Keywords
adolescence - pregnancy - vulnerability - contraception
Palavras-chave
adolescência - gravidez - vulnerabilidade - contracepção
Introduction
Adolescent pregnancy is a global health problem and can be associated with high rates
of maternal death and adverse newborn outcomes. The World Health Organization (WHO)
defines adolescents as those between the ages of 10 and 19 years old.[1] In the United States, it is estimated that 35% of adolescents will have a second
pregnancy in less than 2 years, and most of those are unintended.[2]
Teenagers tend to postpone the beginning of prenatal care and need careful attention
to detect common conditions in this age group, such as use of alcohol, drugs and smoking,
besides the higher risk of sexually transmitted infections.[3] For these young girls, pregnancy means a higher risk during prenatal care and childbirth,
as they are at higher risk of preeclampsia and other hypertensive disorders, like
anemia, inadequate nutrition, sexually transmitted diseases, low birth weight, fetal
growth restriction and prematurity.[4] Therefore, the infant mortality rate is higher among children born from adolescent
mothers compared with those born from young adult women, aged from 20 to 24 years
old.[5]
Adolescent pregnancy constitutes a social problem, as there are social factors involving
and determining pregnancy at a young age and the consequences related to childbirth
at this age. Childbearing during this period feeds a cycle of deprivation that can
compromise young mothers and their children's lives, leading to social disadvantage,
with higher rates of unemployment, poverty and discrimination. Up to 40% of adolescent
mothers feel depressive and stigmatized by the pregnancy; furthermore, low self-esteem
is very common among them.[4]
There are several risk factors that can be associated with teenage pregnancy.[3]
[6] Apparently, socioeconomic characteristics are the major risk factor, although some
may argue that socioeconomic status is more related to a prognostic evaluation of
those women. Some studies have not been able to identify factors that are related
to incidence of a second pregnancy during adolescent stage. Therefore, there is no
evidence of predictors for a higher risk of repeat pregnancy under age of 20.[5] Some studies have shown obstetric outcomes as an independent determining factor
in the incidence of adolescent repeated pregnancies, observing longer inter-pregnancy
intervals among women who experienced prenatal and/or childbirth complications.[7] However, it has been also observed the opposite, as many women with history of poor
outcomes during their first pregnancy tend to have a rapid repeat pregnancy, with
a less than 12 months between deliveries interval.[8]
It appears that, to reduce adolescent pregnancy rates in developed and developing
countries, actions should be focused on a multifaceted and interdisciplinary management
that address not only the risk factors and risk-behavior, but also aims for social
and cultural factors that influence young people's decision making.[9] It means that contraception promotion (especially the use of long-acting reversible
contraceptives), and sexual orientation should be considered when counseling adolescents,[10] but those alone may not be enough to decrease adolescent pregnancy rates. A single
component action could not be the solution.
This study aimed to evaluate social, obstetric and psychological risk factors related
with repeat pregnancy among adolescents in comparison to those of adolescents after
their first delivery and adult women with more than one delivery.
Methods
This case control study was conducted at Centro de Atenção à Saúde Integral da Mulher
(Caism, in the Portuguese acronym), at Universidade Estadual de Campinas (UNICAMP)
from August of 2015 to August of 2017.
We considered three groups: a case-group of adolescents (≤ 19 years) who had given
birth for the second time, that is, as a result of repeat adolescent pregnancy, hereby
referred to as repeat pregnancy teenagers, (RPTeens), and two control groups; the
first one composed of teenagers who had given birth for the first time (1stPTeens), and the control-group of adult women with repeat pregnancy (adults). For
each one of these groups, 30 patients were enrolled as in a convenience sampling.
