Zenilda Vieira Bruno

Adolescent pregnancy 1 year later: the effects of abortion vs. motherhood in Northeast Brazil

PURPOSE To determine social and behavioral consequences of pregnancy and how these differed according to the pregnancy outcome (live birth or abortion) 1 year after the event. METHODS This was a prospective study of two groups of young women aged 12-18 years, one attending prenatal services and the other admitted for abortion complications at the same hospital in northeast Brazil. Adolescents who gave birth were subsequently classified as having intended or unintended pregnancies, and those who aborted were divided between those who terminated their pregnancies and those who miscarried. Baseline data were collected between 1995 and 1997 from all teens who met the eligibility criteria. Information was collected through one-on-one interviews using a questionnaire that was structured and precoded. Multiple logistic regression was used to identify characteristics that predicted outcomes at 1 year. RESULTS Teens who terminated their pregnancies were the most likely to be in school or working 1 year later. They also showed the greatest increase in self-esteem. The young mothers, however, had the highest self-esteem but perceived the impact of pregnancy on their lives as being more negative than they did initially. Group affiliation was not associated with the quality of partner relationships, which tended to deteriorate over time. The young mothers used contraception at 1 year at higher rates and had experienced fewer subsequent pregnancies than the two abortion groups. CONCLUSIONS The experience of adolescent pregnancy for this group of teens produced mixed findings, some more negative than others. Interventions to decrease the adolescents desire to have a baby will have to be tailored differently from those designed to prevent an unintended pregnancy, but both are needed.

Reincidência de gravidez em adolescentes

OBJETIVO: avaliar os aspectos epidemiologicos na reincidencia de gravidez na adolescencia. METODOS: estudo de coorte que incluiu 187 adolescentes gravidas, atendidas e acompanhadas durante cinco anos apos o parto em um servico de atendimento de adolescentes do Estado do Ceara. Foram analisados: faixa etaria, estar ou nao estudando, morar com os pais, escolaridade, condicao marital e condicao do companheiro atual. Os dados foram digitados e analisados no programa EPI-INFO. Foram feitas analises estatisticas das variaveis independentes (idade, escolaridade, estudar, trabalhar, morar com os pais, estado civil e mudanca de parceiro) e comparadas quanto a variavel dependente (ter ou nao uma nova gravidez cinco anos depois). O teste exato de Fisher foi utilizado para avaliar associacao entre os fatores que poderiam influenciar a repeticao da gravidez, considerado como tendo associacao quando o p<0,05. Foram calculados os riscos relativos para a escolaridade, condicao marital e mudanca de parceiro por serem fatores que se mostraram significativos para a reincidencia de gravidez. RESULTADOS: foi verificado que 61% das adolescentes engravidaram nos cinco anos seguintes ao primeiro parto. Nao foram fatores protetores: idade, estudar, trabalhar ou morar com os pais. Entretanto, quando as adolescentes tinham oito anos ou menos de escolaridade, o risco de engravidar quase duplicou (risco relativo (RR)=1,8 (IC95%=1,3-2,6)). Novas gestacoes foram mais frequentes entre as solteiras sem companheiro estavel (RR=1,3 (IC95%=1,1-1,6)) e aquelas que mudaram de parceiro (RR=1,4 (IC95%=1,1-1,7)). CONCLUSOES: a baixa escolaridade, a mudanca de parceiros e unioes nao estaveis foram fatores de risco para reincidencia de gravidez.PURPOSE To evaluate epidemiological aspects in recurrent adolescence pregnancy. METHODS Cohort study including 187 pregnant adolescents attended and followed-up for five years after delivery in an adolescents attendance service in Ceará state. Age group, being or not at school, living with parents, schooling, marital status and the present partners condition were analyzed. Data were processed by the EPI-INFO program. Statistical analysis of the independent variables (age, schooling, being at school, having a job, living with parents, marital status and switching partners) was done and compared to the dependent variable (being or not pregnant after five years). The Fishers exact test was used to evaluate the association among factors which could influence the pregnancy recurrence, the association being present when p<0.05. Risks related to schooling, marital status and multiple partners have been calculated, since these were significant factors for pregnancy recurrence. RESULTS 61% of the adolescents got pregnant in the five years after the first delivery. Factors such as age, school, work or living with parents were not protective. Nevertheless, when the adolescents had eight or less years of schooling, the risk of getting pregnant has almost duplicated (relative risk (RR)=1.8 (CI 95%=1.3-2.6)). New pregnancies were more frequent among the single adolescents without a stable partner (RR=1.3 (CI 95%=1.1-1.6) and among the ones who had multiple partners (RR=1.4 (CI 95%=1.1-1.7)). CONCLUSIONS Low schooling, multiple partners and non-stable bonds were risk factors for pregnancy recurrence.

