The teenage pregnancy is still preferred in different part of the world against the advice of the medical practitioners. This study aimed to describe the obstetric and perinatal outcomes of the teenage mothers and to compare these with outcomes of the adult mothers. For this purpose, 762 teenage and 756 adult mothers were followed in the eastern region of Sri Lanka for 21 months. This study found that the premature birth was the only negative perinatal outcome directly related to teenage mothers. All other negative pregnancy outcomes associated with teenage pregnancy were caused by the factors which are prevailing in higher percentages among teenagers such as low BMI and less number of parity. No differences in occurrence of small to date (IUGR), perinatal complications and lower segment caesarean section (LSCS) were observed between teenage and adult mothers. Finally, this study concludes the teenage pregnancy can be accepted for the mothers with higher BMI if the risk for premature birth is controlled.
Teenage pregnancy is defined as a teenage girl, usually within the ages of 13 - 19, becoming pregnant [
Globally there were 16 million births yearly to young married and unmarried women aged 15 - 19 years, representing 11% of all births worldwide [
Among the developed countries, USA has the highest percentage of teenage pregnancy and it was accounted for 7.8% of all births in 2012 [
Teenage pregnancy earns the public health attention, because of its biological and the socioeconomic consequences. It has been observed, reduction in age at menarche and change in social and cultural norms regard to sexual relationships, on top of use of drugs and alcohol leads to the increase of premarital intercourse in developed and developing world. These changing biological and social environments have an influence on the trend, prevalence and the outcome of teenage pregnancies. Furthermore, the persisting practices of teenage marriage in various parts of the world also contribute to the problem to persist in various levels.
Many studies have shown that negative pregnancy outcome is significantly higher in teenagers than the adults. Infants of teen mothers are more likely to be premature and experience infant mortality. The children of teenage mothers do less well on indicators of health and social wellbeing than do children of older mothers [
Numerous studies found, the preterm birth rate is significantly high among teenagers mothers [
In a study by Dutta and Joshi (2013), it was found the Low birth weight (LBW) was significantly more for the teenage mothers (29.2%) compared to the adult mothers (16.6%). Also, birth asphyxia was found in 29.2% of the neonates of the teenage mothers and 7.3% of the neonates of the adult mothers [
Meanwhile some studies found that good quality prenatal and natal care will reduce the negative pregnancy outcome in teenagers [
Although the negative consequences of teenage pregnancies were established in many studies, still it is difficult to establish how far the biological factor related to age contributes in the physical outcome such as birth weight, prematurity and other perinatal complications. A WHO multi-country survey across the 29 countries in Africa, Asia, Latin America and the Middle East demonstrated the prevalence of adverse pregnancy outcomes varied by country among adolescents versus adult mothers [
This study was conducted in the Batticaloa district of Sri Lanka. For this prospective study all the 762 teenage mothers who gave single birth during the period of 21 months, from January 2014 to September 2015 were followed for the pregnancy outcomes and related factors. For comparison purpose, another 756 adult mothers (roughly equal number of the teenage mothers) who gave single birth during this period were randomly selected and followed. The recorded variables for each mother were birth weight of baby, status of prematurity and IUGR, perinatal complications, level of education, occupation, family income, height, weight, hemoglobin level, parity, mode of delivery and gestational duration. The mothers with multiple pregnancies and incomplete records were excluded from the study. The noted perinatal complications were placenta praevia, eclampsia, abnormal presentation, delay in labour, Asphyxia related complications, birth abnormality and postpartum psychosis.
Ethical clearance for this study was obtained from the ethics review committee of the Faculty of Medicine, University of Colombo, Sri Lanka. A pilot study was conducted with 20 mothers in another health region before starting the study. Public health midwifes in the relevant regions had been trained on extracting data from available records using a data extraction sheet prepared by the investigator. Epi-Data 3.1 software was used for data entry. The statistical analysis was carried out using Statistical package for Social Science (SPSS) Version 16.
