Adolescent Pregnancy: Problems and Consequences

Adolescent pregnancy: Problems and consequences

Maitri Shaha,*, Saloni Prajapatib, V. Sheneeshkumarc

ABSTRACT

Background: Adolescent pregnancy continues to be a grave problem in India not only from the obstetrical point ofview but from the social and economical perspectives also. Complications of pregnancy and childbirth are the leadingcause of mortality among women between the ages of 15 and 19 in the developing world.

Methods: The present study was carried out in a tertiary care hospital of Gujarat where various sociodemographicand cultural factors associated with adolescent pregnancies were documented and compared with controls. Devel-opment of any complication during antenatal period and perinatal outcome of each pregnancy was noted.

Results: It was found that there are more chances of developing severe anemia, severe PIH and low birth weightbabies in adolescent pregnancies. Poverty and illiteracy increase the risk for the same.

Conclusion: Cultural practices, poor socioeconomic conditions and low literacy rate are the contributory factors toadolescent pregnancy associated poor obstetric outcome.

Copyright © 2012, Indraprastha Medical Corporation Ltd. All rights reserved.

Keywords: Adolescent pregnancy, Sociodemographic factors, Perinatal outcome

INTRODUCTION

Adolescent pregnancy continues to be a grave problem inIndia not only from the obstetrical point of view but fromthe social and economical perspectives also. Also knownas teenage pregnancy, it is defined as a pregnancy occurringfrom the age of 13e19 years of age (or for the matter of factfrom puberty to 19 years of age). It is not limited to anysocial, economic, racial and ethnic groups.

According to UNFPA, State of world population data2003, the incidence of teenage pregnancy is 45 per 1000live birth. Worldwide rates of teenage pregnancy rangefrom 143 per 1000 in some sub-Saharan African countriesto 2.9 per 1000 in South Korea.1,2 Between 15 and 19years, in addition to age there are other socioeconomicrisk factors. Data supporting teenage pregnancy as a socialissue in developed countries include lower educationallevels, higher rates of poverty, and other poorer “lifeoutcomes” in children of teenage mothers. Teenage

pregnancy in developed countries is usually outside ofmarriage, and carries a social stigma in many communitiesand cultures. For these reasons, there have been manystudies and campaigns which attempt to uncover the causesand limit the numbers of teenage pregnancies. In othercountries and cultures, particularly in the developing world,teenage pregnancy is usually within marriage and does notinvolve a social stigma.3

Pregnant teenagers face many of the same obstetricsissues as women in their 20s and 30s. However, there areadditional medical concerns for younger mothers, particu-larly those under 15 and those living in developing coun-tries. The worldwide incidence of premature birth andlow birth weight is higher among adolescent mothers.4e6

Risks for medical complications are greater for girls 14years of age and younger, as an underdeveloped pelviscan lead to difficulties in childbirth. Obstructed labor is nor-mally dealt with by Caesarean section in industrializednations; however, in developing regions where medical

aAssociate Professor, bAssistant Professor, cSenior Resident, Dept. of Obs & Gynec, Medical College & S.S.G. Hospital, Baroda, India.*Corresponding author. 30, Gulabchand Park Soc., Karelibaug, Baroda 390018, India. Tel.: þ91 265 2485727, þ91 9426370499 (mobile),email: maitrishah.gynec@gmail.comReceived: 9.4.2012; Accepted: 29.6.2012; Available online: 13.7.2012Copyright � 2012, Indraprastha Medical Corporation Ltd. All rights reserved.http://dx.doi.org/10.1016/j.apme.2012.06.002

Apollo Medicine 2012 SeptemberVolume 9, Number 3; pp. 176e180 Original Article

services might be unavailable, it can lead to eclampsia,obstetric fistula, infant mortality, or maternal death.6 Formothers in their late teens, age in itself is not a risk factor,and poor outcomes are associated more with socioeconomicfactors rather than with biology.7

The World Health Organization loping estimates that therisk of death following pregnancy is twice as great forwomen between 15 and 19 years than for those betweenthe ages of 20 and 24. The maternal mortality rate can beup to five times higher for girls aged between 10 and 14than for women of about 20 years of age.

