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Implications of teen birth for overweight and obesity in adulthood

  • Tammy Chang
    Correspondence
    Reprints: Tammy Chang, MD, MPH, MS, 2800 Plymouth Rd., Building 10, Room G016, Ann Arbor, MI 48109-2800.
    Affiliations
    University of Michigan Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, MI

    Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
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  • HwaJung Choi
    Affiliations
    University of Michigan Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, MI

    Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
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  • Caroline R. Richardson
    Affiliations
    University of Michigan Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, MI

    Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI

    Veterans Affairs Health Services Research and Development Service, Ann Arbor, MI
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  • Matthew M. Davis
    Affiliations
    University of Michigan Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, MI

    Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI

    Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI

    University of Michigan Gerald R. Ford School of Public Policy, Ann Arbor, MI
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Published:April 15, 2013DOI:https://doi.org/10.1016/j.ajog.2013.04.023

      Objective

      The objective of this study was to examine whether teen birth was independently associated with overweight and obesity in a US cohort.

      Study Design

      We examined whether teen birth is independently associated with overweight and obesity in a multiyear US cohort using the 2001-2010 National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey of the US civilian, noninstitutionalized population. We performed multinomial logistic regression adjusting for survey cohort, age at survey, race, education, and parity. We included women 20-59 years old at the time of survey, with at least 1 live birth, not currently or recently pregnant (unweighted, n = 5220; weighted, n = 48.4 million). Our outcome measure was the effect of teen birth on subsequent overweight and obesity.

      Results

      In bivariate analyses, women with a teen birth were significantly more likely than women without a teen birth to be overweight (relative risk ratios [RRRs], 1.61; 95% confidence interval [CI], 1.37–1.90) or obese (RRR, 1.84; 95% CI, 1.56–2.16) at the time of the survey. In multivariate models, women with a teen birth remained significantly more likely to be overweight (adjusted RRR, 1.33; 95% CI, 1.10–1.62) or obese (adjusted RRR, 1.32; 95% CI, 1.09–1.61) than women without a teen birth.

      Conclusion

      For women in the United States, giving birth as a teen is associated with subsequent overweight/obese status later in life. To inform clinical and policy interventions with the goal to improve the long-term health of teenage mothers, future studies must examine modifiable physiological and sociomedical reasons for early child-bearing and later risk of obesity.

      Key words

      For Editors' Commentary, see Contents
      Despite decades of clinical and research efforts, obesity continues to be a prevalent, debilitating, and expensive public health problem. Rates of obesity in adults and children have not improved and in some groups continue to climb.
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      Pregnancy is a strong risk factor for new or persistent obesity, with minority women having a higher incidence of parity-related obesity than white women.
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      In a recent study of the National Longitudinal Survey of Youth, the 5 year incidence of obesity was 11.3 per 100 in parous women, compared with 4.5 per 100 in nulliparous women.
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      Primary prevention efforts are especially important in population-level obesity management because studies have shown that once obesity is established, it is difficult to reverse
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      Furthermore, obesity in adolescence is significantly associated with an increased risk of severe obesity in adulthood,
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      one population that has not yet been studied as a high-risk group for obesity is women who have given birth as teenagers. Approximately 30% of teen women in the United States become pregnant and 20% give birth by age 20 years.

      Kearney MS, Levine PB. Reducing unplanned pregnancies through Medicaid family planning services; 2008. Available at: http://www.brookings.edu/∼/media/research/files/papers/2008/7/reducing%20pregnancy%20kearney/07_reducing_pregnancy_kearney.pdf Accessed April 26, 2013.

