TEENAGE PREGNANCY MEDICAL AND BIOLOGICAL PROBLEMS in RUSSIAN FEDERATION

(1)

TEENAGE PREGNANCY MEDICAL AND BIOLOGICAL PROBLEMS in RUSSIAN FEDERATION

Nadezhda Petrushkina¹, Olga Kolomietc², Andrea Rucska³, Emőke Kiss-Tóth⁴, Judit Plachy⁵

1,2The Ural State University of Physical Culture, Chelyabinsk, Russia

3,4,5

University of Miskolc, Faculty of Health Care, Miskolc, Hungary

Annotation. The aim of our research work is to evaluate young mothers' (aged 15-16) health peculiarities and their children's state of health at birth. Two groups were formed according to Independent Student t-Test. First (basic) group included 65 young women, who had given birth at the age of 15-16. Second (control) group included 65 women, who had given birth at the age of 20-22. Some significant differences are found out: according to the number of women by onset of menarche (aged 10-12), sexual debut age, abnormal gestation course and birth frequency and degree of incidence for neonatal pathology. The undertaken study allowed drawing a conclusion that adolescence is a risk factor for women's abnormal gestation course and birth as well as new-born children's pathology emergence. This problem requires working out some means, aimed at effective contraceptive behavior forming.

Key words: teenagers, reproductive function, pregnancy, birth, new-born children

INTRODUCTION

Modern demographic situation is characterised by birth-rate failing, population ageing, and mortality rate change. Population reproductive health reserves decrease, as well as all its aspects: impregnation, pregnancy, quality loss, good families forming, children's and parents' health are important social problems [3, 7, 10, 14].

Acceleration has led to precocious puberty, and moral guide change together with insufficient sex education – to early start of sexual activity and promiscuity [4, 9, 15].

Teenagers' sexual relationships start, antenuptial pregnancies and births lead to negative medical and social consequences for themselves, their families, and society the whole [9, 13, 17]. First of all, it includes antenuptial impregnations and young single mothers number increase. According to literature data, extramarital births percent is 18,2% of the whole births number.

Teenage years are viewed as a life period, relative free of problems, connected with health preservation. At the same time, this age is a critical one, when promiscuity and pregnancy may lead to serious consequences. Many danger were connected with teenage pregnancy, the younger a prospective mother is – the more dangers exist. These dangers are:

pregnancy and birth complications risk increase and possible long-term negative health consequences [1, 10, 13].

The research relevance is defined by the fact that teenagers' sexual and contraceptive behavior during last years, often leads to unintended pregnancy and birth. Moreover, adoption (or non-adoption) of the Marrying Age Decrease Act depends on the answering the question:

«Does early start of reproductive function (teenage pregnancy) reflect on young pregnant women's and their new-born children's health status?». We have limited our study group by the age of 15-16 and excluded smoking, imbibing and drug using women, because such factors can serve as leading ones for mothers' and new-born children's health disorders appearance. This is novelty of our research work.

Our research aim is to evaluate health peculiarities, gestation and birth course of young mothers (aged 15-16) and their children's state at birth for further activities on primary prevention of pregnancy in sexual active girls’ groups.

MultiScience - XXXI. microCAD International Multidisciplinary Scientific Conference University of Miskolc, Hungary, 20-21 April 2017

ISBN 978-963-358-132-2

DOI: 10.26649/musci.2017.132

(2)

MATERIAL AND METHODS

The aim of the study was: to evaluate health peculiarities, gestation and birth course of young mothers (aged 15-16) and their children's state at birth for further activities on primary prevention of pregnancy in sexual active girls’ groups.

Questions:

1. Date of first menarche (year; %)

2. Date of first sexual characteristic (year; M±SD)

3. Somatic health characteristics and gynecologic history before impregnation (Prevalence 10²/ diseases)

4. Gestation health status (Prevalence 10² / diseases) 5. Health status of new born baby (Apgar and diseases; %)

Sample: To carry out the research, two groups were chosen. First (basic) group included 65 young women, who had given birth at the age of 15-16. Second (control) group included 65 women, who had given birth at the age of 20-22. This group was formed according to «paired control» principle: all the women were taken care of in one women's health clinic and gave birth in one maternity home all of them having the first singleton pregnancy.

