Analysis of the Relationship Between Adolescent Pregnancy and the

Incidence of Preterm Labor at Kalirejo Health Center, Negeri Katon

District, Pesawaran Regency

Ratna Dewi Puspita Sari

Medical Professional Study Program, Faculty of Medicine, University of Lampung, Indonesia

Keywords: Adolescent Pregnancy, Pregnancy Management, Preterm Delivery.

Abstract: Preterm labor is defined as labor that occurs at a gestational age of less than 37 weeks, that is, between 20

weeks gestation to less than 37 weeks. Adolescent pregnancy is one of the risk factors for premature birth.

The gestational age of adolescents <20 years is one of the predisposing factors for the birth of preterm babies.

This study was conducted to find the relationship between adolescent pregnancy and the incidence of preterm

labor in Negeri Katon District, Pesawaran Regency. The design of this study is analytic descriptive with a

cross sectional approach. Sampling using total sampling technique. The data used in this study are secondary

data. The research data was collected by collecting patient data in accordance with the purpose of the study.

The results of this study are expected to provide information about the importance of analyzing the

relationship between adolescent pregnancy and the incidence of preterm labor and become input for health

agencies to pay more attention to pregnancy management education in adolescence.

1 INTRODUCTION

According to Indonesian Demographic and Health

Survey Data, the maternal mortality rate (MMR) in

Indonesia increased from 228 per 100,000 live births

in 2002 – 2007 to 359 per 100,000 live births in 2007

– 2012. MMR decreased in 2012 – 2015 to 305 per

100,000 live births and the number of maternal deaths

in Indonesia in 2019 was 4,221 cases (Dewi, 2020).

The prevalence of preterm labor in the world

increased from 7.5 to 8.6%. Indonesia ranks 5th with

the highest number of preterm labors, which is

around 657,700 cases (Imron, 2012). The main

causes of preterm birth include infections and the

presence of sexually transmitted diseases and

pregnancy in adolescents is quite high. Based on

Riskesdas in 2018, the proportion of preterm

deliveries in pregnancies aged 10-54 years reached

29.5%, with 26.8% occurring in urban areas and

32.7% occurring in people who have rural residences.

Among the population, there are pregnancies at the

age of <15 years by 35.8% and in the adolescent age

group (10 – 19 years) by 19.8% (Dewi, 2020).

Preterm labor is defined as labor that occurs at a

gestational age of less than 37 weeks, that is, between

20 weeks gestation to less than 37 weeks. Preterm

childbirth complications are the leading cause of

death for children under 5 years of age and cause

approximately 1 million deaths annually (Imron,

2012). Various risk factors for preterm labor are

found, such as maternal diseases during pregnancy,

multiple pregnancies, physical and mental stress,

placental abnormalities, nutritional, medical,

infections. Epidemiology, preterm labor is

associated with socioeconomic, uterine anomalies,

previous preterm labor history, abortion history,

smokers, race, and extreme maternal age, namely

<20 years and >35 years (Putri, 2016).

Teenage pregnancy negatively impacts the health

of adolescents and their babies, it can also have social

and economic impacts. Pregnancy at a young age or

adolescence includes the risk of premature birth, low

birth weight, labor bleeding, which can increase

maternal and infant mortality. Teenage pregnancy is

also linked to unwanted pregnancies and unsafe

abortions (Dewi, 2020).

Young birthing mothers have a higher proportion

of premature births at 27.7% compared to adult births

at 13.1%. Young birthing mothers have a low birth

weight (BBLR) of 38.9% compared to adult births of

30.4% (Setiyawan, 2020). Research conducted by

Ondang et al. (2016) found that the percentage of

diseases or complicating adolescent preterm labor at

this age was the highest number of premature rupture

Sari, R. D. P.

Analysis of the Relationship Between Adolescent Pregnancy and the Incidence of Preterm Labor at Kalirejo Health Center, Negeri Katon District, Pesawaran Regency.

DOI: 10.5220/0013667700003873

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Medical Science and Health (ICOMESH 2023), pages 173-177

ISBN: 978-989-758-740-5

173

of membranes (12.90%), preeclampsia / eclampsia

(6.45%), fluorine albus (3.22%), and anemia (3.22%).

Based on the level of high school / vocational

education, there were 20 cases (64.51%), junior high

school as many as 8 cases (25.80%) and elementary

school as many as 3 cases (9.67%).

One of the efforts to reduce cases of preterm labor

in pregnant women is to pay attention to the mother's

gestational age. Preterm labor can occur due to

teenage pregnancy which can cause various

complications in pregnancy and childbirth.

The purpose of this study is to determine the

relationship between pregnancy in adolescence and

the incidence of preterm labor at the Kalirejo Health

Center, Negeri Katon District, Pesawaran Regency.

