# Pathways to Teen Rapid Repeat Pregnancy and Adverse Birth Outcomes

> **NIH NIH P20** · OSU CENTER FOR HEALTH SCIENCES · 2020 · $368,679

## Abstract

Pathways to Teen Rapid Repeat Birth and Adverse Birth Outcomes
ABSTRACT
Rapid repeat birth (RRB; birth < 24 months of the first birth) among teen mothers heightens the risk for adverse
birth outcomes. Infant mortality, very low birth weight (birth weight < 1500 grams), and pre-term birth are three
times more common among second births to teens as compared to first births. The racial and socioeconomic
disparities that increase the risk of teen parenthood widen among those who give birth a second time within
two years. Investigators are increasingly focusing on differential exposure to adverse childhood experiences
(ACEs; e.g., emotional, physical, or sexual abuse; exposure to domestic violence; substance abusing, mentally
ill, or criminal household member; or separated/divorced parent) to explain health disparities. In this study, we
will determine mechanisms affecting the incidence and timing of teen RRB, and its maternal and infant health
outcomes. The study focuses on ACEs as a trigger launching a trajectory for teen birth and RRB. Specifically,
we will 1) determine if adverse childhood experiences (ACE score) are associated with selected reproductive
attitudes (e.g., ambivalence), behaviors (e.g., risky sexual behaviors and health related behaviors during
pregnancy), and allostatic load among teen mothers; 2) delineate variation in the incidence and timing of RRB
by adverse childhood experiences and determine whether this relationship is mediated by reproductive
attitudes and behaviors; and 3) determine the relationship between ACE score and maternal/infant health
outcomes and ascertain whether psychosocial (e.g., attitudinal and behavioral) and physiological mechanisms
(e.g., allostatic load) mediate the associations between ACE score and adverse birth outcomes. The proposed
study will use a multi-method design in a hospital-based longitudinal, multi-ethnic cohort study of 500 teen
mothers following the birth of their first child. Participants will complete an initial assessment that includes
attitudinal and behavioral measures, as well as an in-depth assessment battery to capture exposure and extent
of ACEs. Dried blood spots will be used to obtain biomarkers of exposure to chronic stressors. Participants will
be tracked for up to 18 months to determine if a second pregnancy occurs. This study is significant because
teen RRB and its negative health outcomes are a public health problem, and current preventative efforts have
had limited success. Findings from this study will elucidate reasons for heightened risk with a particular focus
on pathways leading from stressors. The proposed project is innovative; it will be the first to examine the
biopsychosocial pathways leading from adverse childhood experiences to teen RRB and adverse birth
outcomes. The positive impacts of this work include information that will be used to develop an intervention for
first-time teen mothers with the aim of preventing RRB and its adverse birth outcomes.

## Key facts

- **NIH application ID:** 9924559
- **Project number:** 5P20GM109097-05
- **Recipient organization:** OSU CENTER FOR HEALTH SCIENCES
- **Principal Investigator:** Karina M. Shreffler
- **Activity code:** P20 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $368,679
- **Award type:** 5
- **Project period:** — → 2022-09-05

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9924559

## Citation

> US National Institutes of Health, RePORTER application 9924559, Pathways to Teen Rapid Repeat Pregnancy and Adverse Birth Outcomes (5P20GM109097-05). Retrieved via AI Analytics 2026-06-14 from https://api.ai-analytics.org/grant/nih/9924559. Licensed CC0.

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