The women were selected through medical records to check age and parity of the potential
participants before the medical interview. The cases and controls that met the inclusion
criteria were invited to participate and sign the informed consent form before being
enrolled. Women with communication difficulties and any other condition that might
lead to misunderstanding the questions were also excluded from the study. Then, a
50-minute interview was conducted, in which the women answered objective questions
on sociodemographics, reproductive and obstetric history, habits and comorbidities
in a data collection form developed specifically for this study. Psychological issues
were assessed using the self-esteem scale of Rosenberg, which rates self-esteem as
high, medium or low,[11]
[12]
[13] (low, medium or high self-esteem were considered when the punctuation amounted to < 20,
20–30 or > 30 points respectively) and the evaluation of the participants' relationships
with their parents and partners, measured by them using a 1 to 10 grading system.
For the questions concerning contraception and intention to get pregnant, the “London
Measure of Unplanned Pregnancy” questionnaire, tested and validated by Barrett et
al (2004),[1] was applied.[4] The questionnaires were filled out with no participant identification. Data were
collected during the hospitalization of women 1 to 3 days postpartum in an inpatient
unit for mothers and their infants, where a multidisciplinary team operates that prioritizes
good mother-child interaction, stimulates breastfeeding and guides care for the newborn.
After data were collected, we compared the groups of adolescents using the Mann-Whitney
test for numerical variables, and the Fisher exact test and Chi-squared test were
used for categorical variables. For a univariate and multivariate analysis of the
RPTeens, we compared this group to the primiparous adolescents using logistic regression,
with stepwise selection of variables for the multivariate analysis. The same was done
in the comparison with the adult women. The odds ratio was calculated, considering
a confidence interval (CI) of 95%.
The Institutional Review Board from the University of Campinas, Brazil, CAAE report
00602612.7.1001.5404, approved this study. All the Strengthening the Reporting of
Observational Studies in Epidemiology (STROBE) statement items for a prospective study
were followed and checked in this manuscript.[15]
Results
We collected information of ∼ 90 women, distributed equally between the 3 groups.
The median age among 1stPTeens and RPTeens was 16.8 and 18 years, respectively (p = 0.003). Among the adults, the median age was 26.5 years.
[Table 1] shows the obstetric and sociodemographic characteristics among the participants.
Mostly, there were no significant differences between the groups for social characteristics,
except for educational achievements and drugs use. Repeat pregnancy during adolescence
