Abstract
Purpose
To evaluate differences in health characteristics and birth outcomes for participants of a prenatal education and support program for pregnant teens, “Starting Out Right” (SOR) compared to nonparticipant pregnant teens in Pima, Maricopa, and Gila counties in Arizona to gauge benefits of program participation.
Description
The SOR program is a community education and support program for pregnant teens based on a structured curriculum. All pregnant teens living in the service area are eligible to participate.
Assessment
Vital statistics birth data from 2014 to 2019 were obtained from three counties in Arizona that identified SOR and non-SOR program participants. Logistic regression was used to calculate multivariable -adjusted odds ratios (aOR) for specific health characteristics (smoking, hypertensive disorders, overweight and obesity, gestational diabetes, sexually transmitted infections) and birth outcomes (C-section, preterm birth, NICU admission, birthweight, and breastfeeding) for SOR participants compared with nonparticipants. Variables in the adjusted models included age, BMI, smoking, gestational diabetes, race, ethnicity, county, WIC participation, insurance type, plurality, and month and year prenatal care began.
Conclusion
These results suggest that participation in SOR was associated (p ≤ 0.06) with a reduced odds for low birthweight [aOR 0.7(95% CI 0.5,1.0)] and increased odds (p ≤ 0.05) of breastfeeding [aOR 1.3(95% CI 1.0,1.7)] compared to nonparticipants. These results provide evidence that the education components in the SOR program support improved pregnancy and breastfeeding outcomes for pregnant teens.
Significance
Pregnant teens and their infants are at risk for adverse pregnancy outcomes including low birth weight infants, preterm delivery, and reduced breastfeeding. There have been a variety of programs developed for pregnant teens, however model evidence-based programs to improve birth outcomes are not well established. The results of this study present an evidence-base for the “Starting Out Right” program with participants having a reduced odds for low birthweight and increased odds of breastfeeding at time of discharge from the hospital compared to nonparticipants.
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Data Availability
Data analyzed was from state vital statistics records maintained at the Arizona Department of Health Services.
Code Availability
STATA code available upon request.
References
Abalos, E., Cuesta, C., Carroli, G., Qureshi, Z., Widmer, M., & Vogel, J. P. (2014). Newborn Health Research, N. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG, 121 Suppl 1, 14–24. doi:https://doi.org/10.1111/1471-0528.12629
Bateman, B. T., Bansil, P., Hernandez-Diaz, S., Mhyre, J. M., Callaghan, W. M., & Kuklina, E. V. (2012). Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol, 206(2), 134 e131-138. doi:https://doi.org/10.1016/j.ajog.2011.10.878
Berkowitz, G. S. (1981). An epidemiologic study of preterm delivery. American Journal Of Epidemiology, 113(1), 81–92. https://doi.org/10.1093/oxfordjournals.aje.a113068.
Centers-for-Disease-Control-and-Prevention (2019). STDs in Adolescents and Young Adults. Retrieved from https://www.cdc.gov/std/stats18/adolescents.htm
Chen, X. K., Wen, S. W., Fleming, N., Demissie, K., Rhoads, G. G., & Walker, M. (2007). Teenage pregnancy and adverse birth outcomes: A large population based retrospective cohort study. International Journal Of Epidemiology, 36(2), 368–373. https://doi.org/10.1093/ije/dyl284.
Debiec, K. E., Paul, K. J., Mitchell, C. M., & Hitti, J. E. (2010). Inadequate prenatal care and risk of preterm delivery among adolescents: a retrospective study over 10 years. Am J Obstet Gynecol, 203(2), 122 e121-126. doi:https://doi.org/10.1016/j.ajog.2010.03.001
Drake, P., Driscoll, A. K., & Mathews, T. J. (2018). Cigarette Smoking During Pregnancy: United States, 2016. NCHS Data Brief(305), 1–8. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29528282
Guelinckx, I., Devlieger, R., Beckers, K., & Vansant, G. (2008). Maternal obesity: Pregnancy complications, gestational weight gain and nutrition. Obesity Reviews, 9(2), 140–150. https://doi.org/10.1111/j.1467-789X.2007.00464.x.
Harding, J. F., Knab, J., Zief, S., Kelly, K., & McCallum, D. (2020). A systematic review of programs to promote aspects of Teen Parents’ Self-sufficiency: Supporting Educational Outcomes and healthy birth spacing. Maternal And Child Health Journal, 24(Suppl 2), 84–104. https://doi.org/10.1007/s10995-019-02854-w.
Hussaini, S. K., Holley, P., & Ritenour, D. (2011). Reducing low birth weight infancy: Assessing the effectiveness of the Health Start program in Arizona. Maternal And Child Health Journal, 15(2), 225–233. https://doi.org/10.1007/s10995-009-0556-0.
Kang, G., Lim, J. Y., Kale, A. S., & Lee, L. Y. (2015). Adverse effects of young maternal age on neonatal outcomes. Singapore Medical Journal, 56(3), 157–163. https://doi.org/10.11622/smedj.2014194.
