Teenage pregnancy proportion, and comparison of maternal and neonatal outcomes with adult pregnancy at a General Hospital in Northern Uganda

doi:10.21203/rs.3.rs-4438154/v1

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Research Article

Teenage pregnancy proportion, and comparison of maternal and neonatal outcomes with adult pregnancy at a General Hospital in Northern Uganda

https://doi.org/10.21203/rs.3.rs-4438154/v1

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Background

Teenage pregnancy is a global health concern associated with adverse maternal and neonatal outcomes. In Uganda, while teenage pregnancy rates are high, knowledge about their specific risks compared to those of adult pregnancy remains limited.

Objective

We determined the proportion of pregnant teenagers and compared the maternal and neonatal outcomes between pregnant teenagers and pregnant adults at a general hospital in northern Uganda.

Methods

We conducted a comparative, retrospective cohort study involving chart reviews of deliveries at the maternity ward of Anaka General Hospital, Nwoya, Uganda between July 2020 and June 2023. We performed systematic random sampling to include patient charts. All the data were analyzed using STATA software 17 SE. Binary logistic regression was performed to compare adverse pregnancy outcomes between teenage mothers and adult mothers.

Results

Over the 3-year period, 27.6% (n = 1,842) of the 6,662 deliveries were by teenage mothers. The outcomes of 457 teenage and 457 adult mothers were compared. Compared to adult mothers, teenage mothers had a significantly lower prevalence of HIV (2.2% versus 6.1%, p = 0.003). Teenage mothers had higher odds of having an episiotomy performed (adjusted odds ratio [aOR] = 5.66, 95% confidence interval [CI]: 2.48–12.90, p < 0.001), low birth weight (aOR = 4.66, 95% CI: 2.66–6.37, p < 0.001) or perineal tear (aOR = 2.61, 95% CI: 1.69–4.02, p < 0.001). However, adult mothers had greater odds of developing pre-eclampsia (aOR = 4.0, 95% CI: 1.59–11.1, p = 0.004).

Conclusions

In this study, approximately 1 in every 4 deliveries were by teenage mothers, with increased risks of maternal and neonatal complications, except for pre-eclampsia which was more common among adult mothers. Therefore, it is crucial to implement targeted interventions and comprehensive education programs aimed at reducing teenage pregnancies and providing adequate antenatal care and support for teenage mothers.

Teenage pregnancy

Maternal outcome

Neonatal outcomes

Teenage pregnancy, defined as conception between the ages of 13 and 19 years, is a global public health concern due to its significant medical risks for both mothers and newborns, impacting both developed and developing nations (1–3). Although often used interchangeably, terms such as “adolescent” and “child pregnancy” have distinct meanings from “teenage pregnancy” (4).

Globally, approximately 16 million pregnancies occur in girls aged 15–19, with an additional 1 million pregnancies occurring in girls under 15 years (4). Over 90% of teenage pregnancies occur in sub-Saharan Africa (SSA) (4, 5), where the prevalence of teenage pregnancy is 19.3%, with the highest rate occurring in East Africa (5). Hospital-based studies have revealed varying rates of teenage pregnancy across different settings and populations. In Nepal, a community hospital study revealed that 29.06% of total deliveries over a ten-year period were teenage deliveries (6). Similarly, in Ethiopia’s Assosa General Hospital, the prevalence was 26% (7), and in Egypt’s Bassion General Hospital (8), it was 26.4%. In Uganda, Kiryandongo General Hospital reported a prevalence of 12% (9), while the Mbale Regional Referral Hospital had a prevalence of 20.6% (10).

Teenage pregnancy is linked to serious maternal health complications when compared to adult pregnancy due to biological and psychological unreadiness, limited access to care, and social/economic disadvantages (2, 11). These complications include pregnancy-induced hypertension (8, 12), anaemia (8, 13), preterm delivery (14, 15), increased rates of caesarean sections (12–14), postpartum hemorrhage (PPH) (12, 15), perineal tears (16), and sexually transmitted infections, including HIV (17, 18). Infants born to teenage mothers face risks such as preterm birth (15), low birth weight (12, 19, 20), birth asphyxia (14), neonatal intensive care unit (NICU) admission (8, 19), and long-term permanent physical and mental disabilities (3).

