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Journal of Neonatal-Perinatal Medicine 8 (2015) 1–8 DOI 10.3233/NPM-15814038 IOS Press
Review Article
A review of the risks and consequences of adolescent pregnancy D. Jeha, I. Usta, L. Ghulmiyyah and A. Nassar∗ Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
Received 29 April 2014 Revised 3 October 2014 Accepted 17 December 2014
Abstract. OBJECTIVE: To evaluate the risks and consequences of young maternal age on both the mother and the newborn. STUDY DESIGN: A comprehensive literature review on the risks and consequences of adolescent pregnancy was performed. RESULTS: Young maternal age is associated with an increased risk of maternal anemia, infections, eclampsia and preeclampsia, emergency cesarean delivery, postpartum depression and inadequate breastfeeding initiation. Infants of teenage mothers are more likely to be premature and have a low birth weight, and are at an increased risk for respiratory distress syndrome and autism later in life. CONCLUSIONS: Adolescent pregnancy is a prevalent phenomenon associated with increased risks of both maternal and neonatal complications during and after pregnancy. Being aware of such adverse outcomes is imperative to improving prenatal and perinatal care. Pregnancy progression can also be influenced by the mother’s culture, environment, and economic status; advancement in which may be a possible course for future improvement. Keywords: Adolescent, teenage, pregnancy, obstetric outcome
Abbreviations
UTI PIH OR CI OVD Hb GDM
Urinary Tract Infections Pregnancy Induced Hypertension Odds Ratio Confidence Interval Operative Vaginal Delivery Hemoglobin Gestational Diabetes Mellitus
∗ Corresponding
author: Dr. Anwar H. Nassar, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon. Tel.: +961 1 350000 ext. 5604; Fax: +961 1 370829; E-mail: [email protected].
aRR PPH PPD PDD LBW RDS
Adjusted Relative Risk Postpartum Hemorrhages Postpartum Depression Pervasive Developmental Disorder Low Birth Weight Respiratory Distress Syndrome
1. Introduction According to the World Health Organization, women between the ages of 15–19 years give birth to 16 million newborns worldwide every year [1]. Although some developed countries experienced a relative decline in their incidence of adolescent pregnancy
1934-5798/15/$35.00 © 2015 – IOS Press and the authors. All rights reserved
2
D. Jeha et al. / Risks and consequences of adolescent pregnancy
[2], this phenomenon remains a prevalent occurrence with much room for improvement. Studies have related adolescent pregnancy to low socioeconomic status, lack of awareness, inadequate contraception, as well as insufficient prenatal care [3, 4]. Teenage pregnancy has also been described as a self-perpetuating cycle where early childbirth in one generation increases the likelihood that the following generation will also be comprised of adolescent mothers [5]. Regardless of the reasons for its ubiquity, being of young maternal age may result in additional consequences and risks to the pregnancy, not only pertaining to the newborn, but also to the mother’s health [6]. In this article, the existing literature on the association between adolescent pregnancy and maternal as well as neonatal outcomes is reviewed.
20 years ago and may not be applicable to the current status. 2.2. Gestational diabetes The current literature on gestational diabetes mellitus (GDM) is somewhat unresolved. Several studies discussed lower rates of GDM in adolescents [13, 19, 25, 29], while others noted a significantly higher risk in teenagers [20, 30]. On the other hand, some studies found no significant difference in the risk of GDM between the different age groups [23, 24, 27, 31]. Of the two studies that discussed a higher risk of GDM in adolescents, only Karabulut et al. [30] included women above the age of 35, while the eldest age group in Goonewardene et al. [20] was 20–24 years of age. Excluding women above the age of 35 may explain the comparable rates of GDM in the adult group.
