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Brief Reports Indian Pediatrics 2003; 40:971-976 |
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Anthropometric Profile and Perinatal Outcome of Babies Born to Young Women (<18 years) |
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From the Departments of Pediatrics and *Obstetrics & Gynecology, NSCB Medical College, Jabalpur, MP, India. Correspondence to: V.K. Bhardwaj, G-3, Vaibhav Apartments, Near Prem Mandir, Wright Town, Jabalpur (MP), 482 002, India. E-mail: [email protected]
Key words: Adolescent, Pregnancy. Menarche signifies the attainment of reproductive potential on the part of a girl. Average age of menarche in India is 12.6 years(1). A post-menarcheal girl is bio-logically capable of bearing children. However skeletal growth continues until 16-18 years of age and pelvic growth is completed at 18 years of age(2). Sexual activity on the part of adolescents leads to unintended conceptions and this is a problem faced by all communities(3-10). In India, in addition to unintended pregnancies, there is larger problem of legitimate adolescent pregnancies due to practice of childhood marriages(3,4). Government of India has banned marriage of girls below 18 years and boys below 21 years by enacting a law(11), but the practice of child marriage continues due to socio-economic reasons(3). Earlier studies have found higher frequency of adverse obstetric and perinatal events in adolescents than adult women(3-6), but not confirmed by other investigators(7,8). Present study was undertaken to find out the socio-demographic background of young mothers and to assess the adverse effects, if any, of young motherhood on the woman and her baby. Subjects and Methods This hospital based observational study was undertaken between September 1999-July 2000. Cases were enrolled from amongst the women admitted for delivery in the Department of Obstetrics, NSCB Medical College and in ‘Sutika Grih and Shishu Kalyan Kendra’ (a trust hospital situated in the heart of city and providing services at low cost). The design and aims of the study were explained to the Medical Officer Incharge and staff of the hospital and the obstetric ward and permission was taken. Strict confidentiality was assured and observed. All consecutive primiparous women below 18 years of age were enrolled as the study group and consecutive primiparous women above 18 years of age, about 2 times the number of study group, served as the control group. General information (address, caste, place of living, income, occupation, education, family type and size etc.) was obtained by interview of the woman/attendant. Details of antenatal visits, antenatal investigations & complications and intranatal complications if any were obtained from patient/hospital records. A booked case was defined as one who had come to the same hospital for antenatal checkup at least once, prior to the admission for delivery. Neonate was clinically examined. Gestational age and anthro-pometric parameters (weight, length, chest circumference) were assessed as soon after delivery as possible, preferably within 24 hours of birth. Head circumference was recorded after 48 hours of birth to eliminate error due to skull moulding and caput succedenum. Mother’s weight and height were recorded after delivery. Neonate was clinically examined daily till 7th postnatal day or discharge from the hospital whichever was earlier, to look for any complication like feeding problem, hyper-bilirubinemia, sepsis etc. Data so collected was tabulated and analysis was done using statistical package SPSS PC V2+. Percentage distribution of various socio-demographic variables, mater-nal physical variables, antenatal & perinatal events and neonatal variables was calculated for the study group and control group separately. Socio-demograpic variables of study and control groups were compared by chi-square test. Comparison of maternal nutritional parameters and ‘gestational maturity and birth weight’ based categori-zation of neonates of the two groups was done by z test. Two tailed t test was used to compare the means of anthropometric parameters (birth weight, length, head circumference and chest circumference) of the full-term neonates of the two groups. Analysis of variance (ANOVA) was done to assess whether maternal variables viz., age, weight, height, hemoglobin concentration, maternal literacy and antenatal check-ups had significant effect on gestational maturity and birth weight of neonates of two groups taken together. Results There were 4556 deliveries at the two hospitals during the study period. Of these, 57 were below 18 years of age accounting for 1.25% cases and they served as the study group. Another 128 consecutive primiparous women more than 18 years of age were enrolled as the control group. 21 women (16.4%) in the control group were between 18-19 years of age. Mean age of study cases was 17.2 (±0.8) years (range 15-18 years) and that of control cases was 23.1(±0.9) years (range 18-27 years). Socio-demographic variables of the two groups are compared in Table I. Proportion of short (height <145 cm.), underweight (weight <45 Kg.), and anemic (Hb <9 g/dL) women was significantly higher in the study group. TABLE I Sociodemographic Variable and Maternal Nutritional Parameters.
