Journal of Babylon University/Pure and Applied Sciences/ No.(2)/ Vol.(23): 2015
Teenage Motherhood: Maternal & Fetal Complications
Suha J. Witwit
College of medicineBabylon university
E-mail su_sa_2006 @yahoo.com
Abstract
Background
Teenage pregnancy , which is a determinable to the health of the mother& child , is a common public health problem worldwide.
It is a problem that affect nearly every society- developed & developing a like.
There is a growing awareness that early child bearing has multiple consequences in term of maternal health, child health & overall wellbeing of society.
Aim of the study
Objective : toassessthemagnitude of the problem of teenage pregnancy & it’s complication.
Also to evaluate risk factors associated with teenage pregnancy & compare the obstetric& fetal outcome to older parturient.
Patients & methods
A case-control study was undertaken to compare the different sociodemographic characteristics & perinatal outcome of teenage mothers with those adult one in Babylon Teaching Hospital for maternity & pediatrics from September 2012to June 2013.
The study comprised of (100) teenage mothers between 15-19 years old with (100) randomly selected deliveries in the older age group (control group of pregnant women between 20-29 years old).
Data were collected through interviews& by observations using a pretested & predesigned schedule.
Data included demographic variable, available medical report, maternal complications : anemia ,preterm labor ,preeclampsia. eclampsia, sepsis, postpartum hemorrhage , maternal death, mode of delivery. Also include fetal complications Such as miscarriage ,low birth weight , birth defect& neonatal death.
Result:
Result revealed that the teenage mothers had a higher incidence of anemia 29(29%), pre eclampsia 5(5%) & cesarean section 20(21.97%) compared to 16(16%), 2(2%)& 11(11.57%) respectively in older mothers.
Also the result revealed that the teenage mothers had a higher proportion of preterm deliveries11(11%) compared to 6(6%) in the adult mothers& had low birth- weight babies 8(8% versus 4 (4%) in control group. Neonataldeath was also higher in teenage deliveries 5 (5.49%) versus 3( 3.16%) in older mothers.
Key words : teenage mother ,mother complication , newborn complications.
Conclusions:
The teenage mothers developed more adverse perinatal complications, such as stillbirths, neonatal deaths & delivered low birth weight babies ,when compared with those of the adult mothers.
Furthermore teenager had higher risk of pre eclampsia , preterm delivery,early pregnancy loss& high incidence of cesarean section when compared with older mothers.
الخلاصة:
دراسة الحالات الافرادية المقترنة بالحالات الضابطة أجريت في مستشفى بابل للنسائية والأطفال خلال الفترة من أيلول 2012 لغاية حزيران 02013
تضمنت الدراسة مجموعتين: المجموعة الأولى ( 100) امرأة حامل وتتراوح أعمارهن ما بين(15-19) سنة إما المجموعة الثانية اشتملت على (100) امرأة حامل تتراوح أعمارهن بين (20-29) سنة.
البيانات المأخوذة لكلا المجموعتين تتضمن المستوى الدراسي, عدد الولادات الكلي ,نسبة الهيموغلبين,قراءة ضغط الدم, وجود الزلال في الإدرار, ,الولادات المبكرة ( اقل من 37 أسبوع) , وزن الجنين , طريقة الولادة ( ولادة طبيعية , عملية قيصرية) مضاعفات في فترة النفاس ( نزف ما بعد الولادة , وفيات الأمهات) وحصيلة الولادة (وزن الجنين , جنين حي , متوفي)
نتائج الدراسة:
اغلبية النساء اليافعات العمر كانوا اما ربات بيوت او لم يكملن الدراسة الابتدائية او المتوسطة0
اظهرت الدراسة ان الحمل لدى النساء اليافعات العمر واللواتي تتراوح اعمارهن ما بين 15-19 سنة معرضات للخطورة ومضاعفات الحمل و الولادة وفترة النفاس بنسبة اكبر من النساء الحوامل اللاتي تتراوح اعمارهن ما بين 20-29 سنة وكذالك مضاعفات الجنين لدى النساء اليافعات العمر اكثر من باقي النساء.
فقد اظهرت الدراسة ان نسبة فقر الدم (الهيموغلبين اقل من 11 غم\ديسيللتر), ارتفاع ضغط الدم والولادة المبكرة ( قبل 37 اسبوع) كانت اعلى في النساء اليافعات مقارنة بباقي النساء, كذالك نسبة العملية القيصرية والاجهاض كانت اكثر في النساء اليافعات.
