Teenage pregnancy proportion, and comparison of maternal and neonatal outcomes with adult pregnancy at a General Hospital in Northern Uganda

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In Uganda, while teenage pregnancy rates are high, knowledge about their specific risks compared to those of adult pregnancy remains limited. Objective We determined the proportion of pregnant teenagers and compared the maternal and neonatal outcomes between pregnant teenagers and pregnant adults at a general hospital in northern Uganda. Methods We conducted a comparative, retrospective cohort study involving chart reviews of deliveries at the maternity ward of Anaka General Hospital, Nwoya, Uganda between July 2020 and June 2023. We performed systematic random sampling to include patient charts. All the data were analyzed using STATA software 17 SE. Binary logistic regression was performed to compare adverse pregnancy outcomes between teenage mothers and adult mothers. Results Over the 3-year period, 27.6% (n = 1,842) of the 6,662 deliveries were by teenage mothers. The outcomes of 457 teenage and 457 adult mothers were compared. Compared to adult mothers, teenage mothers had a significantly lower prevalence of HIV (2.2% versus 6.1%, p = 0.003). Teenage mothers had higher odds of having an episiotomy performed (adjusted odds ratio [aOR] = 5.66, 95% confidence interval [CI]: 2.48–12.90, p < 0.001), low birth weight (aOR = 4.66, 95% CI: 2.66–6.37, p < 0.001) or perineal tear (aOR = 2.61, 95% CI: 1.69–4.02, p < 0.001). However, adult mothers had greater odds of developing pre-eclampsia (aOR = 4.0, 95% CI: 1.59–11.1, p = 0.004). Conclusions In this study, approximately 1 in every 4 deliveries were by teenage mothers, with increased risks of maternal and neonatal complications, except for pre-eclampsia which was more common among adult mothers. Therefore, it is crucial to implement targeted interventions and comprehensive education programs aimed at reducing teenage pregnancies and providing adequate antenatal care and support for teenage mothers. Teenage pregnancy Maternal outcome Neonatal outcomes Figures Figure 1 Background Teenage pregnancy, defined as conception between the ages of 13 and 19 years, is a global public health concern due to its significant medical risks for both mothers and newborns, impacting both developed and developing nations ( 1 – 3 ). Although often used interchangeably, terms such as “adolescent” and “child pregnancy” have distinct meanings from “teenage pregnancy” ( 4 ). Globally, approximately 16 million pregnancies occur in girls aged 15–19, with an additional 1 million pregnancies occurring in girls under 15 years ( 4 ). Over 90% of teenage pregnancies occur in sub-Saharan Africa (SSA) ( 4 , 5 ), where the prevalence of teenage pregnancy is 19.3%, with the highest rate occurring in East Africa ( 5 ). Hospital-based studies have revealed varying rates of teenage pregnancy across different settings and populations. In Nepal, a community hospital study revealed that 29.06% of total deliveries over a ten-year period were teenage deliveries ( 6 ). Similarly, in Ethiopia’s Assosa General Hospital, the prevalence was 26% ( 7 ), and in Egypt’s Bassion General Hospital ( 8 ), it was 26.4%. In Uganda, Kiryandongo General Hospital reported a prevalence of 12% ( 9 ), while the Mbale Regional Referral Hospital had a prevalence of 20.6% ( 10 ). Teenage pregnancy is linked to serious maternal health complications when compared to adult pregnancy due to biological and psychological unreadiness, limited access to care, and social/economic disadvantages ( 2 , 11 ). These complications include pregnancy-induced hypertension ( 8 , 12 ), anaemia ( 8 , 13 ), preterm delivery ( 14 , 15 ), increased rates of caesarean sections ( 12 – 14 ), postpartum hemorrhage (PPH) ( 12 , 15 ), perineal tears ( 16 ), and sexually transmitted infections, including HIV ( 17 , 18 ). Infants born to teenage mothers face risks such as preterm birth ( 15 ), low birth weight ( 12 , 19 , 20 ), birth asphyxia ( 14 ), neonatal intensive care unit (NICU) admission ( 8 , 19 ), and long-term permanent physical and mental disabilities ( 3 ). Teenage pregnancy is a significant public health concern in Uganda, where 52% of the population is under 18 years old; however, the prevalence of teenage pregnancy is 25% ( 21 ), particularly affecting areas such as the Nwoya district, where girls face vulnerabilities due to low secondary school attendance (16%), high dropout rates (94%), and early marriage (20% before age 20) ( 22 ). Despite systematic challenges, there is limited information on the outcomes of teenage pregnancy; all studies in Uganda did not compare delivery outcomes between teenage and adult mothers ( 9 , 10 , 23 ). Priority should be given to ensuring safe pregnancy outcomes for teenage mothers. This study therefore aimed to determine the proportion of teenage pregnancy and compare the maternal and neonatal outcomes between pregnant teenage and pregnant adult at Anaka General Hospital. Methods Study design This study was a hospital-based retrospective cohort study involving review of records of deliveries conducted at the maternity ward of Anaka General Hospital, Nwoya District, northern Uganda, from July 2020 to June 2023. Mention here the tools you used Study setting Anaka General Hospital is the only government-owned hospital under governance of Nwoya district local government. The hospital has an average of 2000 deliveries annually. The unit provides care 24 hours a day, 7 days a week, offering comprehensive emergency obstetric, maternal and newborn care. Study population. The study population consisted of deliveries at Anaka general hospital between July 2020 and June 2023. Two arms were compared: women under 20 years (teenage) and those aged 20 years or older (adults). The charts of women who delivered before arrival (BBA), or had multiple pregnancies were excluded. Sample size estimation To determine the proportion of teenage pregnancies, a census of all admissions during the study period was carried out. The sample size for the comparison of delivery outcomes was calculated using the Kish Leslie formula, and the sample size was calculated with the double proportion formula ( 24 ). Employing a critical value of 1.96 at the 5% level of significance, the proportion of caesarean sections was considered to be 12.9% in teenage pregnancies, and 18.8% in adult pregnancies, sourced from a study in Ethiopia ( 12 ). With a margin of error of 0.05 and a power of 80%, we determined a sample size of 457 teenage mothers and 457 unmatched adult mothers, resulting in a total sample size of 914. Sampling strategy. During the study period, there were a total of 6,662 obstetric admissions, which included 1,842 teenagers and 4,830 adults. Charts of 15 teenage mothers and charts of 151 adult mothers were excluded. Systematic random sampling from the integrated maternity register was used to select the charts. The sampling intervals were determined by calculating “K” values, using the formula K = N/n, where “N” is the total number of deliveries and “n” is the calculated sample size. For teenagers, K = 1,827/457 ≈ 4, while for adults, K = 4669/457 ≈ 10. The sampling intervals were 4 and 10 for teenage mothers and adults, respectively. Data collection The data were collected from the patients’ files using a structured data extraction tool. Two midwives served as research assistants. They were briefed on the study’s objectives, data collection procedures, and how to accurately complete the extraction tool. Sample charts identified from the integrated maternity register, including names and inpatient numbers, are listed. Subsequently, charts of sampled mothers and babies admitted to the NICU were retrieved from the records section. Study variables. The maternal outcome (dependent) variables included the mode of delivery (categorized as vaginal delivery or caesarean section); preeclampsia, which was defined as hypertension and proteinuria (++) according to the use of urine dipstick; ante partum haemorrhage; episiotomy performed, and perineal tear, which was defined as any tear that required repair, post-partum haemorrhage and maternal death. The foetal outcome variables included delivery status (alive or dead), birth weight, Apgar score at 1 and 5 minutes, presence of congenital anomalies, admission to the NICU and neonatal death. The main independent variable was age. Other independent (baseline) variables were the sociodemographic characteristics, medical factors and obstetrics factors. The sociodemographic factors included area of residence and referral status. Medical factor captured was the HIV status. The obstetric factors included gravidity, parity, and gestation age at delivery, stage of labour at admission and induction of labor Data management and analysis The data were checked for accuracy and completeness before being coded and entered into an Excel spreadsheet. Analysis was conducted using STATA software version 17 SE. The study utilized two-tailed tests at a 95% confidence interval and a significance of p < 0.05. The baseline characteristics of the participants are summarized; with corresponding p values indicated distribution disparities between cohorts. Categorical variables are presented as frequencies and percentages, with Pearson’s chi-square p-values. Numerical variables were assessed for normality using the Shapiro-Wilk test; normally distributed data were expressed as the mean and standard deviation with the Student’s t-test p values, and non-normally distributed data were summarized using the median, range, and p-values from the Mann-Whitney U test. The proportion of teenage pregnancy was calculated as the number of women aged less than 20 years, expressed as a percentage of the total number of women admitted for delivery during the study period. To compare the teenage pregnancy and adult pregnancy outcomes, maternal outcomes were categorized as dichotomous. Bivariate and multivariate logistic regression models were used to compare outcomes. Outcome variables that had significant ( p < 0.05) or marginally (0.05 ≤ p < 0.25) significant different proportion between the age groups were adjusted for other independent variables using separate multivariate analysis models. We checked for multicollinearity, and in that respect excluded parity (r = 0.72) and gravidity (r = 0.69) from all models as they were highly correlated with age. Backward, stepwise elimination method and Akaike’s information criteria (AIC) were used to select best models. The results are presented as adjusted odds ratios (aORs) with the corresponding 95% confidence intervals (CIs) and p values . Results Study enrollment. During the three-year-study period, there were a total of 6,662 were deliveries conducted, including 1, 842 (27.6%) of which involved teenage mothers (exposed) while 4,820 (72.4%) adult mothers (non-exposed), Fig. 1 . Proportion of teenage pregnancy Teenage mothers comprised 27.6% (n = 842) of the 6,662 total deliveries conducted in Anaka General Hospital over the three-year period. Maternal characteristics of teenage and adult mothers Compared to adult mothers, teenage mothers had a lower median gravidity (1 versus 3, p < 0.001) and parity (0 versus 2, p < 0.001). There was no statistically significant difference in the mean gestational age at delivery ( p = 0.208). The proportion of referrals was greater for teenage mothers (16.4%) than for adult mothers (7.4%) ( p < 0.001). Adult mothers had a greater prevalence of HIV (6.1% vs. 2.2%, p = 0.003). Induction of labor was more common among adult mothers (4.7%) than among teenage mothers (1.1%) ( p < 0.001). Teenage mothers presented earlier in labor, while adult mothers presented later (p < 0.001), (Table 1 ). Table 1 Maternal characteristics of teenage and adult mothers Characteristics Total N (%) Teenage n (%) Adults n (%) P value Age Median (min, max) 19.5 (15, 46) 18 ( 15 – 19 ) 25 (20–46) < 0.001 Gravidity median (min, max) 2 ( 1 , 12 ) 1 ( 1 , 3 ) 3 ( 1 , 12 ) < 0.001 Parity median (min, max) 0 (0, 10) 0 (0, 1) 2 (0, 10) < 0.001 Gestation age (Mean, SD) 38.34 (28, 44) 38.42 (2.08) 38.25 (1.97) 0.208 Referral in Yes No 109 (11.93) 805 (88.07) 75 (16.41) 382 (83.59) 34 (7.44) 423 (92.56) < 0.001 HIV status Positive Negative 38 (4.16) 876 (95.84) 10 (2.19) 447 (97.81) 28 (6.13) 429 (93.87) 0.003 Labor onset Induced Spontaneous 26 (2.9) 370 (97.10) 5 (1.10) 448 (98.90) 21 (4.74) 422 (95.26) < 0.001 Stage of labor Not in labor Latent phase Active phase Second stage 111 (12.14) 250 (27.35) 412 (45.08) 141 (15.43) 45 (9.85) 158 (34.57) 196 (42.89) 58 (12.69) 66 (14.44) 92 (20.13) 216 (47.26) 83 (18.16) < 0.001 Min – minimum value. Max – maximum value. N – Number. SD – standard deviation Comparison of maternal outcomes between pregnant teenagers and pregnant adults The proportion of caesarean deliveries was similar among teenagers (18.6%) and adult mothers (14.9%) ( p = 0.132). A greater proportion of adult mothers had pre-eclampsia than did teenagers (3.9% vs. 1.3%, p = 0.013). There was no statistically significant difference in the incidence of antepartum hemorrhage ( p = 0.363), postpartum hemorrhage ( p = 1.00) or obstructed labor ( p = 0.860). A greater proportion of