Adverse perinatal outcomes of adolescent pregnancies in Cameroon

Pregnancy Outcomes Among Teenagers at a National Referral Hospital in Uganda

Introduction: Teenage pregnancy is a global public health challenge, and it is a major contributor to the high maternal and neonatal morbidity and mortality rates reported in sub-Saharan Africa and Uganda. However, there is a paucity of data regarding pregnancy outcomes and their associated factors among teenagers in Uganda. The purpose of this study was to determine the prevalence and factors associated with pregnancy outcomes among teenagers who delivered at a National Referral Hospital in Kampala, Uganda. Materials and Methods: This cross-sectional study was conducted among teenage mothers who delivered at a National Referral Hospital in Kampala, Uganda. Consecutive participant recruitment was done for those who fulfilled the eligibility criteria. The outcomes of interest included adverse maternal outcome with obstructed labor being used as a proxy and adverse fetal outcomes with birth asphyxia used as a proxy. Logistic regression analysis was used to determine the association between independent and dependent variables with a 5% level of statistical significance (α = 0.05). Results: Teenage pregnancy was associated with adverse maternal outcomes which included obstructed labor (18%) and preterm labor (5.5%). There were no maternal deaths during the study period. Adverse fetal outcomes observed in this study population included low birth weight (83%), birth asphyxia (18%), and stillbirth (4%). The only factor associated with adverse maternal outcome was gestational age where teenage mothers had 4 times likelihood of delivering before 37 weeks. Relatedly, teenage mothers had an 81% chance of having a preterm birth. Conclusion: Teenage pregnancy was generally not associated with adverse maternal or fetal outcomes except for preterm birth. The reasons for adverse pregnancy outcomes may reflect a combination of gynecological and biological immaturity, as well as adverse socioeconomic pressures.

Intimate partner violence during pregnancy against adolescents in sub-Saharan Africa: a systematic review

BACKGROUND

Adolescent pregnancy and intimate partner violence (IPV) are major public health issues that are linked to poor health outcomes particularly during pregnancy. In sub-Saharan Africa (SSA), previous studies on IPV during pregnancy have primarily focused on adults. This review examines the available evidence on adolescents' experience of IPV during pregnancy in SSA.

DESIGN

Systematic review.

METHODS

We searched multiple databases for articles that met our inclusion criteria. Included studies investigated IPV during pregnancy, including prevalence, risk factors and health outcomes among ever-pregnant adolescents aged 10-19 years old or younger in SSA. Studies were peer-reviewed studies from SSA, quantitative and/or qualitative; and published in English regardless of the year of publication.

RESULTS

Nine studies out of 570 abstracts screened, published between 2007 and 2020, met the inclusion criteria. The prevalence of IPV during pregnancy among adolescents in SSA ranged from 8.3% to 41%. Mental health symptoms, particularly depression, and anxiety, were associated with adolescent IPV during pregnancy and qualitatively linked to poor coping strategies when dealing with IPV.

CONCLUSION

This review found evidence of a linkage between pregnancy and IPV during pregnancy among adolescents. Given the long-term negative effects of IPV during pregnancy on adolescents and children, this conclusion points to the critical need for developing interventions to improve IPV detection during pregnancy in SSA among adolescents to interrupt its continuation into adulthood.

A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes

Preterm births (PTB) are the leading cause of neonatal deaths, the majority of which occur in low- and middle-income countries, particularly those in Sub-Saharan Africa (SSA). Understanding the epidemiology of prematurity is an essential step towards tackling the challenge of PTB in the sub-continent. We performed a scoping review of the burden, predictors and outcomes of PTB in SSA. We searched PubMed, Embase, and three other databases for articles published from the database inception to 10 July 2021. Studies reporting the prevalence of PTB, the associated risk factors, and/or its outcomes were eligible for inclusion in this review. Our literature search identified 4441 publications, but only 181 met the inclusion criteria. Last menstrual period (LMP) was the most commonly used method of estimating gestational age. The prevalence of PTB in SSA ranged from 3.4% to 49.4%. Several risk factors of PTB were identified in this review. The most frequently reported risk factors (i.e., reported in ≥10 studies) were previous history of PTB, underutilization of antenatal care (<4 visits), premature rupture of membrane, maternal age (≤20 or ≥35 years), inter-pregnancy interval, malaria, HIV and hypertension in pregnancy. Premature babies had high rates of hospital admissions, were at risk of poor growth and development, and were also at a high risk of morbidity and mortality. There is a high burden of PTB in SSA. The true burden of PTB is underestimated due to the widespread use of LMP, an unreliable and often inaccurate method for estimating gestational age. The associated risk factors for PTB are mostly modifiable and require an all-inclusive intervention to reduce the burden and improve outcomes in SSA.

The Association Between Adequate Prenatal Care and Severe Maternal Morbidity Among Teenage Pregnancies: A Population-Based Cohort Study

Background

The aim of this study was to examine whether inadequate prenatal care affect the risk of severe maternal morbidity in teenage pregnancies.

Methods

We included 23,202 delivery cases among adolescent mothers aged between 13 and 19 years old with ≥ 37 weeks' gestational age. Data were derived from the National Health Insurance Service National Delivery Cohort in Korea between 2003 and 2018. We used a generalized estimating equation model while adjusting for numerous covariates to determine the adjusted relative risk (RR) associated with severe maternal morbidity. The main outcome measures were severe maternal morbidity and the Kessner Adequacy of Prenatal Care Index.

Results

Severe maternal morbidity occurred in 723 (3.1%) of the 23,202 investigated delivery cases. The risk of severe maternal morbidity was 1.8-fold higher among adolescent mothers who had received inadequate prenatal care (RR, 1.81, 95% confidence interval [CI], 1.39–2.37) and 1.6-fold higher among those who had received intermediate prenatal care (RR, 1.59, 95% CI, 1.33–1.87) compared to those with adequate prenatal care. Synergistic effects of inadequate prenatal care and maternal comorbidities affected severe maternal morbidity.

Conclusion

This study confirmed that inadequate prenatal care is associated with increased risk of severe maternal morbidity among pregnant teenagers. Notably, maternal comorbidity and inadequate prenatal care produced synergistic effects on severe maternal morbidity. Public health policy makers should focus on the development and implementation of programs to ensure that adequate prenatal care and financial/healthcare support is provided to teenage mothers during their pregnancies.

Maternal and Neonatal Complications in Teen Pregnancies: A Comprehensive Study of 661,062 Patients

PURPOSE

To provide a comprehensive assessment of maternal and neonatal complications associated with teen pregnancies in the United States.

METHODS

Retrospective analysis of the Centers for Disease Control and Prevention natality live births database (2016-2019). Singleton births to women younger than 35 years from the following racial/ethnic groups were included: non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic. The risks of various complications were compared between teen patients (<20 years old) and nonteen patients (20-35 years old) using Pearson's chi-square test with the Bonferroni correction. Multivariate logistic regressions were used to adjust outcomes for potential confounders, including body mass index, race/ethnicity, payment method, prenatal care, parity, and the presence of chronic comorbidities.

RESULTS

Teen pregnancies comprised approximately 6% of the study population (661,062 of 11,038,489). Teen pregnancies were associated with increased odds of several maternal complications, such as hypertensive disorders of pregnancy, eclampsia, preterm birth, blood transfusion, and chlamydial and gonorrheal infections. Teen pregnancies were also associated with increased odds of several neonatal complications, including congenital birth defects, low 5-minute Apgar score, suspected neonatal sepsis, and assisted ventilation. Conversely, teen pregnancies were associated with decreased odds of gestational diabetes, unplanned hysterectomy, macrosomia, low birth weight, and neonatal intensive care unit admission.

DISCUSSION

Teen pregnancies in the United States are associated with increased risks of multiple adverse outcomes. This information should inform clinicians and policy makers about the unique risks of this highly vulnerable patient population and provide further knowledge for the important efforts to reduce teen birth rates in the United States.

Adolescent pregnancy in Sao Tome and Principe: are there different obstetric and perinatal outcomes?

BACKGROUND

Adolescent childbirth is a major public health problem in Sao Tome and Principe (STP). Adolescent pregnancy and childbirth can carry a risk of morbidity associated with the physiological and sociological characteristics of teenage girls. This study aims to identify the main adverse obstetric and perinatal outcomes for adolescent pregnancies in the Hospital Dr. Ayres de Menezes (HAM), the only hospital in STP.

