Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network's Maternal Newborn Health Registry study

Fernando Althabe, Janet L Moore, Luz Gibbons, Mabel Berrueta, Shivaprasad S Goudar, Elwyn Chomba, Richard J Derman, Archana Patel, Sarah Saleem, Omrana Pasha, Fabian Esamai, Ana Garces, Edward A Liechty, K Hambidge, Nancy F Krebs, Patricia L Hibberd, Robert L Goldenberg, Marion Koso-Thomas, Waldemar A Carlo, Maria L Cafferata, Pierre Buekens, Elizabeth M McClure, Fernando Althabe, Janet L Moore, Luz Gibbons, Mabel Berrueta, Shivaprasad S Goudar, Elwyn Chomba, Richard J Derman, Archana Patel, Sarah Saleem, Omrana Pasha, Fabian Esamai, Ana Garces, Edward A Liechty, K Hambidge, Nancy F Krebs, Patricia L Hibberd, Robert L Goldenberg, Marion Koso-Thomas, Waldemar A Carlo, Maria L Cafferata, Pierre Buekens, Elizabeth M McClure

Abstract

Background: Adolescent girls between 15 and 19 years give birth to around 16 million babies each year, around 11% of births worldwide. We sought to determine whether adolescent mothers are at higher risk of maternal and perinatal adverse outcomes compared with mothers aged 20-24 years in a prospective, population-based observational study of newborn outcomes in low resource settings.

Methods: We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in six low-middle income countries (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). The study population for this analysis was restricted to women aged 24 years or less, who gave birth to infants of at least 20 weeks' gestation and 500g or more. We compared adverse pregnancy maternal and perinatal outcomes among pregnant adolescents 15-19 years, <15 years, and adults 20-24 years.

Results: A total of 269,273 women were enrolled from January 2010 to December 2013. Of all pregnancies 11.9% (32,097/269,273) were in adolescents 15-19 years, while 0.14% (370/269,273) occurred among girls <15 years. Pregnancy among adolescents 15-19 years ranged from 2% in Pakistan to 26% in Argentina, and adolescent pregnancies <15 year were only observed in sub-Saharan Africa and Latin America. Compared to adults, adolescents did not show increased risk of maternal adverse outcomes. Risks of preterm birth and LBW were significantly higher among both early and older adolescents, with the highest risks observed in the <15 years group. Neonatal and perinatal mortality followed a similar trend in sub-Saharan Africa and Latin America, with the highest risk in early adolescents, although the differences in this age group were not significant. However, in South Asia the risks of neonatal and perinatal death were not different among adolescents 15-19 years compared to adults.

Conclusions: This study suggests that pregnancy among adolescents is not associated with worse maternal outcomes, but is associated with worse perinatal outcomes, particularly in younger adolescents. However, this may not be the case in regions like South Asia where there are decreasing rates of adolescent pregnancies, concentrated among older adolescents. The increased risks observed among adolescents seems more likely to be associated with biological immaturity, than with socio-economic factors, inadequate antenatal or delivery care.

Trial registration number: NCT01073475.

Figures

Figure 1
Figure 1
Simplified Conceptual hierarchical framework
Figure 2
Figure 2
Proportion (%) of births among adolescent mothers 15 – 19 years old and

Figure 3

Maternal outcomes Risk Ratios 95%…

Figure 3

Maternal outcomes Risk Ratios 95% CI’s*

Figure 3
Maternal outcomes Risk Ratios 95% CI’s*

Figure 4

Perinatal outcomes Risk Ratios, 95%…

Figure 4

Perinatal outcomes Risk Ratios, 95% CI*

Figure 4
Perinatal outcomes Risk Ratios, 95% CI*
Figure 3
Figure 3
Maternal outcomes Risk Ratios 95% CI’s*
Figure 4
Figure 4
Perinatal outcomes Risk Ratios, 95% CI*

References

    1. World Health Organization. World Health Statistics. 2013.
    1. United Nations. The Millennium Development Goal. Report. 2010.
    1. World Health Organization. Department of Child and Adolescent Health and Development. Adolescent pregnancy – Unmet needs and undone deeds. A review of the literature and programmes.
    1. Conde-Agudelo A, Belizan JM, Lammers C. Maternal–perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: cross-sectional study. Am J Obstet Gynecol. 2005;192(2):342–349. doi: 10.1016/j.ajog.2004.10.593.
    1. Ganchimeg T, Mori R, Ota E, Koyanagi A, Gilmour S, Shibuya K. et al.Maternal and perinatal outcomes among nulliparous adolescents in low- and middle-income countries: a multi-country study. BJOG. 2013;120(13):1622–1630. doi: 10.1111/1471-0528.12391.
    1. Weng YH, Yang CY, Chiu YW. Risk Assessment of Adverse Birth Outcomes in Relation to Maternal Age. PLoS One. 2014;9(12):e114843. doi: 10.1371/journal.pone.0114843.
    1. Chen CW, Tsai CY, Sung FC, Lee YY, Lu TH, Li CY. et al.Adverse birth outcomes among pregnancies of teen mothers: age-specific analysis of national data in Taiwan. Child Care Health Dev. 2010;36(2):232–240. doi: 10.1111/j.1365-2214.2009.01039.x.
    1. de Vienne CM, Creveuil C, Dreyfus M. Does young maternal age increase the risk of adverse obstetric, fetal and neonatal outcomes: a cohort study. Eur J Obstet Gynecol Reprod Biol. 2009;147(2):151–156. doi: 10.1016/j.ejogrb.2009.08.006.
    1. Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med. 1995;332(17):1113–1117. doi: 10.1056/NEJM199504273321701.
    1. Mukhopadhyay P, Chaudhuri RN, Paul B. Hospital-based perinatal outcomes and complications in teenage pregnancy in India. J Health Popul Nutr. 2010;28(5):494–500.
    1. Ganchimeg T, Mori R, Ota E, Koyanagi A, Gilmour S, Shibuya K. et al.Maternal and perinatal outcomes among nulliparous adolescents in low- and middle-income countries: a multi-country study. BJOG. 2013;120(13):1622–1633. doi: 10.1111/1471-0528.12391.
    1. Ekwo EE, Moawad A. Maternal age and preterm births in a black population. Paediatr Perinat Epidemiol. 2000;14(2):145–151. doi: 10.1046/j.1365-3016.2000.00234.x.
    1. Smith GC, Pell JP. Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study. BMJ. 2001;323(7311):476. doi: 10.1136/bmj.323.7311.476.
    1. Stevens-Simon C, Beach RK, McGregor JA. Does incomplete growth and development predispose teenagers to preterm delivery? A template for research. J Perinatol. 2002;22(4):315–323. doi: 10.1038/sj.jp.7210694.
    1. Bose CL, Bauserman M, Goldernberg RL, Goudar SS, McClure EM, Pasha O. et al.The Global Network Maternal Newborn Health Registry: a multi-national, community-based registry of pregnancy outcomes. Reproductive Health. 2015;12(Suppl 2):S1.
    1. Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26:224–227. doi: 10.1093/ije/26.1.224.
    1. Bloch M, Althabe F, Onyamboko M, Kaseba-Sata C, Castilla EE, Freire S. et al.Tobacco Use and Secondhand Smoke Exposure During Pregnancy: An Investigative Survey of Women in 9 Developing Nations. Am J Public Health. 2008;98(10):1833–1840. doi: 10.2105/AJPH.2007.117887.
    1. United Nations’s Children’s Fund (UNICEF). Progress for Children: Achieving the MDGs with Equity. New York: UNICEF; 2010.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi