|ORIGINAL RESEARCH REPORT
|Year : 2019 | Volume
| Issue : 4 | Page : 120-124
Teenage pregnancies: A few years wait until young adulthood is worthy of advocacy
Omololu Adegbola, Mojisola Modupe Sanusi
Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
|Date of Web Publication||22-Oct-2019|
Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos / Lagos University Teaching Hospital. P.M.B. 12003, Lagos
Source of Support: None, Conflict of Interest: None
Background: Teenage pregnancies are health problems of global importance attributed to restrictions of sexually active teenagers access to contraception. It is therefore important to study the impact of pregnancy on teenagers for better care and avert adverse pregnancy outcome. Objectives: The main objective of the study is to compare the pregnancy outcome (early pregnancy loss, preterm delivery, birth weight, live and stillbirths, and other perinatal outcomes) among teenagers (aged 15–19 years) and young adult women (aged 20–24 years). Materials and Methods: This was a comparative study of 74 teenage pregnancies and 690 young adult pregnancies managed at the Lagos University Teaching Hospital over a period of 5 years from May 1, 2008 to April 30, 2013. Results: The teenagers had more miscarriages and more preterm deliveries than young adults (P < 0.0001). Teenagers had more emergency cesarean deliveries and less spontaneous vaginal deliveries (P < 0.0001). Although teenagers had more low birth weight babies compared with young adults (33.3% vs. 22.8%), this was, however, not statistically significant (P = 0.0652). The perinatal mortality rate was 218/1000 total births among teenagers as compared to 90/1000 in young adult women, and this was statistically significant (P = 0.0049). Conclusion: Preventing teenage pregnancies or delaying pregnancy until adulthood results in a better fetomaternal outcome.
Keywords: Nigeria, pregnancy outcome, teenagers versus young adults
|How to cite this article:|
Adegbola O, Sanusi MM. Teenage pregnancies: A few years wait until young adulthood is worthy of advocacy. J Clin Sci 2019;16:120-4
| Introduction|| |
A teenager is that person between the ages of 13 and 19. Teenagers, navigating the phase of childhood to adulthood are vulnerable physically, socially, emotionally, and psychologically.,
Teenage pregnancies are fraught with poor attendance and utilization of antenatal care , with consequent adverse outcome such as anemia, preterm delivery, low birth weight, neonatal admission and other maternal, and neonatal and infant morbidities to mention a few in various parts of Nigeria ,,,, and other parts of the world.,,,,
It has been found that even among the teenagers, the outcomes vary. These complications are worse in those <15 years than those aged 15–19 years;,, however, one study found no difference in pregnancy outcome for teenagers and older women.
Sociocultural and economic factors have an impact on pregnancy outcome in teenagers as most of them are unmarried, students, and dependent on their parents. These preexisting social deficits are associated with adverse health and social outcomes for teen mothers and their children. When compared with women who delay childbearing until their 20s, teen mothers are more likely to drop out of school and have low educational attainment, to be unemployed, to face poverty and be welfare dependent, to become single mothers, and to experience divorce if they marry.
Infants of teen mothers apart from being more likely to be delivered preterm and experience infant mortality, these children do poorly on indicators of health and social well-being than children of older mothers for above reasons,, prepregnancy and prenatal counseling, home visitations, and early childhood interventions have been found to have a significant impact in mitigating these complications., In Nigeria, teenagers were significantly likely to be unbooked, book late, and have higher cesarean section rates. As most pregnant teenagers are unmarried, students, and dependent on their parents, it is not surprising that they are unbooked, as they have no husband to cater for them. In Nigeria, having a husband is a dominant factor in the decision to book early in a maternity center.
This study was designed to evaluate the pregnancy outcome in teenagers and to determine if adverse outcomes can be mitigated by delaying childbearing for a few years.
| Materials and Methods|| |
This was a retrospective comparative study of all teenage pregnancies and pregnancies among young adults managed at the Lagos University Teaching Hospital (LUTH) over a 5-year period from May 1, 2008 to April 30, 2013. Ethical approval for the study was obtained from the Health Research Ethics Committee of the LUTH before the study was carried out (Ethical approval number ADM/DCST/HREC/APP/1297).
