Gravidez na adolescência, pré-natal e resultados perinatais em Montes Claros, Minas Gerais, Brasil

LIVE BIRTHS OF IMMIGRANT MOTHERS IN BRAZIL: A POPULATION-BASED STUDY

Introduction

Methods

Results

Conclusion

Risks of Adverse Neonatal Outcomes in Early Adolescent Pregnancy Using Group Prenatal Care as a Strategy for Public Health Policies: A Retrospective Cohort Study in Brazil

Background: Adolescent pregnancy is a public health concern and many studies have evaluated neonatal outcomes, but few have compared younger adolescents with older using adequate prenatal care. Objective: To compare the risks of adverse neonatal outcomes in younger pregnant adolescents who are properly followed through group prenatal care (GPC) delivered by specialized public services. Methods: This retrospective cohort study followed pregnant adolescents (aged 10-17 years) who received GPC from specialized public services in Brazil from 2009 to 2014. Data were obtained from medical records and through interviews with a multidisciplinary team that treated the patients. The neonatal outcomes (low birth weight, prematurity, Apgar scores with 1 and 5 min, and neonatal death) of newborns of adolescents aged 10-13 years were compared to those of adolescents aged 14-15 years and 16-17 years. Incidence was calculated with 95% confidence intervals (CIs) and compared over time using a chi-squared test to observe trends. Poisson Multivariate logistic regression was used to adjust for confounding variables. The results are presented as adjusted relative risks or adjusted mean differences. Results: Of the 1,112 adolescents who were monitored, 758 were included in this study. The overall incidence of adverse neonatal outcomes (low birth weight and prematurity) was measured as 10.2% (95% CI: 9.7-11.5). Apgar scores collected at 1 and 5 min were found to be normal, and no instance of fetal death occurred. The incidence of low birth weight was 16.1% for the 10-13 age group, 8.7% for the 14-15 age group and 12.1% for the 16-17 age group. The incidence of preterm was measured at 12, 8.5, and 12.6% for adolescents who were 10-13, 14-15, and 16-17 years of age, respectively. Neither low birth weight nor prematurity levels significantly differed among the groups (p > 0.05). The infants born to mothers aged 10-13 years presented significantly (p < 0.05) lower Apgar scores than other age groups, but the scores were within the normal range. Conclusions: Our findings showed lower incidence of neonatal adverse outcomes and no risk difference of neonatal outcomes in younger pregnancy adolescents. It potentially suggests that GPC model to care pregnant adolescents is more important than the age of pregnant adolescent, however further research is needed.

Perinatal health and malocclusions in preschool children: Findings from a cohort of adolescent mothers in Southern Brazil

INTRODUCTION

Pregnancy in adolescence has long-term consequences that can negatively influence oral conditions. In this study, we aimed to assess malocclusion in deciduous dentition and its association with prolonged breastfeeding, pacifier use, and perinatal health indicators pertaining to the periods immediately before and after birth.

METHODS

This cross-sectional study was nested in a cohort of adolescent mothers who became pregnant from 13 to 19 years of age (mean age, 17.3 ± 1.6 years). A total of 509 mother-child dyads were included. Information on perinatal indicators, including Apgar score (0-10), which is a standardized assessment of the condition of the infant at birth (heart rate, breath rate, muscle tone, reflex irritability, and skin color), head circumference, birth weight, and need for intensive care unit admission were collected after delivery through interviews with the mothers. By the time the children were 24 to 36 months of age, malocclusion was assessed, and information on the use of pacifiers and breastfeeding was collected. Multivariate Poisson regression was used to assess the effect of independent variables on the outcome (malocclusion).

RESULTS

The prevalence of malocclusion was 62.33%, and open bite was the most frequent one (47.45%). After adjustments, children with no need for intensive care unit admission had a lower risk of malocclusion (prevalence ratio [PR] = 0.75; 95% CI, 0.56-0.99), whereas those with an Apgar score less than 7 had a higher risk (PR = 1.32; 95% CI, 1.06-1.64). Children who had used a pacifier (PR = 1.82; 95% CI, 1.02-3.24) or were still using it (PR = 3.88; 95% CI, 2.65-5.68) had a higher chance of malocclusion compared with children who never used a pacifier. Children breastfeeding for 24 months or longer were less likely to have malocclusion (PR = 0.46; 95% CI, 0.34-0.73).

CONCLUSIONS

Poor perinatal health and pacifier use may be risk factors for malocclusion development in deciduous teeth. Long duration of breastfeeding is associated with better occlusal conditions in children of adolescent mothers. Further studies are needed with other age groups.

Factors associated to maternal and child's health in Rio Grande do Sul, Brazil

Abstract Objectives: to analyze the factors associated to maternal and child's health from the Live Births Information System (Sinasc) in Rio Grande do Sul, 2012. Methods: a cross-sectional ecological study with analysis on Sinasc variables from 19 Regional Health Coordinations in Rio Grande do Sul. The variables occurrence frequencies were calculated and analyzed by Spearman correlation. Results: we observed that a higher maternal level of education, the presence of a partner and the adequate number of prenatal consultations reduced the frequency of vaginal delivery, as for the proportion of cesarean section, it was 62%. The frequency of low schooling was associated to prematurity (rho = 0.521, p=0.022) and low birth weight (rho = 0.542, p=0.016). The low prenatal coverage correlated positively with the Apgar score ≤ 7 in the 5th minute (rho = 0.467; p=0.044) and negatively with adequate birth weight (rho = -0.500; p=0.029). Conclusions: this study allows to identify factors associated to maternal and child's health contributing information to the development of actions that qualifies pregnant women's healthcare.