      Teenage mothers have both sociodemographic and physiological risk factors for obesity. Sociodemographic risks among women for obesity include black or Hispanic race/ethnicity,
      Vital signs: teen pregnancy—United States, 1991-2009.
      Differences in prevalence of obesity among black, white, and Hispanic adults—United States, 2006-2008.
      poverty,
      • Drewnowski A.
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      Poverty and obesity: the role of energy density and energy costs.
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      Obesity and socioeconomic status in children and adolescents: United States, 2005-2008.
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      Ecological analysis of teen birth rates: association with community income and income inequality.
      and low educational attainment.
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      Obesity and socioeconomic status in children and adolescents: United States, 2005-2008.
      • Elfenbein D.S.
      • Felice M.E.
      Adolescent pregnancy.
      Physiological risks among teenage mothers include greater gestational weight gain and greater postpartum weight retention than adults.
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      • Ances I.G.
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      Gestational weight gain, pregnancy outcome, and postpartum weight retention.
      Studies have also shown that after 28 weeks’ gestation, growing adolescents continue to accrue fat rather than mobilize fat stores like nongrowing adolescents and adults.
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      Weight gain, nutrition, and pregnancy outcome: findings from the Camden study of teenage and minority gravidas.
      Furthermore, a recent US longitudinal study showed that women who give birth during adolescence and young adulthood have substantially greater increments in overall and central adiposity than adolescents who do not give birth.
      • Gunderson E.P.
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      • Schreiber G.
      • et al.
      Longitudinal study of growth and adiposity in parous compared with nulligravid adolescents.
      We are unaware of prior studies that have examined, at the individual or population level, whether a history of teen birth is a risk factor for obesity in later adult life. If teen birth is a risk factor, teen mothers would be a newly identified high-risk group for prevention of long term obesity.
      The purpose of this study was to examine whether teen birth is independently associated with overweight and obesity in a US cohort, using the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2010.

      Materials and Methods

      NHANES is a nationally representative cross-sectional survey designed to assess the health and nutritional status of the US civilian, noninstitutionalized population. NHANES became a continuous survey in 1999 and data are released in 2 year cycles. The NHANES survey includes a personal interview in the household and a detailed physical examination in a Mobile Examination Center (MEC). Additional data on the survey design, questionnaires, and laboratory methods are available online.

      Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination survey. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed June 5, 2012.

      To examine the association between teen birth and overweight and obesity, data were analyzed from five 2-year cycles from 2001 to 2010. The overall examination survey response rates for each cycle ranged from 72% to 81%. During 2001-2010, 8956 women aged 20-59 years participated in the reproductive questionnaire and MEC examination.
      This study sample was restricted to women aged 20-59 years at the time of the survey, whose measured weight and height at the time of participation in the MEC led to calculated body mass index (BMI) greater than 18.5 kg/m2, who had at least 1 child and who were not currently pregnant or recently pregnant (within 12 months). We limited the ages to 20-59 years at the time of the survey to mitigate cohort differences in health care and society that might have been present with inclusion of older women and also to avoid ages 60 years and beyond during which conditions such as cancer can be associated with weight loss. These criteria yielded a sample of 5256 women, of whom 5220 (99.3%) had complete data including BMI, age at first birth, current age, race, education, and parity.
      For each participant, the age at first birth was abstracted from the dataset and used to determine whether the participant had a teen birth. Teen birth is defined in this study as having a live birth between age 13 years and age 19 years, inclusive. Other variables abstracted included survey cohort (2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010), age at time of survey, race/ethnicity (grouped as non-Hispanic white, non-Hispanic black, Mexican-American, and other, which includes multiracial), education (grouped less than ninth grade, ninth to 11th grade, high school graduate or general education degree (GED), some college, and college graduate), and parity (grouped as 1, 2, 3, 4, or ≥5 live births). These variables were included in our model because they have been shown to be strongly associated with both obesity and teen birth and need to be adjusted for to avoid confounding. To avoid overfitting or overadjusting our model, we did not include variables in the causal pathway of obesity such as diet and physical activity.
      • Babyak M.A.
      What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models.
      • Flegal K.M.
      • Kit B.K.
      • Orpana H.
      • Graubard B.I.
      Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.
      The outcome of interest was overweight (BMI 25.0-29.9 kg/m2) vs normal weight (BMI 18.5-24.9 kg/m2) and obese (BMI ≥30 kg/m2) vs normal weight (BMI 18.5-24.9 kg/m2) at the time of the survey. The exposure of interest was teen birth (yes/no). We performed descriptive statistics and then multinomial logistic regression to determine the bivariate association between BMI and teen birth. Subsequently we added available sociodemographic variables (current age, race/ethnicity, education) as well as the survey cohort variable to take into account BMI trends over time by cohort. Finally, we added the parity variable to assess independent associations with obesity.
      To account for the complex, multistage probability survey design, analyses were conducted using STATA (version 12; Stata Corp, College Station, TX), adjusting for sample clustering and applying sampling weights to permit national inferences. Results are presented as unadjusted and adjusted relative risk ratios (aRRRs). Statistical significance was defined as an alpha of less than 0.05. All findings are presented using weighted data, except where otherwise indicated. Institutional review board approval was not required for the analysis of this publically available, deidentified data.

