Obstetric and neonatal outcomes of adolescent primiparous singleton pregnancies: a cohort study in the South of Reunion Island, Indian Ocean

Adolescent Pregnancy: A Comparative Insight into the Prevalence and Risks of Obstetric Complications in a Polish Cohort

Background: Adolescent pregnancy is associated with increased risk of both maternal and neonatal complications. Common maternal complications include anemia, hypertensive disorders, and a higher incidence of infections, including Group B Streptococcus (GBS). Additionally, adolescents are at increased risk for gestational diabetes and postpartum hemorrhage. Neonatal complications often involve low birth weight, prematurity, and an increased likelihood of neonatal intensive care unit (NICU) admission. Objectives: This study aims to assess and compare the prevalence of obstetric complications between adolescent and older pregnant women. Methods: This retrospective study investigates obstetric outcomes in adolescent pregnancies, analyzing data collected from 1 January 2016 to 30 June 2024. This study included 902 participants, of whom 224 were adolescents. The variables were categorized into maternal, birth, and neonatal characteristics. Results: Adolescent patients demonstrated a significantly higher prevalence of Group B Streptococcus (GBS) infection, affecting 25.89% of this group. Adolescent patients reported 17.86% nicotine use during pregnancy, a rate significantly higher than that of older age groups (p < 0.001). Additionally, adolescent pregnancies were associated with the highest mean blood loss during delivery, averaging 500 mL during vaginal birth and 1050 mL during cesarean section, leading to a higher incidence of blood transfusions (3.13%, p = 0.021). Newborns from adolescent pregnancies had the lowest mean birth weight (3199 g) and length (53.6 cm). Neonatal complications were more frequent in this group, affecting 20.09% of newborns, with a significantly higher rate of admission to intensive care units (2.68%, p = 0.008). These findings underscore the need for targeted interventions and more proactive management strategies to address the specific challenges faced by this population.

A comprehensive evaluation of pregnancy and newborn outcomes in Syrian refugees in Turkey

BACKGROUND

The research was conducted to evaluate the birth and newborn outcomes of Syrian immigrant women according to maternal age groups and Vitamin D use.

METHODS

It was conducted retrospectively using the birth records of 2,866 Syrian migrant women, who had given birth at a tertiary center between January 2016 and May 2020. Demographic features, obstetric and neonatal outcomes were analyzed according to age groups and Vitamin D use.

RESULTS

The mean age of the patients included in the study was 26.22 ± 5.90, the mean gestational age at birth was 38.06 ± 2.1 weeks, and the mean newborn birth weight was 3.151 g. The mean hemoglobin value of the patients was 11.55 ± 1.54. While most of the patients were taking iron supplements (80.59%), Vitamin D (Vit D) supplement intake was 38.31%. The mean number of antenatal follow-ups was 3.40 ± 1.65. While the most common delivery method was normal vaginal delivery (61.93%), cesarean section rates were found to be 38.07%. The need for blood transfusion was significantly lower in the group that had received Vitamin D than that in the group that had not received it (2.00% vs. 8.94% p < 0.001). The rate of preterm birth was found to be 5.74% in the group that had received Vitamin D and 9.28% in the group that had not received it, which was significantly higher (p < 0.001).

CONCLUSIONS

We have seen that maternal and fetal outcomes can be improved with hospital follow-up and adequate vitamin supplements in refugee pregnant women.

Nutritional management and interventions in complications of pregnancy: A systematic review

Background: Pregnancy, also known as the "gestation period" which lasts for 37-40 weeks, has been marked as the period of "physiological stress" in a woman's life. A wide range of symptoms, from nausea to ectopic pregnancy, are usually aligned with risk factors like abortion, miscarriage, stillbirth, etc. An estimated total of 15% of total pregnant women face serious complications requiring urgent attention for safe pregnancy survival. Over the past decades, several changes in the environment and nutrition habits have increased the possibility of unfavourable changes during the gestation phase. The diagnostic factors, management and nutritional interventions are targeted and more emphasis has been laid on modifying or managing the nutritional factors in this physiologically stressed phase. Aims: This review focuses on dietary modifications and nutritional interventions for the treatment of complications of pregnancy. Nutritional management has been identified to be one of the primary necessities in addition to drug therapy. It is important to set a healthy diet pattern throughout the gestation phase or even before by incorporating key nutrients into the maternal diet. Methods: The published literature from various databases including PubMed, Google Scholar and ScienceDirect were used to establish the fact of management and treatment of complications of pregnancy. Results: The recommendations of dietary supplements have underlined the concept behind the eradication of maternal deficiencies and improving metabolic profiles. Conclusion: Therefore, the present review summarises the dietary recommendations to combat pregnancy-related complications which are necessary in order to prevent and manage the same.

