2. Ethiopia showed that the prevalence of
2. Literature Review
2.1 Magnitude of
teenage pregnancy
Globally
it is estimated that 11% of total child births are born from adolescents (3). A study employed in 29 countries, low and middle
income countries, revealed that the magnitude of teenage pregnancy rate in
Africa, South America & the Caribbean and Asia was 35.1%, 35.5% and 11.5%,
respectively (8). A year later,
another facility based cross sectional study employed in 359 health facilities
of the world stated that 10.3% of deliveries were to adolescents aged 10 -19
years old (10). A comparative
retrospective study done in Turkey implied that teenage pregnancy rate was 8.1%
(16). A large scale
retrospective study enrolled in Korea showed the least adolescent pregnancy
rate 0.5% (17). Likewise
studies employed in Italy also revealed lesser teenage pregnancy rate than
other countries (9) . In contrast
to this a hospital based cross sectional study in Mexico showed higher
adolescent pregnancy rate, 34% (18). When we came
to Africa in Nigeria the prevalence was 1.67% (15). Studies held
in Yaoundé hospital, Cameroon and Egypt revealed that the prevalence of
adolescent pregnancy was 9.3% & 19.8%, respectively (6),(19). Cross
sectional study done in Assosa general hospital, Ethiopia showed that the
prevalence of teenage pregnancy was 20.4%
(20).
2.2. Adverse
perinatal outcomes
A
case control study done in North India outlined that babies of adolescent
mothers were 1.65 times more likely to be born prematurely and 1.6 times more
likely to be born with low birth weight. Nevertheless, this study also
concluded that there was no statistically significant association on the risks
of stillbirth (21). In another
study done in Turkey strikingly, adolescent mothers were 4.94 times more likely
to face IUFD and 2.7 times more probable to have premature babies than adult
mothers. However, preeclampsia was 50 % less likely to occur in adolescent
mothers. (22).
Retrospective
cohort study conducted in Taiwan showed
that teenagers were 1.58 times more likely to had preterm
delivery and 1.2 times more likely to had fetal
distress than that of the adults (23). Similarly retrospective
cohort study which was done in USA revealed that young teenagers and old
teenagers were 1.36 and 1.16 times more likely to had preterm
delivery than the adults respectively(24). And also study done in Korea shows
that teenagers were 2.47 times more likely to experience
preterm delivery (25). Furthermore
study in Sweden showed that there were
no significant difference between teenage and adult to had preterm delivery(AOR 1.03,95% CI;0.98-1.09) and still birth (AOR 0.97, 95%CI, 0.75-1.5) (26). Study in Nepal
depicted that (20% Vs 7 %, p=0.018) to had preterm delivery
than the adult. Low birth weight in
teenagers and adults were 24% Vs 9% (p=0.013) but this study showed fetal distress was not statistically significant in
two age groups(8% Vs 3%, p==0.178)(27). And also study
done in Ankara (Turkey) which was referral
hospital revealed that teenagers deliver 4.14 times more likely prematurely than adults (28)
Institutional
based cross sectional study done by World Health Organization on multi country
showed that adolescents 1.32 times more likely to give
still birth than the adult mothers. The risk of low birth weight was 1.17 times
higher among early adolescent mothers, compared with adults. The risk of
preterm deliveries was 1.60 times higher among
adolescent mothers as compared with adults. Adolescent mothers had 1.56 times
more likely to had neonatal severe conditions than
that of the adults(10).
Cross
sectional study done in Cameron revealed that teenagers were 2.8 times more
likely to deliver low birth weight neonates than that of the adults and preterm babies
(<37 weeks) (OR: 1.85; 95 % CI,(1.01-3.41). However this study showed that there were no
statistically significant difference in the risk of still birth (29).
Another Cohort study conducted in Cameron
revealed that teenage pregnancy experience 1.94 and 1.46 times more likely to
deliver very low birth weight and low birth weight neonate
than that of adults. And also teenage pregnancy faced 1.47 times more likely to had IUFD than the adults (30). Contrary to this another cross sectional study in Yaoundé
central hospital in Cameron also revealed that no significant difference in
delivery of low birth weight (p=0.42)(6).
