Hazards of Repeat Pregnancy during Adolescence: A Case-control Study

Abstract

Objective To evaluate the social, obstetric and psychological risk factors related to repeat pregnancy in teenagers.

Methods A case control study conducted at Centro de Atenção à Saúde Integral da Mulher (Caism, in the Portuguese acronym), in Campinas, Brazil, from 2015 to 2017. Three groups were selected: a case-group of adolescents who had repeat pregnancy and two control-groups, one consisting of adolescents who had delivered at first time and another one of adult women with more than one deliveries. Participants were asked about habits, socio-demographics characteristics, reproductive and obstetric history and assessed psychological issues.

Results Ninety women were enrolled, 30 in each study group. Adolescents with repeat pregnancy have lower self-esteem scores and more ineffective contraceptive use. When compared with teens at first delivery, they had less schooling level (odds ratio [OR] 4.03 [1.37–11.8]), more school abandon (OR 8.16 [2.36–28.2]) and drugs use (OR 4.97[1.39–17.8]). Non-white skin color (OR 6.2 [1.15–41.0]), drugs use (OR 17.5 [2.62–116.6]) and first sexual intercourse under 15y (OR 18.0[2.82–115.0]) were found as higher risk factors for repeat pregnancy when comparing adolescents and adults. Moreover, adolescents with more than one gestation had lower self-esteem and greater susceptibility to unplanned pregnancy.

Conclusion There was an association between repeat pregnancy among adolescents and lower education, early onset of sexual activity, non-white skin color, low use of contraception and increased use of drugs.

Resumo

Objetivo Avaliar a associação entre fatores de risco sociais, obstétricos e psicológicos relacionados a repetição da gravidez em adolescentes.

Métodos Estudo caso-controle realizado num Hospital Universitário de Campinas, Brasil, de 2015 a 2017. Foram selecionados três grupos: um grupo-caso de adolescentes com repetição de gravidez, e dois grupos controles, um de adolescentes primíparas e outro de mulheres adultas com mais de um parto. Foram coletados dados referentes a aspectos sociodemográficos, história reprodutiva e obstétrica e fatores psicológicos.

Resultados Foram incluídas 90 mulheres, 30 em cada grupo de estudo. Adolescentes com repetição de gravidez apresentaram menor autoestima e mais uso inadequado de contraceptivos. Quando comparadas a adolescentes primíparas, tiveram menor nível escolar (razão de probabilidades [RP] 4.03 [1.37–11.8]), maior interrupção dos estudos (RP 16.3 [3.61–73.6]) e maior uso de drogas (RP 4.97[1.39–17.8]). A comparação entre adolescentes com repetição de gestação e mulheres adultas revelou maior risco para cor da pele não-branca (RP 6.2 [1.15–41.0]), uso de drogas (RP 17.5 [2.62–116.6]) e primeira relação sexual com menos de 15 anos 15y (RP 18.0 [2.82–115.0]). Além disso, as adolescentes com segunda gravidez apresentam menor autoestima, baixo uso de contracepção e maior suscetibilidade a gravidez não planejada.

Conclusão Houve associação entre repetição de gravidez na adolescência e menor tempo de estudo, início precoce de atividade sexual, cor da pele não branca e maior uso de drogas.

Keywords

adolescence - pregnancy - vulnerability - contraception

Palavras-chave

adolescência - gravidez - vulnerabilidade - contracepção

Contributions

Galvão R. B. F., Figueira C. O., Borovac-Pinheiro A., Paulino D. S. M., Faria-Schützer D. B. and Surita F. G. contributed with project and interpretation of data, writing of the article, critical review of the intellectual content and final approval of the version to be published.

