Comparing Pregnancy in Adolescents and Adults: Obstetric Outcomes and Prevalence of Anemia

Maternal Nutrition and Fetal/Infant Development

Nutrition in pregnant mothers has long been known to be an important determinant of fetal/maternal outcomes. In general, the typical American diet shows opportunities for improvement. The intake of fruits, vegetables, whole grains, and fiber may be below recommended levels, but the relative proportion of sodium, fats, and carbohydrates seems high. In this review, we present current evidence on how the fetal/neonatal outcomes may be altered by maternal nutrition at the time of conception, fetal nutrition in utero, contribution of maternal dietary factors in fetal outcomes, weight gain during pregnancy, diabetes during pregnancy, fetal growth restriction (FGR), maternal nutritional status during later pregnancy, and pregnancy in adolescent mothers.

Association of Pregestational BMI and Gestational Weight Gain with Maternal and Neonatal Outcomes in Adolescents and Adults from Mexico City

During pregnancy, adolescents experience physiological changes different from adults because they have not concluded their physical growth. Therefore, maternal and neonatal outcomes may not be the same. This paper aimed to analyze the association between pregestational BMI (pBMI) and gestational weight gain (GWG) with maternal and neonatal outcomes in adolescent and adult pregnant women. The authors performed an observational study that included 1112 women, where 52.6% (n = 585) were adolescents. Sociodemographic information, pBMI, GWG, neonatal anthropometric measures, and maternal and neonatal outcomes were obtained. Adolescent women had a mean lower (21.4 vs. 26.2, p ≤ 0.001) pBMI than adults and a higher gestational weight gain (12.3 vs. 10.7 kg, p ≤ 0.001). According to Poisson regression models, gestational diabetes is positively associated with insufficient GWG and with pregestational obesity. Furthermore, the probability of developing pregnancy-induced hypertension increased with pBMI of obesity compared to normal weight. Preeclampsia, anemia, and preterm birth were not associated with GWG. Insufficient GWG was a risk factor, and being overweight was a protective factor for low birth weight and small for gestational age. We conclude that pBMI, GWG, and age group were associated only with gestational diabetes and low birth weight.

Prevalence of Low Birth Weight, Premature Birth, and Stillbirth Among Pregnant Adolescents in Canada: A Systematic Review and Meta-analysis

Although most studies show that adolescent pregnant women are at a higher risk for adverse birth outcomes, there has been limited research examining this relationship in Canada. This systematic review and meta-analysis investigated the prevalence of low birthweight (LBW), preterm birth (PTB), and stillbirth in Canadian adolescent women compared to adult women. Studies were included if they were primary research and included a sample of adolescent mothers (≤19 years) and adult mothers (≥20 years) who gave birth to singleton infants in Canada. Birth outcomes must have been measured consistently in at least 3 studies for inclusion. Comprehensive electronic literature searches were conducted from database inception until August 2020 in 5 databases. Random effects meta-analysis models were used to estimate pooled odds ratios (pOR) for LBW, PTB, and stillbirth between adolescent and adult pregnant women. Outcomes reported included PTB (8 studies), LBW (6 studies), and stillbirth (3 studies). Compared to adult mothers, adolescent mothers had a 56% increase in the prevalence of LBW (pOR 1.56, 95% confidence interval [CI] 1.24, 1.97), a 23% increase in PTB (pOR 1.23, 95% CI 1.06, 1.42), a 20% increase in stillbirth (pOR 1.20, 95% CI 1.05, 1.37). Heterogeneity, as assessed by I², was high for LBW and PTB and was low for stillbirth. A subgroup analysis did not remove the high heterogeneity, and some studies did not adjust for confounding variables and were missing information on sociodemographic and behavioral factors. Future research is needed to investigate the mechanisms surrounding these differences by maternal age.

Teenage pregnancy and experience of physical violence among women aged 15-19 years in five African countries: Analysis of complex survey data

BACKGROUND

Pregnant teenage women are prime targets of violence against women perpetrated by intimate partners, family members, and miscreants in their neighborhoods. This study estimated the prevalence of Teenage pregnancy (TP) and Physical Violence (PV) and further assessed the relationship between TP and PV in five Low-and-Middle-Income Countries (LMICs).

METHODS

The study was conducted among five LIMCs (Burkina Faso, Kenya, Malawi, Nigeria, and Tanzania) using data from the most recent Demographic and Health Surveys conducted in these countries. Modified Poisson with the robust standard error was used to quantify the association between TP and PV. All analyses adjusted for the complex survey design structure (clustering, weighting, and stratification).

