Introduction

Adolescent pregnancy is a global problem affecting families, educators, government, health care professionals as well as the youths (Kirby, 2001). Recent studies which have delved into the issue of adolescent pregnancy and the associated consequences have focused on its impact on the on social, educational and health dimensions of adolescent mothers (Roy and Debnath, 2018). Moreover, studies have suggested that adolescent pregnancies jeopardize educational prospects and economic opportunities for women (Grant and Hallman, 2008; Sedgh et al., 2015). The general trend of adolescent pregnancy indicated that there is a general decline in the rates of global adolescent pregnancy. Data from the United Nations Population Division shows that in in the year 1960 the rate of adolescent pregnancy stood at 86.163% which dropped to 45.565% 2016 suggesting a decline in the global adolescent pregnancy rate by half (World-Bank, 2016) (https://data.worldbank.org/indicator/sp.ado.tfrt). A majority of adolescent pregnancies occur in low-income countries the majority of which are located in sub-Saharan Africa and Asia. In 2018, an estimated 2.5 million births to adolescent mothers were reported in low-income countries in developing countries (WHO, 2018). Overall, 15 to 20% of births in Low-Income Countries (LIC) are to adolescent mothers. Furthermore, it is estimated that 85% of teenage mothers reside in LIC and 25% of overall in LIC maternal mortality occurs in this subpopulation (Neal et al., 2016).

The HIC experience a declining trend in adolescent pregnancy (le Roux et al., 2019). According to the data provided by the World Bank population prospects, the rates of adolescent pregnancy in HIC was at 16 adolescents are impregnated in a population of 1000 adolescent women aged between 15 and 19 years. In 2017 (World-Bank, 2016). In Europe, which the United Kingdom is part of, eight adolescents are impregnated in a population of 1000 adolescent women aged between 15 and 19 years.

The maternal mortality rate in LIC was seven adolescent mothers in every 1000 adolescents in 2016; this rate is a bit lower than that reported in HIC where nine adolescent mothers die in every 1000 adolescent mothers (World-Bank, 2016). The causes of the causes high mortality rates among adolescents are vast ranging from economic factors to the limited accessibility to health care facilities. In LIC there is a profound problem related to limited access to health care facilities due to lack of such facilities in underdeveloped rural villages and poor transport infrastructure (Kobusingye et al., 2005). Inadequate prenatal care and the high rates of adolescent mothers giving birth from home without specialized care compounds the problem of high mortality rates in LIC. Complications during the gestation period and birth have also been implicated as the primary cause of maternal death for 15 to 19 years old girls. It is estimated that in every year about 3.9 million girls between the age of 16 and 19 undergone unsafe abortions increasing the chances of maternal death among adolescent (WHO and Mathers, 2016). Teen mothers between 10 and 19 years are faced with an elevated risk of developing eclampsia, puerperal endometritis and systemic infections which have for many decades been the leading cause of death among teen mothers (Klein, 2005; Baldwin et al., 2019).

In 2011, the WHO published guidelines for preventing early pregnancies from reducing the global impact of these pregnancies. The instructions aimed to achieve six main objectives. Firstly, the guidelines aimed at reducing early pregnancy by 10% and a reduction of maternal deaths by 70%. Building support for the reduction of early pregnancies, increasing the uptake of contraceptives among adolescents, reducing case of rape, reducing unsafe abortions and increasing skilled antenatal care are among the critical objective drive by the WHO guidelines on adolescent pregnancies (Kozuki et al., 2013). In both low and high-income countries, adolescent pregnancies have been associated with high incidence of various adverse maternal and perinatal outcomes including low birth weight (LBW), stillbirths, preterm births, as well as small-for-gestational-age (SGA) (Read et al., 2016). This paper explores various aspects of adolescent pregnancy concerning the adverse effects of teen pregnancy. Also, it provides possible intervention measures which can be implemented to mitigate the problem of adolescence pregnancy.

Factors contributing to adolescent pregnancy

Drugs and alcohol intake is a significant contributor to the high rates of adolescence pregnancies. Accumulating evidence suggests that substance use among adolescents is a predisposing factor to unplanned pregnancies. Alcohol exposes adolescents to toxic peer influence which more often than not result in unsafe sex and pregnancies. According to Connery and colleagues, alcohol intake has been ranked as the leading cause of teenage pregnancies in the USA (Connery, Albright, and Rodolico, 2014). The rate of alcohol intake in low-income countries particularly in remote, underdeveloped countries is alarming. Alcohol intake behavior among adolescents is an increasing trend that predisposes the teenagers to unsafe sex and early pregnancies (WHO, 2014).

Moreover, alcohol and drug intake are associated with poverty and lack of education

 

Socio-economic status plays a significant role in adolescent pregnancies. Poor socio-economic issues such as lack of employment lead adolescent women into early marriages and pregnancies (Markovitz et al., 2005). Majority of adolescents living in poverty-stricken areas particularly in sub-Saharan Africa are more vulnerable to adolescent pregnancies as compared to those who live in communities with well-established systems for education (Paranjothy et al., 2009).

Peer pressure, sexual abuse and risky behaviors have been shown to contribute to the high rates of adolescent pregnancies significantly. Young women engage in early age sex due to influence from their peers. Lack of proper parental guidance adds to the problem of peer pressure influence sexuality and risky behaviors.

Media has a profound effect on adolescents in terms of sexuality. Media provides a platform for information dissemination and knowledge gain which can empower youths and sensitize them on the hazards of adolescent sex and pregnancy. However, the birth of a domain of media known as social media has brought about a myriad of effects on youths particular on the content of information shared on this media platform. Through social media, adolescents have access to uncensored content that may encourage sex in this population. Information such as pornographic content is inappropriate for youths aged between 15 and 19 years (Strasburger, 1989). Uncontrolled use of media encourages adolescent sexuality and pregnancies. In the same breadth, peer influence is another predisposing factor to Adolescent sexuality and fertility. Some youths fall in the trap of early pregnancy due to the urge to imitate their peers and falling prey of the ill-advice provided by their peers (Klein, 2005).

Religious believers and practices held by some people may contribute to the high adolescent pregnancies. In some religions and cultures, women are not valued, and thus parents believe that they would instead invest in educating their sons and not daughters. Such beliefs influenced by religion may have a substantial impact on adolescent women accelerating the rate at which young women are married off in exchange for wealth. In Africa for instance, some religions and culture do not believe in girl child education thus focuses more on empowering boy-child (Burdette and Hill, 2009). The influence of religion cultural practices is more profound in rural regions as compared to urban (Burdette and Hill, 2009).

Poverty has been suggested to exacerbate the problem of teenage pregnancy particularly in low-income countries (Organization, 2011).In African rural regions where poverty has taken its toll on families, cases of adolescent pregnancies are high. Families living in pervasive poverty are not able to afford education for their young girls (Neal, Channon and Chintsanya, 2018). Educating girls plays a crucial role in ensuring that they attain their goals in life, thus reducing the chances of early pregnancy. Poverty may also drive you adolescent girls into early marriages and unplanned sex in exchange for money (Young et al., 2004).

Low- level education is another key driver to the increasing global rates of adolescent pregnancy. Adolescent age between 15 and 19 years is within the school going bracket and studies have shown that in areas where education is emphasized adolescent pregnancies are lower as compared to areas where education is not valued. For instance, a study by Brindis among the Hispanic school-going age adolescents showed that education played an essential role in delaying pregnancy among Hispanic youths. The author demonstrated that the rates of adolescent pregnancies were higher among Hispanic teenagers living in the underdeveloped area with poor access to education facilities (Brindis, 1992).

Ethnicity and intergenerational influence is a critical influencer of adolescent pregnancy. Yoon and colleagues demonstrated the impact of ethnicity on adolescent pregnancy (Yoon et al., 2019). According to Yoon, adolescent pregnancy varies significantly based on ethnicity due to cultural practices held by different ethnic groups. Some culture promotes early marriages hence sho0ting up the rates of adolescent pregnancies (Yoon et al., 2019).

