Hospitalisation for non‐lethal self‐harm and premature mortality in the 3 years following adolescent pregnancy: Population‐based nationwide cohort study

Abstract

AbstractObjectiveTo evaluate the risk of non‐lethal self‐harm and mortality related to adolescent pregnancy.DesignNationwide population‐based retrospective cohort.SettingData were extracted from the French national health data system.PopulationWe included all adolescents aged 12–18 years with an International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD‐10) code for pregnancy in 2013–2014.MethodsPregnant adolescents were compared with age‐matched non‐pregnant adolescents and with first‐time pregnant women aged 19–25 years.Main outcome measuresAny hospitalisation for non‐lethal self‐harm and mortality during a 3‐year follow‐up period. Adjustment variables were age, a history of hospitalisation for physical diseases, psychiatric disorders, self‐harm and reimbursed psychotropic drugs. Cox proportional hazards regression models were used.ResultsIn 2013–2014, 35 449 adolescent pregnancies were recorded in France. After adjustment, pregnant adolescents had an increased risk of subsequent hospitalisation for non‐lethal self‐harm in comparison with both non‐pregnant adolescents (n = 70 898) (1.3% vs 0.2%, HR 3.06, 95% CI 2.57–3.66) and pregnant young women (n = 233 406) (0.5%, HR 2.41, 95% CI 2.14–2.71). Rates of hospitalisation for non‐lethal self‐harm were lower during pregnancy and higher between 12 and 8 months pre‐delivery, 3–7 months postpartum and in the month following abortion. Mortality was significantly higher in pregnant adolescents (0.7‰) versus pregnant young women (0.4‰, HR 1.74, 95% CI 1.12–2.72), but not versus non‐pregnant adolescents (0.4‰, HR 1.61, 95% CI 0.92–2.83).ConclusionsAdolescent pregnancy is associated with an increased risk of hospitalisation for non‐lethal self‐harm and premature death. Careful psychological evaluation and support should be systematically implemented for adolescents who are pregnant.