Teenage pregnancy is a significant public health concern in Uganda, where 52% of the population is under 18 years old; however, the prevalence of teenage pregnancy is 25% (21), particularly affecting areas such as the Nwoya district, where girls face vulnerabilities due to low secondary school attendance (16%), high dropout rates (94%), and early marriage (20% before age 20) (22). Despite systematic challenges, there is limited information on the outcomes of teenage pregnancy; all studies in Uganda did not compare delivery outcomes between teenage and adult mothers (9, 10, 23). Priority should be given to ensuring safe pregnancy outcomes for teenage mothers.

This study therefore aimed to determine the proportion of teenage pregnancy and compare the maternal and neonatal outcomes between pregnant teenage and pregnant adult at Anaka General Hospital.

Study design

This study was a hospital-based retrospective cohort study involving review of records of deliveries conducted at the maternity ward of Anaka General Hospital, Nwoya District, northern Uganda, from July 2020 to June 2023. Mention here the tools you used

Study setting

Anaka General Hospital is the only government-owned hospital under governance of Nwoya district local government. The hospital has an average of 2000 deliveries annually. The unit provides care 24 hours a day, 7 days a week, offering comprehensive emergency obstetric, maternal and newborn care.

Study population.

The study population consisted of deliveries at Anaka general hospital between July 2020 and June 2023. Two arms were compared: women under 20 years (teenage) and those aged 20 years or older (adults). The charts of women who delivered before arrival (BBA), or had multiple pregnancies were excluded.

Sample size estimation

To determine the proportion of teenage pregnancies, a census of all admissions during the study period was carried out. The sample size for the comparison of delivery outcomes was calculated using the Kish Leslie formula, and the sample size was calculated with the double proportion formula (24). Employing a critical value of 1.96 at the 5% level of significance, the proportion of caesarean sections was considered to be 12.9% in teenage pregnancies, and 18.8% in adult pregnancies, sourced from a study in Ethiopia (12). With a margin of error of 0.05 and a power of 80%, we determined a sample size of 457 teenage mothers and 457 unmatched adult mothers, resulting in a total sample size of 914.

Sampling strategy.

During the study period, there were a total of 6,662 obstetric admissions, which included 1,842 teenagers and 4,830 adults. Charts of 15 teenage mothers and charts of 151 adult mothers were excluded. Systematic random sampling from the integrated maternity register was used to select the charts. The sampling intervals were determined by calculating “K” values, using the formula K = N/n, where “N” is the total number of deliveries and “n” is the calculated sample size. For teenagers, K = 1,827/457 ≈ 4, while for adults, K = 4669/457 ≈ 10. The sampling intervals were 4 and 10 for teenage mothers and adults, respectively.

Data collection

The data were collected from the patients’ files using a structured data extraction tool. Two midwives served as research assistants. They were briefed on the study’s objectives, data collection procedures, and how to accurately complete the extraction tool. Sample charts identified from the integrated maternity register, including names and inpatient numbers, are listed. Subsequently, charts of sampled mothers and babies admitted to the NICU were retrieved from the records section.

Study variables.

The maternal outcome (dependent) variables included the mode of delivery (categorized as vaginal delivery or caesarean section); preeclampsia, which was defined as hypertension and proteinuria (++) according to the use of urine dipstick; ante partum haemorrhage; episiotomy performed, and perineal tear, which was defined as any tear that required repair, post-partum haemorrhage and maternal death. The foetal outcome variables included delivery status (alive or dead), birth weight, Apgar score at 1 and 5 minutes, presence of congenital anomalies, admission to the NICU and neonatal death.

The main independent variable was age. Other independent (baseline) variables were the sociodemographic characteristics, medical factors and obstetrics factors. The sociodemographic factors included area of residence and referral status. Medical factor captured was the HIV status. The obstetric factors included gravidity, parity, and gestation age at delivery, stage of labour at admission and induction of labor

Data management and analysis

The data were checked for accuracy and completeness before being coded and entered into an Excel spreadsheet. Analysis was conducted using STATA software version 17 SE. The study utilized two-tailed tests at a 95% confidence interval and a significance of p < 0.05. The baseline characteristics of the participants are summarized; with corresponding p values indicated distribution disparities between cohorts. Categorical variables are presented as frequencies and percentages, with Pearson’s chi-square p-values. Numerical variables were assessed for normality using the Shapiro-Wilk test; normally distributed data were expressed as the mean and standard deviation with the Student’s t-test p values, and non-normally distributed data were summarized using the median, range, and p-values from the Mann-Whitney U test.