teenage mothers had perineal tears (18.6% vs. 7.4%, p < 0.001) and underwent episiotomy (8.1% vs.1.5%, p < 0.001). Puerperal sepsis was rare in teenage mothers (0.1%) with no cases in adult mothers ( p = 0.317). The median hospitalization duration was 2 days for teenagers and 1 day for adult mothers ( p = 0.557), (Table 2 ). Table 2 Obstetric outcomes of teenage and adult deliveries Variable Total N (%) Teenage n (%) Adult n (%) P value Mode of delivery Caesarean Vaginal 153 (16.7) 761 (83.3) 85 (18.6) 372 (81.4) 68 (14.9) 389 (85.1) 0.132 Indication of C/S Prolong/obstructed Fetal distress Previous C/S Contracted pelvis Pre-eclampsia Others 38 (25.2) 19 (12.6) 45 (29.8) 25 (16.5) 9 (6.0) 15 (9.9) 26 (30.9) 11 (13.1) 12 (14.3) 23 (27.4) 3 (3.6) 9 (10.7) 12 (17.9) 8 (11.9) 33 (49.2) 2 (3.0) 6 (9.0) 6 (9.0) < 0.0001 Type of C/S Elective Emergent 10 (6.6) 142 (93.4) 1 (1.2) 83 (98.8) 9 (13.2) 59 (86.8) 0.003 Pre-eclampsia Yes No 24 (2.6) 890 (97.4) 6 (1.3) 451 (98.7) 18 (3.9) 439 (96.1) 0.013 APH Yes No 11 (1.2) 903 (98.8) 4 (0.9) 453 (99.1) 7 (1.5) 450 (98.5) 0.363 Obstructed/prolonged Yes No 31 (3.4) 882 (96.6) 16 (3.5) 441 (96.5) 15 (3.3) 441 (96.7) 0.860 Perineal tear Tear No tear 119 (13.0) 795 (87.0) 85 (18.6) 372 (81.4) 34 (7.4) 423 (92.6) < 0.001 Episiotomy Performed Not performed 44 (4.8) 870 (95.2) 37 (8.1) 420 (91.9) 7 (1.5) 450 (98.5) < 0.001 PPH Yes No 12 (1.3) 902 (98.7) 6 (1.3) 451 (98.7) 6 (1.3) 451 (98.7) 1.00 Puerperal sepsis Yes No 1 (0.1) 456 (99.9) 1 (0.1) 456 (99.9) 0 (0.00) 457 (100.00) 0.317 Hospitalization days 2 ( 1 , 18 ) 2 ( 1 , 18 ) 1 ( 1 , 17 ) 0.577 After bivariate and multivariate analysis, the proportions of several maternal outcomes remained significantly different between the age groups. Adult mothers had a fourfold likelihood of pre-eclampsia compared to teenage mothers ( p = 0.004). Teenage mothers were 2.61 times more likely to experience perineal tear ( p < 0.001) and 5.66 times more likely to undergo episiotomy (p < 0.001) compared to adult mothers, (Table 4 ). Table 4 Logistic regression models of adverse maternal outcomes of teenage and adult mothers Obstetric outcome Bivariate Multivariable Yes n (%) No n (%) Crude OR (95% CI) P value Adjusted OR (95% CI) P value Caesarean section Age Teenage Adult 85 (55.6) 68 (44.4) 372 (48.9) 389 (51.1) 1.31 (0.92–1.85) 0.133* 1.27 (0.86–1.87) 0.224 Parity Multiparous Nulliparous 69 (45.1) 84 (54.9) 372 (48.9) 389 (51.1) 0.86 (0.61–1.22) 0.393 -------- ----- Birth weight ≥ 3.5 < 3.5 33 (21.6) 120 (78.4) 94 (12.4) 663 (87.6) 1.94 (1.25–3.02) 0.003** 2.09 (1.29–3.37) 0.003*** Referral Yes No 37 (24.2) 116 (75.8) 72 (9.5) 689 (90.5) 3.05 (1.96–4.75) < 0.001** 3.20 (2.00–5.14) < 0.001*** Stage of labor Second stage Active phase Latent phase Not in labor 2 (1.3) 64 (41.8) 50 (32.7) 37 (24.2) 139 (13.3) 348 (45.7) 200 (26.3) 74 (9.7) 0.03 (0.01–0.12) 0.38 (0.23–0.59) 0.50 (0.30–0.83) 1 < 0.001** < 0.001** 0.007** --- 0.03 (0.01–0.12) 0.34 (0.20–0.55) 0.49 (0.29–0.82) 1 < 0.001*** < 0.001*** 0.011*** --- Pre eclampsia/eclampsia Age Teenage Adult 6 (25.0) 18 (75.0) 451 (50.7) 439 (49.3) 1 3.13 (1.20–7.69) 0.018** 4.0 (1.59–11.11) 0.004*** Parity Multiparous Nulliparous 14 (58.3) 10 (41.67) 427 (48.0) 463 (52.0) 1.51 (0.66–3.45) 0.320 ------- Referral Yes No 8 (33.3) 16 (66.7) 101 (11.3) 789 (88.7) 3.91 (1.63–9.36) 0.002** 5.38 (2.17–13.37) < 0.001*** APH Yes No 4 (36.4) 7 (63.6) 453 (50.2) 450 (49.8) 0.57 (0.17–1.95) 0.369 ------- Obstructed/prolonged labor Yes No 16 (51.6) 15 (48.4) 441 (50.0) 441 (50.0) 1.07 (0.52–2.18) 0.860 ------- Perineal tear Age Teenage Adult 85 (71.4) 34 (28.6) 372 (46.8) 423 (53.2) 2.84 (1.87–4.33) < 0.001** 2.61 (1.69–4.02) < 0.001*** Birth weight ≥ 3.5 < 3.5 23 (19.3) 96 (80.7) 104 (13.2) 687 (86.8) 1.58 (0.96–2.61) 0.072* 1.26 (0.75–2.10) 0.385) Stage labor Second stage Active phase Latent phase Not in labor 18 (15.1) 50 (42.0) 44 (37.0) 7 (5.9) 123 (15.5) 362 (45.5) 206 (25.9) 104 (13.1) 2. 17 (0.87–5.41) 2.05 (0.90–4.66) 3.17 (1.38–7.29) 1 0.095* 0.086* 0.006** --- 2.18 (0.86–5.48) 1.95 (0.85–4.46) 2.66 (1.14–6.16) 1 0.096 0.115 0.023 ---- Episiotomy Age Teenage Adult 37 (84.1) 7 (15.9) 420 (48.3) 450 (51.7) 5.66 (2.50–12.84) < 0.001** 5.66 (2.48–12.90) < 0.001*** Birth weight ≥ 3.5 < 3.5 6 (13.6) 38 (86.4) 121 (14.0) 745 (86.0) 0.97 (0.40–2.35) 0.950 ------- ---- Stage labor Second stage Active phase Latent phase Not in labor 5 (11.4) 23 (52.3) 13 (29.5) 3 (6.8) 136 (15.6) 389 (44.7) 237 (27.3) 108 (12.4) 1.32 (0.31–5.66) 2.13 (0.63–7.22) 1.97 (0.55–7.07) 0.705 0.226* 0.296 1.31 (0.30–5.71) 1.93 (0.56–6.65) 1.45 (0.40–5.26) 1 0.712 0.293 0.575 --- * Marginally significant on bivariate (p ≤ 0.05 < 0.25) ** significant on bivariate (p < 0.05) *** significant after multivariate CI – confidence interval OR – Odds ratio Comparison of neonatal outcomes of teenage pregnancy to adult pregnancy The proportion of stillbirth was similar among teenage mothers (1.8%) and adult mothers (2.0%), ( p = 0.795). Apgar scores below 7 at 1 minute were observed in 9.7% for teenagers and 7.2% for adult ( p = 0.187) and at 5 minutes, 3.3% for teenagers and 2.0% for adults ( p = 0.213). Sex distribution did not significantly differ among teenagers (51.9% boys, 48.1% girls) and adult mothers (47.9% boys, 52.1% girls) (p = 0.234). The proportion of babies that had birth asphyxia was 11.6% for teenagers and 8.9% for adults ( p = 0.190). Teenage mothers had significantly higher proportion of low birth weight compared to adult mothers (22.6% vs. 7.0%, p < 0.001). Proportion of congenital anomalies was similar ( p = 0.156). The proportion of babies that had NICU admission was 10.9% among teenagers and 12.3% among adult mothers ( p = 0.524). Among teenage mothers, 95.8% of babies were discharged alive, compared to 94.5% among adult mothers. However, this difference was not statistically significant ( p = 0.354), (Table 3 ). Table 3 Neonatal outcomes of teenage and adult pregnancies Variable Total N (%) Teenage n (%) Adult n (%) P value Status Stillbirth Live birth 17 (1.9) 897 (98.1) 8 (1.8) 449 (98.2) 9 (2.0) 450 (98.0) 0.795 Apgar 1 minute < 7 7–10 77 (8.4) 836 (91.6) 44 (9.7) 412 (90.3) 33 (7.2) 424 (92.8) 0.187 Apgar 5 minute < 7 7–10 24 (2.6) 889 (97.4) 15 (3.3) 441 (96.7) 9 (2.0) 448 (98.0) 0.213 Baby sex Male Female 456 (49.9) 458 (50.1) 237 (51.7) 220 (48.1) 219 (47.9) 238 (52.1) 0.234 Birth asphyxia Yes No 92 (10.3) 805 (89.7) 52 (11.5) 397 (88.4) 40 (8.9) 408 (91.1) 0.190 Low birth weight < 2.5 ≥ 2.5 135 (14.8) 775 (85.2) 103 (22.6) 352 (77.4) 32 (7.0) 423 (93.0) < 0.001 Anomaly Yes No 8 (0.9) 905 (99.1) 2 (0.4) 454 (99.6) 6 (1.3) 451 (98.7) 0.156 NICU admission Yes No 104 (11.6) 793 (88.4) 49 (10.9) 400 (89.1) 55 (12.3) 393 (87.7) 0.524 Discharged alive No Yes 44 (4.8) 870 (95.2) 19 (4.2) 438 (95.8) 25 (5.5) 432 (94.5) 0.354 NICU – Neonatal Intensive Care Unit After multivariate analysis, independently teenage mothers had 4.12-fold higher odds of delivering a low-birth-weight baby compared to adult mothers (p < 0.001), (Table 5 ). Table 5 Logistic models of adverse neonatal outcomes of teenage and adult mothers Variable Obstetric outcome Bivariate Multivariate Yes n (%) No n (%) Crude OR (95% CI) P value Adjusted OR (95% CI) P value Stillbirth Age Teenage Adult 8 (47.1) 9 (52.9) 449 (50.1) 448 (49.9) 0.87 (0.34–2.32) 0.807 --------- Apgar score at 5 minute less than 7 Age Teenage Adult 15 (60.0) 10 (40.0) 441 (49.7) 447 (50.3) 1.52 (0.68–3.42) 0.311 --------- Birth asphyxia Age Teenage Adult 52 (56.5) 40 (43.5) 397 (49.3) 408 (50.7) 1.34 (0.86–2.06) 0.192* 1.31 (0.85–2.03) 0.219 Birth weight < 2.5 ≥ 2.5 14 (15.4) 77 (84.6) 112 (14.0) 690 (86.0) 1.12 (0.61–2.05) 0.713 -------- Baby’s sex Male Female 53 (57.6) 39 (42.4) 396 (49.2) 409 (50.8) 1.40 (0.91–2.17) 0.127* 1.41 (0.91–2.19) 0.121 Obstructed/prolonged labor Yes No 1 (1.1) 91 (98.9) 30 (3.7) 774 (96.3) 0.28 (0.04–2.10) 0.218* 0.27 (0.04–1.99) 0.198 Low birth weight Age Teenage Adult 103 (76.3) 32 (23.7) 352 (45.4) 423 (54.6) 3.87 (2.54–5.89) < 0.001** 4.12 (2.66–6.37) < 0.001*** Parity Multiparous Nulliparous 36 (26.7) 99 (73.3) 403 (52.0) 372 (48.0) 0.34 (0.22–0.50) < 0.001** -------- Gestation age Unknown ≥ 40 37–39 < 37 7 (5.2) 16 (11.9) 70 (51.9) 42 (31.1) 35 (4.5) 215 (27.8) 449 (57.9) 76 (9.8) 0.36 (0.15–0.89) 0.13 (0.07–0.25) 0.28 (0.18–0.44) 1 0.026** < 0.001** < 0.001** 0.39 (0.15–1.00) 0.13 (0.07–0.25) 0.27 (0.17–0.43) 1 0.05 < 0.001*** < 0.001*** Baby’s sex Male Female 55 (40.7) 80 (59.3) 397 (51.2) 378 (48.8) 0.65 (0.45–0.95) 0.025** 0.61 (0.41–0.90) 0.013*** Preterm birth Age Teenage Adult 65 (54.6) 54 (45.4) 376 (49.9) 377 (50.1) 1.21 (0.82–1.78) 0.342 ---------- NICU admission Age Teenage Adult 49 (47.1) 55 (52.9) 400 (50.4) 393 (49.6) 0.87 (0.58–1.32) 0.524 ---------- Perinatal death Age Teenage Adult 19 (43.2) 25 (56.8) 438 (50.3) 432 (49.7) 0.75 (0.41–1.38) 0.355 --------- * Marginally significant on bivariate (p ≤ 0.05 < 0.25) ** significant on bivariate (p < 0.05) *** significant after multivariate CI – confidence interval OR – Odds ratio Discussion In this study, we aimed to determine the proportion of teenage pregnancies and compare the outcomes of these pregnancies with those of adult pregnancies. The study revealed a high prevalence of teenage pregnancies, and that; compared with adults, teenage mothers had significantly greater proportion of episiotomy, perineal tears, and low birth weight babies compared to adults. However adults had a greater proportion of preeclampsia. Our study found a high proportion of teenage pregnancy among the total deliveries at Anaka general hospital. The factors contributing to the high rate may be related to the increased vulnerability of girls in Nwoya due to low secondary school attendance (16%), high dropout rates (94%), and early marriage (20% before age 20) ( 22 ). This may also be attributed to inaccessibility of contraceptive services, poor attitudes of the community towards the use of contraceptives by teenagers, poor sexual and reproductive health knowledge among teenage girls, and early onset of sexual activity ( 5 ). The proportion of teenage pregnancy found in this study is higher than that documented in Ugandan studies ( 9 , 10 , 23 ) and other African countries ( 25 , 26 ), This variation could be due to the differences in culture, resources and education levels as was seen elsewhere ( 5 ). Our study findings is however comparable to rates of teenage pregnancy of 26.4% in Egypt ( 8 ) and 29.06% in rural Nepal ( 6 ). Our study further highlights the increased risk of adverse maternal outcomes; importantly; compared to adults, teenage mothers are approximately six times more likely to undergo episiotomies compared to adults. Similar findings were reported in studies from Ethiopia ( 12 ), Cameroon ( 16 ) and Malaysia ( 27 ). Teenage mothers might need more episiotomies due to factors such as tight perineum and the perceived need for assistance by healthcare providers based on their age ( 11 ). However our study differs from a Turkish study ( 28 ), possibly because of the narrow age range for adults and higher rates of episiotomy across groups, suggesting routine practice in both groups. This study revealed that adult mothers had a greater proportion of preeclampsia compared to teenage mothers, with the adults four times more likely to develop preeclampsia. Advanced maternal age and differences in healthcare utilization may contribute to this disparity, as older mothers have more risk factors and may receive more intensive monitoring. The current finding is in agreement with those of a study in Turkey ( 28 ), and in Egypt ( 14 ). However, it was inconsistent with a study in Ethiopia ( 12 ) and a study in Ethiopia ( 8 ). This difference could be due to differences in demographic characteristics (socioeconomic status or healthcare access) and may also be because of age restrictions in the adult group (adults were restricted to the 20–34 year-old age group) unlike our study, were we did not restrict the age of the adults recruited. Our study also revealed a greater proportion of teenage mothers compared to adult mothers sustained perineal tears that required suturing; teenage mothers were 2.61 times more likely to experience tears even after adjustment for birth weight and labor stage. The findings of the present study are consistent with those of 2 studies conducted in Cameroon ( 16 , 29 ). Teenage mothers’ anatomical differences such as smaller pelvis and less tissue elasticity, coupled with limited antenatal care and awareness, may increase perineal tear risk. Our finding however is not in agreement with a study in Ethiopia that found no significant association between teenage pregnancy and perineal tear ( 12 ) and that in Mecadonia, perineal tear rates were statistically significantly lower among teenage mothers ( 30 ). This could be due to differences in the demographic characteristics of our study population compared to those of the other populations. The comparison group (adults) in the study by Mecadoni was age group 20–24 unlike our study in which there was no age restriction. According to this study, 22.6% of teenage mothers delivered low birth weight neonates while only 7.1% delivered low birth weight neonates. After adjustments for the influence of gestational age at delivery and