RGUHS Nat. J. Pub. Heal. Sci Vol: 15 Issue: 1 eISSN: pISSN
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1Dr. Prathima S, Associate Professor, Department of OBG, Bangalore Medical College & Research Institute, Bengaluru, Karnataka, India.
2Department of OBG, Bangalore Medical College & Research Institute, Bengaluru, Karnataka, India
3Department of OBG, Bangalore Medical College & Research Institute, Bengaluru, Karnataka, India
4Department of OBG, Bangalore Medical College & Research Institute, Bengaluru, Karnataka, India
5Department of OBG, Bangalore Medical College & Research Institute, Bengaluru, Karnataka, India
*Corresponding Author:
Dr. Prathima S, Associate Professor, Department of OBG, Bangalore Medical College & Research Institute, Bengaluru, Karnataka, India., Email: gynaec2006@gmail.com
Abstract
Objectives: To assess maternal and neonatal outcomes in teenage versus adult pregnant women and also to compare the sociodemographic characteristics of these women.
Methods: It was a cross-sectional study conducted at Bangalore Medical College and Research Institute, in which 1,368 teenage pregnant women and 15,605 adult pregnant women were studied for a period of 12 months. Maternal parameters such as sociodemographic details, education status, parity, antenatal complications, postpartum complications and mode of delivery were compared. Neonatal parameters compared included gestational age at birth, birth weight, need for resuscitation, neonatal intensive care unit (NICU) admission and perinatal death.
Results: The percentage of teenage pregnancies was 8.05%. Majority of women in the teenage group were from rural background (68.56%), had only primary education (76.68%), were primiparous (95%), had lesser antenatal visits (52.26%), with late initiation of first antenatal visit in second trimester (65,05%). The occurrence of anaemia (6%), hypertensive disorders (17.25%), low birth weight (30.26%), NICU admissions (24%) and perinatal deaths (2.5%) was greater in teenage group (P value-<0.0001). Significant differences were noted between the two studied groups regarding sociodemographic characteristics, pattern of antenatal care, antenatal complications (hypertensive disorders of pregnancy and anaemia) and neonatal outcomes.
Conclusion: Teenage pregnancy was found linked to high incidence of maternal and neonatal complications. Maternal and perinatal morbidity and mortality can be minimized in teenage pregnancies by providing education, improving their nutritional status, socioeconomic status, educating them about contraception, safe sex practices to avoid unintended pregnancies and by providing them good antenatal care.
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Introduction
Pregnancy in girls aged between 10-19 years is termed as ‘Teenage Pregnancy’, according to the World Health Organization.1 Around 16 million girls accounting to 11% of the worldwide births belong to 10-19 years age group, and 95% of these girls are from developing countries.2,3
Teenage period marks the transition from childhood to adulthood, during which numerous changes in the physiological, anatomical, structural and psychological aspects occur.4
Maternal and neonatal mortality and morbidity is high in teenage pregnancies.5 Risk of developing anaemia, hypertensive disorder, obstructed labour, postpartum haemorrhage, sexually transmitted infections, and mental disorders such as depression is greater in the mother, while preterm delivery, low birth weight, malformations and infant deaths contribute to a greater risk for the neonate.6,7 Fewer antenatal visits along with late initiation of antenatal care, inadequate antenatal care, low level of education and low maternal weight are the factors attributed to these adverse outcomes.8
The aim of the study was to compare the maternal and neonatal outcomes in teenage and adult pregna-ncies, along with comparison of sociodemographic characteristics among these women.
Materials and Methods
It was a cross-sectional study conducted in the Department of Obstetrics & Gynaecology at Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, for a duration of one year between October 2021 to September 2022. The study included two groups of women admitted in the hospital based on their age after taking into consideration the study criteria. One group included teenage pregnant women aged between 10 to 19 years and the other group included adult pregnant women aged 20 years and above. Maternal parameters including sociodemo-graphic characteristics such as education, area of residence, consanguinity, parity, pattern of antenatal care like booking status, number of antenatal visits, timing of initiation of antenatal care, antenatal complications, obstetric outcome and postpartum complications like postpartum haemorrhage, perineal tears, were collected and compared. Neonatal outcomes such as gestational age at birth, birth weight, neonatal intensive care unit (NICU) admissions and perinatal deaths, were collected and compared. Data collected were compared between the two groups.
