Effect of Young Maternal Age on Obstetric and Perinatal Outcomes: Results from the Tertiary Center in Turkey

A Review of Anemia Prevalence, and Prevention and Control Strategies, in the Eastern Europe and Central Asia Region

Anemia is a global public health and nutrition problem. However, data on its prevalence and potential causal factors in the 22 countries of the UNICEF Europe and Central Asia region are not systematically collected, analyzed, and reported, leading to challenges in formulating appropriate preventative strategies. We examined available anemia prevalence data among different population groups through reviewing survey reports from 2010 to 2022; conducted a literature review to explore underlying determinants of anemia including iron deficiency; and collated and reviewed program and policy documentation across the region. Anemia prevalence data for the period 1999-2009 were also researched to examine trends in anemia prevalence in the region over the past 23 y. Nationally representative data for anemia for ≥1 population group since 2010 were found for half the 22 countries, whereas less than a quarter of countries had recent data for iron deficiency. There was a lack of evidence for other factors potentially contributing to anemia in the region. Where information was available, our findings highlight that anemia remained a problem of public health significance among girls and women 15-49 y old and preschool children in all countries with data; anemia was highly associated with iron deficiency; large discrepancies in anemia prevalence existed between geographical regions and subpopulation groups within countries; and only a few countries were implementing the recommended WHO strategies to prevent and control anemia. The paucity of recent, representative, data on anemia in many countries and on the etiology of anemia in most countries remain obstacles to ensuring that effective anemia prevention strategies are placed high on national agendas in the region.

The prevalence of adolescent pregnancy and its associated consequences in the Eastern Mediterranean region: a systematic review and meta-analysis

BACKGROUND

Adolescent pregnancy is one of the public health problems that both mother and baby suffer from its consequences. This study was conducted to estimate the prevalence and consequences of adolescent pregnancy in the Eastern Mediterranean region.

METHODS

In this systematic review and meta-analysis, four databases (PubMed, ProQuest, Web of Science and Scopus) were systematically searched for relevant articles published from 1990 to 2022. The screening process for articles was conducted in accordance with the PRISMA guidelines. Joanna Briggs checklists were used to assess the quality of included studies. A random effects model was performed for the meta-analysis. Narrative synthesis of adolescent pregnancy prevalence, as well as a meta-analysis of adolescent pregnancy prevalence was performed using STATA 14.

RESULTS

The review included 12 studies and 94,189 study participants. The prevalence of adolescent pregnancy was [9% (95% CI 6.9, 11.2, p < 0.001)]. Pregnancy outcomes included preeclampsia [12.9%(95% CI 7.3,18.5, p < 0.001)], low birth weight [16.1%(95% CI 7.4-24.8, p < 0.001)], anemia [33%(95% CI 14.4, 51.7, p < 0.001)], and cesarean delivery [15.9%(95% CI 11.1-20.7, p < 0.001)].The results showed that 16.9% of deliveries were cesarean sections.

CONCLUSION

The study's findings indicate that adolescent pregnancy is prevalent in the Middle East region and is associated with negative outcomes for teenagers. Therefore, it is necessary to carry out effective interventions to reduce adolescent pregnancy.

The epidemiology of gestational diabetes, gestation hypertension, and anemia in North Palestine from 2018 to 2020: A retrospective study

BACKGROUND

In Palestine, women face a challenging environment and a demanding lifestyle, which puts them at a higher risk of experiencing complications during pregnancy. This study aimed to examine the risk factors linked with abnormal hemoglobin (Hb) levels, gestational diabetes (GD), and gestational hypertension (GH) among pregnant women. The results was compared between women residing in cities or villages areas and those in refugee camps.

