Abstract:
Sub-Saharan Africa suffers high rates of maternal and neonatal mortality and morbidity. Adolescent mothers (age ≤ 19 years at time of delivery) are often considered to be particularly prone to adverse pregnancy outcomes, such as low birth weight (LBW, birth weight < 2,500 grams) and prematurity. Various risk factors have been identified so far to contribute to adverse pregnancy outcome, but available data remains insufficient for low income countries. The considerably high rate of adolescent mothers in many regions of sub-Saharan Africa reflects the need for assessing the prevalence of adolescent pregnancies in this area as well as their influence on obstetric outcomes and the necessity of analyzing further associated risk factors.
The present study assesses the prevalence of adolescent pregnancies in a semi-urban and rural region in the Central African country Gabon. Furthermore, it analyzes maternal adolescence among other parameters as a potential risk factor for adverse pregnancy outcome, focusing on LBW.
A retrospective cohort study was performed. Data from birth registers from three different health centers in Gabon were entered in a purpose built database. A total of 1,972 births were registered in the database, the registered births took place between December 15th 2009 and August 29th 2011.
Adolescent pregnancy had a prevalence of 23.7% (N=453/1910) and 251 out of 1,915 live births (13.1%) were classified as presenting with LBW.
In univariable analysis, the percentage of newborns with LBW was significantly higher in adolescent women. 16.6% (74/445) of newborns to adolescent mothers presented with LBW, compared to 8.8% (121/1371) in mothers older than 19 years (OR: 2.1, 95% CI: 1.5-2.8). The frequency of preterm births was as well significantly higher in adolescent pregnancies with 26.1% (99/380) when compared to adult pregnancies with 15.9% (198/1244) (OR: 1.9, 95% CI: 1.4-2.5).
In multivariable analysis, young maternal age (≤19 years) and low number of attended antenatal care visits (<4 visits during the index pregnancy) showed a significant association preterm delivery and delivery of a LBW child.
Further, an association of adolescence with a low frequency of antenatal care visits was demonstrated, and therefore one confounding factor concerning the influence of young maternal age on birth weight could be identified.
Our data suggests that teenage pregnancy in the study area is significantly associated with higher risks of adverse pregnancy outcomes such as preterm delivery and low birth weight. Besides of young maternal age, low frequency of antenatal care visits could be identified as independent risk factor for low birth weight and preterm delivery.
Education among adolescents and improvement of availability of antenatal care is crucial to improve pregnancy outcomes among adolescents in the study area and comparable regions.