METHODS

An institution-based cross-sectional study. Pregnant women ≤ 19 years of age (n = 104) were compared to non-adolescent women (n = 414). The obstetric and perinatal outcomes were compared between groups using the t test. Odds ratio (OR) were calculated through Cochran's and Mantel-Haenszel statistics test for odds ratio equal to 1, 95% confidence intervals (CI) and p values (p < 0.05) were considered significant.

RESULTS

The adverse perinatal outcomes imputable to adolescent births were foetal distress with low first minute Apgar score < 7 (OR 1.94, 95% CI 1.18-3.18, p = 0.009) and performance of neonatal resuscitation manoeuvres (OR 2.4, 95% CI 1.07-5.38, p = 0.032). Compared to older mothers, teenage girls were likely to have a non-statistically significant threefold higher risk of having an obstructed labour (OR 3.40, 95% CI 0.89-12.94, p = 0.07). Other perinatal outcomes as neonatal asphyxia, risk for cerebral palsy, premature birth, early neonatal infection, and neonatal death were identical between groups as well as maternal anaemia, mode of delivery or other obstetrical outcomes.

CONCLUSION

Adolescent pregnancies were associated with worse perinatal outcomes as foetal distress and higher need for neonatal resuscitation manoeuvres. This study may support STP health authorities in their efforts to make Sustainable Development Goals 3 (good health and wellbeing), 4 (quality education) and 5 (gender equality) a reality by 2030, since it identifies specific problems that need to be addressed to improve maternal adolescent health.

Teenage pregnancy and the sociodemographic attributes as a major contributor: Findings from an urban referral center in Nepal

BACKGROUND

Teenage pregnancy is a challenging issue worldwide. Yet, despite the increased health risk and socioeconomic impact of teenage pregnancy, the numbers remain high in Nepal.

AIM

To determine the prevalence and sociodemographic factors associated with teenage pregnancy in Nepal.

METHODS

A hospital-based cross-sectional study was conducted in the Paropakar Maternity and Women’s Hospital from April to August 2017. A total of 1359 mothers were assessed and interviewed regarding their reproductive history and sociodemographic attributes. Ethical approval from the Nepal Health Research Council, permission from the concerned hospital, and consent from study subjects were obtained.

RESULTS

Of the 5526 deliveries, 679 (12.3%) were teenage pregnancy deliveries. The majority (85.1%) of mothers (out of 1359) were married at < 20 years of age, with a mean age of marriage of 17.57 years (± 1.994, range: 12-25 years). Marriage age was a significant determinant of teenage pregnancy (odds ratio [OR] 2.423 [2.262-2.596]; P < 0.001). Likewise, a love marriage (OR: 2.018 [1.585-2.570]; P < 0.001) and first teenage pregnancy (OR: 3.622 [3.265-4.017]; P < 0.001) were significant determinants for subsequent teen pregnancies. Knowledge of family planning methods (OR: 0.474; 0.288-0.779; P = 0.003) and use of any methods of family planning utilization (OR: 0.345; 0.248-0.479; P = 0.000) significantly lowered the chance of teenage pregnancy.

CONCLUSION

Teenage pregnancy occupies a substantial proportion of total deliveries in the Nepalese maternity hospital. In addition, early pregnancy was significantly associated with age and type of marriage, education level, knowledge, and practice of contraceptive methods.

An Increased Adverse Fetal Outcome Has Been Observed among Teen Pregnant Women in Rural Eastern Ethiopia: A Comparative Cross-Sectional Study

Background: According to the World Health Organization, teenage pregnancies are high-risk due to increased risks of fetal and infant morbidity and mortality. This study compares adverse fetal outcomes between teen and adult pregnant women from rural Eastern Ethiopia. Methods: Institutional-based cross-sectional study was conducted among women visiting maternity units from surrounding rural areas. A total of 481 teenagers (13-19 years old) and 481 adults (20-34 years old) women with a singleton pregnancy were included in the study. Two hospitals and 3 health centers were selected in Eastern Hararghe Zone, Eastern Ethiopia. Comparative analysis was carried out using the log-binomial regression model to identify factors associated with adverse fetal outcomes in both categories. The results are reported in adjusted prevalence ratios with 95% confidence intervals. Results: High proportion of adverse fetal outcome was observed among teenage women than adult (34.9% vs 21%). Statistically significant difference (P < .05) in the proportion of low birth weight (21.1% vs 9.3%), preterm birth (18.7% vs 10.6%), APGAR score at 5th minute (9.3% vs 4%) were found in teenagers compared to adult women. Antenatal care attendance (APR = 0.44; 95% CI: 0.23, 0.86); eclampsia (APR = 1.96; 95% CI: 1.26, 3.06); pre-eclampsia (APR = 1.73; 95% CI: 1.12, 2.67); and wealth index (rich) (APR = 0.55; 95% CI: 0.32, 0.94) were significantly associated with adverse fetal outcomes among the teenage women. Whereas intimate partner violence (APR = 2.22; 95% CI: 1.26, 3.90); preeclampsia (APR = 3.05; 95% CI: 1.61, 5.69); antepartum hemorrhage (APR = 2.77; 95% CI: 1.73, 4.46); and hyperemesis gravderm (APR = 1.75; 95% CI: 1.09, 2.79) were significantly associated with adverse fatal outcomes among the adult women. Conclusion: teenage pregnancy is associated with a high rate of adverse fetal outcomes. Early identification and treatment of problems during antenatal follow-up should be the mainstay to avert the massive adverse fetal effects.

Comparative analysis of perinatal outcomes and birth defects amongst adolescent and older Ugandan mothers: evidence from a hospital-based surveillance database

Background

Uganda has one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes between adolescents (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals.

Methods

Maternal demographics, HIV status, and birth outcomes of all live births, stillbirths, and spontaneous abortions delivered from August 2015 to December 2018 were extracted from a hospital-based birth defects surveillance database. Differences in the distributions of maternal and infant characteristics by maternal age groups were tested with Pearson’s chi-square. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated using logistic regression to compare the prevalence of adverse birth outcomes among adolescents to mothers 20–34 years.

Results

A total of 100,189 births were analyzed, with 11.1% among adolescent mothers and 89.0% among older mothers. Adolescent mothers had an increased risk of preterm delivery (aOR: 1.14; CI 1.06–1.23), low birth weight (aOR: 1.46; CI 1.34–1.59), and early neonatal deaths (aOR: 1.58; CI 1.23–2.02). Newborns of adolescent mothers had an increased risk of major external birth defects (aOR: 1.33; CI 1.02–1.76), specifically, gastroschisis (aOR: 3.20; CI 1.12–9.13) compared to mothers 20–34 years. The difference between the prevalence of gastroschisis among adolescent mothers (7.3 per 10,000 births; 95% CI 3.7–14.3) was statistically significant when compared to mothers 20–34 years (1.6 per 10,000 births; 95% CI 0.9–2.6).

Conclusions

This study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years, similar to findings in the region and globally. Interventions are needed to improve birth outcomes in this vulnerable population.

Adolescent pregnancies are a global problem occurring in high-, middle-, and low-income countries with Uganda having one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes, including major external birth defects, between adolescents, (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals.

All informative births, including live births, stillbirths, and spontaneous abortions; regardless of gestational age, delivered at four selected hospitals in Kampala from August 2015 to December 2018 were examined. Demographic data were obtained by midwives through maternal interviews and review of hospital patient notes.

Of the 100,189 births, 11.0% were among adolescent mothers and 89.0% among mothers (20–34 years). Adolescent mothers were more likely than mothers (20–34 years) to have an infant with preterm delivery, low birth weight, early neonatal death, and major external birth defects. Adolescent pregnancies were also associated with an increased risk of gastroschisis when compared to mothers (20–34 years).

In conclusion, this study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years. Research on the potential underlying causes or mechanisms for these adverse outcomes among adolescent births is necessary to identify possible interventions.

Adolescent motherhood in Mozambique. Consequences for pregnant women and newborns

Introduction

In sub-Saharan Mozambique, high adolescent fertility rates are a significant public health problem. Understanding the consequences of teenage pregnancies facilitates effective strategies for improving the quality of care of both mother and the newborn.

Aims

To identify the factors associated with adolescent motherhood in Tete (Mozambique).

Methods

This was a cross-sectional study including 821 pregnant women (255 teenagers) admitted to the general maternity ward of the Provincial Hospital between March and October 2016. The survey included clinical data of the mother and newborn.