METHODS

Medical records (N = 7889) for pregnant women at primary healthcare centers in the North West Bank were reviewed for sociodemographic and medical data along with the reported fasting blood sugar, hemoglobin, and blood pressure in the first and second trimesters from July 2018 to July 2020. However, only 6640 were included in the analysis as 1249 were excluded for having multiple pregnancy or lost to follow up. Complications and risk factors were defined according to the available global guidelines. Then, descriptive analysis was used to show the percentages of different risk factors and complications among them. The correlation between the several characteristics and variables with these complications was assessed by calculating the odds ratios (OR) using logistic regression. P-values of <0.05 were considered significant.

RESULTS

The prevalence of adolescent pregnancy was the highest among women living in rural areas (9.8%) and grand multigravidity among refugee women (22%). The overall prevalence of anemia was higher in the second-trimester (16.2%) than in the first-trimester (11.2%), with anemic women in the first-trimester being more likely to be anemic in the second-trimester (OR = 8.223, P-value<0.001). Although anemia was less common in the first-trimester among refugees than among women living in urban areas (OR = 0.768, P-value = 0.006), it was more prevalent in the second-trimester (OR = 1.352, P-value<0.001). Moreover, refugee women were at lower risk than women living in urban areas of having GD (OR = 0.687, P-value<0.001) and diabetes mellitus (OR = 0.472, P-value<0.001) in the second-trimester. GH was associated with GD (OR = 1.401, P-value = 0.003) and DM (OR = 1.966, P-value<0.001).

CONCLUSION

The findings of this study provide evidence-based data on the considerable prevalence of pregnancy complications, anemia, GD, and GH among Palestinian pregnant women living in the north of the West Bank. Multi gravida, gestational age, Hb levels, and the type of settings were strong predictors of pregnancy complications. Therefore, a national plan is needed to ensure adequate maternal care for all, especially disadvantaged women, those in rural areas and refugee camps.

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.

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis

Background

Episiotomy, a surgical procedure that enlarges the vaginal opening during childbirth, was common practice until the early 2000s. Other sources, including the World Health Organization (WHO), advocate for the selective use of episiotomy. Episiotomy rates, on the other hand, have remained high in developing countries, while declining in developed countries. As a result, the current study sought to determine the overall prevalence of episiotomy in Africa as well as the risk factors associated with its practice.

Methods

Articles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 14 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. A random-effects meta-analysis model was used to determine the pooled prevalence of episiotomy. A heterogeneity test was conducted using I-Squared (I²) statistics. Egger's test and funnel plots were conducted to detect publication bias. Subgroup analysis was also conducted. Association was expressed through a pooled odds ratio (OR) with a 95% Confidence Interval (CI).

Result

A total of 21 studies with 40,831 participants were included in the systematic review and meta-analysis. The pooled prevalence of episiotomy practice was 41.7% [95% CI (36.0–47.4), I² = 99.3%, P < 0.001). Primiparity [OR: 6.796 (95% CI (4.862–9.498)), P < 0.001, I²: 95.1%], medical doctors- assisted delivery [OR: 3.675 (95% CI (2.034–6.640)), P < 0.001, I²: 72.6%], prolonged second stage of labor [OR: 5.539 (95% CI (4.252–7.199)), P < 0.001, I²: 0.0%], using oxytocin [OR: 4.207 (95% CI (3.100–5.709)), P < 0.001, I²: 0.0%], instrument -assisted vaginal delivery [OR: 5.578 (95% CI (4.285–7.260)), P < 0.001, I²: 65.1%], and macrosomia [OR: 5.32 (95% CI (2.738–10.339)), P < 0.001, I²: 95.1%] were factors associated with episiotomy practice.

Conclusion

In this review, the prevalence of episiotomy among African parturients was high. A selective episiotomy practice should be implemented to reduce the high episiotomy rates.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021293382, identifier: CRD42021293382.