the sex of the baby, low birth weight was still significantly greater among teenage mothers. Compared with adults mothers, the teenage mothers were four times more likely to deliver a low-birth-weight baby compared to adult mothers. This was similar to findings of studies from Ethiopia ( 12 ), Egypt ( 14 ), Nigeria ( 20 ), India ( 19 ) and Indonesia ( 13 ). The reason for the high rates of low birth weight among teenage mothers is that they are still immature and still continuing to grow as well and therefore during pregnancy there is competition with the developing foetus for nutrients, and this competition is often detrimental to the foetus ( 11 ). Additionally, teenage mothers are more disadvantaged socioeconomically than adult mothers; factors such as poverty, food insecurity and inadequate housing may contribute to increased stress levels and poor maternal nutrition during pregnancy, which can impact fetal growth and result in low birth weight. Strengths and limitations The main strength of this study lies in its comparison of maternal and neonatal outcomes between teenage and adult mothers, a novel approach in Uganda and East Africa. Controlling for confounding factors enhances the study’s credibility. However, socioeconomic factors such as education and employment status, as well as behavioral risk factors such as maternal smoking and alcohol consumption, were not considered. Additionally, the study did not assess factors such as antenatal care attendance, weight gain during pregnancy, or maternal illness, which could influence maternal and neonatal outcomes in either group. We also found incomplete information in some charts reviewed, and to ensure accuracy, missing information in chart reviews was addressed by crosschecking essential registers such as the integrated maternity register, theatre register, and NICU register before considering it incomplete. Implications of the study findings The study highlights the urgent need for targeted interventions to reduce teenage pregnancy rates, addressing social factors like poverty and limited access to reproductive health services. It emphasizes the need for increased antenatal education and support for teenage mothers, along evidence-based obstetric practices such as promoting upright birth positions and non-pharmacological pain management techniques to reduce tears and episiotomies. Policy implications include prioritizing adolescent-friendly reproductive health services, comprehensive sex education to non pregnant teenage girls, and improved access to contraception, in addition to ensuring comprehensive antenatal care and support for socioeconomically disadvantaged teenage mothers. Reducing barriers to healthcare access can improve maternal and neonatal outcomes. Future directions Further research is needed to explore the roles of interventions such sex education, contraceptives use in reducing teenage pregnancy as well as factors facilitating the high teenage rates. Studies investigating the role of socioeconomic factors, healthcare access, and provider practices in shaping maternal and perinatal outcomes among the teenagers are warranted. Additionally longitudinal studies tracking maternal and perinatal outcomes over time among teenage and adult mothers can provide valuable insights into the long-term implications of age at childbirth on maternal and child development. Conclusions In this study, approximately one-quarter of the deliveries in Anaka General Hospital were by a teenage mother. Teenage mothers had increased risk of delivering a low-birth-weight baby, perineal tears and episiotomies compared to adult mothers. We recommend implementing; comprehensive sex education, and access to contraception to reduce teenage pregnancy rates and targeted antenatal education programs and evidence based obstetric practices to improve pregnancy outcomes among the teenagers. Abbreviations AGH Anaka General Hospital AIC Akaike’s Information Criterion aOR Adjusted odds ratio APH Antepartum haemorrhage C/S Caesarean section CI Confidence interval cOR Crude odds ratio GUREC Gulu University Research Ethics Committee LBW Low birth weight NICU Neonatal Intensive Care Unit PPH Postpartum haemorrage SVD Spontaneous vaginal delivery Declarations Acknowledgements We are grateful to the Department of Public Health, Gulu University and all the lecturers for their support during the study. We thank the Administration of Anaka General Hospital, the District Health Office and the Administration of Nwoya District Local Government for their support and acceptance of this study. We thank the research assistants, Acen Lucy, and Ahirwe Clemensia for their immense contributions to the data collection. Author contributions JJL, EO, FB, PA, and PFP contributed to the conception and design of the study. JJL performed the formal data analysis. JJL drafted the manuscript. EO, FB, PA, and PFP critically reviewed and revised the manuscript. JJL prepared the final manuscript. All the authors have read and approved the final manuscript. Funding The research received no specific grant for this project. Data availability The research data and materials used to support the research findings of this study are available upon request from the corresponding author. Ethics approval and consent to participate This study was approved by the Gulu Research Ethics Committee (Ref GUREC-2023-586), including the approval of the request for a waiver of consent. Administrative clearance was obtained from the Chief Administrative Officer of the Nwoya District Local Government before conducting the study. Consent for publication. Not applicable Competing interests The authors declare that there are no conflicts of interest regarding the publication of this paper. References Sayegh MA, Castrucci BC, Lewis K, Hobbs-Lopez A. Teen pregnancy in Texas: 2005 to 2015. Matern Child Health J. 2010;14(1):94–101. Paller L, Feldman F, Lauria W. Obstetric and perinatal outcomes in teenage pregnancy: a literature review. Int J Fam Commun Med. 2021;5(1):1–5. Kiani MA, Ghazanfarpour M, Saeidi M. Adolescent pregnancy: a health challenge. Int J Pediatr. 2019;7(7):9749–52. Cook SMC, Cameron ST. Social issues of teenage pregnancy. Obstet Gynaecol Reprod Med. 2015;25(9):243–8. Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and meta-analysis. Reprod Health. 2018;15(1):1–17. Maharjan M, Thapa N, Maharjan N, Rai P, Pun P, Petrini MA, et al. Prevalence of teenage pregnancy in a community hospital of rural Nepal: a cross-sectional study. JNMA J Nepal Med Assoc. 2019;57(217):176. Beyene A, Muhiye A, Getachew Y, Hiruye A, Mariam DH, Derbew M et al. Assessment of the magnitude of teenage pregnancy and its associated factors among teenage females visiting Assosa General Hospital. EMJ. 2015;25–37. Eldaboly SA, Allam NE, Ibrahim MM, Abo-Elhssan HA. Prevalence and outcome of teenage pregnancy among attendants of labour room in Bassion general hospital-Egypt (cross section study). J Recent Adv Med. 2021;2(2):166–72. Zakari M. The prevalence of teenage pregnancies and their perinatal complications among teenage mothers in Kiryandongo General Hospital. https//www.kiu.ac.ug . 2019. Chemutai V, Musaba MW, Amongin D, Wandabwa JN. Prevalence and factors associated with teenage pregnancy among parturients in Mbale Regional Referral Hospital: a cross sectional study. Afr Health Sci. 2022;22(2):451–8. Moraes AN, Likwa RN, Nzala SH. A retrospective analysis of adverse obstetric and perinatal outcomes in adolescent pregnancy: the case of Luapula Province, Zambia. Matern Heal Neonatol Perinatol. 2018;4(1):1–11. Abebe AM, Fitie GW, Jember DA, Reda MM, Wake GE. Teenage pregnancy and its adverse obstetric and perinatal outcomes at Lemlem Karl Hospital, Tigray, Ethiopia, 2018. Biomed Res Int. 2020;2020. Indarti J, Al Fattah AN, Dewi Z, Hasani RDK, Mahdi FAN, Surya R. Teenage pregnancy: Obstetric and perinatal outcome in a tertiary centre in Indonesia. Obstet Gynecol Int. 2020;2020. Abbas AM, Ali SS, Ali MK, Fouly H, Altraigey A. The maternal and neonatal outcomes of teenage pregnancy in a tertiary university hospital in Egypt. Proc Obstet Gynecol. 2017;7(3). Kirbas A, Gulerman HC, Daglar K. Pregnancy in adolescence: is it an obstetrical risk? J Pediatr Adolesc Gynecol. 2016;29(4):367–71. Fouelifack FY, Tameh TY, Mbong EN, Nana PN, Fouedjio JH, Fouogue JT, et al. Outcome of deliveries among adolescent girls at the Yaoundé central hospital. BMC Pregnancy Childbirth. 2014;14:1–10. Elly AD, Musa S, Kafunjo BJ. Prevalence and Factors Associated with HIV Infection among Teenage Mothers Delivered at Mulago Hospital—A Cross-Sectional Study. Open J Obstet Gynecol. 2022;12(7):661–70. Organization WH. Actions for improved clinical and prevention services and choices: preventing HIV and other sexually transmitted infections among women and girls using contraceptive services in contexts with high HIV incidence, June 2020: policy brief. World Health Organization; 2020. Divya NV, Pillai SK, Srinivasan B. A study on the fetomaternal outcomes of teenage pregnancies in a tertiary care hospital. From ymerdigital com/uploads/YMER. 2022;210603. Eugene I, Israel J, Atombosoba E. Teenage pregnancy and obstetric outcome: A comparative study in urban Nigeria. Nepal J Obstet Gynaecol. 2016;11(1):37–43. UDHS. Uganda demographic and health survey. https//www.ubos.org/wp- . 2016. UBOS. Area Specific Profiles Nwoya District. Natl Popul Hous Census 2014Area Specif profiles [Internet]. 2017;(April):49. https://www.ubos.org/wp-content/uploads/publications/2014CensusProfiles/NWOYA.pdf . Tabula J. Prevalence of teenage deliveries, and the subsequent maternal and neonatal out comes among women delivering from Bwera Hospital, Kasese Uganda. 2017. Kish L. Sampling organizations and groups of unequal sizes. Am Sociol Rev. 1965;564–72. Onwubuariri MI, Kasso T. Teenage pregnancy: Prevalence, pattern and predisposing factors in a tertiary Hospital, Southern Nigeria. Asian J Med Heal. 2019;17(3):1–5. Olofinbiyi BA, Oluleye JT, Simeon O, Olatunya BP, Olofinbiyi RO, Akintoye OO, et al. Teenage pregnancy at a tertiary health institution in south-western Nigeria: Socio demographic correlates and obstetric outcome. Int J Clin Obstet Gynaecol. 2019;3(4):97–101. Nagandla K, Kumar K. Prevalence of teenage pregnancy in 2015–2016 and its obstetric outcomes compared to non-teenage pregnancy at Hospital Tuanku Ja’afar Seremban (HTJS), Negeri Sembilan, Malaysia: A retrospective case-control study based on the national obstetric registry. Malaysian Fam physician Off J Acad Fam Physicians Malaysia. 2020;15(2):2. Ergen EB, Yayla CA, Sanverdi I, Ozkaya E, Kilicci C, Kocakusak CK. Maternal-fetal outcome associated with adolescent pregnancy in a tertiary referral center: a cross-sectional study. Ginekol Pol. 2017;88(12):674–8. Agbor VN, Mbanga CM, Njim T. Adolescent deliveries in rural Cameroon: an 8-year trend, prevalence and adverse maternofoetal outcomes. Reprod Health. 2017;14:1–8. Rexhepi M, Besimi F, Rufati N, Alili A, Bajrami S, Ismaili H. Hospital-based study of maternal, perinatal and neonatal outcomes in adolescent pregnancy compared to adult women pregnancy. Open access Maced J Med Sci. 2019;7(5):760. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4438154","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":307634778,"identity":"84e3aca2-c728-4d63-8880-0dc4b2f3c349","order_by":0,"name":"Jolly Joe Lapat","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACPjDJw1bPD6ITCojQwgYiDvCwJUg2gLQYEK0FpPgAiEWUFvazBz9/kOHLMz6/OvHDAwMGeX6xAwS08OQlSwAdVmx24+1mCaDDDGfOTiDksBwDkBbGbTfObgBpSTC4TUgL/xvjHyAtm2ec3fyDOC0SOWYgWxI38PduI9IWiXdpFmd42IwlbvBus0gwkCDsF37+3MM3KnuOyfH3n91880eFjTy/NAEtwJhnYGDsOcbAIAFWKUFIOVQLw48aoH0HiFE9CkbBKBgFIxEAALu+Qf0GbuDOAAAAAElFTkSuQmCC","orcid":"","institution":"Anaka General Hospital, Nwoya District Local Government","correspondingAuthor":true,"prefix":"","firstName":"Jolly","middleName":"Joe","lastName":"Lapat","suffix":""},{"id":307634779,"identity":"a37bb5cf-ac32-4b96-b28b-294259f85dfc","order_by":1,"name":"Pebalo Francis Pebolo","email":"","orcid":"","institution":"Gulu University","correspondingAuthor":false,"prefix":"","firstName":"Pebalo","middleName":"Francis","lastName":"Pebolo","suffix":""},{"id":307634781,"identity":"945b6976-c271-4e7b-bda3-5c2c64281d3a","order_by":2,"name":"Peter Akera","email":"","orcid":"","institution":"Gulu University","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Akera","suffix":""},{"id":307634782,"identity":"a177ed4d-2695-4f42-aa0d-b50012e8bbed","order_by":3,"name":"Emmanuel Ochola","email":"","orcid":"","institution":"St. Mary’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Emmanuel","middleName":"","lastName":"Ochola","suffix":""},{"id":307634783,"identity":"ac70bd35-d756-4411-9edc-94e99250f0e3","order_by":4,"name":"Felix Bongomin","email":"","orcid":"","institution":"Gulu University","correspondingAuthor":false,"prefix":"","firstName":"Felix","middleName":"","lastName":"Bongomin","suffix":""}],"badges":[],"createdAt":"2024-05-17 17:48:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4438154/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4438154/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57728572,"identity":"249a8810-c456-4c88-b05d-cf33b51c4d02","added_by":"auto","created_at":"2024-06-04 21:46:53","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":341281,"visible":true,"origin":"","legend":"\u003cp\u003eShowing study enrollment\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4438154/v1/a51418df38218e9cdc60d1df.jpeg"},{"id":57729683,"identity":"60aff87f-4990-4834-839b-f54b5c7cb24b","added_by":"auto","created_at":"2024-06-04 21:54:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1588486,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4438154/v1/d8f499ec-5a3c-4a6d-a0d1-366857f65787.