Results

The overall prevalence of adolescent deliveries was 31.8% (95% CI 27.9% - 34.2%). Multivariate analysis showed that independent factors associated with teenage motherhood were: number of pregnancies (OR 0.066; 95% CI 0.040–0.110), pregnancy follow-up (OR 0.29; CI 0.173–0.488) and previous abortions (OR 4.419; 95% CI 1.931–10.112). When the age of the mother was analysed as a continuous variable, positively associated factors were body mass index, arterial hypertension, HIV infection, previous abortions, pregnancy follow-up, and the weight of the newborn. Negatively associated factors were episiotomy and respiratory distress in the newborn.

Conclusion

Teenage motherhood is a serious public health problem in Mozambique. Intensive sexual and reproductive health planning for adolescents is needed.

Prevalence of adolescent deliveries and its complications in Cameroon: a systematic review and meta-analysis

BACKGROUND

Adolescent deliveries (10-19 years) carry a high risk of adverse outcomes due to the biological and physiological immaturity of these mothers. They pose a significant health burden in Cameroon, as it is reported that a high proportion of women attending delivery services are teenagers. We therefore sought to systematically assess the prevalence of adolescent deliveries in the country and its maternal and neonatal outcomes.

METHODS

This was a systematic review of literature and a meta-analysis. We searched MEDLINE, CINAHL and Global Health online databases for all studies that reported the proportion of adolescent women who presented for delivery in health facilities in Cameroon. All observational studies published up to 10th July 2019, were included.

RESULTS

A total of 47 articles were identified by the search. After removal of duplicates and screening of the titles and abstracts, 11 eligible studies were retained with ten articles meeting the inclusion criteria. These ten studies finally retained reported on nine different cohorts with a total of 99,653 women. The pooled prevalence of adolescent deliveries from the nine cohorts in Cameroon was 14.4% (95% CI: 10.7-18.6%), the prevalence for early adolescent deliveries was 2.8% (95% CI: 0.4-7.2%), meanwhile that for late adolescent deliveries was 12.5% (95% CI: 6.7-19.8%). The prevalence of adolescent deliveries in urban areas - 13.1% (95% CI: 7.8-19.6%) was similar to that in semi-urban areas- 14.1% (95% CI: 6.7-23.5%). Adolescents were more likely than adults (> 19 years) to have low birth weight babies (OR: 1.8; 95% CI: 1.6, 2.1); babies born with asphyxia (OR: 1.7; 95% CI: 1.3, 2.1); babies born before term (OR: 1.5; 95% CI: 1.1, 1.9) and babies who die in the neonatal period (OR: 2.1; 95% CI: 1.2, 3.8).

CONCLUSION

The prevalence of adolescent deliveries in Cameroon is high. Implementation of adolescent-friendly policies is necessary to reduce the proportion of adolescents who become pregnant in Cameroon.

Prevalence of hypertensive disorders of pregnancy and pregnancy outcomes in Sub-Saharan Africa: A systematic review and meta-analysis

Hypertensive disorders of pregnancy are one of the leading causes of poor pregnancy outcomes and are associated with increased rates of maternal mortality, preterm birth, small for gestational age newborns, stillbirth, and neonatal death. The overall and type-specific prevalence of hypertensive disorders of pregnancy and associated pregnancy outcomes are unknown in Sub-Saharan Africa. Therefore, this review aimed to identify the prevalence of hypertensive disorders of pregnancy and associated pregnancy outcomes in Sub-Saharan Africa. A systematic review and meta-analysis were conducted on observational facility-based studies irrespective of publication status, sample size, language, and follow-up duration from 19 countries between the years 2000 and 2018 in Sub-Saharan Africa. A review of studies using PubMed, EMBASE, African Index Medicus, and African Journals Online was completed with independent extraction of studies by review authors using the predefined inclusion criteria. Quality and risk of bias of individual studies were assessed using the Joanna Briggs Institute Checklist. Random effects model was used to estimate the pooled prevalence of hypertensive disorders of pregnancy and type-specific hypertensive disorders of pregnancy. A pooled adjusted odds ratio with 95% confidence interval for each study was calculated using comprehensive meta-analysis version 2 software to estimate the association of hypertensive disorders of pregnancy and its outcomes. The existence of heterogeneity was assessed using I2 and its corresponding P value. We assessed the presence of publication bias using the Egger's test. Subgroup analysis was performed to assess the potential effect of variables, and a sensitivity analysis was conducted to assess any undue influence from studies. The analysis included 70 studies. The pooled prevalence of hypertensive disorders of pregnancy (all types combined), chronic hypertension, gestational hypertension, preeclampsia, and eclampsia were 8% (95% confidence interval = [5, 10]), 0.9% (95% confidence interval = [0.4, 1.8]), 4.1% (95% confidence interval = [2.4, 7]), 4.1% (95% confidence interval = [3.2, 5.1]), and 1.5% (95% confidence interval = [1, 2]), respectively. Compared with normotensive pregnant or postpartum women, women with hypertensive disorders of pregnancy were associated with increased risk of maternal mortality, odds ratio = 17 (95% confidence interval = [9.6, 28.8]); cesarean section, odds ratio = 3.1 (95% confidence interval = [1.7, 5.6]); perinatal mortality, odds ratio = 8.2 (95% confidence interval = [2.8, 24]); low birth weight, odds ratio = 3.2 (95% confidence interval = [2, 5]); and preterm delivery, odds ratio = 7.8 (95% confidence interval = [2.5, 25.3]) according to this analysis. The pooled prevalence of hypertensive disorders of pregnancy was high in Sub-Saharan Africa compared to those reported from other regions. Pregnant or postpartum women with hypertensive disorders of pregnancy have increased risk of maternal mortality, cesarean section, preterm delivery, perinatal mortality, and low birth weight newborn. Therefore, creating awareness of the risks of hypertensive disorders of pregnancy is essential. Pregnant women with hypertensive disorders need due attention to manage appropriately and more importantly to have favorable outcomes in this population.

Adolescent Mothers' Experiences With Community Health Assistants in Rural Zambia

Adolescent health demands specific attention because adolescents have the lowest levels of health-care coverage of any age-group globally. The main objective as addressed in this article was to explore the lived experience of adolescent mothers and the services provided to them by community health assistants (CHAs) in rural Zambia. Because the number of adolescent mothers in rural Zambia is so high, it is even more critical to describe the lived experiences of health care among these young women with particular emphasis on primary health care as delivered by CHAs in rural Zambia. We used a mixed-methods design to address our research questions. Data were collected from nine focus groups, which were conducted with young mothers from four provinces and 10 districts (n = 60). To support our effort to better understand the delivery of maternal and child health care in rural Zambia, key informant interviews were conducted with adolescent mothers (n = 12). We also conducted surveys (n = 44) and one-on-one interviews (n = 22) with CHAs. To the best of our knowledge, this is the largest study focused on the intersection of adolescents, maternal child health, and CHA delivery of care in Zambia. The results of our study suggest opportunities for change to operational practices within the rural health-care setting and the need to develop structured and age-appropriate services that focus on adolescents. This work addresses the gap in research for adolescents in health care in rural Zambia and brings attention to the unique health-care needs of adolescent mothers within the rural health-care setting.

Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

Introduction Birth-related perineal trauma (BPT) is a common consequence of vaginal births. When poorly managed, BPT can result in increased morbidity and mortality due to infections, haemorrhage, and incontinence. This review aims to collect data on rates of BPT in low- and middle-income countries (LMICs), through a systematic review and meta-analysis. Methods The following databases were searched: Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACs), and the World Health Organization (WHO) regional databases, from 2004 to 2016. Cross-sectional data on the proportion of vaginal births that resulted in episiotomy, second degree tears or obstetric anal sphincter injuries (OASI) were extracted from studies carried out in LMICs by two independent reviewers. Estimates were meta-analysed using a random effects model; results were presented by type of BPT, parity, and mode of birth. Results Of the 1182 citations reviewed, 74 studies providing data on 334,054 births in 41 countries were included. Five studies reported outcomes of births in the community. In LMICs, the overall rates of BPT were 46% (95% CI 36–55%), 24% (95% CI 17–32%), and 1.4% (95% CI 1.2–1.7%) for episiotomies, second degree tears, and OASI, respectively. Studies were highly heterogeneous with respect to study design and population. The overall reporting quality was inadequate. Discussion Compared to high-income settings, episiotomy rates are high in LMIC medical facilities. There is an urgent need to improve reporting of BPT in LMICs particularly with regards to births taking in community settings.

