Obstetric Complications in Adolescents and Impact on Maternal and Infant Health: Results of a Retrospective Analysis in a Brazilian Hospital (2019-2021)

Natália Abou Hala Nunes^*, Amanda Martins Lino, Gabriela Torino dos Reis and Luiza Malosti Matias
^*Correspondence: Natália Abou Hala Nunes, Department of Medicine, University of Taubaté, Rua Quatro de Março 432, Taubate, São Paulo, Brazil, Email:

Keywords

Adolescent pregnancy • Obstetric complications • Family planning

Introduction

Adolescence, defined by the World Health Organization (WHO) as the period between 10 and 19 years of age, is a phase marked by significant physical, emotional and social changes [1]. During this period, early sexual initiation and limited access to reproductive health information increase the risk of unplanned pregnancy, which constitutes a public health issue in many parts of the world, especially in developing countries like Brazil [2]. Adolescent pregnancy is considered a public health challenge due to its association with a series of obstetric complications, such as maternal anemia, pregnancy-specific hypertension, preterm birth and low birth weight [3]. These issues can lead to serious consequences for both the mother and the newborn, requiring special attention during the gestational and postpartum periods.

In addition to physical complications, early pregnancy can lead to long-term social and economic disadvantages. Pregnant adolescents often face educational and employment barriers, perpetuating cycles of poverty that affect their future opportunities and quality of life [4]. This situation makes adolescent pregnancy not only a health problem but also a significant social challenge. Studies indicate that approximately 21% of births in Brazil occur among adolescent mothers, an alarming statistic that underscores the need for effective interventions [5]. This scenario is even more concerning in regions with high levels of social inequality, where access to prenatal care and effective contraceptive methods is limited.

The choice of a Brazilian university hospital as the study site is justified by the representativeness of the institution, which serves a diverse population and reflects the reality of pregnant adolescents in similar contexts [6]. Furthermore, the hospital serves as a reference centre for clinical studies, providing a robust database for retrospective analysis. This study aims to analyse the incidence of adolescent pregnancy, types of deliveries, hospitalization categories and obstetric diagnoses. The study period covers from 2019 to 2021, offering a comprehensive view of the challenges faced by this population in a Brazilian hospital context [7].

Based on these data, this study seeks to contribute to a deeper understanding of the factors influencing maternal and infant outcomes in adolescents. The findings of this study may inform the development of public health strategies aimed at reducing adolescent pregnancy rates and improving obstetric care [8].

Objectives

To identify the number, types of deliveries, hospitalization categories and obstetric diagnoses among adolescents aged 10 to 19 years treated at a Municipal University Hospital from January 2019 to August 2021.

Methodology

Study design

This retrospective study was conducted based on the analysis of electronic medical records of adolescents treated in the Gynaecology and Obstetrics departments of a Brazilian University Hospital between January 2019 and August 2021. The sample included medical records of patients aged 10 to 19 years.

Inclusion and exclusion criteria

The study included medical records of pregnant adolescents aged 10 to 19 years who received complete obstetric care at the hospital during the study period. The records had to contain complete information on age, number of pregnancies, type of delivery, maternal and neonatal complications, as well as data on postpartum family planning.

Medical records were excluded if they contained incomplete or inconsistent data, duplications, or if the patient was transferred to another unit before completing obstetric care at the hospital. Additionally, records of adolescents with severe pre-existing conditions that could confound results related to obstetric complications specific to adolescent pregnancy were excluded.

Data collection

Data collection was conducted during April and May 2024, using a standardized protocol to ensure consistency and uniformity of the recorded information. The researchers were specifically trained for this task and the collected data underwent double-checking to minimize errors and ensure the integrity of the information.

Variables analysed

The variables collected included:

• Demographic data: Age, city of origin.

• Obstetric history: Number of pregnancies, types of delivery.

• Clinical data: Risk level of hospitalization, length of hospital stay, maternal and fetal complications, obstetric diagnoses.

• Family planning: Acceptance of postpartum contraceptive methods, type of method used.

• Gestational age at birth.

Statistical analysis

Data were analyzed using SPSS version 25.0. Descriptive analyses were performed to calculate absolute frequencies, percentages, means, standard deviations and medians. The normality of the data was verified using the Shapiro-Wilk test.

For comparative analysis between groups (e.g., types of delivery and complications), parametric tests, such as Student's t-test for continuous variables with normal distribution and non-parametric tests, such as the Mann-Whitney test, for variables that did not follow normal distribution, were applied. Associations between categorical variables were evaluated using the chi-square test or Fisher's exact test, as appropriate. A p-value of <0.05 was considered statistically significant.

