Lower rates of adolescent Cesarean delivery, but increased neonatal morbidity

1. Compared with young adults (ages 20-24 years), young adolescents (ages 11-14 years) were less likely to require a cesarean or operative vaginal delivery

2. However, infants born to young adolescents were at a significantly increased risk of preterm birth, low birth weight and death.

Evidence Rating Level: 2 (Good) 

Study Rundown: In the US, the teen pregnancy rate has declined almost continuously over the past 20 years, yet in 2013 alone, more than 3100 girls ages 10-14 gave birth. Not only is teen pregnancy problematic socially, but many studies have shown that adolescent pregnancy outcomes are worse for both mother and child compared with pregnancy in adult women. It has long been proposed that young adolescents, under the age of 15, might be at increased risk for cesarean or operative vaginal deliveries (e.g. forceps or vacuum assisted) because an underdeveloped pelvis may not be large enough for a vaginal delivery. However, multiple large database studies have actually found a decreased risk for cesarean delivery among teens, but most of these primarily look at adolescents 16 and older. Ultimately, few population-based studies have looked at birth outcomes for young adolescents. In this study, researchers used a population based cohort in Washington State to compare delivery type and neonatal outcomes in young adults and young adolescents over a 22 year period.

Young adolescents, ages 11-14, were less likely to require a cesarean or operative delivery than young adults (ages 20-24 years), but their infants were at greater risk for preterm birth, low birth weight and even death. Strengths of this study included the large, population-based sample size which included a large cohort of young adolescents. One limitation is that researchers were not able to control for factors not present on birth certificates or patient charts, such as parental support and psychological factors that may contribute to the poor pregnancy outcomes for adolescents who give birth at such a young age. Future studies might prospectively survey a national group of young adolescents to better assess these factors.

Click to read the study in AJOG

Relevant Reading: National Vital Statistics Reports–Births: Final Data for 2013

In-Depth [retrospective cohort]: Researchers used Washington State birth certificate data linked to hospital records from 1987-2009 to collect data on 26 091 nulliparous, singleton births in adolescents and young adults. Young adolescents (age 11-14) (n=2007) were matched with control groups of young teens (age 15-17 years), older teens (18-19 years) and young adults (20-24 years; n=8028 each). The primary outcome was method of delivery, while secondary outcomes included various markers of neonatal morbidity and mortality.

Young adolescents were less likely to have a cesarean delivery (RR=0.73, 95% CI=0.65-0.83) or operative vaginal delivery (RR=0.87, 95% CI 0.78-0.97) than young adults. However, young adolescents were more likely to have a prolonged length of hospital stay for both vaginal and cesarean deliveries (RR=1.34, 95% CI=1.20-1.49 and RR=1.71, 95% CI=1.38-2.12), preterm delivery (RR=2.11, 95% CI=1.79-2.48), low and very low birth weight infant (RR=2.08, 95% CI=1.73-2.50 and RR=3.25, 95% CI=2.22-4.77) and infant death (RR=3.90, 95% CI=2.36-6.44) compared with young adults.

Image: PD

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