During the period of study, 74 teenage pregnancies (aged 15–19 years) and 690 young adult pregnancies (aged 20–24 years) were managed at LUTH, and these served as the case and control groups, respectively. Data were collected from the records in case notes, labor ward, gynecology and obstetrics wards, accident and emergency ward, modular theater, and family planning clinic registers for analysis.
The characteristics of the females such as age, parity, booking status, mode of delivery, estimated blood loss, the status of the mother and child, as well as the need for further care for mother and/or baby such as admission to the intensive care unit or special care baby unit (SCBU) were noted.
The details of the teenagers and the young adult women who were managed within the study period that served as study and control groups, respectively, were kept strictly confidential. The decision for cesarean section or vaginal delivery are usually made after considering the obstetric history as well as taking into cognizance of individual risk factors, ultrasound reports, clinical examination, as well as patient's counseling as in our departmental protocol.
Neonatologists usually attend every delivery by cesarean section and are usually present at vaginal deliveries when indicated by the obstetric history and progress of labor.
Statistical analysis was performed using SPSS version 21, SPSS Inc., Chicago, IL, USA. Categorical variables were compared using the Chi-square test and Fisher exact test as appropriate, while continuous variables were analyzed using Student's t-test. P < 0.05 was considered statistically significant.
| Results|| |
There were 10,269 deliveries during the 5-year study period in our center, 74 (0.72%) were teenagers, while 690 (6.72%) were young adults. The age range for the teenagers was 15–19 years (mean value 15 ± 1.1 years), while the young adults ranged from 20 to 24 years of age (mean value 22 ± 1.4 years).
The sociodemographic and obstetric characteristics of these women are as shown in [Table 1]. In the period under study, there was a proportionately higher number of unbooked teenagers as compared to young adults (64.9% vs. 32.6%), odds ratio 3.8154 (95% confidence interval [CI] 2.307–6.3101) which was statistically significant with P < 0.0001. A lower proportion of teenagers were married as compared to young adults (12.2% vs. 88.4%), odds ratio 0.0182 (95% CI 0.0087–0.0379) which was statistically significant with P < 0.0001.
|Table 1: Sociodemographic and Obstetric characteristics of Teenage and Young adult women|
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The proportion of teenagers having miscarriages (termination of a pregnancy before 28 weeks) was higher than young adults (27% vs. 6.9%), odds ratio 4.6537 (95% CI 2.7433–8.945) with P < 0.0001. The teenagers were also less likely to have term deliveries compared to the young adults (46% vs. 72.8%), odds ratio 0.3183 (95% CI 0.1956–0.518) with P < 0.0001.
The mean birth weight of the 54 babies delivered by teenagers was 2801.2 ± 691 g (range 700–4000 g), while the mean birth weight of the 642 babies delivered by the young adults was 2951.9 ± 675 g (range 500–4350 g). The mean difference was not statistically significant (P = 0.4572), though teenagers had more low birth weights babies when compared with young adults (33.3% vs. 22.8%).
The teenagers were less likely to have spontaneous vaginal deliveries when compared with young adults (24% vs. 57.8%), odds ratio 0.2316 (95% CI 0.1217–0.4407) which was statistically significant at P < 0.0001.
The teenagers were more likely to have an emergency cesarean section when compared to young adults (63% vs. 33%), odds ratio 3.4481 (95% CI 1.9377–6.1357) with P < 0.0001.
Eight (10.8%) of the teenagers had primary postpartum hemorrhage (blood loss of ≥500 ml) as compared to 102 (14.8%) of the young adults, and this was not statistically different, odds ratio 0.6988 (95% CI 0.3257–1.499), P = 0.45426.
The mean Apgar score of babies delivered at 1st min of life was 6.5854 ± 2.42 (range 0–10) for teenagers and 7.7526 ± 1.80 (range 0–10) for young adults, P < 0.0001.
The mean Apgar score of babies delivered at 5th min of life was 8.8780 ± 1.42 (range 0–10) for teenagers and 9.3691 ± 1.47 (range 0–10) for young adults, P = 0.0184.
Out of the 54 teenagers that delivered, 9 babies (16.7%) were admitted to SCBU for monitoring and further care. This was similar to 114 babies (17.8%) of the 642 delivered by young adults who were also admitted to the SCBU, odds ratio 0.9263 (95% CI 0.4403–1.9488), P = 0.08415.
