ORIGINAL

Niger J Paed 2013; 40 (3): 290 –294

Ogunlesi TA

Ayeni VA

Jagun EO

Socio-clinical factors related to the

perinatal outcome of teenage

pregnancies in a Nigerian teaching

hospital

Ogunfowora OB

DOI:http://dx.doi.org/10.4314/njp.v40i3,18

Accepted: 25th February 2013

Abstract Background: The

incidence of teenage pregnancies

is rising in most parts of the

world. This is associated with a

wide spectrum of complications in

the teenage mothers and their

infants.

Objective: To determine the social

and clinical factors related to

perinatal outcome of teenage

pregnancies.

Methods: A retrospective study of

mothers aged < 20years managed

at Olabisi Onabanjo University

Teaching Hospital, Sagamu

between 2008 and 2011 was done.

Mothers aged 20 years and above

were used as controls and

significantly higher proportions of

the cases had less than senior sec-

ondary education, were unmarried,

with relatively younger spouses

who were mainly unemployed or

employed as unskilled workers. In

addition, teenage mothers were

significantly more likely to have

preterm deliveries and babies with

1-minute Apgar scores <7. Still-

birth rate, early neonatal mortality

rate and hospitalization rate were

also higher among the cases. Poor

perinatal outcome was more com-

mon among the cases in the lower

socio-economic classes and those

with low education.

(

)

Ogunlesi TA

Ogunfowora OB, Ayeni VA

Department of Paediatrics,

Olabisi Onabanjo University Teaching

Hospital, Sagamu.

P. O. Box 652, Sagamu-121001,

Email: tinuade_ogunlesi@yahoo.co.uk

Jagun EO

Department of Obstetrics and

Gynaecology,

Olabisi Onabanjo University Teaching

Hospital, Sagamu.

Conclusion: Socio-economic

comparisons were made using

bivariate analysis.

factors are directly or indirectly

related to poor outcomes of teen-

age pregnancies.

Results: The prevalence of teen-

age pregnancies was 1.3%. The

mean age of the cases was 17.8

years (range of 16 - 19 years).

Compared to the controls,

Key words: Perinatal mortality,

Socio-economic factors, Stillbirth,

Teenage pregnancy

Introduction

been documented to contribute to social disadvantage

which ad₃versely affects morbidity among hospitalised

children. This observation may be related to poor

knowledge of teenage mothers about health and preven-

tion of diseases as well as poor utilisation of available

health services for socio-economic and cultural reasons.

Globally, teenage or school-age pregnancies have been a

matter of concern mainly because of the risks to the

health and well-being of underage mothers. These in-

clude the risks of pregnancy-related morbidities and

deaths. Equally important are the adverse social effects

of school-age pregnancies such as abrupt termination of

education, disruption of the family system and prema-

ture assumption of the duties and responsibilities of par-

enthood which school-age mothers are usually

1

Globally, perinatal and neonatal deaths contribute sig-

nificantly to childhood deaths and efforts are presently

directed at minimising perinatal and neonatal deaths as a

4

means of reducing childhood deaths. The risk of mor-

ill-prepared for.

There are suggestions that the prevalence of teenage

pregnancies may be on the increase in some parts of the

bidities and mortality in the products of teenage preg-

nancy may be directly related to poor care during preg-

nancy, unsupervised difficult deliveries and the associ-

ated complications and indirectly, to unfavourable social

circumstances of the teenage mothers. Several studies

have described the pattern of perinatal morbidities an₅_-d₇

mortality among the products of teenage pregnancies.

The survival of the products of teenage pregnancies ob-

viously depends on many factors related to the quality of

maternity services and neonatal services available to

pregnant teenagers. This is related to observations from

2

developed world. This trend may be explained in terms

of the declining age of menarche and increasing aware-

ness and knowledge of sexuality without commensurate

good use of contraception. The situation is expected to

be worse in the developing world. Beyond the concerns

for the health of the teenage mothers, there should also

be concerns for the survival and well-being of the prod-

ucts of teenage pregnancies. Teenage motherhood has

2

91

other studies that the accessibility and utilisation of

quality prenatal care and delivery servic₈es may be af-

fected by several socio-economic factors.

five teenage mothers and 50 mothers aged 20 years or

more were studied. Overall, there were 75 mothers and

78 babies; one of the cases and two of the controls had

multiple births.

