Semin Reprod Med 2022; 40(01/02): 116-123
DOI: 10.1055/s-0041-1735847
Review Article

Social Determinants of Health and Adverse Outcomes in Adolescent Pregnancies

S. Amjad
1   Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
,
M. Adesunkanmi
1   Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
,
J. Twynstra
2   School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
,
J.A. Seabrook
2   School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
3   Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
4   Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
5   Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada
,
1   Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
› Author Affiliations
Funding Women and Children's Health Research Institute Canada Research Chairs 950-232833.

Abstract

The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.



Publication History

Article published online:
09 September 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 World Health Organization. Adolescent pregnancy. 2020 . Accessed April 15, 2021 at: https://www.who.int/en/news-room/fact-sheets/detail/adolescent-pregnancy
  • 2 United Nations Children's Fund. The state of the world's children 2009. Maternal and newborn health, UNICEF. 2008 . Accessed April 15, 2021 at: https://www.unicef.org/media/84866/file/SOWC-2009.pdf
  • 3 Cunnington AJ. What's so bad about teenage pregnancy?. J Fam Plann Reprod Health Care 2001; 27 (01) 36-41
  • 4 Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med 1995; 332 (17) 1113-1117
  • 5 Jolly MC, Sebire N, Harris J, Robinson S, Regan L. Obstetric risks of pregnancy in women less than 18 years old. Obstet Gynecol 2000; 96 (06) 962-966
  • 6 Hoffman SD, Maynard RA. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy. 2nd ed.. Urban Institute Press; 2008: 359-402
  • 7 Indicator 3.7.2, Series: Adolescent Birth Rate (per 1,000 women aged 15–19 years) SP_DYN_ADKL. Accessed April 15, 2021 at: https://unstats.un.org/sdgs/indicators/database/
  • 8 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep 2018; 67 (08) 1-50
  • 9 Adolescent fertility rate (births per 1,000 women ages 15–19). Accessed April 24, 2021 at: https://data.worldbank.org/indicator/SP.ADO.TFRT
  • 10 Finer LB, Zolna MR. Shifts in intended and unintended pregnancies in the United States, 2001–2008. Am J Public Health 2014; 104 (Suppl. 01) S43-S48
  • 11 Azevedo WF, Diniz MB, Fonseca ES, Azevedo LM, Evangelista CB. Complications in adolescent pregnancy: systematic review of the literature. Einstein (Sao Paulo) 2015; 13 (04) 618-626
  • 12 Jeha D, Usta I, Ghulmiyyah L, Nassar A. A review of the risks and consequences of adolescent pregnancy. J Neonatal Perinatal Med 2015; 8 (01) 1-8
  • 13 Lopoo LM. Labor and delivery complications among teenage mothers. Biodemogr Soc Biol 2011; 57 (02) 200-220
  • 14 Hodgkinson S, Beers L, Southammakosane C, Lewin A. Addressing the mental health needs of pregnant and parenting adolescents. Pediatrics 2014; 133 (01) 114-122
  • 15 Kingston D, Heaman M, Fell D, Chalmers B. Maternity Experiences Study Group of the Canadian Perinatal Surveillance System, Public Health Agency of Canada. Comparison of adolescent, young adult, and adult women's maternity experiences and practices. Pediatrics 2012; 129 (05) e1228-e1237
  • 16 Dinwiddie KJ, Schillerstrom TL, Schillerstrom JE. Postpartum depression in adolescent mothers. J Psychosom Obstet Gynaecol 2018; 39 (03) 168-175
  • 17 Briggs G, Brownell M, Roos NP. Teen mothers and socioeconomic status: The chicken-egg debate. J Assoc Res Mothering 2007; 9 (01) 62-74
  • 18 Paranjothy S, Broughton H, Adappa R, Fone D. Teenage pregnancy: who suffers?. Arch Dis Child 2009; 94 (03) 239-245