RESULTS

The analysis involved a total of 26055 adolescent women aged 15-19 years across the five countries. The overall prevalence of TP was 25.4% (95%CI = 24.4-26.4) with the highest prevalence occurring among Malawians [29.0% (95%CI = 27.4-30.7)]. Meanwhile, the prevalence of TP among older adolescents (18-19 years) was approximately two-thirds significantly higher compared with young adolescents [aPR(95%CI) = 1.60[1.49-1.71)]. The prevalence of PV among teenagers across the five countries was 24.2% (95%CI = 22.3-26.2). The highest prevalence of PV was recorded among Nigerian adolescent women [31.8% (95%CI = 28.5-35.3)]. The prevalence of PV among adolescent women who were pregnant was approximately 5-folds significant compared to those who were not pregnant (adjusted prevalence ratio; aPR = 4.70; 95% CI: 3.86-5.73; p<0.0001).

CONCLUSION

There was a high prevalence of pregnancy among older teenagers aged 18-19 years. Close to a quarter of teenage women ever experienced physical violence. Pregnant teenage women ever experience of physical violence was very high compared to non-pregnant peers. Intervention should target PV and TP by adopting a gender-sensitive approach to eliminate physical violence, particularly among teenagers to prevent TP.

Effect of Integrated Pictorial Handbook Education and Counseling on Improving Anemia Status, Knowledge, Food Intake, and Iron Tablet Compliance Among Anemic Pregnant Women in Indonesia: A Quasi-Experimental Study

Purpose

To determine the effect of individual education through a pictorial handbook on anemia in conjunction with counseling on improving hemoglobin and hematocrit level, birth weight, knowledge, iron-rich food and iron-folic acid (IFA) intake.

Patients and Methods

The study developed a pictorial handbook that was conceptualized based on the Health Belief Model and adjusted to some cultural and local contexts. A quasi-experimental pre-test–post-test control group design was used, purposefully conducted between two homogenous municipalities, each having a rate of anemic pregnancy that was 40% or greater. The sample consists of 140 anemic pregnant women randomly allocated via lottery into two groups; the intervention group (n=70), which received two home visits—one for education and another for a counseling session, and control group (n=70), which received routine antenatal care. A chi-square test and a Mann–Whitney U-test were conducted to compare the baseline socio-demographics. An analysis of covariance (ANCOVA), controlling some possible confounders, was performed to analyze the effect of intervention.

Results

The post-test means of hemoglobin F (1, 132) = 122, p-value <0.001, and hematocrit levels F (1, 132) = 373, p-value <0.001, were significantly different and higher in the intervention group compared to the control group. Similar results were found in knowledge, food frequency score, number of IFA intake (with p-value <0.001), birth weight and daily iron intake from food (with p-value <0.05). The intervention had a particularly large effect on food frequency score and number of IFA intake, and medium effect on hemoglobin and hematocrit levels.

Conclusion

Individual education through a pictorial handbook on anemia in conjunction with the counseling intervention program had a positive impact on hemoglobin and hematocrit levels for anemic pregnant women in their third trimester of pregnancy.

Descriptive epidemiology of anaemia among pregnant women initiating antenatal care in rural Northern Ghana

Background

Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana.

Aim

The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits.

Setting

The study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana.

Methods

A retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC.

Results

We analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31–13.8). The median gestational age at booking was 14 weeks (5–36 weeks). The prevalence of anaemia was 42.7%, with 95% confidence interval (CI) [38.4–47.1], and was high among teenage mothers (52% [34.9–67.8]), mothers who booked in the third trimester (55% [33.6–74.7]) and grand multiparous women (58% [30.7–81.6]). Factors associated with anaemia included grand multiparity (odds ratio [OR] = 1.94 with 95% CI [1.58–2.46]), booking during the third trimester (OR = 2.06 [1.78–2.21]) and mother who were underweight compared to those with normal weight (OR = 3.17 [1.19–8.32]).

Conclusion

Burden of anaemia in pregnancy is still high in rural northern Ghana. We advocate further strengthening of the primary health care system to improve early access to ANC delivery.

Keywords

anaemia in pregnancy; booking visit; maternal and child health; Navrongo; rural; Ghana.

The impact of maternal age on foetal growth patterns and newborn size

The association patterns between maternal age and foetal growth parameters as well as newborn size were analysed using a dataset of 4737 singleton term births taking place at the Viennese Danube hospital. Foetal growth patterns were reconstructed by the results of three ultrasound examinations carried out at the 11th/12th, 20th/21th and 32th/33thweek of gestation. In detail, crown-rump length, biparietal diameter, fronto-occipital diameter, head circumference, abdominal transverse diameter, abdominal anterior-posterior diameter, abdominal circumference, and femur length were determined. Birth weight, birth length and head circumference were measured immediately after birth. Young teenage mothers (≤15 years), older adolescent mothers (16-19 years), mothers of optimal age range (20-35 years) and mothers of advanced age (>35 years) differed significantly in body height, pre-pregnancy weight status and gestational weight gain. Surprisingly, the foetuses of young adolescent mothers were the largest ones during first trimester. During the second and third trimester however, the foetuses of mothers of optimal age range (20-35 years) and mothers older than 35 years showed larger biometric dimensions than adolescent mothers. According to multiple regression analyses, maternal age was significantly related to Foetal head size (ß =-0.04; 95% CI = -0,08 – 0.01; p=0.034) and abdominal dimensions (ß= 0.03; 95% CI = 0.01-0.05; p=0,011) during the second trimester and to birthweight (ß= -0.03; 95% CI= -4.40 – 0.04; p=0.050). The associations however, are quite weak and the statistical significance is maybe due to the large sample size. At the time of birth, offspring of mothers of optimal age range (20 to 35 years) is significantly larger than that of adolescent mothers and mothers of advanced age. Mothers of advanced age showed the significantly highest (p=<0.0001) prevalence (5.6%) of SGA newborns (<2500g). The small size of newborn among young adolescent mothers may be due to a competition over nutrients between the still growing mothers and the foetuses during the third trimester, while placental ageing may be responsible for smaller size of offspring among mothers of advanced age.

