BMJ 2001;323:476 ( 1 September )

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Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study

Gordon C S Smith, specialist registrar in maternal-fetal medicine, ^a Jill P Pell, consultant. ^b

^a Department of Obstetrics and Gynaecology, University of Glasgow, Queen Mother's Hospital, Glasgow G3 8SH, ^b Department of Public Health, Greater Glasgow Health Board, Glasgow G3 8YU

Correspondence to: G C S Smith, Department of Obstetrics and Gynaecology, University of Cambridge, Rosie Hospital, Cambridge CB2 2SW gcss2{at}cam.ac.uk

Objective: To determine whether first and second births among teenagers are associated with increased risk of adverse perinatal outcomes after confounding variables have been taken into account.
Design: Population based retrospective cohort study using routine discharge data for 1992-8.
Setting: Scotland.
Main outcome measures: Stillbirth, preterm delivery, emergency caesarean section, and small for gestational age baby among non-smoking mothers aged 15-19 and 20-29.
Results: The 110 233 eligible deliveries were stratified into first and second births. Among first births, the only significant difference in adverse outcomes by age group was for emergency caesarean section, which was less likely among younger mothers (odds ratio 0.5, 95% confidence interval 0.5 to 0.6). Second births in women aged 15-19 were associated with an increased risk of moderate (1.6, 1.2 to 2.1) and extreme prematurity (2.5, 1.5 to 4.3) and stillbirth (2.6, 1.3 to 5.3) but a reduced risk of emergency caesarean section (0.7, 0.5 to 1.0).
Conclusions: First teenage births are not independently associated with an increased risk of adverse pregnancy outcome and are at decreased risk of delivery by emergency caesarean section. However, second teenage births are associated with an almost threefold risk of preterm delivery and stillbirth.

What is already known on this topic Teenage mothers are more likely to deliver prematurely and to have a perinatal death than older women Teenage mothers are also more likely to smoke, be having a first baby, and live in adverse social circumstances What this study adds Non-smoking women aged 15-19 having a first birth were not at increased risk of adverse obstetric outcomes compared with women aged 20-29 after potential confounding variables were adjusted for Non-smoking women aged 15-19 having a second birth were at significantly increased risk of both premature delivery and stillbirth compared with women aged 20-29

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