Meta-Analysis of Associations between Maternal Age, Low Hemoglobin Level during Pregnancy, Low Birth Weight, and Preterm Birth
DOI:
https://doi.org/10.26911/thejmch.2023.08.06.10Abstract
Background: Maternal age <19 years and anemia in pregnancy are often associated with adverse neonatal outcomes. This study aims to analyze the relationship between maternal age <19 years and anemia in pregnancy (Hb <11 g/dL) on the incidence of low birth weight babies (LBW) and premature birth.
Subjects and Method: The research meta-analysis took cohort studies published in 2018-2022. The PICO formulation used: the population is pregnant women, the intervention consists of groups of pregnant women aged <19 years and pregnant women with anemia (Hb<11 gr/dL), comparison is the group of pregnant women aged 20-35 years and pregnant women are not anemic while Outcomes were LBW and premature birth. Search articles through databases: PubMed, springer, science direct and google scholar with the keywords “Adolescence pregnancy OR young OR Teenage AND Pregnancy AND neonatal outcome OR Low birth weight OR preterm birth OR Low weight”, “Anemia OR Maternal anemia AND Neonatal outcome OR Preterm birth". Data analysis using the Review Manager (RevMan) 5.4 application.
Results: A total of 7 cohort articles on pregnancy aged <19 years and 5 cohort articles on anemia were analyzed. Articles come from Canada, Turkey, England, Russia, Finland, China, Chinese Taipei, Ethiopia, Zambia and Bangladesh. The sample sizes were n=43,399 (maternal age and LBW), n=55,049 (maternal age with premature birth), n=16,544,075 (anemia and premature birth). Pregnant women aged <19 years have a 1.63 risk of giving birth to LBW babies (aOR= 1.63; 95% CI= 0.96 to 2.78; p= 0.070) and 1.41 times giving birth to premature babies (aOR= 1.41; 95% CI= 0.78 to 2.56; p= 0.250). Pregnant women with anemia have a 1.60 times risk of giving birth to premature babies (aOR= 1.60; 95% CI= 1.10 to 2.32; p= 0.010).
Conclusion: The age of pregnant women <19 years does not have a significant effect on the occurrence of LBW and premature birth. Pregnant women with anemia increase the risk of premature birth.
Keywords: Maternal age, anemia, low birth weight, premature birth
Correspondence: Ima Kusumawati. Master's Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36A, Surakarta 57126, Central Java, Indonesia. Email:Ima.kusumawati@student.uns.ac.id Mobile: +6285740839246
References
Abebe AM, Fitie GW, Jember DA, Reda MM, Wake GE (2020). Teenage pregnancy and its adverse obstetric and perinatal outcomes at Lemlem Karl Hospital, Tigray, Ethiopia, 2018. Biomed Res Int. 2020: 1–9. https://doi.org/10.1155/2020/3124847
Chu FC, Shao, SSW, Lo LM, Hsieh TT, Hung TH (2020). Association between maternal anemia at admission for delivery and adverse perinatal outcomes. J Chinese Med Assoc. 83(4): 400–405. https://doi.org/10.1097/JCMA.0000000000000215
Critical Appraisal Skills Programme. (2018). CASP Checklist: 12 questions to help you make sense of a Cohort Study. CASP Checklists Oxford, 2018: 1–7. http://www.caspuk.net/casptoolschecklists
Daniels S, Robson D, Flatley C, Kumar S (2017). Demographic characteristics and pregnancy outcomes in adolescents – experience from an Australian perinatal centre. Aust New Zeal J Obstet Gynaecol. 57(6): 630–635. https://doi.org/10.1111/ajo.12651
DeMarco N, Twynstra J, Ospina MB, Darrington M, Whippey C, Seabrook JA (2021). Prevalence of low birth weight, premature birth, and stillbirth among pregnant adolescents in Canada: A Systematic Review and Meta-analysis. J Pediatr Adolesc Gynecol. 34(4): 530–537. https://doi.org/10.1016/J.JPAG.2021.03.003
Diabelková J, Rimárová K, Dorko E, Urdzík P, Houžvičková A, Argalášová Ľ (2023). Adolescent pregnancy outcomes and risk factors. International Int J Environ Res Public Health 20(5): 0–9. https://doi.org/10.3390/ijerph20054113
Elias D, Campaña H, Poletta FA, Heisecke, SL, Gili JA, Ratowiecki J, Pawluk M et al. (2022). Preterm birth etiological pathways: a Bayesian networks and mediation analysis approach. Pediatr Res. 91(7): 1882–1889. https://doi.org/10.1038/S41390021016594
Fleming N, Ng N, Osborne C, Biederman S, Yasseen AS, Dy J, White RR, Walker M (2013). Adolescent pregnancy outcomes in the province of Ontario: A cohort study. J Obstet Gynaecol Canada. 35(3): 234–245. https://doi.org/10.1016/S17012163(15)309956
Garzon S, Cacciato PM, Certelli C, Salvaggio C, Magliarditi M, Rizzo G (2020). Iron deficiency anemia in pregnancy: novel approaches for an old problem. Oman Med J. 35(5): e166. https://doi.org/10.5001/OMJ.2020.108
Genc S, Ciftci MA, Cingillioglu B, Akturk E, Sahin O, Kukrer S, Yurci A, Mihmanli V (2022). Adverse obstetric outcomes in early and late adolescent pregnancy. J Exp Clin Med. 39(1): 237–244. https://doi.org/10.52142/omujecm.39.1.46
Gurung R, Målqvist M, Hong Z, Poudel PG, Sunny AK, Sharma S, Mishra S, et al. (2020). The burden of adolescent motherhood and health consequences in Nepal. BMC Pregnancy Childbirth. 20(1). https://doi.org/10.1186/S12884020030138
Huang L, Purvarshi G, Wang S, Zhong L, Tang H (2015). The influence of iron-deficiency anemia during the pregnancy on preterm birth and birth weight in South China. J Food Nutr Res. 3(9): 570–574. https://doi.org/10.12691/JFNR392
Indarti J, Al Fattah AN, Dewi Z, Hasani RDK, Mahdi FAN, Surya R (2020). Teenage pregnancy: obstetric and perinatal outcome in a tertiary centre in Indonesia. Obstet Gynecol Int. 2020. https://doi.org/10.1155/2020/2787602
Jaleel R, Khan A (2008). Severe anemia and adverse pregnancy outcome. J Surg Pakistan. 13(4): 147–150.