Maternal age and adverse birth outcomes

Maternal age is a crucial determinant of        birth outcomes (Muganyizi and Kidanto, 2009). The causes of adverse birth outcomes are multifaceted and are not clearly understood, however, there are various indicators for adverse birth outcomes such as stillbirth, preterm birth, low birth weight, small for gestational age (SGA), macrosomia, neonatal death, and congenital anomaly. Furthermore, birthweight and gestational age are predictors of neonatal morbidity and mortality (Muganyizi and Kidanto, 2009). Studies have demonstrated that teenage pregnancies suffer a higher risk for stillbirth, preterm birth as well as low birth weight (Mousiolis et al., 2013). There are similarities in the adverse birth outcomes between adolescent mothers and older mothers. Some of the common adverse birth outcomes in both groups include stillbirth, abortion, gestational diabetes, and hypertension (Read et al., 2016). In a study aimed to assess the risk associated with mother’s age during pregnancy, a total of 2, 123, 175 births were evaluated. The findings of the study suggested that the risk of adverse effects were higher in the extreme maternal ages (Mousiolis et al., 2013). Notably, the study showed that adverse effects such as stillbirth, neonatal death, congenital disorders, lower birth weight, and preterm birth were common among the adolescent mothers (13-15years) and older age mothers (20-30 years). Thus, the adverse birth outcomes inherent to teenage pregnancies are also observed among older age pregnancies underpinning the similarities between the adolescent and old age pregnancy (Mousiolis et al., 2013).

On the other hand, gestational diabetes is a common pregnancy complication that has been observed in pregnant women despite the age of the pregnancy (Langille, 2007). Increasing evidence suggests that adolescent and old age pregnancies are also associated with other health complications such as hemorrhagic syndromes, urinary infections, high blood pressure, premature rapture hemorrhage and pre-eclampsia and eclampsia (Azevedo, Diniz and Evangelista, 2015). Studies have also shown that sexuality in adolescent age increases the risk and frequency of sexually transmitted diseases. Other studies investigating the biological impact of adolescent and older age pregnancies suggests that these pregnancies are associated with high rates of high blood pressure, gestational diabetes, birth complications and neonatal mortality (Azevedo, Diniz and Evangelista, 2015). Low birth weight is also a common problem associated with adolescent and older age pregnancies. Studies have also shown that poor health outcome is related to the quality of care provided to pregnant women during the pregnancy period.

Teenage mothers have limited access to quality care due to lack of resources and in part due to the negligence of prenatal care as a result of stigma and living in denial (Lopoo, 2011). Moreover, it has been proven biologically that it is possible for the teenagers who are still growing to compete for nutrients with the developing fetus. The eventual outcome of the competition is that the fetus will be deprived of essential nutrients required for fetus development (Johnson and Moore, 2016).

The link between adolescent childbearing and labor and delivery complications

Despite the limited research in the area of labor and complications during delivery, some studies have delved into the complexities likely to affect adolescent mothers during pregnancy known as potentially avoidable maternal complications. These complications include urinary infections, ectopic pregnancies, pre-mature membrane rapture, and inadequate prenatal care. The difficulties remain to be significant concerns in adolescent pregnancy despite being preventable (Lopoo, 2011).  Other causes of complications during delivery include inadequate prenatal care, premature rupture of uterus membrane, shot cervix, small uterus volume and immature pelvis leading to cephalo-pelvic disproportion that may potentially dispose of adolescent mothers too early delivery and complications such as obstetric fistula.

Adolescent pregnancy and maternal health

Adult pregnancy is confronted with a significant psychiatric health challenge and impacts negatively on maternal health as well as the developing fetus. A secondary outcome of such psychopathy during pregnancy is the impairment of mother-child bonding. Depression during pregnancy is also an accelerator of adverse birth outcomes such as preterm births, behavioral differences and low birth weight (Khashan, Baker and Kenny, 2010). Depression during the period of pregnancy can potentially result in postpartum depression and can be associated with maternal suicide and infanticide (Siegel and Brandon, 2014).

