MATERNAL AND PERINATAL OUTCOMES IN ADOLESCENT MOTHERS REFERRED TO A CENTRAL HOSPITAL IN WEST JAVA INDONESIA

Introduction: The number of adolescent birth in the world is still high. In South-East Asia, about 6 million adolescents give birth each year, including in West Java, Indonesia. Moreover, several adolescent pregnancies are referred to the central hospital to receive medical treatment during delivery. Objective: This study aimed to analyze the adverse maternal and perinatal outcomes of adolescent mother referred to a central hospital in West Java. Methode: This study was a cross sectional study with secondary data, gathered from adolescent who gave birth at Hasan Sadikin Hospital in West Java, Indonesia. There were 517 pregnant women referred between January 2019 to August 2020 for delivery. Data were entered, cleaned, and analyzed by using SPSS version 27. Result: The Chi-square analysis showed a significant relationship between age and preeclampsia, eclampsia, premature rupture of membranes (PROM), placenta previa, and other complications. The most common maternal outcomes showing a significant relationship in adolescence were eclampsia (5.15%); PROM (23.18%); preterm birth (23.60%); placental abruption (0.34%), with the most vaginal delivery method (65.24%). Conclusion: Prevalence of eclampsia, PROM, preterm birth, and placenta abruption were higher in adolescent pregnancy. Adolescent childbirth poses many risks compared to adult women. Suggestions: The role of various parties is needed to prevent adolescent childbirth start with primary healthcare. Keyword: adolescent childbirth; maternal and perinatal outcomes JKM (Jurnal Kebidanan Malahayati),Vol 9, No. 3. July 2023, ISSN (Print) 2476-8944 ISSN (Online) 2579-762X, Hal 402-407 DOI 10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan 403 INTRODUCTION According to the World Health Organization (WHO), adolescents are people between the ages of 10 and 19 who are at a critical point in their human development. WHO has recently released the global report on health of adolescents, which clearly highlights the burden of adolescent sexual and reproductive health issues including adolescent pregnancy. Adolescent pregnancy is still a problem in both developing and developed country (UNFPA, 2015; Sedgh et al, 2015; Kassa et al, 2018; Montgomery et al, 2014). About 21 million girls were aged 15 to 19 years in developing countries become pregnant, and 12 million of them predicted gave birth (Darroch et al, 2016; Neal et al, 2011; WHO; UNICEF 2016). Meanwhile in Southeast Asia, a number of adolescents is 6 million giving birth each year (WHO, 2014). About 2 million adolescent (15-19 years) in Indonesia from 2005 to 2010 giving birth (WHO, 2014). The proportion of adolescents in West Java who giving birth is 8,9% (Ministry of Health, 2017). Early pregnancies among adolescents have a major health and social consequences (Sedgh et al, 2015; Medhi et al, 2016; WHO, 2019). In many societies, girls who had early marriage generally leads to early child bearing, in accordance with social norms. Girls choose to become pregnant because they have limited educational and employment prospects and given that motherhood is valued, marriage and child bearing may be the best of the limited options they have (WHO, 2014; WHO, 2019; Nove et al, 2014). In other study, adolescents had significantly lower rates of prenatal class attendance and prenatal visits in the first trimester (Fleming et al, 2013). An approach to decrease the prevalence of adolescent deliveries should be investigated and implemented in view of attaining the sustainable development goals (Njim et al, 2017). Adolescent pregnancy is a public health concern that affects both the adolescent mother, her child, and the broader community (Chandra et al, 2013). Previous studies have reported that adolescent pregnancy and delivery are associated with adverse maternal and neonatal outcomes, such as: maternal anemia, preterm birth, low birth weight and postpartum complication (Sedgh et al, 2015; Medhi et al, 2016; Fleming et al, 2013; Thaitae et al, 2011; Ganchimeg et al, 2014; Indarti et al, 2020; Al Haddabi, 2014; Kemenkes, 2017; Kawakita et al, 2016; Kingston et al, 2012; Zhang et al, 2020; Mombo Ngoma et al, 2016; Kayika et al, 2018). Adolescents are often noted to have an increased risk of death during pregnancy or childbirth compared with older women (Ganchimeg et al, 2014; WHO, 2016; Patton et al, 2009). However, many recent studies have found that adolescent mothers were more likely to have vaginal delivery than section caesarean (Timoveef et al, 2013). In addition, higher maternal outcomes in adolescent pregnancy were PROM and placenta abruption. This study aimed to analyze adolescent pregnancy referred to a central hospital in West Java and the adverse maternal and perinatal outcomes. RESEARCH METHODOLOGY This study was a cross sectional study. Secondary data were gathered from women who gave birth at Hasan Sadikin Hospital in West Java, Indonesia. There were 517 pregnant women referred between January 2019 to August 2020 for delivery. The study was conducted in accordance with the Declaration of Helsinki, and approved by Ethics Committee of Hasan Sadikin Hospital with ethical review committee number LB.02.01/X.6.5/274/2020. We had a permission to access the data used from medical record. All methods were carried out in accordance with relevant guidelines and regulations in ethics declaration section. Data on sociodemographic characteristics such as age, level of education, occupation, marital status, obstetric and neonatal outcomes, were collected from the medical records of Hasan Sadikin Hospital. These included, gravidity, parity, hemoglobin concentration at current visit and gestational age. The sample consisting of those with incomplete records was excluded from the study. The data taken included the number of adolescent and adult pregnancies. Data were entered, cleaned, and analysed by using SPSS version 27. Descriptive statistics was used to summarize data. We compared basic data using Chisquare test and Man Whitney to measure the strength of association between maternal and perinatal outcomes. Significance of statistical association were tested at p<0.05. RESEARCH RESULT Based on the study's results (Table 1), there were 517 mothers giving birth with the age group of 233 adolescents (14-19 years) and 284 adults (20-35 years). Characteristics of mothers are described in table 1. The most recent education was the tertiary level in adolescent mothers, as many as 101 and adults 189. Adolescents and adults mostly were unemployed. Residential places for both adolescent and adults mostly live in urban area. The data shows that the marital status of adolescent and adult mothers is only slightly divorced. In adolescents, 217 were first pregnancies, while for adults, 106 were second pregnancies. Puspa Sari, Hartanto Bayuaji, Dany Hilmanto 404 DOI 10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan Table 1 Maternal Demographic Characteristics Variable Name Adolescent % (n=233) Adult % (n=284) Maternal Age* 18(14-19) 28(20-35) Last Education Level Primary 60 (25.75) 24 (8.45) Secondary 72 (30.90) 38 (13.38) Tertiary 101 (43.35) 189 (66.55) College and above 0 33 (11.62) Occupation of Participant Unemployed 224 (96.14) 231 (81.34) Employed 1 (0.43) 51 (17.96) Others (Student) 8 (3.43) 2 (0.70) Residence Rural 115 (49.36) 139 (48.94) Urban 118 (50.64) 145 (51.06) Marital Status Divorced 12 (5.15) 3 (1.06) Married 221 (94.85) 281 (98.94) Gravida 1st Pregnancy 217 (93.13) 103 (36.27) 2nd Pregnancy 16 (6.87) 106 (37.32) ≥3rd Pregnancy 0 75 (26.41)