Furthermore comparative cross sectional study done in Egypt revealed
that teenagers and adult had 18.7% Vs 14% (p=0.006) preterm delivery and low
birth weight 25.1%Vs 19.3 % (p=0.001)(19). In contrary to this study done in South Africa showed that there
were no statistically significant difference to deliver low birth
weight(p=0.174) and preterm delivery(p=0.702)(31).
2.3. Adverse
Obstetrical Outcome
A large scale
retrospective cohort study done in Sweden revealed that teenagers were 1.7
times more likely to give birth normal vaginally
and 45% less likely to undergo cesarean section than adult mothers. In addition
to this teenagers were 21%, 43% less likely to had post term delivery and
postpartum hemorrhage respectively (26). Furthermore study conducted in USA showed that younger adolescents had
decreased risks of cesarean delivery (AOR 0.49; 95% CI, 0.42-0.59) and older adolescents had decreased risks of cesarean delivery (AOR 0.75; 95%
CI,0.71-0.79) and teenagers were also 1.34 times more likely to develop pregnancy induced hypertension(24). In contrast to this, study done in Pakistan showed
that there was no difference in development of pregnancy induced hypertension
(p>0.05)(32). Similar to this, study done in Ankara, Turkey
revealed that pregnancy induced hypertension (p=0.31) and PPH (p=0.38) were not
statistically significant with maternal age (28).
Institutional
based, cross sectional study done by World Health Organization on multi country
showed that adolescents undergo 23% less likely of cesarean section than that
of adult mothers. Furthermore adolescent mothers had a lower risk of preeclampsia
which was 27% less likely than adult mothers. However the risk of eclampsia was
1.55 times more likely among adolescent mothers
compared with adult mothers(10).
A
large scale retrospective cohort study in Sweden concluded that teenagers were
30% less likely to develop PPH, 63% less probable to be complicated by APH
secondary to placenta previa & 57%
less likely experience grade 3 & 4 perineal tears. However this study
concluded that age was not significantly associated with risk of preeclampsia (33). In contrast to
this study done in India stated that there were no statistically significant
difference between teenage and adult mothers with the occurrence of APH and PPH(21). Retrospective register based study which was conducted in
Finland showed that teenagers are 1.2, 3.2 times more likely to develop
preeclampsia and eclampsia than the adults (34). A
retrospective cohort study in Romania showed that teenagers were 1.42 times
more likely to develop PPH and episiotomy (p<0.01) (35).
A
study in Turkey concluded that age did not appear to have statistically
significant association with mode of delivery, PPH, placenta previa.
Nevertheless, this study claimed that teenagers were 2.14 times more likely to
develop preeclampsia than adult mothers (11). Another study done in Turkey depicted that
teenage had higher rate episiotomy (p=0.0001) (22). comparative study in south
Africa showed that Significantly higher
rate of caesarean delivery was found among adult mothers compared to teenage
mothers (p=0.002) (31).
A
study conducted in Nigeria stated that there was statistically significant
difference between teenagers and older mothers with rate of unemployment,
marital status, ANC, preterm delivery(18.9% Vs 11.4%),episiotomy
(61.7% Vs 28.7% p=0.001) but there was no significant difference in the
development of eclampsia (36). Cohort study
conducted at Cameron shows that teenagers develop 3.46 times more likely of preeclampsia/eclamsia but
there were no significance difference in terms of placenta previa ,cesarean section ,instrumental delivery, perineal tear
and episiotomy(30).
Cross
sectional study in Cameron shows that teenagers were 2.15 times more likely to
had episiotomy than adults. In addition this study showed that post term
delivery was more common in teenage than adult(4.9 %versus 2.4) but it deals
there were no significant difference in cesarean
delivery, perineal tear and instrumental delivery (6). Furthermore
another cross sectional study done in Cameron revealed that teenagers were 1.6 times
more likely to face perianal tear than that of the adult. In addition to
maternal age Employment (p=0.003), marital status (p=0.017) and gravidity (p=0.001)
had also significant association with adverse maternal outcomes. However, this
study revealed that no significance difference between the two age groups in cesarean delivery (p=0.3) and episiotomy (p=0.2) (29).