The age of the cases ranged between 16 and 19 years

with a mean of 17.8 ± 1.3 years. Table 1 shows that

96.0% were nulliparous, 44.0% were unmarried and

44.0% had less than senior secondary education.

While efforts are going on to curb the trend of increas-

ing incidence of teenage pregnancies, it is equally im-

portant to ensure better survival of the products of teen-

age pregnancy. One important step towards this goal is a

study of the epidemiological factors which may influ-

ence the survival of the products of teenage pregnancies.

Therefore, this study aims to describe the social and

clinical factors affecting the perinatal outcome of teen-

age pregnancies in the locality.

Table 1: Socio-demographic characteristics of Teenage

Mothers

Characteristics

Frequency

Percentages

Age (years)

1

6

7

8

9

5

8

7

20.0

32.0

28.0

Methods

Education

The study was conducted at the Neonatal Ward and

Maternity Unit of the Olabisi Onabanjo University

Teaching Hospital, Sagamu between January 2008 and

December 2011. The hospital serves as a referral centre

for private and public primary and secondary health in-

stitutions in Ogun State and parts of the neighbouring

Lagos and Ondo states. Thus, women of all socioeco-

nomic background utilize the services in the hospital.

The subjects were parturient aged less than 20 years of

age and their babies. Purposive sampling was adopted

for the selection of cases while systematic random sam-

pling was used to recruit the controls. Thus, for every

teenage parturient, the next two parturient aged 20 years

and above with their babies were used as controls. The

hospital records of the subjects and their babies were

retrieved and studied.

Primary

10

1

40.0

4.0

Junior Secondary

Senior Secondary

12

2

48.0

8.0

Post-secondary

Parity

0

24

1

96.0

4.0

1

Marital status

Unmarried

Married

11

14

44.0

56.0

Characteristics of the spouses

The spouses of the cases were aged 21-30 years while

the spouses of the controls were aged 28-53 years. None

of the spouses in both groups were teenagers. Most of

the spouses of the cases (72%) were aged 20-24 years

compared with 8% of the controls (p < 0.001). The

mean age of the spouses of the cases was significantly

less than the mean age of the comparison group: 24.9 ±

The data obtained included the maternal age, parity,

marital status, details of prenatal care, details of delivery

care, obstetric complications, outcome of pregnancy and

the outcome of hospitalization of the babies. The highest

educational attainment and present occupation of the

parturient and their spouses were recorded. The socio-

economic status of each family was derived from the

2

.5 years Vs 36.4 ± 5.7 years; t = 9.6, p < 0.0001.

Occupation: Six (24%) of the spouses of cases were

skilled workers and professionals compared to 25 (50%)

of the spouses of the controls (p = 0.003).

9

education and occupation of both partners. The socio-

Socioeconomic status: Only three (12.0%) of the cases

compared with 19 (38.0%) of the controls belonged to

socioeconomic classes I to III. This difference was sta-

tistically significant (p = 0.02).

economic status of the subjects were classified into up-

per (classes I and II), middle (class III) and lower

(

classes IV and V). Poor perinatal outcome was defined

as the occurrence of still birth or early neonatal death.

The cases and the controls were compared for social and

clinical factors related to pregnancy outcome.

Comparison of cases and controls

The data were analyzed with SPSS version 17.0 using

descriptive and inferential statistical methods such as the

Student’s t-test and the Pearson’s Chi-square test. The p-

value less than 0.05 defined statistical significance (95%

confidence level).

Table 2 shows that significantly higher proportion of the

cases compared with the controls, had less than senior

secondary education (p = 0.029), were nulliparous (p <

0

.0001), unbooked for antenatal care (p = 0.001), had

morbidities (p = 0.005), had obstetric complications

p = 0.029) and presented in preterm labour (p = 0.004).

(

Twenty (80.0%) of the 25 cases compared to 20 (40.0%)

of the 50 controls presented with emergencies in labour

and following referral from other health facilities

Results

2

(

χ = 10.72; p = 0.001).

Out of a total of 1858 parturient, 25 were teenagers

giving a teenage pregnancy prevalence of 1.3%. Twenty

2

93

8

erty, poor knowledge about and poor access to₁contra-

ception and changes in societal values and norms.