was associated with lower schooling (36.7% vs 70% of both adults and 1stPTeens; p = 0.007 and p = 0.019, respectively), higher drop-out rates (80% vs 33.3%) in comparison with 1stPTeens (p < 0.001) and with adults (p = 0.003). The case group (RPTeens) was more often related to drugs use (43.3% vs
13.3%) in comparison with 1stPTeens (p = 0.010) and adults (p < 0.001).
Table 1
Comparison between obstetric and sociodemographic characteristics among 1st pregnancy
teenagers, repeated pregnancy teenagers and adults (n = 90)
|
Variables
|
1stPTeens n (%)
|
1stPTeens vs RPTeens
p-value
|
RPTeens n (%)
|
RPTeens vs Adults
p-value
|
Adults
n (%)
|
|
Skin color (white)
|
17 (56.7)
|
0.197[***]
|
12 (40.0)
|
0.071[***]
|
19 (63.3)
|
|
Partner (yes)
|
20 (66,7)
|
0.067[***]
|
26 (86.7)
|
1.000[***]
|
26 (86.7)
|
|
No actual schooling
|
10 (33.3)
|
< 0.001[**]
|
24 (80.0)
|
0.003[**]
|
12 (40.0)
|
|
High school or college
|
21 (70.0)
|
0.019[**]
|
11 (36.7)
|
0.007[**]
|
16 (70.0)
|
|
Family income ≥ 3 MW
|
13 (43.3)
|
0.598[***]
|
11 (36.7)
|
0.039[***]
|
19 (63.3)
|
|
Paid work
|
14 (46.7)
|
0.510[**]
|
10 (33.3)
|
0.011[**]
|
19 (63.3)
|
|
Smoking
|
4 (13.3)
|
1.000[**]
|
5 (16.7)
|
0.519[**]
|
7 (23.3)
|
|
Alcohol
|
8 (26.7)
|
0.347[***]
|
5 (16.7)
|
0.707[***]
|
3 (10.0)
|
|
Drugs use
|
4 (13.3)
|
0.010[***]
|
13 (43.3)
|
< 0.001[***]
|
0 (0.00)
|
|
Menarche < 12 years
|
7 (23.3)
|
0.390[***]
|
10 (33.3)
|
0.787[***]
|
11 (36.7)
|
|
First sexual intercourse < 15yrs
|
18 (60.0)
|
0.273[**]
|
22 (73.3)
|
< 0.001[***]
|
7 (23.3)
|
|
First delivery < 15 years
|
3 (10.0)
|
0.166[***]
|
7 (23.3)
|
0.011[***]
|
0 (0.00)
|
|
Prenatal care < 6 visits
|
1 (3.70)
|
0.054[*]
|
7 (23.3)
|
0.146[*]
|
2 (6.67)
|
|
Vaginal delivery
|
20 (66.7)
|
1.000[***]
|
20 (66.7)
|
0.787[***]
|
19 (63.3)
|
|
Birth weight < 2,500kg
|
5 (16.1)
|
1.000[**]
|
5 (16.1)
|
0.275[**]
|
2 (6.67)
|
|
Preterm birth (< 37 weeks)
|
4 (13.3)
|
1.000[**]
|
5 (16.7)
|
0.707[**]
|
3 (10.0)
|
|
Previous contraception (yes)
|
23 (76.7)
|
1.000[***]
|
(76.7)
|
0.317[***]
|
26 (86.7)
|
Abbreviations: 1stPTeens, group of teenagers at first pregnancy (n = 30); Adults, group of adult women with more than one pregnancy (n = 30); MW, Brazilian minimum wage; RPTeens, group of non-primiparous teenagers (n = 30).
*
p-value according to Mann-Whitney test.
**
p-value according to Fisher exact test.
***
p-value according to Chi-squared test.
Comparing RPTeens with adults, it was also noted that the case group showed lower
frequency of paid work (33.3% vs 63.3% of adults; p = 0.039) and lower age of first sexual intercourse, showing sexual activity under
the age of 15 more frequently (43.3% vs 13.3% of adults; p < 0.001).
Some differences among the groups were confirmed when we made a univariate analysis,
which showed that RPTeens presented higher risks for drugs use when compared with
1stPTeens (OR 4.97[1.39–17.8]), lower educational level (OR 4.03 [1.37–11.8]) and more
school interruption (OR 8.16 [2.36–28.2]). The case group (RPTeens) also seemed to
have a higher number of people living in the same home (median of 4.77 vs 3.53; OR
1.39 [1.01–1.90]). These results are shown in [Table 2].
