Reproductive Health Challenges Among Adolescents in Eastern Europe: Evidence from a Romanian Tertiary Hospital

<b>Background</b>: Adolescent pregnancy remains a major global public health issue, often linked to socioeconomic and educational disparities rather than biological immaturity. This study aimed to identify sociodemographic factors associated with adolescent pregnancies and to evaluate their impact on maternal and neonatal outcomes in a tertiary hospital in Northeastern Romania. <b>Methods</b>: A retrospective analysis was conducted at the "Cuza Vodă" Obstetrics-Gynecology Clinic Hospital, Iași, over two periods: 2013-2017 and January-October 2025. Records of 637 mothers aged <20 years were reviewed. Variables included age, education, prenatal monitoring, gestational age, delivery mode, neonatal outcomes, and obstetric complications. Statistical analyses were performed using SPSS v26, employing ANOVA, Welch ANOVA, and post hoc tests (<i>p</i> < 0.05). Ethical approval was obtained from the institutional ethics committee. <b>Results</b>: The mean maternal age was 17.26 ± 1.5 years, with 82.6% from rural areas. Most had only primary or lower secondary education. Fully monitored pregnancies were associated with significantly higher birth weights (mean = 3249 g) compared with unmonitored pregnancies (mean = 3009 g; <i>p</i> < 0.001). Infants of mothers with low education had the lowest mean birth weights (2963 g; <i>p</i> = 0.002). Preterm births represented 14.3% of cases, and cesarean deliveries accounted for 34.5%. A slight but significant increase in maternal age was observed between 2013-2017 and 2025 (<i>p</i> < 0.001), suggesting delayed adolescent childbearing. <b>Conclusions</b>: Low educational attainment and inadequate prenatal monitoring remain major determinants of adverse neonatal outcomes among adolescent mothers. Comprehensive sexual education, improved prenatal care accessibility, and social support programs are essential to reduce adolescent pregnancy rates and improve reproductive health in Romania.