The Obstetric and Perinatal Outcomes of Adolescent Pregnancies in a Developed Cosmopolitan Middle Eastern Country: A Retrospective Pearl-Peristat Registry
Background: Early marriage is prevalent in Middle Eastern culture. The objective of this study was to investigate the pregnancy outcomes of married pregnant adolescents in a prosperous and highly developed Middle Eastern society, when they receive sufficient prenatal care and social assistance. Methods: A retrospective analysis was performed on the Peristat-based Maternal-Newborn registry utilizing hospital data acquired from four main governmental hospitals in Qatar. The study analyzed the pregnancy outcomes of young adults [ages 20 - 24) who experienced their first pregnancy and compared them to the pregnancy outcomes of adolescents aged 15 to 19 years old. Results: The study comprised a cohort of 3152 pregnant married women. This cohort included 2674 women between the ages of 20 and 24, as well as 478 adolescents aged 15 to 19 years old. In comparison to the young adult group, the non-Qatari population in the adolescent group was significantly higher (78.6% (376/478) vs. 71.5% (1914/2674), p-value = 0.003). Other Arab nationalities accounted for more than half of the adolescent population. All the mothers were married, did not use alcohol, and were nonsmokers. There were no documented mothers under the age of 15. Attending antenatal clinics was significantly higher in the adolescent group (p < 0.001). There was no significant difference in the mean gestational age at birth between adolescents and young adults (38.5 ± 2.3 weeks vs. 38.7 ± 2.1 weeks, p = 0.06). Furthermore, adolescent mothers had a higher rate of low birth weight (13.6% vs. 10.4%, p < 0.001) than young mothers. There was a non-statistically significant rise in pre-eclampsia incidence. Other unfavorable pregnancy outcomes were less common among them, such as diabetes, operative vaginal delivery, caesarean section, stillbirth, NICU hospitalization, and an Apgar score of less than 7 at five minutes. There were no maternal deaths; however, there was a comparable rate of neonatal in-hospital mortality. Conclusion: Pregnancy during adolescence may not relate to significant problems in a well-tolerant culture that ensures dedicated antenatal and social support.
References
[1]
World Health Organization (2011) WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Health Outcomes among Adolescents in Developing Countries.
[2]
Ganchimeg, T., Ota, E., Morisaki, N., Laopaiboon, M., Lumbiganon, P., Zhang, J., et al. (2014) Pregnancy and Childbirth Outcomes among Adolescent Mothers: A World Health Organization Multi-Country Study. BJOG: An International Journal of Obstetrics & Gynaecology, 121, 40-48. https://doi.org/10.1111/1471-0528.12630
[3]
Lindberg, L.D., Santelli, J.S. and Desai, S. (2018) Changing Patterns of Contraceptive Use and the Decline in Rates of Pregnancy and Birth Among U.S. Adolescents, 2007-2014. Journal of Adolescent Health, 63, 253-256.
[4]
Alkema, L., Chou, D., Hogan, D., Zhang, S., Moller, A., Gemmill, A., et al. (2016) Global, Regional, and National Levels and Trends in Maternal Mortality between 1990 and 2015, with Scenario-Based Projections to 2030: A Systematic Analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet, 387, 462-474. https://doi.org/10.1016/s0140-6736(15)00838-7
[5]
Van Dommelen-Gonzalez, E., Deardorff, J., Herd, D. and Minnis, A.M. (2015) The Social Environment and Childbearing Expectations: Implications for Strength-Based Sexual Health Interventions for Latino Youth. Journal of Racial and Ethnic Health Disparities, 3, 291-300. https://doi.org/10.1007/s40615-015-0145-4
[6]
Raj, A. and Boehmer, U. (2013) Girl Child Marriage and Its Association with National Rates of HIV, Maternal Health, and Infant Mortality across 97 Countries. Violence Against Women, 19, 536-551. https://doi.org/10.1177/1077801213487747
[7]
Finer, L.B. and Zolna, M.R. (2011) Unintended Pregnancy in the United States: Incidence and Disparities, 2006. Contraception, 84, 478-485. https://doi.org/10.1016/j.contraception.2011.07.013
[8]
Finer, L.B. and Zolna, M.R. (2016) Declines in Unintended Pregnancy in the United States, 2008-2011. New England Journal of Medicine, 374, 843-852. https://doi.org/10.1056/nejmsa1506575
[9]
Smid, M., Martins, S., Whitaker, A.K. and Gilliam, M. (2014) Correlates of Pregnancy before Age 15 Compared with Pregnancy between the Ages of 15 and 19 in the United States. Obstetrics & Gynecology, 123, 578-583. https://doi.org/10.1097/aog.0000000000000136
[10]
Hall, K.S., Kusunoki, Y., Gatny, H. and Barber, J. (2014) The Risk of Unintended Pregnancy among Young Women with Mental Health Symptoms. Social Science & Medicine, 100, 62-71. https://doi.org/10.1016/j.socscimed.2013.10.037
[11]
