thesis statement for what is the right age to get pregnant?

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• Open Access
• Published: 25 May 2016

Teenage pregnancy: the impact of maternal adolescent childbearing and older sister's teenage pregnancy on a younger sister

BMC Pregnancy and Childbirth volume 16, Article number:120 (2016) Cite this article

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Abstract

Background

Gamble factors for teenage pregnancy are linked to many factors, including a family history of teenage pregnancy. This research examines whether a female parent'due south teenage childbearing or an older sis'due south teenage pregnancy more strongly predicts teenage pregnancy.

Methods

This study used linkable authoritative databases housed at the Manitoba Eye for Health Policy (MCHP). The original accomplice consisted of 17,115 women born in Manitoba betwixt April 1, 1979 and March 31, 1994, who stayed in the province until at to the lowest degree their 20^th birthday, had at least ane older sis, and had no missing values on key variables. Propensity score matching (ane:2) was used to create balanced cohorts for ii conditional logistic regression models; 1 examining the impact of an older sister's teenage pregnancy and the other analyzing the outcome of the mother's teenage childbearing.

Results

The adjusted odds of becoming significant between ages xiv and 19 for teens with at to the lowest degree 1 older sister having a teenage pregnancy were 3.38 (99 % CI 2.77–4.13) times higher than for women whose older sister(s) did non accept a teenage pregnancy. Teenage daughters of mothers who had their first child before historic period xx had ane.57 (99 % CI one.30–i.89) times college odds of pregnancy than those whose mothers had their first kid subsequently age 19. Educational achievement was adjusted for in a sub-population examining the odds of pregnancy betwixt ages 16 and 19. Afterwards this adjustment, the odds of teenage pregnancy for teens with at least ane older sister who had a teenage pregnancy were reduced to 2.48 (99 % CI 2.01–3.06) and the odds of pregnancy for teen daughters of teenage mothers were reduced to 1.39 (99 % CI one.15–1.68).

Determination

Although both were significant, the relationship between an older sister's teenage pregnancy and a younger sis'due south teenage pregnancy is much stronger than that betwixt a female parent'due south teenage childbearing and a younger girl's teenage pregnancy. This report contributes to understanding of the broader topic "who is influential most what" within the family.

Peer Review reports

Background

The risks and realities associated with teenage maternity are well documented, with consequences starting at childbirth and post-obit both mother and child over the life bridge.

Teenage births result in health consequences; children are more than probable to be born pre-term, have lower birth weight, and higher neonatal mortality, while mothers feel greater rates of post-partum depression and are less likely to initiate breastfeeding [1, 2]. Teenage mothers are less likely to complete loftier schoolhouse, are more than likely to alive in poverty, and have children who frequently experience health and developmental problems [iii]. Agreement the take chances factors for teenage pregnancy is a prerequisite for reducing rates of teenage motherhood. Diverse social and biological factors influence the odds of teenage pregnancy; these include exposure to adversity during childhood and boyhood, a family history of teenage pregnancy, conduct and attention bug, family instability, and low educational achievement [four, five].

Mothers and older sisters are the main sources of family influence on teenage pregnancy; this is due to both social hazard and social influence. Family members both contribute to an private'south attitudes and values around teenage pregnancy, and share social risks (such every bit poverty, ethnicity, and lack of opportunities) that influence the likelihood of teenage pregnancy [6, 7]. Having an older sis who was a teen mom significantly increases the take a chance of teenage childbearing in the younger sister and daughters of teenage mothers were significantly more likely to become teenage mothers themselves [8, 9]. Girls having both a mother and older sis who had teenage births experienced the highest odds of teenage pregnancy, with ane study reporting an odds ratio of 5.ane (compared with those who had no history of family teenage pregnancy) [v]. Studies consistently point that girls with a familial history of teenage childbearing are at much higher take chances of teenage pregnancy and childbearing themselves, but methodological complexities have resulted in inconsistent findings around "parent/child sexual communication and adolescent pregnancy risk" [ten]. A review of family unit relationships and adolescent pregnancy risk institute chance factors to include living in poor neighborhoods and families, having older siblings who were sexually active, and being a victim of sexual abuse [10]. Research effectually the impact of sister'south teenage pregnancy has been limited to mostly qualitative studies using small samples of minority adolescents in the United States [five, 11].