  • 19 Not Just another Single Issue: Teen Pregnancy Prevention's Link to Other Critical Social Issues. Washington, DC: National Campaign to Prevent Teen Pregnancy; 2002. . Accessed April 15, 2021 at: https://eric.ed.gov/?id=ED462522
  • 20 Mahfouz AA, El-Said MM, al-Erian RA, Hamid AM. Teenage pregnancy: are teenagers a high risk group?. Eur J Obstet Gynecol Reprod Biol 1995; 59 (01) 17-20
  • 21 Olausson PM, Cnattingius S, Goldenberg RL. Determinants of poor pregnancy outcomes among teenagers in Sweden. Obstet Gynecol 1997; 89 (03) 451-457
  • 22 Anderson NE, Smiley DV, Flick LH, Lewis CY. Missouri rural adolescent pregnancy project (MORAPP). Public Health Nurs 2000; 17 (05) 355-362
  • 23 Robson S, Cameron CA, Roberts CL. Birth outcomes for teenage women in New South Wales, 1998-2003. Aust N Z J Obstet Gynaecol 2006; 46 (04) 305-310
  • 24 Laureano J, Gil E, Leticia Mejia M, Cesar de la Torre A. Adolescent pregnancy in Jalisco Mexico: a view from social marginalization. Rev Peru Ginecol Obstet 2016; 62 (03) 211-220
  • 25 Coley SL, Nichols TR, Rulison KL, Aronson RE, Brown-Jeffy SL, Morrison SD. Does neighborhood risk explain racial disparities in low birth weight among infants born to adolescent mothers?. J Pediatr Adolesc Gynecol 2016; 29 (02) 122-129
  • 26 Chen XK, 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 2007; 36 (02) 368-373
  • 27 Mayor S. Pregnancy and childbirth are leading causes of death in teenage girls in developing countries. BMJ 2004; 328 (7449): 1152
  • 28 Seneesh K, Shah M. Feto-maternal outcome in teenage pregnancy - a comparative case control study. J Pregnancy Child Health 2015; 02: 136
  • 29 Mahajan S. Teenage Deliveries and Risk of Adverse Outcomes: A Hospital Based Case-Control Study. Suva, Fiji: UNFPA: Secretariat of the Pacific Community; 2007: 1-46
  • 30 Wong SPW, Twynstra J, Gilliland JA, Cook JL, Seabrook JA. Risk factors and birth outcomes associated with teenage pregnancy: a Canadian sample. J Pediatr Adolesc Gynecol 2020; 33 (02) 153-159
  • 31 Seabrook JA, Avison WR. Socioeconomic status and cumulative disadvantage processes across the life course: implications for health outcomes. Can Rev Sociol 2012; 49 (01) 50-68
  • 32 Conde-Agudelo A, Belizán JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: cross-sectional study. Am J Obstet Gynecol 2005; 192 (02) 342-349
  • 33 DeMarco N, Twynstra J, Ospina MB, Darrington M, Whippey C, Seabrook JA. Prevalence of low birth weight, premature birth, and stillbirth among pregnant adolescents in Canada: a systematic review and meta-analysis. J Pediatr Adolesc Gynecol 2021; 34 (04) 530-537
  • 34 Gladstone M, Oliver C, Van den Broek N. Survival, morbidity, growth and developmental delay for babies born preterm in low and middle income countries - a systematic review of outcomes measured. PLoS One 2015; 10 (03) e0120566
  • 35 Numerato D, Fattore G, Tediosi F. et al. Mortality and length of stay of very low birth weight and very preterm infants: a EuroHOPE study. PLoS One 2015; 10 (06) e0131685
  • 36 Kramer MS. The epidemiology of adverse pregnancy outcomes: an overview. J Nutr 2003; 133 (5, Suppl 2): 1592S-1596S
  • 37 Amjad S, MacDonald I, Chambers T. et al. Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: a systematic review and meta-analysis. Paediatr Perinat Epidemiol 2019; 33 (01) 88-99
  • 38 World Health Organization. Social determinants of health. 2017 . Accessed April 15, 2021 at: http://www.who.int/social_determinants/en/
  • 39 World Health Organization. A conceptual framework for action on the social determinants of health. 2010 . Accessed April 15, 2021 at: http://www.who.int/social_determinants/publications/9789241500852/en/
