The implications of childbearing in postpubertal girls in Sokoto, Nigeria

The implications of childbearing in postpubertal girls in Sokoto, Nigeria

Int. J. Gynecol. Obstet., 13 1988,21: 73-11 International Federation of Gynecology&Obstetrics The implications Sokoto, Nigeria 0.0. Adetoroa of...

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Int. J. Gynecol.

Obstet.,

13

1988,21: 73-11

International Federation of Gynecology&Obstetrics

The implications Sokoto, Nigeria 0.0.

Adetoroa

of childbearing

in postpubertal

girls in

and A. Agahb

“Department of Obstetrics and Gynaecology, Teaching Hospital, Sokoto (Nigeria)

University

of Ilorin and =‘Department of Obstetrics

and Gynaecology,

Sokoto

University

(Received March 10th. 1987) (Revised and accepted July 8th. 1987)

Abstract A retrospective analysis of 337 young postpubertal delivered mothers was compared with other parturient women in Sokoto University Teaching Hospital (S. U. T.H.) during a l-year period. In this analysis, late booking was identified as the most important factor that directly affects the perinatal outcome in young postpubertal pregnant mothers. The problems of postpubertal pregnancy were highlighted in order to motivate individuals to wards family planning. Keywords: Implications; pubertal girls.

Child bearing; Post-

burden of reproduction and growth, reports on the subject are inconsistent. Some [5,6] believe that adolescent obstetrics pose no greater risk than obstetrics in general. However, despite the relatively high proportion of early postpubertal marriage in Northern Nigeria, to the best of our knowledge, no study has been conducted in Sokoto city addressing itself solely on the implications of childbearing in early postpubertal girls, late teenagers and in other reproductive age women. The purpose of this investigation, therefore, was to evaluate the characteristics and the outcome of pregnancy in young postpubertal girls and in other women of childbearing age.

Introduction

Materials and methods

Marriage is almost universal in Africa [l] and unlike the western world, early marriage is traditionally encouraged, before or shortly after puberty, especially in Islamic states [2]. In Sokoto, an Islamic city in Northern Nigeria, 94% of the women with no western style of education marry before the age of 16 years [3]. While there is evidence [4] that adolescents may constitute a high risk group in reproductive terms, because of the assumed double

During the l-year period, January 1985 to December 1985, 425 1 Nigerian women were delivered at Sokoto University Teaching Hospital (S.U.T.H.). The characteristics of all the women were examined with respect to age, parity, mode of delivery, maternal and fetal complications.

0020-7292/88/$03.50 0 1988 International Federation of Gynecology & Obstetrics

Results Of the 4251 singleton delivered mothers, Clinical and Clinical Research

74

Adetoro and Agah

Table I.

The weight of babies of young postpubertal mothers and other parturient mothers (n = 4251). x2 = 819.45 at u = 0.01.

Weight (g)

Age distribution in years 16

17-19

20-29

30-39

40

< 2500 2501-3000 3001-3500 3501-4000 4001-4500 > 4500

191 109 34 3 -

85 204 177 51 11 -

185 1545 551 231 57 16

77 397 205 91 8 5

4 19 8 6 5 3

Total

337

528

2558

783

45

377 were young adolescents (aged 16 years), giving an incidence of 7.9%. The young postpubertal girl weighed less at booking and was shorter. The antenatal attendance was low before 26 weeks of pregnancy, and 77.9% of the postpubertal pregnant women received no antenatal care. Lack of antenatal care and late booking were among the factors identified which directly affected the perinatal outcome in postpubertal pregnant women. Labor was significantly longer in the young postpubertal girls. Tables I and II show the birthweights and parity distribution in relation to maternal age. The incidence of low birthweight and low parity was higher in young postpubertal mothers. Using the test of independence in R and C analysis contingency tables, those differences are statistically sig-

Table II. 0.01.

nificant (x2 = 819.45 at a = 0.01 and x2 = 2571.9 at 4 = 0.01, respectively). The mode of delivery is shown in Table III. Spontaneous vertex deliveries were significantly higher in mothers of 17 years of age and above. Forceps and vacuum deliveries were more common in the young postpubertal mothers, so also were cesarean sections and destructive operations. The difference is highly statistically significant (x2 = 413.42 at a = 0.01). The fetal complications observed (Table IV), including prematurity and stillbirths, were higher in babies of these young mothers and also gives a statistically significant result h’ = 76.87 at a = 0.05). Table V shows the maternal complications in the young adolescent mothers. Anemia, postpartum hemor-