Statistical data: Descriptive statistic was analysed (Frequency); Independent Student t-test and Prevalece (P) was examined (cases / 10²). Statistical significance between groups was defined according to Student's criterion (t>1,96) as well as to Fisher's criterion (F>3,92).

Significance level of CI<95% were accepted.

RESULTS AND DISCUSSION

Although mean age of menarche onset was equal in both groups M1=12,2+ 0,13;

M2=12,6+0,11, significant differences were found out in women distribution according to this factor. The group of young pregnant women contained significantly more women, having their first menses at the age of 10-12 years (M1=85,7%), then in it was the second (control) group (M2=43,1%).

Mean sexual debut age, as it was expected, was lower in the basic group than in the control one (M₁=13,4 + 0,09; M₂=18,9 + 0,08).

While somatic health evaluation it was stated, that the majority of women from both groups were healthy (P1=67,6; P2=63,16 cases/10²). As it appears from the data, shown in Table 1, chronic infection focuses Otos-Rhyns-Larynx (ORL) disorder, cholecyctopathy and allergic diseases were registered more often. Other disorders were registered in individual cases. Significant differences between groups were registered by oligophrenia, which was registered only among young pregnant women’s group (P₁=4,6 cases/10²).

While gynecologic history evaluation (Table 2) 20% women in the control group, and 23,1% in the basic group had some anamnesis record, mainly by infectious diseases of reproductive system. Notably had some specific etiology diseases among young pregnant women (P₁=10,8; P₂=1,5 cases/10²). Trichomoniasis were registered significantly more often (P1=9,2; P2=1,5 cases/10²).

While gestation course evaluation (Table 3) significant increase of late gestosis frequency is stated in the basic group, as compared to the control one (P₁=49,3; P₂=30,8 cases/10²), especially of such form as edema of pregnancy (P1=44,6; P2=37,7 cases/10²).

Other disorders were registered with the same frequency in both groups.

The most significant differences show in birth process peculiarities (Table 4). The abnormal labor sum was 61,5 cases/10² in the basic group and 41,5 cases/10² in the control

(3)

one. In the group of young matures’ births were registered three times more often than in the control one: 18,5 cases/10² vs 6,2 cases/10². Significant differences were registered also in powerless labor frequency (P1=33,8; P2=13,3 cases/10²), which were followed by vacuum extraction (P₁=12,3; P₂=3,1 cases/10²) and breakages (P₁=9,2; P₂=2,5 cases/10²). These differences were significant.

It is clear, that these birth peculiarities were reflected on the new-born children's state of health (Table 5). More women's children in both groups were born in satisfactory condition. They were born with Apgar score of 8-10, but some children in the basic group was born with Apgar 0-3 score, it was three times more than the control one. While birth state was evaluated, it was examined, that prematurity was significantly more often registered among children of the basic group women (P₁=18,5; P₂= 6,2 cases/10²).

New-born children's morbidity analysis in the basic group showed significant increased than the control group children for example: pneumopathy (P1=12,3; P2=3,1 cases/10²), fetal hypotrophy (P₁=9,2; P₂=1,5 cases/10²) and birth injury (P₁=9,2; P₂=1,5 cases/10²).

We compared the received results with other authors, where health assessment of young pregnant women was carried out, compared to similar characteristics of pregnant women in optimal reproductive age, and more seldom to the same age women, who did not refer to the studied group. In the context of the undertaken research the most interesting was the morbidity assessment of the reproductive system, firstly on the somatic morbidity, which influenced the pregnancy negatively. On the other hand, on its negative consequences for new-born children.

The received data generally agree with another literatures regarding the high infection level with chronic infection focuses (also in reproductive organs) is more characteristic for young pregnant women [1, 6, 15]. Majority of the examined publications show more often cases of pregnancy complications of teenage girls. They demonstrate pregnancy pathology connection just with such women's state of health disorders even before impregnation.

