Original Article

Outcome of Teenage Pregnancy

Ashok Kumar, Tej Singh, Sriparna Basu, Sulekha Pandey1 and V. Bhargava

Departments of Pediatrics and 1Obstetrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

ABSTRACT
Objective. The objective of the study was to evaluate the obstetric, fetal and neonatal outcomes of teenage pregnancy in a
tertiary care teaching hospital.

Methods. A retrospective case control study was performed over a period of 5 years. Data were retrieved from hospital records.
All teenage mothers (aged 13-19 completed years at delivery) delivering in the University Hospital were taken as cases. Next
3 consecutive deliveries in the age group of 20-30 year were selected as controls for each case. For statistical analysis the cases
were further subdivided into 2 groups, ≤17 years (Group A) and 18 -19 years (Group B). Groups were compared for obstetric
complications and neonatal outcome. Statistical analysis was done by software package SPSS 10.

Results. The incidence of teenage deliveries in hospital over last 5 years was 4.1%. Majority of the teenagers were primigravida
(83.2% vs. 41.4%, p<0.01). Complications like pregnancy induced hypertension (PIH) (11.4% vs 2.2%, p<0.01), pre-eclamptic
toxemia (PET) (4.3% vs 0.6%, p<0.01) eclampsia (4.9% vs 0.6%, p<0.01) and premature onset of labor (26.1% vs 14.6%,
p<0.01) occurred more commonly in teenagers compared to controls. Teenage mothers also had increased incidence of low
birth weight (LBW) (50.4% vs 32.3%, p<0.01), premature delivery (51.8% vs 17.5%, p<0.01) and neonatal morbidities like
perinatal asphyxia (11.7% vs 1.9%, p<0.01), jaundice (5.7% vs 1.2%, p<0.01) and respiratory distress syndrome (1.9% vs 0.3%,
p<0.05). Teenage pregnancy was also associated with higher fetal (1.9% vs 0.3%, p<0.05) and neonatal mortality (3.8% vs
0.5%, p<0.05).

Conclusion. Teenage pregnancy was associated with a significantly higher risk of PIH, PET, eclampsia, premature onset of
labor, fetal deaths and premature delivery. Increased neonatal morbidity and mortality were also seen in babies delivered to
teenage mothers. Younger teenager group (≤17 years) was most vulnerable to adverse obstetric and neonatal outcomes.
[Indian J Pediatr 2007; 74 (10) : 927-931] E-mail: ashokkumar_bhu@hotmail.com

Key words : Neonatal outcome; Obstetric outcome; Teenage pregnancy

Teenage pregnancy is coming up as one of the most
important social and public health problems all over the
world with a varying prevalence rate. In recent years the
incidence is increasing due to early onset of puberty, early
sexual activity in girls and relative lack of education on
contraceptive methods. Although adolescent marriage is
a cognizable offence in India, it is still a common practice
in many parts of the country. A high fertility rate, social
customs, poverty and ignorance make early marriage a
common feature in this part of the world. The teenage
period itself constitutes a high risk group requiring high
priority services. It is well known that teenagers face
greater risks of pregnancy than the women in their
Correspondence and Reprint requests : Dr. Ashok Kumar,
Professor, Department of Pediatrics, Institute of Medical Sciences,
Banaras Hindu University, Varanasi – 221005, India
[Received : November 1, 2006; Accepted March 28, 2007]
adulthood.1,2 There is paucity of recent data regarding the
outcome of teenage pregnancy from this region. In the
present study we have evaluated the maternal, fetal and
neonatal outcomes of teenage pregnancies in a teaching
hospital over a period of five years.
MATERIALS AND METHOD
A retrospective case control study was conducted in the
University Hospital, Banaras Hindu University, Varanasi
over a period of 5 years. Data were retrieved from
hospital records. The objective was to evaluate the
obstetric, fetal and neonatal outcomes of teenage
pregnancy. Teenage pregnancy was defined as pregnancy
occurring between the maternal ages of 13-19 completed
years at delivery. All teenage mothers attending the
University Hospital for delivery were taken up
consecutively as cases. For each case next 3 consecutive
singleton deliveries in the age group of 20-30 year were
selected as controls. Detailed medical, obstetric and

