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At a time when teenage pregnancies worldwide are declining, a new Canadian study has found girls with mental health issues are three times more likely to get pregnant than young women outside the mental health spectrum.

Researchers at Women's College Hospital and the Institute for Clinical Evaluative Sciences (ICES) found the threefold increase among teens with major mental illness after studying the fertility rates of roughly 4.5 million girls ages 15-19 in Ontario during the period of 1999-2009. In this group, one in every 25 teenage mothers was to a girl with issues ranging from psychosis, bipolar disorder or depression.

"The report clearly raises a red flag that we need more preventative education in schools, hospitals and other institutions that offer adolescent mental health services," study co-author Dr. Simone Vigod, a psychiatrist at Women's College Hospital, said in an interview.

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The study, published Monday in the journal Pediatrics, also found that while all teenage pregnancies in Ontario fell during the 10-year time period, the decline in births by young moms with mental health issues did not keep pace with the others. Those births fell by only 14 per cent compared with a 22-per-cent drop among teen girls with no mental health disorder. Vigod says the gap stems from the the fact that most developed countries have not put enough importance on mental health as a key risk factor in teen pregnancy prevention.

"Research tells us that all young girls are at high risk of pregnancy complications, ranging from preterm birth, poor fetal growth and postpartum depression," Vigod said. "Add to this a pre-existing mental illness, and these young women are forced to manage significant additional challenges … which means their children also may be 'doubly' vulnerable."

The study – the first to examine trends in fertility rates among girls with mental illness according to the authors – was welcomed by Dr. Jean Wittenberg, head of infant psychiatry at the Hospital for Sick Children in Toronto, who was not a part of the study.

"It points to the vulnerability of the girls in this situation and it draws attention to the implications for the babies. I see many young girls with babies who turn their lives around, but there are also many who find it difficult to cope because of where they are developmentally," she said.

"Teen mothers already have to deal with social stigma – they get looked and treated differently. Add to that stigma, someone grappling with a serious psychiatric disorder, and the situation becomes that much harder for these girls," Wittenberg added.

Cindy-Lee Dennis, senior scientist at Women's College Research Institute and a study co-author, says early "interventions that target and integrate reproductive and mental health care for young women are crucial to ensure" young moms get the best possible care.

"Having these programs and offerings in place will also help reduce teenage pregnancy and improve the health of both mother and child."

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