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Abstract

A teenage mother is more likely to drop out of high school, affect employment and social
class, increased risk for preterm delivery and low birth weight, less likely to receive prenatal
care. Advanced maternal age associated with increased risks of birth defects, low birth
weight, increase rate of caesarean section, gestational diabetes, preeclampsia.
The objective of the study is to identify obstetric and perinatal outcomes among teeagers and
old pregnant women (older than 35 years) in a sample of maternity hospitals in Baghdad,
2016.
A comparative cross-sectional study, carried out in three hospitals during the period of 15th
of March 2016-15th of June 2016.
A convenient sample of pregnant women admitted for delivery were included. The pregnant
women were divided into three groups: group A represents 120 pregnant women aged below
20 years(teenage pregnant), group B represents 120 pregnant women aged 20-34 years (low
risk pregnancy) and group C represents 92 pregnant women aged 35+ years ( advanced age
pregnant).In a comparison between group A and B; group A had higher proportion of
participants that visited clinics for 1st time in the 1st trimester (62.5%) emergency type of
Cesarean section (62.9%), fetal distress, contracted pelvis and obstructed labor than group B.
In a comparison between group C and B; group C had higher proportion of participants who
had one or two visits, Hypertensive disorders of pregnancy, medical disorders fetal distress
than group B. No association found between antepartum hemorrhage, postpartum
hemorrhage, premature delivery, still birth and neonatal care admission anemia, and maternal
age.
In conclusion adolescent mothers tend to visit antenatal care (both public and private) more
than and at early stage of pregnancy. Women aged 35 year or more had delayed antenatal
care and less numbers of visits and a higher proportion of complications during pregnancy
like hypertension disorder of pregnancy, medical disorders and caesarean section

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References

  1. (1) Unicef. World population day. Plan your future, plan your famlies. July11, 2008.
  2. (2) Kost K, Henshaw S, Carlin L.U.S. TeenagePregnancies, Births and Abortions, National and State
  3. Trends by Age, Race and Ethnicity. 2014.
  4. (3) Locoh T. Early marriage and motherhood in sub-Saharan Africa. African Environment 1999; 10(3):
  5. -42.
  6. (4) Mehta S, Groenen R, Roque F. Adolescents in changing times: issues and perspectives for adolescent
  7. reproductive health in the ESCAP region. United Nations Economic and Social Commission for Asia and the
  8. Pacific. 2012.
  9. (5) Fog A. Cultural selection. Kulwer Academic Publications, 1999.P. 254.
  10. (6) UNICEF. A league Table of teenage births in rich nations. Issue No 3. 2001.
  11. (7) Moore AK, Miller BC, Sugland BW, Morrison DR, Glei DR, Blumenthal DA. Bebinning too soon:
  12. Adolescent sexual behavior, pregnancy and parenthood. Child Trends Inc. 1995.
  13. (8) Guttmacher Institute. Sex and Relationships. Retrieved August 8, 2006.
  14. (9) Darroch JE, Frost JJ, Singh S. Teenage sexual and reproductive behavior in developed counteries.
  15. Can more progress be made? The Alan Guttmacher Institute. New York and Washington, DC. 2001.
  16. (10) East PL. Do adolescent pregnancy and childbearing affect younger siblings? Family Planning
  17. Perspectives, 1996; 28 (4): 148-153.
  18. (11) Wyshack G, Frisch RE. Evidence for a secular trend in age of menarche. N Engl J Med 1982; 306:
  19. -35.
  20. (12) McCauley AP, Salter C, Kiragu K, Senderowitz. Meeting the needs of young adults. Popul Rep J
  21. ; 10(41): 1-43.
  22. (13) Guttmacher Institute In Their Own Right: Addressing the Sexual and Reproductive Health Needs of
  23. Men Worldwide.www.guttmatcher.org. Archived report 2003. pp. 19-21.
  24. (14) Grunbaum JA, Kann L. Kinchen SA. Williams B et al. Youth risk behavior surveillance-United
  25. States, 2001. Centers for Disease Control and Prevention Morbidity and Mortality. Weekly Report June 28,
  26. ;51(SS04);1-64
  27. (15) Kaiser Family Foundation. U S teen sexual
  28. activity.http://web.archive.org/web/20080216015345/http:/www.kff.org/youthhivstds/upload/U-S-Teen-SexualActivity-Fact-Sheet.pdf. 2005.
  29. (16) Besharov D J, Gardiner K N. Trends in Teen Sexual Behavior. Children and Youth Services Review.
  30. :19 (5–6): 341–367.