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Teenage pregnancy proportion, and comparison of maternal and neonatal outcomes with adult pregnancy at a General Hospital in Northern Uganda","fulltext":[{"header":"Background","content":"\u003cp\u003eTeenage pregnancy, defined as conception between the ages of 13 and 19 years, is a global public health concern due to its significant medical risks for both mothers and newborns, impacting both developed and developing nations (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although often used interchangeably, terms such as \u0026ldquo;adolescent\u0026rdquo; and \u0026ldquo;child pregnancy\u0026rdquo; have distinct meanings from \u0026ldquo;teenage pregnancy\u0026rdquo; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, approximately 16\u0026nbsp;million pregnancies occur in girls aged 15\u0026ndash;19, with an additional 1\u0026nbsp;million pregnancies occurring in girls under 15 years (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Over 90% of teenage pregnancies occur in sub-Saharan Africa (SSA) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), where the prevalence of teenage pregnancy is 19.3%, with the highest rate occurring in East Africa (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Hospital-based studies have revealed varying rates of teenage pregnancy across different settings and populations. In Nepal, a community hospital study revealed that 29.06% of total deliveries over a ten-year period were teenage deliveries (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Similarly, in Ethiopia\u0026rsquo;s Assosa General Hospital, the prevalence was 26% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), and in Egypt\u0026rsquo;s Bassion General Hospital (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), it was 26.4%. In Uganda, Kiryandongo General Hospital reported a prevalence of 12% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), while the Mbale Regional Referral Hospital had a prevalence of 20.6% (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTeenage pregnancy is linked to serious maternal health complications when compared to adult pregnancy due to biological and psychological unreadiness, limited access to care, and social/economic disadvantages (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These complications include pregnancy-induced hypertension (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), anaemia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), preterm delivery (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), increased rates of caesarean sections (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), postpartum hemorrhage (PPH) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), perineal tears (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and sexually transmitted infections, including HIV (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Infants born to teenage mothers face risks such as preterm birth (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), low birth weight (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), birth asphyxia (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), neonatal intensive care unit (NICU) admission (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and long-term permanent physical and mental disabilities (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTeenage pregnancy is a significant public health concern in Uganda, where 52% of the population is under 18 years old; however, the prevalence of teenage pregnancy is 25% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), particularly affecting areas such as the Nwoya district, where girls face vulnerabilities due to low secondary school attendance (16%), high dropout rates (94%), and early marriage (20% before age 20) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Despite systematic challenges, there is limited information on the outcomes of teenage pregnancy; all studies in Uganda did not compare delivery outcomes between teenage and adult mothers (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Priority should be given to ensuring safe pregnancy outcomes for teenage mothers.\u003c/p\u003e \u003cp\u003eThis study therefore aimed to determine the proportion of teenage pregnancy and compare the maternal and neonatal outcomes between pregnant teenage and pregnant adult at Anaka General Hospital.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study was a hospital-based retrospective cohort study involving review of records of deliveries conducted at the maternity ward of Anaka General Hospital, Nwoya District, northern Uganda, from July 2020 to June 2023. Mention here the tools you used\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003eAnaka General Hospital is the only government-owned hospital under governance of Nwoya district local government. The hospital has an average of 2000 deliveries annually. The unit provides care 24 hours a day, 7 days a week, offering comprehensive emergency obstetric, maternal and newborn care.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy population.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe study population consisted of deliveries at Anaka general hospital between July 2020 and June 2023. Two arms were compared: women under 20 years (teenage) and those aged 20 years or older (adults). The charts of women who delivered before arrival (BBA), or had multiple pregnancies were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size estimation\u003c/h2\u003e \u003cp\u003eTo determine the proportion of teenage pregnancies, a census of all admissions during the study period was carried out. The sample size for the comparison of delivery outcomes was calculated using the Kish Leslie formula, and the sample size was calculated with the double proportion formula (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Employing a critical value of 1.96 at the 5% level of significance, the proportion of caesarean sections was considered to be 12.9% in teenage pregnancies, and 18.8% in adult pregnancies, sourced from a study in Ethiopia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). With a margin of error of 0.05 and a power of 80%, we determined a sample size of 457 teenage mothers and 457 unmatched adult mothers, resulting in a total sample size of 914.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSampling strategy.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDuring the study period, there were a total of 6,662 obstetric admissions, which included 1,842 teenagers and 4,830 adults. Charts of 15 teenage mothers and charts of 151 adult mothers were excluded. Systematic random sampling from the integrated maternity register was used to select the charts. The sampling intervals were determined by calculating \u0026ldquo;K\u0026rdquo; values, using the formula K\u0026thinsp;=\u0026thinsp;N/n, where \u0026ldquo;N\u0026rdquo; is the total number of deliveries and \u0026ldquo;n\u0026rdquo; is the calculated sample size. For teenagers, K\u0026thinsp;=\u0026thinsp;1,827/457\u0026thinsp;\u0026asymp;\u0026thinsp;4, while for adults, K\u0026thinsp;=\u0026thinsp;4669/457\u0026thinsp;\u0026asymp;\u0026thinsp;10. The sampling intervals were 4 and 10 for teenage mothers and adults, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThe data were collected from the patients\u0026rsquo; files using a structured data extraction tool. Two midwives served as research assistants. They were briefed on the study\u0026rsquo;s objectives, data collection procedures, and how to accurately complete the extraction tool. Sample charts identified from the integrated maternity register, including names and inpatient numbers, are listed. Subsequently, charts of sampled mothers and babies admitted to the NICU were retrieved from the records section.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy variables.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe maternal outcome (dependent) variables included the mode of delivery (categorized as vaginal delivery or caesarean section); preeclampsia, which was defined as hypertension and proteinuria (++) according to the use of urine dipstick; ante partum haemorrhage; episiotomy performed, and perineal tear, which was defined as any tear that required repair, post-partum haemorrhage and maternal death. The foetal outcome variables included delivery status (alive or dead), birth weight, Apgar score at 1 and 5 minutes, presence of congenital anomalies, admission to the NICU and neonatal death.\u003c/p\u003e \u003cp\u003eThe main independent variable was age. Other independent (baseline) variables were the sociodemographic characteristics, medical factors and obstetrics factors. The sociodemographic factors included area of residence and referral status. Medical factor captured was the HIV status. The obstetric factors included gravidity, parity, and gestation age at delivery, stage of labour at admission and induction of labor\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003eThe data were checked for accuracy and completeness before being coded and entered into an Excel spreadsheet. Analysis was conducted using STATA software version 17 SE. The study utilized two-tailed tests at a 95% confidence interval and a significance of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The baseline characteristics of the participants are summarized; with corresponding p values indicated distribution disparities between cohorts. Categorical variables are presented as frequencies and percentages, with Pearson\u0026rsquo;s chi-square p-values. Numerical variables were assessed for normality using the Shapiro-Wilk test; normally distributed data were expressed as the mean and standard deviation with the Student\u0026rsquo;s t-test p values, and non-normally distributed data were summarized using the median, range, and p-values from the Mann-Whitney U test.\u003c/p\u003e \u003cp\u003eThe proportion of teenage pregnancy was calculated as the number of women aged less than 20 years, expressed as a percentage of the total number of women admitted for delivery during the study period.\u003c/p\u003e \u003cp\u003eTo compare the teenage pregnancy and adult pregnancy outcomes, maternal outcomes were categorized as dichotomous. Bivariate and multivariate logistic regression models were used to compare outcomes. Outcome variables that had significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) or marginally (0.05\u0026thinsp;\u0026le;\u0026thinsp;\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.25) significant different proportion between the age groups were adjusted for other independent variables using separate multivariate analysis models. We checked for multicollinearity, and in that respect excluded parity (r\u0026thinsp;=\u0026thinsp;0.72) and gravidity (r\u0026thinsp;=\u0026thinsp;0.69) from all models as they were highly correlated with age. Backward, stepwise elimination method and Akaike\u0026rsquo;s information criteria (AIC) were used to select best models. The results are presented as adjusted odds ratios (aORs) with the corresponding 95% confidence intervals (CIs) and \u003cem\u003ep values\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eStudy enrollment.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the three-year-study period, there were a total of 6,662 were deliveries conducted, including 1, 842 (27.6%) of which involved teenage mothers (exposed) while 4,820 (72.4%) adult mothers (non-exposed), Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eProportion of teenage pregnancy\u003c/h2\u003e\n \u003cp\u003eTeenage mothers comprised 27.6% (n\u0026thinsp;=\u0026thinsp;842) of the 6,662 total deliveries conducted in Anaka General Hospital over the three-year period.