Maternal Age at Birth and Pregnancy Outcomes in Liberia

Abstract

Background: Liberia has been experiencing high rates of maternal and neonatal morbidity and mortality, which are, in part, attributable to persistent adverse pregnancy outcomes, including stillbirths, miscarriages, and low birth weight. These challenges are further exacerbated by socioeconomic disparities, limited access to quality healthcare, and a deficiency in context-specific research. Addressing these issues is imperative, particularly as trends in maternal age evolve in response to changes in fertility patterns and socio-cultural factors. This study sought to examine the prevalence of adverse pregnancy outcomes and the influence of maternal age at birth on these outcomes among women of reproductive age in Liberia. Methods: The study utilized a population-based retrospective cross-sectional design, drawing on secondary data from the 2019/2020 Liberia Demographic and Health Survey (LDHS). A sample of 8,065 women of reproductive age was used for the study. Adverse pregnancy outcomes were defined as experiencing at least one of the following: stillbirth, miscarriage (terminated pregnancy), or low birth weight (LBW). Descriptive statistics were employed to summarize the participants' background characteristics and the prevalence of adverse pregnancy outcomes. To determine factors associated with composite adverse pregnancy outcomes, multiple logistic regression analysis was performed, with the results reported at a 95% confidence interval. Results: The results of the study have indicated an overall prevalence of any adverse pregnancy outcomes of 24.2%, with significant variation by age group (p < 0.001). Women aged 20-24 (adjusted odds ratio [aOR] = 2.23, 95% CI: 1.77 - 2.83), 40-44 (aOR = 4.94, 95% CI: 3.73 - 6.54), and 45-49 years (aOR=5.12, 95% CI: 3.92 - 6.71) had significantly higher odds of adverse outcomes compared to those aged 15-19 years. Higher odds were also observed among women with primary (aOR=1.23, 95% CI: 1.07 - 1.41), secondary (aOR=1.39, 95% CI: 1.20 - 1.60), and higher education (aOR=1.42, 95% CI: 1.04 - 1.92). Employment (aOR=1.23, 95% CI: 1.08 - 1.39) and marital status, including married (aOR=1.45), widowed (aOR=2.12), divorced (aOR=1.81), and separated women (aOR=1.69), were associated with increased risk, while those in the NorthCentral Region had lower odds (aOR = 0.61). Conclusion: The findings of the study show significant associations between maternal age, education, marital status, and employment with adverse pregnancy outcomes in Liberia. Maternal age was found to be a strong determinant of adverse pregnancy outcomes, with both adolescent and advanced maternal age at birth groups experiencing markedly higher risks. These findings recommend the implementation of age-specific and regionally tailored maternal health programmes, with particular emphasis on younger and older mothers, towards effectively reducing the risk of adverse pregnancy outcomes and enhancing maternal and neonatal health in Liberia.