The outcomes of pregnancy and childbirth in adolescents in Slovenia

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Abstract

Introduction

The objective of the study was to determine the course and outcomes of pregnancy and childbirth in adolescents compared to women aged 20–24 years in Slovenia.

Methods

In the retrospective study, the course of pregnancy and labour and the perinatal outcome of newborns in primiparous adolescents aged ≤19 years (study group) have been compared to the control group of primiparous women aged 20–24 years. The study group was further divided into a study subgroup of adolescents aged ≤17 years. Data were retrieved from the National Perinatal Information System in Slovenia for the period 2008–2012. Altogether, 13,663 women and their newborns were included.

Results

Adolescent pregnancy was associated with increased rates of unknown estimated date of delivery, preterm labour, low birth weight newborns, small for gestational age newborns and low gestational weight gain. Spontaneous labour was more common in adolescents, while emergency and elective Caesarean sections were less common than in women aged 20–24 years. In addition, pregnancy in adolescents aged ≤17 years was associated with increased rate of maternal anaemia and labour without complications. Higher rates of smoking, lower rates of parenting school attendance, lower rates of pregnancy check-ups and screening tests in pregnancy such as nuchal translucency in adolescents were found.

Conclusions

The results of the study show that adolescent pregnancy is related to higher health risks for pregnant adolescents and their newborns. In addition, adolescents are subject to poorer prenatal care comparing to older women.

1 Introduction

Adolescence is a period of human growth and development between childhood and adulthood, from ages 10 to 19 years. Many adolescents face pressures to initiate sexual relationships at earlier age, putting themselves at high risk for consequences from sexually transmitted infections to unintended pregnancies (1). Early childbearing increases the risks for both mothers and their newborns, and can also have negative social and economic effects on girls, their families and communities (2). Therefore, the adolescent pregnancy is a public health problem.

The research on sexual behaviour of secondary–school students in Slovenia in 1996, showed that median age of first sexual intercourse was 18.5 years (3) and dropped to 17.0 years in 2004 (4), and 17.6 years in 2012 (5). In 2012, contraceptive methods used at last sexual intercourse by 3rd grade secondary–school students were condom (54.1%), the pill (27.1%), double method (4.2%), withdrawal (4.0%), other methods (3.5%) and no method (7.1%) (5).

In Slovenia, abortion rates in women of reproductive age (aged 15–49 years) have decreased from 25.9 in 1992, to 8.8 in 2012; in women aged 15–19 years, from 12.7 in 1992, to 5.8 in 2012; in women aged 20–24 years, from 33.5 in 1992, to 11.1 in 2012. In the same period, fertility rates in women aged 15–49 years have increased from 39.1 in 1992, to 46.2 in 2012; however, in women aged 15–19 years, fertility rates decreased from 13.9 in 1992, to 4.6 in 2012, and in women aged 20–24 years, from 98.2 in 1992, to 43.7 in 2012 (6, 7). Slovenia had one of the lowest ratios of all live births to mothers aged below 20 years, 1.01 % in 2012 (8).

The studies showed that adolescents’ pregnancy and childbirth were related to increased health risk for adolescents and newborns. Girls who got pregnant at the age of 14 years or younger, and, to a lesser extent, at 15–17 years and 18–19 years, were at higher risk of complications during pregnancy (9). They were more likely to experience obstructed labour, fistula, premature birth, and gave birth to low birth weight newborns than older women (10). Moreover, medical risks of adolescent pregnancy could include higher rates of anaemia, pregnancy-induced hypertension, cephalopelvic disproportion, problems with progression of labour, and higher perinatal morbidity (1114). On the other hand, some studies showed that adolescent mothers had lower risks of third trimester bleeding, gestational diabetes (15) and preeclampsia (16).

Aiming at getting new insights in characteristics of adolescent pregnancy in Slovenia, the objective of our study was to determine the course and outcomes of pregnancy and childbirth in primiparous adolescents compared to primiparous women aged 20–24 years.

2 Material and methods

The study was done on the total population of observed population groups of primiparous women aged up to 24 years, and their newborns in Slovenia for the period 2008–2012. In the retrospective study, the incidence of complications during pregnancy and labour and the perinatal outcome in primiparous adolescents aged up to 19 years (study group) was compared to the control group of primiparous women aged 20–24 years.

