Exploring the need for additional nutritional support in adolescent pregnancies

There is significant evidence to suggest that pregnancy outcomes among adolescent pregnant women may be less favourable compared to those of adult women. Incidence of preterm delivery, low birthweight and babies who are small for their gestational age have been identified as outcomes of particular concern for this population. One school of thought regarding this issue suggests that nutrition in adolescent pregnancies may have a role to play in reducing these differences and improving outcomes for adolescent mothers and their babies, however this area is in need of further research. The primary aim of this thesis therefore is to address the research question "Is there a need for additional nutritional support in adolescent pregnancies? " This is a mixed methods study following a sequential explanatory design in which priority is given to the quantitative research phase. Following a systematic review of the academic literature, the program of research is carried out in two distinct phases and the findings from each integrated. The quantitative research phase utilises secondary data from the Born in Bradford cohort study to investigate differences in maternal and neonatal outcomes and dietary patterns between adolescents (age ≤19 years) and an adult control group (age 20-34 years). Differences in outcomes were assessed using logistic regression models and differences in dietary pattern assessed using a combination of principle component analysis and regression models. The qualitative research phase was informed by the results of the quantitative phase and sought the perspectives of youth support professionals on supporting healthy eating in adolescent pregnancies through semi-structured interviews. Interviews were transcribed and analysed thematically. Findings from the program of research as a whole were then integrated narratively. The results of the systematic literature review confirmed that the nutritional status of pregnant adolescents is likely to be poor. The quantitative analyses identified significant differences in outcomes between adolescent and adult women, particularly a higher odds of delivering babies who were very (<32 weeks gestation) or extremely (<28 weeks gestation) pre-term (aOR 2.12, 95% CI 1.06 to 4.25 and aOR 5.06, 95% CI 1.23 to 20.78, respectively), or at an extremely low birthweight (<1000g, aOR 4.13, 95% CI 1.41 to 12.11). 5 Results from the quantitative phase were used to inform the development of the qualitative interview guide following which the integration of findings from the program of research as a whole identified three overarching themes; social context, dietary pattern and need for support. Adolescent pregnant women were found to live in areas with higher levels of socio-economic deprivation, were more likely to be single parents and have unstable family backgrounds and housing insecurity. Adolescents were also found to consume higher levels of snack and processed foods, less fruit and vegetables, were likely to eat less regularly than older women and took fewer nutritional supplements. The need for additional social support, both in terms of the provision of services and facilitating young women to access existing services was also a key theme from the qualitative data. The overarching themes identified in this program of work suggest that there are differences in diet quality between pregnant adolescents and adult pregnant women and that this may impact upon the health of the pregnancy. This research highlights that while additional support for eating healthily during pregnancy is important for this population, a more holistic approach which encompasses the range of complex issues faced by adolescent pregnant women is likely to have a greater impact on overall pregnancy health. This work makes an original contribution to knowledge by investigating an important large British cohort with unique characteristics to answer questions which have not previously been investigated in this data set. It has identified issues for pregnant adolescents which have not previously been documented and included the perspectives of a key professional group whose views have not previously been included in this debate.