title: Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network's Maternal Newborn Health Registry study.
abstract: BACKGROUND
  Adolescent girls between 15 and 19 years give birth to around 16 million babies each year, around 11% of births worldwide. We sought to determine whether adolescent mothers are at higher risk of maternal and perinatal adverse outcomes compared with mothers aged 20-24 years in a prospective, population-based observational study of newborn outcomes in low resource settings.
  
  
  METHODS
  We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in six low-middle income countries (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). The study population for this analysis was restricted to women aged 24 years or less, who gave birth to infants of at least 20 weeks' gestation and 500g or more. We compared adverse pregnancy maternal and perinatal outcomes among pregnant adolescents 15-19 years, <15 years, and adults 20-24 years.
  
  
  RESULTS
  A total of 269,273 women were enrolled from January 2010 to December 2013. Of all pregnancies 11.9% (32,097/269,273) were in adolescents 15-19 years, while 0.14% (370/269,273) occurred among girls <15 years. Pregnancy among adolescents 15-19 years ranged from 2% in Pakistan to 26% in Argentina, and adolescent pregnancies <15 year were only observed in sub-Saharan Africa and Latin America. Compared to adults, adolescents did not show increased risk of maternal adverse outcomes. Risks of preterm birth and LBW were significantly higher among both early and older adolescents, with the highest risks observed in the <15 years group. Neonatal and perinatal mortality followed a similar trend in sub-Saharan Africa and Latin America, with the highest risk in early adolescents, although the differences in this age group were not significant. However, in South Asia the risks of neonatal and perinatal death were not different among adolescents 15-19 years compared to adults.
  
  
  CONCLUSIONS
  This study suggests that pregnancy among adolescents is not associated with worse maternal outcomes, but is associated with worse perinatal outcomes, particularly in younger adolescents. However, this may not be the case in regions like South Asia where there are decreasing rates of adolescent pregnancies, concentrated among older adolescents. The increased risks observed among adolescents seems more likely to be associated with biological immaturity, than with socio-economic factors, inadequate antenatal or delivery care.
  
  
  BACKGROUND
  NCT01073475.
authors.forename: Fernando
authors.initials: F
authors.lastname: Althabe
authors.forename: Janet L
authors.initials: JL
authors.lastname: Moore
authors.forename: Luz
authors.initials: L
authors.lastname: Gibbons
authors.forename: Mabel
authors.initials: M
authors.lastname: Berrueta
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleem
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.forename: Edward A
authors.initials: EA
authors.lastname: Liechty
authors.forename: K
authors.initials: K
authors.lastname: Hambidge
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Krebs
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Marion
authors.initials: M
authors.lastname: Koso-Thomas
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Maria L
authors.initials: ML
authors.lastname: Cafferata
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
mesh_terms: D000293:Adolescent; D000367:Age Factors; D036861:Delivery, Obstetric / Q000379:methods; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011253:Pregnancy in Adolescence; D047928:Premature Birth / Q000453:epidemiology; D011295:Prenatal Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000453:epidemiology; D012042:Registries; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult