Evaluation of the Blood Level of Adiponectin in Pregnant Adolescents.

OBJECTIVE: To evaluate serum levels of adiponectin in pregnant adolescents between 30 and 36 weeks of gestation. METHOD: A prospective cross-sectional study enrolled 67 normal pregnant women between 30 and 36 weeks of gestation and eutrophic (body mass index [BMI]: 18.5-25 kg/m2), of which 36 were adolescents (< 20 years old) and 31 adults (≥ 20 years old). Serum adiponectin levels were determined by enzyme-linked immunosorbent assay (ELISA). The t-student or Mann-Whitney tests were used for intergroup comparison. RESULTS: Pregnant adolescents showed significantly higher serum adiponectin concentrations compared with pregnant adults (p = 0.04). No differences were observed in adiponectin levels in younger pregnant adolescents (< 16 years old) compared with older pregnant adolescents (≥ 16 years old). Adiponectin values were divided into 3 subgroups: < 3,000 ng/mL, between 3,000 and 5,000 ng/mL, and > 5,000 ng/mL. Birthweight was significantly higher in women > 5,000 ng/mL when compared with < 3,000 ng/mL in the adolescent group. No association between pregestational adiponectin levels and BMI, gestational weight gain, and gestational age was observed; however, there was a positive relation with birthweight (p = 0.0239). CONCLUSION: Serum adiponectin values in pregnant adolescents between 30 and 36 weeks of gestation were higher compared with pregnant adults; however, no differences between younger and older pregnant adolescents were observed.

OBJETIVO: Avaliar os níveis séricos de adiponectina em gestantes adolescentes entre 30 e 36 semanas de gestação. MéTODOS: Estudo prospectivo e transversal incluindo 67 gestantes normais entre 30 a 36 semanas e eutróficas (índice de massa corporal [IMC]: 18,5­25 kg/m2), sendo 36 adolescentes (< 20 anos) e 31 adultas (≥ 20 anos). Os níveis séricos de adiponectina foram avaliados por teste imunoenzimático (ELISA, na sigla em inglês). Para a comparação entre os grupos, utilizou-se os testes t-Student ou Mann-Whitney. RESULTADOS: As gestantes adolescentes apresentaram significativamente maiores concentrações séricas de adiponectina do que as adultas (p = 0,04). Não houve diferenças nos níveis de adiponectina quando comparadas as gestantes adolescentes precoces (< 16 anos) às tardias (≥ 16 anos). Os valores de adiponectina foram subdivididos em 3 grupos: < 3.000 ng/mL, entre 3.000 e 5.000 ng/mL e > 5.000 ng/mL. O peso do recém-nascido foi significantemente maior nas mulheres com > 5.000 ng/mL, quando comparadas as com < 3.000 ng/mL no grupo das adolescentes. Não foi observada associação entre os níveis de adiponectina e o IMC pré-gestacional, ganho de peso gestacional e a idade gestacional, porém houve relação positiva com o peso do recém-nascido (p = 0,0239). CONCLUSãO: Os valores séricos de adiponectina em gestantes adolescentes entre 30 e 36 semanas de gestação foram maiores do que os das gestantes adultas; contudo, sem diferenças entre gestantes adolescentes precoces e tardias.

Evaluation of the Blood Level of Adiponectin in Pregnant Adolescents / Avaliação dos níveis séricos de adiponectina em gestantes adolescentes

Abstract Objective To evaluate serum levels of adiponectin in pregnant adolescents between 30 and 36 weeks of gestation. Method: A prospective cross-sectional study enrolled 67 normal pregnant women between 30 and 36 weeks of gestation and eutrophic (body mass index [BMI]: 18.5-25 kg/m2), of which 36 were adolescents (< 20 years old) and 31 adults (≥ 20 years old). Serum adiponectin levels were determined by enzyme-linked immunosorbent assay (ELISA). The t-student or Mann-Whitney tests were used for intergroup comparison. Results Pregnant adolescents showed significantly higher serum adiponectin concentrations comparedwith pregnant adults (p=0.04). No differences were observed in adiponectin levels in younger pregnant adolescents (< 16 years old) compared with older pregnant adolescents (≥ 16 years old). Adiponectin values were divided into 3 subgroups:<3,000 ng/mL, between 3,000 and 5,000 ng/mL, and>5,000 ng/mL. Birthweight was significantly higher in women>5,000 ng/mL when compared with<3,000 ng/mL in the adolescent group. No association between pregestational adiponectin levels and BMI, gestational weight gain, and gestational age was observed; however, there was a positive relation with birthweight (p=0.0239). Conclusion Serum adiponectin values in pregnant adolescents between 30 and 36 weeks of gestation were higher compared with pregnant adults; however, no differences between younger and older pregnant adolescents were observed.