A retrospective analysis of adverse obstetric and perinatal outcomes in adolescent pregnancy: the case of Luapula Province, Zambia

Background

About three in ten young women aged 15–19 have begun childbearing among the Zambian population, with adolescent pregnancy levels as high as 35% in rural areas. In 2009, Luapula reported 32.1% adolescent pregnancies. The study sought to investigate obstetric and perinatal outcomes among adolescents compared to mothers aged 20-24 years delivering at selected health facilities in Kawambwa and Mansa districts of Luapula.

Methods

A retrospective analysis was carried out of all deliveries to mothers aged between 10 and 24 years for the period January 2012 to January 2013. A total of 2795 antenatal and delivery records were reviewed; 1291 adolescent mothers and 1504 mothers aged 20–24 years. Crude and adjusted odds ratios for the association between maternal age and adverse obstetric and perinatal outcomes were obtained using logistic regression models.

Results

The mean age of the adolescent mothers was 17.5 years. Mothers younger than 20 years faced a higher risk for eclampsia, anaemia, haemorrhage, Cephalopelvic disproportion, prolonged labour and caesarean section. After adjustment for potential confounders, the association between maternal age and adverse obstetric and perinatal outcome diminished. Children born to mothers younger than 20 were at increased risk for low birth weight, pre-term delivery, low Apgar score and neonatal death; the risk for asphyxia, however, tended to increase with age.

Conclusion

The findings demonstrate that adolescent pregnancy increases the risk of adverse obstetric and perinatal outcomes. High rates of adolescent pregnancies in Luapula province are likely as a result of the predominantly rural and poor population. Understanding the factors that contribute to the high levels of adolescent pregnancy in the region will be vital in addressing the situation and subsequently reducing the high obstetric and perinatal morbidity and mortality.

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

PURPOSE

To analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon.

PATIENTS AND METHODS

Cross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20-24 years), and young women (25-30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient's medical records.

RESULTS

In total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents' group compared with the young women's group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14-2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02-3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11-3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36-14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49-2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47-2.98; PFDI, PR = 2.12, 95% CI 1.47-2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04-3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03-5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21-13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60-2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61-3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68-3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section.

CONCLUSION

Adolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section.

Adolescent deliveries in urban Cameroon: a retrospective analysis of the prevalence, 6-year trend and adverse outcomes

Objective

Adolescent deliveries remain a public health problem in most developing countries. The aim of our study was to determine the prevalence, trends and outcome of adolescent deliveries in an urban setting in Cameroon. We carried out a retrospective register analysis over a 6-year period (January 2010–December 2015) at the Saint Albert Le Grand hospital Douala.

Results

The overall prevalence of adolescent deliveries was 8.2% (662 out of 8056). There was a significant decrease over the 6-year period (p-trend: < 0.05). Adolescents were at higher risk of preterm deliveries (gestational age < 37 weeks; odds ratio [OR], 1.7; 95% confidence interval [CI]; 1.3–2.2; p < 0.01): low birth weight (defined as birth weight < 2650 g, OR; 1.7, CI 1.4–2.2, p < 0.01) and asphyxia at 1st minute (OR, 1.5; 95% CI 1.1–2.2; p = 0.02). There was no difference in delivery outcomes between early and late adolescents. Our results suggest that the prevalence of adolescent deliveries is lower in urban settings. Adolescent deliveries are more likely to result in adverse fetal outcomes than adult deliveries. Measures directed towards the prevention of adolescent pregnancies should be implemented to reduce neonatal morbidity and mortality.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3578-0) contains supplementary material, which is available to authorized users.

Adolescent deliveries in rural Cameroon: an 8-year trend, prevalence and adverse maternofoetal outcomes

Background

Adolescent deliveries remain a global public health concern especially in low- and middle-income countries where 95% of these deliveries occur. In Cameroon, adolescent pregnancies have a high disease burden due to their association with adverse pregnancy outcomes. We sought to evaluate the prevalence, trend and adverse maternofoetal outcomes of adolescent deliveries in a rural community in Cameroon.

Method

We carried out a retrospective register analysis of 1803 singleton deliveries in two health facilities located in the Oku sub-division over an 8-year period (2009 to 2016). We excluded: records without maternal age, babies born before arrival, birthweights less than 1000 g, multiple deliveries and deliveries before 28 weeks gestation. Data analysis was done using Epi info 7.0.8.3. The Fisher’s exact test was used to compare categorical variables, while the chi-square test for trends was used to determine time trends. P-values below 5% were considered statistically significant.

Results

The 8-year prevalence of adolescent deliveries was 20.4% (95% CI = 18.6–22.4) with a significant, downward trend between 2009 and 2016 (P trend = 0.05). Second-fourth degree perineal tears were more likely to complicate adolescent (Age < 20 years) deliveries compared with their adult (Age ≥ 20 years) counterparts (OR = 2.9; 95% CI = 1.8–4.7; p < 0.001). Also, babies born to adolescent mothers were more likely to have a low birthweight (OR = 1.7; 95% CI = 1.1–2.6; p = 0.009) and be asphyxiated at the fifth minute of life (OR = 3.2; 95% CI = 1.9–5.5; p < 0.001). Over an eight-year period, the downward trend in the prevalence of adolescent deliveries was associated with a significant decrease in the trend of neonatal asphyxia at the fifth minute. Married adolescents and their babies were as likely to develop the complications of adolescent delivery such as second-fourth degree perineal tears (OR = 0.8; 95% CI = 0.4–1.6; p = 0.456), low birthweight (OR = 2.1; 95% CI = 0.9–4.7; p = 0.070) and fifth minute neonatal asphyxia (OR = 0.9; 95% CI = 0.4–2.0; p = 0.832) as single adolescents and their babies.

Conclusion

The prevalence of adolescent deliveries in this rural community is high with one of every five babies born to an adolescent mother. Despite the downward trend indicating a decrease in adolescent deliveries, our study demonstrates the need to reinforce and effectively apply existing government-based public health programme to target key indicators of adolescent pregnancy in Cameroon.

Rate of teenage pregnancy in Jordan and its impact on maternal and neonatal outcomes

Objective Research regarding the adverse outcomes of adolescent childbearing has suffered from many limitations such as a small sample size and non-representative samples. This study was conducted to determine the rate of teenage pregnancy among Jordanian adolescents and its associated adverse maternal and neonatal outcomes. Methods The study is a part of a comprehensive national study of perinatal mortality that was conducted between 2011 and 2012 in Jordan. All women who gave birth after 20 weeks of gestation in 18 maternity hospitals in Jordan between 2011 and 2012 were invited to participate in the study. Consenting women were interviewed by the trained midwives in these hospitals using a structured questionnaire prepared for the purpose of this study. Additional information was also collected based on the physical examination by the midwife and the obstetrician at admission and at discharge. Data on the newborn were also collected by the pediatric nurses and the neonatologists in these hospitals. Results The overall rate of teenage pregnancy [95% confidence interval (CI) was 6.2% (5.9%, 6.5%)]. Of the studied maternal and neonatal outcomes, women aged <20 years were more likely to deliver prematurely compared to women aged 20-35 years [odds ratio (OR)=1.5, 95% CI: 1.2, 1.9; p < 0.005)]. However, the two groups of women did not differ significantly in low birth weight delivery (OR = 1.2, 95% CI: 0.9, 1.5; p = 0.167) and neonatal mortality (OR = 1.2, 95% CI: 0.8, 1.3; p = 0.491) in the multivariate analysis. Conclusion Teenage pregnancy was associated with increased risk of premature delivery, apart from the effects of socioeconomic factors.

Adolescent deliveries in semi-urban Cameroon: prevalence and adverse neonatal outcomes

Objectives

Adolescent pregnancies are high risk due to the increased probability of adverse outcomes; as adolescents are usually considered to be ill-equipped to deal with the burden of pregnancy. We sought to determine the prevalence of adolescent deliveries in a secondary-level care hospital in semi-urban Cameroon-Bamenda, the adverse neonatal outcomes and to assess if previous obstetric history could preclude adolescents from having adverse outcomes in their present pregnancy.