[Telephone monitoring service for pregnant women and impact on prevalence of prematurity and associated risk factors in Piracicaba, São Paulo State, Brazil]

This study aims to assess the impact of a telephone monitoring service on prevalence of prematurity and to analyze associated risk factors using data on 2,739 pregnant women. Estimation was based on hierarchical multiple logistic regression, with p ≤ 0.05 for variables to remain in the model. Prevalence of preterm birth was 8.34% in monitored pregnant women and 10.18% in unmonitored women (p = 0.0058). Prevalence of preterm birth was inversely proportional to the number of monitoring calls (p < 0.0001). Variables associated with prematurity were maternal age < 19 years, history of death of two or more children, multiple pregnancy, diabetes, hypertension, fewer monitoring calls, extended standing or lifting heavy weights at work, smoking, fewer prenatal visits, no ultrasound examination, gestational diabetes, multiple pregnancy, and fetal abnormality. This low-cost strategy proved effective for reducing the preterm birth rate.

Obstetric, Sociodemographic, and Psychosocial Problems of Postpartum Adolescents of Huambo, Angola

This study aims to establish a profile of teenage pregnancy (<20 years) at a hospital in Huambo, Angola. Subjects were categorized into two age groups, 10-16 and 17-19 years. We interviewed 381 mothers in the postpartum maternity ward of the Central Hospital of Huambo. Statistical analysis then followed two stages, a descriptive analysis of the study population and analysis through a bivariate 2 × 2 table, using a chi-squared test to evaluate the hypothesis of homogeneity of proportions with a significance level of 5%. Comparing the two groups revealed a more frequent occurrence of problems among mothers under 17 years of age, including a higher frequency of involvement with unemployed parents, more often not living with parents, and fewer prenatal consultations.

The study of the mother-child binomium: description and general results

OBJECTIVE: The present study investigated the characteristics of women during pregnancy/immediate postpartum cycles and the product of their pregnancy. METHOD: Data collection was conducted for a period of three months in 2011, in six maternity hospitals in the State of São Paulo. The data were obtained in an interview with the women after the end of the pregnancy and collected from hospital records. The sample included 7,058 women hospitalized for abortion or childbirth in five hospitals from SUS (Unified Health System) and from only one hospital for private health insurance patients and their 6,602 conceptuses (live births and stillborns). Statistical analysis was based on χ2 tests, with a significance level of α = 5%. RESULTS: It was observed that 6,530 women gave birth and 528 showed interruption of pregnancy. Regarding age, 1,448 were teenagers (20.5%). There were no deaths during hospitalization and 99.8% of women received a medical discharge. Maternal morbidity in the current pregnancy was analyzed, showing urinary tract infection, anemia and excessive vomiting as the main problems. The rate of cesarean sections accounted for 31.1% and complications in childbirth and postpartum were shown, respectively, by 834 (12.8%) and 265 (4.1%) women. The characteristics of the conceptuses were also studied: gestation length (9.3% of preterm among live births, and 68% among the stillborn); birth weight (underweight in 8.2% among live births, and 66% among the stillborn) and morbidity, measured by congenital anomalies and other diseases; these diseases were responsible for ICU stay, transfers to better-equipped hospitals (10 cases) and 37 deaths. Thirteen live births were still hospitalized at the end of the investigation.

Characteristics of antenatal care for adolescents from state capitals in Southern and Northeastern Brazil

Quantitative and descriptive study that intended to describe some aspects of antenatal care for adolescents at teaching hospitals in the South and Northeast of Brazil, based on the quality criteria established by the Humanization Program of Antenatal and Birth Care. This is an excerpt from the research "Social support networks for fatherhood during adolescence". The data collection occurred between December 2008 and December 2009. The sample consisted of 559 puerperal adolescents. The results showed that 98% of the interviewees received antenatal care, 67.2% attended six or more consultations and 62.5% started the care in the first pregnancy terms. As regards the routine exams, not all of them were done, and 41.8% denied having received any kind of information about labor and delivery during the antenatal consultations. In conclusion, most of the adolescents received antenatal care according to the criteria recommended in the Program. Nevertheless, educational actions and orientations are needed during the consultations.

Millennium Development Goal 5 and adolescents: looking back, moving forward

Since the Millennium Declaration in 2000, unprecedented progress has been made in the reduction of global maternal mortality. Millennium Development Goal 5 (MDG 5; improving maternal health) includes two primary targets, 5A and 5B. Target 5A aimed for a 75% reduction in the global maternal mortality ratio (MMR), and 5B aimed to achieve universal access to reproductive health. Globally, maternal mortality since 1990 has nearly halved and access to reproductive health services in developing countries has substantially improved. In setting goals and targets for the post-MDG era, the global maternal health community has recognised that ultimate goal of ending preventable maternal mortality is now within reach. The new target of a global MMR of <70 deaths per 100 000 live births by 2030 is ambitious, yet achievable and to reach this target a significantly increased effort to promote and ensure universal, equitable access to reproductive, maternal and newborn services for all women and adolescents will be required. In this article, as we reflect on patterns, trends and determinants of maternal mortality, morbidity and other key MDG5 indicators among adolescents, we aim to highlight the importance of promoting and protecting the sexual and reproductive health and rights of adolescents as part of renewed global efforts to end preventable maternal mortality.

