The association of maternal age with adverse neonatal outcomes in Lusaka, Zambia: a prospective cohort study

Tannia Tembo, Aybüke Koyuncu, Haoran Zhuo, Martha Mwendafilumba, Albert Manasyan, Tannia Tembo, Aybüke Koyuncu, Haoran Zhuo, Martha Mwendafilumba, Albert Manasyan

Abstract

Background: Pregnancy among adolescents, whether intended or not, is a public health concern as it is generally considered high risk for both mothers and their newborns. In Zambia, where many women engage in early sexual behaviour or marry at a young age, 28.5% of girls aged 15-19 years were pregnant with their first child in the year 2013-2014. This study sought to explore associations between maternal age and neonatal outcomes among pregnant women in Lusaka, Zambia.

Methods: This was a secondary analysis of data nested within a larger population-based prospective cohort study which was implemented in three government health facilities-two first level hospitals and one clinic in Lusaka, Zambia. Women presenting to the study sites for antenatal care were enrolled into the study and followed up for collection of maternal and neonatal outcomes at 7, 28 and 42 days postpartum. The study's primary outcomes were the incidence of maternal and newborn complications and factors associated with adverse neonatal outcomes. Statistical significance was evaluated at a significance level of P < 0.05.

Results: The study included 11,501 women, 15.6% of whom were adolescents aged 10-19 years. Generally, adolescence did not have statistically significant associations with poor maternal health outcomes. However, the risk of experiencing obstructed labour, premature rupture of membranes and postpartum hemorrhage was higher among adolescents than women aged 20-24 years while the risk of severe infection was lower and non-significant. Adolescents also had 1.36 times the odds of having a low birthweight baby (95% CI 1.12, 1.66) and were at risk of preterm birth (aOR = 1.40, 95% CI 1.06, 1.84). Their newborns were in need of bag and mask resuscitation at birth (aOR = 0.62, 95% CI 0.41, 0.93). Advanced maternal age was significantly associated with increased odds of hypertension/ pre-eclampsia (95% CI 1.54, 5.89) and preterm labour (aOR = 2.78, 95% CI 1.24, 6.21).

Conclusions: Adolescence is a risk factor for selected pregnancy outcomes in urban health facilities in Lusaka, Zambia. Health care workers should intensify the provision of targeted services to improve neonatal health outcomes.

Trial registration: Clinical trial number and URL: NCT03923023 (Retrospectively registered). Clinical trial registration date: April 22, 2019.

