Background: Adolescent pregnancies remain associated with increased maternal and neonatal morbidity. This study describes the clinical and demographic characteristics of very young pregnant adolescents in Brașov County, Romania. Methods: We conducted a retrospective observational study of 1322 singleton deliveries to adolescents aged 12–16 years at Clinical Hospital “Dr. I.A. Sbârcea”, Brașov (2018–2024). Descriptive statistics, Chi-square tests, t-tests, and correlation analyses were performed. No multivariable adjustment was applied. Results: Mean maternal age was 15.3 ± 0.8 years; 82.8% were from rural areas; 76% were primigravida. Cesarean section rate was 31.5%. Maternal complications included anemia (45%), postpartum hemorrhage (29.4%), preeclampsia (8%), and urogenital infections (28%). Among neonates, 33.7% had low birth weight, 18% were preterm, and 32.4% had APGAR scores < 7 at 1 min. Adolescents aged 12–14 years had lower postpartum hemoglobin (8.72 vs. 10.42 g/dL, p < 0.001) and higher rates of APGAR < 7 at 1 min (51.4% vs. 28.8%, p < 0.001) compared to those aged 15–16 years. Rural residence was associated with higher anemia rates (46.8% vs. 36.4%, p = 0.003) and inadequate prenatal care (40.0% vs. 23.7%, p < 0.001). Conclusions: This single-centre cohort shows high rates of obstetric complications and adverse neonatal outcomes among very young adolescents, with observed differences by age and residence. These descriptive findings may inform further research into risk factors and preventive interventions for adolescent pregnancies in Romania.

Pregnancy in adolescence represents a major nutritional challenge, with competing demands between maternal development and fetal growth. Choline is the essential nutrient with a critical role for fetal brain development and exhibits distinct metabolic patterns in pregnant adolescents aged 15–19 years compared to adult pregnant women. This narrative review examines the specific impact of choline status on fetal neurodevelopment in adolescent pregnancies. A comprehensive literature review was conducted using PubMed and Web of Science databases from 2000 to 2025, focusing on choline metabolism, placental transport mechanisms, and neurodevelopmental outcomes in adolescent pregnancy. Adolescent pregnant women demonstrate reduced choline clearance (0.8 ± 0.2 vs. 1.2 ± 0.3 mL/min/kg), decreased choline kinase activity (25–30% reduction), and reduced placental transporter expression (CTL1 reduced by 15–20%) compared to adults. These metabolic differences result in maternal–fetal competition for limited choline resources, potentially compromising fetal brain development during critical neurodevelopmental windows. The consequences include increased risk of neural tube defects, altered hippocampal development, and long-term cognitive impairments in offspring. Adolescent pregnancy creates a unique biochemical environment that may predispose to choline deficiency with lasting neurodevelopmental consequences, and current supplementation guidelines do not address adolescent-specific needs, pointing out the urgent requirement for appropriate age recommendations and targeted interventions to optimize maternal and fetal outcomes in this vulnerable population.

Background: Adolescent pregnancies represent a significant global health challenge, with increased risks of maternal and neonatal complications. Traditional obstetrical risk assessment tools have limited applicability in this population due to unique physiological and anatomical characteristics. This study aimed to develop and validate novel predictive scores specifically designed for obstetrical risk stratification in adolescent pregnancies. Methods: A retrospective study was conducted over seven years (2018–2024) in Brasov County, Romania, including 1322 adolescent pregnancies (ages 12–16 years). Two novel predictive scores were developed: the Cervical Ripening Ultrasound Index (CRUI) for predicting successful vaginal delivery and labor induction, and the ADOLESRISK score for comprehensive obstetrical risk stratification. Statistical analysis included logistic regression, ROC curve analysis, and validation testing using SPSS 26.0 and R Studio version 4.3.2. Results: The CRUI score demonstrated superior predictive performance (AUC = 0.87, 95% CI: 0.84–0.90) compared to traditional Bishop score (AUC = 0.62, 95% CI: 0.58–0.66) for successful labor induction in adolescents. The ADOLESRISK score achieved 84% sensitivity and 76% specificity for predicting major obstetrical complications, significantly outperforming conventional risk assessment tools. Key risk factors incorporated included maternal age, educational level, nutritional status, and specific ultrasound parameters. Internal validation using train–test split methodology (70–30%) confirmed robust performance in the independent validation cohort (n = 397), with maintained discriminative ability (CRUI: AUC = 0.85, 95% CI: 0.80–0.90; ADOLESRISK: AUC = 0.82, 95% CI: 0.77–0.87) across different demographic subgroups. Conclusions: The CRUI and ADOLESRISK scores represent significant advances in adolescent obstetrical care, providing clinicians with tools for personalized risk assessment and management. Implementation of these scores could potentially reduce maternal complications by 25–30% and improve neonatal outcomes by 20–25%, representing a major contribution to adolescent reproductive health globally.