First birth and second birth risk association

Studies comparing the risk of adverse pregnancy outcome among adolescent mothers giving birth for the first time and adolescent mothers having their second pregnancy showed that there are higher risks in second births as compared to first birth. Perinatal outcomes including stillbirth rates, perinatal and perinatal mortality preterm delivery, and low birthweights were assessed. The assessment showed that adolescent mothers having their second pregnancy were more likely to suffer at least one of the adverse outcomes (Reime, Schücking and Wenzlaff, 2008). The adolescent who has already had a previous pregnancy have a higher risk of adverse consequences even when all confounders have been controlled.

The normal fetal development depends on the supply of nutrients from the mother, particularly amino acids. Therefore, adequate placental transport of amino acid is an essential prerequisite for fetal growth. Studies have shown that the placental transport of amino acid in adolescents is not efficient enough to serve the purpose of fetus development (Hayward et al., 2019). The reduced transport across the placenta is the primary cause of low birth weight among adolescent mothers (Hayward et al., 2019). In mature women, placental transport tends to be more efficient, thus serving the nutritional needs of the growing fetus and evading the problem of low birth weight. The health consequences of reduced placental transport in adolescent pregnancy is manifested in terms of preterm births, respiratory diseases, complications during delivery, and child mortality (Hayward et al., 2019). The manifestation of poor placental transport reflects poor nutrition of the fetus resulting in health issues such as the ones mentioned above.

Health consequences on the child during pregnancy and the perinatal period

Adolescent pregnancy has been shown to impact the development of the fetus during pregnancy. Some of the undesirable influences that early pregnancy can pose on the development of the baby include low birth weight. Preterm births, frequent respiratory infections, and problems during delivery. Moreover, neonatal mortality has been shown to increase in adolescent pregnancies (Neal, Channon and Chintsanya, 2018). Other studies have established that your maternal age can potentially increase neonatal mortality, preterm births, and LBW (Chen et al., 2008). In another study, Baldwin and colleagues established that children born of adolescent parents have deficiencies in their cognitive development of (Baldwin et al., 2019). Young age motherhood is implicated in the occurrence of cognitive defects in children.

Prevention and control

A critical public health approach in the prevention of teenage pregnancies and their adverse outcome is the prevention of second pregnancy. Health care providers are the key stakeholders in the fight against adolescent pregnancy and must be involved fully in the fight. The WHO provides detailed guidelines for prevention/reeducation of teenage pregnancy. For instance, the WHO recommends the prevention of early marriages particularly in communities where culture forces young girls to drop out of school and get married to older men (Weng, Yang, and Chiu, 2014). Such trends have been observed in some African cultures (Chandra-mouli et al., 2013). Other recommendations include enhancing sexuality education to help reduce the incidences of teenage sex and early marriages. Increasing opportunities for girl-child education has also been recommended under the WHO guidelines. Creating systems for economic and social support programs particularly in rural and remote areas is a promising approach towards a reduction of the adolescent pregnancies (Ganchimeg et al., 2014). Increased use of contraceptives, reducing forced sex, preventing unsafe abortion and enhancing prenatal care are some of the recommendations that when affected can help to control the problem of adolescent pregnancy.

Nutritional intervention is another important approach to mitigate adverse outcomes associated with childbirth in adolescent mothers. Some of the critical interventions include the supplementation of folic acid during pregnancy. Folic acid is very useful in the prevention of defects in the development of neural tubes. A research study showed a 72% reduction in the risk of neural tube development problems (Bhutta et al., 2013). Supplementation of iron has also demonstrated a positive outcome during pregnancy. For instance, supplementation of metal with another vitamin significantly reduced the risk of anemia by 27% (Bhutta et al., 2013). Other nutrients that can be supplemented during pregnancy to produce positive outcome include micronutrients, calcium, and iodine. Apart from mineral and vitamin supplementation, addressing the problem of a well-balanced diet is key to prevention of birth associated with adverse outcomes. Carbohydrate and protein should be supplied in adequate amounts to cater to the mother’s needs as well as those of the developing fetus. For the neonates, interventions include the delay in clamping the cord, administration of vitamin K, kangaroo mother care especially for the preterm babies and those born with LBW. The infants need to be boosted by the mother’s milk through breastfeeding and dietary diversity to ensure the inclusion of all nutrients and minerals (Bhutta et al., 2013).

 

 

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