Adolescent pregnancy, nutrition, and health outcomes in low‐ and middle‐income countries: what we know and what we don't know

Adolescents may be particularly susceptible to malnutrition owing to the energy and nutrient costs of the pubertal growth spurt. Here, our aim is to compare differences in selected markers of nutritional status between adolescents and adults in rural Gambia. The Keneba Biobank collects cross‐sectional data and samples for all consenting individuals resident in the West Kiang region of the Gambia. For this study, participants between the ages of 10 and 40 years were selected (n = 4201, females 2447). Height, body mass index, body composition, hemoglobin concentration, fasting glucose concentration, and blood pressure were compared using linear regression models adjusting for age, parity, season of measurement, and residence, across three age groups: early adolescent (10–14.9 years), late adolescent (15–19.9 years), and adult (20–39.9 years). Adolescents, particularly early‐adolescent girls and boys, were shorter, lighter, and leaner than adults. By late adolescence, differences were smaller, particularly in girls where, notably, the prevalence of overweight, hypertension, and impaired fasting glucose was low. Given the importance of maternal health for reproductive outcomes and intergenerational health, the results of the study, albeit with limited biomarkers available, indicate that adolescent girls are no more compromised than adult women or males from the same population.

Section: Discussionmentioning

confidence: 70%

“…In sub‐Saharan Africa, 30–35% of the population are aged 10–24 years . Adolescent growth and timing of puberty are important determinants of adult and intergenerational health and noncommunicable disease risk . Clearly, at a time of rapid growth, the energy and nutrient requirements of an individual increase substantially.…”

Section: Introductionmentioning

confidence: 99%

In rural Gambia, do adolescents have increased nutritional vulnerability compared with adults?

Schoenbuchner

Moore

Johnson

et al. 2018

“…2 There are increased risks for both mother and newborn associated with early child bearing; in 2017, pregnancy and childbirth complications are the second leading cause of death among 15-to 19-year-old girls. 3 Adolescence is a critical time for growth and development when one's nutritional requirements increase significantly to support rapid growth. 4 Similarly, pregnancy is a physiologic state that triggers an increase in nutritional requirements that are essential to support the rapid growth and development of the fetus.…”

Section: Challenges Of Pregnancy During Adolescence In the Developingmentioning

confidence: 99%

“…17 There is emerging agreement that nutrition support is necessary to improve the health of vulnerable women, as well as an escalating consensus that this process begins in adolescence. [3][4][5] This study aims to provide a better understanding and to improve nutritional interventions for adolescent pregnant women. The aim of the following analyses is twofold: to determine whether the effects of treatment on adolescent mothers in the Mamachiponde study differ between the three treatment groups and to determine whether there are differing effects of treatment after pooling all adolescents and stratifying by age.…”

Section: Challenges Of Pregnancy During Adolescence In the Developingmentioning

confidence: 99%

Adolescent pregnancy and nutrition: a subgroup analysis from the Mamachiponde study in Malawi

Friebert

Callaghan-Gillespie

Papathakis

et al. 2017

Young age at childbearing (ࣘ19 years) is common and associated with poor birth outcomes. A trial among Malawian pregnant women with moderate malnutrition was used to determine outcomes of young adolescents (ࣘ18 years), older adolescents (18-20 years), and adults (>20 years). Women received one of three supplementary foods that provided ß900 kcal/day and 33-36 g protein/day and returned every 2 weeks. Newborn/maternal measurements were taken at delivery and after 6 and 12 weeks. Upon enrollment, adolescents had greater body mass index than adults (19.9 ± 1.3 versus 19.5 ± 1.4 kg/m 2 , P < 0.001). Young adolescents received more rations of food and enrolled and delivered with a lower fundal height than adults (21.7 ± 5.2 versus 23.0 ± 5.6, P = 0.00 enrollment; 30.2 ± 3.1 versus 31.0 ± 2.8, P < 0.001 delivery). Among newborns, length for age was lowest in young adolescents, greater in older adolescents, and greatest in adults (Z-scores -1.7 ± 1.2, -1.4 ± 1.2, and -1.1 ± 1.1, respectively; P < 0.001). These differences persisted in length for age at 6 and 12 weeks of age for infants. Adolescents enrolled earlier in pregnancy and appeared more nutritionally adequate than adults; adolescent outcomes were inferior to those of adults, suggesting that they were subject to more physiologic stressors and/or different nutritional needs.

“…Pregnancy at an early age is also associated with a number of adverse maternal and neonatal outcomes . Maternal short stature, often a consequence of childhood stunting, is consistently associated with lower infant birth weight . Inadequate gestational weight gain is associated with low birth weight (LBW) and SGA birth .…”

Section: Introductionmentioning

confidence: 99%

Delivering an action agenda for nutrition interventions addressing adolescent girls and young women: priorities for implementation and research

Bhutta

Lassi

Bergeron

et al. 2017

Adolescent nutritional behaviors are assuming considerable importance in nutrition interventions given their important relationships with medium-and long-term outcomes. This is the period when young people undergo major anatomical and physiological maturational changes in preparation for adulthood. Nutritional requirements during puberty are higher during adolescence than during the prepubertal stage and during adulthood. A significant proportion of adolescents also become parents, and hence the importance of their health and nutritional status before as well as during pregnancy has its impact on their own health, fetal well-being, and newborn health. In this paper, we describe the evidence-based nutrition recommendations and the current global guidance for nutrition actions for adolescents. Despite the limitations of available information, we believe that a range of interventions are feasible to address outcomes in this age group, although some would need to start earlier in childhood. We propose packages of preventive care and management comprising nutrition-specific and nutrition-sensitive interventions to address adolescent undernutrition, overnutrition, and micronutrient deficiencies. We discuss potential delivery platforms and strategies relevant to low-and middle-income countries. Beyond the evidence synthesis, there is a clear need to translate evidence into policy and for implementation of key recommendations and addressing knowledge gaps through prioritized research.