Abstract

The present study aims to analyze the socioeconomic and demographic factors associated with the recurrence of teenage pregnancy, as well as to verify the association with unfavorable maternal and neonatal outcomes. It is a cross-sectional study, based on data from “Nascer no Brasil”, comprised of adolescent mothers and their newborns. Univariate and multiple logistic regression were used to indicate the factors associated with this recurrence. Recurrence of teenage pregnancy was associated with a maternal age of 17-19 years (OR=3.35; 95%CI=2.45-4.59); an inadequate education for their age (OR=4.34; 95%CI=3.50-5.39), with no intention of becoming pregnant; residency in the state capital; and the fact that the partner is the head of the family. However, as independent primiparous teenagers, there is a greater chance of hypertension and restricted intrauterine growth. It can therefore be concluded that there is a high percentage of teenage pregnancies in Brazil. Teenagers with a partner, inadequate education, and no reproductive planning are more likely to have two or more pregnancies before the age of 20, demonstrating difficulties in postponing the first pregnancy. However, as primiparous teenagers, they are more likely to have complications than multiparous teenagers.

Key words:
Pregnancy in adolescence; Prenatal care; Pregnancy complications; Pregnancy outcome; Socioeconomic factors

Introduction

According to the Pan-American Health Organization (PAHO), Brazil presented one of the highest teenage pregnancy rates in Latin America in 2016, with 68.4 live births in every 1,000 girls aged 15-19 years¹1 Organización Panamericana de la Salud (OPAS). Fondo de Población de las Naciones Unidas y Fondo de las Naciones Unidas para la Infancia. Acelerar el progreso hacia la reducción del embarazo en la adolescencia en América Latina y el Caribe. Informe de consulta técnica. Washington, D.C.: OPAS; 2018.. Although the percentage of teenage pregnancies has diminished over time, the recurrence of pregnancies remains stable, at approximately 20%²2 Lopes MCL, Oliveira RR, Silva MAP, Padovani C, Oliveira NLB, Higarashi IH. Tendência temporal e fatores associados à gravidez na adolescência. Rev Esc Enferm USP 2020; 54:e03639.. In Rio Grande, municipality of the extreme South of Brazil, the overall recurrence rate among teenagers was of 53.6%, given that two years after the first birth, half of the teenagers had become pregnant once again, and in three years, this rate increased to 80%³3 Zanchi M, Mendoza-Sassi RA, Silva MR, Almeida SG, Teixeira LO, Gonçalves CV. Pregnancy recurrence in adolescents in Southern Brazil. Rev Assoc Med Bras 2017; 63(7):628-635..

The recurrence of early pregnancy can compromise the future of these young girls and their children, since a new birth during adolescence often occurs in contexts of social inequality, perpetuating the history of poverty⁴4 Nery IS, Gomes KRO, Barros IC, Gomes IS, Fernandes ACN, Viana LMM. Fatores associados à reincidência de gravidez após gestação na adolescência no Piauí, Brasil. Epidemiol Serv Saude 2015; 24(4):671-680.. The social determinants of the teenagers, added to factors like inadequate pre-natal care⁵5 Domingues RMSM, Viellas EF, Dias MAB, Torres JA, Theme-Filha MM, Gama SGN, Leal MC. Adequação da assistência pré-natal segundo as características maternas no Brasil. Rev Panam Salud Publica 2015; 37(3):140-147., unintentional pregnancy⁶6 Ajayi AI, Odunga SA, Oduor, C, Ouedraogo R, Ushie BA, Wado YD. "I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls. Reprod Health 2021; 18(1):19., and repeated pregnancy in a short period of time⁷7 Vieira CL, Flores PV, Camargo KR, Pinheiro RS, Cabral CS, Aguiar FP, Coeli CM. Rapid Repeat Pregnancy in Brazilian Adolescents: Interaction between Maternal Schooling and Age. J Pediatr Adolesc Gynecol 2016; 29(4):382-385. can lead to unfavorable maternal and neonatal repercussions.