Options Counseling for the Pregnant Adolescent Patient

Each year, more than 500 000 girls and young women younger than 20 years become pregnant. It is important for pediatricians to have the ability and the resources in their offices to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental pregnancy options counseling. Counseling includes an unbiased discussion of the adolescent's legal options to either continue or terminate her pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.

Influence of gestational weight gain and BMI on cesarean delivery risk in adolescent pregnancies

OBJECTIVE

Obesity and excessive gestational weight gain (GWG) increase cesarean delivery (CD) risk; however, their influence on teen pregnancies is less clear. We describe the influence of GWG and pre-pregnancy body mass index (BMI) on primary CD (PCD) risk in adolescent compared with adult pregnancies.

STUDY DESIGN

Population-based cohort study of Ohio births (2006 to 2012), n=1 034 552. Analyses were limited to 251 398 singleton live births in term (37 to 42 weeks) primiparas. Multivariate logistic regression estimated the association between BMI, GWG and CD risk in teens compared with adults (20 to 34 years), adjusting for maternal race, smoking status and labor induction.

RESULTS

The primary cesarean rate (PCD) for primiparous women was 25.6%. It was lower for adolescents (17% <15 years, 17% 15 to 17 years, 19% 18 to 19 years) compared with adults (26%, P<0.001). The PCD rate increased with excessive (29%) vs Institute of Medicine (IOM)-recommended GWG (20%). The PCD rate was also increased in mothers who were overweight (29%), and obese (39%) vs those with normal pre-pregnancy BMI (20%, P<0.001). The lowest PCD rate (11.6%) observed in normal weight teens <18 years was with appropriate GWG (adjusted odds ratio (aOR) 0.61; 95% CI 0.54 to 0.69). Compared with adults, teens have 43% lower PCD risk (aOR 0.57; 95% CI 0.55 to 0.60). Excessive GWG increased the risk for PCD in adults by 64% (aOR 1.64; 95% CI 1.59 to 1.68). Excessive GWG increased PCD in the highest risk groups, obese adults (aOR 1.24; 1.17 to 1.32) and obese teens (aOR 1.26; 95% CI 1.08 to 1.46).

CONCLUSION

Excessive GWG increases the risk of PCD. Young maternal age was protective of this effect. However, excessive GWG increased PCD risk in both teen and adult mothers. To reduce the primary cesarean rate, efforts should target interventions to promote optimal GWG, especially in those at highest risk, obese women of all ages.

Adverse obstetrical and perinatal outcome in adolescent mothers associated with first birth: a hospital-based case-control study in a tertiary care hospital in North-East India

PURPOSE

To analyze the adverse obstetrical and perinatal outcome of adolescent mothers associated with first birth.

PATIENTS AND METHODS

This prospective case-control study was conducted in a tertiary care teaching hospital of North-East India between January 2014 and December 2014. All adolescent primigravidae completing 28 weeks of gestation with singleton pregnancy and delivered at our institution were included in the study group. Primigravidae aged between 20 and 25 years were taken as a control group. Mothers having pregnancy complicated with diabetes mellitus, renal disorder, thyroid disorders, and cardiac diseases were excluded from the study. Demographic data, maternal complications like severe anemia, pre-eclampsia, eclampsia, gestational age at delivery, mode of delivery, and postpartum complications were compared. Among fetal complications, low-birth weight, preterm birth, neonatal intensive care unit admission, still birth, and early neonatal death were compared. All the patients were interviewed regarding contraceptive knowledge and its use preceding the pregnancy.

RESULTS

Quality antenatal care was received by 80.6% of adolescent mothers. The adolescent mothers had a higher incidence of pre-eclampsia (odds ratio [OR] 2.017 95% confidence interval [CI]: 1.045-3.894, P=0.03), preterm deliveries (OR: 1.655, 95% CI: 1.039-2.636, P=0.03). Among fetal outcomes, the low- birth weight babies (OR: 1.59, 95% CI: 1.016-2.478), low mean birth weight (2,544.4±622.09 g versus 2,701.6±582.51 g), and higher admission to neonatal intensive care unit (OR: 1.957, 95% CI: 1.120-3.417) were significantly associated with adolescent mothers. There was no significant difference found regarding the mode of delivery, still birth, and early neonatal death. Moreover, contraceptive knowledge and its use were found to be poor among adolescent mothers.