In the study, 13,663 primiparous women aged up to 24 years who gave birth during 2008–2012 in Slovenia, and their newborns were included: 1,413 adolescents aged up to 19 years and their 1,423 newborns, and 12,112 women aged 20–24 years and their 12,240 newborns. The study group of primiparous adolescents (≤19 years) was further divided into a subgroup of adolescents aged up to 17 years (≤17 years, 318 women, 318 newborns). Data were retrieved from the National Perinatal Information System. In the study, the variables for the course of pregnancy, the course of labour, the status of the newborn and prenatal care were used. The majority of variables were observed outcomes, except for participants’ age and gestational age at childbirth. Participants’ age was an explanatory factor. In multivariate analyses, gestational age was the confounding factor. All dichotomous variables were coded accordingly (e.g. hypertension: 0=no, 1=yes).

Variables on body weight gain during pregnancy (i.e. gestational weight gain) in relation to body mass index (BMI) before pregnancy were used according to the Institute of Medicine guidelines (US) (17). The data were analysed by SPSS programme. Descriptive analysis, analysis of variance (ANOVA), x2 test, correlation and multivariate analyses (multiple linear and multiple logistic regression) were applied where appropriate. Statistical significance was set at p<0.05.

3 Results

3.1 The Course of Pregnancy

Gestational diabetes and bleeding during pregnancy were less common in the study group of adolescents aged ≤19 years, while anaemia was more common only in the younger subgroup of adolescents aged ≤17 years. In addition, unknown estimated date of delivery, threatened preterm labour and preterm labour were more common in adolescents. It was more common for adolescents to have a low and appropriate gestational weight gain compared to women in the control group. No statistically significant differences regarding hypertension, intrauterine growth restriction (IUGR) and foetal anomalies were found (Table 1).

Table 1

Results of univariate analysis of the course of pregnancy group of observed outcomes between the study group (age ≤19 years) or the study subgroup (age ≤17 years) and the control group (age 20–24 years) of primiparous women, Slovenia, 2008–2012.

Control groupStudy groupStudy subgroup



The course of pregnancy20–24 years (N=12,112)≤19 years(N=1, 413)≤17 years (N=318)



n (%)n (%)P*n (%)P*
Hypertension598 (4.9)68 (4.8)0.83715 (4.7)0.858
Anaemia273 (2.3)43 (3.0)0.06314 (4.4)0.012
Gestational diabetes265 (2.2)10 (0.7)<0.0011 (0.3)0.023
Unknown estimated date of delivery55 (0.5)27 (1.9)<0.00118 (5.7)<0.001
Bleeding during pregnancy616 (5.1)41 (2.9)<0.0018 (2.5)0.038
Intrauterine growth restriction (IUGR)291 (2.4)43 (3.0)0.14212 (3.8)0.118
Foetal anomalies33 (0.3)4 (0.3)0.9422 (0.6)0.236
Threatened preterm labour473 (3.9)82 (5.8)0.00121 (6.6)0.015
Duration of pregnancy
     Birth at ≤17 weeks124 (1.0)28 (2.0)0.0017 (2.2)0.017
     Birth at 32-36 weeks649 (5.4)94 (6.7)25 (7.9)
     Birth at ≥37 weeks11338 (93.6)1290 (91.4)286 (89.9)
Gestational weight gain in relation to BMI before pregnancy
     Appropriate gestational weight gain3135 (26.0)341 (24.2)<0.00181 (25.6)<0.001
     Low gestational weight gain1986 (16.4)357 (25.3)104 (32.8)
     High gestational weight gain6953 (57.6)712 (50.5)132 (41.6)

Legend:

3.2 The Course of Labour

The onset of labour was more commonly spontaneous in adolescents; it was less common for adolescents to need either an administration of PGE2, artificial rupture of membranes or an elective Caesarean section. No differences were found regarding augmentation with oxytocin or regarding foetal position and breech presentations. It was less common for adolescents to have an incorrect descent of the presenting part, emergency Caesarean section and minor maternal injuries. Instrumental interventions were more frequent in adolescents. No statistically significant differences were found in delay of cervical dilatation, foetal distress, rates of labour dystocia, episiotomy, uterine cervix and severe maternal injuries and complications of the third stage of labour (Table 2).

Table 2

Results of univariate analysis of the course of labour group of observed outcomes between the study group (age ≤19 years) or the study subgroup (age ≤17 years) and the control group (age 20–24 years) of primiparous women, Slovenia, 2008–2012.

