Comparison of maternal socioeconomic status and anxiety and child development between adolescent and adult pregnancies in Thailand

Abstract

Background: Adolescent pregnancy has become a worldwide public health concern because the rate has been increasing. Adolescent pregnancy is associated with poor physical and mental health as well as socioeconomic constraints. Most adolescent pregnancies occur at school ages, which leads to adverse educational and economic outcomes. As a result, most studies focus more on negative consequences among adolescent mothers; however, these negative consequences are influenced by other factors related to the time and methods of measurement, socio-economic status, social norms, and country contexts. Because of a lack of comprehensive studies, adverse consequences of adolescent compared to adult pregnancy are inconclusive. Furthermore, long-term consequences of anxiety and socioeconomic status of adolescent pregnancy in mothers as well as child development of the adolescent pregnancy are lacking. Such information is essential for policy development and decision making in Thailand. Objectives: This study aimed to 1) compare the education, work and income status at subsequent pregnancy of pregnant adolescent and adult pregnancy, 2) assess the transition in school or work status at first pregnancy between adolescent and adult pregnancies, 3) explore factors associated with adverse socioeconomic status at subsequent pregnancy, 4) compare the anxiety levels between adolescent and adult pregnancies and between women who ended up with termination and delivery, and 5) compare the childhood development of the first born child from adolescent and adult pregnancy. Method: A historical cohort study was conducted among pregnant women who gave birth from April to September 2014 at the Maharat Nakhon Ratchasima Hospital, a tertiary care hospital, in Nakhon Ratchasima province. The participants were multiparous Thai women aged 15-34 years who gave birth in the study hospital and had a single baby at the first pregnancy not longer than 5 years before regardless of delivery status. The interval of five years was chosen to minimize recall bias of important factors of the first pregnancy. Those, who had physical disabilities, neurological disorders, psychiatric disorders, inability to communicate, mental retardation or hearing loss, were excluded. Women who agreed to participate in the study were categorized into two groups based on their ages at their first pregnancy: those who had their first pregnancy at ag10-19 years and 20-29 years. All eligible women were interviewed using a structured questionnaire in private area of postpartum ward. The data were analyzed using univariate analysis and multiple logistic regression. A p-valaue less than 0.05 was considered as statistical significance. Results: A total of 180 women with the first pregnancy at age 10-19 years and 267 women with the first pregnancy at age 20-29 years were included in the study. At subsequent pregnancy, women with adolescent pregnancy, who had low education (junior high school and lower), had higher odds (AOR 2.15; 95% CI 1.02-4.55). Those women, who were unemployed, had lower odds compared with adult mothers. For personal income, the result was not statistically significant. Adolescent pregnancy, intention of pregnancy, and continuing pregnancy to delivery were statistically significant and associated with negative changes in school or working status at the first pregnancy. A high prevalence of antenatal anxiety among women during their first pregnancy was revealed in both adolescent and adult pregnancy. The level of anxiety increased in subsequent pregnancies among women who were at a high risk of experiencing anxiety in their first pregnancy. There are three strong risk factors of anxiety in pregnant women. Those were unplanned pregnancy, high stress and low social support. A higher prevalence of suspected delayed child development was found among children aged above 36 months while poor growth was common in children younger than 24 months. Hyperactivity was more common in pre-school- aged boys. The prevalence of delayed language development was similar in children from adolescent and adult pregnancy. The prevalence of delayed personal-social development was higher in children of mothers with adult pregnancy but the difference was not statistically significant. Conclusion: This study showed evidence that adolescent pregnancy was associated with low socioeconomic status in later life. There was not sufficient evidence to show the differences in prevalences of anxiety in mothers and delay in child development between adolescent and adult pregnancies. One quarter of children faced one of the domains of delay development which was a concern. A national policy to support educational continuation among pregnant adolescents should be considered.