P3.P302: Health Disparities in Puerto Rican Teen Pregnancy Outcomes

Background: Infant mortality rates have reduced through the years, but not as much for infants of teenage mother, indicative that disparities are still present in this group. Research on maternal-infant morbidity and mortality disparities among teen pregnancies in Hispanic population is crucial. Mortality rates are highest for infants of teens aged 15 to 19. From 2002 to 2021 the infant mortality rate decline by 22%. The current infant mortality rate for Puerto Rico in 2024 is 4.613 deaths per 1000 live births, a 2.49% decline from 2023. In United States during 2019-2021, the infant mortality rate (per 1,000 live births) was highest for women under 20 (8.8) and ages 40 and older (6.8), compared to 5.5 for all live births. We aim to compare maternal risk factors and outcomes of infants born to teen versus non-teen mothers to address the challenges for healthcare services in this vulnerable population.

Methods: This retrospective cohort study was conducted at a Level IV Neonatal Intensive Care Unit (NICU) in Puerto Rico utilizing the Vermont Oxford Network and the Neonatology Section databases from January 2015 to January 2023. We compared maternal-infant morbidity and infant mortality rates between teen (19 years and younger) and non-teen (20 years and older) pregnancies. The dataset underwent comprehensive analysis using Intellectus Statistics Software, employing rigorous statistical tests including t-test, Fisher exact, Pearson’s chi-square, to compare differences among groups. IRB approval #2020517.

Results: Within the cohort of 3161 patients, 9.36% comprised adolescents (n=296). The median age of mothers was 27 years. Regarding maternal morbidity, maternal chronic illnesses had a marked disparity that emerged within non-teen mothers, exhibiting a higher prevalence (52% versus 34%; p value < 0.001). In contrast, the presence of Chorioamnionitis had a higher prevalence in teen mothers (8% versus 4%; p value 0.010). Cesarean sections were more common in non-teenagers (65% compared to 48%; p value < 0.001). Regarding infant morbidity, infants' birth weight, gestational age at birth and comorbidities developed at the NICU, were similar among groups. But congenital anomalies were more prevalent in non-teen mothers (29% compared to 24%; p value 0.038). Infant survival rate, in the other hand, revealed a notable contrast, with a significantly lower survival rate for infants born to teen mothers with an 86% survival rate compared to 90% in non-teen mothers (p value 0.0287, OR 1.47 [1.04-2.09]).

Conclusion: Despite maternal chronic illnesses, cesarean sections and congenital anomalies were more statistically significantly prevalent in non-teen pregnancies as well as similar comorbidities in infants, adolescent pregnancies are at more risk of infant mortality. These early insights underscore the importance of further investigation into the unique healthcare needs and challenges faced by adolescent mothers, emphasizing the potential impact on both maternal and infant health outcomes.