  • 40 Campbell EE, Gilliland J, Dworatzek PDN, De Vrijer B, Penava D, Seabrook JA. Socioeconomic status and adverse birth outcomes: a population-based Canadian sample. J Biosoc Sci 2018; 50 (01) 102-113
  • 41 Amjad S, Chandra S, Osornio-Vargas A, Voaklander D, Ospina MB. Maternal area of residence, socioeconomic status, and risk of adverse maternal and birth outcomes in adolescent mothers. J Obstet Gynaecol Can 2019; 41 (12) 1752-1759
  • 42 O'Neill J, Tabish H, Welch V. et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol 2014; 67 (01) 56-64
  • 43 Brewin D. Contributions of multidimensional contextual factors during adolescence and young adulthood to racial disparities in birth outcomes. PhD Thesis. University of Massachusetts Boston, Boston, MA; 2014
  • 44 Afulani PA. Rural/urban and socioeconomic differentials in quality of antenatal care in Ghana. PLoS One 2015; 10 (02) e0117996
  • 45 Downe S, Finlayson K, Walsh D, Lavender T. ‘Weighing up and balancing out’: a meta-synthesis of barriers to antenatal care for marginalised women in high-income countries. BJOG 2009; 116 (04) 518-529
  • 46 Heaman MI, Sword W, Elliott L. et al. Barriers and facilitators related to use of prenatal care by inner-city women: perceptions of health care providers. BMC Pregnancy Childbirth 2015; 15: 2
  • 47 Cassata L, Dallas C. Nurses' attitudes and childbearing adolescents: bridging the cultural chasm. ABNF J 2005; 16 (04) 71-76
  • 48 Kramer MS, Séguin L, Lydon J, Goulet L. Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly?. Paediatr Perinat Epidemiol 2000; 14 (03) 194-210
  • 49 Evans GW, Kim P. Multiple risk exposure as a potential explanatory mechanism for the socioeconomic status-health gradient. Ann N Y Acad Sci 2010; 1186: 174-189
  • 50 Braun B. Rural, low-income mothers: persistent problems, possible interventions. Online J Rural Res Policy 2008; 3 (06) 1-17
  • 51 Cohen SA, Cook SK, Kelley L, Foutz JD, Sando TA. A closer look at rural-urban health disparities: associations between obesity and rurality vary by geospatial and sociodemographic factors. J Rural Health 2017; 33 (02) 167-179
  • 52 Hospital Births in Canada: A Focus on Women Living in Rural and Remote Areas—Executive Summary. Ottawa, Canada: Canadian Institute for Health Information; 2013
  • 53 Grzybowski S, Stoll K, Kornelsen J. Distance matters: a population based study examining access to maternity services for rural women. BMC Health Serv Res 2011; 11: 147
  • 54 DesMeules M, Pong RW. How Healthy Are Rural Canadians? An Assessment of Their Health Status and Health Determinants. A Component of the Initiative “Canada's Rural Communities: Understanding Rural Health and Its Determinants.”. Ottawa, Canada: Canadian Institute for Health Information; 2006
  • 55 Jennissen T. Health Issues in Rural Canada. 1992 . Accessed April 15, 2021 at: http://publications.gc.ca/Collection-R/LoPBdP/BP/bp325-e.htm#1.%20Womentxt
  • 56 Doolittle-Millmann B. At-Risk Factors for Adolescents in Rural Areas. MSc Thesis. Adler Graduate School, Minnetonka, MN; 2015
  • 57 Seabrook JA, Smith A, Clark AF, Gilliland JA. Geospatial analyses of adverse birth outcomes in southwestern Ontario: examining the impact of environmental factors. Environ Res 2019; 172: 18-26
  • 58 Shah PS, Balkhair T. Knowledge Synthesis Group on Determinants of Preterm/LBW births. Air pollution and birth outcomes: a systematic review. Environ Int 2011; 37 (02) 498-516
  • 59 Li L, Ma J, Cheng Y. et al. Urban-rural disparity in the relationship between ambient air pollution and preterm birth. Int J Health Geogr 2020; 19 (01) 23