Newborns from teenage mothers, when compared to adult mothers, present a greater chance of negative outcomes, such as premature births, low birth weight, and neonatal mortality⁸8 Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, Yamdamsuren B, Temmerman M, Say L, Tunçalp Ö, Vogel JP, Souza JP, Mori R, WHO Multicountry Survey on Maternal Newborn Health Research Network. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014; 121 (Supl. 1):40-48.^,99 Tuon RA, Ambrosana GMB, Silva SMCV, Pereira AC. Impacto do monitoramento telefônico de gestantes na prevalência da prematuridade e análise dos fatores de risco associados em Piracicaba, São Paulo, Brasil. Cad Saude Publica 2016; 32(7):e00107014.. There is also a greater chance of other complications, including urinary infections, abortions, preeclampsia, hypertension associated with a premature rupture of the membranes during teenage pregnancies¹⁰10 Almeida AHV. Gravidez e parto em adolescentes no Brasil: desigualdades raciais e socioeconômicas na assistência pré-natal e associação com nascimento prematuro [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca; 2018.

11 Azevedo WF, Diniz MB, Fonseca ES, Azevedo LM, Evangelista CB. Complicações da gravidez na adolescência: revisão sistemática da literatura. Einstein 2015; 13(4):618-626.^-1212 Grønvik T, Sandøy IF. Complications associated with adolescent childbearing in Sub-Saharan Africa: A systematic literature review and meta-analysis. PLoS One2018; 13(9):e0204327..

However, information on the recurrence of teenage pregnancy (associated factors and maternal and perinatal outcomes) is scarce in the literature¹³13 Amongin D, Nakimuli A, Hanson C, Nakafeero M, Kaharuza F, Atuyambe L, Benova L. Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys. PLoS One 2020; 15(4):e0231557.^,1414 Benova L, Neal S, Radovich EG, Ross DA, Siddiqi M, Chandra-Mouli V. Usando três indicadores para compreender a contribuição específica da paridade da gravidez adolescente para todos os nascimentos. BMJ Glob Health 2018; 3(6):e001059.. Thus, as a means through which to contribute to the formulation of effective strategies for the reduction of the early recurrence of pregnancies within the teenage population, this study aims to analyze the socioeconomic and demographic factors associated with the recurrence of teenage pregnancy, as well as to verify the association with unfavorable maternal and neonatal outcomes.

Methods

The data for this study were obtained from the national study “Nascer no Brasil”, a hospital-based study conducted with postpartum women and their newborns collected between February 2011 and October 2012. The sample was selected in three stages. The first stage included hospitals with more than 500 births/year, which were stratified according the macroregions of the country (North, South, Northeast, Southeast, and Midwest), the location (capital or countryside), and the type of service (public, private, or mixed). The second stage defined the number of days necessary to interview 90 pastpartum women in each of the 266 previously selected hospitals (minimum of 7 days), using the inverse sampling method. In the third stage, postpartum women and their newborns were selected, with additional information available about the sample design¹⁵15 Vasconcellos MTL, Silva PLN, Pereira APE, Schilithz AOC, Souza Junior PRB, Szwarcwald CL. Desenho da amostra Nascer no Brasil: Pesquisa Nacional sobre Parto e Nascimento. Cad Saude Publica 2014; 30: S49-S58..

The complex sample design was taken into consideration during the entire statistical analysis. Each selection stratum received a procedure of calibration of the rate of basic sample weight to ensure that the distribution of postpartum women was similar to that observed in the births among the sampled population in 2011, deriving weighted percentages.

This analysis considered all of the newborns from postpartum teenagers of less than or equal to 19 years of age, categorized as primiparous or multiparous (teenagers with recurring pregnancies). No postpartum women of less than 12 years of age were found in this study. The data were collected through electronic forms. This study considered the information from interviews with the teenager herself during hospitalization; those from the pre-natal card, which were photographed and transcribed; and those from the maternal and newborn medical records. This last piece of data was collected after the teenagers had been released from the hospital or on the 42^nd day of hospitalization, and/or after the newborn had been released or on the 28^th day of hospitalization. All details regarding data collection are available for consultation¹⁶16 Leal MC, Silva AAM, Dias MAB, Gama SGN, Rattner D, Moreira ME, Theme Filha MM, Domingues RM, Pereira AP, Torres JA, Bittencourt SD, D'orsi E, Cunha AJ, Leite AJ, Cavalcante RS, Lansky S, Diniz CS, Szwarcwald CL. Birth in Brazil: national survey into labour and birth. Reprod Health 2012; 9:15..