Keywords: Adolescents; LMIC; adolescent pregnancies; neonatal; neonatal mortality.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Khalil A, Syngelaki A, Maiz N, et al. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstetric Gynecology. 2013;42:634–43. doi: 10.1002/oug.12494.
    1. Aloufi W, Othman M, Aloufi S, et al. Impact of maternal age on pregnancy in Madinah Region. EC Gynecology. 2019;8(10):984–90.
    1. Londero AP, Rossetti E, Pittini C, et al. Maternal age and risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth. 2019; 19(261). 10.1186/s12884-019-2400-x.
    1. Blomberg M, Tyrberg RB, Kjølhede P. Impact of maternal age on obstetric and neonatal outcome with emphasis on primiparous adolescents and older women: a Swedish Medical Birth Register study. BMJ Open. 2014;4(11):e005840. doi: 10.1136/bmjopen-2014-005840.
    1. Lean SC, Derricott H, Jones RL, et al. Advanced age and adverse pregnancy outcomes: a systematic review and meta-analysis. Plos One. 2017;12(10):e0186287. doi: 10.1371/journal.pone.0186287.
    1. Omole-Ohonsi A, Attah RA. Teenage pregnancy and outcomes in Nigeria. West African Journal of Medicine. 2010;29:5.
    1. Kayastha S, Pradhan A. Obstetric outcomes of teenage pregnancy. Nepal Journal of Obstetrics Gynecology. 2012;2:29–32.
    1. Caroline HD, Fall DM, Harshpal SS, et al. Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). The Lancet Global Health. 2015;3(7):366–377. https://doi.10.1016/S2214-109X(15)00038-8.
    1. Korencan S, Pinter B, Grebenc M, et al. The outcomes of pregnancy and childbirth in adolescents in Slovenia. De Gruyter Open. 2017;56(4):268–75.
    1. Jeha D, Usta L, Ghulmiyyah L, et al. A review of the risks and consequences of adolescent pregnancy. Journal of Neonatal-Perinatal Medicine. 2015;8(2015):1–8. doi: 10.3233/NPM-15814038.
    1. Moraes AN, Likwa RW, Nzala SH. A retrospective analysis of adverse obstetric and perinatal outcomes in adolescent pregnancy: the case of Luapula Province, Zambia. Maternal Health Neonatology Perinatology. 2018;4:20. doi: 10.1186/s40748-018-0088-y.
    1. UNFPA. State of the World Population: By Choice, Not by Chance: Family Planning, Human Rights and Development. UNFPA. 2012. . Accessed 27 March 2019.
    1. Carlson-Babila S, Ngasa SN, Dzekem BS, et al. Prevalence, predictors and adverse outcomes of adolescent pregnancy in sub-Saharan Africa: a protocol of a systematic review. BMC Protocol. 2017;6:247. doi: 10.1186/s13643-017-0650-0.
    1. Population Council, UNFPA, and Government of the Republic of Zambia. [Internet]: Adolescent Pregnancy in Zambia. 2017. Lusaka, Zambia. . Accessed 1 November 2018.
    1. Nove A, Matthews Z, Neal S, et al. Maternal mortality in adolescents compared with women of other ages: Evidence from 144 countries. The Lancet Global Health. 2014;2:e155–e154. doi: 10.1016/S2214-1-9X(13)70179-7.
    1. Andriyana H, Amelya M, Nababan B, et al. Outcome and risk of obstetric complication in teenage pregnancy in tertiary center hospital in Indonesia. ASPIRE Conference Proceedings: The 6th Congress of the Asia Pacific Initiative on Reproduction. KnE Medicine. ASPIRE 2016;70–75. Doi: 10.18502/kme.v1i1.539.
    1. UNFPA. Motherhood in childhood: Facing the challenge of adolescent pregnancy: The State of World Population – 2013. New York: United Nations Population Fund. 2013;163–196. . Accessed 20 November 2019.
    1. Kamini S, Avvaru KV. Teenage pregnancy: maternal and fetal outcomes. IOSR Journal of Dental Medical Sciences. 2014;13(4):41–4. doi: 10.9790/0853-13464144.
    1. Wall-Wieler E, Roos LL, Nickel NC. Teenage pregnancies: the impact of maternal adolescent childbearing and older sister’s teenage pregnancy on a young sister. BMC Pregnancy Childbirth. 2016;16(120). Doi:10.1186/s12884-016-0911-2.
    1. Population Council. UNFPA, and Government of the Republic of Zambia. [Internet]: Adolescent Pregnancy in Zambia. 2017. Lusaka, Zambia. . Accessed 1 November 2018.
    1. WHO Guidelines on preventing early pregnancy and poor reproductive outcome among adolescents in developing countries. WHO, Editor, WHO: Geneva. 2011. . Accessed 19 January 2019.
    1. United Nations Population Fund. World population day 2013 focuses on adolescent pregnancy. [Internet]. Available from: . Accessed 1 November 2018.
