Maternal and perinatal outcomes among nulliparous adolescents in low- and middle-income countries: a multi-country study

ObjectiveTo investigate the risk of adverse pregnancy outcomes and caesarean section among adolescents in low- and middle-income countries. DesignSecondary analysis using facility-based cross-sectional data from the World Health Organization (WHO) Global Survey on Maternal and Perinatal Health. SettingTwenty-three countries in Africa, Latin America, and Asia. PopulationWomen admitted for delivery in 363 health facilities during 2-3months between 2004 and 2008. MethodsWe constructed multilevel logistic regression models to estimate the effect of young maternal age on risks of adverse pregnancy outcomes. Main outcome measuresRisk of adverse pregnancy outcomes among young mothers. ResultsA total of 78646 nulliparous mothers aged 24years and their singleton infants were included in the analysis. Compared with mothers aged 20-24years, adolescents aged 16-19years had a significantly lower risk of caesarean section (adjusted OR 0.75, 95% CI 0.71-0.79). When the analysis was restricted to caesarean section indicated for presumed cephalopelvic disproportion, the risk of caesarean section was significantly higher among mothers aged 15years (aOR 1.27, 95% CI 1.07-1.49) than among those aged 20-24years. Higher risks of low birthweight and preterm birth were found among adolescents aged 16-19years (aOR 1.10, 95% CI 1.03-1.17; aOR 1.16, 95% CI 1.09-1.23, respectively) and 15years (aOR 1.33, 95% CI 1.14-1.54; aOR 1.56, 95% CI 1.35-1.80, respectively). ConclusionsAdolescent girls experiencing pregnancy at a very young age (i.e. <16years) have an increased risk of adverse pregnancy outcomes.