Characteristics and adverse outcomes of Chinese adolescent pregnancies between 2012 and 2019

AbstractWe aimed to describe the characteristics of adolescent pregnancy, determine its effect on adverse maternal and perinatal outcomes and explore whether that association varies with gestational age with the goal of proposing specific recommendations for adolescent health in China. This study included 2,366,559 women aged 10–24 years who had singleton pregnancies between 2012 and 2019 at 438 hospitals. Adolescent pregnancy was defined as younger than 20 years of age. We used multivariable logistic regression to estimate the effects. Women aged 20–24 years served as the reference group in all analyses. The proportion of rural girls with adolescent pregnancies rebounded after 2015 even though common-law marriage in rural areas decreased. Higher risks of eclampsia (adjusted odds ratio (aOR) 1.87, 95% confidence interval (CI) 1.57 ~ 2.23), severe anaemia (aOR 1.18, 95% CI 1.09 ~ 1.28), maternal near miss (MNM; aOR 1.24, 95% CI 1.12 ~ 1.37), and small for gestational age (SGA; aOR 1.30, 95% CI 1.28 ~ 1.33) were observed when gestational age was > 37 weeks. Adolescent pregnancy was independently associated with increased risks of other perinatal outcomes. Further implementation of pregnancy prevention strategies and improved health care interventions are needed to reduce adolescent pregnancies and prevent adverse fertility outcomes among adolescent women in China at a time when adolescent fertility rate is rebounding.

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Characteristics and Adverse Outcomes of Chinese Adolescent Pregnancy Between 2012 and 2019: An Observational Study of 438 Health Facilities

10.21203/rs.3.rs-253568/v1 ◽

2021 ◽

Author(s):

Yanxia Xie ◽

Xiaodong Wang ◽

Yi Mu ◽

Zheng Liu ◽

Yanping Wang ◽

...

Keyword(s):

Adolescent Pregnancy ◽

Gestational Age ◽

Rural Areas ◽

Reference Group ◽

Perinatal Outcomes ◽

Severe Anaemia ◽

Adverse Outcomes ◽

Near Miss ◽

Adolescent Women ◽

Adolescent Fertility

Abstract We aimed to describes characteristic of adolescent pregnancy, determines its effect on adverse maternal and perinatal outcomes and explores whether that association varies with gestational age with the goal of proposing specific recommendations for adolescent health in China. 2,366,559 women aged 10-24 years who had singleton pregnancies between 2012 and 2019 from 438 hospitals were included in the study. Adolescent pregnancy was defined as younger than 20 years of age. We used multivariable logistic regression to estimate the effect. Women aged 20-24 years served as the reference group in all analyses. The proportion of rural girls with adolescent pregnancies rebounded after 2015 despite common-law marriage in rural areas have improved. Higher risks of eclampsia (adjusted odds ratio (aOR) 1.87, 95% confidence interval (CI) 1.57~2.23), severe anaemia (aOR 1.18, 95% CI 1.09~1.28), maternal near miss (aOR 1.24, 95% CI 1.12~1.37), and small-for-gestational-age (aOR 1.30, 95% CI 1.28~1.33) were observed when gestational age was > 37 weeks. Adolescent pregnancy was independently associated with increased risks of other perinatal outcomes. Further implementation of pregnancy prevention strategies and improved health care interventions are needed to reduce adolescent fertility and to avoid adverse fertility outcomes among adolescent women in China at a time when adolescent fertility is rebounding.

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Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

Journal of Clinical Medicine ◽

10.3390/jcm10040643 ◽

2021 ◽

Vol 10 (4) ◽

pp. 643

Author(s):

Veronica Giorgione ◽

Corey Briffa ◽

Carolina Di Fabrizio ◽

Rohan Bhate ◽

Asma Khalil

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Adverse Outcomes ◽

Chi Square ◽

Increased Risk ◽

Twin Pregnancies

Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally.