All the data collected were tabulated and analyzed using SPSS software version 24.0. The statistical methods applied in the current study included descriptive statistics-percentage, mode, frequency distribution and Chi-square test. Chi-square test was used to test the association between different variables. P value <0.05 indicated significant results.
Inclusion criteria
1. Pregnant women willing to provide informed consent.
2. Teenage pregnant women aged 10-19 years and adult pregnant women aged 20 years and above.
Exclusion criteria
1. Pregnant women with medical disorders before pregnancy.
2. Pregnant women not willing to provide informed consent.
Results
A total of 16,973 expectant mothers were recruited for the study, of which, 1,368 (8.06%) were teenage pregnant women and 15,605 (91.94%) were adult pregnant women.
Table 1 shows the comparison of sociodemographic characteristics between the two groups. Majority (98.74%) of the teenage expectant mothers were in the 18-19 years age group, 68.56% came from rural background, 76.68% had only primary education and 95% were primiparous. About 86.33% of the teenage group women and 84.22% of the adult pregnant women did not have consanguineous marriage. The current study revealed statistically significant variations in the sociodemographic characteristics between the two groups.
Table 2 compares the pattern of antenatal care received by the teenage and adult pregnant women. Majority of the teenage pregnant women were unbooked (52.26%), had less than four antenatal visits throughout their pregnancy (52.26%), and had their first antenatal visit during the second trimester (65.05%). In contrast, most adult pregnant women were booked cases (72.31%), had more than four antenatal visits during their pregnancy (72.31%) and had their first antenatal visit in the first trimester (65.59%). The study demonstrated statistically significant difference between the two groups regarding the pattern of antenatal care.
Table 3 compares the antenatal complications in teenage and adult pregnant women. About 17.25% of the teenage pregnant women had pre-eclampsia and eclampsia, whereas 13.8% of the adult pregnant women had pre-eclampsia and eclampsia. Around 6% of the teenage expectant mothers were diagnosed with anaemia, while 2.1% of the adult pregnant women had anaemia. The study showed statistically significant differences between both the groups in terms of antenatal complications.
Table 4 depicts the comparison of obstetric outcomes between the two groups. There was no significant difference in the percentage of women who had abortion between the two groups. Majority of the teenage pregnant women (80%) and adult pregnant women (69.7%) delivered vaginally. No significant difference in the postpartum complications like postpartum haemorrhage and perineal tears were found between the two groups. There were two (0.14%) maternal deaths in the teenage group compared to 51 (0.33%) in the adult pregnant group during the study period.
Table 5 compares the neonatal outcomes between the teenage and adult pregnant women. Majority of the teenage (82.02%) and adult pregnant women (77.58%) delivered at term. About 30.26% of the teenage pregnant women had low birth weight babies compared to 26.92% of the adult pregnant women. There was a statistically significant difference between the two studied groups regarding the need for resuscitation of the new born, number of NICU admissions and perinatal deaths (P<0.0001).
Discussion
Worldwide, pregnancy in teenage girls is a significant public health concern due to lack of preparedness to deal with the burden of pregnancy.9 The present study showed statistically significant differences between the two studied groups regarding sociodemographic characteristics. In the current study, 68.56% of the teenage pregnant women came from rural background (P<0.0001). Our study results correlate with the reports of Hassan et al. where 69% of the teenage pregnant women came from rural background.10
In the present study, 75.73% of the teenage pregnant women had only primary education in comparison to the adult pregnant women where 89.08% had either secondary education or higher. This is consistent with other studies conducted by Adekanle et al., Abdel-Wahed & Abdel-Rahman, Gayathri Devi et al., Jana Diabelkova et al.11-14 In this study, a statistically significant difference in the education status (P<.001) between the two studied groups was noted. According to National Family Health Survey-4 (NFHS-4), women educational status is inversely proportional to the prevalence of child marriage and adolescent pregnancies amongst 15 to 19 years.15 It might be due to education having an important role in boosting self-esteem, improving their awareness about contraception, sexual health, preventing from early marriage and unintended adolescent pregnancies.