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eMaternal characteristics of teenage and adult mothers\u003c/h2\u003e\n \u003cp\u003eCompared to adult mothers, teenage mothers had a lower median gravidity (1 versus 3, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and parity (0 versus 2, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There was no statistically significant difference in the mean gestational age at delivery (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.208). The proportion of referrals was greater for teenage mothers (16.4%) than for adult mothers (7.4%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Adult mothers had a greater prevalence of HIV (6.1% vs. 2.2%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). Induction of labor was more common among adult mothers (4.7%) than among teenage mothers (1.1%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Teenage mothers presented earlier in labor, while adult mothers presented later (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMaternal characteristics of teenage and adult mothers\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTeenage n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdults n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e Median (min, max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.5 (15, 46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (20\u0026ndash;46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravidity\u003c/strong\u003e median (min, max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e median (min, max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0, 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0, 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0, 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestation age\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Mean, SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.34 (28, 44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.42 (2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.25 (1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReferral in\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109 (11.93)\u003c/p\u003e\n \u003cp\u003e805 (88.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (16.41)\u003c/p\u003e\n \u003cp\u003e382 (83.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (7.44)\u003c/p\u003e\n \u003cp\u003e423 (92.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (4.16)\u003c/p\u003e\n \u003cp\u003e876 (95.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (2.19)\u003c/p\u003e\n \u003cp\u003e447 (97.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (6.13)\u003c/p\u003e\n \u003cp\u003e429 (93.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLabor onset\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eInduced\u003c/p\u003e\n \u003cp\u003eSpontaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (2.9)\u003c/p\u003e\n \u003cp\u003e370 (97.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.10)\u003c/p\u003e\n \u003cp\u003e448 (98.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (4.74)\u003c/p\u003e\n \u003cp\u003e422 (95.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage of labor\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNot in labor\u003c/p\u003e\n \u003cp\u003eLatent phase\u003c/p\u003e\n \u003cp\u003eActive phase\u003c/p\u003e\n \u003cp\u003eSecond stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e111 (12.14)\u003c/p\u003e\n \u003cp\u003e250 (27.35)\u003c/p\u003e\n \u003cp\u003e412 (45.08)\u003c/p\u003e\n \u003cp\u003e141 (15.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (9.85)\u003c/p\u003e\n \u003cp\u003e158 (34.57)\u003c/p\u003e\n \u003cp\u003e196 (42.89)\u003c/p\u003e\n \u003cp\u003e58 (12.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66 (14.44)\u003c/p\u003e\n \u003cp\u003e92 (20.13)\u003c/p\u003e\n \u003cp\u003e216 (47.26)\u003c/p\u003e\n \u003cp\u003e83 (18.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eMin \u0026ndash; minimum value. Max \u0026ndash; maximum value. N \u0026ndash; Number. SD \u0026ndash; standard deviation\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of maternal outcomes between pregnant teenagers and pregnant adults\u003c/h2\u003e\n \u003cp\u003eThe proportion of caesarean deliveries was similar among teenagers (18.6%) and adult mothers (14.9%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.132). A greater proportion of adult mothers had pre-eclampsia than did teenagers (3.9% vs. 1.3%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013). There was no statistically significant difference in the incidence of antepartum hemorrhage (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.363), postpartum hemorrhage (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.00) or obstructed labor (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.860). A greater proportion of teenage mothers had perineal tears (18.6% vs. 7.4%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and underwent episiotomy (8.1% vs.1.5%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Puerperal sepsis was rare in teenage mothers (0.1%) with no cases in adult mothers (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.317). The median hospitalization duration was 2 days for teenagers and 1 day for adult mothers (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.557), (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eObstetric outcomes of teenage and adult deliveries\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTeenage n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdult n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCaesarean\u003c/p\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153 (16.7)\u003c/p\u003e\n \u003cp\u003e761 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 (18.6)\u003c/p\u003e\n \u003cp\u003e372 (81.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (14.9)\u003c/p\u003e\n \u003cp\u003e389 (85.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndication of C/S\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eProlong/obstructed\u003c/p\u003e\n \u003cp\u003eFetal distress\u003c/p\u003e\n \u003cp\u003ePrevious C/S\u003c/p\u003e\n \u003cp\u003eContracted pelvis\u003c/p\u003e\n \u003cp\u003ePre-eclampsia\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (25.2)\u003c/p\u003e\n \u003cp\u003e19 (12.6)\u003c/p\u003e\n \u003cp\u003e45 (29.8)\u003c/p\u003e\n \u003cp\u003e25 (16.5)\u003c/p\u003e\n \u003cp\u003e9 (6.0)\u003c/p\u003e\n \u003cp\u003e15 (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (30.9)\u003c/p\u003e\n \u003cp\u003e11 (13.1)\u003c/p\u003e\n \u003cp\u003e12 (14.3)\u003c/p\u003e\n \u003cp\u003e23 (27.4)\u003c/p\u003e\n \u003cp\u003e3 (3.6)\u003c/p\u003e\n \u003cp\u003e9 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (17.9)\u003c/p\u003e\n \u003cp\u003e8 (11.9)\u003c/p\u003e\n \u003cp\u003e33 (49.2)\u003c/p\u003e\n \u003cp\u003e2 (3.0)\u003c/p\u003e\n \u003cp\u003e6 (9.0)\u003c/p\u003e\n \u003cp\u003e6 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of C/S\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eElective\u003c/p\u003e\n \u003cp\u003eEmergent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (6.6)\u003c/p\u003e\n \u003cp\u003e142 (93.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.2)\u003c/p\u003e\n \u003cp\u003e83 (98.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (13.2)\u003c/p\u003e\n \u003cp\u003e59 (86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-eclampsia\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (2.6)\u003c/p\u003e\n \u003cp\u003e890 (97.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.3)\u003c/p\u003e\n \u003cp\u003e451 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (3.9)\u003c/p\u003e\n \u003cp\u003e439 (96.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPH\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (1.2)\u003c/p\u003e\n \u003cp\u003e903 (98.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0.9)\u003c/p\u003e\n \u003cp\u003e453 (99.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (1.5)\u003c/p\u003e\n \u003cp\u003e450 (98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eObstructed/prolonged\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (3.4)\u003c/p\u003e\n \u003cp\u003e882 (96.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (3.5)\u003c/p\u003e\n \u003cp\u003e441 (96.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (3.3)\u003c/p\u003e\n \u003cp\u003e441 (96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerineal tear\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTear\u003c/p\u003e\n \u003cp\u003eNo tear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119 (13.0)\u003c/p\u003e\n \u003cp\u003e795 (87.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 (18.6)\u003c/p\u003e\n \u003cp\u003e372 (81.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (7.4)\u003c/p\u003e\n \u003cp\u003e423 (92.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpisiotomy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePerformed\u003c/p\u003e\n \u003cp\u003eNot performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (4.8)\u003c/p\u003e\n \u003cp\u003e870 (95.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (8.1)\u003c/p\u003e\n \u003cp\u003e420 (91.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (1.5)\u003c/p\u003e\n \u003cp\u003e450 (98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePPH\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (1.3)\u003c/p\u003e\n \u003cp\u003e902 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.3)\u003c/p\u003e\n \u003cp\u003e451 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.3)\u003c/p\u003e\n \u003cp\u003e451 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePuerperal sepsis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.1)\u003c/p\u003e\n \u003cp\u003e456 (99.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.1)\u003c/p\u003e\n \u003cp\u003e456 (99.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003cp\u003e457 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalization days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAfter bivariate and multivariate analysis, the proportions of several maternal outcomes remained significantly different between the age groups. Adult mothers had a fourfold likelihood of pre-eclampsia compared to teenage mothers (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004). Teenage mothers were 2.61 times more likely to experience perineal tear (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 5.66 times more likely to undergo episiotomy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to adult mothers, (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLogistic regression models of adverse maternal outcomes of teenage and adult mothers\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"13\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eObstetric outcome\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eBivariate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eMultivariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNo n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"12\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaesarean section\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e Teenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e85 (55.6)\u003c/p\u003e\n \u003cp\u003e68 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e372 (48.9)\u003c/p\u003e\n \u003cp\u003e389 (51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.31 (0.92\u0026ndash;1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.133*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27 (0.86\u0026ndash;1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e69 (45.1)\u003c/p\u003e\n \u003cp\u003e84 (54.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e372 (48.9)\u003c/p\u003e\n \u003cp\u003e389 (51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.86 (0.61\u0026ndash;1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e-----\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth weight\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;3.5\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e33 (21.6)\u003c/p\u003e\n \u003cp\u003e120 (78.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94 (12.4)\u003c/p\u003e\n \u003cp\u003e663 (87.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.94 (1.25\u0026ndash;3.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.09 (1.29\u0026ndash;3.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReferral\u003c/strong\u003e Yes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e37 (24.2)\u003c/p\u003e\n \u003cp\u003e116 (75.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (9.5)\u003c/p\u003e\n \u003cp\u003e689 (90.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3.05 (1.96\u0026ndash;4.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.20 (2.00\u0026ndash;5.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage of labor\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSecond stage\u003c/p\u003e\n \u003cp\u003eActive phase\u003c/p\u003e\n \u003cp\u003eLatent phase\u003c/p\u003e\n \u003cp\u003eNot in labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003cp\u003e64 (41.8)\u003c/p\u003e\n \u003cp\u003e50 (32.7)\u003c/p\u003e\n \u003cp\u003e37 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e139 (13.3)\u003c/p\u003e\n \u003cp\u003e348 (45.7)\u003c/p\u003e\n \u003cp\u003e200 (26.3)\u003c/p\u003e\n \u003cp\u003e74 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.03 (0.01\u0026ndash;0.12)\u003c/p\u003e\n \u003cp\u003e0.38 (0.23\u0026ndash;0.59)\u003c/p\u003e\n \u003cp\u003e0.50 (0.30\u0026ndash;0.83)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.007**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e---\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03 (0.01\u0026ndash;0.12)\u003c/p\u003e\n \u003cp\u003e0.34 (0.20\u0026ndash;0.55)\u003c/p\u003e\n \u003cp\u003e0.49 (0.29\u0026ndash;0.82)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.011***\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"12\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre eclampsia/eclampsia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTeenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6 (25.0)\u003c/p\u003e\n \u003cp\u003e18 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e451 (50.7)\u003c/p\u003e\n \u003cp\u003e439 (49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e3.13 (1.20\u0026ndash;7.