Sandro Sendin Mitsuhiro

Gravidez na adolescência: perfil sócio-demográfico e comportamental de uma população da periferia de São Paulo, Brasil

To identify the socio-demographic behavioral profile of low-income pregnant teenagers, 1,000 adolescents admitted to a Brazilian public maternity hospital from July 24, 2001, to November 27, 2002, were interviewed. Socio-demographic and behavioral variables were assessed through a questionnaire. Over the 492 days of the study, 24.3% of admissions were adolescents (930 for childbirth and 70 for miscarriage). Mean maternal age was 17 years. Most teenagers (72.9%) lived near the hospital. 930 (93%) belonged to socioeconomic classes C, D, and E. School dropout was identified in 67.3% of the total. 80.1% of the subjects were giving birth for the first time. 81.2% had not planned the pregnancy, and 23.8% had been using some contraceptive method. 67.4% had vaginal deliveries. Some 13.3% of the newborns were premature and 15.9% had low birth weight. 17.3% of these adolescent mothers reported smoking during pregnancy, with 2.8% reporting alcohol and 1.7% illicit drugs. Teenage pregnancy is a complex phenomenon associated with various economic, educational, and behavioral factors. The study provides importance references for public policies to prevent teenage pregnancy.

The impact of maternal experience of violence and common mental disorders on neonatal outcomes: a survey of adolescent mothers in Sao Paulo, Brazil

BackgroundBoth violence and depression during pregnancy have been linked to adverse neonatal outcomes, particularly low birth weight. The aim of this study was to investigate the independent and interactive effects of these maternal exposures upon neonatal outcomes among pregnant adolescents in a disadvantaged population from Sao Paulo, Brazil.Methods930 consecutive pregnant teenagers, admitted for delivery were recruited. Violence was assessed using the Californian Perinatal Assessment. Mental illness was measured using the Composite International Diagnostic Interview (CIDI). Apgar scores of newborns were estimated and their weight measured.Results21.9% of mothers reported lifetime violence (2% during pregnancy) and 24.3% had a common mental disorder in the past 12 months. The exposures were correlated and each was associated with low education. Lifetime violence was strongly associated with Common Mental Disorders. Violence during pregnancy (PR = 2.59(1.05–6.40) and threat of physical violence (PR = 1.86(1.03–3.35) and any common mental disorders (PR = 2.09 (1.21–3.63) (as well as depression, anxiety and PTSD separately) were independently associated with low birth weight.ConclusionEfforts to improve neonatal outcomes in low income countries may be neglecting two important independent, but correlated risk factors: maternal experience of violence and common mental disorder.

Underreporting of use of cocaine and marijuana during the third trimester of gestation among pregnant adolescents

OBJECTIVE The aim of this study is to check the validity of the self-report of drug use by pregnant adolescents, by comparing their responses to a structured interview about their use of cocaine and marijuana during the pregnancy with an analysis of their hair. RESULTS Hair analysis detected the use of cocaine and/or marijuana in the third trimester of pregnancy in 60 (6%) patients. 40 (4%) patients used only marijuana, 17 (1.7%) used only cocaine, and 3 (0.3%) used both drugs. None of the patients had reported the use of these substances in their interviews with healthcare professionals. CONCLUSION Although the prevalence of the use of drugs during pregnancy is significant despite consistent evidence about the compromise of the neurobehavioral development of the newborns that are exposed to drugs during the prenatal period, drug use is frequently not reported. Therefore, more sensitive methods of detection should be used so that appropriate medical and psychosocial interventions can be implemented for the mothers as well as for their children.

