Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017

Original Article Imprimir 

Páginas 143 a 149


Adolescence pregnancy: characteristics of mothers and newborn according to the birth information system

Embarazo en la adolescencia: características de las madres y recién nacidos según el sistema de información de nacimientos

Gravidez na adolescência: características das mães e recém-nascido segundo o sistema de informação de nascimentos

Autores: Cintia Leci Rodrigues1; Patricia Garcia dos Santos2

1. MSc in Public Health from the University of São Paulo (USP). São Paulo, SP, Brazil. Assistant Professor at the University of Santo Amaro (UNISA). São Paulo, SP, Brazil
2. Graduated in Nursing from the University of Santo Amaro (UNISA). São Paulo, SP, Brazil

Correspondência:
Cintia Leci Rodrigues
Rua Professor Candido Nogueira da Mota, 409, Interlagos
São Paulo, SP, Brasil. CEP: 04786-035
kikarodrigues@hotmail.com

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How to cite this article

Keywords: Pregnancy, adolescent, infant, newborn, health information systems.
Palabra Clave: Embarazo, adolescente, recién nacido, sistemas de informaciónensalud.
Descritores: Gravidez, adolescente, recém-nascido, sistemas de informação em saúde.

Abstract:
OBJECTIVE: Describe the characteristics of the adolescent mothers and their newborn through the Birth Information System of the São Paulo city during the year 2015.
METHODS: This is a cross-sectional descriptive study based on the Birth Information System.
RESULTS: Based on information collected from the Live Birth Information System (SINASC) of the São Paulo city, during the study period, there were 22,507 births among adolescents with ages between 15 to 19 years old.53,9% had brown skin color, 73,4% lived without a partner, 64,8% had seven or more pre natal consults. The age group
among 15 to 19 years had the most vaginal birth (68,8%), and 88,5% were to term (37 weeks or more).
CONCLUSION: This study evidenced teenage pregnancy and highlights that it is necessary to develop programs of health education that are not only occasional curative and preventive, that not only inform but also form and educate parents and children. I tis important to go beyond the anatomy and physiology of the human reproductive tract, and point to the emotional, social and cultural experiences of the adolescent mothers and their newborns

Resumen:
OBJETIVO: Describirlas características maternas y del recién nacido de madres adolescentes através del Sistema de Información de Nacimientos de la ciudad de São Paulo durante el año 2015.
MÉTODOS: Se trata de un estudio transversal descriptivo con base en el Sistema de Información de Nascidos Vivos (SINASC) de la ciudad de São Paulo, en el periodo de enero a diciembre de 2015.
RESULTADOS: Con base en las informaciones levantadas junto al Sistema de Información de Nacidos Vivos (SINASC) de la ciudad de São Paulo, en el periodo estudiado, ocurrieron 22.507 nacimientos entre adolescentes conedades entre 15 a 19 años. Se observó que el 53,9% eran pardas, 73,4% viven sin compañero, 64,8% de las adolescentes realizaron siete o más consultas de pre-natal, la franja etaria de 15 a 19 años fuela que más concentró partos vaginales (68,8%), y 88,5% fueron de nacimiento al término (37 semanas o más).
CONCLUSIÓN: Este estudio evidencióelembarazoen la adolescencia yse percibió que es necesario desarrollar programas de educación para la salud que no sean apenas ocasionales curativos y preventivos, que no solo informen, sino también formeny eduquen padresehijos. Es importante que aborden, ademásde la anatomía y fisiología del aparato reproductor humano, y abordar las vivencias emocionales, sociales y culturales de las de madres adolescentes y sus recién nacidos.

