6. that teenagers were 1.46 and 2.8 times more

 

6. Discussion

This
is a preliminary study which has focused on the adverse obstetric and perinatal
outcomes of teenage and adult pregnancy. There were many conflicting results
from previously done studies in different parts of the world and there is lack
of data in sub-Saharan African countries including Ethiopia. So we aimed to
analyses the effect of teenage pregnancy on obstetric and perinatal outcomes in
comparison with adult pregnancy. In this study low birth weight, preterm
delivery and sever neonatal conditions were significantly associated with
teenage pregnancy but fetal distress and still birth/intrauterine fetal death
were not significantly associated with teenage pregnancy i.e. there were no
significance difference between teenage and adult delivery. Regarding to the
obstetric outcomes pregnancy induced hypertension, episiotomy and post term
delivery were significantly associated with teenagers but antepartum
hemorrhage, postpartum hemorrhage, instrumental delivery, and perineal tear
were not significantly associated with teenage pregnancy which means there were
no statistically significant difference in between the two age groups.

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This
study result shows that 17.5 % of the teenagers deliver low birth weight and
6.8 % of the adults deliver low birth weight neonate. After adjusting to
different confounding factors teenagers were 2.07 times more likely to deliver
low birth weight neonate than the adult mothers (AOR: 2.07; 95% CI, 1.03-4.17). This study
is congruent with study done in north India, which shows the occurrence of low
birth weight was 1.6 times more likely to be delivered from teenagers than
adults and study done in Nepal teenage gave low birth weight ( 24% Vs 7%, p=0.013)(21) (27). Likewise
cohort and cross sectional study conducted in Cameron in different years
revealed that teenagers were 1.46 and 2.8 times more likely to deliver low
birth weight neonates than the adult mothers respectively. Moreover study in
Egypt also reports that teenage deliver low birth weight (25.1 Vs 19.3%, p=0.001)
(19) (29) (30). These almost nearly
the same results of low birth weight outcomes might be due to the anatomical
immaturity and continued growth of the teenagers may represent the biological
growth barrier to their fetus and the low socio-economic status, low level of
education in teenagers put them to give low birth weight neonate more than
adult mothers. Nevertheless this finding is contradicted by studies done in Yaoundé
central hospital, Cameron (p=0.42) and South Africa (0.174) showed low birth
weight had no significant association with maternal age (6) (31). This might be
probably due to the socio-economic difference, study area setting and
difference in sample size

Concerning
to the preterm delivery this study result show that teenagers were 2.92 times
more likely to deliver prematurely than the adult mothers(AOR: 2.92; 95% CI, 1.48-5.75). The same
finding were observed studies done at India, Turkey ,Taiwan ,Korea and
retrospective case study in Cameron, WHO, cohort study done in Cameron revealed
that 1.65,2.7,1.58,2.47,1.85,1.60 times more likely teenagers experience
delivery of premature neonates than the adult mothers respectively (10),(21), (22),(23),(17),(29),(30). Furthermore
similar finding was reported from 
studies conducted in USA and Sweden (24) (26). The possible
reason for this might be teenagers are more liable to psychological instability/stress
because of the pregnancy and low level of education which triggers labour.
Furthermore this stress imposes the endocrine disturbance and the immaturity of
the uterine/cervical blood supply in teenagers stimulates prostaglandin
production which leads to preterm delivery. Despite our finding, studies done
in Sweden (AOR 1.03, 95% CI; 0.98-1.09) and South Africa (p=0.702) showed that
there were no significance difference in preterm deliveries between the two age
groups (26), (31). This might be
due to quality of ANC, nutritional conditions.

Sever
neonatal condition in this study depicted that teenagers were 2.6 times more
likely to had sever neonatal conditions than the adult mothers (AOR: 2.6; 95% CI, 1.08-6.28 ). This
result was congruent with institutional based cross sectional study conducted
by world health organization which shows those teenagers were 1.56 times more
likely to had sever neonatal conditions than adult mothers(10). The possible
explanation might be socio-economic condition, health service utilization and
nutritional status of mothers especially for those teenagers.

This
study indicated there were significant difference between teenagers and adult
with regarding to the development of pregnancy induced hypertension. Teenagers
develop pregnancy induced hypertension 2.29 times more likely than the adult
mothers. (AOR: 2.29; 95% CI, 1.01-5.19).
Alongside to our finding study done in USA showed that there were significant
association of pregnancy induced hypertension with maternal age. Teenagers
develop PIH 1.34 times more likely than their counter age groups (24). This might be
attributed to the fact that null parity and age less than 20 years are the
possible risk factors for the development of pregnancy induced hypertension. However,
our finding was inconsistent with studies done in Pakistan (p>0.05 and
Ankara, Turkey (p=0.31) which revealed that as there were no significant
association of PIH with teenagers and adults(28)(32). This variation
might be explained by the environmental factors and socio-economic variation.
In addition to these the variation might be due to difference in health care
service utilization, preconception care especially folic acid supplementation.
The study time gap between the studies may also put the difference that
probably PIH had seasonal variation.

Regarding
cesarean delivery teenagers were 47% less likely to deliver by cesarean section
than adult mothers (AOR: 0.53; 95% CI,
0.333-0.847). This study nearly had the same finding with studies done in
Sweden and USA which was their finding was 40%, 51% less likely that teenagers
undergo cesarean delivery (AOR: 0.49;
95% CI, 0.42-0.59) and (AOR: 0.60;
95% CI, 0.58-0.64) respectively (24), (26). Another
study done in Ankara, Turkey also showed that teenagers were 36 % less like to
undergo cesarean delivery than adults (AOR: 0.64; 95% CI, 0.64-0.89) (28). The possible explanation for this might be
due to the awareness difference between the two age groups about
cesarean section and teenagers are more favored to vaginal delivery due to
better myometrium function. Lastly it could be also the small size or birth
weight of the neonate from teenagers break the widely held belief that
teenagers are prone to CPD but not in the ground. However this study finding
has contradiction with three studies done in Cameron which was conducted at
different time. All these studies declare that cesarean delivery had no any
significant association with maternal age. Both teenagers and adults undergo
cesarean delivery without any significant difference (6),(29), (30). This variation
might be due to difference in decision making ability of the two age groups and
study area setting

In
this study episiotomy was done about 2 times more likely on teenagers than
adults. Similar to our finding studies done in Romania (p