The obstetric and neonatal performance of teenage mothers in an Australian community

A comparison of neonatal outcomes between adolescent and adult mothers in developed countries: A systematic review and meta-analysis

Evidence suggests that adolescent pregnancies are at increased risk of adverse neonatal outcomes compared to adult pregnancies; however, there are significant inconsistencies in the literature, particularly in studies conducted in developed countries. The objective of this study therefore is to systematically review the current literature with regard to the relationship between adolescent pregnancy and neonatal outcomes. A literature search was conducted in eight electronic databases (AMED, ASSIA, Child Development and Adolescent Studies, CINAHL, Cochrane Library, Health Source: Nursing, Maternity and Infant Care, MEDLINE and Scopus. The reference lists of included studies were also hand searched. Studies were included if: they were conducted in countries with very high human development according to the United Nations Human Development Index; reported at least one comparison between adolescents (19 years or under) and adult mothers (20-34 years); and were published between January 1998 and March 2018. Studies were screened for inclusion and data extracted by one reviewer. A second reviewer independently reviewed a sub-set of studies. Disagreements were resolved by consensus. Meta-analysis was performed using RevMan 5.3 using crude counts reported in the included studies. Sub-group analyses of adolescents aged 17 and under and 18-19 were conducted. Pooled analysis of adjusted odds ratios was also undertaken in order to consider the effect of confounding factors. Meta-analysis effect estimates are reported as risk ratios (RR) and pooled association as adjusted odds ratios (aORs). Point estimates and 95% confidence intervals are presented. After removal of duplicates a total of 1791 articles were identified, of which 20 met the inclusion criteria. The results of the meta-analysis showed adolescents to have increased risk of all primary adverse outcomes investigated. Sub-group analysis suggests an increased risk of perinatal death and low birthweight for children born to adolescent mothers; 17 and under (perinatal death: RR 1.50, CI 1.32-1.71: low birthweight RR 1.43, CI 1.20-1.70); 18-19 (perinatal death RR 1.21, CI 1.06-1.37: low birthweight RR 1.10, CI 1.08-1.57). Mothers aged 17 and under were also at increased risk of preterm delivery (RR 1.64, CI 1.54-1.75). Analysis adjusted for confounders showed increased risk of preterm delivery (aOR 1.23, CI 1.09-1.38), very preterm delivery (aOR 1.22, CI 1.03-1.44) and neonatal death (aOR 1.31, CI 1.14-1.52). Findings show that young maternal age is a significant risk factor for adverse neonatal outcomes in developed countries. Adolescent maternal age therefore should be considered as a potential cause for concern in relation to neonatal health and it is recommended that health care professionals respond accordingly with increased support and monitoring.

The Outcomes of Pregnancy and Childbirth in Adolescents in Slovenia

Introduction

The objective of the study was to determine the course and outcomes of pregnancy and childbirth in adolescents compared to women aged 20–24 years in Slovenia.

Methods

In the retrospective study, the course of pregnancy and labour and the perinatal outcome of newborns in primiparous adolescents aged ≤19 years (study group) have been compared to the control group of primiparous women aged 20–24 years. The study group was further divided into a study subgroup of adolescents aged ≤17 years. Data were retrieved from the National Perinatal Information System in Slovenia for the period 2008–2012. Altogether, 13,663 women and their newborns were included.

Results

Adolescent pregnancy was associated with increased rates of unknown estimated date of delivery, preterm labour, low birth weight newborns, small for gestational age newborns and low gestational weight gain. Spontaneous labour was more common in adolescents, while emergency and elective Caesarean sections were less common than in women aged 20–24 years. In addition, pregnancy in adolescents aged ≤17 years was associated with increased rate of maternal anaemia and labour without complications. Higher rates of smoking, lower rates of parenting school attendance, lower rates of pregnancy check-ups and screening tests in pregnancy such as nuchal translucency in adolescents were found.

Conclusions

The results of the study show that adolescent pregnancy is related to higher health risks for pregnant adolescents and their newborns. In addition, adolescents are subject to poorer prenatal care comparing to older women.

Perinatal outcomes and risk factors of Turkish adolescent mothers

STUDY OBJECTIVE

Adolescent pregnancy is considered a high risk for both the mother and infant. The aim of this study was to determine obstetric and neonatal outcomes and risk factors in adolescent pregnant women and to compare perinatal outcomes among the teen age groups and between adolescent and adult women.

DESIGN

Retrospective study including adolescent pregnant women and adult women.

SETTING

A public maternal hospital.

MAIN OUTCOME MEASURES

This retrospective cohort study included 945 teenagers who gave birth at year 2004 in a maternity hospital in Izmir. Dependent variables included perinatal and maternal outcomes. Independent variables were miscellanous socio-demographic characteristics and obstetric complications. Chi-square, Fisher exact test, and t-tests were used for the comparison of the adolescent group and adult women.

RESULTS

Overall, adolescents accounted for 11.8% of all deliveries in hospital. 99.7% of teenagers were unemployed, and 59.8% of those had no health insurance. 81.5% of the pregnant adolescents were nulliparous. 27.5% of teenagers gave birth by cesarean delivery. The rates of preterm birth and low birthweight of teen mothers were 18.2% and 12.1%, respectively. Twenty-eight percent of women had some obstetric and neonatal complications. The rate of preterm delivery was higher in adolescent mothers; however, cesarean delivery rate was higher in adult women (P = 0.000, P = 0.0002 respectively). Absence of health insurance, less education, and non-official marriage were significantly higher in pregnant women aged 17 years or younger compared with women aged 18-19 years (for all, P = 0.000). However, there was no statistically significant difference between the adolescent age groups regarding perinatal complications.

CONCLUSION

The rates of pregnancy and the rates of adverse obstetric and neonatal outcomes were considerably higher in teenagers.

Coping styles of pregnant adolescents

This descriptive study examined the coping styles and specific strategies used by a group of pregnant adolescents attending an adolescent family support service. Seventy-one adolescents, with a mean age of 17 years, and a mean gestation of 25 weeks, completed the Revised Jalowiec Coping Scale (JCS-R). The findings demonstrated that the optimistic coping style (emotion-focused) was the most frequently used and most effective coping style for these young women. A confrontive coping style (problem-focused) was also used and found to be effective. A combination of problem-focused and emotion-focused styles is recommended, with an increased emphasis on problem-focused approaches. The focus by the adolescents on optimistic approaches is suggestive of a lack of understanding of the challenges that motherhood will place upon them, but is consistent with their age and developmental stage. A longitudinal study of coping styles and changes in style throughout pregnancy and early motherhood is recommended. Initial assessment and monitoring of coping styles of pregnant adolescents is proposed. This assessment would be the beginning point for a teaching program that highlights increased use of adaptive coping styles (problem-focused) with decreased use of maladaptive approaches, and includes emotion-focused styles. By expanding the repertoire of coping styles and strategies available to the adolescent, the public health nurse (PHN) prepares these vulnerable mothers for the challenges ahead.

What's so bad about teenage pregnancy?

A systematic literature review identified the most frequently cited medical consequences of teenage pregnancy as anaemia, pregnancy-induced hypertension, low birth weight, prematurity, intra-uterine growth retardation and neonatal mortality. Critical appraisal suggested that increased risks of these outcomes were predominantly caused by the social, economic, and behavioural factors that predispose some young women to pregnancy. Maternal age less than 16 years was associated with a modest (1.2-2.7 fold) increase in prematurity, low birth weight and neonatal death.