  31. (17) Sax L. Why Gender Matters: What parents and teachers need to know about the emerging science of
  32. sex differences. Doubleday books, Random House Inc., 2005: p. 128.
  33. (18) Trani F, Gnisci F, Nobile CG, Angelillo IF. Adolescents and sexually transmitted infections:
  34. Knowledge and behaviour in Italy, J Paediatr Child Health 2005; 41: 260-64.
  35. (19) The National Campaign to Prevent Teen Pregnancy. What the Polling Data Tell Us: A Summary of
  36. Past Surveys on Teen Pregnancy. teenpregnancy.org. 1997.
  37. (20) Slater J. Britain: Sex Education Under Fire. The Courier. July/August 2000.
  38. http://web.archive.org/web/20070703000657/http:/www.unesco.org/courier/2000_07/uk/apprend.htm
  39. (21) SpeidelJJ, Harper CC, Shields WC. The potential of long-acting reversible contraception to decrease
  40. unintended pregnancy. Contraception 2008; 78 (3): 197-200.
  41. (22) Trussell J, Wynn LL. Reducing unintended pregnancy in the United States. Contraception 2008; 77
  42. (1): 1–5.
  43. (23) Colabianchi N. Teen Pregnancy. In: Loue S, Sajatovic M (Eds.). Encyclopedia of Women's Health.
  44. Springer. New York. 2004.PP. 1288-1290.
  45. (24) QuinlivanJTeenage pregnancy. Obstetrics and Gynecology 2006; 8 (2): 25–6.
  46. (25) Hsu G. Statutory rape. Family Research Council. http://jkalb.freeshell.org/misc/statutory.html.
  47. (26) SaewycEM, Magee LL, Pettingell SE. Teenage pregnancy and associated risk behaviors among
  48. sexually abused adolescents. Perspectives on Sexual and Reproductive Health, 2004; 36 (3): 98-105.
  49. (27) Science Blog. Childhood sexual abuse, teen pregnancy. University of Southern
  50. California,.http://www.scienceblog.com/community. 2004.
  51. (28) Speizer I S, Pettifor A, Cummings S, MacPhail C, Kleinschmidt I, Rees H V. Sexual violence and
  52. reproductive health outcomes among South African female youths: A contextual analysis. American Journal of
  53. Public Health 2009. 99 (Suppl 2): S425–31.
  54. (29) Cullinan K. Teen mothers often forced into sex. www.csa.za.org. November, 2003.
  55. (30) Aquino EM, Heilborn ML, Knauth D, Bozon M, Almeida MC, Araújo J et al. Adolescência e
  56. reprodução no Brasil: a heterogeneidade dos perfissociais. Cad SaudePublica 2003;19 (Supl 2):S377-88.
  57. (31) Pallitto CC, Murillo V. Childhood abuse as a risk factor for adolescent pregnancy in El Salvador. J
  58. Adolesc Health 2008;42 (6): 580-6.
  59. (32) Smith C. The link between childhood maltreatment and teenage pregnancy. Social Work Research
  60. ; 20 (3): 131–141.
  61. (33) Tamkins T. Teenage pregnancy risk rises with childhood exposure to family strife. Perspectives on
  62. Sexual and Reproductive Health, March/April 2004.
  63. (34) Ellis BJ, Bates JE, Dodge KA, Fergusson DM, HorwoodLJ, Pettit GS, Woodward L. Does father
  64. absence place daughters at special risk for early sexual activity and teenage pregnancy? Child Development
  65. ; 74 (3): 801–821.
  66. (35) Quigley A. Father's Absence Increases Daughter's Risk of Teen Pregnancy. Health Behavior News
  67. Service. May 2003.
  68. (36) Furstenberg FF, Levine JA, Brooks-Gunn J. The children of teenage mothers: patterns of early
  69. childbearing in two generation. FamPlannPerspect 1990; 22 (2): 54–61.
  70. (37) East PL, Jacobson LJ. The younger siblings of teenage mothers: a follow-up of their pregnancy risk.
  71. Dev Psychol 2001; 37 (2): 254–64.
  72. (38) L'EngleKL, Brown JD, Kenneavy K, Brown, Jane D, Kenneavy K. The mass media are an important
  73. context for adolescents' sexual behavior. Journal of Adolescent Health 2006; 38 (3): 186-192.
  74. (39) Mangiaterra V, Pendse R, McClure K, Rosen J. MPS Notes: Adloescent pregnancy. WHO.
  75. Department of making pregnancy safer, October 2008.Vol. 1, No. 1.
  76. (40) Unicef. A League Table of Teenage Births in Rich Nations.https://www.unicefirc.org/publications/328/.2001.