Resumo Objetivo Avaliar os níveis séricos de adiponectina em gestantes adolescentes entre 30 e 36 semanas de gestação. Métodos Estudo prospectivo e transversal incluindo 67 gestantes normais entre 30 a 36 semanas e eutróficas (índice de massa corporal [IMC]: 18,5-25 kg/m2), sendo 36 adolescentes (< 20 anos) e 31 adultas (≥ 20 anos). Os níveis séricos de adiponectina foram avaliados por teste imunoenzimático (ELISA, na sigla em inglês). Para a comparação entre os grupos, utilizou-se os testes t-Student ou Mann-Whitney. Resultados As gestantes adolescentes apresentaram significativamente maiores concentrações séricas de adiponectina do que as adultas (p=0,04). Não houve diferenças nos níveis de adiponectina quando comparadas as gestantes adolescentes precoces (< 16 anos) às tardias (≥ 16 anos). Os valores de adiponectina foram subdivididos em3 grupos:<3.000 ng/mL, entre 3.000 e 5.000 ng/mL e>5.000 ng/mL. O peso do recém-nascido foi significantemente maior nas mulheres com>5.000 ng/mL, quando comparadas as com<3.000 ng/mL no grupo das adolescentes. Não foi observada associação entre os níveis de adiponectina e o IMC pré-gestacional, ganho de peso gestacional e a idade gestacional, porém houve relação positiva com o peso do recém-nascido (p=0,0239). Conclusão Os valores séricos de adiponectina em gestantes adolescentes entre 30 e 36 semanas de gestação foram maiores do que os das gestantes adultas; contudo, sem diferenças entre gestantes adolescentes precoces e tardias.

Teenage pregnancy.

BACKGROUND: Teenage pregnancy rates are falling in many high-resource settings, but for those who do conceive, the socioeconomic and educational disadvantage that ensues is often long lasting and intergenerational. The adverse maternal and neonatal outcomes can be ameliorated through antenatal and postnatal care that attends to the special needs of this group. OBJECTIVE: The aim of this article is to provide an overview of the social, obstetric and medical complications of teenage pregnancy and the role of the general practitioner (GP) in mitigating adverse outcomes. DISCUSSION: Management and prevention of teenage pregnancy requires broad efforts that involve schools, health services and the community. The GP has a key role in providing supportive continuity of care that spans the antenatal and crucial postnatal periods.

Maternal Characteristics and Obstetric and Neonatal Outcomes of Singleton Pregnancies Among Adolescents.

BACKGROUND Adolescent pregnancy remains a global public health issue with serious implications on maternal and child health, particularly in developing countries The aim of this study was to investigate maternal characteristics and obstetric and neonatal outcomes of singleton pregnancies among adolescents. MATERIAL AND METHODS A total of 241 adolescent women who gave birth to singletons between January 2015 and December 2015 at our hospital were included in this descriptive cross-sectional study. Data on maternal sociodemographic and obstetric characteristics as well as neonatal outcome were recorded. RESULTS Primary school education (66.0%), lack of regular antenatal care (69.7%), religious (36.7%) and consanguineous (37.0) marriage, Southeastern Anatolia hometown (34.9%) and Eastern Anatolia hometown (21.2%) were noted in most of the adolescent pregnancies, while 95% were desired pregnancies within marriage. Pregnancy complications were noted in 19.5% (preeclampsia in 5.8%) and cesarean delivery was performed in 44.8% of adolescent pregnancies. Preterm delivery rate was 27.0% (20.3% were in >34 weeks). Overall, 13.3% of neonates were admitted to neonatal intensive care unit (NICU) in the postpartum period (prematurity in 28.1%), while 25.3% were re-admitted to NICU admission in the post-discharge 1-month (hyperbilirubinemia in 55.7%). Adolescent pregnancies were associated considerably high rates of fetal distress at birth (28.7%), preterm delivery (26.9%), and re-admission to NICU after hospital discharge (25.3%). CONCLUSIONS In conclusion, our findings indicate that along with considerably high rates of poor antenatal care, maternal anemia and cesarean delivery, adolescent pregnancies were also associated with high rates for fetal distress at birth, preterm delivery, and NICU re-admission within post-discharge 1-month.

Stereological Analysis of Adolescent Placentas and Anthropometric Characteristics of Newborns.