Jeena PM, Asharam K, Mitku AA, Naidoo P, Naidoo RN (2020). Maternal demographic and antenatal factors, low birth weight and preterm birth: findings from the mother and child in the environment (MACE) birth cohort, Durban, South Africa. BMC Pregnancy Childbirth. 20-(625): 1–11. https://doi.org/10.1186/s12884020033286
Kabir MA, Rahman MM, Khan MN (2022). Maternal anemia and risk of adverse maternal health and birth outcomes in Bangladesh: A nationwide population-based survey. PLoS ONE. 17(12): 1–14. https://doi.org/10.1371/journal.pone.0277654
Karataşlı V, Kanmaz AG, İnan AH, Budak A, Beyan E (2019). Maternal and neonatal outcomes of adolescent pregnancy. J Gynecol Obstet Hum Reprod. 48(5): 347–350. https://doi.org/10.1016/j.jogoh.2019.02.011
Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW (2019). Adverse neonatal outcomes of adolescent pregnancy in northwest Ethiopia. PLoS ONE. 14(6): https://doi.org/10.1371/JOURNAL.PONE.0218259
Mann L, Bateson D, Black KI (2020). Teenage pregnancy. Aust J Gen Pract. 49(6): 310–316. https://doi.org/10.31128/AJGP02205224
Dowle KM, Kilner K, Burley VJ, Soltani H (2018). Impact of adolescent age on maternal and neonatal outcomes in the Born in Bradford cohort. BMJ Open. 8(3): 1–10. https://doi.org/10.1136/bmjopen2017016258
Minjares GRO, López SAR, Valdez SC, Carrillo ML, Corral DVC (2016). Maternal and perinatal outcomes among adolescents and mature women: a hospital-based study in the North of Mexico. J Pediatr Adolesc Gynecol. 29(3): 304–311. https://doi.org/10.1016/j.jpag.2015.11.005
Moraes AN, Likwa RN, Nzala SH (2018). A retrospective analysis of adverse obstetric and perinatal outcomes in adolescent pregnancy: the case of Luapula Province, Zambia. Maternal Health, Neonatology and Perinatology, 4(1):20. https://doi.org/10.1186/s407480180088y
Retnawati H, Apino E, Djidu HK, Anazifa RD (2018). Pengantar Analisis Meta (Edisi 1) (Issue July).
Ronkainen J, Lowry E, Heiskala A, Uusitalo I, Koivunen P, Kajantie E, Vääräsmäki M. et al. (2019). Maternal hemoglobin associates with preterm delivery and small for gestational age in two finnish birth cohorts. Eur J Obstet Gynecol Reprod Biol. 238: 44–48. https://doi.org/10.1016/j.ejogrb.2019.04.045
Serunjogi RB, linda M, Mumpe MD, Willianson D, Valencia D (2021). Comparative analysis of perinatal outcomes and birth defect amongst adolescent and older Ugandan mothers: evidence from a hospital-based surveillance database. Reprod Health. 18(56). https://doi.org /10.1186/s1297802101115w
Shi H, Chen L, Wang Y, Sun M, Guo Y, Ma S, Wang X et al. (2022). Severity of anemia during pregnancy and adverse maternal and fetal outcomes. JAMA Netw Open. 5(2): 1–13. https://doi.org/10.1001/jamanetworkopen.2021.47046
Smith C, Teng F, Branch E, Chu S, Joseph KS (2019). Maternal and perinatal morbidity and mortality associated with anemia in pregnancy. Obstet Gynecol. 134(6):1234–1244. https://doi.org/10.1097/AOG.0000000000003557
Simon CS, Beach RK, McGregor JA (2002). Does incomplete growth and development predispose teenagers to preterm delivery? A template for research. J Perinatol. 22(4): 315–323. https://doi.org/10.1038/sj.jp.7210694
Usynina AA, Postoev V, Odland JØ, Grjibovski AM (2018). Adverse pregnancy outcomes among adolescents in Northwest Russia: A population registry-based study. Int J Environ Res Public Health. 15(2): https://doi.org/10.3390/ijerph15020261
WHO (2022). Retrieved November 30, 2022, from https://www.who.int/newsroom/factsheets/detail/adolescentpregnancy
Young MF, Oaks BM, Tandon S, Martorell R, Dewey KG, Wendt AS (2019). Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann N Y Acad Sci. 1450 (2019): 47–68 https://doi.org/10.1111/nyas.14093
Yuce T, Aker SS, Seval MM, Kalafat E, Soylemez F (2015). Obstetric and neonatal outcomes of adolescent pregnancy. North Clin Istanbul. 2(2): 122–127. https://doi.org/10.14744/nci.2015.86158
