Int J Gynaecol Obstet 16: 20-23, 1978
A Clinical Study of Maternal Age and Parturition in 2791 Tanzanian Primiparae A. A. Arkutu Department of Obstetrics and Gynaecology, Muhimbili Medical Centre, Dar es Salaam, L 'ruled Republic of Tanzania
ABSTRACT Arkutu AA (Dept of Obstetrics and Gynaecology, Muhimbili Medical Centre, Dar es Salaam, United Republic of Tanzania). A clinical study of maternal age and parturition in 2791 Tanzanian primiparae. Int J Gynaecol Obstet 16: 20-23, 1978 The influence of age on the outcome of pregnancy and labor was studied in 2791 Tanzanian primiparae delivered between September 1976 and February 1977. Seventy percent of the primiparae were younger than 20 years of age. Most primiparae were between 16 and 17 years of age. First births occurring to women after the age of 26 years were uncommon. The risks ofpreeclampsia, difficult and operative delivery and perinatal mortality rose with advancing maternal age, but eclampsia and maternal death appear to be confined to patients 20 years or younger.
INTRODUCTION T h a t maternal age can significantly influence the outcome of pregnancy and labor is suggested by expressions such as "teenage mothers" and "elderly primigrávida." Teenage pregnancy has been shown by several authors (3-5) to be associated with a high incidence of preeclampsia, prematurity and perinatal death. Similarly, delaying the first pregnancy until after the age of 35 years has been shown to increase the risk of hypertension, dystocia and the rates of operative delivery and perinatal mortality (1, 2, 5, 7, 8). There is no consensus regarding the ideal age for a woman's first pregnancy. Marchetti and Menaker (6) suggest 16 years or younger as the optimum age. Others (7) regard anywhere between 20 and 24 years as the most suitable. Most obstetricians, however, probably agree with Lawson and Stewart (5), who recommend 18 years as the most desirable age for commencing childbearing. In Tanzania, as in many other African countries, early marriage and childbearing are common. Voluntary postponement of the birth of the first baby until late
Int J Gynaecol Obstet 16
in life is rare. This study was undertaken to find the most common age at which childbearing begins and to determine the influence, if any, of maternal age on ine outcome of pregnancy and labor in Tanzanian orimiparae delivered in a Dar es Salaam medical center.
MATERIALS A N D M E T H O D S All primiparae who were delivered in the Ocean Road and Maternity Block delivery units of the Muhimbili Medical Centre, Dar es Salaam, between September 1976 and February 1977 were studied. Their hospital records were analyzed after delivery. The patients were divided into four age groups as follows: Group A were patients younger than 20 years of age; Group B were patients 20-25 years of age; Group C were those 26-30 years of age; and Group D were those older than 30 years of age. In order to compare the statistical significance of the various pathologic parameters studied, values were calculated between Groups A and D. These two groups were chosen because they represent the two extremes of the age distribution of the study sample. Therefore, any differences due to age might be expected to be greater between these two groups.
RESULTS In ¡lie six months from September 1, 1976, to Febi,.., "!, 1977, there were 13 027 deliveries. T h e numlx-i ", primiparae delivered during the same period was '.'791 or 21.4% of the total deliveries. The patients ranged in age from 11 to 45 years, with a mean of 18.7 years. Of the 2791 primiparae, 1947 (70%) were younger than 20 years of age, 716 (26%) were between 20 and 25 years, and 91 (3%) were aged 26-30 years. Only 37 patients (1.3%) were older than 30 years. Fewer than 5% of the primiparae were aged 26 years or older. T h e peak inci-
Maternal age and parturition
dence of first births occurred between the ages of 16 and 17 years. Details of the various antenatal complications are given in Table I. Anemia was defined as a hemoglobin level of 8.7 gm/100 ml or less (5). T h e lowest level recorded for the patient during pregnancy was used for purposes of diagnosis. T h e incidence of anemia in pregnancy was found to be uniformly high. There was no statistically significant difference between the groups. Patients aged 26 years and older (Groups C and D) had a higher incidence of preeclampsia (18.7% and 32.0%, respectively) than the younger age groups (11.0% in Group A and 10.0% in Group B). T h e difference between Groups A and D was statistically significant. Eclampsia, however, was exclusively confined to women in the younger age groups. Thus, of the 36 cases of eclampsia recorded, 26 occurred in patients younger than 20 years of age. Ten cases occurred among patients aged 20-25 years. Eclampsia did not occur among patients aged 26 years and older. Premature labor condition was more common in the oldest and youngest age groups than in the other two groups, but the difference was not significant.
21
Analysis of the data presented in Table II shows a clear and statistically significant difference between Groups A and D in the rates of spontaneous vaginal delivery, vacuum extraction and cesarean section. A significantly higher proportion of patients younger than 20 years of age successfully completed their labor within 12 hours, compared with patients older than 30 years. For labors lasting longer than 24 hours, the difference between the two groups was not significant (Table III). T h e data presented in T a b l e IV indicate a positive correlation between maternal age and birth weight. T h e correlation coefficient (r) was 0.1. This is statistically significant (p30 years)
No.
%
No.
%
No.
%
No.
