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

Socioeconomic factors increase the risk of teenage pregnancy: spatial and temporal analysis in a Brazilian municipality

OBJECTIVE

To evaluate the distribution of the proportion of teenage mothers (PTM) in time and space and its relationship with socioeconomic indicators and social vulnerability.

METHODS

An ecological study was carried out with teenage mothers living in 322 census tracts in Foz do Iguaçu (state of Paraná, Brazil) between 2013 and 2019. Spatial clusters of teenage mothers were identified by spatial scanning and grouped into strata with different prevalence. The association between these strata and the individual social vulnerability of the mothers was evaluated using the Pearson's Chi-square test. Linear regression models were adjusted to evaluate the association between PTM and socioeconomic factors by census tract and temporal trend in PTM in different strata.

RESULTS

We identified five high prevalence clusters in peripheral regions and six with low prevalence in the central region of the municipality. Proportionally, there were more teenage mothers with a worse vulnerability index in the high prevalence stratum than in the low prevalence stratum. Places with worse socioeconomic conditions present higher PTM, a profile that did not change over time. For the increase of one unit in the Brazilian Deprivation Index and proportion of women responsible for the household, the PTM increased, respectively, by 3.8 (95%CI 3.1-4.4) and 0.086% (95%CI 0.03-0.14). There was a reduction in the global PTM in part of the period, which occurred later in the higher prevalence strata, but the proportions were stable again in the last years of study.

CONCLUSION

Teenage pregnancy is concentrated in regions with worse socioeconomic conditions and greater maternal vulnerability and its behavior over time occurred differently in these areas.

Nursing Scientific Production on Teenage Pregnancy: An Integrative Review

Objective: To identify, in the national and international scientific literature, the evidence produced by Nursing that provides subsidies to prevent teenage pregnancy. Material and method: An integrative literature review study, based on papers available in the PubMed, BVS, Scopus and Web of Science metabases, and in the Lilacs and BDEnf databases, in Portuguese, English and Spanish languages, published from January 2013 to March 2020. Results: According to the inclusion criteria, 13 articles were selected. The findings are presented in the categories “lower socio-economic conditions”, “knowledge, attitudes and cultural aspects” and “sexual education and specialized services”. Conclusions: Teenage pregnancy is strongly associated with poverty and other socio-economic issues. Gender relations, communication about sex education in the family and other cultural aspects were found in the discussions, which indicates their impact on this phenomenon. Interventions involving sex education are shown as an alternative to cope. The presence of the nurse at the places that assist or concentrate adolescents can be a great element to reduce pregnancy rates in this phase.

Previsão do Índice de Desenvolvimento Humano e da expectativa de vida nos países da América Latina por meio de técnicas de mineração de dados

Resumo A previsibilidade de indicadores epidemiológicos pode contribuir na projeção de variáveis dependentes, auxiliar em tomadas de decisões para sustentar ou não políticas públicas e justificar o cenário vivido pelos países e o mundo. O artigo tem por objetivo predizer o Índice de Desenvolvimento Humano e a expectativa de vida nos países latino-americanos no período de 2015 a 2020, utilizando técnicas de mineração de dados. Foram percorridas as etapas do processo Descoberta de Conhecimento em Base Dados. Adotaram-se para previsões modelos desenvolvidos com séries multivariadas através do algoritmo de mineração de dados SMOReg, que apresentaram melhor desempenho em testes desenvolvidos durante o experimento. As médias do Índice de Desenvolvimento Humano e da expectativa de vida nos países latino-americanos tendem a aumentar no período analisado, respectivamente, 4,99 ± 3,90 % e 2,65 ± 0,06 anos. Experiências multivariadas possibilitam maior aprendizagem dos algoritmos, aumentando sua precisão. As técnicas de mineração de dados apresentaram melhor qualidade nas previsões em relação à técnica mais popular, ARIMA. As previsões sugerem média de crescimento do IDH e EV dos países latino-americanos maiores que a mundial.

Spatio-temporal trends in the risk of adolescent pregnancy in Minas Gerais, Brazil, 2000-2015

PURPOSE

To investigate, through a spatio-temporal analysis, the association between the percentages of live births of adolescent mothers (LBAM) and the human development index (HDI), including the three components: income, education and longevity.

METHODS

The percentage of LBAM was obtained from the Brazilian Live Births Information System for the state of Minas Gerais, Brazil in the period 2000-2015 and the HDI data and its components were obtained from United Nations Development Program's (UNDP) Human Development Reports. A generalized additive model (GAM) was used to estimate the relative risk of LBAM in relation to the HDI and to identify spatial clusters of the geographical distribution of LBAM, the Moran global and local index was used.

RESULTS

There is an association between the HDI and its components with LBAM. The high values of relative risk are spatially concentrated in the northern part of the state of Minas Gerais. The graphs indicated a nonlinear relationship between LBAM over the years.

CONCLUSIONS

There is a strong spatial dependence of LBAM in Minas Gerais, which suggests that a geographical location plays a fundamental role in understanding it. The regional disparity confirmed in this study is inherent in the process of human development, it is important for planning actions aimed at the development of these regions in order to minimize existing disparities.