  77. (41) Mayor S. Pregnancy and childbirth are leading causes of death in teenage girls in developing
  78. countries. BMJ 2004; 328 (7449): 1152.
  79. (42) Treffers PE. Teenage pregnancy, a worldwide problem. Nederlandstijdschriftvoorgeneeskunde 2003;
  80. (47): 2320-2325.
  81. (43) Dawan H. Teen pregnancies higher in India than even UK, US. The Economic times. November 28,
  82. (44) Centers for Disease Control and Prevention. Morbidity and mortality weekly report MMWR. Health
  83. Disparities and Inequality Report – United States. Supplement Volume 60. U.S. Department of health and
  84. Human Service. January 14,2011.
  85. (45) Guttmatcher Insitiute. U.S. Teenage Pregnancy Rate Drops For 10th Straight Year. News Release.
  86. March 30,2004.
  87. (46) Better Health Channel. Teenage pregnancy. Victoria State Government. Department of Health and
  88. Human Service. Australia.https://www.betterhealth.vic.gov.au/health/healthyliving/teenage-pregnancy. April
  89. (47) Dryburgh, H. Teenage pregnancy. Statistics Canada Catalgue. Health Reports, Vol. 12 No. 1.
  90. http://www.statcan.gc.ca/pub/82-003-x/2000001/article/5299-eng.pdf
  91. (48) Bielski Z. Why teen pregnancy is on the rise again in Canada (and spiking in these provinces). The
  92. Globe and Mail.http://www.theglobeandmail.com/life/health-and-fitness/health/why-teen-pregnancy-is-on-therise-again-in-canada-and-spiking-in-these-provinces/article7927983/. January 29, 2013.
  93. (49) HashimTJ, Anokute CC. Imbalances in perinatal mortality in health regions of Saudi Arabia. Saudi
  94. Med J 1994; 15: 376-379.
  95. (50) Mesleh RA, Al-Aql AS, Kurdi AM; Teenage Pregnancy, Saudi Med J 2001; 22 (10): 864-867.
  96. (51) The World Bank, IBR. IDA. Adolecent fertility rate (birth per1,000 women age 15-19).
  97. http://data.worldbank.org/indicator/SP.ADO.TFRT. Accessed 2016.
  98. (52) Singh S, Darroch JE. Adolescent pregnancy and childbearing: levels and trends in developed
  99. countries. FamPlannPerspect 2000. Jan/Feb; 32(1):14-23.
  100. (53) Roudi-Fahimi F, Ibrahim S. Ending child marriage in the Arab region.
  101. http://www.prb.org/pdf13/child-marriage-arab-region.pdf. May 2013.
  102. (54) Abalkhail BA (1995). Adolescent pregnancy: Are there biological barriers for pregnancy outcomes?
  103. The Journal of the Egyptian Public Health Association 1995; 70 (5–6): 609-625.
  104. (55) Institute of Education Sciences ERIC. Not Just Another Single Issue: Teen Pregnancy Prevention's
  105. Link to Other Critical Social Issues.National Campaign To Prevent Teen Pregnancy, Washington, DC.
  106. https://eric.ed.gov/?id=ED462522. Accessed 2016.
  107. (56) Seitz V, Apfel N H. Adolescent mothers and repeated childbearing: Effects of a school-based
  108. intervention program. The American journal of orthopsychiatry 1993; 63 (4): 572-81.
  109. (57) Hofferth SL, Reid L, Mott FL. The effects of early childbearing on schooling over time. Family
  110. Planning Perspectives 2001; 33 (6): 259–267.
  111. (58) O’Halloran P. Pregnancy, Poverty, School and Employment.
  112. http://www.moappp.org/Documents/pregnancypovertyschoolandemployment.pdfmoappp.org. April 1998.
  113. (59) Teenage Pregnancy. Presented to parliament by the prime minster.
  114. http://dera.ioe.ac.uk/15086/1/teenage-pregnancy.pdf. June 1999.
  115. (60) Clemmens D. Adolescent mother’s depression after the birth of their babies: weathering the storm.
  116. Adolescence 2002; 37(143): 551-65.
  117. (61) Child Trends. Conceptualizing a “Strong Start”: Antecedents of Positive Child Outcomes at Birth and
  118. Into Early Childhood. https://www.childtrends.org/publications/conceptualizing-a-strong-start-antecedents-ofpositive-child-outcomes-at-birth-and-into-early-childhood/. February2007.
  119. (62) The Psychological Effects of Teenage Women During Pregnancy. http://sean-cpowers.com/TeenagePregnancy.html. Retrieved January, 2009.
