MJSBH Journal.indd Medical Journal of Shree Birendra Hospital 15 ABSTRACT Introducti on: Teenage childbearing is linked to a host of negati ve social, economic and medical consequences for both mother and child. Maternal mortality among girls under 18 years is two to fi ve ti mes higher than that of women in their 20s. This study was conducted to determine the relati onship between maternal age on fetal weight. Method: It was a prospecti ve, hospital based study, carried out in 491 primi gravidas with fullterm singleton pregnancy. The study populati on was divided into two groups, women who were 19 and less than 19 years of age and women who were more than 19 years of age. Fetal weight as the outcome variable was compared between these groups. Results: The age of the mother ranged from 16 to 37 years. 24.8% women in the study populati on were <19 years of age. Although the diff erence was not clinically signifi cant (p=0.51), 1/3rd of the mothers who were <19 had low birth weight. Conclusion: the relati on of low birth weight and young maternal age could not be proven in this study. Key Words: age, fetal weight, maternal age. EFFECT OF MATERNAL AGE ON FETAL WEIGHT Sadikchya Singh Rana 1 1Dept. of Obs and Gynae. Shree Birendra Hospital INTRODUCTION Teenage pregnancy and childbearing have become pressing social concerns in the world. Research has shown that teenage childbearing is linked with negati ve social, economic and medical consequences for both mother and child. There is a great deal of debate, however, whether these consequences are due to maternal age per se, or whether they are caused by the adverse economic and social circumstances of teenagers who become mothers. The World Health Organizati on (WHO) stressed that acceptable progress to reduce maternal and perinatal mortality will not be realized unti l the governments make a full commitment to lower maternal deaths. About 529 000 women in the world die each year from pregnancy- related causes-and almost half of these deaths occur in the Western Pacifi c and South-East Asia Regions. Maternal mortality among girls under 18 years is two to fi ve ti mes higher than that of women in their 20s. In the South-East Asian Region, the child-bearing rate among adolescents aged 15 to 19 years ranges from 146 live births per 1000 women in Bangladesh to 26 per 1000 in the Republic of Korea. There are studies from third world countries menti oning the relati on between LBW and the maternal age. Although, we have high incidence of adolescent mother, in our country no such research have been done. This study was conducted to fi nd correlati on between maternal age and LBW. Correspondence: Dr. Sadhikchya Singa Rana Department of Obst Gyanacoloy, Shree Birendra Hospital. E-mail: drssrana@gmail.com Cell No.: 9851078400 Original Arti cleJuly-December 2011/Vol.10/Issue2 16 Medical Journal of Shree Birendra Hospital METHOD This was a Hospital based prospecti ve comparati ve study done at Paropakar Maternity and Women’s Hospital Thapathali, Kathmandu, Nepal. This study was conduced from 1st Poush to 30th Chaitra 2063 [16th December 2006 to 12th April 2007]. The study populati on were all the primi gravidas who were admitt ed with full term pregnancy. Women who were 19 years and below were considered young primi. There were total of 7627 obstetric admissions in the study period out of which there were 2693 primi gravidas. Five hundred pregnant women were enrolled for the study as per inclusion and exclusion criteria. All the primi pati ents admitt ed in the hospital with term and Singleton pregnancy were included in the study. Multi gravidae, pati ents with anaemia, Twin or multi ple pregnancies, Sti llbirths and pati ents not willing to parti cipate in the study were excluded. Permission of the hospital was taken before the study began. Questi onnaire was fi lled at the admission room which included informati on regarding identi fi cati on, age, residence, occupati on, educati on, socio-economic status, any previous diseases. A full obstetric history including at menarche, menstrual cycles, last menstrual period, durati on of marriage, gravida, para, number of antenatal visits (if they have done), iron intake was asked. The pati ent was examined generally and systemically. General examinati on included general conditi on, pallor, oedema, jaundice, pulse rate, blood pressure, height, weight, respiratory system, cardiovascular system followed by detail obstetric examinati on. The study populati on was divided into two groups, women more than 19 and less than 19 years of age. Then the pati ent was followed either in the labour room, operati on theatre or ward. The weight of the baby was taken and recorded. Low birth weight was considered if birth weight was below 2500gm. The collected informati on was entered daily in the Master Chart. SPSS version 10 was used for calculati ons. Stati sti cal analysis was done using Chi-square test and students t-test as applicable. RESULTS Although fi ve hundred cases were initi ally enrolled in the study, only four hundred ninety one of them were fi