Results

The prevalence of adolescent deliveries was 8.7% (95% CI 7.01–10.73%). The neonates of adolescent mothers were more likely to have severe asphyxia (OR 4.0; 95% CI 1.2–12.9; p = 0.03) and low birth weight (OR 2.4; 95% CI 1.3–4.4; p < 0.01). The neonates of primipara adolescents were just as likely to have complications as multipara adolescents. The prevalence of adolescent deliveries (8.7%) in the Regional Hospital Bamenda is high. Their babies are at a high risk of adverse neonatal outcomes irrespective of their previous obstetric history (previous delivery) emphasising that adolescents are generally ill-prepared to deal with pregnancy. Strategies to reduce the prevalence of adolescent deliveries should be investigated and implemented in view of attaining the sustainable development goals.

[Study of maternal and perinatal prognosis for vaginal delivery in adolescent girls in Lubumbashi, Democratic Republic of the Congo]

Introduction

L’objectif de cette étude était de déterminer la fréquence et d’évaluer le pronostic maternel et périnatal lors de l’accouchement chez les adolescentes dans la ville de Lubumbashi.

Méthodes

C’était une étude cas-témoin des accouchées d’une grossesse monofoetale de Décembre 2013 à Mai 2014 dans 10 maternités de référence à Lubumbashi (RD Congo). Les adolescentes (< 20 ans) ont été comparées aux femmes âgées de 20-34 ans. Les paramètres sociodémographiques maternels, la morbi-mortalité maternelle et périnatale ont été analysées. Les statistiques usuelles et la régression logistique ont été utilisées pour analyser les résultats. Le seuil de signification a été fixé à une valeur de p<0,05.

Résultats

L a fréquence d’accouchement chez les adolescentes était de 7,7%. Nous avons observé que la césarienne (ORa=1,9 (1,1-3,1)), l’épisiotomie (ORa=4,2 (2,9-5,9)), la délivrance pathologique (ORa= 2,7 (1,1-6,5)), l’éclampsie (ORa= 4,4 (1,3-14,5)) et le faible poids de naissance (ORa=2,0 (1,3-3,0)) ont été significativement plus élevés chez les adolescentes que chez les adultes.

Conclusion

L ’accouchement chez les adolescentes, comparativement à celui de femmes âgées de 20-34 ans, reste associé à un mauvais pronostic. D’où l’organisation des séances de sensibilisation pour une meilleure fréquentation des services consultations prénatales, une optimisation du dépistage, de la surveillance et de la prévention des pathologies de la grossesse chez les adolescentes s’avère importante et urgente.

Introduction

This study aimed to determine the frequency and to assess maternal and perinatal prognosis for vaginal delivery in adolescent girls in the city of Lubumbashi.

Methods

We conducted a case-control study of vaginal deliveries in singleton pregnancy in 10 referral hospitals in Lubumbashi (DR Congo) from December 2013 to May 2014. Adolescent girls (< 20 years) were compared to older women aged 20-34 years. Maternal sociodemographic parameters, morbi-maternal and perinatal mortality were analyzed. Usual statistics and logistic regression were used to analyze the results. The significance level was set at p <0.05.

Results

Vaginal delivery rate among adolescent girls was 7.7%. Cesarean section (OR=1.9 (1.1-3.1)), episiotomy (OR=4.2 (2.9-5.9)), pathological delivery (OR=2.7 (1.1-6.5)), eclampsia (OR=4.4 (1.3-14.5)) and low birth weight (OR=2.0 (1.3-3.0)) were significantly higher among adolescent girls than in adults.

Conclusion

Vaginal delivery in adolescent girls, compared to that of older women aged 20-34 years, is associated with a poor prognosis. Hence the importance and the urgent need to implement awareness sessions to increase attendance to prenatal consultation services, for screening optimization, monitoring and prevention for pregnancy pathologies in adolescent girls.

Adolescent Deliveries in a Secondary-Level Care Hospital of Cameroon: A Retrospective Analysis of the Prevalence, 6-Year Trend, and Adverse Outcomes

STUDY OBJECTIVE

Adolescents are generally ill-equipped to deal with the burden of a pregnancy. A high prevalence of adolescent pregnancies is among the indicators of limitations toward the achievement of the Millennium Development Goals in most developing countries. We sought to determine the prevalence, 6-year trend, and adverse outcomes of adolescent deliveries. We also tested whether being married decreased the risk of adverse fetal outcomes in these adolescents.

DESIGN

A 6-year retrospective register analysis.

SETTING

Buea Regional Hospital.

PARTICIPANTS

Birth records from 2007 to 2012.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Prevalence and 6-year trend in the rate of adolescent deliveries; adverse fetal outcomes.

RESULTS

The overall prevalence of adolescent deliveries was 9.9% (491 of 4941). There was no significant change in the annual prevalence of adolescent deliveries over 6 years (P trend = .8). Adolescent pregnancies were at higher risk of preterm deliveries (deliveries at gestational age <37 completed weeks; odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3-2.2; P < .01), low birth weight (defined as birth weight <2600 g; OR, 1.8; 95% CI, 1.4-2.3; P < .01), and neonatal asphyxia (OR, 1.4; 95% CI, 1.1-1.7; P < .01). There was no significant difference in the frequency of adverse outcomes between married and single adolescents.

CONCLUSION

One of every 10 babies is born from adolescent mothers in the Buea Regional Hospital. Whether these mothers are married or not, their neonates are exposed to higher morbidity. This emphasizes the need for more adolescent-friendly public health policies geared toward reducing the prevalence of this condition to improve the chances of attaining the Millennium Development Goals in Cameroon.

Newborn Care Practices among Adolescent Mothers in Hoima District, Western Uganda

INTRODUCTION

Adolescent childbearing remains a major challenge to improving neonatal mortality especially in Sub Saharan countries which are still struggling with high neonatal mortality rates. We explored essential newborn care practices and associated factors among adolescent mothers in Western Uganda.

METHODS

Data were collected among 410 adolescent mothers with children aged one to six months in Hoima district. Three composite variables (appropriate neonatal breastfeeding, cord care and thermal protection) were derived by combining related practices from a list of recommended newborn care practices. Logistic regression analysis was conducted to identify factors independently associated with practice of essential newborn care.

RESULTS

Appropriate newborn feeding, optimal thermal protection and dry cord care were practiced by 60.5%, 67.2% and 31% of adolescent mothers respectively. Independent predictors' of cord care were: knowledge of cord care (AOR 5.34, 95% CI (1.51-18.84) and having delivered twins (AOR 0.04, 95% CI (0.01-0.22). The only predictor of thermal care was knowledge (AOR 25.15, 95% CI (7.01-90.20). Staying in a hospital for more than one day postpartum (AOR 2.45, 95%CI (1.23-4.86), knowledge of the correct time of breastfeeding initiation (AOR 14.71, 95% CI (5.20-41.58), predicted appropriate neonatal feeding, whereas; adolescent mothers who had had a caesarean delivery (AOR 0.19, 95% CI (I 0.04-0.96) and a male caretaker in the postnatal period (AOR 0.18, 95% CI (0.07-0.49) were less likely to practice the recommended newborn feeding.

CONCLUSION

Sub optimal essential newborn care practice was noted especially suboptimal cord care. Adolescent mothers should be a focus of strategies to improve maternal and neonatal health.

Prevalence and outcome of teenage hospital births at the Buea Health District, South West Region, Cameroon

BACKGROUND

Teenage pregnancy is a high-risk condition that requires skilled antenatal care for good outcome. World estimates in 2008 report about 16 million births to adolescent mothers, most of them occurring in low and middle-income countries. In Cameroon, about 12% of all births are to adolescent mothers. This study determines the prevalence of hospital teenage deliveries in the Buea Health District and compares the delivery outcomes and demographic characteristics between pregnant teenage mothers (14-19) and adult mothers (20-29 years). We also identify factors associated with adverse pregnancy outcomes.

METHODS

We undertook a retrospective study of case files of patients who gave birth in the Buea Regional Hospital during the period 2009-2012, to determine the prevalence of hospital-delivered teenage pregnancies in the BHR. We also undertook a, cross-sectional study to compare the outcomes of 148 singleton adolescent births with 360 adult births in three health facilities in the Buea Health District during the period March 1 to August 31, 2013.