  120. (63) National Campaign to Prevent Teen Pregnancy and unplanned pregnancy. Statistics on Teen
  121. Pregnancy.
  122. (64) Cornelius MD, Goldschmidt L, Willford JA, Leech SL et al. Body size and intelligence in 6-year old:
  123. are offspring of teenage mother at risk? Maternal and Child Health Journal 2009; 13 (6): 847-856.
  124. (65) New York State Department of Health, Public Health Information Group.
  125. (66) Personal communication to Diane Mastin from New York State Office of Children and Family
  126. Services. 2006.
  127. (67) Gibbs CM, Wendt A, Peters S, Hogue CJ. The impact of early age at first childbirth on maternal and
  128. infant health. PaediatrPerinatEpidemiol 2012; 26 (Suppl 1): 259-84.
  129. (68) American Academy of Pediatrics: Care of adolescent parents and their children. Pediatrics 2001; 107
  130. (2): 429-34.
  131. (69) Hofferth SL, Reid L. Early Childbearing and Children's Achievement And Behavior over Time.
  132. Perspectives on Sexual and Reproductive Health 2002; 34 (1): 41-49.
  133. (70) Hoffman SD, Maynard RA. (Eds.).Kids Having Kids: ecomonic cost and social consequences of teen
  134. pregnancy. The Urban Institute Press, Washington D.C. 2008.
  135. (71) Gilbert W, Jandial D, Field N, Bigelow P et al. Birth outcomes in teenage pregnancies, J Matern Fetal
  136. Neonatal Med 2004; 16: 265-70.
  137. (72) Jolly MC, Sebire N, Harris J, Robinson HS, Regan L.Obstetric risk of pregnancy in women less than
  138. years old. ObstetGynecol 2000; 96: 962-66.
  139. (73) Gortzak-Uzan L, Hallak M, Press F, Katz M et al. Teenage pregnancy: risk factors for adverse
  140. perinatal outcome. J Matern Fetal Med 2001; 10: 393-97.
  141. (74) Igwegbe AO, Udigwe GO. Teenage pregnancy: still an obstetric risk. J ObstetGynaecol 2001; 21:
  142. -81.
  143. (75) Bacci A, Manhica GM, Machungo F, Bugalho A et al. Outcome of teenage pregnancy in Maputo,
  144. Mozambique. Int J GynaecolObstet 1993; 40: 19-23.
  145. (76) Satin AJ, Leveno KJ, Sherman ML, Reedy NJ et al. Maternal youth and pregnancy outcome: middle
  146. school versus high school age groups compared with women beyond teen years. Am J ObstetGynecol 1994;171:
  147. -87.
  148. (77) Bukulmez O, Deren O. Perinatal outcome in adolescent pregnancies: a case-control study from a
  149. Turkish university hospital. Eur J ObstetGynecolReprodBiol 2000; 88: 207-12.
  150. (78) Olausson PM, Cnattingius S, GoldenberyRL. Determinants of poor pregnancy outcomes among
  151. teenagers in Sweden. ObstetGynecol 1997; 89: 451-57.
  152. (79) Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive
  153. outcomes. N Engl J Med 1995; 332:1113-17.
  154. (80) Conde-Agudelo A, BelizanJM, Lammers C. Maternal-perinatal morbidity and mortality associated
  155. with adolescent pregnancy in Latin America: cross-section study. Am J ObstetGynecol 2005; 192: 342-49.
  156. (81) Smith GCS, Pell JP. Teenage pregnancy and risk of adverse perinatal outcomes associated with first
  157. and second births: population based retrospective cohort study. Br Med J 2001; 323: 476-79.
  158. (82) Olausson PO, Cnattingius S, Haglund B. Teenage pregnancies and risk of late fetal death and infant
  159. mortality. BJOG 1999; 106: 116-21.
  160. (83) Zabin LS, Kiragu K. The health consequences of adolescent sexual and fertility behaviour in subSaharan Africa. Stud FamPlann 1998; 29: 210-32.
  161. (84) Makinson C. The health consequences of teenage fertility. Family Planning Perspectives 1985; 17
  162. (3): 132–139.
  163. (85) Guttmacher Institute. Teen Sex andPregnancy.https://www.guttmacher.org/pubs/fb_teen_sex.html.
  164. September 1999.
  165. (86) Gutierrez Y, King JC. Nutrition during teenage pregnancy. Pediatric annals 1993; 22 (2): 99–108.
  166. (87) Sanchez PA, Idrisa A, BobzomDN, Airede A et al. Calcium and vitamin D status of pregnant
  167. teenagers in Maiduguri, Nigeria. Journal of the National Medical Association 1997; 89 (12): 805-811.