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Maternal Thinness and Obesity and Customized Fetal Weight Charts

Fetal Diagnosis and Therapy ◽

10.1159/000515251 ◽

2021 ◽

pp. 1-9

Author(s):

Nieves L. González González ◽

Enrique González Dávila ◽

Agustina González Martín ◽

Erika Padrón ◽

José Ángel García Hernández

Keyword(s):

At Risk ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Perinatal Outcomes ◽

Adverse Outcomes ◽

Analysis Of Covariance ◽

Large For Gestational Age ◽

Perinatal Morbidity ◽

Accurate Identification ◽

Cephalopelvic Disproportion

Objective: The aim of the study was to determine if customized fetal growth charts developed excluding obese and underweight mothers (CC(18.5–25)) are better than customized curves (CC) at identifying pregnancies at risk of perinatal morbidity. Material and Methods: Data from 20,331 infants were used to construct CC and from 11,604 for CC(18.5–25), after excluding the cases with abnormal maternal BMI. The 2 models were applied to 27,507 newborns and the perinatal outcomes were compared between large for gestational age (LGA) or small for gestational age (SGA) according to each model. Logistic regression was used to calculate the OR of outcomes by the group, with gestational age (GA) as covariable. The confidence intervals of pH were calculated by analysis of covariance. Results: The rate of cesarean and cephalopelvic disproportion (CPD) were higher in LGAonly by CC(18.5−25) than in LGAonly by CC. In SGAonly by CC(18.5−25), neonatal intensive care unit (NICU) and perinatal mortality rates were higher than in SGAonly by CC. Adverse outcomes rate was higher in LGAonly by CC(18.5−25) than in LGAonly by CC (21.6%; OR = 1.61, [1.34–193]) vs. (13.5%; OR = 0.84, [0.66–1.07]), and in SGA only by CC(18.5−25) than in SGAonly by CC (9.6%; OR = 1.62, [1.25–2.10] vs. 6.3%; OR = 1.18, [0.85–1.66]). Conclusion: The use of CC(18.5–25) allows a more accurate identification of LGA and SGA infants at risk of perinatal morbidity than conventional CC. This benefit increase and decrease, respectively, with GA.

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Female Reproductive Failures in Mouse Adolescent Pregnancy

10.21203/rs.3.rs-588305/v1 ◽

2021 ◽

Author(s):

Chen Yang ◽

Yue Li ◽

Hai-Yang Pan ◽

Meng-Yuan Li ◽

Ji-Min Pan ◽

...

Keyword(s):

Adolescent Pregnancy ◽

Embryo Implantation ◽

Multiple Pregnancy ◽

Perinatal Outcomes ◽

Mature Female ◽

Placental Development ◽

Adolescent Pregnancies ◽

Multiple Abnormalities

Abstract Background: There are around 300 million adolescent pregnancies worldwide, accounting for 11% of all births worldwide. Accumulating evidence demonstrates that many adverse perinatal outcomes are associated with adolescent pregnancies. However, how and why these abnormalities occur remain to be defined. Methods: To compare uterine maturity, implantation, decidualization and placental development between 25-30 days old and 3 months old mature female CD-1 strain mice. Both in vivo mouse pregnancy and in vitro cell culture were used. Western blot, real time RT-PCR, immunostaining and immunofluorescence were used to study the progress of pregnancy during two groups.Results: We found the litter size of adolescent pregnancy is significantly decreased from F1 to F3 generations compared to mature pregnancy. On days 8 and 12 of pregnancy, multiple abnormalities in placental and decidual developments appear in F3 adolescent pregnancy. On days 5 and 8, uterine endoplasmic reticulum stress is dysregulated compared to mature pregnancy. Embryo implantation and decidualization are also compromised in adolescent pregnancy. Many genes are abnormally expressed in adolescent estrous uteri. Conclusion: The uterine immaturities and abnormal implantation may cause multiple pregnancy failures in adolescent pregnancy.

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Perinatal outcomes in adolescent pregnancy

Journal of Chitwan Medical College ◽

10.3126/jcmc.v8i2.23734 ◽

2018 ◽

Vol 8 (2) ◽

pp. 27-31

Author(s):

Yam Prasad Dwa ◽

Sunita Bhandari ◽

Devendra Shrestha ◽

Ajaya Kumar Dhakal

Keyword(s):

Adolescent Pregnancy ◽

Perinatal Asphyxia ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Breech Presentation ◽