To our cognition, no previous studies accept examined the affect of an older sister'southward teenage pregnancy on the odds of her younger sis having a teenage pregnancy, and compared this upshot with the direct outcome of having a female parent who bore her showtime child earlier age 20. By controlling for a multifariousness of social and biological factors (such as neighborhood socioeconomic status, marital condition of mother, residential mobility, family structure changes, and mental wellness), and the use of a strong statistical blueprint—propensity score matching with a large population-based dataset—this written report aims to determine whether teenage pregnancy is more than strongly predicted by having an older sister who had a teenage pregnancy or by having a mother who bore her kickoff kid earlier historic period 20.

Methods

Setting

The setting of this study, Manitoba, is mostly representative of Canada as a whole, ranking in the centre for several health and education indicators [12, xiii]. At the fourth dimension of the 2011 Demography, approximately 1.2 1000000 people resided in Manitoba, with more than one-half (783,247) living in the two urban areas, Winnipeg and Brandon [fourteen]. Teenage pregnancy rates in Manitoba exceed the national; in 2010 teenage pregnancy rates in Canada were 28.2 per yard, in Manitoba the rate was 48.7 per m [15]. The Manitoba teen pregnancy rates in 2010 were slightly lower than rates in England and Wales (54.6 per 1000), and the U.s. (57.4 per thousand) [16, 17].

Information

The Manitoba Population Wellness Research Data Repository contains province-wide, routinely collected private information over time (going dorsum to 1970 in some files), across infinite (with residential location documented using six digit postal codes), for each family (with changes in family unit structure recorded every 6 months) and for each resident. Health variables are measured continuously from md claims and hospital abstracts (as long equally an individual remains in Manitoba) [18].

A inquiry registry identifies every provincial resident, with data on births, arrival and divergence dates, and deaths created from the provincial health registry and coordinated with Vital Statistics files. Given approximately 16,000 births annually, follow-upwards (about 74 % over 20 years) is comparable to that in the largest cohort studies based on primary data [19]. Previous inquiry using similar data shows the results are not biased by individuals leaving the province or dying. Information on information linkage, confidentiality/privacy, and validity of the datasets used take been described elsewhere [twenty–22]. Children are linked to mothers using hospital birth record information; the mother was noted in essentially all cases [23]. Sisters were divers equally having the same biological female parent.

The cohort consists of women who were born in Manitoba between April 1, 1979 and March 31, 1994, stayed in the province until at least their twenty^thursday birthday, had at least one older sister, and had no missing values on fundamental variables. In this study, teenage pregnancies are defined as those between the ages of 14 and 19; pregnancies prior to age 14 were excluded due to low numbers and for comparability to other studies. For this reason, families in which at least one sister had a pregnancy before age 14 were removed (34 families). To accost threats of independence, when a family had more than one younger sis (more 2 daughters), one younger sister was randomly selected. Effigy 1 diagrams the choice trajectory for the 17,115 individuals selected—boxes in bold signal the included accomplice. At age 14, just over 85 % of girls in this cohort were living in the aforementioned postal code as at least i older sis.

Fig. 1

Cohort selection

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Outcome

Teenage pregnancy was defined equally having at to the lowest degree one pregnancy between the ages of fourteen and 19 (inclusive). A pregnancy is defined as having at least i hospitalization of with a live birth, missed abortion, ectopic pregnancy, abortion, or intrauterine death, or at least one infirmary process of surgical termination of pregnancy, surgical removal of ectopic pregnancy, pharmacological termination or pregnancy or intervention during labour and delivery. Pregnancy condition was adamant by ICD-nine-CM codes (for diagnoses before April 1, 2004), ICD-10-CA codes (for diagnoses on or later on April one, 2004), and Canadian Nomenclature of Health Intervention (CCI) codes in the hospital discharge abstract database [24]. Appendix 1 presents specific codes used to determine pregnancy condition.

Contained variable

The independent variables of interest were whether an individual had an older sister with a teenage pregnancy (defined for all sisters as described in a higher place) and whether an individual's mother bore her first child before age xx.