  168. (88) Peña E, Sánchez A, Solano L. Profile of nutritional risk in pregnant adolescents. Archivos
  169. latinoamericanos de nutricion 2003; 53 (2): 141-149.
  170. (89) UNFPA-United Nations Populations Fund Adolescent pregnancy.http://www.unfpa.org/adolescentpregnancy. Retrieved April 2016.
  171. (90) Santelli J, Lindberg L, Finer L, Singh S. Explaining Recent Declines in Adolescent Pregnancy in the
  172. United State: The Contribution of Abstinence and Improved Contraceptive Use. American Journal of Public
  173. Health 2007; 97(1): 150-156.
  174. (91) Valk G. The Dutch Model. In: Youth,
  175. s sonic forces. The Courier, July/August 2000; 53 (7): 19.
  176. (92) Ott MA, Santelli JS. Abstinence and abstinence-only education. Current opinion in obstetrics &
  177. gynecology 2007; 19 (5): 446-52.
  178. (93) Underhill K, Operario D, Montgomery P.Systematic review of abstinence-plus for HIV prevention in
  179. high-income countries. PLoS Med 2007; (4)9: e275.
  180. (94) The National Campaign to Prevent Teen and Unplanned Pregnancy. "Policy Brief: Title X Plays a
  181. Critical Role in Preventing Unplanned Pregnancy" (PDF). Retrieved 15 February 2011.
  182. (95) Fretts RC. Effect of advanced age on fertility and pregnancy in women.
  183. UpToDate.http://www.uptodate.com/contents/effect-of-advanced-age-on-fertility-and-pregnancy-in-women
  184. (96) Bianco A, Stone L, Lynch R, Lapinski R, Berkowitz G, Berkowitz RL. Pregnancy outcome at age 40
  185. and older. Obstet. Gynecol 1996; 87: 917-22.
  186. (97) Mills M, Rindfuss RR, McDonald P, teVelde E, ESHRE Reproduction and Society Task Force. Why
  187. do people postpone parenthood? Reasons and social policy incentives. Hum Reprod Update 2011; 17(6):848-60.
  188. (98) Cooke A, Mills TA, Lavender T.Advanced maternal age: delayed childbearing is rarely a conscious
  189. choice a qualitative study of women's views and experiences.Int J Nurs Stud 2012; 49(1):30-9.
  190. (99) The Sydney Morning Herald. Woman, 61, pregnant. http://www.smh.com.au/world/woman-61-
  191. pregnant-20110926-1ktkg.html. September 27, 2011.
  192. (100) Huang L, Sauve R, Birkett N, Fergusson D et al. Maternal age and risk of stillbirth: a systematic
  193. review. CMAJ 2008; 178: 165-172.
  194. (101) Mathews T, Hamilton B. Mean age of mother, 1970–2000. National Vital Statistics Reports, Vol. 50
  195. No. 1. Hyattsville, Maryland: National Center for Health Statistics. 2002.
  196. (102) Martin J, Hamilton B, Sutton P, Ventura S et al. Births: Final data for 2006. National Vital Statistics
  197. Reports, Vol. 57 No. 7. Hyattsville, Maryland: National Center for Health Statistics. 2009.
  198. (103) Martin J, Hamilton B, Ventura S, Osterman M et al. Births: Final Data for 2009. National Vital
  199. Statistics Reports Vol. 60 No. 1. Hyattsville, Maryland: National Center for Health Statistics. 2011.
  200. (104) Eurostat. Statistics Explaned. Fertility statistics.
  201. http://ec.europa.eu/eurostat/statisticsexplained/index.php/Fertility_statistics. March 2017.
  202. (105) Leridon H. Can assisted reproduction technology compensate for the natural decline in fertility with
  203. age? A model assessment. Human Reproduction 2004; 19 (7): 1548–1553.
  204. (106) Morris JK, Mutton DE, Alberman E. Revised estimates of the maternal age specific live birth
  205. prevalence of Down's syndrome. Journal of medical screening 2002; 9 (1): 2–6.
  206. (107) Nelson S M, Telfer E E, Anderson R A. The ageing ovary and uterus: new biological insights. Human
  207. Reproduction Update 2012; 19 (1): 67–83.
  208. (108) Jolly M, Sebire N, Harris J, Robinson S et al. The risks associated with pregnancy in women aged 35
  209. years or older. Hum Reprod 2000; 15: 2433–37.
  210. (109) Joseph KS, Allen AC, Dodds L, Turner LA et al. The perinatal effects of delayed childbearing.