Teenage pregnancy: use of drugs in the third trimester and prevalence of psychiatric disorders

OBJECTIVE To determine the prevalence of psychiatric disorders during pregnancy, the prevalence of cocaine and marijuana use during the third trimester of gestation and the socio-demographic characteristics of a population of low-income teenagers. METHOD One thousand pregnant teenagers were evaluated using the Composite International Diagnostic Interview, and a socio-demographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo, Brazil. Hair sample was collected for analysis. RESULTS Of the 1000 pregnant teenagers interviewed, 53.6% were poor, 90.4% were unemployed, 92.5% were financially dependent and 60.2% dropped out of school. Those using drugs during the third trimester of pregnancy were equal to 6% (marijuana: 4%, cocaine: 1.7%, both: 0.3%). Those having at least one psychiatric disorder equaled 27.6%. The most frequent diagnoses were depression (12.9%), posttraumatic stress disorder (10.0%) and anxiety disorders (5.6%). DISCUSSION Unstructured families, dropping out of school, unemployment and a low level of professional training are all contributing factors to the maintenance of an unfavorable socio-economic environment in which there is a high prevalence of cocaine and marijuana use during the third trimester of pregnancy and an abnormally high incidence of psychiatric disorders.

Crack Cocaine—A Two-Year Follow-Up of Treated Patients

Abstract Objectives: To investigate the 2-year outcome of the first 131 crack cocaine users who had been admitted for a period of inpatient treatment. Design: Follow-up study of consecutive patients admitted between 1992 and 1994. Setting: Inpatient detoxification unit of a public general hospital in São Paulo City, Brazil. Participants: 131 consecutive crack cocaine users. Measures: Reported crack use during last 12 months, incarceration and death. Findings: After 2 years, 50 patients reported crack use in the last 12 months, 29 said that they had not used it during this period, 9 were in prison, 13 had died, 2 had disappeared and no information was available on 28. Conclusions: Crack cocaine use seems to be associated with a high mortality rate and criminal involvement but about one-third of patients give up using the drug within 2 years of inpatient treatment.

Neurobehavior of Late Preterm Infants of Adolescent Mothers

Background: Late preterm infants have higher morbidity in the neonatal period and difficulties at school age. There are few data about neonatal neurobehavior performance that may interfere in their development. Objectives: To compare the neurobehavior of healthy late preterm and full-term neonates born to adolescent mothers. Methods: This prospective cross-sectional study included infants with a gestational age of 400/7–406/7 weeks (full term) and 340/7–366/7 weeks (late preterm) aged 24–72 h without exposure to alcohol, tobacco, drugs or infections and free of clinical problems during the first 3 days of life. Infants were assessed with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Outcomes were analyzed by ANOVA. Results: From July 2001 to November 2002, 3,685 infants were born, 928 of adolescent mothers. After exclusion, 36 late preterm and 96 term infants were enrolled. Adjusted for anesthesia type, delivery mode, gender, age at NNNS examination, time between last feeding and examination, and examination duration, late preterm, compared to term neonates, presented lower scores for attention (p = 0.041), arousal (p = 0.011), regulation (p < 0.001), quality of movements (p < 0.001) and higher scores for non-optimal reflexes (p < 0.001) and hypotonicity (p = 0.029). Conclusion: Late preterm infants of adolescent mothers have a more immature neurobehavioral performance at 24–72 h of life in multiple areas compared to term neonates suggesting a need for careful follow-up.

Neurocomportamento de recém-nascidos a termo, pequenos para a idade gestacional, filhos de mães adolescentes

OBJECTIVE: To compare the neurobehavior of small (SGA) and adequate (AGA) for gestational age full-term neonates born to adolescent mothers. METHODS: This prospective cross-sectional study included full-term newborn infants aged 24-72 hours, free from central nervous system malformations and born to adolescent mothers at a single center in Brazil. Infants were assessed with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) for: habituation, attention, arousal, regulation, handling, quality of movement, excitability, lethargy, nonoptimal reflexes, asymmetry, hypertonia, hypotonia, and stress/abstinence signals. The chi-square test and analysis of variance were used to compare SGA and AGA infants. Multivariate regression was used to analyze factors associated with the score of each NNNS variable. RESULTS: Of 3,685 infants born in the study hospital, 928 (25%) had adolescent mothers. Of these, 477 infants met the inclusion criteria: 419 (88%) were AGA and 58 (12%) were SGA. Univariate analysis did not show any differences between AGA and SGA neonates in terms of NNNS variables. Multivariate analysis showed that SGA neonates born by vaginal delivery had lower scores for quality of movements than those born by caesarean section. The SGA neonates born with local or without anesthesia had higher scores for excitability than those born with spinal anesthesia. Additionally, female SGA neonates had lower scores for stress/abstinence signals than males. CONCLUSION: SGA neonates born to adolescent mothers showed poorer quality of movements, more excitability and more signals of stress in association with sex of infant and variables related to delivery.