Covariates

Based on an extensive literature review and availability of data in the database, several fundamental variables describing neighborhood, maternal, and individual characteristics were included [4, 25]. Covariates measure characteristics in the younger sister's life before historic period 14. Neighborhood socioeconomic condition at age 14 was measured by the Socioeconomic Gene Index (SEFI) (college SEFI score corresponds with lower socioeconomic status), which is generated using Manitoba (Statistics Canada) dissemination areas [26]. This index combines neighborhood data on income, teaching, employment, and family structure. These neighborhoods typically include between 400 and 700 urban individuals and are somewhat larger in rural areas. Neighborhood location at age xiv was divided into urban (Winnipeg and Brandon), rural southward (South Eastman, Central, and Assiniboine Regional Wellness Authorities), and rural mid/n (North Eastman, Interlake, Parkland, Nor-Homo, Churchill, and Burntwood Regional Health Regime). The maternal characteristic included is marital condition at nascence of child. An individual's number of older sisters was also accounted for.

3 fourth dimension-varying covariates betwixt birth and historic period thirteen for the younger sister were included in the study- mental health weather, residential mobility, and family structure alter. These variables can occur at specific points in fourth dimension and the timing of their occurrence can differ across individuals. Mental health is defined using the Johns Hopkins University Adjusted Clinical Grouping (ACG) software; this software groups medical and hospital diagnoses over the form of a twelvemonth into 27 Major Expanded Diagnostic Clusters (MEDCs) [27]. If for 1 year betwixt birth and historic period 13, the diagnoses an individual received fell into the 'Mental Health' MEDC, that private was categorized as having mental health conditions earlier age 13. Residential mobility was measured past at least one residential movement (defined by alter in half-dozen digit postal code) betwixt birth and age 13. At to the lowest degree one modify in family structure (parental divorce, death, wedlock, remarriage) betwixt birth and historic period 13 was noted as 'family construction change'.

Low educational achievement has been linked to an increased take a chance of teenage pregnancy [28]. The earliest measure out of educational achievement available is the Grade nine Achievement Alphabetize, which was built on a technique developed past Mosteller and Tukey using enrollment files, course grades, and the provincial population registry [29, 30]. As some of the individuals in this cohort experience their beginning pregnancy before completing grade 9, this covariate is merely appropriate for girls having their first pregnancy after their 16^thursday altogether. Sensitivity testing was done with this population to make up one's mind how strongly educational achievement affected the odds of the variables of interest.

Analytic approach

The relationship between pregnancy during 1's teenage years and having an older sister who became pregnant during adolescence or having a female parent who bore her first kid every bit a teenager is confounded by many measured and unmeasured characteristics. We adjusted for these confounding characteristics using 2:1 propensity score matching [31]; ii controls were matched with every instance as this "will result in optimal estimation of handling effect [32]". Propensity score matching both enables aligning for several confounders simultaneously and facilitates diagnostic tests to place whether the adjustment strategy created comparable exposure groups (i.e., whether women with and without an older sister who got pregnant during adolescence are like on observed characteristics) [31]. Logistic regression models were used to calculate propensity scores for ii responses—the predicted probability of having an older sister having a teenage pregnancy and the predicted probability of having a mother bearing her first child before age xx. For each model, nosotros investigated the comparability of our 2 groups—those with and without an older sister having a teenage pregnancy, and those with and without a mother who bore her first child as a teenager—using ii diagnostics. A kernel density plot verified that the distribution of propensity scores in our two groups overlapped [33]; each case was matched to ii controls using greedy matching [34]. Second, later matching, the balance of the covariates was assessed using standard differences and t-tests. Covariate residue was checked past t-statistics calculated for the standardized differences between cases and controls for each covariate before and after matching. Whatsoever point outside of the two vertical dotted lines signified a statistically significant departure between the cases and controls on that covariate (at p = 0.05) (Figs. two and iii).

Fig. 2

Checking covariate balance of older sister's teenage pregnancy status

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Fig. 3

Checking covariate balance of mother' teenage mom condition

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Conditional logistic regression analysis of the matched cohorts examined the impact of an older sister's teenage pregnancy and of a female parent's teenage childbearing on teenage pregnancy. Sensitivity analysis helped assess the validity of the assumption of no unobservable confounders, and assessed how strong the influence of unobserved covariates would have to be in order to nullify our findings [35, 36]. The lower limit of the 99 % confidence interval (selected to be more than bourgeois) was used to decide the threshold unobserved covariates would accept to reach to void the observed relationship.

