Influencia de los factores socioculturales en la morbilidad y/o mortalidad materna y perinatal de adolescentes atendidas en tres estados de la República Mexicana / Effect of sociocultural factors on maternal and perinatal morbidity with or without mortality among adolescents seen in 3 states of the Mexican Republic

ABSTRACT

This study was aimed on comparing the degree of association between social-cultural factors and maternal or perinatal morbidity and/or mortality of the adolescent. A paired case-control study was designed with adolescent in puerperal immediate stage affiliated to the Mexican Institute of Social Security from Tabasco, Tlaxcala and Northern Veracruz, that were adjusted to the selection criteria of the sample, between June of 1998 and February of 1999. Two groups were integrated, cases, with adolescent in puerperal immediate stage affected (with maternal or perinatal morbidity and/or mortality) and controls, with adolescent not affected in puerperal immediate stage. Information concerned to biological and social-cultural risk factors from each subject was obtained applying a validated survey (EFRASEMA 1) and checking their clinical file, whose information was poured in a database (EFRASEMA 2). Interviewers did not know the outcome of the study, which in turn assured the blindness of the information. Once data was obtained, subjects were assigned to each group of study. Matching factors were age, nutritional status, intergenesic interval and previous pregnancy systemic pathology. Proportion of subjects, cases and controls; with or without social-cultural risk factors was determined. The risk of maternal or perinatal morbidity and/or mortality in the exposed subjects was estimated by odds ratio (OR) and the differences inferred through Mantel and Haenszel chi 2 and Fisher's exact tests (confidence intervals alpha = 0.05 and beta = 0.2). There was a sample of 486 subject, 44 were eliminated due to insufficient data. Studied population was integrated finally with 221 cases and 221 paired controls 1 1. 71.950 of participants were married, 22.62 in free union, 4.98 single and 0.45 separate, average global age was 17.98 +/- 1.39 years. The inferential analysis showed an OR 0.64 (Cornfield 95 confidence limits 0.40 < OR < 1.03, p = 0.0510600) concerning desired pregnancy in favor to controls. Appropriate reproductive information had an OR = 0.34 (Cornfield 95 confidence limits 0.21 < OR < 0.54 p = 0.0000014). Ideal cumulated fertility offered an OR 0.62 (Cornfield 95 confidence limits 0.39 < OR < 0.98, p = 0.0298500). These results show an association between the social-cultural factors and the presence of maternal or perinatal morbidity and/or mortality in the studied adolescents. Desired pregnancy, appropriate reproductive information and ideal cumu