%
481 760 535 146 47
24.70 39.03 27.47 7.49 2.41
129 250 218 86 46
18.01 34.90 30.44 12.01 6.42
13 31 23 19 5
14.28 34.06 25.27 20.87 5.49
7 15 5 9 3
18.91 40.54 13.51 24.32 8.10
" The larger number of babies compared with patients is due to the inclusion of twins. Correlation coefficient (r) p
A Clinical Study of Maternal Age and Parturition in 2791 Tanzanian Primiparae A. A. Arkutu Department of Obstetrics and Gynaecology, Muhimbili Medical Centre, Dar es Salaam, L 'ruled Republic of Tanzania
ABSTRACT Arkutu AA (Dept of Obstetrics and Gynaecology, Muhimbili Medical Centre, Dar es Salaam, United Republic of Tanzania). A clinical study of maternal age and parturition in 2791 Tanzanian primiparae. Int J Gynaecol Obstet 16: 20-23, 1978 The influence of age on the outcome of pregnancy and labor was studied in 2791 Tanzanian primiparae delivered between September 1976 and February 1977. Seventy percent of the primiparae were younger than 20 years of age. Most primiparae were between 16 and 17 years of age. First births occurring to women after the age of 26 years were uncommon. The risks ofpreeclampsia, difficult and operative delivery and perinatal mortality rose with advancing maternal age, but eclampsia and maternal death appear to be confined to patients 20 years or younger.
INTRODUCTION T h a t maternal age can significantly influence the outcome of pregnancy and labor is suggested by expressions such as "teenage mothers" and "elderly primigrávida." Teenage pregnancy has been shown by several authors (3-5) to be associated with a high incidence of preeclampsia, prematurity and perinatal death. Similarly, delaying the first pregnancy until after the age of 35 years has been shown to increase the risk of hypertension, dystocia and the rates of operative delivery and perinatal mortality (1, 2, 5, 7, 8). There is no consensus regarding the ideal age for a woman's first pregnancy. Marchetti and Menaker (6) suggest 16 years or younger as the optimum age. Others (7) regard anywhere between 20 and 24 years as the most suitable. Most obstetricians, however, probably agree with Lawson and Stewart (5), who recommend 18 years as the most desirable age for commencing childbearing. In Tanzania, as in many other African countries, early marriage and childbearing are common. Voluntary postponement of the birth of the first baby until late
Int J Gynaecol Obstet 16
in life is rare. This study was undertaken to find the most common age at which childbearing begins and to determine the influence, if any, of maternal age on ine outcome of pregnancy and labor in Tanzanian orimiparae delivered in a Dar es Salaam medical center.
MATERIALS A N D M E T H O D S All primiparae who were delivered in the Ocean Road and Maternity Block delivery units of the Muhimbili Medical Centre, Dar es Salaam, between September 1976 and February 1977 were studied. Their hospital records were analyzed after delivery. The patients were divided into four age groups as follows: Group A were patients younger than 20 years of age; Group B were patients 20-25 years of age; Group C were those 26-30 years of age; and Group D were those older than 30 years of age. In order to compare the statistical significance of the various pathologic parameters studied, values were calculated between Groups A and D. These two groups were chosen because they represent the two extremes of the age distribution of the study sample. Therefore, any differences due to age might be expected to be greater between these two groups.
RESULTS In ¡lie six months from September 1, 1976, to Febi,.., "!, 1977, there were 13 027 deliveries. T h e numlx-i ", primiparae delivered during the same period was '.'791 or 21.4% of the total deliveries. The patients ranged in age from 11 to 45 years, with a mean of 18.7 years. Of the 2791 primiparae, 1947 (70%) were younger than 20 years of age, 716 (26%) were between 20 and 25 years, and 91 (3%) were aged 26-30 years. Only 37 patients (1.3%) were older than 30 years. Fewer than 5% of the primiparae were aged 26 years or older. T h e peak inci-
Maternal age and parturition
dence of first births occurred between the ages of 16 and 17 years. Details of the various antenatal complications are given in Table I. Anemia was defined as a hemoglobin level of 8.7 gm/100 ml or less (5). T h e lowest level recorded for the patient during pregnancy was used for purposes of diagnosis. T h e incidence of anemia in pregnancy was found to be uniformly high. There was no statistically significant difference between the groups. Patients aged 26 years and older (Groups C and D) had a higher incidence of preeclampsia (18.7% and 32.0%, respectively) than the younger age groups (11.0% in Group A and 10.0% in Group B). T h e difference between Groups A and D was statistically significant. Eclampsia, however, was exclusively confined to women in the younger age groups. Thus, of the 36 cases of eclampsia recorded, 26 occurred in patients younger than 20 years of age. Ten cases occurred among patients aged 20-25 years. Eclampsia did not occur among patients aged 26 years and older. Premature labor condition was more common in the oldest and youngest age groups than in the other two groups, but the difference was not significant.
21
Analysis of the data presented in Table II shows a clear and statistically significant difference between Groups A and D in the rates of spontaneous vaginal delivery, vacuum extraction and cesarean section. A significantly higher proportion of patients younger than 20 years of age successfully completed their labor within 12 hours, compared with patients older than 30 years. For labors lasting longer than 24 hours, the difference between the two groups was not significant (Table III). T h e data presented in T a b l e IV indicate a positive correlation between maternal age and birth weight. T h e correlation coefficient (r) was 0.1. This is statistically significant (p30 years)
No.
%
No.
%
No.
%
No.
%
481 760 535 146 47
24.70 39.03 27.47 7.49 2.41
129 250 218 86 46
18.01 34.90 30.44 12.01 6.42
13 31 23 19 5
14.28 34.06 25.27 20.87 5.49
7 15 5 9 3
18.91 40.54 13.51 24.32 8.10
" The larger number of babies compared with patients is due to the inclusion of twins. Correlation coefficient (r) p