Alsaidi, A. (2015) What Drives Child Marriage in the Arab World and How the World Is Combating the Problem. https://scholarship.shu.edu/student_scholarship/775
[12]
Al-Amodi, A.A. (2013) Child Marriage in Yemen. The Lancet, 382, 1979-1980. https://doi.org/10.1016/s0140-6736(13)62653-7
[13]
Vigod, S.N., Dennis, C.L., Kurdyak, P.A., Cairney, J., Guttmann, A. and Taylor, V.H. (2014) Fertility Rate Trends among Adolescent Girls with Major Mental Illness: A Population-Based Study. Pediatrics, 133, e585-e591. https://doi.org/10.1542/peds.2013-1761
[14]
Fraser, A.M., Brockert, J.E. and Ward, R.H. (1995) Association of Young Maternal Age with Adverse Reproductive Outcomes. New England Journal of Medicine, 332, 1113-1118. https://doi.org/10.1056/nejm199504273321701
[15]
Malabarey, O.T., Balayla, J., Klam, S.L., Shrim, A. and Abenhaim, H.A. (2012) Pregnancies in Young Adolescent Mothers: A Population-Based Study on 37 Million Births. Journal of Pediatric and Adolescent Gynecology, 25, 98-102. https://doi.org/10.1016/j.jpag.2011.09.004
[16]
Olausson, P.M.O., Cnattingius, S. and Goldenberg, R.L. (1997) Determinants of Poor Pregnancy Outcomes among Teenagers in Sweden. Obstetrical & Gynecological Survey, 89, 451-457. https://doi.org/10.1097/00006250-199703000-00027
[17]
Paranjothy, S., Broughton, H., Adappa, R. and Fone, D. (2009) Teenage Pregnancy: Who Suffers? Archives of Disease in Childhood, 94, 239-245. https://doi.org/10.1136/adc.2007.115915
[18]
Phipps, M.G., Blume, J.D. and de Monner, S.M. (2002) Young Maternal Age Associated with Increased Risk of Postneonatal Death. Obstetrics & Gynecology, 100, 481-486. https://doi.org/10.1097/00006250-200209000-00014
[19]
Rees, J.M., Lederman, S.A. and Kiely, J.L. (1996) Birth Weight Associated with Lowest Neonatal Mortality: Infants of Adolescent and Adult Mothers. Pediatrics, 98, 1161-1166. https://doi.org/10.1542/peds.98.6.1161
[20]
Brosens, I., Muter, J., Gargett, C.E., Puttemans, P., Benagiano, G. and Brosens, J.J. (2017) The Impact of Uterine Immaturity on Obstetrical Syndromes during Adolescence. American Journal of Obstetrics and Gynecology, 217, 546-555. https://doi.org/10.1016/j.ajog.2017.05.059
[21]
Traisrisilp, K., Jaiprom, J., Luewan, S. and Tongsong, T. (2015) Pregnancy Outcomes among Mothers Aged 15 Years or Less. Journal of Obstetrics and Gynaecology Research, 41, 1726-1731. https://doi.org/10.1111/jog.12789
[22]
Uecker, J.E. (2014) Religion and Early Marriage in the United States: Evidence from the Add Health Study. Journal for the Scientific Study of Religion, 53, 392-415. https://doi.org/10.1111/jssr.12114
[23]
Conde-Agudelo, A., Belizán, J.M. and Lammers, C. (2005) Maternal-Perinatal Morbidity and Mortality Associated with Adolescent Pregnancy in Latin America: Cross-Sectional Study. American Journal of Obstetrics and Gynecology, 192, 342-349. https://doi.org/10.1016/j.ajog.2004.10.593
[24]
Raatikainen, K., Heiskanen, N., Verkasalo, P.K. and Heinonen, S. (2005) Good Outcome of Teenage Pregnancies in High-Quality Maternity Care. European Journal of Public Health, 16, 157-161. https://doi.org/10.1093/eurpub/cki158
[25]
Chen, X.-K., Wen, S.W., Fleming, N., Demissie, K., Rhoads, G.G. and Walker, M. (2007) Teenage Pregnancy and Adverse Birth Outcomes: A Large Population Based Retrospective Cohort Study. International Journal of Epidemiology, 36, 368-373. https://doi.org/10.1093/ije/dyl284
[26]
Sharma, V., Katz, J., et al. (2008) Young Maternal Age and the Risk of Neonatal Mortality in Rural Nepal. Archives of Pediatrics & Adolescent Medicine, 162, 828-835. https://doi.org/10.1001/archpedi.162.9.828
[27]
Conway, D.L., Hansen, N.I., Dudley, D.J., Parker, C.B., Reddy, U.M., Silver, R.M., et al. (2013) An Algorithm for the Estimation of Gestational Age at the Time of Fetal Death. Paediatric and Perinatal Epidemiology, 27, 145-157. https://doi.org/10.1111/ppe.12037
[28]
Loto, O., Ezechi, O., Kalu, B., Loto, A.B., Ezechi, L.O. and Ogunniyi, S. (2004) Poor Obstetric Performance of Teenagers: Is It Age or Quality of Care-Related? Journal of Obstetrics and Gynaecology, 24, 395-398. https://doi.org/10.1080/01443610410001685529
[29]
Blanc, A.K., Winfrey, W. and Ross, J. (2013) New Findings for Maternal Mortality Age Patterns: Aggregated Results for 38 Countries. PLOS ONE, 8, e59864. https://doi.org/10.1371/journal.pone.0059864
[30]
de Vienne, C.M., Creveuil, C. and Dreyfus, M. (2009) Does Young Maternal Age Increase the Risk of Adverse Obstetric, Fetal and Neonatal Outcomes: A Cohort Study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 147, 151-156. https://doi.org/10.1016/j.ejogrb.2009.08.006
[31]
Zeteroglu, S., Sahin, I. and Gol, K. (2005) Cesarean Delivery Rates in Adolescent Pregnancy. The European Journal of Contraception & Reproductive Health Care, 10, 119-122. https://doi.org/10.1080/13625180500131600