The Incidence of Adolescent Pregnancy at Clinic of Gynecology and Obstetrics of Clinical Center Kragujevac

Adolescent pregnancy belongs to a group of high-risk pregnancies with high maternal and fetal mortality and morbidity rate with high prevalence globally (11%). The aim of this observational study is to show the incidence of adolescent deliveries in relation to the total number of births in the twelve-year period from 2007 to 2019 at the Department of Gynecology and Obstetrics of Clinical Center in Kragujevac from medical protocols and patients’ medical records. By evaluating the data of our research, we noticed a continuing decrease in the percentage of adolescents that give births each year. The total number of births in our clinic in this twelve-year period was 26544, and the number of teenage deliveries was 390 (1.74%), which is in accordance with the results of a similar research which was conducted in our clinic in the period from 2002 to 2007 (16.1%). However, despite the increase in the number of caesarean sections, Apgar score of newborn babies was similar to the results of previous tests - 8.31 which proves that the increase in caesarean sections is not correlated with growth of Apgar score. The average pregnancy duration of adolescents is similar as in the previous five-year period (37.5 w.g.), while in the general population of pregnant women it is 39.2 w.g which represents a statistically significant difference. The main causes of poor outcomes of adolescent pregnancies are biological immaturity of mothers, poor health care, that comes from poor socio-demographic conditions, as well as emotional stress. It is necessary to change the attitude of society towards these young people, give them support in the environment they live and provide them with better health care and social treatment.

An Increased Adverse Fetal Outcome Has Been Observed among Teen Pregnant Women in Rural Eastern Ethiopia: A Comparative Cross-Sectional Study

Background: According to the World Health Organization, teenage pregnancies are high-risk due to increased risks of fetal and infant morbidity and mortality. This study compares adverse fetal outcomes between teen and adult pregnant women from rural Eastern Ethiopia. Methods: Institutional-based cross-sectional study was conducted among women visiting maternity units from surrounding rural areas. A total of 481 teenagers (13-19 years old) and 481 adults (20-34 years old) women with a singleton pregnancy were included in the study. Two hospitals and 3 health centers were selected in Eastern Hararghe Zone, Eastern Ethiopia. Comparative analysis was carried out using the log-binomial regression model to identify factors associated with adverse fetal outcomes in both categories. The results are reported in adjusted prevalence ratios with 95% confidence intervals. Results: High proportion of adverse fetal outcome was observed among teenage women than adult (34.9% vs 21%). Statistically significant difference (P < .05) in the proportion of low birth weight (21.1% vs 9.3%), preterm birth (18.7% vs 10.6%), APGAR score at 5th minute (9.3% vs 4%) were found in teenagers compared to adult women. Antenatal care attendance (APR = 0.44; 95% CI: 0.23, 0.86); eclampsia (APR = 1.96; 95% CI: 1.26, 3.06); pre-eclampsia (APR = 1.73; 95% CI: 1.12, 2.67); and wealth index (rich) (APR = 0.55; 95% CI: 0.32, 0.94) were significantly associated with adverse fetal outcomes among the teenage women. Whereas intimate partner violence (APR = 2.22; 95% CI: 1.26, 3.90); preeclampsia (APR = 3.05; 95% CI: 1.61, 5.69); antepartum hemorrhage (APR = 2.77; 95% CI: 1.73, 4.46); and hyperemesis gravderm (APR = 1.75; 95% CI: 1.09, 2.79) were significantly associated with adverse fatal outcomes among the adult women. Conclusion: teenage pregnancy is associated with a high rate of adverse fetal outcomes. Early identification and treatment of problems during antenatal follow-up should be the mainstay to avert the massive adverse fetal effects.

The impact of adolescent pregnancy on maternal and infant health in Turkey: Systematic review and meta-analysis

OBJECTIVES

To examine the impact of adolescent pregnancy on maternal and infant health on the basis of studies conducted in Turkey.

MATERIAL AND METHODS

Systematic reviews and meta-analyses of cross-sectional and case-control. A systematic scan was performed in January 2020 based on the keywords "adolescent pregnancy or teenage pregnancy and Turkey" in the electronic databases PubMed, Clinical Key, Science Direct, Web of Science, Google Scholar, National Thesis Center, DergiPark, Ulakbim, Turkish Medline and Turkish Clinics. Two of the authors carried out a scan independently of each other, making a selection of articles, performing data extraction and quality assessment procedures under the supervision of the senior researcher.