While teenage pregnancies constituted between 5.2%

of maternity services as previously observed. Thus, the

poorer booking status for antenatal care, the higher fre-

quencies of pregnancy-related morbidities and obst₆e_,t₇r_,i₁c₇

complications among teenage mothers in this study

may be worse in the presence of poor socio-economic

statuses of the spouses and poor social supports

generally.

1

and 13% in Australia and USA, the prevalence rate

(

1.3%) obtained in the present study appeared unexpect-

edly low. We speculate that most cases of teenage preg-

nancy will not present in the Teaching Hospital unless it

becomes absolutely necessary due to the shame arising

from cultural disapproval of teenage pregnancy. This

obviously reflected in the finding that most of the cases

presented with emergencies in labour following referral

from other health facilities including the Traditional

Birth Homes. Therefore, a community-based study is

likely to yield a higher prevalence rate of teenage preg-

nancy in the locality. Nevertheless, the prevalence rate

of 1.3% was similar to 1.6% obtained from Enugu, east-

ern Nigeria but l₇o_,₁w₁er than 6.5% reported in Calabar,

The observed higher rate of preterm deliveries by teen-

age mothers compared to mothers in the olde₇r_,₁a₈ge group

was similar to previous reports from within

side the country.

and out-

5, 13, 19

This may be quite challenging in

the face of higher risks of morbidities and mortality as-

sociated with preterm infants compared to term infants.

This may even be more daunting in the developing

world where the infrastructural supports required for the

care of very₂₀preterm infants may be unavailable or very

expensive. The implication of this is that the increas-

ing prevalence of teenage pregnancies may be a cogent

reason for policy makers to increase the funding of the

health sector including the provision of well-eq₂₁uipped

neonatal intensive care units as earlier suggested.

southern Nigeria.

In India, the prevalence of teenage

5

pregnancy was 4.1%. The observed differences may be

attributed to diversity in the populations studied. Spe-

cifically, the present study was hospital-based and may

not be truly representative of the incidence of teenage

pregnancy in the community. Nevertheless, it is still a

cause for concern that girls who should still be in school

get pregnant when they are physiologically, anatomi-

cally and emotionally ill-prepared for motherhood.

Stillbirth rates, perinatal mortality rates and neonatal

mortality rates were higher among the infants of teenage

7

,

m₁₃_,o₁t₉hers in the present study similar to previous reports.

This observation is challenging since the reduction

of perinatal and neonatal mortality rates had been identi-

fied to be crucial to the reduction of childhood deaths as

desired according to the tenets of the Fourth₄_,₂M₂ illennium

The mean age of the teenagers studied was 17.8 years,

similar to mean ages of 17.0 ye₁₂a_,rs₁₃ and 17.4 years re-

ported in South Africa and Iran

but slightly higher

Development Goals as earlier suggested.

One step

7

than 16.7 years for the Enugu population. Interestingly,

the Sagamu population of teenage mothers were rela-

tively older (16 to 19 years) compared to the compara-

tive groups (13 to 18 years).

towards achieving this goal is the improvement of the

quality of obstetric and neonatal care available, particu-

larly to teenage mothers. Given the peculiarities of the

developing world, where pregnant teenagers may not

access orthodox health services for reasons of guilt,

shame and loss of self esteem, the role of social and wel-

fare workers is crucial to satisfactory utilization of qual-

ity antenatal care and delivery services. Early identifica-

tion and referral of teenage pregnancies to higher levels

of health care may ensure better care in pregnancy with

remarkable reduction in perinatal and neonatal losses.

It is remarkable that 44% of the Sagamu population of

teenage mothers were unmarried in consonance with

previous₄reports from Ilesha, another western Nigeria

1

setting. This observation may be related to previous

reports that teenage pregna₄ncies were often described as

1

"

accidental or a mistake". This is not unexpected since

the school age is characterised by increasing sexual

awareness, sexuality and the tendencies to experiment

with sexuality₅without taking precautions in terms of

As observed in the present study, all the teenage mothers

with poor perinatal outcome were poorly educated and

belonged to the lowermost socioeconomic classes. Simi-

larly, babies of teenage mothers, whose care givers de-

clined hospitalization, belonged to mothers who were

unmarried, poorly educated with unemployed spouses.

