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Kareem YO, Abubakar Z, Adelekan B, Ameyaw EK, Gbagbo FY, Goldson E, Mueller U, Yaya S. Prevalence, Trends, and Factors Associated with Teen Motherhood in Nigeria: An Analysis of the 2008-2018 Nigeria Demographic and Health Surveys. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:248-262. [PMID: 38595858 PMCID: PMC10903619 DOI: 10.1080/19317611.2023.2189763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2024]
Abstract
Background: Teen pregnancy and childbearing are common in Nigeria, and understanding the complexities, such as sociodemographics and economic factors including sexual and reproductive health knowledge and awareness among adolescents over time can trigger innovative approaches and interventions. This study intends to capture the patterns and associated factors of teen motherhood among sexually active adolescents (15-19 years) between 2008 and 2018. Methods: The study data was extracted from 2008, 2013, and 2018 Nigeria Demographic and Health Surveys. Descriptive analysis was presented using frequencies and percentages; multivariable analysis was conducted using log-binomial logistic regression at a p-value <0.05. All analyses were performed using Stata 15.0, weighted and adjusted for the complex survey design and population size. Results: The prevalence of teen motherhood increased between the three successive survey waves (50.9% vs. 52.4% vs. 55.2%) from 2008, 2013, and 2018. Although, the pooled adjusted analysis revealed no significant change over the 10-year period. Knowledge of modern contraceptive methods, primary education, non-Catholic Christians, residing in the South-South region, and those currently or formerly married were associated with increased risk of teen motherhood. There was an inverse relationship between teen motherhood and wealth status; lower wealth status was associated with high adolescent pregnancy and childbearing. Conclusion: This study revealed an increase in the proportion of teen pregnancy and childbearing in Nigeria. Notably, there exist variations across age groups, geographic location, educational level, religious belief, marital and economic status. Interventions that ensure comprehensive sexuality education, girl child education, and economic empowerment especially for school dropouts are advocated to reduce teen motherhood.
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Affiliation(s)
| | - Zubaida Abubakar
- United Nations Population Fund, Nigeria Country Office, Abuja, Nigeria
| | | | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong, China
| | | | - Erika Goldson
- United Nations Population Fund, Nigeria Country Office, Abuja, Nigeria
| | - Ulla Mueller
- United Nations Population Fund, Nigeria Country Office, Abuja, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Hinojosa-Gonzalez DE, Ramonfaur D, Morales-Palomino KL, Tellez-Giron VC, Latapi X, Insua J, Hernández-Escobar C, Apodaca-Ramos I, Flores-Villalba E. Relationship of Age at Menarche, Coitarche and First Gestation: A Retrospective Cohort Analysis. Eur J Obstet Gynecol Reprod Biol X 2023; 18:100189. [PMID: 37095764 PMCID: PMC10121602 DOI: 10.1016/j.eurox.2023.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/19/2023] [Accepted: 03/29/2023] [Indexed: 03/31/2023] Open
Abstract
Introduction Teenage pregnancy is defined as a pregnancy occurring between ages 10 and 19 (Loredo-Abdlá et al., 2017; Belitzky, 1985; Kaplanoglu et al., 2015), and is associated with increased morbidity and mortality for both mother and child. Several factors have been identified with increased risk of a teenage pregnancy, including incomplete sexual education awareness and increased exposure at a young age. In addition, an earlier onset of sexual intercourse, or coitarche, has been linked to a higher risk of teenage pregnancy. Early menarche, defined as first menstruation before the age of 12 has been previously identified as a risk factor for an earlier coitarche, possibly linking an early menarche with a higher incidence of teenage pregnancy. This study aims to compare and determine the relationship between the incidence of teenage pregnancy with early menarche and coitarche in a low income setting. Design Setting Participants Interventions Main Outcome Measures A cross sectional review of electronic records of women admitted for delivery in a second level center in northeastern Mexico, being a low-income setting, where 814 teenage and 1474 adult mothers were included. Results Primigravid teenagers had earlier menarche and coitarche than adult counterparts and opted for postpartum contraception more frequently. Linear regression analysis revealed significant unadjusted beta coefficients between age at first pregnancy and coitarche (0.839) and menarche (0.362). Menarche and coitarche had a significant linear regression association of 0.395. Conclusion We found amongst primigravid patients that teenagers had earlier menarche and coitarche than adults, which in turn correlated to their age at their first pregnancy.
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Affiliation(s)
| | - Diego Ramonfaur
- Harvard Medical School, Division of Postgraduate Medical Education, 25 Shattuck St, Boston, MA 02115, United States
| | | | | | - Ximena Latapi
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo, León 64000, Mexico
- Correspondence to: Av. Batallon de San Patricio 112, Real San Agustín, 66278 San Pedro Garza García, Mexico.
| | - Jesús Insua
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo, León 64000, Mexico
| | - Claudia Hernández-Escobar
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo, León 64000, Mexico
| | - Irasema Apodaca-Ramos
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo, León 64000, Mexico
| | - Eduardo Flores-Villalba
- Harvard Medical School, Division of Postgraduate Medical Education, 25 Shattuck St, Boston, MA 02115, United States
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Diabelková J, Rimárová K, Dorko E, Urdzík P, Houžvičková A, Argalášová Ľ. Adolescent Pregnancy Outcomes and Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4113. [PMID: 36901128 PMCID: PMC10002018 DOI: 10.3390/ijerph20054113] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
One of the major social and public health problems in the world is adolescent pregnancy. Adolescent pregnancy is strongly associated to less favorable results for both the mother and the newborn. We conducted this research to ascertain the impact of teenage age on neonatal outcomes and also observed the lifestyles of pregnant teenage girls. We conducted a study of 2434 mothers aged ≤19 years (n = 294) or 20-34 years (n = 2140) who gave birth in 2019-2020 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. The data on mothers and newborn infants have been reported from the reports on mothers at childbirth. Women between the ages of 20 and 34 served as the reference group. The teenage mothers were more likely to become pregnant if they were unmarried (OR = 14.2; 95% CI = 9.3-21.6; p < 0.001) and had a basic education or lack of education (OR = 16.8; 95% CI = 11.5-24.6; p < 0.001). Additionally, they were more likely to smoke when pregnant (OR = 5.0; 95% CI = 3.8-6.6; p < 0.001). Low birth weight was more common in newborns born to adolescent mothers than in those born to adult mothers (p < 0.001). Our findings showed that infants of teenage mothers often had lower birth weights (-332.6 g, p < 0.001). Adolescent mothers were associated with lower Apgar scores at the first minute (p = 0.003). As compared with the control group, pregnant teenage girls had a greater prevalence of preterm deliveries in our research (p = 0.004). This study finds significant age-related disparities in neonatal outcomes between mothers. These results might be used to identify vulnerable groups who need special assistance and actions to reduce the probability of negative outcomes for such groups.
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Affiliation(s)
- Jana Diabelková
- Department of Public Health and Hygiene, Medical Faculty, University of Pavol Jozef Šafárik, Šrobárova 2, 041 80 Košice, Slovakia
| | - Kvetoslava Rimárová
- Department of Public Health and Hygiene, Medical Faculty, University of Pavol Jozef Šafárik, Šrobárova 2, 041 80 Košice, Slovakia
| | - Erik Dorko
- Department of Public Health and Hygiene, Medical Faculty, University of Pavol Jozef Šafárik, Šrobárova 2, 041 80 Košice, Slovakia
| | - Peter Urdzík
- Department of Gynaecology and Obstetrics, Medical Faculty, Louis Pasteur University Hospital, University of Pavol Jozef Šafárik, Trieda SNP 1, 040 11 Košice, Slovakia
| | - Andrea Houžvičková
- Department of Public Health and Hygiene, Medical Faculty, University of Pavol Jozef Šafárik, Šrobárova 2, 041 80 Košice, Slovakia
| | - Ľubica Argalášová
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Špitálska 24, 813 72 Bratislava, Slovakia
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Kanyesigye H, Ngonzi J, Mulogo E, Fajardo Y, Kabakyenga J. Health Care Workers' Experiences, Challenges of Obstetric Referral Processes and Self-Reported Solutions in South Western Uganda: Mixed Methods Study. Risk Manag Healthc Policy 2022; 15:1869-1886. [PMID: 36225611 PMCID: PMC9550169 DOI: 10.2147/rmhp.s377304] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/25/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction In resource limited settings, the highest burden of adverse maternal-fetal outcomes at referral hospitals is registered from emergency obstetric referrals from lower health facilities. Implementation of referral protocols has not been optimally successful possibly attributed to lack of understanding of profile of obstetric referrals and local challenges faced during implementation process. Objective This study described the profile of emergency obstetric referrals, challenges faced in implementation of obstetric referral processes and explored self-reported solutions by health workers. Methods This was a mixed methods study done at Mbarara Regional Referral Hospital (MRRH) and health centre IVs in South-Western Uganda. We consecutively recruited emergency obstetric referrals from Isingiro district for delivery at MRRH. Using a pre-tested questionnaire, we collected demographics, obstetric and referral characteristics. We described the profile of referrals using frequencies and proportions based on demographics, obstetric and referral characteristics. We conducted focus group discussions and in-depth interviews with health workers using discussion/interview guides. Using thematic analysis, we ascertained the challenges and health worker self-reported solutions. Results We recruited 161 referrals: 104(65%) were below 26 years, 16(10%) had no formal education, 11(7%) reported no income, 151(94%) had no professional-escort, 137(85%) used taxis, 151(96%) were referred by midwives. Common diagnoses were previous cesarean scar (24% [n=39]) and prolonged labour (21% [n=33]). There was no communication prior to referral and no feedback from MRRH to lower health facilities. Other challenges included inconsistencies of ambulance and anesthesia services, electric power, medical supplies, support supervision, and harassment by colleagues. Self-reported solutions included the use of phone call technology for communication, audit meetings, support supervision and increasing staffing level. Conclusion Most referrals are of poor social-economic status, use taxis, and lack professional-escort. Health workers suffer harassment, lack of communication and shortage of supplies. We need to experiment whether mobile phone technology could solve the communication gap.