CONCLUSION

With quality antenatal, intranatal, and postnatal care, the obstetric risk of childbirth in adolescent mothers may not be as serious as perceived to be.

The Collection and Analysis of Carbon Monoxide Levels as an Indirect Measure of Smoke Exposure in Pregnant Adolescents at a Multidisciplinary Teen Obstetrics Clinic

STUDY OBJECTIVE

In this study we aimed to collect and analyze CO levels as an indirect measure of smoke exposure in pregnant adolescents.

DESIGN, SETTING, AND PARTICIPANTS

Participants included pregnant adolescents who received antenatal care over 18 months (2012-2013) at the Multidisciplinary Teen Obstetrics Clinic at a tertiary-care hospital in Southeastern Ontario.

INTERVENTIONS

The CO breath test is a noninvasive method that is used to assess smoke exposure, in which nonsmokers have levels of 0-6 ppm, and levels of 7-10, 11-20 and more than 20 ppm are consistent with light, typical, and heavy smokers, respectively. Expired CO, smoking status, cigarette number, and home secondhand smoke exposure were documented at 3 clinic visits.

MAIN OUTCOME MEASURES

To determine mean CO levels as a measure of smoke exposure and prevalence of secondhand smoke exposure.

RESULTS

The mean age of participants was 17.6 years. CO means (ppm) across 3 visits were 6.0, 5.9, and 4.8. Sixty-two percent of patients were self-reported nonsmokers, 38% were self-reported smokers (n = 93). CO means (standard error of the mean) were consistently different for nonsmokers vs smokers at visits 1 to 3, respectively: 2.9 (0.79) vs 9.7 (1.8); 3.0 (0.71) vs 12.9 (2.2), and 2.4 (0.71) vs 8.8 (1.5; P < .01, t test; n = 91). Of patient's highest CO (COmax), 62%, 9%, 15%, and 12% had levels of 6 or less, 7-10, 11-20, and greater than 20, respectively. Eighty-four percent of pregnant adolescents had home secondhand smoke exposure, which included 40% of nonsmokers and 100% of smokers (n = 57). Although most nonsmokers had a COmax of 6 or fewer ppm, 56% of smokers had COmax greater than 10 ppm (P < .05, χ(2)).

CONCLUSION

Emphasis on smoking cessation is imperative in pregnant adolescents and should particularly target partners and families, because secondhand smoke exposure was very prevalent.

Adolescent Pregnancy Guidelines

OBJECTIVE

To describe the needs and evidence-based practice specific to care of the pregnant adolescent in Canada, including special populations.

OUTCOMES

Healthy pregnancies for adolescent women in Canada, with culturally sensitive and age-appropriate care to ensure the best possible outcomes for these young women and their infants and young families, and to reduce repeat pregnancy rates.

EVIDENCE

Published literature was retrieved through searches of PubMed and The Cochrane Library on May 23, 2012 using appropriate controlled vocabulary (e.g., Pregnancy in Adolescence) and key words (e.g., pregnancy, teen, youth). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to English or French language materials published in or after 1990. Searches were updated on a regular basis and incorporated in the guideline to July 6, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, national and international medical specialty societies, and clinical practice guideline collections.

VALUES

The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS/HARMS/COSTS: These guidelines are designed to help practitioners caring for adolescent women during pregnancy in Canada and allow them to take the best care of these young women in a manner appropriate for their age, cultural backgrounds, and risk profiles.