Age - parity distribution in young postpubertal mothers and other parturient mothers (n = 4251). x2 = 2572.89 at a =

Parity

Age distribution in years 16

0

17-19

20-29

30-39

40

1 2 3 4 5 5

251 64 22 -

83 175 232 25 13 -

53 346 620 818 241 291 189

11 26 49 66 81 311 239

1 2 2 5 4 8 23

Total

337

528

2558

783

45

Int J Gynecol Obstet 27

Child bearing in postpubertal girls Table III.

The mode of delivery in young postpubertal Age distribution 16

mothers

and other parturient

women.

x2 = 413.44 at a = 0.01. Total

in years 17-19

20-29

30-39

40

Spontaneous vaginal delivery Assisted breech delivery Forceps Cesarean section Destructive operation

251 9 41 32 4

427 15 59 23 4

2452 31 39 29 7

741 14 11 7 2

32 4 5 3

Total

337

528

2558

783

45

rhage, pre-eclampsia, eclampsia and maternal deaths were more common in the young adocomplications maternal The lescents . observed also reached levels of statistical significance (x2 = 541.89 at a = 0.01). Most of the mothers in this study were seen for the first time at a late stage of pregnancy. The overall result showed that obstetric and perinatal problems were definitely high in all age groups but significantly more in the young postpubertal mothers. Discussion Despite the fact that early marriage tends to ensure that most pregnancies and births occur within marriage, and the young bride often receives moral and maternal assistance, the outcome sometimes has serious and negaTable IV.

Maternal

complications

in young postpubertal Age distribution 16

Anemia Postpartum hemorrhage Obstructed labor Ante-partum hemorrhage Pre-eclampsia Eclampsia Vesico vaginal fistula Maternal death Total

75

1

3906 72 155 98 20 425 1

tive consequences on the young mothers, their children, and on the health care resources of the nation. The striking features of the young postpubertal mothers in this study as in other reports [7,8] were relatively low level of education, low socio-economic status, and social and psychological immaturity. This analysis revealed a relatively low birthweight and low parity in the young adolescent mothers, and this agrees with other studies [5,9]. The high incidence of maternal and fetal complications contradicts some other reports [ 11,13,14] which indicate that adolescent obstetrics present no greater challenge than obstetrics in general. Anemia and prematurity were common in the young mothers in our study. This finding is in accordance with the report of Israel and Wouterz [ 111. In contrast, Roopnariresigh [ 151, Coates [ 161,

and other parturient

women.

x2 = 541.89 at o = 0.01

in years 17-19

20-29

30-39 62 197 9 136 11 4

5 3 2 3 2

40

69 27 31 6 21 10 4 26

7 21 42 17 25 5 2 31

163 271

32

13

2

194

150

590

432

24

I 98 19 5

7

I

Clinical and Clinical Research

76

Adetoro and Agah

Table V.

The fetal complications in young postpubertal mothers and other parturient women. x2 = 76.87 at (I = 0.05.

Fetal complications

Prematurity Stillbirth Early neonatal deaths Congenital malformation Neonatal jaundice Neonatal sepsis Total

Age distribution in years 16

17-19

51 49 37 3 51 43

65 65 41 9 75 37

244

292

Hay and Boyd [17] and Omu et al. [lo] found that anemia was rare in adolescents. The high incidence of anemia and other obstetric complications in our study was most probably due to delay in booking and late presentation in labor, where patients at risk would have been quickly recognized and treated promptly. The cesarean section rate was high and the main indication was cephalopelvic disproportion. This analysis showed that the period of greatest risk of cephalopelvic disproportion, due to pelvic bone immaturity is in women under 16 years of age as in the earlier report of Omu et al. [lo]. Furthermore, while the adverse affect of young maternal age on the obstetric and perinatal outcome can be significantly reduced by early antenatal care for these mothers, our findings which are similar to other reports [18 -201, show that it is unaltered for teenagers having subsequent pregnancies. Hence, the young postpubertal mothers, having a second or third birth in this analysis experience a dramatic increase in the rate of low birthweight infants and perinatal deaths. This indicates that the poor obstetric and neonatal outcome in the young postpubertal women is probably not only due to age but rather because of other factors associated with parity and delayed antenatal care. Although, no stigmata is attached to adolescent pregnancy in the Sokoto community as in black Jamaica group [ 171, the major facInt J Gynecol Obstet 27