Table 2
Factors associated with repeat adolescent pregnancy comparing 1st pregnancy teenagers
to repeated pregnancy teenagers and adults (Univariate logistic regression = 90)
|
Variables
|
Categories
|
1stPTeens n (%)
|
1stPTeens vs RPTeens
OR (95%CI)
|
RPTeens
n (%)
|
RPTeens vs Adults
OR (95%CI)
|
Adults
n (%)
|
|
Age
|
Continuous variable (md ± sd)
|
16.8 ± 1.58
|
1.90 (1.22–2.95)
|
18.0 ± 1.10
|
———-
|
26.5 ± 3.88
|
|
Schooling
|
High school/college
|
—
|
1.00
|
—
|
1.00
|
—
|
|
Less than high school/college
|
9 (30.0)
|
4.03 (1.37–11.8)
|
19 (63.3)
|
4.03 (1.37–11.8)
|
9 (30.0)
|
|
Actual schooling
|
Out of school
|
17 (56.7)
|
1.00
|
5 (16.7)
|
1.00
|
18 (60.0)
|
|
At school
|
3 (10.0)
|
1.13 (0.10–13.4)
|
1 (3.33)
|
10.09 (0.36–284.5)
|
0 (0.00)
|
|
Interrupted school
|
10 (33.3)
|
8.16 (2.36–28.2)
|
24 (80.0)
|
7.20 (2.15–24.1)
|
12 (40.0)
|
|
Onset of labor
|
Spontaneous
Induced
Elective
C-section
|
23 (76.7)
7 (23.3)
0 (00.0)
|
1.00
1.21 (0.36–4.06)
10.8 (1.01–214.1)
|
19 (63.3)
7 (23.3)
4 (13.3)
|
1.00
0.64 (0.20–1.99)
9.00 (0.45–178.7)
|
19 (63.3)
11 (36.7)
0 (0.00)
|
|
N of people at home
|
Continuous variable (md ± sd)
|
3.53 ± 1.70
|
1.39 (1.01–1.90)
|
4.77 ± 2.43
|
1.23 (0.89–1.70)
|
4.13 ± 0.94
|
|
Drugs use
|
No
|
26 (86.7)
|
1.00
|
17 (56.7)
|
1.00
|
30 (100)
|
|
Yes
|
4 (13.3)
|
4.97 (1.39–17.8)
|
13 (43.3)
|
47.0 (2.63–840.9)
|
0 (0.00)
|
|
Family monthly income
|
≥ 3 salaries
|
13 (43.3)
|
1.00
|
11 (36.7)
|
1.00
|
19 (63.3)
|
|
< 3 salaries
|
17 (56.7)
|
1.32 (0.47–3.72)
|
19 (63.3)
|
2.98 (1.04–8.53)
|
11 (36.7)
|
|
First sexual intercourse
|
≥15 years
|
12 (40.0)
|
1.00
|
8 (26.7)
|
1.00
|
23 (76.7)
|
|
<15 years
|
18 (60.0)
|
1.83 (0.62–5.45)
|
22 (73.3)
|
9.04 (2.80–29.1)
|
7 (23.3)
|
|
First birth
|
≥15 years
|
27 (90.0)
|
1.00
|
23 (76.7)
|
1.00
|
30 (100)
|
|
<15 years
|
3 (10.0)
|
2.74 (0.63–11.8)
|
7 (23.3)
|
19.5 (1.06–358.4)
|
0 (0.00)
|
|
Postpartum contraception after second birth
|
Oral
|
NE
|
NE
|
8 (34.8)
|
1.00
|
19 (73.1)
|
|
Injectable
|
15 (65.2)
|
7.13 (1.93–26.3)
|
5 (19.2)
|
|
Others
|
0 (0,00)
|
0.46 (0.02–10.6)
|
2 (7.70)
|
|
No use
|
7 (23.3)
|
4.16 (0.95–18.3)
|
4 (13.3)
|
Abbreviations: 1stPTeens, group of teenagers at first pregnancy (n = 30); Adults, group of adult women with more than one pregnancy (n = 30); md, median; NA, not applicable; NE, Not evaluated; OR, odds ratio for repeated
pregnancy; RPTeens, group of non-primiparous teenagers (n = 30); sd, standard deviation.
When we compared the case group with adult women, RPTeens referred lower family income
(OR 2.98 [1.04–8.53]). They are more prone to use drugs (OR 47.0 [2.63–840.9]) and
had the first sexual intercourse at a younger age, before 15 years old (OR 9.04 [2.80–29.1]).
Adolescents in the case group also presented higher risk for lower educational level
(OR 4.03 [1.37–11.8]), school abandon (OR 7.20 [2.15–24.1]) and first delivery before
the age of 15 (OR 19.5[1.06–358.4]) ([Table 2]).
