Early perinatal outcomes in adolescent pregnancy: a Romanian decade of demographic and social change (2011–2012 vs. 2022–2023)

Background: Pregnancy in adolescence disrupts education, perpetuates economic dependence, and contributes to repeated cycles of poverty. Romania continues to report high adolescent birth rates within the European Union. We evaluated changes in adolescent socioeconomic profiles, perinatal care patterns, and early neonatal outcomes in a Romanian public academic maternity hospital between two snapshots taken ten years apart. Materials and methods: We conducted a retrospective repeated cross-sectional study of 2237 mother-newborn dyads from two periods: 2011-2012 and 2022-2023. Adolescents (<20 years) were compared with adults aged 25-29 years. The outcomes were delivery mode, preterm birth, low birth weight, small for gestational age (SGA), 5-Apgar score <7, Neonatal Intensive Care Unit (NICU) admission, and breastfeeding initiation. Multivariable logistic models included age group, time period, and their interaction, adjusting for education, antenatal care, and parity. Results: In 2022-2023, adolescent pregnancy was associated with decreased odds of cesarean delivery (OR 0.34, 95% CI 0.26-0.46), SGA (OR 1.76, 95% CI 1.1-2.93), and NICU admission (OR 2.31, 95%CI 1.56-3.01). Breastfeeding initiation declined over time and was less likely among adolescents in the newer period (OR 0.49, 95% CI 0.29-0.84). Conclusions: Despite improved antenatal care, education and reduced early marriage/cohabiting, adolescents continued to experience higher-risk neonatal outcomes over the past decade. Implementing interventions that strengthen social determinants of health and expand postpartum support is essential.