Reproductive outcomes in adolescents who had a previous birth or an induced abortion compared to adolescents' first pregnancies

Background: Recently, attention has been focused on subsequent pregnancies among teenage mothers. Previous studies that compared the reproductive outcomes of teenage nulliparae and multiparae often did not consider the adolescents' reproductive histories. Thus, the authors compared the risks for adverse reproductive outcomes of adolescent nulliparae to teenagers who either have had an induced abortion or a previous birth. Methods: In this retrospective cohort study we used perinatal data prospectively collected by obstetricians and midwives from 1990–1999 (participation rate 87–98% of all hospitals) in Lower Saxony, Germany. From the 9742 eligible births among adolescents, women with multiple births, >1 previous pregnancies, or a previous spontaneous miscarriage were deleted and 8857 women <19 years remained. Of these 8857 women, 7845 were nulliparous, 801 had one previous birth, and 211 had one previous induced abortion. The outcomes were stillbirths, neonatal mortality, perinatal mortality, preterm births, and very low birthweight. Bivariate and multivariable logistic regression models were conducted. Results: In bivariate logistic regression analyses, compared to nulliparous teenagers, adolescents with a previous birth had higher risks for perinatal [OR = 2.08, CI = 1.11,3.89] and neonatal [OR = 4.31, CI = 1.77,10.52] mortality and adolescents with a previous abortion had higher risks for stillbirths [OR = 3.31, CI = 1.01,10.88] and preterm births [OR = 2.21, CI = 1.07,4.58]. After adjusting for maternal nationality, partner status, smoking, prenatal care and pre-pregnancy BMI, adolescents with a previous birth were at higher risk for perinatal [OR = 2.35, CI = 1.14,4.86] and neonatal mortality [OR = 4.70, CI = 1.60,13.81] and adolescents with a previous abortion had a higher risk for very low birthweight infants [OR = 2.74, CI = 1.06,7.09] than nulliparous teenagers. Conclusion: The results suggest that teenagers who give birth twice as adolescents have worse outcomes in their second pregnancy compared to those teenagers who are giving birth for the first time. The prevention of the second pregnancy during adolescence is an important public health objective and should be addressed by health care providers who attend the first birth or the abortion and the follow-up care. Also, health care workers should attempt to improve the pregnancy outcomes of subsequent teenage pregnancies by addressing modifiable risk factors, for example, supporting smoking cessation and utilization of prenatal care.Other UBCNon UBCReviewedFacult

The role of mediating factors in the association between social deprivation and low birth weight in Germany

This study examines whether the association between social inequalities and low birth weight (LBW) (occurring in both pre- and full-term births) in Germany can be explained by several potentially confounding factors. These include maternal age, occupational status, marital status, nationality, employment status, smoking, prenatal care, psychosocial stress, obesity, short stature, short inter-pregnancy interval, chronic conditions, and several obstetrical risk factors such as pregnancy induced hypertension. We also examined how the risk for LBW varies over time within each socioeconomic group. We analyzed routinely collected perinatal data on singletons born in the federal state of Lower Saxony, Germany, in 1990, 1995, and 1999 (n=182,444). After adjustment for all potentially confounding factors in multivariate logistic regression models, working class women, unemployed women, single mothers, and women over 39 years of age were at increased risk for pre- and full-term LBW infants. Migrant status was not related to LBW. We examined variations in the risk for LBW over time within groups, using the 1990 birth cohort as the referent group for the 1995 and 1999 birth cohorts. Compared to 1990, in 1999 women aged 19-34 years, housewives, unemployed women, women of German nationality and women with partners had higher risks for pre- and full-term LBW infants; the eldest subgroup had lower risks for LBW after adjustment for confounding factors. The factors we examined partly explain the social inequalities in LBW occurring in pre- and full-term infants. The subgroups with higher rates of LBW in 1999 compared to 1990, included women experiencing childbirth in an optimal stage of life or in a privileged social context. Public health policies in Germany should target social inequalities contributing to the aetiology of LBW and to the factors that result in increased LBW rates.Deprivation Inequalities Low birth weight Preterm birth Social epidemiology Germany

Health Needs for Suicide Prevention and Acceptance of e-Mental Health Interventions in Adolescents and Young Adults: Qualitative Study.

Background: Adolescence is a phase of higher vulnerability for suicidal behavior. In Germany, almost 500 adolescents and young adults aged 15-25 years commit suicide each year. Youths in rural areas are characterized by a higher likelihood of poorer mental health. In rural areas, appropriate support for adolescents and young adults in mental health crises is difficult to access. The general acceptability of digital communication in youths can make the provision of an eHealth tool a promising strategy. Objective: The aim of this study was to explore the health needs regarding suicide prevention for adolescents and young adults in rural areas of Germany and Switzerland and to identify characteristics of suitable e-mental health interventions. Methods: This study reports on a qualitative secondary analysis of archived data, which had been collected through formative participatory research. Using 32 semistructured interviews (individually or in groups of 2) with 13 adolescents and young adults (aged 18-25 years) and 23 experts from relevant fields, we applied a deductive-inductive methodological approach and used qualitative content analyses according to Kuckartz (2016). Results: Experts as well as adolescents and young adults have reported health needs in digital suicide prevention. The health needs for rural adolescents and young adults in crises were characterized by several categories. First, the need for suicide prevention in general was highlighted. Additionally, the need for a peer concept and web-based suicide prevention were stressed. The factors influencing the acceptability of a peer-driven, web-based support were related to low-threshold access, lifelike intervention, anonymity, and trustworthiness. Conclusions: The results suggest a need for suicide prevention services for adolescents and young adults in this rural setting. Peer-driven and web-based suicide prevention services may add an important element of support during crises. By establishing such a service, an improvement in mental health support and well-being could be enabled. These services should be developed with the participation of the target group, taking anonymity, trustworthiness, and low-threshold access into account