International Journal of Scientific Research in Knowledge, 3(4), pp.

0106-113, 2015
Available online at http://www.ijsrpub.com/ijsrk
ISSN: 2322-4541; ©2015; Author(s) retain the copyright of this article
http://dx.doi.org/10.12983/ijsrk-2015-p0106-0113

Full Length Research Paper

The Impact of Teenage Pregnancy on Maternal, Fetal and Neonatal Outcomes

Thikra Najim1‫٭‬, Khawla Ibrahim Ghathwan2, Ulfat Mohammad Alnakkash3, Yousif Abdelraheem4
1
Assistant Professor, Dept. of Obs. & Gyn., Al-Kindy College of Medicine, University of Baghdad, Iraq
2
Senior house officer, Al-Elwiya Maternity Teaching Hospital, Iraq
3
Specialist in Obs. & Gyn, Al-Elwiya Maternity Teaching Hospital, Iraq
4
Professor, Dept. of Community Medicine, Al-Kindy College of Medicine, University of Baghdad, Iraq
*Corresponding Author: Email drthikra@yahoo.com

Received 06 March 2015; Accepted 18 May 2015

Abstract. Adolescent pregnancy is common health problem still found in both developed and developing
countries; as adolescent may have early sexual practice or early marriage. Adolescent mothers face substantially
higher maternal and perinatal morbidity and mortality than adult women. This is a randomized prospective clinical
study conducted at Al-Elwiya Maternity Teaching Hospital, Baghdad, Iraq. The objective of this work is to assess
the adverse maternal, fetal and neonatal outcomes in early and late teenage pregnant mothers. Study sample
consisted of 220 primigravid women with a singleton, cephalic, viable fetus and no congenital abnormality that
gave birth at Al-Elwiya Maternity Teaching Hospital, Baghdad, Iraq. The 1stgroup: early teenage (46 women
between 11-14 years), the 2nd group: late teenage (74 women between 15-19 years) and the 3rdgroup: control
group (100 women between 20-29 years). Pregnancy outcomes were observed for mothers: mode and duration of
labor, post-partum hemorrhage and endometritis and for neonates: gestational age, birth weight, Apgar score,
admission to neonatal care unit and neonatal outcome. Anemia was the only significant medical complication
associated with pregnancy that was observed in both teenage groups (P-value=0.0001). Prolonged labor,
postpartum hemorrhage and blood transfusion all were significantly higher in teenage groups (P-value=0.019,
0.0001 and 0.0001 successively). Adolescents showed lower birth weights as compared to adults (mean birth
weight was 2.8kg, 2.98kg in both teenage groups and 3.98kg in the control group), Lower Apgar scores at 1 minute
and 5minute (P-value=0.001 and 0.023 successively). Adolescent births were associated with an increased risk for
preterm delivery (P-value=0.0001).

