6. Discussion Thisis a preliminary study which has focused on the adverse obstetric and perinataloutcomes of teenage and adult pregnancy. There were many conflicting resultsfrom previously done studies in different parts of the world and there is lackof data in sub-Saharan African countries including Ethiopia. So we aimed toanalyses the effect of teenage pregnancy on obstetric and perinatal outcomes incomparison with adult pregnancy. In this study low birth weight, pretermdelivery and sever neonatal conditions were significantly associated withteenage pregnancy but fetal distress and still birth/intrauterine fetal deathwere not significantly associated with teenage pregnancy i.e.
there were nosignificance difference between teenage and adult delivery. Regarding to theobstetric outcomes pregnancy induced hypertension, episiotomy and post termdelivery were significantly associated with teenagers but antepartumhemorrhage, postpartum hemorrhage, instrumental delivery, and perineal tearwere not significantly associated with teenage pregnancy which means there wereno statistically significant difference in between the two age groups.Thisstudy result shows that 17.5 % of the teenagers deliver low birth weight and6.8 % of the adults deliver low birth weight neonate. After adjusting todifferent confounding factors teenagers were 2.07 times more likely to deliverlow birth weight neonate than the adult mothers (AOR: 2.07; 95% CI, 1.
03-4.17). This studyis congruent with study done in north India, which shows the occurrence of lowbirth weight was 1.6 times more likely to be delivered from teenagers thanadults and study done in Nepal teenage gave low birth weight ( 24% Vs 7%, p=0.013)(21) (27). Likewisecohort and cross sectional study conducted in Cameron in different yearsrevealed that teenagers were 1.46 and 2.8 times more likely to deliver lowbirth weight neonates than the adult mothers respectively.
Moreover study inEgypt also reports that teenage deliver low birth weight (25.1 Vs 19.3%, p=0.
001)(19) (29) (30). These almost nearlythe same results of low birth weight outcomes might be due to the anatomicalimmaturity and continued growth of the teenagers may represent the biologicalgrowth barrier to their fetus and the low socio-economic status, low level ofeducation in teenagers put them to give low birth weight neonate more thanadult mothers. Nevertheless this finding is contradicted by studies done in Yaoundécentral hospital, Cameron (p=0.42) and South Africa (0.174) showed low birthweight had no significant association with maternal age (6) (31). This might beprobably due to the socio-economic difference, study area setting anddifference in sample size Concerningto the preterm delivery this study result show that teenagers were 2.92 timesmore likely to deliver prematurely than the adult mothers(AOR: 2.
92; 95% CI, 1.48-5.75). The samefinding were observed studies done at India, Turkey ,Taiwan ,Korea andretrospective case study in Cameron, WHO, cohort study done in Cameron revealedthat 1.
65,2.7,1.58,2.47,1.85,1.60 times more likely teenagers experiencedelivery of premature neonates than the adult mothers respectively (10),(21), (22),(23),(17),(29),(30). Furthermoresimilar finding was reported from studies conducted in USA and Sweden (24) (26). The possiblereason for this might be teenagers are more liable to psychological instability/stressbecause of the pregnancy and low level of education which triggers labour.
Furthermore this stress imposes the endocrine disturbance and the immaturity ofthe uterine/cervical blood supply in teenagers stimulates prostaglandinproduction which leads to preterm delivery. Despite our finding, studies donein Sweden (AOR 1.03, 95% CI; 0.98-1.09) and South Africa (p=0.
702) showed thatthere were no significance difference in preterm deliveries between the two agegroups (26), (31). This might bedue to quality of ANC, nutritional conditions.Severneonatal condition in this study depicted that teenagers were 2.6 times morelikely to had sever neonatal conditions than the adult mothers (AOR: 2.6; 95% CI, 1.08-6.
28 ). Thisresult was congruent with institutional based cross sectional study conductedby world health organization which shows those teenagers were 1.56 times morelikely to had sever neonatal conditions than adult mothers(10). The possibleexplanation might be socio-economic condition, health service utilization andnutritional status of mothers especially for those teenagers. Thisstudy indicated there were significant difference between teenagers and adultwith regarding to the development of pregnancy induced hypertension. Teenagersdevelop pregnancy induced hypertension 2.29 times more likely than the adultmothers. (AOR: 2.
29; 95% CI, 1.01-5.19).Alongside to our finding study done in USA showed that there were significantassociation of pregnancy induced hypertension with maternal age. Teenagersdevelop PIH 1.34 times more likely than their counter age groups (24). This might beattributed to the fact that null parity and age less than 20 years are thepossible risk factors for the development of pregnancy induced hypertension. However,our finding was inconsistent with studies done in Pakistan (p>0.
05 andAnkara, Turkey (p=0.31) which revealed that as there were no significantassociation of PIH with teenagers and adults(28)(32). This variationmight be explained by the environmental factors and socio-economic variation.
In addition to these the variation might be due to difference in health careservice utilization, preconception care especially folic acid supplementation.The study time gap between the studies may also put the difference thatprobably PIH had seasonal variation.Regardingcesarean delivery teenagers were 47% less likely to deliver by cesarean sectionthan adult mothers (AOR: 0.53; 95% CI,0.333-0.
847). This study nearly had the same finding with studies done inSweden and USA which was their finding was 40%, 51% less likely that teenagersundergo cesarean delivery (AOR: 0.49;95% CI, 0.42-0.59) and (AOR: 0.60;95% CI, 0.58-0.
64) respectively (24), (26). Anotherstudy done in Ankara, Turkey also showed that teenagers were 36 % less like toundergo cesarean delivery than adults (AOR: 0.64; 95% CI, 0.
64-0.89) (28). The possible explanation for this might bedue to the awareness difference between the two age groups aboutcesarean section and teenagers are more favored to vaginal delivery due tobetter myometrium function.
Lastly it could be also the small size or birthweight of the neonate from teenagers break the widely held belief thatteenagers are prone to CPD but not in the ground. However this study findinghas contradiction with three studies done in Cameron which was conducted atdifferent time. All these studies declare that cesarean delivery had no anysignificant association with maternal age. Both teenagers and adults undergocesarean delivery without any significant difference (6),(29), (30).
This variationmight be due to difference in decision making ability of the two age groups andstudy area settingInthis study episiotomy was done about 2 times more likely on teenagers thanadults. Similar to our finding studies done in Romania (p<0.01) and Turkey(p=0.0001) showed that teenagers were more to had episiotomy than the counterage (34) (29). Furthermorestudies done in Cameron (2.
15 times more likely) and Nigeria (61.7 Vs 28.7%,p=0.001) also congruent with our finding(6) (35). This might bedue to study area setting, the rules to apply episiotomy.
However, studies donein Cameron contradict to our finding. This study revealed that there was nostatistically significant difference between the two age groups. This variationmight be due to the difference in parity of the clients. 7.
Strength and Limitation Strength of the study § Theresult of the study depicts that evidence based information on the obstetricand perinatal outcomes of teenagers and adults delivery.§ 100% response rate.§ Orientationgiven to the data collectors and supervisor.Limitation of the study § Factorslike economic status, educational level and other unmentioned factors whichmight affect the outcomes of teenage and adult pregnancy outcomes could not beaddressed in this study.§ Theuse of small sample size § Theuse of secondary data § Thisstudy only includes those mothers who deliver at institution which do notincorporate home delivery outcomes.§ Cardsmight not provide complete information as needed.