Maternal and perinatal outcomes among nulliparous adolescents in low- and middle-income countries: a multi-country study

Abstract

Objective: To investigate the risk of adverse pregnancy outcomes and caesarean section among adolescents in low- and middle-income countries.

Design: Secondary analysis using facility-based cross-sectional data from the World Health Organization (WHO) Global Survey on Maternal and Perinatal Health.

Setting: Twenty-three countries in Africa, Latin America, and Asia.

Population: Women admitted for delivery in 363 health facilities during 2-3 months between 2004 and 2008.

Methods: We constructed multilevel logistic regression models to estimate the effect of young maternal age on risks of adverse pregnancy outcomes.

Main outcome measures: Risk of adverse pregnancy outcomes among young mothers.

Results: A total of 78 646 nulliparous mothers aged ≤24 years and their singleton infants were included in the analysis. Compared with mothers aged 20-24 years, adolescents aged 16-19 years had a significantly lower risk of caesarean section (adjusted OR 0.75, 95% CI 0.71-0.79). When the analysis was restricted to caesarean section indicated for presumed cephalopelvic disproportion, the risk of caesarean section was significantly higher among mothers aged ≤15 years (aOR 1.27, 95% CI 1.07-1.49) than among those aged 20-24 years. Higher risks of low birthweight and preterm birth were found among adolescents aged 16-19 years (aOR 1.10, 95% CI 1.03-1.17; aOR 1.16, 95% CI 1.09-1.23, respectively) and ≤15 years (aOR 1.33, 95% CI 1.14-1.54; aOR 1.56, 95% CI 1.35-1.80, respectively).

Conclusions: Adolescent girls experiencing pregnancy at a very young age (i.e. <16 years) have an increased risk of adverse pregnancy outcomes.

Keywords: Adolescent pregnancy; caesarean section; low birthweight; low- and middle-income countries; perinatal mortality; preterm birth.