Adverse Maternal and Delivery Outcomes in Children and Very Young (Age ≤13 Years) US Adolescents Compared With Older Adolescents and Adults

Pineles, Beth L.; Harris, Anthony D.; Goodman, Katherine E

doi:10.1001/jama.2022.18340

Cited by 8 publications

(8 citation statements)

References 6 publications

(13 reference statements)

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“…4,7 At the same time, it is recognized that pregnant adolescents have at least twice the rate of preeclampsia/eclampsia and CD compared to adults 20 years old or older 10 ; the risk for these adverse maternal outcomes is significantly higher in very young adolescents compared to older adolescents. 10,11 In concordance with what has been published, we observed in our adolescent cohort that preeclampsia/eclampsia and CD were significantly associated with SARS-CoV-2 infection. Our cohort did not reflect the increased risk for PTD or FGR reported in general pregnant people infected with COVID-19 4,7 ; this may be explained by the limited number of eligible adolescent pregnancies during the study period.…”

Section: Discussionsupporting

confidence: 91%

“…Therefore, we sought to study obstetric and neonatal outcomes among pregnant adolescents infected with SARS-CoV-2 compared with those associated with noninfected pregnant adolescents during the beginning of the pandemic before availability of COVID-19 immunization. Because very young teens are at higher obstetric risk than older teens, 10,11 we also evaluated clinical outcomes of pregnant adolescents infected with SARS-CoV-2 stratified by age. We hypothesize that pregnant adolescent patients infected with SARS-CoV-2 remain at increased risk for adverse obstetric and nonobstetric outcomes compared with noninfected pregnant adolescent patients.…”

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confidence: 99%

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Outcomes in Pregnant Adolescent Patients Infected With SARS-CoV-2

Nguyen

Murrin

Nasrallah

et al. 2023

Pediatric Infectious Disease Journal

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Background: Pregnant patients with coronavirus disease 2019 (COVID-19) are at risk for adverse pregnancy outcomes. Although clinical outcomes for pregnant adults have been reported, the impact of COVID-19 on adolescents is lacking. We sought to evaluate obstetric outcomes of pregnant adolescents infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and compare them with uninfected adolescent controls. Methods: Retrospective cohort study of pregnant adolescents (14–19 years) who had a positive polymerase chain reaction test for SARS-CoV-2 from April 2020 to December 2020 at Inova Health System Hospitals. Controls included pregnant adolescents who tested negative. The primary outcome was a composite of preeclampsia, preterm delivery, cesarean delivery, fetal growth restriction and stillbirth. Secondary outcomes included maternal and neonatal morbidity. Results: Forty-eight pregnant adolescents who tested positive for SARS-CoV-2 were compared with 394 controls. Infected adolescents were more likely to be Hispanic (91.67% vs. 12.18%; risk ratio [RR] 41.85 [95% CI: 15.43–113.5]) and uninsured (50% vs. 7.87%; RR 7.04 [95% CI: 4.31–11.49]. Nearly 80% of infected adolescents remained asymptomatic, whereas one-third of symptomatic adolescents progressed to severe or critical COVID-19. The primary composite outcome was more prevalent in infected adolescents compared with noninfected controls (41.67% vs. 25.38%; adjusted RR 2.65 [95% CI: 1.19–5.93]). Maternal morbidity was more prevalent in infected adolescents (6.25% vs. 0.76%; adjusted RR 9.53 [95% CI: 3.83–23.71]). Primary and secondary maternal outcomes were more prevalent in younger adolescents and those with higher severity of COVID-19. Maternal SARS-CoV-2 infection was not associated with neonatal morbidity. Conclusions: Pregnant adolescents infected with SARS-CoV-2 are more likely to have adverse obstetric outcomes and maternal morbidity compared with noninfected pregnant adolescents.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Outcomes in Pregnant Adolescent Patients Infected With SARS-CoV-2

Nguyen

Murrin

Nasrallah

et al. 2023

Pediatric Infectious Disease Journal

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“…[32][33][34] However, this physiological theory to explain PTB has historically remained contested since gravid adolescents were found to have socioeconomic factors that are associated with a higher risk of PTB, which may contribute to this outcome, [35][36][37] although the results of our study argue against this. Our study also demonstrates that this PTB risk is increased in Table 4 Multivariable logistic regression showing association of adolescent subgroups (younger [13][14][15][16][17] and older [18][19]) with adverse outcomes, as compared with adults…”

Section: Discussionsupporting

confidence: 56%

Adverse Perinatal and Neonatal Outcomes among Adolescent Pregnancies in the United States

et al. 2023

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Background: Despite a downward trend in recent years, adolescent pregnancies in the United States remain higher than any other Western country. Adolescent pregnancies have been inconsistently associated with adverse perinatal outcomes. Objective: To investigate the association between adolescent pregnancies and adverse perinatal and neonatal outcomes in the United States. Methods: This is a retrospective cohort study of singleton births in the US from 2014 to 2020 using national vital statistics data. Perinatal outcomes included gestational diabetes (GDM), gestational hypertension (gHTN), preterm delivery <37 weeks (PTB), cesarean delivery (CD), chorioamnionitis, small for gestational age (SGA), large for gestational age (LGA), and neonatal composite outcome. Chi-square tests were used to compare outcomes among adolescent (13-19 years) vs. adult (20-29 years) pregnancies. Multivariable logistic regression models were used to examine association of adolescent pregnancies with perinatal outcomes. For each outcome, we utilized three models: unadjusted logistic regression, adjusted for demographics, and adjusted for demographics and medical comorbidities. Similar analyses were used to compare younger (13-17 years) and older (18-19 years) adolescent pregnancies to adults. Results: In a cohort of 14,014,078 pregnancies, we found that adolescents were at an increased risk of PTB (adjusted odds ratio (aOR) 1.12, 99% confidence interval (CI)1.12-1.13) and SGA (aOR 1.02, 99% CI 1.01-1.03) compared to adult pregnancies. We also found that multiparous adolescents with a prior history of CD were at an increased risk of CD, compared to adults. For all other outcomes, adult pregnancies were at higher risk for adverse outcomes in the adjusted models. When comparing birth outcomes among adolescents, we found that older adolescents are at an increased risk of PTB, while younger adolescents are at an increased risk of both PTB and SGA. Conclusion: After adjusting for confounders, our study demonstrates adolescents have an increased risk of preterm birth and SGA, compared to adults.

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“…First, although this study included a sensitivity analysis based on history of depression, study design, and definitions of pregnancy as unintended, the potential effects of maternal age on adverse maternal and delivery outcomes should not be overlooked. Prior studies have found that very young individuals (aged ≤13 years) or older people (aged >45 years) have a higher risk of adverse pregnancy-related outcomes, whether or not they intended to get pregnant. Therefore, a more detailed subgroup analysis in this study of whether there was a restriction of maternal age in the included studies would be helpful.…”

mentioning

confidence: 99%