Adverse Maternal and Neonatal Outcomes in Adolescent Pregnancy.

STUDY

OBJECTIVE

To investigate the outcomes of adolescent pregnancy.

DESIGN

Retrospective cohort study from the Consortium on Safe Labor between 2002 and 2008.

SETTING

Twelve clinical centers with 19 hospitals in the United States.

PARTICIPANTS

Nulliparous women (n = 43,537) younger than 25 years of age, including 1189 younger adolescents (age ≤ 15.9 years), 14,703 older adolescents (age 16-19.9 years), and 27,645 young adults (age 20-24.9 years).

INTERVENTIONS: Adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated, controlling for maternal characteristics and pregnancy complications (young adults as a reference group).

MAIN OUTCOME MEASURES: Maternal, neonatal outcomes, cesarean indications, and length of labor.

RESULTS

Younger adolescents had an increased risk of maternal anemia (aOR = 1.25; 95% CI, 1.07-1.45), preterm delivery at less than 37 weeks of gestation (aOR = 1.36; 95% CI, 1.14-1.62), postpartum hemorrhage (aOR = 1.46; 95% CI, 1.10-1.95), preeclampsia or hemolysis, increased liver enzyme levels, and low platelet syndrome (aOR = 1.44; 95% CI, 1.17-1.77) but had a decreased risk of cesarean delivery (aOR = 0.49; 95% CI, 0.42-0.59), chorioamnionitis (aOR = 0.63; 95% CI, 0.47-0.84), and neonatal intensive care unit admission (aOR = 0.80; 95% CI, 0.65-0.98). Older adolescents had an increased risk of maternal anemia (aOR = 1.15; 95% CI, 1.09-1.22), preterm delivery at less than 37 weeks of gestation (aOR = 1.16; 95% CI, 1.08-1.25), and blood transfusion (aOR = 1.21; 95% CI, 1.02-1.43), but had a decreased risk of cesarean delivery (aOR = 0.75; 95% CI, 0.71-0.79), chorioamnionitis (aOR = 0.83; 95% CI, 0.75-0.91), major perineal laceration (aOR = 0.82; 95% CI, 0.71-0.95), and neonatal intensive care unit admission (aOR = 0.89; 95% CI, 0.83-0.96). Older adolescents were less likely to have a cesarean delivery for failure to progress or cephalopelvic disproportion (aOR = 0.89; 95% CI, 0.81-0.98). For adolescents who entered spontaneous labor, the second stage of labor was shorter (P < .01).

CONCLUSION

Adolescents were less likely to have a cesarean delivery. Failure to progress or cephalopelvic disproportion occurred less frequently in older adolescents. Adolescents who entered spontaneous labor had a shorter second stage of labor.