This may be related to the poor finances of the spouses

and the need to minimize expenses. Low socioeconomic

status, and perhaps associated parental conflicts, had

been identified as one of the reasons why ill children

may be prematurel₂y₃discharged from the hospital in this

part of the world. Similarly, the previous report from

Ilesha identified paternity denial and inter-family con-

flicts as some of the social problems affect₁i₄ng the care

of the products of school age pregnancies. Therefore,

there may be need for legislations to ensure that health

care for pregnant teenagers and their infants are pro-

vided free of charge. This may be helpful in improving

the outcome of teenage pregnancies in this part of the

world.

1

contraception. This is supported by the observation in

this study that, most of the teenage mothers had less

than senior secondary education or had spent less than

ten years in basic education. This might have been ac-

centuated by factors like dislike for school, persistent

instabilities in school calendars, poor family back-

ground,₆unhappy childhood and low expectations for the

1

future. On the other hand, the Enugu population of

7

teenage mothers were mostly married, suggesting prob-

able cultural approval of early marriage, if need be, in

that part of the country.

Most of the spouses in the present study were age₄ d 20 to

1

2

4 years unlike in the earlier report from Ilesha, almost

three decades ago, where most of the spouses were also

teenagers. In spite of higher age of the spouses in the

present study, most of them belonged to the lower socio-

economic classes (IV and V), employed as unskilled

workers or unemployed. This may imply poor utilization

2

92

2

Table 2: Comparison of the socio-clinical profile of teenage

mothers and the controls

(53.8%) Vs 10/52 (19.2%); χ = 9.75; p = 0.002}. Simi-

larly, a significantly higher proportion of the infants of

the cases were small for gestational age (SGA) com-

Parameters

Cases (n=25)

Controls (n=50)

Statistics

pared with the infants of the controls (10/26 (38.5%) Vs

Education

Junior secondary

or less

Senior secondary

or more

2

8

/52 (15.4%); χ = 5.20; p = 0.023}. Apgar scores less

11 (44.0)

14 (56.0)

10 (20.0)

than 7 at 1 minute was recorded among 63.6% (14/22)

of the babies of the cases compared with 16.3% (8/49)

40.0 (80.0)

χ2 = 4.76; p

= 0.029

2

of the babies of the controls (χ = 15.89; p = 0.0006).

Parity

0

24 (96.0)

1 (4.0)

20 (40.0)

30 (60.0)

Hospitalization and its outcome

>

1

χ2 = 21.55; p

<

0.001

Hospitalization was significantly more frequent among

the infants of the cases compared with the infants of the

controls {8/22 (36.4%) Vs 6/49 (12.2%); χ = 5.58; p =

Booking status

Booked

Unbooked

6 (24.0)

19 (76.0)

32 (64.0)

18 (36.0)

2

χ2 = 10.66; p

= 0.001

0

.018}. In the case group, the indications for hospitaliza-

Morbidities*

Present

Absent

tion included prematurity with asphyxia (4; 50%), pre-

maturity with sepsis (1; 12.5%) asphyxia only (2;

25.0%) and prematurity only (1; 12.5%). Of these eight

infants recommended for hospitalization, three (37.5%)

declined hospitalization for reasons of financial con-

straints. These three infants belonged to mothers who

were unmarried, had only primary education and whose

spouses were unemployed. Two of the five hospitalized

babies (40.0%) died within 24 hours of hospitalization

from prematurity coexisting with asphyxia.

For the control group, the indications for hospitalization

included prematurity (2; 33.3%), asphyxia (2; 33.3%),

suspected cyanotic congenital heart disease (1; 16.7%)

and sepsis only (1; 16.7%). Of these six infants recom-

mended for hospitalization, none declined hospitaliza-

tion but one (16.7%) died from suspected cyanotic con-

gested heart disease within an hour of hospitalization.

The neonatal mortality rate for the cases was 2/22

10 (40.0)

15 (60.0)

6 (12.0)

44 (88.0)

χ2 = 7.78; p

0.005

=

Obstetric compli-

cations**

Present

22 (88.0)

3 (12.0)

32 (64.0)

18 (36.0)

Absent

χ2 = 4.76; p

= 0.029

Gestational age

(weeks)

<

37 weeks

11 (44.0)

14 (56.0)

7 (14.0)

43 (86.0)

>

37 weeks

χ2 = 8.22; p

= 0.004

Age of spouse

years)

0-24

(

2

18 (72.0)

7 (28.0)

4 (8.0)

>

25

46 (92.0)

χ2 = 32.93; p

< 0.001

Occupation of

spouse

Professionals/

Skilled

Unskilled/ Unem- 19 (76.0)

ployed

Socioeconomic

classes

6 (24.0)

25 (50.0)

(

the difference lacked statistical significance (χ with

9.1%) compared with 1/49 (2.0%) for the contro₂ls but

χ2 = 4.64; p

= 0.003

Yate’s correction = 0.515, p = 0.473).