RECOMMENDATIONS

1. Health care providers should adapt their prenatal care for adolescents and offer multidisciplinary care that is easily accessible to the adolescent early in the pregnancy, recognizing that adolescents often present to care later than their adult counterparts. A model that provides an opportunity to address all of these needs at one site may be the preferred model of care for pregnant adolescents. (II-1A) 2. Health care providers should be sensitive to the unique developmental needs of adolescents through all stages of pregnancy and during intrapartum and postpartum care. (III-B) 3. Adolescents have high-risk pregnancies and should be managed accordingly within programs that have the capacity to manage their care. The unique physical risks of adolescent pregnancy should be recognized and the care provided must address these. (II-1A) 4. Fathers and partners should be included as much as possible in pregnancy care and prenatal/infant care education. (III-B) 5. A first-trimester ultrasound is recommended not only for the usual reasons for properly dating the pregnancy, but also for assessing the increased risks of preterm birth. (I-A) 6. Counselling about all available pregnancy outcome options (abortion, adoption, and parenting) should be provided to any adolescent with a confirmed intrauterine gestation. (III-A) 7. Testing for sexually transmitted infections (STI) (II-2A) and bacterial vaginosis (III-B) should be performed routinely upon presentation for pregnancy care and again in the third trimester; STI testing should also be performed postpartum and when needed symptomatically. a. Because pregnant adolescents are inherently at increased risk for preterm labour, preterm birth, and preterm pre-labour rupture of membranes, screening and management of bacterial vaginosis is recommended. (III-B) b. After treatment for a positive test, a test of cure is needed 3 to 4 weeks after completion of treatment. Refer partner for screening and treatment. Take the opportunity to discuss condom use. (III-A) 8. Routine and repeated screening for alcohol use, substance abuse, and violence in pregnancy is recommended because of their increased rates in this population. (II-2A) 9. Routine and repeated screening for and treatment of mood disorders in pregnancy is recommended because of their increased rates in this population. The Edinburgh Postnatal Depression Scale administered in each trimester and postpartum, and more frequently if deemed necessary, is one option for such screening. (II-2A) 10. Pregnant adolescents should have a nutritional assessment, vitamins and food supplementation if needed, and access to a strategy to reduce anemia and low birth weight and to optimize weight gain in pregnancy. (II-2A) 11. Conflicting evidence supports and refutes differences in gestational hypertension in the adolescent population; therefore, the care usual for adult populations is supported for pregnant adolescents at this time. (II-2A) 12. Practitioners should consult gestational diabetes mellitus (GDM) guidelines. In theory, testing all patients is appropriate, although rates of GDM are generally lower in adolescent populations. Practitioners should be aware, however, that certain ethnic groups including Aboriginal populations are at high risk of GDM. (II-2A) 13. An ultrasound anatomical assessment at 16 to 20 weeks is recommended because of increased rates of congenital anomalies in this population. (II-2A) 14. As in other populations at risk of intrauterine growth restriction (IUGR) and low birth weight, an ultrasound to assess fetal well-being and estimated fetal weight at 32 to 34 weeks gestational age is suggested to screen for IUGR. (III-A) 15. Visits in the second or third trimester should be more frequent to address the increased risk of preterm labour and preterm birth and to assess fetal well-being. All caregivers should be aware of the signs and symptoms of preterm labour and should educate their patients to recognize them. (III-A) 16. It should be recognized that adolescents have improved vaginal delivery rates and a concomitantly lower Caesarean section rate than their adult counterparts. (II-2A) As with antenatal care, peripartum care in hospital should be multidisciplinary, involving social care, support for breastfeeding and lactation, and the involvement of children's aid services when warranted. (III-B) 17. Postpartum care should include a focus on contraceptive methods, especially long-acting reversible contraception methods, as a means to decrease the high rates of repeat pregnancy in this population; discussion of contraception should begin before delivery. (III-A) 18. Breastfeeding should be recommended and sufficient support given to this population at high risk for discontinuation. (II-2A) 19. Postpartum care programs should be available to support adolescent parents and their children, to improve the mothers' knowledge of parenting, to increase breastfeeding rates, to screen for and manage postpartum depression, to increase birth intervals, and to decrease repeated unintended pregnancy rates. (III-B) 20. Adolescent women in rural, remote, northern, and Aboriginal communities should be supported to give birth as close to home as possible. (II-2A) 21. Adolescent pregnant women who need to be evacuated from a remote community should be able to have a family member or other person accompany them to provide support and encouragement. (II-2A) 22. Culturally safe prenatal care including emotional, educational, and clinical support to assist adolescent parents in leading healthier lives should be available, especially in northern and Aboriginal communities. (II-3A) 23. Cultural beliefs around miscarriage and pregnancy issues, and special considerations in the handling of fetal remains, placental tissue, and the umbilical cord, must be respected. (III).

Prepregnancy Body Mass Index and Gestational Weight Gain Have No Negative Impact on Maternal or Neonatal Iron Status

OBJECTIVE

To assess the impact of maternal obesity and excessive gestational weight gain (GWG) on maternal and neonatal iron status and to explore the possible mediating role of inflammation on hepcidin.

METHODS

This analysis included 230 pregnant adolescents (13-18 years) enrolled in either a longitudinal or a cross-sectional study. Prepregnancy body mass index (ppBMI) and GWG were obtained from medical records. Maternal iron status (hemoglobin, serum iron, ferritin, transferrin receptor, total body iron, and hepcidin) and inflammation (interleukin-6 [IL-6] and leptin) were assessed at midgestation (26.2 ± 3.3 weeks) in the longitudinal cohort and at delivery (39.8 ± 1.3 weeks) in both study cohorts. Cord blood was collected in both studies and analyzed for iron indicators.

RESULTS

Approximately 40% of the adolescents entered pregnancy overweight or obese. Multivariate analysis identified ppBMI as a negative predictor of serum iron at midgestation (P = .009) and a positive predictor of serum hepcidin at delivery (P = .02). None of the other maternal iron status indicators were significantly associated with ppBMI or GWG. Serum IL-6 was significantly positively associated with hepcidin at delivery (P = .0001) but not at midgestation. There was a positive relationship between ppBMI and cord hemoglobin (P = .03).