INTRODUCTION: Knowledge of the size of surfaces available for transport is important for assessing the amount of nutrients that can be transmitted to the fetus for its normal growth and development. AIM: The aim of our study, was to determine the stereological structural parameters of the parenchymal part of placenta, ratio of birth weight and placental weight, and to determine their correlation with the body length and head circumference of the newborns of adolescent pregnant women. METHODS: The study was conducted on a total of 60 human placentas of term pregnancy, divided into two groups according to the age of pregnant women. The experimental group consisted of 30 placenta of pregnant women aged 13-19. The control group consisted of 30 placenta of pregnant women aged 20-35. Computer assisted morphological analysis of images of histological preparations using stereological methods was performed. RESULTS: Surface density of terminal villi of adolescent placentas is significant higher than the control group (t = 14,179, df = 29, p <0,0001). The T-test (t = -5,868, df = 29, p <0,0001) showed statistically significant difference in the surface density of fibrinoid in two compared groups. T-test (t = 6.438, df = 29, p <0.0001) found that total surface of terminal villi was significantly higher in adolescent placentas. The T-test (t = -6,747, df = 29, p <0,0001) found that total surface of fibrinoid was significantly lower in adolescent group. The T-test (t = 4.203, df = 29, p <0.0001) found that the ratio of birth weight of newborn and adolescent placental weight was significantly higher in relation to the control group. CONCLUSION: Adolescent placentas was more efficient in increasing the weight of newborns, compared to the control group placentas.

Ambulatory Blood Pressure Trajectory and Perceived Stress in Relation to Birth Outcomes in Healthy Pregnant Adolescents.

OBJECTIVE: An early decline in resting blood pressure (BP), followed by an upward climb, is well documented and indicative of a healthy pregnancy course. Although BP is considered both an effector of stress and a clinically meaningful measurement in pregnancy, little is known about its trajectory in association with birth outcomes compared with other stress effectors. The current prospective longitudinal study examined BP trajectory and perceived stress in association with birth outcomes (gestational age (GA) at birth and birth weight (BW) percentile corrected for GA) in pregnant adolescents, a group at risk for stress-associated poor birth outcomes. METHODS: Healthy pregnant nulliparous adolescents (n = 139) were followed from early pregnancy through birth. At three time points (13-16, 24-27, and 34-37 gestational weeks ±1 week), the Perceived Stress Scale was collected along with 24-hour ambulatory BP (systolic and diastolic) and electronic diary reporting of posture. GA at birth and BW were abstracted from medical records. RESULTS: After adjustment for posture and pre-pregnancy body mass index, hierarchical mixed-model linear regression showed the expected early decline (B = -0.18, p = .023) and then increase (B = 0.01, p < .001) of diastolic BP approximating a U-shape; however, systolic BP displayed only an increase (B = 0.01, p = .010). In addition, the models indicated a stronger systolic and diastolic BP U-shape for early GA at birth and lower BW percentile and an inverted U-shape for late GA at birth and higher BW percentile. No effects of perceived stress were observed. CONCLUSIONS: These results replicate the pregnancy BP trajectory from previous studies of adults and indicate that the degree to which the trajectory emerges in adolescence may be associated with variation in birth outcomes, with a moderate U-shape indicating the healthiest outcomes.

Adolescent pregnancy and linear growth of infants: a birth cohort study in rural Ethiopia.

BACKGROUND: Evidences indicate that the risk of linear growth faltering is higher among children born from young mothers. Although such findings have been documented in various studies, they mainly originate from cross-sectional data and demographic and health surveys which are not designed to capture the growth trajectories of the same group of children. This study aimed to assess the association between young maternal age and linear growth of infants using data from a birth cohort study in Ethiopia. METHODS: A total of 1423 mother-infant pairs, from a birth cohort study in rural Ethiopia were included in this study. They were followed for five time points, with three months interval until the infants were 12 months old. However, the analysis was based on 1378 subjects with at least one additional follow-up measurement to the baseline. A team of data collectors including nurses collected questionnaire based data and anthropometric measurements from the dyads. We fitted linear mixed-effects model with random intercept and random slope to determine associations of young maternal age and linear growth of infants over the follow-up period after adjusting for potential confounders. RESULTS: Overall, 27.2% of the mothers were adolescents (15-19 years) and the mean ± SD age of the mothers was 20 ± 2 years. Infant Length for Age Z score (LAZ) at birth was negatively associated with maternal age of 15-19 years (ß = - 0.24, P = 0.032). However, young maternal age had no significant association with linear growth of the infants over the follow-up time (P = 0.105). Linear growth of infants was associated positively with improved maternal education and iron-folate intake during pregnancy and negatively with infant illness (P < 0.05). CONCLUSION: Young maternal age had a significant negative association with LAZ score of infants at birth while its association over time was not influential on their linear growth. The fact that wide spread socio economic and environmental inequalities exist among mothers of all ages may have contributed to the non-significant association between young maternal age and linear growth faltering of infants. This leaves an opportunity to develop comprehensive interventions targeting for the infants to attain optimal catch-up growth.

Association between adolescent pregnancy and adverse birth outcomes, a multicenter cross sectional Japanese study.