Ethical considerations

This study was approved by the Human Research Ethics Committee under protocol no. 5.761.236, in accordance with Resolution 466/12. All data collected were kept confidential and the patients were not identified at any time during the study.

Results

Sociodemographic characteristics and length of hospital stay

The sociodemographic characteristics of the adolescents and the length of hospital stay are summarized in Table 1. The mean age of the patients was 15 years (median: 14 years; standard deviation: 1.5 years), with an average hospital stay of 4.5 days (median: 3 days; standard deviation: 2 days) (Table 1).

Table 2 details the types of surgeries performed and the access routes used, highlighting the predominance of normal deliveries and the vaginal route.

Obstetric complications and diagnoses are presented in Table 3, with episiotomy being the most common complication and hypothyroidism the most frequent diagnosis.

Family planning data are presented in Table 4, showing that the majority of adolescents refused family planning, with the IUD being the most accepted method among those who agreed.

Table 5 presents data on the gestational age of the newborns, highlighting the mean, median, standard deviation, minimum and maximum for this variable.

The age distribution of pregnant adolescents is represented in Figure 1, highlighting the predominance of ages between 14 and 17 years.

Figure 2 shows the distribution of postpartum family planning, indicating that the IUD was the most accepted contraceptive method.

Figure 3 illustrates the postpartum contraceptive methods accepted by the adolescents, with the IUD being the most frequent.

The distribution of delivery types among adolescents, highlighting the predominance of vaginal delivery, is illustrated in Figure 4.

Figure 5 illustrates the distribution of the number of abortions and primigravida among the analyzed adolescents.

Figure 6 presents the distribution of gestational age at birth among the newborns.

Discussion

Adolescent pregnancy is a global public health issue with significant implications for both adolescent mothers and their children. Numerous studies have compared obstetric and neonatal outcomes in pregnant adolescents with those of adult women, revealing a series of complications associated with adolescent pregnancies [1,9].

Studies conducted in different regions of Brazil and other countries show results similar to those of this study. For example, a study conducted in the Northeast region of Brazil found that adolescent pregnancy is frequently associated with obstetric complications such as anemia, gestational hypertension and preterm birth. Another study by corroborated these findings, indicating a higher prevalence of complications such as cephalopelvic disproportion, urinary tract infections and acute fetal distress in pregnant adolescents [10-15].

On an international scale, data from the United Nations Population Fund (UNFPA) show that pregnant adolescents in underdeveloped countries face higher risks of obstetric and neonatal complications due to factors such as limited access to prenatal care and unfavorable socioeconomic conditions. A study conducted in Chile identified that pregnant adolescents have a significantly higher risk of preterm birth, low birth weight and neonatal mortality compared to adult women [16-20].

In the European context, a longitudinal study in England highlighted that pregnant adolescents are more likely to face complications such as pre-eclampsia and gestational diabetes, as well as a greater need for obstetric interventions, including cesarean sections and episiotomies [11]. These findings are consistent with the results of this study, where a significant prevalence of perineal lacerations and episiotomies was observed.

The socioeconomic impact of adolescent pregnancy is also a critical factor to consider. Adolescent pregnancy contributes to the perpetuation of the poverty cycle, as many adolescents are unable to complete their education, limiting their employment opportunities and affecting their financial independence. Point out that the lack of access to effective contraceptive methods and inadequate sex education are key factors contributing to the high rates of adolescent pregnancy in developing countries [10-15].

This study highlights the high acceptance of postpartum contraceptive methods, particularly the intrauterine device (IUD), among adolescents, suggesting an opportunity for educational and reproductive health interventions. Promoting family planning and access to effective contraceptive methods can significantly reduce adolescent pregnancy rates and improve maternal and infant health outcomes [21-25].

Reinforcing the importance of adequate prenatal care, the literature indicates that pregnant adolescents who receive comprehensive prenatal care have better obstetric and neonatal outcomes. Adherence to prenatal consultations is associated with a reduction in complications such as prematurity and low birth weight. Implementing public health programs that promote awareness of the importance of early and frequent prenatal care can play a crucial role in improving health outcomes for this vulnerable population [8,10,13].

Therefore, adolescent pregnancy is a complex phenomenon that requires multifaceted approaches for its prevention and management. Strategies that combine sex education, access to contraceptive methods, psychosocial support and adequate prenatal care are essential to mitigate the negative impacts of adolescent pregnancy. Future studies should focus on effective interventions and the implementation of public policies that address the specific needs of pregnant adolescents, ensuring continuous and comprehensive support from conception to postpartum.