  211. ObstetGynecol 2005; 105: 1410–18.
  212. (110) Aliyu MH, Salihu HM, Wilson RE, Alio AP et al. (2008) The risk of intrapartum stillbirth among
  213. smokers of advanced maternal age. Arch GynecolObstet 2008; 278: 39-45.
  214. (111) Delbaere I, Verstraelen H, Goetgeluk S, Martens G et al. Pregnancy outcome in primiparae of
  215. advanced maternal age. Eur J ObstetGynecolReprodBiol 2007;135: 41–46.
  216. (112) Hoffman MC, Jeffers S, Carter J, Duthely L et al. Pregnancy at or beyond age 40 years is associated
  217. with an increased risk of fetal death and other adverse outcomes. Am J ObstetGynecol 2007;196: e11–13.
  218. (113) O’Leary CM, Bower C, Knuiman M, Stanley FJ. Changing risks of stillbirth and neonatal mortality
  219. associated with maternal age in Western Australia 1984–2003. PaediatrPerinatEpidemiol 2007;21: 541–549.
  220. (114) Flenady V, Koopmans L, Middleton P, FroenJF et al.Major risk factors for stillbirth in high-income
  221. countries: a systematic review and meta-analysis. Lancet 2011; 377: 1331–1340.
  222. (115) Janssens S, Wallace KL, Chang AM. Prepartum and intrapartum caesarean section rates at Mater
  223. Mothers’ Hospital Brisbane 1997–2005. Aust N Z J ObstetGynaecol 2008; 48: 564–569.
  224. (116) Jolly M, Sebire N, Harris J, etal. The risks associated with Pregnancy in women aged 35 years or
  225. older. Hum Reprod 2000;15: 2433–7.
  226. (117) Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome.
  227. ObstetGynecol 2004;104:727–33.
  228. (118) Cleary-Goldman J, Malone F D,Vidaver J, etal. Impact of maternal age on obstetric outcome.
  229. ObstetGynecol 2005;105:983–90.
  230. (119) Joseph KS, Allen AC, Dodds L, etal. The perinatal effects of delayed child bearing. ObstetGynecol
  231. ;105:1410–18.
  232. (120) . Luke B, Brown MB. Elevated risks of pregnancy complications and adverse outcome within
  233. creasing maternal age. Hum Reprod 2007;22:1264–72.
  234. (121) Delbaere I, VerstraelenH ,Goetgeluk S, etal. Pregnancy outcome in Primiparae of advanced maternal
  235. age. EurJ ObstetGyneco l ReprodBiol 2007;135:41–6.
  236. (122) HsiehTT,LiouJD,HsuJJ, etal .Advanced maternal age andAdverseperinataloutcomesinan Asian
  237. population. Eur J ObstetGynecolReprodBiol 2010;148:21–6.
  238. (123) MatsudaY,KawamichiY, Hayashi K, et al. Impact of maternal age on the prevalence of obstetrical
  239. complicationsi n Japan J ObstetGynaecol Res 2011;37:1409–14.
  240. (124) Biro MA, Davey MA, Carolan M, et al. Advanced maternal age and Obstetric morbidity for women
  241. giving birth inVictoria, Australia:a population-based study. Aust N Z J ObstetGynaecol 2012;52: 229–34.
  242. (125) Edmonds K (Ed.). Dewhurst,
  243. s textbook of obstetrics and gynecology. Wiley Blackwell, 2012.
  244. (126) Hoque M, Hoque S. Comparison of obstetrics and perinatal outcome of teenagers and older women:
  245. Experience from rural South Africa. Afr J Pm Health Care Fam Med 2010; 2(1):171.
  246. (127) Saxena P, Salhan S, Chattopadhyay B, Kohli MPS, et al.Obstetric and perinatal outcome of teenage
  247. and older primigravidas: A retrospectiveanalysis. Health and Population: Perspectives and Issues 2010; 33(1):
  248. -22.
  249. (128) Gazala Y, Arunan K, Bharti P. Teenage Pregnancy: its impact on maternal and foetal outcome.
  250. International Journal of Scientific Study 2014;1(6): 9-13.
  251. (129) Borton C. Gravidity and parity definitions (and their implications in risk assessment). Patient.
  252. http://patient.info/doctor/gravidity-and-parity-definitions-and-their-implications-in-risk-assessment. 2014.
  253. (130) World Health Organization. Antenatal
  254. Care.www.who.int/gho/urbn_health/services/antenatal_care_text/en/ . Retrieved July 2016.
  255. (131) Chamberlian G (Ed). Obstetric by ten teacher. Arnold. Oxford University press. New York,1995.
  256. (132) Kim, SC, Pope J. Physical Growth in Newborns. Emedicine health, January 10, 2013.
