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Study Objective: Few studies examining predictors of twinning consider younger mothers who do not use assisted reproductive technologies (ART). Higher parity is associated with greater odds of having a twin birth, but it is unclear whether this association is present among young women. We tested the hypothesis that the rates and odds of twinning would increase with parity among teenage and young adult mothers who did not use ART., Design, Setting, and Participants: We conducted a retrospective, population-based cohort study using 2009-2018 United States National Vital Statistics data on 11,383,370 (58.94% first, 41.06% repeat) births to adolescent and adult women aged 15-24 years., Interventions: None., Main Outcome Measures: Rates and odds of twinning by parity among teenage (15-19 years) and young adult (20-24 years) mothers., Results: The adjusted twin birth rate among first-time teenage mothers was 13.28 per 1000 births compared to 16.62 twins per 1,000 births among repeat teenage mothers. This difference by parity was present but smaller among mothers aged 20-24 (18.31 vs 21.44 twins per 1000 births for first-time and repeat young adult mothers, respectively)., Conclusion: Repeat young mothers, particularly teenage mothers, are a high-risk group in terms of infant and maternal health outcomes; their higher rate of twinning puts them at an additional risk for adverse birth outcomes. Practitioners may counsel young mothers at risk for subsequent unintended pregnancy on elevated risk of twinning., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Early childbearing is associated with adverse health and well-being throughout the life course for women in the United States. As education continues to be a modifiable social determinant of health after a young woman gives birth, the association of increased educational attainment with long-term health for women who begin childbearing as teenagers is worthy of investigation., Methods: Data are from 301 mothers in the National Longitudinal Survey of Youth 1979 who gave birth prior to age 19. We estimated path models to assess women's incomes, partner characteristics, and health behaviors at age 40 as mediators of the relationship between their educational attainment and self-rated general health at age 50., Results: After accounting for observed background factors that select women into early childbearing and lower educational attainment, higher levels of education (high school diploma and GED attainment vs. no degree) were indirectly associated with higher self-rated health at age 50 via higher participant income at age 40., Conclusions: As education is a social determinant of health that is amenable to intervention after a teen gives birth, our results are supportive of higher educational attainment as a potential pathway to improving long-term health outcomes of women who begin childbearing early.