Results

Impact of older sis having a teenage pregnancy

Table 1 displays the descriptive statistics of the covariates and issue variables. Of the girls having an older sister with a teenage pregnancy, 40.4 % had a teenage pregnancy. This is significantly higher than the 10.iii % teenage pregnancy charge per unit among those non having an older sister with a teenage pregnancy.

Table 1 Covariates and outcomes (older sister having a teenage pregnancy)

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The covariates, in general, accord with social stratification theory [37]. Teens with an older sister having a teenage pregnancy were as well more probable to have been built-in to an single mother and have a female parent who herself was a teenage mother (43 % versus xiv %). At age 14, approximately 42 % of those whose older sister had a teenage pregnancy lived in Rural Mid/Northern Manitoba; only 22 % of those whose older sister did not have a teenage pregnancy lived in this region at age fourteen. Lower teenage pregnancy was associated with residence in relatively prosperous southern Manitoba. Individuals with older sisters having teenage pregnancies were more than likely to alive in lower socioeconomic status neighborhood (college SEFI scores at age fourteen) with college rates of residential mobility (68 % vs 59 %), family unit construction change (28 % vs 16 %), and mental health issues (nineteen % vs 16 %).

Afterwards propensity score matching (on all variables in Fig. two), the terminal sample consisted of 1873 cases and 3746 controls (1:2); a total of 1618 cases and 9878 controls were excluded from the assay. T-statistics calculated for each covariate before and after matching to check for covariate balance; all covariates differed significantly in the unmatched sample and balanced in the matched sample (Fig. 2).

The final conditional logistic regression model indicates the odds of condign meaning before age 20 for those having an older sister with a teenage pregnancy to be 3.38 (99 % CI 2.77–four.13) times greater than for girls whose older sis(south) did non accept a teenage pregnancy (Table 3).

Touch on of mother's teenage childbearing

Tabular array ii displays the descriptive statistics of the covariates and upshot variables. Of the girls having a teenage female parent, 39.4 % had a teenage pregnancy. This is significantly higher than the thirteen.ane % teenage pregnancy rates among those whose mother bore her first child after age 19.

Table two Covariates and outcomes (mother's teenage childbearing)

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Afterwards propensity score matching (on all variables in Fig. three), the last sample consisted of 1522 cases and 3044 controls (1:ii); a total of 659 cases and 11890 controls were excluded from the analysis. T-statistics calculated for each covariate showed all covariates to differ significantly in the unmatched sample and to balance in the matched sample (Fig. 3).

The last conditional logistic regression model indicates that the odds of becoming pregnant before age 20 for those whose mother had her first kid before age 20 are 1.57 (99 % CI 1.30–1.89) times greater than for girls whose mother had her start kid afterwards historic period xix (Tabular array 3). Thus, the impact of existence built-in to a mother having her first child before age xx on teenage pregnancy is much less than that of an older sisters' teenage pregnancy.

Table 3 Odds ratios for original and boosted analyses

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Sensitivity analysis and limitations

With the conviction interval for the first model (examining the association between an older sister's teenage pregnancy and a younger sister's teenage pregnancy) ranging between 2.77 and 4.13, to aspect the college rates of teenage pregnancy to unmeasured confounding rather than to an older sisters' teen pregnancy status, that covariate would need to generate more a 2.viii-fold increment in the odds of teenage pregnancy and be a almost perfect predictor of teenage pregnancy. In the second model (assessing the association between a mother'due south teenage childbearing and a younger sister's teenage pregnancy), the 99 % conviction interval was ane.xxx to i.89; unobserved covariates would demand to produce a much smaller increment in odds of teen pregnancy to nullify this finding.