RESULTS

The results of a total of 38 studies, of which twenty-three were cross-sectional and 15 were case-control, were compiled for the meta-analysis (adolescents: 20,768; control: 59,481). The results of the meta-analysis showed that the more common effects of adolescent pregnancies were preterm birth (OR: 2.12, p < 0.001), early membrane rupture (OR: 1.49, p < 0.001), anemia (OR: 2.60, p < 0.001), low birthweight/intrauterine growth retardation (OR: 2.06, p < 0.001), and fetal distress (OR: 1.78, p = 0.003). On the other hand, it was observed in the meta-analysis that childbirth by cesarean section (OR: 0.70, p < 0.001), gestational diabetes (OR: 0.35, p < 0.001), placenta previa (OR: 0.52, p = 0.01), polyhydramnios (OR: 0.52, p = 0.04) and macrosomia (OR: 0.54, p < 0.001) were less common among adolescents compared to adults.

CONCLUSION

Our review revealed that adolescent pregnancy had an adverse impact on maternal and infant health in terms of preterm childbirth, early membrane rupture, anemia, low birthweight/intrauterine growth retardation, low Apgar scores and fetal distress.

Evaluating Health Literacy among Adolescent and Young Adult Pregnant Women from a Low-Income Area of Northeast Brazil

Adequate health literacy is important for strong health outcomes during pregnancy, particularly among mothers with high risk of adverse outcomes related to pregnancy and childbirth. Understanding the health literacy of young pregnant women in low-income settings could support strategies to reduce adverse outcomes in this population. This exploratory study assessed the health literacy of young pregnant adolescents and young adults from a rural area in Northeast Brazil and associated factors such as socioeconomic conditions, adequacy of prenatal care, and social support from family and friends. In this cross-sectional study, 41 pregnant adolescents (13–18 years) and 45 pregnant adults (23–28 years) from the Rio Grande do Norte state, Brazil, were assessed regarding health literacy through the Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHLPA, score from 0–18, inadequate if <15). Income sufficiency, self-perceived school performance, compliance with recommendations for adequate prenatal care, and social support were also assessed. A linear regression analysis was conducted to evaluate the variables associated with the SAHLPA score. Ninety-five percent of the adolescents and 53.3% of the adults (p < 0.001) presented inadequate health literacy. Adolescent age (β − 3.5, p < 0.001), poorer self-perceived school performance (β − 2.8, p < 0.001), and insufficient income for basic needs (β − 2.8, p = 0.014) were associated with worse SAHLPA scores. Adolescent mothers have higher rates of inadequate health literacy in this population. Policies are needed to improve access to health information for young populations from rural low-income areas.

Magnetic resonance imaging evaluation of cervical length by the women's age: a retrospective cohort study

OBJECTIVE

The anthropometric characteristics of the uterus evolve with pubertal development in girls. It is therefore permissible to ask until these anthropometric characteristics change, in order to know if the cervical length criterion defined for preterm delivery threats is applicable to all ages. The main objective of our study was to analyze the evolution of cervical length with the women's age outside pregnancy to overcome factors related to pregnancy that can affect cervical length.

MATERIAL AND METHODS

This retrospective descriptive study over a period of 1 year from March 2017 to March 2018. The cervical length measurements were performed by Magnetic Resonnance Imaging. The cervical length was defined by sagittal T2-weighted magnetic resonance imaging (MRI) as the distance on a straight line between the external cervical os (at the point of divergence of the anterior and posterior lips) and the internal cervical os identified by an intersection between the line of the hypersignal of the glandular epithelium and a line passing through the isthmus.