Indian Journal of Pediatrics, Volume 74—October, 2007 927

 A. Kumar et al

neonatal information was recorded on a predesigned
proforma. Literacy was defined as attending primary
school education and ability to read and write in local
language. Adequate antenatal care (ANC) was defined as
the presence of all the following criteria viz., (1) ≥3
antenatal check ups by a qualified medical personnel, and
(2) receipt of 2 doses of tetanus toxoid and iron and folic
acid supplementation during pregnancy. Exclusion
criteria included (1) mothers with major illnesses existing
from pre-pregnant state which could have adversely
affected the outcome of pregnancy, viz., heart or kidney
disease, bronchial asthma, diabetes mellitus,
hypothyroidism, connective tissue disorders or
hypertension, and (2) incomplete records. Obstetric
complications compared between the two groups were
anemia, pregnancy induced hypertension (PIH), pre-
eclamptic toxemia (PET), eclampsia, gestational diabetes,
oligo/polyhydramnios, antepartum hemorrhage (APH),
premature onset of labor (POL) and presence of
chorioamnionitis. Details of delivery and postnatal period
were noted. In newborns anthropometric measurements
recorded within 24 hours of birth were birth weight,
crown-heel length (CHL), head circumference (HC), chest
circumference (CC) and mid arm circumference (MAC).
Gestational assessment was done from history (calculated
from first day of last menstrual period), fetal USG, if
available, and clinical assessment by modified Ballard
Score. 3 Neonatal morbidities assessed were birth
asphyxia, birth trauma, sepsis, meconium aspiration
syndrome (MAS), congenital pneumonia, respiratory
distress syndrome (RDS), neonatal hyperbilirubinemia
and congenital anomalies. Mothers and babies were
examined twice daily for development of any
complications till discharge.
Data were analyzed by commercial statistical software
package SPSS 10. Statistical significance was calculated by
Chi square (χ2) test and Student’s‘t’ test. P value less than
0.05 was taken as statistically significant.
RESULTS
The total number of deliveries during the study period
TABLE 1. Demographic Characteristics of Study Subjects
was 9317, of which 382 (4.1%) were teenage pregnancies.
After following the exclusion criteria, 369 teenage
mothers remained in the study. Reasons for exclusion
were pre-existing medical disorders (n = 6) and
incomplete records (n = 7). Maximum number of teenage
mothers were of the age of 18 yr (141; 38.2%), followed by
19 yr (103; 27.9%), 17 yr (91; 24.7%), 16 yr (22; 5.9%) and
15 yr (9; 2.4%), 14 yr (3; 0.8%) and none of 13 yr. A total
of 1107 controls were selected. For statistical analysis the
cases were categorized into 2 subgroups; ≤ 17 yr (group
A) and 18-19 yr (group B). Demographic characteristics
are summarized in table 1.
Obstetric outcome of teenage pregnancy is shown in
table 2. Anemia was found to be widely prevalent in both
the groups. The frequencies of PIH, PET, eclampsia and
POL were found to be significantly higher in teenage
mothers. There was no difference in the incidence of
gestational diabetes, oligo/polyhydramnios, APH and
chorioamnionitis between cases and controls. Stillbirth
was more common in teenage group.
Impact of teenage pregnancy on gestation and fetal
growth is depicted in table 3. It was obvious that younger
age was associated with the lower birth weight and the
birth weight showed significantly increasing trend with
increasing maternal age. A trend for smaller babies being
born to the younger teenage mothers was noticed when
cumulative frequency of birth weight of all babies were
recorded. Majority of the babies (87.2%) in this group
were low birth weight (<2500 g). Other anthropometric
parameters (HC, CHL, CC and MAC) also followed the
same trend as birth weight. The frequency of premature
births was found more frequently in teenagers. The
younger teenagers (Group A) had significantly higher
percentage of premature deliveries.
Table 4 compares neonatal morbidity and mortality
between teenage and control mothers. The incidence of
birth asphyxia, respiratory distress syndrome and
neonatal hyperbilirubinemia were significantly more in
babies born to teenage mothers. Maximum affection was
observed in group A. Regarding the neonatal outcome,
neonatal mortality was found to be almost 3 times more