We aimed to clarify how maternal physical characteristics explains the association between adolescent pregnancy and adverse birth outcomes, focusing on their height. We used a national multicenter-based delivery registry among 30,831 women under age 25 years with a singleton pregnancy between 2005 and 2011. Adolescent pregnancy was defined as younger than 20 years of age, and categorized into "junior adolescent" (aged ≤15 years) and "senior adolescent" (aged 16-19 years). We used multivariate Poisson regression and mediation analysis to assess the extent to which maternal height explained the association between adolescent pregnancy and risk of adverse birth outcomes. Risks for preterm birth [(adjusted risk ratio (aRR) 1.17, 95% confidence interval (95% CI), 1.08-1.27], low birthweight (aRR 1.08, 95% CI, 1.01-1.15), and low Apgar score (aRR 1.41 95%CI, 1.15-1.73) were significantly higher among adolescent women compared to women of 20-24 years of age. The mediation effect of maternal height on these outcomes were moderate for low birthweight (45.5%) and preterm birth (10.5%), and smaller for low Apgar score (6.6%). In all analyses, we did not detect significant differences between junior adolescent and senior adolescent. Adolescent women have higher risk of adverse birth outcomes. This association is partially mediated by shorter maternal height.

Ovarian Function in Adolescents Conceived Using Assisted Reproductive Technologies.

STUDY OBJECTIVE: To compare ovarian function between adolescents conceived using assisted reproductive technology (AcART) and adolescents who were conceived spontaneously (AcSP). DESIGN: Multicenter study of ovarian function in AcART because of male or tubal infertility. SETTING: University Hospital. PARTICIPANTS: We evaluated 22 AcART and 53 AcSP at 1-2 years after menarche. The participants were born at term (≥37 weeks of gestation) with normal birth weights (≥2500 g) from singleton pregnancies. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Differences in ovulation, reproductive hormones, and ovarian morphology. RESULTS: AcART had an older age of menarche than that of AcSP, even after adjusting for maternal age at menarche, gestational age, and birth weight (P = .027). AcART had lower incidence of ovulation (P = .021) and higher luteinizing hormone serum levels (P = .01) than those of AcSP. The incidence of oligomenorrhea and the cycle length were similar between AcART and AcSP. AcART had levels of anti-Müllerian hormone, inhibin B, follicle-stimulating hormone, estradiol, and androgens similar to those of AcSP. The ovarian morphology, ovarian volume, and follicle counts were similar in both groups. CONCLUSION: AcART had later menarche, lower ovulation rates, and higher luteinizing hormone levels than those of AcSP. Future studies should investigate whether these findings are indicative of a risk of ovarian dysfunction later in life for AcART.

Basal metabolic rate in pregnant adolescents.

BACKGROUND & AIMS: In most clinical settings basal metabolic rate (BMR) is estimated by predictive equations (PE) but there is no specific algorithm for pregnant women. To this end, this study aimed to measure BMR (BMRm) in single-fetus primigravida 63 adolescent pregnant women recruited from primary health care units from a tropical municipality in Brazil. Additionally, BMRm was compared with estimated BMR from internationally recommended PE for nonpregnant adolescents. METHODS: BMR was measured by indirect calorimetry early in the morning in the fasting pregnant adolescents in a quiet, noise and luminosity controlled room. Anthropometry was measured by conventional research protocols and pre-pregnancy anthropometry was obtained from a questionnaire. RESULTS: Mean BMRm was 5447.3 (SD, 917.3) kJ/day. The PE provided biased (overestimation of 747.2 ± 774.1 kJ/day representing 15.7 ± 17.6%) and inaccurate (approximately 40% fell within ±10% of BMRm). CONCLUSIONS: It is necessary to develop accurate estimates of BMR and energy requirements during pregnancy especially in adolescents who are still growing but already nurture a new human being.

Executive function in teen and adult women: Association with maternal status and early adversity.

The aim of this study was to determine the impact of maternal age on executive function and the moderating effects of women's maternal status and early-life experiences. Four groups of women were assessed as a function of their age (teens vs. adults) and maternal status (mothers vs. nonmothers). Participants completed executive function tests, including Spatial Working Memory (SWM), Intra-Extra-Dimensional-Set-Shift (IED), and Stockings of Cambridge (SOC). Women also completed the Childhood Trauma Questionnaire to assess their experiences of early adversity. Results showed that for the IED-task, there were main effects of age and maternal status and an interaction between the two; adults performed better than teens, mothers performed better than nonmothers, and teen nonmothers performed the least well of all groups. For the SWM-task, adults performed better than teens. Our results indicate that although age is an important factor for proper executive functioning, different tasks are affected differently and other factors such as maternity and adverse childhood experiences moderate this functioning.

Nutrition for the Next Generation: Older Children and Adolescents.