Fetal Distress ◽

Neonatal Deaths ◽

Medical College ◽

Adolescent Women ◽

Pregnant Adolescent

Introduction: Adolescent pregnancy is prevalent in Nepal and bears significant consequences to both mother and newborn. Methods: All pregnant women aged 19 years or less who were admitted for delivery at KIST Medical College during 14th April 2017 to 15th July 2018 were included in this study. Maternal and immediate neonatal outcomes were analyzed retrospectively from their medical records. Results: There were 135 pregnant adolescent women out of 1300 deliveries. Preeclampsia was observed in 2 pregnancies. Vaginal delivery (99; 73.3%) was the predominant mode of delivery. Emergency LS CS was performed in 35 (25.9%) deliveries and most frequent indications for LS CS were nonprogress of labor (8/35), breech presentation (8/35) and fetal distress (6/35). 10 (7.4%) babies were born preterm. 23 (17%) babies were born low birth weight. 37 (27.4%) neonates were symptomatic and required neonatal admission. Respiratory distress was the most frequent neonatal problem (29; 21.5%), followed by neonatal sepsis (18; 13.3%) and perinatal asphyxia (9; 6.7%). There were 3 (2.2%) still birth and 2 (1.5%) early neonatal deaths. Conclusion: Adolescent pregnancy was common and associated with increased early neonatal problems.

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The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China

10.21203/rs.2.17282/v2 ◽

2020 ◽

Author(s):

Ting Zhang ◽

Huien Wang ◽

Xinling Wang ◽

Yue Yang ◽

Yingkui Zhang ◽

...

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Adolescent Pregnancy ◽

Pregnancy Outcomes ◽

Neonatal Death ◽

Perinatal Outcomes ◽

Hebei Province ◽

Adolescent Group ◽

Adolescent Women ◽

Adverse Pregnancy

Abstract Background The adverse pregnancy outcomes caused by teenage pregnancy are major public health problems with significant social impact, especially in developing countries. While China is the most populous country in the world, and 8.5% of the women aged 10-50 years are adolescent women, we aimed to analyze the adverse maternal and perinatal outcomes of the adolescent pregnant women in Hebei Province, China.Methods There were 238,598 singleton pregnant women aged 10-34 years from January 1, 2013 to December 31, 2017 in the database of Hebei Province Maternal Near Miss Surveillance System (HBMNMSS). The 238,598 pregnant women were divided into two groups: adolescent group (aged 10-19 years) and adult group (aged 20-34 years), the adolescent group was divided into two subgroups (aged 10-17 years, aged 18-19 years). The information that was collected included sociodemographic characteristics, obstetric history, place and mode of delivery, pregnancy outcome, complications during pregnancy. We compared the risk of adverse pregnancy outcomes between the two groups and two subgroups using univariate and multivariate Logistic regression. Results Compared with women aged 20-34 years, women aged 10-19 years had lower risk of cesarean delivery [adjusted risk ratio (aRR): 0.75, 95% confidence interval (CI): 0.70-0.80], gestational diabetes mellitus (GDM) (aRR: 0.55, 95% CI: 0.41-0.73). The women aged 10-19 years had higher risk of preterm birth (aRR: 1.76, 95% CI: 1.54-2.01), small for gestational age (SGA) (aRR: 1.19, 95% CI: 1.08-1.30), stillbirth (aRR: 2.58, 95% CI: 1.83-3.62), neonatal death (aRR: 2.63, 95% CI: 1.60-4.32). The adolescent women aged 10-17 years had significantly higher risk of stillbirth (aRR: 4.83, 95% CI: 2.86-8.14) and neonatal death (aRR: 6.35, 95% CI: 3.16-12.77) compared with the women aged 20-34 years, but there was no association with the risk of incidence of GDM (aRR: 1.03, 95% CI: 0.63-1.68) and SGA (aRR: 1.11, 95% CI: 0.89-1.39). Conclusions The adolescent pregnancy was related to adverse perinatal (fetal and neonatal) outcomes, such as preterm birth, stillbirth and neonatal death, especially in younger adolescent pregnancies (aged 10-17 years).