Brief report: Prevalence of psychiatric disorders in pregnant teenagers

PURPOSE To evaluate the prevalence of ICD-10 psychiatric disorders in a population of pregnant teenage women from a Brazilian public hospital. METHOD 1000 pregnant teenage women were evaluated using the Composite International Diagnostic Interview, a structured interview which establishes diagnoses according to the International Classification of Diseases. RESULTS 325 of the 1000 patients were found to have at least one psychiatric disorder; 33.2% of them had a second psychiatric diagnosis. The most prevalent disorders were depression (12.9%), post-traumatic stress disorder (10%), and tobacco dependence/harmful use (10.3%). The most prevalent co-morbidity was ICD-10 Affective Disorders versus Neurotic, Stress-related, and Somatoform Disorders. Substance-related disorders are significantly correlated with all of the ICD-10 psychiatric diagnoses but Psychotic Disorders. CONCLUSION The prevalence of psychiatric disorders in this population is high, and one third of them had co-morbidities, a condition usually associated with a more serious course of illness. This finding has important implications for clinical management and prognosis, and demands preventive public policies.

Alcohol and Crack Cocaine Use in Women: A 14-Year Cross-Sectional Study

This article aims to describe the record type for first-time hospital admissions of 761 women at a single institution between 1997 and 2010 according to International Classification of Diseases, 10th revision, criteria, for mental and behavioral disorders due to psychoactive substance use (F10-F19). This cross-sectional study included a convenience sample of 4,736 patients in the Brazilian public health system, among whom 761 were women. Overall, the rate of alcohol-related hospitalizations decreased from 93.6% in 1997 to 50.9% in 2010. In contrast, the rate of crack cocaine-related hospitalizations increased in women from 2.8% in 1997 to 67.8% in 2010. The linear regression was R2 = 0.8472. These data indicate a new trend in the pattern of psychoactive substance use in women.

Prenatal tobacco exposure is related to neurobehavioral modifications in infants of adolescent mothers

INTRODUCTION: Prenatal tobacco exposure interferes with neonatal outcomes. OBJECTIVE: To determine the neonatal neurobehavioral effects of in utero tobacco exposure. METHODS: This prospective cross-sectional study included healthy, term, with birth weight appropriate for gestacional age neonates without exposure to alcohol, drugs, or infections, born to adolescent mothers without psychiatric disorders or post-traumatic stress. Infants were classified according to in utero tobacco exposure, as identified by the Composite International Diagnostic Interview administered to mothers. Neurobehavior was assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Both tools were administered between 24 and 72 hours after birth. Neurobehavioral outcomes were compared between exposed and non-exposed infants by ANOVA. The associations between neurobehavioral scores and number of cigarettes smoked were studied by linear correlation. RESULTS: During the study, 928 newborns of adolescent mothers were born, and 388 were included in the study. Of these, 23 were exposed to tobacco, and 365 neonates were not exposed. There were no differences between the groups in gestational age, birth weight, post-natal age at the exam, or time between last feeding and exam. Exposed neonates showed higher scores on arousal (p = 0.004), excitability (p = 0.003), and stress/abstinence signals (p = 0.019) and a lower score on regulation (p = 0.025). After adjusting for the type of anesthesia, mode of delivery, gender, age at neurologic exam, exam duration and time between last feeding and exam, differences in arousal and excitability remained significant. The mean number of cigarettes consumed daily was positively correlated with lethargy (p = 0.013) and inversely with attention (p = 0.043). CONCLUSIONS: Neonates exposed in utero to tobacco showed worse neurobehavioral performance between 24 and 48 hours of life.