Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network's Maternal Newborn Health Registry study.

Fernando Althabe,Luz Gibbons,Mabel Berrueta,Fabian Esamai,Elwyn Chomba,Sarah Saleem,Archana Patel,Elizabeth M Mcclure,Omrana Pasha,Pierre Buekens,Nancy F Krebs ,K Michael Hambidge ,Janet Moore ,Shivaprasad S Goudar ,Marion Koso‐Thomas ,Patricia L Hibberd ,Ana Garcés ,María Luisa Cafferata ,Robert L Goldenberg ,Waldemar A Carlo ,Edward A Liechty ,Richard J Derman

doi:10.1186/1742-4755-12-s2-s8

Abstract

BackgroundAdolescent girls between 15 and 19 years give birth to around 16 million babies each year, around 11% of births worldwide. We sought to determine whether adolescent mothers are at higher risk of maternal and perinatal adverse outcomes compared with mothers aged 20–24 years in a prospective, population-based observational study of newborn outcomes in low resource settings.MethodsWe undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in six low-middle income countries (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). The study population for this analysis was restricted to women aged 24 years or less, who gave birth to infants of at least 20 weeks’ gestation and 500g or more. We compared adverse pregnancy maternal and perinatal outcomes among pregnant adolescents 15-19 years, <15 years, and adults 20-24 years.ResultsA total of 269,273 women were enrolled from January 2010 to December 2013. Of all pregnancies 11.9% (32,097/269,273) were in adolescents 15-19 years, while 0.14% (370/269,273) occurred among girls <15 years. Pregnancy among adolescents 15-19 years ranged from 2% in Pakistan to 26% in Argentina, and adolescent pregnancies <15 year were only observed in sub-Saharan Africa and Latin America. Compared to adults, adolescents did not show increased risk of maternal adverse outcomes. Risks of preterm birth and LBW were significantly higher among both early and older adolescents, with the highest risks observed in the <15 years group. Neonatal and perinatal mortality followed a similar trend in sub-Saharan Africa and Latin America, with the highest risk in early adolescents, although the differences in this age group were not significant. However, in South Asia the risks of neonatal and perinatal death were not different among adolescents 15-19 years compared to adults.ConclusionsThis study suggests that pregnancy among adolescents is not associated with worse maternal outcomes, but is associated with worse perinatal outcomes, particularly in younger adolescents. However, this may not be the case in regions like South Asia where there are decreasing rates of adolescent pregnancies, concentrated among older adolescents. The increased risks observed among adolescents seems more likely to be associated with biological immaturity, than with socio-economic factors, inadequate antenatal or delivery care.Trial registration numberNCT01073475

Highlights

Adolescent girls between 15 and 19 years give birth to around 16 million babies each year, around 11% of births worldwide
While the proportion of all births in adolescents 15-19 years in the sub-Saharan African (SSA) and Latin American (LA) sites ranged from 16.1% (Guatemala) to 26.0% (Argentina), in the South Asian (SA) sites this proportion ranged from
There was no significant association between early adolescence and stillbirths (Table 2, figure 4). In this large population-based study conducted in six large middle income countries (LMIC), the prevalence of adolescent pregnancy was heterogeneous among regions; while in India and Pakistan the prevalence did not exceed 10%, in sub-Saharan African and Latin American sites it ranged from 16% to 27%

Summary

Introduction

Adolescent girls between 15 and 19 years give birth to around 16 million babies each year, around 11% of births worldwide. The evidence is still controversial; the extent to which the observed associations were caused by the biological immaturity of the adolescent mothers, or were confounded by their frequently poor socioeconomic conditions and lack of health care is still a matter of debate [4,5,7,8,12,13,14] This conflicting evidence of research on adolescent pregnancy outcomes to date may be explained by the heterogeneity of study settings (hospital-based vs population-based studies), small sample sizes, especially for adolescents

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