1. Introduction {#sec1}
===============

One of the major public health issues across the whole world is teenage pregnancy which is defined as pregnancy in girls aged 13--19 years \[[@B1], [@B2]\]. According to WHO, seven countries mainly constitute for half of all adolescent births, namely, Bangladesh, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Nigeria, and the United States of America \[[@B1], [@B3], [@B4]\].

Determinants of teenage pregnancy in a study employed in developing countries included the following reasons as attributing factors for teenage pregnancy; lack of knowledge on sexuality education, ineffective utilization of modern contraceptives, cultural obedience, socioeconomic dependence of females on males, and peer influence \[[@B5]--[@B7]\].

Teenage pregnancy is greatly associated with adverse pregnancy outcomes like obstructed labor, pre-eclampsia, anemia, operative deliveries, puerperal endometritis, postpartum hemorrhage, low birth weight, preterm delivery, and perinatal death \[[@B8]--[@B15]\].

Studies conducted in North India and Turkey outlined that babies of adolescent mothers were 1.65 and 4.94 times more likely to be born prematurely and face intrauterine fetal death (IUFD), respectively \[[@B16], [@B17]\].

Studies conducted in Taiwan, USA, and Korea showed that teenagers were 1.58, 1.36, and 1.16 times more likely to have preterm delivery than the adults, respectively \[[@B18]--[@B20]\]. A study in Nepal showed that low birth weight in teenagers and adults was 24% vs. 9% (*P*=0.013) \[[@B21]\]. Another study was conducted in Ankara in a referral hospital revealed that teenagers deliver 4.14 times more likely prematurely than adults \[[@B22]\].

A study conducted in Cameron revealed that subjects with teenage pregnancy were 1.94 and 1.46 times more likely to deliver very low birth weight and low birth weight neonates than adults \[[@B23]\]. Studies showed that a significantly higher rate of cesarean delivery was found among adult mothers compared with teenage mothers \[[@B24], [@B25]\]. In a study conducted in Sweden, teenagers were 30% less likely to develop postpartum hemorrhage (PPH) and 63% less probable to be complicated by Antepartum hemorrhage (APH) secondary to placenta Previa \[[@B26]\]. As a study in Finland showed, teenagers are 1.2 and 3.2 times more likely to develop preeclampsia and eclampsia than adults \[[@B27]\]. Even though a lot has been said about teenage pregnancy and its associated factors and some deals about the outcomes across the globe, as far as the investigator\'s knowledge, there are limited published researches on adverse obstetric and perinatal outcomes of teenage pregnancy in Ethiopia. In addition, there are three studies on teenage pregnancy and associated factors in Ethiopia. But these studies had not touched about the negative outcome of the teenage pregnancy. Therefore, the aim of this study was to assess teenage pregnancy and its adverse obstetric and perinatal outcomes at Lemlem Karl hospital, Tigray, Ethiopia, 2018.

2. Methods and Materials {#sec2}
========================

2.1. Study Area and Study Period {#sec2.1}
--------------------------------

This retrospective cohort study design was conducted at Lemlem Karl general hospital which is found at Maychew town, southern zone of Tigray regional state, northern Ethiopia, at a distance of 662 km from Addis Ababa to the North. Maychew town has a total population of 36,925 and has four kebeles which are located in the southern part of Tigray but in the northern part of Ethiopia \[[@B28]\]. The study was conducted from November 2017 to December 2017.

2.2. Sample Size {#sec2.2}
----------------

The sample size was calculated using the double population proportion formula considering an assumption of 95% confidence level, power 80%, the proportion of low birth weight in teenage pregnancy is 9.5%, and adult pregnancy is 3.6% taken from a study conducted in Cameron \[[@B29]\], and then using Epi info statistical software, the final sample size calculated gives 618 (309 teenagers and 309 adults) with 1 : 1 ratio. Six hundred and eighteen is the highest sample size that the principal investigator calculated for different outcome variables by using the Epi info statistical software ([Table 1](#tab1){ref-type="table"}).