اما بالنسبة للجنين فقد بينت الدراسةان نسبة الولادة المبكرة و قلة وزن الجنين ( اقل من 2.5 كيلوغرام) ووفيات الوليد كانت اكثر في النساء اليافعات من باقي النساء.
الاستنتاج:
1.ان التحصيل الدراسي والمستوى العلمي له علاقة وثيقة بالزواج والحمل المبكر ومشاكلهما.
2. النساء اليافعات العمر عرضة للإصابة بفقر الدم اثناء الحمل والولادة المبكرة وقلة وزن الجنين إضافة الى ارتفاع ضغط الدم وزيادة نسبة الإجهاض اكثر من باقي النساء.
التوصيات:
تقديم النصح والإرشاد حول مخاطر الحمل والولادة في السن المبكر له دور فعال في تقليل نسبة المشاكل حيث ان توعية المريضة الى تأخير الحمل الى العمر المناسب من خلال استخدام مانع الحمل او توجيه المرأة الحامل على الزيارة المنتظمة لمراكز الرعاية الأولية له اثر كبير في الحد من الكثير من المضاعفات.
الكلمات المفتاحية: الأمومة اليافعة,مضاعفات ومخاطر الأم والجنين
Introduction
Teenage pregnancy is a worldwide problem bearing serious social & medical implication relating to maternal & child health. It represent a high risk group in reproductive term because of the double burden of reproduction & growth. Complication of pregnancy & child birth are the leading cause of mortality among girls aged 15-19 years in developing countries.Mayor S, 2004.
Teenagers younger than 15 are five times more likely to die during pregnancy or childbirth than women in their twenties & mortality rate for their infants are higher as well.Barber JS, 2007 .
Transition from childhood to adulthood may referredto adolescence or teenage which has been defined by WHO as the period between(10-19years), this the period when structural, functional& psychosocial development occur. As the child begin to prepare herself for assuming the responsibility for motherhood.Bartali B,2009.
Globally, young people aged between 15 &24 years make up 1.2 billion of the world’s population. The majority live in sub- Saharan Africa& are vulnerable to teenage pregnancy& HIV infection & this continue to be daunting problems for young people.Kost K,2010.
Being a young mother can affect one’s education, teenage mothers are more likely to dropout of education. As well as early motherhood can affect the psychological development of infant such as developmental disability& behavioral issue of their children.Chris Bonell ,2011.
Industrialized & developing countries have distinctly different rate of teenage pregnancy& in developing countries , early pregnancy may combined with malnutrition & poor health care. 13 million child are born to women under age of 20 years worldwide, more than 90% of these birth occur to women in developing countries. Mayor S, 2004.
However in developing countries, the most common causes of teenage pregnancy are early marriage ,poverty, low value & self-esteem of girls, low level of education, low level of contraception use ,lack of school ,poor school performance or dropping out of school.Haffenrs D.W,1995.
While in developed countries, teenage parents tend to be unmarried as well as adolescents may lack knowledge of conventional methods for preventing pregnancy. Inadequate use of oral contraception ,incorrect use of condom may also be the causes. In addition to that the failure rate of oral contraceptive are higher for teenager than in older one.Kip Addotta,2010.
Regarding socioeconomic & psychological impact of teenage pregnancy : Teenage mother are more likely to drop out of high school & only 14-29% of those whogave birth during their teens complete their secondary school when compared with women who waited until the age of 30.Hofferts ,2006.
Adolescent girls who give birth each year have a much higher risk of dying from maternal causes compare to women in their 20s & 30s, moreover, babies born to adolescent also faced a significantly higher risk of death compared to babies born to older mothers.Mangiaterre V.,2008
Adolescent pregnancy is associated with higher rate of morbidity & mortality for both the mother & infant. As a pregnancy in a still growing girl mean an increase in nutritional requirement not only for growth of the fetus but also for the mother herself& adolescent pregnancy have been associated with many medical problems including poor maternal weight gain, nutritional anemia ,vitamins deficiency & pregnancy induced hypertension.G. Dangol:2005
As well as the increase demand for blood flow during pregnancy can place strain on teenage mother’s underdeveloped cardiovascular system which can be unprepared to handle the extra circulatory load, so high blood pressure (Pregnancy induced hypertension),can develop as result which consequently lead to decrease fetal weight & growth.Elizabeth Otto,2010.
Also teenage mother face the possibility of preterm labor or labor before 37 weeks gestation as physically teenage mother have immature reproductive organs that may not be prepared to carry infantto term , also immature cervix & metabolic system play a role in causing preterm birth.Catherine Stevens,2002.