Relationship of Age at Menarche, Coitarche and First Gestation: A Retrospective Cohort Analysis

Introduction

Teenage pregnancy is defined as a pregnancy occurring between ages 10 and 19 (Loredo-Abdlá et al., 2017; Belitzky, 1985; Kaplanoglu et al., 2015), and is associated with increased morbidity and mortality for both mother and child. Several factors have been identified with increased risk of a teenage pregnancy, including incomplete sexual education awareness and increased exposure at a young age. In addition, an earlier onset of sexual intercourse, or coitarche, has been linked to a higher risk of teenage pregnancy. Early menarche, defined as first menstruation before the age of 12 has been previously identified as a risk factor for an earlier coitarche, possibly linking an early menarche with a higher incidence of teenage pregnancy. This study aims to compare and determine the relationship between the incidence of teenage pregnancy with early menarche and coitarche in a low income setting.

Design Setting Participants Interventions Main Outcome Measures

A cross sectional review of electronic records of women admitted for delivery in a second level center in northeastern Mexico, being a low-income setting, where 814 teenage and 1474 adult mothers were included.

Results

Primigravid teenagers had earlier menarche and coitarche than adult counterparts and opted for postpartum contraception more frequently. Linear regression analysis revealed significant unadjusted beta coefficients between age at first pregnancy and coitarche (0.839) and menarche (0.362). Menarche and coitarche had a significant linear regression association of 0.395.

Conclusion

We found amongst primigravid patients that teenagers had earlier menarche and coitarche than adults, which in turn correlated to their age at their first pregnancy.

Understanding barriers and motivations to Papillomavirus vaccination in a middle school in Reunion Island

BACKGROUND

In Reunion Island, papillomavirus (HPV) vaccination coverage is low. A study encouraging vaccination in middle school showed low rate of participation. The main objective of the study was to understand barriers and motivations to HPV vaccination in populations yet sensitized to its benefits.

METHODS

The study focused on population around the intervention school where a health promotion program was conducted during school year 2020-2021. Semi-structured face-to-face interviews among children, children's parents, school staff, general practitioners (GP) and association members were conducted. A qualitative study was adopted using a grounded theory approach to obtain an in-depth understanding of issues pertaining to HPV vaccination.

FINDINGS

A total of 19 school staff members, 20 parents of middle school children, 39 children, 5 GPs and 3 association members were interviewed in May 2021. Anti-vaccination attitudes included: fear of serious adverse effects (such as fertility) due to poor knowledge, fear of encouraging sexuality among teenagers, mistrust towards scientists and the pharmaceutical industry and the negative impact from social networks. However, we found that the influence of the school, GP's and 'story-telling' study testimonials were crucial to invert the balance and motivate children's vaccination.

INTERPRETATION

Reproductive adverse events related to the HPV vaccine may be strongly perceived amongst our population, either regarding fertility or negative fetal effects; though Reunion island has 5% of pregnancies among teenagers. It is crucial to lift this taboo related to sexuality and encourage dialogue between children and their close social network. This better understanding of barriers and motivations will help us increase the impact of school-based HPV vaccination, which will be introduced in September 2023 in whole France.

