Teenage pregnancy in South Australia, 1986-1988

A better start to life: Risk factors for, and prevention of, preterm birth in Australian First Nations women - A narrative review

The unacceptable discrepancies in health outcomes between First Nations and non-Indigenous Australians begin at birth. Preterm birth (birth before 37 completed weeks of gestation) is a major contributor to adverse short- and long-term health outcomes and mortality. Australian First Nations infants are more commonly born too early. No tangible reductions in preterm births have been made in First Nations communities. Factors contributing to high preterm birth rates in Australian First Nations infants are reviewed and interventions to reduce preterm birth in Australian First Nations women are discussed. More must be done to ensure Australian First Nations infants get a better start to life. This can only be achieved with ongoing and improved research in partnership with Australian First Nations peoples.

Are rural adolescents necessarily at risk of poorer obstetric and birth outcomes?

OBJECTIVE

The purpose of the present study were to describe the sociodemographic and clinical characteristics of adolescent women giving birth at Wagga Wagga Base Hospital, and compare these with those with all adolescents in New South Wales.

DESIGN

An investigative approach.

MAIN OUTCOME MEASURES

Obstetric complications, delivery intervention and adverse infant outcomes.

SETTING

Wagga Wagga Base Hospital.

PARTICIPANTS

One hundred and sixteen adolescents aged 15-19 years.

RESULTS

In relation to obstetric complications and infants with complications, the study sample was found to be representative of New South Wales adolescents. However, for type of delivery there was a higher rate of forceps delivery (12.3% (15) vs 4.7% (415) P = 0.0001), forceps rotation (4.1% (5) vs 0.9% (80) P = 0.004) and fewer normal vaginal deliveries (67.2% (82) vs 80.8% (7108) P = 0.006) at Wagga Wagga Base Hospital.

CONCLUSION

These findings suggest that rural adolescents are at risk of delivery complications and are less likely to have a normal vaginal delivery. More research is required into obstetric and birth outcomes for the rural adolescent population.

Aboriginal teenage pregnancies compared with non-Aboriginal in South Australia 1995-1999

OBJECTIVE

To compare pregnancy characteristics and outcomes between Aboriginal and non-Aboriginal teenagers. DESIGN, SETTING AND POPULATION: A retrospective cohort study using the perinatal data collection for South Australian births in 1995-1999: 449 Aboriginal and 4,625 non-Aboriginal teenagers.

METHODS

Comparison of socio-demographic and clinical characteristics, using relative risks.

MAIN OUTCOME MEASURES

Rates of pregnancy, smoking during pregnancy, induction, delivery method, preterm and small-for-gestational-age births and perinatal mortality

RESULTS

Aboriginal teenagers have a pregnancy rate more than twice as high as non-Aboriginal, but a smaller proportion of pregnancies are terminated. They have pregnancies earlier, are more likely to be single, to smoke during pregnancy, to have few antenatal visits, to give birth in a country hospital and to have infections and anaemia. They have lower induction and analgesia rates, but a higher caesarean section rate. Their babies are more likely to be small-for-gestational-age and preterm, to have a congenital abnormality, to require special and intensive nursery care and stay longer in hospital. While their perinatal mortality rate has halved since a decade ago, their neonatal death rate is still twice that of non-Aboriginal births.

CONCLUSIONS

Aboriginal teenagers need special attention. Support in particular is needed for Aboriginal health workers in preconceptional counselling and health promotion programs that build the capacity of the community, eg concerning proper nutrition during pregnancy, smoking cessation, breastfeeding, SIDS prevention, support for early and regular attendance for antenatal care in friendly and culturally appropriate environments. Outreach services and sexual health services for young Aboriginal people also need expansion.

Teenage pregnancy: trends, characteristics and outcomes in South Australia and Australia

OBJECTIVES

To describe trends in teenage pregnancy rates in South Australia and Australia in 1970-2000, and the socio-demographic and clinical characteristics and outcomes of teenage women who gave birth in South Australia in 1995-99.

METHODS

A descriptive study using population-based legislated South Australian perinatal and abortion data, Australian Medicare and hospital morbidity data on abortions, and birth registration rates from the Australian Bureau of Statistics.

RESULTS

The teenage pregnancy rate in South Australia fell in the 1970s and 1980s, increased in the 1990s, but is declining at the turn of the century. Teenage abortions exceeded livebirths annually from 1994, and in 2000 the teenage abortion, birth and pregnancy rates were 22.4,18.3 and 40.8 per 1,000 respectively. The Australian rates, which are an underestimate, follow the South Australian trends and are declining but still much higher than in many western European countries. High socio-economic areas in South Australia have the lowest teenage pregnancy rates but the highest proportion of teenage pregnancies terminated. Teenagers who gave birth were more likely than older women to be Australian-born, Aboriginal, smokers during pregnancy (47% vs. 23%), to attend few antenatal visits, and to have preterm, small-for-gestational-age and low birthweight babies and neonatal deaths. Perinatal mortality has halved among teenagers under 17 years in the past decade.

CONCLUSIONS AND IMPLICATIONS

Births to South Australian teenage women are associated with social disadvantage and relatively poor perinatal outcomes, although these have improved. Current strategies are aimed at reducing the incidence of unplanned teenage pregnancy and improving support for pregnant teenagers.

