Riscos da repetição da gestação na adolescência: um estudo de caso-controle

Estudo caso-controle realizado num Hospital Universitário de Campinas, Brasil, de 2015 a 2017. Foram selecionados três grupos: um grupo-caso de adolescentes com repetição de gravidez, e dois grupos controles, umde adolescentes primíparas e outro demulheres adultas com mais de umparto. Foram coletados dados referentes a aspectos sociodemográficos, história reprodutiva e obstétrica e fatores psicológicos.

Resultados

Foram incluídas 90 mulheres, 30 em cada grupo de estudo. Adolescentes comrepetição de gravidez apresentaram menor autoestima e mais uso inadequado de contraceptivos. Quando comparadas a adolescentes primíparas, tiveram menor nível escolar (razão de probabilidades [RP] 4.03 [1.37-11.8]), maior interrupção dos estudos (RP 16.3 [3.61-73.6]) e maior uso de drogas (RP 4.97[1.39-17.8]). A comparação entre adolescentes com repetição de gestação e mulheres adultas revelou maior risco para cor da pele não-branca (RP 6.2 [1.15-41.0]), uso de drogas (RP 17.5 [2.62-116.6]) e primeira relação sexual com menos de 15 anos 15y (RP 18.0 [2.82-115.0]). Além disso, as adolescentes com segunda gravidez apresentam menor autoestima, baixo uso de contracepção e maior suscetibilidade a gravidez não planejada.

Conclusão

Houve associação entre repetição de gravidez na adolescência e menor tempo de estudo, início precoce de atividade sexual, cor da pele não branca e maior uso de drogas.

Palavras-chave:
adolescência; gravidez; vulnerabilidade; contracepção

Variables	1^stPTeens n (%)	1^stPTeens vs RPTeensp-value	RPTeens n (%)	RPTeens vs Adultsp-value	Adultsn (%)
Skin color (white)	17 (56.7)	0.197^*** p-value according to Chi-squared test.	12 (40.0)	0.071^*** p-value according to Chi-squared test.	19 (63.3)
Partner (yes)	20 (66,7)	0.067^*** p-value according to Chi-squared test.	26 (86.7)	1.000^*** p-value according to Chi-squared test.	26 (86.7)
No actual schooling	10 (33.3)	< 0.001^** p-value according to Fisher exact test.	24 (80.0)	0.003^** p-value according to Fisher exact test.	12 (40.0)
High school or college	21 (70.0)	0.019^** p-value according to Fisher exact test.	11 (36.7)	0.007^** p-value according to Fisher exact test.	16 (70.0)
Family income ≥ 3 MW	13 (43.3)	0.598^*** p-value according to Fisher exact test.	11 (36.7)	0.039^*** p-value according to Chi-squared test.	19 (63.3)
Paid work	14 (46.7)	0.510^** p-value according to Fisher exact test.	10 (33.3)	0.011^** p-value according to Fisher exact test.	19 (63.3)
Smoking	4 (13.3)	1.000^** p-value according to Fisher exact test.	5 (16.7)	0.519^** p-value according to Fisher exact test.	7 (23.3)
Alcohol	8 (26.7)	0.347^*** p-value according to Chi-squared test.	5 (16.7)	0.707^*** p-value according to Chi-squared test.	3 (10.0)
Drugs use	4 (13.3)	0.010^*** p-value according to Chi-squared test.	13 (43.3)	< 0.001^*** p-value according to Chi-squared test.	0 (0.00)
Menarche < 12 years	7 (23.3)	0.390^*** p-value according to Chi-squared test.	10 (33.3)	0.787^*** p-value according to Chi-squared test.	11 (36.7)
First sexual intercourse < 15yrs	18 (60.0)	0.273^** p-value according to Fisher exact test.	22 (73.3)	< 0.001^*** p-value according to Chi-squared test.	7 (23.3)
First delivery < 15 years	3 (10.0)	0.166^*** p-value according to Chi-squared test.	7 (23.3)	0.011^*** p-value according to Chi-squared test.	0 (0.00)
Prenatal care < 6 visits	1 (3.70)	0.054^* p-value according to Mann-Whitney test.	7 (23.3)	0.146^* p-value according to Mann-Whitney test.	2 (6.67)
Vaginal delivery	20 (66.7)	1.000^*** p-value according to Chi-squared test.	20 (66.7)	0.787^*** p-value according to Chi-squared test.	19 (63.3)
Birth weight < 2,500kg	5 (16.1)	1.000^** p-value according to Fisher exact test.	5 (16.1)	0.275^** p-value according to Fisher exact test.	2 (6.67)
Preterm birth (< 37 weeks)	4 (13.3)	1.000^** p-value according to Fisher exact test.	5 (16.7)	0.707^** p-value according to Fisher exact test.	3 (10.0)
Previous contraception (yes)	23 (76.7)	1.000^*** p-value according to Chi-squared test.	(76.7)	0.317^*** p-value according to Chi-squared test.	26 (86.7)