[Facing the difficult experience even with support: the underage adolescent experiencing motherhood]

OBJECTIVES

To understand the meaning of childcare for the underage adolescent mother, to reveal the demands of care and to build a theoretical model based on this experience.

METHOD

Qualitative research with symbolic interactionism as the theoretical framework and the grounded theory as the methodological framework; nine adolescents participated in the study. The semi-structured interview was used to collect data from September 2008 to September 2011, during paediatric nursing consultation at the Centro Assistencial Cruz de Malta, a philanthropic institution in the city of São Paulo/Brazil.

RESULTS

Data analysis led to the construction of the theoretical model,Facing a difficult experience even with support.

CONCLUSION

The experience shows that the difficulties to care for a child, even with help, are not met, only mitigated, and that underage adolescents do not have the maturity to cope with this experience.

O significado da maternidade na trajetória de três jovens mães: um estudo psicanalítico

O objetivo desse artigo é apresentar o significado da experiência da maternidade na trajetória de três jovens mães. As participantes se encontravam em um abrigo para mães adolescentes no município de São Paulo, São Paulo. Foram realizados cinco encontros com cada dupla, formada por mãe e filho, a fim de compreender a experiência de cada mãe em relação à gestação e à maternidade, a experiência com as diversas formas de violência e o vínculo com o filho. Os conteúdos encontrados se articulam com as ideias do psicanalista Donald W. Winnicott. Nos três casos analisados, observamos que a maternidade tem um significado especial e revela-se como sinal de esperança, segundo a conceituação de Winnicott, de reencontrar uma experiência de afeto significativa, por meio da qual se constitua um sentimento autêntico de preocupação e comprometimento com o próximo. No entanto, deixar as mães à própria sorte nesse momento as coloca em uma situação de risco para a repetição de abandono e violência vivenciados.

Baixo peso ao nascer em adolescentes e adultas jovens na Região Nordeste do Brasil

Objetivos: avaliar a associação entre as características sociodemográficas, do pré-natal e do parto de mães adolescentes e adultas jovens com o baixo peso ao nascer, em capitais e outros municípios da Região Nordeste do Brasil, no período de 2011 e 2012. Métodos: estudo transversal, de base hospitalar e nível regional, realizado em 2011 e 2012. As informações foram obtidas por meio de entrevista com a puérpera no pós-parto imediato e coletados dados dos prontuários maternos e dos recém-nascidos. Um modelo teórico conceitual foi estabelecido com três níveis de hierarquia e a variável dependente foi o baixo peso ao nascer (BPN). Resultados: do total de 3009 puérperas entrevistadas, 9,7% apresentaram conceptos com baixo peso. As puérperas que realizaram menos que seis consultas no pré-natal apresentaram uma chance 1,7 vezes maior de ter RN com baixo peso; ser primigesta aumentou a chance da ocorrência do BPN em 1,5 vezes; assim como a prematuridade que representou o principal fator de exposição, elevando em 21 vezes a chance desse desfecho. Conclusões: o estudo demonstrou alta frequência de baixo peso ao nascer entre mães adolescentes e adultas jovens, tendo como principais fatores associados o número insuficiente de consultas pré-natal, primigestação e prematuridade.

Gravidez na adolescência: análise de fatores de risco para baixo peso, prematuridade e cesariana

O objetivo do estudo foi analisar possíveis associações entre a faixa etária materna até 16 anos, com o peso e a idade gestacional do recém-nascido, assim como a ocorrência de cesaria na. Estudo transversal com dados das Declarações de Nascidos Vivos/DN obtidos através do Sistema Nacional de Nascidos Vivos/SINASC, de Feira de Santana, Bahia, Brasil, no período 2006 a 2012. Nas análises, utilizou-se regressão logística, em razão de odds (OR) e intervalo de confiança de 95 %, medindo a força de associação entre variáveis, ajustadas aos fatores de confundimento. Os Recém Nascidos de baixo peso e de peso insuficiente mostraram associação significante com a faixa etária materna (< 16 anos); e interação estatística do pré-natal inadequado e cesariana; em gestantes adolescentes com idade abaixo de 16 anos, a cesariana mostrou associação significante com estado civil solteira (OR 1,24), pré-natal inadequado (OR 1,58) e Recém Nascidos de baixo peso (OR 1,34). Os dados sugerem que múltiplos fatores podem interferir no tipo de parto e resultado gestacional de adolescentes em idade muito precoce, apontando a importância de investimentos em políticas e ações direcionadas a esse grupo, considerado de alta vulnerabilidade aos agravos gestacionais e perinatais.

