Adverse obstetric and perinatal outcomes among Palestinian adolescent mothers in the West Bank: a retrospective cohort study

TL;DR

This study finds that Palestinian adolescent mothers in the West Bank face higher risks of preterm birth and low birth weight compared to older mothers.

Contribution

The study provides region-specific evidence on the increased risk of adverse outcomes in adolescent pregnancies in the occupied Palestinian territory.

Findings

Adolescent mothers had a higher risk of preterm birth and low birth weight babies.

Adolescent primiparous mothers were less likely to deliver via cesarean section but had higher fetal malpresentation rates.

No significant differences were found in gestational diabetes or other major complications between age groups.

Abstract

It is estimated that 13% of adolescent girls globally give birth before the age of 18. Several studies have shown that pre-eclampsia, eclampsia, puerperal infections, preterm birth, low birth weight, and neonatal death are more common in adolescent mothers than in adult mothers. This study aimed to investigate whether adolescent pregnancy increases the risk of adverse obstetric and perinatal outcomes compared with pregnancies among women aged 20–35 years in the West Bank, occupied Palestinian territory.

A retrospective cohort study utilizing data extracted from the electronic health information system database. The study population comprised 11,189 women who gave birth in three governmental hospitals in the West Bank during the year 2022, of whom 762 (6.8%) were aged ≤19 years. Differences between the two age groups were analyzed using chi-square test (χ2) for categorical variables and independent student test for continuous variables. Multiple logistic regression and sensitivity analyses were performed to adjust for confounders and to examine the association between the adolescent age group and adverse obstetric and perinatal outcomes.

Most adolescent mothers were primiparous (82.2%) and had a singleton pregnancy (98.2%). Adolescent mothers were more likely to experience preterm birth (aOR 1.568, CI 95% 1.262–1.949, p < 0.001) and low birth weight (aOR 1.657, CI 1.327–2.068, p < 0.001). Low Apgar score at first minute was demonstrated among primiparous adolescents (aOR 1.774, CI 1.149–2.737, p = 0.01). While adolescent primiparous mothers were less likely to deliver by cesarean section compared to older mothers (aOR 0.270, CI 0.212–0.342, p = 0.00), fetal malpresentation as an indication for cesarean section was higher among adolescents (aOR 2.150, CI 1.329–3.479, p = 0.002). No significant differences were observed between the two age groups in terms of gestational diabetes, hypertensive disorders, antepartum or postpartum hemorrhage, blood transfusion, induction of labor, instrumental delivery, five-minute Apgar score, admission to neonatal intensive care unit, neonatal malformation, or stillbirth.

Adolescent pregnancies should be classified as high-risk given their association with multiple adverse obstetric and perinatal outcomes. These findings underscore the need for policymakers to strengthen preventive strategies and to ensure strict enforcement of the child marriage prohibition law.

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