Maternal mortality in adolescents and young adults: temporal trend and correlation with prenatal care coverage in the state of Bahia, Brazil, 2000-2020

Galvão, Lorena Ramalho; Costa, Maria Conceição Oliveira; Gama, Silvana Granado Nogueira da; Amaral, Magali Teresópolis Reis; Santos, Djanilson Barbosa dos; Barros, Naysa Farias; Rosario, Wanessa Oliveira

doi:10.1590/S2237-96222023000200022

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Brasil

Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 32 (2) • 2023 • https://doi.org/10.1590/S2237-96222023000200022 copy

Maternal mortality in adolescents and young adults: temporal trend and correlation with prenatal care coverage in the state of Bahia, Brazil, 2000-2020

Mortalidad materna en la adolescencia y la juventud: tendencia temporal y correlación con la cobertura prenatal en Bahia, Brasil, 2000-2020

Authorship SCIMAGO INSTITUTIONS RANKINGS

Study contributions

Main results

From 2000 to 2020, maternal mortality among adolescents and young adults showed a decreasing trend in the state of Bahia. It could be seen an inverse and significant correlation between the highest number of prenatal care visits and maternal mortality in the studied groups.

Implications for services

The study suggests the importance of quality obstetric care during prenatal, childbirth, and postpartum period for reducing maternal mortality among adolescents and young adults, especially from preventable causes.

Perspectives

Improving the records of causes of death on information systems, enhancing obstetric care, and investing in sexual and reproductive health policies aimed at adolescents may contribute to the reduction of maternal deaths.

ABSTRACT

Objective:

to analyze the temporal trend of maternal mortality and correlate it with prenatal care coverage among adolescents and young adults, state of Bahia, Brazil, 2000-2020.

Methods:

this was an ecological time-series study and correlation between maternal deaths and prenatal care visits in 10-19 and 20-24 age groups, using the Mortality Information System; the trend analysis was performed by means of Prais-Winsten regression, according to race/skin color, timing and causes of death; and Spearman coefficient was used for correlation.

Results:

in the study period, 418 deaths among adolescents and 574 among young adults were recorded; maternal mortality ratio was 59.7 and 63.2 deaths/100,000 live births, with a significant decreasing trend (-2.2% and -2.9% respectively); it could be seen an inverse correlation between a higher number of prenatal care visits and maternal mortality in the age groups.

Conclusion:

maternal mortality showed a decreasing trend in the study period, but with high proportions of death; there was a significant correlation between prenatal care coverage and maternal mortality among adolescents and young adults.

Keywords:
Time-Series Studies; Epidemiological Studies; Prenatal Care; Maternal Mortality; Adolescent; Young Adult.

Groups of causes	ICD-10^th codes
1 - Pregnancy with abortive outcome	O00-O07
2 - Hypertensive disorders in pregnancy, childbirth and the puerperium	O11-O16
3 - Obstetric hemorrhage	O20; O43-O46; O67; O71.0; O71.1, O71.3, O71.4, O71.7; O72
4 - Infections during pregnancy	O23; O41.1; O75.3; O85-O86; O91
5 - Other obstetric complications	O21.1, O21.2; O22; O24.4; O26.6, O26.9; O30-O36^b; O40^b; O41.0, O41.8, O41.9^b; O42^b; O60-061^b; O62; 063-066^b; O71.2, O71.5, O71.6, O71.8, O71.9; O73; O75.0-O75.2, O75.4-O75.9; O87.1, O87.3, O87.9; O88; O90
6 - Unanticipated complications (related to anesthesia)	O29; O74; O89
7 - Non-obstetric complications	O10; O24.0, O24.2, O24.3, O24.9; O98 (inclui B20-24) e O99
8 - Unspecified cause	O95