Control groupStudy groupStudy subgroup



The course of labour20–24 years (N=12,112)≤19 years (N=1,413)≤17 years (N=318)



n (%)n (%)P*n (%)P*
Onset of labour
     Spontaneous9197 (76.1)1.152 (81.7)<0.001269 (84.6)0.006
     Administration of PGE21.451 (12.0)139 (9.9)<0.00125 (7.9)0.006
     Artificial rupture of membranes971 (8.0)79 (5.6)<0.00116 (5.0)0.006
     Elective Caesarean section465 (3.8)40 (2.8)<0.0018 (2.5)0.006
     Augmentation with oxytocin7751 (64.0)875 (61.9)0.126188 (59.1)0.074
Foetal position
     Occipito-anterior foetal position10857 (88.7)1270 (89.2)0.927280 (87.8)0.614
     Other foetal head positions785 (7.4)89 (6.3)0.92725 (7.8)0.614
     Breech presentations567 (4.6)61 (4.3)0.92714 (4.4)0.614
Delay of cervical dilatation252 (2.1)15 (1.1)0.091 (0.3)0.028
Incorrect descent of the presenting part754 (6.2)67 (4.7)0.02716 (5)0.383
Foetal distress503 (4.2)62 (4.4)0.67613 (4.1)0.954
Labour dystocia84 (0.7)9 (0.6)0.8085 (1.6)0.067
Instrumental intervention (vacuum, forceps)556 (4.5)62 (4.4)0.00118 (5.6)0.040
Emergency Caesarean section2006 (16.4)180 (12.6)0.00136 (11.3)0.040
Episiotomy5432 (44.9)482 (44.0)0.872155 (48.7)0.169
Maternal injuries
     Minor injuries2937 (24.2)298 (21.1)0.00875 (23.6)0.785
     Uterine cervix injury199 (1.6)25 (1.8)0.7259 (2.8)0.103
     Severe injuries46 (0.4)4 (0.3)0.5710 (0.0)0.271
Complications of the third stage of labour420 (3.5)48 (3.4)0.89117 (5.3)0.073
Labour without complications8902 (73.5)1061 (75.1)0.199255 (80.2)0.007

Legend:

Median duration of labour was 4 hours in all the study and control groups, while the interquartile range was 3-6 hours. Mann-Whitney test did not show any statistically significant difference among the groups.

3.3 The Status of the Newborn

Newborns of adolescents have had more commonly very low birth weight, and were more commonly small for gestational age (SGA). Furthermore, it was less common for newborns of adolescents to have an appropriate newborn’s birth weight as well as excessive newborn’s birth weight. There was no statistically significant difference in stillbirth or in Apgar score <7 at 1st minute (Table 3).

Table 3

Results of univariate analysis of the newborn status group of observed outcomes between the study group (age ≤19 years) or the study subgroup (age ≤17 years) and the control group (age 20–24 years) of primiparous women, Slovenia, 2008–2012.

Control groupStudy groupStudy subgroup



Status of the newborn20–24 years (N=12,112)≤19 years (N=1,413)≤17 years (N=318)



n (%)n (%)P*n (%)P*
Stillbirth62 (0.5)7 (0.5)0.9410 (0.0)0.202
Apgar score <17 at 1st minute453 (3.7)56 (3.9)0.65914 (4.4)0.522
Apgar score <17 at 5th minute156 (1.3)33 (2.3)0.0017 (2.2)0.152
Newborn’s birth weight
     Very low newborn’s birth weight <17 g133 (1.1)25 (1.8)<0.0016 (1.9)<0.001
     Low newborn’s birth weight 1500-2499 g642 (5.2)108 (7.6)35 (11.0)
     Appropriate newborn’s birth weight 2500-3999 g10488 (85.7)1193 (83.8)265 (83.1)
     Excessive newborn’s birth weight ≥4000 g972 (7.9)97 (6.8)13 (4.1)
Small for gestational age (SGA)708 (5.8)104 (7.3)0.02231 (9.7)0.003

Legend:

Regarding the newborn’s birth weight, the results of multivariate analysis showed that newborns of adolescents aged ≤17 years were on average 120 g lighter, and newborns of adolescent aged 18-19 years were 49 g lighter when adjusted for gestational age, compared to newborns of women aged 20–24 years (B=-0.04 for age group ≤17 years, B=-0.03 for age group 18-19 years; both were statistically significant, p<0.001).

Regarding SGA newborns, the results of multivariate analysis showed that full-term newborns were SGA in 10.1% if born to adolescents aged ≤17 years, and in 5.8% if born to adolescents aged 18–19 years, compared to 5.3% if born to women aged 20–24 years. Odds ratio for SGA was 1.8 (1.2–2.8) for adolescents aged ≤17 years (p=0.002) and 1.1 (0.8–1.4) for adolescents aged 18–19 years (p=0.533).

3.4 Prenatal Care

Adolescents have had their first check-up at gynaecologist later in pregnancy; have had less check-ups at gynaecologist and less ultrasonography check-ups during pregnancy. Adolescents also less commonly attended parenting school, but more frequently smoked during pregnancy. It was less common for adolescents to get prenatal screening tests: nuchal translucency or cervix uteri measurement (Table 4).