Resumo:
OBJETIVO: Descrever as características maternas e do recém-nascido de mães adolescentes através do Sistema de Informação de Nascimentos da cidade de São Paulo durante o ano de 2015.
MÉTODOS: Trata-se de um estudo transversal descritivo com base no Sistema de Informação de Nascidos Vivos (SINASC) da cidade de São Paulo, no período de janeiro a dezembro de 2015.
RESULTADOS: Com base nas informações levantadas junto ao Sistema de Informação de Nascidos Vivos (SINASC) da cidade de São Paulo, no período estudado, ocorreram 22.507 nascimentos entre adolescentes com idades entre 15 a 19 anos. Observou-se que 53,9% eram pardas, 73,4% vivem sem companheiro, 64,8% das adolescentes realizaram sete ou mais consultas de pré-natal, a faixa etária de 15 a 19 anos foi a que mais concentrou partos vaginais (68,8%), e 88,5% foram de nascimento à termo (37 semanas ou mais).
CONCLUSÃO: Este estudo evidenciou a gravidez na adolescência e percebeu-se que é necessário desenvolver programas em educação para a saúde que não sejam apenas ocasionais curativos e preventivos, que não só informem, mas também formem e eduquem pais e filhos. É importante que abordem, além da anatomia e fisiologia do aparelho reprodutor humano, e abordar as vivências emocionais, sociais e culturais das de mães adolescentes e seus recém-nascidos.

INTRODUCTION

Today society has undergone several changes regarding social norms, where we have observed breaks in taboos, especially in what refers to sexual freedom. This fact has contributed to the adoption of permissive behaviors, where sex has become banal and with an increasingly early initiation1.

Adolescence is understood as a phase of transition between childhood and adulthood, between the ages of 10 and 19 years. This phase is marked by a series of physical, psychic and biological transformations2.

Around the world, annually 16 million girls between the ages of 15 and 19 become pregnant, where the highest pregnancy rate in this age group is recorded in developing countries3. In Brazil, according to the DATASUS system, only in the year 2014, 562,608 births were registered, of women between 10 and 19 years old4.

Pregnancy in adolescence is considered a serious event, mainly due to the complications that derive from it. Pregnancy itself is described as a normal event in any woman's life, this event involves physical and psychological changes necessary for motherhood5.

Maternity during adolescence interferes in the natural course of development, since it imposes on adolescents innumerable responsibilities and challenges, since pregnancy at this moment in life impacts on family coexistence, socioeconomic level, prenatal complication, among others2.

It is understood that both social and economic factors are directly related to early pregnancy, which in most cases occurs in an unplanned manner, while in others pregnancy is desired. The factors that involve pregnancy in adolescence are innumerable, and may be due to an insecure marital situation, low schooling, maternal history of pregnancy during adolescence, low knowledge about contraceptive methods, non-access to contraceptive methods and health services, search for independence, among others 6 . The adolescent still has to deal with family disapproval in most cases, encouragement for family and companion abortion, lack of partner support, social discrimination, and the risks that teenage pregnancy presents5.

The literature shows that gestation in adolescence presents great maternal, perinatal and neonatal risks, since the biological immaturity may increase the risk of intrauterine growth retardation, perinatal mortality, gestational diabetes, gestational hypertension, preterm labor, prematurity, among other 6 . These risks are often related to low adolescent adherence to the prenatal care network3. Data indicate that there is a higher risk of complications and maternal mortality in adolescents aged 15 to 19 years than in women over 20 years of age, and that under 15 years the risk of complications during pregnancy or childbirth is five times higher7.

According to some authors7,8, maternal and perinatal mortality may be related to pregnancy, childbirth and the puerperium itself, where the most frequent complications are pregnancy toxemia, uterine dysfunction, higher rate of cesarean delivery, hemorrhagic syndromes, perineal lacerations, abortion, among others.

Based on the above, the present study aims to describe the maternal and newborn characteristics of adolescent mothers through the Information System for Live Births (SISNAC) in the city of São Paulo during the year 2015.


