Maternal and neonatal outcomes among adolescent mothers in a high-risk NICU population in Ecuador
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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Mónica Sánchez-Moreira1, Fabricio González-Andrade2
1Colegio Ciencias de la Salud, Escuela de Especialidades Médicas, Universidad San Francisco de Quito USFQ, calle Diego de Robles s/n y Pampite, Quito, 170901, Ecuador.
Insights
Adolescent mothers in Ecuador face socioeconomic disadvantages and inadequate prenatal care, leading to poorer neonatal outcomes. Low birth weight and pulmonary hypertension, not maternal age, are key predictors of neonatal distress in high-risk NICU settings.
Area of Science:
- Neonatalogy
- Public Health
- Maternal-Fetal Medicine
Background:
- Adolescent pregnancy is a significant public health issue in Ecuador, disproportionately affecting vulnerable populations.
- Limited data exist on neonatal outcomes for adolescent mothers in low- and middle-income countries' neonatal intensive care units (NICUs).
- Structural and healthcare factors, not just maternal age, likely influence adverse neonatal outcomes in adolescent pregnancies.
Purpose of the Study:
- To compare maternal characteristics, obstetric practices, and neonatal outcomes between adolescent and adult mothers in a high-risk NICU population in Ecuador.
- To stratify comparisons by term and preterm births.
- To identify clinical predictors of neonatal distress in this population.
Main Methods:
- A cross-sectional observational study analyzed medical records from the NICU of Pablo Arturo Suárez General Hospital (2018-2021).
- Included 288 neonates with risk factors for pulmonary hypertension, categorized into four groups: term/preterm adolescent mothers and term/preterm adult mothers.
- Neonatal distress defined by low APGAR score, low birth weight for gestational age, and pulmonary hypertension severity; multivariate logistic regression used for predictor identification.
Main Results:
- Adolescent mothers exhibited lower education, socioeconomic status, and fewer prenatal visits (p < 0.001).
- Cesarean section rates were higher in preterm adolescent pregnancies (91.7%) versus adult controls (25.0%).
- Term infants of adolescent mothers had lower normal APGAR scores (26.4% vs. 75.0%) and higher low birth weight (65.3% vs. 25.0%) compared to adult mothers.
Conclusions:
- Adolescent mothers in high-risk NICUs face socioeconomic disadvantages, inadequate care, and increased interventions, correlating with poorer neonatal outcomes.
- Low birth weight and pulmonary hypertension were the primary drivers of neonatal distress, independent of maternal age.
- Targeted improvements in prenatal care and social support for adolescent mothers in high-risk settings are crucial.
Background:
Adolescent pregnancy remains a public health concern in Ecuador, particularly among socially vulnerable populations. Evidence from high-risk neonatal settings suggests that adverse neonatal outcomes associated with adolescent pregnancy may be strongly influenced by structural and healthcare-related factors rather than maternal age alone. However, data from neonatal intensive care units (NICUs) in low- and middle-income countries remain limited.
Objective:
To compare maternal characteristics, obstetric practices, and neonatal outcomes between adolescent and adult mothers in a high-risk NICU population in Ecuador, stratified by term (37-41 weeks) and preterm (< 37 weeks) births, and to identify clinical predictors of neonatal distress.
Methods:
A cross-sectional observational study was conducted using medical records from the Neonatal Intensive Care Unit of Pablo Arturo Suárez General Hospital (Quito, Ecuador) between 2018 and 2021. The study included 288 neonates admitted with prenatal, perinatal, or postnatal risk factors for pulmonary hypertension. Four groups were analyzed: term and preterm neonates born to adolescent mothers and to adult mothers (n = 72 per group). Neonatal distress was operationally defined by adverse early clinical indicators, including low APGAR score, low birth weight for gestational age, and the presence and severity of pulmonary hypertension. Multivariate ordinal logistic regression models were used to identify predictors of neonatal distress.
Results:
Adolescent mothers had significantly lower educational attainment, lower socioeconomic status, and fewer prenatal care visits compared with adult mothers (p < 0.001). Cesarean section rates were markedly higher among preterm adolescent pregnancies (91.7% vs. 25.0% in adults). Neonatal outcomes differed across groups: among term births, only 26.4% of infants born to adolescent mothers had normal APGAR scores compared with 75.0% among adults (p < 0.001), and low birth weight was more frequent (65.3% vs. 25.0%). In multivariate analyses, low birth weight and moderate-to-severe pulmonary hypertension were the strongest independent predictors of neonatal distress, whereas maternal age showed no direct effect after adjustment.
Conclusions:
In this high-risk NICU population, adolescent mothers experienced greater socioeconomic disadvantage, inadequate prenatal care, and higher rates of obstetric intervention, which were associated with poorer neonatal indicators. Adverse outcomes were primarily driven by clinical and structural factors-particularly low birth weight and pulmonary hypertension-rather than maternal age itself. These findings highlight the need for targeted improvements in prenatal care and social support for adolescent mothers within high-risk clinical settings.
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