Table 4

Results of univariate analysis of prenatal care group of observed outcomes between the study group (age ≤19 years) or the study subgroup (age ≤17 years) and the control group (age 20–24 years) of primiparous women, Slovenia, 2008–2012.

Control groupStudy groupStudy subgroup



Prenatal care20–24 years (N=12,112)≤19 years (N=1,413)≤17 years (N=318)



n (%)n (%)P*n (%)P*
Week of the first check-up at gynaecologist<0.001<0.001
     First check-up at gynaecologist <12 weeks of pregnancy9966 (82.3)888 (62.9)1174 (54.7)
     First check-up at gynaecologist at 12-22 weeks of pregnancy1800 (14.9)370 (26.2)95 (29.9)
     First check-up at gynaecologist ≥23 weeks of pregnancy342 (2.8)154 (10.9)49 (15.4)
     No check-ups during pregnancy50 (0.4)30 (2.1)<0.00118 (5.7)<0.001
Number of check-ups during pregnancy<0.001<0.001
     1-7 check-ups during pregnancy1.773 (14.6)426 (30.1)124 (39.0)
     8-12 check-ups during pregnancy8305 (68.6)810 (57.2)154 (48.4)
     ≥13 check-ups during pregnancy1.983 (16.4)147 (10.4)22 (6.9)
Number of ultrasonography check-ups<0.001<0.001
     0-1 ultrasonography check-up333 (2.8)122 (8.6)42 (13.2)
     2 ultrasonography check-ups1660 (13.7)284 (20.1)78 (24.5)
     ≥3 ultrasonography check-ups10116 (83.5)1006 (71.2)198 (62.3)
Parenting school attendance8431 (69.6)543 (38.5)<0.00168 (21.4)<0.001
Smoking during pregnancy2213 (18.3)457 (32.4)<0.001121 (38.1)<0.001
Nuchal translucency8007 (66.1)455 (32.0)<0.00145 (14.1)<0.001
Cervix uteri measurement937 (7.7)61 (4.3)<0.00110 (3.1)<0.002

Legend:

4 Discussion

4.1 Summary of the Most Important Results of the Study

Our study revealed that in Slovenia, anaemia in pregnancy was more common in adolescents aged ≤17 years than in women aged 20–24 years. Unknown estimated date of delivery was more common in adolescents, particularly in the adolescents aged ≤17 years. Preterm birth was also more common in adolescents. Adolescents’ newborns had more commonly very low birth weight and low birth weight, they were lighter then newborns of women aged 20–24 years even after adjustment for gestational week. Additionally, full term newborns of adolescents aged ≤17 years were more frequently SGA, odds ratio for SGA was 1.8 (1.2–2.8), compared to full-term newborns of women aged 20–24 years. Last but not least, adolescents had poorer prenatal care. On the other hand, gestational diabetes was less common in adolescents, it was less common for adolescents to have a high gestational weight gain, there was more common spontaneous onset of labour, lower incidences of elective and emergency Caesarean sections in adolescents, and more commonly labour without complications in adolescents aged ≤17 years. There was no statistically significant difference in rates of hypertension and IUGR, nor in the presence of foetal anomalies.

4.2 Comparison and Contrast with the Findings of Similar Studies

Our findings on anaemia are congruent with other studies; anaemia is usually attributed to a lower socio-economic status and prenatal care in these women, as well as to a growing need for iron and other haemoglobin substrates (18, 19).Unknown estimated date of delivery could be attributable to the fact that a lot of adolescent women have their first check-up at gynaecologist later than older women, as it was obvious also in our study, and that it is common for adolescent women not to know the date of their last period, since their periods tend to be irregular (20). More frequent preterm birth in adolescents was found also in other studies (21). The mechanisms responsible for preterm birth are still unclear: the immaturity of cervical blood supply in young mothers stimulates prostaglandin production that could lead to a preterm birth (22).

More common spontaneous onset of labour in adolescents was observed also by other studies (16, 21). Some researches attributed a lower incidence of Caesarean sections to a lower newborns’ birth weight and size of newborns of adolescents (21). There was no difference in foetal positions, breech presentations or in delay of cervical dilatation, which contrasts with studies founding breech presentations to be more common in adolescents (23). Maternal injuries were more common in adolescents, mostly due to higher rates of minor injuries. The study from Sweden, however, showed a significantly lower incidence of perineal rupture in adolescents (24).