Although linkable administrative data have significant advantages, some of import predictors are lacking. Information on interest with Child and Family Services (CFS) and parental utilise of income assistance have recently been added to the Manitoba databases, but exercise non embrace the cohort used hither. While having a teenage female parent and condign a teenage mother have both been linked to involvement with CFS, in 2001 less than two pct of children under age xviii were in care [38, 39]. A variable available (and applicable) for a subpopulation is educational achievement, which is highly correlated with both involvement with CFS and parental welfare use [twoscore]. These ii new measures would likely explain petty additional variance in teenage pregnancy. Appendix 2 describes the cohort and propensity score matching for this additional analysis, comparison these findings with the original results in Table three. Educational attainment is measured using the Grade 9 Accomplishment Alphabetize, a standardized measure taking into account the number of courses completed in Form 9 and the boilerplate marks of those courses. After adjusting for educational achievement, the odds of teenage pregnancy for teens with at least 1 older sister who had a teenage pregnancy were reduced to 2.48 (99 % CI 2.01–iii.06) and the corresponding odds for teen daughters of teenage mothers were lowered to 1.39 (99 % CI 1.xv–one.68).

Discussion

The rate differences of teenage pregnancy were similar for those whose older sister had a teenage pregnancy (40.iv per 100 - x.3 per 100 = 30.1 per 100) and for those whose mother bore her kickoff child before age 20 (39.4 per 100 - 13.1 per 100 = 26.iii per 100). After propensity score matching on a serial of variables, the odds of becoming significant for a teenager were much higher if her older sister had a teenage pregnancy than if her female parent had been a teenage mother. For both older sisters' teenage pregnancy and female parent'southward teenage childbearing, the odds in this study are lower than those reported elsewhere; this is likely due to the larger sample size, more rigorous methods, and inclusion of of import predictors.

Several examinations of family unit histories in the literature bear witness older sisters to have the greatest influence on a younger sis's odds of having a teenage pregnancy. Controlling for family unit socioeconomic status, maternal parenting, and sibling relationships, teens with an older sister who had a teenage birth were 4.8 times more likely to have a teenage nascency themselves; these odds increased to five.one if both the older sister and mother had a teenage nascence [11]. 4 older studies estimated the rate of teen pregnancy to be betwixt 2 and half-dozen times college for those with older sisters having a teenage pregnancy [41]. This piece of work focused primarily on young black women in the United states of america and controlled for express confounders (bated from race and age). None of the previous studies examining the bear on of an older sister'due south teenage pregnancy controlled for female parent's teenage childbearing or fourth dimension-varying factors before age 14 (mental wellness, residential mobility, family unit structure changes); this research probably overestimated the relationship between sisters' teenage pregnancy status.

The mechanisms driving the relationship between an older sister'southward teenage pregnancy and the pregnancy of a younger boyish sister have been examined through approaches based on social learning theory, shared parenting influences, and shared societal chance [41]. Bandura'due south social learning theory indicates that "most human behavior is learned observationally through modeling: from observing others one forms an thought of how new behaviors are performed, and on after occasions this coded information serves as a guide for action" [seven]. When sisters live in the same surroundings, seeing an older sister get through a teenage pregnancy and childbirth may make this a more acceptable selection for the younger sister [11]. Not only exercise both sisters have the same maternal influence that may affect their odds of teenage pregnancy, having an older sister who is a teenage mother may change the parenting style of the female parent. Mothers involved in parenting of their teenage daughters' child may have "supervised their children less, communicated with their children less about sex and contraception, and perceived teenage sex equally more than acceptable when the older daughter'southward status changed from meaning to parenting" [42]. Finally, both sisters share the same social risks, such as poverty, ethnicity, and lack of opportunities, that increase their chances of having a teenage pregnancy [42].

Having a mother bearing her kickoff child before age xx was a meaning predictor for teenage pregnancy. We found daughters of teenage mothers to be 51 % more likely to have a teenage pregnancy than those whose mothers were older than 19 when they bore their beginning kid. This is quite close to the 66 % increase found by Meade et al (2008), who controlled for many of the same variables except having an older sister with a teenage pregnancy, and the time-varying covariates of family construction change, mental wellness weather condition, and residential mobility. Meade et al. [ix] did arrange for school performance; in the adapted sub-sample, the odds ratio reduced to 1.34, indicating a 34 % increment in teenage pregnancy.