2.3. Sampling Technique {#sec2.3}
-----------------------

There were a total of 4,683 deliveries from September 2014 to September 2017 GC. Of these, 932 and 3,089 were teenagers and adult deliveries, respectively. Records were reviewed from the delivery registration book of the obstetrics ward and registration logbook used as a sampling frame. Then, the investigator would have two different *K* values for teenagers and for adults. Calculating the *K* (*N*/*n* = 932/309 ≈ 3), value for teenagers where "*N*" is total delivered teenage mothers admitted in the ward during the three years period and "*n*" is calculated sample size for teenagers, then study cards were selected in every 3rd interval from the registration book of teenager\'s in the three years record. Similarly, the investigator calculate the *K* value for the adults, the *K* (*N*/*n* = 3089/309 ≈ 10), value for adults where "*N*" is total delivered adult mothers admitted in the ward during the three years period, and "*n*" is calculated sample size for adults, and then study cards were selected in every 10th interval from the registration book of adults in the three years period. The first study card/chart was selected randomly for both teenagers and adults from their own frame.

2.4. Data Collection Tools and Procedures {#sec2.4}
-----------------------------------------

Data were collected from the patients/clients card by reviewing retrospectively from the year 2014--2017 GC. One master in clinical midwifery student, two BSc midwifery professionals, and two diploma midwifery professionals were oriented by the principal investigator about the purpose of the study and how to collect the data, as well as how to fill the questionnaire properly.

2.5. Data Quality Assurance {#sec2.5}
---------------------------

A checklist was prepared in English language by the principal investigator and reviewed by the advisors. The checklist was pretested in 31 (5%) of the mothers\' charts at Lemlem Karl general hospital before going to the actual data collection. The collected data was checked by the supervisor and principal investigator daily for completeness.

2.6. Data Analysis Procedure {#sec2.6}
----------------------------

The data were coded, entered, cleaned with Epi info version 3.5.1, and analyzed by SPSS version 20. In multivariate logistic regression analysis, variables having a *P* value less than or equal to 0.05 were considered to have a statistically significant association with the dependent variable, and the result was presented with different tables and graph.

3. Results {#sec3}
==========

3.1. Sociodemographic Information of Teenage and Adult Mothers {#sec3.1}
--------------------------------------------------------------

A total of 618 charts of women who delivered at Lemlem Karl general hospital were reviewed, who met the eligibility criteria of this study. Of these, 309 were charts of teenage while the rest were adult women charts. The median age of the study population was 21, the 75th percentile was 27 years, and 25th was 19. So, IQR = 27--19, 50% of the study populations were found in the age range of 19--27 years. The majority of them from both age groups were unemployed which was about 89% and 71.8% for teenagers and adults, respectively.

Regarding the obstetric characteristics, more than three-quarters of teenagers 260 (84.1%) and about 80 (25.9%) of adults were primigravida. Concerning to antenatal care visits, more than three-quarters of the study populations had at least one antenatal care (ANC) visits during their current pregnancy time, and teenagers had lower ANC follow-up than adults, 77.3% and 83.2%, respectively ([Table 2](#tab2){ref-type="table"}).

3.2. Obstetric Outcomes of Teenage and Adult Mothers at Lemlem Karl General Hospital {#sec3.2}
------------------------------------------------------------------------------------

From the total teenage mothers, about thirty-five (11.3%) of them had to develop pregnancy-induced hypertension, whereas about thirteen (4.2%) of adults developed pregnancy-induced hypertension.

Episiotomy was performed for more than one-quarter of the teenager\'s delivery and about twelve percent of adult delivery. In relation to the gestational age at delivery, 14 (4.5%) and 29 (9.4%) of the teenage and adult had post-term delivery, respectively ([Table 3](#tab3){ref-type="table"}).

3.3. Perinatal Outcomes of Teenage and Adult Mothers at Lemlem Karl General Hospital {#sec3.3}
------------------------------------------------------------------------------------

Concerning to adverse perinatal outcomes of teenage delivery, about 12.9% delivered prematurely whereas in adult-only, about 4.5% delivered prematurely. Regarding birth weight of the newborn, teenagers deliver low birth weight neonates more than double of the adult deliveries ([Table 4](#tab4){ref-type="table"}).