ADOLESCENTS’ DECISION-MAKING AND ATTITUDES TOWARDS ABORTION IN NORTH-EAST BRAZIL

Three groups of adolescents are compared with regard to their own considerations of abortion and when they believe abortion is justified. One group of adolescents terminated their pregnancies (n=95), a second became pregnant and carried their pregnancies to term but considered abortion (n=68), and the third also carried their pregnancies to term but did not consider abortion (n=204). The study was carried out between 1995 and 1998 in Fortaleza, Brazil. Adolescents were interviewed at the time of their hospitalization or their first prenatal visit and again at 6 weeks and 1 year post-abortion or postpartum. Friends and family recommended abortion to at least half of the teenagers in each group. Teenagers who aborted were more accepting of abortion than those who did not abort, while those who considered abortion found the practice more justified than those who did not consider abortion. Teenagers who aborted became less accepting a year later, while those who did not consider abortion became more accepting. A better understanding of adolescent attitudes towards abortion and their decision-making process should help adults and professionals meet the needs of adolescents for support in the process and in the reduction of the number of unintended pregnancies in the future.

Fatores preditivos de hipertensão gestacional em adolescentes primíparas: análise do pré-natal, da MAPA e da microalbuminúria

OBJECTIVE: To quantify PH prevalence in primiparous adolescents; define predictive factors for the occurrence of PH and its impact on newborns. METHODS: We followed 29 primiparous adolescents from the prenatal period through the 12th week of the puerperium, with a mean of sixteen years of age, served at the Outpatient Facility for Adolescents of Maternidade Escola Assis Chateaubriand (MEAC) of Universidade Federal do Ceara (Fortaleza, Brazil). The pregnant adolescents were divided into two groups, that is, those who remained normotensive (Group I) and those who developed PH (Group II). The variables investigated in the assessment of the value of predictability for the development of PH were anthropometric measures, socioeconomic aspects, smoking habit, inheritance for SAH (father/mother), prenatal tests requested in the first prenatal care visit in addition to microalbuminuria and ambulatory blood pressure monitoring (ABPM) in the 28th week of gestation. The pregnant adolescents were followed up at delivery and late puerperium (12th week after the puerperium). The newborns to the mothers included in our study were assessed at birth according to the Apgar score and the Capurro method, for weight, height and perinatal hypoxia. RESULTS: The prevalence of PH was 51.7%. Inheritance for SAH presented the highest predictive value for PH with an odds ratio of 10.99. Diastolic arterial pressure equal to or above 70 mmHg at the gestational age of 35 weeks was statistically significant as a predictive value for PH. At ABPM we found a predictive value for PH: diastolic pressure load during alertness, diastolic and systolic pressure load during night sleep, pressure variability and maximum diastolic pressure during sleep. Specifically a maximum diastolic arterial pressure (DAP) at ABPM during the period of night sleep ³64 mmHg presented an odds ratio of 6 for PH with a sensitivity of 80% and a specificity of 60% for the development of PH. CONCLUSION: The research for PH predictive factors in primiparous adolescents showed to be easy to apply and useful to stratify high-risk pregnant women as regards the development of PH.

Gravidez na adolescência e baixo peso ao nascer: existe associação?