Keywords: Pregnancy outcomes, teenage pregnancy, non-teenage pregnancy

1. INTRODUCTION About 16 million women 15–19 years old give

Teenage pregnancy is a common public health
problem worldwide which is detrimental to the health
of mother and child and has long been considered a
high-risk situation (Hamilton et al., 2009, Katherine et
al., 2010). Adolescent pregnancy continues to be a
challenging public health issue around the world,
mainly in developing countries (Conde –Agudelo et
al., 2005).
Teenage pregnancy is formally defined as a
pregnancy in a young woman who has not reached her
20th birthday when the pregnancy ends, regardless of
whether the woman is married or is legally an adult
(10-19 years) (National research center for women
and families, 2001).
106
birth each year, about 11% of all births worldwide.
Ninety-five percent of these births occur in low- and
middle-income countries (WHO, 2014). The youngest
mothers (16 years) had substantially higher risks for
maternal and perinatal morbidity and mortality than
the late adolescent age group (16-19 years) especially
if they live in a developing country (Granja et al.,
2001, Mbonye, 2001).
Data suggest that pregnant teenagers are more
likely than adult women to suffer adverse medical and
obstetric outcomes, such as hypertensive disease,
anemia, infection, and depression during pregnancy
(Cunningham et al., 2010). Higher incidence of
caesarean section (Kumbi and Isehak, 1999),
operative vaginal delivery (both vacuum and forceps
extraction) (Bacci et al., 1993) and obstetric fistulas in
 Najim et al.
The Impact of Teenage Pregnancy on Maternal, Fetal and Neonatal Outcomes
adolescents compared with that of older women,
suggest an increased risk of prolonged and obstructed
labour (Kelly and Kwast, 1993). They may continue
to have consequences, like depression later in life,
delayed or discontinued education, or increased
utilization of public assistance (National research
center for women and families, 2001). Also it has
been associated with an increased incidence of several
adverse perinatal outcomes such as low birth weight,
preterm delivery, small-for-gestational-age infants and
perinatal death (Conde –Agudelo et al., 2005). The
rates of preterm birth, low birth weight and asphyxia
are higher among the children of adolescents, all of
which increase the chance of death and of future
health problems for the baby. Stillbirths and death in
the first week of life are 50% higher among babies
born to mothers younger than 20 years than among
babies born to mothers 20–29 years old (WHO, 2014).
The goal of the study is to assess the adverse
maternal, fetal and neonatal outcomes in early and late
teenage pregnant mothers.
2. MATERIALS AND METHODS
This is a randomized prospective clinical study,
conducted at Al-Elwiya Maternity Teaching Hospital
in Baghdad from the 1st of October 2011 to the 1st of
October 2012. The study protocol was approved by
the Authority of Hospital Administration. The study
sample was 220 primigravid women with
uncomplicated first pregnancy and singleton viable
fetus in cephalic presentation. Their age ranged
between 11-29 years. The study sample was divided
into three groups; 46 women between 11-14 years
were considered as group one (early teenage), 74
women between 15-19 years were considered as
group two (late teenage), those two groups served as
the study groups. The remaining 100 women who
were between 20-29 years served as control group.
Consent was obtained from all women included in the
study.
Participating women were those attending the
hospital in labor at the study period. Each woman was
followed from her admission to labor room to
discharge from hospital. Each neonate was also
assessed and followed by a pediatrician after delivery
or after admission to neonatal care unit. Detailed
history and examination for each woman was done.
Blood samples were sent for: blood group and Rh
group, Hb level, blood sugar, blood urea and urine for
albumin. Ultrasound was done to ensure viability,
singleton pregnancy and gestational age.
107
2.1. Maternal, fetal & neonatal data
According to the level of education of the three
groups; women were divided into educated and non-
educated. The educated group included women who
completed their education. They were further
subdivided into 3 levels according to the stage of
education they achieved: primary, secondary or high
school. Non-educated group included all women who
failed to achieve any education level or they left their
primary school.
Regarding the antenatal care (ANC); the women
who had ANC were subdivided into 2 groups (regular
and irregular) according to the visits to private doctors
or hospital and ANC clinics units.
Intra-partum Partograph was performed for each
woman. The maternal status, labor progress, delivery
characteristics and neonatal outcomes were reviewed
and recorded. Labor progress was assessed by
monitoring of uterine contractions and progress of
cervical dilatation. The fetal heart rate (FHR) was
monitored every15-30 minutes by sonic aid or
continuous fetal heart rate monitoring when
necessary.
Cesarean section was done for obstetric indications
which include failure of progress of labor (arrest of
dilatation or descent despite efficient uterine
contractions), persistent or non-assuring FHR pattern
and for maternal distress. All women were followed
after delivery for 24hs looking for any postpartum
complications (postpartum hemorrhage, blood
transfusion and fever). All the neonates were assessed
for weight, Apgar score at one and five minutes,
respiratory distress syndrome (RDS), and those who
were admitted to neonatal care unit (NCU) were
followed for 24 hours.
2.2. Statistical analysis
The results of the study were analyzed statistically by
using the following procedures:
a- Descriptive statistics: Tables, graphs, frequency,
percentages, mean and SD.
b- Inferential statistics: Chi square test and one
way ANOVA test (F test) were used to find the
association between the related variables. Data were
entered and analyzed by (MINI TAB) software. P
value ˂ 0.05 was considered statistically significant.
3. RESULTS
Of the random selection during one-year study period,
120 adolescents aged 11 to 19 years and 100 control
subjects (age 20-29years) were delivered at Al-
Elwiya Maternity Teaching Hospital. The mean
maternal age of 1st group was 13.96, for the second
 International Journal of Scientific Research in Knowledge, 3(4), pp. 0106-113, 2015