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Affiliation(s)
- Hamson Kanyesigye
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,Correspondence: Hamson Kanyesigye, Tel +256752806921, Email
| | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jerome Kabakyenga
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Toxoplasma gondii Infection and Threatened Abortion in Women from Northern Peru. Infect Dis Obstet Gynecol 2022; 2022:1163655. [PMID: 35978967 PMCID: PMC9377906 DOI: 10.1155/2022/1163655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Toxoplasma gondii infection can cause important complications during pregnancy. Threatened abortion may be a late indicator for infection in settings with high prevalence of toxoplasmosis. We aimed to determine the association between T. gondii infection and threatened abortion in women from northern Peru. Methods We conducted a secondary analysis of a cross-sectional study in pregnant women from a hospital and a rural community in Lambayeque, Peru. Exposure variable was serological diagnosis of toxoplasmosis, defined as the demonstration of either IgM or IgG antibodies against T. gondii. Outcome variable was threatened abortion, defined as the diagnosis of bloody vaginal discharge or bleeding during the first half of pregnancy. Prevalence ratios were estimated in simple and multiple regression analyses. Results Of 218 pregnant women, 35.8% presented positive serology for T. gondii and 14.7% had threatened abortion in their current pregnancy. Pregnant women with positive T. gondii infection had 2.45-fold higher frequency of threatened abortion (PR: 2.45, 95% CI: 1.15-5.21). In addition, the frequency of threatened abortion decreased by 9% for each additional year of age (PR: 0.91, 95% CI: 0.86-0.97). A previous history of threatened abortion also showed a higher frequency of threatened abortion (PR: 5.22, 95% CI: 2.45-11.12). Conclusions T. gondii infection is associated with threatened abortion. An early age of pregnancy and a previous history of abortion are also associated with this condition.
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Santos SFMD, Costa ACCD, Araújo RGPDS, Silva LAT, Gama SGND, Fonseca VDM. Factors associated with the adequacy of gestational weight gain among Brazilian teenagers. CIENCIA & SAUDE COLETIVA 2022; 27:2629-2642. [PMID: 35730834 DOI: 10.1590/1413-81232022277.17812021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
Abstract
The scope of this article is to evaluate the adequacy of total gestational weight gain (GWG) according to maternal characteristics of Brazilian adolescents. It involved a cross-sectional, hospital-based study. A total of 3,904 teenagers with a single fetus gestation and gestational age (GA) at birth ≥ 37 weeks were included. A hierarchical model was built to analyze the dependent and independent variables adequacy of GWG: sociodemographic, care, obstetric and behavioral characteristics. The chances of insufficient GWG were higher for adolescents from the North (OR = 1.50, 95%CI: 1.07-2.10) and Northeast (OR = 1.68, 95%CI: 1.27-2.21). Paid work increased the chances of insufficient (95%CI: 1.15-2.39) and excessive (95%CI: 1.01-1.86) GWG. The pre-pregnancy body mass index of overweight or obese adolescents was associated with excessive GWG (OR = 1.86, 95%CI: 1.19-2.92 and OR = 3.06, 95%CI: 2.10-4.45, respectively), as well as GA ≥ 42 weeks (OR = 2.23, 95%CI: 1.03-4.81). Living in the North and Northeast regions increases the chances of adolescents having insufficient GWG. Having paid work was associated with a greater chance of excessive and insufficient GWG. Furthermore, pre-pregnancy excess weight or obesity and GA ≥ 42 weeks increased the chances of excessive GWG.
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Affiliation(s)
- Samira Fernandes Morais Dos Santos
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Ana Carolina Carioca da Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | | | - Laís Araújo Tavares Silva
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | | | - Vania de Matos Fonseca
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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Jackson-Gibson M, Zash R, Mussa A, Caniglia EC, Diseko M, Mayondi G, Mabuta J, Morroni C, Mmalane M, Lockman S, Makhema J, Shapiro RL. High risk of adverse birth outcomes among adolescents living with HIV in Botswana compared to adult women living with HIV and adolescents without HIV. BMC Pregnancy Childbirth 2022; 22:372. [PMID: 35490225 PMCID: PMC9055710 DOI: 10.1186/s12884-022-04687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 04/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Adolescent girls are three times more likely to be living with HIV than boys of the same age. Prior studies have found associations between adolescent pregnancies and increased maternal morbidity and infant mortality, but few studies have assessed the impact of HIV infection on maternal and infant outcomes in adolescents. Methods The Tsepamo Study abstracts maternal and infant data from obstetric records in government maternity wards in Botswana. We assessed maternal complications and adverse birth outcomes for all singleton pregnancies from August 2014 to August 2020 at eighteen Tsepamo sites among adolescents (defined as 10–19 years of age) and adults (defined as 20–35 years of age), by HIV status. Univariate and multivariate logistic regression using a complete case analysis method were used to evaluate differences in outcomes. Results This analysis included 142,258 singleton births, 21,133 (14.9%) to adolescents and 121,125 (85.1%) to adults. The proportion of adults living with HIV (N = 22,114, 22.5%) was higher than adolescents (N = 1593, 7.6%). The proportion of most adverse birth outcomes was higher in adolescents. Among adolescents, those with HIV had increased likelihoods of anemia (aOR = 1.89, 95%CI 1.66, 2.15) and cesarean sections (aOR = 1.49, 95%CI 1.3,1.72), and infants with preterm birth (aOR = 1.15, 95%CI 1.0, 1.32), very preterm birth (aOR = 1.35, 95%CI 1.0,1.8), small for gestational age (aOR = 1.37, 95%CI 1.20,1.58), and very small for gestational age (aOR = 1.46, 95%CI 1.20, 1.79). Conclusions Adolescent pregnancy and adolescent HIV infection remain high in Botswana. Adolescents have higher risk of adverse maternal and infant birth outcomes than adults, with the worst outcomes among adolescents living with HIV. Linking HIV prevention and family planning strategies for this age group may help minimize the number of infants with poor birth outcomes among this already vulnerable population.
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Affiliation(s)
- Maya Jackson-Gibson
- Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA.
| | - Rebecca Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Aamirah Mussa
- Botswana-Harvard Partnership AIDS Institute, Gaborone, Botswana
| | - Ellen C Caniglia
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Modiegi Diseko
- Botswana-Harvard Partnership AIDS Institute, Gaborone, Botswana
| | - Gloria Mayondi
- Botswana-Harvard Partnership AIDS Institute, Gaborone, Botswana
| | - Judith Mabuta
- Botswana-Harvard Partnership AIDS Institute, Gaborone, Botswana
| | - Chelsea Morroni
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
| | - Mompati Mmalane
- Botswana-Harvard Partnership AIDS Institute, Gaborone, Botswana
| | - Shahin Lockman
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph Makhema
- Botswana-Harvard Partnership AIDS Institute, Gaborone, Botswana
| | - Roger L Shapiro
- Harvard T. H Chan School of Public Health, Boston, Massachusetts, USA
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Santos SFMD, Costa ACCD, Araújo RGPDS, Silva LAT, Gama SGND, Fonseca VDM. Factors associated with the adequacy of gestational weight gain among Brazilian teenagers. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022277.17812021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract The scope of this article is to evaluate the adequacy of total gestational weight gain (GWG) according to maternal characteristics of Brazilian adolescents. It involved a cross-sectional, hospital-based study. A total of 3,904 teenagers with a single fetus gestation and gestational age (GA) at birth ≥ 37 weeks were included. A hierarchical model was built to analyze the dependent and independent variables adequacy of GWG: sociodemographic, care, obstetric and behavioral characteristics. The chances of insufficient GWG were higher for adolescents from the North (OR = 1.50, 95%CI: 1.07-2.10) and Northeast (OR = 1.68, 95%CI: 1.27-2.21). Paid work increased the chances of insufficient (95%CI: 1.15-2.39) and excessive (95%CI: 1.01-1.86) GWG. The pre-pregnancy body mass index of overweight or obese adolescents was associated with excessive GWG (OR = 1.86, 95%CI: 1.19-2.92 and OR = 3.06, 95%CI: 2.10-4.45, respectively), as well as GA ≥ 42 weeks (OR = 2.23, 95%CI: 1.03-4.81). Living in the North and Northeast regions increases the chances of adolescents having insufficient GWG. Having paid work was associated with a greater chance of excessive and insufficient GWG. Furthermore, pre-pregnancy excess weight or obesity and GA ≥ 42 weeks increased the chances of excessive GWG.