This paper reviews information on why the nutrition of older children (5-9 years) and adolescents (10-19 years) is important and the consequences that it can have over generations. Developing countries still face a high burden of undernutrition and anemia, while the burden of overweight and obesity is on the rise in both developing and developed countries. There are evidence-based interventions which can improve the nutritional status and these include interventions for a balanced and diverse diet and micronutrient supplementation, especially iron and multiple micronutrient supplementation where there is sufficient evidence to reduce anemia. There is mixed evidence for the effective strategies to prevent and control obesity and a dearth of evidence from developing countries. Adolescent pregnancy also poses greater challenges to the health of mother and child, and advocacy should be rampant to delay the age of marriage and pregnancy. Interventions targeted to improving the nutritional status among "pregnant adolescents" have shown improvement in birth weight and a reduction in low birth weight and preterm delivery. Traditional platforms including school-based and community-based approaches offer a mixed picture of effectiveness, but emerging avenues of mHealth and social media could also be channelized to reach this population. The population of this age group is on the rise globally, and failure to invest in improving the nutrition of older children and adolescents will further increase the number of dependents in coming generations and negatively influence the health of future generations and progress of nations.

Adolescent motherhood in Bangladesh: Trends and determinants.

BACKGROUND: While studies on fertility and contraceptives issues are available, until recently adolescent motherhood has not received enough attention among policy makers in understanding adolescent motherhood in Bangladesh. We aimed to examine the trends and determinants of adolescent motherhood among women aged 15-49 years. METHODS: For trend analysis we used all the 7 waves of Bangladesh Demographic and Health Survey (BDHS, 1993-2014) data but for multivariate analysis 4 waves of BDHS (2004-2014). Two separate analyses were carried out on ever married women aged 15-49: (1) teenage girls aged 15-19 and (2) adult women aged 20 and above. RESULTS: The prevalence of adolescent motherhood had declined to a slower pace from 1993 to2014 (from 33.0% to 30.8%). Lower spousal age gap and higher education were found to be associated with lower likelihood of adolescent motherhood both among teenage girls [OR 0.447 (0.374-0.533)] and adult women [OR 0.451 (0.420-0.484)]. Teenage girls in the poorest wealth quintile [OR 1.712 [1.350-2.173] were more likely to experience adolescent motherhood than the richest wealth quintile. Teenage girls who had no education were found to have 2.76 times higher odds of adolescent motherhood than their counterparts who had higher than secondary education. Concerning the time effect, the odds of adolescent motherhood among adult women was found to decline overtime. CONCLUSIONS: Despite substantial decrease in total fertility rate in Bangladesh adolescent motherhood is still highly prevalent though declining from 1993 to 2014. Social policies including those addressing poverty, ensuring greater emphasis on education for women; and adolescent mothers in rural areas are needed.

Correlates of institutional deliveries among teenage and non-teenage mothers in Nepal.

INTRODUCTION: Globally, maternal age is identified as an important predictor of institutional service utilization during delivery. This study aims to assess the correlates of institutional delivery among teenage and non-teenage mothers in Nepal by using the data from Nepal Demographic and Health Survey 2011. METHODS: The study population consisted of 5391 women of reproductive age (15-49 years) who had given birth to a child within five years before the survey. Out of them, 381 (7.07%) were teenage mothers. The association between the background characteristics and institutional delivery was assessed separately for the teenage and non-teenage mothers using chi-square test and multiple logistic regression analysis. RESULTS: After adjusting for background characteristics, teenage mothers were found more likely to deliver at a health facility [AOR: 2.25; 95% CI: 1.10 4.59] in comparison to the non-teenage mothers. Place of residence, occupation, socioeconomic status, and frequency of ANC visits were associated with institutional delivery in both the teenage and non-teenage mothers. However, educational status, parity, birth preparedness and women autonomy had statistically significant association with institutional delivery among the non-teenage mothers only. None of the background characteristics were significantly associated with institutional delivery in teenage mothers only. CONCLUSIONS: This study identified a significant difference in institutional delivery service utilization among the teenage and non-teenage mothers. While the association of most of the background characteristics with institutional delivery was uniform for both teenage and non-teenage mothers, the association with educational status, parity, birth preparedness and women autonomy was significant only for non-teenage mothers. Considering this difference in the interaction of women's background characteristics with institutional delivery between teenage and non-teenage mothers might help in identifying the pain points and devise targeted interventions to encourage institutional delivery in teenage mothers or non-teenage mothers or both.

Maternal abuse history and reduced fetal heart rate variability: Abuse-related sleep disturbance is a mediator.

