Adolescent pregnancy and long-term maternal health outcomes: a systematic review

Abstract

Pregnancy during adolescence accounts for 11% of births worldwide and is associated with a higher risk of premature delivery, low birthweight, and neonatal morbidity/mortality relative to adult women. Adolescent mothers themselves are more likely to experience anaemia, eclampsia, and systemic infections and in the developing world adolescent pregnancy is a major cause of maternal death due to obstetric complications. The present study aimed to examine whether or not there are any long-term impacts on the health of the mother, through a systematic review. A search strategy to identify articles linking adolescent pregnancy and later health was developed for Embase and Medline. Inclusion criteria was age at first birth ≤20 years with follow-up after index birth sufficient for later health effects to become apparent. Exclusion criteria were studies involving nulliparous women only or with no older-age comparison group. Titles (n=10,224) and abstracts (n=168) were screened and 43 full articles included in the review. Data on study characteristics and outcomes were tabulated and a study quality-score developed. Studies were mainly conducted in high-income countries and quality was high. Early age at first birth was strongly associated with increased risk of Obesity, Diabetes, Hypertension, Metabolic syndrome, Coronary heart disease, Myocardial infarction, cancer mortality (lung, cervix, gastric), Glaucoma and impaired physical growth. Adolescent mothers were at moderate risk of poor physical performance, Osteoporosis, Suicide and poor Mental health, and at normal risk of Cataract, Stroke, Breast cancer, Chronic lung disease. There is a strong association between an early age at first birth and long-term health outcomes.