title: Childhood pregnancy (10-14 years old) and risk of stillbirth in singletons and twins.
abstract: OBJECTIVE
  To clarify the association between childhood pregnancy and risk of stillbirth.
  
  
  METHODS
  We analyzed singleton and twin pregnancies that occurred in children (10-14 years old) in the United States from 1989 to 2000. We estimated the absolute and relative risks of stillbirth by using 15- to19-year-old and 20- to 24-year-old mothers as comparison groups.
  
  
  RESULTS
  The analysis involved 17.8 million singletons and 337,904 individual twins. The rate of stillbirth was highest in pediatric mothers for both singletons (12.8/1000) and twins (56/1000) compared with adolescent (6.8/1000 in singletons and 29/1000 in twins) and mature (5.5/1000 in singletons and 20/1000 in twins) mothers. After adjusting for confounding characteristics, pediatric mothers continued to exhibit significantly elevated risk for stillbirth in both singletons (odds ratio, 1.57; 95%CI, 1.49-1.66) and twins (odds ratio, 1.97; 95%CI, 1.42-2.73). Preterm birth rather than small size for gestational age was revealed by means of sequential modeling to account for the excess risk of stillbirth observed in pediatric gravidas.
  
  
  CONCLUSIONS
  Pregnancy in childhood is a risk factor for stillbirth; shortened gestation rather than reduction in fetal growth is the mediating pathway.
authors.affiliation: Department of Maternal and Child Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham 35294, and Department of Family Medicine, Baptist Health Systems, Montgomery, Alabama, USA. hsalihu@uab.edu
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
authors.forename: Puza P
authors.initials: PP
authors.lastname: Sharma
authors.forename: Olaniyi J
authors.initials: OJ
authors.lastname: Ekundayo
authors.forename: Sibylle
authors.initials: S
authors.lastname: Kristensen
authors.forename: Abiodun P
authors.initials: AP
authors.lastname: Badewa
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
authors.forename: Greg R
authors.initials: GR
authors.lastname: Alexander
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D016015:Logistic Models; D016555:Matched-Pair Analysis; D015999:Multivariate Analysis; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000208:ethnology; D018566:Pregnancy, High-Risk / Q000208:ethnology; D012306:Risk; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology* / Q000208:ethnology; D014427:Twins / Q000208:ethnology; D014481:United States / Q000453:epidemiology