We found no statistically significant difference in stillbirth or in Apgar score <17 at 1st minute. Apgar score <17 at 5th minute was more common in newborns of adolescents, compared to women aged 20–24 years. Some studies have found similarly lower Apgar scores in adolescents’ newborns (25), while others have not (16). More commonly, very low birth weight and low birth weight in adolescents’ newborns was found in many other studies (10, 11, 26), as well as SGA newborns of adolescents (15), but others found no difference regarding SGA newborns, when comparing adolescents to older women (23). It is interesting that we observed a higher incidence of SGA newborns and preterm births in adolescents, yet we did not observe any statistically significant difference regarding IUGR. This could be attributable to adolescents’ late first check-up and poorer follow-up regarding growth restriction, due to a lower number of check-ups in adolescents overall. Not knowing the date of their last period and, consequently, unknown estimated date of delivery also attributes to a higher risk for missed IUGR diagnosis.

In general, adolescent women had their first check-up at the gynaecologist later than older women and a lower rate of regular check-ups and ultrasonography check-ups during pregnancy. A lower number of pregnancy check-ups could be due to the fact that adolescents make a later first check-up at the gynaecologist than older women, have higher incidence of preterm births, and that their check-ups are most frequent towards the end of pregnancy. More than two thirds of women aged 20–24 years and only one third of adolescents attended parenting school. A similar study has shown that adolescents in Slovenia have a poorer psychological readiness for pregnancy, lower education, and often live in rural areas and have poorer prenatal care compared to older women. All of this attributes to a lower percentage of parenting school attendance (27). A higher prevalence of smoking during pregnancy in adolescents is congruent with other studies (28). Smoking has been recognised as an important risk factors for having SGA newborns (29) and has also been linked to a higher incidence of low birth weight newborns (30). We observed a much higher incidence in nuchal translucency in women aged 20–24 years than in adolescents. This could be due to a later first check-up in adolescents and, therefore, a missed time frame for nuchal translucency. Also, cervix uteri measurement was more common in women aged 20–24 years than in adolescents, which we could not explain with the current data.

Adolescents were more frequently underweight before pregnancy than older women. Moreover, the incidence of a low gestational weight gain was higher in adolescents. Studies have shown that adolescents with gestational weight gain under the recommendations, however, had decreased odds of having an LGA newborn and increased odds of having an SGA newborn (31). Moreover, they had increased odds of preterm birth and infant death (32). A lower gestational weight gain in adolescents could be attributable to the fact that many adolescents exhibit long bone growth during pregnancy and pelvic immaturity. This growth may lead to competition between mother and foetus for nutrients, suggesting that adolescents may require greater gestational weight gain than adult women to optimize outcomes in pregnancy (33).

4.3 Limitations and Strengths of the Study

Limitations of our study could be found in mainly only univariate analysis and less proper comparison of two distant age groups; more data could be additionally analysed with multiple regression. With our study, we gained new insights into population of pregnant adolescents in Slovenia; new knowledge is the strength of this study.

4.4 Implications of the Study Results for Obstetrics and Public Health

The results of our study confirmed that adolescent pregnancy is related to higher health risks for pregnant adolescents and their newborns. Poor prenatal care of adolescents could be improved with better health education and counselling of adolescents in reproductive health (e.g. reproductive cycle, contraception, nutrition, smoking…), in addition to more frequent and intense health and social service given to pregnant adolescents.

4.5 Suggestions for Future Research in the Field

The research on factors of poorer prenatal care in adolescents could be the challenge for future research.

5 Conclusions

There are differences regarding pregnancy and pregnancy outcomes between adolescents and women aged 20–24 years. These differences should be taken into consideration by health professionals when encountering adolescent pregnant women. Health professionals should intensify prenatal care at first encounter with pregnant adolescents in terms of regular medical check-ups and psychosocial counselling and support.

Conflicts of interest: The authors declare that no conflicts of interest exist.
Funding: The study had no accessional financial support.
Ethical approval: Received from the Republic of Slovenia National Medical Ethics Committee, reference number 0120-732/2015-2.

References

  • 1

    World Health Organization. Maternal newborn child and adolescent health. Available Aug 31 2016 from: http://www.who.int/maternal_child_adolescent/topics/adolescence/dev/en/.

  • 2

    World Health Organization. Adolescent pregnancy. Available Apr 11 2017 from: http://www.who.int/mediacentre/factsheets/fs364/en/.

  • 3

    Pinter B Tomori M. Sexual behavior of secondary-school students in Slovenia. Eur J Contracept Reprod Health Care 2000; 5: 71–6.

    • Crossref
    • Export Citation
  • 4

    Pinter B Verdnik I Grebenc M Ceh F. Sexual activity and contraceptive use among secondary-school students in Slovenia. Eur J Contracept Reprod Health Care 2009; 14: 127–33.

