Fertility Rate Trends Among Adolescent Girls With Major Mental Illness: A Population-Based Study

Abstract

OBJECTIVE: Fertility rates among adolescents have decreased substantially in recent years, yet fertility rates among adolescent girls with mental illness have not been studied. We examined temporal trends in fertility rates among adolescent girls with major mental illness. METHODS: We conducted a repeated annual cross-sectional study of fertility rates among girls aged 15 to 19 years in Ontario, Canada (1999–2009). Girls with major mental illness were identified through administrative health data indicating the presence of a psychotic, bipolar, or major depressive disorder within 5 years preceding pregnancy (60 228 person-years). The remaining girls were classified into the comparison group (4 496 317 person-years). The age-specific fertility rate (number of live births per 1000 girls) was calculated annually and by using 3-year moving averages for both groups. RESULTS: The incidence of births to girls with major mental illness was 1 in 25. The age-specific fertility rate for girls with major mental illness was 44.9 per 1000 (95% confidence interval [CI]: 43.3–46.7) compared with 15.2 per 1000 (95% CI: 15.1–15.3) in unaffected girls (rate ratio: 2.95; 95% CI: 2.84–3.07). Over time, girls with major mental illness had a smaller reduction in fertility rate (relative rate: 0.86; 95% CI: 0.78–0.96) than did unaffected girls (relative rate: 0.78; 95% CI: 0.76–0.79). CONCLUSIONS: These results have key clinical and public policy implications. Our findings highlight the importance of considering major mental illness in the design and implementation of pregnancy prevention programs as well as in targeted antenatal and postnatal programs to ensure maternal and child well-being.

Preterm birth, unplanned hospital contact, and mortality in infants born to teenage mothers in five countries: An administrative data cohort study

“…8 Similarly in Canada, falling teenage pregnancy rates have been less pronounced in teenagers with mental illness. 9 This suggests that as teenage pregnancy rates decline, teenagers who do give birth represent a more vulnerable group, with a higher concentration of individual risk factors such as mental health, conduct problems, or adversity. 10 Provided careful consideration is given to the comparability and quality of data collected in different contexts, international comparisons can offer powerful external benchmarks and evidence on where and how improvements to health and services might be made.…”

Body Image in Adolescent Pregnancy

“…This should include assessing body image satisfaction before, during and after pregnancy, as well as the development of a clinical tool to assess body satisfaction during pregnancy that is standardized to adolescents. Furthermore, to date there seem to be no specific intervention or prevention programs targeting body image of pregnant adolescents 33 and it is unclear as to when during pregnancy might be the best time to intervene. Prospective research is also needed tracking body image perceptions in adolescent pregnancy in conjunction with dieting and unhealthy weight control behaviors, as well as outcomes of pregnancy.…”

But We’re Not Like the People on TV: A Qualitative Examination of How Media Messages are Perceived by Pregnant and Parenting Youth

“…For some, these depictions contribute to their own sense of alienation and isolation, and in some cases, the fear of judgement affected their social and health interactions. Media influences that could further distance and marginalize PPY are a concern because many adolescent mothers have experienced a major mental health issue prior to becoming pregnant [38], and this group of adolescents is already at high risk for poorer mental health outcomes than their peers or adult counterparts.…”