RESULTS

The prevalence of teenage births was 13.3%. The adverse fetal outcomes imputable to adolescent births were low birth weight (<2,500 g) (OR, 2.79; 95% CI, 1.28-6.09), preterm babies (<37 weeks) (OR: 1.85; 95% CI, 1.01-3.41), low 5 min Apgar score < 7 (OR: 1.66; 95% CI, 0.91-3.0). Adverse maternal outcomes associated with teenage pregnancies were mainly perineal tear (OR, 1.6; 95% CI, 0.95-2.7). Teenage births were not discovered in any significant way to cause preeclampsia/eclampsia, episiotomy, premature rupture of membranes and caesarean section. Maternal factors like age and gravidity were discovered to lead to adverse fetal outcomes in adolescents, while maternal factors like age, unemployment, marital status and gravidity were, for their part, directly responsible for adverse maternal outcomes in adolescents.

CONCLUSION

Teenage pregnancies are quite prevalent in the Buea Health District, and hospital delivery common. Adolescent pregnancies are more likely to lead to adverse fetal and maternal outcomes than adult pregnancies.

Complications in adolescent pregnancy: systematic review of the literature

Sexual activity during adolescence can lead to unwanted pregnancy, which in turn can result in serious maternal and fetal complications. The present study aimed to evaluate the complications related to adolescent pregnancy, through a systematic review using the Medical Subject Headings: “pregnancy complication” AND “adolescent” OR “pregnancy in adolescence”. Only full original articles in English or Portuguese with a clearly described methodology, were included. No qualitative studies, reviews or meta-analyses, editorials, case series, or case reports were included. The sample consisted of 15 articles; in that 10 were cross-sectional and 5 were cohort studies. The overall prevalence of adolescent pregnancy was 10%, and among the Brazilian studies, the adolescent pregnancy rate was 26%. The cesarean delivery rate was lower than that reported in the general population. The main maternal and neonatal complications were hypertensive disorders of pregnancy, prematurity and low birth weight, respectively. Adolescent pregnancy is related to increased frequency of neonatal and maternal complications and lower prevalence of cesarean delivery.

Adolescent childbearing and women's attitudes towards wife beating in 25 sub-Saharan African countries

Preventing unwanted adolescent pregnancy is key for keeping girls in school, leading to a more productive and healthier workforce in sub-Saharan Africa. Gender norms are an important indicator of the status of women and more conservative gender norms are associated with experiencing domestic violence, and poorer maternal and reproductive health care. This paper examines the association between adolescent childbearing and norms towards wife beating in sub-Saharan Africa, and the role of education in moderating this association. Data come from the most recent Demographic and Health Surveys-nationally representative cross-sectional surveys conducted every 5 years. Country-by-country multivariable logistic regressions were conducted in 25 countries, and country and regional estimates were obtained using meta-analytical techniques. More than half of sub-Saharan African adolescents have a child, with levels ranging from 23% in Rwanda to 69% in Niger. Between 12 and 87% of women believed wife beating is acceptable. In 20 of the 25 countries, women with a birth during adolescence were significantly more likely to believe wife beating is justified [OR = 1.39; 95% confidence interval (CI) 130-1.39]. After multivariate adjustment, the overall finding remains statistically significant [AOR = 1.09; 95% CI 105-1:13]. Education attenuates the observed association. Overall, the effects are strongest and most consistent in West Africa. Results suggest that women who have an adolescent birth more likely to hold more conservative attitudes. Working with adolescents to improve their attitudes on relationship expectations and the importance of furthering their education even after a pregnancy could be integrated into life skills and sexual education curricula.

Millennium Development Goal 5 and adolescents: looking back, moving forward

Since the Millennium Declaration in 2000, unprecedented progress has been made in the reduction of global maternal mortality. Millennium Development Goal 5 (MDG 5; improving maternal health) includes two primary targets, 5A and 5B. Target 5A aimed for a 75% reduction in the global maternal mortality ratio (MMR), and 5B aimed to achieve universal access to reproductive health. Globally, maternal mortality since 1990 has nearly halved and access to reproductive health services in developing countries has substantially improved. In setting goals and targets for the post-MDG era, the global maternal health community has recognised that ultimate goal of ending preventable maternal mortality is now within reach. The new target of a global MMR of <70 deaths per 100 000 live births by 2030 is ambitious, yet achievable and to reach this target a significantly increased effort to promote and ensure universal, equitable access to reproductive, maternal and newborn services for all women and adolescents will be required. In this article, as we reflect on patterns, trends and determinants of maternal mortality, morbidity and other key MDG5 indicators among adolescents, we aim to highlight the importance of promoting and protecting the sexual and reproductive health and rights of adolescents as part of renewed global efforts to end preventable maternal mortality.

Risk Factors for Preterm Birth among HIV-Infected Tanzanian Women: A Prospective Study

Premature delivery, a significant cause of child mortality and morbidity worldwide, is particularly prevalent in the developing world. As HIV is highly prevalent in much of sub-Saharan Africa, it is important to determine risk factors for prematurity among HIV-positive pregnancies. The aims of this study were to identify risk factors of preterm (<37 weeks) and very preterm (<34 weeks) birth among a cohort of 927 HIV positive women living in Dar es Salaam, Tanzania, who enrolled in the Tanzania Vitamin and HIV Infection Trial between 1995 and 1997. Multivariable relative risk regression models were used to determine the association of potential maternal risk factors with premature and very premature delivery. High rates of preterm (24%) and very preterm birth (9%) were found. Risk factors (adjusted RR (95% CI)) for preterm birth were mother <20 years (1.46 (1.10, 1.95)), maternal illiteracy (1.54 (1.10, 2.16)), malaria (1.42 (1.11, 1.81)), Entamoeba coli (1.49 (1.04, 2.15)), no or low pregnancy weight gain, and HIV disease stage ≥2 (1.41 (1.12, 1.50)). Interventions to reduce pregnancies in women under 20, prevent and treat malaria, reduce Entamoeba coli infection, and promote weight gain in pregnant women may have a protective effect on prematurity.

Early-married and sexually abused girls differ in their psychiatric outcomes

Early marriage and sexual abuse are the two of the most frequent types of childhood abuse. Although early marriage is also a type of sexual abuse, it is associated with different physical, social, and mental outcomes than sexual abuse alone. The purpose of this study was to compare early-married girls and sexually abused girls who were referred for forensic evaluation in Turkey in terms of their sociodemographic characteristics, mental disorder rates, and mental symptom severity. We included 63 adolescent girls for whom a judicial report had been demanded and who were under 15 years old when they were married but were not yet 18 years old during the evaluation (15.51±0.78) and 72 sexually abused adolescent girls between 14 and 18 years old (15.80±1.10) in this study. Following a psychiatric evaluation, the study participants completed the Child Posttraumatic Stress Disorder Reaction Index (CPTS-RI) and the Brief Symptom Inventory (BSI). We used the Windows SPSS 16.0 software program to assess the results. At least one psychiatric disorder was determined in 44.4% of the early-married and 77.8% of the sexually abused cases (p<0.001). A diagnosis of PTSD or ASD was observed in 11.1% of the early-married cases and in 54.2% of the sexually abused victims (p<0.001). MDD was determined in 33.3% of the early-married cases and 56.9% of the sexually abused cases (p=0.006). The CPTS-RI scores of the sexually abused victims were higher than those of the early-married cases (p<0.001). All of the subscale scores of the BSI were higher in the sexually abused adolescents than in the early-married cases (p<0.001). Although early marriage has severe physical, social and mental outcomes, it is not as severe as sexual abuse in terms of psychiatric disorder rates and the psychiatric symptom severity it causes.

Comparison of medical issues in antenatal and perinatal periods in early youth, adolescent, and young adult mothers in Taiwan: a 10-year nationwide study

BACKGROUND

Limited information is available concerning investigating the separate effect of teenage childbirth on medical issues in the antenatal and perinatal periods. Therefore, this study aimed to assess medical problems in antenatal and perinatal periods among early youth, adolescent and young adult mothers in Taiwan.

METHODS

This retrospective population-based cohort study was conducted by using data from Taiwan's National Health Insurance Research Database. A total of 335,590 mothers aged less than 25 years who had singleton births were identified between 2002 and 2011. Univariate and multivariate logistic regression analyses were conducted to estimate unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI) of each medical problem category in the antenatal and perinatal periods.