nally analysed as six cases refused to take part in the study, two had sti ll birth and one had undiagnosed twin pregnancy. Majority of the mothers in the study populati on were between 19-24 years of age. Very few mothers were between 35-40 years of age. A total of 122 (24.8%) pati ents were below the age of 19 years (Table 1). Almost 1/3rd of the mothers below the age of 19 had low birth weight. But the diff erence in fetal weight was not stati sti cally signifi cant (P value= 0.51) among the mothers who were more or less than 19 years of age (table 2). DISCUSSION Over half of the world’s populati on is below 25 years of age and more than 80% of the world’s youth live in developing countries. In the mid-1990s, the global teenage populati on was esti mated at 513 million. In this study the youngest mother was 16 years of age and the eldest mother was 37 years of age. A total of 122 (24.8%) women in the study populati on were <19 years of age (Table 1). Almost 1/3rd of the mothers below the age of 19 had low birth weight. But the diff erence in fetal weight was not stati sti cally signifi cant (P value =0.51) among the mothers who were more or less than 19 years of age (Table 2). Similar to this study Reichman NE et al1 reported the youngest (younger than 15) and oldest (aged 40 and older) mothers were only at higher risk to deliver a low-birth- weight baby; older teenagers were not at any signifi cantly increased risk to deliver a low-birth-weight baby than women aged 25-29. The seemingly poorer birth outcomes of teenage mothers appeared to result largely from their adverse socioeconomic circumstances, not from young maternal age. But Hirve SS2 reported the unadjusted relati ve risks for LBW were signifi cantly higher for maternal age less than 20 years (RR = 1.27). Leppert PC et al3 also reported aft er comparing three birth outcomes, gestati onal age, birth weight, and type of delivery, among adolescent (13-19) and those over 20 years of age, that younger mothers were more likely than older ones to have babies 38 weeks gestati on and weighing 2500 g. He concluded that, even with similar Table 1.Maternal Age Distribution Age No. of Pati ents Percentage <19 122 24.8 19-24 293 59.7 25-29 61 12.4 30–34 12 2.4 35-40 3 0.6 Total 491 100 Table 2.Fetal Weight in Relation to Maternal Age Age Low Birth weight(<2.5kg) Normal Birth Weight(>2.5kg) <19 32 90 >19 86 283 Total 118 373 Medical Journal of Shree Birendra Hospital 17 comprehensive care, adolescent mothers in this study were at greater risk of adverse outcomes than older mothers. Briggs MM et al4 also reported adolescents (<19years of age) had signifi cantly more low birth weight infants (<2500 g) than adults (>20 years old) (P=0.008). Anemia is signifi cant risk factor for poor obstetric outcomes and is potenti ally modifi able. Similar analysis was done by Machedo CJ5 in a populati on based study on the impact of maternal age at fi rst birth on low birth weight, preterm birth and low Apgar scores at one minute and at fi ve minutes among live births delivered to primiparous on 73,820 birth records from the 1998 birth cohort Maternal ages below 20 and above 30 years were signifi cantly associated with the risks of low birth weight and preterm birth, but no associati on was found between maternal ages and Apgar score. But this result seems to be inconsistent, low birth weight, preterm birth and low Apgar scores measure diff erent dimensions of newborn well-being, and the associati on of each measure with maternal age is expected to diverge. CONCLUSION Although in this study, the eff ect of young maternal age on low birth weight could not be proven stati sti cally we could see the high incidence of low birth weight in younger age group. Our study has several limitati ons including the sample size and considering only few variables. A detailed study with large sample size and correlati on of other variables will be more appropriate. Eventhough the birth weight is less in young age group the diff erence is stati sti cally not signifi cant in our study. REFERENCES 1. Reichman NE, Pagnini DL. Maternal Age and Birth Outcomes. Fam. Planning Perspect. 1997; 29(6):268-72. 2. Hirve SS, Ganatra BR., Determinants of Low Birth Weight: a community based prospecti ve cohort study. Indian Pediatrics J. 1994;31(10):1221-5. 3. Leppert PC, Pregnancy Outcome among Adolescent and Older Women Receiving Comprehensive Prenatal Care. J of Adolescent health care. 1986;7(2);112-7. 4. Briggs MM, Hopman WM, Comparing Pregnancy in Adolescents and Adults: obstetric outcomes and prevalence of anemia. J Obstet Gynaecol Can. 2007;29(7):546-55. 5. Machedo CJ. Impact of Maternal Age on Birth Outcomes: A populati on based study of primiparous Brazilian women. Cambridge Journals. 2005;10:1017. 6. Rees JM, Lederman SA, Kiely JL. Birth weight associated with Lowest Neonatal Mortality: infants of adolescent and adult mothers. J of Pediatrics. 1996;98(6):61-8. 7. Strobino DM, Margaret E, Kim YJ, Nanda J. Mechanisms for Maternal Age Diff erences in Birth Weight. American Journal of Epidemiology. 1998; 142(5):504-14.