Trends and birth outcomes in adolescent refugees and migrants on the Thailand-Myanmar border, 1986-2016: an observational study

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Abstract

Background: Currently there are more adolescents (10-19 years old) and young adults (20-24 years old) than ever. Reproductive health among this age group is often overlooked, although it can have a profound impact on the future. This is especially the case in conflict zones and refugee settings, where there is a heightened need for reproductive health care, and where both the resources and possibility for data collation are usually limited.

Methods: Here we report on pregnancies, birth outcomes and risk factors for repeat pregnancies among adolescent and young adult refugees and migrants from antenatal clinics on the Thailand-Myanmar border across a 30 year time span.

Results: Pregnancy and fertility rates were persistently high. Compared with 20-24-year-olds, 15-19-year-olds who reported being unable to read had 2.35 (CI: 1.97 – 2.81) times the odds for repeat pregnancy (gravidity >2). In primigravidae, the proportion of small for gestational age (SGA) and preterm births (PTB), and neonatal deaths (NND) decreased with increasing maternal age (all p <0.001). After adjustment, this association retained significance for PTB (cut-off point, ≤18 years) but not for SGA and NND.

Conclusions: There is considerable room for improvement in adolescent pregnancy rates in these border populations, and educational opportunities may play a key role in effective interventions.

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Most cited references 33

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Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth

D Barker, C N Hales, C H D Fall … (1993)

Two follow-up studies were carried out to determine whether lower birthweight is related to the occurrence of syndrome X-Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia. The first study included 407 men born in Hertfordshire, England between 1920 and 1930 whose weights at birth and at 1 year of age had been recorded by health visitors. The second study included 266 men and women born in Preston, UK, between 1935 and 1943 whose size at birth had been measured in detail. The prevalence of syndrome X fell progressively in both men and women, from those who had the lowest to those who had the highest birthweights. Of 64-year-old men whose birthweights were 2.95 kg (6.5 pounds) or less, 22% had syndrome X. Their risk of developing syndrome X was more than 10 times greater than that of men whose birthweights were more than 4.31 kg (9.5 pounds). The association between syndrome X and low birthweight was independent of duration of gestation and of possible confounding variables including cigarette smoking, alcohol consumption and social class currently or at birth. In addition to low birthweight, subjects with syndrome X had small head circumference and low ponderal index at birth, and low weight and below-average dental eruption at 1 year of age. It is concluded that Type 2 diabetes and hypertension have a common origin in sub-optimal development in utero, and that syndrome X should perhaps be re-named "the small-baby syndrome".

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Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study.

Xi-Kuan Chen, Shi Wen, Nathalie Fleming … (2007)

Whether the association between teenage pregnancy and adverse birth outcomes could be explained by deleterious social environment, inadequate prenatal care, or biological immaturity remains controversial. The objective of this study was to determine whether teenage pregnancy is associated with increased adverse birth outcomes independent of known confounding factors. We carried out a retrospective cohort study of 3,886,364 nulliparous pregnant women <25 years of age with a live singleton birth during 1995 and 2000 in the United States. All teenage groups were associated with increased risks for pre-term delivery, low birth weight and neonatal mortality. Infants born to teenage mothers aged 17 or younger had a higher risk for low Apgar score at 5 min. Further adjustment for weight gain during pregnancy did not change the observed association. Restricting the analysis to white married mothers with age-appropriate education level, adequate prenatal care, without smoking and alcohol use during pregnancy yielded similar results. Teenage pregnancy increases the risk of adverse birth outcomes that is independent of important known confounders. This finding challenges the accepted opinion that adverse birth outcome associated with teenage pregnancy is attributable to low socioeconomic status, inadequate prenatal care and inadequate weight gain during pregnancy.

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The impact of early age at first childbirth on maternal and infant health.

Parker C. Gibbs, Amanda Wendt, Nicholas S. Peters … (2012)