      Results

      The baseline characteristics in our sample of women (unweighted, n = 5220; weighted, n = 48.4 million) are presented in Table 1. Women with a teen birth differed in several respects, as expected, from women without a teen birth. Women with a teen birth were more likely to be non-Hispanic black, or Mexican-American and more likely to report less than high school education than women without a teen birth. Women with a teen birth were also significantly more likely to have higher parity (2.70; 95% confidence interval [CI], 2.63–2.76) than women without a teen birth (2.12; 95% CI, 2.08–2.17).
      Table 1Characteristics of women aged 20-59 years with at least 1 live birth who are not currently or recently pregnant
      CharacteristicNon-teen birth, % (95% CI)Teen birth, % (95% CI)Student t test, P valueχ2, P value
      n34221798
      Total n34.8 million13.6 million
      Percent of sample65.634.4
      Mean age43.5 (43.1–43.9)40.7 (40.0–41.4)< .001
      Race/ethnicity< .001
       White, non-Hispanic72.5 (69.3–75.5)54.0 (48.3–59.6)
       Black, non-Hispanic9.6 (8.2–11.3)22.3 (18.9–26.1)
       Mexican-American7.0 (5.8– 8.5)12.5 (10.1–15.6)
       Other10.8 (8.1–12.8)11.2 (8.9–14.0)
      Education< .001
       Less than ninth grade3.3 (2.7–4.0)9.6 (8.2–11.2)
       Ninth to 11th grade8.4 (7.3–9.7)24.7 (22.6–27.0)
       HS grad or GED22.0 (20.1–24.0)32.1 (29.5–34.8)
       Some college36.0 (33.9–38.2)29.0 (26.4–31.8)
       College graduate and above30.3 (28.1–32.6)4.6 (3.3–6.3)
      Parity< .001
       127.2 (25.4–29.1)14.2 (12.3–16.4)
       243.1 (41.0–45.2)34.0 (31.3–36.8)
       322.1 (20.5–23.8)29.4 (26.8–32.2)
       45.3 (4.6–6.3)12.6 (10.7–14.8)
       ≥52.3 (1.6–3.2)9.8 (8.5–11.3)
      United States, National Health and Nutrition Examination Survey, 2001-2010 (n = 5220; total n = 48.4 million). Non-teen birth is defined as a live birth from a woman aged 20 years old or older. Teen birth is defined as a live birth from a woman between the ages of 13 and 19 years. Recently, pregnant is defined as age of birth equal to current age. Parity is the number of live births. For race/ethnicity, other includes multiracial.
      CI , confidence interval; GED, general equivalency degree; HS, high school.
      Chang. Teen birth and overweight/obesity. Am J Obstet Gynecol 2013.
      At the time of the survey, significantly more women with a teen birth were obese (44.2%; 95% CI, 41.5–47.0) compared with women without a teen birth (35.2%; 95% CI, 33.2–37.3; P < .001). Significantly fewer women with a teen birth were normal weight (26.1%; 95% CI, 23.3–29.0) compared with women without a teen birth (37.9%; 95% CI, 35.9–40.0; P < .001). There was no significant difference in the prevalence of overweight by teen birth status (Figure).
      Figure thumbnail gr1
      FigureDistribution of weight status by teen birth status
      Percentage of normal weight, overweight, and obesity among women aged 20-59 with at least one live birth who are not currently or recently pregnant, US, National Health and Nutrition Examination Survey, 2001-2010. Within a nationally representative sample of women age 20-59, this figure shows the difference in the proportion of normal weight, overweight, and obese women by teen birth status. Teen birth is defined as any birth between age 13-19 and non-teen birth is birth at age 20 and older.
      Chang. Teen birth and overweight/obesity. Am J Obstet Gynecol 2013.
      In an unadjusted multinomial logistic regression, women with a teen birth were significantly more likely than women without a teen birth to be overweight (relative risk ratios [RRRs], 1.61; 95% CI, 1.37–1.90; P < .001) or obese (RRR, 1.84; 95% CI, 1.56–2.16; P < .001) at the time of the survey (Tables 2 and 3). In multivariate models, women with a teen birth remained significantly more likely than women without a teen birth to be overweight (adjusted RRR, 1.33; 95% CI, 1.10–1.62; P = .004) or obese (aRRR, 1.32; 95% CI, 1.09–1.61; P = .005). When the BMI variable was further stratified into grade 1 (BMI of 30 to <35 kg/m2), grade 2 (BMI of 35 to <40 kg/m2), and grade 3 (BMI of ≥40 kg/m2), the effect of teen birth was generally unchanged (data not shown).
      Table 2Multinomial logistic regression models for overweight vs normal weight–unadjusted model and model adjusted for all covariates
      VariableUnadjusted, RRR (95% CI, P value)Adjusted for sociodemographic factors, RRR (95% CI, P value)Adjusted for sociodemographic factors and parity, RRR (95% CI, P value)
      Overweight vs normal weight
       Teen birth1.61