The proportion of teenage pregnancy was calculated as the number of women aged less than 20 years, expressed as a percentage of the total number of women admitted for delivery during the study period.

To compare the teenage pregnancy and adult pregnancy outcomes, maternal outcomes were categorized as dichotomous. Bivariate and multivariate logistic regression models were used to compare outcomes. Outcome variables that had significant (p < 0.05) or marginally (0.05 ≤ p < 0.25) significant different proportion between the age groups were adjusted for other independent variables using separate multivariate analysis models. We checked for multicollinearity, and in that respect excluded parity (r = 0.72) and gravidity (r = 0.69) from all models as they were highly correlated with age. Backward, stepwise elimination method and Akaike’s information criteria (AIC) were used to select best models. The results are presented as adjusted odds ratios (aORs) with the corresponding 95% confidence intervals (CIs) and p values.

Study enrollment.

During the three-year-study period, there were a total of 6,662 were deliveries conducted, including 1, 842 (27.6%) of which involved teenage mothers (exposed) while 4,820 (72.4%) adult mothers (non-exposed), Fig. 1.

Proportion of teenage pregnancy

Teenage mothers comprised 27.6% (n = 842) of the 6,662 total deliveries conducted in Anaka General Hospital over the three-year period.

Maternal characteristics of teenage and adult mothers

Compared to adult mothers, teenage mothers had a lower median gravidity (1 versus 3, p < 0.001) and parity (0 versus 2, p < 0.001). There was no statistically significant difference in the mean gestational age at delivery (p = 0.208). The proportion of referrals was greater for teenage mothers (16.4%) than for adult mothers (7.4%) (p < 0.001). Adult mothers had a greater prevalence of HIV (6.1% vs. 2.2%, p = 0.003). Induction of labor was more common among adult mothers (4.7%) than among teenage mothers (1.1%) (p < 0.001). Teenage mothers presented earlier in labor, while adult mothers presented later (p < 0.001), (Table 1).

Table 1

Maternal characteristics of teenage and adult mothers
Characteristics	Total N (%)	Teenage n (%)	Adults n (%)	P value
Age Median (min, max)	19.5 (15, 46)	18 (15–19)	25 (20–46)	< 0.001
Gravidity median (min, max)	2 (1, 12)	1 (1, 3)	3 (1, 12)	< 0.001
Parity median (min, max)	0 (0, 10)	0 (0, 1)	2 (0, 10)	< 0.001
Gestation age (Mean, SD)	38.34 (28, 44)	38.42 (2.08)	38.25 (1.97)	0.208
Referral in Yes No	109 (11.93) 805 (88.07)	75 (16.41) 382 (83.59)	34 (7.44) 423 (92.56)	< 0.001
HIV status Positive Negative	38 (4.16) 876 (95.84)	10 (2.19) 447 (97.81)	28 (6.13) 429 (93.87)	0.003
Labor onset Induced Spontaneous	26 (2.9) 370 (97.10)	5 (1.10) 448 (98.90)	21 (4.74) 422 (95.26)	< 0.001
Stage of labor Not in labor Latent phase Active phase Second stage	111 (12.14) 250 (27.35) 412 (45.08) 141 (15.43)	45 (9.85) 158 (34.57) 196 (42.89) 58 (12.69)	66 (14.44) 92 (20.13) 216 (47.26) 83 (18.16)	< 0.001
Min – minimum value. Max – maximum value. N – Number. SD – standard deviation

Comparison of maternal outcomes between pregnant teenagers and pregnant adults

The proportion of caesarean deliveries was similar among teenagers (18.6%) and adult mothers (14.9%) (p = 0.132). A greater proportion of adult mothers had pre-eclampsia than did teenagers (3.9% vs. 1.3%, p = 0.013). There was no statistically significant difference in the incidence of antepartum hemorrhage (p = 0.363), postpartum hemorrhage (p = 1.00) or obstructed labor (p = 0.860). A greater proportion of teenage mothers had perineal tears (18.6% vs. 7.4%, p < 0.001) and underwent episiotomy (8.1% vs.1.5%, p < 0.001). Puerperal sepsis was rare in teenage mothers (0.1%) with no cases in adult mothers (p = 0.317). The median hospitalization duration was 2 days for teenagers and 1 day for adult mothers (p = 0.557), (Table 2).

