Are There Heart Disease Risks For Teen Moms?

This blog was originally published in U.S. News & World Report

Having a baby as a teenager already presents a host of challenges for the young mother, but a recent study adds a serious health concern to the mix. The study, published in November in the Journal of the American Heart Association, found that women who became first-time mothers as teens were significantly more likely than older first-time mothers to have greater risks for heart and blood vessel disease later in life.

The study used information for 1,047 women between the ages of 65 and 74 who were from Canada, Albania, Colombia and Brazil and who participated in the International Mobility in Aging Study in 2012. The study found that women reporting a first birth before the age of 20 scored significantly higher on the Framingham Risk Score, a screening test commonly used to estimate the risk for heart disease in the next 10 years. Women whose first births occurred at older ages had lower average risk scores.

The study’s lead author, Catherine Pirkle, an assistant professor in the Office of Public Health Studies at the University of Hawaii at Manoa in Honolulu, had been looking at women’s reproductive past and health outcomes. “We already had evidence that adolescent childbearing influenced women’s health later on, specifically with mobility,” she says. “And we know mobility function is predicted by chronic disease and that cardiovascular disease is an obvious one to look at.”

According to the Centers for Disease Control and Prevention, a total of 229,715 babies were born to women aged 15-19 years in 2015. That number has been dropping over the past decade, but it is still substantially higher than in other Western industrialized nations, the CDC says.

How does early childbirth relate to heart disease? An adverse childhood increases the risk of unhealthy behaviors, including pregnancy, and that sets up a greater likelihood of an unhealthy adulthood. “If you are a teenage mother, that has strong implications on various aspects of your life,” Pirkle says. Teen moms are more likely to drop out of school, have less opportunity to make a living wage, are more likely to have a stressful family environment and are less likely to engage in healthy lifestyles. “There is a cascade of adversity after becoming an adolescent mom,” she adds.

So, is it the pregnancy itself that is linked to heart disease, or is it the social framework that leads to teenage motherhood? “The very simple answer is yes, I do think there is something about pregnancy itself that creates risk,” Pirkle says. “We adjusted for two measures of childhood adversity to tease this out, and we still saw a very strong association between early pregnancy and later-life cardiovascular risk.”

Pregnancy is known to carry risks, such as preeclampsia and gestational diabetes, that may portend future heart disease risk, says Dr. Marla Mendelson, associate professor of cardiology and pediatrics at Northwestern University’s Feinberg School of Medicine. “We know there is a lot about pregnancy being risky, but there are also a lot of confounding variables,” says Mendelson, who also directs a special program on heart disease and pregnancy. Still, the study raises an important issue, she believes: “Too many times clinicians assume pregnant women are healthy. They don’t connect pregnancy with risk, and we have to be aware of all these factors that may be present.”

Dr. Neha Pagidipati, assistant professor of medicine in the department of cardiology at Duke University School of Medicine, agrees. “This study is important because it identifies a group of women who are at very high risk of future heart disease, but who are likely undertreated – namely, those who give birth before the age of 20 years.” She isn’t sure whether the study clearly implicates pregnancy itself over socioeconomic factors. “What we do know is that women who have their first childbirth before 20 years old are more likely to be overweight, have high blood pressure and diabetes than women who do not give childbirth at a young age. These comorbidities are also closely linked to heart disease,” Pagidipati says.

Whether adolescent childbirth is a potential cause of heart disease or simply a marker associated with other direct risks, the consequences are still important and risk avoidance is critical. “The first thing to do is, don’t become an adolescent mother in the first place. That means sex education and access to family planning,” Pirkle says. “The second thing is, if [early pregnancy] truly is a risk, as our research implies, that puts the onus on society to support young mothers, to keep them in school, to assure a living wage, to have supports even if they are adolescent mothers.”

And, of course, preventive medicine is the same for everyone, young women included, Pagidipati says. “Regardless of why young motherhood is associated with future heart disease, we know that improving risk factors, such as obesity, hypertension, high cholesterol, diabetes and smoking, will reduce their risk of future heart disease.” In order to do all that, stop smoking, maintain a healthy weight through diet and exercise and control or avoid diabetes, high blood pressure and high cholesterol. “It is also very important for women with these risk factors to seek medical care, whether pregnant or not,” Pagidipati adds.

Pirkle, remember, came at this problem while researching mobility in aging, and she points out that heart disease is the leading cause of disability and death around the world. “This is an important global public health problem,” she concludes.