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TEENAGE PREGNANCY: MATERNAL & FETAL OUTCOMESMohd Pazudin I, Najihah AZ, NM Zaki, Mohd Shukri O, Noraliza AG

Department of Obstetrics & Gynaecology, School of Medical Sciences, Health Campus USM, 16150 Kubang Kerian, Kelantan, Malaysia.

Objectives

INTRODUCTION

Teenage pregnancy nowadays is reducing but still remains relatively high and the rates vary worldwide. Some important factors like socioeconomic deprivation, disrupted family structure and limited education appear to be most consistently related to teenage pregnancy. Many adverse outcomes of the fetal as well as the maternal, have been associated with teenage pregnancy including premature delivery, small for gestational age, low birth weight and increased neonatal mortality, anaemia and gestational hypertension. Teenage Pregnancy is defined as a teenage or underage girl (19years old and less), usually refers to women who have not reached legal adulthood that become pregnant

OBJECTIVES

To study the maternal and fetal outcomes of teenage pregnancy and to compare the outcomes with the normal population.

SPECIFIC OBJECTIVES 1. To compare the maternal demographic, major antenatal complications, outcome of labour, mode of delivery and perinatal outcome between the study group and the control group. 2. To identify the fetomaternal outcomes and complications among the study groups.

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Methods

STUDY DESIGN This is a comparative cross sectional study carried out in Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kota Bharu Kelantan. Study ParticipantsDuring the study period, all nulliparous women aged ≤19 years old and at gestation of more than 24 weeeks, seen in clinics, antenatal ward or labour room were included as teenage group (study group). When each of the teenage group delivered in labour room HUSM, the first nulliparous women aged 20-34years delivered following each teenage case was selected as the non teenage group (control group). Data regarding the maternal demographic , various fetal and maternal outcome were compiled by reviewing their antenatal and delivery records, and also interview was conducted. Inclusion criteria Singleton pregnancy Gestation>24weeks

Exclusion criteria Multiple pregnancyNo consent from patient.

OUTCOME MEASURES Antenatal Outcome: Anaemia, Antepartum haemorrhage, Hypertension or PE, GDM and PROM Labour outcome:Premature or term labour, IOL, mode of delivery, duration of labour, Postpartum Haemorrhage and Third and fourth degree perineal tear.

Perinatal outcome:Apgar scoreBirthweightcongenital abnormalitiesNICU AdmissionPerinatal mortality

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Results

A total of 488 pregnant nulliparous successfully participated and completed in this study. They were divided into two groups, which were the teenage group (study group, n=244 patients) and the non teenage group (control group, n=244 patients).

Table 1: Characteristics of Patients in Teenage and Non Teenage Group

aIndependent t test, significant at p<0.05b Pearson Chi-square tes; tsignificant at p < 0.05

Table 2: Univariate Analysis of Maternal-Fetal Outcomes In Teenage and Non teenage Group

significant at p<0.05

Table 3 : Birth weight of Newborn In Teenage and Non Teenage Group

b Pearson Chi-square test; significant at p < 0.05

Conclusions

References

1. The youngest age in the teenage group was 13 years-old. The mean age of teenage group was 17.49 (±SD 1.35) while the non teenage group was 27.29 (±SD 3.05), statistically significant p value of 0.001. All non-teenage mothers were married whereas only 85.7% of the teenage mothers were married (14.3% single mother). About 30% of the teenage group conceived before they got married while in the non teenage group only 1% (p value <0.001). There were 8 cases of rape in teenage group but only one case in non-teenage group. There were significant delay booking in teenage group, mean gestational 18.48 weeks vs 14.92 weeks.

2. There were higher incidence of premature delivery in teenage group as compare to non-teenage group (p value, 0.016). However there were no significant difference incidence of pre-eclampsia, prelabour rupture of membrane, antepartum haemorrhage, anaemia and instrumental delivery between the groups.

3. The incidence of postpartum haemorrhage was about the same between both groups. For the incidence of third and fourth degree perineal tear, surprisingly 14 cases happened in the non teenage group as compared to only one case from the teenage group (p value 0.001).

4. There were higher incidence of baby weighing less then 2.5kg in teenage group about 19% vs 10% in the non teenage group. This would be explained by the higher incidence of premature delivery in the teenage group. The incidence of poor Apgar score and admission to NICU were doubled in the teenage group as compared to the non teenage group however the p value were not significant.

5. The incidence of congenital abnormality was 7 (2.9%) in teenage group , while nil from the non teenage group, a significant p value of 0.015. The congenital abnormality found were congenital talipes equinavarus, cleft lips and hydrocephalus.