  • 60 Ellison GT, Smart A, Tutton R, Outram SM, Ashcroft R, Martin P. Racial categories in medicine: a failure of evidence-based practice?. PLoS Med 2007; 4 (09) e287
  • 61 Braun L, Fausto-Sterling A, Fullwiley D. et al. Racial categories in medical practice: how useful are they?. PLoS Med 2007; 4 (09) e271
  • 62 Smedley A, Smedley BD. Race as biology is fiction, racism as a social problem is real: anthropological and historical perspectives on the social construction of race. Am Psychol 2005; 60 (01) 16-26
  • 63 Alhusen JL, Bower KM, Epstein E, Sharps P. Racial discrimination and adverse birth outcomes: an integrative review. J Midwifery Womens Health 2016; 61 (06) 707-720
  • 64 Dominguez TP. Adverse birth outcomes in African American women: the social context of persistent reproductive disadvantage. Soc Work Public Health 2011; 26 (01) 3-16
  • 65 Giurgescu C, McFarlin BL, Lomax J, Craddock C, Albrecht A. Racial discrimination and the black-white gap in adverse birth outcomes: a review. J Midwifery Womens Health 2011; 56 (04) 362-370
  • 66 Mutambudzi M, Meyer JD, Reisine S, Warren N. A review of recent literature on materialist and psychosocial models for racial and ethnic disparities in birth outcomes in the US, 2000-2014. Ethn Health 2017; 22 (03) 311-332
  • 67 Crowshoe L, Dannenbaum D, Green M, Henderson R, Hayward MN, Toth E. Diabetes Canada Clinical Practice Guidelines Expert Committee. Type 2 diabetes and Indigenous peoples. Can J Diabetes 2018; 42 (Suppl. 01) S296-S306
  • 68 Voaklander B, Rowe S, Sanni O, Campbell S, Eurich D, Ospina MB. Prevalence of diabetes in pregnancy among Indigenous women in Australia, Canada, New Zealand, and the USA: a systematic review and meta-analysis. Lancet Glob Health 2020; 8 (05) e681-e698
  • 69 Westenberg L, van der Klis KA, Chan A, Dekker G, Keane RJ. Aboriginal teenage pregnancies compared with non-Aboriginal in South Australia 1995-1999. Aust N Z J Obstet Gynaecol 2002; 42 (02) 187-192
  • 70 Lewis LN, Hickey M, Doherty DA, Skinner SR. How do pregnancy outcomes differ in teenage mothers? A Western Australian study. Med J Aust 2009; 190 (10) 537-541
  • 71 Ordolis E. A Story of Their Own: Adolescent Pregnancy and Child Welfare in Aboriginal Communities. Accessed May 2, 2021 at: https://fpcfr.com/index.php/FPCFR/article/view/57
  • 72 Aguiar W, Halseth R. Aboriginal peoples and historic trauma: the processes of intergenerational transmission. National Collaborating Centre for Aboriginal Health; 2015. . Accessed May 2, 2021 at: https://www.ccnsa-nccah.ca/docs/context/RPT-HistoricTrauma-IntergenTransmission-Aguiar-Halseth-EN.pdf
  • 73 Strayhorn JM, Strayhorn JC. Religiosity and teen birth rate in the United States. Reprod Health 2009; 6: 14
  • 74 Tomal A. The effect of religious membership on teen abortion rates. J Youth Adolesc 2001; 30: 103-116
  • 75 Jesse DE, Schoneboom C, Blanchard A. The effect of faith or spirituality in pregnancy: a content analysis. J Holist Nurs 2007; 25 (03) 151-158 , discussion 159
  • 76 Mortimer JT. The benefits and risks of adolescent employment. Prev Res 2010; 17 (02) 8-11
  • 77 Rickert VI, Wiemann CM, Goodrum LA, Berenson AB. Employment and health-risk behaviors among pregnant adolescents. J Pediatr Adolesc Gynecol 1998; 11 (02) 79-84
  • 78 Gama SG, Viellas EF, Schilithz AO. et al. Factors associated with caesarean section among primiparous adolescents in Brazil, 2011-2012. Cad Saude Publica 2014; 30 (Suppl. 01) S1-S11
  • 79 Karlsen S, Say L, Souza JP. et al. The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health. BMC Public Health 2011; 11: 606
  • 80 Alvarez JL, Gil R, Hernández V, Gil A. Factors associated with maternal mortality in sub-Saharan Africa: an ecological study. BMC Public Health 2009; 9: 462