Risco reprodutivo e renda familiar: análise do perfil de gestantes

Em face do desafio de enfrentar a morbimortalidade materna e perinatal, a discussão sobre risco reprodutivo e sua associação com situações de vulnerabilidade em saúde é relevante à saúde publica. A pesquisa realizada teve como objetivos descrever o perfil de risco reprodutivo de 3440 mulheres matriculadas em um serviço de pré-natal de alto risco, entre 2006 e 2008, e investigar sua relação com renda familiar e situações de vulnerabilidade em saúde. Trata-se de estudo transversal que teve como fonte o banco de dados do pré-natal. O perfil econômico do grupo estudado é de baixa renda. Encontrou-se associação entre baixa renda familiar e malformações fetais, gravidez antes dos 15 anos e HIV. Renda familiar mais elevada foi associada à idade materna acima de 35 anos, translucência nucal alterada, ginecopatias e abortamento habitual. Os achados podem refletir situações de vulnerabilidade de mulheres de baixa renda, como condições de saúde desfavoráveis e menor acesso e utilização de serviços de saúde. É necessário obter um maior conhecimento do perfil do risco reprodutivo no Brasil e sua distribuição segundo características sociodemográficas, visando ao aperfeiçoamento das práticas assistenciais.

[Determinants of neonatal mortality: a case-control study in Fortaleza, Ceará State, Brazil]

This case-control study with 132 cases and 264 controls aimed to determine predictors of neonatal mortality using hierarchical modeling. Cases were defined as newborns that died within 28 days of birth, and controls as the survivors, among infants of mothers living in Fortaleza, Ceará State, Brazil. Hierarchical logistic regression identified factors associated with neonatal death: maternal race, with brown/black race showing a protective effect (OR = 0.23; IC95%: 0.09-0.56), time spent from home to the hospital > 30 minutes (OR = 3.12; 95%CI: 1.34-7.25), time < 1h or > 10 hours between hospital admission and delivery (OR = 2.43; 95%CI: 1.24-4.76), inadequate prenatal care (OR = 2.03; 95%CI: 1.03-3.99), low birth weight (OR = 14.75; 95%CI: 5.26-41.35), prematurity (OR = 3.41; 95%CI: 1.29-8.98), and male gender (OR = 2.09; 95%CI: 1.09-4.03). In this case series, neonatal deaths were associated with the quality of prenatal care and direct care during labor.

O perfil das puérperas adolescentes atendidas em uma maternidade de referência de Fortaleza-Ceará

Objetivou-se caracterizar o perfil das puérperas adolescentes de uma maternidade de Fortaleza-CE. Estudo descritivo, transversal e quantitativo, realizado no Alojamento Conjunto da Maternidade Escola Assis Chateaubriand, no período de março a julho de 2009, com 200 adolescentes. Os dados foram obtidos por meio de entrevistas. A maioria apresentava idade entre 15 e 19 anos (91,0%), residia na capital (78,0%), vivia com o pai de seu filho (64,5%), tinha baixa escolaridade (55,5%), considerava-se parda (61,5%) e dona-de-casa (53%). Quanto aos métodos anticonceptivos, 73,5% usaram algum método antes de engravidar, 65,5% desejaram a gravidez e 32,5% planejaram a gravidez. Durante a gravidez, 18,5% tiveram internação hospitalar e 82,5% não utilizavam drogas. Torna-se relevante a função do enfermeiro como educador em saúde para orientá-las e torná-las autônomas na promoção de sua saúde sexual.

[Pre-pregnancy nutritional status, maternal weight gain, prenatal care, and adverse perinatal outcomes among adolescent mothers]

OBJECTIVE

To identify the association between pre-gestational nutritional status, maternal weight gain, and prenatal care with low birth weight (LBW) and prematurity outcomes in infants of adolescent mothers.

METHODS

Cross-sectional study with 542 pairs of adolescent mothers and their children attending a public maternity hospital in Rio de Janeiro. Data were collected from medical records. To determine the association between independent variables and the outcomes studied, odds ratio (OR) and a 95% confidence interval (CI) were estimated

RESULTS

With respect to pre-pregnancy nutritional status of adolescents, 87% had normal weight, 1% were underweight, 10% were overweight, and 2% obese. Inadequate total gestational weight gain (72%) exceeded adequacy (28%). Birth weight was favored with greater gestational weight gain, and reduced with late onset of prenatal care. The comparison between the low birth weight and normal birth weight groups revealed significant differences between variable means: interval between the past pregnancy and current pregnancy (p = 0.022), pre-gestational weight (p = 0.018); pre-gestational body mass index (p < 0.001), and total gestational weight gain (p = 0.047). The odds of LBW (OR 2.70, 95% CI 1.45 to 5.06) and prematurity (OR 5.82, 95% CI 3.10 to 10.92) fell when the adolescent received six or more prenatal visits.

CONCLUSION

Birth weight was associated with inter-gestational interval, pre-pregnancy weight and body mass index before pregnancy. The minimum frequency of six prenatal care visits was a protective factor against LBW and prematurity.

Avaliação da qualidade da atenção à saúde de adolescentes no pré-natal e puerpério

Pesquisa avaliativa que objetivou avaliar a qualidade da atenção pré-natal e puerperal a adolescentes com filhos nascidos vivos em instituição pública de saúde de Teresina, Piauí. Foram utilizados dois parâmetros para avaliar o cuidado pré-natal: um índice internacional (Adequacy of Prenatal Care Utilization) e outro nacional, baseado em recomendações do Ministério da Saúde. A qualidade da atenção foi categorizada em adequada superior, adequada, intermediária e inadequada. Identificou-se que mais da metade das mulheres iniciou o pré-natal precocemente e o número de consultas de pré-natal foi inadequada. A maioria realizou exames de pré-natal de rotina, 75% tiveram as mamas examinadas e 88,6% foram orientadas sobre aleitamento materno. A atenção puerperal foi intermediária para 38,6% das mulheres, 52,3% não retornaram à unidade de saúde e tampouco receberam visita domiciliar, 70,5% foram orientadas sobre os métodos contraceptivos e 93,2%, sobre aleitamento materno. Esforços devem ser empreendidos para garantir a qualidade da atenção no ciclo gravídico-puerperal.