Various sociodemographic variables were used: maternal age (12-16 years, 17-19 years), education (adequate, inadequate for age), economic classification according to the Brazilian Association of Market Research Institutes (classes A/B, C, D/E), race/color (white, black, brown, yellow, and indigenous), region of residency (North, South, Northeast, Southeast, and Midwest), intention to become pregnant (yes, no), marital status (without partner, with partner), paid work (yes, no), location of residency (capital, other municipalities), and head of the family (mother herself, partner, father/mother/other person).

The negative maternal and neonatal outcomes considered for the association with the recurrence of teenage pregnancy were: low birth weight (yes, no), prematurity (yes, no), Intrauterine Growth Restriction (IUGR) (yes, no), adequacy of weight for the gestational age (small, adequate, large for the gestational age), neonatal hospitalization (without, with Intensive Care Unit (ICU), without hospitalization), use of oxygen (yes, no), Apgar 5 min <7 (yes, no), neonatal death (yes, no, stillbirth), gestational diabetes (yes, no), hypertension - chronic hypertension, preeclampsia, eclampsia, and HELLP syndrome (yes, no), syphilis infection (yes, no).

Later, for the outcomes that revealed an association (hypertension and IUGR), directed acyclic graphs (DAGs) were constructed. For hypertension, the variables suggested by the DAG for controls were: Body Mass Index (BMI) (underweight, normal weight, overweight, and obese), financing of the birth (public, private), adequacy of pre-natal care (adequate, inadequate), economic classification according to the Brazilian Association of Market Research Institutes, and type of birth (vaginal/forceps, Caesarean section). For the IUGR, the following variables were used: BMI, preeclampsia, type of birth and HIV, syphilis, and other infections.

The Rao-Scott (X²) chi-squared test was used to verify differences between the proportions, considering a 95% confidence interval (95%CI). After, to verify which social conditions were associated with the recurrence of teenage pregnancy and to understand if the parity was associated with hypertension and IUGR, the univariate and multivariate logistic regression analyses were applied. This study tested the effect of the interaction before the final regression analysis. The variables initially selected for adjustments were those indicated by the DAGs formulated for each outcome. Later, what remained in the model were those with a p-valor≤0.05, and those whose pseudo-R² statistics (Cox & Snell and Nagelkerke) were closest to 1, indicating the best adjustment.

This study was approved by the Research Ethics Committee of the National Public Health School from the Oswaldo Cruz Foundation, logged under protocol number 92/2010. Digital consent was obtained from each postpartum woman after having read the free and informed consent form before the interview. The secondary data analysis conducted in this article was approved by the Research Ethics Committee of the Health Sciences Center of the Federal University of Espírito Santo, logged under protocol number 3.565.689/2019.

Results

This study counted on the participation of 4,571 pastpartum teenagers, including 3,721 primiparous and 850 multiparous (18.6%). When comparing the teenagers in the first stage of gestation with those in recurring pregnancies, it was possible to observe that the recurrence of pregnancy occurred more often in teenagers aged 17-19 years (p<0.001), in less favorable sociodemographic and demographic conditions, such as inadequate education for their age (p<0.001), economic classes C, D+E (p=0.022), unplanned gestation (p<0,001), teenagers who live with their partner and who were the head of the family (p<0,001), and teenagers who lived in the their state’s capital city (p=0.022) (Table 1).

After adjustments to the final model, the recurrence of teenage pregnancy was associated with a maternal age of 17-19 years (OR=3.35; 95%CI=2.45-4.59), inadequate education for their age (OR=4.34; 95%CI=3.50-5.39), unintentional pregnancy (OR=2.34; 95% CI=1.77-3.08), residency in the state’s capital city (OR=1.40; 95%CI=1.10-1.78), and partner as the head of the family (OR=2.07; 95%CI=1.47-2.91) (Table 2).