OBJETIVO: Verificar la asociacion entre embarazo en la adolescencia (10 a 19 anos) y bajo peso al nacer. METODOS: Estudio transversal realizado en maternidad terciaria entre junio de 2000 a junio de 2001. Por sorteo aleatorio simple, se seleccionaron madres adolescentes y no adolescentes entrevistadas en el primer dia despues del parto. Se aplico el analisis multivariado mediante regresion logistica de las variables implicadas con el bajo peso al nacer. RESULTADOS: Se seleccionaron 539 parejas (madres y sus respectivos recien-nacidos), siendo 331 (61,4%) mujeres con 20 anos o mas y 208 (38,5%) abajo de los 20 anos. Entre las adolescentes, 50 bebes (24%) tuvieron edad gestacional <37 semanas, mientras que entre las madres con mas de 20 anos, 52 (15,7%) eran prematuros (OR 1,58; IC95% 1,00-2,51). Entre las adolescentes, ocurrieron 52 (25%) recien nacidos con peso <2.500g entre las adultas, 56 (16,9%) tenian bajo peso (OR 1,64; IC95% 1,05-2,56). Entre las que realizaron prenatal adecuado, la ocurrencia de bajo peso fue de 12,3% y de 22,1% en el grupo cuya asistencia fue inadecuada. En esa casuistica, la asociacion encontrada en el analisis bivariado entre bajo peso y madre adolescente no se mantuvo en el analisis multivariado. CONCLUSIONES: Bajo peso al nacer en gestaciones en la adolescencia no puede ser atribuido aisladamente a la edad materna.ABSTRACT Objective: To study the association between teenage pregnancy (ten to 19 years old) and low birthweight. Methods: Cross-sectional study carried out at a tertiary center from June 2000 to June 2001. A simple random drawing selected teenagers and adult mothers who were interviewed during the first day after birth. multivariate analysis using logistic regression of variables related to low birthweight was applied. Results: 539 pairs (mothers and their newborns) were studied – 331 (61.4%) women with 20 years old or more and 208 (38.5%) <20 years old. Among the adolescents, 50 (24%) infants had gestational age <37 weeks, whereas among mothers over 20 years old, 52 (15.7%) were preterm (OR 1.58; 95%CI 1.00-2.51). Among the adolescent and adult women, there were respectively 52 (25%) and 56 (16.9%) newborns <2500g (OR 1.64; 95%CI 1.05-2.56). Among those who had adequate prenatal care, low birth weight was detected in 12.3 and 22.1% of mothers with adequate and inadequate prenatal care, respectively. The association found in the univariate analysis between low birth weight and maternal age was not sustained in the multivariate analysis.

Pregnancy in teenagers and low birthweight infant: is there an association?

OBJETIVO: Verificar la asociacion entre embarazo en la adolescencia (10 a 19 anos) y bajo peso al nacer. METODOS: Estudio transversal realizado en maternidad terciaria entre junio de 2000 a junio de 2001. Por sorteo aleatorio simple, se seleccionaron madres adolescentes y no adolescentes entrevistadas en el primer dia despues del parto. Se aplico el analisis multivariado mediante regresion logistica de las variables implicadas con el bajo peso al nacer. RESULTADOS: Se seleccionaron 539 parejas (madres y sus respectivos recien-nacidos), siendo 331 (61,4%) mujeres con 20 anos o mas y 208 (38,5%) abajo de los 20 anos. Entre las adolescentes, 50 bebes (24%) tuvieron edad gestacional <37 semanas, mientras que entre las madres con mas de 20 anos, 52 (15,7%) eran prematuros (OR 1,58; IC95% 1,00-2,51). Entre las adolescentes, ocurrieron 52 (25%) recien nacidos con peso <2.500g entre las adultas, 56 (16,9%) tenian bajo peso (OR 1,64; IC95% 1,05-2,56). Entre las que realizaron prenatal adecuado, la ocurrencia de bajo peso fue de 12,3% y de 22,1% en el grupo cuya asistencia fue inadecuada. En esa casuistica, la asociacion encontrada en el analisis bivariado entre bajo peso y madre adolescente no se mantuvo en el analisis multivariado. CONCLUSIONES: Bajo peso al nacer en gestaciones en la adolescencia no puede ser atribuido aisladamente a la edad materna.ABSTRACT Objective: To study the association between teenage pregnancy (ten to 19 years old) and low birthweight. Methods: Cross-sectional study carried out at a tertiary center from June 2000 to June 2001. A simple random drawing selected teenagers and adult mothers who were interviewed during the first day after birth. multivariate analysis using logistic regression of variables related to low birthweight was applied. Results: 539 pairs (mothers and their newborns) were studied – 331 (61.4%) women with 20 years old or more and 208 (38.5%) <20 years old. Among the adolescents, 50 (24%) infants had gestational age <37 weeks, whereas among mothers over 20 years old, 52 (15.7%) were preterm (OR 1.58; 95%CI 1.00-2.51). Among the adolescent and adult women, there were respectively 52 (25%) and 56 (16.9%) newborns <2500g (OR 1.64; 95%CI 1.05-2.56). Among those who had adequate prenatal care, low birth weight was detected in 12.3 and 22.1% of mothers with adequate and inadequate prenatal care, respectively. The association found in the univariate analysis between low birth weight and maternal age was not sustained in the multivariate analysis.