2 METHOD

This type of research is an analytical descriptive study

with a cross-sectional research design. The

population is mothers experiencing childbirth during

the period of 2022. The population of preterm labor

cases and the control population were mothers who

did not experience preterm labor during the period

of 2022, all case populations were sampled at a ratio

of 1:1. The source of this research data came from a

cohort of pregnant women in the working area of

Kalirejo Health Center, Gedong Tataan District,

Pesawaran Regency.

3 RESULTS AND DISCUSSION

Overview of the location of activities One of the

community health center in Pesawaran Regency

provides health services that include medical

examinations, medical referrals, as well as the

issuance of health certificates, and so on. This health

center runs various health programs such as routine

medical checks, making health certificates, outpatient

services, postoperative wound care, and various other

services, such as tooth extraction, blood pressure

measurement, pregnancy tests, child examinations, as

well as blood type, uric acid, and cholesterol tests. In

addition, this Community health center also helps in

providing referrals to BPJS patients who require

follow-up care at the hospital. Community health

center Kalirejo, Pesawaran Regency, offers good

health services with qualified medical staff, including

nurses and doctors, as well as providing complete

medical equipment and medicines. As a result, this

Community health center has become one of the main

choices for the people of Pesawaran Regency in

meeting their health needs.

Kalirejo Health Center, located in Kalirejo Village,

Negeri Katon District with working areas covering

health services in Keagungan Ratu Village, Kalirejo,

Purworejo, Pujo Rahayu, Katon State, Tanjung Rejo,

Karang Rejo, Halangan Ratu, Pejambon, Saka State

and Ulangan Jaya State in Negeri Katon District and

overseeing the Pejambon Assistant Health Center and

Tanjung Rejo Auxiliary Health Center.

Table 1: Statistical Data

Descri

tion n %

e Grou

–

17 years ol

34,5

–

20 years 27 40,9

Over 20 years ol

36 54,5

e at Maternit

Eve

33 50,0

Neve

33 50,0

Age Class

Adolescent 30 45,0

Non-Adolescent 36 55,0

Total 66 100

Based on Table 1, it can be seen that the interview

results presented the percentage of age groups that the

age group 14 - 17 years the percentage is 4.5%,

meaning that of the entire population or sample

measured, about 4.5% of individuals are in the age

range of 14 to 17 years. Age Group 18 - 20 years the

percentage is 40.9%, indicating that about 40.9% of

the population or sample is in the age group of 18 to

20 years and the age group above 20 years the

percentage is 54.5%, this indicates that about 54.5%

of the entire population or sample has an age above

20 years. These data provide an overview of age

distribution within the population or sample being

measured and can be used for demographic analysis

or planning specific programs related to specific age

groups.

ICOMESH 2023 - INTERNATIONAL CONFERENCE ON MEDICAL SCIENCE AND HEALTH

174

Table 2: Test results of pregnancy relationship in adolescence with the incidence of preterm labor at Kalirejo Health Center.

Age Class

e at Maternit

Total p-Value Preter

Ater

n % n %

Adolescent 25 83,3% 5 16,7% 33 0,001

Non-Adolescent 8 22,2% 28 77,8% 33

Total 33 50,0% 33 50,0% 66

In Table 2, this data is a contingency table that

illustrates the relationship between maternal age class

at childbirth (Adolescent and Non-Adolescent

Adolescents) and infant birth status (Preterm and

Aterm). There were 25 cases (83.3%) of preterm births

and 5 cases (16.7%) of term births in the non-

adolescent group. There were 8 cases (22.2%) of

preterm births and 28 cases (77.8%) of term births and

a total of 33 cases of preterm (50.0%) and 33 cases of

term (50.0%) in this sample.

There is a p-value of 0.001 which is likely the

result of a statistical test that measures the significance

of the relationship between the age class of the mother

at childbirth and the birth status of the baby. A very

low p-value (0.001) indicates that there is a significant

relationship between the mother's age class at delivery

and the baby's birth status. From these data, we can

conclude that the Adolescent group has a higher

percentage of preterm births, while the Non-

Adolescent group has a higher percentage of term

births. These results may be relevant in the context of

maternal and infant health and health care planning.

The ideal age for marriage for women is 21-25

years, while for men it is 25-28 years. This is

recommended because at these ages, the female

reproductive organs have achieved good physical

development, are strong, and are ready to give birth.

Similarly, in men in the age range of 25-28 years, they

are expected to be financially and emotionally ready

to support their family life. However, in reality, many

women and men marry at a younger age, which is

often referred to as early marriage. The incidence of

early marriage is common in various parts of the world

with diverse backgrounds (Dewi &; Son, 2020).

