Abstract:
Background: Adolescent girls between 15 and 19 years give birth to around 16 million babies each year, around
11% of births worldwide. We sought to determine whether adolescent mothers are at higher risk of maternal and
perinatal adverse outcomes compared with mothers aged 20–24 years in a prospective, population-based
observational study of newborn outcomes in low resource settings.
Methods: We undertook a prospective, population-based multi-country research study of all pregnant women in
defined geographic areas across 7 sites in six low-middle income countries (Kenya, Zambia, India, Pakistan,
Guatemala and Argentina). The study population for this analysis was restricted to women aged 24 years or less,
who gave birth to infants of at least 20 weeks’ gestation and 500g or more. We compared adverse pregnancy
maternal and perinatal outcomes among pregnant adolescents 15-19 years, <15 years, and adults 20-24 years.
Results: A total of 269,273 women were enrolled from January 2010 to December 2013. Of all pregnancies 11.9%
(32,097/269,273) were in adolescents 15-19 years, while 0.14% (370/269,273) occurred among girls <15 years.
Pregnancy among adolescents 15-19 years ranged from 2% in Pakistan to 26% in Argentina, and adolescent
pregnancies <15 year were only observed in sub-Saharan Africa and Latin America. Compared to adults,
adolescents did not show increased risk of maternal adverse outcomes. Risks of preterm birth and LBW were
significantly higher among both early and older adolescents, with the highest risks observed in the <15 years
group. Neonatal and perinatal mortality followed a similar trend in sub-Saharan Africa and Latin America, with the
highest risk in early adolescents, although the differences in this age group were not significant. However, in South
Asia the risks of neonatal and perinatal death were not different among adolescents 15-19 years compared to
adults.
Conclusions: This study suggests that pregnancy among adolescents is not associated with worse maternal
outcomes, but is associated with worse perinatal outcomes, particularly in younger adolescents. However, this may
not be the case in regions like South Asia where there are decreasing rates of adolescent pregnancies,
concentrated among older adolescents. The increased risks observed among adolescents seems more likely to be
associated with biological immaturity, than with socio-economic factors, inadequate antenatal or delivery care.