CONCLUSION

These results suggest that adiposity-related inflammation does not override the iron-mediated signals that regulate hepcidin production during pregnancy, and in this adolescent cohort, there is no strong evidence for a detrimental effect of maternal obesity and excessive weight gain on iron status in the offspring at birth.

Gynecologic age is an important risk factor for obstetric and perinatal outcomes in adolescent pregnancies

BACKGROUND

Adolescent pregnancy is an important public health problem. Physiological maturity affects obstetric and perinatal outcomes. Almost all assessments of adolescent pregnancies are based on chronological age. Gynecologic age (GA) is defined as age in years at conception minus age at menarche and it is an indicator of physiological maturity.

AIM

To compare obstetric and perinatal outcomes between adult and adolescent pregnancies as categorized according to GA.

METHODS

In this retrospective study, 233 adolescent pregnant women were divided into two groups based on GA≤3 years (101 women) and GA>3 years (132 women). Their obstetric and perinatal results were compared with 202 adult pregnancies who gave birth in the same period.

FINDINGS

Gestational age at delivery, APGAR scores, birth weight, and incidence of preterm birth, admission to neonatal intensive care unit (NICU), intrauterine growth restriction, low birth weight, and premature rupture of membranes were significantly different between the study groups. Compared to adolescent pregnancies with GA>3 years, adolescent pregnancies with GA≤3 years had significantly lower birth weight, gestational age, APGAR scores, and significantly higher incidence of intrauterine growth restriction, low birth weight and admission to NICU.

CONCLUSION

Low GA is associated with an increased rate of obstetric and perinatal complications in adolescent pregnancies. Although the main aim is the prevention of adolescent pregnancies, a detailed evaluation of such pregnancies including determination of the gynecological age together with a multidisciplinary approach may decrease potential complications.

A review of the risks and consequences of adolescent pregnancy

OBJECTIVE

To evaluate the risks and consequences of young maternal age on both the mother and the newborn.

STUDY DESIGN

A comprehensive literature review on the risks and consequences of adolescent pregnancy was performed.

RESULTS

Young maternal age is associated with an increased risk of maternal anemia, infections, eclampsia and preeclampsia, emergency cesarean delivery, postpartum depression and inadequate breastfeeding initiation. Infants of teenage mothers are more likely to be premature and have a low birth weight, and are at an increased risk for respiratory distress syndrome and autism later in life.

CONCLUSIONS

Adolescent pregnancy is a prevalent phenomenon associated with increased risks of both maternal and neonatal complications during and after pregnancy. Being aware of such adverse outcomes is imperative to improving prenatal and perinatal care. Pregnancy progression can also be influenced by the mother's culture, environment, and economic status; advancement in which may be a possible course for future improvement.

Is teenage pregnancy an obstetric risk in a welfare society? A population-based study in Finland, from 2006 to 2011

OBJECTIVE

To assess obstetric outcomes in teenage pregnancies in a country with a low teenage delivery rate and comprehensive high-quality prenatal care.

DESIGN

Retrospective population-based register study.

SETTING

Finland.

PARTICIPANTS

All nulliparous teenagers (13-15 years (n=84), 16-17 years (n=1234), 18-19 years (n=5987)) and controls (25-year-old to 29-year-old women (n=51 142)) with singleton deliveries in 2006-2011.

MAIN OUTCOME MEASURES

Risk of adverse obstetric outcomes adjusted for demographic factors and clinically relevant pregnancy complications, with main focus on maternal pregnancy complications.

RESULTS

Teenage mothers were more likely than controls to live in rural areas (16% (n=1168) vs 11.8% (n=6035)), smoke (36.4% (n=2661) vs 7% (n=3580)) and misuse alcohol or drugs (1.1% (n=82) vs 0.2% (n=96); p<0.001 for all). Teenagers made a good mean number of antenatal clinic visits (16.4 vs 16.5), but were more likely to have attended fewer than half of the recommended visits (3% (n=210) vs 1.4% (n=716)). Teenagers faced increased risks of several obstetric complications, for example, anaemia (adjusted OR 1.8, 95% CI 1.6 to 2.1), proteinuria (1.8, 1.2 to 2.6), urinary tract infection (UTI; 2.9, 1.8 to 4.8), pyelonephritis (6.3, 3.8 to 10.4) and eclampsia (3.2, 1.4 to 7.3), the risks increasing with descending age for most outcomes. Elevated risks of pre-eclampsia (3.7, 1.5 to 9.0) and preterm delivery (2.5, 1.2 to 5.3) were also found among 13-year-olds to 15-year-olds. However, teenage mothers were more likely to have vaginal delivery (1.9, 1.7 to 2.0) without complications. Inadequate prenatal care among teenagers was a risk factor of eclampsia (12.6, 2.6 to 62.6), UTI (5.8, 1.7 to 19.7) and adverse neonatal outcomes.