Cytology-based screening during antenatal care as a method for preventing cervical cancer

Background: Cervical cancer is one of the most serious threats to women’s lives. Therefore, the present study aimed to know the dynamics in the collection of cytologic samples during antenatal care as a method of cervical cancer screening and to identify the factors associated with its performance. Material and Methods: Analytical cross-sectional study carried out with pregnant and postpartum women in Fortaleza, Ceará, Northeastern Brazil. Data were collected using a questionnaire addressing sociodemographic variables, antenatal care, pregnancy and cytology-based screening for cervical cancer during antenatal care. Measures of central tendency were calculated and the Chi-squared test and Fisher’s exact test were used with a significance level of 5%. Results: Participants were 229 pregnant women and 89 postpartum women. Age ranged 18 to 43 years, with a mean of 27.9 years (SD=6.1). Only 35 (11%) participants had Pap smears during antenatal care. A total of 283 women did not have Pap smears during pregnancy; of these, 229 (80.9%) did not have the test because of lack of clear information from the health professional, 25 (8.8%) for fear of bleeding or abortion, and 29 (10.3%) because they had had the test before pregnancy. Undergoing cytology-based screening for cervical cancer was associated with high-risk pregnancy (p=0.002), antenatal care provided by a physician (p=0.003), knowledge about the possibility of having the test during pregnancy (p<0.001) and paid job (p=0.043). Conclusion: The percentage of cytology-based screening for cervical cancer during antenatal care was low. Therefore, health education is suggested to improve this figure. However, receiving antenatal care at MEAC, having consultations with a physician, and knowing that it is possible to have a Pap smear during pregnancy were significant protective factors for undergoing cytology screening during pregnancy.

Embarazo en la adolescencia y bajo peso al nacer: ¿existe asociación?

OBJETIVO: Verificar la asociacion entre embarazo en la adolescencia (10 a 19 anos) y bajo peso al nacer. METODOS: Estudio transversal realizado en maternidad terciaria entre junio de 2000 a junio de 2001. Por sorteo aleatorio simple, se seleccionaron madres adolescentes y no adolescentes entrevistadas en el primer dia despues del parto. Se aplico el analisis multivariado mediante regresion logistica de las variables implicadas con el bajo peso al nacer. RESULTADOS: Se seleccionaron 539 parejas (madres y sus respectivos recien-nacidos), siendo 331 (61,4%) mujeres con 20 anos o mas y 208 (38,5%) abajo de los 20 anos. Entre las adolescentes, 50 bebes (24%) tuvieron edad gestacional <37 semanas, mientras que entre las madres con mas de 20 anos, 52 (15,7%) eran prematuros (OR 1,58; IC95% 1,00-2,51). Entre las adolescentes, ocurrieron 52 (25%) recien nacidos con peso <2.500g entre las adultas, 56 (16,9%) tenian bajo peso (OR 1,64; IC95% 1,05-2,56). Entre las que realizaron prenatal adecuado, la ocurrencia de bajo peso fue de 12,3% y de 22,1% en el grupo cuya asistencia fue inadecuada. En esa casuistica, la asociacion encontrada en el analisis bivariado entre bajo peso y madre adolescente no se mantuvo en el analisis multivariado. CONCLUSIONES: Bajo peso al nacer en gestaciones en la adolescencia no puede ser atribuido aisladamente a la edad materna.ABSTRACT Objective: To study the association between teenage pregnancy (ten to 19 years old) and low birthweight. Methods: Cross-sectional study carried out at a tertiary center from June 2000 to June 2001. A simple random drawing selected teenagers and adult mothers who were interviewed during the first day after birth. multivariate analysis using logistic regression of variables related to low birthweight was applied. Results: 539 pairs (mothers and their newborns) were studied – 331 (61.4%) women with 20 years old or more and 208 (38.5%) <20 years old. Among the adolescents, 50 (24%) infants had gestational age <37 weeks, whereas among mothers over 20 years old, 52 (15.7%) were preterm (OR 1.58; 95%CI 1.00-2.51). Among the adolescent and adult women, there were respectively 52 (25%) and 56 (16.9%) newborns <2500g (OR 1.64; 95%CI 1.05-2.56). Among those who had adequate prenatal care, low birth weight was detected in 12.3 and 22.1% of mothers with adequate and inadequate prenatal care, respectively. The association found in the univariate analysis between low birth weight and maternal age was not sustained in the multivariate analysis.

