{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T10:54:03Z","timestamp":1774608843848,"version":"3.50.1"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Unintentional injury, suicide, and homicide are leading causes of death among young females. Teen pregnancy may be a marker of adverse life experiences.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the risk of premature mortality from 12 years of age onward in association with number of teen pregnancies and age at pregnancy.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This population-based cohort study was conducted among all females alive at 12 years of age from April 1, 1991, to March 31, 2021, in Ontario, Canada (the most populous province, which has universal health care and data collection). The study period ended March 31, 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>The main exposure was number of teen pregnancies between 12 and 19 years of age (0, 1, or \u22652). Secondary exposures included how the teen pregnancy ended (birth or miscarriage vs induced abortion) and age at first teen pregnancy.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcome was all-cause mortality starting at 12 years of age. Hazard ratios (HRs) were adjusted for year of birth, comorbidities at 9 to 11 years of age, and area-level education, income level, and rurality.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 2\u202f242\u202f929 teenagers, 163\u202f124 (7.3%) experienced a pregnancy at a median age of 18 years (IQR, 17-19 years). Of those with a teen pregnancy, 60\u202f037 (36.8%) ended in a birth (of which 59\u202f485 [99.1%] were live births), and 106\u202f135 (65.1%) ended in induced abortion. The median age at the end of follow-up was 25 years (IQR, 18-32 years) for those without a teen pregnancy and 31 years (IQR, 25-36 years) for those with a teen pregnancy. There were 6030 deaths (1.9 per 10\u202f000 person-years [95% CI, 1.9-2.0 per 10\u202f000 person-years]) among those without a teen pregnancy, 701 deaths (4.1 per 10\u202f000 person-years [95% CI, 3.8-4.5 per 10\u202f000 person-years]) among those with 1 teen pregnancy, and 345 deaths (6.1 per 10\u202f000 person-years [95% CI, 5.5-6.8 per 10\u202f000 person-years]) among those with 2 or more teen pregnancies; adjusted HRs (AHRs) were 1.51 (95% CI, 1.39-1.63) for those with 1 pregnancy and 2.14 (95% CI, 1.92-2.39) for those with 2 or more pregnancies. Comparing those with vs without a teen pregnancy, the AHR for premature death was 1.25 (95% CI, 1.12-1.40) from noninjury, 2.06 (95% CI, 1.75-2.43) from unintentional injury, and 2.02 (95% CI, 1.54-2.65) from intentional injury.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this population-based cohort study of 2.2 million female teenagers, teen pregnancy was associated with future premature mortality. It should be assessed whether supports for female teenagers who experience a pregnancy can enhance the prevention of subsequent premature mortality in young and middle adulthood.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.1833","type":"journal-article","created":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T15:01:26Z","timestamp":1710428486000},"page":"e241833","source":"Crossref","is-referenced-by-count":18,"title":["Teen Pregnancy and Risk of Premature Mortality"],"prefix":"10.1001","volume":"7","author":[{"given":"Joel G.","family":"Ray","sequence":"first","affiliation":[{"name":"Department of Medicine, St Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Obstetrics and Gynaecology, St Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Longdi","family":"Fu","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter C.","family":"Austin","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison L.","family":"Park","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hilary K.","family":"Brown","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia M.","family":"Grandi","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Vandermorris","sequence":"additional","affiliation":[{"name":"Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada"},{"name":"Division of Adolescent Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexa","family":"Boblitz","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eyal","family":"Cohen","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada"},{"name":"Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"},{"name":"Edwin S. 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