A hidden burden on public health: adolescent pregnancy and increased adverse perinatal outcomes
Abstract
Objective: Adolescent pregnancy, associated with increased adverse pregnancy outcomes, is a major public health problem. We aimed to assess adverse perinatal outcomes in adolescent pregnanciesto develop preventive strategies or treatment options.
Methods: A total of 37248 births were registered between 2017 and 2020. Random numbers table was used to choose participants. Patients who had unavailable records,different ethnicity, education level, marital status,insurance type were excluded and3567 pregnant were included in the study. The adolescent pregnant group comprised 1104 women whileadults comprised 2463 pregnan.Fetal anomaly, gestational diabetes, preeclampsiaeclampsia, intrauterine growth restriction, intrahepatic cholestasis, polyhydramnios, placenta previa, inutero mort fetus, uterine rupture, placenta abruption, umbilical cord prolapse, acute fetal distress, preterm birth, cesarean section, labor arrest, birth weight, macrosomia, dystocia, birth trauma, APGAR scores, neonatal intensive care unit admission, postpartum hemorrhage, hysterectomy, blood transfusion, and postpartum infection were recorded.
Results: Rates of acute fetal distress, preterm birth, low birth weight, neonatal intensive care unit admission, postpartum hemorrhage, and blood transfusion were higher while birth weight, APGAR scores, the rates of cesarean section, prolonged and arrested labor, gestational diabetes,and macrosomia were lower in adolescents. Being adolescent increase the risk of acute fetal distress by 1.4 times (aOR=1.44;95%CI=1.03-2.01,p=0.033), preterm birth by 1.7 times(aOR=1.69;95%CI=1.10-2.60,p=0.016) and decrease the risk of gestational diabetes(aOR=0.18;95%CI=0.12-.29,p<0.001),macrosomia(aOR=0.59;95%CI=0.40-0.9,p=0.08),labor arrest(aOR=0.50;95%CI=0.27-0.95,p=0.033) and cesarean section(aOR=0.33;95%CI=0.27-0.39,p<0.001) after adjusting for confounders.
Conclusion: Considering increased acute fetal distress, preterm birth, low birth weight, neonatal intensive care unit admission, postpartum hemorrhageblood transfusion risk for adolescent pregnancies, adolescents and healthcare providers should be informed and follow-ups must be performed in well-equipped centers.
Keywords
adolescent pregnancy, cesarean section, gestational diabetes, labor arrest, preterm birth
References
- Kawakita T, Wilson K, Grantz KL, et al. Adverse maternal and neonatal outcomes in adolescent pregnancy. J Pediatr Adolesc Gynecol. 2016;29(2):130–6.
- Ganchimeg T, Ota E, Morisaki N, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. Bjog. 2014;121(Suppl 1):40–8.
- Karacam Zekiye, Damla Kizilca Cakaloz, and Rukiye Demir. “The impact of adolescent pregnancy on maternal and infant health in Turkey: Systematic review and meta-analysis. Journal of Gynecology Obstetrics and Human Reproduction 50.4 2021:102093.
- Hacettepe University Institute of Population Studies. Turkey Demographic and Health Survey 2013. Ankara, Turkey: Hacettepe University Institute of Population Studies, Ministry of Health General Directorate of Mother and Child Health and Family Planning, T.R. Prime Ministry Undersecretary of State Planning Organization and TUBİTAK; 2014. www.hips.hacettepe.edu.tr/eng/tdhs08/TDHS-2008_Main_Report.pdf.
- WHO. Adolescent Pregnancy: World Health Organization; 2014. Available from: http://www.who.int/mediacentre/factsheets/fs364/en/.
- Conde-Agudelo A, Belizán JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American journal of obstetrics and gynecology. 2005;192(2):342–9. 10.1016/j.ajog.2004.10.593
- Amjad S, MacDonald I, Chambers T, et al. Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: a systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2019;33(1):88–99.
- Westenberg L, van der Klis KA, Chan A, et al. Aboriginal teenage pregnancies compared with non-aboriginal in South Australia 1995-1999. Aust NZJ Obstet Gynaecol. 2002;42(2):187–92.
- Munim S, Islam Z, Zohra N, Yasmin H, Korejo R. Guidelines on prevention of preterm birth. The Journal of Maternal-Fetal & Neonatal Medicine. 2022;35(25): 9527-9531.
- Chen X-K, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. International journal of epidemiology. 2007;36(2):368–73.