      (1.37–1.90, < .001)
      Indicates statistical significance.
      1.34

      (1.11–1.60, .002)
      Indicates statistical significance.
      1.33

      (1.10–1.62, .004)
      Indicates statistical significance.
       Current age1.02

      (1.01–1.03, < .001)
      Indicates statistical significance.
      1.02

      (1.01–1.03, < .001)
      Indicates statistical significance.
      Race/ethnicity
       White, non-Hispanic1.00

      Referent
      1.00

      Referent
       Black, non-Hispanic2.27

      (1.72–2.99, < .001)
      Indicates statistical significance.
      2.30

      (1.75–3.04, < .001)
      Indicates statistical significance.
       Mexican-American1.93

      (1.53–2.44, < .001)
      Indicates statistical significance.
      1.95

      (1.54–2.46, < .001)
      Indicates statistical significance.
       Other1.27

      (0.96–1.69, .095)
      1.28

      (0.97–1.70, .085)
      Education
       Less than 9th grade1.00

      Referent
      1.00

      Referent
       Ninth to 11th grade0.76

      (0.51–1.13, .166)
      0.75

      (0.50–1.13, .166)
       HS grad or GED0.75

      (0.51–1.10, .134)
      0.75

      (0.51–1.10, .136)
       Some college0.81

      (0.56–1.18, .278)
      0.82

      (0.56–1.19, .291)
       College graduate and above0.49

      (0.33–0.73, .001)
      Indicates statistical significance.
      0.49

      (0.33–0.72, .001)
      Indicates statistical significance.
      Parity
       11.00

      Referent
       21.02

      (0.82–1.27, .844)
       31.17

      (0.92–1.49, .204)
       40.80

      (0.52–1.24, .319)
       ≥51.12

      (0.71–1.76, .618)
      Sociodemographic factors include the following: current age, race/ethnicity, and education. All models are adjusted for cohort year.
      CI, confidence interval; GED, general equivalency degree; HS, high school; RRR, relative risk ratio.
      Chang. Teen birth and overweight/obesity. Am J Obstet Gynecol 2013.
      a Indicates statistical significance.
      Table 3Multinomial logistic regression models for obese vs normal weight–unadjusted model and model adjusted for all covariates
      VariableUnadjusted, RRR (95% CI, P value)Adjusted for sociodemographic factors, RRR (95% CI, P value)Adjusted for sociodemographic factors and parity, RRR (95% CI, P value)
      Obese vs normal weight
       Teen birth1.84

      (1.56–2.16, < .001)
      Indicates statistical significance.
      1.38

      (1.14–1.66, .001)
      Indicates statistical significance.
      1.32

      (1.09–1.61, .005)
      Indicates statistical significance.
       Current age1.02

      (1.02–1.03, < .001)
      Indicates statistical significance.
      1.02

      (1.01–1.03, < .001)
      Indicates statistical significance.
      Race/ethnicity
       White, non-Hispanic1.00