Table 3 shows the maternal and perinatal outcomes associated with the recurrence of teenage pregnancy. Only hypertension (p=0.029) and IUGR (p=0.002) were associated with primiparity. Upon adjusting the models of the relationship between parity and negative maternal and neonatal outcomes, the primiparity continued to be associated with hypertension (OR=1.54; 95%CI=1.01-2.35) and the IUGR (OR=1.90; 95%CI=1.23-2.91), even when controlling important confounding factors (Table 4).

Discussion

The recurrence of teenage pregnancy was of 18.6% and proved to be associated with socioeconomic and demographic factors, such as an age from 17-19 years, inadequate education for their age, unintentional pregnancy, residency in the state´s capital city, and partner as the head of the family. In addition, the IUGR and hypertension proved to be negative outcomes associated with primiparity, even when controlling important confounding factors.

Adequate education is a protective factor for the women not to have a recurrent pregnancy during their adolescence, that is, the teenagers with an inadequate education, when compared to those with an adequate education, were twice as likely to become pregnant, which was demonstrated in a study conducted with 59,000 live births in Rio de Janeiro⁷7 Vieira CL, Flores PV, Camargo KR, Pinheiro RS, Cabral CS, Aguiar FP, Coeli CM. Rapid Repeat Pregnancy in Brazilian Adolescents: Interaction between Maternal Schooling and Age. J Pediatr Adolesc Gynecol 2016; 29(4):382-385.. In the state of Ceará, when the teenagers had eight or less years of education, the risk of recurrent pregnancy nearly doubled (RR=1.8; 95%CI=1.3-2.6)¹⁷17 Bruno ZV, Feitosa FEL, Silveira KP, Morais IQ, Bezerra MF. Reincidência de gravidez em adolescentes. Rev Bras Ginecol Obstetr 2009; 31(10):480-484.. This negative context tends to worsen with subsequent teenage pregnancies, since the pregnancy itself contributes to the lack of education and to school evasion.

Inadequate education is related to the early onset of sexual activity, which increases the chances of teenage pregnancy and its recurrence¹⁸18 Maranhão TA, Gomes KRO, Oliveira DC, Moita Neto JM. Repercussão da iniciação sexual na vida sexual e reprodutiva de jovens de capital do Nordeste brasileiro. Cien Saude Colet 2017; 22(12):4083-4094.. Each year that we are able to postpone the first gestation in teenagers, the probability of repeated births is reduced by 23%. Therefore, improving teenagers’ educational level, in addition to increasing their chances in the work market, contributes to a conscious postponement of pregnancy¹³13 Amongin D, Nakimuli A, Hanson C, Nakafeero M, Kaharuza F, Atuyambe L, Benova L. Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys. PLoS One 2020; 15(4):e0231557..

In addition to education, the low family income contributes to the recurrence of teenage pregnancies, which can perpetuate the history of teenage pregnancy for generations, which hinders the family’s social ascension⁴4 Nery IS, Gomes KRO, Barros IC, Gomes IS, Fernandes ACN, Viana LMM. Fatores associados à reincidência de gravidez após gestação na adolescência no Piauí, Brasil. Epidemiol Serv Saude 2015; 24(4):671-680.^,1919 Liu N, Vigod, SN, Farrugia MM, Urquia, ML, Ray JG. Intergenerational teen pregnancy: a population-based cohort study. BJOG 2018; 125:1766-1774.. Thus, the limited perspective of professional growth, the lack of educational attractiveness, and the difficulty to enter the work market contribute to these teenagers considering the role of being a mother in their pregnancies to be a life option²⁰20 World Health Organization (WHO). Adolescent pregnancy. Fact sheet. Geneva: WHO; 2020.^,2121 Silva JLP, Surita FG. Pregnancy in Adolescence - A Challenge Beyond Public Health Policies. Rev Bras Ginecol Obstet 2017; 39(2):41-43..

