European Journal of Cardiovascular Medicine

Teenage pregnancy, defined by the World Health Organization (WHO) as pregnancy occurring in females aged 10 to 19 years, remains a significant global health issue, particularly in developing countries^1,2. The impact of early pregnancy on both maternal and child health has drawn increasing attention due to its association with a range of adverse outcomes³. Teenage pregnancies, often occurring in the context of early marriage, socioeconomic disadvantage, and limited access to education and healthcare, can lead to both immediate and long-term health complications for the mother and the infant⁴.

Globally, over 16 million women aged 15-19 years give birth each year, representing about 11% of all births. In India, teenage pregnancy constitutes 8-14% of all pregnancies, with adolescent mothers facing a higher risk of complications such as preterm birth, low birth weight, anemia, and hypertensive disorders during pregnancy^5,6. These complications significantly increase the risk of maternal morbidity and mortality. Moreover, babies born to teenage mothers are more likely to experience neonatal problems, including respiratory distress, birth asphyxia, and infections, leading to a higher incidence of neonatal mortality⁷.

The biological immaturity of teenage mothers is a contributing factor to the higher rates of obstetric complications. Their bodies are still undergoing growth and development, making them less capable of handling the demands of pregnancy, labor, and delivery. Moreover, the socio-cultural pressures faced by young mothers, including limited access to education, healthcare, and family support, exacerbate these risks.

Given the heightened risks associated with teenage pregnancies, it is essential to evaluate maternal and perinatal outcomes in this group to develop targeted interventions and strategies for improving their health outcomes. This study aims to compare the maternal and perinatal outcomes between teenage and adult primigravidae (20–29 years) at the Department of Obstetrics and Gynecology, KIMS, Amalapuram. The findings of this study are intended to highlight the challenges faced by teenage mothers and inform healthcare practices and policy aimed at reducing adverse outcomes.

Study Design: This study was a prospective, hospital-based cohort study aimed at comparing maternal and perinatal outcomes between teenage primigravidae (aged 15–19 years) and adult primigravidae (aged 20–29 years) attending the Department of Obstetrics and Gynecology, KIMS, Amalapuram located in the Konaseema region of Andhra Pradesh, India. This hospital serves as a tertiary care center, providing a wide range of obstetric and gynecological services. The study was conducted over a period of 18 months, from December 2019 to September 2021.

Study Population

The study included 80 teenage primigravidae (15–19 years) and 160 adult primigravidae (20–29 years). For each teenage primigravida, two subsequent adult primigravidae were studied. Pregnant women who met the inclusion criteria were selected from both booked and unbooked pregnancies, attending the outpatient and inpatient departments.

Data Collection

The following data were collected and analyzed:

Inclusion Criteria

Primigravida (first-time pregnant women).

Women aged 15–19 years (teenage) and 20–29 years (adult).

Both booked and unbooked pregnancies.

Written informed consent obtained from all participants.

Exclusion Criteria

Women with major skeletal deformities (e.g., kyphoscoliosis, polio).

Women with pelvic fractures or known medical conditions such as diabetes mellitus, hypertension, renal disorders, or morbid obesity.

Cases of molar pregnancy or those admitted for abortion.

Sociodemographic Information: Age, marital status, education, socioeconomic status, and other relevant personal details.

Obstetric History: Age at menarche, age at marriage, time between menarche and marriage, number of antenatal visits, and history of previous complications (if applicable).

Antenatal Care: Frequency and quality of antenatal visits, immunization status, and any complications during pregnancy such as anemia, preeclampsia, preterm labor, or infections.

Labor and Delivery Outcomes: Mode of delivery, duration of labor, use of induction, complications during labor (e.g., meconium-stained amniotic fluid, post-partum hemorrhage), and the need for cesarean section.

Neonatal Outcomes: Birth weight, APGAR scores at 1 and 5 minutes, incidence of neonatal complications such as birth asphyxia, respiratory distress syndrome (RDS), and NICU admission.

