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Indian Journal of Community Medicine

Study of Some Epidemiological Factors in Teenage Pregnancy - Hospital Based Case Comparison Study

Author(s): M.S. Chahande, A.R. Jadhao, S.K. Wadhva, Suresh Ughade

Vol. 27, No. 3 (2002-07 - 2002-09)

Government Medical College and Hospital, Nagpur

Abstract:

Research questions: 1. What are epidemiological factors related with teenage pregnancy? 2. What are outcomes and complications associated with teenage pregnancy?

Objectives: To study epidemiological factors related with teenage pregnancy and its outcome and complications.? Study design: Hospital based cross-sectional study with comparison group.?

Setting: Government Medical College and Hospital, Nagpur.?

Participants: Of all the women who delivered in labour wards of Govt. Medical College and Hospital, Nagpur from 1st October 1999 to 30th June 2000, 462 women <20 years constituted the cases and 500 primiparous women in the age group of 20-29 years formed the comparison group.?

Study variables: Socio-demographic factors, pregnancy outcome and complications.?

Statistical analysis: Chi-square and Z test, Odds Ratio, 95% C.I.?

Results: Mean age of cases was 18.5 years and that of comparison group was 22.4 years. Incidence of still birth, preterm delivery, low birth weight and complications during pregnancy and labour like toxaemia of pregnancy, eclampsia, cephalopelvic disproportion were more in teenagers. However, caesarean section rate was not significantly different in two groups. Relation of antenatal care services and favourable outcome did not show any statistical significance.?

Keywords:Teenage pregnancy, Pregnancy outcome, Complications

Introduction:

Teenage pregnancy is on the rise, emerging as a serious problem today all over the world and more so in the developing countries like India, as early marriages and early pregnancy are the accepted cultural norms of our society1. Pregnancy in very young women is generally considered to be a very high risk event, because teenage girls are physically and psychologically immature for reproduction. In addition, there are some extrinsic factors such as inadequate prenatal care, illiteracy, poor socio-economic conditions which affect the outcome of pregnancy in teenage girls2,3. While there is a growing recognition of the need for action to promote adolescent reproductive health, work done in this field is often piecemeal4.

Material and Methods:

Present hospital based cross-sectional study with a comparison group was carried out on inpatients of department of Obstetric and Gynaecology at Government Medical College and Hospital, Nagpur.

462 women <20 years who delivered at Government Medical College and Hospital, Nagpur over a period of 9 months from 1st October 1999 to 30th June, 2000 constituted the cases. The comparison group included 500 primiparous women in the age group of 20-29 years who delivered at Government Medical College and Hospital, Nagpur during the same period.

The data was collected using a predesigned and pretested schedule, using interview technique. Data was analysed and appropriate statistical tests were applied wherever required.

Results:

Majority of the cases (97.8%) were in the age group of 18-19 years. Mean age of the cases was 18.5 years. In the comparison group majority (81.0%) were in the age group of 20-22 years. 302(65.3%) cases and 313(62.6%) females from comparison group belonged to Hindu community, rest of them belonged to Budh, Muslim and Christian community. 

40(8.6%) cases and 35(7.0%) women from comparison group were illiterate. Husbands of 18(3.9%) cases and 25(5.0%) from comparison group were illiterate.

246(53.2%) cases and 376(75.2%) women from comparison group were house-wives. Husbands of 283(61.3%) cases and 310(62.0%) from comparison group were labourers. Of the total 462 cases, 246(53.2%) were from urban area and 216(46.8%) were from rural area. Out of 500 women from comparison group 283(56.6%) were from urban area and 217(43.4%) were from rural area. 188(76.5%) cases belonged to middle socio-economic status and rest belonged to lower and upper socio-economic status in urban area, whereas, in rural area 183(84.7%) belonged to middle socio-economic status and rest belonged to lower and upper socio-economic status.

Mean age of marriage in cases was 16.7 years and in comparison group 18.6 years. 137(29.6%) cases and 8(1.6%) from comparison group got married due to their parents wish. Other reasons were custom in village (24.4% in cases, 11.1% in comparison group), custom in religion (22.0% in cases, 25.1% in comparison group). In 3(0.6%) unmarried girls reasons for pregnancy was rape.

Essential antenatal care was received by 418(91.2%) cases and 452(90.4%) females from comparison group. 418(91.1%) cases and 452(90.4%) from comparison group were registered before 16 weeks. 421(91.7%) cases and 456(91.2%) women from comparison group consumed iron and folic acid tablets for three months. 446(97.2%) cases and 485(97.0%) from comparison group received tetanus immunisation.

Table I: Pregnancy outcome in study subjects and comparison group.

Pregnancy outcome Study subjects Comparison group
No. (%) No. (%)
Live birth 439 (94.6) 490 (97.6)
Still birth 25 (5.4) 12 (2.4)
Total 464 (100)* 502 (100)

*2 twin deliveries in study subjects and comparison group.
x2 = 5.88, df = 1, OR = 2.32, 95%CI = 1.11-5.14, p=0.0153

Table I clearly shows the high incidence of still birth in teenagers as compared to comparison group. This difference was found to be statistically significant.

