The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China

Abstract

Background: The adverse pregnancy outcomes caused by teenage pregnancy are major public health problems with significant social impact. While China is the most populous country in the world, and 8.5% of the women aged 10-50 years are adolescent women, we aimed to analyze the adverse maternal and perinatal outcomes of the adolescent pregnancy in Hebei Province, China.

Methods: There were 238,598 singleton pregnant women aged 10-34 years from January 1, 2013 to December 31, 2017 in the database of Hebei Province Maternal Near Miss Surveillance System (HBMNMSS). The 238,598 pregnant women were divided into two groups: adolescent group (aged 10-19 years) and adult group (aged 20-34 years). The adolescent group was divided into two subgroups (aged 10-17 years, aged 18-19 years), the adult group was divided into two subgroups (aged 20-24 years, aged 25-34 years). We compared the risk of adverse pregnancy outcomes using univariate and multivariate logistic regression. We also made a stratified analysis of nulliparous and multiparous adolescent pregnancy.

Results: Compared with women aged 20-34 years, women aged 10-19 years had lower risk of cesarean delivery [adjusted risk ratio (aRR): 0.75, 95% confidence interval (CI): 0.70-0.80], gestational diabetes mellitus (GDM) (aRR: 0.55, 95%CI: 0.41-0.73). Women aged 10-19 years had higher risk of preterm delivery (aRR: 1.76, 95%CI: 1.54-2.01), small for gestational age (SGA) (aRR: 1.19, 95%CI: 1.08-1.30), stillbirth (aRR: 2.58, 95%CI: 1.83-3.62), neonatal death (aRR: 2.63, 95%CI: 1.60-4.32). The adolescent women aged 10-17 years had significantly higher risk of stillbirth (aRR: 5.69, 95%CI: 3.36-9.65) and neonatal death (aRR: 7.57, 95%CI: 3.74-15.33) compared with the women aged 25-34 years. Younger adults (20-24 years) also had higher risks of preterm delivery (aRR: 1.26, 95%CI: 1.20-1.32), stillbirth (aRR: 1.45, 95%CI: 1.23-1.72), and neonatal death (aRR: 1.51, 95%CI: 1.21-1.90) compared with women aged 25-34 years. The structural equation model showed that preterm delivery and cesarean delivery had an indirect effect on neonatal death in adolescent pregnancy.

Conclusions: The adolescent pregnancy was related to adverse perinatal (fetal and neonatal) outcomes, such as preterm delivery, stillbirth and neonatal death, especially in younger adolescent pregnancies.

Keywords: Adolescent; Maternal outcomes; Perinatal outcomes; Pregnancy.

Fig. 1

The Flow Chart of Case Selection from 2013 to 2017, Hebei Province, China. Data of the pregnant women was collected from Hebei Province Maternal Near Miss Surveillance System (HBMNMSS)

Fig. 2

Number and Percentage of Adolescent Pregnant Women in Hebei Province, China, from 2013 to 2017. Bar chart represents the number and line chart represents the percentage. Among the adolescent pregnant women, pregnant women ≤15 years was 88 (2.4%), 16 years was 174 (4.7%), 17 years was 428 (11.6%), 18 years was 979 (26.6%), 19 years was 2010 (54.6%)

Fig. 3

Forest Plots of Risks of Adverse Outcomes of Adolescent Pregnancy Compared with Adult Pregnancy. Compared with women (aged 25–34 years. Adjusted by maternal education, marital status, delivery place, history of miscarriage, parity, previous cesarean delivery

Fig. 4

The Structural Equation Model of Risk Factors between Adolescent Pregnancy and Neonatal Death. The path coefficients was showed in figure