Table 2

Obstetric outcomes of teenage and adult deliveries
Variable	Total N (%)	Teenage n (%)	Adult n (%)	P value
Mode of delivery Caesarean Vaginal	153 (16.7) 761 (83.3)	85 (18.6) 372 (81.4)	68 (14.9) 389 (85.1)	0.132
Indication of C/S Prolong/obstructed Fetal distress Previous C/S Contracted pelvis Pre-eclampsia Others	38 (25.2) 19 (12.6) 45 (29.8) 25 (16.5) 9 (6.0) 15 (9.9)	26 (30.9) 11 (13.1) 12 (14.3) 23 (27.4) 3 (3.6) 9 (10.7)	12 (17.9) 8 (11.9) 33 (49.2) 2 (3.0) 6 (9.0) 6 (9.0)	< 0.0001
Type of C/S Elective Emergent	10 (6.6) 142 (93.4)	1 (1.2) 83 (98.8)	9 (13.2) 59 (86.8)	0.003
Pre-eclampsia Yes No	24 (2.6) 890 (97.4)	6 (1.3) 451 (98.7)	18 (3.9) 439 (96.1)	0.013
APH Yes No	11 (1.2) 903 (98.8)	4 (0.9) 453 (99.1)	7 (1.5) 450 (98.5)	0.363
Obstructed/prolonged Yes No	31 (3.4) 882 (96.6)	16 (3.5) 441 (96.5)	15 (3.3) 441 (96.7)	0.860
Perineal tear Tear No tear	119 (13.0) 795 (87.0)	85 (18.6) 372 (81.4)	34 (7.4) 423 (92.6)	< 0.001
Episiotomy Performed Not performed	44 (4.8) 870 (95.2)	37 (8.1) 420 (91.9)	7 (1.5) 450 (98.5)	< 0.001
PPH Yes No	12 (1.3) 902 (98.7)	6 (1.3) 451 (98.7)	6 (1.3) 451 (98.7)	1.00
Puerperal sepsis Yes No	1 (0.1) 456 (99.9)	1 (0.1) 456 (99.9)	0 (0.00) 457 (100.00)	0.317
Hospitalization days	2 (1, 18)	2 (1, 18)	1 (1, 17)	0.577

After bivariate and multivariate analysis, the proportions of several maternal outcomes remained significantly different between the age groups. Adult mothers had a fourfold likelihood of pre-eclampsia compared to teenage mothers (p = 0.004). Teenage mothers were 2.61 times more likely to experience perineal tear (p < 0.001) and 5.66 times more likely to undergo episiotomy (p < 0.001) compared to adult mothers, (Table 4).