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

PURPOSE

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

METHODS

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

RESULTS

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

DISCUSSION

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

Comparison of obstetric and neonatal outcomes between Syrian adolescent refugees and local Turkish adolescent citizens

The provision of antenatal care in adolescents in refugee populations presents particular difficulties because of conflict, nutritional deficiencies, language barriers and lack of access to health care facilities. Due to the absence of prenatal care, associated medical complications can occur. A total of 525 adolescent women who gave birth to singletons agreed to participate in this study. Data about maternal demographic and obstetric characteristics, as well as neonatal outcomes were analysed. In conclusion, adolescent pregnancy continues to be an important social problem due to health support needs. However, the results of our present study are important in terms of showing that perinatal care is quietly improving in Turkey.Impact StatementWhat is already known on this subject? Adolescent pregnancies are at much higher risk than adult pregnancies in terms of complications. These complications include preterm delivery, intrauterine growth retardation, maternal morbidity and mortality, neonatal morbidity and mortality. According to various beliefs and traditions, marriages in early ages are observed in some societies and as a result, adolescents become pregnant. Additionally, the present study includes early adolescent aged pregnancies as 14,15 and 16. As far as we search in the literature, there is no reported about early adolescent pregnancies.What do the results of this study add? Often, such pregnancies occur more frequently in societies with low socioeconomic levels. For this reason routine pregnancy screening, support during pregnancy, prenatal care is not adequately provided. Some of the complications develop on them. Primarily, the adolescent pregnancies should be gotten under control, if not, some complications can be prevented by routine pregnancy follow-up and adequate provision of prenatal care and support.What are the implications of these findings for clinical practice and/or further research? As a guide on clinical practices and further studies; an effective method of contraception should be applied to sexually active women at early maternal age. If not, pregnancies should be kept under close follow-up and with adequate support to avoid complications.

[Prognosis of pregnancy among married child students in Niamey, Republic of Niger]

Introduction

l´objectif de cette étude était de déterminer la fréquence et d´évaluer le pronostic maternel et périnatal lors de la grossesse suivi de l´accouchement chez les élèves mineures mariées, dans la ville de Niamey. Méthodes: c´était une étude cas-témoin des gestantes et parturientes de janvier 2018 au 31 décembre 2018 à la Maternité Issaka Gazobi de Niamey. Les élèves mineures (<18 ans) ont été comparées aux élèves âgées de 18-27 ans. Les paramètres sociodémographiques maternels, la morbi-mortalité maternelle et périnatale ont été analysées. Les statistiques usuelles et la régression logistique ont été utilisées pour analyser les résultats. Le seuil de signification a été fixé à une valeur de P-value (p<0,05).

Résultats

la fréquence d´accouchement chez les élèves mineures était de 3,06%. Les mineures étaient plus assidues au suivi prénatal (46,7% vs 41,9%). La césarienne (ORa=2 [1,0-3,0]), l´éclampsie (ORa=2 [1,0-4,4]), l´épisiotomie (ORa=2[1,2-1,8]) et la dépression néonatale (P<0,05 (10,6% vs 5,8%)) étaient plus élevés chez les mineures que chez les adultes. La mortalité périnatale était élevée dans les deux groupes.

Conclusion

nos résultats sont proches de ceux décrits dans d´autres études européennes et africaines. Les différences retrouvées pour les risques obstétricaux et périnatals semblent être liées aux facteurs sociodémographiques entourant ces gestantes mineures. Ces derniers devraient être pris en compte dans toute démarche de prévention des complications des grossesses chez les mineures.

Post-traumatic stress disorder and association with low birth weight in displaced population following conflict in Malakand division, Pakistan: a case control study

Background

The northern part of the province of Khyber Pakhtunkhwa in Pakistan experienced armed conflict since September 2007 till the autumn of 2011. Conflict involved widespread insurgency activity and military intervention including in 2009 internally displacing the 2.5 million people of the valley of Swat to live in camps, with relatives, or in rented accommodation across the region for approximately 4 months. It was during this period the current study was conducted to determine whether Post-Traumatic Stress Disorder in pregnant women was independently associated with Low Birth Weight (LBW) in an area affected by conflict and militancy.

Methods

A case control study was conducted in tertiary care hospitals of district Peshawar, Khyber Pakhtunkhwa. Two hundred twenty-five cases (neonates with birth weight <  2.5 kg) and 225 controls (neonates with birth weight of > 2.5 kg) were enrolled within 24 h of delivery. Post-Traumatic Stress Disorder was assessed through the MINI Neuropsychiatric Interview 5.0, a validated questionnaire along with the birth weight of the newborn. Maternal anthropometry, anemia and other sociodemographic details were also obtained during data collection. Data was analyzed using statistical package (STATA version 14). Logistic regression analysis of the association between LBW and all variables collected with a p-value of < 0.25 on uni-variate analysis were entered.