In the current study, a statistically significant difference between the two studied groups was found regarding parity and pattern of antenatal care. About 95% of teenage pregnant women in our study were primiparous women (P<0.0001). This finding correlates with the findings of other investigators (El-Zanaty & Way, Adekanle et al.,) who reported that young couples are under social pressure to prove their fertility once the marriage occurs.12,16
In the present study, a statistically significant difference between the two studied groups was noted regarding the pattern of antenatal care (P<0.0001). About 52.26% of the teenage pregnant women were unbooked, and had less than four antenatal visits. Around 65.05% of the teenage pregnant women had their first antenatal visit in the second trimester while 65.59% of the adult pregnant women had their first antenatal visit during the first trimester. This finding correlates with other studies.17,18 This could be linked to lack of awareness in the teenage pregnant women regarding the importance of antenatal care. This also reflects their ignorance or lack of awareness about the health care facilities provided by the Government. Poor utilization of the antenatal care facilities could result in certain antenatal complications in teenage pregnancies, such as anaemia.
In the present study, a statistically significant higher percentage of pre-eclampsia and anaemia (P<0.0001) were observed in the teenage group which corelates with other studies conducted by Sevgi et al., Mahavarkar & Madhu and Vorapong & Keng.13,19-21 This reflects inadequate nutrition due to high nutritional demand and poor eating habits observed in adolescence.
In the present study, majority of the teenagers (80%) delivered by vaginal route and only 20% delivered by caesarean section. Opinions on the mode of delivery differed widely. AI-Ramahi et al., Shruthi et al., in Bombay have reported high incidence of caesarean section in teenage pregnancies.22,23 In agreement with the present study, Maryam & Ali reported that caesarean deliveries were not higher in teenage mothers.24 Also, Vorapong & Keng reported that adolescent girls were less likely to deliver by caesarean section.
In the present study, there was no significant difference in the percentage of abortions between the two studied groups. There is no statistically significant difference in the postpartum complications between the two studied groups, such as postpartum haemorrhage and perineal tears.
Majority of the teenage pregnant women (82.02%) and adult pregnant women (77.8%) delivered at term gestation in our study. About 17.98% of the teenage pregnant women delivered preterm. This correlates with the study conducted by Devi G et al., who reported that 22.3% of the teenage pregnant women delivered preterm.
Despite having only 17.98% preterm births, the percentage of low birth weight was 30.26%, which is quite high. This reflects the component of intrauterine growth restriction in the teenage pregnant women and might be a contributing factor for increase in NICU admissions and adverse neonatal outcomes.
A statistically significant difference was observed in the neonatal outcomes between the two groups studied regarding low birth weight, need for resuscitation, need for NICU admission and perinatal deaths (P<0.0001). This finding correlates with the other studies.10,13,25,26
Conclusion
The percentage of teenage pregnancies was found to be 8.06% in our institution, which is comparable to teenage pregnancy rate in India (6.8%), according to NFHS- 5. Most of the teenage pregnant women came from rural background, had lower education status and were primiparous. Majority of the teenage expectant mothers had fewer antenatal visits, delayed initiation of antenatal care and inadequate antenatal care. High incidence of maternal and neonatal complications was associated with teenage pregnancies.
Early marriage and childbirth in the adolescent period have a negative impact on the overall healthy development of the girl’s future. Prevention of teenage pregnancies requires utmost attention and this can be achieved by educating them in school about safe sexual practices, contraception, sexually transmitted diseases and also regarding the impact pregnancy can have on their future career, social independence, and security.
Ethics approval
The study was reviewed and approved by Ethical committee of Bangalore Medical College and Research Institute on 04-09-2021, Ref. no: BMCRI/PS/147/ 2021-22
Funding
Nil
Ethical statement
Disclosure of Interest – none declared
Supporting File
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