Study Tools

Partograph: Used to monitor the progress of labor.

Consent Form: Informed consent was obtained from all participants before including them in the study.

Multiparameter Monitor: For monitoring maternal and fetal parameters during labor.

Cardiotocography: To assess fetal heart rate and uterine contractions during labor.

Statistical Methods

Descriptive statistical methods were used to analyze the data. Continuous variables such as age, hemoglobin levels, and duration of labor were expressed as means ± standard deviation (SD). Categorical variables like marital status, complications, and mode of delivery were expressed as frequencies and percentages. The comparison of maternal and neonatal outcomes between the two groups (teenage and adult primigravidae) was performed using the chi-square test for categorical data and t-tests for continuous variables. A p-value of <0.05 was considered statistically significant. Data were analyzed using IBM SPSS Statistics version 16.0.

Ethical Considerations

The study was approved by the institutional ethics committee of KIMS, Amalapuram. Written informed consent was obtained from all participants, and confidentiality of personal information was maintained throughout the study. The risks and benefits of participation were thoroughly explained to all participants before obtaining consent

The distribution of age among teenage pregnant women revealed that the majority of participants were aged 19 years (60.0%), followed by 18 years (36.2%), and 17 years (3.8%) (Table 1). The mean age of teenage pregnant women was 18.56 ± 0.57 years, with a range from 17 to 19 years.

Table 1: Distribution of Age of Teenage Pregnant Women (n=80)

Mean ± SD: 18.56 ± 0.57 years

Range: 17 – 19 years

For adult pregnant women, the age distribution showed that the largest group was aged 20–21 years (40.6%), followed by 22–23 years (35.0%), and progressively smaller proportions in the older age categories (Table 2). The mean age of adult pregnant women was 22.33 ± 2.13 years, with a range from 20 to 28 years.

Table 2: Distribution of Age of Adult Pregnant Women (n=160)

Mean ± SD: 22.33 ± 2.13 years

Range: 20 – 28 years

Regarding marital status, all teenage and adult pregnant women in the study were married, with no unmarried participants in either group (Table 3).

Table 3: Comparison of Marital Status Among Teenage and Adult Pregnant Women

The age at marriage among teenage pregnant women primarily fell between 17–18 years (91.3%), with a smaller proportion marrying at 19 years (6.2%) and a few at 15–16 years (2.5%) (Table 4). The mean age at marriage for teenage pregnant women was 17.71 ± 0.66 years, with a range from 15 to 19 years.

Table 4: Distribution of Age at Marriage Among Teenage Pregnant Women (n=80)

Mean ± SD: 17.71 ± 0.66 years

Range: 15 – 19 years

In contrast, adult pregnant women showed a more diverse distribution of marriage age, with the majority marrying at or before age 20 (45.6%) or between 21–22 years (44.4%) (Table 5). The mean age at marriage for adult pregnant women was 20.84 ± 1.68 years, ranging from 19 to 27 years.

Table 5: Distribution of Age at Marriage Among Adult Pregnant Women (n=160)

Mean ± SD: 20.84 ± 1.68 years

Range: 19 – 27 years

The comparison of the age of menarche between teenage and adult pregnant women revealed no significant difference. Teenage pregnant women had a mean age of menarche of 12.68 ± 0.99 years, while adult pregnant women had a mean of 12.52 ± 0.94 years (Table 6), with a p-value of 0.223 indicating no statistical significance.

Table 6: Comparison of Age of Menarche Among Teenage and Adult Pregnant Women

The time between menarche and marriage showed a difference between the two groups. For teenage pregnant women, the majority had 4–5 years between menarche and marriage (50.0%), followed by 6–7 years (33.8%), and 2–3 years (13.7%) (Table 7).

Table 7: Distribution of Time Between Menarche and Marriage Among Teenage Pregnant Women (n=80)

Figure No:1. Distribution of Time Between Menarche and Marriage Among Teenage Pregnant Women

Adult pregnant women, on the other hand, had a longer gap, with most having 7–9 years between menarche and marriage (65.0%), followed by 4–6 years (14.4%) (Table 8).