The multivariate analysis showed that between 1stPTeens and RPTeens, schooling remained as a significantly factor associated with repeat
pregnancy (OR 16.3 [3.61–73.6]). In comparison with adults, we found a statistically
significant difference for 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]) as
characteristics associated with repeat pregnancy ([Table 3]).
Table 3
Factors associated with repeat adolescent pregnancy comparing (Multivariate logistic
regression = 90). 1st pregnancy teenagers to repeated pregnancy teenagers and adults
|
Variables
|
Categories
|
1stPTeens n (%)
|
1stPTeens vs RPTeens
OR (95%CI)
|
RPTeens
n (%)
|
RPTeens vs Adults
OR (95%CI)
|
Adults
n (%)
|
|
Age
|
Continuous variable (md ± sd)
|
16.8 ± 1.58
|
2.34 (1.39–3.94)
|
18.0 ± 1.10
|
|
|
|
Actual schooling
|
Out of school
|
17 (56.7)
|
1.00
|
5 (16.7)
|
|
|
|
At school
|
3 (10.0)
|
2.70 (0.14–52.8)
|
1 (3.33)
|
|
Interrupted school
|
10 (33.3)
|
16.3 (3.61–73.6)
|
24 (80.0)
|
|
Skin color
|
White
|
|
|
12 (40.0)
|
1.00
|
63.3
|
|
Non-white
|
|
|
18 (60.0)
|
6.20 (1.15–41.0)
|
36.7
|
|
Drugs use
|
No
|
|
|
17 (56.7)
|
1.00
|
30 (100)
|
|
Yes
|
|
|
13 (43.3)
|
17.5 (2.62–116.6)
|
0(0.00)
|
|
First sexual intercourse
|
≥15 years
|
|
|
8 (26.7)
|
1.00
|
23 (76.7)
|
|
<15 years
|
|
|
22 (73.3)
|
18.0 (2.82–115.0)
|
7 (23.3)
|
Abbreviations: 1stPTeens, group of teenagers at first pregnancy (n = 30); Adults, group of adult women with more than one pregnancy (n = 30); Criterion, stepwise selection of variables; md, median; OR, odds ratio for
repeated pregnancy; RPTeens, group of non-primiparous teenagers (n = 30); sd, standard deviation; 95%CI, 95% confidence interval.
The evaluation of psychological factors using the self-esteem scale of Rosenberg and
the “London Measure of Unplanned Pregnancy” questionnaire showed that RPTeens presented
lower self-esteem scores than 1stPTeens and Adults (median of 26.8 ± 4.75 vs 31.1 ± 3.12; p < 0.001 and 30.9 ± 3.17; p < 0.001 respectively). The RPTeens presented significantly more “medium” self-esteem
when compared with 1stPTeens, who had significantly more “high” self-esteem results (80% of RPTeens vs 47.6%
of 1stPTeens with self-esteem scores of 20–30 and 16% vs 52.4%, respectively, for scores
higher than 30) ([Table 4]). When we compared RPTeens pregnancy with adults, it was noted that family acceptance
of pregnancy was significantly lower among younger women (median score of 9.37 ± 1.33
vs 9.83 ± 0.65; p = 0.027). For family relationships, women in the three groups referred relationship
with their mothers better than with their fathers and partners however the difference
was not significant (data not shown).