The objective of this review was to assess whether early age at first childbirth is associated with increased risk of poor pregnancy outcomes. Early age at childbirth is variously defined in studies of its effect on maternal and infant health. In this systematic review, we limit analysis to studies of at least moderate quality that examine first births among young mothers, where young maternal age is defined as low gynaecological age (≤ 2 years since menarche) or as a chronological age ≤ 16 years at conception or delivery. We conduct meta-analyses for specific maternal or infant health outcomes when there are at least three moderate quality studies that define the exposure and outcome in a similar manner and provide odds ratios or risk ratios as their effect estimates. We conclude that the overall evidence of effect for very young maternal age (<15 years or <2 years post-menarche) on infant outcomes is moderate; that is, future studies are likely to refine the estimate of effect or precision but not to change the conclusion. Evidence points to an impact of young maternal age on low birthweight and preterm birth, which may mediate other infant outcomes such as neonatal mortality. The evidence that young maternal age increases risk for maternal anaemia is also fairly strong, although information on other nutritional outcomes and maternal morbidity/mortality is less clear. Many of the differences observed among older teenagers with respect to infant outcomes may be because of socio-economic or behavioural differences, although these may vary by country/setting. Future, high quality observational studies in low income settings are recommended in order to address the question of generalisability of evidence. In particular, studies in low income countries need to consider low gynaecological age, rather than simply chronological age, as an exposure. As well, country-specific studies should measure the minimum age at which childbearing for teens has similar associations with health as childbearing for adults. This 'tipping point' may vary by the underlying physical and nutritional health of girls and young women. © 2012 Blackwell Publishing Ltd.

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Author and article information

Contributors

Amber L. Parker: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – Original Draft PreparationRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-6248-3904

Daniel M. Parker: Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – Original Draft PreparationRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-5352-7338

Blooming Night Zan: Role: ConceptualizationRole: InvestigationRole: Writing – Review & Editing

Aung Myat Min: Role: Data CurationRole: Project AdministrationRole: Writing – Review & Editing

Mary Ellen Gilder: Role: ConceptualizationRole: Project AdministrationRole: Writing – Original Draft PreparationRole: Writing – Review & Editing

Maxime Ringringulu: Role: ConceptualizationRole: Data CurationRole: Project AdministrationRole: Writing – Review & Editing

Elsi Win: Role: Data CurationRole: Project AdministrationRole: Writing – Review & Editing

Jacher Wiladphaingern: Role: Data CurationRole: Project AdministrationRole: Writing – Review & Editing

Prakaykaew Charunwatthana: Role: Writing – Review & Editing

François Nosten: Role: Data CurationRole: Funding AcquisitionRole: Project AdministrationRole: ResourcesRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-7951-0745

Sue J. Lee: Role: ConceptualizationRole: Data CurationRole: Formal AnalysisRole: MethodologyRole: Writing – Original Draft PreparationRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-8409-4248

Rose McGready: Role: ConceptualizationRole: Formal AnalysisRole: Funding AcquisitionRole: MethodologyRole: Project AdministrationRole: ResourcesRole: SupervisionRole: Writing – Original Draft PreparationRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0003-1621-3257

Journal

Journal ID (nlm-ta): Wellcome Open Res

Journal ID (iso-abbrev): Wellcome Open Res

Journal ID (pmc): Wellcome Open Res

Title: Wellcome Open Research

Publisher: F1000 Research Limited (London, UK )

ISSN (Electronic): 2398-502X

Publication date (Electronic): 21 May 2018

Publication date Collection: 2018

Volume: 3

Electronic Location Identifier: 62

Affiliations

[1 ]Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Un, Mahidol University, Mae Sot, 63110, Thailand

[2 ]Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, California, USA

[3 ]Karen Refugee Committee, Mae Sot, Thailand

[4 ]Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, 10400, Thailand

[5 ]Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand

[6 ]Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, OX3 7FZ, UK

[1 ]Department of Epidemiology, Tulane University, New Orleans, LA, USA

[1 ]Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut (AUB), Beirut, Lebanon

Author notes

[a ] dparker1@ 123456uci.edu

No competing interests were disclosed.

Competing interests: No competing interests were disclosed.

Author information

Amber L. Parker https://orcid.org/0000-0002-6248-3904

Daniel M. Parker https://orcid.org/0000-0002-5352-7338

François Nosten https://orcid.org/0000-0002-7951-0745

Sue J. Lee https://orcid.org/0000-0002-8409-4248

Rose McGready https://orcid.org/0000-0003-1621-3257

Article

DOI: 10.12688/wellcomeopenres.14613.1

PMC ID: 6039938

SO-VID: 0512069b-0a11-4abb-8580-e64ac7bc57a7

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This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date accepted : 15 May 2018

Funding

Funded by: Wellcome Trust

Award ID: 041843

Award ID: 106698

This work was supported by the Wellcome Trust (106698, 041843), Major Overseas Programme–Thailand Unit, which supports the Shoklo Malaria Research Unit, part of the Mahidol Oxford University Research Unit.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Trends and birth outcomes in adolescent refugees and migrants on the Thailand-Myanmar border, 1986-2016: an observational study

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Most cited references 33

Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth

Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study.

The impact of early age at first childbirth on maternal and infant health.

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