Relation of antenatal care services and unfavourable outcome did not show any statistical significance. Preterm deliveries occurred in 74(16.0%) cases and 14(2.8%) from comparison group. Incidence of preterm deliveries was 5 times more in teenage mothers and the difference was found to be statistically significantfont face="Arial" size="2">(x2 = 19.38, df = 1, p<0.0001).

Caesarean section rate (27.3%) in teenage mothers and (26.4%) in comparison group did not show statistically significant difference.

Table II: Birth weight of babies in study subjects and comparison group.

Birth weight Study subjects Comparison group
No. (%) No. (%)
<2 Kg. 86 (18.5) >19 (3.8)
2-2.5 Kg 251 (54.1) 278 (55.4)
>2.5 Kg. 127 (27.4) 205 (40.8)
Total 464 (100) 502  

x2 = 19.38, df = 1, OR = 1.83, 95%CI = 1.35-2.42, p=0.0001

It is obvious from Table II that the incidence of low birth weight babies is higher in teenage group, `p' value being significant. Low socio-economic status, inadequate antenatal care and mother's nutrition are the common causes predisposing to delivery of low birth weight babies.

Table III: Complications during pregnancy and labour in study subjects and comparison group.

Complications during pregnancy and labour l

Complications Study subjects
(n=462)
No.(%)
Comparison group
(n=500)
No.(%)
OR 95% CI x2 df p
Toxaemia of
pregnancy
95   63 (12.6) 2.88 1.94-4.28 31.55 1 <0.0001
Eclampsia 13 (2.8) 3 (0.6) 8.28 2.22-45.79 14.71 1 <0.0001
APH 4 (0.8) 5 (1) 1.53 0.30-7.21 0.4 1 >0.5287
Preterm labour 75 (16.2) 14 (2.8) 10.24 5.48-20.00 74.81 1 <0.0001
Foetal distress 82 (17.7) 105 (21) 1.49 1.03-2.15 5.01 1 <0.0252
Cephalopelvic
disproportion
42 (9.1) 9 (1.8) 8.92 4.12-21.33 43.9 1 <0.0001
Retained placenta 3 (0.6) 4 (0.8) 1.43 0.21-8.59 0.22 1 >0.6387

ike toxaemia of pregnancy, eclampsia, preterm labour, cephalopelvic disproportion were more in teenagers as compared to comparison group. The difference was found to be statistically significant. Whereas, complications like antepartum haemorrhage and retained placenta showed no statistically significant difference. The risk of toxaemia of pregnancy is almost three times more in study group as compared to comparison group.

Main indication for caesarean section in teenagers was cephalopelvic disproportion (33.3%), whereas, in comparison group it was only in 6.8%. This difference was found to be statistically significant (x2 = 36.56, df = 2, p<0.001).

Discussion:

There is substantial evidence to suggest that early child bearing is on the increase every where and it presents a serious problem in many countries1. The minimum legal age of marriage for girls as envisaged in the national policy by Government of India is 18 years, even then the problem of teenage pregnancy is widespread, as early marriages are still prevalent in Indian community3. There is evidence that teen age may constitute "high risk group" in reproductive terms because of assumed double burden of reproduction and growth, reports on the subject are inconsistent5.

The purpose of this investigation, therefore, was to evaluate the characteristics and the outcome of the pregnancy in teenage girls and compare them with other women of the age group 20-29 years5. The results of this study confirm the findings of other studies in showing that pregnant teenagers experience higher risk of adverse perinatal outcome and various complications during pregnancy and labour1-3,5-8.

Though caesarean section rate was not high in the present study the main indication was cephalopelvic disproportion. The pelvic architecture is not yet completely formed and mature enough for term delivery. Therefore, cephalopelvic disproportion is the commonest problem encountered during labour, the p value being significant1.

Emphasis on delaying the onset of child bearing beyond 20 years of age should be an important element of population control programme1.

References:

  1. Nitwe MT et al. Teenage Pregnancy, A Health Hazard. J Obst and Gyn of India, 1989; 39: 303-6.
  2. Bhaduria S et al. Teenage pregnancy: A retrospective study. J Obst and Gyn of India, 1991; 41(4): 454-6.
  3. Kale KM et al. Socio-medical correlates of teenage pregnancy. J Obst and Gyn of India, 1996; 46(2): 180-4.
  4. Pandit SN, Rao S. Teenage pregnancy - Unmet needs for counselling. J Obst and Gyn of India, 1999; 49(5): 140-4.
  5. A detoro OO, Agah A. The implication of child bearing in post pubertal girls in Sokoto, Nigeria. International J Obst and Gyn, 1988; 27: 73-7.
  6. Ambadekar NN et al. Teenage pregnancy outcome. Indian J of Medical Sciences 1999; 53(1): 19-23.
  7. Bacci A et al. Outcome of teenage pregnancy in Maputo, Mozambique. International J Obst and Gyn, 1993; 40: 19-23.
  8. Ventura S, Green ES. Risk in pregnant teenagers. International J Obst and Gyn, 1990; 32: 7-13.
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