RESULTS

A total of 209 patients were included. The cervical length ranged from 25.2 mm on average in children under 16 years (23.6-27.1 mm) to 39.7 mm between 36 and 40 years (27.9 -58.9 mm). There was a linear association between age and cervical length, irrespective of maternal anthropometric data (Pearson's coefficient ρ = 0.43, 95% CI 0.32-0.54 (p < 0.01). In multivariate analysis, the only factors associated with cervical length were women's age (p < 0.01) and the prior delivery (p < 0.01).

CONCLUSION

The cervical length is correlated with women age and the prior delivery.

Prevalence of teenage pregnancy in 2015-2016 and its obstetric outcomes compared to non-teenage pregnancy at Hospital Tuanku Ja'afar Seremban (HTJS), Negeri Sembilan, Malaysia: A retrospective case-control study based on the national obstetric registry

OBJECTIVE

To determine the prevalence of teenage pregnancy and compare its obstetric and perinatal outcomes with those of non-teenage pregnancy.

METHOD

This retrospective hospital-based case-control study was conducted in the Department of Obstetrics and Gynaecology in Hospital Tuanku Ja'afar Seremban. The study made use of the Malaysian National Obstetric Registry (NOR) records of teenage pregnant women aged 11-19 at Hospital Tuanku Ja'afar Seremban over a 12-month period between May 2015 and May 2016 (n=164). Socio-demographic profiles, obstetric outcomes, and perinatal outcomes were detailed for each pregnant woman. The results were compared to a control group of 169 pregnant women aged 20-30 who also delivered in hospital Tuanku Ja'afar Seremban during the same period. The aim of this study was to assess the obstetric outcomes of teenage pregnancy and to compare them with those of the control group. A chi-squared test was used to identify the statistical significance of the relationship between teenage pregnancy rates and obstetric outcomes. Results with p <0.05 was considered statistically significant.

RESULTS

The prevalence of teenage pregnancy was 2.8%. The mean age of the teenage group was 17.9; that of the control group was 26.4. Teenage mothers had a significantly higher risk of anemia (p<0.05), episiotomy (p<0.001), preterm labor (p<0.001), and delivering low-birthweight babies (p<0.001). There were no significant differences between the two groups in mode of delivery, antenatal complications, birth outcomes, APGAR scores at 5th minute, or neonatal complications.

CONCLUSION

The prevalence of teenage pregnancy in this study is relatively low but is associated with an increased risk of some perinatal complications. The primary care physician's role is pivotal in educating adolescents on sexual health, providing continual care in hospitals, and empowering teenagers in their reproductive health decisions.

Maternal Characteristics and Obstetric and Neonatal Outcomes of Singleton Pregnancies Among Adolescents

Background

Adolescent pregnancy remains a global public health issue with serious implications on maternal and child health, particularly in developing countries The aim of this study was to investigate maternal characteristics and obstetric and neonatal outcomes of singleton pregnancies among adolescents.

Material/Methods

A total of 241 adolescent women who gave birth to singletons between January 2015 and December 2015 at our hospital were included in this descriptive cross-sectional study. Data on maternal sociodemographic and obstetric characteristics as well as neonatal outcome were recorded.

Results

Primary school education (66.0%), lack of regular antenatal care (69.7%), religious (36.7%) and consanguineous (37.0) marriage, Southeastern Anatolia hometown (34.9%) and Eastern Anatolia hometown (21.2%) were noted in most of the adolescent pregnancies, while 95% were desired pregnancies within marriage. Pregnancy complications were noted in 19.5% (preeclampsia in 5.8%) and cesarean delivery was performed in 44.8% of adolescent pregnancies. Preterm delivery rate was 27.0% (20.3% were in >34 weeks). Overall, 13.3% of neonates were admitted to neonatal intensive care unit (NICU) in the postpartum period (prematurity in 28.1%), while 25.3% were re-admitted to NICU admission in the post-discharge 1-month (hyperbilirubinemia in 55.7%). Adolescent pregnancies were associated considerably high rates of fetal distress at birth (28.7%), preterm delivery (26.9%), and re-admission to NICU after hospital discharge (25.3%).