Intergenerational teenage pregnancy may be influenced by such mechanisms as "biological heritability, intergenerational transmission of values regarding family, the female parent'south level of fertility, the indirect impact of socioeconomic and family surround through educational deficits or low opportunity or aspirations, and directly through the mother's role modeling" [43]. Women bearing their first child in their adolescence are more probable to laissez passer on "risky" characteristics, which could produce negative outcomes in their offspring [44]. Some other machinery identified as contributing to intergenerational teenage pregnancy is that daughters of teenage mothers accept an increased internalized preference for early motherhood, take low levels of maternal monitoring, and are thus more likely to get sexually active at a young age and appoint in unprotected sexual practice [44]. The influence of a female parent's teenage pregnancy therefore works through the environment created and parenting manner causeless as a result of a mother's teenage childbearing.

The utilise of authoritative information to carry health services research has some significant advantages and limitations. Administrative data from a large birth cohort have higher levels of accurateness is not depending on recall (such equally in retrospective surveys) and is ideal for examining take chances factors over time due to the longitudinal follow-up [45]. These information—with a large N and a number of covariates—are well-suited for propensity scoring. A significant limitation (shared with almost all observational studies) is that sure covariates and mediating effects are unobservable due to lack of data. The data can only capture recorded variables; for example, simply individuals seeking mental health handling will receive a diagnosis, which may not be include all individuals with mental health weather condition [46]. Sensitivity testing addresses this limitation, only such covariates might well take impacted study results. Every bit mentioned above, not adjusting for interest with child protective services (such as CFS) is a limitation. Although the number of teenage girls involved with CFS is relatively minor, they may non be interacting with their mother or older sister on a regular basis and thus are less likely to model themselves after their family members. The availability of an educational predictor was an identified limitation. To business relationship for the touch on of educational achievement in our full cohort, educational outcomes would demand to be available for anybody for grade 7 at the latest (as almost all teenage pregnancies occur after grade vii). Since educational achievement by and large remains quite similar from year to twelvemonth—grade ix achievement is probable to be quite similar to class 7 accomplishment [thirty]; this reduced odds ratio may improve estimate the true odds. In several years, such variables can be incorporated into models of teenage pregnancy. Additionally, we were unable to identify Ancient individuals; this is a limitation as teenage pregnancy rates are more than twice as high in the Aboriginal population than in the general population [47]. Family and peer relationships, social norms, and cultural differences will likely never exist measured through administrative data; limiting the degree to which these confounders tin be controlled for.

Conclusions

This paper contributes to understanding of the broader topic "who is influential nearly what" within the family. The teenage pregnancy take chances seen in younger sisters when older sisters had a teenage pregnancy appears based on the interaction with that sis and her kid; the family unit surround experienced past the siblings is quite like. Much of the pregnancy chance among teenage daughters of mothers bearing a kid before age xx seems likely to effect from the agin environment ofttimes associated with early childbearing. Given that an older sister'south teenage pregnancy has a greater impact than a mother's teenage childbearing, social modelling may exist a stronger risk factor for teenage pregnancy than living in an adverse environs.

Abbreviations

ACG:

Adapted Clinical Group

CCI:

Canadian Classification of Wellness Intervention

CFS:

Kid and Family Services

ICD-9-CM:

International Nomenclature of Diseases, 9th Revision, Clinical Modification

ICD-10-CA:

International Classification of Diseases, 10th Revision, with Canadian Enhancements

MEDC:

Major Expanded Diagnostic Clusters

MCHP:

Manitoba Middle for Health Policy

SEFI:

Socioeconomic Factor Alphabetize

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Acknowledgements

The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Wellness Policy, Manitoba Health, Active Living and Seniors, or other data providers is intended or should be inferred. Data used in this report are from the Population Health Inquiry Data Repository housed at the Manitoba Centre for Wellness Policy, Academy of Manitoba and were derived from data provided by Manitoba Wellness, Agile Living and Seniors and Manitoba Education nether projection #2013/2014-04. All information management, programming and analyses were performed using SAS® version 9.3. Aggregated Diagnosis Groups™(ADGs®) codes were created using The Johns Hopkins Adjusted Clinical Grouping® (ACG®) Instance-Mix Arrangement" version 9.

Funding

This research has been supported by the Canadian Institute for Avant-garde Research and the Western Regional Preparation Centre. The funding sources had no involvement in study design, analysis and estimation of data, in writing the article, and in the determination to submit for publication. None of the authors received any reimbursement for participating in the writing of this paper.