group: 16.99, and 22.35 years for the third group
while the mean gestational age was 36.28, 36.94
and38.69 weeks successively, Table 1. A high number
of non-educated women were found in the first 2
groups; all women in the 1st group did not reach their
secondary school stage compared to72 women in the
2nd group and 43 in the 3rd group, P–value = 0.0001,
table 2. Regarding ANC; 34.8% and 43.2% women in
group one and two had attended the antenatal care
clinic compared to 93% of women in the control
group, P -value = 0.0001. Of those who had ANC; the
early teenage group had the least regular ANC visits
(37.5%, as compared to 62.5% in the late teenage and
48.4% in the control groups), Table 2. Anemia in
pregnancy was found to be the only statistically
significant medical disorder associated with
pregnancy in both teenage groups compared to control
group (P-value = 0.0001), Table 3.

Table1: Age and BMI of women in the study and control groups
Demographic Characteristics Group1 (n=46) Group 2 (n=74) Group 3 (n=100)
Mean (±SD) Mean (±SD) Mean (±SD)
Maternal age (years) 13.96 (±0.21) 16.99 (±1.03) 22.35 (±2.54)
BMI (Kg\m2) 27.30 (±3.20) 27.27 (±2.87) 29.06 (±1.46)
Gestational age (weeks) 36.28 (±0.649) 36.94 (±0.574) 38.69 (±0.219)

Table 2: Education level and ANC of women in the study and control groups
Educational level &ANC Group1 (n=46) Group2 (n=74) Group3 (n=100) P-value
No. (%) No. (%) No. (%)
Non-educated 36 (78.3) 43 (58.1) 21 (21)
Educated 10 (21.7) 31 (41.9) 79 (79)
-Primary school 10 (100) 29 (93.5) 22 (27.8) 0.0001
-Secondary school 0 (0) 2 (6.5) 45 (57)
-College 0 (0) 0 (0) 12 (15.2)
ANC
-No 30 (65.2) 42 (56.8) 7 (7)
-Yes 16 (34.8) 32 (43.2) 93 (93)
Regular visits 6 (37.5) 20 (62.5) 45 (48.4) 0.0001
Irregular visits 10 (62.5) 12 ( 37.5) 48 (51.6)

Table 3: Medical diseases associated with pregnancy in the study and control groups
Diseases during Group 1 (n=46) Group 2 (n=74) Group3 (n=100) P-value
pregnancy No. (%) No. (%) No. (%)
Anemia 34 (73.9) 45 (60.8) 27 (27) 0.0001
PIH 2 (4.35) 1 (1.35) 2 (2) 0.547
Gestational DM 0 (0) 3 (4.05) 8 (8) 0.108
APH 2 (4.35) 1 (1.4) 4 (4) 0.542
*Others 0 (0) 0 (0) 4 (4)
*Others= UTI, chest infection

5
4
3 Early teenage

2 Late teenage

1 Control group
0
Mean of birth weight(Kg) SD

Fig. 1: Mean and SD of birth weight in the study and control groups

Of the maternal intrapartum outcomes, prolonged cesarean or vaginal) revealed no significant

labor was significantly higher in teenage groups: (P- difference, Table 4.
value =0.019) with lower episiotomy rate noticed (P- Regarding maternal postpartum outcomes,
value=0.002) while the mode of delivery (whether postpartum hemorrhage (PPH) was one of the
complications that has been found to be statistically