An unintended pregnancy is also something that marks teenage pregnancy. One study, conducted in the countryside of the state of Goiás, found that 75% of the teenagers who had a recurrent pregnancy had no intention of becoming pregnant²²22 Honorio-França AC, Cardoso APM, França EL, Ferrari CKB. Gestação precoce e reincidência de gestações em adolescentes e mulheres de uma unidade de estratégia de saúde da família. Rev APS 2013; 16:2.. Moreover, those who had a recurrent pregnancy, when compared to other teenagers, presented a greater chance of never having used a contraceptive (OR=1.69; 95%CI=1.25-2.29)⁶6 Ajayi AI, Odunga SA, Oduor, C, Ouedraogo R, Ushie BA, Wado YD. "I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls. Reprod Health 2021; 18(1):19.. One longitudinal study, conducted in Uganda, observed that the percentage of teenagers who wanted to postpone the birth of the second child increased from 22.5% in 1995 to 43.1% in 2016, highlighting the need to provide support to these teenagers through better reproductive planning services¹³13 Amongin D, Nakimuli A, Hanson C, Nakafeero M, Kaharuza F, Atuyambe L, Benova L. Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys. PLoS One 2020; 15(4):e0231557..

Family planning and reproductive health among teenagers are still questions of inequality in health care. Reproductive health as a public health policy, as well as the provisions for effective contraceptive methods among teenagers, are in need of more comprehensive debates²³23 Brandão ER, Cabral CS. Juventude, gênero e justiça reprodutiva: iniquidades em saúde no planejamento reprodutivo no Sistema Único de Saúde. Cien Saude Colet 2021; 26(7):2673-2682.. Half of the teenagers in Brazil of the low and middle-income classes have unintentional pregnancies. This is because the teenagers in particular have substantial sexual and reproductive healthcare needs that go unattended. Teenagers from 15 to 19 years of age, who wish to avoid pregnancy, have less access to modern contraceptive methods than women at a reproductive age who wish to avoid pregnancy. Teenagers confront barriers to obtain contraceptive care, especially those who do not have partners, due to the fear of exposing that they are sexually active. Married women are forced to confront the social pressure of having children, especially in low and middle-income countries, which see a perspective of life in marriage²⁴24 Sully E, Biddlecom A, Darroch JE, Riley T, Ashford LS, Lince-Deroche N. Somando: Adding It Up: Investing in Sexual and Reproductive Health 2019. Nova York: Instituto Guttmacher; 2020..

In African nations, recurring teenage pregnancies are associated with the onset of sexual activity and with early marriages among teenage girl²⁵25 Chirwa-Kambole E, Svanemyr J, Sandøy I, Hangoma P, Zulu JM. Acceptability of youth clubs focusing on comprehensive sexual and reproductive health education in rural Zambian schools: a case of Central Province. BMC Health Serv Res 2020; 20(1):42.

26 Glynn JR, Sunny BS, De Stavola B, Dube A, Chihana M, Price AJ, Crampin AC. Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi. PLoS One 2018; 13(5):e0196041.^-2727 Mehra D, Sarkar A, Sreenath P, Behera J, Mehra S. Effectiveness of a community based intervention to delay early marriage, early pregnancy and improve school retention among adolescents in India. BMC Public Health 2018; 18(1):732.. The factors associated with a quick repetition of pregnancy among women are those who are currently married or living together with their partners, who generally live in poorer rural regions, and who are in the early years of their marriage²⁸28 Burke HM, Santo LD, Bernholc A, Akol A, Chen M. Correlates of Rapid Repeat Pregnancy Entre Adolescentes e Mulheres Jovens em Uganda. Int Perspect Sex Reprod Health 2018; 44(1):11-18., which can be explained by the unequal access to family planning among married and poorer teenagers²⁹29 Mutua MK, Wado YD, Malata M, Kabiru CW, Akwara E, Melesse DY, Fall NA, Coll CVN, Faye C, Barros AJD. Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa. Reprod Health 2021; 18(Supl. 1):116..

Due to the specific characteristics of teenagers, health policies for this population are necessary but are currently insufficient³⁰30 Sawyer SM, Azzopardi OS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health 2018; 2(3):223-228.. The lack of attraction to primary health care among the teenagers can lead to an unintentional pregnancy, inadequate pre-natal care, and, consequently, negative outcomes in the first gestation, mainly explained by late access to health services and preconception care²³23 Brandão ER, Cabral CS. Juventude, gênero e justiça reprodutiva: iniquidades em saúde no planejamento reprodutivo no Sistema Único de Saúde. Cien Saude Colet 2021; 26(7):2673-2682.^,3131 Abebe AM, Fitie GW, Jember DA, Reda MM, Wake GE. Teenage Pregnancy and Its Adverse Obstetric and Perinatal Outcomes at Lemlem Karl Hospital, Tigray, Ethiopia, 2018. Biomed Res Int 2020; 2020:3124847..