    • Crossref
    • Export Citation
  • 5

    Pinter B. Spolno vedenje slovenskih srednješolcev 2012. In: Juričič M. Šolska adolescentna medicina: celosten pristop in vloga javnega zdravja. Zbornik člankov in izvlečkov. VI. kongres šolske študentske in adolescentne medicine Slovenije in IX. Cvahtetovi dnevi javnega zdravja. Debeli Rtič 27. –29. september 2013. Ljubljana: Slovensko zdravniško društvo Sekcija za šolsko študentsko in adolescentno medicino 2013: 147–55.

  • 6

    Nacionalni inštitut za javno zdravje. NIJZ podatkovni portal. Zdravstveno stanje prebivalstva. Available Aug 31 2016 from: https://podatki.nijz.si/pxweb/sl/NIJZ%20podatkovni%20portal/.

  • 7

    Inštitut za varovanje zdravja Republike Slovenije. Informacijski sistem spremljanja fetalnih smrti v Sloveniji 2009. Ljubljana: Inštitut za varovanje zdravja Republike Slovenije 2011: 10–1.

  • 8

    World Health Organization. Regional Office for Europe. European health for all database WHO/Europe July 2016. Available 31 Aug 2016 from: http://data.euro.who.int/hfadb/.

  • 9

    Senderowitz J. Adolescent health: reassessing the passage to adulthood. World Bank discussion papers; no. WDP 272. Washington DC: The World Bank. Available 31 Aug 2016 from: http://documents.worldbank.org/curated/en/278081468739243027/Adolescent-health-reassessing-the-passage-to-adulthood.

  • 10

    Ganchimeg T Ota E Morisaki N Laopaiboon M Lumbiganon P Zhang J et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014; 121(Suppl 1): 40–8.

    • Crossref
    • Export Citation
  • 11

    Kumar A Singh T Basu S Pandey S Bhargava V. Outcome of teenage pregnancy. Indian J Pediatr 2007; 74: 927–31.

    • Crossref
    • Export Citation
  • 12

    Glynn LM Scjetter CD Hobel CJ Sandman CA. Pattern of percieved stress and anxiety in pregnancy predicts pretermbirth. Health Psychol 2008; 27: 43–51.

    • Crossref
    • Export Citation
  • 13

    Goldenberg RL Culhane JF Iams JD Romero R. Epidemiology and causes of pretermbirth. Lancet 2008; 371: 75–84.

    • Crossref
    • Export Citation
  • 14

    Mahavarkar SH Madhu CK Mule VD. A comparative study of teenage pregnancy. J Obstet Gynaecol 2008; 28: 604–7.

    • Crossref
    • Export Citation
  • 15

    Conde-Agudelo A Belizán JM Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: cross-sectional study. Am J Obstet Gynecol 2005; 192: 342–9.

    • Crossref
    • Export Citation
  • 16

    Thato S Rachukul S Sopajaree C. Obstetrics and perinatal outcomes of Thai pregnant adolescents: a retrospective study. Int J Nurs Stud 2007; 44: 1158–64.

  • 17

    Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Washington DC: National Academies Press 2009.

  • 18

    Scholl TO Hediger ML Belsky DH. Prenatal care and maternal health during adolescent pregnancy: a review and meta–analysis. J Adolesc Health 1994; 15: 444–54.

    • Crossref
    • Export Citation
  • 19

    Peterlin A. Nosečnost in porod v adolescenci vpliv mladoletnosti matere na novorojenčka: magistarski rad. Zagreb: Medicinski fakultet sveučilišta u Zagrebu 1978.

  • 20

    Chen XK Wen SW Fleming N Demisse K Rhoads G Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol 2007; 36: 368–73.

    • Crossref
    • Export Citation
  • 21

    Lao TT Ho LF. The obstetric implications of teenage pregnancy. Hum Reprod 1997; 12: 2303–5.

    • Crossref
    • Export Citation
  • 22

    de Vienne CM Chreveuill C Dreyfus M. Does young maternal age increase the risk of adverse obstetric fetal and neonatal outcomes: a cohort study. Eur J Obstet Gynecol Reprod Biol 2009; 147: 151–6.

    • Crossref
    • Export Citation
  • 23

    Khwaja SS Al-Sibai H Al-Suleiman SA El-Zibdeh MY. Obstetric implication of pregnancy in adolescence. Acta Obstet Gynecol Scand 1986; 65: 57–61.

    • Crossref
    • Export Citation
  • 24

    Tyrberg RB Blomberg M Kjølhede P. Deliveries among teenage women – with emphasis on incidence and mode of delivery: a Swedish national survey from 1973 to 2010. BMC Pregnancy Childbirth 2013; 13: 204.e1–10.

  • 25

    Mayor S. Pregnancy and childbirth are leading causes of death in teenage girls in developing countries. BMJ 2004; 328: 1152.

  • 26

    Bai J Wong F Stewart H. The obstetric and neonatal performance of teenage mothers in an Australian community. J Obstet Gynaecol 1999; 19: 345–8.