Table 4

Logistic regression models of adverse maternal outcomes of teenage and adult mothers
		Obstetric outcome			Bivariate				Multivariable
		Yes n (%)	No n (%)		Crude OR (95% CI)		P value		Adjusted OR (95% CI)		P value
Caesarean section
Age Teenage Adult	85 (55.6) 68 (44.4)		372 (48.9) 389 (51.1)	1.31 (0.92–1.85)		0.133*			1.27 (0.86–1.87)	0.224
Parity Multiparous Nulliparous	69 (45.1) 84 (54.9)		372 (48.9) 389 (51.1)	0.86 (0.61–1.22)		0.393			--------	-----
Birth weight ≥ 3.5 < 3.5	33 (21.6) 120 (78.4)		94 (12.4) 663 (87.6)	1.94 (1.25–3.02)		0.003**			2.09 (1.29–3.37)	0.003***
Referral Yes No	37 (24.2) 116 (75.8)		72 (9.5) 689 (90.5)	3.05 (1.96–4.75)		< 0.001**			3.20 (2.00–5.14)	< 0.001***
Stage of labor Second stage Active phase Latent phase Not in labor	2 (1.3) 64 (41.8) 50 (32.7) 37 (24.2)		139 (13.3) 348 (45.7) 200 (26.3) 74 (9.7)	0.03 (0.01–0.12) 0.38 (0.23–0.59) 0.50 (0.30–0.83) 1		< 0.001 < 0.001 0.007 ---**			0.03 (0.01–0.12) 0.34 (0.20–0.55) 0.49 (0.29–0.82) 1	< 0.001* < 0.001* 0.011*** ---
Pre eclampsia/eclampsia
Age Teenage Adult	6 (25.0) 18 (75.0)		451 (50.7) 439 (49.3)		1 3.13 (1.20–7.69)			0.018**	4.0 (1.59–11.11)	0.004***
Parity Multiparous Nulliparous	14 (58.3) 10 (41.67)		427 (48.0) 463 (52.0)		1.51 (0.66–3.45)			0.320	-------
Referral Yes No	8 (33.3) 16 (66.7)		101 (11.3) 789 (88.7)		3.91 (1.63–9.36)			0.002**	5.38 (2.17–13.37)	< 0.001***
APH Yes No	4 (36.4) 7 (63.6)		453 (50.2) 450 (49.8)		0.57 (0.17–1.95)			0.369	-------
Obstructed/prolonged labor Yes No	16 (51.6) 15 (48.4)		441 (50.0) 441 (50.0)		1.07 (0.52–2.18)			0.860	-------
Perineal tear
Age Teenage Adult	85 (71.4) 34 (28.6)		372 (46.8) 423 (53.2)		2.84 (1.87–4.33)			< 0.001**	2.61 (1.69–4.02)	< 0.001***
Birth weight ≥ 3.5 < 3.5	23 (19.3) 96 (80.7)		104 (13.2) 687 (86.8)		1.58 (0.96–2.61)			0.072*	1.26 (0.75–2.10)	0.385)
Stage labor Second stage Active phase Latent phase Not in labor	18 (15.1) 50 (42.0) 44 (37.0) 7 (5.9)		123 (15.5) 362 (45.5) 206 (25.9) 104 (13.1)		2. 17 (0.87–5.41) 2.05 (0.90–4.66) 3.17 (1.38–7.29) 1			0.095* 0.086* 0.006** ---	2.18 (0.86–5.48) 1.95 (0.85–4.46) 2.66 (1.14–6.16) 1	0.096 0.115 0.023 ----
Episiotomy
Age Teenage Adult	37 (84.1) 7 (15.9)		420 (48.3) 450 (51.7)		5.66 (2.50–12.84)			< 0.001**	5.66 (2.48–12.90)	< 0.001***
Birth weight ≥ 3.5 < 3.5	6 (13.6) 38 (86.4)		121 (14.0) 745 (86.0)		0.97 (0.40–2.35)			0.950	-------	----
Stage labor Second stage Active phase Latent phase Not in labor	5 (11.4) 23 (52.3) 13 (29.5) 3 (6.8)		136 (15.6) 389 (44.7) 237 (27.3) 108 (12.4)		1.32 (0.31–5.66) 2.13 (0.63–7.22) 1.97 (0.55–7.07)			0.705 0.226* 0.296	1.31 (0.30–5.71) 1.93 (0.56–6.65) 1.45 (0.40–5.26) 1	0.712 0.293 0.575 ---
* Marginally significant on bivariate (p ≤ 0.05 < 0.25) significant on bivariate (p < 0.05) * significant after multivariate CI – confidence interval OR – Odds ratio

Comparison of neonatal outcomes of teenage pregnancy to adult pregnancy

The proportion of stillbirth was similar among teenage mothers (1.8%) and adult mothers (2.0%), (p = 0.795). Apgar scores below 7 at 1 minute were observed in 9.7% for teenagers and 7.2% for adult (p = 0.187) and at 5 minutes, 3.3% for teenagers and 2.0% for adults (p = 0.213). Sex distribution did not significantly differ among teenagers (51.9% boys, 48.1% girls) and adult mothers (47.9% boys, 52.1% girls) (p = 0.234). The proportion of babies that had birth asphyxia was 11.6% for teenagers and 8.9% for adults (p = 0.190). Teenage mothers had significantly higher proportion of low birth weight compared to adult mothers (22.6% vs. 7.0%, p < 0.001). Proportion of congenital anomalies was similar (p = 0.156). The proportion of babies that had NICU admission was 10.9% among teenagers and 12.3% among adult mothers (p = 0.524). Among teenage mothers, 95.8% of babies were discharged alive, compared to 94.5% among adult mothers. However, this difference was not statistically significant (p = 0.354), (Table 3).

