Infant Outcomes among Teenage and Young Mothers: Racial Inequities and the Role of Educational Attainment

Catherine G Coughlin; Shetal Shah; DeWayne M Pursley; Shanshan Liu; Lois K Lee

doi:10.1016/j.jpeds.2022.03.045

Infant Outcomes among Teenage and Young Mothers: Racial Inequities and the Role of Educational Attainment

J Pediatr. 2022 Aug:247:87-94.e2. doi: 10.1016/j.jpeds.2022.03.045. Epub 2022 Mar 29.

Authors

Catherine G Coughlin¹, Shetal Shah², DeWayne M Pursley³, Shanshan Liu⁴, Lois K Lee⁵

Affiliations

¹ Boston Combined Residency Program, Boston Children's Hospital, Boston, MA; Boston Combined Residency Program, Boston Medical Center, Boston, MA. Electronic address: catherine.coughlin@childrens.harvard.edu.
² Division of Neonatal Medicine, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY.
³ Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
⁴ Institutional Centers for Clinical and Translational Research (ICCTR), Boston Children's Hospital, Boston, MA.
⁵ Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.

PMID: 35364098
DOI: 10.1016/j.jpeds.2022.03.045

Abstract

Objective: To examine the association of age-appropriate maternal educational attainment in teenage and young mothers on infant health outcomes across racial/ethnic groups.

Study design: In this retrospective, cross-sectional study using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Natality data (2016-2017), we included live births comparing 14- to 19- year-old mothers with 20- to 24-year-old mothers. To analyze the association of maternal age-appropriate education (≥8th grade for 15-18 years of age, 9th-12th grade/completed high school for 19-24 years of age), we conducted multivariable regression adjusting for mothers' demographics, reporting adjusted incidence rate ratios with 95% CI for infant mortality rate, and logistic regression for extreme prematurity and low birth weight, reporting aORs with 95% CI.

Results: From 2016 to 2017, there were 1 976 334 live births among women 14-24 years of age; 407 576 (20.6%) were in 14- to 19-year-olds. In the multivariable model, increased term infant mortality rate was associated with age 14-19 years (adjusted incidence rate ratio 1.18, 95% 1.10, 1.27), age-inappropriate education (adjusted incidence rate ratio 1.38, 95% CI 1.28, 1.48), and non-Hispanic Black mothers (adjusted incidence rate ratio 1.21, 95% CI 1.12, 1.30). Extreme prematurity was associated with women age 14-19 years (aOR 1.35, 95% CI 1.30, 1.40), non-Hispanic Black (aOR 2.50, 95% CI 2.39, 2.61), and Hispanic mothers (aOR 1.09, 95% CI 1.04, 1.15). Term infant low birth weight was associated with age 14-19 years (aOR 1.14, 95% CI 1.12, 1.16), age-inappropriate education for non-Hispanic White (aOR 1.16, 95% CI 1.11, 1.21), and non-Hispanic Black (aOR 1.08, 1.04, 1.12) mothers.

Conclusions: Inadequate maternal educational attainment, which is influenced by modifiable social policies, is associated with increased adverse infant outcomes in mothers 14-24 years of age.

Keywords: infant mortality; low birthweight; preterm birth; racial inequities.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Cross-Sectional Studies
Educational Status
Female
Humans
Infant
Infant Mortality
Mothers*
Racial Groups*
Retrospective Studies
Young Adult