The consequences of childhood maltreatment are profound and long lasting. Not only does the victim of abuse suffer as a child, but there is mounting evidence that a history of maltreatment places the next generation at risk for significant psychopathology. Research identifies postnatal factors as affecting this intergenerational transmission of trauma. However, emerging evidence suggests that part of this risk may be transmitted before birth, passed on via abuse-related alterations in the in utero environment that are as yet largely unidentified. To date, no study has directly assessed the influence of pregnant women's abuse history on fetal neurobehavioral development, nor considered trauma-associated poor sleep quality as a mediator reflecting established physiological dysregulation. Using data from 262 pregnant adolescents (ages 14-19), a population at elevated risk for childhood maltreatment, the current study examined maternal emotional abuse history and sleep quality in relation to third-trimester fetal resting heart rate variability, an index of parasympathetic nervous system functioning. The results indicate that maternal emotional abuse history is indirectly associated with lower fetal heart rate variability via abuse-related sleep disturbances. These data demonstrate an association between maternal abuse histories and fetal development, showing that at least part of the intergenerational transmission of risk occurs during pregnancy.

Factores de riesgo relacionados con el Trabajo de Parto Prematuro en adolescentes embarazadas: revisión integradora de la literatura / Fatores de risco relacionados ao Trabalho de Parto Prematuro em adolescentes grávidas: revisão integrativa da literatura / Risk factors related to premature labor in pregnant adolescents: an integrative literature review

Introducción: El parto prematuro (TPP) es una de las principales complicaciones del embarazo y causa importante de morbilidad y mortalidad neonatal. El diagnóstico es complejo y las causas pueden ser varias. La literatura sugiere que el embarazo adolescente es un factor de riesgo y puede considerarse de manera aislada o en asociación con otros. Objetivo: Analizar la evidencia disponible en la literatura sobre TPP relacionado con factores de riesgo de embarazo y adolescentes. Material y Método: Revisión Integradora con consulta en bases de datos: LILACS; MEDLINE, SciELO y PUBMED. Búsqueda en agosto de 2015, con los criterios de inclusión: artículos publicados en Portugués, Inglés y Español, de 2009 a 2014 y estudios con datos primarios. Encontrados 511 artículos de los cuales fueron excluidos: 339 estudios por haber sido publicados fuera del periodo; 155 por no cumplir con los objetivos y 6, después de leer el texto en su totalidad. De esta forma, la muestra final estuvo formada por 11 artículos. Resultados: El análisis de las publicaciones seleccionadas permitió la identificación de cuatro temas: el acceso y la asistencia a los servicios de atención prenatal; educación para la salud sobre la anticoncepción para adolescentes; aspectos socio-demográficos y económicos frente a la inmadurez biológica y el apoyo de la red social. Conclusión: A través del estudio, podemos identificar que existe una relación entre el embarazo adolescente y TPP, pero hay varios factores de riesgo implicados en esta ocurrencia. Por lo tanto, sugerimos que se deben hacer más estudios sobre el tema (AU)

Introdução: O trabalho de parto prematuro (TPP) é uma das principais complicações gestacionais e importante causa de morbimortalidade neonatal. Seu diagnóstico é complexo e as causas podem ser diversas. A literatura aponta que a gravidez na adolescência é fator de risco, podendo ser considerada isoladamente ou associado a outros. Objetivo: Analisar evidências disponíveis na literatura acerca da temática: trabalho de parto prematuro, relação com gestação na adolescência e fatores de risco. Material e método: Revisão integrativa a partir de consulta nas bases de dados: LILACS; MEDLINE, SciELO e PUBMED. Busca realizada em agosto de 2015 com os critérios de inclusão: artigos publicados em português, inglês e espanhol, entre 2009 a 2014 de forma a atender o objetivo da revisão. Foram utilizados apenas estudos com dados primários e estudos de revisão foram excluídos. Encontrados 511 artigos, dos quais foram excluídos: 339 estudos por terem sido publicados fora do período; 155 por não atenderem aos objetivos e 6, após a leitura do texto na íntegra. Desta forma, a amostra final constituiu-se da análise de 11 artigos. Resultados: A análise das publicações selecionadas permitiu a identificação de quatro categorias temáticas: acesso e frequência aos serviços de pré-natal; educação em saúde em anticoncepção / planejamento familiar para adolescentes; aspectos sócio-demográficos-econômicos versus imaturidade biológica e apoio da rede social. Conclusão: Através deste estudo, podemos identificar que existe relação entre a gestação na adolescência e TPP, porém são múltiplos os fatores de risco envolvidos nesta ocorrência. Assim, sugerimos que sejam realizados mais estudos sobre a temática (AU)