One-fourth of adolescent mothers will have a second childwithin 24 months of the first. Factors that determine whichmothers are more likely to have a closely-spaced repeat birthinclude marriage and education: the likelihood decreaseswith the level of education of the young woman e or herparents e and increases if she gets married.

This paper attempts to evaluate various sociodemographicand cultural factors responsible for adolescent pregnancies. Italso shows various pregnancy related complications in thisage group and compares them with the control group.

MATERIALS AND METHOD

This study was carried out in Medical college hospital ofVadodara, over a period of 1 year amongst antenatalmothers attending outpatient and emergency Departments.The case group includes mothers who are less than 19 yearsof age and are married primigravida with gestational age ofless than 20 weeks. The next antenatal mother fulfilling thesame criteria and between the age group of 20e29 yearswere taken as control for the same case. The motherswith any history of medical or surgical disorders, havingRh negativity, with multiple pregnancies or showing fetalcongenital anomalies were excluded from the study.

The aim of the study was to find out association betweenvarious socio-cultural and demographic factors withnumber of adolescent pregnancies. Various maternalcomplications and perinatal outcome of this age groupwere noted and compared with that of control group.

It was a longitudinal follow-up study where data wascompared amongst two groups. Semi-structured open endedquestionnaire was provided to each case and control afterobtaining their written informed consent. Both cases andcontrols were given antenatal care as per the existing stan-dards at the hospital. All the details of the cases andcontrols were documented systematically in the proforma.Details covered their sociodemographic aspects, antenatalcare, baseline investigations, labor details and feto-maternaloutcome. The data was then organized and subjected tostatistical tests of significance.

RESULTS AND DISCUSSION

The present study highlights the magnitude of problem ofadolescent pregnancies and discusses the consequences ofperinatal outcomes. There were 4098 confinements inSSG Hospital Vadodara over a period of 1 year. Of these115 were teenage pregnancies with prevalence, therefore,of 2.81%. The number of the adolescent mothers hasincreased by 50% during the last 27 years and is likely toincrease further due to the population momentum.8

Teenage mothers included in this study ranged from 15years of age to 19. Twenty percent of them were below thelegal age of marriage. Thus in a significant number of casesmarriage and conception occurred even before the legal agewas attained (Table 1).

Comparing educational achievements, 54.3% of thecases were illiterate compared to 12.9% controls. Husbandsof 51.4% of the cases were illiterate whereas the same ratefor controls was 14.3%. In all higher educational classes,cases lagged behind controls (Table 2).

Important causes for early marriage were economic pres-sure, social pressure and family pressure. Same factors playa role in poor antenatal care. Education also plays a definiterole in the causation of teenage pregnancy. Attainment ofhigher education leads to a late age of marriage and concep-tion due to professional pursuit and desire for economicindependence.

Other sociodemographic and cultural factors studiedshows that 74.3% of the cases were from rural areascompared to 51.4% controls. 48.6% of the controls werefrom urban areas whereas the same rate for cases was25.7%. This association was statistically significant(p ¼ 0.0056, Odds ratio ¼ 2.7). It also reflects thatHusbands of 57.2% of cases were unskilled laborerswhereas the same rate for controls was 24.3%. Respectiverates of cases were lower compared to controls for allhigher occupation levels. All the associations were statisti-cally significant. The results also show that 68.6% of caseswere from low socioeconomic classes compared to 38.6%of the controls. 55.7% of the controls were from middleclass and 5.7% from upper class. This was statisticallysignificant (p ¼ 0.0007). Teenage pregnancy was

Table 1 Age wise distribution of cases (n ¼ 70).

