Pregnancy in teen years ‘High risk as it comes with many complications’

Marriage below 18 years: The Medical Dimension

By Dr CS Ramdaursingh

In the context of the Children’s Bill, marriage below 18 years is a subject of serious consideration. There is a medical dimension which has been altogether missed out and which is critical to the phenomenon of pregnancy and childbirth in those below 18 years of age. We have sought the views of Dr CS Ramdaursingh, Gynaecologist/Obstetrician with wide experience in his specialty, as well as an engaged social worker who has been President of Rotary Club Curepipe, and is currently the secretary of AB Caring, an NGO which comprises members who have more than 20 years of service above self and whose main objectives are: to improve health including maternal health; to promote education, and to empower women and children.

The mission of the association is: To work towards creation of a POSITIVE IMPACT in people’s lives. The President is Mrs Corina Hookoom Padaruth.

Dr CS Ramdaursingh:

A pregnancy below the age of 18 is a major challenge to the patient as well as to the family and partner, whether married or not. In obstetrics, teenage pregnancy is considered to be a high risk pregnancy as it comes with many complications.

There is a high risk of the baby being born before term (preterm) as well as having a low birth weight. But there are also other very serious complications that can occur in a pregnancy below 18 years. They are anemia, infections, high blood pressure or pregnancy-induced hypertension which can lead to a dreaded condition known as pre-eclampsia which can be fatal. These patients are also more at risk of having miscarriages, as well as recourse to cesarean sections due to a disproportion in the shape and size of the pelvis known as cephalopelvic disproportion. These pregnancies are associated with a higher rate of infant deaths, increased maternal deaths and morbidity (other disease conditions) as well as poverty.

Besides, young mothers might have a tendency to go for rapid repeat pregnancy which further increases the risk of complications to themselves as well as to their babies.

Significantly, hips grow wider as age increases. The female pelvis continues to grow after puberty and becomes wider. It reaches its full width around the age of 25-30 years. From the age of 40 onwards the female pelvis then begins to narrow again. There are thus more cesarean sections in teenagers (and elderly women with first pregnancies).  

Changes in the pelvic bones are influenced by the level of hormones in the body: high estrogen levels guarantee development of the female pelvis and maintain the pelvis in its most favourable obstetric form (Gynaecoid Pelvis). Hormonal levels are in turn dependent upon environmental and nutritional factors.

It is important to realize that the size and shape of the pelvis are important for labour and delivery. Adult women who are well-built and who have a good diet especially during their childhood have a broad pelvis which is well adapted for childbirth. The teenage pelvis is narrower; this creates a disproportion which makes passage of the foetus more difficult and leads to serious complications of ‘cephalopelvic disproportion’.

Overall, the pelvis grows and develops slowly but continuously (in four dimensions),  and is therefore much smaller at age 15 than at 18. This immaturity of the birth canal below 18 contributes to significant obstetrics risks.

Furthermore, the emotional, psychological and social needs of pregnant adolescent girls are greater than those of adult women, especially if there are complications.
Girls who become pregnant before age 18 are more likely to experience violence within marriage or a partnership. They tend to leave their school and education.

Of further interest are some salient facts:

Pregnancies in teenagers are a global problem that occurs in high, middle, and low income countries. These pregnancies are more likely to occur in marginalized communities, commonly driven by poverty and lack of education and unemployment.

WHO published guidelines in 2011 with the UN Population Fund (UNFPA) on preventing early pregnancies and reducing poor reproductive outcomes. They made recommendations for action that countries could take, with 6 main objectives:

• Reducing marriage before the age of 18 years. Estimates suggest a 10% reduction in child marriage could contribute to a 70% reduction in a country`s maternal mortality rate.
• Creating understanding and support to reduce pregnancy before the age of 20 years.
• Increasing the use of contraception by adolescents at risk of unintended pregnancy. If this need was to be met, 2.1 million unplanned births, 3.2 million abortions, and 5600 maternal deaths could be averted each year.
• Reducing coerced sex among adolescents.
• Reducing unsafe abortion among adolescents.
• Increasing use of skilled antenatal, childbirth and postnatal care among adolescents.

* Published in print edition on 27 September 2019