108
 Najim et al.
The Impact of Teenage Pregnancy on Maternal, Fetal and Neonatal Outcomes

significant between the 3 groups (P- value= 0.0001),
especially in early teenage. where 54.3% of women
developed PPH compared to 17.6% in late teenage
and 7% in the control group, also post-delivery blood
transfusion has been found to be statistically
significant between the 3 groups (P- value= 0.0001),
more for the teenage groups.
Regarding fetal and neonatal outcomes; the highest
rate of preterm deliveries was found in early teenage
(43.5%), while only 12.2% in late teenage and 5% in
the control group (P-value=0.0001). No significant
difference was found between the 3 groups regarding
intra-uterine growth restriction (IUGR). Low Apgar
scores at 1 and 5 minute were found to be statistically
significant in both teenage groups (P-value=0.001 and
0.023 respectively). Highest rates of neonatal
admission (56.5%) and neonatal deaths (23.1%) were
detected in early teenage group, table 5. Neonatal
birth weights were statistically significantly lower in
the first 2 groups: 2.8kg (±0.42), 2.9kg (±0.41) as
compared with the control group: 3.9kg (±0.27) with a
P-value of 0.0001, Fig.1.

Table 4: Maternal intrapartum and postpartum outcomes of women in the study and control groups
Intra and post-partum Group1 (n=46) Group 2 (n=74) Group3 n=100) P-value
comes No. (%) No. (%) No. (%)
Duration of labor
-Normal 30 (65.2) 46 (62.2) 81 (81) 0.019
-Prolonged 16 (34.8) 28 (37.8) 19 (19)
Mode of delivery
-Vaginal delivery 34 (73.9) 56 (75.7) 84 (84) 0.256
-Cesarean section 12 (26.1) 18 (24.3) 16 (16)
Episiotomy
-Yes 28 (82.4) 45 (80.4) 82 (97.6) 0.002
-No 6 (17.6) 11 (19.6) 2 (2.4)
Postpartum
-PPH 25 (54.3) 13 (17.6) 7 (7) 0.0001
-Blood transfusion 6 (13.04) 25 (33.8) 4 (4) 0.0001
-Endometritis 7 (15.2) 8 (10.8) 5 (5) 0.164

Table 5: Fetal and neonatal outcomes in the study and control groups
Fetal and neonatal Group1 (n=46) Group 2 (n=74) Group3 n=100) P-value
outcomes No. (%) No. (%) No. (%)
IUGR 4 (8.7) 5 (6.8) 2 (2) 0.088
Preterm 20 (43.5) 9 (12.2) 5 (5) 0.0001
Alive 44 (95.7) 71 (95.95) 96 (96)
Stillbirth 2 (4.3) 3 (4.05) 4 (4) 0.995
Apgar score (1min.)
-Good 28 (60.9) 56 (75.7) 88 (88) 0.001
-Low 18 (39.1) 18 (24.3) 12 (12)
Apgar score (5min.)
-Good 38 (82.6) 60 (81.08) 94 (94) 0.023
-Low 8 (17.4) 14 (18.92) 6 (6)
NCU admission
-Yes 26 (56.5) 19 (25.7) 14 (14) 0.0001
-No 20 (43.5) 55 (74.3) 86 (86)
NCU outcome
-Healthy 8 (30.8) 10 (52.6) 10 (71.4)
-Needs further care 12 (46.2) 7 (36.8) 4 (28.6)
-Dead 6 (23.1) 2 (10.5) 0 (0)

