Adolescent Pregnancy and Anemia: A Descriptive Analysis in a Tertiary Care Hospital in Kolkata, West Bengal

INTRODUCTION

Adolescent pregnancy is a major public health problem in India due to its deleterious consequences on maternal and child health outcomes.^1,2 Adolescence is a period of fast growth; the requirement of iron becomes high, thus predisposing them to more risk of anemia than their adult counterpart.³ Anemia, through its intergenerational cycle, leads to short- and long-term outcomes. Further, it is one of the preventable and treatable maternal complications.

In West Bengal, 16.4% of the adolescents between 15 and 19 years were pregnant or had already experienced childbirth, as per the latest round of the National Family Health Survey (NFHS).⁴ In the context of a high proportion of institutional delivery (92%) in West Bengal, as found in NFHS, the hospital records on maternal and newborn indicators can provide a fair estimate of the burden of the problem. Routine data collected by the hospital in the preceding years showed a considerable proportion of adolescent pregnancy, which warranted taking stock of the problem among this vulnerable group. With this background, the present study was carried out to assess the proportion of adolescent pregnancy and its association with maternal anemia among pregnant women attending a tertiary care hospital in Kolkata, West Bengal. Associations of selected newborn parameters with adolescent pregnancy were also examined.

MATERIAL AND METHODS

RESULTS

The final sample size for the analysis was 3039, after excluding the entries with missing values and twin pregnancies. Out of this, 351 (11.5%) were adolescents. The distribution of anemia among adolescent and adult pregnant women is depicted in figure 1. The hemoglobin level was significantly lower among adolescent pregnant women (mean [SD] 10.99 [1.32] g/dL) than that of adult pregnant women in the present analysis (mean [SD] 11.15 [1.31] g/dL).

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Figure 1:

Distribution of hemoglobin level among adolescents and adult pregnant women (n = 3039).

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As many as 61 (17.4%) of adolescent pregnant women are found to be multigravida. There is no difference in gestational age among these two groups. The proportion of cesarean delivery is also high (35.1%) among adolescent women [Table 1].

It was found that the proportion of stillborn babies among adolescent pregnant women (0.9%) was lower than that of their adult counterparts (2.5%). A similar finding was also observed in the case of low birth weight (20.5% compared to 21.3%).

DISCUSSION

Adolescent pregnancy or teenage pregnancy (pregnancy at or below the age of 19 years) is an important risk factor for adverse maternal and perinatal outcomes. Maternal anemia is one such outcome stressed by this study. Important maternal and newborn variables are also included that could have a relationship with the age of the mother.

In the present analysis, 11.5% of the antenatal women were adolescents. Although this is lower than a similar study conducted in 2018, where the proportion of teenage pregnancy was 19.4%⁵ still, the proportion is not at all negligible. A comparative study among adolescents (<20 years) and adult (20–30 years) pregnant women in Guntur revealed that the proportion of under-nutrition (36% vs. 14%) is significantly higher among the adolescent group.⁶ Anemia is one of the nutritional indicators identified by national programs. Therefore, it can be said that the present study came out with similar results. The difference in maternal anemia (46.4% vs. 40.7%, P < 0.05) was identified even when there were no significant differences in important factors, such as gravida and gestational age, among the two groups. The proportion of multigravida (17.4%) is found to be higher than in a study conducted in a rural teaching hospital of Telangana in 2018, where 14% of teenage mothers studied were multigravida.⁷ In an older study in similar settings, 28.3% of the adolescent mothers had cesarean delivery compared to 36.9% among adults. However, there was no significant association between the age of mothers and the mode of delivery.⁸ This is in congruence with the present analysis. On the other hand, findings related to newborn parameters are dissimilar. In the present study, the proportion of low birth weight (20.5%) among adolescent women was similar to a hospital-based study in Sri Lanka (18.2%); however, in the latter, the proportion was 1.3 times higher than for adult pregnant women and was statistically significant.⁹ Such observations might be due to the fact that the nutritional deficiency was not to such an extent that it could result in nutritional deficiency in newborns. Our study findings are aligned with a study in different settings, where the proportion of adolescent pregnancy is quite low (2.27%); however, they were significantly more anemic. Further, except for a higher proportion of preterm, no other perinatal outcomes were significantly different among the two age groups.¹⁰ Although a hospital-based study could not truly reflect the picture in the community, it could provide a snapshot of the scenario. Further, socio-epidemiological research is required to gain deeper insight into the problem.

CONCLUSION

Although the gestational age of the fetuses among adolescent and adult antenatal pregnant women is the same, the hemoglobin level is significantly lower among the former group. However, there is no significant difference in newborn parameters in the present analysis.