Unveiling Trends and Disparities: A Comprehensive Analysis of Adolescent Births in California - Navigating the Challenges and Prioritizing Adolecent Maternal Health

Background: The adolescent birth rate in the United States, measured as births per 1,000 females aged 15 to 19 years, has steadily declined since 1991, reaching a historic low of 16.7 per 1,000 females in 2019. Despite this positive trend, teenage pregnancy continues to pose significant social and health challenges, manifesting in heightened rates of maternal high school dropout, birth complications, infant mortality, adolescent incarceration, and chronic childhood medical conditions. This study aims to examine recent trends in teen birth prevalence, identifying associated risk factors and disparities in the state of California.

Methods: Conducted as a retrospective cohort study, we analyzed 372,352 teen births out of the 5,137,376 resident live births (7.25%) documented in the California Birth Statistical Master Files (BSMF) spanning from 2007 to 2016. Age at birth was categorized as 15 to 19 years, with a reference category of 20 to 29 years. The study investigated various birth outcomes, including low birth weight (LBW), very low birth weight (VLBW), preterm birth (PTB), very preterm birth (VPTB), small-for-gestational-age birth (SGA), large-for-gestational-age birth (LGA), and cesarean delivery (CD). Utilizing descriptive analysis, simple linear regression, and multivariate logistic regression (MLR), we calculated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) to explore associations. The MLR analysis specifically delved into predictors of teen pregnancy, referencing mothers aged 20 to 29 years.

Results: While the teenage pregnancy rate exhibited a linear decline (p < 0.001) from 40.1 in 2007 to 15.8 in 2016 (per 1,000 females), certain maternal characteristics witnessed an increase over time. Adjusted odds ratios revealed that women with less than a high school education and those with a high school diploma had a 9.0-fold and 3.3-fold higher prevalence of teen births, respectively, compared to women with some college or an associate degree. Hispanic women were twice as likely to experience teen births compared to White women. Teen mothers were nearly 50% more likely to rely on Medi-Cal (public health insurance) and 46% more likely not to receive first-trimester prenatal care. Importantly, they were 43% more likely to be underweight.

Conclusion: Our findings emphasize the need to address racial and ethnic disparities and improve birth outcomes among adolescent births. Policymakers should prioritize ensuring pregnant adolescents have access to high-quality maternal health services, encompassing both pre and postnatal care, to safeguard the health of both mothers and infants in the years ahead.