Variable	10 to 19 years old						20 to 24 years old
Variable	n	Total MMR^a	APC^b	_95% CI ^c	p-value	Trend	N	Total MMR^a	APC^b	_95% CI ^c	p-value	Trend
Total number of deaths	418	59.7^d	-2.2	-4.3;-0.01	0.049	Decreasing	574	63.2^d	-2.9	-4,5;-1.4	0.001	Decreasing
Race/skin color
White	70	83.6	1.5	-2.3;5.5	0.413	Stability	79	66.4	-2.9	-18.1;15.1	0.722	Stability
Black	37	68.4	-16.5	-30.6;0.5	0.056	Stability	89	118.9	-31.5	-12.5;7.2	0.518	Stability
Mixed-race	259	34.4	2.8	0.3;5.4	0.031	Increasing	334	35.2	-0.1	-2.2;2.1	0.913	Stability
Direct causes	266	26.4	0.8	-1.1;2.7	0.393	Stability	360	27.7	-0.8	-2.2;0.6	0.254	Stability
Abortion	52	5.2	-4.7	-13.7;5.1	0.316	Stability	57	4.4	-0.5	-8.9;8.7	0.910	Stability
Hypertension	86	8.5	0.2	-7.7;8.9	0.951	Stability	112	8.6	-7.3	-13.7;-0.4	0.039	Decreasing
Hemorrhage	26	2.6	1.9	-9.7;15.0	0.746	Stability	61	4.7	-4.7	-15.1;7.0	0.397	Stability
Infections	40	4.0	9.5	-3.1;23.8	0.138	Stability	40	3.1	0.8	-7.1;9.5	0.837	Stability
Other obstetric complications	60	6.0	-0.08	-4.34;4.37	0.970	Stability	87	6.7	1.46	-1.67;4.70	0.345	Stability
Indirect causes	140	13.9	0.8	-3.9;5.6	0.740	Stability	192	14.8	-0.1	-4.4;4.4	0.969	Stability
Non-obstetric complications	140	13.9	0.8	-3.9;5.6	0.740	Stability	192	14.8	-0.1	-4.4;4.4	0.969	Stability
Unspecified cause	12	1.2	2.6	-9.2;16.0	0.662	Stability	22	1.7	21.2	11.2;32.0	0.000	Increasing
Unknown causes	12	1.2	2.6	-9.2;16.0	0.662	Stability	22	1.7	21.2	11.2;32.0	< 0.001	Increasing
Time of death
During pregnancy, childbirth or abortion	146	14.5	2.9	-2.5;8.7	0.280	Stability	198	15.3	3.0	-6.5;13.5	0.532	Stability
Up to 42 days postpartum	133	13.2	11.0	5.1;17.3	0.001	Increasing	212	16.3	7.2	0.05;14.9	0.049	Increasing

Variable	10 to 19 years old			20 to 24 years old
Variable	Mean	Standard deviation	p-value	Mean	Standard deviation	p-value
Total MMR^a	57.9	18.7		61	16.5
Race/skin color^b
White	88.4	43.8	0.015	69.8	44.9	< 0.001
Black	132.9	176.8		194.1	235.4
Mixed race	35.1	10.8		35.1	8.2
Type of causes^b
Direct	26.6	7.0	< 0.001	27.6	5.4	< 0.001
Indirect	13.8	5.9		14.6	6.8
Unspecified	1.2	1.2		1.9	1.8
Time of death^c
During pregnancy, childbirth or abortion	14.6	7.00	0.906	15.2	8.7	0.439
Up to 42 days postpartum	14.3	8.3	0.906	17.4	9.6	0.439

Variable	CSMMR^a
	10 to 19 years old		20 to 24 years old
	r^b	p-value	r^b	p-value
Prenatal care coverage
Did not have any prenatal care visits	0.34	0.138	0.42	p-value	0.057
≤ 6 prenatal care visits	0.32	0.151	0.81	< 0.001
> 6 prenatal care visits	-0.52	0.017	-0.73	< 0.001

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Corresponding author:
Lorena Ramalho Galvão.
e-mail:
loregalvao20@gmail.com