Repeated adolescent pregnancy in Brazil from 2015 to 2019

SUMMARY OBJECTIVE: The aim of this study was to assess the rate of repeated pregnancy in adolescence and its association with early marriage and education level. METHODS: This is a cross-sectional study conducted by searching the Live Births Data System. The study included all adolescents in the age group 10-19 years with live births from 2015 to 2019 (n=2,405,248), divided into three groups: G1: primiparas; G2: with 1 previous pregnancy; and G3: with two or more previous pregnancies. RESULTS: Total repeated pregnancies remained stable, along the years. In the age group 10-14 years, the decrease in the period was from 5.0 to 4.7%, whereas in the age group 15-19 years, it was from 27.8 to 27.3%. Being married or in a stable union increases by 96% the chance of repeated pregnancy in the age group 10-14 years (p<0.001; OR=1.96; 95% confidence interval [CI] 1.85-2.09). In the age group 15-19 years, the chance of repeated pregnancy among the married or in stable union increased 40% (p<0.001; OR=1.40; 95%CI 1.39-1.41)). Girls aged 10-14 years with an education level of<8 years had a 64% higher chance of repeated pregnancy (p<0.001; OR=1.64; 95%CI 1.53-1.75), and among those aged 15-19 years, there was a 137% higher chance of repeated pregnancy (p<0.001; OR=2.37; 95%CI 2.35-2.38). CONCLUSION: Repeated pregnancy in adolescence in Brazil remains very high over the years. There is an association between low education level and early marriage with repeated pregnancies in adolescence.

Adolescent pregnancy trends in the last decade

SUMMARY INTRODUCTION Teenage pregnancy is a universal phenomenon, with higher prevalence in developing countries. Although there has been a reduction in Brasil since the year 2000, the age-specific fertility rate for this age group remains high. OBJECTIVE To evaluate the frequency of adolescence pregnancy in in Brasil from 2006 to 2015 and its association with the Human Development Index (HDI). METHODS A descriptive epidemiological study, conducted by searching the database of the Department of Informatics of the Unified Health System (DATASUS), using information from the Information System on Live Births (SINASC) for the five Brazilian regions. RESULTS There was a reduction in the percentage of live births (LB) from adolescent mothers (10 to 19 years old) in Brasil by 13.0% over the last ten years. This decline was observed in all Brazilian regions among mothers aged 15 to 19 years. The number of LB increased by 5.0% among mothers aged 10 to 14 years in the North and decreased in the other regions, with higher rates in the South (18.0%). The specific fertility rate for the 15-19-year-old group decreased from 70.9/1,000 to 61.8/1,000 in the period. The proportion of LB is inversely associated with the HDI, except in the Northeast (the lowest HDI in the country), where there was a significant reduction (18.0%) among mothers aged 15-19 and 2% among those aged 10-14 years. CONCLUSION Teenage pregnancy in Brasil is in slow decline, especially among mothers aged 10-14 years and is inversely associated with the HDI, except in the Northeast.

RESUMO INTRODUÇÃO A gravidez na adolescência é fenômeno universal, com maior prevalência nos países em desenvolvimento. Embora venha apresentando redução desde 2000 no Brasil, a taxa de fecundidade específica para essa faixa etária permanece elevada. OBJETIVO Avaliar a frequência da gravidez na adolescência no Brasil, no período de 2006 a 2015, e a associação com o Índice de Desenvolvimento Humano (IDH). MÉTODO Estudo epidemiológico, descritivo, realizado por busca no banco de dados no Departamento de Informática do Sistema Único de Saúde (Datasus), utilizando informações do Sistema de Informação sobre Nascidos Vivos (Sinasc) sobre as cinco regiões brasileiras. RESULTADOS Ocorreu queda do percentual de nascidos vivos (NV) de mães adolescentes (10 a 19 anos) no Brasil de 13,5% nos últimos dez anos. Essa redução foi notada em todas as regiões brasileiras, entre mães de 15 e 19 anos. O número de NV aumentou 5,0% entre aquelas de 10 a 14 anos na Região Norte e foi reduzido nas demais regiões, sendo maior no Sul (18,0%). A taxa de fecundidade específica de 15-19 anos diminiu de 70,9/1.000 para 61,8/1.000 no período. A proporção de NV se associa inversamente ao IDH, exceto no Nordeste, onde ocorreu importante redução (18,0%) entre as mães de 15-19 anos e de 2% entre 10-14 anos. CONCLUSÃO A gravidez na adolescência no Brasil encontra-se em lento declínio, especialmente entre 10-14 anos, e está inversamente associada ao IDH, exceto no Nordeste.

Câncer de mama na gravidez e quimioterapia: revisão sistemática / Breast cancer during pregnancy and chemotherapy: a systematic review

O objetivo do estudo é estabelecer a segurança do uso da quimioterapia na gestante portadora de câncer de mama e verificar as possíveis intercorrências no feto. Para identificação de publicações foi realizada pesquisa bibliográfica nas bases de dados: MEDLINE/PubMed, LILACS, SciELO, Cochrane, Uptodate e Google acadêmico. A busca totalizou 86 artigos publicados de 2001 a 2012, que foram avaliados por dois revisores obedecendo aos critérios de exclusão e inclusão pré-estabelecidos, sendo selecionados 39 artigos para a elaboração deste estudo. Todos os quimioterápicos utilizados no tratamento do câncer de mama na gravidez pertencem à categoria D, consistindo no uso de 5-fluorouracil (F), doxorrubicina (A) ou epirrubicina (E) e ciclofosfamida (C) ou na combinação de doxorrubicina e ciclofosfamida (AC), método seguro quando utilizado após o primeiro trimestre da gestação. Poucos estudos avaliaram o uso de taxanos (T) como docetaxel (D) e paclitaxel (P), não sendo demonstrado aumento da ocorrência de malformações fetais e outras complicações maternas quando utilizados no segundo e terceiro trimestres da gestação. O uso do trastuzumabe em gestantes encontra-se associado à oligodramnia e adramnia, não sendo recomendado na gravidez. Em função da quase totalidade dos estudos serem observacionais e retrospectivos, torna-se necessário a confecção de novos estudos prospectivos sobre o tema.

This study aimed to establish the safety of chemotherapy use in pregnant women with breast cancer, and to find possible effects in the fetus. A search of MEDLINE/PubMed, LILACS, SciELO, Cochrane, UpToDate, and Google Scholar databases was performed to identify publications, 86 articles published from 2001 to 2012 were retrieved and evaluated by two readers in accordance predetermined exclusion and inclusion criteria; 39 articles were selected. All the chemotherapy drugs used to treat breast cancer during pregnancy belonged to class D, and consisted of 5-fluorouracil (F), doxorubicin (A) or epirubicin (E) and cyclophosphamide (C), or the combination doxorubicin and cyclophosphamide (AC), a safe regimen when used after the first trimester of pregnancy. Few studies evaluated the use of taxanes (T), such as docetaxel (D) and paclitaxel (P), with no increase in the occurrence of fetal defects and other maternal complications when used in the second and third trimesters of pregnancy. The use of trastuzumab in pregnant women is associated with oligohydramnios and anhydramnios; thus, it is not recommended during pregnancy. As almost all studies were observational and retrospective, new prospective studies on the subject are needed.