Adolescent pregnancy continues to be a grave problem in India not only from the obstetrical point of view but from the social and economical perspectives also. Complications of pregnancy and childbirth are the leading cause of mortality among women between the ages of 15 and 19 in the developing world.

1. Adolescent Pregnancy: Problems and Consequences

2. Adolescent pregnancy: Problems and consequences
Maitri Shaha,*, Saloni Prajapatib
, V. Sheneeshkumarc
ABSTRACT
Background: Adolescent pregnancy continues to be a grave problem in India not only from the obstetrical point of
view but from the social and economical perspectives also. Complications of pregnancy and childbirth are the leading
cause of mortality among women between the ages of 15 and 19 in the developing world.
Methods: The present study was carried out in a tertiary care hospital of Gujarat where various sociodemographic
and cultural factors associated with adolescent pregnancies were documented and compared with controls. Devel-
opment of any complication during antenatal period and perinatal outcome of each pregnancy was noted.
Results: It was found that there are more chances of developing severe anemia, severe PIH and low birth weight
babies in adolescent pregnancies. Poverty and illiteracy increase the risk for the same.
Conclusion: Cultural practices, poor socioeconomic conditions and low literacy rate are the contributory factors to
adolescent pregnancy associated poor obstetric outcome.
Copyright © 2012, Indraprastha Medical Corporation Ltd. All rights reserved.
Keywords: Adolescent pregnancy, Sociodemographic factors, Perinatal outcome
INTRODUCTION
Adolescent pregnancy continues to be a grave problem in
India not only from the obstetrical point of view but from
the social and economical perspectives also. Also known
as teenage pregnancy, it is defined as a pregnancy occurring
from the age of 13e19 years of age (or for the matter of fact
from puberty to 19 years of age). It is not limited to any
social, economic, racial and ethnic groups.
According to UNFPA, State of world population data
2003, the incidence of teenage pregnancy is 45 per 1000
live birth. Worldwide rates of teenage pregnancy range
from 143 per 1000 in some sub-Saharan African countries
to 2.9 per 1000 in South Korea.1,2
Between 15 and 19
years, in addition to age there are other socioeconomic
risk factors. Data supporting teenage pregnancy as a social
issue in developed countries include lower educational
levels, higher rates of poverty, and other poorer “life
outcomes” in children of teenage mothers. Teenage
pregnancy in developed countries is usually outside of
marriage, and carries a social stigma in many communities
and cultures. For these reasons, there have been many
studies and campaigns which attempt to uncover the causes
and limit the numbers of teenage pregnancies. In other
countries and cultures, particularly in the developing world,
teenage pregnancy is usually within marriage and does not
involve a social stigma.3
Pregnant teenagers face many of the same obstetrics
issues as women in their 20s and 30s. However, there are
additional medical concerns for younger mothers, particu-
larly those under 15 and those living in developing coun-
tries. The worldwide incidence of premature birth and
low birth weight is higher among adolescent mothers.4e6
Risks for medical complications are greater for girls 14
years of age and younger, as an underdeveloped pelvis
can lead to difficulties in childbirth. Obstructed labor is nor-
mally dealt with by Caesarean section in industrialized
nations; however, in developing regions where medical
a
Associate Professor, b
Assistant Professor, c
Senior Resident, Dept. of Obs & Gynec, Medical College & S.S.G. Hospital, Baroda, India.
*
Corresponding author. 30, Gulabchand Park Soc., Karelibaug, Baroda 390018, India. Tel.: þ91 265 2485727, þ91 9426370499 (mobile),
email: maitrishah.gynec@gmail.com
Received: 9.4.2012; Accepted: 29.6.2012; Available online: 13.7.2012
Copyright Ó 2012, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2012.06.002
Apollo Medicine 2012 September
Volume 9, Number 3; pp. 176e180
Original Article