The combination of poor nutrition & early child bearing expose young woman to serious healthrisk during pregnancy& childbirth including damage to the reproductive tract, pregnancy-related complications, such as anemia, pregnancy-induced hypertension ,preterm labor, cephalo-pelvic disproportion maternal mortality, perinatal & neonatal mortality& low birth weight.Agarwal N,2005.Pelvic bone do not reach their maximum size until the age of 18 years, therefore the pelvis of teenage mother may not have grown enough to allow vaginal delivery of normal size baby. For this reason , the incidence of cesarean section is higher in teenage mothers.. Mehal T Parmar,2012.Teenage pregnancy may complicated by other medical problems like placenta previa, maternal depression. As the teenagers may fall into depression while trying to handle the emotions which may lead to neglection of her baby.Julia Bodeeb ,2006.Infants born to teenagers are 2-6 timesmore likely to have Low birth weight than those born to mothers aged 20 or older, prematurity play a great role in Low birth weight but intrauterine growth retardation is also a factor.The Alan Guttmacher institute,2010.
Low birth weight is the most immediate health problem & Low birth weight babies may have immature organ system( brain, heart ,lung), difficulty in controlling of body temperature& blood sugar , increase incidence of mental retardation, a risk of dying in early pregnancy when compared with normal weight babies.Debbie Lawlor ,2001.
In addition to the cost potential of girls who are married at earlier age, there are real cost associated with woman’s health & infant mortality. Some young girls are forced into marriage at a very early age .on the other hand, several social factors such as religious believe, idleness, economic factors have been identified as factors contributing to early marriage & pregnancy. Allen E, Borell C,2007.
Great attention have been given to prevention of teenage pregnancy in recent time to prevent teenage pregnancy related complications.Mckee MD,2006.
Patients & method:
A case-control study was done at BabylonMaternityHospitalfrom September 2012 - June 2013 .
Total No. of cases was(200) pregnant women divided into 2 groups each one consist of (100)women. First : group one include study group & their age range from 15-19 years.
Second :control group & their age range from 20-29 years.
Age between 20-29 years was considered, since this age group is generally regarded as a safe for child birth. Multiple gestation ,women with multiple illness during pre-pregnancy stateany perinatal complications occurring after 48 hours after delivery were excluded from this study.
The sociodemographic data include age, occupation ,address ,socioeconomic state & level of education, antenatal& intrapartum complications & neonatal outcome were considered in both groups attending the delivery room or the emergency unit during the period of the study.
Statistical analysis: the data were expressed in term of number of patients ,percentage & p-value using SPSS version 18.
< 0.05 considered significant
<0.01 considered highly significant
<0.001 extremely significant
Result:
Illiteracy & patient’s education were significantly associated with teenage pregnancy. A higher proportion (79%) of adult mothers received ANC check up compared to( 58%) in teenage mothers. As shown in table -1-
About 65(65%) of teenage mothers were housewives & (61%) had primary school compared to (32%)(40%) respectively in control group . As shown in table -1-
This study show that the incidence of preterm labor was (11%) in teenage mothers compared to (6%) in adult mothers.(as shown in table -2-)
Group A show that the incidence of anemia & Small for gestational age in teenage group was 29(29%), 8(8%), respectively in comparison to control group (16%),(4 %) .
.(as shown in table -2-)
Group A show higher incidence of pre eclampsia 5(5%) than control group 1 (1%).
Regarding postpartum hemorrhage, only 2(2%) cases had been reported in both study & control group.
No cases of sepsis or maternal death was reported in both groups .
About 23(23%) of teenage women had no any complication compared to 55(55%) of older mothers.(as in table -2-)
About 12(12%) of teenage had combined complications : include 8(66.6%) had preterm labor & anemia ,3(25%) had pre eclampsia ended by preterm termination of pregnancy & 1 (8.3%) had preterm labor&SGA compared with 6(66.67%), 2(22.2%)&1(11.1 ) respectively.(as shown in table -3-)
Incidence of cesarean section is higher in group A 20(21.9%) than in control group 11(11.57%) & larger No. was for failure of progress of labor 10(50%) in study group.(as shown in table( 4 &5)
The study show no statistical significance in the incidence of miscarriage. spontaneous abortion6(66.6%)missed abortion2(22.22%) were recorded in teenage group than in control group 3(60 %), 1(20 %) respectively .
1 case of molar pregnancy was reported equally in both groups.( as in table -6-)
Incidence of neonatal death is higher in group A (5%) , & mostly because of prematurity (80%) than in control group ( 3%)& (66.6%) respectively( as in table -7-)
Table -1- Demographic criteria of pregnant women
Show that the teenage pregnancy largely associated with the occupation of the patients & most of them were housewives &dropped out the primary school when compared with adult mothers.