    • Crossref
    • Export Citation
  • 27

    Rajgelj U. Mladostniške nosečnosti v Sloveniji. Ljubljana: Založba ZRC ZRC SAZU 2005: 39–74.

  • 28

    Mohsin M Wong F Bauman A Bai J. Maternal and neonatal factors influencing premature birth and low birth weight in Australia. J Biosoc Sci 2003; 35: 161–74.

    • Crossref
    • Export Citation
  • 29

    Treffers PE Olukoya AA Fergoson BJ Liljestrand J. Care for adolescent pregnancy and childbirth. Int J Obstet Gynaecol 2001; 75: 111–21.

    • Crossref
    • Export Citation
  • 30

    Mannocci A Vaschetto C Semyonov L Poppa G Massimi A Rabacchi G et al. Maternal smoking and socio-demographic characteristics in correlation with low birth weight: a Turin (Piedmont) study. Zdr Varst 2014; 53: 221–5.

  • 31

    Wilhelmova R Hruba D Vesela L. Key determinants influencing the health literacy of pregnant women in the Czech Republic. Zdr Varst 2015; 54: 27–36.

  • 32

    Harper LM Chang JJ Macones GA. Adolescent pregnancy and gestational weight gain: do the Institute of Medicine recommendations apply? Am J Obstet Gynecol 2011; 205: 140.e1–8.

    • Crossref
    • Export Citation
  • 33

    Scholl TO Hediger ML. Weightgain nutrition and pregnancy outcome: findings from the Camden study of teenage and minority gravidas. Semin Perinatol 1995; 19: 171–81.

    • Crossref
    • Export Citation

Footnotes

*comparison to the control group - χ2 test
*comparison to the control group - χ2 test
*comparison to the control group - χ2 test
*comparison to the control group - χ2 test
*comparison to the control group - χ2 test
*comparison to the control group - χ2 test
*comparison to the control group - χ2 test
*comparison to the control group - χ2 test

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  • 1

    World Health Organization. Maternal newborn child and adolescent health. Available Aug 31 2016 from: http://www.who.int/maternal_child_adolescent/topics/adolescence/dev/en/.

  • 2

    World Health Organization. Adolescent pregnancy. Available Apr 11 2017 from: http://www.who.int/mediacentre/factsheets/fs364/en/.

  • 3

    Pinter B Tomori M. Sexual behavior of secondary-school students in Slovenia. Eur J Contracept Reprod Health Care 2000; 5: 71–6.

    • Crossref
    • Export Citation
  • 4

    Pinter B Verdnik I Grebenc M Ceh F. Sexual activity and contraceptive use among secondary-school students in Slovenia. Eur J Contracept Reprod Health Care 2009; 14: 127–33.

    • Crossref
    • Export Citation
  • 5

    Pinter B. Spolno vedenje slovenskih srednješolcev 2012. In: Juričič M. Šolska adolescentna medicina: celosten pristop in vloga javnega zdravja. Zbornik člankov in izvlečkov. VI. kongres šolske študentske in adolescentne medicine Slovenije in IX. Cvahtetovi dnevi javnega zdravja. Debeli Rtič 27. –29. september 2013. Ljubljana: Slovensko zdravniško društvo Sekcija za šolsko študentsko in adolescentno medicino 2013: 147–55.

  • 6

    Nacionalni inštitut za javno zdravje. NIJZ podatkovni portal. Zdravstveno stanje prebivalstva. Available Aug 31 2016 from: https://podatki.nijz.si/pxweb/sl/NIJZ%20podatkovni%20portal/.

  • 7

    Inštitut za varovanje zdravja Republike Slovenije. Informacijski sistem spremljanja fetalnih smrti v Sloveniji 2009. Ljubljana: Inštitut za varovanje zdravja Republike Slovenije 2011: 10–1.

  • 8

    World Health Organization. Regional Office for Europe. European health for all database WHO/Europe July 2016. Available 31 Aug 2016 from: http://data.euro.who.int/hfadb/.

  • 9

    Senderowitz J. Adolescent health: reassessing the passage to adulthood. World Bank discussion papers; no. WDP 272. Washington DC: The World Bank. Available 31 Aug 2016 from: http://documents.worldbank.org/curated/en/278081468739243027/Adolescent-health-reassessing-the-passage-to-adulthood.

  • 10

    Ganchimeg T Ota E Morisaki N Laopaiboon M Lumbiganon P Zhang J et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014; 121(Suppl 1): 40–8.

    • Crossref
    • Export Citation
  • 11

    Kumar A Singh T Basu S Pandey S Bhargava V. Outcome of teenage pregnancy. Indian J Pediatr 2007; 74: 927–31.