      Referent
      1.00

      Referent
       Black, non-Hispanic3.30

      (2.59–4.20, < .001)
      Indicates statistical significance.
      3.30

      (2.59–4.21, < .001)
      Indicates statistical significance.
       Mexican-American1.85

      (1.50–2.27, < .001)
      Indicates statistical significance.
      1.81

      (1.47–2.23, < .001)
      Indicates statistical significance.
       Other0.84

      (0.62–1.12, .232)
      0.83

      (0.62–1.11, .213)
      Education
       Less than 9th grade1.00

      Referent
      1.00

      Referent
       Ninth to 11th grade0.90

      (0.61–1.35, .616)
      0.93

      (0.63–1.38, .716)
       HS graduate or GED0.96

      (0.64–1.44, .845)
      1.01

      (0.68–1.49, .964)
       Some college0.91

      (0.62–1.33, .619)
      0.95

      (0.66–1.38, .792)
       College graduate and above0.42

      (0.28–0.64, < .001)
      Indicates statistical significance.
      0.44

      (0.29–0.66, < .001)
      Indicates statistical significance.
      Parity
       11.00

      Referent
       21.07

      (0.86–1.32, .540)
       31.27

      (1.04–1.54, .019)
      Indicates statistical significance.
       41.12

      (0.80–1.56, .502)
       ≥51.38

      (0.94–2.01, .096)
      Sociodemographic factors: current age, race/ethnicity, and education. All models are adjusted for cohort year.
      CI, confidence interval; GED, general equivalency degree; HS, high school; RRR, relative risk ratio.
      Chang. Teen birth and overweight/obesity. Am J Obstet Gynecol 2013.
      a Indicates statistical significance.
      Adjusting for parity caused little change in the magnitude of the effect of teen birth on subsequent overweight or obesity. Among other factors, older age in years at time of the survey was associated with both overweight and obesity. Race/ethnicity was also associated with both overweight and obesity, with African-American and Mexican-American women at higher risk of overweight and obesity than non-Hispanic white women. Compared with women with less than a ninth-grade education, college graduates were significantly less likely to be overweight or obese (Tables 2 and 3).

      Comment

      Rates of teen birth and adult obesity among women are both higher in the United States than in many other industrialized nations, but the potential association between these problems has not been described previously at the population level. In this national study of women aged 20-59 years who participated in the NHANES between 2001 and 2010, we found that women who had a teen birth are significantly more likely to be overweight or obese than women who did not have a teen birth, after adjusting for many potentially confounding factors. Consistent with past studies, advancing age and race/ethnicity were also both independently associated with obesity.
      • Flegal K.M.
      • Carroll M.D.
      • Kit B.K.
      • Ogden C.L.
      Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010.
      Teen birth was associated with an increased risk of overweight as well as obesity. As described by longitudinal data of US adults, BMI increases throughout adulthood with obese individuals passing through a period of overweight before ultimately becoming obese.
      • McTigue K.M.
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      • Popkin B.M.
      The natural history of the development of obesity in a cohort of young US adults between 1981 and 1998.
      Therefore, the association between teen birth and overweight could represent women who will eventually become obese in time, making this association as concerning as the association between teen birth and obesity.
      These novel findings between teen birth and overweight and obesity have several implications for the care of teenagers and women who have had a teen birth. First, these findings support the prevention of teen pregnancy as an additional strategy that may decrease the risk of long-term morbidity associated with obesity for women. Successful interventions to prevent teen pregnancy in the United States include free contraception
      • Peipert J.F.
      • Madden T.
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      • Secura G.M.
      Preventing unintended pregnancies by providing no-cost contraception.
      and early sex education,
      • Lindberg L.D.
      • Maddow-Zimet I.
      Consequences of sex education on teen and young adult sexual behaviors and outcomes.
      both of which could be more widely implemented.
      Recent reports have shown that teen pregnancy rates are decreasing in the United States.
      • Hamilton B.E.
      • Ventura S.J.
      Birth rates for US teenagers reach historic lows for all age and ethnic groups.
      However, compared with other developed countries, the United States continues to have among the highest levels of teen birth.
      • Kearney M.S.
      • Levine P.B.
      Why is the teen birth rate in the United States so high and why does it matter?.
      High levels of obesity among reproductive-age women in the United States together with high levels of teen birth warrant further policy attention and clinical intervention, despite incremental improvements in teen pregnancy rates in the United States.
      Second, during prenatal care for teenagers, interventions that support appropriate weight gain are vital to prevent postpartum weight retention because excess gestational weight gain is a strong predictor of maternal overweight and obesity following pregnancy.
      • Herring S.J.
      • Rose M.Z.
      • Skouteris H.
      • Oken E.
      Optimizing weight gain in pregnancy to prevent obesity in women and children.
      Teens represent a distinct population of pregnant women for whom traditional perinatal weight management strategies may not be effective or even possible because of extenuating financial or social circumstances. Therefore, development of innovative perinatal weight management programs accessible to this unique group of women is needed.
      Third, among women who have had teen births in the past, health care providers, researchers, and policy makers can begin to focus on this group as at increased risk for later overweight and obesity, which previously has not been done. Importantly, teen birth is associated with rapid repeat pregnancies
      • Raneri L.G.
      • Wiemann C.M.
      Social ecological predictors of repeat adolescent pregnancy.
      and increased parity, although our study found that parity is not associated with later overweight or obesity when teen birth is taken into account. The significance of this relationship is unclear, although it likely represents the complex social and physiological risks associated with teen birth leading to overweight and obesity.
      Because rates of teen pregnancy are higher among low-income women who may largely depend on Medicaid and other public health care coverage, our study also suggests that policies that expand eligibility for family-planning services may offer ways to decrease the risk of obesity in these high-risk women. One recent study showed that expanded Medicaid eligibility policies had a significant impact on reducing unplanned births,