Introduction: Premature labor is one of the main complications in pregnancy and an important cause of neonatal morbidity and mortality. It is difficult to diagnose and there may be a variety of causes. The literature indicates that teenage pregnancy is a risk factor and may be considered on its own or in combination with others. Objective: Study the evidence in the literature on the subject: premature labor, relationship with teenage pregnancy and risk factors. Material and method: Integrative literature review based on the databases LILACS; MEDLINE, SciELO and PubMed. The search was performed in August 2015 with the following inclusion criteria: articles published in Portuguese, English and Spanish, from 2009 to 2014, which meet the review objective. Only studies with primary data were used and review studies were excluded. The search yielded 511 articles, of which the following were excluded: 339 studies because they were published outside the stipulated time period; 155 because they did not comply with the objectives; and 6 after they were fully read. The final sample consisted of 11 articles. Results: Analysis of the selected publications resulted in the identification of four thematic categories: access to and frequency of prenatal care; birth control and family planning education for adolescents; social, demographic and economic aspects vs. biological immaturity and social network support. Conclusion: The present study found that there is a relationship between teenage pregnancy and premature labor, although multiple risk factors are involved. Therefore, it is suggested that more studies be carried out on this topic (AU)

Nutrient intakes and nutritional biomarkers in pregnant adolescents: a systematic review of studies in developed countries.

BACKGROUND: Babies born to adolescent mothers have been shown to have poorer outcomes compared to those born to adults. Nutritional status may have an important role to play in improving the health of pregnant adolescents; however there is a lack of evidence regarding the adequacy of adolescent diets during pregnancy. This systematic review aims to examine what is known about the nutritional status of adolescent pregnant women. METHODS: A systematic search of the literature identified 21 studies which met the inclusion criteria for the review. Primary research papers using any methods were included where they were published in English between January 1995 and May 2015 and included measurements of nutrient intakes or biological markers of nutritional status in pregnant women aged 11-19 years. Individual study data was first summarised narratively before study means were pooled to give an estimate of nutritional status in the population. RESULTS: The results show that individual studies reported intakes of energy, fibre and a number of key micronutrients which were below recommended levels. Biological markers of iron and selenium status also showed cause for concern. Pooled analysis of individual means as a percentage of UK Dietary Reference Intakes showed intakes of vitamin D (34.8 % CI 0-83.1) to be significantly below recommendations (p = 0.05). Serum selenium levels were also found to be low (61.8 µg/L, CI 39-84). CONCLUSIONS: This review has identified a number of areas where the nutritional status of pregnant adolescents is sub-optimal, which may have implications for the health of adolescent mothers and their babies. It was not however possible to examine the impact of supplement use or socio-demographic characteristics which limits the interpretation these results. Further work is needed to establish the characteristics of those most at risk within this population, how this differs from adult pregnant women and the role of supplementation in achieving adequate nutrition.

Resultados perinatales en adolescentes nulíparas. Estudio de cohorte retrospectiva / Perinatal outcomes in nulliparous adolescents. A hospital-based retrospective cohort study

Objetivo. Explorar los resultados perinatales en gestantes adolescentes nulíparas comparado con gestantes nulíparas de 20-29 años de edad. Materiales y métodos. Estudio de cohorte histórica poblacional. La población fueron gestantes de 11-29 años de edad con parto único ≥ 24 semanas en el periodo 2008-2009. Se distinguió 2 cohortes: 1) cohorte de estudio: adolescentes nulíparas (n = 3.555), y 2) cohorte de adultas nulíparas de 20-29 (n = 7.040). Además del análisis bivariado, se realizó análisis de regresión logística para ajustar por las principales variables confusoras. Los resultados perinatales evaluados son: bajo peso al nacer, parto pretérmino, feto muerto anteparto, cesárea y puntaje Apgar menor de 7 a los 5 minutos. Resultados. El parto pretérmino < 37 semanas fue más frecuente entre adolescentes que en mujeres de 20-29 años (7,5 vs. 5,4% respectivamente, p < 0,001). No hubo diferencia en el número de recién nacidos con bajo peso al nacer < 2.500 g (6,8 vs. 5,8%, en adolescentes vs. adultas respectivamente, p = 0,05), en la tasa de parto pretérmino < 34 semanas (1,7 vs. 2,1%, en adolescentes vs. adultas respectivamente p = 0,17), ni < 28 semanas (0,4 vs. 0,3%, en adolescentes vs. adultas respectivamente p = 0,32). Tampoco hubo diferencia en el número de fetos muertos anteparto (0,7 vs. 1,0%, en adolescentes vs. adultas respectivamente p = 0,11) ni en el puntaje Apgar < 7 a los 5 minutos (0,4 vs. 0,4%, en adolescentes vs. adultas respectivamente p = 0,983). El análisis de regresión logística mostró diferencia significativa en el riesgo de parto pretérmino < 37 semanas (OR = 1,3, IC 95%: 1,1-1,6), pero no de bajo peso al nacer < 2.500 g (OR = 1,0, IC 95% 0,8-1.3). Conclusiones. El embarazo en adolescentes nulíparas se asoció a parto pretérmino < 37 semanas. Otros resultados perinatales adversos como: bajo peso al nacer, puntaje Apgar < 7 a los 5 minutos y feto muerto anteparto no estuvieron asociados con embarazo en adolescentes nulíparas (AU)

