INVESTIGATING THE EFFECT OF MATERNAL AGE ON NEONATAL COMPLICATIONS AND OUTCOMES IN WEST AZERBAIJAN PROVINCE: A PROSPECTIVE COHORT STUDY

Babamiry, Parisa; Moghaddam Tabrizi, Fatemeh; Alinejad, Vahid

doi:10.61186/unmf.22.10.828

Volume 22, Issue 10 (January 2025) Nursing and Midwifery Journal 2025, 22(10): 828-842 | Back to browse issues page

‎ 10.61186/unmf.22.10.828

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Babamiry P, Moghaddam Tabrizi F, Alinejad V. INVESTIGATING THE EFFECT OF MATERNAL AGE ON NEONATAL COMPLICATIONS AND OUTCOMES IN WEST AZERBAIJAN PROVINCE: A PROSPECTIVE COHORT STUDY. Nursing and Midwifery Journal 2025; 22 (10) :828-842
URL: http://unmf.umsu.ac.ir/article-1-5280-en.html

INVESTIGATING THE EFFECT OF MATERNAL AGE ON NEONATAL COMPLICATIONS AND OUTCOMES IN WEST AZERBAIJAN PROVINCE: A PROSPECTIVE COHORT STUDY

Parisa Babamiry¹

, Fatemeh Moghaddam Tabrizi ^*²

, Vahid Alinejad³

1- Master of Counseling in Midwifery, Midwifery Counseling Department, Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
2- Associate Professor of Mother and Child Health, Reproductive Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran , Moghaddam f@umsu.ac.ir
3- Assistant Professor of Biostatistics, Biostatistics Department, Urmia School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

Abstract: (483 Views)

Background & Aim: Pregnancy under the age of 20 is considered a high-risk pregnancy. Given the global growth of the adolescent population, predictions indicate that the number of adolescent pregnancies will increase by 2030. However, some studies suggest that with appropriate prenatal and antenatal care, the complications of such pregnancies can be comparable to those in women over 20 years of age. Understanding the outcomes of pregnancy and childbirth, as well as neonatal complications, with a focus on maternal age, can assist policymakers in planning, developing, and improving fertility policies in the country. Therefore, this study aimed to determine the impact of maternal age on adverse neonatal outcomes among mothers in West Azerbaijan Province as part of a prospective cohort study.
Materials & Methods: This study was an analytical observational study and part of a prospective cohort study conducted from the beginning of Khordad 1402 (May 2023) to the end of Ordibehesht 1403 (April 2024) in urban health centers and five public hospitals in five cities of West Azerbaijan Province (Bukan, Sardasht, Chaypareh, Salmas, and Urmia) that had maternity wards. The study lasted one year. A total of 554 pregnant women were enrolled through census sampling over six months based on inclusion criteria. These women were divided into two age groups: under 20 years and 20-34 years. Both groups were monitored throughout pregnancy and childbirth, and neonatal complications were recorded after delivery. Data were collected through questionnaires and checklists in several stages by the researcher, using information recorded in national pregnancy and childbirth systems as well as existing medical records. The collected data were analyzed using SPSS version 16, with statistical tests including T-test, Chi-square, and Mann-Whitney U test. A P-value of less than 0.05 was considered statistically significant.
Results: The results of this study showed that most pregnant adolescents had low education levels, were homemakers, and lived in suburban areas. Neonatal outcomes, including low birth weight, intrauterine growth restriction (IUGR), need for neonatal resuscitation, admission to the neonatal intensive care unit, fetal distress, low Apgar scores, and preterm birth, showed statistically significant differences between the two groups (P < 0.05), with these outcomes being more prevalent in the adolescent mothers (under 20 years). However, there were no significant differences between the two groups in terms of congenital anomalies, miscarriage, stillbirth, neonatal death, referral to a higher-level hospital, or mode of delivery (P > 0.05). The mode of delivery was similar in both groups, with 63.2% of women under 20 years and 66.1% of women aged 20-34 years delivering vaginally. However, the ratio of cesarean to vaginal delivery was slightly higher in the adolescent group.
Conclusion: Adolescent pregnancy remains a public health issue in Iran, associated with adverse neonatal outcomes. Implementing health policies that address the socio-economic and cultural determinants of adolescent pregnancy, as well as conducting prospective studies to better understand the factors involved in these outcomes, is crucial.