Modifying effect of prenatal care on the association between young maternal age and adverse birth outcomes

OBJECTIVES

The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes.

METHODS

A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction.

RESULTS

Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes.

CONCLUSION

Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines.

Pregnancies in young adolescent mothers: a population-based study on 37 million births

OBJECTIVES

Pregnancy in young adolescents is often understudied. The objective of our study was to evaluate the effect of young maternal age on adverse obstetrical and neonatal outcomes.

METHODS

We conducted a population-based cohort study using the Center for Disease Control and Prevention's Linked Birth-Infant Death and Fetal Death data on all births in the US between 1995 and 2004. We excluded all births of gestational age under 24 weeks and those with reported congenital malformations or chromosomal abnormalities. Maternal age was obtained from the birth certificate and relative risks estimating its effect on obstetrical and neonatal outcomes were computed using unconditional logistic regression analysis.

RESULTS

37,504,230 births met study criteria of which 300,627 were in women aged <15 years with decreasing rates from 11/1,000 to 6/1,000 over a 10-year period. As compared to women 15 years and older, women <15 were more likely to be black and Hispanic, less likely to have adequate prenatal care, and more likely to not have had any prenatal care. In adjusted analysis, births to women <15 were more likely to be IUGR, born under 28, 32, and 37 weeks' gestation and to result in stillbirths and infant deaths. Prenatal care was protective against infant deaths in women < 15 years of age.

CONCLUSION

Although public health initiatives have been successful in decreasing rates of young adolescent pregnancies, these remain high risk pregnancies that may benefit from centers capable of ensuring adequate prenatal care.

[Brazilian live birth information system: a review study]

The aim of this study was to perform a systematic review of the use of the Live Birth Information System (Sistema de Informações de Nascidos Vivos--SINASC) in health research. MEDLINE, LILACS and SciELO databases were searched from 1994 to 2005 using the following combination of descriptors: "SINASC", "live birth", "Brazil". We identified 157 abstracts within the reference period, among which 44 were selected and classified according to specific criteria. The number of articles published per year increased during the period studied. The majority of the studies was carried out in the Southeast region and used the municipality as the geographic unity of analysis. A varied range of subjects were assessed including descriptions of live births profiles, health service and programs evaluations and risk factors for infant outcomes. In conclusion, although the SINASC represents an important data source for maternal-infant health research, the system's coverage and the reliability of its data need to be better evaluated.

Resultados perinatais nos extremos da vida reprodutiva e fatores associados ao baixo peso ao nascer

Objetivou-se investigar os resultados perinatais nos extremos da vida reprodutiva e verificar os fatores de risco para o baixo peso ao nascer. Trata-se de um estudo retrospectivo dos partos ocorridos no município de Sarandi, Paraná, no ano de 2008, a partir de consultas aos dados do Sistema de Informação de Nascidos Vivos. As 331 gestantes foram subdivididas em dois grupos: adolescentes (10-19 anos) e tardias (35 anos ou mais). As taxas de parto cesáreo foram significativamente maiores (66,1%) nas gestantes com 35 anos ou mais do que nas adolescentes (26,8%). Quanto aos fatores de risco para o baixo peso ao nascer, observou-se que este esteve fortemente associado com prematuridade e o estado civil. Os resultados perinatais das gestantes com 35 anos ou mais não apresentaram diferença significativa quando comparados aos resultados das adolescentes, confirmando a ocorrência de resultados adversos nos dois extremos da vida reprodutiva, exceto pela ocorrência de parto cesáreo.

Características sociodemográficas e de assistência à gestação e ao parto no extremo sul do Brasil

Este estudo teve por objetivo comparar a assistência à gestação e ao parto entre mães adolescentes e não adolescentes residentes no Município de Rio Grande, Rio Grande do Sul, Brasil. Entre 1º de janeiro e 31 de dezembro de 2007 aplicou-se questionário padronizado a todas as mães destes recém-nascidos buscando informações sobre cuidados recebidos do inicio da gravidez até momento do parto. Utilizou-se teste do qui-quadrado para comparar proporções. Um quarto (516) dos recém-nascidos era filho de mães adolescentes. Em relação às demais mães, uma menor proporção de adolescentes completou seis ou mais consultas de pré-natal (61% x 75%), iniciou o pré-natal no primeiro trimestre de gravidez (58% x 77%), recebeu vacina antitetânica (81% x 85%) e fez todo o pré-natal com o mesmo profissional (70% x 78%); no entanto, foram mais comumente suplementadas com sulfato ferroso (66% x 57%), submetidas a fórcipe (11% x 6%), à episiotomia (86% x 66%), e atendidas no SUS (92% x 76%). Estes dados mostram que a assistência recebida pelas mães adolescentes foi sistematicamente pior àquela recebida pelas demais mães.