Majority of women in both the groups were booked cases of the respective hospitals. Incidence of antepartum hemorrhage and pre-eclampsia/eclampsia occurred with compara-ble frequency in both the groups, but the incidence of isolated hypertension detected during pregnancy was 9.33% in the control group as against nil in the young mothers’ group. Cesarian section was required with almost equal frequency in the two groups, i.e., 15.4% in study group and 15.6% in control group. Significantly higher percentage of women in the study group had premature labor while significantly higher proportion of women in the control group carried their pregnancy to term. Number of still birth in study group (n = 2) was comparable to the control group (n = 3). Birth asphyxia occurred in 1 and 2 cases in study and control groups respectively. Comparative data regarding birth weight and neonatal maturity in the two groups is shown in Table II. TABLE II Comparison of Neonatal Variables, Outcome and Anthropometry in Study and Control Groups
FT: Full term; PT: Preterm; AFD: Appropriate for date; SFD: Small for date.*Anthropometry depicts mean (±SD) of full term neonates only. Maternal age, weight and hemoglobin concentration were found to have significant effect on neonatal maturity while ante-natal check-ups, height and literacy did not have significant influence on the maturity. Interaction of maternal variables with birth weight revealed that only maternal weight and hemoglobin concentration had significant influence while maternal age, antenatal check-ups, height and literacy lacked significant effect on birth weight. Neonatal hyper-bilirubinemia occurred significantly more often in the babies of study group (38.2% vs 18.4%, P <0.0025). Incidence of early onset sepsis and respiratory distress was not signi-ficantly different in the two groups and there were no early neonatal deaths in either group. Discussion Traditionally ‘adolescent pregnancy’ is defined as pregnancy in girls until 19 years of age. However in the present study, young mothers were defined as those delivering a baby below 18 years of age because of two reasons: (i) the skeletal maturity of a girl is complete by 18 years(2), and (ii) 18 years is the legal age of marriage for girls(11). Young mothers accounted for 1.25% of deliveries, which is less than reported inci-dence by other investigators. Sarkar, et al.(4) from Kolkata reported l8.7% incidence of teenage pregnancy (upto 19 years) in retrospective analysis of hospital records for 3 years from 1985-1987. Ambadekar, et al.(3) reported teenage pregnancy rate of 3.94% over 5 year period (1993-1997). Lower incidence in our study is due to the fact that only girls upto 18 years were included. Also the enrolment in the study was at the time of delivery and hence the pregnancies terminated in the 1st / 2nd trime-ster are not represented in the study. Additionally, unintended adoles-cent pregnancies are terminated clandestinely or are delivered at home or in private nursing home under strict secrecy. All these factors may have influenced the percentage of adolescent pregnancy in the study. All the young mothers in the present study were married and had legitimate babies. All of them were primiparous, possibly because of lower cut off age. Incidence of multiparity in adolescents was reported to be 23.4% by Sarkar et al.(4). Studies from HongKong(7) and Turkey(8) have also reported multiparity in ado1escents. Higher representation of illiterate women in the study group is in agreement with a recent report from Eastern Nepal(12). Anemia was significantly more common in the young mothers (52.5% vs 37.3%, P <0.005). Sarkar et al.(4) from Calcutta, Adedoyin, et al.(5) from Ilorin, Nigeria and Sharma, et al.(12) from Nepal have also reported higher prevalence of anemia in the adolescent mothers. Young mothers of the study group delivered preterm babies more often and when they carried their pregnancy to the term, they delivered small for date, i.e., intrauterine growth retarded (IUGR) babies significantly more often than older women. Mean birth weight, length, head circumference and chest circumference of full term neonates of young mothers was significantly lower which is in accordance with earlier reports(5,6). Maternal age, weight and hemoglobin concentration had significant effect on neo-natal maturity while only maternal weight and hemoglobin concentration had significant effect on birth weight. Higher proportion of girls in study group were <45 Kg weight and had hemoglobin concentration of <9 g/dL which probably contributed to higher frequency of premature labor and lower birth weight of babies in this group. These observations may not be true for teenage pregnancies which do not have access to desirable level of medical care. Additionally the sample size is also small. Acknowledgement Authors wish to express thanks to Dr Sulochana Suley, Medical Officer In-charge and the staff of ‘Sutika Grih & Shishu Kalyan Kendra’ Wright Town Jabalpur for their help in data collection and to Mr. M.P. Singh, statistician, RMRCT, Jabalpur for help in data analysis. Contributors: Data was collected and compiled by MKM as part of his thesis for MD (Pediatrics). Study was planned by VKB, MC and SK. Manuscript was written by VKB and MKM and it was crticially reviewed by MC and SK. VKB shall act as gurantor. Funding: None stated. Competing interests: None.
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