title: Young adolescent girls are at high risk for adverse pregnancy outcomes in sub-Saharan Africa: an observational multicountry study.
abstract: One of Africa's most important challenges is to improve maternal and neonatal health. The identification of groups at highest risk for adverse pregnancy outcomes is important for developing and implementing targeted prevention programmes. This study assessed whether young adolescent girls constitute a group at increased risk for adverse birth outcomes among pregnant women in sub-Saharan Africa.
  
  
  
  Data were collected prospectively as part of a large randomised controlled clinical trial evaluating intermittent preventive treatment of malaria in pregnancy (NCT00811421-Clinical Trials.gov), conducted between September 2009 and December 2013 in Benin, Gabon, Mozambique and Tanzania.
  
  
  
  Of 4749 participants, pregnancy outcomes were collected for 4388 deliveries with 4183 live births including 83 multiple gestations. Of 4100 mothers with a singleton live birth delivery, 24% (975/4100) were adolescents (≤19 years of age) and 6% (248/4100) were aged ≤16 years.
  
  
  
  Primary outcomes of this predefined analysis were preterm delivery and low birth weight.
  
  
  
  The overall prevalence of low birthweight infants and preterm delivery was 10% (371/3851) and 4% (159/3862), respectively. Mothers aged ≤16 years showed higher risk for the delivery of a low birthweight infant (OR: 1.96; 95% CI 1.35 to 2.83). Similarly, preterm delivery was associated with young maternal age (≤16 years; OR: 2.62; 95% CI 1.59 to 4.30). In a subanalysis restricted to primiparous women: preterm delivery, OR 4.28; 95% CI 2.05 to 8.93; low birth weight, OR: 1.29; 95% CI 0.82 to 2.01.
  
  
  
  Young maternal age increases the risk for adverse pregnancy outcomes and it is a stronger predictor for low birth weight and preterm delivery than other established risk factors in sub-Saharan Africa. This finding highlights the need to improve adolescent reproductive health in sub-Saharan Africa.
  
  
  
  NCT00811421; Post-results.
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany German Centre for Infection Research (DZIF), Tübingen, Germany Département de Parasitologie-Mycologie, Université des Sciences de la Santé, Libreville, Gabon Leiden University Medical Centre (LUMC), Leiden, The Netherlands.
authors.forename: Ghyslain
authors.initials: G
authors.lastname: Mombo-Ngoma
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany German Centre for Infection Research (DZIF), Tübingen, Germany.
authors.forename: Jean Rodolphe
authors.initials: JR
authors.lastname: Mackanga
authors.affiliation: ManhiçaHealthResearch Center (CISM), Manhiça, Mozambique ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: González
authors.affiliation: Faculté de Sciences de la Santé, Université Abomey Calavi, Cotonou, Benin Institut pour la Recherche et le Développement (IRD), Paris, France.
authors.forename: Smaila
authors.initials: S
authors.lastname: Ouedraogo
authors.affiliation: Ifakara Health Institute, Dodoma, Tanzania.
authors.forename: Mwaka A
authors.initials: MA
authors.lastname: Kakolwa
authors.affiliation: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany Ngounie Medical Research Centre, Fougamou, Gabon.
authors.forename: Rella Zoleko
authors.initials: RZ
authors.lastname: Manego
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany German Centre for Infection Research (DZIF), Tübingen, Germany.
authors.forename: Arti
authors.initials: A
authors.lastname: Basra
authors.affiliation: ManhiçaHealthResearch Center (CISM), Manhiça, Mozambique ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Rupérez
authors.affiliation: Institut pour la Recherche et le Développement (IRD), Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Cot
authors.affiliation: Ifakara Health Institute, Dodoma, Tanzania.
authors.forename: Abdunoor M
authors.initials: AM
authors.lastname: Kabanywany
authors.affiliation: Ngounie Medical Research Centre, Fougamou, Gabon.
authors.forename: Pierre-Blaise
authors.initials: PB
authors.lastname: Matsiegui
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany German Centre for Infection Research (DZIF), Tübingen, Germany.
authors.forename: Seldiji T
authors.initials: ST
authors.lastname: Agnandji
authors.affiliation: ManhiçaHealthResearch Center (CISM), Manhiça, Mozambique.
authors.forename: Anifa
authors.initials: A
authors.lastname: Vala
authors.affiliation: Faculté de Sciences de la Santé, Université Abomey Calavi, Cotonou, Benin.
authors.forename: Achille
authors.initials: A
authors.lastname: Massougbodji
authors.affiliation: Ifakara Health Institute, Dodoma, Tanzania.
authors.forename: Salim
authors.initials: S
authors.lastname: Abdulla
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany German Centre for Infection Research (DZIF), Tübingen, Germany Leiden University Medical Centre (LUMC), Leiden, The Netherlands.
authors.forename: Ayôla A
authors.initials: AA
authors.lastname: Adegnika
authors.affiliation: ManhiçaHealthResearch Center (CISM), Manhiça, Mozambique ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Esperança
authors.initials: E
authors.lastname: Sevene
authors.affiliation: ManhiçaHealthResearch Center (CISM), Manhiça, Mozambique.
authors.forename: Eusebio
authors.initials: E
authors.lastname: Macete
authors.affiliation: Leiden University Medical Centre (LUMC), Leiden, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Yazdanbakhsh
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany German Centre for Infection Research (DZIF), Tübingen, Germany.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kremsner
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: John J
authors.initials: JJ
authors.lastname: Aponte
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany German Centre for Infection Research (DZIF), Tübingen, Germany Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Ramharter
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D017954:Africa South of the Sahara / Q000453:epidemiology; D006293:Health Promotion; D007230:Infant, Low Birth Weight; D007234:Infant, Premature; D008423:Maternal Age; D000068101:Maternal-Child Health Services / Q000458:organization & administration; D011253:Pregnancy in Adolescence / Q000517:prevention & control / Q000523:psychology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies
keywords: adolescent pregnancy; low birth weight; preterm birth; sub-Saharan Africa