Our research shows, that in somatic health initial state had not have any differences of the control group women. Only among young pregnant women one case of oligophrenia was registered, so, it is necessary to carry out special kind of work with girls having such diagnosis. Infection diseases of reproductive system were more often registered among young girls (trichomoniasis). It can be explained by promiscuity and correct contraceptive behavior absence.

Often labor disorders in the basic group, which can be explained by the fact, that carrying of a pregnancy is a serious trial for women's organism and it set high demands to it.

In young age pregnancy and birth proceed under the conditions of functional immaturity and adaptive mechanisms are inadequate. It leads to high complications risk for mothers and for fetus as well [8, 9, 11, 17].

Besides, nervous processes immaturity and widespread teenaged girls' sexual infantilism cause unsatisfactory labor dominance forming, which can be seen by labor disorders and labor injuries high level [18, 9, 14]. The cause for bad labor process, inadequate behavior and labor injuries of young women is her social disadaptation, as well as negative desire to pregnancy and birth. Pathological birth can be reflected also on new-born children state. So, young women are more subject to great danger of obstructed labor than women having birth in mature age.

The conclusion is, that teenage is a risk factor in pregnancy and birth pathology for women, as well as new-born children's pathology emergence. Firstly, in their prevention necessary to carry out early, effective contraceptive behavior, in case we can preserve the normal process in pregnancy. Specially care for young women during pregnancy, which evidently, is going on under organism's functional immaturity at young age, in spite of

(4)

«acceleration», and inadequate adaptive processes. We can see in the research perspective, that we have to work out a program, and evaluate its effectiveness regarding manage the form of contraceptive behavior in groups for sexually active teenagers. Some programmes are planned by us:

• Defining the attitude of sexually active women of extramarital age towards pregnancy, their idea of its «harm and usefulness» and knowledge of contraceptive means.

• Defining the way of actually used contraceptive means in this group.

• Organize a program for contraceptive behavior for teenagers, its implementation and effectiveness evaluation.

CONCLUSION

1. Young age is a risk factor for pathological pregnancy and birth.

2. Young mothers' children have worse health characteristics at birth, than mature mothers' ones.

3. When a young woman wishes to preserve pregnancy, special care and birth training are recommended.

4. For pregnancy prophylactics at young age, forming effective contraceptive behavior is necessary.

Table 1.- Mothers' health characteristics in examined groups, Prevalence in cases/10²women

Characteristics

Groups, number of women, cases /10²persons, Fisher's criterion

Basic, N=65 Control, N=65 number on 10² number on 10² F

Healthy mothers 44 67,6 41 63,1 0,3

Number of mothers, having somatic pathology

11 16,9 11 16,9 0

Chronic infection focuses, including:

3 4,6 3 4,6 0

ORL-disorder 1 1,5 1 1,5 0

kidneys and urinary tract infections

3 4,6 2 3,1 0,21

cholecyctopathy 4 6,2 5 7,7 0,12

others 1 1,5 2 3,1 0,35

Pathology of cardiovascular system (neuro-circulatory dystonia)

1 1,5 1 1,5 0

Endocrine diseases 3 4,6 1 1,5 0

Neuropsychic diseases 3 4,6* 0 0 6,09

including: oligophrenia 4 6,2 5 7,7 0,12

Allergic diseases 3 4,6 4 6,2 0,15

* - significant difference with the control (group)

(5)

Table 2.- Gynecologic history peculiarities in examined groups, Prevalence in cases/10² women

Kinds of disorder

Burdened gynecological history 13 20,0 15 23,1 0,19

Reproductive system inflammatory conditions,

including:

10 15,3 6 9,2 1,16

nonspecific ethiology 3 4,6 5 7,7 0,54

specific ethiology, including:

7 10,8* 1 1,5 5,73

gonorrhea 1 1,5* 0 0 2,01

trichomoniasis 6 9,2* 1 1,5 4,42

Menstrual disorder 3 4,6 2 2 0,21

Table 3. - Gestation course peculiarities in investigated groups, Prevalence in cases/10² women

Gestation course peculiarities

Basic, N=65 Control, N=65 number on 10² number on 10² F Gestation course without

complications

31 47,7 30 46,2 0,03

Gestational toxicosis (recent pregnancy)

2 3,1 3 4,6 0,21

Gestational toxicosis (late pregnancy), including:

32 49,3* 20 30,8 4,68

Edema 29 44,6* 18 37,7 4,09

Albuminuria 2 3,1 1 1,5 0,35

Pregnancy hypertonia 1 1,5 1 1,5 0

Complex toxicosis 1 1,5 2 3,1 0,35

Acute diseases in I^st trimester, including:

9 13,8 10 15,4 0,06

contagious 6 9,2 6 9,2 0

Acute diseases in mid-trimester, including:

31 47,7 33 50,8 0,12

contagious 20 30,8 18 27,7 0,15

Contagious diseases of genital tracts

13 20,0 10 15,4 0,48

Anemia of pregnancy 10 15,4 8 12,3 0,26

(6)

Table 4. – Features of a course of childbirth, Prevalence in cases/10² women

Features

Birth in time 51 78,5 58 89,2 2,86

Immature delivery 12 18,5* 4 6,2 4,86

Postmature delivery 2 3,1 3 4,6 0,21

Normal delivery 25 38,5* 38 58,5 5,28

Abnormal labor 40 61,5* 27 41,4 5,28

Contracted pelvis 20 30,8* 9 13,8 5,56

Breech position 2 3,1 2 3,1 0

Hydramnios 1 1,4 0 0 2,01

Early rupture of membrane 17 26,1 18 27,7 0,03

Powerless labor 22 33,8* 9 13,3 7,46

Accelerated labor 1 1,5 2 3,1 0,35

Premature separation of placenta

1 1,5 0 0 2,01

Intrapartum hemorrhage 1 1,5 1 1,5 0

Manual umbilical cord detachment

1 1,5 1 1,5 0

Vacuum-extraction or graspers 8 12,3* 2 3,1 4,31

Cesarean operation 1 1,5 1 1,5 0

Breakages 6 9,2* 1 1,5 4,41

Table 5. – New-born children's state, Prevalence in cases/10² newborns

Characteristics

Basic, N=65 Control, N=65 number on 10² number on 10² F Without pathological

findings

30 16,2* 52 80,0 16,87

Prematurity 12 18,5* 4 6,2 4,86

Postmaturity 1 1,5 3 4,6 1,10

Nuchal cord, including: 19 29,3 18 27,7 0,04

tight (neck) 3 4,6 3 4,6 0

Pneumopathy 8 12,3* 2 3,1 4,31

Fetal infection 3 4,6 1 1,5 1,10

Fetal hypoxia 3 4,6 1 1,5 1,10

Asphyxia (or risk of it) 3 4,6 2 3,1 0,21

Birth injury 6 9,2* 1 1,5 4,42

Encephalopathy 1 1,5 1 1,5 0

Fetal hypotrophy 6 9,2* 1 1,5 4,42

Congenital disorders 1 1,5 1 1,5 0

(7)

Characteristics

Basic, N=65 Control, N=65 number on 10² number on 10² F Apgar score (points):

0-3 3 4,6 1 1,5 1,10

4-7 15 23,1* 6 9,2 4,81

8-10 47 72,3* 58 89,2 6,28

* - significant difference with the control (group) REFERENCES

1. Adamyan L. V. Gestation course peculiarities of teenaged girls / L. V. Adamyan, E. V.

Sibirskaya, N. О. Tarbaya // Reproduktivnoe zdorov'e detej i podrostkov. 2016, # 2 (67). P. 19-20. (in Rus)

2. Aivazyan S. A. Applied statistics. Basic concepts of modelling and data pre- processing / S. A. Aivazyan, I. S. Enyukov, L. D. Meshalkin. - M. : Finansy i statistika, 1983. –286 p. (in Rus)

3. Akuzina O. P. Family planning service role in preservation of population reproductive health under the conditions of health care reforming / O. P. Akuzina // Extended abstract of dissertation Candidate of Medical Sciences. 2008, 22 p. (in Rus)

4. Grigoryan V. A. Attitude to reproductive health: young people viewpoint / V. A.

Grigoryan, M. S. Selikova // Reproduktivnoe zdorov'e detej i podrostkov. 2016, # 3 (68). P. 17. (in Rus)

5. Koch L. I. Psychosocial factors significance in teenagers' reproductive health forming / L. I. Koch // Reproduktivnoe zdorov'e detej i podrostkov. 2015, # 6 (65). P. 48-55.

(in Rus)

6. Koch L. I. Gestation course and birth of young women / L. I. Koch, Yu. V. Egorkina //

Reproduktivnoe zdorov'e detej i podrostkov. 2016, # 1 (66). P. 40-43. (in Rus) 7. Kokolina V. F. Pediatric and adolescent gynecology. M., 2006. – 640 p. (in Rus) 8. Kokolina V. F. Modern girls' and teenaged girls' state of health under current

conditions / V. F. Kokolina, M. Yu. Mitin // Rossijskij vestnik akusherstva i ginekologii. 2005. # 3. – P. 19-23. (in Rus)

9. Kolomejсev M. G. Non-medical aspects of teenagers' and young people's reproductive health preservation and social-hygienical culture forming in the system of inter- institutional medical psychological cooperation / M. G. Kolomejcev // Reproduktivnoe zdorov'e detej i podrostkov. 2006, # 3. P. 9-15. (in Rus)

10. Krasnopolsky V. I. Family planning and reproductive health of teenaged girls and young women / V. I. Krasnopolsky, I. S. Savel'eva, Yu. B. Belokhvostova //

Ginekologija. 2009, # 10. P. 3-6 (in Rus)

(8)

11. Krivolapchuk I. A. Psychophysiological characteristics of teenagers' functional state in different puberty stages under the conditions of hard informational loading / I. A.

Krivolapchuk // Fiziologija cheloveka . 2005, # 6 (31). P.13-25. (in Rus)

12. Kulakov V. I. Basic trends of girls' reproductive health changes under current conditions / V. I. Kulakov, I. S. Dolzhenko // Reproduktivnoe zdorov'e detej i podrostkov. 2005, # 1 (1). P. 22-26. (in Rus)

13. Lebedev T. B. Girls' and young women's reproductive health modern aspects / T. B.

Lebedev, A. N. Baranov // Zhurnal akusherstva i zhenskih boleznej. 2007. - # 4. – P.

66-73. (in Rus)

14. Mikhajlin E. S. Reproductive health peculiarities of modern teenaged girls (analytical survey) / E. S. Mikhajlin, L. A. Ivanova, A. G. Savitzky, I. V. Berlev //

Reproduktivnoe zdorov'e detej i podrostkov. 2015, # 2 (61). P. 63-72. (in Rus)

15. Pestrikova T. Yu. Modern youth reproductive health and sexual behavior / T. Yu.

Pestrikova, Yu. S. Chesnokova, V. V. Fedorova // Medicina. 2003, # 4. P.60-62. (in Rus)

16. Petrushkina, N. P. Vozrastnaya fiziologiya / N. P. Petrushkina, E. V. Zhukovskaya. – Chelyabinsk : Izd-vo UralGUFK, 2010. – 300 s. (in Rus)

17. Strozenko L. A., Klimenov L. N., Lobanov Yu. F. Modern teenaged girls' reproductive behavior ane their somatic health level / L. A. Strozenko, L. N. Klimenov, Yu. F.

Lobanov // Mat' i ditja v Kuzbasse. – 2011. - # 4 (47). – P.43-46. (in Rus)

18. Zakharova T. G. Medical and social characteristics of teenaged girls reproductive function / T. G. Zakharova, O. S. Filippov, G. N. Goncharova // Zdravoohranenie Rossijskoj Federacii. 2002, # 5. P. 30-31. (in Rus)