• References

• 1 World Health Organization. Adolescence: A Period Needing Special Attention - Age-Not-the-Whole-Story . http://apps.who.int/adolescent/second-decade/section2/page2/age-not-the-whole-story.html . Accessed June 19, 2018
• 2 Hindin MJ, Kalamar AM, Thompson TA, Upadhyay UD. Interventions to prevent unintended and repeat pregnancy among young people in low- and middle-income countries: a systematic review of the published and Gray literature. J Adolesc Health 2016; 59 (3, Suppl) S8-S15 . Doi: 10.1016/j.jadohealth.2016.04.021
• 3 Marino JL, Lewis LN, Bateson D, Hickey M, Skinner SR. Teenage mothers. Aust Fam Physician 2016; 45 (10) 712-717 https://www.racgp.org.au/download/Documents/AFP/2016/October/AFP-OCT-Focus-Skinner-V2.pdf AccessedJanuary302018 [serial online]
• 4 Leftwich HK, Alves MVO. Adolescent Pregnancy. Pediatr Clin North Am 2017; 64 (02) 381-388 . Doi: 10.1016/j.pcl.2016.11.007
• 5 Socolov DG, Iorga M, Carauleanu A. , et al. Pregnancy during adolescence and associated risks: an 8-year Hospital-Based Cohort Study (2007–2014) in Romania, the country with the highest rate of teenage pregnancy in Europe. BioMed Res Int 2017; 2017: 9205016
• 6 Yussif AS, Lassey A, Ganyaglo GY, Kantelhardt EJ, Kielstein H. The long-term effects of adolescent pregnancies in a community in Northern Ghana on subsequent pregnancies and births of the young mothers. Reprod Health 2017; 14 (01) 178 . Doi: 10.1186/s12978-017-0443-x
• 7 Männistö J, Bloigu A, Mentula M, Gissler M, Heikinheimo O, Niinimäki M. Interpregnancy interval after termination of pregnancy and the risks of adverse outcomes in subsequent birth. Obstet Gynecol 2017; 129 (02) 347-354 . Doi: 10.1097/AOG.0000000000001836
• 8 Wilkie GL, Leung K, Kumaraswami T, Barlow E, Moore Simas TA. Effects of obstetric complications on adolescent postpartum contraception and rapid repeat pregnancy. J Pediatr Adolesc Gynecol 2016; 29 (06) 612-616 . Doi: 10.1016/j.jpag.2016.05.002
• 9 Stevens J, Lutz R, Osuagwu N, Rotz D, Goesling B. A randomized trial of motivational interviewing and facilitated contraceptive access to prevent rapid repeat pregnancy among adolescent mothers. Am J Obstet Gynecol 2017; 217 (04) 423.e1-423.e9 . Doi: 10.1016/j.ajog.2017.06.010
• 10 Norton M, Chandra-Mouli V, Lane C. Interventions for preventing unintended, rapid repeat pregnancy among adolescents: a review of the evidence and lessons from high-quality evaluations. Glob Health Sci Pract 2017; 5 (04) 547-570 . Doi: 10.9745/GHSP-D-17-00131
• 11 Terra FdeS, Marziale MHP, Robazzi ML. Evaluation of self-esteem in nursing teachers at public and private universities. Rev Lat Am Enfermagem 2013; 21 (Spec No): 71-78 . Doi: 10.1590/S0104-11692013000700010
• 12 Dini GM, Quaresma MR, Ferreira LM. Translation into portuguese, cultural adaptation and validation of the Rosenberg self-esteem scale. Rev Bras Cir Plást 2004; 19: 41-52
• 13 Instituto Brasileiro Geografia e Estatística. Indicadores Sociodemográficos e de Saúde no Brasil . Rio de Janeiro, RJ: IBGE; 2009. https://ww2.ibge.gov.br/english/estatistica/populacao/indic_sociosaude/2009/indicsaude.pdf . Accessed February 2, 2018
• 14 Barrett G, Smith SC, Wellings K. Conceptualisation, development, and evaluation of a measure of unplanned pregnancy. J Epidemiol Community Health 2004; 58 (05) 426-433 . Doi: 10.1136/jech.2003.014787
• 15 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. ; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370 (9596): 1453-1457 . Doi: 10.1016/S0140-6736(07)61602-X
• 16 Yakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review. Reprod Health 2018; 15 (01) 15 . Doi: 10.1186/s12978-018-0460-4
• 17 Bundy DAP, de Silva N, Horton S, Patton GC, Schultz L, Jamison DT. ; Disease Control Priorities-3 Child and Adolescent Health and Development Authors Group. Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition. Lancet 2018; 391 (10121): 687-699
• 18 Figueiredo B, Tendais I, Dias CC. Maternal adjustment and maternal attitudes in adolescent and adult pregnant women. J Pediatr Adolesc Gynecol 2014; 27 (04) 194-201 . Doi: 10.1016/j.jpag.2013.09.014
• 19 Jenkins M, Roye CF, Frederickson K. No rush to motherhood: the lived experience of African American never pregnant sexually active female teens. J Pediatr Nurs 2017; 32: 41-46 . Doi: 10.1016/j.pedn.2016.10.001
• 20 Nelson DB, Zhao H, Corrado R, Mastrogiannnis DM, Lepore SJ. Preventing unintended pregnancy among young sexually active women: recognizing the role of violence, self-esteem, and depressive symptoms on use of contraception. J Womens Health (Larchmt) 2017; 26 (04) 352-360 . Doi: 10.1089/jwh.2016.5753