Obstetric profile of pregnant adolescents in a public hospital: risk at beginning of labor, at delivery, postpartum, and in puerperium

Prevalence, socioeconomic factors and obstetric outcomes associated with adolescent motherhood in Ceará, Brazil: a population-based study

BACKGROUND

Adolescent motherhood (AM) remains a public health problem, especially in low and middle income countries, where approximately 95% of these births occur. Evidence from studies with population representativeness about events associated with AM is limited. We assessed the prevalence of AM, as well as its association with Socioeconomic Factors and Obstetric Outcomes.

METHODS

A population-based cross-sectional study on maternal and child health of women aged 10 to 49 years, living in the state of Ceará, in northeastern Brazil was carried out to assess the prevalence of AM, as well as its association with Socioeconomic Factors and Obstetric Outcomes. The definition of adolescence used in the study was the one utilized by the WHO. In addition to the interview, data were double-checked according to the information in the government's pregnancy health booklet. Sample-adjusted logistic models to determine the association of socioeconomic factors and AM, as well as the association of AM with obstetric outcomes, with a causal approach to multivariate analyses, were used.

RESULTS

The prevalence of adolescent motherhood was 18.6%. Poverty and household crowding were associated with greater chances of AM (p values of 0.038 and <  0.001, respectively), as well as not being in a stable relationship (OR 2.26 (95%CI: 1.67, 3.07), p <  0.001). AM showed a greater chance of not using community health services (p <  0.001), had fewer prenatal consultations (β - 0.432 (95%CI: - 0.75, - 0.10)) and started prenatal care at a later date (β 0.38 (95%CI: 0.21, 0.55), p <  0.001)). AM are also less likely to be tested for HIV and more likely to have urinary tract infections.

CONCLUSIONS

Interventions aimed at socially-vulnerable adolescents are suggested. However, if pregnant, adolescents should receive proactive and differentiated prenatal care.

Comprehensive evaluation of the risk of lactational mastitis in Chinese women: combined logistic regression analysis with receiver operating characteristic curve

Objective: To identify the potential risk factors for acute mastitis during lactation comprehensively. Subsequently, to evaluate logistic regression model in predicting the risk of lactational mastitis in Chinese women by applying receiver operating characteristic (ROC) curve.

Methods: A case–control study among Chinese women enrolled 652 patients with mastitis and 581 healthy women with breastfeeding experience as control. The retrospective information was obtained by questionnaires that included medical history of pregnancy, delivery, puerperium and breastfeeding behaviors. Univariate analysis and multivariate logistic regression model were performed to investigate the relationship between these factors and the occurrence of lactational mastitis. Using ROC curve to evaluate the prognostic value of these selected indicators in the risk of acute mastitis.

Results: The multivariate logistic regression analysis showed that the primiparity (P < 0.001), mastitis in previous breastfeeding (P < 0.001), nipple’s heteroplasia (P < 0.001), cracked nipple (P < 0.001), breast trauma by external force (P = 0.002), lateral position (P = 0.007), breast pump (P = 0.039), nipple sucking (P = 0.007), sleep with sucking (P = 0.007), and tongue-tie (P = 0.013) were risk variables independently and significantly related with mastitis. While vaginal delivery (P = 0.015), clean nipple before breastfeeding (P = 0.015), first contact with child within 1 h (P = 0.027) were protective factors. The ROC analysis demonstrated that the area under the curve of model 2 was 0.8122 (95%CI = 0.7885–0.8360), which stated that the model presented a high sensitivity and specificity.

Conclusion: By means of collecting and summarizing the risk factors associated with the occurrence of breast mastitis in Chinese women, we established risk discriminant model to identify and warn the individuals susceptible to acute mastitis early, which will allow practitioners to provide appropriate management advice and effective individual care.