2. Maternal outcomes 2.3. Placenta previa 2.1. Anemia Maternal anemia is commonly encountered in pregnancy, however many studies have shown that pregnant adolescents may have significantly higher rates of anemia compared with adult pregnant women [4, 7–23]. On the other hand, some studies argue that there is no significant difference in the risk of maternal anemia between adolescents and adults [24, 25]. Caution should be exercised with such generalizations since studies do not show consensus on hemoglobin (Hb) cut-off levels in maternal anemia or the age range chosen when labeling participants as adolescents or adults. For example, some authors [4, 8, 11, 20, 22] consider anemia at Hb
Journal of Neonatal-Perinatal Medicine 8 (2015) 1–8 DOI 10.3233/NPM-15814038 IOS Press
Review Article
A review of the risks and consequences of adolescent pregnancy D. Jeha, I. Usta, L. Ghulmiyyah and A. Nassar∗ Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
Received 29 April 2014 Revised 3 October 2014 Accepted 17 December 2014
Abstract. OBJECTIVE: To evaluate the risks and consequences of young maternal age on both the mother and the newborn. STUDY DESIGN: A comprehensive literature review on the risks and consequences of adolescent pregnancy was performed. RESULTS: Young maternal age is associated with an increased risk of maternal anemia, infections, eclampsia and preeclampsia, emergency cesarean delivery, postpartum depression and inadequate breastfeeding initiation. Infants of teenage mothers are more likely to be premature and have a low birth weight, and are at an increased risk for respiratory distress syndrome and autism later in life. CONCLUSIONS: Adolescent pregnancy is a prevalent phenomenon associated with increased risks of both maternal and neonatal complications during and after pregnancy. Being aware of such adverse outcomes is imperative to improving prenatal and perinatal care. Pregnancy progression can also be influenced by the mother’s culture, environment, and economic status; advancement in which may be a possible course for future improvement. Keywords: Adolescent, teenage, pregnancy, obstetric outcome
Abbreviations
UTI PIH OR CI OVD Hb GDM
Urinary Tract Infections Pregnancy Induced Hypertension Odds Ratio Confidence Interval Operative Vaginal Delivery Hemoglobin Gestational Diabetes Mellitus
∗ Corresponding
author: Dr. Anwar H. Nassar, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon. Tel.: +961 1 350000 ext. 5604; Fax: +961 1 370829; E-mail: [email protected].
aRR PPH PPD PDD LBW RDS
Adjusted Relative Risk Postpartum Hemorrhages Postpartum Depression Pervasive Developmental Disorder Low Birth Weight Respiratory Distress Syndrome
1. Introduction According to the World Health Organization, women between the ages of 15–19 years give birth to 16 million newborns worldwide every year [1]. Although some developed countries experienced a relative decline in their incidence of adolescent pregnancy
1934-5798/15/$35.00 © 2015 – IOS Press and the authors. All rights reserved
2
D. Jeha et al. / Risks and consequences of adolescent pregnancy
[2], this phenomenon remains a prevalent occurrence with much room for improvement. Studies have related adolescent pregnancy to low socioeconomic status, lack of awareness, inadequate contraception, as well as insufficient prenatal care [3, 4]. Teenage pregnancy has also been described as a self-perpetuating cycle where early childbirth in one generation increases the likelihood that the following generation will also be comprised of adolescent mothers [5]. Regardless of the reasons for its ubiquity, being of young maternal age may result in additional consequences and risks to the pregnancy, not only pertaining to the newborn, but also to the mother’s health [6]. In this article, the existing literature on the association between adolescent pregnancy and maternal as well as neonatal outcomes is reviewed.
20 years ago and may not be applicable to the current status. 2.2. Gestational diabetes The current literature on gestational diabetes mellitus (GDM) is somewhat unresolved. Several studies discussed lower rates of GDM in adolescents [13, 19, 25, 29], while others noted a significantly higher risk in teenagers [20, 30]. On the other hand, some studies found no significant difference in the risk of GDM between the different age groups [23, 24, 27, 31]. Of the two studies that discussed a higher risk of GDM in adolescents, only Karabulut et al. [30] included women above the age of 35, while the eldest age group in Goonewardene et al. [20] was 20–24 years of age. Excluding women above the age of 35 may explain the comparable rates of GDM in the adult group.
2. Maternal outcomes 2.3. Placenta previa 2.1. Anemia Maternal anemia is commonly encountered in pregnancy, however many studies have shown that pregnant adolescents may have significantly higher rates of anemia compared with adult pregnant women [4, 7–23]. On the other hand, some studies argue that there is no significant difference in the risk of maternal anemia between adolescents and adults [24, 25]. Caution should be exercised with such generalizations since studies do not show consensus on hemoglobin (Hb) cut-off levels in maternal anemia or the age range chosen when labeling participants as adolescents or adults. For example, some authors [4, 8, 11, 20, 22] consider anemia at Hb
