Mode of Delivery and Neonatal Outcome in Adolescent Pregnancy (13–16 Years Old) Associated with Anemia

Abstract

Background: Adolescent pregnancy represents an important public-health problem due to its maternal and fetal outcomes. Adolescent patients are predisposed to multiple obstetrical complications, including anemia and preterm birth which has a higher incidence among this population; withal, in the specialty literature, anemia is considered to be a risk factor for preterm delivery; furthermore, multiple studies have demonstrated that a very young age is an independent risk factor for preterm birth. Objectives: The study aims to reveal if anemia during adolescent pregnancy has a negative impact on the time and mode of delivery and newborns’ outcomes. Patients and methods: We performed a retrospective multicentric study on adolescent pregnancy. We analyzed 172 patients aged between 13 and 16 years who delivered in two large tertiary hospitals between 1 October 2018 and 15 April 2022. We divided the patients into two groups—a study group (n = 64) with anemia and a control group (n = 108) without anemia. We evaluated the modes of delivery, the times of birth, and the neonatal outcomes by 1-min newborn’s Apgar score, neonatal intensive-care unit (NICU) admission, and the newborns’ weights. Results: The rate of cesarean section was higher in patients with anemia than in the control group (45.31% vs. 38.88%, p < 0.001). We found that patients between 13 and 16 years diagnosed with anemia have a higher risk of preterm birth than those without anemia (35.93% vs. 21.29%, p < 0.001); however, an increased rate of LBW neonates was observed in the anemic adolescent group ≤14 years (p < 0.001). Regarding the newborns’ 1-min Apgar score, NICU admission, no statistically significant differences were recorded between the two groups according to the severity of anemia. In the anemic patients’ group, prenatal screening was identified in 9.37% of cases, while in the control group, in 16.67% (p = 0.034), which represents negative predictive factors, along with a low socio-economic status for the presence of anemia in young adolescent patients. Conclusions: Anemia is a risk factor for preterm birth, LBW, and cesarean section in young adolescent pregnancy. The association of lack of prenatal care and low socio-economic status worsens maternal and neonatal outcomes.

Determinants of anemia level among reproductive-age women in 29 Sub-Saharan African countries: A multilevel mixed-effects modelling with ordered logistic regression analysis

“…Moreover, gestational anemia results in an increased risk of antepartum, intrapartum, and postpartum maternal hemorrhage [ 12 – 14 ] and subsequent blood transfusions [ 5 , 6 , 13 – 15 ], pregnancy-induced hypertension [ 5 , 13 ], prolonged and induced labor [ 13 ], cesarean birth [ 3 – 6 , 13 ], puerperal infections [ 15 ], maternal shock, longer hospitalization and critical care admission [ 5 ], and mortality [ 7 , 8 , 12 , 16 , 17 ]. Likewise, the risk of poor neonatal outcomes such as low birth weight [ 3 , 4 , 13 , 16 ], small-for-gestational-age [ 3 , 5 , 13 ], preterm birth [ 3 , 4 , 6 , 12 , 13 ], low Apgar score [ 3 , 5 , 6 ], stillbirth [ 12 , 13 ], and neonatal and perinatal mortality [ 5 , 13 , 16 ] is higher among neonates and children born to anemic mothers. In addition, low maternal hemoglobin level during pregnancy was also found to increase the risk of placenta previa [ 5 ] and abruption, fetal malformation, growth restriction [ 12 ], and neonatal admission [ 6 , 14 ].…”

Anemia del tercer trimestre como factor asociado a resultados materno-perinatales adversos en gestantes adolescentes. Instituto Nacional Materno Perinatal, 2020-2021

“…Además, se asoció a la hemorragia postparto, parto por cesárea, oligohidramnios y trastorno hipertensivo del embarazo, resultado, en la mayoría de casos, de la relajación de la fibra muscular del útero por hipoxia secundaria a los niveles bajos de hemoglobina. La evidencia disponible coincide con dichos resultados, al respecto Uzunov et al 18 identificaron asociación entre anemia y el parto por cesárea (p= 0.001), así también Basbug y Sonmez 20 refirieron asociación con trastornos hipertensivos (p = 0.01) mientras Yilmaz et al 21 evidenciaron asociación significativa entre anemia y hemorragia postparto (p= 0.003). Ver en tabla 8.…”

“…Uzunov et al 18 , respaldaron estos hallazgos, pues identificaron relación significativa entre anemia y prematuridad (p<0.001), además de bajo peso al nacimiento (p<0.001). Perez 23 también determinó relación entre anemia y prematuridad (p = 0.007).…”

“…Uzunov et al 18 , 2022, realizaron un estudio "Mode of Delivery and Neonatal Outcome in Adolescent Pregnancy Associated with Anemia" en el cual su objetivo fue investigar los resultados neonatales en gestantes adolescentes con anemia. En materiales y métodos, la metodología de estudio fue analítica, retrospectiva y la población estuvo conformada por 172 mujeres embarazadas.…”

“…Ficha de recolección de datos. Arango-Ochante et al 14 Lugo 17 Uzunov et al 18 Gyimah et al 19 Yilmaz et al 21 Pinho…”