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Abstract
The request for a contraception in adolescent women makes it possible to address HPV vaccination and prevention of STIs and to search for abuse. Optimizing the use of contraception is the priority. Any contraceptive methods can be offered. Adhesion is improved by prior information and individualized counselling. Apart from the vascular risk associated with the combined hormonal contraception, hormonal contraception provides gynecologic benefits. The efficacy of long-acting methods is higher compared to short-acting methods but their tolerance is a sensitive matter. Emergency contraception can be prescribed in advance. There are measures to facilitate the delivery to minors.
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Affiliation(s)
- Lise Duranteau
- Unité de gynécologie adolescente et jeune adulte, AP-HP, université Paris Saclay (Bicêtre), Hôpital Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
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Mejia JR, Quincho-Estares ÁJ, Flores-Rondon AJ, Reyes-Beltran G, Arias-Sulca IL, Palomino-Hilario E, Barrientos-Cochachi JE, Toro-Huamanchumo CJ. Determinants of adolescent pregnancy in indigenous communities from the Peruvian central jungle: a case-control study. Reprod Health 2021; 18:203. [PMID: 34641910 PMCID: PMC8507392 DOI: 10.1186/s12978-021-01247-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/22/2021] [Indexed: 06/21/2024] Open
Abstract
Background Adolescent pregnancy carries a high risk of severe health issues for both the mother and the newborn. Worldwide, 21 million adolescents give birth every year, with high percentages in Latin America. Most of the risk factors are met in indigenous communities, which is an underrepresented and poorly studied population. We aimed to assess the determinants of adolescent pregnancy in indigenous communities from the Peruvian central jungle. Methods Through a case–control study, female adolescents aged 13 to 19 years old from seven indigenous communities of the Peruvian central jungle were interviewed. Adolescents with (cases) and with no (controls) pregnancy history, such as current pregnancy, children and abortion, fulfilled our eligible criteria. Our instrument explored: sociodemographic, adolescent and family characteristics, as well as perceptions of adolescent pregnancy. We performed a penalized maximum likelihood logistic regression analysis to obtain Odds Ratios (OR) and their 95% confidence intervals (95% CI). Results We enrolled 34 cases and 107 controls. Overall, 53.9% were 15 to 19 years old. We found a significant association of being 15–19 years old (OR = 6.88, 95% CI 2.38–19.86, p < 0.0001) and an elementary school level of instruction (OR = 5.59, 95% CI 1.95–16.06, p = 0.001) with the risk of adolescent pregnancy. A marginal statistical significance between having five to six siblings and adolescent pregnancy was also reported (OR = 2.70, 95% CI 0.85–8.61, p = 0.094). Furthermore, adolescents with sexual and reproductive health communication with parents had a lower risk of adolescent pregnancy (OR = 0.17, 95% CI 0.06–0.47, p = 0.001). Conclusion Our results suggest that public health and educational efforts should be age-specific focused within indigenous communities of the Peruvian central jungle, encouraging parents to talk about sexual and reproductive health topics with adolescents. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01247-z. Worldwide, 21 million adolescents give birth every year, with high percentages in Latin America and rural areas. Indigenous communities are mainly located in rural areas and are exposed to multiple risk factors of adolescent pregnancy. We aimed to find the factors that have an influence on adolescent pregnancy in indigenous communities from the Peruvian central jungle. We conducted a case–control study identifying female indigenous adolescents from the Peruvian central jungle with or without pregnancy history. Our survey explored sociodemographic, adolescent and family characteristics, as well as perceptions of adolescent pregnancy. Being 15 to 19 years old, having an elementary educational level, and five to six siblings increased the risk of adolescent pregnancy. On the other hand, adolescents with sexual and reproductive health communication with parents had a lower risk of adolescent pregnancy. Furthermore, eight out of ten adolescents opposed to sexual intercourse at an early age. Public health and educational efforts should be age-specific focused within indigenous communities of the Peruvian central jungle, encouraging parents to talk about sexual and reproductive health with adolescents.
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Affiliation(s)
- Jhonatan R Mejia
- Universidad Nacional del Centro del Perú, Sociedad Científica de Estudiantes de Medicina del Centro, Huancayo, Peru.
| | - Ángel J Quincho-Estares
- Universidad Nacional del Centro del Perú, Sociedad Científica de Estudiantes de Medicina del Centro, Huancayo, Peru
| | - Asstrid J Flores-Rondon
- Universidad Nacional del Centro del Perú, Sociedad Científica de Estudiantes de Medicina del Centro, Huancayo, Peru
| | - Giancarlo Reyes-Beltran
- Universidad Nacional del Centro del Perú, Sociedad Científica de Estudiantes de Medicina del Centro, Huancayo, Peru
| | - Irene L Arias-Sulca
- Universidad Nacional del Centro del Perú, Sociedad Científica de Estudiantes de Medicina del Centro, Huancayo, Peru
| | - Estephanie Palomino-Hilario
- Universidad Nacional del Centro del Perú, Sociedad Científica de Estudiantes de Medicina del Centro, Huancayo, Peru
| | | | - Carlos J Toro-Huamanchumo
- Universidad San Ignacio de Loyola, Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
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Pires R, Araújo-Pedrosa A, Pereira J, Canavarro MC. How Can Unintended Pregnancies Be Prevented among Adolescents Who Engaged in Sexual Intercourse at Earlier Ages? The Role of Female Education and Partner Age Difference. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10631. [PMID: 34682377 PMCID: PMC8535923 DOI: 10.3390/ijerph182010631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022]
Abstract
Several studies have identified explicative factors for adolescents' sexual risk behaviors and related outcomes such as unintended pregnancy; however, less is known about the mechanisms through which such factors act. Our study explored the role of female education and partner age difference as explicative mechanisms of the association between age at first sexual intercourse (AFSI) and unintended pregnancy while controlling for the role of other contextual factors (i.e., socioeconomic status, ethnicity, religious beliefs, and place of residence) and sexual-related mechanisms (i.e., number of sexual partners) that are known to be associated with adolescent pregnancy. The sample consisted of 613 sexually experienced female adolescents who did not intend to become pregnant: 349 were pregnant for the first time, and 264 had never been pregnant. Mediation and moderation analyses were performed. An earlier AFSI was associated with unintended pregnancy 1-6 years after first sexual intercourse by increasing the adolescents' likelihood of having less education and being involved with partners older than themselves. There was no significant direct effect of AFSI on pregnancy occurrence after controlling for the mediators. Our findings bring to light nonsexual mechanisms that must be considered in public health interventions aimed at preventing unintended pregnancies among adolescents who engaged in sexual intercourse at early ages. Specific implications are discussed.
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Affiliation(s)
- Raquel Pires
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
| | - Anabela Araújo-Pedrosa
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
- Clinical Psychology Service Centro Hospitalar e Universitário de Coimbra, 3030-165 Coimbra, Portugal
| | - Joana Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
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Annan RA, Gyimah LA, Apprey C, Asamoah-Boakye O, Aduku LNE, Azanu W, Luterodt HE, Edusei AK. Predictors of adverse birth outcomes among pregnant adolescents in Ashanti Region, Ghana. J Nutr Sci 2021; 10:e67. [PMID: 34527225 PMCID: PMC8411264 DOI: 10.1017/jns.2021.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/25/2022] Open
Abstract
Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13-19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 15⋅2 and 12⋅5 %, respectively. Pregnant adolescents with no formal education (AOR 9⋅0; P = 0⋅004; 95 % CI 2⋅1, 39⋅8), those who experienced illness (AOR 3⋅0; P = 0⋅011; 95 % CI 1⋅3, 7⋅0), those who experienced hunger (OR 2⋅9; P = 0⋅010; 95 % CI 1⋅3, 6⋅5) and those with high LPI (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅2, 5⋅3) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-treated net (ITN) (AOR 0⋅4; P = 0⋅013; 95 % CI 0⋅2, 0⋅9) presented reduced odds LBW children; while those who experienced illness (AOR 2⋅7; P = 0⋅020; 95 % CI 1⋅2, 6⋅0), poorer pregnant adolescents (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅1, 4⋅8) and those who experienced hunger (AOR 3⋅0; P = 0⋅028; 95 % CI 1⋅1, 8⋅1) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended.