Kawakita, T., Wilson, K., Grantz, K. L., Landy, H. J., Huang, C. C., & Gomez-Lobo, V. (2016). Adverse maternal and neonatal outcomes in adolescent pregnancy. Journal Of Pediatric And Adolescent Gynecology, 29(2), 130–136. https://doi.org/10.1016/j.jpag.2015.08.006.
Kotelchuck, M. (1994). An evaluation of the Kessner adequacy of prenatal Care Index and a proposed adequacy of prenatal care utilization index. American Journal Of Public Health, 84(9), 1414–1420. https://doi.org/10.2105/ajph.84.9.1414.
Leddy, M. A., Power, M. L., & Schulkin, J. (2008). The impact of maternal obesity on maternal and fetal health. Rev Obstet Gynecol, 1(4), 170–178. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19173021
Martin, J. A., Hamilton, B. E., & Osterman, M. J. K. (2019). Births in the United States, 2018. NCHS Data Brief(346), 1–8. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/31442195
Montoya-Williams, D., Williamson, V. G., Cardel, M., Fuentes-Afflick, E., Maldonado-Molina, M., & Thompson, L. (2020). The Hispanic/Latinx Perinatal Paradox in the United States: A scoping review and recommendations to Guide Future Research. Journal Of Immigrant And Minority Health. https://doi.org/10.1007/s10903-020-01117-z.
Olaiya, O., Dee, D. L., Sharma, A. J., & Smith, R. A. (2016). Maternity Care Practices and Breastfeeding among adolescent mothers aged 12–19 Years–United States, 2009–2011. Mmwr. Morbidity And Mortality Weekly Report, 65(2), 17–22. https://doi.org/10.15585/mmwr.mm6502a1.
Pedersen, L. L., & Chesser, C., S (2017). Starting out right: Positive strategies to guide adolescents through healthy pregnancy and childbirth. Tucson, AZ: Wheatmark.
Singh, G. K., & DiBari, J. N. (2019). Marked Disparities in Pre-Pregnancy Obesity and Overweight Prevalence among US Women by Race/Ethnicity, Nativity/Immigrant Status, and Sociodemographic Characteristics, 2012–2014. J Obes, 2019, 2419263. doi:https://doi.org/10.1155/2019/2419263
SmithBattle, L., Loman, D. G., Chantamit, O. P. C., & Schneider, J. K. (2017). An umbrella review of meta-analyses of interventions to improve maternal outcomes for teen mothers. Journal Of Adolescence, 59, 97–111. https://doi.org/10.1016/j.adolescence.2017.05.022.
Sukhato, K., Wongrathanandha, C., Thakkinstian, A., Dellow, A., Horsuwansak, P., & Anothaisintawee, T. (2015). Efficacy of additional psychosocial intervention in reducing low birth weight and preterm birth in teenage pregnancy: A systematic review and meta-analysis. Journal Of Adolescence, 44, 106–116. https://doi.org/10.1016/j.adolescence.2015.07.013.
Torvie, A. J., Callegari, L. S., Schiff, M. A., & Debiec, K. E. (2015). Labor and delivery outcomes among young adolescents. Am J Obstet Gynecol, 213(1), 95 e91-95 e98. doi:https://doi.org/10.1016/j.ajog.2015.04.024
Ventura, S. J., Hamilton, B. E., & Matthews, T. J. (2014). National and state patterns of teen births in the United States, 1940–2013. Natl Vital Stat Rep, 63(4), 1–34. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25142408
Victora, C. G., Bahl, R., Barros, A. J., Franca, G. V., Horton, S., Krasevec, J., & Sankar, M. J. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. 387(10017), 475–490. doi:https://doi.org/10.1016/S0140-6736(15)01024-7
Weng, Y. H., Yang, C. Y., & Chiu, Y. W. (2014). Risk Assessment of adverse birth outcomes in relation to maternal age. PLoS One, 9(12), e114843. https://doi.org/10.1371/journal.pone.0114843.
Acknowledgements
We would like to acknowledge Vern Pilling, Director of Biomedical Informatics Services from the University of Arizona Center for Biomedical Informatics and Biostatistics for his work in receiving and de-identifying the state of Arizona vital statistics data, and S. Robert Bailey, Chief of the Bureau of Public Health Statistics for the Arizona Department of Health Services for approval of the project.
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Dr. Allison Root developed the idea, study design, conducted data analysis, and wrote large portions of the manuscript. Ms. Pedersen assisted with development of the idea. Dr. Taren, Dr. Farland and Dr. Cutshaw assisted with study design and interpretation of results.
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Laura Pedersen was involved in curriculum development and administration of the Starting Out Right program.
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The University of Arizona IRB determined that human subjects review was not required for this study (it was an evaluation with all data de-identified).
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Root, A.D., Pedersen, L.A., Cutshaw, C.A. et al. Health Characteristics and Birth Outcomes for “Starting Out Right,” a Teen Pregnancy Program. Matern Child Health J 27, 1689–1696 (2023). https://doi.org/10.1007/s10995-023-03687-4
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DOI: https://doi.org/10.1007/s10995-023-03687-4