3.4. Association of Adverse Obstetric Outcomes with Maternal Age {#sec3.4}
----------------------------------------------------------------

Teenagers developed pregnancy-induced hypertension 2.29 times more likely than the adult mothers (AOR: 2.29; 95% CI, 1.01--5.19). Teenagers were 43% less likely to undergo cesarean delivery than the adult mothers (AOR: 0.57; 95% CI, 0.36--0.90). Teenagers were 2.01 times more likely to have episiotomy than the adult mothers (AOR: 2.01; 95% CI, 1.25--3.39). The probability of teenagers to deliver post-term was 31.5% (OR: 0.46; 95% CI, 0.24--0.89) ([Table 5](#tab5){ref-type="table"}).

3.5. Association of Adverse Perinatal Outcomes with Maternal Age {#sec3.5}
----------------------------------------------------------------

Adverse perinatal outcomes revealed that teenage mothers were 2.87 times more likely to deliver prematurely than the adult mothers (AOR: 2.87; 95% CI, 1.49--5.52). Chance of giving low birth weight was more than double in teenagers as compared with the adult age group mothers (AOR: 2.22; 95% CI, 1.13--4.36). A severe neonatal condition was also more pronounced in teenage groups than the adults which was about 2.98 times more likely (AOR: 2.98; 95% CI, 1.25--7.14) ([Table 6](#tab6){ref-type="table"}).

4. Discussion {#sec4}
=============

According to this study, 17.5% of the teenagers deliver low birth weight and 6.8% of the adults deliver low birth weight neonates. Teenagers were 2.22 times more likely to deliver low birth weight neonates than adult mothers (AOR: 2.22; 95% CI, 1.13--4.36). This study was aligned with a study conducted in North India, in Cameron, and in Egypt \[[@B16], [@B23], [@B29]\]. This might be due to the anatomical immaturity, and continued growth of the teenagers may represent the biological growth barrier to their fetus and the low socioeconomic status.

According to this study, the result shows that teenagers were 2.87 times more likely to deliver prematurely than adult mothers (AOR: 2.87; 95% CI, 1.49--5.52). The same finding was observed in studies conducted in India, Turkey, Taiwan, Korea, and Cameron \[[@B10], [@B16]--[@B18], [@B23], [@B29]\]. The possible reason for this might be that teenagers were highly exposed to psychological instability/stress because of cultural, social, and economic factors in their living environment. Despite our finding, studies conducted in Sweden (AOR: 1.03; 95% CI, 0.98--1.09) and South Africa (*P*=0.702) showed there was no significant difference in preterm deliveries between the two age groups \[[@B24], [@B31]\]. This could be attributed by the study area setting and difference in sample sizes.

Based on this study, teenagers were 2.98 times more likely to have severe neonatal conditions than adult mothers (AOR: 2.98; 95% CI, 1.25--7.14). This result was similar with an institutional-based cross-sectional study conducted by the average health organization \[[@B10]\]. The possible explanation might be a socioeconomic condition, health service utilization, and nutritional status of mothers.

In this study, teenagers develop pregnancy-induced hypertension 2.29 times more likely than adult mothers (AOR: 2.29; 95% CI, 1.01--5.19). Our finding was supported the study conducted in the USA \[[@B19]\]. This might be attributed to the fact that null parity and age less than 20 years are the possible risk factors for the development of pregnancy-induced hypertension. However, our finding was inconsistent with studies conducted in Pakistan and Ankara \[[@B22], [@B25]\]. This difference might be explained by the difference in health-care service utilization and preconception care especially folic acid supplementation.

Regarding cesarean delivery, teenagers were 43% less likely to deliver by cesarean delivery than adult mothers (AOR: 0.57; 95% CI, 0.36--0.90). This study had a similar finding with studies conducted in Sweden and USA \[[@B19], [@B31]\]. Another study conducted in Ankara, Turkey also showed that teenagers were 36% less likely to undergo cesarean delivery than adults (AOR: 0.64; 95% CI, 0.64--0.89) \[[@B22]\]. The possible explanation for this might be due to the awareness difference between the two age groups about cesarean delivery.