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Affiliation(s)
- Reginald Adjetey Annan
- Human Nutrition and Dietetics Unit, Department of Biochemistry and Biotechnology, Faculty of Biosciences, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Linda Afriyie Gyimah
- Human Nutrition and Dietetics Unit, Department of Biochemistry and Biotechnology, Faculty of Biosciences, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Apprey
- Human Nutrition and Dietetics Unit, Department of Biochemistry and Biotechnology, Faculty of Biosciences, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Odeafo Asamoah-Boakye
- Human Nutrition and Dietetics Unit, Department of Biochemistry and Biotechnology, Faculty of Biosciences, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Linda Nana Esi Aduku
- Human Nutrition and Dietetics Unit, Department of Biochemistry and Biotechnology, Faculty of Biosciences, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Azanu
- Department of Obstetrics and Gynecology, University of Allied Health Sciences, Ho, Ghana
| | - Herman E. Luterodt
- Department of Food Science and Technology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony K. Edusei
- Department of Community Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Mendes RCMG, Frazão CMFDQ, Lacerda ACTD, Lopes MVDO, Linhares FMP, Mangueira SDO. Content validation of the nursing diagnosis Risk for disturbed maternal-fetal dyad. Rev Esc Enferm USP 2021; 55:e03689. [PMID: 33886915 DOI: 10.1590/s1980-220x2019041403689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 09/19/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To validate the content of the diagnosis Risk for disturbed maternal-fetal dyad in high-risk pregnant women. METHOD Nursing diagnosis content analysis study in which 48 nurses evaluated agreement regarding title, definition, class, and domain of the studied nursing diagnosis, as well as the relevance of its antecedents. The items were considered relevant when the Confidence Interval of the Content Validity Index was 0.8 or higher. When lower, the item was modified or excluded according to the experts' suggestions. RESULTS Out of 21 antecedents, 14 were considered relevant. The labels of five elements considered irrelevant were changed, and one item was excluded. The experts did not choose the title and definition proposed by NANDA-I, preferring instead the ones suggested in this study. The experts agreed with the class and domain proposed by the taxonomy. CONCLUSION Ten risk factors, four populations at risk, and six associated conditions for this nursing diagnosis were maintained; these may provide a basis for nursing practice. The phase of clinical validation is suggested to be conducted to corroborate this study's results.
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Affiliation(s)
| | | | | | | | | | - Suzana de Oliveira Mangueira
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Recife, PE, Brazil
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Silva Júnior AED, Macena MDL, Vasconcelos LGL, Almeida NB, Praxedes DRS, Pureza IRDOM, Bueno NB, Clemente APG. Trend of the nutritional status of pregnant adolescent beneficiaries of the Brazilian Bolsa Família conditional cash transfer program in the 2008-2018 period. CIENCIA & SAUDE COLETIVA 2021; 26:2613-2624. [PMID: 34231674 DOI: 10.1590/1413-81232021267.08172021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/08/2021] [Indexed: 11/22/2022] Open
Abstract
This ecological study aimed to analyze the trend of the nutritional status of pregnant adolescent beneficiaries of the Brazilian Bolsa Família conditional cash transfer program in the 2008-2018 period. We evaluated secondary data of pregnant adolescent beneficiaries of the Bolsa Família Program from January 2008 to December 2018, extracted from the public reports of the WEB Food and Nutrition Surveillance System. We accessed the monitoring reports on the consolidated public-access health conditionalities of the Bolsa Família Program, always considering the second validity. An annual variation of -1.2% (95%CI: [-1.6; -0.8] p<0.01) was observed in the prevalence of underweight in Brazil in the studied sample. The prevalence of overweight and obesity in the country had annual variations of 2.9% (95%CI: [2.0; 3.7] p<0.01) and 7.5% (95%CI: [5.7; 9.3] p<0.01), respectively. We conclude by saying, that, in the evaluated period, the prevalence of underweight among pregnant adolescent beneficiaries of the Bolsa Família Program showed a decreasing trend, while the prevalence of overweight and obesity increased throughout Brazil.
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Affiliation(s)
- André Eduardo da Silva Júnior
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo. R. Botucatu s/n, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | | | | | | | | | | | - Nassib Bezerra Bueno
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo. R. Botucatu s/n, Vila Clementino. 04023-062 São Paulo SP Brasil. .,Faculdade de Nutrição, Universidade Federal de Alagoas. Maceió AL Brasil
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Karaçam Z, Kizilca Çakaloz D, Demir R. The impact of adolescent pregnancy on maternal and infant health in Turkey: Systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2021; 50:102093. [PMID: 33592347 DOI: 10.1016/j.jogoh.2021.102093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/02/2021] [Accepted: 02/08/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To examine the impact of adolescent pregnancy on maternal and infant health on the basis of studies conducted in Turkey. MATERIAL AND METHODS Systematic reviews and meta-analyses of cross-sectional and case-control. A systematic scan was performed in January 2020 based on the keywords "adolescent pregnancy or teenage pregnancy and Turkey" in the electronic databases PubMed, Clinical Key, Science Direct, Web of Science, Google Scholar, National Thesis Center, DergiPark, Ulakbim, Turkish Medline and Turkish Clinics. Two of the authors carried out a scan independently of each other, making a selection of articles, performing data extraction and quality assessment procedures under the supervision of the senior researcher. RESULTS The results of a total of 38 studies, of which twenty-three were cross-sectional and 15 were case-control, were compiled for the meta-analysis (adolescents: 20,768; control: 59,481). The results of the meta-analysis showed that the more common effects of adolescent pregnancies were preterm birth (OR: 2.12, p < 0.001), early membrane rupture (OR: 1.49, p < 0.001), anemia (OR: 2.60, p < 0.001), low birthweight/intrauterine growth retardation (OR: 2.06, p < 0.001), and fetal distress (OR: 1.78, p = 0.003). On the other hand, it was observed in the meta-analysis that childbirth by cesarean section (OR: 0.70, p < 0.001), gestational diabetes (OR: 0.35, p < 0.001), placenta previa (OR: 0.52, p = 0.01), polyhydramnios (OR: 0.52, p = 0.04) and macrosomia (OR: 0.54, p < 0.001) were less common among adolescents compared to adults. CONCLUSION Our review revealed that adolescent pregnancy had an adverse impact on maternal and infant health in terms of preterm childbirth, early membrane rupture, anemia, low birthweight/intrauterine growth retardation, low Apgar scores and fetal distress.
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Affiliation(s)
- Zekiye Karaçam
- Aydın Adnan Menderes University, Faculty of Health Sciences, Division of Midwifery, Aydın, Turkey.
| | - Damla Kizilca Çakaloz
- Aydın Adnan Menderes University, Faculty of Health Sciences, Division of Midwifery, Aydın, Turkey.
| | - Rukiye Demir
- Aydın Adnan Menderes University, Health Sciences Institute, Division of Midwifery, Aydın, Turkey.
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Soares MC, de Matos MB, da Cunha GK, Leite CF, Caruccio HS, Trettim JP, Scholl CC, Rubin BB, Coelho FMDC, Quevedo LDA, Pinheiro RT, Pinheiro KAT. Suicide risk and prematurity: A study with pregnant adolescents. J Psychiatr Res 2021; 133:125-133. [PMID: 33340791 DOI: 10.1016/j.jpsychires.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/03/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To verify the association between mood and anxiety disorders, and suicide risk during pregnancy and their relationship with premature birth in a population of pregnant adolescents attending prenatal care in the public health system of Pelotas, a southern city in Brazil. METHODS This was a cohort study with all pregnant adolescents attending antenatal public services in the urban area of Pelotas between October 2009 and May 2011. The first assessment occurred between the 20th and 22 nd week of pregnancy and the second occurred one month after delivery. We used the Mini International Neuropsychiatric Interview (MINI) to assess mood and anxiety disorders and suicide risk. RESULTS A total of 645 pregnant women aged between 12 and 19 years old were interviewed. An anxiety disorder was present in 9.1% of the pregnant adolescent, and 28.5% had a mood disorder. The prevalence of suicide risk was 12.6%, and 15.3% of the babies were born premature. A multivariate analysis adjusted for maternal education, number of previous pregnancies and previous preterm birth indicated that adolescents who had suicide risk during pregnancy were approximately twice as likely to give birth prematurely when compared to those who were not diagnosed with suicide risk (PR 1.79; CI 1.06-3.03). CONCLUSION Our findings suggest that pregnant adolescents who were at risk of suicide during pregnancy were more likely to have premature babies. It is important to pay attention to the mental health of this specific population to prevent obstetric complications and consequently improve the health of the children.
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Affiliation(s)
- Mariana Carret Soares
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil
| | - Mariana Bonati de Matos
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil
| | - Gabriela Kurz da Cunha
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil
| | - Ciciliane Foster Leite
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil
| | - Henrique Seus Caruccio
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil
| | - Jéssica Puchalski Trettim
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil
| | - Carolina Coelho Scholl
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil
| | - Bárbara Borges Rubin
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil
| | | | - Luciana de Avila Quevedo
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil
| | - Ricardo Tavares Pinheiro
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil.