Keywords: Adolescent Pregnancy, Fetal Outcomes, Intrauterine Growth Retardation, Low Birth Weight, Stillbirth

Full-Text [PDF 491 kb] (706 Downloads)

Type of Study: Research | Subject: مامایی

References

1. Organization WH. WHO best-practice statement on the off-label use of bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis. WHO; 2017. [URL:]

2. Parvizi S, Ahmadi F, Nikbakht A. Golden Triangle of family, health and adolescent. J Psychol 2006;10(2):156-68. (Persian). [URL:]

3. Aliyu MH, Luke S, Kristensen S, Alio AP, Salihu HM. Joint effect of obesity and teenage pregnancy on the risk of preeclampsia: a population-based study. J Adolesc Health 2010;46(1):77-82. [PMID: 20123261] [DOI:10.1016/j.jadohealth.2009.06.006]

4. Bulage L, Ssewanyana I, Nankabirwa V, Nsubuga F, Kihembo C, Pande G, et al. Factors associated with virological non-suppression among HIV-positive patients on antiretroviral therapy in Uganda, August 2014-July 2015. BMC Infect Dis 2017;17:1-11. [PMID: 28468608] [DOI:10.1186/s12879-017-2428-3] [PMCID: PMC5415758]

5. Frederiksen LE, Ernst A, Brix N, Lauridsen LLB, Roos L, Ramlau-Hansen CH, et al. Risk of adverse pregnancy outcomes at advanced maternal age. Obstetr Gynecol 2018;131(3):457-63. [PMID: 29420406] [DOI:10.1097/AOG.0000000000002504]

6. Kirbas A, Gulerman HC, Daglar K. Pregnancy in adolescence: is it an obstetrical risk? J Pediatr Adolesc Gynecol 2016;29(4):367-71. [PMID: 26762668] [DOI:10.1016/j.jpag.2015.12.010]

7. Chesnutt AN. Physiology of normal pregnancy. Crit Care Clin 2004;20(4):609-15. [PMID: 15388191] [DOI:10.1016/j.ccc.2004.06.001]

8. Erfani A. Fertility in Tehran city and Iran: rates, trends and differentials. J Iran Popul Stud 2013;1(1):87-107. (Persian). [URL:]

9. Kolahi A-A. Population policies in Islamic republic of Iran: The wisdom stage. Community Health 2019;6(2):108-11. (Persian). [URL:]

10. Sarani M, Shahraki Z, Shirazi M, Saravani S. Risk factors of maternal mortality in Sistan region: 10-year report. Tehran Univ Med J 2014;72(9): (Persian). [URL:]

11. Xie Y, Wang X, Mu Y, Liu Z, Wang Y, Li X, et al. Characteristics and adverse outcomes of Chinese adolescent pregnancies between 2012 and 2019. Sci Rep 2021;11(1):12508. [PMID: 34131205] [DOI:10.1038/s41598-021-92037-x] [PMCID: PMC8206124]

12. Maheshwari MV, Khalid N, Patel PD, Alghareeb R, Hussain A. Maternal and neonatal outcomes of adolescent pregnancy: a narrative review. Cureus 2022;14(6). [URL:] [DOI:10.7759/cureus.25921]

13. Darroch JE, Woog V, Bankole A, Ashford LS. Adding it up: costs and benefits of meeting the contraceptive needs of adolescents. Guttmacher 2016. [URL:]

14. Organization WH. European regional status report on road safety 2019: WHO/Europe; 2020. [URL:]

15. Steenkamp M, Boyle J, Kildea S, Moore V, Davies M, Rumbold A. Perinatal outcomes among young Indigenous Australian mothers: A cross‐sectional study and comparison with adult Indigenous mothers. Birth 2017;44(3):262-71. [PMID: 28432735] [DOI:10.1111/birt.12283]

16. Amjad S, MacDonald I, Chambers T, Osornio‐Vargas A, Chandra S, Voaklander D, et al. Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: a systematic review and meta‐analysis. Paediatr Perinat Epidemiol 2019;33(1):88-99. [PMID: 30516287] [DOI:10.1111/ppe.12529]

17. Kassa GM, Arowojolu A, Odukogbe A, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and meta-analysis. Reprod Health 2018;15:1-17. [PMID: 30497509] [DOI:10.1186/s12978-018-0640-2] [PMCID: PMC6267053]

18. Ezegwui H, Ikeako L, Ogbuefi F. Obstetric outcome of teenage pregnancies at a tertiary hospital in Enugu, Nigeria. Niger J Clin Pract 2012;15(2):147-50. [PMID: 22718161] [DOI:10.4103/1119-3077.97289]

19. Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: a WHO multicountry study. Br J Obstatr Gynecol 2014;121:40-8. [PMID: 24641534] [DOI:10.1111/1471-0528.12630]