RESULTS

Compared with mothers aged 20-24 years, adolescents (16-19 years) and early youth mothers (≤ 15 years), particularly those aged 10-15, had a significantly higher risk of intrauterine growth retardation (IUGR, OR = 1.37, 95% CI: 1.00-1.89) and preterm delivery (OR = 2.98, 95% CI: 2.48-3.58) after adjusting for demographic characteristics and clinical factors. Additionally, adolescents mothers were at an increased risk of anemia (OR = 1.32, 95% CI: 1.24-1.40), oligohydramnios (OR = 1.21, 95% CI: 1.12-1.32), failed labor induction (OR = 1.33, 95% CI: 1.24-1.43), and fetal distress (OR = 1.20, 95% CI: 1.14-1.26) after adjustment.

CONCLUSIONS

Not all young mothers in our study experienced the same magnitude of increased medical problems in the antenatal and perinatal periods. However, a sufficiently higher probability of having IUGR and preterm delivery was observed among early youth and adolescent mothers.

Predictors of psychological distress among postnatal mothers in rural Nepal: a cross-sectional community-based study

BACKGROUND

Perinatal common mental disorders are a major cause of disability among women and have consequences for children's growth and development. We aimed to identify factors associated with psychological distress, a proxy for common mental disorders, among mothers in rural Dhanusha, Nepal.

METHODS

We used data from 9078 mothers who were screened for distress using the 12-item General Health Questionnaire (GHQ-12) around six weeks after delivery. We assessed the association between GHQ-12 score and socioeconomic, gender-based, cultural and reproductive health factors using a hierarchical analytical framework and multilevel linear regression models.

RESULTS

Using a threshold GHQ-12 score of ≥6 to indicate caseness, the prevalence of distress was 9.8% (886/9078). Factors that predicted distress were severe food insecurity (β 2.21 (95% confidence interval 1.43, 3.40)), having a multiple birth (2.28 (1.27, 4.10)), caesarean section (1.70 (0.29, 2.24)), perinatal health problems (1.58 (1.23, 2.02)), no schooling (1.37 (1.08, 1.73)), fewer assets (1.33 (1.10, 1.60)), five or more children (1.33 (1.09, 1.61)), poor or no antenatal care (1.31 (1.15, 1.48) p<0.001), having never had a son (1.31 (1.14, 1.49)), not staying in the parental home in the postnatal period (1.15 (1.02, 1.30)), having a husband with no schooling (1.17 (0.96, 1.43)) and lower maternal age (0.99 (0.97, 1.00)).

LIMITATIONS

The study was cross-sectional and we were therefore unable to infer causality. Because data were not collected for some established predictors, including infant death, domestic violence and history of mental illness, we could not assess their associations with distress.

CONCLUSIONS

Socioeconomic disadvantage, gender inequality and poor reproductive health predict distress among mothers in Dhanusha. Maternal and child health programmes, as well as poverty-alleviation and educational interventions, may be beneficial for maternal mental health.

Maternal age and low birth weight: a reinterpretation of their association under a demographic transition in southern Brazil

To evaluate the relationship between changes in fecundity rates and maternal age and the impact of maternal age on low birth weight (LBW) rates in a developed region in southern Brazil. A time series study evaluating birth weight and maternal ages through the born alive information system (SINASC) in Porto Alegre from 1996 to 2008. The Chi-square test for trends was used to evaluate the trend of LBW and fecundity rates at each maternal age. Population attributed risk (PAR) was used to calculate the impact of maternal age on LBW rates. The study included 271,100 newborns. There was a significant reduction in fecundity rates in all age groups younger than 34 years, but especially in the groups between 20 and 29 years. Overall LBW increased from 9.3 to 10.7 % (P < 0.001). The PAR for LBW showed a reduction in the group from 17 to 19 years (from 1.7 % in 1996-1999 to 0.1 % in 2004-2008), and an increase in the groups from 35 to 39 years (from 2.0 % in 1996-1999 to 2.3 % in 2004-2008) and above 40 (from 1.1 % in 1996-1999 to 1.5 % in 2004-2008). There was a significant change in fecundity pattern in the last 12 years in southern Brazil. Adolescent mothers were surpassed by mothers over 30 years of age in terms of vulnerability for LBW babies. The results show a change in the maternal age distribution towards older mothers, accompanied by an increasing incidence of LBW. This demographic transition also involved a paradoxical pattern with a remarkable reduction in fecundity rates in intermediate maternal age groups with concomitant increase in their risk for LBW.

The interplay of variants near LEKR and CCNL1 and social stress in relation to birth size

BACKGROUND

We previously identified via a genome wide association study variants near LEKR and CCNL1 and in the ADCY5 genes lead to lower birthweight. Here, we study the impact of these variants and social stress during pregnancy, defined as social adversity and neighborhood disparity, on infant birth size. We aimed to determine whether the addition of genetic variance magnified the observed associations.

METHODOLOGY/PRINCIPAL FINDINGS

We analyzed data from the Northern Finland Birth Cohort 1986 (n=5369). Social adversity was defined by young maternal age (<20 years), low maternal education (<11 years), and/or single marital status. Neighborhood social disparity was assessed by discrepancy between neighborhoods relative to personal socio-economic status. These variables are indicative of social and socioeconomic stress, but also of biological risk. The adjusted multiple regression analysis showed smaller birth size in both infants of mothers who experienced social adversity (birthweight by -40.4 g, 95%CI -61.4, -19.5; birth length -0.14 cm, 95%CI -0.23, -0.05; head circumference -0.09 cm 95%CI -0.15, -0.02) and neighborhood disparity (birthweight -28.8 g, 95%CI -47.7, -10.0; birth length -0.12 cm, 95%CI -0.20, -0.05). The birthweight-lowering risk allele (SNP rs900400 near LEKR and CCNL1) magnified this association in an additive manner. However, likely due to sample size restriction, this association was not significant for the SNP rs9883204 in ADCY5. Birth size difference due to social stress was greater in the presence of birthweight-lowering alleles.

CONCLUSIONS/SIGNIFICANCE

Social adversity, neighborhood disparity, and genetic variants have independent associations with infant birth size in the mutually adjusted analyses. If the newborn carried a risk allele rs900400 near LEKR/CCNL1, the impact of stress on birth size was stronger. These observations give support to the hypothesis that individuals with genetic or other biological risk are more vulnerable to environmental influences. Our study indicates the need for further research to understand the mechanisms by which genes impact individual vulnerability to environmental insults.

Risk factors of delivery by caesarean section in cameroon (2003-2004): a regional hospital report

We conducted this retrospective case-control study to identify possible risk factors of delivery through caesarean section in the Far North Region of Cameroon. Data was collected retrospectively from delivery room registers at the Provincial Hospital, Maroua, Cameroon from 01/01/2003 to 31/12/2004. The overall 125 eligible caesarean deliveries were compared with 244 women who delivered vaginally during the study period. The odds ratio as well as the 95% confidence interval was used to measure the relationship between maternal characteristic and risk of delivery by caesarean section. We found that the marital status is similar in the two study populations. Risk factors associated with cesarean section were: maternal age less than 17 years (OR 3.55, 95%CI: 1.46-8.64), maternal age over 39 years (OR 3.55, 95% CI: 1.17-10.75), nulliparity (OR 2.72, 95% CI: 1.59-4.66), grand multiparty (OR 3.43, 95% CI: 1.79-6.57), and macrosomia (OR 4.82, 95% CI: 1.49-16.44). There was a weak association with absent or poor. Caesarean delivery is associated with extreme ages of reproductive life, macrosomia, nulliparous and grand multiparous status. We strongly recommend that these factors be taken into consideration to strengthen the mother and child health programs in Cameroon and countries with similar socioeconomic profiles.

Parental age and child growth and development: child health check-up data

BACKGROUND

The aim of the present study was to determine whether parental age has any influence on child health.

METHODS

Well-baby check-up data at 1 month and at 12 months of age were used. The trends of parental age in association with growth measurements, incidence of physical and developmental abnormalities, occurrence of low birthweight, and maternal history of spontaneous abortion were analyzed.

RESULTS

Associations between increasing paternal age and incidence of psychomotor developmental delay at 12 months, increasing paternal and maternal age and increasing birthweight, and increasing parental age and higher incidence of history of spontaneous abortion were found. The incidence of low-birthweight infants was significantly decreased with increasing paternal age.

CONCLUSIONS

Not only increasing maternal age but also increasing paternal age have influences on child development and growth in the general population.

Early life undernutrition and adolescent pregnancy outcome in rural India

BACKGROUND

In poor communities of the Third World, adolescent pregnancy outcomes are likely to be worse in view of the prevailing chronic undernutrition.

AIM

The study examined the confounding effect of early life undernutrition on adolescent pregnancy outcome in rural India.