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Ayala-Ramírez P, Serrano N, Barrera V, Bejarano JP, Silva JL, Martínez R, Gil F, Olaya-C M, García-Robles R. Risk factors and fetal outcomes for preeclampsia in a Colombian cohort. Heliyon 2020; 6:e05079. [PMID: 33015399 PMCID: PMC7522495 DOI: 10.1016/j.heliyon.2020.e05079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/23/2020] [Accepted: 09/23/2020] [Indexed: 01/12/2023] Open
Abstract
In Latin America and the Caribbean, hypertensive pregnancy disorders are responsible for almost 26% of all maternal deaths [1] and, in Colombia, they account for 59% of all severe maternal morbidity (SMM) cases, and 59.7% of all SMM cases in adolescents [2]. One of the most important hypertensive pregnancy disorders is preeclampsia (PE). Lives can be saved, if PE is prevented, or detected early and properly managed. Prevention and detection depend on identifying the risk factors associated with PE, and, as these have been shown vary by population, they should be determined on a population-by-population basis. The following study utilized the nested case-control model to evaluate 45 potential PE risk factors of a cohort in Bogotá, Colombia, making it perhaps the most comprehensive study of its kind in Colombia. It found PE to have a statistically significant association with 7 of the 45 factors evaluated: 1) pre-gestational BMI >30 kg/m2, 2) pregnancy weight gain >12 kg, 3) previous history preeclampsia/eclampsia, 4) previous history of IUGR-SGA (Intrauterine Growth Restriction-Small for Gestational Age), 5) maternal age <20 or ≥35 years (20–34 was not associated), and 6) family history of diabetes. Finally, prenatal consumption of folic acid was found to lower the risk of PE. We recommend that, in Colombia, factors 1–6 be used to identify at risk mothers during pregnancy check-ups; that mothers be encouraged to take folic acid during pregnancy; and, that Colombia's health system and public policy address the problem of pregestational obesity.
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Affiliation(s)
- Paola Ayala-Ramírez
- Human Genetics Institute, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Corresponding author.
| | - Natalia Serrano
- Research Seedbed in Perinatal Medicine Pontificia Universidad Javeriana: Medical School Pontificia Universidad Javeriana and Medical Residents Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Viviana Barrera
- Research Seedbed in Perinatal Medicine Pontificia Universidad Javeriana: Medical School Pontificia Universidad Javeriana and Medical Residents Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juan Pablo Bejarano
- Research Seedbed in Perinatal Medicine Pontificia Universidad Javeriana: Medical School Pontificia Universidad Javeriana and Medical Residents Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Jaime Luis Silva
- Department of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Rodolfo Martínez
- Department of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Fabian Gil
- Clinical Epidemiology and Biostatistics Department, Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Mercedes Olaya-C
- Department of Pathology, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Reggie García-Robles
- Department of Physiological Sciences, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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Perez MJ, Chang JJ, Temming LA, Carter EB, López JD, Tuuli MG, Macones GA, Stout MJ. Driving Factors of Preterm Birth Risk in Adolescents. AJP Rep 2020; 10:e247-e252. [PMID: 33094012 PMCID: PMC7571551 DOI: 10.1055/s-0040-1715164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/06/2020] [Indexed: 11/06/2022] Open
Abstract
Objective We examined rates of spontaneous and indicated preterm births (S-PTB and I-PTB, respectively) and clinical risk factors for PTB in adolescents. Study Design This is a population-based, retrospective cohort using 2012 U.S. natality data of nulliparous women who delivered a nonanomalous singleton birth between 20 and 42 weeks' gestation. Maternal age included <16, 16 to 19.9, and ≥20 years. Rates of total, S-PTB, and I-PTB were compared across age groups. Multinomial logistic regression tested clinical risk factors for S-PTB. Results In 1,342,776 pregnancies, adolescents were at higher risk for PTB than adults. The rate of total PTB was highest in young adolescents at 10.6%, decreased to 8.3% in older adolescents, and 7.8% in adults. The proportion of S-PTB was highest in the youngest adolescents and decreased toward adulthood; the proportion of I-PTB remained stable across age groups. Risk factors for S-PTB in adolescents included Asian race, underweight body mass index (BMI), and poor gestational weight gain (GWG). In all age groups, carrying a male fetus showed a significant increased S-PTB, and Women, Infants, and Children's (WIC) participation was associated with a significantly decreased risk. Conclusion The higher risk for PTB in adolescents is driven by an increased risk for S-PTB. Low BMI and poor GWG may be potentially modifiable risk factors. Condensation Adolescents have a higher risk for spontaneous PTB than adult women, and risk factors for spontaneous PTB may differ in adolescents.
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Affiliation(s)
- Marta J. Perez
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Jen J. Chang
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Lorene A. Temming
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Atrium Health Women's Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Julia D. López
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Methodius G. Tuuli
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana
| | - George A. Macones
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Molly J. Stout
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
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Barbieri MM, Juliato CRT, Bahamondes L, Surita FG. ENG-releasing subdermal implants in postpartum teenagers - an open-label trial study protocol. Reprod Health 2020; 17:100. [PMID: 32576199 PMCID: PMC7310555 DOI: 10.1186/s12978-020-00952-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 06/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background Higher than expected adolescent pregnancy high rates continue globally, with repeated unplanned pregnancy (UP) in this age group is a public health problem. In Brazil, 16% of pregnancies occur in adolescents under 18 years old, with high maternal morbidity and mortality rates in this age group. Effective and safe contraception is required to reduce UP rates. The objective of our study is to evaluate acceptance of etonogestrel (ENG)-releasing subdermal contraceptive implant after childbirth, before discharge, as well as clinical performance up to one year after placement. Comparison between teenagers who opt for ENG-implant versus other contraceptive methods after childbirth will be also evaluated, specifically regarding UP, continuation and discontinuation rates and reasons, body composition, pelvic ultrasound characteristics and user satisfaction. Methods A non-randomized open-label trial will be conducted with teenagers after childbirth and followed up to one year at the Women’s Hospital, University of Campinas (UNICAMP), Campinas, Brazil. The study group will consist of patients who accepted to use ENG-implant and placed before discharge. The comparison group will include adolescents who choose to use other contraceptive methods at the first postpartum visit (42 ± 3 days after childbirth). All women will follow-up at 40–60 days postpartum, as well as, at 6 and 12 months post-enrollment. Patient satisfaction, contraceptive effectiveness, reasons of discontinuation, continuation rate and body composition will be evaluated. Transvaginal ultrasound and electric bio impedance tests will be performed at all follow-up appointments. A 5% significance level was assumed, as well as, a sampling error (absolute) for 10% prevalence. The sample size was calculated at n = 100, obtaining an estimate of 50 to 70 adolescents who would accept the method offered, according to the prevalence and sample error assumed. Discussion Long-acting reversible contraceptive (LARC) methods include subdermal implants and intrauterine contraceptives, are considered first line contraception for teenagers. Immediate postpartum use is a safe option, which significantly reduces rates of repeated UP and all the undesirable consequences inherent to this process. Trial registration This study was approved by the Ethics and Research Commission of UNICAMP (CAAE: 92869018.5.0000.5404) and the Brazilian Registry of Clinical Trials (REBEC): http://www.ensaiosclinicos.gov.br/rg/RBR-4z7bc6, (number 2.901.752).
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Affiliation(s)
- M M Barbieri
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil
| | - C R T Juliato
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil
| | - L Bahamondes
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil
| | - F G Surita
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil.
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Eckert LO, Jones CE, Kachikis A, Bardají A, Silva FTD, Absalon J, Rouse CE, Khalil A, Cutland CL, Kochhar S, Munoz FM. Obstetrics risk Assessment: Evaluation of selection criteria for vaccine research studies in pregnant women. Vaccine 2020; 38:4542-4547. [PMID: 32448618 PMCID: PMC7211583 DOI: 10.1016/j.vaccine.2020.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 10/31/2022]
Abstract
Vaccines designed for use in pregnancy and vaccine trials specifically involving pregnant women are rapidly expanding. One of the key challenges in designing maternal immunization trials is that developing exclusion criteria requires understanding and quantifying the background risk for adverse pregnancy outcomes in the pregnancy being studied, which can occur independent of any intervention and be unrelated to vaccine administration. The Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project has developed and published case definitions and guidelines for data collection, analysis, and evaluation of maternal immunization safety in trials involving pregnant women. Complementing this work, we sought to understand how to best assess obstetric risk of adverse outcomes and differentiate it from the assessment of vaccine safety. Quantification of obstetric risk is based on prior and current obstetric, and maternal medical history. We developed a step-wise approach to evaluate and quantify obstetric and maternal risk factors in pregnancy based on review of published literature and guidelines, and critically assessed these factors in the context of designing inclusion and exclusion criteria for maternal vaccine studies. We anticipate this risk assessment evaluation may assist clinical trialists with study design decisions, including selection of exclusion criteria for vaccine trials involving pregnant women, consideration of sub-group classification, such as high or low risk subjects, or schedule considerations, such as preferred trimester of gestation for an intervention during pregnancy. Additionally, this tool may be utilized in data stratification at time of study analyses.
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Affiliation(s)
- Linda O Eckert
- Department of Obstetrics and Gynecology University of Washington, School of Medicine Seattle, WA; Department of Global Health, University of Washington School of Medicine, Seattle, WA.
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alisa Kachikis
- Department of Obstetrics and Gynecology University of Washington, School of Medicine Seattle, WA
| | - Azucena Bardají
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Caroline E Rouse
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN
| | - Asma Khalil
- Department of Obstetrics & Gynecology, St. George's Hospital, University of London, London, UK
| | - Clare L Cutland
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, African Leadership Iin Vaccinology Expertise, Faculty of Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonali Kochhar
- Department of Global Health, University of Washington School of Medicine, Seattle, WA; Global Healthcare Consulting, India; Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Flor M Munoz
- Department of Pediatrics and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States.