METHOD

This is a descriptive cross-sectional study based on the Live Birth Information System (SINASC)9 in the city of São Paulo, from January to December 2015. Maternal characteristics were: adolescent mothers (10 to 19 years old) , age, race/color, type of delivery, schooling, marital status (living with partner or without partner), number of prenatal consultations, beginning of prenatal care. They were surveyed as characteristics of the newborn: Apgar scale between 1 and 5 minutes, birth weight, gestational age, congenital anomaly.

This research exempts approval from the Ethics and Research Committee of the University of Santo Amaro, since it is a survey of public domain database, according to the Resolution of the National Health Council (CNS-466/12).


RESULTS

Based on the information gathered at SINASC in the city of São Paulo, during the study period, there were 22,507 births of newborns of adolescent mothers. The southern region represents 29.1% of the births of adolescent mothers in the city of São Paulo.

As shown in table 1, mothers under the age of 15 accounted for 3.4% of births, while the 15-19 age group had 96.6% of births. Regarding the race/color of the parturient, 53.91% are brown adolescents. Regarding the characteristics of type of delivery, it can be observed that in the age group under 15 years, the highest frequency was vaginal deliveries (2.6%), followed by cesarean delivery (0.8%). However, in the age group of 15 to 19 years, vaginal delivery had an occurrence of (68.8%) cases, while cesarean delivery obtained (27.8%) of the cases.




Data regarding schooling were also collected from SISNAC in the city of São Paulo during the year 2015, and 0.4% had schooling less than 3 years of schooling, 16.8% had 4 to 7 years of schooling, 80.9% from 8 to 11 years of study. Another maternal variable was the conjugal situation of the adolescents, where 73.4% of the adolescents lived without a partner and 26.4% of the adolescents lived with their partners.

As shown in table 2, 64.8% of adolescents performed seven or more prenatal consultations, a number recommended by the Ministry of Health.




Regarding the onset of prenatal care: 34.1% of the adolescents started the second month of gestation and 13.8% started prenatal care with 5 months or more of gestation. In relation to the Apgar 1 minute scale: 0 to 3 (1.9%); 4 to 7 (12.3%), 8 to 10 (85.6%). On the 5th minute Apgar scale: 0 to 3 (0.6%), 4 to 6 (2.2%), 8 to 10 (97.1%).

As to the presence of congenital anomaly of newborns of adolescent mothers, in 1.7% an anomaly was identified. A limitation of the present study, that through SISNAC it is not possible to identify the type of congenital anomaly.

In relation to gestational age, 11.3% of the births of adolescent mothers in the city of São Paulo were premature (less than 37 weeks), 88.5% were birth at term (37 weeks and over).




DISCUSSION

During the study period, there were 22,507 births of adolescent mothers in the city of São Paulo. It is known that recent socio-cultural transformations both at the national and at the world level provide an 'early' beginning of sexual life, and that teenage motherhood is a worrying event, as it transcends clinical aspects; social, economic and cultural factors also interact, causing an impact on maternal and neonatal health status10.

According to the place of residence of the adolescents, 29.1% was in the southern region of the city of São Paulo. The socio-spatial logic of the city of São Paulo is based on a model of clearly polarized and unequal urban occupation. Since the 1970s, the phenomenon of outskirts has intensified in São Paulo, with the incorporation of a large area into the urban sprawl of the metropolis, often due to the occupation of lands by clandestine subdivisions and favelas. According to Borelli11, studies on patterns of socio-spatial segregation in São Paulo found that the high proportion of adolescents in a given region correlates closely with the existence of poverty in this same region, which, in a way, points to a specificity of São Paulo's reality.

Among adolescent mothers, 3.4% were younger than 15 years of age. In recent decades, the onset of sexual intercourse has become increasingly precocious. However, the debate about sexuality within families and schools did not follow the changes, which, to a certain extent, contributed to the increased frequency of pregnancy in adolescence12. In the characterization of the adolescents studied, there was a higher prevalence of gestations among the browns (53.9%). These data may represent a worse life condition for Afro-descendants, according to Teixeira and Taquette13, due to the racial discrimination to which this segment of the population is subjected in Brazilian society, which implies circumstances of vulnerability to gestations and higher maternal mortality13.

