Pregnancy outcomes of adolescent primigravida and risk of pregnancy-induced hypertension: a hospital-based study in Southern Thailand.

The objectives were to examine pregnancy outcomes in adolescent primigravida and to determine the effects of adolescent pregnancy on pregnancy-induced hypertension (PIH). A retrospective analysis of pregnancy outcomes was carried out in 2440 adolescent primigravida, compared with 14,259 primigravida aged 20-29 years. The adolescents had significantly higher rates of maternal death, maternal heart disease, PIH, puerperal infection, chorioamnionitis, urinary tract infection, foetal anomaly, preterm delivery, low birth weight, low Apgar scores and stillbirth. Multivariate logistic regression analysis showed that both older (16-19 years old) and younger (≤15 years old) adolescents were significantly at an increased risk of PIH (adjusted OR of 1.29; 95% CI, 1.03-1.62 and 1.90; 95% CI, 1.02-3.54, respectively). Adolescent primigravida had significantly lower rates of caesarean delivery, diabetes mellitus, chronic hypertension, placenta praevia and cephalopelvic disproportion (CPD). Inadequate antenatal care in adolescents increased rates of PIH and adverse foetal outcomes. Impact statement What is already known on this subject? Adolescent pregnancy is associated with adverse pregnancy outcomes in both mothers and foetuses. Conflicting evidence on some adverse maternal outcomes still exists. What the results of this study add? Our data suggest a significant increase risk of pregnancy-induced hypertension (PIH) in both younger and older adolescent primigravida. Inadequate antenatal care (<4 times) in adolescents increased rates of PIH and adverse foetal outcomes. Rate of maternal death was higher than previous study, with different causes of death. In our study, the major cause of death was heart disease, but previous study found hypertensive disorder to be the leading cause of death in adolescents. Rates of infection also increased during pregnancy and postpartum period. The adolescents had lower rates of caesarean delivery, diabetes mellitus, chronic hypertension, placenta praevia and cephalopelvic disproportion (CPD). What the implications are of these findings for clinical practice and/or further research? Early detection and prompt treatment for adverse maternal complications, especially PIH, infection and preterm labour are essential. Ultrasound screening at 18-20 weeks' gestation should be performed due to an increased risk of foetal anomaly. Further research in prevention of PIH in adolescent pregnancy is suggested.