Teses e Dissertações

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Embora as taxas de fecundidade na adolescência estejam diminuindo, a maternidade na adolescência mantém sua visibilidade como fenômeno social que necessita especial atenção de gestores públicos e pesquisadores. Muitos estudos sugerem que ser mãe na adolescência tem efeitos deletérios para a saúde da própria mãe e para seu filho nos primeiros anos de vida. Outros autores apontam para efeitos adversos a longo prazo, porém, a literatura neste sentido é limitada, particularmente em países de renda media e baixa. As coortes de nascimentos de Pelotas de 1982, 1993 e 2004 ofereceram uma valiosa oportunidade para estudar as consequências a curto e longo prazo da maternidade na adolescência sobre diferentes desfechos relacionados à saúde, comportamento, educação e emprego dos filhos. A hipótese de que a maternidade na adolescência confere um maior risco de mortalidade nos períodos fetal, perinatal, neonatal, pós-neonatal e infantil foi testada nas três coortes. Adicionalmente, foram analisadas consequências a longo prazo, incluindo comportamentos relacionados à saúde, atividade sexual, escolaridade e emprego em adolescentes e adultos jovens. Nossos resultados apontaram para uma maior probabilidade de morte no período pós-neonatal entre filhos de mães adolescentes após ajuste para fatores de confusão. No entanto, este efeito desapareceu após controle para variáveis relacionadas aos cuidados durante a gravidez (ganho de peso e visitas pré-natais). Além disso, filhos de mães adolescentes apresentaram maior probabilidade de iniciar relações sexuais antes dos 16 anos, de serem pais na adolescência e de formarem suas próprias famílias mais precocemente. Em geral, tanto nos resultados das coortes de Pelotas quanto em uma revisão sistemática da literatura, identificou-se que características socioeconômicas e familiares pré-gestacionais explicaram a maior parte dos efeitos adversos observados nos filhos. Portanto, os programas para a prevenção da maternidade na adolescência devem visar à modificação das circunstâncias que envolvem as mães adolescentes, como a baixa escolaridade e a pobreza, pois estas continuam sendo as preditoras de maior importância das condições de desvantagens de seus filhos em relação à saúde e características socioeconômicas.

Artigo 1- Restrepo-Méndez MC, Barros AJ, Santos IS, Menezes AM, Matijasevich A, Barros FC, Victora CG. Childbearing during adolescence and offspring mortality: findings from three population-based cohorts in southern Brazil. BMC Public Health. 2011;11:781. PDF

Abstract

Background: The role of young maternal age as a determinant of adverse child health outcomes is controversial, with existing studies providing conflicting results. This work assessed the association between adolescent childbearing and early offspring mortality in three birth cohort studies from the city of Pelotas in Southern Brazil.
Methods: All hospital births from 1982 (6,011), 1993 (5,304), and 2004 (4,287) were identified and these infants were followed up. Deaths were monitored through vital registration, visits to hospitals and cemeteries. The analyses were restricted to women younger than 30 years who delivered singletons (72%, 70% and 67% of the original cohorts, respectively). Maternal age was categorized into three groups (<16, 16-19, and 20-29 years). Further analyses compared mothers aged 12-19 and 20-29 years. The outcome variables included fetal, perinatal, neonatal, postneonatal and infant mortality. Crude and adjusted odds ratios (ORs) were estimated with logistic regression models.
Results: There were no interactions between maternal age and cohort year. After adjustment for confounding, pooled ORs for mothers aged 12-19 years were 0.6 (95% CI = 0.4; 1.0) for fetal death, 0.9 (0.6; 1.3) for perinatal death, 1.0 (0.7; 1.6) for early neonatal death, 1.6 (0.7; 3.4) for late neonatal death, 1.8 (1.1; 2.9) for postneonatal death, and 1.6 (1.2; 2.1) for infant death, when compared to mothers aged 20-29 years. Further adjustment for mediating variables led to the disappearance of the excess of postneonatal mortality. The number of mothers younger than 16 years was not sufficient for most analyses.
Conclusion: The slightly increased odds of postneonatal mortality among children of adolescent mothers suggest that social and environmental factors may be more important than maternal biologic immaturity.

Key-words: pregnancy in adolescence; infant mortality; neonatal mortality; perinatal mortality; fetal mortality; cohort studies.


Artigo 2 - Behavioral and socioeconomic outcomes among young adults born to adolescent mothers: a prospective birth cohort study

Purpose: To assess whether being born to an adolescent mother is associated with behavioral, educational and employment outcomes among young adults.
Methods: Individuals from the 1982 Pelotas birth cohort were interviewed in 2004-5 (N=4,297; follow-up rate of 77.3%). Maternal age was categorized into <20 and 20-34 years. The outcomes included early sexual initiation; parenthood before age 20; common mental disorders and variables related to family formation, educational achievement, and employment. Confounding variables included family income, maternal and paternal education, maternal skin colour and marital status. Crude and adjusted estimates were calculated with Poisson, Cox and linear regression models.
Results: In the unadjusted analyses, being born to an adolescent mother was associated with poorer performance in several offspring outcomes. After adjustment for confounders, young adults born to adolescent had greater risk of an earlier sexual initiation (HR=1.3; 95%CI=1.1 to 1.4), of earlier parenthood (HR=1.3; 95%CI=1.3 to 1.5) and were more likely to live with a partner (PR=1.2; 95%CI=1.1 to 1.3). There was no evidence for associations of adolescent childbearing with the other offspring outcomes, except for income, which showed an interaction with sex. Mean log income was higher in male offspring born to adolescent mothers (β= 0.10; 95% CI=0.01 to 0.20), but there was no association among females.
Conclusion: When adequate adjustment is made for socioeconomic position and other indicators of social circumstances much of the effect of young maternal age disappears. However, individuals born to adolescent mothers were at greater risk of earlier sexual initiation and parenthood.

Key words: Pregnancy in adolescence, socioeconomic factors, educational status, health behavior, family characteristics


Artigo 3-Teenage childbearing and offspring educational and employment outcomes: a systematic review.

We reviewed the most frequently reported consequences of teenage childbearing, including child development, educational achievement and employment status of adolescents and adults. Differences in maternal age definition, inadequate adjustment for confounding factors, and different analytical approaches largely account for the conflicting results among studies. Unadjusted analyses consistently showed worse indicators among children born to teen mothers. Adjustment for socioeconomic variables markedly reduced these associations. Overall, there was no evidence of a detrimental effect of teen pregnancy on child development. Studies of educational and employment outcomes in adolescents and adults showed mixed results, either lack of association or poorer outcomes among subjects born to teen mothers. Pre-pregnancy socioeconomic conditions were by far stronger predictors of educational and employment outcomes than maternal childbearing age.

Key-words: adolescent pregnancy, socioeconomic factors, educational status, employment, intelligence tests