Pregnancy in adolescence in Brazil: associated factors with maternal age

Assis, Thamara de Souza Campos; Martinelli, Katrini Guidolini; Gama, Silvana Granado Nogueira da; Santos Neto, Edson Theodoro dos

doi:10.1590/1806-93042021000400006

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 21 (4) • Oct-Dec 2021 • https://doi.org/10.1590/1806-93042021000400006 copy

Pregnancy in adolescence in Brazil: associated factors with maternal age

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

describing maternal characteristics, risk behavior, obstetric data, prenatal care and childbirth in adolescent mothers in Brazil (age groups: 12-16 years and 17-19 years).

Methods:

hospital-based cross-sectional study substantiated by Nascer no Brasil”, (Born in Brazil) data. The study encompassed puerperal adolescent mothers from all regions in the country, and their newborns. Chi-square test was used to compare adolescents in the 12-16 years old age group and those in the 17-19 years old age group.

Results:

pregnant women in the 12-16 years old age group mostly lived in the Northeast of Brazil (p=0.014); most of them did not have a partner (p<0.001), unplanned pregnancy (p<0.001), they had inadequate schooling for their age (p=0.033), had less than six prenatal consultations (p=0.021), were subjected to episiotomy (p=0.042) and accounted for the largest number of premature babies (p=0.014).

Conclusions:

puerperal women in the 12-16 years old age group presented vulnerability in their socioeconomic conditions, inadequate assistance at the prenatal and childbirth care, as well as their babies showed neonatal complications that pointed towards these adolescent mothers’ need of multidisciplinary care.

Key words:
Pregnancy in adolescence; Prenatal care; Childbirth; Risk behaviors

Variables	Total (N=4,571)		12-16 years old (N=1,375)		17-19 years old (N=3,196)		p
Variables	n	%	n	%	n	%	p
Maternal characteristics
Schooling (n=4,362)							0.033
Adequate for the age	1,569	36.0	437	33.9	1,132	36.8
Inadequate for the age	2,793	64.0	853	66.1	1,940	63.2
Economic classification (n=4,535)							0.097
Class D+E	1,576	34.8	529	38.9	1,047	33.0
Class C	2,465	54.3	709	52.1	1,757	55.3
Class A+B	494	10.9	123	9.0	372	11.7
Skin color (n=4,570)							0.434
White	1,242	27.2	349	25.4	893	27.9
Black	405	8.9	121	8.8	283	8.9
Mixed	2,847	62.3	874	63.6	1,973	61.8
Asian Descendant	45	1.0	15	1.1	30	0.9
Indigenous	31	0.7	15	1.1	16	0.5
Pre-gestational BMI (Kg/m²) (n=4,537)							0.014
< 18.5	395	8.7	143	10.5	252	7.9
18.5 – 24.9	2,768	61.0	824	60.4	1,944	61.3
25.0 – 29.9	962	21.2	303	22.2	659	20.8
≥ 30	412	9.1	95	7.0	318	10.0
Region (n=4,571)							0.014
North	614	13.4	175	12.7	438	13.7
Northeast	1,467	32.1	511	37.2	957	29.9
Southeast	1,686	36.9	469	34.1	1,217	38.1
South	493	10.8	133	9.7	360	11.3
Midwest	311	6.8	87	6.3	224	7.0
Marital status (n=4,568)							<0.001
Without a partner	1,435	31.4	529	38.6	905	28.3
With a partner	3,133	68.6	843	61.4	2,290	71.7
Paying job (n=4,568)							<0.001
Yes	538	11.8	56	4.1	482	15.1
No	4,030	88.2	1317	95.9	2,713	84.9
Risk behaviors
Smoking during pregnancy (n=4,568)							0.007
Yes	394	8.6	90	6.6	305	9.5
No	4,174	91.4	1284	93.4	2,891	90.5
Inappropriate alcohol intake during pregnancy (n=4,451)							0.322
Yes	505	11.3	132	9.9	373	12.0
No	3,946	88.7	1204	90.1	2,742	88.0