Pre-pregnancy body mass index classification and gestational weight gain on neonatal outcomes in adolescent mothers: A follow-up study

Introduction: Institute of Medicine gestational weight gain recommendations are based on body mass index (BMI) status using adult cut-off points for women of all ages, even though adolescents have specific criteria, like WHO and CDC, so adolescents can receive inadequate weight gain recommendations. Objectives: To estimate the proportion of classification disparity between the three criteria (WHO, CDC and IOM) of pre-pregnancy BMI status; and to analyze neonatal outcomes according to weight gain recommendation based on pre-pregnancy BMI using the three criteria. Methods: Follow-up study in pregnant adolescents 12–19 years. Sociodemographic, anthropometric and pregnancy data were obtained. Percentage of pre-pregnancy BMI classification disparity was calculated between three criteria. Gestational weight gain was categorized in adequate, low and high according to IOM. Regression models were used to analyze negative neonatal outcomes. Results: 601 pregnant adolescents were included, mean age was 16±1.4 years. For pre-pregnancy BMI classification, 28.5% had classification disparity using IOM vs WHO, and 14% when comparing IOM vs CDC. Greater classification disparity was observed as BMI increased. When using WHO categories, a high weight gain was associated with increased risk of having a low birth weight baby (OR: 1.91, CI95%: 1.03–3.53). For CDC criteria, a low weight gain was associated with increased risk of having a preterm baby (OR: 2.65; CI95%: 1.16–6.08) and a high weight gain was associated with low birth weight (OR: 2.10; CI95%: 1.10–4.01). For IOM criteria, a weight gain either low or high were associated with increased risk of low birth weight and preterm birth. Conclusion: There is pre-pregnancy BMI classification disparity using criteria for adolescents compared to adult criteria. Nevertheless, with WHO and CDC only a high gestational weight gain was a risk for negative neonatal outcome. It is important to have a BMI classification system for adolescents that better predicts neonatal outcomes.

Low Level of Knowledge of Contraceptive Methods among Pregnant Teens in Brazil

STUDY OBJECTIVE

To describe knowledge and use of contraceptive methods among pregnant teens in Brazil.

DESIGN

A cross-sectional survey.

SETTING

A tertiary care center in Bahia, Brazil.

PARTICIPANTS

Pregnant teens 10-19 years old.

INTERVENTIONS

Participants were asked about contraceptive knowledge and previous contraceptive use.

MAIN OUTCOME MEASURES

Contraceptive knowledge, previous contraceptive use, and contraceptive intentions for after pregnancy. Other survey topics included demographic characteristics, school attendance, and sexual history.

RESULTS

A total of 90 participants wereincluded in the study, with an average age of 15.4 ± 1.7 years, and a mean age at first sexual intercourse of 13.8 ± 1.2 years. Most participants were unmarried (58/90), of mixed race (57/90), had a household income below minimum wage (59/83), lived with their parents (54/90), and unemployment (81/90). More than 80% were not using contraception or were using it irregularly whenthey became pregnant. Most participants reported knowledge of condoms (82/90), of the combined oral contraceptive pill (75/90) and of injectable contraceptives (68/90). However, less than half reported knowledge oflong-acting reversible contraceptive methods. In terms of contraceptive intentions after pregnancy, the most commonly cited methods were the contraceptive injection (36/90), the intrauterine device (17/90) and the combined pill (9/90).

CONCLUSION

In this study we found a low level of knowledge of contraceptive methods, and especially of long-acting reversible contraceptive methods, among pregnant teens in Northeast Brazil. Low socioeconomic status and high rates of unplanned pregnancy might be reasons for insufficient sexual and reproductive health counseling in this population.

Vulnerability synthetic indices: a literature integrative review

The concept of vulnerability is delimited by dynamic social and multigenerational processes involving at least three dimensions: exposure to risk trajectories, internal and external capabilities of reaction and possibilities of adaptation based on both the intensity of risk and the resilience of people. In order to identify and describe the synthetic indices of vulnerability, there was an integrative literature review. We consulted free access articles indexed in the following databases: BioMed, Bireme, PubMed, Reldalyc, SciELO and Web of Science; and we used controlled descriptors in English and Portuguese for all time slots available with selection and analysis of 47 studies that reported results of 23 synthetic indices of vulnerability. The results showed that the synthetic indices of vulnerability address four themes: social determinants of health; environmental and climatic conditions; family and course of life; territories and specific geographic areas. It was concluded that the definition of the components and indicators, as well as the methodologies adopted for the construction of synthetic indices need to be evaluated by means of the limitations and advantages of reporting the vulnerability through summary measures in policy formulation and decision-making aimed at human development.

Adolescent pregnancy and transition to adulthood in young users of the SUS

OBJECTIVE

The objective of this study is to contextualize adolescent pregnancy from milestones associated with the process of transition from youth to adulthood.

METHODS

This is a cross-sectional study conducted with 200 adolescents, users of the Brazilian Unified Health System. The sample size for the estimation of proportions has been calculated assuming a population ratio of 0.50 and 95% confidence level. The dependent variables – planned pregnancy, living with a partner, and having left the parents’ house – have been considered as markers of transition from dependence to independence, from youth to adulthood. In the analysis of the associated factors, we have used the Poisson model with robust variance.

RESULTS

Average age was 17.3 years, and most adolescents lived with a partner; approximately half of the adolescents got pregnant from their first partner and the average age of first sexual intercourse was 14.6 years. Only 19% of the adolescents were studying and most dropped out of school before the beginning of the pregnancy. In the bivariate and multiple analysis, we could see that the relationship with a partner for more than two years was associated with the three dependent variables.

CONCLUSIONS

The path of transition to adulthood has been the establishment of a link with a partner and consequent pregnancy, suggesting a clear pattern of male guardianship. The changing role of women in society observed in recent decades, which means choosing a professional career, defining the number of children, and choosing their partner(s), has not reached these young persons.

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.