2. Literature Review2.1 Magnitude ofteenage pregnancyGloballyit is estimated that 11% of total child births are born from adolescents (3).
A study employed in 29 countries, low and middleincome countries, revealed that the magnitude of teenage pregnancy rate inAfrica, 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 facilitiesof the world stated that 10.3% of deliveries were to adolescents aged 10 -19years old (10).
A comparativeretrospective study done in Turkey implied that teenage pregnancy rate was 8.1%(16). A large scaleretrospective study enrolled in Korea showed the least adolescent pregnancyrate 0.5% (17). Likewisestudies employed in Italy also revealed lesser teenage pregnancy rate thanother countries (9) .
In contrastto this a hospital based cross sectional study in Mexico showed higheradolescent pregnancy rate, 34% (18). When we cameto Africa in Nigeria the prevalence was 1.67% (15). Studies heldin Yaoundé hospital, Cameroon and Egypt revealed that the prevalence ofadolescent pregnancy was 9.3% & 19.8%, respectively (6),(19). Crosssectional study done in Assosa general hospital, Ethiopia showed that theprevalence of teenage pregnancy was 20.4% (20).
2.2. Adverseperinatal outcomesAcase control study done in North India outlined that babies of adolescentmothers were 1.65 times more likely to be born prematurely and 1.6 times morelikely to be born with low birth weight. Nevertheless, this study alsoconcluded that there was no statistically significant association on the risksof stillbirth (21). In anotherstudy done in Turkey strikingly, adolescent mothers were 4.
94 times more likelyto face IUFD and 2.7 times more probable to have premature babies than adultmothers. However, preeclampsia was 50 % less likely to occur in adolescentmothers.
(22).Retrospective cohort study conducted in Taiwan showedthat teenagers were 1.58 times more likely to had pretermdelivery and 1.2 times more likely to had fetaldistress than that of the adults (23). Similarly retrospectivecohort study which was done in USA revealed that young teenagers and oldteenagers were 1.36 and 1.16 times more likely to had pretermdelivery than the adults respectively(24).
And also study done in Korea showsthat teenagers were 2.47 times more likely to experiencepreterm delivery (25). Furthermorestudy 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 Nepaldepicted that (20% Vs 7 %, p=0.018) to had preterm deliverythan the adult. Low birth weight inteenagers and adults were 24% Vs 9% (p=0.013) but this study showed fetal distress was not statistically significant intwo age groups(8% Vs 3%, p==0.
178)(27). And also studydone in Ankara (Turkey) which was referralhospital revealed that teenagers deliver 4.14 times more likely prematurely than adults (28)Institutionalbased cross sectional study done by World Health Organization on multi countryshowed that adolescents 1.32 times more likely to givestill birth than the adult mothers. The risk of low birth weight was 1.17 timeshigher among early adolescent mothers, compared with adults. The risk ofpreterm deliveries was 1.60 times higher amongadolescent mothers as compared with adults.
Adolescent mothers had 1.56 timesmore likely to had neonatal severe conditions thanthat of the adults(10).Crosssectional study done in Cameron revealed that teenagers were 2.8 times morelikely 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 nostatistically significant difference in the risk of still birth (29). Another Cohort study conducted in Cameronrevealed that teenage pregnancy experience 1.94 and 1.46 times more likely todeliver very low birth weight and low birth weight neonatethan 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 Yaoundécentral hospital in Cameron also revealed that no significant difference indelivery of low birth weight (p=0.42)(6).Furthermore comparative cross sectional study done in Egypt revealedthat teenagers and adult had 18.
7% Vs 14% (p=0.006) preterm delivery and lowbirth weight 25.1%Vs 19.3 % (p=0.001)(19). In contrary to this study done in South Africa showed that therewere no statistically significant difference to deliver low birthweight(p=0.174) and preterm delivery(p=0.
AdverseObstetrical OutcomeA large scaleretrospective cohort study done in Sweden revealed that teenagers were 1.7times more likely to give birth normal vaginallyand 45% less likely to undergo cesarean section than adult mothers. In additionto this teenagers were 21%, 43% less likely to had post term delivery andpostpartum hemorrhage respectively (26). Furthermore study conducted in USA showed that younger adolescents haddecreased 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 showedthat there was no difference in development of pregnancy induced hypertension(p>0.05)(32).
Similar to this, study done in Ankara, Turkeyrevealed that pregnancy induced hypertension (p=0.31) and PPH (p=0.38) were notstatistically significant with maternal age (28). Institutionalbased, cross sectional study done by World Health Organization on multi countryshowed that adolescents undergo 23% less likely of cesarean section than thatof adult mothers. Furthermore adolescent mothers had a lower risk of preeclampsiawhich was 27% less likely than adult mothers. However the risk of eclampsia was1.55 times more likely among adolescent motherscompared with adult mothers(10).
Alarge scale retrospective cohort study in Sweden concluded that teenagers were30% less likely to develop PPH, 63% less probable to be complicated by APHsecondary to placenta previa & 57%less likely experience grade 3 & 4 perineal tears. However this studyconcluded that age was not significantly associated with risk of preeclampsia (33). In contrast tothis study done in India stated that there were no statistically significantdifference between teenage and adult mothers with the occurrence of APH and PPH(21). Retrospective register based study which was conducted inFinland showed that teenagers are 1.2, 3.
2 times more likely to developpreeclampsia and eclampsia than the adults (34). Aretrospective cohort study in Romania showed that teenagers were 1.42 timesmore likely to develop PPH and episiotomy (p<0.01) (35). Astudy in Turkey concluded that age did not appear to have statisticallysignificant association with mode of delivery, PPH, placenta previa.
Nevertheless, this study claimed that teenagers were 2.14 times more likely todevelop preeclampsia than adult mothers (11). Another study done in Turkey depicted thatteenage had higher rate episiotomy (p=0.0001) (22). comparative study in southAfrica showed that Significantly higherrate of caesarean delivery was found among adult mothers compared to teenagemothers (p=0.002) (31).
Astudy conducted in Nigeria stated that there was statistically significantdifference 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 thedevelopment of eclampsia (36). Cohort studyconducted at Cameron shows that teenagers develop 3.46 times more likely of preeclampsia/eclamsia butthere were no significance difference in terms of placenta previa ,cesarean section ,instrumental delivery, perineal tearand episiotomy(30). Crosssectional study in Cameron shows that teenagers were 2.
15 times more likely tohad episiotomy than adults. In addition this study showed that post termdelivery was more common in teenage than adult(4.9 %versus 2.4) but it dealsthere were no significant difference in cesareandelivery, perineal tear and instrumental delivery (6). Furthermoreanother cross sectional study done in Cameron revealed that teenagers were 1.6 timesmore likely to face perianal tear than that of the adult.
In addition tomaternal age Employment (p=0.003), marital status (p=0.017) and gravidity (p=0.001)had also significant association with adverse maternal outcomes. However, thisstudy revealed that no significance difference between the two age groups in cesarean delivery (p=0.3) and episiotomy (p=0.