Gravidez na adolescência e características socioeconômicas dos municípios do Estado de São Paulo, Brasil: análise espacial

A gravidez na adolescência é um problema de saúde pública comum em todo o mundo. O objetivo deste estudo ecológico é estudar o padrão espacial da associação entre os percentuais de gravidez na adolescência e características socioeconômicas dos municípios do Estado de São Paulo, Brasil. Para isso, foi utilizado um modelo bayesiano com uma distribuição espacial que segue uma estrutura condicional autorregressiva (CAR), baseado em algoritmos Monte Carlo em cadeias de Markov (MCMC). Foram usados dados do Sistema de Informações sobre Nascidos Vivos (SINASC) e do Instituto Brasileiro de Geografia e Estatística (IBGE). Verificou-se que a ocorrência de gravidezes precoces apresentou-se maior nos municípios de menor produto interno bruto (PIB) per capita, com maior incidência de pobreza, de menor tamanho populacional, menor índice de desenvolvimento humano (IDH) e maior percentual de indivíduos com índice paulista de vulnerabilidade social (IPVS) igual a 5 ou 6, ou seja, mais vulneráveis. O estudo demonstra uma estreita associação entre gravidez na adolescência e indicadores econômicos e sociais.

[Girls from Santa Catarina: losing your life to become a mother]

The Maternal Mortality Ratio (MMR) is an indicator that analyses the life conditions and care given to pregnant women, and indicates whether the constitutional rights related to life and health are being complied with. This study shows losses of lives among adolescent women associated with pregnancy, childbirth and the puerperal period, in the state of Santa Catarina between 1994 and 2005. It is an exploratory study of a quantitative nature. There were 72 maternal deaths in adolescents, 67% had a direct obstetric cause, 23% had an indirect obstetric cause and about 9% were classified as accidental or incidental. The Maternal Mortality Ratio in adolescents was high and most could have been prevented and its causes controlled. The identified situation shows an absence of quality health care. To reduce these deaths it is central that nursing action be combined with other professionals and other organized sectors of society.

A comparison of low birth weight among newborns of early adolescents, late adolescents, and adult mothers in the Peruvian Amazon

To compare low birth weight (LBW: <2,500 g) between infants born to adolescent and adult mothers in Iquitos, Peru. A random sample of 4,467 records of women who delivered at the Hospital Apoyo Iquitos between 2005 and 2007 was collected from hospital birth registries. Multivariate logistic and linear regression analyses were performed to compare LBW in newborns of adolescents (10-14, 15-19 years) and adults (≥20 years) and then for primiparous mothers with a normal gestational age, adjusting for newborn sex, antenatal care, and location of the mother's residence. A total of 4,384 mothers had had a singleton live birth and 1,501 were primiparous with a normal gestational age. Early and late adolescents had significantly greater odds of having a LBW infant than adults (OR = 2.28, 95%CI: 1.09, 4.78; OR = 1.67, 95%CI: 1.30, 2.14, respectively). For primiparous mothers with a normal gestational age, the same was true only for early adolescents (OR = 3.07, 95%CI: 1.09, 8.61). There were significant differences in mean birth weight between adults (3178.7 g) and both adolescent age groups overall (10-14 years: 2848.9 g; 15-19 years: 2998.3 g) and for primiparous mothers with a normal gestational age (10-14 years: 2900.8 g; 15-19 years: 3059.2 g; ≥20 years: 3151.8 g). Results suggest there is an important difference between adolescent and adult mothers in terms of newborn birth weight, especially among early adolescents. Future research on LBW and possibly other adverse birth outcomes should consider early adolescents as a separate sub-group of higher risk.

Parto prematuro de adolescentes: influência de fatores sociodemográficos e reprodutivos, Espírito Santo, 2007

A gravidez na adolescência é um problema de saúde pública, podendo trazer consequências negativas para a adolescente, sua família e para o concepto/recém-nascido. Objetivos: Identificar diferenças entre as características sociodemográficas e reprodutivas das mães adolescentes com parto a termo e com parto pré-termo, no Espírito Santo em 2007. Metodologia: Estudo retrospectivo quantitativo. Os dados foram coletados no Sistema de Informação de Nascidos Vivos, sendo realizada análise descritiva de 9.841 Declarações de Nascidos Vivos. A relação entre a variável dependente (termo) e fatores foi testada pelo teste exato de Fisher, com á=0,05. Os resultados evidenciaram que as diferenças nas características das mães adolescentes com parto a termo e pré-termo ocorreram nas seguintes variáveis: idade entre 10 a 14 anos (p=0,016), estado civil casada (p=0,014), número de consultas pré-natais quando insuficientes (p=0,000) e gestação dupla (p=0,000). Houve maior incidência de partos prematuros no Sistema Único de Saúde (p=0,000).

Prematurity and low birth weight among Brazilian adolescents and young adults

STUDY OBJECTIVE

To compare the incidence of preterm birth and low birth weight infants in young and older primiparous adolescents versus young adults.

DESIGN

Cross-sectional study.

SETTING

Maternity hospital in Vitória, ES, Brazil.

PARTICIPANTS

During a 5-year period, young primiparous women who delivered a singleton liveborn infant over 22 weeks were interviewed while in the postpartum ward.

INTERVENTIONS

A single investigator performed all the individual interviews to collect sociodemographic variables and obtained gestational age and birth weight from the patients' charts before discharge.

