Teenagers who give birth are more likely to die prematurely, according to a new report published in the Journal of the American Medical Association on Thursday.

Female teens who gave birth to two or more babies were most at risk of dying, as were teens who became pregnant before the age of 16.

“Teen pregnancy may be a marker of adverse life experiences preceding and/or during the formative teen years,” the researchers said.

Teens who become pregnant are more likely to have been exposed to adverse childhood experiences such as sexual and emotional abuse; parental divorce; or income decline. Those exposures are in turn associated with teen pregnancy, substance use, suicide and premature mortality.

Female teens who became pregnant were more likely to live in low-income neighborhoods that also had lower rates of high school graduation. They also harmed themselves at higher rates than those who did not become pregnant.

The Canadian study was based on 2.2 million female teenagers in the province of Ontario. Researchers looked at all females who were alive at 12 years of age between April 1991 and March 2021, using data collected through the country’s universal health care system.

About 7.3% of the teens in the study experienced a pregnancy at a median age of 18. Of those who became pregnant, about a third (36.8%) gave birth and almost two-thirds (65.1%) ended the pregnancy with an induced abortion.

Female teenagers who had one pregnancy had 1-1/2 times higher risk of dying by the age of 31 compared with teens who did not get pregnant. Teens with two or more pregnancies had more than double the risk, the researchers found.