Teenage pregnancy risk rises with childhood exposure to family strife.

Women exposed to abuse, violence and family strife in childhood are more likely than those without such experiences to have a teenage pregnancy; the greater the number of adverse childhood experiences, the higher the likelihood of pregnancy, according to a retrospective study of women attending a primary care clinic in San Diego. (1) In addition, problems often attributed to teenage pregnancy, such as fetal death and family, job and financial problems in adulthood, were associated with adverse childhood experiences, but not with adolescent pregnancy itself. Programs that focus on reducing family dysfunction have the potential to prevent teenage pregnancy and psychological and social problems in adulthood, the authors conclude.

The study sample included 9,159 sexually experienced women aged 18 or older who were enrolled in the Kaiser Permanente Medical Care Program and underwent a routine health examination between 1995 and 1997. Participants were mailed questionnaires assessing their history of pregnancy and childhood exposure to abuse, violence and family strife. The questionnaire asked about eight types of childhood experiences: verbal, physical and sexual abuse; domestic violence in the household; and adult household members' substance abuse, mental illness, incarceration and divorce. Data were collected in two survey waves; the first was mailed two weeks after the health examination, and the second was mailed 1-2 years later. A Kaiser Health Appraisal questionnaire was used to measure study participants' current psychosocial issues, including stress level, fear of uncontrollable anger, and serious or disturbing problems related to family, job or finances.

The majority of participants were 50 or older (62%), were white (77%) and had attended college (72%). Sixty-six percent of the women reported at least one childhood experience involving abuse, violence or family strife. Compared with women who had had no such experiences, a greater proportion of women who reported at least one experience smoked during adolescence (30% vs. 18%) and had had five or more lifetime sex partners (39% vs. 17%). According to data collected in the second wave only (from 4,558 women), a greater proportion of women reporting at least one adverse childhood experience than of women reporting no such experiences were daughters of adolescent mothers (15% vs. 13%), drank alcohol during adolescence (55% vs. 36%), used street drugs during adolescence (15% vs. 5%) and attempted suicide during adolescence (4% vs. less than 1%).

Overall, nearly one in four women had had a teenage pregnancy. Compared with women who did not report a given adverse event, women who had experienced incarceration of a family member, household substance abuse, parental domestic violence, verbal abuse, sexual abuse, divorced parents, physical abuse or household mental illness were more likely to have become pregnant as teenagers (relative risks, 1.2-1.9). In addition, the proportion of women who had become pregnant as teenagers increased steadily from 16% among women with no adverse childhood experiences to 53% among those who reported 7-8. Compared with women who had had no such experiences, the odds of a first pregnancy in adolescence rose from 1.4 for those with one adverse experience to 5.6 for those with 7-8 experiences, with adjustment for age at interview, education and race.

Women's risk of current psychological or social problems rose with exposure to adverse experiences during childhood. Compared with women who had experienced no such events, those who had experienced 1-2 had elevated odds of serious family problems, serious job problems, serious financial problems, high stress and fear of inability to control anger (odds ratios, 1.4-1.6). These risks were even higher among women who had had five or more adverse childhood experiences (2.2-4.5).

Adolescent pregnancy was associated with modest increases in family and financial problems and in stress and fear of uncontrollable anger in women who reported adverse childhood experiences, but it was not associated with these outcomes in women without such experiences.

In ever-pregnant women, adverse childhood experiences were significantly associated with fetal death (stillbirth or miscarriage). Compared with women with no adverse experiences, those with 1-2 such experiences had 20% higher odds of a fetal death after the first or second pregnancy (odds ratio, 1.2), and those with five or more experiences had almost twice the odds (1.7). Adolescent pregnancy was not associated with fetal death.

According to their calculations of the population attributable risk associated with childhood experiences of abuse, violence and family strife, the researchers estimate that one-third of teenage pregnancies could be prevented by eliminating these exposures. They note that their analysis demonstrates "that family dysfunction has enduring and unfavorable health consequences for women during the adolescent years, the childbearing years, and beyond." When the family environment does not include adverse childhood experiences, becoming pregnant as an adolescent does not appear to raise the likelihood of long-term, negative psychosocial consequences, they note.

REFERENCE

(1.) Hillis SD et al., The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death, Pediatrics, 2004, 113(2):320-327.