Study limitations

Due to the retrospective nature of the study, some limitations must be considered. The quality and completeness of the data depend on the accuracy and consistency of the medical records. The sample may not adequately represent all pregnant adolescents, which could limit the generalizability of the results. Additionally, some records may be incomplete or contain incorrect information, affecting the validity of the results.

Social impact and clinical applicability

The results of this study have important practical and social implications. The analysis of postpartum contraceptive use among adolescents highlights the need for effective and accessible family planning programs. The increased acceptance of the IUD suggests that educational interventions focused on long-term contraceptive methods may be particularly effective. In clinical practice, healthcare professionals should be trained to provide appropriate contraceptive counseling and continuous support to pregnant adolescents, promoting the use of effective contraceptive methods to prevent unwanted pregnancies.

Furthermore, the findings on obstetric and neonatal complications associated with adolescent pregnancy reinforce the need for rigorous and comprehensive prenatal care for this population. Public health programs should prioritize sex education, access to quality prenatal care and psychosocial support for pregnant adolescents to improve maternal and infant health outcomes and reduce the incidence of obstetric complications.

Conclusion

Adolescent pregnancy continues to be a significant public health challenge with substantial implications for maternal and neonatal health. This study revealed a high rate of obstetric complications among pregnant adolescents, including perineal lacerations, episiotomies and preterm births. Additionally, the high acceptance of postpartum contraceptive methods, particularly the Intrauterine Device (IUD), underscores the importance of educational and reproductive health interventions in this population.

The results indicate that pregnant adolescents face increased risks of complications, reinforcing the need for rigorous and comprehensive prenatal care. Public health programs should be directed towards promoting comprehensive sex education and access to effective contraceptive methods, aiming to reduce the incidence of unplanned pregnancies and improve maternal and infant health outcomes.

To strengthen the evidence base and inform effective policies, future research should focus on longitudinal studies that follow pregnant adolescents and their children over time, evaluating the long-term impacts of obstetric and neonatal complications. Additionally, it is essential to investigate the effectiveness of different educational and reproductive health interventions in reducing adolescent pregnancy rates, with comparisons across different regions and socioeconomic contexts.

In clinical practice, healthcare professionals should be trained to provide appropriate contraceptive counseling and continuous support to pregnant adolescents, promoting the use of effective contraceptive methods to prevent unwanted pregnancies. Implementing public policies that ensure access to quality prenatal care and psychosocial support is crucial to mitigating the negative impacts of adolescent pregnancy.

Investing in strategies that combine sex education, access to contraceptive methods, psychosocial support and adequate prenatal care can play a decisive role in improving health outcomes for pregnant adolescents. These actions not only promote healthy reproductive health but also contribute to reducing associated complications and breaking the cycle of poverty, providing a more promising future for young mothers and their children.

Acknowledgement

None.

Conflict of Interest

None.

References

1. https://www.who.int/health-topics/adolescent-health#tab=tab_1
2. https://www.unfpa.org/sites/default/files/pub-pdf/SoWP2021_Report_Low-Res.pdf
3. Martins, Marília da Glória, Graciete Helena Nascimento dos Santos, Márcia da Silva Sousa and Janne Eyre Fernandes Brito da Costa, et al. "Association of pregnancy in adolescence and prematurity." Rev Bras Ginecol Obstet 33 (2011): 354-360.

Google Scholar, Crossref, Indexed at

4. Silva, Beatriz Machado da, Brenda Rullyane Vasconcelos Nogueira, Graciana de Sousa Lopes and Larissa Rodrigues de Souza, et al. "Risk factors associated with teenage pregnancy: An integrative review." (2020).

Google Scholar, Crossref                      

5. IBGE. "Sociodemographic and Health Indicators in Brazil. Rio de Janeiro: Brazilian Institute of Geography and Statistics." (2020).
6. Pinheiro, Yago Tavares, Natália Herculano Pereira and Giane Dantas de Macêdo Freitas. "Factors associated with pregnancy among adolescents of a municipality of northeast of Brazil." Cad Saúde Colet 27 (2019): 363-367.

Google Scholar

7. Azevedo, Walter Fernandes de, Michele Baffi Diniz, Eduardo Sérgio Valério Borges da Fonseca and Lícia Maria Ricarte de Azevedo, et al. "Complications in adolescent pregnancy: Systematic review of the literature." Einstein (Sao Paulo) 13 (2015): 618-626.

