Teenage pregnancy and ethnicity in the Netherlands: frequency and obstetric outcome

Abstract

Objectives To study differences in frequency and obstetric outcome of teenage pregnancy (not ending in induced abortion) between the main ethnic groups in the Netherlands. Design A retrospective cohort study based on the 1990–93 birth cohort in the National Obstetric Registry.

Subjects A total of 10 583 teenagers and 54 501 20–24-year-old women who had a singleton pregnancy and were primiparous.

Main obstetric outcome measures These were perinatal death occurring between the 16th week of pregnancy and 24 h after birth, preterm birth and operative delivery (vaginal extraction and Cesarean section).

Method Comparison of the frequency of teenage pregnancy between ethnic groups and by bivariate and multivariate analysis of the three outcome measures between the teenage groups, the teenage groups and ethnically related 20–24-year-old women, and the teenage groups and Dutch 22–24-year-old women.

Results A total of 55.2% of pregnant teenagers had non-Dutch ethnicity compared to 13.8% of all pregnant women. Islamic-Mediterranean teenagers constituted the largest group, one in four of all primiparous Mediterranean women being younger than 20 years of age, followed by black teenagers.

Except for Hindustani teenagers, perinatal death occurred in all non-Dutch teenage groups more frequently than in Dutch teenagers, but the differences were only significant for black teenagers (odds ratios of black compared to Dutch teenagers were 2.89 (95% confidence interval (CI) 1.89–4.4) and 1.53 (95% CI 1.19–1.98), respectively). Rates for preterm birth were higher in black and Asian than in Dutch teenagers, but the difference was only significant for black teenagers (odds ratio 1.53, 95% CI 1.19–1.98). Compared to ethnically related 20–24-year-old women, rates of perinatal death and preterm birth were significantly higher in Dutch, black and Asian teenagers and, for preterm birth only, in Mediterranean teenagers. Correction for preterm birth showed that only part of these differences in perinatal death could be explained by preterm birth.

Vaginal extraction and Cesarean section occurred less frequently in teenagers than in ethnically related (and in Dutch) 20–24-year-old women. Mediterranean teenagers had the lowest Cesarean section rate and Blacks the lowest vaginal extraction rate.

Conclusion Teenage pregnancy in the Netherlands is much more common in minority ethnic groups than in the indigenous population, particularly among Islamic-Mediterraneans and Blacks. Obstetric outcomes vary considerably, these being best in Hindustani and poorest in black teenagers, and being worse in teenagers than in 20–24-year-old women. However, teenagers less often had assisted delivery.

The results of this study were first reported in the Nederlands Tijdschrift voor Geneeskunde 1999;143:465-71

KEY WORDS:

• Teenage pregnancy
• Ethnicity
• Obstetric outcome