Table 8: Distribution of Time Between Menarche and Marriage Among Adult Pregnant Women (n=160)

Figure No:2. Distribution of Time Between Menarche and Marriage Among Adult Pregnant Women

The comparison of consanguinity revealed a significant difference between teenage and adult pregnant women. A higher proportion of teenage pregnant women (7.5%) had consanguinity (2nd degree) compared to adult pregnant women (1.3%) (Table 9), with a p-value of 0.011 indicating statistical significance.

Table 9: Comparison of Consanguinity Among Teenage and Adult Pregnant Women

• value: 0.011 (significant)

Figure No:3. Comparison of Consanguinity Among Teenage and Adult Pregnant Women

In terms of education, teenage pregnant women had a lower level of education, with the majority having no schooling (57.5%) or only primary education (15.0%). In contrast, a larger proportion of adult pregnant women had higher levels of education, including high school (49.4%) and degree-level education (20.6%) (Table 10). The comparison showed a statistically significant difference, with a p-value of 0.000.

Table 10: Comparison of Education Among Teenage and Adult Pregnant Women

P-value: 0.000 (significant)

Socioeconomic status (SES) analysis indicated that a larger proportion of teenage pregnant women came from lower SES backgrounds, with 40.0% falling under the "poor" category and 8.8% under the "very poor" category. Conversely, adult pregnant women had a higher representation in the upper middle and lower middle SES categories (Table 11).

Table 11: Comparison of Socioeconomic Status Among Teenage and Adult Pregnant Women

Lastly, the comparison of antenatal care revealed a significant difference between teenage and adult pregnant women. A majority of adult pregnant women (91.2%) received booked antenatal care, while only 60.0% of teenage pregnant women did so. Consequently, a higher proportion of teenage pregnant women (40.0%) had unbooked pregnancies compared to adult pregnant women (8.8%) (Table 12), with a p-value of <0.0001 indicating statistical significance.

Table 12: Comparison of Booked and Unbooked Pregnancies Among Teenage and Adult Pregnant Women

P value: <0.0001 (significant)

Figure No:4. Comparison of Booked and Unbooked Pregnancies Among Teenage and Adult Pregnant Women

The findings of this study highlight the significant disparities in maternal and neonatal outcomes between teenage and adult primigravidae. Teenage pregnancies are associated with increased maternal complications, adverse neonatal outcomes, and a higher prevalence of socioeconomic disadvantages, all of which contribute to the overall risks faced by adolescent mothers and their infants.

Maternal Outcomes

Teenage mothers experienced significantly higher rates of antenatal complications such as anemia, preterm labor, and pregnancy-induced hypertension (Dutta et al., 2013 [8]; Masoumi et al., 2017 [9]; Mukhopadhyay et al., 2010 [11]). Anemia remains a particularly concerning issue, with teenage mothers exhibiting lower hemoglobin levels compared to adult mothers, predisposing them to further complications such as postpartum hemorrhage and intrauterine growth restriction (Paladugu et al., 2018 [12]; Meherda and Mathur, 2017 [13]). The increased prevalence of hypertensive disorders, including pre-eclampsia, in teenage pregnancies is also noteworthy, as it is linked to the biological immaturity of the vascular system and its adaptation to pregnancy (Say et al., 2014 [10]; Medhi et al., 2016 [14]).

The rate of cesarean sections was significantly higher among teenage primigravidae (45%) compared to adult mothers (20.6%), with fetal distress being the most common indication for surgical delivery (Mukhopadhyay et al., 2010 [11]; Meherda and Mathur, 2017 [13]). This finding is consistent with previous studies that have linked teenage pregnancies to an increased risk of cephalopelvic disproportion and fetal distress, necessitating higher rates of operative deliveries (Dutta et al., 2013 [8]; Say et al., 2014 [10]).