Those with low socioeconomic background were more likely to be pregnant as teenager when compared to those from higher socioeconomic background.
Criteria of the pregnant women / Study group(No. &%) / Control group
(No. & %) / P-value
Age(years) / 15-<16: 25(25)
16-<17 : 35(35)
17-<18: 18(18)
18- 19 : 22(22) / 20-22: 24(24)
22-24 : 22(22)
24-26 : 19 (19)
26- 28 : 17 (17)
28- 29 : 18(18) / > 0.05
Occupation: 1.employer
2.housewives / 35(35)
65(65) / 68(68)
32(32) / <0.0001
Address
1.rural
2.urban / 61(61)
39(39) / 28(28)
72(72) / <0.0001
Educational level
1.illitracy
2. primary school
3. secondary school
4.post graduate / 22(22)
61(61)
13(13)
4 (4) / 9(9)
40(40)
29(29)
22(22) / <0.011
0.003
0.0055
0.0002
Antenatal care attendance
- attend
- not attend
42(42) / 79(79)
21 (21) / 0.0014
Socioeconomic state
1.low Socioeconomic
2.High / 67(67)
33(33) / 44(44)
56(56) / 0.0011
Table -2-Distribution of subject according to complication:
Show the comparison between teenager & control group according to the complications.
Teenage mothers liable for many complications include miscarriage ,preterm labor ,anemia,preeclampsia & small for gestational age baby(SGA) .as presented in table -2-
complications / Teenage group / Control group / p-valueNo. / percentage
% / No / Percentage
%
Miscarriage
Preterm labor
Pre eclampsia
Eclampsia
Anemia
SGA
PPH
Sepsis
Maternal death
No complication
Total / 9
11
5
1
29
8
2
Zero
Zero
23
100 / 9
11
5
1
29
8
2
23
100 / 5
6
2
1
16
4
2
Zero
Zero
55
100 / 5
6
2
1
16
4
2
55
100 / >0.05
>0.05
>0.05
>0.05
<0.027
>0.05
>0.05
<0.05
Table -3-Combined complications
About 12 patients in teenage group have combined complications like preterm labor & anemia , pre eclampsia & preterm labor, pre eclampsia & small for gestational age fetus compared to 9 patients in control group. P-value 0.05
Teenage group control group
Complications / No. / Percentage% / No. / Percentage
% / p-value
Preterm labor& anemia / 8 / 66.6 / 6 / 66.67 / >0.05
Pre eclampsia& preterm labor / 3 / 25 / 2 / 22.2 / >0.05
Pre eclampsia& SGA
Total / 1
12 / 8.3
100% / 1
9 / 11.1
100% / >0.05
Table -4- Mode of delivery in teenage pregnancy
show the mode of delivery in teenager: as 9% of patients had abortion. only 91 patient had delivery in which NVD was the route of delivery in the majority of patients(75.82%).
Teenage group control group
mode of delivery: / No. / percentage% / No. / percentage
% / p-value
NVD
C\S
Instrumental delivery
Total / 69
20
2
91 / 75.82
21.97
2.19
100% / 79
11
5
95 / 83.15
11.57
5.26
(100%) / <0.004
>0.05
>0.05
Figure -1- show the mode of delivery in both groups
Table -5- incidence & indications of C\S in study group
Show the incidence & indication for C\S & about 50% of those with cesarean section was for failure of progress of labor & this is clinically significant but statistically un significant because of small sample size.
Teenage group control group
indication of c\s / No. / % / No. / % / p-value
Contracted pelvis
Malpresentation(breech)
Failure of progress of labor
Pre eclampsia
Total / 5
3
10
2
20 / 25
15
50
10
100% / 3
3
4
1
11 / 27.27
27.27
36.36
9.09
100% / >0.05
>0.05
>0.05
>0.05
Figure -2- show the indications of C\S in teenage group
Table -6-Early pregnancy losses in both groups
Show the No. & percentage of early pregnancy loss in both groups: there is no statistical difference regarding the incidence of miscarriage in both groups.
Teenage group control group
Early pregnancy loss / No. / percentage% / No. / Percentage
% / p-value
Spontaneous miscarriage
Missed miscarriage
Molar pregnancy
Total / 6
2
1
9 / 66.66
2.44
11.11
100% / 3
1
1
5 / 60
20
20
100% / >0.05
>0.05
>0.05
Table -7- Incidence of early neonatal death within 48 hours
Show the neonatal death in both groups & there is non significant difference between teenager & adult patients.
P-value > o.o5
Odd ratio 2 times> in teenager than in adult.