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Impact of adolescent age on maternal and neonatal outcomes in the Born in Bradford cohort

BMJ Open ◽

10.1136/bmjopen-2017-016258 ◽

2018 ◽

Vol 8 (3) ◽

pp. e016258 ◽

Cited By ~ 11

Author(s):

Katie Marvin-Dowle ◽

Karen Kilner ◽

Victoria Jane Burley ◽

Hora Soltani

Keyword(s):

Reference Group ◽

Adverse Outcomes ◽

Neonatal Outcomes ◽

Extremely Low Birth Weight ◽

Vulnerable Groups ◽

Royal Infirmary ◽

Large Hospital ◽

Adolescent Group ◽

Adolescent Women ◽

Maternal And Neonatal Outcomes

ObjectivesExplore associations between maternal and neonatal outcomes and maternal age, with particular reference to adolescent women.DesignPopulation-based cohort study.SettingMaternity department of a large hospital in Northern England.ParticipantsPrimiparous women delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 aged ≤19 years (n=640) or 20–34 years (n=3951). Subgroup analysis was performed using women aged ≤16 years (n=68). Women aged 20–34 years were used as the reference group.Primary outcome measuresMaternal and neonatal outcomes.ResultsThe odds of extremely low birth weight (<1000 g) were significantly higher in the adolescent group (≤19 years) compared with the reference group (adjusted OR (aOR) 4.13, 95% CI 1.41 to 12.11). The odds of very (<32 weeks) and extremely (<28 weeks) preterm delivery were also higher in the adolescent group (aOR 2.12, 95% CI 1.06 to 4.25 and aOR 5.06, 95% CI 1.23 to 20.78, respectively).Women in the adolescent group had lower odds of gestational diabetes (aOR 0.35, 95% CI 0.20 to 0.62), caesarean delivery (aOR 0.53, 95% CI 0.42 to 0.67 and instrumental delivery (aOR 0.53, 95% CI 0.41 to 0.67).ConclusionsThis study identifies important differences in maternal and neonatal outcomes between women by age group. These findings could help in identifying at-risk groups for additional support and tailored interventions to minimise the risk of adverse outcomes for these vulnerable groups. Further work is needed to identify the causal mechanisms linking age with outcomes in adolescent women where significant gaps in the literature exist.

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Based on the perceptions of community stakeholders, how can adolescent pregnancies be prevented? A qualitative study

F1000Research ◽

10.12688/f1000research.14220.1 ◽

2018 ◽

Vol 7 ◽

pp. 428

Author(s):

Sadudee Phuhongsai ◽

Somdej Pinitsoontorn

Keyword(s):

Public Health ◽

Adolescent Pregnancy ◽

Sex Education ◽

Sexual Behaviors ◽

Rural Areas ◽

Pregnancy Prevention ◽

District Health ◽

Community Stakeholders ◽

Adolescent Pregnancy Prevention ◽

Adolescent Pregnancies

Background: Adolescent pregnancy an important problem in adolescent health and government agencies need to focus on solving problem. The purpose of this research was to survey the perceptions of community stakeholders concerning the prevention of adolescent pregnancies in rural communities. Methods: Data collection was performed using group meetings with 103 stakeholders involved in adolescent pregnancy prevention. They were nurses, public health officials, parents or guardians, students, teachers, public health volunteers and community leaders. Thematic analysis indicated work on adolescent pregnancy prevention problems in rural areas was carried out by only some agencies such as district and sub-district health promoting hospitals, providing youth-friendly health service clinics and educating student leaders in schools on sex education. Results: Collectively, these results draw attention to the need for an appropriate program to strengthen adolescent, family and practitioner skills for the prevention of teenage pregnancies. Schools provide sex education as part of a health education curriculum, and some schools provide additional instruction in guidance classes. Problems from inconsistent work when networks fail were encountered. Stakeholders believe adolescent pregnancy prevention should focus on the following: (1) adolescents should receive training for skill development with content related to knowledge about sex, negotiation, refusal, morality and ethics, (2) teachers should receive training on comprehensive sexual education, and, (3) families should work to improve their communication on sexual health and development Conclusions: There is a strong need for families to develop the ability to communicate with each other about sexuality and reproductive health. Developing parenting skills on how and when to talk about sex with their adolescents and open parental communication on sexuality issues at home is necessary. Activities need to also be developed for adolescents who are more inclined to engage in risky sexual behaviors.

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The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

BMC Medicine ◽

10.1186/s12916-021-01941-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Yi Mu ◽

Xiaodong Wang ◽

Yanping Wang ◽

Zheng Liu ◽

Mingrong Li ◽

...