    • Crossref
    • Export Citation
  • 12

    Glynn LM Scjetter CD Hobel CJ Sandman CA. Pattern of percieved stress and anxiety in pregnancy predicts pretermbirth. Health Psychol 2008; 27: 43–51.

    • Crossref
    • Export Citation
  • 13

    Goldenberg RL Culhane JF Iams JD Romero R. Epidemiology and causes of pretermbirth. Lancet 2008; 371: 75–84.

    • Crossref
    • Export Citation
  • 14

    Mahavarkar SH Madhu CK Mule VD. A comparative study of teenage pregnancy. J Obstet Gynaecol 2008; 28: 604–7.

    • Crossref
    • Export Citation
  • 15

    Conde-Agudelo A Belizán JM Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: cross-sectional study. Am J Obstet Gynecol 2005; 192: 342–9.

    • Crossref
    • Export Citation
  • 16

    Thato S Rachukul S Sopajaree C. Obstetrics and perinatal outcomes of Thai pregnant adolescents: a retrospective study. Int J Nurs Stud 2007; 44: 1158–64.

  • 17

    Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Washington DC: National Academies Press 2009.

  • 18

    Scholl TO Hediger ML Belsky DH. Prenatal care and maternal health during adolescent pregnancy: a review and meta–analysis. J Adolesc Health 1994; 15: 444–54.

    • Crossref
    • Export Citation
  • 19

    Peterlin A. Nosečnost in porod v adolescenci vpliv mladoletnosti matere na novorojenčka: magistarski rad. Zagreb: Medicinski fakultet sveučilišta u Zagrebu 1978.

  • 20

    Chen XK Wen SW Fleming N Demisse K Rhoads G Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol 2007; 36: 368–73.

    • Crossref
    • Export Citation
  • 21

    Lao TT Ho LF. The obstetric implications of teenage pregnancy. Hum Reprod 1997; 12: 2303–5.

    • Crossref
    • Export Citation
  • 22

    de Vienne CM Chreveuill C Dreyfus M. Does young maternal age increase the risk of adverse obstetric fetal and neonatal outcomes: a cohort study. Eur J Obstet Gynecol Reprod Biol 2009; 147: 151–6.

    • Crossref
    • Export Citation
  • 23

    Khwaja SS Al-Sibai H Al-Suleiman SA El-Zibdeh MY. Obstetric implication of pregnancy in adolescence. Acta Obstet Gynecol Scand 1986; 65: 57–61.

    • Crossref
    • Export Citation
  • 24

    Tyrberg RB Blomberg M Kjølhede P. Deliveries among teenage women – with emphasis on incidence and mode of delivery: a Swedish national survey from 1973 to 2010. BMC Pregnancy Childbirth 2013; 13: 204.e1–10.

  • 25

    Mayor S. Pregnancy and childbirth are leading causes of death in teenage girls in developing countries. BMJ 2004; 328: 1152.

  • 26

    Bai J Wong F Stewart H. The obstetric and neonatal performance of teenage mothers in an Australian community. J Obstet Gynaecol 1999; 19: 345–8.

    • Crossref
    • Export Citation
  • 27

    Rajgelj U. Mladostniške nosečnosti v Sloveniji. Ljubljana: Založba ZRC ZRC SAZU 2005: 39–74.

  • 28

    Mohsin M Wong F Bauman A Bai J. Maternal and neonatal factors influencing premature birth and low birth weight in Australia. J Biosoc Sci 2003; 35: 161–74.

    • Crossref
    • Export Citation
  • 29

    Treffers PE Olukoya AA Fergoson BJ Liljestrand J. Care for adolescent pregnancy and childbirth. Int J Obstet Gynaecol 2001; 75: 111–21.

    • Crossref
    • Export Citation
  • 30

    Mannocci A Vaschetto C Semyonov L Poppa G Massimi A Rabacchi G et al. Maternal smoking and socio-demographic characteristics in correlation with low birth weight: a Turin (Piedmont) study. Zdr Varst 2014; 53: 221–5.

  • 31

    Wilhelmova R Hruba D Vesela L. Key determinants influencing the health literacy of pregnant women in the Czech Republic. Zdr Varst 2015; 54: 27–36.

  • 32

    Harper LM Chang JJ Macones GA. Adolescent pregnancy and gestational weight gain: do the Institute of Medicine recommendations apply? Am J Obstet Gynecol 2011; 205: 140.e1–8.

    • Crossref
    • Export Citation
  • 33

    Scholl TO Hediger ML. Weightgain nutrition and pregnancy outcome: findings from the Camden study of teenage and minority gravidas. Semin Perinatol 1995; 19: 171–81.

    • Crossref
    • Export Citation
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