3. services might be unavailable, it can lead to eclampsia,
obstetric fistula, infant mortality, or maternal death.6
For
mothers in their late teens, age in itself is not a risk factor,
and poor outcomes are associated more with socioeconomic
factors rather than with biology.7
The World Health Organization loping estimates that the
risk of death following pregnancy is twice as great for
women between 15 and 19 years than for those between
the ages of 20 and 24. The maternal mortality rate can be
up to five times higher for girls aged between 10 and 14
than for women of about 20 years of age.
One-fourth of adolescent mothers will have a second child
within 24 months of the first. Factors that determine which
mothers are more likely to have a closely-spaced repeat birth
include marriage and education: the likelihood decreases
with the level of education of the young woman e or her
parents e and increases if she gets married.
This paper attempts to evaluate various sociodemographic
and cultural factors responsible for adolescent pregnancies. It
also shows various pregnancy related complications in this
age group and compares them with the control group.
MATERIALS AND METHOD
This study was carried out in Medical college hospital of
Vadodara, over a period of 1 year amongst antenatal
mothers attending outpatient and emergency Departments.
The case group includes mothers who are less than 19 years
of age and are married primigravida with gestational age of
less than 20 weeks. The next antenatal mother fulfilling the
same criteria and between the age group of 20e29 years
were taken as control for the same case. The mothers
with any history of medical or surgical disorders, having
Rh negativity, with multiple pregnancies or showing fetal
congenital anomalies were excluded from the study.
The aim of the study was to find out association between
various socio-cultural and demographic factors with
number of adolescent pregnancies. Various maternal
complications and perinatal outcome of this age group
were noted and compared with that of control group.
It was a longitudinal follow-up study where data was
compared amongst two groups. Semi-structured open ended
questionnaire was provided to each case and control after
obtaining their written informed consent. Both cases and
controls were given antenatal care as per the existing stan-
dards at the hospital. All the details of the cases and
controls were documented systematically in the proforma.
Details covered their sociodemographic aspects, antenatal
care, baseline investigations, labor details and feto-maternal
outcome. The data was then organized and subjected to
statistical tests of significance.
RESULTS AND DISCUSSION
The present study highlights the magnitude of problem of
adolescent pregnancies and discusses the consequences of
perinatal outcomes. There were 4098 confinements in
SSG Hospital Vadodara over a period of 1 year. Of these
115 were teenage pregnancies with prevalence, therefore,
of 2.81%. The number of the adolescent mothers has
increased by 50% during the last 27 years and is likely to
increase further due to the population momentum.8
Teenage mothers included in this study ranged from 15
years of age to 19. Twenty percent of them were below the
legal age of marriage. Thus in a significant number of cases
marriage and conception occurred even before the legal age
was attained (Table 1).
Comparing educational achievements, 54.3% of the
cases were illiterate compared to 12.9% controls. Husbands
of 51.4% of the cases were illiterate whereas the same rate
for controls was 14.3%. In all higher educational classes,
cases lagged behind controls (Table 2).
Important causes for early marriage were economic pres-
sure, social pressure and family pressure. Same factors play
a role in poor antenatal care. Education also plays a definite
role in the causation of teenage pregnancy. Attainment of
higher education leads to a late age of marriage and concep-
tion due to professional pursuit and desire for economic
independence.
Other sociodemographic and cultural factors studied
shows that 74.3% of the cases were from rural areas
compared to 51.4% controls. 48.6% of the controls were
from urban areas whereas the same rate for cases was
25.7%. This association was statistically significant
(p ¼ 0.0056, Odds ratio ¼ 2.7). It also reflects that
Husbands of 57.2% of cases were unskilled laborers
whereas the same rate for controls was 24.3%. Respective
rates of cases were lower compared to controls for all
higher occupation levels. All the associations were statisti-
cally significant. The results also show that 68.6% of cases
were from low socioeconomic classes compared to 38.6%
of the controls. 55.7% of the controls were from middle
class and 5.7% from upper class. This was statistically
significant (p ¼ 0.0007). Teenage pregnancy was
Table 1 Age wise distribution of cases (n ¼ 70).
Age No. of cases
15 1 (1.4%)
16 4 (5.7%)
17 9 (12.8%)
18 32 (45.7%)
19 24 (34.3%)
Total 70
Adolescent pregnancy Original Article 177

