Abstract
Background: The perinatal health of minor mothers (< 18 years) is understudied in American countries. We assessed the association between marital status and perinatal health among minors in four countries: Brazil (2011-2018), Ecuador (2014-2018), the USA (2014-2018) and Canada (2008-2018).
Methods: We used national birth registrations to extract singleton births with complete information on maternal age, marital status, and birth characteristics. We used logistic regression to assess associations with preterm birth (< 37 weeks), small for gestational age (SGA < 10 percentile) and repeat birth. Results: The proportion of births to minor mothers (< 18 years) was 9.9% in Ecuador (N = 1,519,168), 8.9% in Brazil (N = 23,117,661), 1.5% in the United States (N = 18,618,283) and 0.9% in Canada (N = 3,907,610). Among minor mothers, the proportion of births to legally married mothers was 3.0%, 4.8%, 3.7% and 1.7%, respectively. In analyses restricted to mothers aged ≤ 24 years, preterm birth but not SGA rates were higher among minor mothers compared to those aged 20-24 years, irrespective of marital status. However, among minor mothers, being married was associated with lower odds of preterm birth in Brazil [Adjusted Odds Ratio (AOR): 0.85, 95%CI: 0.83, 0.87] and in Ecuador [AOR: 0.83, 95%CI: 0.72, 0.95], but not in the USA or Canada. Repeat birth was twice as likely among married compared to unmarried minors in Ecuador, the USA and Canada but not in Brazil [AOR: 0.98, 95%CI: 0.97, 1.00].
Discussion: The prevalence of births to minor mothers varies considerably between countries in the region. A small fraction of minor mothers are legally married
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