Teenage mothers present a greater chance of gestational hypertension³²32 Costa COM, Gama SGN, Amaral MTR, Almeida AHV. Factors associated with Specific Hypertensive Gestation Syndrome (SHGS) in postpartum adolescent and young adult mothers in the Northeast of Brazil: a multiple analysis of hierarchical models. Rev Bras Saude Materno Infant 2017; 17(4):673-681., in addition to preeclampsia and eclampsia³³33 Leppälahti S, Gissler M, Mentula M, Heikinheimo O. Is teenage pregnancy an obstetric risk in a welfare society? A population-based study in Finland, from 2006 to 2011. BMJ Open 2013; 3(8):e003225., while their newborns face a greater risk of low birth weight, premature birth, and severe neonatal conditions²⁰20 World Health Organization (WHO). Adolescent pregnancy. Fact sheet. Geneva: WHO; 2020..

Primiparous teenagers present a complex context, marked by profound changes, primarily by physical changes, worries about their image, greater responsibility, and distancing from friends³⁴34 Zanettini A, Urio A, Souza JB, Geremia DS. As Vivências da Maternidade e a Concepção da Interação Mãe-Bebê: Interfaces Entre as Mães Primíparas Adultas e Adolescentes. Rev Pesqui Cuid Fundam 2020; 11(3):655-663., which can contribute to negative maternal and neonatal outcomes, such as those identified in this study. In Indonesia, one study with more than 80,000 women, in which teenage women were compared with adult women, and primiparous with multiparous women, found that the teenage and primiparous women are more likely not to perceive the signs of the dangers of pregnancy³⁵35 Wulandari RD, Laksono AD. Determinants of knowledge of pregnancy danger signs in Indonesia. PLoS One 2020; 15(5):e0232550.. In practice, the primiparous teenagers tend to wait longer to search for health services and stay away from pertinent care, thereby increasing the risk of gestational complications³⁶36 Rossetto MS, Schermann LB, Béria JU. Maternidade na adolescência: in dicadores emocionais negativos e fatores associados em mães de 14 a 16 anos em Porto Alegre, RS, Brasil. Cien Saude Colet 2014; 19(10):4235-4246..

One study in Thailand, conducted only with primiparous women, found a greater chance of gestational hypertension among young teenagers (≤15 years) (OR=1.90; 95%CI=1.02-3.54), which in older teenagers (16-19 years) (OR=1.29; 95%CI=1.03-1.62) when compared to adults³⁷37 La-Orpipat T, Suwanrath C. Pregnancy outcomes of adolescent primigravida and risk of pregnancy-induced hypertension: a hospital-based study in Southern Thailand. J Obstet Gynaecol 2019; 39(7):934-940.. In addition, the earlier the pregnancy, the greater the chance of the women contracting chronic hypertension, that is, there is a significant and robust association between early gestation and the subsequent state of hypertension, hence the need to postpone the first pregnancy³⁸38 Datta BK, Husain MJ, Kostova D. Hypertension in women: the role of adolescent childbearing. BMC Public Health 2021; 21:1481..

IUGR is an incapacity of the fetus to reach its genetic potential in body mass. The etiologies are diverse, including placental insufficiency, maternal malnutrition and smoking, genetic disorders, drugs, and obesity³⁹39 Sá RAM, Oliveira CA, Peixoto-Filho FM, Lopes LM. Predição e prevenção do crescimento intrauterino restrito. FEMINA 2009; 37(9):511-514.. Such as alteration occurs in approximately 9% of the newborns, with a greater prevalence in children of teenagers and primiparous women (p<0.05)⁴⁰40 Kale PL, Lordelo CVM, Fonseca SC, Silva KS, Lobato JCP, Costa AJL, Cavalcanti MLT. Adequação do peso ao nascer para idade gestacional de acordo com a curva INTERGROWTH-21 st e fatores associados ao pequeno para idade gestacional. Cad Saude Colet 2018; 26(4):391-399..

