Pregnancies and their obstetric outcome in two selected age groups of teenage women in Greece

Seasonal Variations in Birth Patterns in Greece: A Comprehensive Analysis of National Data From 1956 to 2022

INTRODUCTION

The seasonality of human births has been studied globally for over two centuries, revealing diverse patterns across populations shaped by intricate interactions involving both biological and socio-cultural factors. This study offers a thorough examination of national birth data in Greece spanning from 1956 to 2022, aiming to elucidate long-term trends and changes in seasonal birth patterns.

MATERIALS AND METHODS

Data on live births in Greece were categorized by month based on national registries, and the analysis of birth seasonality was conducted annually. The Edwards method was utilized to evaluate birth seasonality by calculating the peak angle (PA), which identifies the center of the seasonal birth distribution. Additionally, the peak-to-low ratio (PLR) was computed for each year to serve as an indicator of the amplitude of birth seasonality. To investigate trends and temporal changes, joinpoint regression analysis was employed, specifically focusing on the annual percentage change (APC) within defined segments, along with a 95% confidence interval (95% CI).

RESULTS

A total of 8,144,465 live births were recorded between 1956 and 2022. Birth seasonality was statistically significant for all examined years. The results revealed a progressive shift in the concentration of births to the second half of the year, transitioning from a peak in January and February to two significant major peaks in July and September. Additionally, in the last two decades, the lowest birth rates were observed in spring, particularly in April, as well as in December. The PA shifted significantly over time, moving from mid-January in 1956 to late August in 2022, with an APC of 39.6 (95% CI: 17.4 to 99.7) during 1956-1960 and 7.5 (95% CI: 2.2 to 11.3) during 1960-1975. Between 1975 and 2022, the trend continued at a lower stable rate (APC = 1.0, 95% CI: 0.2 to 1.5). The PLR, after a brief upward trend during 1956-1960 (APC = 6.0, 95% CI: 3.1 to 11.3), exhibited a statistically significant decline in seasonal amplitude from 1960 to 1992 (1960-1964: APC = -5.5, 95% CI: -8.6 to -2.4, 1964-1992: APC = -0.4, 95% CI: -0.8 to -0.2), and relatively stabilized during the last thirty years (1992-2022).

CONCLUSIONS

This study highlights significant changes in birth seasonality in Greece, marked by a shift in the distribution of births toward the second half of the year and a transition from peaks in births during January and February to two major surges in July and September. These trends reflect evolving reproductive behaviors in the Greek population and hold important implications for reproductive and perinatal healthcare in the country.

The effect of increases in the Syrian refugee population in Turkey on public maternal and child health outcomes

Our purpose in this study is to explore the effect that increases in the Syrian refugee population could have on public maternal and child health outcomes. Data collected from official records from 81 Turkish provinces in 2018, and then, subjected to mediating analysis using a path analytic approach to examine the interrelationships between the Syrian population, adolescent marriage, and economic integration factors on refugee maternal and child health outcomes. An increase in the Syrian population would lead to a rise in adolescent birth rates and under-5 mortality under the mediating effect of an increase in adolescent female marriage.

Teenage pregnancies in Western Greece: experience from a university hospital setting

PURPOSE

Teenage pregnancies have consistently been associated with preterm labor in a wide range of studies. Evidence regarding the incidence and potential complications of teenage pregnancies in Greece is at present scarce. The aim of this study was to evaluate the perinatal outcomes as well as the risk of perinatal and obstetric complications of teenage pregnancies.

METHODS

This retrospective study was conducted at the Department of Obstetrics and Gynecology of the University Hospital of Patras, Greece, and all data recorded concerned the year 2019 (January-December). We retrospectively reviewed 643 cases of singleton pregnancies divided into two groups, as follows: Group A included women of average maternal age (AMA) (20-34 years old), and Group B included teenagers, defined as women less than 20 years old. Data regarding demographic and pregnancy characteristics as well as obstetric and neonatal complications were collected.