Conclusions

In conclusion, our findings indicate that along with considerably high rates of poor antenatal care, maternal anemia and cesarean delivery, adolescent pregnancies were also associated with high rates for fetal distress at birth, preterm delivery, and NICU re-admission within post-discharge 1-month.

Teenage Pregnancy and Its Adverse Obstetric and Perinatal Outcomes at Lemlem Karl Hospital, Tigray, Ethiopia, 2018

Introduction

One of the major public health issues across the whole world these days is teenage pregnancy which is defined as being pregnant in the age ranging from 13–19 years. About 11% of all births which occurred worldwide accounted for girls aged 15 to 19 years. From these, 95% teenage deliveries occur in low- and middle-income countries. World health 2014 statistics show that complications during pregnancy and childbirth are the second cause of death for 15–19-year-old girls globally. The aim of this study was to determine adverse obstetrical and perinatal outcomes of teenage pregnancy among deliveries at Lemlem Karl General Hospital, Tigray, Ethiopia, 2018.

Result

This study result showed that 17.5% of the teenagers and 6.8% of the adults deliver low birth weight neonates. From the total teenage mothers, about thirty-five (11.3%) of them had developed pregnancy-induced hypertension, whereas about thirteen (4.2%) of adults develop pregnancy-induced hypertension. Regarding cesarean delivery, forty (12.9%) of those teenage mothers deliver by a cesarean section while 58 (18%) of the adult mothers deliver by cesarean delivery. Teenage pregnancy was significantly associated with adverse obstetric and perinatal outcomes, a cesarean delivery (AOR: 0.57; 95% CI, 0.36–0.90), episiotomy (AOR: 2.01; 95% CI, 1.25–3.39), and low birth weight (AOR: 2.22; 95% CI, 1.13–4.36), and premature delivery were 2.87 (1.49–5.52). This study shows that adverse obstetric and perinatal outcomes were significantly associated with teenagers than adult mothers. Therefore, giving health education on focused ANC is very important to bring change to the teenager at this study area.

A comparison of obstetric outcomes in adolescent pregnancies and adult pregnancies

Introduction: Adolescent pregnancies are associated with adverse maternal and fetal outcomes including preeclampsia, preterm birth, and fetal growth restriction compared to adult pregnancies. The purpose of our study is to compare the incidents of obstetric outcomes between the adolescent pregnancies and adult pregnancies.Materials and methods: This retrospective case-control study was conducted between January 2013 and January 2018 at Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey. The institutions' medical records were screened for women with pregnancies after 24 weeks of gestation. Women under 19 years of age were included as the adolescent group and women between the ages of 20 and 29 were included as the control group. Obstetric outcomes were compared between the groups.Results: There were 3875 adolescent pregnancies in the case group and 3875 adult pregnancies in the control group. Even after adjusting for confounders in our adolescent pregnant cohort, the odds of intrauterine growth restriction, preterm birth and premature rupture of membranes were higher than in our adult pregnant cohort. On the other hand, we found low incidents of preeclampsia and gestational diabetes mellitus in pregnant women younger than 19 years of age.Conclusions: Adolescent pregnancies should be closely followed up as they have higher preterm birth rates as well as the risk of intrauterine growth restriction.

Hospital-Based Study of Maternal, Perinatal and Neonatal Outcomes in Adolescent Pregnancy Compared to Adult Women Pregnancy

BACKGROUND

Adolescent pregnancy, defined as a pregnancy in girls aged 10 to 19 years. Adolescent mothers are at high risk for maternal and neonatal complications.

AIM

To compare maternal, perinatal and neonatal outcomes in adolescents and adult women aged 20-24 years.

MATERIAL AND METHODS

This retrospective cohort study included all singleton pregnancies during a three-year period (January 2016-December 2018) who gave birth in a Clinical Hospital in Tetovo, Republic of Macedonia. After exclusion criteria, a total of 932 cases were reviewed and divided into two groups: one of the teenage mothers (< 19 years old) (115 women) and the other of adult mothers (20-24 years old) (817 women).