Age No. of cases

15 1 (1.4%)16 4 (5.7%)17 9 (12.8%)18 32 (45.7%)19 24 (34.3%)Total 70

Adolescent pregnancy Original Article 177

statistically associated with larger families (p ¼ 0.003,Odds ratio ¼ 0.34) (Table 3).

Thus teenage pregnancy is associated with low socioeco-nomic levels. This is an amalgamation of earlier tables allof which reflected parameters of socioeconomic stratifica-tion. Larger families means limited resources, lesser educa-tional opportunities and economic constraints. This leads topressure to get the girl married off earlier so that she canplay her traditional role of homemaker. Strategic planningmust include socioeconomic upliftment and improvingliteracy rates so as to circumvent the problem of teenagepregnancy.

There are increased chances of preeclampsia, anemia,preterm labor and prolonged labor in adolescent pregnan-cies. Due to increased rate of complications seen duringpregnancy and at delivery, this group, comes under thepreview of ‘high-risk pregnancy’ requiring constant andregular supervision.9

In our study, the incidence of severe anemia, severe PIHand short stature was more amongst the cases as compared

to controls, which was statistically significant a p-value of0.039, 0.029 and 0.029 respectively. However, the inci-dence of moderate anemia, mild PIH and eclampsia werecomparable amongst the cases and controls, which wasnot significantly significant. The incidence of preterm laborwas 17.1% in cases and 5.7% in the controls. This washowever not statistically significant (p ¼ 0.063). The inci-dence of IUGR and oligohydramnios was 2.8% and 4.2%in the cases respectively. None of these were observed inthe controls. One case of PROM was observed in thecontrols and none in the cases. The incidence of CPD andAbruptio Placentae was similar and not statically significant(Table 4).

It was seen that adolescents aged 16 or younger in Indiawere less likely to use any health care than were olderwomen.10 The standard of antenatal care in teenage motherswas poor. 27.1% have never taken an ANC visit accordingto this study.

The incidences of various complications likepreeclampsia (23.7%), eclampsia (8.7%), anemia (11.2%),premature labor (30.0), prolonged labor (13.7%) areobserved in study by Bhadauria et al9 (Table 5).

Table 3 Socio-cultural factors.

Case Control

ResidenceRural 52 (74.3%) 36 (51.4%)Urban 18 (25.7%) 34 (48.6%)OccupationUnskilled laborer 40 (57.2%) 17 (24.35)Skilled laborer 8 (11.4%) 18 (25.7%)Business 8 (11.4%) 6 (8.6%)Office 6 (8.6%) 21 (30%)Services 8 (11.45%) 8 (11.4%)Socioeconomic classa

Low 48 (68.6%) 27 (38.6%)Middle 22 (31.45%) 39 (55.7%)Upper 0 4 (5.7%)Family size3e4 20 (28.6%) 38 (54.3%)>4 50 (71.4%) 32 (45.7%)a Kuppuswamy’s classification.

Table 4 Presence of complications in adolescent pregnancies.

Complications Cases Controls p-value

Anemia Mild 55 (85.8%) 64 (94.4%) e

Moderate 2 (2.8%) 3 (4.2%) 1.0Severe 8 (11.4%) 1 (1.4%) 0.039

PIH Mild 3 (4.2%) 2 (2.8%) 1.0Severe 12 (17.1%) 3 (4.2%) 0.029

Preterm labor 12 (17.1%) 4 (5.7%) 0.063Oligohydramnios 3 (4.2%) 0 e

IUGR 2 (2.8%) 0 e

Placenta praevia 0 0 e

Abruptio Placentae 1 (1.4%) 2 (2.8%) 1.0PROM 0 1 (1.4%) e

CPD 4 (5.7%) 2 (2.8%) 0.678Short stature 10 (14.3%) 1 (1.4%) 0.029Eclampsia 2 (2.8%) 1 (1.4%) 1.0Postdatism 1 (1.4%) 0 e

Table 2 Educational levels of the study participants.