Care for adolescent pregnancy and childbirth

The rise in adolescent pregnancy in the 20th century has been influenced by declining age at menarche, increased schooling, delay of marriage, inadequate contraception and poverty. The main problems are preterm labor, hypertensive disease, anemia, more severe forms of malaria, obstructed labor in very young girls in some regions, poor maternal nutrition and poor breastfeeding. In many regions HIV infection is an important problem. The infants of adolescent mothers are more prone to low birth weight and increased neonatal mortality and morbidity. Antenatal care is often inadequate. The most important problem is the increased incidence of preterm labor and delivery, the youngest age groups running the highest risk. Technically, care of adolescents during labor need not differ from care of older women; most adolescents are not at increased risk during labor, although, they are more in need of empathic support. Generally, care of pregnant adolescents should be adjusted to their specific needs.

The support needs of pregnant and parenting adolescents in rural communities

Pregnant adolescents and teenage mothers in rural communities face extraordinary difficulties accessing appropriate and adequate support services, despite having recognised specialist health needs and unique support requirements. The Australian Rural Health Research Institute at Charles Sturt University, Wagga Wagga, is currently engaged in a federally funded project aimed it significantly improving access to services for this disadvantaged and often neglected group, through the publication and wide dissemination of a resource booklet identifying successful aspects of service delivery across a range of rural support settings. Five existing health and welfare support services for pregnant or parenting adolescent: in rural Australia have been selected for inclusion in the booklet, which is being developed for community use. Assessment is being undertaken during visits to each of the services, and, following interviews with staff, referral agencies and consumers. This paper outlines the strengths, attributes and access difficulties associated with two contrasting service models involved in the project, and stresses the importance of improving access to services for rural adolescents. A framework for establishing innovative and effective new services is also presented.

Perinatal mortality trends among South Australian aboriginal births 1981-92

OBJECTIVE

To assess changes in perinatal mortality and risk factors for births to Aboriginal mothers in South Australia in 1981-92.

METHODOLOGY

All 4013 singleton Aboriginal births in the South Australian perinatal data collection were included. Trends in proportions with specific maternal and infant characteristics, and perinatal mortality by year of birth, were investigated by logistic regression analysis.

RESULTS

Changes found included an increase in the proportion of mothers aged 35 years and over, preterm births and births of very low birthweight (< 1500 g), but a decrease in the proportions of births to women under 20 years of age, and of births with a birth defect. There was no statistically significant change in the crude perinatal mortality rate nor in the risk of perinatal death after adjusting for risk factors.

CONCLUSIONS

The perinatal mortality rate among Aboriginal births, which is three times higher than the rate for all South Australian births, is not declining, in contrast to the State rate overall. This highlights the need for a concerted approach to Aboriginal perinatal health.

Birthweight-specific trends in perinatal mortality by hospital category in South Australia, 1985-1990

OBJECTIVE

To investigate differences by birthweight in risk of perinatal death between level 3 hospitals (which provide care for high risk pregnancies and neonatal intensive care) and other hospitals in South Australia, using perinatal data for the 1985-1990 period.

DESIGN

Analysis of birthweight-specific trends in risk of perinatal death by hospital category for singleton births, adjusting for risk factors.

SUBJECTS

114 725 singleton births of at least 400 g birthweight (or at least 20 weeks' gestation) born in hospitals in the 1985-1990 period and notified to the perinatal data collection.

MAIN OUTCOME MEASURE

The relative odds of a perinatal death, as opposed to a live birth which survived the neonatal period.

RESULTS

Births at level 3 hospitals had a higher crude risk of perinatal death than those at other hospitals, but this was due to the higher frequency of low birthweights at level 3 hospitals. For birthweights under 2000 g, and especially for the very low birth-weights, there was a higher risk at non-level-3 than level 3 hospitals. There was also the unexpected finding that births at level 3 hospitals in the 2500-2999 g range had a comparatively high risk of perinatal death. There was little difference in risk for births of higher birthweight.

CONCLUSIONS

The greatly reduced risk of perinatal death in level 3 hospitals for babies with birthweights under 2000 g seems likely to be due to the specialist services in these hospitals. Further investigation is required to determine why babies in the 2500-2999 g range of birthweights had a comparatively high risk of perinatal death at these hospitals. This appears to be due, at least in part, to an excess contribution of deaths from congenital abnormalities. Also, it seems that the higher prevalence of complications in pregnancy in level 3 hospitals, and the transfers for induction of labour after intrauterine fetal death, would have made a contribution. These same factors may also have affected the risk in level 3 hospitals for higher birthweight births.

A perinatal perspective on South Australia in the 1980s

OBJECTIVE

To assess changes in sociodemographic characteristics of mothers, their obstetric management and perinatal outcomes in the 1980s.

DESIGN

A survey of data recorded in the South Australian perinatal data collection. For singleton births, we compared risks of stillbirth, neonatal death and perinatal death by year of birth, after adjusting for risk factors.

SUBJECTS

There were 176,637 births of at least 400 g birthweight (or at least 20 weeks' gestation) notified to the perinatal data collection between 1981 and 1989.

MAIN OUTCOME MEASURES

Frequency of risk factors and relative risks of stillbirth, neonatal death and perinatal death by year of birth.

RESULTS

There have been changes in the sociodemographic characteristics of mothers, their obstetric management and perinatal outcomes during the 1980s. Crude perinatal mortality rates have not increased, despite increases in the frequency of low birthweight, preterm births, mothers aged 35 years and over, and some other risk factors. After adjusting for risk factors, the risks of stillbirth, neonatal death and perinatal death were lower among singletons in 1987-1989 than in the 1981-1982 reference period.

CONCLUSION

Advances in clinical management may be preventing increases in stillbirths, neonatal deaths and perinatal deaths in response to increased numbers of births with low birthweight, preterm delivery and some other risk factors in South Australia.