Teenage Pregnancy Adverse Reproductive Outcomes Health And Social Care Essay

Teenage Pregnancy Adverse Reproductive Outcomes Health And Social Care Essay Teenage pregnancy is a critical public health issue in both the developing and developed world. It has been thought to have an intrinsic effect on the infant and maternal morbidity and mortality statistics worldwide. In its publication, the State of the Worlds Children report, UNICEF stated that worldwide over 500,00 women of all age groups die yearly and 70000 females aged 15-19 years would die during child birth [1] . Currently, evidence of causal hypothesis is conflicting and inconclusive as to whether adverse outcomes are the result of immaturity of the reproductive system or attributable to other socio-demographic characteristics of adolescents .A study demonstrated that majority of pregnant adolescents had no source of income and lacked health insurance [2] .Teenagers were also found to be more likely to be single, less educated and receive or attend insufficient antenatal care when compared with older mothers [3-5] . Fraser et al conducted a large population-based study which showed that pregnancy in adolescence was associated with an inherently increased risk for obstetric and neonatal outcomes [6] .However, some other studies demonstrated a lack of association attributing the outcome to social factors. This article aims to review, critically appraise, and synthesise evidence from original publications of observational studies on the relationship between teenage pregnancy and adverse reproductive outcomes. It focuses mainly on prematurity, low birth weight and route of delivery as there are a myriad of adverse birth outcomes-maternal: preeclampsia, anaemia, premature rupture of membranes (PROM), perineal tears, instrumental delivery, caesarean delivery and infant-related complications: prematurity, low birth weight, intrauterine growth restriction, small for gestational age, perinatal morbidity- attributable to teenage pregnancy and there is strict limitation on the article word count. Methodology: literature search and selection of studies A literature search on teenage pregnancy and adverse reproductive outcomes of primary studies published in the last 10 years was carried out .Included studies were journal articles published in the English language-this limitation confers some degree of bias to the review. Epidemiological evidence for this review is defined as observational studies- cross-sectional surveys, case-control studies, retrospective cohort studies and prospective cohort studies. Database searching of Medline (U.S. National Library of Medicine, Bethesda, Maryland) and Embase (Elsevier) was conducted using the following keyword phrases and related terms as search terms teenage pregnancy or pregnancies, adolescent pregnancy or pregnancies and pregnancy outcome, adverse reproductive outcomes and related terms(refer appendix 1). The Medline search yielded 110 articles but reviewing the abstracts showed only few of the studies met the inclusion criteria or were readily available online or in print. A similar search conducted on the Embase database yielded less promising results. Additional journal articles were located by reviewing cited references and citation tracking of some of the selected studies. The related article or similar article feature of some journals was used to identify similar studies and their abstracts were reviewed to check if they met the selection criteria. Case studies, case reports, editorials, and reviews were excluded from the search. Selection criteria To be included in this review, the selected studies had to meet the following criteria: -teenage pregnancy is defined as pregnancy in young women under 20 years -women above 35 years old were either excluded from or treated as an independent category in the study as they are known to have high obstetric risks -must demonstrate some statistical description and /or analysis of confounding variables in the association between teenage pregnancy and adverse reproductive outcomes -should have some comparative element in which teenagers are compared with a suitable reference category -outcome measures include at least two of the following: prematurity preterm delivery, Caesarean section (CS), low birth weight (LBW), infant mortality, neonatal mortality, perinatal mortality, maternal mortality, severe anaemia, preeclampsia and eclampsia -a significance assessment can be made either by using p-values or confidence intervals Table 1:Characteristics of selected studies Authors Publication year(Study period) Setting Study design Sample size Age of teenage subjects(years) Outcome measures of interest Confounding variables considered Other study characteristics Ekwo and Moawad [3] 2000(1989-1995) U.S.A Hospital based retrospective cohort 6,072 3 groups-=15,16-17,18-19 20-24 as reference group Preterm birth, low birth weight Maternal smoking, drug abuse, insurance status, adequacy of prenatal care, median family income, marital status Primaparous black women , singleton pregnancies Bukulmez et al [7] 2000(1990-1998) Turkey Hospital-based matched case-control study 4,470(1,490 cases,3980 controls) Cases:15-19 controls:20-34 stratified during analysis as =17,18-19,20-34 Low birth weight, preterm delivery, pregnancy induced hypertension(preeclampsia, eclampsia),LBW, Antenatal care, gravidity, parity, Singleton pregnancies, subjects matched on marital status, socioeconomic class and ethnicity-white married women of high social status Jolly et al [4] 2000(1988-1997) United Kingdom Hospital based retrospective cohort 341,708