However, this study finding has contradiction with three studies conducted in Cameron which were conducted at different time periods \[[@B6], [@B23], [@B29]\]. This variation might be due to the difference in sample sizes and study area setting. In this study, episiotomy was performed about two times more likely on teenagers than adults. Our finding is similar to the studies conducted in Cameron, Turkey, Romania, and Cameron \[[@B6], [@B19], [@B27], [@B32]\]. This might be due to the study area setting and the rules to apply episiotomy.

5. Conclusion {#sec5}
=============

This study shows that adverse obstetric and perinatal outcomes were significantly associated with teenage mothers than adult mothers like pregnancy-induced hypertension and episiotomy. Low birth weight, preterm delivery, and severe neonatal conditions are also clearly more significant in teenagers.

The authors would like to acknowledge Mekelle University for providing sponsoring ship and all study participants for their cooperation during sample collection.

APH:

:   Antepartum hemorrhage

ANC:

:   Antenatal care

AOR:

:   Adjusted odds ratio

CPD:

:   Cephalopelvic disproportion

EDHS:

:   Ethiopian demographic health survey

ETB:

:   Ethiopian birr

GA:

:   Gestational age

GC:

:   Gregorian calendar

GP:

:   General practitioner

IESO:

:   Integrated, emergency surgery and obstetrics

IUFD:

:   Intrauterine fetal death

OB/GYN:

:   Obstetrics/gynecology

PPH:

:   Postpartum hemorrhage

SNC:

:   Severe neonatal condition

SPSS:

:   Statistical package for social science

SVD:

:   Spontaneous vertex delivery

UN:

:   United Nation

WHO:

:   World Health Organization.

Data Availability
=================

Data supporting the conclusions of this article are available by request to Ayele Mamo. The questionnaire and full research will be made available to researchers wishing to use them for noncommercial purposes. The Supplementary data will be put below the acknowledgement.

Additional Points
=================

*Limitations*. Factors like economic status, educational level, and other unmentioned factors which might affect the outcomes of teenage and adult pregnancy outcomes could not be addressed in this study.

Ethical Approval
================

Ethical clearance was obtained from research and ethical review board of Mekelle University, and permission was obtained from Public Health Institute of Tigray region and Lemlem Karl General hospital. The research proposal was evaluated and approved by the Research Ethics Review Committee \[HRERC 0812/2018\] of College of Health Sciences.

Consent
=======

After informing participants about the purpose of the study, the importance of their participation, and their right to withdraw at any, verbal consent was obtained. Privacy was assured by interviewing in a separate room, and confidentiality of information given by each respondent was maintained by using code and anonymous.

Conflicts of Interest
=====================

The authors declare that they have no conflicts of interest.

Authors\' Contributions
=======================

All authors wrote the research, developed the questionnaire, analyzed the data, and wrote the paper, interpreting the findings as well as participating in the preparation of the manuscript. Girma supervised the data collection and contributed to the interpretation of the findings. Ayele and Girma trained data collectors and participated in the preparation of the manuscript. All authors read and approved the final manuscript.

###### 

Sample size calculated by Epi info statistical software from different outcome variables based on their proportion for teenagers and adult mothers (in 1 : 1 ratio of teenage and adult), 2018 (*n*=618).

  Variable           Proportion of outcomes in exposed   Proportion of outcomes in nonexposed   OR     Sample        Reference
  ------------------ ----------------------------------- -------------------------------------- ------ ------------- -----------------------------------
  Cesarean section   18.5                                9.5                                    1.99   Exposed 255   Ikeako et al. \[[@B30]\]
  Nonexposed 255                                                                                                     
  Total **510**                                                                                                      
                                                                                                                     
  Low birth weight   9.5                                 3.6                                    2.81   Exposed 309   Egbe et al. \[[@B29]\]
  Nonexposed 309                                                                                                     
  Total **618**                                                                                                      
                                                                                                                     
  Preterm            20                                  7                                      3.32   Exposed 123   Tripathi and Sherchand \[[@B21]\]
  Nonexposed 123                                                                                                     
  Total **246**                                                                                                      

###### 

Sociodemographic information of teenage and adult mothers in Lemlem Karl general hospital, Tigray region, Ethiopia, 2018 (*n*=618).