4. DISCUSSION related complications (Berenson et al., 1997, Eure et

Pregnancy among adolescents is a public health
problem. Studies on the outcome of pregnancies in
adolescents have yielded conflicting results. Some
studies have reported an increased risk of pregnancy-
related complications in adolescents, including
preeclampsia, anemia, cesarean delivery, small-for
gestational- age infants and perinatal mortality,
although other studies have failed to find an
association between adolescents and some pregnancy-
109
al., 2002).
The adverse effects of adolescent childbearing also
extend to the health of their infants. Although there
are several reports indicating that adolescent
pregnancy is not associated with increased risks of
adverse perinatal outcomes (Kramer, 1987, Oakley et
al., 1995), most studies from both developed and
developing countries have consistently reported that
pregnant adolescents are at increased risk for preterm
delivery, (Cooper et al., 1995, Hediger et al., 1997,
Kumbi and Isehak, 1999) and LBW (Lenders et al.,
 International Journal of Scientific Research in Knowledge, 3(4), pp. 0106-113, 2015
1994, Scholl et al., 1991, Zabin and Kiragu, 1998) ,
with the risk of associated long term effects (Berenson
et al., 1997, Eure et al., 2002). Although both
adolescent age groups had poorer pregnancy outcomes
than adult women, the youngest mothers (16 years)
had substantially higher risks for maternal and
perinatal morbidity and mortality than the late
adolescent age group (16-19 years) especially if they
live in a developing country (Granja et al., 2001,
Mbonye, 2001). Our study also found that adolescent
mothers, mainly those younger than 16 years, are at
increased risk of several adverse maternal and
perinatal outcomes.
4.1. Maternal antenatal outcome
In this prospective study, a high number of non-
educated women are found in the teenage group
especially in the young teenagers. Most of the teenage
mother's education did not correlate with their age
since they left school when they got married. Low
educational standards are more in adolescents (P-
value 0.0001) and this is similar to the results of a
study from Turkey (Edirne et al., 2010) which shows
a higher proportion of inappropriate education for age
in adolescents (82.5% versus 70.1%; P value=0.001).
Adolescents are less likely to seek regular prenatal
care; 34.8%, 43.2 % in the early and late teenage
groups had some kind of ANC as compared to 93% in
non-teenage pregnant (P-value = 0.0001). A study at
Egypt and Sudan (Galal, 1999), shows that 63.3% of
adolescents had ANC as compared to 82.3% of older
women. Other studies also showed that adolescents
had poor antenatal care (Mayor, 2004, Miller et al.,
2003, Morris et al., 1993). This indicates that the
teenage mothers were less careful about their
pregnancy probably because of the lack of awareness
and maturity (Chike-Obi, 1993).
Regarding medical diseases associated with
pregnancy; anemia is found significant in younger
adolescents than older women (73.9%, 60.8% in early
and late teenage groups and 27% in the adult group,
P-value=0.0001). This result was also shown by the
study at Eastern Nepal (Sharma et al., 2001), where
48% of adolescents suffered from anemia, as well as
other studies (Brabin et al., 2001, Jolly et al., 2000).
Anemia is thought to be more in adolescents because
an adolescents’ developing body has to compete for
nourishment with the fetus, causing rapidly depleting
iron and nutrient reserves (Zabin and Kiragu, 1998).
Other medical disorders (hypertension, gestational
diabetes, antepartum hemorrahge, UTI…) are not
increased in the adolescents of our study. According
to Table 3, The Pb (ppm) concentration was in soil
under T1, T2, T3 and T4 after 30 days in order of
0.00, 45.03, 82.78 and 155.92, respectively. (Sorry,
110
but this sentence was not included in my original
research).
4.2. Maternal intrapartum outcome
Regarding complications of labor and delivery; the
study reveals a higher rate of prolonged labor and a
lower rate of episiotomy in the adolescents as
compared to adults while no difference in cesarean
section rate and endometritis. For prolonged labor;
34.8% and 37.8% of early and late teenagers and 19%
of adults had longer labor time (P-value= 0.019). This
is also reported by studies at Mozambique and
Ethiopia (Bacci et al., 1993, Kumbi and Isehak, 1999)
who reported a prolonged labor in adolescents.
Episiotomy is found in 82.4%, 80.4% of early and
late teenage group as compared to 97.6% in the adult
group (P-value=0.002) while a study at Latin America
(Conde –Agudelo et al., 2005) shows a clear trend
toward increasing rates of operative vaginal delivery
and episiotomy in teenagers (69.3%) as compared to
adults (53.7%).
Evidence suggests that because of the relative
immaturity of their physiological development,
adolescents are more likely than older women to
experience complications during delivery (Greenberg
et al., 2006). In developing countries, especially in
some poorer regions, there are indications that in very
young adolescents (<16 years) the pelvic bones and
the birth canal may still be in the process of growth,
resulting in complications of cephalopelvic
disproportion and obstructed labor (Sukalich et al.,
2006). Some studies have shown that the risk of
caesarean section is increased in teenage
pregnancy(Bacci et al., 1993, Kumbi and Isehak,
1999), while some have shown the opposite (Jolly et
al., 2000, Lao, 1998), our study shows that this risk is
not significantly different. Lower cesarean section rate
could be due to a higher incidence of low birth weight
in teenage pregnancies as this would be associated
with a higher chance of successful vaginal delivery
(Lao, 1998).
4.3. Maternal postpartum outcome
Of the postpartum complications, PPH and blood
transfusion are found more significant in adolescents
as compared to adults while this is not the case for
puerperal Endometritis (P-values= 0.0001, 0.0001
and0.164 successively). Similar results are recorded
by many studies (Airede and Ekele, 2003, Granja et
al., 2001, Mbonye, 2001). Young adolescents had
anemia more frequently than older women and severe
anemia is one of the important causes of maternal
mortality and there is a scarcity of data on the severity
 Najim et al.
The Impact of Teenage Pregnancy on Maternal, Fetal and Neonatal Outcomes
of anemia and adolescent mortality, particularly in
developing countries (Brabin et al., 2001).
4.4. Neonatal outcome
In regard to adverse perinatal outcomes, higher risks
of lower birth weights were seen in the adolescent
group: 2.8kg, 2.9kg as compared to 3.9kg in adult
group (P-value =0.0001). Preterm delivery (43.5%,
12.2% and 5%, P- value = 0.0001) and low Apgar
scores are found among infants of adolescent mothers,
with the youngest age groups running the highest
risks, this agrees with other studies (Abbey et al.,
1997, Conde –Agudelo et al., 2005, Katherine et al.,
2010). The reduction in fetal growth described in
some studies has been proposed to result from
competition for nutrients between the still growing
adolescent mother and her fetus. However, this theory
is controversial (Chen et al., 2007, Raatikainen et al.,
2006).
5. CONCLUSION
In this study, we found that adolescent mothers were
still at increased risk for adverse pregnancy outcomes
in regard to maternal, fetal and neonatal complications
as compared with adult control mothers and many of
these pregnancy adverse outcomes were noticed in the
early teenage group of the study.
6. RECOMMENDATIONS
In order to reduce the rate of early child bearing;
adolescents, their parents and community should be
made more aware of the negative health, social and
economic consequences of it. Such awareness could
be created through social mobilization, information
dissemination, sex education and communication
campaigns. By reducing the number of adolescent
pregnancies and by providing better prenatal, obstetric
care and family planning to those adolescents who
become pregnant, maternal and perinatal morbidity
and mortality in the developing world could be
reduced.
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 Najim et al.
The Impact of Teenage Pregnancy on Maternal, Fetal and Neonatal Outcomes