      Kearney MS, Levine PB. Reducing unplanned pregnancies through Medicaid family planning services; 2008. Available at: http://www.brookings.edu/∼/media/research/files/papers/2008/7/reducing%20pregnancy%20kearney/07_reducing_pregnancy_kearney.pdf Accessed April 26, 2013.

      which implies that coverage expansions planned as part of the Patient Protection and Affordable Care Act could also have similar effects of reducing unplanned births among women, including teens.
      Although our analysis has several strengths, our findings must be interpreted with specific caveats related to our data source and methods. First, the NHANES is a cross-sectional study and can be used to describe associations but not causation or temporal relationships. Second, we adjusted for educational attainment as a surrogate for socioeconomic status, a commonly performed practice. However, because our sample included women aged 20 to 59 years, it is possible women in their 20s have not reached their educational or reproductive potential.
      Another limitation of our study is the exclusion of the effect of breast-feeding on obesity in our model because breast-feeding for longer than 6 months has been shown to significantly influence postpartum weight retention.
      • Bobrow K.L.
      • Quigley M.A.
      • Green J.
      • Reeves G.K.
      • Beral V.
      Persistent effects of women's parity and breastfeeding patterns on their body mass index: results from the Million Women Study.
      Data on breast-feeding are missing for a high proportion of the NHANES sample, and inclusion of this variable would decrease our sample size by almost 20%. Women with lower education attainment have been found to breast-feed at a lower rate,
      • Dubois L.
      • Girard M.
      Social inequalities in infant feeding during the first year of life. The Longitudinal Study of Child Development in Quebec (LSCDQ 1998-2002).
      • Dubois L.
      • Girard M.
      Social determinants of initiation, duration and exclusivity of breastfeeding at the population level: the results of the Longitudinal Study of Child Development in Quebec (ELDEQ 1998-2002).
      and we expect that by controlling for education, we also account for some of the effect of breast-feeding.
      Women in the United States who have given birth in their teenage years are significantly more likely to be overweight or obese than women who first gave birth at older ages. Although the long-term health of teen mothers is not commonly addressed in the course of routine clinical care, effective interventions for this unique group may reduce the risk of obesity later in adulthood and its associated morbidities. Studies that examine this relationship further are warranted to inform clinical and policy interventions with the goal to improve the long-term health of teenage mothers, focusing on those at elevated risk for obesity.

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