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Macedo TC, Montagna E, Trevisan CM, Zaia V, de Oliveira R, Barbosa CP, Laganà AS, Bianco B. Prevalence of preeclampsia and eclampsia in adolescent pregnancy: A systematic review and meta-analysis of 291,247 adolescents worldwide since 1969. Eur J Obstet Gynecol Reprod Biol 2020; 248:177-186. [DOI: 10.1016/j.ejogrb.2020.03.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 02/08/2023]
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Parada-Rico DA. Embarazo en condición juvenil: contexto histórico en Colombia y trayectoria en ciudad fronteriza. DUAZARY 2020. [DOI: 10.21676/2389783x.3316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Al hacer referencia al embarazo en adolescentes o jóvenes, de una parte, implica todo un abordaje acerca del riesgo en la salud estimado para la madre y su hijo por nacer; y de otra, la connotación dada al hecho de maternar o paternar dentro de una temporalidad y trayectoria del curso de vida asignada socialmente para estudiar, laborar o dedicarse simplemente al cuidado de sí. El objetivo del actual trabajo es analizar el panorama histórico del embarazo en condición juvenil en Colombia y su trayectoria en el municipio de Cúcuta durante el periodo de 2012 a 2017. La metodología utilizada fue la búsqueda y revisión sistemática de investigaciones, documentos históricos, normativas, Actas de las mesas intersectoriales municipal y departamental de “prevención de embarazo en adolescentes” alrededor del tema. Dentro de los resultados hallados, se observa una perspectiva de riesgo marcada, construida históricamente, así como una tendencia al aumento de embarazos en menores de 15 años. Conclusiones: se hace necesario establecer nuevas vías que permitan promover en conjunto con adolescentes y jóvenes, la toma de decisiones basada en sus derechos sexuales y reproductivos, teniendo en cuenta además el contexto en el que se inscriben determinantes sociales asociados.
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Teenage Pregnancy and Its Adverse Obstetric and Perinatal Outcomes at Lemlem Karl Hospital, Tigray, Ethiopia, 2018. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3124847. [PMID: 32051825 PMCID: PMC6995314 DOI: 10.1155/2020/3124847] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/14/2019] [Accepted: 12/11/2019] [Indexed: 11/18/2022]
Abstract
Introduction One of the major public health issues across the whole world these days is teenage pregnancy which is defined as being pregnant in the age ranging from 13–19 years. About 11% of all births which occurred worldwide accounted for girls aged 15 to 19 years. From these, 95% teenage deliveries occur in low- and middle-income countries. World health 2014 statistics show that complications during pregnancy and childbirth are the second cause of death for 15–19-year-old girls globally. The aim of this study was to determine adverse obstetrical and perinatal outcomes of teenage pregnancy among deliveries at Lemlem Karl General Hospital, Tigray, Ethiopia, 2018. Result This study result showed that 17.5% of the teenagers and 6.8% of the adults deliver low birth weight neonates. From the total teenage mothers, about thirty-five (11.3%) of them had developed pregnancy-induced hypertension, whereas about thirteen (4.2%) of adults develop pregnancy-induced hypertension. Regarding cesarean delivery, forty (12.9%) of those teenage mothers deliver by a cesarean section while 58 (18%) of the adult mothers deliver by cesarean delivery. Teenage pregnancy was significantly associated with adverse obstetric and perinatal outcomes, a cesarean delivery (AOR: 0.57; 95% CI, 0.36–0.90), episiotomy (AOR: 2.01; 95% CI, 1.25–3.39), and low birth weight (AOR: 2.22; 95% CI, 1.13–4.36), and premature delivery were 2.87 (1.49–5.52). This study shows that adverse obstetric and perinatal outcomes were significantly associated with teenagers than adult mothers. Therefore, giving health education on focused ANC is very important to bring change to the teenager at this study area.
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Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia. PLoS One 2019; 14:e0218259. [PMID: 31194833 PMCID: PMC6564016 DOI: 10.1371/journal.pone.0218259] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/29/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescents have physical, social and psychological characteristics that are different from adults. Adolescent pregnancy results in pregnancy and childbirth complications- an area neglected in developing countries like Ethiopia. This study, therefore, was conducted to assess the adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia. METHODS Institutional-based study was conducted in East Gojjam zone, Northwest Ethiopia. A total of 374 adolescent (15-19 years) and 760 adult (20-34 years) women were included in this study. Data were collected among women who came to randomly selected health facilities in East Gojjam zone. Data were collected by trained research assistants using a structured data collection questionnaire. Descriptive statistics, chi-square test, and Student's t-tests were utilized. Bivariate and multivariable logistic regression analysis were employed to adjust for confounding factors of adverse neonatal outcomes. Statistical significance was declared when the p-value was less than 0.05. RESULTS Higher proportion of adolescent than adult women were from rural area (57.2% vs 44.7%), were not married (5.1% vs 1.7%), were pregnant for the first time (91.7% vs 34.1%), didn't attend antenatal care (ANC) follow-up (12% vs 4.5%), and had late initiation of ANC follow-up. After adjusting for known confounding factors, the odds of low birth weight (LBW) was higher among adolescents than adult women (AOR 2.14; 95% CI, 1.36, 3.36, p-value = 0.001). Similarly, the odds of preterm birth was higher among adolescents than adult women (AOR 1.65; 95% CI, 1.09, 2.49, p-value = 0.017). There was no statistically significant difference in the rate of low Apgar score at first and five minutes after birth and neonatal Intensive Care Unit (ICU) admission between babies born from adolescent and adult women. CONCLUSIONS Adolescent women were less likely to receive ANC service. Babies born from adolescent women are at higher odds of adverse neonatal outcomes like LBW and preterm birth than babies born from adult women. Use of community- and health facility-based intervention programs that can prevent adolescent pregnancy and reduce adverse neonatal outcomes among adolescent girls is recommended.
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Affiliation(s)
- Getachew Mullu Kassa
- Pan African University Life and Earth Sciences Institutes, Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - A. O. Arowojolu
- Department of Obstetrics and Gynaecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - A. A. Odukogbe
- Department of Obstetrics and Gynaecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Alemayehu Worku Yalew
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Zhang X, Xu H, Hu R, Xiong Y, Gu W, Zhou Q, Li X. Changing trends of adverse pregnancy outcomes with maternal age in primipara with singleton birth: A join point analysis of a multicenter historical cohort study in China in 2011-2012. Acta Obstet Gynecol Scand 2019; 98:997-1003. [PMID: 30801657 DOI: 10.1111/aogs.13595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adverse pregnancy outcomes are related to two opposite maternal factors, youth and aging. However, the change in trend of specific outcomes with childbearing age is unknown. The aim of this study was to investigate the changing trend of various maternal and neonatal outcomes with maternal age from 17 to 44 years. MATERIAL AND METHODS Data were extracted from the medical records from 2011-2012 of 39 public hospitals of 14 cities in China. The eligibility criteria were primiparity and singleton birth. Join point regression analysis was used to estimate the percent change per year of age (PCA) to explore the trends of adverse pregnancy outcomes with regard to maternal age and to identify the join point of maternal age when the trend was changed. RESULTS A total of 89 171 women were eligible for analysis. There were four categories of trend styles. Continuously increasing trends were linear for placenta previa (PCA, 0.1%), placenta implantation (PCA, 0.09%) and postpartum hemorrhage (PCA, 0.22%), and nonlinear for gestational diabetes mellitus with one join point of 23 years (PCA, 0.17% and 0.71%) and cesarean section with four join points of 25, 28, 31 and 36 years (PCA, 1.39%, 0.34%, 1.51%, 3.49% and 0.94%). Continuously decreasing trends were linear for intrahepatic cholestasis (PCA, -0.02%) and nonlinear for anemia with one join point of 28 years (PCA, -0.49% and -0.04%). The bidirective trends were downward to upward for preterm birth (PCA, -2.93%, -0.36% and 0.38%), hypertension in pregnancy (PCA, -0.09%, 0.47%), low birthweight (PCA 0.51% and 0.38%), low 1-minute Apgar score (PCA, -0.28% and 0.07%), low 5-minute Apgar score at (PCA, -0.10% and 0.06%) and neonatal intensive care unit admission (PCA, -1.92%, -0.07% and 0.12%) with a nadir age of 28 years. The bidirective trend was upward to downward for macrosomia (PCA, 0.39% and -0.11%), with a peak age of 30 years. CONCLUSIONS The changes in the trend of specific outcomes were different with maternal age, which means that youth, aging or both could affect the outcomes.
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Affiliation(s)
- Xiaolei Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Huangfang Xu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Rong Hu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yu Xiong
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Weirong Gu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Qiongjie Zhou
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.,Institute of Biomedical Sciences, Fudan University, Shanghai, China
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Schildberger B, Linzner D, Hehenberger L, Leitner H, Pfeifer C. Influence of Maternal Age on Selected Obstetric Parameters. Geburtshilfe Frauenheilkd 2019; 79:1208-1215. [PMID: 31736510 PMCID: PMC6846731 DOI: 10.1055/a-0859-0826] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/21/2018] [Accepted: 02/17/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction
In recent decades, there has been a continuous rise in the average age at which women give birth. A maternal age of 35 years and above is considered an independent risk factor in pregnancy and birth, due to higher rates of intervention. This study investigates the influence of maternal age on birth procedure, gestational age, and rate of interventions during delivery. The influence of maternal parity is also analyzed.