20. Daniels S, Robson D, Flatley C, Kumar S. Demographic characteristics and pregnancy outcomes in adolescents-Experience from an Australian perinatal centre. Aust N Z J Obstet Gynaecol 2017;57(6):630-5. [PMID: 28635013] [DOI:10.1111/ajo.12651]

21. Marvin-Dowle K, Kilner K, Burley VJ, Soltani H. Impact of adolescent age on maternal and neonatal outcomes in the Born in Bradford cohort. BMJ Open 2018;8(3):e016258 . [PMID: 29549196] [DOI:10.1136/bmjopen-2017-016258] [PMCID: PMC5857698]

22. Althabe F, Moore JL, Gibbons L, Berrueta M, Goudar SS, Chomba E, et al. Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network's Maternal Newborn Health Registry study. Reprod Health 2015;12:1-9. https://doi.org/10.1186/1742-4755-12-S2-S1 [PMID: 26063166] [DOI:10.1186/1742-4755-12-S2-S1 https://doi.org/10.1186/1742-4755-12-S2-S8] [PMCID: PMC4464212]

23. Khatun M, Al Mamun A, Scott J, William GM, Clavarino A, Najman JM. Do children born to teenage parents have lower adult intelligence? A prospective birth cohort study. PLoS One 2017;12(3):e0167395 . [PMID: 28278227] [DOI:10.1371/journal.pone.0167395] [PMCID: PMC5344312]

24. Zhang B, Chan A. Teenage pregnancy in south Australia, 1986-1988. Aust N Z J Obstet Gynaecol 1991;31(4):291-8. [PMID: 1799337] [DOI:10.1111/j.1479-828X.1991.tb02805.x]

25. Bacci A, Manhica G, Machungo F, Bugalho A, Cuttini M. Outcome of teenage pregnancy in Maputo, Mozambique. Int J Gynecol Obstet 1993;40(1):19-23. [PMID: 8094345] [DOI:10.1016/0020-7292(93)90767-Q]

26. Khwaja SS, Al-Sibai MH, Al-Suleiman SA, El-Zibdeh MY. Obstetric implications of pregnancy in adolescence. Acta Obstet Gynecol Scand 1986;65(1):57-61. [PMID: 3716783] [DOI:10.3109/00016348609158231]

27. Harden A, Brunton G, Fletcher A, Oakley A. Teenage pregnancy and social disadvantage: systematic review integrating controlled trials and qualitative studies. Br Med J 2009;339. [PMID: 19910400] [DOI:10.1136/bmj.b4254] [PMCID: PMC2776931]

28. Lowdermilk D, Perry S, Bobak I. Maternity women's health care (E. F Olshansky (ed.). Elsevier; 2000. [URL:]

29. Yu M, Chen H, Li N. Influence of nutritional guidance during pregnancy on nutritional status and pregnancy outcome of pregnant women. Afr J Reprod Health 2025;28(12). [PMID: 32943297] [DOI:10.29063/ajrh2024/v28i12.3]

30. Baheiraei A, Soltani F, Ebadi A, Foroushani AR, Cheraghi MA. Risk and protective profile of tobacco and alcohol use among Iranian adolescents: a population-based study. Int J Adolesc Med Health 2017;29(3): (Persian). [PMID: 26982610] [DOI:10.1515/ijamh-2015-0089]

31. Baheiraei A, Soltani F, Ebadi A, Cheraghi MA, Foroushani AR, Catalano RF. Psychometric properties of the Iranian version of 'Communities That Care Youth Survey'. Glob J Health Sci 2016;31(1):59-72. (Persian). [PMID: 25107919] [DOI: 10.1093/heapro/dau062]

32. Shahhosseini Z, Hamzehgardeshi Z. Female adolescents' perspective about reproductive health education needs: a mixed methods study with explanatory sequential design. Int J Adolesc Med Health 2015;27(1):57-63. (Persian). [PMID: 24864298] [DOI:10.1515/ijamh-2014-0008]

33. Mangeli M, Rayyani M, Cheraghi MA, Tirgari B. Iranian mothers' experiences of the outcomes of early motherhood: A qualitative study. Soc Work Public Health 2018;33(3):163-72. (Persian). [PMID: 29368996] [DOI:10.1080/19371918.2018.1425648]

34. Chethana R, Kiruffi DV, Seema K, Shivalingaiah AH. A Retrospective Study on Maternal and Neonatal Outcomes of Adolescent Pregnancies at a Referral Hospital in Bengaluru. Arch Med Health Sci 2024;12(1):36-9. [URL:] [DOI:10.4103/amhs.amhs_243_23]

