Comparative analysis of perinatal outcomes and birth defects amongst adolescent and older Ugandan mothers: evidence from a hospital-based surveillance database

Abstract

Background Uganda has one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes between adolescents (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals. Methods Maternal demographics, HIV status, and birth outcomes of all live births, stillbirths, and spontaneous abortions delivered from August 2015 to December 2018 were extracted from a hospital-based birth defects surveillance database. Differences in the distributions of maternal and infant characteristics by maternal age groups were tested with Pearson’s chi-square. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated using logistic regression to compare the prevalence of adverse birth outcomes among adolescents to mothers 20–34 years. Results A total of 100,189 births were analyzed, with 11.1% among adolescent mothers and 89.0% among older mothers. Adolescent mothers had an increased risk of preterm delivery (aOR: 1.14; CI 1.06–1.23), low birth weight (aOR: 1.46; CI 1.34–1.59), and early neonatal deaths (aOR: 1.58; CI 1.23–2.02). Newborns of adolescent mothers had an increased risk of major external birth defects (aOR: 1.33; CI 1.02–1.76), specifically, gastroschisis (aOR: 3.20; CI 1.12–9.13) compared to mothers 20–34 years. The difference between the prevalence of gastroschisis among adolescent mothers (7.3 per 10,000 births; 95% CI 3.7–14.3) was statistically significant when compared to mothers 20–34 years (1.6 per 10,000 births; 95% CI 0.9–2.6). Conclusions This study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years, similar to findings in the region and globally. Interventions are needed to improve birth outcomes in this vulnerable population.

Survival patterns of neonates born to adolescent mothers and the effect of pregnancy intentions and marital status on newborn survival in Kenya, Uganda, and Tanzania, 2014–2016

“…Our overall finding of HR 1.8 for hazard of mortality among neonates born to adolescent mothers is comparable to findings of a nationwide study conducted in Nigeria, a similar setting, by Akinyemi et al that found hazard ratios of 1.75 and 1.5 for its 2008 analytical models, comparing neonatal deaths among adolescent mothers to mothers 20–35 years old [ 52 ]. Other studies across the globe have reported comparable higher risks of neonatal death among neonates born to adolescent mothers [ 5 , 19 , 20 , 53 , 54 ]. Furthermore, the USA 2020 national report indicated highest NMR among adolescent mothers compared to older mothers [ 55 ].…”

Maternal and Neonatal Outcomes of Adolescent Pregnancy: A Narrative Review

“…As per a study conducted in Missouri, the risk of intrapartum stillbirth is four times and 50% higher in older adolescent pregnant females than in adult pregnant women [50]. In a cross-sectional study conducted in Hebei, China, by Zhang et al worked over four years (2013-2017) with 238,593 women subdivided into the adolescent group (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and adult group (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), adolescent women had a higher risk of stillbirth and neonatal death as compared to the adult group. It was also noted that preterm deliveries were at a higher rate in the adolescent group [51].…”

Neonatal Outcome Associated With Maternal COVID-19 Infection in Adolescent Patients

“…Patients aged 10-19 years have a higher risk to develop preeclampsia, eclampsia, and systemic infections [9,11]. Newborns from young mothers are also exposed to increased risks for low birth weight, prematurity, stillbirth, congenital anomalies, and early neonatal demise [9,11,[12][13][14][15][16]. The explication of these complications may result in the lack of maturation of biological, psychological, and sociological systems [12,16].…”