Results

A total of 450 newborn and mother pairs participated in the study with 225 cases and 225 controls. On univariate analysis factors significantly associated with LBW include: less than 5 years of paternal schooling and PTSD. On logistic regression, PTSD was independently associated with low birth weight in the presence of other factors like maternal/paternal schooling, gravida, history of preterm, BMI of the mother and maternal anemia.

Conclusion

PTSD was found to be independently associated with LBW. In light of the current findings and other similar literature, intervention programs should be considered for pregnant women exposed to traumatic events.

Adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia

BACKGROUND

Adolescents have physical, social and psychological characteristics that are different from adults. Adolescent pregnancy results in pregnancy and childbirth complications- an area neglected in developing countries like Ethiopia. This study, therefore, was conducted to assess the adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia.

METHODS

Institutional-based study was conducted in East Gojjam zone, Northwest Ethiopia. A total of 374 adolescent (15-19 years) and 760 adult (20-34 years) women were included in this study. Data were collected among women who came to randomly selected health facilities in East Gojjam zone. Data were collected by trained research assistants using a structured data collection questionnaire. Descriptive statistics, chi-square test, and Student's t-tests were utilized. Bivariate and multivariable logistic regression analysis were employed to adjust for confounding factors of adverse neonatal outcomes. Statistical significance was declared when the p-value was less than 0.05.

RESULTS

Higher proportion of adolescent than adult women were from rural area (57.2% vs 44.7%), were not married (5.1% vs 1.7%), were pregnant for the first time (91.7% vs 34.1%), didn't attend antenatal care (ANC) follow-up (12% vs 4.5%), and had late initiation of ANC follow-up. After adjusting for known confounding factors, the odds of low birth weight (LBW) was higher among adolescents than adult women (AOR 2.14; 95% CI, 1.36, 3.36, p-value = 0.001). Similarly, the odds of preterm birth was higher among adolescents than adult women (AOR 1.65; 95% CI, 1.09, 2.49, p-value = 0.017). There was no statistically significant difference in the rate of low Apgar score at first and five minutes after birth and neonatal Intensive Care Unit (ICU) admission between babies born from adolescent and adult women.

CONCLUSIONS

Adolescent women were less likely to receive ANC service. Babies born from adolescent women are at higher odds of adverse neonatal outcomes like LBW and preterm birth than babies born from adult women. Use of community- and health facility-based intervention programs that can prevent adolescent pregnancy and reduce adverse neonatal outcomes among adolescent girls is recommended.

Magnitude and Risk of Dying among Low Birth Weight Neonates in Rural Ethiopia: A Community-Based Cross-Sectional Study

BACKGROUND

Even if remarkable progress has been made in reducing preventable child deaths worldwide, neonatal mortality reduction has remained unsatisfactory. Low birth weight (LBW) is the major risk factor for child deaths during the neonatal period, yet only 5% of babies are weighed at birth in Ethiopia. The aim of the present study was to determine the magnitude and risk of dying among low birth weight neonates in rural Gedeo, Southern Ethiopia.

METHODS

Community-based mixed-method approach design was employed between September and October 2016 to identify and enroll study participants in rural Gedeo, Southern Ethiopia. Records of 17,503 live birth babies, of whom 2,065 (11.8%) had LBW, born in the last 12 months were screened to identify 885 (42.8%) biological mother-LBW neonate pairs from eight health centers. The study subjects were randomly selected using a multistage stratified cluster sampling technique. Cox proportional hazards regression model was used to predict maternal and neonatal risk factors associated with the risk of neonatal death.