Table 3

Neonatal outcomes of teenage and adult pregnancies
Variable	Total N (%)	Teenage n (%)	Adult n (%)	P value
Status Stillbirth Live birth	17 (1.9) 897 (98.1)	8 (1.8) 449 (98.2)	9 (2.0) 450 (98.0)	0.795
Apgar 1 minute < 7 7–10	77 (8.4) 836 (91.6)	44 (9.7) 412 (90.3)	33 (7.2) 424 (92.8)	0.187
Apgar 5 minute < 7 7–10	24 (2.6) 889 (97.4)	15 (3.3) 441 (96.7)	9 (2.0) 448 (98.0)	0.213
Baby sex Male Female	456 (49.9) 458 (50.1)	237 (51.7) 220 (48.1)	219 (47.9) 238 (52.1)	0.234
Birth asphyxia Yes No	92 (10.3) 805 (89.7)	52 (11.5) 397 (88.4)	40 (8.9) 408 (91.1)	0.190
Low birth weight < 2.5 ≥ 2.5	135 (14.8) 775 (85.2)	103 (22.6) 352 (77.4)	32 (7.0) 423 (93.0)	< 0.001
Anomaly Yes No	8 (0.9) 905 (99.1)	2 (0.4) 454 (99.6)	6 (1.3) 451 (98.7)	0.156
NICU admission Yes No	104 (11.6) 793 (88.4)	49 (10.9) 400 (89.1)	55 (12.3) 393 (87.7)	0.524
Discharged alive No Yes	44 (4.8) 870 (95.2)	19 (4.2) 438 (95.8)	25 (5.5) 432 (94.5)	0.354
NICU – Neonatal Intensive Care Unit

After multivariate analysis, independently teenage mothers had 4.12-fold higher odds of delivering a low-birth-weight baby compared to adult mothers (p < 0.001), (Table 5).

Table 5

Logistic models of adverse neonatal outcomes of teenage and adult mothers
Variable	Obstetric outcome				Bivariate		Multivariate
	Yes n (%)	No n (%)			Crude OR (95% CI)	P value	Adjusted OR (95% CI)		P value
Stillbirth
Age Teenage Adult	8 (47.1) 9 (52.9)		449 (50.1) 448 (49.9)	0.87 (0.34–2.32)		0.807		---------
Apgar score at 5 minute less than 7
Age Teenage Adult	15 (60.0) 10 (40.0)		441 (49.7) 447 (50.3)	1.52 (0.68–3.42)		0.311		---------
Birth asphyxia
Age Teenage Adult	52 (56.5) 40 (43.5)		397 (49.3) 408 (50.7)	1.34 (0.86–2.06)		0.192*		1.31 (0.85–2.03)		0.219
Birth weight < 2.5 ≥ 2.5	14 (15.4) 77 (84.6)		112 (14.0) 690 (86.0)	1.12 (0.61–2.05)		0.713		--------
Baby’s sex Male Female	53 (57.6) 39 (42.4)		396 (49.2) 409 (50.8)	1.40 (0.91–2.17)		0.127*		1.41 (0.91–2.19)		0.121
Obstructed/prolonged labor Yes No	1 (1.1) 91 (98.9)		30 (3.7) 774 (96.3)	0.28 (0.04–2.10)		0.218*		0.27 (0.04–1.99)		0.198
Low birth weight
Age Teenage Adult	103 (76.3) 32 (23.7)		352 (45.4) 423 (54.6)	3.87 (2.54–5.89)		< 0.001**		4.12 (2.66–6.37)	< 0.001***
Parity Multiparous Nulliparous	36 (26.7) 99 (73.3)		403 (52.0) 372 (48.0)	0.34 (0.22–0.50)		< 0.001**		--------
Gestation age Unknown ≥ 40 37–39 < 37	7 (5.2) 16 (11.9) 70 (51.9) 42 (31.1)		35 (4.5) 215 (27.8) 449 (57.9) 76 (9.8)	0.36 (0.15–0.89) 0.13 (0.07–0.25) 0.28 (0.18–0.44) 1		0.026 < 0.001 < 0.001**		0.39 (0.15–1.00) 0.13 (0.07–0.25) 0.27 (0.17–0.43) 1	0.05 < 0.001* < 0.001*
Baby’s sex Male Female	55 (40.7) 80 (59.3)		397 (51.2) 378 (48.8)	0.65 (0.45–0.95)		0.025**		0.61 (0.41–0.90)	0.013***
Preterm birth
Age Teenage Adult	65 (54.6) 54 (45.4)		376 (49.9) 377 (50.1)	1.21 (0.82–1.78)		0.342		----------
NICU admission
Age Teenage Adult	49 (47.1) 55 (52.9)		400 (50.4) 393 (49.6)	0.87 (0.58–1.32)		0.524		----------
Perinatal death
Age Teenage Adult	19 (43.2) 25 (56.8)		438 (50.3) 432 (49.7)	0.75 (0.41–1.38)		0.355		---------
* Marginally significant on bivariate (p ≤ 0.05 < 0.25) significant on bivariate (p < 0.05) * significant after multivariate CI – confidence interval OR – Odds ratio

In this study, we aimed to determine the proportion of teenage pregnancies and compare the outcomes of these pregnancies with those of adult pregnancies. The study revealed a high prevalence of teenage pregnancies, and that; compared with adults, teenage mothers had significantly greater proportion of episiotomy, perineal tears, and low birth weight babies compared to adults. However adults had a greater proportion of preeclampsia.