So far, there is a mistaken view that acts of

violence against women, especially wives, are often

regarded as normal and treated as domestic conflicts

only. This view becomes more serious with myths that

degrade women, make them inferior objects, and at the

same time, reinforce the dominant role of men,

especially as powerful figures in the household. In

this situation, there is an imbalance in the power

relations between women and men in the household,

which often tends to be unequal. The excessive power

possessed by men in the household is the reason for

acts of violence. Unfortunately, this is often accepted

as a true condition or as the norm, which ends up

perpetuating domestic violence. It is important to

realize that these views harm not only women, but also

entire families and communities. Efforts to change this

view and the rejection of acts of domestic violence are

key to creating a healthy, safe, and fair home

environment for all family members (Setiyawan,

2020).

Preterm events in pregnancy are often triggered by

patient characteristics associated with poor socio-

economic status, such as low income, limited level of

education, which results in inadequate nutritional

patterns. In addition, age also plays an important role,

with the risk of preterm increased in pregnancy that

occurs at the age of 16 years or in primigravida that is

more than 30 years old (Wahyuni & Rohani, 2017).

The factors that cause the risk of preterm labor

(less months) can be grouped based on the age of the

mother. Mothers who become pregnant at a relatively

young age, under 20 years old, may face the risk of

prematurity because their reproductive organs have

not reached optimal development and physiological

function. Psychologically, they may also not have

reached enough emotional maturity to understand and

deal with pregnancy, which in turn affects preparation

and care during pregnancy. This can have a negative

impact on the development of the fetus conceived, and

be one of the factors increasing the risk of preterm

labor. Conversely, mothers who become pregnant at

a later age, especially over 30 years, also have a high

risk for preterm labor. This is due to a general decline

in physiological and reproductive functions at that

age. In addition, older mothers may have a history of

obstetrics such as previous preterm labor, miscarriage,

or being an older primiparous mother (giving birth to

their first child after age 35). This obstetric history can

also increase the risk of preterm labor. Too young or

too old during pregnancy can affect the risk of preterm

labor through various mechanisms that include

physiological and psychological aspects. Therefore, it

is important to give special attention and proper

medical care during pregnancy in this age group to

reduce the risk of preterm labor (Imron & Oktaviana,

2012).

Preterm labor can occur in teenage pregnancy or

early age. Pregnancy in adolescence increases the risk

Analysis of the Relationship Between Adolescent Pregnancy and the Incidence of Preterm Labor at Kalirejo Health Center, Negeri Katon

District, Pesawaran Regency

175

of illness and death for both mother and baby caused

by preterm delivery. The mechanism of preterm labor

is similar to aterm (full-month) labor, which involves

uterine contraction, cervical maturation, and

membrane rupture. The difference lies in the

activation of the labor process. In term labor, this

activation is part of normal physiological processes,

while in preterm labor, such activation is pathological.

The incidence of preterm labor in adolescent mothers

can also be associated with a lack of blood circulation

to the cervix and uterus. In adolescents, this

circulation is often not fully developed, which can

reduce the flow of nutrients to the fetus and increase

the risk of infections that can lead to preterm labor.

Sex hormones that are active during puberty can also

contribute to menstrual irregularities in adolescents.

Some teens who become pregnant may not be aware

of their pregnancy because they experience bleeding

that they mistake for irregular periods. This may result

in delays in pregnancy checks. In addition, nutrition

also plays an important role in teenage pregnancy.

They still need adequate nutrition for their own

growth, while also having to support fetal growth.

Pregnancy in adolescence can require special attention

related to nutrition and medical care to ensure optimal

fetal development (Imron & Oktaviana, 2012).

The age of the mother during pregnancy affects the

health of the mother and fetal development. Age

Under 20 Years: At the age of under 20 years,

reproductive organs, including the uterus, are not fully

formed and developed properly. In addition, the uterus

may still be relatively small because the formation

process has not been completed, and the pelvic bones

may not have reached a sufficient width. This can

result in a high risk of pregnancy complications, such

as preterm labor. In addition, mothers who are still in

the growth stage may not get enough food intake for

themselves and the fetus, which can adversely affect

fetal growth. Age Over 35 Years: At the age of over

35 years, the risk of pregnancy complications

increases. Older women tend to face a higher risk of

problems such as hypertension, gestational diabetes,

and other pregnancy complications. This can result in

higher morbidity (disease) in both mother and baby,

as well as a higher risk of death in the soon-to-be baby

(Princess &; Dew, 2016).

4 CONCLUSION

Preterm labor in adolescent pregnancy involves a

variety of factors, including circulation, hormones,

and nutrition, therefore, proper medical care and

support are essential to reduce the risk of preterm

labor in the adolescent population. The age of the

mother during pregnancy is an important factor that

affects the development and health of the fetus as well

as pregnancy complications. Therefore, proper

prenatal care and medical monitoring are essential,

regardless of the age of the mother, to reduce the risk

and ensure the health of the mother and baby during

the gestation period.

ACKNOWLEDGMENTS

We would like to thank the Faculty of Medicine,

University of Lampung for providing research

funding

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