MAIN OUTCOME MEASURES

Participants were divided into 3 groups according to age: young adolescents (10-15 years), older adolescents (16-19 y) and young adults (20-24 y). The chi(2) test was used to compare the rate of preterm birth and low birth weight between the groups and analyze differences in sociodemographic characteristics between the 3 groups. P<0.05 was considered significant.

RESULTS

A total of 1124 participants were included: 164 young adolescents, 537 older adolescents and 423 adults. The rate of preterm birth was similar in the 3 groups: 4.3%, 3.5% and 4.5%, for young adolescents, older adolescents and adults, respectively (P=0.48). The rate of low birth weight was significantly higher among young adolescents (9.7%) compared to older adolescents (6.1%) and young adults (3.5%) (P=0.012).

CONCLUSIONS

The rate of preterm birth was similar in adolescents and young adults. Adolescent mothers under 16 years of age have a significantly higher incidence of low birth weight infants.

[Risk factors for pre-term birth in Londrina, Paraná State, Brazil]

The objective of this study was to identify risk factors associated with pre-term birth among live births in a hospital in Londrina, Paraná State, Brazil. Cases consisted of 328 pre-term births, and controls were 369 births with gestational age greater than 37 weeks. A multiple hierarchical logistic regression analysis was carried out. There was a significant correlation (p < 0.05) between pre-term birth and the following variables: socioeconomic status (slum residence); low age of head-of-family; maternal BMI < 19 or > 30 kg/m2; history of prematurity; history of assisted reproduction; mothers in a relationship for less than two years; maternal stress; weekly maternal alcohol consumption; insufficient prenatal care; gestational complications such as bleeding, genital tract infection, altered amniotic fluid volume, high blood pressure, and hospital admission; and twin pregnancy. Regular walks during pregnancy were a protective factor. Improved quality of prenatal care and the identification of the above factors during pregnancy may help reduce premature birth.

Comparison of prenatal care coverage in early adolescents, late adolescents, and adult pregnant women in the Peruvian Amazon

OBJECTIVE

To compare prenatal care coverage between adolescent (early and late) and adult pregnant women in Iquitos, Peru.

METHODS

A random sample of 4467 birth records was collected. Multivariate analyses were performed to compare prenatal care coverage in all adolescent (10-14 years, 15-19 years) and adult (>or=20 years) age groups and then for primiparous women only.

RESULTS

The mean number of visits was 5.0 for adolescents aged 10-14 years, 6.1 for adolescents aged 15-19 years, and 6.2 for women aged 20 years or older. For primiparous women, the means were 5.1, 6.2, and 6.8, for the respective age groups. Both the proportion attending and the number of prenatal visits were significantly lower in primiparous adolescents aged 10-14 years than in primiparous women aged 20 years or older (aOR 0.25; 95% CI, 0.10-0.62 and aRR 0.83; 95% CI, 0.74-0.94, respectively).

CONCLUSION

All women attended prenatal care more frequently than the WHO's recommended 4 visits; however, early adolescents attended significantly less often than late adolescents or adult women. Further study of this inequality is warranted to adequately inform local health services.

Fatores de risco para prematuridade: pesquisa documental

Objetivou-se identificar o perfil de mães e de prematuros nascidos vivos e caracterizar os recém-nascidos prematuros em situação de risco para o crescimento e desenvolvimento. Estudo epidemiológico de corte transversal realizado em Guarapuava, PR. Os dados foram obtidos a partir do sistema de informações sobre nascidos vivos (SINASC) com base nas declarações de nascidos vivos. A análise estatística foi realizada em uma amostra composta por 106 declarações de nascidos vivos prematuros, de janeiro a junho de 2005, e suas respectivas mães. As variáveis utilizadas foram: características sociodemográficas, condições da gestação e parto e características dos prematuros nascidos vivos. Concluiu-se que conhecer e avaliar o perfil das mães e o número e a situação dos nascimentos de crianças de uma área, em um período de tempo, é importante na determinação dos riscos vitais relacionados a condições do nascimento, crescimento e desenvolvimento infantil, sendo esses aspectos componentes de vários indicadores de saúde e fundamentais para a assistência na área materno-infantil.

Seroepidemiology of Toxoplasma infection in a metropolitan region of Brazil

Seroprevalence data from a representative population were used to estimate the annual incidence of congenital toxoplasmosis in São Paulo Metropolitan Region (SPMR). Retrospective anti-toxoplasma IgG serological analysis was conducted to determine age-dependent seroprevalence, force of infection, average age of acquisition of infection and curve of decay of maternally derived antibodies. Seroprevalence was used to calculate the number of new infections. Toxoplasmosis in pregnant women was estimated by total number of deliveries in a given year as a proxy for the number of pregnancies per year. Toxoplasma seroprevalence was 64.9% in women of childbearing age. Average age of acquisition of toxoplasmosis was 10.74 years. The estimated annual incidence of congenital toxoplasmosis varied from 9.5 to 10.6/1000 births in the studied period. The toxoplasmosis seroprevalence model allowed a good incidence estimation of congenital disease in SPMR compared to other published data, indicating that this mathematical approach is useful in calculating the potential demand of congenital disease due to Toxoplasma gondii in a given community.

