Teenage pregnancy is not a public health problem

doi:10.1136/bmj.323.7326.1428

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Debbie Lawlor, lecturer in epidemiology and public health medicine (D.A.Lawlor@bristol.ac.uk),
Mary Shaw, senior research fellow,
Sarah Johns, PhD student

Department of Social Medicine, University of Bristol, Bristol BS8 2PR
School of Geographical Sciences, University of Bristol, Bristol BS8 1SS

EDITOR—We agree with Smith and Pell's interpretation of their own and others' results that first teenage pregnancies are not associated with adverse outcomes, but we disagree with their conclusion that the associations they found between second teenage pregnancy and risk of preterm delivery and stillbirth indicate causation.1 The most likely explanation is a combination of inadequate control for socioeconomic position, which the authors concede, and differences in the interval between pregnancies among teenage compared with older mothers.

Differences in pregnancy spacing cannot be …