Adolescent Pregnancy in Southeastern Romania: A Ten-Year Retrospective Cohort from a Regional Referral Center

Background and Objectives: Adolescent pregnancy remains a major global public-health concern, particularly in low- and middle-income countries. Romania consistently reports the highest teenage birth rate in the European Union, with pronounced regional disparities. This study aimed to assess the incidence, sociodemographic predictors, and obstetric outcomes of adolescent pregnancies over a ten-year period in southeastern Romania. Materials and Methods: A retrospective, population-based study was conducted at the Clinical County Hospital "Saint Andrew the Apostle", Constanța, from 1 January 2014 to 31 December 2023. All deliveries involving mothers aged ≤19 years were identified from institutional databases. Demographic variables (age, residence, education) and obstetric outcomes (mode of delivery, gestational age, neonatal parameters) were analyzed. Statistical tests included Pearson's χ², t-tests or Mann-Whitney U tests, and multivariate logistic regression to identify independent predictors of cesarean delivery and preterm birth. Results: Among 13,416 hospital deliveries, 1640 (12.2%) involved adolescent mothers (mean age 16.3 ± 1.4 years). Most originated from rural areas (64.6%) and had only primary education (42.8%). Cesarean section was performed in 58.3% of cases-significantly higher among rural (61.2%) and low-education (62.4%) groups (p < 0.05). The leading indications were cervical dystocia (19.2%) and cephalopelvic disproportion (16.9%). Preterm birth occurred in 30.5% and low birth weight in 27.1% of neonates. Multivariate analysis identified primiparity (OR 2.10; 95% CI 1.45-3.05; p < 0.001) and low education (OR 1.56; 95% CI 1.09-2.21; p = 0.015) as independent predictors of cesarean delivery, while rural residence and low education predicted prematurity (OR 1.84; 95% CI 1.12-3.02; p = 0.016). Conclusions: Adolescent pregnancy in southeastern Romania remains a persistent public-health challenge concentrated among rural and low-education populations. These patterns are consistent with previously described vulnerabilities in adolescent populations, including developmental and healthcare-access challenges, although such factors were not directly measured in this study. Community-based prevention, comprehensive sexual education, and adolescent-friendly obstetric pathways are urgently needed to reduce the burden of teenage pregnancy in Eastern Europe. These associations should be interpreted with caution, as the retrospective design precludes causal inference.