Educational level Case Control

Wife Husband Wife Husband

Illiterate 38 (54.3%) 36 (51.4%) 9 (12.9%) 10 (14.3%)Primary 14 (20%) 2 (2.8%) 15 (21.4%) 5 (7.1%)Secondary 17 (24.3%) 17 (24.3%) 33 (47.1%) 18 (25.7%)Higher secondary 1 (1.4%) 7 (10%) 9 (12.9%) 7 (10%)College 0 8 (11.4%) 4 (5.7%) 20 (26.6%)

178 Apollo Medicine 2012 September; Vol. 9, No. 3 Shah et al.

According to our study, 17.1% of the babies born toteenage mothers were preterm compared to 5.7% incontrols. This was statistically significant (p ¼ 0.039). Inci-dence of low birth weight babies was 77.2%. Of these 23%was less than 2 kg, 17.1% of the babies were preterm,28.1% required NICU admissions. Important causes wereprematurity and asphyxia (Table 6).

After delivery, while asking preference for contracep-tion, 37.1% of the teenage mothers desired some form ofcontraception compared to 65.7% of controls. This wasstatistically significant (p ¼ 0.008%). This reflects signifi-cantly low desire for contraception amongst teenagemothers (Table 7).

Adolescent motherhood adversely affects child survivaland maternal life. Because of the high incidence of fetalwastage, women have to experience a comparativelygreater number of pregnancies to give birth to a child thatwill survive. It has been observed that adolescent motherssuffer a higher child loss than mothers aged 20e24 or25e29 years. Maternal mortality among mothers’ aged15e19 is also very high as compared to that among mothersin the 20e24 age group. Due to frequent pregnancy, thehealth of the mother is badly affected she becomes anemicand gives birth to an underweight child who faces a higherrisk of death at each age.18

Cultural and psychological barriers within communitiesmay prevent young women-especially those who are verypoor- from using clinic-based reproductive health services

even when they do exist.19 Reynolds et al showed thatyoung women are less likely than older women to knowabout pregnancy and reproductive health issues in general,and they have less experience in using health services.18

This paper aims to create awareness amongst health-careproviders on the burning issue of adolescent pregnancies.A study on a larger scale is recommended to assess publichealth importance of the subject. However provision ofinformation, counseling and life-skills education to adoles-cent through various “Adolescent friendly health centres”can be helpful to decrease the magnitude of the problem.In our literate society, where teenage pregnancies out ofwedlock, are on rise, sex education and contraceptiveknowledge should be made an integral part of healtheducation.9

CONCLUSION

This study shows that teenage pregnancies are stilla common occurrence in rural India in spite of variouslegislations and government programs. Teenage pregnancyis a risk factor for poor obstetric outcome. Cultural prac-tices, poor socioeconomic conditions, low literacy rateand lack of awareness of the risks are some of the maincontributory factors. Early booking, good care during preg-nancy and delivery and proper utilization of contraceptiveservices can prevent the incidence and complications inthis high-risk group.

CONFLICTS OF INTEREST

All authors have none to declare.

REFERENCES

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Sharma et al 14.2 e e

Sarkar et al 10.6 e e

Mahaverkar e e e

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Sen e 19.5 e

Asha Negi 11.3Present study 21.3 42.67 17.1

Table 6 Perinatal outcome.

Case Control

Maturity Preterm 12 (17.1%) 4 (5.7%)Term 58 (82.9%) 66 (94.3%)

Birth weight <2 kg 16 (22.9%) 5 (7.1%)2e2.5 kg 38 (54.3%) 16 (22.9%)>2.5 kg 16 (22.9%) 49 (70%)

Table 7 Desire for contraception postpartum.

Case Control

Yes 26 (37.1%) 46 (65.7%)No 44 (62.9%) 24 (34.3%)

Adolescent pregnancy Original Article 179

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180 Apollo Medicine 2012 September; Vol. 9, No. 3 Shah et al.

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