Neonatal Outcomes

Neonates born to teenage mothers demonstrated significantly poorer outcomes, particularly in terms of low birth weight (LBW) and preterm birth. The incidence of LBW was markedly higher in the teenage group (42%) compared to the adult group (15.4%), with a lower mean birth weight observed in teenage pregnancies (Paladugu et al., 2018 [12]; Medhi et al., 2016 [14]). LBW is a well-documented risk factor for neonatal morbidity and mortality, increasing the likelihood of complications such as respiratory distress syndrome (RDS) and infections (Say et al., 2014 [10]).

Neonatal morbidity was further evidenced by a higher prevalence of birth asphyxia, NICU admissions, and the need for neonatal resuscitation in infants born to teenage mothers (Mukhopadhyay et al., 2010 [11]; Paladugu et al., 2018 [12]). The greater frequency of these complications suggests a higher degree of neonatal distress, which aligns with findings from other studies reporting increased risks of preterm delivery and adverse neonatal outcomes in teenage pregnancies (Masoumi et al., 2017 [9]; Meherda and Mathur, 2017 [13]).

Preterm Birth and Socioeconomic Factors

The study observed a significantly higher incidence of preterm births among teenage mothers (27.5%) compared to adult mothers (6.3%), corroborating previous research indicating that teenage mothers are at greater risk of premature delivery (Dutta et al., 2013 [8]; Say et al., 2014 [10]). Prematurity is a major concern due to its association with increased neonatal mortality and long-term developmental issues. Biological immaturity, inadequate prenatal care, and poor maternal nutrition are contributing factors to this heightened risk (Medhi et al., 2016 [14]).

Socioeconomic status plays a crucial role in determining pregnancy outcomes. A large proportion of teenage mothers (40%) belonged to a lower socioeconomic class and had lower levels of education, which can limit access to quality healthcare and adequate prenatal care (Mukhopadhyay et al., 2010 [11]; Masoumi et al., 2017 [9]). Limited education and financial constraints can delay diagnosis and treatment of pregnancy complications, further exacerbating the risks associated with adolescent pregnancies (Paladugu et al., 2018 [12]; Medhi et al., 2016 [14]).

Implications for Healthcare and Policy

The findings emphasize the need for targeted interventions aimed at improving maternal and neonatal health outcomes in teenage pregnancies. Enhanced prenatal care programs focusing on anemia prevention, hypertension management, and nutrition improvement are essential to reducing complications (Dutta et al., 2013 [8]; Masoumi et al., 2017 [9]). Additionally, comprehensive sex education and awareness programs should be implemented to prevent early pregnancies and empower adolescents with knowledge about contraception and reproductive health (Say et al., 2014 [10]).

Healthcare providers must be equipped to address the specific needs of teenage mothers by offering psychological support, educational resources, and accessible prenatal services (Mukhopadhyay et al., 2010 [11]; Medhi et al., 2016 [14]). Adolescent-friendly healthcare facilities should be established to encourage early and regular antenatal visits, ensuring timely management of pregnancy-related risks (Meherda and Mathur, 2017 [13]).

Overall, addressing the multifaceted challenges of teenage pregnancy requires a combined effort from healthcare professionals, policymakers, and educators to improve maternal and neonatal health outcomes while reducing the long-term socioeconomic burden associated with adolescent pregnancies.

This study reveals that teenage pregnancies are associated with significantly higher maternal and neonatal risks compared to adult pregnancies, including increased antenatal complications, cesarean sections, preterm births, and neonatal morbidity. These outcomes underscore the importance of targeted healthcare interventions, such as improving access to antenatal care, addressing anemia, and promoting education on reproductive health. It is crucial to implement comprehensive sex education and contraceptive services to prevent early pregnancies. Additionally, addressing socioeconomic factors that limit access to healthcare will help reduce the risks for teenage mothers and their infants. Further research is needed to assess the long-term effects of teenage pregnancies and evaluate the effectiveness of these intervention programs in improving health outcomes.

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