CONCLUSIONS

Pregnant teenagers tended to be socioeconomically disadvantaged versus controls and faced higher risks of various pregnancy complications. Special attention should be paid to enrolling teenagers into adequate prenatal care in early pregnancy.

The association between young maternal age and pregnancy outcome

OBJECTIVE

We aimed to determine the association between young maternal age at delivery with adverse pregnancy outcome in a single, tertiary, university-affiliated medical center.

METHODS

A retrospective, cohort, matched control study using the first percentile distribution of maternal age at delivery (21 years old, n = 461) as the study group, and four control groups by maternal age matched by parity in a 2:1 ratio (22-25, 26-30, 31-35 and 36-40 years; n = 922 each).

RESULTS

Women aged ≤21 years were found to have lower rates of chronic hypertension [compared with women aged 36-40 years old (0.0% versus 1.3%, p < 0.05)], lower rates of gestational diabetes mellitus (GDM) (1.3% versus 3.7%, p = 0.007), higher rates of perineal lacerations [compared with women aged 31-35 and 36-40 years old, 41% versus 31.8% and 31.1%, respectively, p < 0.01)], higher rates of postpartum hemorrhage (4.6% versus 1.5%, p < 0.0001) and higher rates of low 5-min Apgar score (2.2% versus 0.8%, p = 0.004). No significant differences were found in terms gestational age at delivery, birth weight, fetal sex, intrapartum or antepartum mortality.

CONCLUSION

Young maternal age at delivery is associated with increased risk of short-term complications after delivery.

Análise comparativa das gestações e da frequência de prematuridade e baixo peso ao nascer entre filhos de mães adolescentes e adultas

OBJETIVO: Realizar uma análise comparativa entre frequência de prematuridade e baixo peso ao nascer entre recém-nascidos de mães adolescentes e adultas, e avaliar dados maternos selecionados. MÉTODOS: Estudo de coorte comparativo, envolvendo 703 gestantes internadas em hospital público da cidade de São Paulo e seus recém-nascidos (270 mães entre 10 e 19 anos e 433 entre 20 e 35 anos), no período de março a agosto de 2003. RESULTADOS: O nascimento de crianças prematuras ou com baixo peso não foi predominante em nenhuma das faixas etárias; pequenas diferenças encontradas não foram estatisticamente significativas. No entanto, foram encontradas diferenças significativas entre os dois grupos etários nos quesitos: número de gestações, predominando maior número de primeiras gestações entre as adolescentes (70,3%) e maior número de segundas ou terceiras entre as adultas (26,9 e 53,3%, respectivamente) e, no pré-natal, predominando menor número de consultas entre as adolescentes e maior entre as adultas (45,1% e 63,3%, respectivamente). CONCLUSÃO: O grupo de gestantes adolescentes, na população estudada, não diferiu do grupo de adultas, quanto à frequência de prematuridade e ao baixo peso ao nascer. Entre as adolescentes, houve significativamente maior número de primíparas, em relação às adultas, e menor número de consultas pré-natais.

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.

Comparison of adolescent, young adult, and adult women's maternity experiences and practices

BACKGROUND AND OBJECTIVE

Pregnant adolescents face unique challenges. Understanding the experiences, knowledge, and behaviors of adolescents during the pregnancy and postpartum periods may contribute to improvement of their maternity care. The purpose of this study was to compare the maternity experiences, knowledge, and behaviors of adolescent, young adult, and adult women by using a nationally representative sample.

METHODS

This study used data from the Canadian Maternity Experiences Survey (N = 6421). The weighted proportions of each variable were calculated by using survey sample weights. Logistic regression was used to estimate odds ratios. Bootstrapping techniques were used to calculate variance estimates for prevalence and 95% confidence intervals.

RESULTS

Adolescents and young adults were more likely to experience physical abuse in the previous 2 years, initiate prenatal care late, not take folic acid before or during pregnancy, have poor prenatal health behaviors, have a lower cesarean delivery rate, have lower breastfeeding initiation and duration rates, experience more stressful life events, experience postpartum depression symptoms, and rate their infant's health as suboptimal than adult women. Adolescents were more likely to rate their own health as suboptimal.

CONCLUSIONS

Adolescents have unique needs during pregnancy and postpartum. Health care professionals should seek to provide care in a manner that acknowledges these needs.

Testing the theory of reasoned action in explaining sexual behavior among African American young teen girls

This study tested the Theory of Reasoned Action to examine the prediction of early sexual behavior among African American young teen girls. Baseline data from a longitudinal randomized clinical trial were used. Between 2001 and 2005, 198 middle-school girls aged 11 to 14 years were recruited. As girls aged, they held more permissive attitudes toward engaging in early sexual behavior and had a higher intention to engage in early sexual behavior. Intention was a significant predictor to explain sexual behavior among the girls. There is a need to develop strategies that promote intention related to delay and prevention of early sexual behavior.