Assistant prof. Thikra Najim Abdullah was born in Baghdad (1966), got her M.B.Ch.B Degree (1989);
Post graduate diploma in Obs. & Gye. (D.G.O) 1996; Board in Obs. & Gyn. (F.I.C.O.G) 1997; worked
as Specialist in Many Maternity Hospitals and at Al-Samaraee Hospital for infertility and IVF center
between 1997 and 2006, she joined the academic staff at University of Baghdad, Al Kindey Medical
College at 2006 and got the assistant professor degree at 2012.

Dr Khawla Ibrahim Ghathwan was born in Baghdad (1978), got her M.B.Ch.B Degree (2002);
working as senior house officer and postgraduate student at Elwiya Maternity Teaching Hospital.

Dr. Ulfat Mohammed Ali Jawad Al Nakkash was born in Baghdad (1968); got his M.B.Ch.B Degree
(1992), Post graduate Diploma in Obs. & Gyn. (D.O.G) 2003; Board in Obs.& Gye. (C.A.B.O.G)
2004; he is the Director of Elwyia Maternity Teaching Hospital. Director of Zenat al hayat Fertility
Centre.

Dr. Yousif Abdelraheem was born in Baghdad (1969), got M.B.Ch.B degree (1993), Post graduate
Board Degree in Community medicine (F.I.C.M.S /CM) 2004; worked as lecturer in community
medicine department at Al- Kindy College of Medicine, University of Baghdad (2005 till now) and got
the assistant professor degree in 2008 and the professor degree on 2013. He has more than 25
published researches in different medical journals.

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