Variable Cases Controls p value Group A Group B p value

(n = 369) (n = 1107) ≤ 17 yr 18-19 yr
(n = 125) (n = 244)
n % n % n % n %

Gravida 307 83.2 459 41.4 <0.01 116 92.8 191 78.3 < 0.05
G1 52 14.1 312 28.2 < 0.01 8 6.4 44 18.0 < 0.05
G2 10 2.7 335 30.3 < 0.01 1 0.8 9 3.7 < 0.05
G3 and above 10 2.7 335 30.3 < 0.01 1 0.8 9 3.7 < 0.05
Adequate antenatal care 195 52.9 761 68.7 < 0.05 23 18.4 172 70.5 < 0.01
taken
Literate 177 47.9 812 73.4 < 0.01 37 29.6 140 57.4 < 0.01
Wt < 40 Kg 85 23.0 246 22.2 NS 29 23.2 56 22.9 NS
Ht < 145 cm 106 28.7 291 26.3 NS 37 29.6 69 28.3 NS

928 Indian Journal of Pediatrics, Volume 74—October, 2007

 Outcome of Teenage Pregnancy

common in babies born to teenage mothers compared to
the controls and the difference was statistically
significant. Neonatal mortality was highest (8%) in group
A. The most common cause of neonatal mortality in both
cases and controls was prematurity followed by perinatal
asphyxia.
DISCUSSION
Mothers more than 30 yr of age were not included in the
present study as controls due to higher pregnancy
complications common in this age group. Incidence of
teenage pregnancy was 4.1% in the present study
whereas other studies showed the incidence ranging from
8.3 to 23.4%. 1,4 All mothers attending the hospital for
deliveries were married. We did not come across any
unmarried teenage mother in the study. It is a common
practice for unmarried mothers to go either for
termination of pregnancy or to quacks for delivery
because of strong social taboos preventing them to attend
a large public hospital. This could be a reason for low
incidence of teenage delivery in the present study. As
number of subjects of 16 yr and below was too small (34

TABLE 2. Obstetric Outcome

Variable Cases Controls p Group A Group B p value

(n = 369) (n = 1107) value =17 yr 18-19 yr
(n = 125) (n = 244)
n % n % n % n %

Anemia (Hb < 11 g/dl) 232 62.9 707 63.9 NS 78 62.4 154 63.1 NS
Premature labor 96 26.1 162 14.6 < 0.01 54 43.2 42 17.2 < 0.01
Chorioamnionitis 29 7.9 76 6.9 NS 10 8.0 19 7.8 NS
Pregnancy induced hypertension 42 11.4 24 2.2 < 0.01 23 18.4 19 7.8 < 0.01
Antepartum hemorrhage 10 2.7 23 2.1 NS 3 2.4 7 2.9 NS
Polyhydramnios 8 2.2 11 0.9 NS 2 1.6 6 2.5 NS
Eclampsia 18 4.9 7 0.6 < 0.01 11 8.8 7 2.9 < 0.05
Oligohydramnios 4 1.1 6 0.6 NS 2 1.6 2 0.8 NS
Preeclamptic toxemia 16 4.3 3 () 0.3 < 0.01 9 7.2 7 2.9 < 0.05
Gestational diabetes 1 0.3 3 0.3 NS 0 0.0 1 0.4 NS
Mode of delivery
Normal vaginal delivery 240 65.0 658 59.4 NS 81 64.8 159 65.2 NS
Cesarean Section 119 32.2 426 38.5 NS 41 32.8 78 31.9 NS
Forceps 10 2.7 24 2.2 NS 3 2.4 7 2.9 NS
Maternal mortality 1 0.3 3 0.3 NS 1 0.8 0 0.0 NS
Still births 7 1.9 3 0.3 < 0.05 5 4.0 2 0.8 < 0.01

n = number of subjects; NS = not significant

TABLE 3. Gestational Age and Fetal Growth

Variable Cases Controls p value Group A Group B p value

(n = 369) (n = 1107) ≤17 yr 18 - 19 yr
(n = 125) (n = 244)