Our study found a high proportion of teenage pregnancy among the total deliveries at Anaka general hospital. The factors contributing to the high rate may be related to the increased vulnerability of girls in Nwoya due to low secondary school attendance (16%), high dropout rates (94%), and early marriage (20% before age 20) (22). This may also be attributed to inaccessibility of contraceptive services, poor attitudes of the community towards the use of contraceptives by teenagers, poor sexual and reproductive health knowledge among teenage girls, and early onset of sexual activity (5). The proportion of teenage pregnancy found in this study is higher than that documented in Ugandan studies (9, 10, 23) and other African countries (25, 26), This variation could be due to the differences in culture, resources and education levels as was seen elsewhere (5). Our study findings is however comparable to rates of teenage pregnancy of 26.4% in Egypt (8) and 29.06% in rural Nepal (6).

Our study further highlights the increased risk of adverse maternal outcomes; importantly; compared to adults, teenage mothers are approximately six times more likely to undergo episiotomies compared to adults. Similar findings were reported in studies from Ethiopia (12), Cameroon (16) and Malaysia (27). Teenage mothers might need more episiotomies due to factors such as tight perineum and the perceived need for assistance by healthcare providers based on their age (11). However our study differs from a Turkish study (28), possibly because of the narrow age range for adults and higher rates of episiotomy across groups, suggesting routine practice in both groups.

This study revealed that adult mothers had a greater proportion of preeclampsia compared to teenage mothers, with the adults four times more likely to develop preeclampsia. Advanced maternal age and differences in healthcare utilization may contribute to this disparity, as older mothers have more risk factors and may receive more intensive monitoring. The current finding is in agreement with those of a study in Turkey (28), and in Egypt (14). However, it was inconsistent with a study in Ethiopia (12) and a study in Ethiopia (8). This difference could be due to differences in demographic characteristics (socioeconomic status or healthcare access) and may also be because of age restrictions in the adult group (adults were restricted to the 20–34 year-old age group) unlike our study, were we did not restrict the age of the adults recruited.

Our study also revealed a greater proportion of teenage mothers compared to adult mothers sustained perineal tears that required suturing; teenage mothers were 2.61 times more likely to experience tears even after adjustment for birth weight and labor stage. The findings of the present study are consistent with those of 2 studies conducted in Cameroon (16, 29). Teenage mothers’ anatomical differences such as smaller pelvis and less tissue elasticity, coupled with limited antenatal care and awareness, may increase perineal tear risk. Our finding however is not in agreement with a study in Ethiopia that found no significant association between teenage pregnancy and perineal tear (12) and that in Mecadonia, perineal tear rates were statistically significantly lower among teenage mothers (30). This could be due to differences in the demographic characteristics of our study population compared to those of the other populations. The comparison group (adults) in the study by Mecadoni was age group 20–24 unlike our study in which there was no age restriction.

According to this study, 22.6% of teenage mothers delivered low birth weight neonates while only 7.1% delivered low birth weight neonates. After adjustments for the influence of gestational age at delivery and the sex of the baby, low birth weight was still significantly greater among teenage mothers. Compared with adults mothers, the teenage mothers were four times more likely to deliver a low-birth-weight baby compared to adult mothers. This was similar to findings of studies from Ethiopia (12), Egypt (14), Nigeria (20), India (19) and Indonesia (13). The reason for the high rates of low birth weight among teenage mothers is that they are still immature and still continuing to grow as well and therefore during pregnancy there is competition with the developing foetus for nutrients, and this competition is often detrimental to the foetus (11). Additionally, teenage mothers are more disadvantaged socioeconomically than adult mothers; factors such as poverty, food insecurity and inadequate housing may contribute to increased stress levels and poor maternal nutrition during pregnancy, which can impact fetal growth and result in low birth weight.