Google Scholar, Crossref, Indexed at

8. Theme-Filha, Mariza Miranda, Marcia Leonardi Baldisserotto, Ana Claudia Santos Amaral Fraga and Susan Ayers, et al. "Factors associated with unintended pregnancy in Brazil: Cross-sectional results from the Birth in Brazil National Survey, 2011/2012." Reprod Health 13 (2016): 235-243.

Google Scholar, Crossref, Indexed at

9. Farias, RV, S. F. Silva, J. M. Souza and V. C. Santos. "Adolescent pregnancy and the outcome of prematurity: An integrative literature review." Rev Eletr Acervo Saúde 56 (2020): 1-10.
10. da Silva Santos, Thayna Pinheiro, Emilia da Silva Pio and Francely de Castro e Sousa. "Adolescent pregnancy and prematurity: Is there an association?." Cadernos ESP 16 (2022).

Google Scholar

11. Conde-Agudelo, Agustin, José M. Belizán and Cristina Lammers. "Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study." Am J Obstet Gynecol 192 (2005): 342-349.

Google Scholar, Crossref, Indexed at

12. Eliner, Yael, Moti Gulersen, Amita Kasar and Erez Lenchner, et al. "Maternal and neonatal complications in teen pregnancies: A comprehensive study of 661,062 patients." J Adolesc Health70 (2022): 922-927.

Google Scholar, Crossref, Indexed at

13. Yazlle mehd. "Adolescent pregnancy." Rev Bras Ginecol Obstet 28 (2006): 443-445.
14. Matos GC de, Escobal AP de L, J. S. Palma, K. D. Gonçalves and E. B. Blank, et al. "Normal birth or cesarean section in adolescence: Whose decision is it?." Rev Enferm UFPE On Line 12 (2018): 1681-1687.
15. Lima Da Costa E, M. Ferreira and A. Dias. "Adolescent pregnancy - determinant for prematurity and low birth weight." Com Ciências Saúde 22 (2011): 183-188.
16. Goldenberg, Paulete, Maria do Carmo Tolentino Figueiredo and Rebeca de Souza Silva. "Adolescent pregnancy, prenatal care, and perinatal outcomes in Montes Claros, Minas Gerais, Brazil." Cad Saúde Pública21 (2005): 1077-1086.

Google Scholar, Crossref, Indexed at

17. Bruno ZV, Feitosa FE de L, K. P. Silveira, Morais IQ de and Bezerra M de F. "Recurrence of pregnancy in adolescents." Rev Bras Ginecol Obstet 31 (2009): 480-484.
18. Crittenden, Colleen P., Neil W. Boris, Janet C. Rice and Catherine A. Taylor, et al. "The role of mental health factors, behavioral factors and past experiences in the prediction of rapid repeat pregnancy in adolescence." J Adolesc Health 44 (2009): 25-32.

Google Scholar, Crossref, Indexed at

19. Shveiky, David, Loral Patchen, Henry H. Chill and Marieta Pehlivanova, et al. "Prevalence and location of obstetric lacerations in adolescent mothers." J Pediatr Adolesc Gynecol 32 (2019): 135-138.

Google Scholar, Crossref, Indexed at

20. Antunes, Marcos Benatti, Robson Marcelo Rossi and Sandra Marisa Pelloso. "Relationship between gestational risk and type of delivery in high risk pregnancy." Rev Esc Enferm USP 54 (2020): e03526.

Google Scholar, Crossref, Indexed at

21. M Amorim, M., Isabela Cristina Coutinho, Inês Melo and Leila Katz. "Selective episiotomy vs. implementation of a non-episiotomy protocol: A randomized clinical trial." Reprod Health 14 (2017): 1-10.

Google Scholar, Crossref, Indexed at

22. Carvalho, RV, I.C. Miranda, A.C.R. Moraes and R. G. Alvim. Adolescent pregnancy: An analysis of the profile of adolescents assisted in a teaching hospital in the city of Maceió-AL. Ciência Plural 7 (2021): 100-120.
23. Braga, Giordana Campos, Suelem Taís Pereira Clementino, Patrícia Ferreira Neves da Luz and Adriana Scavuzzi, et al. "Risk factors for episiotomy: A case-control study." Rev Assoc Med Bras60 (2014): 465-472.

Google Scholar

24. de Episiotomia, E.M.U.M.A. and Maternidade Estadual de Alto Risco. "Frequency and factors associated with the performance of episiotomy in a high risk state maternity."

Google Scholar, Crossref, Indexed at

25. Pan American Health Organization (PAHO). “Adolescent pregnancy in Latin America and the Caribbean.” (2021).