Gestational age (weeks)

<28 8 (2.2) 4 (0.4) < 0.05 5 (4.0) 3 (1.2) < 0.01
<32 39 (10.6) 30 (2.7) < 0.01 22 (17.6) 17 (6.9) < 0.01
<37 191 (51.8) 194 (17.5) < 0.01 109 (87.2) 82 (33.6) < 0.01
≤37 173 (46.9) 912 (82.4) < 0.01 14 (11.2) 159 (65.2) < 0.01
Birth weight category (g)
< 1000 11 (2.98) 4 (0.4) < 0.01 5 (4.0) 6 (2.5) < 0.05
<1500 33 (8.9) 39 (3.5) < 0.01 17 (13.6) 16 (6.6) < 0.01
<2000 73 (19.8) 128 (11.6) < 0.01 52 (41.6) 21 (8.6) < 0.01
<2500 186 (50.4) 358 (32.3) < 0.01 109 (87.2 77 (31.6) < 0.01
≤ 2500 183 (49.6) 743 (67.1) < 0.01 16 (12.8) 167 (68.4) < 0.01
Crown heel length (cm) 44.9 48.3 < 0.05 41.4 46.7 < 0.01
(Mean ± S.D.) ± 5.6 ± 3.4 ± 5.1 ± 5.8
Head circumference (cm) 30.9 33.7 < 0.05 27.9 32.4 < 0.01
(Mean ± S.D.) ± 3.4 ± 2.1 ± 3.0 ± 3.6
Chest circumference (cm) 28.4 31.6 < 0.05 26.2 29.5 < 0.01
(Mean ± S.D.) ± 2.1 ± 3.4 ± 2.0 ± 2.3
Mid arm circumference (cm) 7.4 8.8 < 0.05 6.8 7.7 < 0.05
(Mean ± S.D.) ± 0.9 ± 1.6 ± 0.8 ± 1.0

Figures in parentheses indicate percentage

Indian Journal of Pediatrics, Volume 74—October, 2007 929

 A. Kumar et al

TABLE 4. Neonatal Morbidity and Mortality

Variable Cases Controls p value Group A Group B p value

(n = 369) (n = 1107) ≤17 yr 18-19 yr
(n = 125) (n = 244)
n % n % n % n %

Birth asphyxia 43 11.7 21 1.9 < 0.01 28 22.4 15 6.1 < 0.01
Neonatal hyperbilirubinemia 21 5.7 13 1.2 < 0.01 12 9.6 9 3.7 < 0.01
Respiratory distress syndrome 7 1.9 3 0.3 < 0.05 5 4.0 2 0.8 < 0.05
Meconium aspiration syndrome 6 1.6 12 1.1 NS 2 1.6 4 1.6 NS
Sepsis 7 1.9 13 1.2 NS 3 2.4 4 1.6 NS
Congenital anomalies 2 0.5 4 0.4 NS 1 0.8 1 0.4 NS
Neonatal mortality 14 3.8 5 0.5 < 0.05 10 8.0 4 1.6 < 0.01