The mean birth weight of the babies of teenage and adult mothers was 2.80 kg and 2.96 kg respectively. Although these two mean birth weights are above the cutoff for the LBW, the mean birth weight for the babies of the teenage mothers is significantly less than the babies of adult mothers (p < 0.001). The percentage of LBW among the sample was found to be 13.5% (95% CI, 12.0%. 15.0%) where as it was 17% and 10% for teenage and adult pregnant mothers respectively. The teenage mother had 1.76 times higher chance of having LBW compare to the adult mother (95% CI, 1.36, 2.29). Overall 31.1% of the pregnant mothers had the low BMI of less than 18.5 at the beginning of the pregnancy (on or before 12 weeks of POA). The binary logistic regression reveals that the teenage mothers had 2.71 times higher chance for being a low BMI mother compared to the adult mothers (95% CI, 2.21, 3.33). No significant difference in the mean haemoglobin levels was found between the adult (11.7 g/dL) and the teenage mothers (11.6 g/dL)(p = 0.068). An association was found between the education level and teenage pregnancy (p < 0.001) where 84% adult mothers were educated above the primary level but it was 91% for the teenage mothers. This difference might be due to increase in education among the young generation. However,
Parameter | Teenage Mothers | Adult Mothers |
---|---|---|
Mean birth weight of the babies | 2.80 kg | 2.96 kg |
Percentage of LBW | 17% | 10% |
Percentage of Mothers with BMI < 18.5 at the beginning of the pregnancy | 43% | 22% |
Mean Haemogloboin level (g/dL) | 11.6 | 11.7 |
Percentage mothers educated above the primary level | 84% | 91% |
Average family income (SLR.) | 14,570 | 16,977 |
the school dropout at grade 10 was higher among the teenage mothers and it is understandable. Due to this school dropout, all the teenage mothers were house wives. Therefore, the family has to depend only on the income of husband’s. In this study, 31% of the adult mother’s husband had regular job and this figure was 19% for the teenage mothers. The monthly average family income for the teenage mothers was SLR. 14,570.00 and for adult mothers it was SLR. 16,977.00. This shows that the socio economic condition is significantly less for the teenage mothers (p < 0.001).This study contained two ethnic groups Tamil and Muslim, and no association in the teenage pregnancy was found between these two ethnic groups (p = 0.349). With use of statistics discussed in
This apparent significant difference discussed above between teenage and adult mothers in the LBW cannot be attributable to age only because some biological and socio economic factors were not controlled while doing these analyses. Therefore, a multiple logistic regression was performed between dichotomized birth weight group as a dependent variable and the age group with the selected factors and the result is given in
A cohort study involving all adolescent and adult pregnant women and their respective newborns delivered at the Maternity unit of the Hospital Municipal Doutor Fernando Mauro Pires da Rocha, in the city of São Paulo also showed that there is no significant difference in the prevalence of LBW between teenage and adult mothers [
The percentage of delivering premature babies among the teenage mothers (11%) was higher than the adult mothers (6%). The analysis revealed that that teenage mother had 1.78 times (95% CI, 1.18, 2.68) higher chance of delivering a
Parameters | S.E. | Wald | df | Sig. | Exp(B) |
---|---|---|---|---|---|
Mother’s Education | 3.669 | 4 | 0.453 | ||
Not schooled | 1.350 | 0.097 | 1 | 0.756 | 1.522 |
Grade 1 - 6 | 1.233 | 0.086 | 1 | 0.769 | 0.696 |
Grade 7―GCE O/L | 1.218 | 0.122 | 1 | 0.727 | 0.654 |
GCE Advance level | 1.217 | 0.007 | 1 | 0.935 | 0.906 |
Higher education | Referral group | ||||
Mother’s Occupation | 2.247 | 2 | 0.325 | ||
Housewife | 1.096 | 0.190 | 1 | 0.663 | 0.620 |
Government servant | 1.610 | 1.861 | 1 | 0.173 | 0.111 |
Private employee | Referral group | ||||
Ethnicity | |||||
Tamil | 0.168 | 4.772 | 1 | 0.029 | 1.443 |
Muslim | Referral group | ||||
Husband’s Job | 0.245 | 2 | 0.885 | ||
Government Servant | 0.532 | 0.149 | 1 | 0.699 | 0.814 |
Private Sector | 0.199 | 0.147 | 1 | 0.701 | 0.926 |
Day to day worker | Referral group | ||||
BMI of Mother (<12 wk) | |||||
Low BMI | 0.144 | 11.456 | 1 | 0.001 | 1.628 |
