Maternal and neonatal outcomes among adolescent mothers in a high-risk NICU population in Ecuador.

backgroundAdolescent pregnancy remains a public health concern in Ecuador, particularly among socially vulnerable populations. Evidence from high-risk neonatal settings suggests that adverse neonatal outcomes associated with adolescent pregnancy may be strongly influenced by structural and healthcare-related factors rather than maternal age alone. However, data from neonatal intensive care units (NICUs) in low- and middle-income countries remain limited.

objectiveTo compare maternal characteristics, obstetric practices, and neonatal outcomes between adolescent and adult mothers in a high-risk NICU population in Ecuador, stratified by term (37-41 weeks) and preterm (< 37 weeks) births, and to identify clinical predictors of neonatal distress.

methodsA cross-sectional observational study was conducted using medical records from the Neonatal Intensive Care Unit of Pablo Arturo Suárez General Hospital (Quito, Ecuador) between 2018 and 2021. The study included 288 neonates admitted with prenatal, perinatal, or postnatal risk factors for pulmonary hypertension. Four groups were analyzed: term and preterm neonates born to adolescent mothers and to adult mothers (n = 72 per group). Neonatal distress was operationally defined by adverse early clinical indicators, including low APGAR score, low birth weight for gestational age, and the presence and severity of pulmonary hypertension. Multivariate ordinal logistic regression models were used to identify predictors of neonatal distress.

resultsAdolescent mothers had significantly lower educational attainment, lower socioeconomic status, and fewer prenatal care visits compared with adult mothers (p < 0.001). Cesarean section rates were markedly higher among preterm adolescent pregnancies (91.7% vs. 25.0% in adults). Neonatal outcomes differed across groups: among term births, only 26.4% of infants born to adolescent mothers had normal APGAR scores compared with 75.0% among adults (p < 0.001), and low birth weight was more frequent (65.3% vs. 25.0%). In multivariate analyses, low birth weight and moderate-to-severe pulmonary hypertension were the strongest independent predictors of neonatal distress, whereas maternal age showed no direct effect after adjustment.

conclusionsIn this high-risk NICU population, adolescent mothers experienced greater socioeconomic disadvantage, inadequate prenatal care, and higher rates of obstetric intervention, which were associated with poorer neonatal indicators. Adverse outcomes were primarily driven by clinical and structural factors-particularly low birth weight and pulmonary hypertension-rather than maternal age itself. These findings highlight the need for targeted improvements in prenatal care and social support for adolescent mothers within high-risk clinical settings.