  Variable         Response       Age category   Total *N* (%)   
  ---------------- -------------- -------------- --------------- ------------
  Residence        Urban          103 (33.3)     196 (63.4)      299 (48.4)
  Rural            206 (66.7)     113 (36.6)     319 (51.6)      
                                                                 
  Employment       Unemployed     275 (89.0)     222 (71.8)      497 (80.4)
  Employed         34 (11.0)      87 (28.2)      121 (19.6)      
                                                                 
  Marital status   Married        278 (90.0)     297 (96.1)      575 (93.0)
  Single           31 (10.0)      12 (3.9)       43 (7.0)        
                                                                 
  Gravidity        Multigravida   49 (15.9)      229 (74.1)      278 (45.0)
  Primigravida     260 (84.1)     80 (25.9)      340 (55.0)      
                                                                 
  ANC              Yes            239 (77.3)     257 (83.2)      496 (80.3)
  No               70 (22.7)      529 (16.8)     122 (19.7)      

###### 

Obstetric outcomes of teenage and adult mothers delivered at Lemlem Karl general hospital, Tigray region, Ethiopia, 2018 (*n*=618).

  Variable                Response    Age category   Total *N* (%)   
  ----------------------- ----------- -------------- --------------- ------------
  PIH                     No          274 (88.7)     296 (95.8)      570 (92.2)
  Yes                     35 (11.3)   13 (4.2)       48 (7.8)        
                                                                     
  Cesarean delivery       No          269 (87.1)     251 (81.2)      520 (84.1)
  Yes                     40 (12.9)   58 (18.8)      98 (15.9)       
                                                                     
  Instrumental delivery   No          283 (91.6)     282 (91.2)      565 (91.4)
  Yes                     26 (8.4)    27 (8.8)       53 (8.6)        
                                                                     
  PPH                     No          297 (96.2)     292 (94.5)      593 (96.0)
  Yes                     12 (3.8)    17 (5.5)       25 (4.0)        
                                                                     
  APH                     No          298 (96.4)     291 (94.2)      589 (95.3)
  Yes                     11 (3.6)    18 (5.8)       29 (4.7)        
                                                                     
  Perineal tear           No          286 (92.6)     293 (94.8)      579 (93.7)
  Yes                     23 (7.4)    16 (5.2)       39 (6.3)        
                                                                     
  Post-term delivery      No          295 (95.5)     280 (90.6)      575 (93.0)
  Yes                     14 (4.5)    29 (9.4)       43 (7.0)        
                                                                     
  Episiotomy              No          214 (69.3)     272 (88.0)      486 (78.6)
  Yes                     95 (30.7)   37 (12.0)      132 (21.4)      

###### 

Perinatal outcomes of teenage and adult mothers delivered at Lemlem Karl general hospital, Tigray region, Ethiopia, 2018 (*n*=618).

  Variable           Response    Age category   Total *N* (%)   
  ------------------ ----------- -------------- --------------- ------------
  Preterm delivery   No          269 (87.1)     295 (95.5)      564 (91.3)
  Yes                40 (12.9)   14 (4.5)       54 (8.7)        
                                                                
  Low birth weight   No          255 (82.5)     288 (93.2)      543 (87.9)
  Yes                54 (17.5)   21 (6.8)       74 (12.1)       
                                                                
  Still birth/IUFD   No          290 (93.9)     299 (96.8)      589 (95.3)
  Yes                19 (6.1)    10 (3.2)       29 (4.7)        
                                                                
  SNC                No          276 (89.3)     298 (96.4)      574 (92.9)
  Yes                33 (10.7)   11 (3.6)       44 (7.1)        
                                                                
  Fetal distress     No          294 (95.1)     296 (95.8)      590 (95.5)
  Yes                15 (4.9)    13 (4.2)       28 (4.5)        

###### 

Bivariate and multivariate analysis of the adverse obstetrical outcomes of teenagers and adult mothers delivered at Lemlem Karl general hospital, Tigray region, Ethiopia, 2018 (*n*=618).