20-29

30-39

40

57 149 97 17 91 61

31 81 27 4 19 15

1 6 6 2 4 1

472

177

16

tor responsible for the difference in obstetric complications is probably due to lack of medical care in the majority of the women in our series. Since medical problems associated with young postpubertal mothers are largely controllable, the mothers must therefore avail themselves of early booking and continuous antenatal care. It is by so doing that young teenage mothers will be less susceptible to the problems associated with teenage pregnancy. As young teenage pregnancy does not seem desirable from psychological, socio-economic and obstetric viewpoints, the health promoters in the community must discourage early marriage through health education, but where the culture still approves of it, family health planning must be emphasized. In conclusion, for most developing countries of the world, especially where there is inadequate medical care, pregnancy and delivery in young postpubertal girls appear unsafe and must be discouraged through appropriate reproductive health care in the community. References Population Reports: Age at Marriage and fertility Series M. No. 4,1979. Harriagton JA: Education, female status and fertility in Nigeria. Presented at the population Association of America, Atlanta, Georgia, April 15th, p. 49, 1978. Trevor J: Family change in Sokoto: a traditional Moslem/Fulani Hausa City. In Population Growth and

Child bearing in postpubertal girls

4

5

6 I

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Socio-Economic Change in West Africa (ed JC Coldwell), p. 236. Colombia University Press, New York, 1975. Effiong EI, Banjoko MO: Obstetric performance of Nigerian primigravidae aged 16 years and under. Br J Obstet Gynaecol82 (3): 228, 1975. Oppel WC, Royston AB: Teenage births, some social psychological and physical sequelae. Am J Public Health 61(4):751, 1971. Stickle G: Pregnancy in adolescents: scope of the problem. Contemp Obstet Gynaecol5 (6): 85, 1975. Dotts AB, Fort AT: Medical and social factors affecting early teenage pregnancy. Am J Obstet Gynaecol125: 532, 1975. Arkutu AA: Pregnancy and labour in Tanzania primigravidae age 15 years and under. Int J Gynaecol Obstet 16: 128, 1978. O’Brien MJ, Chang AMZ, Esler EJ: Antenatal care: obstetrics and neonatal outcome of teenage pregnancies in Asia-Oceania. J Obstet Gynaecol Br Commonw 77: 424, 1970. Omu AE, Omene JA, Oronsaye AU, Faal KB: Obstetric performance and fetal outcome of the young adolescent primipara. Singapore J Obstet Gynaecol12 (3): 39, 1982. Israel SL, Woutersz TB: Teenage Obstetrics. Am J Obstet Gynaecol85: 659, 1963. McAnarney ER: Adolescent pregnancy, and child bearing: new data, new challenges. Pediatrics 74: 973, 1984.

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14

15 16 17

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19 20

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Naiye RL: Teenaged, and preteenaged pregnancies: consequences of fetal maternal competition for nutrients. Pediatrics 67: 146, 1981. Elster BA: The effect of maternal age, parity and prenatal care on perinatal outcome in adolescent mothers. Am J Obstet Gynaecol149 (8): 845, 1984. Roopnanesingh S: Teenage pregnancy in Trinidad. West Indian Med J 24: 129, 1975. Coates JB: Obstetrics in the very young adolescents. Am J Obstet Gynaecol142: 813, 1970. Hay DM, Boyd JJ: A comparative study of obstetric performance of the adolescent Jamaican primigravida. West Indian Med J 22: 84, 1973. Oronsaye AU, Ogbeide 0, Unugbe E: Pregnancy among school girls in nigeria. Int J Gynaecol Obstet 20: 409, 1982. Goldberg CL, Craig CJT: Obstetrics complications in adolescent pregnancies. S Afr Med J 64: 863, 1983. Roopnarinesingh SS: The young negro primigravida in Jamaica. J Obstet Gynaecol Br Commonw 77: 424, 1970.

Address for reprints: 0.0. Adetoro, FMCOG, FWACS Department of Obstetrics and Gynaecology University of Ilorin P.M.B. 1515 Ilorin, Nigeria

Clinical and Clinical Research