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.0 (1.59\u0026ndash;11.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e14 (58.3)\u003c/p\u003e\n \u003cp\u003e10 (41.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e427 (48.0)\u003c/p\u003e\n \u003cp\u003e463 (52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1.51 (0.66\u0026ndash;3.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReferral\u003c/strong\u003e Yes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e8 (33.3)\u003c/p\u003e\n \u003cp\u003e16 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e101 (11.3)\u003c/p\u003e\n \u003cp\u003e789 (88.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e3.91 (1.63\u0026ndash;9.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.38 (2.17\u0026ndash;13.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPH\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e4 (36.4)\u003c/p\u003e\n \u003cp\u003e7 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e453 (50.2)\u003c/p\u003e\n \u003cp\u003e450 (49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.57 (0.17\u0026ndash;1.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.369\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eObstructed/prolonged labor\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e16 (51.6)\u003c/p\u003e\n \u003cp\u003e15 (48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e441 (50.0)\u003c/p\u003e\n \u003cp\u003e441 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1.07 (0.52\u0026ndash;2.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerineal tear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTeenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e85 (71.4)\u003c/p\u003e\n \u003cp\u003e34 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e372 (46.8)\u003c/p\u003e\n \u003cp\u003e423 (53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e2.84 (1.87\u0026ndash;4.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.61 (1.69\u0026ndash;4.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth weight\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;3.5\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e23 (19.3)\u003c/p\u003e\n \u003cp\u003e96 (80.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e104 (13.2)\u003c/p\u003e\n \u003cp\u003e687 (86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1.58 (0.96\u0026ndash;2.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.072*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.26 (0.75\u0026ndash;2.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.385)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage labor\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSecond stage\u003c/p\u003e\n \u003cp\u003eActive phase\u003c/p\u003e\n \u003cp\u003eLatent phase\u003c/p\u003e\n \u003cp\u003eNot in labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e18 (15.1)\u003c/p\u003e\n \u003cp\u003e50 (42.0)\u003c/p\u003e\n \u003cp\u003e44 (37.0)\u003c/p\u003e\n \u003cp\u003e7 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e123 (15.5)\u003c/p\u003e\n \u003cp\u003e362 (45.5)\u003c/p\u003e\n \u003cp\u003e206 (25.9)\u003c/p\u003e\n \u003cp\u003e104 (13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e2. 17 (0.87\u0026ndash;5.41)\u003c/p\u003e\n \u003cp\u003e2.05 (0.90\u0026ndash;4.66)\u003c/p\u003e\n \u003cp\u003e3.17 (1.38\u0026ndash;7.29)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.095*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.086*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.006**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.18 (0.86\u0026ndash;5.48)\u003c/p\u003e\n \u003cp\u003e1.95 (0.85\u0026ndash;4.46)\u003c/p\u003e\n \u003cp\u003e2.66 (1.14\u0026ndash;6.16)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.023\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpisiotomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTeenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e37 (84.1)\u003c/p\u003e\n \u003cp\u003e7 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e420 (48.3)\u003c/p\u003e\n \u003cp\u003e450 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e5.66 (2.50\u0026ndash;12.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.66 (2.48\u0026ndash;12.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth weight\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;3.5\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6 (13.6)\u003c/p\u003e\n \u003cp\u003e38 (86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e121 (14.0)\u003c/p\u003e\n \u003cp\u003e745 (86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.97 (0.40\u0026ndash;2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage labor\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSecond stage\u003c/p\u003e\n \u003cp\u003eActive phase\u003c/p\u003e\n \u003cp\u003eLatent phase\u003c/p\u003e\n \u003cp\u003eNot in labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e5 (11.4)\u003c/p\u003e\n \u003cp\u003e23 (52.3)\u003c/p\u003e\n \u003cp\u003e13 (29.5)\u003c/p\u003e\n \u003cp\u003e3 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e136 (15.6)\u003c/p\u003e\n \u003cp\u003e389 (44.7)\u003c/p\u003e\n \u003cp\u003e237 (27.3)\u003c/p\u003e\n \u003cp\u003e108 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1.32 (0.31\u0026ndash;5.66)\u003c/p\u003e\n \u003cp\u003e2.13 (0.63\u0026ndash;7.22)\u003c/p\u003e\n \u003cp\u003e1.97 (0.55\u0026ndash;7.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.705\u003c/p\u003e\n \u003cp\u003e0.226*\u003c/p\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.31 (0.30\u0026ndash;5.71)\u003c/p\u003e\n \u003cp\u003e1.93 (0.56\u0026ndash;6.65)\u003c/p\u003e\n \u003cp\u003e1.45 (0.40\u0026ndash;5.26)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003cp\u003e0.575\u003c/p\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\"\u003e\u003cem\u003e* Marginally significant on bivariate (p\u0026thinsp;\u0026le;\u0026thinsp;0.05\u0026thinsp;\u0026lt;\u0026thinsp;0.25) ** significant on bivariate (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) *** significant after multivariate CI \u0026ndash; confidence interval OR \u0026ndash; Odds ratio\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of neonatal outcomes of teenage pregnancy to adult pregnancy\u003c/h2\u003e\n \u003cp\u003eThe proportion of stillbirth was similar among teenage mothers (1.8%) and adult mothers (2.0%), (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.795). Apgar scores below 7 at 1 minute were observed in 9.7% for teenagers and 7.2% for adult (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.187) and at 5 minutes, 3.3% for teenagers and 2.0% for adults (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.213). Sex distribution did not significantly differ among teenagers (51.9% boys, 48.1% girls) and adult mothers (47.9% boys, 52.1% girls) (p\u0026thinsp;=\u0026thinsp;0.234). The proportion of babies that had birth asphyxia was 11.6% for teenagers and 8.9% for adults (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.190). Teenage mothers had significantly higher proportion of low birth weight compared to adult mothers (22.6% vs. 7.0%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Proportion of congenital anomalies was similar (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.156). The proportion of babies that had NICU admission was 10.9% among teenagers and 12.3% among adult mothers (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.524). Among teenage mothers, 95.8% of babies were discharged alive, compared to 94.5% among adult mothers. However, this difference was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.354), (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eNeonatal outcomes of teenage and adult pregnancies\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTeenage n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdult n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatus\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eStillbirth\u003c/p\u003e\n \u003cp\u003eLive birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (1.9)\u003c/p\u003e\n \u003cp\u003e897 (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (1.8)\u003c/p\u003e\n \u003cp\u003e449 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (2.0)\u003c/p\u003e\n \u003cp\u003e450 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eApgar 1 minute\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;7\u003c/p\u003e\n \u003cp\u003e7\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77 (8.4)\u003c/p\u003e\n \u003cp\u003e836 (91.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (9.7)\u003c/p\u003e\n \u003cp\u003e412 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33 (7.2)\u003c/p\u003e\n \u003cp\u003e424 (92.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eApgar 5 minute\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;7\u003c/p\u003e\n \u003cp\u003e7\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (2.6)\u003c/p\u003e\n \u003cp\u003e889 (97.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (3.3)\u003c/p\u003e\n \u003cp\u003e441 (96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (2.0)\u003c/p\u003e\n \u003cp\u003e448 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaby sex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e456 (49.9)\u003c/p\u003e\n \u003cp\u003e458 (50.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e237 (51.7)\u003c/p\u003e\n \u003cp\u003e220 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e219 (47.9)\u003c/p\u003e\n \u003cp\u003e238 (52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth asphyxia\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92 (10.3)\u003c/p\u003e\n \u003cp\u003e805 (89.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (11.5)\u003c/p\u003e\n \u003cp\u003e397 (88.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (8.9)\u003c/p\u003e\n \u003cp\u003e408 (91.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow birth weight\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;2.5\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135 (14.8)\u003c/p\u003e\n \u003cp\u003e775 (85.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103 (22.6)\u003c/p\u003e\n \u003cp\u003e352 (77.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (7.0)\u003c/p\u003e\n \u003cp\u003e423 (93.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnomaly\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (0.9)\u003c/p\u003e\n \u003cp\u003e905 (99.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.4)\u003c/p\u003e\n \u003cp\u003e454 (99.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.3)\u003c/p\u003e\n \u003cp\u003e451 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNICU admission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104 (11.6)\u003c/p\u003e\n \u003cp\u003e793 (88.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (10.9)\u003c/p\u003e\n \u003cp\u003e400 (89.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (12.3)\u003c/p\u003e\n \u003cp\u003e393 (87.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDischarged alive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (4.8)\u003c/p\u003e\n \u003cp\u003e870 (95.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (4.2)\u003c/p\u003e\n \u003cp\u003e438 (95.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (5.5)\u003c/p\u003e\n \u003cp\u003e432 (94.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cem\u003eNICU \u0026ndash; Neonatal Intensive Care Unit\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAfter multivariate analysis, independently teenage mothers had 4.12-fold higher odds of delivering a low-birth-weight baby compared to adult mothers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLogistic models of adverse neonatal outcomes of teenage and adult mothers\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"12\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eObstetric outcome\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBivariate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eNo n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"12\"\u003e\n \u003cp\u003e\u003cstrong\u003eStillbirth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003eTeenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e8 (47.1)\u003c/p\u003e\n \u003cp\u003e9 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e449 (50.1)\u003c/p\u003e\n \u003cp\u003e448 (49.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.87 (0.34\u0026ndash;2.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e---------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"12\"\u003e\n \u003cp\u003e\u003cstrong\u003eApgar score at 5 minute less than 7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003eTeenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e15 (60.0)\u003c/p\u003e\n \u003cp\u003e10 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e441 (49.7)\u003c/p\u003e\n \u003cp\u003e447 (50.