Teenage Pregnancy and its Outcomes in a Tertiary Care Hospital in Assam

Abstract

Background: 

Teenage pregnancy is one of the determinants of high maternal morbidity and mortality. Assam is known for its highest contribution of maternal death in India. In Assam, around 31% of teenage girls get married before the age of 18, and around 12% teenage girls become mothers before they turn out to be 18 years.

Objectives: 

The objective of this study is to know the maternal and fetal outcomes of teenage pregnancy and its determinants in a tertiary care setting in Assam.

Materials and Methods: 

A cross-sectional study was conducted among 118 teenage mothers admitted to Jorhat Medical College and Hospital from June to August 2019. Required data on sociodemographic characteristics of the mother, antenatal, intranatal, and postnatal histories, and maternal and fetal outcomes of the pregnancy, were collected in predesigned and pretested schedule. Data analysis was done using Microsoft Excel software. Ethical approval was obtained from the Institutional Ethics Committee.

Results: 

Among the 118 teenage mothers which constitute 14.6% of total deliveries conducted during the study period, 61% were anemic during pregnancy and 75.42% of teenagers had term delivery while 19.49% had either preterm or postterm deliveries. Cesarean section was done for 50.85% of pregnancies and 45.77% of teenage mothers had complications such as eclampsia, prolonged labor, cephalopelvic disproportion, and premature rupture of membrane during labor. About 42.73% of the newborns were found to be low birth weight babies. A statistically significant association was found between determinants such as lower socioeconomic class, younger age at marriage, less education of mothers, lack of knowledge about contraceptives, and teenage pregnancy.

Conclusion: 

Our study findings indicated a high percentage of teenage pregnancy and increased complications among teenage mothers and newborns.

Introduction

Adolescent years are the period of rapid growth and development for a girl child. A teenage girl is very much vulnerable both physically and mentally during the adolescent period resulting in many adverse outcomes in their later life as a mother as well as their children.[¹] In India, social and cultural factors influence the age of marriage for a girl leading to teenage pregnancy. Along with adverse health impacts, adolescent pregnancy has a permanent effect on the financial, social life, and education of a teenager preventing her from achieving the full potential in her life.[²] Nearly, 10 million adolescent girls in India become pregnant every year, contributing to a large sunk of total maternal and neonatal mortality.[³] Those infants who survived are also at risk of suffering from different childhood morbidity and forming the intergenerational cycle of morbidity and malnutrition.[⁴] Thus, contributing to the malnutrition and morbidity burden of the community as well as to the nation's burden. In India, malnutrition among teenage girls is very high, teenage pregnancy accentuates this problem.[⁵] Assam which is situated in the northeastern corner of the country contributes to the highest number of maternal deaths in the country and also has the third-highest infant mortality rates within the country.[^6,7] In Assam state, around 31% of teenage girls get married before the age of 18, and around 12% of teenage girls become mothers before they turn 18.[⁸] Therefore, in the said context teenage pregnancy is a major public health issue in Assam. Moreover, the knowledge gap about teenage pregnancy and its outcome in the scientific literature from this region prompted us to inquire the determinants of teenage pregnancy and its maternal and fetal outcomes among the teenage mothers in a hospital setting.

Objectives of our study

To identify the maternal and fetal outcomes of teenage pregnancy among the adolescent mothers admitted to Jorhat Medical College Hospital (JMCH).

To find out the various determinants influencing teenage pregnancy and its outcome among the adolescent mothers.

Materials and Methods

The present study was a hospital-based cross-sectional study conducted in JMCH which is a tertiary care health institute in Assam. The study population was adolescent mothers who has delivered in JMCH and admitted to JMCH during the study from June to August 2019.

Inclusion criteria

All adolescent women up to 19 years of age who have delivered in Jorhat Medical College and Hospital during our study period and who gave informed consent to be part of our study were included in the data analysis.

Exclusion criteria

Adolescent mothers/Guardians giving incomplete information were excluded from the data analysis.