Table 4
Comparison between 1st pregnancy teenagers, repeated pregnancy teenagers and adults
regarding self-esteem scores, intention to become pregnant and contraception before
actual pregnancy
|
Variables
|
Categories
|
1stPTeens n (%)[a]
|
1stPTeens vs RPTeens
(p-value)
|
RPTeens
n (%)[b]
|
RPTeens vs Adults
(p-value)
|
Adults
n (%)[c]
|
|
Self-esteem (md ± sd)
|
< 20
20–30
> 30
|
0 (0.00)
10 (47.6)
11 (52.4)
|
0.018
[**]
|
1 (4.00)
20 (80.0)
4 (16.0)
|
0.053[**]
|
0 (0.00)
12 (54.5)
10 (45.4)
|
|
Intent to be pregnant
|
Intended
Unintended
|
7 (25.0)
21 (75.0)
|
0.086[***]
|
14 (46.7)
16 (53.3)
|
0.118[***]
|
20 (66.7)
10 (33.3)
|
|
Contraception before pregnancy
|
No use
Irregular use
Ideal use
|
4 (17.4)
19 (82.6)
0 (0.00)
|
< 0.001
[**]
|
15 (51.7)
12 (41.4)
2 (6.90)
|
0.002
[**]
|
7 (26.9)
19 (73.1)
0 (0.00)
|
Abbreviations: 1stPTeens, group of teenagers at first pregnancy (n = 30); Adults, group of adult women with more than one pregnancy (n = 30). md, median; RPTeens, group of non-primiparous teenagers (n = 30); sd, standard deviation.
**
p-value according to Fisher exact test.
***
p-value according to Chi-squared test.
a Missing data from 9 women for self-esteem score, 2 women for answer about intention
to become pregnant and 7 women for answer about contraception use before pregnancy.
b Missing data from 5 women for self-esteem score and 1 woman for answer about contraception
use before pregnancy.
c Missing data from 8 women for self-esteem score and 4 women for answer about contraception
use before pregnancy.
Most of participants in the three groups referred to have used contraceptive methods
at some point in their lives, with no significant difference among them. Comparing
Adults and RPTeens, the last ones referred use of injectable methods more often (65.2%
vs 19.2%; OR 7.13 [1.93–26.3]), but there was no significant difference about other
types of contraceptive methods. In contrast, when asked about the use of contraceptives
right before getting pregnant, most 1stPTeens and Adults women referred irregular use (82.6% and 73.1%, respectively, vs
27.6% of RPTeens). The RPTeens referred no use of any contraception more frequently
than the control groups (51.7% vs 17.3% of 1stPTeens and 26.9% of adults). When asked about their intention to become pregnant,
primiparous adolescents were more likely to refer unintended pregnancy when compared
with the other groups (75% of primiparous adolescents vs 53.3% of non-primiparous
adolescents and 33.3% of adult women) ([Table 4]).
Between adult women and RPTeens, there were also no difference concerning obstetrical
issues, such as quality of prenatal care, mode of delivery, maternal pathological
conditions or neonatal outcomes, including Apgar scores and birth weight. Additionally,
there was no significant difference about tobacco or alcohol use either.
Discussion
Our study shows some factors associated with repeat pregnancy in adolescents, such
as early sexual debut (before 15 years), first delivery before 15 years of age and
drugs use. Additionally, having a second delivery significantly increases the risk
of educational interruption in comparison with adolescents who had only one delivery.
These results are in concordance with the literature. Many studies confirm the age
of first sexual intercourse, whether consented or not, as a risk factor for repeat
adolescent pregnancy, as well as for rapid repeat pregnancy (new pregnancy in less
than 2 years after the first delivery).[16] In our study, this was more evident when we compared non-primiparous adolescents
with adult women, as 73.3% of adolescents referred first sexual intercourse before
the age of 15, whereas only 23.3% of adults related early sexual debut (OR 9.04; CI
2.80–29.1). The difference in sexual behavior between these groups may be due to an
easier exposition to sexual contents alongside with lack of parental counseling and
guidance.
Usually, rates in girls under 15 years are unstable because these data routinely collected
from statistics from around the world. In our study, few participants had given birth
before 15 years, but most had sexual debut before the age of 15 and ∼ 26% of them
had sexual relations before 13 years.