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.52 (0.68\u0026ndash;3.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e---------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"12\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth asphyxia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003eTeenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e52 (56.5)\u003c/p\u003e\n \u003cp\u003e40 (43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e397 (49.3)\u003c/p\u003e\n \u003cp\u003e408 (50.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.34 (0.86\u0026ndash;2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.192*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.31 (0.85\u0026ndash;2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.219\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth weight\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;2.5\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e14 (15.4)\u003c/p\u003e\n \u003cp\u003e77 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112 (14.0)\u003c/p\u003e\n \u003cp\u003e690 (86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.12 (0.61\u0026ndash;2.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e--------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaby\u0026rsquo;s sex\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e53 (57.6)\u003c/p\u003e\n \u003cp\u003e39 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e396 (49.2)\u003c/p\u003e\n \u003cp\u003e409 (50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.40 (0.91\u0026ndash;2.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.127*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.41 (0.91\u0026ndash;2.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObstructed/prolonged labor\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1 (1.1)\u003c/p\u003e\n \u003cp\u003e91 (98.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (3.7)\u003c/p\u003e\n \u003cp\u003e774 (96.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.28 (0.04\u0026ndash;2.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.218*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.27 (0.04\u0026ndash;1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"12\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow birth weight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003eTeenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e103 (76.3)\u003c/p\u003e\n \u003cp\u003e32 (23.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e352 (45.4)\u003c/p\u003e\n \u003cp\u003e423 (54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3.87 (2.54\u0026ndash;5.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.12 (2.66\u0026ndash;6.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e36 (26.7)\u003c/p\u003e\n \u003cp\u003e99 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e403 (52.0)\u003c/p\u003e\n \u003cp\u003e372 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.34 (0.22\u0026ndash;0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGestation age\u003c/p\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e\n \u003cp\u003e37\u0026ndash;39\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e7 (5.2)\u003c/p\u003e\n \u003cp\u003e16 (11.9)\u003c/p\u003e\n \u003cp\u003e70 (51.9)\u003c/p\u003e\n \u003cp\u003e42 (31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (4.5)\u003c/p\u003e\n \u003cp\u003e215 (27.8)\u003c/p\u003e\n \u003cp\u003e449 (57.9)\u003c/p\u003e\n \u003cp\u003e76 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.36 (0.15\u0026ndash;0.89)\u003c/p\u003e\n \u003cp\u003e0.13 (0.07\u0026ndash;0.25)\u003c/p\u003e\n \u003cp\u003e0.28 (0.18\u0026ndash;0.44)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.026**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.39 (0.15\u0026ndash;1.00)\u003c/p\u003e\n \u003cp\u003e0.13 (0.07\u0026ndash;0.25)\u003c/p\u003e\n \u003cp\u003e0.27 (0.17\u0026ndash;0.43)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaby\u0026rsquo;s sex\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e55 (40.7)\u003c/p\u003e\n \u003cp\u003e80 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e397 (51.2)\u003c/p\u003e\n \u003cp\u003e378 (48.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.65 (0.45\u0026ndash;0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.025**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61 (0.41\u0026ndash;0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreterm birth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003eTeenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e65 (54.6)\u003c/p\u003e\n \u003cp\u003e54 (45.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e376 (49.9)\u003c/p\u003e\n \u003cp\u003e377 (50.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.21 (0.82\u0026ndash;1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e----------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"12\"\u003e\n \u003cp\u003e\u003cstrong\u003eNICU admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003eTeenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e49 (47.1)\u003c/p\u003e\n \u003cp\u003e55 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e400 (50.4)\u003c/p\u003e\n \u003cp\u003e393 (49.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.87 (0.58\u0026ndash;1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e----------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"12\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerinatal death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003eTeenage\u003c/p\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e19 (43.2)\u003c/p\u003e\n \u003cp\u003e25 (56.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e438 (50.3)\u003c/p\u003e\n \u003cp\u003e432 (49.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.75 (0.41\u0026ndash;1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e---------\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003e\u003cem\u003e* Marginally significant on bivariate (p\u0026thinsp;\u0026le;\u0026thinsp;0.05\u0026thinsp;\u0026lt;\u0026thinsp;0.25) ** significant on bivariate (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) *** significant after multivariate CI \u0026ndash; confidence interval OR \u0026ndash; Odds ratio\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we aimed to determine the proportion of teenage pregnancies and compare the outcomes of these pregnancies with those of adult pregnancies. The study revealed a high prevalence of teenage pregnancies, and that; compared with adults, teenage mothers had significantly greater proportion of episiotomy, perineal tears, and low birth weight babies compared to adults. However adults had a greater proportion of preeclampsia.\u003c/p\u003e \u003cp\u003eOur study found a high proportion of teenage pregnancy among the total deliveries at Anaka general hospital. The factors contributing to the high rate may be related to the increased vulnerability of girls in Nwoya due to low secondary school attendance (16%), high dropout rates (94%), and early marriage (20% before age 20) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This may also be attributed to inaccessibility of contraceptive services, poor attitudes of the community towards the use of contraceptives by teenagers, poor sexual and reproductive health knowledge among teenage girls, and early onset of sexual activity (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The proportion of teenage pregnancy found in this study is higher than that documented in Ugandan studies (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and other African countries (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), This variation could be due to the differences in culture, resources and education levels as was seen elsewhere (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Our study findings is however comparable to rates of teenage pregnancy of 26.4% in Egypt (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and 29.06% in rural Nepal (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study further highlights the increased risk of adverse maternal outcomes; importantly; compared to adults, teenage mothers are approximately six times more likely to undergo episiotomies compared to adults. Similar findings were reported in studies from Ethiopia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), Cameroon (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and Malaysia (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Teenage mothers might need more episiotomies due to factors such as tight perineum and the perceived need for assistance by healthcare providers based on their age (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However our study differs from a Turkish study (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), possibly because of the narrow age range for adults and higher rates of episiotomy across groups, suggesting routine practice in both groups.\u003c/p\u003e \u003cp\u003eThis study revealed that adult mothers had a greater proportion of preeclampsia compared to teenage mothers, with the adults four times more likely to develop preeclampsia. Advanced maternal age and differences in healthcare utilization may contribute to this disparity, as older mothers have more risk factors and may receive more intensive monitoring. The current finding is in agreement with those of a study in Turkey (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), and in Egypt (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, it was inconsistent with a study in Ethiopia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and a study in Ethiopia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This difference could be due to differences in demographic characteristics (socioeconomic status or healthcare access) and may also be because of age restrictions in the adult group (adults were restricted to the 20\u0026ndash;34 year-old age group) unlike our study, were we did not restrict the age of the adults recruited.\u003c/p\u003e \u003cp\u003eOur study also revealed a greater proportion of teenage mothers compared to adult mothers sustained perineal tears that required suturing; teenage mothers were 2.61 times more likely to experience tears even after adjustment for birth weight and labor stage. The findings of the present study are consistent with those of 2 studies conducted in Cameroon (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Teenage mothers\u0026rsquo; anatomical differences such as smaller pelvis and less tissue elasticity, coupled with limited antenatal care and awareness, may increase perineal tear risk. Our finding however is not in agreement with a study in Ethiopia that found no significant association between teenage pregnancy and perineal tear (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and that in Mecadonia, perineal tear rates were statistically significantly lower among teenage mothers (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This could be due to differences in the demographic characteristics of our study population compared to those of the other populations. The comparison group (adults) in the study by Mecadoni was age group 20\u0026ndash;24 unlike our study in which there was no age restriction.\u003c/p\u003e \u003cp\u003eAccording to this study, 22.6% of teenage mothers delivered low birth weight neonates while only 7.1% delivered low birth weight neonates. After adjustments for the influence of gestational age at delivery and the sex of the baby, low birth weight was still significantly greater among teenage mothers. Compared with adults mothers, the teenage mothers were four times more likely to deliver a low-birth-weight baby compared to adult mothers. This was similar to findings of studies from Ethiopia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), Egypt (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), Nigeria (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), India (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and Indonesia (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The reason for the high rates of low birth weight among teenage mothers is that they are still immature and still continuing to grow as well and therefore during pregnancy there is competition with the developing foetus for nutrients, and this competition is often detrimental to the foetus (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Additionally, teenage mothers are more disadvantaged socioeconomically than adult mothers; factors such as poverty, food insecurity and inadequate housing may contribute to increased stress levels and poor maternal nutrition during pregnancy, which can impact fetal growth and result in low birth weight.