n = number of subjects; NS = not significant

out of 369) for statistical analysis, cases were further
subdivided into two groups, ≤ 17 yr; (group A) and 18 -
19 yr; (group B). As expected majority of younger
teenagers were primigravida. But it was surprising to
find that nearly 17% of teenage mothers were carrying
their second or third pregnancy. This finding suggests
that teenage women have no control over fertility in our
country and are exposed to repeated pregnancies at short
intervals with all its inherent dangers. Poor antenatal care
and illiteracy were documented in other studies also as
similar to the present study.5-8 Youngest mothers were
most commonly affected. Poor weight gain during
pregnancy in teenagers was reported in several studies.6,9
In the present study weight below 40 Kg or height below
145 cm were comparable between the cases and controls
reflecting an overall female undernutrition in the country.
Incidences of PIH, PET, eclampsia and POL in teenage
mothers were found to be significantly higher than the
controls in the present study. This is in accord once with
earlier studies.6,10 However, other investigators have
observed no difference in various age groups. 4,8,9,11
Younger mothers were found to be worst affected.
Regarding the mode of delivery, difference in
observations is present. Some authors have reported
increased operative (cesarean or instrument assisted)
deliveries,4,6,12,13 others found significantly less operative
interventions,9,14,15 in adolescent age group. No statistical
significant difference was found in the frequency of
operative deliveries in the two groups. In several studies
anemia was found to be more common in teenage
mothers7,12,13 but it was widely prevalent in all age groups
in the present study, reflecting the high prevalence of
anemia during pregnancy. Though increased maternal
mortality has been documented in some studies,16 it was
not the same in the present one, most likely due to small
sample size.
Many studies have reflected poor perinatal outcome in
the form of LBW, preterm delivery and increased
perinatal mortality2,4,12 which is in accordance with the
present one. There is a significant association between
young age of mother and low birth weight even in
developed countries. Babies born to teenagers are more
likely than those born to women in their 20s to be born
early and to weigh less than 2,500 g at birth. Further
research suggests that these risks vary by age even
among teenage mothers, younger mothers having the
worst outcomes.17 Some of the explanations proposed for
these adverse birth outcomes are biological. Biological
immaturity in teenage mothers itself is an inherent risk
factor for poor outcome and even adequate prenatal care
does not completely eliminate the risk. Two general
features of biologic immaturity could have a role in
increasing the risk of adverse outcomes: a young
gynecologic age (defined as conception within two years
after menarche) 18 and the effect of a girl becoming
pregnant before her own growth has ceased, thus
competing with the developing fetus for nutrients adding
to its detriment. Immaturity of the uterine or cervical
blood supply may predispose teenage mothers to
subclinical infection, an increase in prostaglandin
production, and a consequent increase in the incidence of
preterm delivery.19-21 Psychological factors may also be
involved, since many adolescent pregnancies are
unplanned, unwanted or discovered late; a pregnant
teenager may lack the emotional maturity to take
responsibility for a pregnancy even after she has decided
to carry it to term. The authors think, in the present study,
along with their poor nutritional status, PIH, PET and
POL were added reasons for increased number of
premature and LBW deliveries to teenager mothers.
Among the neonatal morbidities, incidence of birth
asphyxia, respiratory distress syndrome and neonatal
hyperbilirubinemia were significantly more in the
teenager group. The younger subgroup was maximally
affected. Most probable reason would be higher number
of premature and LBW babies in this age group.
Incidence of MAS, sepsis and congenital anomalies were
similar in both the groups. Most of the other studies
present the same results, except some which reported
increased incidence of infection, meconium aspirations
and systemic malformations.2,4,12 Increased incidence of
fetal death, similar to the present one, had been reported
by other studies also.11,22,23

930 Indian Journal of Pediatrics, Volume 74—October, 2007

 Outcome of Teenage Pregnancy
The limitation of this study is that it is a hospital-based
study and therefore may not be a true reflection of the
situation in the community. It is possible that some cases
of teenage pregnancy did not come to the hospital
because of poverty, ignorance or social reasons.
India is fast approaching to be the most populous
country in the world, and increasing teenage pregnancy,
an important factor for the population rise, is likely to
aggravate the problem. Poor illiterate young girls are
getting married early and becoming pregnant before
achieving their own growth potential. Not only they
themselves are suffering from different complications of
pregnancy but also they are making a future generation
already compromised from birth. Teenage pregnancies
are now-a-days getting the much deserved publicity, and
unless there is improvement in the general socioeconomic
status, female literacy, increased public awareness,
proper sex education in school and lifting of restrictions
of teenage access to contraceptive services, no long term
benefit can be expected. Not only there should be efforts
to improve the socio-demographic environment of
pregnant teenagers to improve the reproductive outcome
but also decrease the incidence of teenage pregnancy by
increasing public awareness, enforcing marriage law and
ensuring female education. The younger teenage group is
most vulnerable and maximum attention should be
diverted to them.
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