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

Authors

Catherine G. Coughlin, 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.
Shetal Shah, Division of Neonatal Medicine, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY.
DeWayne M. Pursley, Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
Shanshan Liu, Institutional Centers for Clinical and Translational Research (ICCTR), Boston Children's Hospital, Boston, MA.
Lois K. Lee, Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.

Author Type(s)

Faculty

Journal Title

The Journal of Pediatrics

First Page

87

Last Page

94.e2

Document Type

Article

Publication Date

8-1-2022

Department

Pediatrics

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.

Recommended Citation

Coughlin, C. G., Shah, S., Pursley, D. M., Liu, S., & Lee, L. K. (2022). Infant Outcomes Among Teenage and Young Mothers: Racial Inequities and the Role of Educational Attainment. The Journal of Pediatrics, 247, 87-94.e2. https://doi.org/10.1016/j.jpeds.2022.03.045