35. Rani RA, Gayatri A, Bharathi R, Sweetha S. A Retrospective Study of Maternal and Fetal Outcomes in Adolescent Pregnancy in Tertiary Care Hospital. Int J Acad Med Pharm 2024;6(6):176-9. [URL:]

36. Choi F, Cheng A, Chiu W. Perinatal and developmental outcomes of teenage pregnancy: An analysis of a 10-year period in a local region in Hong Kong. Hong Kong J Paediatr 2022;27(1):25-32. [URL:]

37. Poudel S, Razee H, Dobbins T, Akombi-Inyang B. Adolescent pregnancy in south Asia: a systematic review of observational studies. Int J Environ Res Public Health 2022;19(22):15004. [PMID: 36429723] [DOI:10.3390/ijerph192215004] [PMCID: PMC9690629]

38. Malekmohammadi EA. Comparison of pregnancy and childbirth outcomes in teenage and young married women. Iran J Obstet Gynecol Infertil 2023: (Persian). [URL:]

39. Fatemeh M-T, Maryam N, Leila M. The story of staying out of normal routine life in adolescent mothers in marginal areas in Urmia through the lens of conventional content analysis approach. Midwifery 2024;137:104108. [PMID: 39068701] [DOI:10.1016/j.midw.2024.104108]

40. Karmaker R, Lemon MHA. Female students, dropping out of education. Indones J Multidiscip Res 2024;4(1):77-88. [URL:]

41. Khazaei S, Bashirian S, Bathaei A, Sadri M, Shirani F, Jenabi E. Pregnancy outcomes in adolescents: a case-control study in the west of Iran. Curr Women's Health Rev 2022;18(2):53-8. (Persian). [URL:] [DOI:10.2174/1573404817666210322154035]

42. Varmaghani M, Pourtaheri A, Ahangari H, Tehrani H. The prevalence of adolescent pregnancy and its associated consequences in the Eastern Mediterranean region: a systematic review and meta-analysis. Reprod Health 2024;21(1):113. [PMID: 39085959] [DOI:10.1186/s12978-024-01856-4] [PMCID: PMC11292957]

43. DeMarco N, Twynstra J, Ospina MB, Darrington M, Whippey C, Seabrook JA. Prevalence of low birth weight, premature birth, and stillbirth among pregnant adolescents in Canada: a systematic review and meta-analysis. J Pediatr Adolesc Gynecol 2021;34(4):530-7. [PMID: 33727190] [DOI:10.1016/j.jpag.2021.03.003]

44. Xie Y, Wang X, Mu Y, Liu Z, Wang Y, Li X, et al. Characteristics and Adverse Outcomes of Chinese Adolescent Pregnancy Between 2012 and 2019: An Observational Study of 438 Health Facilities. 2021. [URL:] [DOI:10.21203/rs.3.rs-253568/v1]

45. Çakır SÇ, Çelik S, Yazıcıoğlu B, Soyer Çalışkan C. Early neonatal outcomes of adolescent pregnancies. Ankara Med J 2021;21(4):515-25. [URL:] [DOI:10.5505/amj.2021.39019]

46. Xu L, Sheng X-J, Gu L-P, Yang Z-M, Feng Z-T, Gu D-F, et al. Influence of perinatal factors on full-term low-birth-weight infants and construction of a predictive model. World J Clin Cases 2024;12(26):5901. [PMID: 39286375] [DOI:10.12998/wjcc.v12.i26.5901] [PMCID: PMC11287508]

47. Biyang YVS, Bisseye C, Saidou M. Determinants of low birth weight in Franceville, Southeast Gabon. Pan Afr Med J 2024;47:218. [PMID: 39247776] [DOI:10.11604/pamj.2024.47.218.40737] [PMCID: PMC11380620]

48. Wa Kabanga AK, Islam MS. Low Birth Weight Associated with Maternal Age, Number of Delivery and Birth Spacing: A Study in the Uvira Town in Democratic Republic of Congo. Eur J Appl Sci 2024;12(5). [URL:] [DOI:10.14738/aivp.125.17535]

49. Diabelková J, Rimárová K, Dorko E, Urdzík P, Houžvičková A, Argalášová Ľ. Adolescent pregnancy outcomes and risk factors. Int J Environ Res Public Health 2023;20(5):4113. [PMID: 36901128] [DOI:10.3390/ijerph20054113] [PMCID: PMC10002018]

