Teses de doutorado

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    Repercussões maternas e neonatais da gravidez na adolescência no Brasil
    (Universidade Federal do Espírito Santo, 2021-11-30) Assis, Thamara de Souza Campos; Santos Neto, Edson Theodoro dos; https://orcid.org/0000000273517719; http://lattes.cnpq.br/5430137427291413; https://orcid.org/0000-0001-6207-5962; http://lattes.cnpq.br/8095268915724563; Miranda, Angelica Espinosa Barbosa; https://orcid.org/0000-0002-5556-8379; http://lattes.cnpq.br/5842271060162462; Gama, Silvana Granado Nogueira da; https://orcid.org/0000-0002-9200-0387; http://lattes.cnpq.br/2586311977350388; Araújo, Alisson; https://orcid.org/0000-0002-4623-3745; http://lattes.cnpq.br/7116545718554968; Esposti, Carolina Dutra Degli; https://orcid.org/0000000181027771; http://lattes.cnpq.br/7465412734380334
    Introduction: Adolescent pregnancy is a topic of great relevance in the Brazilian reproductive health context due to its high prevalence and because it is one of the main morbidity and mortality causes in this population. Recurrent pregnancies at this stage of life, in low- and middle-income countries, also reach considerable rates. Brazilian adolescent pregnancy rates did not decrease in recent years, mostly because it happens in places where the population lives under inequality conditions and lacks access to healthcare services. Therefore, adolescent pregnancy, either in primiparous or multiparous mothers, can have unfavorable repercussions on both delivery and childbirth. Aim: Analyzing both pregnancies and deliveries of adolescent mothers living in Brazil, as well as their maternal and neonatal repercussions. Methods: The current study was based on data from the research titled “Nascer no Brasil: Inquérito Nacional sobre o Parto e Nascimento” [Born in Brazil: National Survey on Delivery and Childbirth]. It was carried out with puerperal adolescents and their newborns, from February 2011 to October 2012, in all Brazilian regions - it comprised 191 municipalities and 266 hospital units. The investigated population comprised 4,571 postpartum women younger than 20 years and their newborns; mothers were categorized based on the following age groups: from 12 to 16 years old and from 17 to 19 years old. Data were analyzed in a descriptive and inferential manner, based on absolute and relative frequencies, as well as on Pearson’s chi-square or Fisher’s exact test. Univariate and multiple logistic regressions were performed to determine associations, by controlling confounding factors. Results: 12-16-year-old pregnant adolescents mostly lived in Northeastern Brazil (p=0.014), did not have a partner (p<0.001), got pregnant unintentionally (p<0.001), had inadequate education for their age (p=0.033), attended less than six prenatal consultations (p=0.021), required episiotomy (p=0.042) and presented spontaneous prematurity (p=0.014), in comparison to the 17-19-year old ones. Recurrent adolescent pregnancy was associated with maternal age of 17-19 years (OR=3.35; 95%CI=2.45-4.59), inadequate schooling for mothers’ age (OR=4.34; 95%CI =3.50-5.39), unintentional pregnancy (OR=2.34; 95%CI=1.77-3.08), dwelling in the state’s capital (OR=1.40; 95%CI= 1.10-1.78), as well as with the fact that partners of adolescent mothers were the head of the family (OR=2.07; 95%CI=1.47-2.91). Primiparous adolescents were more likely to have hypertensive disease (OR=1.54; 95%CI=1.01-2.35) and intrauterine growth restriction (OR=1.90; 95%CI=1.23-2.91). In addition, factors associated with neonatal near miss among adolescent mothers comprised public payment source (OR=4.57, 95%CI=2.02-10.32), having to seek help in different maternity hospitals (OR=1.52; 95%CI=1.05-2.20), incidence of maternal near miss (OR=5.92; 95%CI=1.94-18.05), history of low weight (OR=3.12 ; 95%CI=1.61–6.04) and twin newborns (OR=7.49; 95%CI=3.28-16.82). Conclusion: The current study has outlined adolescent pregnancy aspects in Brazil, which are associated with maternal age and with its outcomes, as well as factors associated with recurrent pregnancies. Thus, it is reasonable believing that effective strategies focused on postponing adolescent pregnancy - such as developing public policies consistent with adolescents’ vulnerabilities and with the work done by health professionals (who establish bonds and provide medical assistance, based on adolescents’ specificities) are likely to help reducing both social and health-related impacts on adolescents.