Obstetric and Perinatal Outcomes of Teenage Pregnancy

There were many conflicting results from previously done studies in different parts of the world and there is also lack of data in sub-Saharan African countries including Ethiopia. In this study we aimed to analyses the effect of maternal age on obstetric and perinatal outcomes in comparison. This study revealed that low birth weight, preterm delivery and sever neonatal conditions were significantly associated with teenage pregnancy but fetal distress and still birth/intrauterine fetal death were not significantly associated with maternal age i. e there were no significance difference between teenage and adult delivery. Regarding the obstetric outcomes pregnancy induced hypertension, episiotomy and cesarean delivery were significantly associated with maternal age but antepartum hemorrhage, postpartum hemorrhage, instrumental delivery, and perineal tear were not significantly associated with maternal which means there were no statistically significant difference in between the two age groups.

This study result showed that 17. 5 % of the teenagers deliver low birth weight and 6. 8 % of the adults deliver low birth weight neonate. Teenagers were 2. 07 times more likely to deliver low birth weight neonate than the adult mothers (AOR: 2. 07; 95% CI, 1. 03-4. 17). This study is congruent with study done in north India, which showed the occurrence of low birth weight was 1. 6 times more likely to be delivered from teenagers than adults and study done in Nepal teenage gave low birth weight ( 24% Vs 7%, p=0. 013)(21) (27). Moreover cohort and cross sectional study conducted in Cameron in different years revealed that teenagers were 1. 46 and 2. 8 times more likely to deliver low birth weight neonates than the adult mothers respectively. Moreover study in Egypt also reports that teenagers deliver low birth weight (25. 1 Vs 19. 3%, p=0. 001) (19) (29) (30). This might be due to the anatomical immaturity and continued growth of the teenagers may represent the biological growth barrier to their fetus and the low socio-economic status, low level of education in teenagers put them to give low birth weight neonate more than adult mothers. Nevertheless this finding contradicted by studies done in Yaoundé central hospital, Cameron (p=0. 42) and South Africa (0. 174) showed low birth weight had no significant association with maternal age (6) (31). This might be probably due to study area setting and difference in sample size. Concerning to the preterm delivery this study result show that teenagers were 2. 92 times more likely to deliver prematurely than the adult mothers(AOR: 2. 92; 95% CI, 1. 48-5. 75). The same finding were observed studies done at India, Turkey, Taiwan, Korea and retrospective case study in Cameron, WHO, cohort study done in Cameron revealed that 1. 65, 2. 7, 1. 58, 2. 47, 1. 85, 1. 60 times more likely teenagers experience delivery of premature neonates than the adult mothers respectively (10), (21), (22), (23), (17), (29), (30).

Furthermore similar finding was reported by studies conducted in USA and Sweden (24), (26). The possible reason for this might be teenagers are more liable to psychological instability/stress because of hormonal changes and physiologic change during pregnancy. Stress imposes the endocrine disturbance and the immaturity of the uterine/cervical blood supply in teenagers stimulates prostaglandin production which leads to preterm delivery. Despite our finding, studies done in Sweden (AOR 1. 03, 95% CI; 0. 98-1. 09) and South Africa (p=0. 702) showed that there were no significance difference in preterm deliveries between the two age groups (26), (31). This could be attributed by the study area setting and difference in sample size. This study depicted that teenagers were 2. 6 times more likely to have sever neonatal conditions than the adult mothers (AOR: 2. 6; 95% CI, 1. 08-6. 28). This result was congruent with institutional based cross sectional study conducted by world health organization (29 African countries, Latin America, Asia and Middle East) which showed teenagers were 1. 56 times more likely to had sever neonatal conditions than adults (10). The possible explanation might be socio-economic condition, health service utilization and nutritional status of mothers especially for those teenagers.

This study indicated there were significant difference between teenagers and adults regarding the development of pregnancy induced hypertension. Teenagers develop pregnancy induced hypertension 2. 29 times more likely than the adult mothers. (AOR: 2. 29; 95% CI, 1. 01-5. 19). Alongside to our finding study done in USA showed that there were significant association of pregnancy induced hypertension with maternal age. Teenagers develop PIH 1. 34 times more likely than their counter age groups (24). This might be attributed to the fact that null parity and age less than 20 years are the possible risk factors for the development of pregnancy induced hypertension. However, our finding was inconsistent with studies done in Pakistan (p>0. 05 and Ankara, Turkey (p=0. 31) which revealed that there were no significant association of PIH with teenagers and adults (28)(32). This difference might be explained by difference in health care service utilization, preconception care especially folic acid supplementation. Regarding cesarean delivery teenagers were 47% less likely to deliver by cesarean section than adult mothers (AOR: 0. 53; 95% CI, 0. 33-0. 85). This study nearly had the same finding with studies done in Sweden and USA which was their finding was 40%, 51% less likely that teenagers undergo cesarean delivery (AOR: 0. 49; 95% CI, 0. 42-0. 59) and (AOR: 0. 60; 95% CI, 0. 58-0. 64) respectively (24), (26).

Another study done in Ankara, Turkey also showed that teenagers were 36 % less like to undergo cesarean delivery than adults (AOR: 0. 64; 95% CI, 0. 64-0. 89) (28). The possible explanation for this might be due to the awareness difference between the two age groups about cesarean delivery and teenagers are more favored to vaginal delivery due to better myometrium function. Lastly it could be also the small size or birth weight of the neonate from teenagers break the widely held belief that teenagers are prone to CPD but not in the ground. However this study finding has contradiction with three studies done in Cameron which were conducted at different time. All these studies declare that cesarean delivery had no any significant association with maternal age. Both teenagers and adults underwent cesarean delivery without any significant difference (6), (29), (30). This variation might be due to difference in sample size and study area setting.

In this study episiotomy was done about 2 times more likely on teenagers than adults. Similar to our finding studies done in Romania (p