RESULTS

Teenage pregnancies accounted for 6.7% of all deliveries. We detected significantly higher rates of preterm births (p = 0.025), primiparity (p < 0.001), and negative marital status (p < 0.001) in teenage mothers compared to pregnant women of AMA. There were no significant differences concerning other factors between the two groups.

CONCLUSIONS

The findings of the present study raise concern regarding the perinatal, obstetric, and social consequences of teenage pregnancies in Greece. Extended studies that will include further information on antenatal care and detailed socioeconomic factors (i.e., level of education, income, and ethnicity) are required to formulate reliable conclusions concerning teenage pregnancies and their effect on maternal and neonatal health.

Antenatal Care and Weight Gain in Adolescent Compared to Adult Pregnancy

Background:

The aim of this study is to compare the antenatal care, body weight, and weight gain in pregnancy between the adolescent and adult pregnancies and, thus, examine the impact of adolescence on the studied parameters.

Methods:

This prospective study includes 300 pregnant women who were the patients of University Clinical Center Tuzla, Clinic for Gynecology and Obstetrics from January 2011 to December 2014. The women were divided into two groups: an experimental group consisted of 150 adolescent pregnant women aged 13–19 years and a control group consisted of 150 adult pregnant women aged 20–35 years. The following parameters were analyzed: age of pregnant women, number of antenatal controls in pregnancy, prepregnancy body weight, weight gain in pregnancy, parity, and obstetric history data.

Results:

A significantly higher number of adolescent pregnant women belongs to a subgroup from one to two examinations during pregnancy (P < 0.000013) and to subgroups from three to five examinations (P < 0.000001). A significantly smaller number of adolescent pregnant women performed their first antenatal control in the first 2 lunar months (P < 0.01). A subgroup with optimal body weight (from 51 to 69 kg) are the most prevalent among adolescent pregnant women (P < 0.000001). A significantly larger number of adolescent pregnant women had an optimal weight gain of 7.8 to 12.99 kg (P < 0.001).

Conclusions:

The adolescent pregnant women have suboptimal antenatal care, which could lead to adverse maternal and birth outcomes, but have optimal body weight and weight gain during pregnancy.

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.

Adverse perinatal outcome in teenage pregnancies: an analysis of a 5-year period in Southeastern Hungary

OBJECTIVE

To determine the risks of adverse perinatal outcomes of teenage mothers.

MATERIAL AND METHODS

A retrospective analysis was performed on teenage mothers (under 20 years of age) who delivered in the period of 2010-2014 at the Department of Obstetrics and Gynecology, University of Szeged (study group). All mothers who delivered in Hungary during the same period were studied as a control group. The following parameters were analyzed: demographic data of the mothers, maternal complications, perinatal outcome and congenital malformations of the newborns. The binominal test, Student's t-test and Poisson's regression were applied using STATA 9.0 (StataCorp, College Station, TX, USA) statistical software (p < .05 was considered to be statistically significant).

RESULTS

During this 5-year period, 12,845 births were recorded at the Department, of these 274 (2.1%) were teenage pregnancies with 275 newborns. The offsprings of teenage mothers had significantly lower mean birth weight (3110.2 ± 564.03 g versus 3247 g), higher rate of congenital malformations (8.0 versus 5.0%) and higher admission to neonatal intensive care unit (12.4 versus 8.0%) than the infants in the control group.

CONCLUSIONS

Younger maternal age was significantly associated with lower mean birth weight, higher risk of congenital malformations, and increased admission rate to neonatal intensive care unit.