Teenage group control group
Neonatal death / No. / % / No. / % / p-valuePreterm baby / 4 / 80 / 2 / 66.66 / >0.05
Term baby / 1 / 20 / 1 / 33.33 / >0.05
Total / 5 / 100 / 3 / 100
Discussion :
Teenage pregnancy is defined as an under age of 19 years becoming pregnant. Anemia is defined as Hemoglobin level below 11 g\dl during last trimester of pregnancy. Preterm labor is define as delivery occurring before 37 completed weeks of gestational age.
Low birth weight is defined as babies weight below two thousand five hundred gm at birth corrected for gestational age.
Young maternal age at delivery has been proposed as risk factor for adverse pregnancy outcome, it occurs in all races, faiths ,socioeconomic status & religions. Teenage pregnancy can have serious physical consequences.
Many studies show that those in low socioeconomic background are twice more likely to get pregnant as a teenage when compared to those from high socioeconomic background.Ibrahim Is Ayuba,2010.
Social difference should given a special consideration in the design of programs targeting adolescent in family education.
Low level of literacy adversely affect reproductive & sexual health awareness, thus quality of life. In this study the literacy was higher among adult mother compared to teenage mothers.
Adverse outcome of teenage pregnancy arise not only from physical& medical causes but are also associated with individual , family& sociocultural factors beside lack of access to healthcare, contraception& other resources which is the prevailing situation in the most developing countries.
Several studies have show that dislike of school& lack of job & education have all emerge as explanatory factors in causing increase in teenage pregnancy.Wiggins M,2005.
Anemia is one of the complication of teenage mothers & it result either from inadequate nutrition ,infection ,bad eating habit consumption of fast food.
Sever anemia can lead to preterm labor, postpartum hemorrhage, sepsis & pre eclampsia , which if untreated lead to eclampsia.Chris Bonell ,2011.
In this study , the incidence of anemia & preterm delivery was (29%)& (11%) which is higher than in control group(16%), (6%) respectively.
This is similar to an Indian study which show that the prevalence of anemia was significantly higher in the teenage mothers(52.96%) than in the control group(43.59)& the incidence of preterm delivery was (51.72%) than in control group(25.88%).Bartali B,GK,2009.
The result of our study show that anemia was higher in teenager(29%) than in older mothers(16%) in contrast to other study which show that the anemia was lower in teenage mothers(33%) in comparison to those who were 20-30 years old (62.1%). Sen SP. Pregnancy in adolescence,1974.
LBW babies are 5-30 times more likely to die than babies of normal weight. if the mother is under 18 years , her baby’s chance of dying in the first year of life is 60% higher than in the baby born to a mother older than 19 years.Ibrahim Is Ayuba,2012.
Low birth weight baby has be found to be an important outcome of teenage pregnancy. As our study show that27 (27%) of LBW babies were born to teenage mothers compared to (9% )of LBW in control group.
& this is correspond to an Indian study done at hospital in Kalkata show that 72.6% of low birth weight babies were born to teenage mothers compared to 59.2% of LBW in control group.Chanande MS,2002.
Also other study found that the No. of LBW babies was more in the case of teenage mothers (38.9%) compared to adult mothers(30.4%). Babies delivered to teenage mothers are likely to be premature& hence the incidence of LBW is higher in them.ChenYK,Wen SW,2007.
In our study carried at Maternity Hospital, out of 100 teenage pregnancies 78(78%) patients had spontaneous vaginal deliveries& 20(20%) patients had LSCS while an Indian study carried out BYL Nair Hospital show that the incidence of NVD was 57.74% but comparable incidence of C\S (21.12%).Chris Bonell ,2011.
.Other study show that vaginal delivery as the major route of delivery in control group 55(66.2%), however teenage mothers had significantlymore C\S 26(31.3%), majority of them(84.6%) was performed as an emergencies for failure of progress.Ebeige PN,Gharoro EP,2012.
Our study show that about 20 (20%) of teenage mothers delivered by C\S & most of these operation was due to failure of progress of labor 7cases(35 %) fallowed by malpresentation5 cases (25%) while other study show that the most overall indication for C\S was fetal distress(60%) fallowed by cephalopelvic disproportion (22.8%). Also found that the indication for c\s in fetal distress & preeclampsia was more commonly among the teenage mothers than among adult mothers. Al- Ramahi M,2006.
In our study ,2(2%) instrumental deliveries had been reported in teenage mothers while 5cases(5%) in control group was recorded. similar to other study which show that about )34%( of teenage mothers had instrumental deliveries compared to )39%( of adult mothers.Prianka Mukhopadhyay,2007.