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1. Chandra, P. C., Schiavello, H. J., Ravi, B., Weinstein, A. G. & Hook, F. B. (2002). Pregnancy outcomes in urban teenagers. Int J Gynaecol Obstet, 79 (2), 117-22.

2. Chen, X. K., Wen, S. W., Fleming, N., Demissie, K., Rhoads, G. G. & Walker, M. (2007a). Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol, 36 (2), 368-73.

3. Elster, A. B. (1984). The effect of maternal age, parity, and prenatal care on perinatal outcome in adolescent mothers. Am J Obstet Gynecol, 149 (8), 845-7.

4. Gale, R., Seidman, D. S., Dollberg, S., Armon, Y. & Stevenson, D. K. (1989). Is teenage pregnancy a neonatal risk factor? J Adolesc Health Care, 10 (5), 404-8.

5. Imamura, M., Tucker, J., Hannaford, P., da Silva, M. O., Astin, M., Wyness, L., Bloemenkamp, K. W., Jahn, A., Karro, H., Olsen, J. & Temmerman, M. (2007). Factors associated with teenage pregnancy in the European Union countries: a systematic review. Eur J Public Health, 17 (6), 630-6.

6. Lao, T. T. & Ho, L. F. (1998). Obstetric outcome of teenage pregnancies. Hum Reprod, 13 (11), 3228-32.

7. Zhang, B. & Chan, A. (1991). Teenage pregnancy in South Australia, 1986-1988. Aust N Z J Obstet Gynaecol, 31 (4), 291-8.

Outcome Teenage

N (%)

Non Teenage

N (%)Wald Crude Or

(95% CI)

p Value

Hypertension or PE 16 (6.6) 17 (7.0) 0.126 0.881 (0.438,1.771) 0.595

APH 2 (0.8) 3 (1.2) 0.199 0.664 (0.110,4.009) 1.000

Anaemia 44 (18.0) 35 (14.3) 1.219 1.314 (0.809,2.132) 0.269

GDM 3 (1.2) 22 (9.0) 11.108 0.126 (0.037,0.429) <0.001

Premature Delivery 31 (12.7) 15(6.1) 4.969 2.254 (1.103,4.604) 0.016

PROM 52 (21.3) 38 (15.6) 2.652 0.681 (0.429,1.081) 0.102

IOL 27 (11.1) 53 (21.7) 9.785 0.448 (0.279,0.741) <0.001

SVD 213 (87.3) 191 (78.3) 8.829 2.107 (1.289,3.445) 0.003

LSCS 28 (11.5) 51 ( 20.9) 7.788 0.491 (0.297,0.809) 0.005

Instrumental delivery 3 (1.2) 2 (0.8) 0.199 1.506 (0.249,9.094) 0.653

PPH 3 (1.2) 6 (2.5) 2.652 0.494 (0.122,1.997) 0.362

3rd or 4th degree tear 1 (0.4) 14 ( 5.7) 6.721 0.068 (0.009,0.518) 0.001

Poor Apgar Score 10 (4.1) 5 ( 2.0) 1.654 2.043 (0.688,6.067) 0.190

Congenital Anomaly 7 (2.9) 0 (0) 0.000 4.711 (1.008,) 0.015

NICU Admission 24 (9.8) 13 (5.3) 0.3.437 1.938 (0.963,3.903) 0.064

Perinatal Mortality 2 01.8) 2 (0.8) 0.199 0.664 (0.110,4.009) 1.000

Characteristic Teenage Non Teenage p value

Maternal age(year, mean ± SD) 17.49 ± 1.35 27.±3.02 <0.001a

Height ( meter, mean ± SD) 1.54 ± 0.49 1.55±0.52 0.056a

Marital status(married-nonmarried)

85.7% ( n=209) 100% ( n=244) <0.001b

Gestation at booking(week, mean ± SD)

18.48 ± 7.45 14.92 ± 5.28 <0.001a

Gestation at delivery(week, mean ± SD)

38.59 ± 2.18 38.86 ± 1.64 0.123a

Rape case, n (%) 8 (3.3) 1 (0.4) 0.037c

Premarital conception, n (%)

74 (30.3) 3 (1.2) <0.001b

GROUP

Birth weight (kg) n(%)

X2 value (df) p valueb

≤ 2.50 2.51-3.99 ≥ 4.00

Teenage48 (19.7) 194 (79.5) 2 (0.8)

8.543 (2) 0.014

Non Teenage25 (10.2) 217 (88.9) 2 (0.8)