RESULTS

The overall neonatal mortality rate (NMR) among LBW infants was 110 per 1000 live births (95% confidence interval: 75 -228). Close to half, 374 (42.3%), of the LBW neonates died during the first week of life. The estimated hazard ratios of mortality were higher among neonates whose mothers did not attend antenatal care (ANC) (HR=1.58, 95 % CI: 1.02-2.43), gave birth by assisted or cesarean delivery (HR=1.81 and 3.72; 95% CI: 1.10 - 3.02 and 2.11-6.55), and experienced some form of illness during pregnancy (HH=3.34, 95 % CI: 2.11-5.29), respectively. Similarly, neonates born with very low (<2000gm) birth weight and born prematurely (before 37 weeks of gestation) carried a higher (HR= 1.90 and 1.47; 95 % CI: 1.22 - 2.96 and 1.07-2.28) risk of death. On the other hand, maternal formal education was found to be the single protective factor (HR= 0.65,95 % CI: 0.43-0.99).

CONCLUSION

Nearly one in every ten (11%) of neonates die before celebrating their firth month of life, mainly during the first week in rural Ethiopia. The risk of dying from LBW during the neonatal period is almost fourfold of the current estimated national NMR. Maternal obstetric characteristics and fetal maturity were predictors of mortality.

The impact of young maternal age at birth on neonatal mortality: Evidence from 45 low and middle income countries

Objectives

This study explores the impact of early motherhood on neonatal mortality, and how this differs between countries and regions. It assesses whether the risk of neonatal mortality is greater for younger adolescent mothers compared with mothers in later adolescence, and explores if differences reflect confounding socio-economic and health care utilisation factors. It also examines how the risks differ for first or subsequent pregnancies.

Methods

The analysis uses 64 Demographic and Health Surveys collected between 2005 and 2015 from 45 countries to explore the relationship between adolescent motherhood (disaggregated as <16 years, 16/17 years and 18/19 years) and neonatal mortality. Both unadjusted bivariate association and logistic regression are used. Regional level multivariate models that adjust for a range of socio-economic, demographic and health service utilisation variables are estimated. Further stratified models are created to examine the excess risk for first and subsequent births separately.

Findings

The risk of neonatal mortality in all regions was markedly greater for infants with mothers under 16 years old, although there was marked heterogeneity in patterns between regions. Adjusting for socio-economic, demographic and health service utilisation variables did not markedly change the odds ratios associated with age. The increased risks associated with adolescent motherhood are lowest for first births.

Conclusion

Our findings particularly highlight the importance of reducing adolescent births among the youngest age group as a strategy for addressing the problem of neonatal mortality, as well ensuring pregnant adolescents have access to quality maternal health services to protect the health of both themselves and their infants. The regional differences in increased risk are a novel finding which requires more exploration.

Linear association between maternal age and need of medical interventions at delivery in primiparae: a cohort of 21,235 singleton births

OBJECTIVES

We sought to investigate the potential association between maternal age and the need for active obstetrical intervention intrapartum in primiparas.

STUDY DESIGN

Observational study over 14 years (2001-2014) of all consecutive primiparous singleton births having delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion's maternity (French overseas department, Indian Ocean).

RESULTS

Of the 21,235 singleton primiparous births, there were three significant linear associations between maternal age from 12 years of age to 42 + (all χ² for linear trend, p < .0001) (a) vaginal deliveries without any medical intervention, (b) rate of cesarean sections, and (c) rate of operative vaginal procedures. These three linear associations persisted when controlling for maternal obesity (±30 kg/m²), "heavy babies" (>3.5 kg), and ethnicity. Using maternal age remained significantly an independent risk factor (p < .0001), after controlling for the major confounders: maternal BMI, maternal height, birthweight ≥3500 g, p < .0001.

CONCLUSIONS

Increasing maternal age has a linear association with vaginal deliveries without any medical intervention, rate of cesarean sections, and rate of operative vaginal procedures. These associations are independent of maternal BMI and maternal height. We currently do not have a specific explanation why younger women appear to be protected from requiring intrapartum obstetric intervention. Nevertheless, these strong facts deserve acknowledgement and further research.

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

Introduction

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

Méthodes

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

Résultats

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

Conclusion

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Linear association between maternal age and spontaneous breech presentation in singleton pregnancies after 32 weeks gestation

PURPOSE

To investigate the association between maternal age and spontaneous breech presentation.

MATERIAL AND METHODS

Fifteen-year observational study over (2001-2015). All consecutive singleton births delivered at the Centre Hospitalier Universitaire Sud Reunion's maternity. The only single exclusion criterion was uterine malformations (N = 123) women.