Availability of data and materials

The datasets supporting the conclusions of this article are bachelor in the inquiry repository at the Manitoba Centre for Wellness Policy. Access to data is given upon approvals from the University of Manitoba Health Research Ethics Board and the Wellness Information Privacy Committee, and permission from all data providers. More information on access to these databases tin exist institute at http://umanitoba.ca/faculties/health_sciences/medicine/units/community_health_sciences/departmental_units/mchp/resources/access.html.

Authors' contributions

EW participated in the blueprint of the report, carried out the assay and drafted the manuscript. LR conceived of the report, and participated in its design and coordination and helped to draft the manuscript. NN participated in its design and interpretation of results. All authors read and approved the final manuscript.

Authors' data

EW is a PhD candidate in the Department of Community Health Sciences at the University of Manitoba. LLR is a Distinguished Professor in the Faculty of Health Sciences at the University of Manitoba and a founding director of the Manitoba Middle for Health Policy. NCN is a Enquiry Scientist at the Manitoba Middle for Health Policy and an Assistant Professor in the Section of Community Health Sciences at the University of Manitoba.

Competing interests

The authors declare that they take no competing interests.

Consent for publication

Not Applicative.

Ethics approving and consent to participate

This study involved secondary assay of de-identified information files but, with linkages to other files where identifiers have been removed or scrambled. Consent was not obtained from study subjects, as permitted under department 24(3)c of the Personal Health Data Human action. Ethics approvals for this project were obtained from the University of Manitoba Health Research Ethics Board (reference number 2013-033) and the Health Information Privacy Commission (reference number 2013/2014-04).

Author information

Affiliations

1. Manitoba Eye for Health Policy, Department of Community Health Sciences, Faculty of Wellness Sciences, College of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada

   Elizabeth Wall-Wieler, Leslie 50. Roos & Nathan C. Nickel

Respective author

Correspondence to Elizabeth Wall-Wieler.

Appendix 1

Pregnancy diagnosis codes

Teenage pregnancy is defined as females with a hospitalization with one of the following diagnoses (MCHP, 2013):

• ○ live nativity: ICD-9-CM code V27, ICD-10-CA code Z37

• ○ missed ballgame: ICD-9-CM code 632, ICD-ten-CA code O02.i

• ○ ectopic pregnancy: ICD-9-CM lawmaking 633, ICD-10-CA code O00

• ○ ballgame: ICD-9-CM codes 634-637 ICD-10-CA codes O03-O07; or

• ○ intrauterine death: ICD-9-CM code 656.4, ICD-10-CA code O36.4

Or, a hospitalization with one of the post-obit procedures:

• ○ surgical termination of pregnancy: ICD-9-CM codes 69.01, 69.51, 74.91; CCI codes 5.CA.89, five.CA.90

• ○ surgical removal of extrauterine (ectopic) pregnancy: ICD-9-CM codes 66.62, 74.3; CCI code five.CA.93

• ○ pharmacological termination of pregnancy: ICD-9-CM code 75.0; CCI code 5.CA.88; or

• ○ interventions during labour and commitment, CCI codes five.MD.five, 5.MD.60

Appendix ii

Adjustment for educational achievement

Table four Covariates and outcomes for older sister's teenage pregnancy status model

Full size tabular array

Older sister's teenage pregnancy condition

Fig. 5

Checking covariate balance of older sister'south teenage pregnancy status

Tabular array 5 Covariates and outcomes for mother'southward teenage childbearing model

Full size tabular array

Female parent'south teenage childbearing status

Fig. 6

Checking covariate balance of female parent' teenage mom condition

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Wall-Wieler, E., Roos, L.Fifty. & Nickel, N.C. Teenage pregnancy: the affect of maternal adolescent childbearing and older sister's teenage pregnancy on a younger sister. BMC Pregnancy Childbirth xvi, 120 (2016). https://doi.org/10.1186/s12884-016-0911-2

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• Received: twenty January 2016

• Accepted: fourteen May 2016

• Published: 25 May 2016

• DOI : https://doi.org/10.1186/s12884-016-0911-2

Keywords

• Teenage pregnancy
• Familial influence
• Social modelling
• Intergenerational effects
• Linkable administrative data

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