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Young adolescent girls are at high risk for adverse pregnancy outcomes in sub-Saharan Africa: an observational multicountry study
  1. Ghyslain Mombo-Ngoma1,2,3,4,5,
  2. Jean Rodolphe Mackanga1,2,3,
  3. Raquel González6,7,
  4. Smaila Ouedraogo8,9,
  5. Mwaka A Kakolwa10,
  6. Rella Zoleko Manego2,11,
  7. Arti Basra1,2,3,
  8. María Rupérez6,7,
  9. Michel Cot9,
  10. Abdunoor M Kabanywany10,
  11. Pierre-Blaise Matsiegui11,
  12. Seldiji T Agnandji1,2,3,
  13. Anifa Vala6,
  14. Achille Massougbodji8,
  15. Salim Abdulla10,
  16. Ayôla A Adegnika1,2,3,5,
  17. Esperança Sevene6,7,
  18. Eusebio Macete6,
  19. Maria Yazdanbakhsh5,
  20. Peter G Kremsner1,2,3,
  21. John J Aponte7,
  22. Clara Menéndez7,
  23. Michael Ramharter1,2,3,12
  1. 1Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
  2. 2Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
  3. 3German Centre for Infection Research (DZIF), Tübingen, Germany
  4. 4Département de Parasitologie-Mycologie, Université des Sciences de la Santé, Libreville, Gabon
  5. 5Leiden University Medical Centre (LUMC), Leiden, The Netherlands
  6. 6ManhiçaHealthResearch Center (CISM), Manhiça, Mozambique
  7. 7ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
  8. 8Faculté de Sciences de la Santé, Université Abomey Calavi, Cotonou, Benin
  9. 9Institut pour la Recherche et le Développement (IRD), Paris, France
  10. 10Ifakara Health Institute, Dodoma, Tanzania
  11. 11Ngounie Medical Research Centre, Fougamou, Gabon
  12. 12Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Dr Michael Ramharter; michael.ramharter{at}


Objectives One of Africa's most important challenges is to improve maternal and neonatal health. The identification of groups at highest risk for adverse pregnancy outcomes is important for developing and implementing targeted prevention programmes. This study assessed whether young adolescent girls constitute a group at increased risk for adverse birth outcomes among pregnant women in sub-Saharan Africa.

Setting Data were collected prospectively as part of a large randomised controlled clinical trial evaluating intermittent preventive treatment of malaria in pregnancy (NCT00811421—Clinical, conducted between September 2009 and December 2013 in Benin, Gabon, Mozambique and Tanzania.

Participants Of 4749 participants, pregnancy outcomes were collected for 4388 deliveries with 4183 live births including 83 multiple gestations. Of 4100 mothers with a singleton live birth delivery, 24% (975/4100) were adolescents (≤19 years of age) and 6% (248/4100) were aged ≤16 years.

Primary and secondary outcome measures Primary outcomes of this predefined analysis were preterm delivery and low birth weight.

Results The overall prevalence of low birthweight infants and preterm delivery was 10% (371/3851) and 4% (159/3862), respectively. Mothers aged ≤16 years showed higher risk for the delivery of a low birthweight infant (OR: 1.96; 95% CI 1.35 to 2.83). Similarly, preterm delivery was associated with young maternal age (≤16 years; OR: 2.62; 95% CI 1.59 to 4.30). In a subanalysis restricted to primiparous women: preterm delivery, OR 4.28; 95% CI 2.05 to 8.93; low birth weight, OR: 1.29; 95% CI 0.82 to 2.01.

Conclusions Young maternal age increases the risk for adverse pregnancy outcomes and it is a stronger predictor for low birth weight and preterm delivery than other established risk factors in sub-Saharan Africa. This finding highlights the need to improve adolescent reproductive health in sub-Saharan Africa.

Trial registration number NCT00811421; Post-results.

  • adolescent pregnancy
  • sub-Saharan Africa
  • low birth weight
  • preterm birth

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