  Variable                  Category       Obstetric outcomes PIH   COR (95% CI)        AOR (95% CI)           *P* value              
  ------------------------- -------------- ------------------------ ------------------- ---------------------- ---------------------- ------------
  Age                       Teenage        35 (72.9)                274 (48.1)          2.91 (1.51--5.61)      2.29 (1.01--5.19)      0.048
  Adult                     13 (27.1)      296 (51.9)               1                   1                                             
  Residence                 Rural          32 (66.7)                287 (50.4)          1.97 (1.06--3.67)      1.51 (0.79--2.88)      0.217
  Urban                     16 (33.3)      283 (49.6)               1                   1                                             
  Gravidity                 Primigravida   34 (70.8)                306 (53.7)          2.1 (1.10--3.99)       1.18 (0.54--2.59)      0.69
  Multigravida              14 (29.2)      264 (46.3)               1                   1                                             
  ANC                       No             15 (31.2)                107 (18.8)          0.51 (0.27--0.97)      0.56 (0.29--1.07)      0.079
  Yes                       33 (68.8)      463 (81.2)               1                   1                                             
                                                                                                                                      
  *Cesarean delivery*                                                                                                                  
  Age                       Teenage        40 (40.8)                269 (51.7)          0.64 (0.415--0.997)    0.57 (0.36--0.90)      0.016^*∗*^
  Adult                     58 (59.2)      251 (48.3)               1                   1                                             
  Residence                 Rural          58 (59.2)                261 (50.2)          1.5 (0.970--2.319)     1.78 (1.12--2.82)      0.014
  Urban                     40 (40.8)      259 (49.8)               1                   1                                             
                                                                                                                                      
  *Instrumental delivery*                                                                                                              
  Age                       Teenage        26 (49.1)                283 (50.1)          0.96 (0.55--1.69)      ---                    0.886
  Adult                     27 (50.9)      282 (49.9)               1                                                                 
  Gravidity                 Primigravida   41 (78.8)                299 (52.8)          3.040 (1.564--5.905)   3.004 (1.544--5.843)   0.001
  Multigravida              11 (21.2)      267 (47.2)               1                   1                                             
                                                                                                                                      
  *Episiotomy*                                                                                                                         
  Age                       Teenage        95 (72)                  214 (44)            3.26 (1.39--3.33)      2.01 (1.25--3.39)      0.004^*∗*^
  Adult                     37 (28)        272 (56)                 1                   1                                             
  Gravidity                 Primigravida   85 (79.4)                255 (49.9)          2.88 (2.35--6.39)      2.35 (1.39--3.96)      0.001
  Multigravida              22 (20.6)      256 (50)                 1                   1                                             
                                                                                                                                      
  *Postpartum hemorrhage*                                                                                                              
  Age                       Teenage        12 (41.4)                297 (50.4)          0.69 (0.33--1.48)      ---                    0.96
  Adult                     17 (68)        292 (49.2)               1                                                                 
                                                                                                                                      
  *APH*                                                                                                                                
  Age                       Teenage        11 (37.9)                298 (50.6)          0.597 (0.28--1.29)     0.82 (0.31--2.2)       0.698
  Adult                     18 (62.1)      291 (49.4)               1                                                                 
  Residence                 Rural          21 (72.4)                298 (50.6)          2.56 (1.12--5.9)       3.1 (1.32--7.44)       0.009
  Urban                     8 (27.6)       291 (49.4)               1                   1                                             
  Gravidity                 Multigravida   20 (69)                  258 (43.8)          1                      1                       
  Primigravida              9 (31%)        331 (56.2)               0.35 (0.16--0.78)   0.34 (0.125--0.918)    0.033                  
                                                                                                                                      
  *Perennial tear*                                                                                                                     
  Age                       Teenage        23 (59)                  286 (49.4)          1.47 (0.762.85)        ---                    0.249
  Adult                     16 (41)        293 (50.6)               1                                                                 
                                                                                                                                      
  *Post-term delivery*                                                                                                                 
  Age                       Teenage        14 (32.6)                295 (51.3)          0.46 (0.24--0.89)                             0.02
  Adult                     29 (67.4)      280 (48.7)               1                                                                 

###### 

Bivariate and multivariate analysis of the adverse perinatal outcomes of teenagers and adult mothers delivered at Lemlem Karl general hospital, Tigray region, Ethiopia, 2018 (*n*=618).

