The association of maternal age with adverse neonatal outcomes in Lusaka, Zambia: a prospective cohort study

Abstract

Background Pregnancy among adolescents, whether intended or not, is a public health concern as it is generally considered high risk for both mothers and their newborns. In Zambia, where many women engage in early sexual behaviour or marry at a young age, 28.5% of girls aged 15–19 years were pregnant with their first child in the year 2013–2014. This study sought to explore associations between maternal age and neonatal outcomes among pregnant women in Lusaka, Zambia. Methods This was a secondary analysis of data nested within a larger population-based prospective cohort study which was implemented in three government health facilities-two first level hospitals and one clinic in Lusaka, Zambia. Women presenting to the study sites for antenatal care were enrolled into the study and followed up for collection of maternal and neonatal outcomes at 7, 28 and 42 days postpartum. The study’s primary outcomes were the incidence of maternal and newborn complications and factors associated with adverse neonatal outcomes. Statistical significance was evaluated at a significance level of P < 0.05. Results The study included 11,501 women, 15.6% of whom were adolescents aged 10–19 years. Generally, adolescence did not have statistically significant associations with poor maternal health outcomes. However, the risk of experiencing obstructed labour, premature rupture of membranes and postpartum hemorrhage was higher among adolescents than women aged 20–24 years while the risk of severe infection was lower and non-significant. Adolescents also had 1.36 times the odds of having a low birthweight baby (95% CI 1.12, 1.66) and were at risk of preterm birth (aOR = 1.40, 95% CI 1.06, 1.84). Their newborns were in need of bag and mask resuscitation at birth (aOR = 0.62, 95% CI 0.41, 0.93). Advanced maternal age was significantly associated with increased odds of hypertension/ pre-eclampsia (95% CI 1.54, 5.89) and preterm labour (aOR = 2.78, 95% CI 1.24, 6.21). Conclusions Adolescence is a risk factor for selected pregnancy outcomes in urban health facilities in Lusaka, Zambia. Health care workers should intensify the provision of targeted services to improve neonatal health outcomes. Trial registration Clinical trial number and URL: NCT03923023 (Retrospectively registered). Clinical trial registration date: April 22, 2019.

A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes

“…Maternal age was most commonly identified as a risk factor for PTB reported in 17 of these studies. Eight of these studies [ 11 , 21 , 62 , 64 , 66 , 80 , 98 , 106 ] reported an increased risk of PTB among younger mothers compared to older mothers although the age cut-offs for the younger mothers varied (≤16, ≤20 or ≤24). However, in one study [ 30 ], younger mothers aged ≤20 years were less likely to have a PTB.…”

Sociodemographic and gestational factors of adolescent mothers associated with prematurity

“…A prematuridade, frequentemente, vem associada ao baixo peso ao nascer (9)(10)(11)(12) , conforme evidenciado neste estudo, o que pode agravar ainda mais as condições do recém-nascido. Coorte de base populacional realizada no Brasil identificou que os riscos de mortalidade neonatal e infantil foram substancialmente maior entre nascidos vivos que combinavam nascimento pré-termo e baixo peso ao nascer, apresentando risco de mortalidade neonatal 62 vezes maior, quando combinados prematuridade, baixo peso ao nascer e pequeno para idade gestacional (12) .…”

“…Entretanto, é relevante considerar que a ruptura prematura de membranas foi a principal condição clínica apresentada pelas adolescentes, além de gestação prolongada, restrição do crescimento fetal, pré-eclâmpsia, doença hipertensiva específica da gestação, dentre outras. Evidencia--se que gestantes adolescentes estão mais expostas a complicações obstétricas, como ruptura prematura de membranas (11) , pré-eclâmpsia e restrição do crescimento fetal (20) , sendo que estas complicações também podem ser associadas ao parto prematuro (2) . Destaca--se que 15% da amostra foi classificada como "gravidez de risco não especificada", o que deixa uma lacuna e dificulta a compreensão acerca dos reais motivos desta gravidez ter sido considerada de risco.…”

“…Além disso, estas meninas apresentam imaturidade do útero e/ou suprimento sanguíneo insuficiente do colo uterino (5) , o que contribui para o aumento de nascimentos prematuros (5,(7)(8) . É consenso na literatura que mães adolescentes têm maior risco de prematuridade, associada ao baixo peso ao nascer (9)(10)(11)(12) , baixo índice de Apgar e mortalidade pós-natal (12) .…”