Variables	Total (N=4,571)		12-16 years old (N=1,375)		17-19 years old (N=3,196)		p
Variables	n	%	n	%	n	%	p
Prenatal care characteristics
Prenatal care location (n=4,555)							0.091
Only public	4,037	88.3	1,238	90.0	2,799	87.6
Some private consultations	455	9.9	109	7.9	345	10.8
No prenatal care	63	1.4	20	1.5	43	1.3
The same professional at prenatal care and childbirth(n=4,567)							0.199
Yes	341	7.5	90	6.6	251	7.9
No	4,226	92.5	1,283	93.4	2,943	92.1
Beginning of prenatal care (n=4,518)							0.149
1^st trimester	2,122	46.4	576	41.9	1,546	48.4
2^nd trimester	2,117	46.3	681	49.5	1,436	44.9
3^rd trimester	216	4.6	78	5.7	138	4.3
No prenatal care	63	1.4	20	1.5	43	1.3
Number of consultations (n=4,495)							0.021
Less than 6 consultations	1,692	39.0	587	43.2	1,104	35.1
More than 6 consultations	2,741	61.0	750	55.3	1,990	63.4
No prenatal care	62	1.4	20	1.5	43	1.4
Prenatal care adequacy (n=4,454)							0.006
Inadequate/partially adequate	2,105	47.3	711	53.0	1,394	44.8
Adequate/more than adequate	2,349	52.7	630	47.0	1,719	55.2
Registered on the examination card
Blood glucose	2,739	59.9	786	57.2	1,953	61.1	0.052
ASE	2,799	61.2	825	60.0	1,974	61.7	0.528
Syphilis	2,887	63.2	842	61.2	2,045	64.0	0.183
HIV	2,534	55.4	737	53.6	1,797	56.2	0.342
Underwent obstetric ultrasound (n=4,553)							0.072
Yes	4,361	95.4	1,294	94.0	3,067	96.0
No	129	2.8	52	3.8	77	2.4
No prenatal care	63	1.4	20	1.5	43	1.3
Labor characteristics
Type of childbirth financing (n=4,571)							0.942
Public	4,325	94.6	1,302	94.7	3,023	94.6
Private	246	5.4	73	5.3	173	5.4
Childbirth pilgrimage (n=4,564)							0.041
Yes	973	21.3	319	23.2	655	20.5
No	3,591	78.7	1,053	76.7	2,538	79.5
Childbirth type (n=4,571)							0.085
Vaginal / Forceps	2,875	62.9	896	65.2	1,978	61.9
Cesarean section	1,696	37.1	478	34.8	1,218	38.1
Episiotomy* (n=2,873)							0.042
Yes	1,609	35.2	543	39.5	1,066	33.4
No	1,264	27.7	354	25.7	910	28.5
Perineal Laceration* (n=2,873)							0.015
Yes	616	21.4	162	18.1	454	23.0
No	2,257	78.6	735	81.9	1,522	77.0
Kristeller maneuver* (n=2,873)							0.552
Yes	96	3.3	26	2.9	70	3.5
No	2,777	96.7	871	97.1	1,906	96.5

Variables	Total (N=4,571)		12-16 years old (N=1,375)		17-19 years old (N=3,196)		p
Variables	n	%	n	%	n	%	p
Obstetric history
Number of pregnancies (n=4,570)							<0.001
Primiparous	3,721	81.4	1,285	93.5	2,436	76.2
≥ 2 pregnancies	849	18.6	90	6.6	760	23.9
Intention to get pregnant (n=4,539)							<0.001
Yes	1,574	34.7	407	29.9	1,167	36.7
No	2,965	65.3	953	70.0	2,011	63.3
Pre-existing diseases
Pre-gestational high blood pressure	83	1.8	29	2.1	54	1.7	0.572
Pre-gestational diabetes	26	0.6	10	0.7	16	0.5	0.400
Heart diseases	15	0.3	5	0.4	10	0.3	0.864
Previous obstetric history
Abortion	360	7.9	61	4.4	299	9.4	<0.001
Low birth weight	114	2.5	11	0.8	103	3.2	<0.001
Prematurity	94	2.1	11	0.8	83	2.6	<0.001
Cesarean section	292	6.4	39	2.8	253	7.9	<0.001
Maternal complications
Urinary infection	724	15.8	219	15.9	505	15.8	0.953
Hypertensive disease in pregnancy	338	7.4	87	6.3	251	7.9	0.079
Placenta previa	11	0.2	4	0.3	7	0.2	0.840
Gestational diabetes	205	4.5	54	3.9	151	4.7	0.269
Eclampsia	24	0.5	9	0.7	15	0.5	0.616
Placental abruption	49	1.1	20	1.5	29	0.9	0.243
Syphilis	41	0.9	8	0.6	33	1.0	0.128
Neonatal complications
Low birth weight	461	10.2	141	10.4	320	10.1	0.712
Gestational age (n=4,571)							0.014
Spontaneous prematurity	464	10.2	183	13.3	281	8.8
Obstetric intervention prematurity	133	2.9	34	2.5	99	3.1
Spontaneous early term	1,037	22.7	310	22.5	727	22.7
Intervention early term	396	8.7	117	8.5	279	8.7
At term	2,541	55.6	731	53.2	1,810	56.6

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[1] Authors’ contribution

Assis TSC: conception, planning, analysis, interpretation of the results and manuscript writing. Martinelli KG, Santos Neto ET and Gama SGN: conception, planning, interpretation of the results and final review of the manuscript. All authors have approved the final version of the manuscript.