Twelve of the 55 babies delivered to the teenagers were stillbirths with no deaths within the 1st week of life giving a perinatal mortality rate of 218/1000 total births. In the young adult mothers, sixty of the 669 babies died (56 stillbirths and 4 early neonatal deaths) giving a perinatal mortality rate of 90/1,000 total births [Table 2]. Thus, babies borne by teenagers are more prone to perinatal deaths when compared to those borne by young adults, and this was statistically significant, odds ratio 2.8326 (95% CI 1.4169–5.6625), P = 0.0049.
There was one maternal death among the teenagers giving a case-fatality rate of 1.4%, whereas there were five maternal deaths among the young adults giving a case fatality rate of 0.7%. Although teenagers are more prone to dying because of pregnancy and childbirth when compared to young adults, this was, however, not statistically significant, odds ratio 1.8767 (95% CI 0.2163–16.2828), P = 0.9999.
| Discussion|| |
There were fewer pregnant teenagers (0.72%) compared to pregnant young adults (6.72%) managed during the study period in our center. The fact that most pregnant teenagers (87.8%) were unmarried with no husband to properly cater for them could have accounted for their significant higher proportion of miscarriages. This may also explain their higher preponderance of being unbooked as they presented when the pregnancies became complicated. This cascade of events could result in less likelihood of spontaneous vaginal delivery at term and higher emergency cesarean deliveries when compared to pregnant young adult mothers with significantly less proportion being unmarried (11.6%) as shown in this study.
The babies born to teenagers are also significantly likely to have lower Apgar scores, especially in the 1st min of life as compared to young adults (P < 0.0001). These findings agree with other studies.,,, There was no statistically significant difference in the mean birth weight of babies delivered to teenagers and young adults. Although teenagers had more low birth weight babies compared to young adults, this was, however, not statistically significant (P = 0.0652). This finding, though similar to that of Hoque et al. in South Africa, is rather contrary to most other studies that found significantly more low birth weights babies and more admissions in SCBUs in teenagers.,,, This is not unusual as many other factors influence birth weight.
The pregnancy outcome in teenagers in this study is not unusual, and there is preponderance of social deficits with adverse social and health outcome in teen mothers and their children, as they are more likely to be unmarried, student and dependent on their parents, more likely to have low educational attainment because of dropping out of school, more likely to be unemployed, and more prone to be victims of poverty. These all culminate in the likelihood of teenage pregnant mothers being unbooked and only seek medical attention when the pregnancy becomes complicated.
The perinatal deaths were also significantly lower in young adult mothers. These findings have far-reaching implications not only to clinicians but also to policy-makers.
Legislation and provision of universal free and quality education as well as female empowerment would ensure the girl child attend school and less likely to get pregnant in the teenage period. Contraceptive awareness and availability would also go a long way in preventing unintended and unwanted pregnancies and its consequences., It is pertinent for Nigeria to emulate interventions done by Americans and Egyptians , where prenatal counseling and early childhood interventions such as sex education, contraceptive availability to gain more ground in reducing the incidence of teenage pregnancies and its sequelae, while at the same time, consolidating the tenets of abstinence.
In some parts of the world, there has been a significant increase in current modern contraceptive usage. The same cannot be said of Nigeria with a low contraceptive prevalence of 5%–15% despite high contraceptive awareness. This is a far cry from the worldwide estimate of the contraceptive prevalence of 55%. It should also be noted that delaying pregnancy till the young adult age when women would probably have been married, would also be beneficial in enforcing the above intervention, as it has been found that male partners have a strong influence on contraceptive acceptance in Nigeria.
| Conclusion|| |
This study has shown that delaying pregnancies in teenagers until age 20–24 years (young adults) result in better pregnancy outcome as compared to pregnant teenagers.
Thus, the benefits of preventing teenage pregnancies or delaying pregnancies until adulthood cannot be overemphasized. This has been shown to immensely benefit mothers, babies, families, and the society at large. In addition to the current abstinence message, access to contraception by sexually active teenagers needs urgent consideration by the society and policy-makers in the country.
Counseling and childhood sex education at home and schools should be encouraged. Legislation against child marriages as well as provision of universal compulsory free and quality education will ensure the girls are positively engaged during the teenage period.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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