Child Bearing Age and Pregnancy Outcomes in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey

Abstract

Background: Delayed childbirth has increased significantly over the past several decades in developed countries while teenage pregnancy is still common in developing countries. Assessing the association between adolescent childbearing and the risk of perinatal and health outcomes may help policy makers to reform or formulate new policies to prevent premature death, disability and other adverse perinatal outcomes. Objectives: To assess the association between adolescent pregnancy and the risk of adverse maternal, obstetrical and neonatal outcomes. Study design: Data was extracted from 2011 Bangladesh Demographic and Health Survey (BDHS). This is a nationally representative population-based survey with a two-stage stratified cluster sample design. Outcomes for adolescent women ≤ 19 years of age were compared with those of women aged 20 to 34 years (young adult) and ≥ 35 years (adult). Multilevel Poisson regression models were used to determine the associated adverse birth and health outcome with maternal age. Results: The mean age at childbearing was 26 years. Prevalence of adverse perinatal outcomes including low birth weight, stillbirths, stunting and perinatal mortality were substantially higher among adolescent mothers compared to the young adults. Multilevel regression models indicated that higher risk of low birth weight (adjusted relative risk (aRR), 1.15; 95% CI, 1.00-1.33), childhood stunting (aRR, 1.06; 95% CI, 0.98-1.14) and early neonatal mortality (aRR, 1.60; 95% CI, 0.85-1.27) were observed among the adolescent mothers compared to young adult mothers. Maternal age 35 years or over found to be a greater risk factor for pregnancy termination (aRR, 1.31; 95% CI, 1.09-1.56), caesarean delivery (aRR, 1.35; 95% CI, 1.02-1.79) and menstrual irregularities (aRR, 1.35; 95% CI, 1.02-1.79) than for young adult mothers. Conclusion: Pregnant women aged ≤ 19 years and ≥ 35 years are at increased risk of different adverse birth and health outcomes. Social awareness needs to be increased about the consequences of early and late childbearing to prevent premature death and disability and adverse perinatal outcomes.