RESULTS

Of the 60,963 singleton births, there was a linear association (χ² for linear trend, p< 0.0001) between maternal age and spontaneous breech presentation. Overall rate of breech presentation was 2.7% in deliveries over 32 weeks gestation, while it was 1.9% in women aged 15 to 19 years and 4.0% in women aged 45+, with a linear progression for each 5-year age category. This linearity remained significant controlling for early prematurity (<33 weeks) and severe fetal malformations (χ² for linear trend = 64, p < 0.0001). Controlling in a multiple logistic regression model for other major risk factors gestational age, female sex, primiparity, maternal age remained significantly an independent risk factor, p < 0.0001.

CONCLUSION

Maternal age (x) is an independent factor for breech presentation in singleton pregnancies after 32 weeks gestation with a linear association that may be approximated at y = 0.1x. (y: incidence, percent).

Knowledge, attitudes and practices of adolescents in Upper Egypt on gender-based violence, with a focus on early girls' marriage

BACKGROUND

A large proportion of the female population all over the world, particularly in developing countries, experience some form of gender-based violence (GBV) during their life. Early marriage, a form of GBV, is particularly highly prevalent in rural Upper Egypt.

OBJECTIVES

The aim of the current study was to assess the knowledge, attitudes and practices (KAP) of adolescents in Upper Egypt on domestic GBV, with a focus on early girls' marriage.

PARTICIPANTS AND METHODS

The study was a cross-sectional descriptive household survey targeting 400 randomly selected adolescent boys and girls aged 11-16 years from five villages of Minya Governorate in Upper Egypt.

RESULTS

The proportion of interviewed adolescents who could identify certain practices as forms of GBV was relatively low: the identified practices were mainly deprivation of work (9.0%), deprivation of inheritance (3.3%), arbitrary neglect and desertion (2.8%), and preventing from visiting relatives (0.5%). Abusive sexual behavior was not identified by any of the study participants as a form of domestic GBV. A total of 112 boys (56.0%) reported that they have been perpetrators in domestic GBV events at least once and 118 girls (59.0%) reported that they have been actual victims of domestic GBV. An overall 65.6% of study participants could correctly identify the legal age of marriage as 18 years, yet only 22.0% identified earlier ages of marriage as a form of domestic GBV. The vast majority of girls and boys reported that they would not agree to get married before the age of 18 years (91.0 and 87.0%, respectively).

CONCLUSION AND RECOMMENDATIONS

Adolescents in Upper Egypt demonstrated a less than satisfactory knowledge about the forms of GBV. Although early girls' marriage was not universally recognized by adolescents as a form of domestic GBV, they demonstrated satisfactory knowledge about the legal age of marriage, as well as a tendency to abandon the practice. Establishing a community-based awareness program for adolescents of both sexes about GBV with a focus on early girls' marriage is highly recommended.

Complications in adolescent pregnancy: systematic review of the literature

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

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.

Adaptation of in vivo amino acid kinetics facilitates increased amino acid availability for fetal growth in adolescent and adult pregnancies alike

During pregnancy, adult women with a normal BMI synthesise extra amino acids after an overnight fast by increasing body protein breakdown and decreasing amino acid oxidation. It is not known whether adolescent girls can make these adaptations during pregnancy. The present study aimed to measure and compare the protein, glutamine and alanine kinetics of adult women and adolescent girls at early-, mid- and late-pregnancy. Kinetics were measured in the overnight fasted state using intravenous infusions of 13C-leucine, 15N-glutamine and 15N-alanine in ten adults and twenty adolescents aged 14-17 years in the first and second trimesters (phase 1 study) and infusions of 13C-leucine and 15N2-urea in ten adults and eleven adolescents aged 16-17 years in the first and third trimesters (phase 2 study). In phase 1 study, there were no significant differences between the groups with regard to any of the kinetic parameters measured. In both groups, leucine flux increased (P< 0.05), the percentage of leucine flux oxidised decreased (P< 0.05) and non-oxidative leucine disposal to protein synthesis increased (P< 0.05) from the first to the second trimester. In phase2 study, leucine flux was significantly slower (P< 0.05) in the adult group than in the adolescent group during both trimesters, and whole-body leucine flux and non-oxidative leucine disposal increased significantly in the adolescent group (P< 0.05, respectively) and were higher in the adult group from the first to the third trimester. These results suggest that similar to their adult counterparts after an overnight fast, adolescent girls with a normal BMI provide extra amino acids required for net protein deposition during pregnancy by increasing protein breakdown and decreasing amino acid oxidation.