Early Marriage and Barriers to Contraception among Syrian Refugee Women in Lebanon: A Qualitative Study

The Syrian conflict has displaced five million individuals outside their country with Lebanon hosting the largest numbers per capita. Around 24% of Syrian refugees fleeing to Lebanon are women of reproductive age (15–49). Yet, a better understanding of the sexual and reproductive health needs of Syrian refugee women in Lebanon is required to improve provided services. Eleven focus group discussions were conducted in four regions of Lebanon with 108 Syrian refugee women of reproductive age. Thematic analysis was used to examine the data. Interviewed women were mainly adults. They believed that, in Lebanon, they were subjected to early marriage compared to the norm in Syria due to their financial situation and uncertainty. Cost was reported as the main barrier to use contraception in Lebanon but some Syrian refugee women were not aware of free services covering sexual and reproductive health. In general, marriage, pregnancy, and family planning behavior of Syrian refugee women in Lebanon slightly differed from those in Syria pre-conflict in terms of age of marriage, conception subsequent to marriage, and contraception method. Hence, interventions to increase awareness of subsidized sexual and reproductive health services, including free contraceptives at primary health care centers, and those targeting protection from early marriage of Syrian refugee women in Lebanon are strongly recommended.

Maternal age and risk of labor and delivery complications

We utilized an updated nationally representative database to examine associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. We used hospital inpatient billing data from the 2009 United States Nationwide Inpatient Sample, part of the Healthcare Cost and Utilization Project. To determine whether the likelihood that maternal morbidity during complications of labor and delivery differed among age groups, separate logistic regression models were run for each complication. Age was the main independent variable of interest. In analyses that controlled for demographics and clinical confounders, we found that complications with the highest odds among women, 11-18 years of age, compared to 25-29 year old women, included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women who were 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women who were ≥35 years old had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Older women (≥40 years old) had increased odds for mild preeclampsia, fetal distress, and poor fetal growth. Our findings underscore the need for pregnant women to be aware of the risks associated with extremes of age so that they can watch for signs and symptoms of such complications.

Follow-up and outcomes of pregnancies in French Guiana: the part of teenage pregnancies

OBJECTIVE

Describe the part that teenage pregnancy plays in overall pregnancies in French Guiana.

METHODS

Descriptive and retrospective study of the medical records of 25,343 women who delivered in French Guiana from January 1, 2009 to December 31, 2012. The study displays and compares several indicators of follow-up visits, pregnancy-linked disorders, delivery and birth outcomes between the years and between minors and adult women.

RESULTS

The proportion of teenage pregnancies was 6.8%; it decreased significantly from 7.2% in 2009 to 6.1% in 2012 (p=0.01). The number of antenatal visits was <7 and the visits were mainly provided by the Mother and Child Health ("Protection Maternelle et Infantile", PMI) services (38.6%). The mean (±SD) gestational age at first antenatal visit was 14.1±6.5 weeks. In comparison with adult pregnancies, teenage pregnancies were more frequently concerned with preterm labour (4.6% vs. 2%; p<0.01) but less concerned with gestational diabetes (0% vs. 2.2%; p<0.05) or pregnancy-induced hypertension (2.2% vs. 4.2%; p<0.05).

CONCLUSION

Teenage pregnancies are still frequent in French Guiana, especially in the Eastern and Western communes, where first visits are often delayed by mothers who are minors and take place in PMI services, which offer less clinical, and paraclinical examinations than other settings.

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.

An assessment of antenatal care among Syrian refugees in Lebanon

BACKGROUND

After more than three years of violence in Syria, Lebanon hosts over one million Syrian refugees creating significant public health concerns. Antenatal care delivery to tens of thousands of pregnant Syrian refugee women is critical to preventing maternal and fetal mortality but is not well characterized given the multiple factors obtaining health data in a displaced population. This study describes antenatal care access, the scope of existing antenatal care, and antenatal and family planning behaviors and practice among pregnant Syrian refugees in various living conditions and multiple geographic areas of Lebanon.

METHODS

A field-based survey was conducted between July and October 2013 in 14 main geographic sites of refugee concentration. The assessment evaluated antenatal services among a non-randomized sample of 420 self-identified pregnant Syrian refugee women that included demographics, gestational age, living accommodation, antenatal care coverage, antenatal care content, antenatal health behaviors, antenatal health literacy, and family planning perception and practices.

