on preconception and prenatal care, maternal health, prenatal substance exposure, and pregnancy and fertility.

Pregnancy and fertility Prenatal substance exposure
Preconception and prenatal health  

Pregnancy and fertility

The Pregnancy and Fertility and Birth Outcomes sections contain additional data for the overall Middlesex-London population.

Teenage pregnancy rates in Middlesex-London decreased significantly between 2006 and 2016; a similar trend seen in Ontario and the Peer Group (Figure 11.4.4). The teenage pregnancy rate in Middlesex-London in 2016 was higher compared to Ontario, but the difference was not statistically significant.

The fertility rate among women age 15–19 decreased over time in Middlesex-London from 2006–2017 (Figure 11.4.7 and Figure 11.4.9). Compared to women age 20–39, the fertility rate among the 15–19 age group was significantly lower (Figure 11.4.8).

The rate of preterm births and large for gestational age (LGA) births were lower among teenage mothers compared to older mothers from 2013–2017 (Figure 12.1.13). However, the rate of small for gestational age (births) was significantly higher among this age group.

Interpretation

Pregnancy and childbirth among females who are particularly young (i.e., teenagers) tend to be associated with greater odds of complications during pregnancy and delivery.4 Babies born to teenage mothers have a higher risk of small for gestational age (SGA), dying within the first 28 days of life, and having a low Apgar score.5 In the past few decades, there has been an overall decline in the rate of teenage pregnancies in Canada; from 1990–2010, rates dropped by 37.2%.2 Higher contraception use has been found to be a key driver for the decline in teenage pregnancies.6

Preconception and prenatal health

The Preconception and Prenatal Care and Maternal Health sections contain additional data for the overall Middlesex-London population.

Teenage mothers reported the lowest use of folic acid supplements prior to pregnancy in Middlesex-London from 2013–2017 (Figure 11.1.2). The percent ranged from 4.0% to 5.9% of women in that age group who gave birth.

Women less than 20 years of age reported the highest percent of mental health concern during pregnancy from 2013–2017 in Middlesex-London (Figure 11.2.2). In 2017, 61.1% of women in this age group reported a mental health concern during pregnancy, compared to 25.3% among women aged 30–34.

Approximately 1 in 5 women under the age of 20 gained the recommended amount of weight during pregnancy in Middlesex-London from 2014–2017 (Figure 11.2.8); the lowest proportion across all age groups.

Interpretation

A Canadian survey found that over 70% of teenage pregnancies (age 15–19) were unplanned.7 Unplanned pregnancies tend to be recognized later in the pregnancy, and thus may receive delayed prenatal care.8 The use of folic acid supplements before pregnancy has also been found to be lower among unplanned pregnancies.9

An unplanned teenage pregnancy can be a highly stressful time due to the disruption to school and life plans, lack of social supports, social stigma, and the financial burden of raising a child.10 Pregnant teens have been found to be at increased risk for mental health issues such as symptoms of depression.11, 12

Prenatal substance exposure

The Prenatal Substance Exposure section contains additional data for the overall Middlesex-London population.

Women under the age of 20 had the highest percent who reported smoking (11.3.2), using drugs (other than alcohol) (Figure 11.3.7), and using cannabis (Figure 11.3.9) during pregnancy in Middlesex-London from 2013 to 2017.

Interpretation

Women under the age of 20 are more likely than older women to use tobacco, alcohol13, and drugs11 during pregnancy. While most stop using during the pregnancy, an important percent continue to use14 which can cause health problems for both the mother and baby. Ongoing supports for teens who become pregnant are needed to ensure a healthy pregnancy for both the mother and baby.

Ontario Public Health Standard: 

Ontario Public Health Standards: Requirements for Programs, Services, and Accountability
Population Health Assessment and Surveillance Protocol, 2018

References:

1. Gavin L, MacKay AP, Brown K, Harrier S, Ventura SJ, Kann L, et al. Sexual and Reproductive Health of Persons Aged 10--24 Years --- United States, 2002--2007. MMWR [Internet]. 2009 [cited 2019 Aug 12];58(SS06):1–58. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5806a1.htm

2. McKay A. Trends in Canadian National and Provincial/Territorial Teen Pregnancy Rates: 2001–2010. Can J Hum Sex [Internet]. 2012 [cited 2019 Aug 12];21(3–4):161–75. Available from: http://www.sieccan.org/pdf/TeenPregancy.pdf

3. Ministry of Health and Long-Term Care. Initial Report on Public Health August 2009 [Internet]. Toronto, ON: Queen's Printer for Ontario, 2009 [cited 2019 Aug 12]. Available from: https://rnao.ca/sites/rnao-ca/files/PMWG_Initial_Report_2009.pdf

4. Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Bommarito K, Madden T, Olsen MA, et al. Maternal Age and Risk of Labor and Delivery Complications. Matern Child Health J [Internet]. 2015 [cited 2018 Nov 8];19(6):1202–11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418963/ DOI: 10.1007/s10995-014-1624-7

5. Chen X-K, 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 [Internet]. 2007 [cited 2018 Nov 15];36(2):368–73. Available from: http://dx.doi.org/10.1093/ije/dyl284 DOI: 10.1093/ije/dyl284

6. Lindberg L, Santelli J, Desai S. Understanding the Decline in Adolescent Fertility in the United States, 2007–2012. J Adolesc Health [Internet]. 2016 [cited 2019 Aug 6];59(5):577–83. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/27595471/ DOI: 10.1016/j.jadohealth.2016.06.024

7. Public Health Agency of Canada. What Mothers Say: The Canadian Maternity Experiences Survey Ottawa, ON: Government of Canada, 2009 [cited 2019 Aug 6]. Available from: http://www.phac-aspc.gc.ca/rhs-ssg/pdf/survey-eng.pdf

8. Kost K, Lindberg L. Pregnancy Intentions, Maternal Behaviors, and Infant Health: Investigating Relationships with New Measures and Propensity Score Analysis. Demography [Internet]. 2015 [cited 2019 Aug 6];52(1):83–111. Available from: https://doi.org/10.1007/s13524-014-0359-9 DOI: 10.1007/s13524-014-0359-9

9. Public Health Agency of Canada. Folic Acid Use among Pregnant Women in Canada [Internet]. Ottawa, ON: Goverment of Canada, 2014 [cited 2019 Aug 6]. Available from: https://www.canada.ca/content/dam/canada/health-canada/migration/healthy...

10. East PL, Chien NC, Barber JS. Adolescents' Pregnancy Intentions, Wantedness, and Regret: Cross-Lagged Relations with Mental Health and Harsh Parenting. J Marriage Fam [Internet]. 2012 [cited 2019 Aug 6];74(1):167–85. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22544975 DOI: 10.1111/j.1741-3737.2011.00885.x

11. Hodgkinson S, Beers L, Southammakosane C, Lewin A. Addressing the Mental Health Needs of Pregnant and Parenting Adolescents. Pediatrics [Internet]. 2014 [cited 2019 Aug 6];133(1):114–22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24298010 DOI: 10.1542/peds.2013-0927

12. Hodgkinson SC, Colantuoni E, Roberts D, Berg-Cross L, Belcher HME. Depressive Symptoms and Birth Outcomes among Pregnant Teenagers. J Pediatr Adolesc Gynecol [Internet]. 2010 [cited 2019 Aug 6];23(1):16–22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19679498 DOI: 10.1016/j.jpag.2009.04.006

13. Public Health Agency of Canada. Canadian Perinatal Health Report, 2008 Edition [Internet]. Ottawa, ON: 2008 [cited 2018 Nov 8]. Available from: http://www.phac-aspc.gc.ca/publicat/2008/cphr-rspc/pdf/cphr-rspc08-eng.pdf

14. Chapman SLC, Wu L-T. Substance Use among Adolescent Mothers: A Review. Child Youth Serv Rev [Internet]. 2013 [cited 2019 Aug 7];35(5):806–15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23641120 DOI: 10.1016/j.childyouth.2013.02.004

15. Committee on Obstetric Practice American Academy of Pediatrics—Committee on Fetus and Newborn. The Apgar Score [Internet]. The American College of Obstetricians and Gynecologists, 2015 Reaffirmed 2017 [cited 2018 Nov 15]. Available from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinio...

Last modified on: November 7, 2019

Jargon Explained: 

Teenage pregnancy
Pregnancy in women aged 15 to 19.

Age-specific pregnancy rate
The number of pregnancies among females in a given age group, per 1,000 females of the given age group.

Age-specific fertility rate
The number of live births to females in a given 5-year age group, per 1,000 females in the given 5-year age group.

Apgar score
A method to quickly assess the clinical status of a newborn baby at one and five minutes after birth. The score consists of five components: colour, heart rate, reflexes, muscle tone, and respiration, each of which is given a score of 0, 1, or 2.15

Preterm birth rate
Number of live births delivered before 37 completed weeks of gestation per 100 live births.

Small-for-gestational-age rate
The number of live births with a birth weight below the tenth percentile of birth weights for their gestational age and sex, per 100 live births.

Large-for-gestational-age rate
The number of live births with a birth weight above the ninetieth percentile of birth weights for their gestational age and sex, per 100 live births.