A total 118 numbers of teenagers were chosen for our study after the application of inclusion and exclusion criteria judiciously.

Consent

Since our study participants included adolescent women <18 years of age hence for those women assent was obtained from them and informed consent was obtained from their parents or husband. Those in the age group of 18–19 years informed consent were obtained from the individual themselves.

Data collection technique

For the study, we selected 118 teenage women admitted to the postnatal ward of Obstetrics and Gynaecology Department, JMCH, who have recently delivered. Investigators visited the ward every day to select the study participants according to the eligible criteria and they were interviewed about the outcomes and determinants of their pregnancy. Furthermore, the relevant medical records available in the bed-head tickets were included for analysis. The age of the respondent was verified from the records available.

Data collection tools

Data were collected in a predesigned, pretested, semi-structured interview schedules. The schedule was validated by pretesting through a pilot study conducted among 10 eligible teenage mothers coming to JMCH.

Statistical analysis

Data collected through the interview method was compiled, tabulated, and analyzed using Microsoft Excel software.

Ethical clearance

Ethical clearance has been obtained from the Institutional Ethics Committee (human), Jorhat Medical College, Jorhat.

Variables under study

• Sociodemographic characteristics of the mother
• Antenatal, intranatal, and postnatal history.

Outcome variables

• Mother – Complications during labour, type of delivery, postpartum complications, admission in intensive care unit (ICU), and death
• Newborns – Live birth/dead born
• Birth weight of the newborn – Low birth weight (LBW)/normal birth weight
• Complication in infants – Neonatal intensive care unit (NICU) admission and congenital deformities.

Results

In our study, we observed out of the total 803 deliveries conducted during our study period, a total of 118 (14.7%) were teenage pregnancies. Among these 118 teenage mothers, 15% were in the age group of 16–17 years and 67.7% respondents were of 18–19 years.

Out of 118 teenagers, most teenagers had studied up to Middle school only. Out of all the respondents we interviewed, most of them, i.e., 52.5% married between 16 and 18 years. While 9.2% had married before they reached 16 years of age. We found that 53.4% of the respondents are from nuclear families. We also found that most of the teenage mothers belonged to lower socioeconomic class families. We found that 26.3% of the respondents had knowledge about contraceptives whereas 73.7% had no knowledge about contraceptives [Table 1].

Table 1: Distribution of teenage mothers according to their sociodemographic characteristics

On analysis of the sociodemographic determinants of teenage pregnancy in Table 1, we observed that the low education level of teenagers and low-socioeconomic status were significantly associated with teenage pregnancy. Similarly, a statistically significant association was found between age at marriage and knowledge of contraceptives with teenage pregnancy. No statistically significant association was found between the age of mothers, type of family, and teenage pregnancy.

Observation of antenatal histories of the adolescent mothers in Table 2 we found that most of the respondents had at least one antenatal checkup (ANC). We have found that 45.5% of the respondents went for more than 4 ANC visits, while 23% went for 1–2 ANC visits. It is seen that all the respondents took tetanus toxoid injections during pregnancy and 97.6% of the respondents had consumed iron–folic acid (IFA) tablets for 100 days or more. We found that 61.2% of teenagers were anemic during pregnancy out of which 32.2% had hemoglobin level in between 10 and 10.9 g/dl, 26.3% had hemoglobin level in between 7 and 9.9 g/dl while the rest 2.7% had hemoglobin level <7 g/dl [Table 2].

Table 2: The teenage mothers according to their antenatal care history

While analyzing the pregnancy outcomes of the adolescents, it was found that 75.4% of teenagers had term delivery, 19.5% preterm while the rest 5.1% had postterm delivery out of which 49.2% of the teenagers underwent normal delivery while the rest 50.8% delivered by cesarean section delivery. In case of complications of teenage mothers during labor, 45.8% of the teenagers had some complications during labor and immediate postpartum period. Eclampsia, premature rupture of membrane, cephalopelvic disproportion (CPD), and oligohydramnios were some of the important complications the teenage mothers were having [Table 3].

