Adolescence is a period of psychological instability and immaturity of organs which may lead to risk abortions and dystocia during childbirth [1]. Early pregnancy is still an issue of concern considering its adverse effects on adolescents’ health, education and rights as well as the precarious prognostic of unborn children. In Benin, adolescents account for 21% of total fertility [2]. However, few studies had been dedicated to the issue. This study aims to identify the prognostic factors of pregnancy and childbirth in adolescents at CHDU-B in Parakou.

The study had been carried out in the gynecology and obstetrics unit of the Borgou Regional University Teaching Hospital located in the town of Parakou (Republic of BENIN).

It was a comparative cross-sectional study with descriptive and analytical purpose which covered a 6-month period ranging from March 1 to August 31, 2014. As target, it focused on all the pregnant nulliparous adolescents under 35 years of age who were attended during the study period in the unit. We divided them into two (02) groups:

-the group of «adolescents » under 20 years of ages considered as a « risk group »;

-the group of « adults » aged 20 to 34 years, considered as the « reference group » used for comparisons in the analytical study. We selected this age group for it is the optimal age group for reproduction [3].

This research work involved the nulliparous pregnant subjects bearing a single pregnancy and under 20 years of age as regards adolescents and those aged 20 to 34 years as regards adults and who accepted to participate to the study. The population study did not involve nulliparous women whose pregnancy did not result in childbirth during the study period, women who gave birth before admission to the unit, pregnancy and multiple birth and women who refused to participate to the study. We selected nulliparous patients because we were concerned with eliminating the effects of obstetrical history of mothers who had already given birth before the study period.

We performed an exhaustive continuous sampling of pregnant adolescents. For each case of adolescent admitted for care, two « control » adults were sélected. They were nulliparous patients bearing a single pregnancy, attended for first childbirth and aged between 20 and 34 years, the one admitted just before the adolescent case and the other just after her. In the event where this last condition was not fulfilled, the two control-cases selected were either the two adult patients who met the same criteria and admitted just before the adolescent case, or the two who were admitted just after the adolescent case. This permitted us to get almost the same care team for each adolescent case and each control case. In fact, as each team has its cares habits we wanted that our patients receive care in the same conditions.

The study variables were related to:

- Course of pregnancy,

- Characteristics of childbirth and newborn.

The data collected were captured in a mask developed in Epi-INFO software version 7.1.1.14 dated July 2, 2013. The results are shown in the form of text with Word 2007 software and figures were made by means ofl Excel 2007. The statistical descriptive analysis consisted in calculating the different frequencies and averages of study variables. The qualitative variables were compared with Pearson’s chi² test followed by p-value. When p ≤ 0.05, the difference is statistically significant. To study the association meaning Odds-Ratio (OR) was calculated.

During the study period, CHDU-Parakou’s maternity registered 978 childbirths, including 110 occurred in primiparous adolescents i.e. an 11.2% frequency.

Pregnancy prognostic factors in adolescents

Poor pregnancy follow-up, hospitalization during pregnancy and diseases such as malaria and anemia are pregnancy risk factors in the adolescent (Table 1).

Table 1: Pregnancy prognostic factors in adolescents at CHDU-B in 2014.

Childbirth prognostic factors in adolescents

Fever during labor was significantly found out in adolescents (OR=5.26; p=0.0004); episiotomy and artificial labor with pelvic examination were significantly performed in adolescents (Table 2).

Table 2: Prognostic factors of childbirth in adolescents at CHDU-B in 2014.

Childbirth complications and length of stay in CHDU-B among adolescents in 2014

During childbirth, adolescents are more at risk of experiencing perineal lacerations and significant length of stay in hospital than adult mothers (Table 3).

Table 3: Childbirth complications and length of stay in CHDU-B hospital among adolescents in 2014.

Newborns’ prognostic factors

The children born of adolescent mothers are more at risk of having low birth weight, being transferred to the neonatal care unit and of dying in that unit than adult mothers (Table 4).

Table 4: Prognostic factors of adolescent mothers’ newborns at CHD-U in 2014.

We made comparative cross-sectional study both descriptive and analytical. This work took into account only the pregnancies ended in childbirth, cases of spontaneous abortion, ectopic pregnancy and molar pregnancies were not considered. This is a bias because it would allow a better comparison of birth outcomes in the two groups studied.

The first prognostic factor encountered was lack of pregnancy follow up or poor pregnancy monitoring. This observation accords with the findings of Iloki et al. [4] and Gandzien et al. [5] in Congo; Dedeckeret [6] in the Reunion Island, Kaka et al. [7] in DRC. Most often, those adolescents are single or they bear unintended pregnancies or are in unstable relationships, thus they lack financial resources to attend hospitals. As well, that age group is associated with ignorance of complications of pregnancy-induced diseases. The type of childbirth is not significantly different in both groups. Vaginal delivery was not associated with childbirth in adolescents in our cohort. There is a discrepancy between this remark and the results of the research works conducted by Foumsou et al. [8] in Chad, Gandzien et al. [5] in Congo and Traore et al. in Mali [9]. However, episiotomy is significantly more performed among adolescents in our investigative work and is in favor of artificial vaginal delivery rate which is significantly associated with childbirth in adolescents. This conclusion is consistent with the findings of other authors [9,10].

Maternal fever on admission, artificial labor and pelvic examination are associated with childbirth in adolescents. Dedecker et al. [6] in the Reunion Island had identified a non-significant difference between adolescents and case controls in their cohort as regards maternal fever. Besides, according to our research work, childbirth in the adolescent is significantly associated with perineal laceration risk. This result had been confirmed by Kaka et al. [7] in DRC and NGEMBI [1] in the Central African Republic.

As far as newborns’ characteristics are concerned, low birth weight was associated with adolescents’ childbirth in our study. This result is not found out during research works performed by Hamada et al. [10] in Morocco but it is consistent with the one encountered by Kaka et al. [7] in DRC.

Moreover, newborns’ transfer to neonatal care unit and perinatal deaths were also associated with those childbirths in adolescents. Our result is not shared by other cohorts investigated: Dedecker et al. [6] in the Reunion Island, Hamada et al. [10] in Morocco. In contrast, the findings of Iloki et al. [4] in Congo and Ngembi et al. [1] in the Central African Republic are similar to our conclusion about transfer to neonatal care unit and perinatal mortality.

We can conclude that childbirth in adolescent involves risks. The reduction of those complications depends on medical care for pregnant subjects and on high quality assisted delivery.