Normal or High BMI | Referral group | ||||
Haemoglobin | |||||
Low Hb% | 0.169 | 1.213 | 1 | 0.271 | 0.830 |
Normal Hb% | Referral group | ||||
Parity | |||||
Primiparous | 0.178 | 4.289 | 1 | 0.038 | 1.447 |
Multiparous | Referral group | ||||
Age of Mother | |||||
Teenage | 0.164 | 2.905 | 1 | 0.088 | 1.323 |
Adult | Referral group | ||||
Monthly Income | 0.725 | 2 | 0.696 | ||
Up to SLR.15,000.00 | 0.408 | 0.017 | 1 | 0.897 | 1.054 |
More than 1SLR. 5000.00 up to SLR.30,000.00 | 0.391 | 0.060 | 1 | 0.806 | 0.908 |
More than SLR. 30,000.00 | Referral group |
premature baby than an adult mother while controlling the all other selected confounding variables discussed in
The percentage of IUGR baby was high in teenage mothers (11%) than in adults (8%). The binary logistic regression analysis revealed that the teenage mother had 1.5 times higher chance of delivering IUGR baby than an adult mother. (95% CI, 1.073, 1.983). Conversely, the multiple logistic regression analysis showed that it is an almost equal chance (1.1 times) of delivering IUGR baby for teenage and adult mothers (95% CI, 0.765, 1.61) while controlling all the selected factor in
Two different studies in Egypt and Iran identified contradictory results that these studies found a significant difference in IUGR between teenage and adult mothers (P < 0.000) [
The percentage of perinatal complications was less among teenage mothers (12%) than the adult mothers (16%) that the chances of developing perinatal complications among teenage mothers were 0.725 times less compare to the adult mothers (95% CI, 0.559, 0.940). This statistical significance had lost in the multiple logistic regression model and the chance of perinatal complication became almost equal to both age groups. The Normal or higher BMI mothers had 2.153 times higher chance for developing perinatal complications compare to low BMI mothers while controlling all other variables discussed in
In terms of mode of delivery, the percentage of LSCS (Emergency & Elective) was low among the teenage mothers (10%) compare to the adult mothers (14%). The binary logistic regression analysis revealed that the chance of LSCS among teenage mothers was 0.677 times compare to the adult mothers. (95% CI, 0.51, 0.897) This statistical significance had lost in the multiple logistic regression model and the chance of LSCS became almost equal to both age groups whereas the normal or high BMI mothers had 2.379 times higher chance for undergoing LSCS than a low BMI mother while controlling all other variables. (95% CI, 1.654, 3.564).
Based on this study, the premature birth was the only perinatal outcome directly related to teenage mothers (P < 0.001). Prematurity is the well-known factor for neonatal morbidity and mortality. This study revealed that the teenage pregnancy had a higher chance of premature delivery. All other negative pregnancy outcomes were associated with teenage pregnancy, and were caused by other factors which are prevailing in higher percentage among teenagers. The higher prevalence rate of LBW among the teenage mothers was due to the presence of high percentage of low BMI and primiparous mothers in the teenage group. No differences in occurrence of IUGR, perinatal complications and LSCS were observed between teenage and adult mothers. The low BMI shows the strong positive association with low birth weight and high BMI shows strong positive association with perinatal complication and LSCS. If there is a way to control the risk of premature birth, teenage pregnancy cannot be a big issue for the mothers with better BMI. Early pregnancies are associated with higher overall fertility rates. Reducing the number of early pregnancies and promoting adequate birth spacing contribute to lower total fertility rates. On the other hand, lower total fertility rates are associated with better health status of children. Therefore, the policy makers have to consider all these facts in health related issues. One main limitation of this study is, all the samples for this study were selected from one district of Sri Lanka and therefore results of this study can’t be easily generalized to the whole country.
Rahman, A.L.F., Razmy, A.M. and Rizath, M.M.A.-A. (2017) Obstetric and Perinatal Outcomes of Teenage Pregnancies: A Cross-Sectional Study. Open Access Library Journal, 4: e3839. https://doi.org/10.4236/oalib.1103839