Socioeconomic risk factors and obstetric outcomes of adolescent pregnancies in Vietnam

Abstract

Background: Adolescent pregnancy remains a pressing concern in the Pacific and Southeast Asia, with birth rates of 51 and 43 per 1000 girls. Teenage mothers face a heightened risk of complications and mortality, while their newborns are more likely to experience challenges such as preterm birth, low birth weight, and poor Apgar scores. In Vietnam, however, evidence on this issue remains limited.

Objective: Our research aims to examine the socioeconomic characteristics and outcomes of adolescent pregnancy in Vietnam.

Study design: We conducted a cross-sectional study recruiting pregnant women aged 10 to 19 hospitalized for delivery at Can Tho Gynecology Obstetrics Hospital from September 1st, 2022, to March 31, 2024. For reference, we established a cohort of pregnant women aged 20 to 34 years who presented at our hospital during the same study period. This cohort was randomly selected (1:1 ratio) and matched with our adolescent cohort based on the delivery date and parity. Primary outcomes included maternal and neonatal outcomes.

Results: Our final analysis included 432 adolescents and 432 adults with mean ages of 18.1±1.1 years and 26.7±3.7 years, respectively. Adolescent pregnancies were more likely to have disadvantageous sociodemographic backgrounds with limited resources, including ethnic minorities, rural residences, and low education. Adolescent individuals had lower prepregnancy weight (48 [43-53] kg vs 50 [46-55] kg, P<.001) and BMI (19.2 [17.7-21.8] vs 20 [18.7-22], P<.001) compared to adults. Their weight gain during pregnancy was also lower (12.8±5.2 kg vs 15.6±6.8 kg, P<.001). Regarding comorbidities, adolescents had fewer chronic conditions (14.4% vs 34.3%, P<.001). However, they tended to have a higher percentage of thyroid disease (1.6% vs 0.5%, P=.09) and anemia (5.6% vs 3.0%, P=.07) compared to adults. Adolescents experienced a higher percentage of maternal adverse outcomes (4.2% vs 1.6%, P=.03), particularly infection/sepsis (3.2% vs 1.2%, P=.04). Regarding indications for cesarean delivery, adolescents had a higher proportion of nonreassuring fetal status (56.3% vs 46.2%) and labor arrest (19.8% vs 11.6%) but lower percentages of fetal malpresentation (5.1% vs 24.9%) and cephalopelvic disproportion (10.2% vs 14.1%) compared to adults. Their newborns had higher rates of preterm birth (15.0% vs 7.2%, P<.001), low birth weight (12.0% vs 6.3%, P<.001), and a 1-minute Apgar score of less than 7 (3.9% vs 1.2%, P<.001).

Conclusion: Adolescent pregnancies had more adverse maternal and neonatal outcomes than adult pregnancies. Further policies and studies are warranted to address socioeconomic disadvantages and develop specific pregnancy care standards for this group.

Keywords: Vietnam; adolescent pregnancies, birth, preterm, comorbidities, low birth weight, socioeconomic factors.

Figure 1

Selection flowchart of the study population

Figure 2

Percentage of fetal age at first prenatal visit Adolescent pregnancies (red) had a lower percentage of first prenatal visits at an early stage (5 weeks) and a higher percentage of late visits (over 12 weeks) compared to adult pregnancies (blue), which had 100% of first prenatal visits within the first trimester.

Figure 3

Differences of maternal comorbidities between adolescent and adult mothers Adolescents (red) had a lower percentage of gestational diabetes (2.3% vs 11.3%, P<.001), infectious diseases (1.9% vs 14.6%, P<.001, and pelvic conditions (0.2% vs 1.6%, P=.03) than adult subjects. However, they tended to have a higher percentage of thyroid disease (1.6% vs 0.5%, P=.09) and anemia (5.6% vs 3.0%, P=.07) compared to adults.

Figure 4

Percentage of the reasons for Cesarean delivery in adolescent and adult mothers Adolescents had a higher proportion of cases due to nonreassuring fetal status (56.3% vs 46.2%) and labor arrest (19.8% vs 11.6%). Conversely, they exhibited lower percentages of cases related to fetal malpresentation (5.1% vs 24.9%) and cephalopelvic disproportion (10.2% vs 14.1%).