    1. The World Bank. Adolescent fertility rates (births per 1,000). . Accessed 1 November 2018.
    1. Lusaka District Health Office. Annual Report. 2015, Lusaka, Zambia. Accessed on 23 January 2019.
    1. Duffy JMN, Rolph R, Gale C, et al. Core outcome sets in women’s and newborn health: a systematic review. BJOG. 2017;124(10):1481–9. doi: 10.1111/1471-0528.14694.
    1. World Health Organisation. Adolescent Pregnancy. World Health Organization, 23. February. 2018, . Accessed 5 February 2019.
    1. Ganchimeg T, Ota E, Morisaki N, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multi-country study. BJOG. 2014;121(1):40–8. doi: 10.1111/1471-0528.12630.
    1. Lampinen R, Vehviläinen-Julkunen K, Kankkunen P. A review of pregnancy in women over 35 years of age. The Open Nursing Journal. 2009;3:33–8. doi: 10.2174/1874434600903010033.
    1. Masembe S, Fajardo Y, Nkonkwa I, et al. Prevalence, outcome, and associated factors among adolescents delivering at Mbarara Regional Referral Hospital. Journal of Health, Medicine and Nursing. 2016;22.
    1. Suwal A. Obstetric and Perinatal Outcome of Teenage Pregnancy. J Nepal Health Res Counc. 2012;10(20):52–6.
    1. Narukhutrpichai P, Khrutmuang D, Chattrpiban T. The obstetrics and neonatal outcomes of teenage pregnancy in Naresuan University Hospital. Journal Medical Association Thailand. 2016;99(4):361–7.
    1. Althabe F, Moore JL, Gibbons L, et al. Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network for women’s and children’s health research maternal and newborn health registry. Biomed Central: Reproductive Health. 2015;12(2):58. doi: 10.1186/1742-4755-12-S2-S8.
    1. Ruedinger E, Cox JE. Adolescent childbearing: Consequences and interventions. Current Opinion. 2012;24(4):446–52.
    1. Gronvik T, Sandoy IF. Complications associated with adolescent childbearing in Sub-Sharan Africa: A systematic literature review and meta-analysis. Plos One. 2018;13(1). 10.1371/journal.pone.0204327.
    1. Egbe TO, Omeichu A, Halle-Ekane GE, et al. Prevalence and outcome of teenage hospital births at the Beua Health District, South West region, Cameroon. BMC Reproductive Health. 2015;12:118. Doi:1001186/s12978-015-0109-5.
    1. United Nations Children’s Fund (UNICEF). Progress for Children: Achieving the MDGs with Equity. New York: UNICEF; 2010. . Accessed 29 October 2019.
    1. Jeelani SF, Jangsher S, Saleem B. Obstetrical outcomes of teenage compared with adult pregnancies. Pakistan Journal of Medical Health Sciences. 2017;11:416–8.
    1. Medhi R, Das B, Das A, et al. Adverse obstetrical an perinatal outcome in adolescent mothers associated with first birth: a hospital-based case-control study in a tertiary care hospital in North-East India. Adolescent Health Medicine Therapeutics. 2016;7:37–42. doi: 10.2147/AHMT.591053.
    1. Ago BU, Abeshi S, Njoku C, et al. Obstetric outcomes of booked teenage pregnancies at the university of Calabar Teaching Hospital, Nigeria. Adolescent Health Medicine Therapeutics. 2012;3:105–9. doi: 10.2147/AMMT.S35234.
    1. Njim T, Agbor VN. Adolescent deliveries in rural Cameroon: comparison of delivery outcomes between primipara and multipara adolescents. BMC Research Notes. 2018;11:427. doi: 10.1186/s13104-018-3550-z.
    1. Rashmi L. Maternal and fetal outcome in teenage pregnancies. International Journal of Current Research. 2016;8(12):43694–7.
    1. Begum T, Rahman A, Nababan H, et al. Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Banglandesh. Plos One. 2017;12(11):e0188074. doi: 10.1371/journal.pone.0188074.
    1. Maaloe N, Sorensen BL, Onesmo R, et al. Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals. BJOG. 2012;119:605–13. doi: 10.1111/j.1471-0528.2012.03284.x.
    1. Pun KD, Chauhan M. Outcome of adolescent pregnancy at Kathmandu University Hospital. Kathmandu University Medical Journal (KUMJ) 2011;9(33):50–3. doi: 10.3126/kumj.v9i1.6263.
    1. Baker AM, Haeri S. Estimating risk factors for development of preeclampsia in teen mothers. Arch Gynecol Obstet. 2012;286:1093–6. doi: 10.1007/s00404-012-2418-z.
    1. Saugstad OD, Aune D. Optimal oxygenation of extremely low birth weight infants: a meta-analysis and systematic review of the oxygen saturation. Neonatology. 2014;105(1):55–63. doi: 10.1159/000356561.

Source: PubMed

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