Adverse reproductive outcomes in minors: New approaches to solving an old problem

Introduction. Teenage pregnancy is recognized by WHO as a serious public health problem, it is widespread throughout the world: both in developed and developing countries.

Aim. To demonstrate the resources of the regional service of pediatric and adolescent gynecology to reduce unwanted reproductive outcomes in minors.

Materials and methods. The study was conducted in obstetric hospitals of the Tyumen region, medical institutions providing outpatient gynecological care to minors. Contingent: 1703 minors with pregnancies completed in 2016–2023. Depending on the pregnancy outcome, the study contingent was divided into two groups. Group 1: 1,173 teenage girls with pregnancies that ended in childbirth. Group 2: 531 teenage girls with an abortive outcome of pregnancy. A separate review of clinical cases of ectopic pregnancy in minors is given (3 cases).

Results. During the period under review, 156,747 pregnancies ended in childbirth in the Tyumen Region (excluding the KhantyMansi Autonomous Okrug – Yugra and the Yamalo-Nenets Autonomous Okrug). Over 6 years, there was a decrease from 23,791 to 17,164 births, i.e. by 27.9%. Statistics on childbirth and abortive outcomes in minors demonstrate a significant reduction in the number of completed pregnancies in minors: from 282 in 2016 to 175 in 2023 (-37.9%). The frequency of pregnancies with an abortive outcome in minors is higher than in adult women. Medical abortion accounts for almost ¾ of pregnancy terminations in minors. There is no significant decrease in the frequency of pregnancy terminations in adolescent girls among minors.

Conclusion. A stable improvement in the situation in this area is possible provided that state programs (federal, regional) are developed and implemented, targeted funding for activities aimed at preserving the reproductive health of children and adolescents, and grant support for scientific research.

1. Sedgh G, Finer LB, Bankole A, Eilers MA, Singh S. Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends. J Adolesc Health. 2015;56(2):223–230. https://doi.org/10.1016/j.jadohealth.2014.09.007.

2. Black AY, Fleming NA, Rome ES. Pregnancy in adolescents. Adolesc Med State Art Rev. 2012;23(1):123–138. Available at: https://pubmed.ncbi. nlm.nih.gov/22764559/.

3. Azevedo WF, Diniz MB, Fonseca ES, Azevedo LM, Evangelista CB. Complications in adolescent pregnancy: systematic review of the literature. Einstein. 2015;13(4):618–626. https://doi.org/10.1590/S1679-45082015RW3127.

4. Wang T, Si L, Jiang Q. Induced abortions among Chinese adolescent girls. BMC Womens Health. 2023;23(1):597. https://doi.org/10.1186/s12905-023-02754-w.

5. Harden A, Brunton G, Fletcher A, Oakley A. Teenage pregnancy and social disadvantage: systematic review integrating controlled trials and qualitative studies. BMJ. 2009;339:b4254. https://doi.org/10.1136/bmj.b4254.

6. Rosenberg M, Pettifor A, Miller WC, Thirumurthy H, Emch M, Afolabi SA et al. Relationship between school dropout and teen pregnancy among rural South African young women. Int J Epidemiol. 2015;44(3):928–936. https://doi.org/10.1093/ije/dyv007.

7. Berhan Y, Berhan A. A meta-analysis of socio-demographic factors for perinatal mortality in developing countries: a subgroup analysis of the national surveys and small scale studies. Ethiop J Health Sci. 2014;24(Spec. Iss.):41–54. https://doi.org/10.4314/ejhs.v24i0.5s.

8. Diabelková J, Rimárová K, Dorko E, Urdzík P, Houžvičková A, Argalášová Ľ. Adolescent Pregnancy Outcomes and Risk Factors. Int J Environ Res Public Health. 2023;20(5):4113. https://doi.org/10.3390/ijerph20054113.

9. Mateykovich EA, Ziyadinov AA, Novikova VA, Radzinsky VE, Polyakova VA. Body mass index and age at menarche as predictors of adverse reproductive outcomes. Meditsinskiy Sovet. 2024;18(23):167–176. (In Russ.) https://doi.org/10.21518/ms2024-539.

10. Liu J, Wu S, Xu J, Temmerman M, Zhang WH; INPAC Group. Is Repeat Abortion a Public Health Problem among Chinese Adolescents? A Cross-Sectional Survey in 30 Provinces. Int J Environ Res Public Health. 2019;16(5):794. https://doi.org/10.3390/ijerph16050794.

11. Chakole S, Akre S, Sharma K, Wasnik P, Wanjari M.B. Unwanted teenage pregnancy and its complications: a narrative review. Cureus. 2022;14(12):e32662. https://doi.org/10.7759/cureus.32662.

12. Kim K. Intergenerational transmission of age at first birth in the United States: Evidence from multiple surveys. Population Research and Policy Review. 2014;33:649–671. https://doi.org/10.1007/s11113-014-9328-7.

13. Mann L, Bateson D, Black KI. Teenage pregnancy. Aust J Gen Pract. 2020;49(6):310–316. https://doi.org/10.31128/AJGP-02-20-5224.

14. Coles MS, Lau M, Akers AY. If You Do Not Ask, They Will Not Tell: Evaluating Pregnancy Risk in Young Women in Pediatric Hospitals. J Adolesc Health. 2016;58(3):251–252. https://doi.org/10.1016/j.jadohealth.2015.12.008.

15. Darroch JE, Woog V, Bankole A, Ashford LS. Adding it Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents, New York: Guttmacher Institute; 2016. Available at: https://www.guttmacher.org/report/adding-itmeeting-contraceptive-needs-of-adolescents.

16. Girlhood, Not Motherhood: Preventing Adolescent Pregnancy. Published by the United Nations Population Fund. UNFPA, New York; 2015. 60 p. Available at: https://www.unfpa.org/sites/default/files/pub-pdf/Girlhood_not_motherhood_final_web.pdf.

17. Renner RM, de Guzman A, Brahmi D. Abortion care for adolescent and young women. Int J Gynaecol Obstet. 2014;126(1):1–7. https://doi.org/10.1016/j.ijgo.2013.07.034.

18. Tung I, Chung T, Krafty RT, Keenan K, Hipwell AE. Alcohol Use Trajectories Before and After Pregnancy Among Adolescent and Young Adult Mothers. Alcohol Clin Exp Res. 2020;44(8):1675–1685. https://doi.org/10.1111/acer.14394.

19. Mateykovich ЕА, Kukarskaya II, Legalova TV. Clinical and statistical assessment of the reproductive health of fertilized women in the Tyumen region and the risks of miscarriage in Western Siberia. Meditsinskiy Sovet. 2021;(21-1):198–204. (In Russ.) https://doi.org/10.21518/2079-701X-2021-21-1-198-204.

20. Bystrova YuV, Ganaeva EE, Dadashov МM. Sexual freedom and sexual inviolability of minors: criminal law and criminological aspects. Bulletin of Kadyrov Chechen State University. 2024;(1):163–170. (In Russ.) Available at: https://www.elibrary.ru/phurur.

21. Ruedinger E, Cox JE. Adolescent childbearing: consequences and interventions. Curr Opin Pediatr. 2012;24(4):446–452. https://doi.org/10.1097/MOP.0b013e3283557b89.