50. Ateşli B, Sofuoğlu K. Maternal and Fetal Outcomes in Adolescent Pregnancies. Eurasian J Med Adv 2023;3(3):127-9. [URL:] [DOI:10.14744/ejma.2023.83803]

51. Jeelani SF, Jangsher S, Saleem B. Obstetrical outcomes of teenage compared with adult pregnancies. Pak J Med Sci 2017;11:416-8. [URL:]

52. Fadaei B, Movahedi M, Akbari M, Ghasemi M, Jalalvand A. Effect of maternal age on pregnancy outcome. J Isfahan Med Sch 2011;29(145):855-60. (Persian). [URL:]

53. Poorali L, Ayati S, Shakeri MT, Vatanchi A, Khatami S. Obstetric and Perinatal Outcomes in Primigravid Adolescent and Adult Women. Iran J Obstet Gynecol Infertil 2018;21(4):1-7. (Persian). [URL:]

54. Chang S-C, O'Brien KO, Nathanson MS, Mancini J, Witter FR. Characteristics and risk factors for adverse birth outcomes in pregnant black adolescents. J Pediatr 2003;143(2):250-7. [PMID: 12970642] [DOI:10.1067/S0022-3476(03)00363-9]

55. Hediger M, Scholl T, Ances I, Belsky D, Salmon R. Rate and amount of weight gain during adolescent pregnancy: associations with maternal weight-for-height and birth weight. Am J Clin Nutr 1990;52(5):793-9. [PMID: 2239753] [DOI:10.1093/ajcn/52.5.793]

56. Kalhor M, Azh N, Alipour M, Eghdampour F. A comparative study of the outcomes of pregnancy and childbirth in teenagers and primiparous women who referred to Kausar educational and therapeutic center in Qazvin city in 2012-1992. Razi J Med Sci 2015: (Persian). [URL:]

57. Radu MC, Manolescu LS, Chivu R, Zaharia C, Boeru C, Pop-Tudose M-E, et al. Pregnancy in Teenage Romanian Mothers. Cureus 2022;14(1). [PMID: 35223313] [DOI:10.7759/cureus.21540] [PMCID: PMC8864497]

58. Chen X-K, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol 2007;36(2):368-73. [PMID: 17213208] [DOI:10.1093/ije/dyl284]

59. Lao T, Ho L. The obstetric implications of teenage pregnancy. Hum Reprod 1997;12(10):2303-5. [PMID: 9402300] [DOI:10.1093/humrep/12.10.2303]

60. Grady MA, Bloom KC. Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. J Midwifery Womens Health2004;49(5):412-20. [PMID: 15351331] [DOI:10.1111/j.1542-2011.2004.tb04435.x]

61. Maryam K, Ali S. Pregnancy outcome in teenagers in East Sauterne of Iran. J Pak Med Assoc 2008;58(10):541. [URL:] [PMID: 18998305]

62. Zhang T, Wang H, Wang X, Yang Y, Zhang Y, Tang Z, et al. The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China. BMC Pregnancy Childbirth 2020;20:1-10. [PMID: 32487101] [DOI:10.1186/s12884-020-03022-7] [PMCID: PMC7268722]

63. Wong SP, Twynstra J, Gilliland JA, Cook JL, Seabrook JA. Risk factors and birth outcomes associated with teenage pregnancy: a Canadian sample. J Pediatr Adolesc Gynecol 2020;33(2):153-9. [PMID: 31634579] [DOI:10.1016/j.jpag.2019.10.006]

64. Sedgh G, Finer LB, Bankole A, Eilers MA, Singh S. Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends. J Adolesc Health 2015;56(2):223-30. (Persian). [PMID: 25620306] [DOI:10.1016/j.jadohealth.2014.09.007] [PMCID: PMC4852976]

65. Kassa GM, Arowojolu AO, Odukogbe ATA, Yalew AW. Adverse maternal outcomes of adolescent pregnancy in Northwest Ethiopia: A prospective cohort study. PLoS One 2021;16(9):e0257485 . [DOI:10.1371/journal.pone.0257485] [PMID: 34550977] [PMCID: PMC8457495]

66. Youseflu S, Keshavarz Afshar M, Mousavi M, Moradi Z, Banaei M, Bayat F. What Are the Maternal and Neonatal Outcomes of Adolescent Pregnancy in Women Referring to Ayatollah Mousavi Hospital in Zanjan? A Comparative Cross-sectional Study. Preventive Care Nurs Midwifery J 2019;9(3):27-34. (Persian). [URL:] [DOI:10.52547/pcnm.9.3.27]