  257. (133) Thato S, Rachukul S, Sopajaree C. Obstetrics and perinatal outcomes of Thai pregnant adolescents: A
  258. retrospective study. International Journal of Nursing Studies 2007; 44(7): 1158-1164.
  259. (134) Amini SB, Catalano PM, DierkLJ, Mann LI. Birth to teenagers: Trends and Obstetric Outcomes.
  260. Obstetrics & Gynecology 1996; 87(5,1): 668-74.
  261. (135) Population Council. Unexplored Elements of Adolescence in the Developing World. Popul Briefs
  262. ;12(1).http://www.popcouncil.org/pdfs/popbriefs/pbjan06.pdf.
  263. (136) Jolly M, Sebire N, Harris J, Robinson S, Regan L. The risks associated with pregnancy in women
  264. aged 35 years or older. Hum Reprod 2000; 15(11): 2433-37.
  265. (137) Ayuba II, Gani, O. Outcome of Teenage Pregnancy in the Niger Delta of Nigeria. Ethiopian journal
  266. of health sciences 2012; 22(1):45-50.
  267. (138) Fraser AM, Brockert JE, Ward RH. Association of Young Maternal Age with Adverse Reproductive
  268. Outcomes. N Engl J Med 1995; 332:1113-1118.
  269. (139) LaoTT, Ho LF. Obstetric outcome of teenage pregnancies. Hum Reprod 1998; 13 (11): 3228-32.
  270. (140) GadowskySL,Wolfe GK, Jory SA, Gibson J et al. Biochemical folate, B12and iron Status of a group
  271. of pregnant adolescents accessed through the public health system in southern Ontario.Journalo Adolescent
  272. Health 1995;16, 465-74.
  273. (141) Hoque M, Hoque S. A comparison of obstetrics and perinatal outcomes of teenagers and older
  274. women: Experiences from rural South Africa. Afr J Prim Health Care Fam Med 2010; 2(1): 171.
  275. (142) Khwaja SS, Al-Sabai MH, Al-Suleiman AS, El-Zibdeh MY. Obstetric implications of pregnancy in
  276. adolescence. Acta Obstet Gynecol Scand 1984; 65:57-61.
  277. (143) Moerman ML. Growth of the birth canal in teenage girls. Am J ObstetGynecol 1982;143:528–532.
  278. (144) Lao TT, Ho LF. The obstetric implications of teenage pregnancy. Hum Reprod 1997;12: 2303–05.
  279. (145) Sagili H, Pramaya N, Parbhu K, Mascarenhas M et al. Are teenage pregnancies at high risk? A
  280. comparison study in a developing country. Arch GynecolObstet 2012;285(3):573-77.
  281. (146) Smith GC, Pell JP Teenage pregnancy and risk of adverse perinatal outcomes associated with first
  282. and second births: Population based retrospective cohort study. BMJ 2001; 323(7311):476.
  283. (147) Ebeigbe PN, Gharoro EP: Obstetric complications, intervention rates and maternofetal outcome in
  284. teenage nullipara in Benin City, Nigeria. Trop Doct2007; 37: 79-83.
  285. (148) Allen LH. Pregnancy and iron deficiency: Unresolved issues. Nutr Rev 1997; 55:91–103.
  286. (149) British Nutrition Foundation. Iron: Nutritional and physiological significance. Chapman and Hall,
  287. London, 1995.
  288. (150) Department of Health Guidelines for maternity care in South Africa: A manual for clinics,
  289. community health centres and district hospitals. Pretoria, Department of Health, 2002.
  290. (151) Hays PM, Cruikshank DP, Dunn LJ. Plasma volume determination in normal and preeclamptic
  291. pregnancies. Am J ObstetGynaecol 1985;151:958–66.
  292. (152) Jolly MC, Sebire N, Harris J, Robinson S, Regan L. Obstetric risks of pregnancy in women less than
  293. years old. Br J Obstet Gynaecol 2000; 96 (6): 962–66.
  294. (153) Carolan M, Nelson S: First mothering over 35 years: questioning the association of maternal age and
  295. pregnancy risk. Health Care Women Int 2007; 28: 534-55.
  296. (154) Cleary-Goldman J, Malone FD, Vidaver J, Ball RH et al. FASTER Consortium. Impact of maternal
  297. age on obstetric outcome. Obstet Gynecol. 2005; 105(5,1): 983-90.
  298. (155) Joseph KS, Allen AC, Dodds L, Turner LA et al.Theperinatal effects of delayed
  299. childbearing.Obstetrics and Gynaecology 2005; 105(6): 1410-1418.