Socioeconomic factors, such as low education and low family income, are not so clearly
defined as a cause or consequence of early pregnancy. There is evidence that adolescent
mothers have lower educational achievements, perhaps because they have never had access
to schools, or because they are more likely to interrupt school before or during pregnancy
or even after delivery, besides, many may never get the chance to return to it. Investments
in health and behavioral education, such as effective interventions to prevent the
first and repeated adolescent pregnancies, when combined with community and family
participation reinforce the importance of contraceptive counseling for avoiding early
pregnancies, thus allowing these women to have the education and economic benefits
that schools could offer.[2]
[17]
In this study, modifiable factors, such as school interruption and poor education,
were associated with repeat adolescent pregnancy. This shows the need for care practitioners
to undertake efforts to stimulate these girls by explaining the possible consequences
of school evasion for them and their babies, while also reinforcing the opportunities
they could have by taking control of the decision-making process in their lives.
Adolescent mothers are submitted to several difficulties during transition to motherhood.
Their adaptations to this new reality get easier when they have a strong family nucleus
that is able to provide the support needed. According to our results, although not
significantly different, women tended to have better relationship with their mothers
than with their fathers or sexual partners. Other studies[18]
[19] found an association between strong family support and fewer rates of teen pregnancies,
showing that good communication between adolescent girls and their parents (especially
their mothers) discouraged early pregnancy and improved the teenage mothers' psychological
adjustment.
Self-esteem is a psychological construction defined as an interpretation of self-concept.
It comprehends feelings and thoughts about positive and negative values that a woman
attributes to herself. Our results showed that adolescents who have repeat unintended
pregnancy tend to present lower self-esteem scores more often than their peers. This
finding is concordant with a study that appoints low self-esteem as an independent
risk for ineffective use of contraceptives and therefore a risk for unwanted pregnancy.[20]
In addition, RPTeens had significantly more drugs use than adults or teens at first
pregnancy. About 35% of adolescents smoke during pregnancy and tend to resume smoking
habits during the peripartum period, and they are also often more likely to present
alcohol and substance abuse.[3]
Despite the high efficacy of long-action reversible contraceptives (LARC), many adolescents
chose less effective forms or no postpartum contraception at all. Some studies point
that teenagers have the lowest LARC usage rates, ∼ 4%, compared with any others age
group.[8] In our study, most participants had used contraceptive method at least once in life.
However, 65% of non-primiparous adolescents referred to be receiving injectable contraceptives
before getting pregnant for the second time, mostly with irregular use. As for LARC
usage rate, it was more frequent amongst adult women but still much less often than
oral contraceptives (3.8% vs 73%). This should be considered when counseling postpartum
contraception, as the literature brings evidence of the safety and effectiveness of
LARC insertion in postpartum visit, with lower unintended repeat pregnancy rates (18–20%)
and longer interval between pregnancies.[9]
This study had limitations because of the short sample, and the fact that some participants
did not answer the self-esteem questionnaires fully, which made it difficult to evaluate
the psychological impacts related to adolescent pregnancy. The retrospective nature
of the questionnaire may lead to inaccuracy of information, especially about previous
use of contraceptives. Another limitation was due to the scenario in which the interviewing
took place, as many girls were with their partners or family members and this may
have influenced their answers concerning psychological issues and family relationship.
This study evaluated psychological factors among teenagers with two or more births
in comparison to primiparous adolescents and adults. Our findings value the importance
of modifiable risk factors, significantly associated with unintended repeat pregnancy
among adolescents. According to this, it is possible to assume repeat pregnancy in
adolescents is a changeable reality alongside all economic, educational and psychological
benefits of its prevention.
Conclusion
An association was established between repeat pregnancy during adolescence and lower
education, as these adolescents are more likely to interrupt school and present educational
underachievement. Additionally, teenagers with repeat pregnancy are more often likely
to present history of drugs use and to initiate early sexual activity (before 15 years).
According to this, adolescent repeat pregnancy is more often unintended, probably
due to absent or ineffective use of contraceptives. Moreover, these girls tend to
present lower self-esteem in comparison with first-time adolescent mothers and adult
women.