Variables	Categories	1^stPTeens n (%)	1^stPTeens vs RPTeensOR (95%CI)	RPTeensn (%)	RPTeens vs AdultsOR (95%CI)	Adultsn (%)
Age	Continuous variable (md ± sd)	16.8 ± 1.58	1.90 (1.22–2.95)	18.0 ± 1.10	———-	26.5 ± 3.88
Schooling	High school/college	—	1.00	—	1.00	—
Schooling	Less than high school/college	9 (30.0)	4.03 (1.37–11.8)	19 (63.3)	4.03 (1.37–11.8)	9 (30.0)
Actual schooling	Out of school	17 (56.7)	1.00	5 (16.7)	1.00	18 (60.0)
	At school	3 (10.0)	1.13 (0.10–13.4)	1 (3.33)	10.09 (0.36–284.5)	0 (0.00)
	Interrupted school	10 (33.3)	8.16 (2.36–28.2)	24 (80.0)	7.20 (2.15–24.1)	12 (40.0)
Onset of labor	SpontaneousInducedElectiveC-section	23 (76.7)7 (23.3)0 (00.0)	1.001.21 (0.36–4.06)10.8 (1.01–214.1)	19 (63.3)7 (23.3)4 (13.3)	1.000.64 (0.20–1.99)9.00 (0.45–178.7)	19 (63.3)11 (36.7)0 (0.00)
N of people at home	Continuous variable (md ± sd)	3.53 ± 1.70	1.39 (1.01–1.90)	4.77 ± 2.43	1.23 (0.89–1.70)	4.13 ± 0.94
Drugs use	No	26 (86.7)	1.00	17 (56.7)	1.00	30 (100)
Drugs use	Yes	4 (13.3)	4.97 (1.39–17.8)	13 (43.3)	47.0 (2.63–840.9)	0 (0.00)
Family monthly income	≥ 3 salaries	13 (43.3)	1.00	11 (36.7)	1.00	19 (63.3)
Family monthly income	< 3 salaries	17 (56.7)	1.32 (0.47–3.72)	19 (63.3)	2.98 (1.04–8.53)	11 (36.7)
First sexual intercourse	≥15 years	12 (40.0)	1.00	8 (26.7)	1.00	23 (76.7)
First sexual intercourse	<15 years	18 (60.0)	1.83 (0.62–5.45)	22 (73.3)	9.04 (2.80–29.1)	7 (23.3)
First birth	≥15 years	27 (90.0)	1.00	23 (76.7)	1.00	30 (100)
First birth	<15 years	3 (10.0)	2.74 (0.63–11.8)	7 (23.3)	19.5 (1.06–358.4)	0 (0.00)
Postpartum contraception after second birth	Oral	NE	NE	8 (34.8)	1.00	19 (73.1)
	Injectable			15 (65.2)	7.13 (1.93–26.3)	5 (19.2)
	Others			0 (0,00)	0.46 (0.02–10.6)	2 (7.70)
	No use			7 (23.3)	4.16 (0.95–18.3)	4 (13.3)

Variables	Categories	1^stPTeens n (%)	1^stPTeens vs RPTeensOR (95%CI)	RPTeensn (%)	RPTeens vs AdultsOR (95%CI)	Adultsn (%)
Age	Continuous variable (md ± sd)	16.8 ± 1.58	2.34 (1.39–3.94)	18.0 ± 1.10
Actual schooling	Out of school	17 (56.7)	1.00	5 (16.7)
	At school	3 (10.0)	2.70 (0.14–52.8)	1 (3.33)
	Interrupted school	10 (33.3)	16.3 (3.61–73.6)	24 (80.0)
Skin color	White			12 (40.0)	1.00	63.3
Skin color	Non-white			18 (60.0)	6.20 (1.15–41.0)	36.7
Drugs use	No			17 (56.7)	1.00	30 (100)
Drugs use	Yes			13 (43.3)	17.5 (2.62–116.6)	0(0.00)
First sexual intercourse	≥15 years			8 (26.7)	1.00	23 (76.7)
First sexual intercourse	<15 years			22 (73.3)	18.0 (2.82–115.0)	7 (23.3)

Variables	Categories	1^stPTeens n (%)^a Missing data from 9 women for self-esteem score, 2 women for answer about intention to become pregnant and 7 women for answer about contraception use before pregnancy.	1^stPTeens vs RPTeens(p-value)	RPTeensn (%)^b Missing data from 5 women for self-esteem score and 1 woman for answer about contraception use before pregnancy.	RPTeens vs Adults(p-value)	Adultsn (%)^c Missing data from 8 women for self-esteem score and 4 women for answer about contraception use before pregnancy.
Self-esteem (md ± sd)	< 2020–30> 30	0 (0.00)10 (47.6)11 (52.4)	0.018 ^** p-value according to Fisher exact test.	1 (4.00)20 (80.0)4 (16.0)	0.053^** p-value according to Fisher exact test.	0 (0.00)12 (54.5)10 (45.4)
Intent to be pregnant	IntendedUnintended	7 (25.0)21 (75.0)	0.086^*** p-value according to Chi-squared test.	14 (46.7)16 (53.3)	0.118^*** p-value according to Chi-squared test.	20 (66.7)10 (33.3)
Contraception before pregnancy	No useIrregular useIdeal use	4 (17.4)19 (82.6)0 (0.00)	< 0.001 ^** p-value according to Fisher exact test.	15 (51.7)12 (41.4)2 (6.90)	0.002 ^** p-value according to Fisher exact test.	7 (26.9)19 (73.1)0 (0.00)

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[1] Address for correspondence Fernanda Garanhani Surita, MD, PhD, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Rua Alexander Fleming, 101, Campinas, SP 13083-881, Brazil (e-mail: surita@unicamp.br).