Outcome of deliveries among adolescent girls at the Yaoundé central hospital

BACKGROUND

Adolescent pregnancies are a growing public health problem in Cameroon. We sought to study the outcome of such pregnancies, in order to inform public health action.

METHODS

A cross-sectional analysis of 5997 deliveries which compared the outcome of deliveries in adolescent (10-19 years old) pregnant women registered at the Yaoundé Central Hospital between 2008 and 2010 to that of their non-adolescent adult (≥ 20 years old) counterparts. Variables used for comparison included socio-demographic and obstetric characteristics of parturients, referral status, and maternal and fetal outcomes. Predictors of maternal and of perinatal mortality were determined through binomial logistic modeling.

RESULTS

Adolescent deliveries represented 9.3% (560) of all pregnancies registered. Adolescent pregnancies had significantly higher rates of both gestational duration extremes: preterm as well as post-term deliveries (29.3% versus 24.5%, p = 0.041 OR 1.28 95% CI 1.01-1.62 and 4.9 versus 2.4%, p = 0.014 OR 2.11 95% CI 1.46-3.87 respectively). Both groups did not differ significantly with respect to mean blood loss, rates of cesarean or instrumental deliveries. Adolescent deliveries however required significantly twice as many episiotomies (OR 2.15 95% CI 1.59-2.90). The likelihood of perineal tears in the adolescent group was significantly higher than that in the adult group on assuming episiotomies done would have been tears if they had not been carried out (OR 1.45 95% CI 1.16-1.82). Adolescent parturients had a higher likelihood of apparent fetal death at birth as well as perinatal fetal death after resuscitation efforts (AOR 1.75 95% CI 1.25-2.47 and AOR 1.69 95% CI 1.17-2.45 respectively).Comparisons of pregnancy outcomes between early (10-14 years), middle (15-17 years) and late adolescence (18-19 years) found no significant differences. Predictors of maternal death included having been referred, having had ≥5 deliveries and preterm deliveries. These were also predictors of perinatal death, as well as being a single mother, primiparous, and multiple gestations.

CONCLUSIONS

Adolescent pregnancies in Cameroon compared to those in adults are associated with poorer outcomes. There is need for adolescent-specific services to prevent teenage pregnancies as well as interventions to prevent and manage the above mentioned predictors of in-facility maternal and perinatal mortality.

Longitudinal health outcome and wellbeing of mother-infant pairs after adolescent pregnancy in Reunion Island, Indian Ocean

OBJECTIVE

To evaluate longitudinal care needs and health service access among mother-infant pairs after adolescent pregnancy.

METHODS

In a case-control study, data were analyzed from primiparous adolescent and adult mother-infant pairs who delivered at Reunion Island University Hospital, France, between January 2004 and December 2006, and were followed-up from maternity discharge until December 2011. Infant outcomes were hospitalization during the first 2 years of life, hospital access for "non-medical" reasons, and neuropsychiatric care. Maternal outcomes were number of pregnancies and childbirths, rapid repeat pregnancy (RRP) rate, pregnancy morbidities, and use of health services.

RESULTS

Data from 476 cases and 476 controls were analyzed. Adolescent and control offspring did not differ in the measured outcomes. Adolescent and control mothers had, respectively, 2.4 ± 1.3 and 1.9 ± 1.1 pregnancies; 1.9 ± 0.8 and 1.6 ± 0.7 childbirths; and RRP rates of 7.6% and 2.7% (all P<0.001). Adolescents had less pregnancy-related pathologies at the index pregnancy and more frequently had natural deliveries (P<0.05). Younger mothers exhibited higher rates (19.7% versus 6.9%, P=0.001) of care for psychosocial reasons (suicide attempt, acute alcohol or drug intoxication, road accident, psychiatric problems, physical abuse).

CONCLUSION

Concerns arise from the long-term psychosocial risk among adolescent mothers.