I – III

IV – V

3 (12.0)

22 (88.0)

19 (38.0)

31 (62.0)

Overall, poor perinatal outcome was more frequent

among the cases (6/25; 24.0%) compared to the controls

χ2 = 5.43; p

=

0.02

Morbidities such as severe anaemia, hypertensive diseases, toxaemia

of pregnancy and eclampsia

*Obstetric complications such as obstructed labour, cord prolapse,

(

4/50; 8.0%) but without statistically significant differ-

*

2

ence (χ = 3.69; p = 0.055). All the cases with poor peri-

natal outcome compared with 84.2% of the cases with

good perinatal outcome belonged to classes IV and V

*

shoulder dystocia, antepartum haemorrhage, malpresentations,

chorioamnionitis and uterine rupture.

(

Fishers p = 0.55). Similarly, all the cases with poor

perinatal outcome had less than senior secondary educa-

tion while 12/19 (63.2%) of those with good perinatal

outcome had at least senior secondary education (Fishers

p = 0.014).

Outcome of pregnancies

One teenage mother and two of the older women had a

set of twin each. Thus, there were 26 babies in the case

group and 52 babies in the control group. The mean esti-

mated gestational age (EGA) of the cases was signifi-

cantly less than the mean EGA of the controls: 36.7 ±

3

cases had 22 (84.6%) live births and 4 (15.4%) still-

births while the controls had 49 (94.2%) live births and

.2 weeks Vs 38.5 ± 2.4 weeks; t = 2.73, p = 0.008. The

Discussion

There have been growing concerns about teenage preg-

nancy in most parts of the developed world. Incidence

rates of 43.7/1000 and 83.6/1000 have been reported in

3

birth compared with the controls but the difference was

not statistically significant (χ = 1.96; p = 0.161).

The mean birth weight of the infants of the cases was

(5.8%) stillbirths. The cases had a higher rate of still-

2

1

Australia and USA. In contrast, the i₁n₀cidence may be as

high as 143/1000 in parts of Africa. This may not be

surprising since the factors identified to encourage teen-

age pregnancies are more rampant in the developing

world. Some of these factors include high level of pov-

2

.4 ± 0.9kg compared with 2.9 ± 0.7kg for the infants of

the controls (t = 2.70, p = 0.009). A significantly higher

proportion of the infants of the cases had low birth

weight compared with the infants of the controls (14/26

2

94

Efforts to reduce the frequency of teenage pregnancy are

most desirable. At-risk groups should be identified by

school teachers and social support groups and appropri-

ate interventions should be applied. The interventions

may include financial empowerment, vocational training

and psychological supports, adoption of socio-cultural

norms aimed at reducing premature exploration of sexu-

ality and improved knowledge and access to safe contra-

ception. Such interventions hav₁e₆ been shown to reduce

the risk of teenage pregnancies.

Authors’ contribution

TAO conceived and designed the study, analyzed the

data and drafted the manuscript. VAA contributed to the

conception and design of the study. All the authors

contributed substantially to the intellectual contents of

the manuscript.

Conflict of Interest: None

Funding: None

Conclusion

Acknowledgement

The poorer perinatal and neonatal outcome of teenage

pregnancies remains a challenge to health providers in

the developing world. Socio-economic factors are di-

rectly or indirectly related to these poor outcomes. Fo-

cused interventional programmes as well as improved

quality and accessibility of health services are most de-

sirable in curbing the menace of foetal and neonatal

losses associated with teenage pregnancy.

The supports of Dr Wole Ogunrotimi, the nursing per-

sonnel attached to the Maternity Unit and the Neonatal

Ward of the OOUTH, Sagamu and Biodun Allison of

the Health Information Department of the OOUTH, Sa-

gamu are deeply appreciated.

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