In this issue of Pediatrics, Cresswell et al1 describe the mental health and cognitive functioning outcomes of the offspring of young mothers. The outcomes of adolescent parents and their children are important to pediatric providers because they represent a dual-generation approach to medicine. It is essential to provide concomitant care and support for both young parents and their offspring to facilitate successful outcomes for each individual. Predicting outcomes for children of young mothers is challenging given the many mediating and moderating factors that influence outcomes over time.
Regardless of the ability to predict outcomes for specific children, it is important to recognize that, compared with children of older mothers, children of young mothers are at risk for worse developmental and behavioral outcomes.2–6 The systematic review by Cresswell et al1 incorporates data from 48 studies and ∼375 000 offspring of young mothers to help us better understand outcomes in this population. Regardless of the methodologic challenges, it is clear that young maternal age is a risk factor for child development, which raises questions about the strategies that could be used in practice to optimize child development.
It is important to note that the studies presented in this review have attrition rates that could affect the overall study findings. The sample size of young mothers is much smaller than the sample size of adult mothers, with 1 study having 617 children of young mothers to 7004 children of adult mothers.1 The discrepancy in control group size might also affect the results. Although the authors do not make mention of race or ethnicity in the studies examined in either the adult or young mother populations, it is well documented in the literature that most young mothers in the United States are minoritized individuals and have a greater risk of early pregnancy.7–9 The mental health and cognitive development of these historically marginalized populations are affected by institutionalized racism and macro- and microaggressions, both as children and as parents, and these factors must be taken into consideration when discussing the conclusions presented here.
Although maternal age is likely a marker for many other underlying risk factors in this population of young mothers, including socioeconomic status, educational attainment, and social support, it is notable that the decline in cognitive and mental health outcomes is not consistent across countries and cultures. As a result, it would be inadequate to use age as the sole risk factor for all children of young mothers because, as noted in the article, some global communities offer more support to young mothers than customarily seen in the United States.10,11 As a result, children of young mothers would likely benefit from models of medical care that incorporate culture and context into service provision, rather than creating a one-size-fits-all approach.
Although providing us with a better understanding of cognitive and mental health outcomes in young mothers is significant, the goal of a systematic review like this one is to inform interventions to improve health outcomes, including child development. Interventions must be comprehensive and address family planning as well as parenting and social support. The birth of a second child to an adolescent worsens medical, educational, socioeconomic, and parenting outcomes associated with teen pregnancy12 ; thus, access to reproductive health care and education is essential. Interventions focused on repeat pregnancy and parenting skills that have been proven to be successful include school-based services,13 mentoring or home-visiting programs,14,15 , and community-based motivational interviewing.16 Successful interventions to improve parenting skills in young mothers have included both brief parenting or life skills intervention17 or a group parenting curriculum within a medical home.18 Targeting interventions to reduce postpartum depression in this population is also important and may include home-visiting, educational, and therapy-based programs.19 Early and targeted intervention, whether through the community or the medical home, is paramount for positive long-term outcomes for both young parents and their children.
Dr Smith drafted the initial manuscript and reviewed and revised the final manuscript; Dr Ashby critically reviewed and revised the final manuscript; and both authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2022-057561.
FUNDING: No external funding.
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.
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