The nutritional state of the teenagers is one of the factors that contributes to the development of IUGR. Malnutrition among young mothers (aged ≤16 years, primiparous and menarche ≤12 years) proved to be associated with negative neonatal outcomes, such as low birth weight and extremely low birth weight⁴¹41 Gibbs CM, Wendt A, Peters S, Hogue CJ. The Impact of Early Age at First Childbirth on Maternal and Infant Health. Paediatr Perinat Epidemiol 2012; 26(Supl. 1):259-284.. The low pre-gestational weight and the low weight gain during pregnancy, which is more common among teenagers, are associated with higher rates of fetal growth restriction⁴²42 Mayer C, Joseph KS. Fetal growth: a review of terms, concepts and issues relevant to obstetrics. Ultrasound Obstet Gynecol 2013; 41:136-145..

In the Southern regions of India, women with a BMI below their weight (OR=1.7; 95%CI=1.3-2.1) and anemic (OR=1.29; 95%CI=1.01-1.6) presented a greater chance of having smaller newborns than normal for the gestational age⁴³43 Sebastian T, Yadav B, Jeyaseelan L, Vijayaselvi R, Jose R. Small for gestational age births among South Indian women: temporal trend and risk factors from 1996 to 2010. BMC Pregnancy Childbirth 2015; 15:7.. Likewise, one study, conducted with 542 postpartum teenagers in a public maternity hospital in Rio de Janeiro, concluded that the teenagers with an adequate pre-gestational weight presented better neonatal outcomes, such as birth weight ≥2500 g (p=0.018)⁴⁴44 Santos MMAS, Baião MR, Barros DC, Pinto AA, Pedrosa PLM, Saunders C. Estado nutricional pré-gestacional, ganho de peso materno, condições da assistência pré-natal e desfechos perinatais adversos entre puérperas adolescentes. Rev Bras Epidemiol 2012; 15(1):143-154..

There is still a scarcity of studies related to the recurrence of teenage pregnancy, which are often sensitive to socioeconomic and demographic characteristics. The present study is important, as it uses data from “Nascer no Brasil”, the first national study with obstetric and perinatal data, including postpartum teenagers, which presented nearly 20% of the national sample, considering births in public, private, and mixed hospitals.

This study does, however, present limitations, such as the elapsed time since the data were collected (10 years), which most likely implies a scenario that is different than the current reality, given that, in recent years, we have witnessed economic, political, and social crises, which most likely increase the strength of the association between more vulnerable adults and the recurrence of pregnancy during adolescence. Not having data from the last birth for multiparous women, not including births in small hospitals and home births, not asking about the use of contraceptive methods, and asking about the intention to become pregnant shortly after the birth may have caused a bias in the collected information, which also show the limitations of this study.

This study exposed the fact that the recurrence of pregnancy during adolescence increases with the maternal age, and tends to be much more prevalent among those aged 17-19 years, who education was inadequate for their age, in those who did not plan their pregnancy, in those who reside in the state’s capital city, and in those who have a partner who is the head of the family. These characteristics show how a new pregnancy during adolescence is related to the lack of family planning and the spread of poverty throughout the country.

In addition, one positive aspect of the present study was the research conducted on the clinical repercussions associated with the recurrence of teenage pregnancies, with hypertension and IUGR related to primiparity and not to the recurrence of teenage pregnancies, even when controlling the confounding factors.

Although teenage pregnancy is a social problem, and its recurrence is an even more complex issue, when analyzing the negative maternal and perinatal outcomes, primiparous women are the most affected. This occurs due to the higher age of the recurring pregnancy group, since it is well-known that after 16 years of age, the gestational complications are drastically reduced. Nevertheless, this does not exclude the incentive to postpone a teenage pregnancy and its non-recurrence. Therefore, as a health service, when a pregnancy cannot be avoided, we should provide greater care to the primiparous women.

In this light, it is necessary to implement effective health education programs that involve schools, families, and health services, in an attempt to defer teenage pregnancies, as well as strengthen family planning, especially among poorer teenagers and those without partners. Moreover, for primiparous teenagers, establishing a connection between health professionals and the teenager and offering pregnancy support groups are necessary measures to recognize risk factors for gestational complications, as well as a way to create effective support networks.

References

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