Material and Methods
Data from the Austrian Register of Births was retrospectively collected and evaluated. The collected data was the data of all singleton live births in Austria between January 1, 2008 and December 31, 2016 (n = 686 272). Multiple births and stillbirths were excluded from the study. Maternal age and parity were analyzed in relation to predefined variables (birth procedure, gestational age, episiotomy in cases of vaginal delivery, epidural anesthesia in both vaginal and cesarean deliveries, and intrapartum micro-blood gas analysis). Statistical data was evaluated using (1) descriptive univariate analysis, (2) bivariate analysis, and (3) multinomial regression models.
Results
The cesarean section rate and the rate of surgically-assisted vaginal deliveries increased with advancing maternal age, especially in primiparous women, while the rate of spontaneous deliveries decreased with increasing maternal age. A parity of ≥ 2 had a protective effect on the cesarean section rate. The rate of premature births also increased with increasing maternal age, particularly among primiparous women.
Discussion
Although higher maternal age has a negative effect on various obstetric parameters, it was nevertheless not possible to identify a causal connection. Maternal age should not be assessed as an independent risk factor; other factors such as lifestyle or prior chronic disease and parity must be taken into consideration.
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Affiliation(s)
| | | | | | - Hermann Leitner
- IET - Institut für klinische Epidemiologie der Tirol Kliniken GmbH, Innsbruck, Austria
| | - Christian Pfeifer
- IET - Institut für klinische Epidemiologie der Tirol Kliniken GmbH, Innsbruck, Austria
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Aslan Çetİn B, Aydogan Mathyk B, Turan G, Güralp O, Gedİkbaşi A. A comparison of obstetric outcomes in adolescent pregnancies and adult pregnancies. J Matern Fetal Neonatal Med 2019; 33:4037-4042. [PMID: 30880513 DOI: 10.1080/14767058.2019.1594192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Adolescent pregnancies are associated with adverse maternal and fetal outcomes including preeclampsia, preterm birth, and fetal growth restriction compared to adult pregnancies. The purpose of our study is to compare the incidents of obstetric outcomes between the adolescent pregnancies and adult pregnancies.Materials and methods: This retrospective case-control study was conducted between January 2013 and January 2018 at Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey. The institutions' medical records were screened for women with pregnancies after 24 weeks of gestation. Women under 19 years of age were included as the adolescent group and women between the ages of 20 and 29 were included as the control group. Obstetric outcomes were compared between the groups.Results: There were 3875 adolescent pregnancies in the case group and 3875 adult pregnancies in the control group. Even after adjusting for confounders in our adolescent pregnant cohort, the odds of intrauterine growth restriction, preterm birth and premature rupture of membranes were higher than in our adult pregnant cohort. On the other hand, we found low incidents of preeclampsia and gestational diabetes mellitus in pregnant women younger than 19 years of age.Conclusions: Adolescent pregnancies should be closely followed up as they have higher preterm birth rates as well as the risk of intrauterine growth restriction.
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Affiliation(s)
- Berna Aslan Çetİn
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Begüm Aydogan Mathyk
- Department of Obstetrics and Gynecology, Mother Infant Research Institute at Tufts Medical Center, Boston, MA, USA
| | - Gökçe Turan
- Department of Obstetrics and Gynecology, Kırıkhan State Hospital, Hatay, Turkey
| | - Onur Güralp
- Department of Obstetrics and Gynecology, Klinikum Oldenburg, Carl Ossietzky University, Oldenburg, Germany
| | - Ali Gedİkbaşi
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
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Rexhepi M, Besimi F, Rufati N, Alili A, Bajrami S, Ismaili H. Hospital-Based Study of Maternal, Perinatal and Neonatal Outcomes in Adolescent Pregnancy Compared to Adult Women Pregnancy. Open Access Maced J Med Sci 2019; 7:760-766. [PMID: 30962834 PMCID: PMC6447330 DOI: 10.3889/oamjms.2019.210] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Adolescent pregnancy, defined as a pregnancy in girls aged 10 to 19 years. Adolescent mothers are at high risk for maternal and neonatal complications. AIM To compare maternal, perinatal and neonatal outcomes in adolescents and adult women aged 20-24 years. MATERIAL AND METHODS This retrospective cohort study included all singleton pregnancies during a three-year period (January 2016-December 2018) who gave birth in a Clinical Hospital in Tetovo, Republic of Macedonia. After exclusion criteria, a total of 932 cases were reviewed and divided into two groups: one of the teenage mothers (< 19 years old) (115 women) and the other of adult mothers (20-24 years old) (817 women). RESULTS Of the total number of 5643 births, 128 (2.27%) were from adolescent pregnancies. Of them, nulliparous adolescent women were 115 (2.04%). Adolescents compare to adult mothers had a higher rate of urinary tract infections (33% vs. 22%), increased rate of maternal anemia (26% vs. 15%), preterm birth, small for gestational age newborns (25.2% vs. 17.1%), lower high school attendance (0 vs. 21.9%) and inadequate prenatal care. Spontaneous labour was more common in adolescents (73% vs 63.5%), while Caesarean sections were less common than in women aged 20-24 years (25.2% vs 33.5%). The rate of other perinatal outcomes was not significantly different between the 2 groups. CONCLUSIONS The results of the study showed that the frequencies of some maternal, perinatal and neonatal complications were considerably higher in adolescent mothers.
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Affiliation(s)
- Meral Rexhepi
- Department of Gynecology and Obstetrics, Clinical Hospital, Tetovo, Republic of Macedonia
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | - Florin Besimi
- Department of Gynecology and Obstetrics, Clinical Hospital, Tetovo, Republic of Macedonia
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | - Nagip Rufati
- Department of Gynecology and Obstetrics, Clinical Hospital, Tetovo, Republic of Macedonia
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | - Arian Alili
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | - Sani Bajrami
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | - Hysni Ismaili
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
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Karataşlı V, Kanmaz AG, İnan AH, Budak A, Beyan E. Maternal and neonatal outcomes of adolescent pregnancy. J Gynecol Obstet Hum Reprod 2019; 48:347-350. [PMID: 30794955 DOI: 10.1016/j.jogoh.2019.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/29/2019] [Accepted: 02/19/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine the maternal and neonatal outcomes of adolescent pregnancies. METHODS Deliveries that occurred in a high-volume tertiary center between January 2013 and December 2016 were retrospectively analyzed. We studied pregnant women who were under 19 years of age at the time at which they gave birth, and who underwent regular follow-up. Pregnancies associated with chromosomal abnormalities, early pregnancy losses (before 20 weeks), and ectopic pregnancies were excluded. RESULTS In all, 101 pregnant women aged <15 years and 3611 aged 15-19 years were enrolled. The control group contained 13,501 randomly selected pregnant women aged 25-30 years. The median gestational week at delivery was lower in adolescents. Adolescent pregnancies were associated with higher rates of threatened abortion and pre-eclampsia. Gestational diabetes mellitus was less common, whereas the risk for cesarean section was higher, in adolescents. In addition, women aged <15 years were at higher risk for preterm delivery. The rates of <3rd percentile birth weight percentiles by gestational age were 6.9%, 5.1%, 4.2% and <10th percentile were 16.8%, 14.5%, 11% in the three groups, respectively. The 5 min Apgar scores were lower for the babies of adolescents, and the requirement of newborn intensive care was higher for the infants of mothers aged <15 years. CONCLUSION Adolescent pregnancy is a significant issue worldwide. Adverse outcomes differ among study populations, but both preterm delivery and low birth weight are of concern, as are a higher cesarean rate.
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Affiliation(s)
- Volkan Karataşlı
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey.
| | - Ahkam Göksel Kanmaz
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | | | - Adnan Budak
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Emrah Beyan
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
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Abstract
OBJECTIVE Pregnancy in adolescence is a global health issue, especially in developing countries. Additionally, the recommended gestational weight gain (GWG) is usually based on pre-pregnancy BMI and that might be complex for pregnant teens. The study objective was to compare three different methods of BMI classification and suggest the best way of determining pre-pregnancy BMI and monitoring GWG among pregnant adolescents. DESIGN Pre-pregnancy weight, weight at first prenatal visit, height, sociodemographic, reproductive and perinatal data were collected. Weighted kappa and McNemar statistics were used to assess agreement between the classification methods. SETTING Prof. Dr Jose Aristodemo Pinotti Women's Hospital, University of Campinas, Brazil.ParticipantsPrimiparas younger than 19 years of age and with less than 20 weeks of gestational age (n 150). RESULTS BMI of the primiparas was determined according to the WHO recommendation for adult women, the Child Growth Standards (CGS) and their gynaecological age (GA). The WHO and GA measurements presented a strong agreement with each other (κ w=0·99; 95 % CI 0·97, 1·00), but did not agree with the CGS classification (κ w=0·62; 95 % CI 0·50, 0·74 by WHO; κ w=0·62; 95 % CI 0·51, 0·74 by GA). Also, inadequate GWG was observed in 72·2 % of cases and was correlated with a higher rate of caesarean birth. CONCLUSIONS BMI classification according to the CGS differed from WHO and GA. However, CGS and WHO agreed on perinatal outcomes. We recommend using BMI classification by WHO to assess pregnant adolescents, since it is easily applied and better known among health professionals.
