A Comparative Study on the Outcome of Pregnancy in Adolescent and Adult Women

Background and purpose: This research was designed to determine the correlation between the maternal age and the outcome of pregnancy in patients admitted to Imam khomeini hospital in Sari during the year 1997.

Materials and methods: The study was a case control research, done on 60 females of 18 years of age (Experimental group) and 91 females of 21-25 years of age (control group). The criterias such as medical history, occupation, socioeconomical status and quality of prenatal care were the same for both the groups.

Malpresentation, antepartum and intrapartum bleeding, pre eclampsi, premature rupture of membranes, preterm labour , anemia , meconium discharge , low birth weight , apgar scoring of lass than 7 and prenatal mortality were the outcome of pregnancy in this study.

The anemia was indicated by HbResults: In this study, majority of adolescent women (97.4%) had 15-18 years of age and only 2.6% of them were less than 15 years of age.

There were no significant differences in the history of abortion, still birth and hydatiform mole. More than 90% of women in both groups had adequate pregnancy care. Stalistical analysis (X² and t-test) indicated that the outcome of pregnancy in two groups had no significant difference.

Conclusion: Maternal age itself has no adverse effect on the outcome of pregnancy, but is associated with school dropouts and further more the adolescent mothers are unable to take a proper care of themselves and their children.

Adolescence Teenage, Pregnancy, Outcome of pregnancy

Introduction

Age of mother at pregnancy is one of the main risk factors for hazarded outcome of pregnancy (1) many researchers have been done on the effect of mother age on the outcome of first pregnancy. They believe that the proper age of pregnancy is 20 t 30 years of age (2). Annually, more than one million young women under 20 years of age in the united stated become pregnant, which less than 50% of these young women give birth. 23% of the births to African Americans were in young women under 20 years of age (3). In our country is no exact figure about the prevalence of adolescents pregnancy but it seems that the age of marriage in our country is low and many but pregnancy occur of this age. It is obvious that the first step to reduce pregnancy in the adolescents is diagnosis of the complication and its outcome. Some of the researches related to adolescents pregnancy indicate that increase in rate of complications particularly pre-eclampsia, Iron deficiency anemia, low birth weight and operative delivery (forceps delivery, vacuum extraction) and caesarean section (2,4). Fraser etal, found that pregnancy in adolescence women increased the complication of pregnancy.A comparative study done by stain etal in 1995 on primigravida women of the age between 16 to 19 years With the older primigravida women indicated that the complication of pregnancy did not increase (6). Amini etal got the same result in 1996(7). Some workers believe that the age of mother itself does not have hazarded but the health behavior of mother like quality of prenatal care is effective on the occurence of complication.

Materials and methods

This research was designed as a case control study done on the women with the age of 18 years or less admitted in Imam Khhomeni hospital for delivery who were considered as study groups and the women age of 20-24. Who were matched for the number of pregnancy, the history of present pregnancy medical history, occupation, socioecnomic condition and prenatal care considered as control group. In this study the number of study and control group was 60 and 91 case. After sampling the information was recorded in ques tionnair divided in three section. Gestatitional age was considered from the first day of last menstural period or on the basis of sonography taken in the first months of pregnancy. Diagnosis of pre eclampsia was done on the basis of blood pressure 140/90 and presence of proteinuria anemia was determined on the basis of hemoglobin less than 10.5 mg/dl. CBC was done for all the samples. The family history was taken to distinguish between iron deficiency anemia and thalasemia minor. All the women selected for this study were primigravida and single tone pregnancy.

Statistical analysis was done with computer. X2 test and X2 test after correction of yates were done for difference in the outcome of pregnancy in two groups.

Results

In this research, the samples were matched for criterias, suc as gravidity , pregnancy and medical history , occupation and socieo-economical states , no significant (97.4%) aged 15 to 18 years and only 2.6% of adolescent mothers aged less than 15 years. Results showed that no statistically significant difference in the history of abortion and mole hydatiform. Antenatal clinic attendance was about the same for the study and control groups. About 90% of study group and 92% of control group were adequate prenatal care ( 7 times). Only 5% of study group and 10% of control group were premature labour but no statisticaly signficant difference. More than 90% cases were cephalic presentation only 6.7% of study group and 6.6% of control groups were mal presentation that about the same for the study and control groups. Complication of pregnancy are shown in tables, anemia was present in 5 (8.3%) patients in study group as against 2(2.2%) in control group however the difference was not statistically significant.

Discussion

Pregnancy in adolescence age is one of the main problems in world with the prevalence rate of 6.5 to 10.5 in l000 pregnancy (4). The prevalence of pregnancy in adolescence age is increasing of low puberty age, early onset of sexual activity in girls and lack of recipient essential education on the contraception methods prevention of pregnancy low age puberty sexual activity in low age (3). In spite of high prevalence rate of this problem, our study showed that these pregnancies are not problematic. Mukasa et al. (1999) in Butterworth hospital in Transkei city, and Createas et al. (1991) at Alexandro hospital of Aten University got the same result (8,9). But Chan and Zhang, (1991) At Queen Victoria hospital in Australia and Bury (1985) approved that the undesired complication during pregnancy and delivery in adolescents increase (10,1), but this research has been done on the 16 years old women.Pregnancy at low age is consider as one of the high risk condition, which is not only due to low age, but also economic problems, lack of sufficient education, pregnancy without marriage and in sufficient prenatal care are effective. In this group increased risk complication maternal and neonatal (19). Mukasa et al, (1991) at Butter worth hospital in transkei city, reported that 70% of the sample under investigation had non married pregnancy, which itself play very important role in the undesired outcome of pregnancy (8). On our study, there was no case of unmarried pregnancy, which can have important role on the reduction of pregnancy complications. In this study there was 6.7% and 6.6% of low birth weight in study and control groups respectively. Which is different from Chan and Zhang finding. They found that the weight at birth in 16 years old and under. Less than the female of above 19years old which can be due to in sufficient prenatal care (11). While Theresa et al (1987) at Newjersy university and Hediger et al. (1987) reported that with proper prenatal care the weight of neonates at birth in young and adolescent female was the same (14,15). The most of the adolescents did not accept their pregnancy, hence were deprived of care. The other reason of not receiving prenatal care was due to unawareness of the importance of prenatal care and fear of pelvic examination (3). In our study 90% of the study group and 94% of the control group since the first trimester of pregnancy received prenatal care regularly. This result differs with other reports of the same (11,13,14,15). The reason of difference in the bad result of pregnancy is probably due to this reason. Prenatal care has good effect on the outcome of pregnancy, so in the adolescent receive enough prenatal care the incidence of some of complications such as Preterm delivery, low birth weight would decline (16). Less number of pregnancy complications in adolescents in this study is due to receiving enough prenatal care. The rate of caesarean section in the study group was 35.5% and in control group 44%, which is not statistically significant Brown et al., 1991 and Lubrarsky, et al. (1994) got the same result (17,18). But this finding is different from Konje's, et al. Finding. This studying was done of tall on the file of 14-16 years old adolescents from 1977 to 1988, the number of caesarean section was more than the control group due to the fact that Cephalo plevic disproportion and occiput posterior condition (4). But in our study mean age of the cases was 16.5 years old, no statistically significant difference was observed with the control group considering the numbers of caesarian section, Iron deficiency anemia is another complication of pregnancy which threatening the adolescent women. In this study, 8.3% of case groups and 2.2% of control group had anemia, this difference was not significant statistically, which is different with Zhang and Chan study (11). The reason of this difference is due to not receiving enough prenatal care, because only 15.7% of case group received enough prenatal care more than 7 times during pregnancy, while 93.9% of control group receive prenatal care more than 7 times. In Zhang et al., (1984) and Mcintosh (1991) study, the prevalence of pre-eclampsia in adolescents females was more than the young females, which differed from our study (11,13). But Konje et al., 1992 reported that there was not significant difference between adolescents and young on the basis pre eclampsia (4). The reason of blood pressure anxiety, exciting and not receiving enough prenatal care. In the cases under our study less problem arise due to the frequent reference for prenatal care. Finally it is concluded that, the age of mother itself, does not have worsen effect on pregnancy. But the fact is that pregnancy in low age is probably associated with problems such as in completion of education and consequently improper job. Further more adolescent females do not accept their pregnancy and can't pay to her child themselves for the necessary attention.

Hence considering the result of this research, education about the pregnancy to the final high school girls is he commended. And the importance of prenatal care for the reduction of the unwanted complications during pregnancy be notified to them, and in case of arise problem, immediately refer to special health service center. And special training be given the adolescent pregnant and the principles of health care to the neonate be thought to in crease the confidence of the mother in caring their neonate.

Submitted By:
Fatemeh Nasiri Amiri,(M.Sc.); Nursing & midwifery Faculty,Babol University of Medical Sciences /IRAN

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