  300. (156) Grotegut CA, Chisholm CA, Johnson LNC, Brown HL, et al. Medical and Obstetric Complications
  301. among Pregnant Women Aged 45 and Older. PLOS One 2016;11(3): e0151307.
  302. (157) Timofeev J, Reddy UM, Huang CC, DriggersRW et al. Obstetric Complications, Neonatal Morbidity,
  303. and Indications for Cesarean Delivery by Maternal Age. ObstetGynecol 2013;122(6): 1184-95.
  304. (158) Dietl A, Farthmann J. Gestational hypertension and advanced maternal age. 2015;386 (10004):
  305. p1627–28.
  306. (159) Balasch J, Gratacós E. Delayed childbearing: effects on fertility and the outcome of pregnancy. Fetal
  307. DiagnTher 2011; 29(4): 263-73.
  308. (160) Shareif M, Dhaymaa A. Effect of advanced maternal age on pregnancy outcome. Thesis for degree
  309. of Diploma in Obstetrics and gynecology. Basrah Medical College. Department of Obstetrics and gynecology,
  310. (161) .Aghamohammad A, Noorityajer M. Maternal age as a risk factor for pregnancy outcome. African
  311. Journal of Pharmacy and Pharmacology 2011; 5 (2): pp. 264 – 269.
  312. (162) JahromiBN, Husseini Z. Pregnancy outcome at maternal age 40 and older. Taiwan J ObstetGynecol
  313. ; 47(3):318-21.
  314. (163) Santos GHN, Martins MG, Sousa MS, BatalhaSJC.
  315. Impactodaidadematernasobreosresultadosperinatais e via de parto. Rev Bras GinecolObstet 2009; 31(7):326-34.
  316. (164) AlmhfoothWF, Dahos MB. Advance Maternal Age and Pregnancy Outcome. Karbala J Med 2013;
  317. (1).
  318. (165) NamavarJB, Husseini Z. Pregnancy outcome at maternal age 40 and older. Taiwan J. Obstet. Gynecol
  319. ; 47(3): 318- 21.
  320. (166) Paulson RJ, Boostanfar R, Saadat P, Mor E et al. Pregnancy in the sixth decade of life. Obstetric
  321. outcome in women of advanced reproductive age. JAMA 2002; 288:2320-23.
  322. (167) Dietl A, Cupisti S, Beckmann MW, Schwab M, Zollner U. Pregnancy and Obstetrical Outcomes in
  323. Women Over 40 Years of Age. Geburtshilfe und frauenheilkunde 2015; 75(8): 827-32.
  324. (168) Kanungo J, James A, McMillan D, Lodha A et al. Advanced maternal age and the outcomes of
  325. preterm neonates: A social paradox? Obstetrics & Gynecology2011; 118 (4): 872-77.
  326. (169) Gill JV, Boyle EM. Outcomes of Infants Born Near Term. Arch Dis Child 2016; 102 (2): 194-8.
  327. (170) SalihuHM,ShumpertMN,SlayM,KirbyRS,AlexanderGR.Childbearingbeyondmaternalage50andfetalo
  328. utcomesintheUnitedStates. Obstet Gynecol 2003;102:1006–1014.
  329. (171) Bell JS, Campbell DM, GrahamWJ, Penney GC, et al. Do obstetric complications explain high
  330. caesarean section rates among women over 30? A retrospective analysis. BMJ 2001; 14(322): 894-95.
  331. (172) Kenny LC, Lavender T, McNamee R, O’Neill SM, et al. Advanced maternal age and adverse
  332. pregnancy outcome: Evidence from a large contemporary Cohort.
  333. http://dx.doi.org/10.1371/journal.pone.0056583. February 2013.
  334. (173) Karlström A, Nystedt A, Hildingsson I. A comparative study of the experience of childbirth between
  335. women who preferred and had a caesarean section and women who preferred and had a vaginal birth. Sex
  336. ReprodHealthc 2011; 2(3): 93-99.
  337. (174) Ates S, Batmaz G, Sevket O,Molla T, Dane C, Dane B. Pregnancy Outcome of Multiparous Women
  338. Aged over 40 Years. International Journal of Reproductive Medicine 2013; Article ID 287519.
  339. (175) Katikireddi SV, Gorman DR, Leyland AH. A comparison of trends in caesarean section rates in
  340. former communist (transition) countries and other European countries. The European Journal of Public Health
  341. ; 23(3): 381-383.
  342. (176) Vaughan DA, Cleary BJ, Murphy DJ. Delivery outcomes for nulliparous women at the extremes of
  343. maternal age: a cohort study.BJOG 2014; 121(3):261-8