What are the nutritional risks of an adolescent pregnancy?

Adolescent pregnancy is a global problem occurring in both developed and developing nations.¹ The situation is dire in developing regions. Around 12 million adolescent girls give birth in developing regions every year, with around 10 million of these pregnancies unplanned.¹

Adolescence is considered a crucial stage, bringing physical, physiological, and psychological changes in girls.¹ Early pregnancies during this critical period have significant health consequences for adolescent mothers and their newborns¹ For example, the relative immaturity of the pelvic bones and birth canal causes significant obstetric risk and labor complications such as prolonged and obstructed labor in adolescent pregnancies, among others.

Adolescent pregnancies and the associated risks

Complications during pregnancy and childbirth are the leading causes of adolescent mortality worldwide.¹ Complications during pregnancy and childbirth are the leading causes of adolescent mortality worldwide According to the estimates, around 5.6 million abortions occur each year, of which approximately 3.9 million are unsafe.¹ These abortions result in maternal mortality, morbidity, and long-term health problems.¹ A multi-country study by the WHO found significant health consequences for adolescent mothers and newborns.²

Risks for adolescent mothers 

• Eclampsia and pre-eclampsia^2,3 
• Anemia⁴
• Infections¹ 
• Emergency cesarean delivery² 
• Postpartum depression⁵ 
• Inadequate breastfeeding initiation⁴ 
• Puerperal endometritis¹ 
• Perineal tear⁶ 
• Episiotomy⁶ 

Risks for newborns  

• Mortality¹
• Prematurity¹ 
• Low birth weight^1,6 
• Stillbirth⁶ 
• Birth asphyxia⁶ 
• Respiratory distress syndrome⁷ 
• Autism⁷ 

Impact of nutritional deficiencies in adolescent girls before and during pregnancy  

Teenagers have high nutritional needs, including requirements for energy, proteins, vitamins, and minerals.⁴ The nutritional needs of the adolescent mother increase even more during pregnancy and can be difficult to achieve.⁴

• Iron deficiency can cause anemia and other complications such as preterm birth, low birth weight, cognitive impairment, impaired immune response, and decreased resistance to infections.⁴ Anemia is the most common complication observed in adolescent pregnancies.⁴ Anemia can be prevented by the intake of non-haem iron foods such as leafy vegetables and soya beans or by the intake of haem iron food sources such as meat and fish.⁴
• Folic acid deficiency can cause impaired metabolism and megaloblastic anemia in adolescent girls. It can also cause neural tube defects and IUGR in infants born to adolescent girls with folic acid deficiency. The WHO recommends daily supplementation of 30mg-60mg elemental iron and 0.4mg of folic acid for adolescent girls.⁴
• Low calcium and Vitamin D levels – can lead to poor fetal bone mineralization and pre-eclampsia during pregnancy in adolescents. Low body weight, BMI, and poor weight gain due to inadequate calcium levels result in low birth weight and prematurity of newborns, leading to infant mortality.⁴
• Bone mineralization needs adequate intakes of micronutrients such as phosphorus and magnesium along with calcium. Deficiency in these micronutrients can lead to bone mineralization disorders.⁴
• Magnesium deficiency can lead to hypertension, Gestational diabetes mellitus, preterm labor, and IUGR.⁴
• Zinc deficiency affects metabolism and the integrity of the immune system.⁴
• Deficiency in iodine, a micronutrient responsible for developing the brain, intelligence, learning and is required to produce thyroxin, due to inadequate intake, can cause mental defects and cretinism during pregnancy.⁴

Conclusion 

Adolescent pregnancies have significant health consequences for both the mother and the child. Aside from the problems that may arise in early childbearing, nutritional deficiencies should also be taken into consideration.⁹ During this period, there are increased energy and nutrient requirements, and malnutrition can increase the risk of complications.⁸ Thus, proper management with an adequate diet and evidence-based supplementation is recommended.

References

1. Adolescent pregnancy. Available at: https://www.who.int. Accessed on 12th July 2022. 
2. Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, Yamdamsuren B, Temmerman M, Say L, Tuncalp O, Vogel JP, Souza JP, Mori R, on behalf of the WHO Multicountry Survey on Maternal Newborn Health Research Network. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014; 121 (Suppl. 1): 40–48. DOI: 10.1111/1471-0528.12630 (https://obgyn.onlinelibrary.wiley.com) 
3. WHO recommendation on calcium supplementation before pregnancy for the prevention of pre-eclampsia and its complications, 2020. Geneva: World Health Organization. https://apps.who.int 
4. Jouanne M, Oddoux S, Noël A, Voisin-Chiret AS. Nutrient Requirements during Pregnancy and Lactation. Nutrients. 2021 Feb 21;13(2):692. DOI:10.3390/nu13020692. https://www.ncbi.nlm.nih.gov 
5. Reid V, Meadows-Oliver M. Postpartum depression in adolescent mothers: an integrative review of the literature. J Pediatr Health Care. 2007 Sep-Oct;21(5):289-98. doi: 10.1016/j.pedhc.2006.05.010. PMID: 17825726. 
6. Vasconcelos, A., Bandeira, N., Sousa, S. et al. Adolescent pregnancy in Sao Tome and Principe: are there different obstetric and perinatal outcomes?. BMC Pregnancy Childbirth 22, 453 (2022). https://doi.org 
7. Jeha, D. et al. A Review of the Risks and Consequences of Adolescent Pregnancy. 18 May 2015:1–8. 
8. How to have a healthy teen pregnancy. Available at: https://americanpregnancy.org. Accessed on 12th July 2022. 
9. Tuncalp Ö, Rogers LM, Lawrie TA, Barreix M, Peña-Rosas JP, Bucagu M, Neilson J, Oladapo OT. WHO recommendations on antenatal nutrition: an update on multiple micronutrient supplements. BMJ Glob Health. 2020 Jul;5(7):e003375. DOI: 10.1136/bmjgh-2020-003375. https://www.ncbi.nlm.nih.gov.
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