Liver iron status and associated haematological parameters in relation to fetal growth and pregnancy outcome in rapidly growing adolescent sheep carrying a singleton lamb derived by embryo transfer

Maternal and fetal liver iron concentrations and associated haematology parameters were determined in an adolescent sheep paradigm characterised by rapid maternal growth, premature delivery and feto-placental growth restriction. Singleton-bearing dams were offered a control or high dietary intake to induce normal or growth-restricted pregnancies, respectively. Pregnancies were terminated on Day 90 or 130 of gestation or progressed to term. Relative blood volume increased (P < 0.05) and liver iron concentration decreased (P < 0.003) from mid to late gestation in control, but not in high-intake dams. At 90 and 130 days gestation, liver iron concentrations were reduced (P < 0.001) in high-intake dams but fetal liver iron was independent of dam nutrition. High intakes leading to poor pregnancy outcome at term were characterised by increased maternal haematocrit, haemoglobin, total plasma protein, albumin (all P < 0.001) and serum iron (P < 0.05), and by reduced oestradiol 17β (P < 0.001) at Day 130. Thus, high dietary intakes that promote rapid maternal growth and adiposity are associated with early depletion of maternal liver iron stores and a relative failure of normal blood volume expansion, which may, in turn, underlie the reduction in uteroplacental blood flows and fetal nutrient delivery previously established for this paradigm.

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.

Leaf concentrate as an alternative to iron and folic acid supplements for anaemic adolescent girls: a randomised controlled trial in India

Objective

Despite public health campaigns based on Fe and folic acid supplements, Fe-deficiency anaemia remains highly prevalent among women in India. We investigated leaf concentrate as an alternative to Fe and folic acid supplements for treating anaemia in adolescent girls.

Design

Randomised controlled two-arm trial over 3 months: one group received daily Fe and folic acid (IFA; 60 mg Fe, 500 μg folic acid); the other daily leaf concentrate (LC; 5 mg Fe, 13 μg folic acid). Hb concentration, mean cell volume, serum Fe, serum ferritin and total Fe-binding capacity were measured pre- and post-intervention.

Setting

Jaipur, India.

Subjects

One hundred and two adolescent girls aged 14–18 years.

Results

Of the 102 girls randomized to the two arms of the trial, four (3·9 %) were severely anaemic (Hb < 7 g/dl), twenty-eight (27·5 %) were moderately anaemic (Hb ≥ 7 g/dl, <10 g/dl) and seventy (68·6 %) were mildly anaemic (Hb ≥ 10 g/dl, <12 g/dl). In the IFA group, eleven girls (20·4 %) withdrew due to side-effects, compared with one girl (2·1 %) in the LC group (P = 0·005). Total losses to follow-up were 14/54 in the IFA group and 2/48 in the LC group. At the end of the trial, none of the eighty-six remaining girls were severely anaemic, nine (10·5 %) were moderately anaemic and twenty-six (30·2 %) were mildly anaemic; fifty-one (59·3 %) had normal Hb levels (≥12 g/dl). After adjustment for baseline values, LC was as effective as IFA in improving serum Fe parameters and treating anaemia.

Conclusions

Leaf concentrate is an effective, and more palatable, alternative to Fe and folic acid supplements for treating anaemia in adolescent girls.

Knowledge and attitudes regarding smoking during pregnancy among Aboriginal and Torres Strait Islander women

OBJECTIVE

To identify factors associated with antenatal smoking and explore characteristics of smoking behaviour among pregnant Aboriginal and Torres Strait Islander women.

DESIGN AND SETTING

Cross-sectional study using interviewer-administered questionnaires of 145 pregnant Aboriginal and Torres Strait Islander women attending a health service in Far North Queensland between November 2005 and December 2006.

MAIN OUTCOME MEASURES

Prevalence of self-reported smoking; predictors and patterns of smoking in early pregnancy; and relationships between smoking and the prevalence of predisposing, enabling and reinforcing factors, including women's knowledge about and attitudes towards smoking and the risks involved.

RESULTS

Of 145 women, 41% (n = 60) reported being daily or occasional smokers. Knowledge about harms of smoking was generally high. Women who were smokers had a significantly higher rate of smoking partners (n = 36) than women who were non-smokers (n = 31) (77% v 41%, P < 0.001). Level of daily stress was significantly higher among smokers than non-smokers (P = 0.001).

CONCLUSION

Shifted population norms among Aboriginal and Torres Strait Islanders are accompanied by a shift in the factors that can effectively differentiate between smokers and non-smokers within this population. Rather than the traditional, mainstream predictors of antenatal smoking, interventions with Aboriginal and Torres Strait Islander women should focus on the social environment, and the influences of social networks and partners on the behaviour of individuals.