COVID-19 pandemic and adolescent pregnancy: a look at urban vs rural Appalachian populations

Teenage pregnancy is a cause for significant social and economic concern. In Tennessee, the teenage pregnancy rate is 30 per 1000 which is significantly higher than the US rate of 18 per 1000. Over the course of the COVID-19 pandemic, the nation has seen decreased birth rates but the effect on the adolescent population is unknown. This study examines pregnancy rates and outcomes for adolescents prior to the COVID-19 pandemic and after Tennessee state-wide containment policies were enforced to evaluate for differences. Information was obtained via retrospective chart review at our regional medical center. Deliveries from January – June 2019 were compared to January - June 2021. This information was further stratified into rural and urban population using maternal zip code and HRSA’s definition of rural populations. Adverse pregnancy outcomes of late prenatal care, preterm delivery, and low birth weight (< 2500g at term) were also evaluated. Patients were asked to self-report their tobacco, marijuana and illicit substance use. The rate of teenage pregnancies was not significantly different before and after statewide shutdowns (5.8% to 5.9%). No differences were noted between the rural and urban adolescent population (7.4% to 5.4%). The rates of adverse pregnancy outcomes were not significantly different. The use of marijuana increased substantially after shutdowns (13.5% to 30.4%, p< .001). There was no difference in illicit drug or tobacco use. The COVID-19 pandemic has widespread and continued effects on the health care system and the population at large. In recent years, the rate of teenage pregnancy in East Tennessee has declined, although it is still significantly higher than national rates. In our study no statistical difference was noted in adolescent pregnancy rates or outcomes. Marijuana use starkly increased in this population. The full effects of the COVID-19 pandemic on pregnancy rates and birth outcomes are still unknown but this study suggests that the teenage birth rate in our population did not change.