RESULTS

Of the total number of 5643 births, 128 (2.27%) were from adolescent pregnancies. Of them, nulliparous adolescent women were 115 (2.04%). Adolescents compare to adult mothers had a higher rate of urinary tract infections (33% vs. 22%), increased rate of maternal anemia (26% vs. 15%), preterm birth, small for gestational age newborns (25.2% vs. 17.1%), lower high school attendance (0 vs. 21.9%) and inadequate prenatal care. Spontaneous labour was more common in adolescents (73% vs 63.5%), while Caesarean sections were less common than in women aged 20-24 years (25.2% vs 33.5%). The rate of other perinatal outcomes was not significantly different between the 2 groups.

CONCLUSIONS

The results of the study showed that the frequencies of some maternal, perinatal and neonatal complications were considerably higher in adolescent mothers.

Spatio-temporal trends in the risk of adolescent pregnancy in Minas Gerais, Brazil, 2000-2015

PURPOSE

To investigate, through a spatio-temporal analysis, the association between the percentages of live births of adolescent mothers (LBAM) and the human development index (HDI), including the three components: income, education and longevity.

METHODS

The percentage of LBAM was obtained from the Brazilian Live Births Information System for the state of Minas Gerais, Brazil in the period 2000-2015 and the HDI data and its components were obtained from United Nations Development Program's (UNDP) Human Development Reports. A generalized additive model (GAM) was used to estimate the relative risk of LBAM in relation to the HDI and to identify spatial clusters of the geographical distribution of LBAM, the Moran global and local index was used.

RESULTS

There is an association between the HDI and its components with LBAM. The high values of relative risk are spatially concentrated in the northern part of the state of Minas Gerais. The graphs indicated a nonlinear relationship between LBAM over the years.

CONCLUSIONS

There is a strong spatial dependence of LBAM in Minas Gerais, which suggests that a geographical location plays a fundamental role in understanding it. The regional disparity confirmed in this study is inherent in the process of human development, it is important for planning actions aimed at the development of these regions in order to minimize existing disparities.

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.

Demographic profile and pregnancy outcomes of adolescents and older mothers in Saudi Arabia: analysis from Riyadh Mother (RAHMA) and Baby cohort study

OBJECTIVES

To investigate the impact of maternal age on pregnancy outcomes with special emphasis on adolescents and older mothers and to investigate the differences in demographic profile between adolescents and older mothers.

METHODS

This study is a secondary analysis of pregnancy outcomes of women in Riyadh Mother and Baby cohort study according to maternal age. The study population was grouped according to maternal age into five subgroups; <20, 20-29, 30-34, 35-39 and 40+years. The age group 20-29 years was considered as a reference group. Investigation of maternal age impact on maternal and neonatal outcomes was conducted with adjustment of confounders using regression models.

RESULTS

All mothers were married when conceived with the index pregnancy. Young mothers were less likely to be illiterate, more likely to achieve higher education and be employed compared with mothers ≥ 40 years. Compared with the reference group, adolescents were more likely to have vaginal delivery (and least likely to deliver by caesarean section (CS); OR=0.6, 95% CI 0.4 to 0.9, while women ≥40 years, were more likely to deliver by CS; OR 2.9, 95% CI 2.3 to 3.7. Maternal age was a risk factor for gestational diabetes in women ≥40 years; OR 1.7, 95% CI 1.3 to 2.1. Adolescents had increased risk of preterm delivery; OR 1.5, 95% CI 1.1 to 2.1 and women ≥40 years had similar risk; OR, 1.3, 95% CI 1.1 to 1.6.

CONCLUSION

Adverse pregnancy outcomes show a continuum with the advancement of maternal age. Adolescents mother are more likely to have vaginal delivery; however, they are at increased risk of preterm delivery. Advanced maternal age is associated with increased risk of preterm delivery, gestational diabetes and CS.