Deliveries Among Patients Aged 11-19 Years and Risk for Adverse Pregnancy Outcomes.

Objective: To characterize delivery hospitalization trends of patients aged 11-19 years and associated comorbidities and outcomes.

Methods: For this repeated cross-sectional analysis, deliveries to patients aged 11-54 years were identified in the 2000-2018 National Inpatient Sample. Temporal trends in deliveries to patients aged 11-14 years and 15-19 years were analyzed using joinpoint regression to estimate average annual percent change with 95% CIs. The association of deliveries among patients aged 11-19 years with other comorbid conditions was analyzed. The relationship between delivery among patients aged 11-19 years and adverse maternal outcomes was analyzed with unadjusted and adjusted logistic regression models, with unadjusted and adjusted odds ratios (aORs) as measures of effect.

Results: An estimated 73,198,153 delivery hospitalizations from 2000 to 2018 were included, of which 88,363 were to patients aged 11-14 years and 6,359,331 were to patients aged 15-19 years. The proportion of delivery hospitalizations among patients aged 11-14 years decreased from 2.1 to 0.4 per 1,000 from 2000 to 2018 (average annual percent change -7.8%, 95% CI -8.5% to -7.2%). Deliveries to patients aged 15-19 years decreased from 2000 to 2018, from 11.5% to 4.8% of all deliveries (average annual percent change -4.9%, 95% CI -5.6% to -4.3%). For deliveries among patients aged 11-19 years, rates of obesity, mental health conditions, substance use disorder, asthma, and pregestational and gestational diabetes all significantly increased over the study period. From 2000 to 2018, rates of severe maternal morbidity (average annual percent change 2.4%, 95% CI 1.6-3.1%), postpartum hemorrhage (average annual percent change 2.4%, 95% CI 1.4-3.4%), cesarean delivery (average annual percent change 1.3%, 95% CI 0.9-1.7%), and hypertensive disorders of pregnancy (average annual percent change 3.3%, 95% CI 2.8-3.8%) all increased significantly among deliveries to patients aged 11-19 years. Compared with deliveries to patients aged 20-54 years, deliveries to patients aged 11-14 years were associated with increased risk for severe maternal morbidity (aOR 1.73, 95% CI 1.49-2.00), hypertensive disorders of pregnancy (aOR 1.79, 95% CI 1.71-1.88), and postpartum hemorrhage (aOR 1.37, 95% CI 1.27-1.49).

Conclusion: Deliveries among patients aged 11-19 years have decreased, but both comorbidity and risk for adverse outcomes increased among this age group.