A study by Gama et al.14 shows that cesarean section was more strongly associated with the better life conditions of primiparous adolescents, such as adequate schooling level, health plan, and even the white skin color of the puerperium, identifying a color gradient showed that the clearer the skin color, the greater the proportion of the surgical procedure. The high proportion of cesareans, representative of Brazil, reproduces the model of interventional delivery adopted in the most recent decades in the country, but in this study there was a higher proportion of vaginal deliveries14.

Regarding the school trajectory of the adolescents, it is observed in this study that most of the adolescents did not have complete elementary education (less than 9 years of study). After the pregnancy, the adolescent faces new difficulties in the role of mother, not finding in her life context the education as a representation that allows her to break with the cycle of poverty15. Thus, the health professional, especially the nurse, as well as school professionals, should apprehend the representations of adolescents about the manifestations of gestation both physical and psychological. This may contribute to the recognition of the factors that make it difficult to stay in school and to strengthen new representations about education in order to promote social empowerment of adolescent mothers15. Data on the marital situation show that 73.4% were single; this may explain the lack of family planning, leading, therefore, to the increase of possible family breakdowns16.

Regarding the number of prenatal consultations, it was identified that 68.4% of the pregnant women performed seven or more visits. It is known that one of the factors that can hinder the access of the pregnant woman living in the periphery of São Paulo to the health unit is the geographic distance. Sometimes, this difficulty of access is aggravated by the precariousness of public transportation for the population. However, it was observed that more than half of the pregnant women performed the number of consultations recommended by the Ministry of Health. In Brazil, health professionals, who often have in their training a predominantly biomedical, technocratic and mechanistic view of health, promote an adequate health monitoring during pregnancy, which minimizes the adverse effects on the pregnant woman and the newborn, without evaluating the pregnant woman in a holistic, spiritual and emotional perspective10.

As to the month of the beginning of prenatal care, it was evidenced that pregnant women tend to start prenatal care (in the 2nd month). It is known the importance of prenatal follow-up as soon as possible, considering the need to perform exams at the beginning of gestation in order to detect abnormalities that can be treated early, thus avoiding neonatal damages. In addition, the later the prenatal period begins, the more the evolution of this gestational period may be unfavorable. It is important to emphasize that prenatal care is essential for the prevention of neonatal problems10.

Newborns in the study population, for the most part, had Apgar scores of 8 to 10 in both the first and fifth minutes. In the analysis of the literature, there was an intimate relationship between the Apgar indices and respiratory disorders, since this score indicates the state of respiratory depression in the first minutes of life of the newborn17.

Low birth weight (LBW) is an essentially relevant indicator of health among the factors associated with perinatal morbidity and mortality. Prematurity and restricted intrauterine growth (IUGR) are the two factors that, associated or isolated, result in newborn births with this outcome. BPN is considered the single largest risk factor for infant mortality. Studies have shown that adolescent mothers present the highest rates of children with low birth weight and prematurity, however, in the present study a large number of newborns had birth weight (greater than 2500g) and were born to term (37 weeks and over)18.


FINAL CONSIDERATIONS

The results show that in São Paulo/SP, from January to December 2015, the profiles of the adolescent parturient were: brown breed lives without partners and resides in the southern region. Regarding the profile of live births, it can be summarized as follows: almost all deliveries occurred in a hospital environment; with a weight greater than or equal to 2500g and forward.

This study evidenced pregnancy in adolescence and it was realized that it is necessary to develop programs in health education that are not only occasional curative and preventive, programs that not only inform but also form and educate parents and children, that address, in addition to the anatomy and physiology of the human reproductive tract, the emotional, social and cultural experiences of people.


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