P1-228 Decreased bone mass in women: importance of early diagnosis for healthy ageing

Objectives Presuming that osteoporosis begins in middle aged women, the present study had as an objective to identify the prevalence of osteopenia and osteoporosis in women whose ages vary from 45 to 59 and from 60 or more. Methodology The study analysed data from a gynaecologic outpatient clinic, related to patients files from 2000 to 2006. The following variables were analysed: age, the first and the last appointments dates, the result of the bones minerals density (DMO) classified by the categories: normal, osteopenia and osteoporosis. χ2 Test was used to verify associations between variables, considering p<0.05. Results Osteopororis was more frequent in the older age group (42.5% vs 5.6%, p<0.05), although osteopenia was more frequent in the younger group (55.0% vs 47.1%, p<0.05). Conclusion These findings suggest that an early screening for lost of bone mass should be done, allowing the beginning of adequate therapy, in order to assure life quality to middle aged and older women.

Avaliação ultra-sonográfica da genitália interna de meninas com puberdade precoce central idiopática antes e durante o tratamento com análogo de GnRH

OBJETIVO: verificar, com o emprego da ultra-sonografia pelvica, a existencia de mudancas na genitalia interna de meninas com puberdade precoce central submetidas a tratamento com analogo do hormonio liberador de gonadotrofinas (GnRH). METODOS: a ultra-sonografia pelvica foi realizada em 18 meninas com diagnostico de puberdade precoce central idiopatica, antes e tres meses apos o inicio do tratamento com analogo de GnRH, para avaliar o impacto da terapia na genitalia interna feminina. Foram avaliados os volumes uterino e ovariano, o diâmetro longitudinal do utero, a relacao entre os diâmetros longitudinais do corpo e colo uterinos, a relacao entre os diâmetros ântero-posteriores do corpo e colo uterinos e o eco endometrial. Para a analise estatistica foi aplicado o teste de Shapiro-Willks para verificacao da normalidade dos dados. Para os dados em que a normalidade foi satisfeita, foi aplicado o teste t de Student. Para os dados cuja distribuicao nao foi normal aplicou-se o teste nao parametrico (teste do sinal). RESULTADOS: apos o tratamento houve reducao estatisticamente significante da media dos volumes uterino (de 5,4 para 3,0 cm3, p<0,001) e ovariano (de 2,2 para 1,1 cm3, p=0,004), da media do diâmetro longitudinal do utero (de 4,2 para 3,4 cm, p=0,001) e da media do eco endometrial (de 1,8 para 0,6 mm, p=0,018). CONCLUSAO: em meninas com puberdade precoce a ultra-sonografia pelvica e util para avaliar a eficacia do tratamento com analogo de GnRH. Os principais parâmetros de resposta a terapia sao as diminuicoes dos volumes uterino e ovariano, a reducao do diâmetro longitudinal do utero e a atrofia ou ausencia do eco endometrial.