Why are complications more common in adolescent pregnancy and childbirth?

Pregnancy and childbirth in adolescence is risky for the health of both mother and baby
• Biologically, an adolescent’s body is still developing and not yet ready to take on an added strain. The pelvic bones are not fully mature, and cephalo-pelvic disproportion could occur. Her body has special nutritional needs and when pregnancy occurs, it is a strain on already depleted reserves, especially if she belongs to a low socio-economic background.

The young girl may not be mentally prepared for motherhood with all its added responsibilities, etc. and this could give rise to mental health problems like depression.

• Socio-culturally, pregnancy outside of marriage bears a terrible stigma and the above situation worsens when the girls is not married, in which case she does not get the emotional support she needs as well as support in terms of nutrition, rest, antenatal check-ups, etc.

• Shortcomings in service delivery deter adolescents from seeking timely medical help and intervention. At many health centres, pregnant adolescents who are unmarried are treated with none of very little respect by all staff, some of whom may not be aware of the risks associated with such pregnancies. So, even if the girls are able to access health services of some kind, she does not necessarily get the benefit of a sensitive and technically competent check up. This is the reason unmarried adolescents hide their pregnancies for as long as they can and medical help is delayed at great risk to their lives.

This situation is not unique to unmarried adolescents as the married ones also may not be aware of the importance of antenatal care. For various reasons, the adolescent woman is more likely to deliver at home. The older women in the home feel that a traditional birth attendant is equipped to carry out the delivery, her services are cheaper and she is easily accessible. A trained birth attendant or a hospital is usually thought of when things get out of hand and complications have already set it.

The risks are high, starting from the antenatal period, through labour and the postpartum period. Adolescent mothers are most likely to give birth to low weight babies and both the mother and child face higher mortality and morbidity.

Complications of pregnancy and childbirth that occur more commonly in adolescents than in adults
• Pregnancy-induced hypertension
• Anaemia during antenatal period
• HIV: Higher incidence of mother to child transmission
• Higher severity of malaria
• Pre-term birth
• Obstructed labour
• Anaemia during postpartum period
• Pre-eclampsia
• Postpartum depression
• Too early repeat pregnancies
• Low birth weight
• Perinatal and neonatal mortality
• Inadequate child care and breastfeeding practices

• Problems is the antenatal period
-pregnancy-induced hypertension: Studies report an increased incidence of the condition in young adolescents, when compared with older women.

-Anaemia: There is an increases risk of anaemia in adolescents because of nutritional deficiencies, especially of iron and folic acid, and by malaria and intestinal parasites.

-Stis/HIV: Sexually active adolescents are at an increased risk of contracting STIs, including HIV infection, owing of their biological and social vulnerability. There is also the increased risk of parent-to child transmission of HIV in adolescents, because the HIV infection is more likely to be recent, and therefore associated with higher viral loads. The presence of other STIs (syphilis, gonorrhoea and Chlamydia) with local inflammation may increase viral shedding, thereby increasing the risk of transmission during labour.

-Higher severity of malaria is often seen in first time pregnant women (which included many adolescents) and is a common cause of anaemia in this group. This puts them at risk and their unborn babies at risk of intrauterine death.

• Problems during labour and delivery
-Pre-term birth is common in women under twenty years of age because of immaturity of the reproductive organs, social factors such as poverty, at play.

-Obstructed labour in young girls (below 15 years of age) occur die to the small size of the birth canal leading to cephalopelvic disproportion. Lack of access to medical and surgical care can result in complications like vesicovaginal nad recto-vaginal fistulae and other birth injuries like cervical, vaginal and perineal tears and lacerations.

• Problems in the postpartum period
-Anaemia is commoner and further aggravated by blood loss during delivery thereby also increasing the risk of infection.

-Pre-eclampsia: Several studies report that pre-eclampsia occurs more often in young adolescents. The symptoms may worsen and sometime recognized only during the first postpartum days.
 -Postpartum depression and common mental health problems are common due to reasons described above.
-Too early repeat pregnancies, especially in unmarried adolescents can occur because of the difficulty in accessing reliable contraception.

• Problems affecting the baby
-Low birth weight: There is a higher incidence of low birth weight (weight <2500 grams) among infants of adolescent mothers.
-Perinatal and neonatal mortality is increased in infants of adolescent mothers, compared with infants of older mothers.
-Inadequate childcare and breastfeeding practices: Young mothers, especially those who are single and poor, may find it hard to provide their children with the adequate care. This is reflected in their poor child feeding, including breastfeeding, practices.