Table 3: Distribution of teenage mothers according to their pregnancy outcomes

During the study period, total three numbers of maternal deaths were reported in the hospital but none belonged to the teenage age group.

The study found that 42.7% of the newborns of teenage mothers were LBW babies. It was seen that 12.8% of those newborns of teenage mothers had some complications needing NICU admission. One of the newborns of the teenage mothers was stillborn [Table 4].

Table 4: Distribution of the newborns of teenage mothers

Discussion

This study conducted in a medical college of Assam among newly delivered teenage mothers, threw up some very important information regarding determinants of teenage pregnancy and outcomes of pregnancy among adolescents.

The incidence of teenage pregnancy was 14.7% in our study. The National Family Health Survey 5 (NFHS-5) reported 11.7% of teenage pregnancy in the state of Assam. The NFHS-5 report also highlighted the high percentage of women in Assam getting married before age 18 which caused a high fertility rate among adolescents.[⁸] Similarly, Saloi et al. in their study found 25% adolescent pregnancy in a rural hospital of Assam.[⁹]

The study found a statistically significant association between low education and socioeconomic status with teenage pregnancy. The analysis of NFHS data also revealed adolescent mothers to have less education and belonged to poorer families compared to adult mothers.[⁵] Similarly, a statistically significant association was found between lower age at marriage, lack of knowledge of contraceptives of respondents and teenage pregnancy in our study. A study by Amoghashree et al. found an association between age at marriage and teenage pregnancy in their study.[¹⁰] In a meta-analysis on teenage pregnancy in Southeast India, authors had found that although the teenagers have knowledge of contraceptives, the use of contraceptives was very poor among teenagers which was an important determinant of teenage pregnancy.[¹¹]

Our study observed that most of the adolescents were availing at least one antenatal care visit and 80% of them getting the services such as supply of IFA tablets and TT immunization from government health centers. It showed good health-seeking behaviors of adolescents. Fulpagare et al. in their study conducted among teenage pregnant women of three states Bihar, Chhattisgarh, and Odisha found better utilization of ANC services among adolescents than their adult counterparts.[¹²] Proper ANC during pregnancy is linked with favorable pregnancy outcomes among adolescents.[¹³]

One major complication of teenage pregnancy found in our study was anemia during pregnancy. A total of 61% of the teenagers were suffering from some kind of anemia during pregnancy. Previous studies in North East India also found a high prevalence of anemia among teenage pregnant girls.[^9,14] Such complications adversely affect the outcomes of adolescent pregnancy.

Around 20% of the teenage mothers in our study delivered prematurely. Moreover, 50% of the teenagers underwent cesarean section delivery as they have some complications during the time of labour (eclampsia, CPD, oligohydramnios, etc.). It showed the risk associated with teenage pregnancy. Previous studies have shown that teenage pregnancy is associated with a higher risk of postpartum complications than adult mothers.[^15,16]

As most teenage mothers were anemic during pregnancy therefore the percentage of LBW babies was also high in our study. About 42.7% of the newborns were found to be LBW babies in our study. Twenty percent of the LBW babies had a birth weight <2 kg. Teenage pregnancy is associated with birth of an undernourished newborn and it also has long-lasting implications on the growth and development of the baby.[^17,18] In our study, 12.8% of the newborns were admitted in neonatal ICU for treatments signifying the need for special care for babies of teenage mothers. Similar findings were reported in other studies.[^19,20]

Conclusion

Our study findings indicated a high percentage of teenage pregnancy. These teenagers who were availing ANC services optimally still had high percentage of anemia during pregnancy and increased complications during labour and postpartum period. The percentage of LBW and premature newborn were found to be high among these teenagers. As the study highlighted the current situation of teenage pregnancy in Assam therefore public health interventions and programs targeting specifically teenage mothers are the need of the hour. Social determinants of teenage pregnancy are to be addressed as well to improve the health of adolescents so that we can have healthier mother and a newborn.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.