The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literature

Abstract

BackgroundWhile the main causes of maternal mortality in low and middle income countries are well understood, less is known about whether patterns for causes of maternal deaths among adolescents are the same as for older women. This study systematically reviews the literature on cause of maternal death in adolescence. Where possible we compare the main causes for adolescents with those for older women to ascertain differences and similarity in mortality patterns.MethodsAn initial search for papers and grey literature in English, Spanish and Portuguese was carried out using a number of electronic databases based on a pre-determined search strategy. The outcome of interest was the proportion of maternal deaths amongst adolescents by cause of death. A total of 15 papers met the inclusion criteria established in the study protocol.ResultsThe main causes of maternal mortality in adolescents are similar to those of older women: hypertensive disorders, haemorrhage, abortion and sepsis. However some studies indicated country or regional differences in the relative magnitudes of specific causes of adolescent maternal mortality. When compared with causes of death for older women, hypertensive disorders were found to be a more important cause of mortality for adolescents in a number of studies in a range of settings. In terms of indirect causes of death, there are indications that malaria is a particularly important cause of adolescent maternal mortality in some countries.ConclusionThe main causes of maternal mortality in adolescents are broadly similar to those for older women, although the findings suggest some heterogeneity between countries and regions. However there is evidence that the relative importance of specific causes may differ for this younger age group compared to women over the age of 20 years. In particular hypertensive conditions make up a larger share of maternal deaths in adolescents than older women. Further, large scale studies are needed to investigate this question further.

Comparing the use and content of antenatal care in adolescent and older first-time mothers in 13 countries of west Africa: a cross-sectional analysis of Demographic and Health Surveys

“…Amongst these components, blood pressure measurement and urine tests are important for making a diagnosis of pre-eclampsia (37), which accounts for more morbidity and mortality in adolescents than older women (4,5). Hence the differences in the proportion of adolescents receiving urine tests in some countries may be an obstacle to detecting and managing this condition appropriately.…”

“…Compared to older women, adolescents' pregnancies carry a higher risk of severe morbidities (e.g. hypertensive disorders of pregnancy) (4,5), and their children less than five years have a higher risk of death (6,7). Sub-Saharan Africa (SSA) has the second highest maternal mortality ratio (8) and the highest rate of adolescent pregnancy and childbearing globally (9).…”

Mortes maternas por aborto entre adolescentes no Piauí, Brasil

“…The main causes of maternal mortality among adolescents are similar to those of older women, with an emphasis on hypertensive disorders, hemorrhages and abortion 16 . However, when compared to women aged 20-24, adolescents tend to have more serious complications during pregnancy and childbirth 17 , which is the most common cause of death among women aged 15 to 19 in the world 13 .…”

Multilevel Analysis on the Predictors of Safe Sexual Behavior among Girl Adolescents in Karanganyar, Central Java

“…Seorang remaja yang hamil berisiko tinggi untuk terjadi aborsi, perdarahan, infeksi/ sepsis, hipertensi, emboli, komplikasi pada persalinan dan meningkatnya risiko kematian ibu. Bayi yang dilahirkannya berisiko tinggi untuk mengalami kematian perinatal, kematian neonatal, lahir prema-tur dan berat badan lahir rendah (Neal et al, 2016;Azevedo et al, 2015). Remaja yang hamil berisiko untuk melakukan bu-nuh diri (Chan et al, 2016).…”