Adverse perinatal outcomes of pregnancies among adolescents vs women of advanced age in the Brazilian public health system

Veiga, Larissa de Lima Pessoa; Tenório, Micaely Cristina dos Santos; Ferreira, Raphaela Costa; Tenório, Marilene Brandão; Vasconcelos, Sandra Mary Lima; Bueno, Nassib Bezerra; Oliveira, Alane Cabral Menezes de

doi:10.1590/1806-93042019000300007

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 19 (3) • Jul-Sep 2019 • https://doi.org/10.1590/1806-93042019000300007 copy

Adverse perinatal outcomes of pregnancies among adolescents vs women of advanced age in the Brazilian public health system

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to compare the adverse perinatal outcomes in pregnancies of adolescents and elderly women of public health network.

Methods:

a cross-sectional study carried out with pregnant women at the extremes of reproductive age according to the classification of the Brazilian Ministry of Health (adolescents those aged ≤19 years and those who were older than 35 years) and their newborns. Socioeconomic data (income, schooling, occupation and marital status), as well as clinical (diseases), anthropometric (maternal BMI) and perinatal (gender, weight, length, Apgar and gestational age) data were collected, and Poisson regression in hierarchical model was performed, with the results in Ratio of Prevalence (PR) and its respective Confidence Interval at 95% (95% CI).

Results:

when comparing adolescent and elderly women, 38.7% vs 54.6% (PR=0.71, CI=0.54-0.94, p=0.002) were observed, respectively, cesarean deliveries; 37.8% vs 25.2% (PR=0.83, CI=0.58-1.19, p=0.332) preterm births; 16.6% vs 20.5% (RP=1.07, CI=0.78-1.46, p=0.666) births of small infants for gestational age (SGA); 18.0% vs 15.3% (RP=1.01, CI=0.69-1.47, p=0.948) births of large-for-gestational-age newborns (LGA); 32.2% vs 34.7% (RP=1.08, CI=0.82-1.42, p=0.578), low birth weight infants and 28.5% vs 42.9% (RP=1.18, CI=0.91-1.54, p=0.201) with high birth length.

Conclusions:

When compared with adolescent women, pregnant women of advanced age presented a higher frequency of cesarean deliveries.

Key words
Maternal age; Pregnancy complications; Pregnant women

Variables	Teenagers (N= 217)		Advanced age (N= 99)		PR set (CI95%)	P ^* * Poisson regression in hierarchical model, as p<0.05 as significant. Intermediate level adjusted by variables= schooling, occupation, stable union and number of prenatal consultations and proximal level adjusted by variables= schooling, occupation, stable union, number of prenatal consultations, preexisting diseases, high blood pressure and low weight and overweight gestational BMI.
Variables	n	%	n	%	PR set (CI95%)
Distal level
Socioeconomic data
Family income
≤1 minimum wage	142	71.8	62	64.0	0.83 (0.57-1.20)	0.334
>1 minimum wage	56	28.2	35	36.0	1.00
No information	19		2
Schooling
≤4 years of study	25	11.5	25	25.8	1.51 (1.10-2.07)	0.010
>4 years of study	192	88.4	72	74.2	1.00
No information	-		2
Occupation
Outside the home	11	5.0	31	31.3	2.15 (1.62-2.85)	<0.001
From home	205	95.0	68	68.7	1.00
No information	1		-
Stable union
Yes	163	75.1	95	96.0	3.58 (1.70-7.50)	0.001
No	54	24.9	4	4.0	1.00
Intermediate level
Prenatal Data
Prenatal start time
1^st quarter	152	71.7	73	74.4	1.10 (0.75-1.61)	0.613
2^nd and 3^rd quarter	60	28.3	25	25.6	1.00
No information	5		1
Number of prenatal consultations
<6 queries	150	72.1	95	98.0	0.05 (0.00-0.34)	0.002
≥6 queries	58	27.9	2	2.0	1.00
No information	9		2
Proximal level
Clinical data
Presence of disease
Yes	22	10.1	26	26.2	1.55 (1.11-2.15)	0.010
No	194	89.9	73	73.8	1.00
No information	1		-
High blood pressure levels
Yes	37	17.1	29	29.2	0.96 (0.71-1.30)	0.809
No	179	82.9	70	70.7	1.00
No information	1		-
Maternal anemia
Yes	50	42.8	16	29.0	0.30 (0.21-0.44)	0.898
No	67	57.2	39	71.0
No information	100		44
Anthropometric data
Gestational BMI
Low weight	78	37.3	4	4.0	0.22 (0.08-0.57)	0.002
Eutrophy	51	24.5	13	13.3	1.00
Overweight	80	38.2	81	82.7	1.17 (0.88-1.55)	0.265
No information	8		1
Gestational weight gain
Insufficient	70	39.1	24	25,5	1.22 (0.75-1.98)	0.422
Suitable	60	33.6	40	42.5	1.00
Excessive	49	27.3	30	32.0	1.11 (0.78-1.56)	0.548
No information	38		5

Variables	Teenagers (N= 217)		Advanced age (N= 99)		PR set (CI95%)	P ^* * Poisson regression, variables adjusted for maternal variables of schooling, occupation, stable union, number of prenatal consultations, pre-existing diseases and low-weight gestational BMI.
Variables	n	%	n	%	PR set (CI95%)
Sex of the NB
Female	110	50.7	56	56.6	1.09 (0.84-1.43)	0.495
Male	107	49.3	43	43.4	1.00
Way of delivery
Caesarean	83	38.7	54	54.6	0.71 (0.54-0.94)	0.002
Vaginal	132	61.3	45	45.4	1.00
No information	2		-
Gestational Age
Pre-term	82	37.8	25	25.2	0.83 (0.58-1.19)	0.332
A term	135	62.2	73	73.8	1.00
Post-term	0	0.0	1	1.0	3,64 (1.29-10.27)	0.014
Birth weight (INTERGROWTH-21^st)
SGA	35	16.6	20	20.5	1.07 (0.78-1.46)	0.666
SUGA	138	65.4	63	64.2	1.00
LGA	38	18.0	15	15.3	1.01 (0.69-1.47)	0.948
No information	6		1
Birth weight (WHO)
Low weight	68	32.2	34	34.7	1.08 (0.82-1.42)	0.578
Suitable	140	66.3	63	64.3	1.00
Macrossomia	3	1.5	1	1.0	0.70 (0.26-1.89)	0.483
No information	6		1
Length at birth
Low	20	11.3	1	1.0	0.25 (0.40-1.64)	0.151
Suitable	106	60.2	55	56.1	1.00
High	50	28.5	42	42.9	1.18 (0.91-1.54)	0.201
Apgar 1º minute
≤6	9	7.0	6	6.1	1.18 (0.67-2.08)	0.563
>7	121	93.0	91	93.9	1.00
Apgar 5º minute
≤ 6	2	1.6	0	0.0	1.06 (0.93-1.21)	0.359
>7	129	98.4	97	100.0	1.00

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[1] Authors contribution

Veiga LLP and Tenório MCS - data collection and the writing of the article. Ferreira RC and Tenório MB - contributed to the writing of the article. Vasconcelos SML - critical review and writing of the article. Bueno NB - statistical analysis and critical review. Oliveira ACM - study design and the writing of the article. All authors approved the final version of the manuscript.