Keyword(s):

Vaginal Delivery ◽

Genital Tract ◽

National Policy ◽

Perinatal Outcomes ◽

Adverse Outcomes ◽

Near Miss ◽

Maternal Near Miss ◽

Adjusted Relative Risk ◽

Neuraxial Analgesia ◽

Vaginal Deliveries

Abstract Background There is a lack of national report of the labour neuraxial analgesia (NA) rates in China in recent years, especially after the national promotion policy. The adverse maternal and perinatal outcomes associated with NA in China are also unknown. The aim of this study is to estimate the trends of NA rates from 2012 to 2019, to evaluate the effect of national policy on promoting NA and to identify the association between NA and adverse outcomes in China. Methods We used the individual data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2019, covering 438 hospitals from 326 urban districts or rural counties in 30 provinces across China. The analysis was restricted to singleton pregnant women who underwent vaginal delivery at or after 28 completed weeks of gestation. We estimate the trends of NA rates between 2012 and 2019, both at the national and provincial levels using Bayesian multilevel model. We also estimated the effect of the national pilot policy launched in 2018 using interrupted time-series analysis and identified the association between NA and adverse outcomes using modified Poisson regression combined with propensity score analysis. Results Over the study period, 620,851 of 6,023,046 women underwent vaginal delivery with NA. The estimated national NA rates increased from 8.4% in 2012 to 16.7% in 2019. Most provinces experienced the same rapid rise during this period. The national pilot policy accelerated the rise of the rates. No differences were observed between women with NA and without any analgesia in the incidence of uterine atony, placental retention, intrapartum stillbirths and 1- and 5-min Apgar scores lower than 7. However, women with NA had higher incidences of genital tract trauma (adjusted relative risk (aRR) 1.53, 95% confidence interval (CI) 1.04–2.26) and maternal near miss (aRR 1.35, 95% CI 1.08–1.69), only in hospitals which were not covered by the national pilot policy and usually lack of sufficient equipment and personnel. Conclusions The national policy can effectively increase the NA rate. However, as genital tract trauma and maternal near miss may increase in low-resource hospitals, but not in high-resource hospitals, further study is required to identify the reasons.

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Iron status in late pregnancy is inversely associated with birth weight in Colombia

Public Health Nutrition ◽

10.1017/s136898002100166x ◽

2021 ◽

pp. 1-29

Author(s):

Alejandra Puerto ◽

Annabelle Trojan ◽

Nelson Rafael Alvis-Zakzuk ◽

Rossana López-Saleme ◽

Francisco Edna-Estrada ◽

...

Keyword(s):

Birth Weight ◽

Prenatal Care ◽

Birth Outcomes ◽

Gestational Age ◽

Small For Gestational Age ◽

Rural Areas ◽

Iron Status ◽

Perinatal Outcomes ◽

Caribbean Region ◽

Birth Cohort Study

ABSTRACT OBJECTIVE: Gestational Anaemia (GA) is common in developing countries. This study assessed the relationship of late GA and negative perinatal outcomes in participants recruited in a reference maternity unit of the Caribbean region of Colombia. DESIGN: Prospective analytical birth cohort study. Maternal haemoglobin and serum ferritin (SF) levels were measured. GA was defined as haemoglobin levels <11 g/dL, SF depletion as SF levels <12 ng/mL. Birth outcomes such as low birth weight (LBW), preterm birth (PB) and small for gestational age (SGA) were examined. SETTING: Mothers in the first stage of labour, living in urban or rural areas of Bolívar, were enrolled in an obstetrical centre located in Cartagena, Colombia. Blood and stool samples were taken prior delivery. Maternal blood count, SF levels and infant anthropometric data were recorded for analysis. PARTICIPANTS: 1,218 pregnant women aged 18 - 42 years-old and their newborns. RESULTS: Prevalence of GA and SF depletion was 41.6% and 41.1%, respectively. GA was positively associated with poverty-related sociodemographic conditions. Prenatal care attendance lowered the risk of PB, LBW and SGA. Birth weight was inversely associated with haemoglobin levels, observing a -36.8 g decrease in newborn weight per 1 g/dl of maternal haemoglobin. SF depletion, but not anaemia was associated with PB. Small for gestational age (SGA) outcome showed a significant association with anaemia, but not a significant relationship with SF depletion. CONCLUSION: Birth weight and other-related perinatal outcomes are negatively associated to haemoglobin and SF depletion. Prenatal care attendance reduced the risk of negative birth outcomes.

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