RESULTS

In total, 420 pregnant Syrian refugees living in Lebanon completed the survey. Of these, 82.9% (348) received some antenatal care. Of those with at least one antenatal visit, 222 (63.8%) received care attended by a skilled professional three or more times, 111 (31.9%) 1-2 times, and 15 (4.3%) had never received skilled antenatal care. We assessed antenatal care content defined by blood pressure measurement, and urine and blood sample analyses. Of those who had received any antenatal care, only 31.2% received all three interventions, 18.2% received two out of three, 32.1% received one out of three, and 18.5% received no interventions. Only (41.2%) had an adequate diet of vitamins, minerals, and folic acid. Access, content and health behaviors varied by gestational age, type of accommodation and location in Lebanon.

CONCLUSIONS

Standards of antenatal care are not being met for pregnant Syrian refugee women in Lebanon. This descriptive analysis of relative frequencies suggests reproductive health providers should focus attention on increasing antenatal care visits, particularly to third trimester and late gestational age patients and to those in less secure sheltering arrangements. With this approach they can improve care content by providing early testing and interventions per accepted guidelines designed to improve pregnancy outcomes.

Adverse pregnancy outcome among teenagers: a reality?

The objective of this retrospective analysis was to evaluate maternal, fetal and neonatal outcomes in primi-adolescent pregnancies in Kuwait. Case records of primigravidae under 29 years of age, attending the antenatal clinic at our tertiary hospital, between January 2002 and December 2010, were analysed. The study group (up to 19 years of age at first pregnancy) consisted of 3,863 women and the control group (20-29 years of age at first pregnancy) comprised of 4,416 women. Maternal obstetric, fetal and neonatal complications were compared between the groups. Rates of ectopic pregnancy, pre-eclampsia, eclampsia, preterm labour, premature rupture of membrane and caesarean section were significantly higher among adolescents < 15 years of age; the risk then decreased steadily with age and became comparable with the control group after 16 years of age.

Born too soon: care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby

Pregnancy and childbirth represent a critical time period when a woman can be reached through a variety of mechanisms with interventions aimed at reducing her risk of a preterm birth and improving her health and the health of her unborn baby. These mechanisms include the range of services delivered during antenatal care for all pregnant women and women at high risk of preterm birth, services provided to manage preterm labour, and workplace, professional and other supportive policies that promote safe motherhood and universal access to care before, during and after pregnancy. The aim of this paper is to present the latest information about available interventions that can be delivered during pregnancy to reduce preterm birth rates and improve the health outcomes of the premature baby, and to identify data gaps. The paper also focuses on promising avenues of research on the pregnancy period that will contribute to a better understanding of the causes of preterm birth and ability to design interventions at the policy, health care system and community levels. At minimum, countries need to ensure equitable access to comprehensive antenatal care, quality childbirth services and emergency obstetric care. Antenatal care services should include screening for and management of women at high risk of preterm birth, screening for and treatment of infections, and nutritional support and counselling. Health workers need to be trained and equipped to provide effective and timely clinical management of women in preterm labour to improve the survival chances of the preterm baby. Implementation strategies must be developed to increase the uptake by providers of proven interventions such as antenatal corticosteroids and to reduce harmful practices such as non-medically indicated inductions of labour and caesarean births before 39 weeks of gestation. Behavioural and community-based interventions that can lead to reductions in smoking and violence against women need to be implemented in conjunction with antenatal care models that promote women's empowerment as a strategy for reducing preterm delivery. The global community needs to support more discovery research on normal and abnormal pregnancies to facilitate the development of preventive interventions for universal application. As new evidence is generated, resources need to be allocated to its translation into new and better screening and diagnostic tools, and other interventions aimed at saving maternal and newborn lives that can be brought to scale in all countries.