Atuação fonoaudiológica em bebês pré-termos de mães adolescentes: uma nova realidade

OBJETIVO: investigar os aspectos do sistema sensório motor oral de recém-nascidos pré-termos de mães adolescentes, comparando-os com os de mães não adolescentes. MÉTODOS: a amostra foi constituída de 15 mães e 18 recém-nascidos, já que duas das puérperas tiveram gravidezes múltiplas, dos quais, quatro bebês pré-termos são de mães adolescentes e 11 de mães não adolescentes na mesma condição, internos na Maternidade do Hospital das Clínicas da Universidade Federal de Pernambuco. RESULTADOS: ficou evidente que existe uma inadequada assistência ao pré-natal, tanto das mães adolescentes quanto das mães não adolescentes, podendo estar relacionado a fatores socioeconômicos. Os recém-nascidos que apresentaram muito baixo peso ao nascer têm maior dificuldade quanto à transição da alimentação por sonda para via oral, tanto no grupo de mães adolescentes quanto no de mães não adolescentes. CONCLUSÃO: a imaturidade biológica dos recém-nascidos pré-termos pode levar na sua maioria à imaturidade do sistema sensório motor oral, independente da idade da mãe. As alterações do sistema sensório motor oral encontradas podem ter acontecido devido à quantidade de aparelhos utilizados pelos recém-nascidos. Não houve diferença no peso ao nascimento entre os bebês de mães adolescentes e não adolescentes, podendo ser explicado pela faixa etária das mães adolescentes que se encontraram entre 16 a 19 anos, o que definiu uma homogeneidade do grupo.

Percepções de adolescentes grávidas em relação a seus familiares e parceiros

Este trabalho objetivou verificar a percepção de adolescentes grávidas sobre familiares e companheiros. Participaram 22 adolescentes grávidas entre 14 e 16 anos. Um questionário específico foi aplicado às participantes. Os resultados mostram que poucas conversavam sobre sexo e gravidez em casa, e a maioria disse que aprendeu no lar algumas informações, mas 40% consideram que nada aprenderam. Houve a tendência de as mães das gestantes serem informadas sobre a gravidez pelas próprias filhas. A primeira reação dos pais foi negativa, mas depois aceitaram a situação. considerou-se que os parceiros tiveram atitudes positivas e se responsabilizaram pelo período de gestação. As famílias das garotas, especialmente as mães, deram suporte à maternidade. com a gravidez, houve mudanças na vida de 68,1% das participantes.

Comparações das condições socioeconômicas e reprodutivas entre mães adolescentes e adultas jovens em três maternidades públicas de Maceió, Brasil

OBJETIVOS: descrever e comparar fatores socio-econômicos, assistência pré-natal, exposições ao fumo e álcool e fatores reprodutivos entre mães adolescentes e adultas jovens em três maternidades públicas de Maceió, Alagoas, Nordeste do Brasil. MÉTODOS: foram entrevistadas 250 puérperas adolescentes (< 20 anos) e 250 puérperas adultas jovens (20 a 30 anos). Estudo de corte transversal realizado de julho a outubro de 1996. Foi utilizado o qui-quadrado para testar hipóteses de homogeneidade de proporções. RESULTADOS: verificou-se entre as puérperas adolescentes um percentual significantemente maior (p < 0,05) de primiparidade, baixa renda familiar, baixa escolaridade e pouca assistência no pré-natal, em relação às adultas jovens. CONCLUSÕES: mães adolescentes dos hospitais públicos estudados estão associadas às piores condições socioeconômicas e reprodutivas quando comparadas às adultas jovens, merecendo, portanto, maior atenção diferenciada e estruturada na saúde perinatal.

Características das mães adolescentes e de seus recém-nascidos e fatores de risco para a gravidez na adolescência em Campinas, SP, Brasil

OBJETIVOS: descrever o perfil das mães e seus recém-nascidos e apontar fatores de risco para gravidez na adolescência. MÉTODOS: estudo transversal que analisou os nascimentos de filhos de adolescentes ocorridos em Campinas, SP, Brasil em 2001. Identificou-se o perfil pelas características sociodemográficas maternas, relacionadas às gestações, aos partos e recém-nascidos. Realizou-se teste de qui-quadrado e calcularam-se os odds ratio (OR) brutos. Para os OR ajustados, empregou-se modelo de regressão logística. RESULTADOS: as adolescentes eram 17,8% das mães. Dessas, 48,4% tinham até sete anos de estudo, 59,9% não tinham companheiro, 87,6% não trabalhavam, 46,0% viviam em regiões com baixas condições de vida; a maioria era primípara, 21,6% tinham um filho ou mais, 35,2% fizeram menos que sete consultas no pré-natal. Dos recém-nascidos, 7,5% nasceram prematuros, 36,2% por cesárea, 9,7% com baixo peso e 30,3% com peso insuficiente. Encontraram-se associações entre gravidez na adolescência e mulheres sem companheiro (ORaj=2,63; IC95%=2,35-2,94), sem ocupação (ORaj=3,29; IC95%=2,85-3,79), de regiões com baixas condições de vida (Noroeste [ORaj=1,30; IC95%=1,07-1,59] e Sudoeste [ORaj=1,22; IC95%=1,01-1,47]) e com pré-natal inadequado (ORaj=1,22; IC95%=1,09-1,38). CONCLUSÕES: o perfil das mães adolescentes e dos seus partos e os fatores de risco para gravidez na adolescência relacionaram-se principalmente com condições socioeconômicas desfavoráveis, sugerindo que as intervenções requerem ações intersetoriais.