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Sychareun V, Vongxay V, Houaboun S, Thammavongsa V, Phummavongsa P, Chaleunvong K, Durham J. Determinants of adolescent pregnancy and access to reproductive and sexual health services for married and unmarried adolescents in rural Lao PDR: a qualitative study. BMC Pregnancy Childbirth 2018; 18:219. [PMID: 29884139 PMCID: PMC5994100 DOI: 10.1186/s12884-018-1859-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 05/25/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early marriage and pregnancy is a risk factor for poor maternal and child health and socio-economic outcomes. Bokeo and Luang Namtha provinces in northern Lao People's Democratic Republic (PDR) has high rates of teenage pregnancy. The purpose of this research was firstly to explore factors contributing to teenage pregnancy in rural Lao. Secondly, to understand the specific challenges adolescent mothers face in accessing maternal health services. METHODS Qualitative interviews were undertaken with adolescent mothers and unmarried adolescents aged 12 to 19 years, living in rural areas, and from different ethnic groups. In total, we undertook six focus group discussions with adolescents aged 13-19 years, twenty in-depth interviews with unmarried/married adolescents aged 12-19 years. In addition, we interviewed husbands of the adolescent mothers (N = 8) and mothers-in-law of both male and female adolescents (N = 9), community leaders and healthcare providers (health providers N = 17 and community leaders N = 12). Thematic analysis was used to analyze the data, based on a conceptual framework identified at the outset of the study. RESULTS The findings suggest that pre-marital sex, early marriage and pregnancy are the norm in these settings. Determinants of teenage pregnancy included liberal attitudes to teen pre-marital sexual intercourse, early marriage and pregnancy, incomplete knowledge of sexual and reproductive health and limited access to appropriate services. CONCLUSION The determinants of teenage pregnancy in this setting are multi-dimensional, and require a range of responses. As some of the determinants are deeply embedded in the system of local values, beliefs and practices, and form part of the logic of what it is to become a healthy woman, these practices are deeply entrenched and may be resistant to new knowledge. The challenge therefore is to find culturally responsive strategies that enable individual and collectively agency.
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Affiliation(s)
- Vanphanom Sychareun
- Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, Lao PDR, Laos
| | - Viengnakhone Vongxay
- Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, Lao PDR, Laos
| | - Souphaphone Houaboun
- Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, Lao PDR, Laos
| | - Vassana Thammavongsa
- Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, Lao PDR, Laos
| | - Phouthong Phummavongsa
- Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, Lao PDR, Laos
| | - Kongmany Chaleunvong
- Faculty of Basic Sciences, University of Health Sciences, Ministry of Health, P.O. Box 7444, Vientiane, Lao PDR Laos
| | - Jo Durham
- School of Public Health, University of Queensland, Herston Road, Hesrston, Brisbane, QLD 4006 Australia
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Usynina AA, Postoev V, Odland JØ, Grjibovski AM. Adverse Pregnancy Outcomes among Adolescents in Northwest Russia: A Population Registry-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E261. [PMID: 29401677 PMCID: PMC5858330 DOI: 10.3390/ijerph15020261] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/17/2022]
Abstract
This study aimed to assess whether adolescents have an increased risk of adverse pregnancy outcomes (APO) compared to adult women. We used data on 43,327 births from the population-based Arkhangelsk County Birth Registry, Northwest Russia, for 2012-2014. The perinatal outcomes included stillbirth, preterm birth (<37 and <32 weeks), low and very low birthweight, 5 min Apgar score <7 and <4, perinatal infections, and the need for neonatal transfer to a higher-level hospital. Multivariable logistic regression was applied to assess the associations between age and APO. Altogether, 4.7% of deliveries occurred in adolescents. Both folic acid intake and multivitamin intake during pregnancy were more prevalent in adults. Adolescents were more likely to be underweight, to smoke, and to have infections of the kidney and the genital tract compared to adult women. Compared to adults, adolescents were at lower risk of low birthweight, a 5 min Apgar score <7, and need for neonatal transfer. Adolescents had no increased risk of other APO studied in the adjusted analysis, suggesting that a constellation of other factors, but not young age per se, is associated with APO in the study setting.
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Affiliation(s)
- Anna A Usynina
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
- Department of Neonatology and Perinatology, Northern State Medical University, 51 Troitsky Ave., Arkhangelsk 163000, Russia.
| | - Vitaly Postoev
- Department of Public Health, Health Care and Social Work, Northern State Medical University, 51 Troitsky Ave., Arkhangelsk 163000, Russia.
| | - Jon Øyvind Odland
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Andrej M Grjibovski
- Central Scientific Research Laboratory, Northern State Medical University, 51 Troitsky Ave., Arkhangelsk 163000, Russia.
- Department of Public Health and Healthcare, Hygiene and Bioethics, North-Eastern Federal University, 58 Belinsky Str., Yakutsk 677000, Russia.
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Abstract
OBJECTIVE We examined the clinical characteristics and obstetric outcomes in adolescent pregnancies in Japanese women. METHODS The present study was a retrospective investigation of all primiparous Japanese women with singleton pregnancies who gave birth at ≥22 weeks' gestation aged ≤18 years old (adolescent pregnancy, n = 325) and aged 28-30 years old (n = 2029) at Japanese Red Cross, Katsushika Maternity Hospital between 2002 and 2016. RESULTS The frequencies of smoking, economic problems, an unmarried single status at delivery and the start of prenatal care in the first trimester in the adolescent pregnancy group were significantly higher than in the control group (p < .01). The incidences of Chlamydia trachomatis, Condyloma acuminatum, and mental disorders in the adolescent pregnancy group were significantly higher than in the control group (p < .01). Pregnancy in adolescence was not related to adverse obstetric outcomes except preterm delivery (p = .02). CONCLUSIONS Adolescent pregnancy was not associated with adverse obstetric outcomes; however, adequate social, economic, and mental support is needed for adolescent pregnant women.
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Affiliation(s)
- Shunji Suzuki
- a Department of Obstetrics and Gynecology , Japanese Red Cross Katsushika Maternity Hospital , Tokyo , Japan
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Maly C, McClendon KA, Baumgartner JN, Nakyanjo N, Ddaaki WG, Serwadda D, Nalugoda FK, Wawer MJ, Bonnevie E, Wagman JA. Perceptions of Adolescent Pregnancy Among Teenage Girls in Rakai, Uganda. Glob Qual Nurs Res 2017; 4:2333393617720555. [PMID: 28835911 PMCID: PMC5555492 DOI: 10.1177/2333393617720555] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/05/2017] [Accepted: 06/15/2017] [Indexed: 11/24/2022] Open
Abstract
The leading causes of death and disability among Ugandan female adolescents aged 15 to 19 years are pregnancy complications, unsafe abortions, and childbirth. Despite these statistics, our understanding of how girls perceive adolescent pregnancy is limited. This qualitative study explored the social and contextual factors shaping the perceptions of adolescent pregnancy and childbirth among a sample of 12 currently pregnant and 14 never pregnant girls living in the rural Rakai District of Uganda. Interviews were conducted to elicit perceived risk factors for pregnancy, associated community attitudes, and personal opinions on adolescent pregnancy. Findings indicate that notions of adolescent pregnancy are primarily influenced by perceptions of control over getting pregnant and readiness for childbearing. Premarital pregnancy was perceived as negative whereas postmarital pregnancy was regarded as positive. Greater understanding of the individual and contextual factors influencing perceptions can aid in development of salient, culturally appropriate policies and programs to mitigate unintended adolescent pregnancies.
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Affiliation(s)
- Christina Maly
- Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine A McClendon
- University of California, Los Angeles School of Nursing, Los Angeles, California, USA
| | | | | | | | - David Serwadda
- Makerere University, College of Health Sciences, Kampala, Uganda
| | | | - Maria J Wawer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Erika Bonnevie
- University of California, San Diego, La Jolla, California, USA
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Castro LC, Nausheen F. Adolescent Pregnancy and Increasing Body Mass Index: Risks and Benefits. J Womens Health (Larchmt) 2017; 26:399-400. [PMID: 28513341 DOI: 10.1089/jwh.2017.6472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lony C Castro
- 1 Department of Medical Education and Obstetrics & Gynecology, School of Medicine, California University of Science and Medicine , Colton, California.,2 Department of Women's Health, Arrowhead Regional Medical Center , Colton, California
| | - Fauzia Nausheen
- 1 Department of Medical Education and Obstetrics & Gynecology, School of Medicine, California University of Science and Medicine , Colton, California
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Association between maternal age at childbirth and metabolic syndrome in postmenopausal women: Korea National Health and Nutrition Examination Survey 2010 to 2012. Menopause 2017; 24:196-202. [DOI: 10.1097/gme.0000000000000740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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