4. statistically associated with larger families (p ¼ 0.003,
Odds ratio ¼ 0.34) (Table 3).
Thus teenage pregnancy is associated with low socioeco-
nomic levels. This is an amalgamation of earlier tables all
of which reflected parameters of socioeconomic stratifica-
tion. Larger families means limited resources, lesser educa-
tional opportunities and economic constraints. This leads to
pressure to get the girl married off earlier so that she can
play her traditional role of homemaker. Strategic planning
must include socioeconomic upliftment and improving
literacy rates so as to circumvent the problem of teenage
pregnancy.
There are increased chances of preeclampsia, anemia,
preterm labor and prolonged labor in adolescent pregnan-
cies. Due to increased rate of complications seen during
pregnancy and at delivery, this group, comes under the
preview of ‘high-risk pregnancy’ requiring constant and
regular supervision.9
In our study, the incidence of severe anemia, severe PIH
and short stature was more amongst the cases as compared
to controls, which was statistically significant a p-value of
0.039, 0.029 and 0.029 respectively. However, the inci-
dence of moderate anemia, mild PIH and eclampsia were
comparable amongst the cases and controls, which was
not significantly significant. The incidence of preterm labor
was 17.1% in cases and 5.7% in the controls. This was
however not statistically significant (p ¼ 0.063). The inci-
dence of IUGR and oligohydramnios was 2.8% and 4.2%
in the cases respectively. None of these were observed in
the controls. One case of PROM was observed in the
controls and none in the cases. The incidence of CPD and
Abruptio Placentae was similar and not statically significant
(Table 4).
It was seen that adolescents aged 16 or younger in India
were less likely to use any health care than were older
women.10
The standard of antenatal care in teenage mothers
was poor. 27.1% have never taken an ANC visit according
to this study.
The incidences of various complications like
preeclampsia (23.7%), eclampsia (8.7%), anemia (11.2%),
premature labor (30.0), prolonged labor (13.7%) are
observed in study by Bhadauria et al9
(Table 5).
Table 3 Socio-cultural factors.
Case Control
Residence
Rural 52 (74.3%) 36 (51.4%)
Urban 18 (25.7%) 34 (48.6%)
Occupation
Unskilled laborer 40 (57.2%) 17 (24.35)
Skilled laborer 8 (11.4%) 18 (25.7%)
Business 8 (11.4%) 6 (8.6%)
Office 6 (8.6%) 21 (30%)
Services 8 (11.45%) 8 (11.4%)
Socioeconomic classa
Low 48 (68.6%) 27 (38.6%)
Middle 22 (31.45%) 39 (55.7%)
Upper 0 4 (5.7%)
Family size
3e4 20 (28.6%) 38 (54.3%)
>4 50 (71.4%) 32 (45.7%)
a
Kuppuswamy’s classification.
Table 4 Presence of complications in adolescent pregnancies.
Complications Cases Controls p-value
Anemia Mild 55 (85.8%) 64 (94.4%) e
Moderate 2 (2.8%) 3 (4.2%) 1.0
Severe 8 (11.4%) 1 (1.4%) 0.039
PIH Mild 3 (4.2%) 2 (2.8%) 1.0
Severe 12 (17.1%) 3 (4.2%) 0.029
Preterm labor 12 (17.1%) 4 (5.7%) 0.063
Oligohydramnios 3 (4.2%) 0 e
IUGR 2 (2.8%) 0 e
Placenta praevia 0 0 e
Abruptio Placentae 1 (1.4%) 2 (2.8%) 1.0
PROM 0 1 (1.4%) e
CPD 4 (5.7%) 2 (2.8%) 0.678
Short stature 10 (14.3%) 1 (1.4%) 0.029
Eclampsia 2 (2.8%) 1 (1.4%) 1.0
Postdatism 1 (1.4%) 0 e
Table 2 Educational levels of the study participants.
Educational level Case Control
Wife Husband Wife Husband
Illiterate 38 (54.3%) 36 (51.4%) 9 (12.9%) 10 (14.3%)
Primary 14 (20%) 2 (2.8%) 15 (21.4%) 5 (7.1%)
Secondary 17 (24.3%) 17 (24.3%) 33 (47.1%) 18 (25.7%)
Higher secondary 1 (1.4%) 7 (10%) 9 (12.9%) 7 (10%)
College 0 8 (11.4%) 4 (5.7%) 20 (26.6%)
178 Apollo Medicine 2012 September; Vol. 9, No. 3 Shah et al.

5. According to our study, 17.1% of the babies born to
teenage mothers were preterm compared to 5.7% in
controls. This was statistically significant (p ¼ 0.039). Inci-
dence of low birth weight babies was 77.2%. Of these 23%
was less than 2 kg, 17.1% of the babies were preterm,
28.1% required NICU admissions. Important causes were
prematurity and asphyxia (Table 6).
After delivery, while asking preference for contracep-
tion, 37.1% of the teenage mothers desired some form of
contraception compared to 65.7% of controls. This was
statistically significant (p ¼ 0.008%). This reflects signifi-
cantly low desire for contraception amongst teenage
mothers (Table 7).
Adolescent motherhood adversely affects child survival
and maternal life. Because of the high incidence of fetal
wastage, women have to experience a comparatively
greater number of pregnancies to give birth to a child that
will survive. It has been observed that adolescent mothers
suffer a higher child loss than mothers aged 20e24 or
25e29 years. Maternal mortality among mothers’ aged
15e19 is also very high as compared to that among mothers
in the 20e24 age group. Due to frequent pregnancy, the
health of the mother is badly affected she becomes anemic
and gives birth to an underweight child who faces a higher
risk of death at each age.18
Cultural and psychological barriers within communities
may prevent young women-especially those who are very
poor- from using clinic-based reproductive health services
even when they do exist.19
Reynolds et al showed that
young women are less likely than older women to know
about pregnancy and reproductive health issues in general,
and they have less experience in using health services.18
This paper aims to create awareness amongst health-care
providers on the burning issue of adolescent pregnancies.
A study on a larger scale is recommended to assess public
health importance of the subject. However provision of
information, counseling and life-skills education to adoles-
cent through various “Adolescent friendly health centres”
can be helpful to decrease the magnitude of the problem.
In our literate society, where teenage pregnancies out of
wedlock, are on rise, sex education and contraceptive
knowledge should be made an integral part of health
education.9
CONCLUSION
This study shows that teenage pregnancies are still
a common occurrence in rural India in spite of various
legislations and government programs. Teenage pregnancy
is a risk factor for poor obstetric outcome. Cultural prac-
tices, poor socioeconomic conditions, low literacy rate
and lack of awareness of the risks are some of the main
contributory factors. Early booking, good care during preg-
nancy and delivery and proper utilization of contraceptive
services can prevent the incidence and complications in
this high-risk group.
CONFLICTS OF INTEREST
All authors have none to declare.
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