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThe main strength of this study lies in its comparison of maternal and neonatal outcomes between teenage and adult mothers, a novel approach in Uganda and East Africa. Controlling for confounding factors enhances the study\u0026rsquo;s credibility. However, socioeconomic factors such as education and employment status, as well as behavioral risk factors such as maternal smoking and alcohol consumption, were not considered. Additionally, the study did not assess factors such as antenatal care attendance, weight gain during pregnancy, or maternal illness, which could influence maternal and neonatal outcomes in either group. We also found incomplete information in some charts reviewed, and to ensure accuracy, missing information in chart reviews was addressed by crosschecking essential registers such as the integrated maternity register, theatre register, and NICU register before considering it incomplete.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eImplications of the study findings\u003c/h2\u003e \u003cp\u003eThe study highlights the urgent need for targeted interventions to reduce teenage pregnancy rates, addressing social factors like poverty and limited access to reproductive health services. It emphasizes the need for increased antenatal education and support for teenage mothers, along evidence-based obstetric practices such as promoting upright birth positions and non-pharmacological pain management techniques to reduce tears and episiotomies. Policy implications include prioritizing adolescent-friendly reproductive health services, comprehensive sex education to non pregnant teenage girls, and improved access to contraception, in addition to ensuring comprehensive antenatal care and support for socioeconomically disadvantaged teenage mothers. Reducing barriers to healthcare access can improve maternal and neonatal outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFuture directions\u003c/h2\u003e \u003cp\u003eFurther research is needed to explore the roles of interventions such sex education, contraceptives use in reducing teenage pregnancy as well as factors facilitating the high teenage rates. Studies investigating the role of socioeconomic factors, healthcare access, and provider practices in shaping maternal and perinatal outcomes among the teenagers are warranted. Additionally longitudinal studies tracking maternal and perinatal outcomes over time among teenage and adult mothers can provide valuable insights into the long-term implications of age at childbirth on maternal and child development.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, approximately one-quarter of the deliveries in Anaka General Hospital were by a teenage mother. Teenage mothers had increased risk of delivering a low-birth-weight baby, perineal tears and episiotomies compared to adult mothers. We recommend implementing; comprehensive sex education, and access to contraception to reduce teenage pregnancy rates and targeted antenatal education programs and evidence based obstetric practices to improve pregnancy outcomes among the teenagers.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAGH \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Anaka General Hospital\u003c/p\u003e\n\u003cp\u003eAIC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Akaike\u0026rsquo;s Information Criterion\u003c/p\u003e\n\u003cp\u003eaOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Adjusted odds ratio\u003c/p\u003e\n\u003cp\u003eAPH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Antepartum haemorrhage\u003c/p\u003e\n\u003cp\u003eC/S\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Caesarean section\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Confidence interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ecOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Crude odds ratio\u003c/p\u003e\n\u003cp\u003eGUREC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Gulu University Research Ethics Committee\u003c/p\u003e\n\u003cp\u003eLBW \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Low birth weight\u003c/p\u003e\n\u003cp\u003eNICU\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Neonatal Intensive Care Unit\u003c/p\u003e\n\u003cp\u003ePPH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Postpartum haemorrage\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSVD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Spontaneous vaginal delivery\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the Department of Public Health, Gulu University and all the lecturers for their support during the study. We thank the Administration of Anaka General Hospital, the District Health Office and the Administration of Nwoya District Local Government for their support and acceptance of this study. We thank the research assistants, Acen Lucy, and Ahirwe Clemensia for their immense contributions to the data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJJL, EO, FB, PA, and PFP contributed to the conception and design of the study. JJL performed the formal data analysis. JJL drafted the manuscript. EO, FB, PA, and PFP critically reviewed and revised the manuscript. JJL prepared the final manuscript. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research received no specific grant for this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research data and materials used to support the research findings of this study are available upon request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Gulu Research Ethics Committee (Ref GUREC-2023-586), including the approval of the request for a waiver of consent. Administrative clearance was obtained from the Chief Administrative Officer of the Nwoya District Local Government before conducting the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest regarding the publication of this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSayegh MA, Castrucci BC, Lewis K, Hobbs-Lopez A. Teen pregnancy in Texas: 2005 to 2015. Matern Child Health J. 2010;14(1):94\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaller L, Feldman F, Lauria W. Obstetric and perinatal outcomes in teenage pregnancy: a literature review. 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World Health Organization; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDivya NV, Pillai SK, Srinivasan B. A study on the fetomaternal outcomes of teenage pregnancies in a tertiary care hospital. From ymerdigital com/uploads/YMER. 2022;210603.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEugene I, Israel J, Atombosoba E. Teenage pregnancy and obstetric outcome: A comparative study in urban Nigeria. Nepal J Obstet Gynaecol. 2016;11(1):37\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUDHS. Uganda demographic and health survey. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps//www.ubos.org/wp-\u003c/span\u003e\u003cspan address=\"https://www.ubos.org/wp-\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUBOS. Area Specific Profiles Nwoya District. Natl Popul Hous Census 2014Area Specif profiles [Internet]. 2017;(April):49. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ubos.org/wp-content/uploads/publications/2014CensusProfiles/NWOYA.pdf\u003c/span\u003e\u003cspan address=\"https://www.ubos.org/wp-content/uploads/publications/2014CensusProfiles/NWOYA.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTabula J. Prevalence of teenage deliveries, and the subsequent maternal and neonatal out comes among women delivering from Bwera Hospital, Kasese Uganda. 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKish L. Sampling organizations and groups of unequal sizes. Am Sociol Rev. 1965;564\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnwubuariri MI, Kasso T. Teenage pregnancy: Prevalence, pattern and predisposing factors in a tertiary Hospital, Southern Nigeria. Asian J Med Heal. 2019;17(3):1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlofinbiyi BA, Oluleye JT, Simeon O, Olatunya BP, Olofinbiyi RO, Akintoye OO, et al. Teenage pregnancy at a tertiary health institution in south-western Nigeria: Socio demographic correlates and obstetric outcome. Int J Clin Obstet Gynaecol. 2019;3(4):97\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagandla K, Kumar K. Prevalence of teenage pregnancy in 2015\u0026ndash;2016 and its obstetric outcomes compared to non-teenage pregnancy at Hospital Tuanku Ja\u0026rsquo;afar Seremban (HTJS), Negeri Sembilan, Malaysia: A retrospective case-control study based on the national obstetric registry. Malaysian Fam physician Off J Acad Fam Physicians Malaysia. 2020;15(2):2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErgen EB, Yayla CA, Sanverdi I, Ozkaya E, Kilicci C, Kocakusak CK. Maternal-fetal outcome associated with adolescent pregnancy in a tertiary referral center: a cross-sectional study. Ginekol Pol. 2017;88(12):674\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgbor VN, Mbanga CM, Njim T. Adolescent deliveries in rural Cameroon: an 8-year trend, prevalence and adverse maternofoetal outcomes. Reprod Health. 2017;14:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRexhepi M, Besimi F, Rufati N, Alili A, Bajrami S, Ismaili H. Hospital-based study of maternal, perinatal and neonatal outcomes in adolescent pregnancy compared to adult women pregnancy. Open access Maced J Med Sci. 2019;7(5):760.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Teenage pregnancy, Maternal outcome, Neonatal outcomes","lastPublishedDoi":"10.21203/rs.3.rs-4438154/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4438154/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTeenage pregnancy is a global health concern associated with adverse maternal and neonatal outcomes. In Uganda, while teenage pregnancy rates are high, knowledge about their specific risks compared to those of adult pregnancy remains limited.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eWe determined the proportion of pregnant teenagers and compared the maternal and neonatal outcomes between pregnant teenagers and pregnant adults at a general hospital in northern Uganda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a comparative, retrospective cohort study involving chart reviews of deliveries at the maternity ward of Anaka General Hospital, Nwoya, Uganda between July 2020 and June 2023. We performed systematic random sampling to include patient charts. All the data were analyzed using STATA software 17 SE. Binary logistic regression was performed to compare adverse pregnancy outcomes between teenage mothers and adult mothers.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOver the 3-year period, 27.6% (n\u0026thinsp;=\u0026thinsp;1,842) of the 6,662 deliveries were by teenage mothers. The outcomes of 457 teenage and 457 adult mothers were compared. Compared to adult mothers, teenage mothers had a significantly lower prevalence of HIV (2.2% \u003cem\u003eversus\u003c/em\u003e 6.1%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). Teenage mothers had higher odds of having an episiotomy performed (adjusted odds ratio [aOR]\u0026thinsp;=\u0026thinsp;5.66, 95% confidence interval [CI]: 2.48\u0026ndash;12.90, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), low birth weight (aOR\u0026thinsp;=\u0026thinsp;4.66, 95% CI: 2.66\u0026ndash;6.37, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) or perineal tear (aOR\u0026thinsp;=\u0026thinsp;2.61, 95% CI: 1.69\u0026ndash;4.02, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, adult mothers had greater odds of developing pre-eclampsia (aOR\u0026thinsp;=\u0026thinsp;4.0, 95% CI: 1.59\u0026ndash;11.1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn this study, approximately 1 in every 4 deliveries were by teenage mothers, with increased risks of maternal and neonatal complications, except for pre-eclampsia which was more common among adult mothers. Therefore, it is crucial to implement targeted interventions and comprehensive education programs aimed at reducing teenage pregnancies and providing adequate antenatal care and support for teenage mothers.\u003c/p\u003e","manuscriptTitle":"Teenage pregnancy proportion, and comparison of maternal and neonatal outcomes with adult pregnancy at a General Hospital in Northern Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-04 21:46:48","doi":"10.21203/rs.3.rs-4438154/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-24T20:56:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-22T15:43:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-16T05:09:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169933713419484989905602033559748395399","date":"2024-07-12T12:31:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176278861216559354936525358113078347764","date":"2024-07-11T04:43:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-28T07:21:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-20T10:09:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-20T08:22:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-20T08:22:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-05-17T17:47:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8cae5dca-6456-49d5-82aa-a1e111fca6cf","owner":[],"postedDate":"June 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T20:54:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-04 21:46:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4438154","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4438154","identity":"rs-4438154","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}