  Variable             Category       Perinatal outcomes of preterm delivery   COR (95% CI)   AOR (95% CI)          *P* value            
  -------------------- -------------- ---------------------------------------- -------------- --------------------- -------------------- ------------
  Age                  Teenage        40 (74.1)                                269 (47.7)     3.13 (1.67--5.89)     2.87 (1.49--5.52)    0.002^*∗*^
  Adult                14 (25.9)      295 (51.3)                               1              1                                          
  Residence            Rural          35 (64.8)                                284 (50.4)     1.8 (1.04--3.25)      1.35 (0.74--2.49     0.33
  Urban                19 (35.2)      280 (49.6)                               1              1                                          
  APH                  Yes            7 (13)                                   22 (3.9)       3.67 (1.49--9.03)     4.9 (1.9--12.9)      0.001
  No                   47 (87)        542 (95.1)                               1              1                                          
  PIH                  Yes            11 (20.4)                                37 (6.6)       3.64 (1.74--7.65)     3.02 (1.39--6.6)     0.005
  No                   43 (79.6)      527 (93.4)                               1              1                                          
                                                                                                                                         
  *Low birth weight*                                                                                                                      
  Age                  Teenage        54 (72)                                  255 (47)       2.91 (1.71--4.94)     2.22 (1.13--4.36)    0.021^*∗*^
  Adult                21 (28)        288 (53)                                 1              1                                          
  Residence            Rural          54 (73)                                  265 (48.7)     2.84 (1.66--4.88)     2.27 (1.29--3.97)    0.004
  Urban                20 (27)        279 (51.3)                                                                                         
  Gravidity            Primigravida   50 (67.6)                                29 (53.3)      1.83 (1.09--3.05)     1.04 (0.55--1.97)    0.911
  Multigravida         24 (32.4)      254 (46.7)                               1              1                                          
  PIH                  Yes            19 (25.3)                                29 (5.3)       6.1 (3.23--11.66)     4.89 (2.53--9.52)    0.001
  No                   56 (74.7)      514 (94.7)                               1              1                                          
                                                                                                                                         
  *Still birth/IUFD*                                                                                                                      
  Age                  Teenage        19 (65.5)                                290 (49.2)     1.96 (0.89--4.28)     ---                  0.43
  Adult                10 (34.5)      299 (50.8)                               1                                                         
                                                                                                                                         
  *SNC*                                                                                                                                   
  Age                  Teenage        33 (75.0)                                276 (48.1)     3.24 (1.606--6.534)   2.98 (1.25--7.14)    0.014^*∗*^
  Adult                11 (25.0)      298 (51.9)                               1              1                                          
  Residence            Rural          28 (70)                                  291 (50.3)     2 (1.10--4.10)        1.58 (0.797--3.12)   0.19
  Urban                12 (30)        287 (49.7)                               1              1                                          
  Gravidity            Primigravida   30 (75)                                  310 (53.6)     1.83 (0.95--3.51)     0.92 (0.41--2.05)    0.837
  Multigravida         10 (25)        268 (46.4)                               1              1                                          
  PIH                  Yes            41 (7)                                   7 (15.9)       2.46 (1.03--5.86)     1.59 (0.63--4.00)    0.326
  No                   533 (93)       37 (84.1                                 1              1                                          
                                                                                                                                         
  *Fetal distress*                                                                                                                        
  Age                  Teenage        15 (53.6)                                294 (49.8)     1.16 (0.54--2.48)     ---                  0.699
  Adult                13 (46.4)      296 (50.2)                               1                                                         

[^1]: Academic Editor: Christina Pabelick