Strengths and limitations

The main strength of this study lies in its comparison of maternal and neonatal outcomes between teenage and adult mothers, a novel approach in Uganda and East Africa. Controlling for confounding factors enhances the study’s credibility. However, socioeconomic factors such as education and employment status, as well as behavioral risk factors such as maternal smoking and alcohol consumption, were not considered. Additionally, the study did not assess factors such as antenatal care attendance, weight gain during pregnancy, or maternal illness, which could influence maternal and neonatal outcomes in either group. We also found incomplete information in some charts reviewed, and to ensure accuracy, missing information in chart reviews was addressed by crosschecking essential registers such as the integrated maternity register, theatre register, and NICU register before considering it incomplete.

Implications of the study findings

The study highlights the urgent need for targeted interventions to reduce teenage pregnancy rates, addressing social factors like poverty and limited access to reproductive health services. It emphasizes the need for increased antenatal education and support for teenage mothers, along evidence-based obstetric practices such as promoting upright birth positions and non-pharmacological pain management techniques to reduce tears and episiotomies. Policy implications include prioritizing adolescent-friendly reproductive health services, comprehensive sex education to non pregnant teenage girls, and improved access to contraception, in addition to ensuring comprehensive antenatal care and support for socioeconomically disadvantaged teenage mothers. Reducing barriers to healthcare access can improve maternal and neonatal outcomes.

Future directions

Further research is needed to explore the roles of interventions such sex education, contraceptives use in reducing teenage pregnancy as well as factors facilitating the high teenage rates. Studies investigating the role of socioeconomic factors, healthcare access, and provider practices in shaping maternal and perinatal outcomes among the teenagers are warranted. Additionally longitudinal studies tracking maternal and perinatal outcomes over time among teenage and adult mothers can provide valuable insights into the long-term implications of age at childbirth on maternal and child development.

In this study, approximately one-quarter of the deliveries in Anaka General Hospital were by a teenage mother. Teenage mothers had increased risk of delivering a low-birth-weight baby, perineal tears and episiotomies compared to adult mothers. We recommend implementing; comprehensive sex education, and access to contraception to reduce teenage pregnancy rates and targeted antenatal education programs and evidence based obstetric practices to improve pregnancy outcomes among the teenagers.

AGH Anaka General Hospital

AIC Akaike’s Information Criterion

aOR Adjusted odds ratio

APH Antepartum haemorrhage

C/S Caesarean section

CI Confidence interval

cOR Crude odds ratio

GUREC Gulu University Research Ethics Committee

LBW Low birth weight

NICU Neonatal Intensive Care Unit

PPH Postpartum haemorrage

SVD Spontaneous vaginal delivery

Acknowledgements

We are grateful to the Department of Public Health, Gulu University and all the lecturers for their support during the study. We thank the Administration of Anaka General Hospital, the District Health Office and the Administration of Nwoya District Local Government for their support and acceptance of this study. We thank the research assistants, Acen Lucy, and Ahirwe Clemensia for their immense contributions to the data collection.

Author contributions

JJL, EO, FB, PA, and PFP contributed to the conception and design of the study. JJL performed the formal data analysis. JJL drafted the manuscript. EO, FB, PA, and PFP critically reviewed and revised the manuscript. JJL prepared the final manuscript. All the authors have read and approved the final manuscript.

Funding

The research received no specific grant for this project.

Data availability

The research data and materials used to support the research findings of this study are available upon request from the corresponding author.

Ethics approval and consent to participate

This study was approved by the Gulu Research Ethics Committee (Ref GUREC-2023-586), including the approval of the request for a waiver of consent. Administrative clearance was obtained from the Chief Administrative Officer of the Nwoya District Local Government before conducting the study.

Consent for publication.

Not applicable

Competing interests

The authors declare that there are no conflicts of interest regarding the publication of this paper.

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Teenage pregnancy proportion, and comparison of maternal and neonatal outcomes with adult pregnancy at a General Hospital in Northern Uganda

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Abstract

Background

Objective

Methods

Results

Conclusions

Figures

Background

Methods

Study design

Study setting

Sample size estimation

Data collection

Data management and analysis

Results

Proportion of teenage pregnancy

Maternal characteristics of teenage and adult mothers

Comparison of maternal outcomes between pregnant teenagers and pregnant adults

Comparison of neonatal outcomes of teenage pregnancy to adult pregnancy

Discussion

Strengths and limitations

Implications of the study findings

Future directions

Conclusions

Abbreviations

Declarations

References

Additional Declarations

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