SUBJECTS AND METHODS

Retrospective information on socio-economic, demographic and anthropometric variables, gynaecological and obstetric history, pregnancy outcome and birth weight was obtained on 326 primigravid young married rural girls during 1998-2001.

RESULTS

Prevalence of pregnancy wastage (stillbirths and abortions) reduced significantly (p < 0.01) with increase in age at first conception. The risk for pregnancy wastage observed (OR = 1.95, 95% CI = 0.91-4.21) in mothers with early conception (<17.25 years) increased significantly to 4.24 (95% CI = 1.4-12.86) in case of girls with delayed menarcheal age (>or=14.5 years) or to 14.2 (95% CI = 1.17-173.2) if they had higher post-menarcheal stature growth (>or=4 cm). Similarly, risk for preterm delivery (OR = 2.18, 95% CI = 0.88-5.42) observed among mothers with early conception increased to 36.6 (95% CI = 3.57-374.0) if they had significant post-menarche gain in height. Our findings thus indicate that pregnancy outcome was adversely affected by early conception and prolonged adolescent growth, which are the features of biological immaturity in undernourished populations.

CONCLUSION

Our findings indicate that in view of prevailing socio-cultural conditions, good nutrition in early life for girls is essential to prevent post-menarcheal height growth while health education programmes are essential to prevent early conception in rural India. These observations have wider implications for similar rural settings especially in other developing countries.

Outcome of adolescent pregnancies in southwestern Nigeria: a case-control study

BACKGROUND

The most important health problems among adolescents in the developing countries are increased incidence of preterm labour and delivery, hypertensive disease, anaemia, more severe forms of malaria, obstructed labour, poor maternal nutrition and poor breastfeeding, low birth weight and increased neonatal mortality and morbidity.

OBJECTIVES

To evaluate the risk factors of adolescent pregnancy, assess and explore the occurrence of specific complications and compare pregnancy complications among adolescent parturients to older controls in a tertiary health centre in order to design appropriate policies and interventions.

METHOD

A retrospective study was conducted in a population of adolescents (age <18 years) delivered at the University College Hospital, Ibadan, Nigeria from January 2007 to November 2008. The birth register for the study-period was reviewed and socio-demographic data and labour records were extracted for both cases and controls.

RESULTS

The proportion of adolescent pregnancy between January 2007 and November, 2008 is between 1.5% and 2.2%. Overall, considering all the complications considered in the study 44.44% of adolescent pregnancies had one form of complication or the other. The corresponding figure among the control was 22.22%. The p-value = 0.002 showing that adolescents had statistically more significant complication rates in pregnancy. Concerning the individual complications, the incidence of eclampsia and pre-eclampsia among adolescent was 20% which was only 3.33% among the controls. The p-value when this was compared was 0.001 showing statistical significance.

CONCLUSION

Psychological, nutritional and social work services should be an integral part of obstetrical care in adolescent pregnancy especially in low resource country like Nigeria.

Geographic Distribution of Childbirth among Adolescents in Cameroon from 2003 to 2005

Objective. To determine the frequency and the trend of adolescents (10–19 years) in childbirth within a period of 3 years in referral maternity units in Cameroon. Method. Descriptive and retrospective study for a 3-year period (2003–2005) in referral maternity units headed by a qualified Obstetrician-Gynecologist. We analyzed the trend and geographic distribution of 8222 adolescent deliveries over 3 years. Epi Info 3.5 software was used for data analysis. Chi square test for trend was used to assess the contribution of adolescent deliveries over years. The trend was considered significant if P < .05. Results. During the period of the study, there was a total of 8387 deliveries. We excluded 165 women because of lack of information about age. We therefore included a total of 8222 adolescent deliveries. Overall, the contribution of adolescents to deliveries ranged from 6.87% to 26.51%, depending on the region with a national mean of 14.23%. Adolescents aged 16 or less contributed to 2.82% of deliveries while those aged from 17 to 19 contributed to 11.41%. The contribution of adolescents to deliveries decreased significantly over 3 years (P < .0001). Conclusion. The study underscores the importance of Public Health programs in strengthening maternity services for adolescents in Cameroon while taking into consideration geographic differences.

Circulating levels of inflammatory markers in intrauterine growth restriction

We aimed to investigate possible alterations in circulating levels of the perinatal stress markers high sensitivity (hs)-CRP, PAI-1, and S100B—probably reflecting brain and adipose tissue inflammation—in intrauterine growth-restricted-(IUGR) and appropriate-for-gestational-age-(AGA) pregnancies, given that these groups differ in fat mass and metabolic mechanisms involving aseptic inflammation. Serum hs-CRP, PAI-1, and S100B levels were measured in 40 mothers, and their 20 AGA and 20 IUGR full-term fetuses and neonates on postnatal days 1 and 4. hs-CRP, PAI-1, and S100B levels did not differ at all time points between AGA and IUGR groups. We conclude that the lack of difference in hs-CRP, PAI-1 and S100B levels, between IUGR and AGA fetuses/neonates—despite the lower birth weight, reflecting reduced fat mass in the former—might indicate more intense adipose tissue and nervous system inflammation in IUGRs. However, implication of other inflammation-related mechanisms, common in the IUGR state (e.g. preeclampsia), cannot be excluded.

Joint effect of obesity and teenage pregnancy on the risk of preeclampsia: a population-based study

PURPOSE

To determine the joint effect of young maternal age and obesity status on the risk of preeclampsia and eclampsia among a large cohort of singleton pregnancies.

METHODS

Data were obtained from birth cohort files recorded in the state of Florida during the years 2004-2007. The study sample consisted of mothers aged 13-24 (n = 290,807), divided into four obesity categories on the basis of prepregnancy body mass index (BMI): nonobese (BMI < 30), Class I obese (30.0 < or = BMI > or = 34.9), Class II obese (35.0 < or = BMI > or = 39.9), and extreme obesity (BMI > or = 40). Nonobese mothers (BMI < 30) between the ages of 20 and 24 years were the reference group. Logistic regression models were generated to adjust for the association between preeclampsia, obesity, and maternal age with sociodemographic variables and pregnancy complications as covariates.

RESULTS

The overall prevalence of preeclampsia in the study population was 5.0%. The risk of preeclampsia and eclampsia increased significantly with increasing BMI and decreasing age. Extremely obese teenagers were almost four times as likely to develop preeclampsia and eclampsia compared with nonobese women aged 20-24 years (adjusted odds ratio [95% confidence interval] = 3.79 [3.15-4.55]). Whereas obesity elevated the risk for preeclampsia and eclampsia among all women in the study, teenagers were most at risk because of the combined effects of young age and obesity.

CONCLUSION

Effective obesity prevention strategies should continue to be advocated for all teenagers, in addition to innovative approaches to teenage pregnancy prevention.

Body size and intelligence in 6-year-olds: are offspring of teenage mothers at risk?

OBJECTIVES

Children born to teenage mothers are at risk for more physical and cognitive problems than those born to adult mothers. Our objective was to examine differences in size and intelligence between two cohorts of offspring born to adolescent (n = 357) and adult mothers (n = 668) who attended the same prenatal clinic.

METHODS

Two prospective study cohorts assessed children from gestation through age 6 years. The adult cohort was studied in the mid-1980's and the teen cohort was evaluated in the mid-1990's. Both samples were of low socio-economic status. The same study design and measures allowed us to adjust for the covariates of size and IQ.

RESULTS

Offspring of adolescent mothers had a significantly smaller mean head circumference (5 mm) (HC) and higher body mass index (BMI) than offspring of adult mothers. Offspring of adolescent mothers scored significantly lower than the offspring of adult mothers on the Stanford-Binet (SBIS) composite score (4 points), and the quantitative (6.2 points), verbal reasoning (4.8 points), and short-term memory (3.9 points) area scores. Additional predictors of child IQ were maternal IQ, home environment, race, and number of siblings. When child HC was entered into our final regression model for the SBIS, maternal age and HC significantly predicted the composite score, the verbal reasoning, and short-term memory area scores. A 1 cm decrease in HC predicted a 1 point decrease in the SBIS composite score.

CONCLUSIONS

Compared to offspring of adult women, children of adolescent mothers have lower mean scores on cognitive measures, smaller head circumference, and higher BMI. These differences were significant after adjusting for differences between the two groups. Adolescent mothers and their children would benefit from interventions such as parenting support, education about nutritional needs, and advice on enriching the environments of their children.