  • 81 Cockerham WC, Dingwall R, Quah SR. The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. Malden, MA: John Wiley & Sons, Ltd; 2014: 2210-2214
  • 82 Seabrook JA, Woods N, Clark A, de Vrijer B, Penava D, Gilliland J. The association between alcohol outlet accessibility and adverse birth outcomes: a retrospective cohort study. J Neonatal Perinatal Med 2018; 11 (01) 71-77
  • 83 Woods N, Gilliland J, Seabrook JA. The influence of the built environment on adverse birth outcomes. J Neonatal Perinatal Med 2017; 10 (03) 233-248
  • 84 Martinson ML, Reichman NE. Socioeconomic inequalities in low birth weight in the United States, the United Kingdom, Canada, and Australia. Am J Public Health 2016; 106 (04) 748-754
  • 85 Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA. Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med 2010; 39 (03) 263-272
  • 86 Campbell E, Seabrook JA. The influence of socio-economic status on adverse birth outcomes. Can J Midwifery Res and Pract 2016; 15: 11-20
  • 87 Metcalfe A, Lail P, Ghali WA, Sauve RS. The association between neighbourhoods and adverse birth outcomes: a systematic review and meta-analysis of multi-level studies. Paediatr Perinat Epidemiol 2011; 25 (03) 236-245
  • 88 Sellström E, Bremberg S. The significance of neighbourhood context to child and adolescent health and well-being: a systematic review of multilevel studies. Scand J Public Health 2006; 34 (05) 544-554
  • 89 Bourdieu P, Wacquant L. An Invitation to Reflexive Sociology. Chicago, IL: University of Chicago Press; 1992. 119.
  • 90 Crosby RA, Holtgrave DR. The protective value of social capital against teen pregnancy: a state-level analysis. J Adolesc Health 2006; 38 (05) 556-559
  • 91 Sekharan VS, Kim TH, Oulman E, Tamim H. Prevalence and characteristics of intended adolescent pregnancy: an analysis of the Canadian maternity experiences survey. Reprod Health 2015; 12: 101
  • 92 McGibbon E, McPherson C. Applying intersectionality & complexity theory to address the social determinants of women's health. Womens Health Urban Life 2011; 10 (01) 59-86
  • 93 Survive, Thrive, Transform. Global Strategy for Women's, Children's and Adolescents' Health: 2018 Report on Progress towards 2030 Targets. Geneva: WHO, UNAIDS, UNFPA, UNICEF, UNWomen, The World Bank Group.. Accessed April 15, 2021 at: http://www.who.int/life-course/partners/globalstrategy/gswcah-monitoring-report-2018.pdf?ua=1
  • 94 Seng JS, Lopez WD, Sperlich M, Hamama L, Reed Meldrum CD. Marginalized identities, discrimination burden, and mental health: empirical exploration of an interpersonal-level approach to modeling intersectionality. Soc Sci Med 2012; 75 (12) 2437-2445
  • 95 Shah MK, Gee RE, Theall KP. Partner support and impact on birth outcomes among teen pregnancies in the United States. J Pediatr Adolesc Gynecol 2014; 27 (01) 14-19
  • 96 Khoury MJ, Iademarco MF, Riley WT. Precision public health for the era of precision medicine. Am J Prev Med 2016; 50 (03) 398-401
  • 97 Fleming N, O'Driscoll T, Becker G, Spitzer RF. CANPAGO COMMITTEE. Adolescent pregnancy guidelines. J Obstet Gynaecol Can 2015; 37 (08) 740-756
  • 98 About Teen Pregnancy. Reproductive Health: Teen Pregnancy. Centers for Disease Control and Prevention. Accessed April 15, 2021 at: https://www.cdc.gov/teenpregnancy/about/index.htm. Updated March 1, 2019
  • 99 MacNeil A. Exploring Action on the Social Determinants of Health in Canada's Health Regions. 2012 . Accessed April 15, 2021 at: https://dspace.library.uvic.ca:8443/bitstream/handle/1828/4409/MacNeil_Andrew_MPA_2012.pdf?sequence=1&isAllowed=y