P3.026: Repeat Adolescent Pregnancy: Trends and Associated Factors in a National Referral Hospital in Ecuador (2009-2022)

Background: Repeat pregnancy among adolescents, defined as the occurrence of two or more pregnancies before the age of 20, remains a persistent public health issue in Latin America, with significant implications for maternal and neonatal health, as well as the social development of young women. Despite existing public policies and prevention programs in Ecuador, the prevalence of adolescent pregnancy, particularly repeat pregnancy, remains high. This phenomenon reflects the influence of unresolved social determinants, including limited access to contraceptives, low educational attainment, and exposure to violence. This study aimed to describe the temporal trend of repeat adolescent pregnancy in patients attended at a national referral hospital and to explore associated sociodemographic, obstetric, and perinatal factors.

Methods: A retrospective cross-sectional study was conducted using data from the Perinatal Information System (SIP) of a tertiary-level hospital in Ecuador between 2009 and 2022. The study included adolescents aged 10 to 19 years with singleton deliveries and live newborns. Records with missing data or multiple pregnancies were excluded. The primary variable was the presence of one or more previous pregnancies. Maternal variables (age, education, marital status, pregnancy planning, obstetric history, complications, substance use, and exposure to violence) and neonatal variables were analyzed. Descriptive analyses and binary logistic regression were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI).

Results: Among the 6,695 adolescents included, 22.8% had a history of at least one previous pregnancy. The proportion of repeat pregnancies declined between 2010 and 2014 but remained stable from 2016 onwards. Adolescents with repeat pregnancies were predominantly older than 15 years (aOR: 2.94; 95% CI: 1.96–4.41), had lower educational levels (aOR: 1.55; 95% CI: 1.33–1.81), and more frequently reported having a stable partner (aOR: 2.47; 95% CI: 2.16–2.81). Repeat pregnancy was also associated with planned pregnancies (aOR: 1.18), exposure to violence during pregnancy (aOR: 1.55), cesarean delivery (aOR: 1.22), and prematurity (aOR: 1.26). No significant differences were found in birth weight, Apgar scores, or neonatal mortality.

Conclusion: Repeat adolescent pregnancy persists as a frequent and concerning issue, with rates exceeding 20% during the study period. The stabilization of rates in recent years suggests that current interventions have been insufficient to significantly alter this trend. Findings reveal a clear association between repeat pregnancy and structural vulnerability conditions, such as low educational attainment, the presence of a stable partner, inadequate reproductive planning, and exposure to violence during pregnancy. Additionally, adolescents with prior pregnancies experienced a higher frequency of adverse obstetric outcomes, such as preterm birth and cesarean section. Although no significant differences were observed in neonatal weight or mortality, the high prevalence of unplanned pregnancies and the continued occurrence of adolescent pregnancies underscore ongoing barriers in access, continuity, and quality of healthcare services.