Objective. To analyse perinatal outcomes in nulliparous adolescents compared with nulliparous women aged 20-29 years. Material and methods. This large hospital-based retrospective cohort study included singleton births at ≥ 24 weeks to women younger than 30 years from 2008 to 2009. The There were two cohorts: a) a study cohort consisting of nulliparous adolescents aged 11 to 19 years (n = 3555), and b) a control cohort comprising nulliparous women aged 20-29 years (n = 7040). In addition to a bivariate analysis, logistic regression was performed to adjust for confounding variables. Perinatal outcomes included low birth weight, preterm delivery, antepartum foetal death, caesarean section, and Apgar score at five minutes < 7. Results. Preterm delivery < 37 weeks was more frequent among adolescents than among women aged 20–29 years (7.5% vs 5.4% respectively, p < 0.001). There was no difference in the number of neonates with low birthweight < 2500 g (6.8% vs 5.8% in adolescents vs adults, respectively, p = 0.05), the rate of preterm delivery < 34 weeks (1.7% vs 2.1% in adolescents vs adults, respectively, p = 0.17), or in preterm delivery < 28 weeks (0.4% vs 0.3% in adolescents vs. adults, respectively, p = 0.32). There were no differences in antepartum foetal deaths (0.7% vs 1.0% in adolescents vs adults, respectively, p = 0.11) or in Apgar score < 7 at 5 minutes (0.4% vs 0.4% in adolescents vs adults, respectively, p = 0.983). Logistic regression analysis showed a significant difference in the risk of preterm delivery < 37 weeks (OR = 1.3, 95% CI: 1.1-1.6), but not in low birthweight < 2500 g (OR = 1.0, 95% CI 0.8–1.3). Conclusions. Preterm delivery < 37 weeks was more frequent in nulliparous adolescents than in women aged 20-29 years. There was no association between pregnancy in nulliparous adolescents and other adverse perinatal outcomes such as low birth weight, low Apgar score and antepartum foetal death (AU)

The Effect of Adequate Gestational Weight Gain among Adolescents Relative to Adults of Equivalent Body Mass Index and the Risk of Preterm Birth, Cesarean Delivery, and Low Birth Weight.

OBJECTIVE: To determine whether similar odds of cesarean delivery (C/S), preterm birth (PTB), and low birth weight (LBW) are observed among adolescents compared with body mass index (BMI)-equivalent adults in cases of adequate gestational weight gain. STUDY DESIGN: We conducted a retrospective, population-based, cohort study using the Center for Disease Control and Prevention's birth data files from the United States for 2012. We selected from the cohort all singleton, cephalic pregnancies and stratified them according to maternal age, prepregnancy BMI, and gestational weight gain following the 2009 Institute of Medicine (IOM) recommendations. The effect of adequate gestational weight gain among adolescents relative to adults of equivalent BMI on the risk of C/S, PTB, and LBW was estimated using logistic regression analysis, adjusting for relevant confounders. RESULTS: We analyzed a total of 3,960,796 births, of which 1,036,646 (26.1%) met the inclusion criteria. In adolescents and adults, likelihood of achieving ideal gestational weight gain decreased with greater prepregnancy BMI. Relative to adults, the overall odds of C/S in all adolescents were (adjusted odds ratio [95% confidence interval]) 0.61 (0.58 to 0.63). When comparing equivalent BMI categories, these odds were unchanged (P < .0001). The overall adjusted odds ratio of LBW was 1.15 (1.13 to 1.16). These odds were significantly higher when BMI stratification took place, decreasing with advancing BMI categories, from 1.23 (1.14 to 1.33) among the underweight, to nonsignificant differences in the obese classes (P < .05). Finally, when including only those achieving ideal weight gain, the overall odds of premature delivery (1.17 [1.14 to 1.20]) were higher among nonobese adolescents, while they were not found among the obese. CONCLUSION: When ideal gestational weight gain is attained, only nonobese adolescents exhibit a greater risk of LBW and preterm birth relative to adults of similar BMI, whereas the risk of C/S remains lower for all adolescents, independent of BMI. This information may be useful in the counseling of adolescent pregnancies.

Meeting the Reproductive Needs of Female Adolescents With Neurodevelopmental Disabilities.

The complexity of caring for female adolescents with neurodisabilities often overshadows normal biological changes. These young women may require additional or individualized support as they adapt to normal puberty and sexual maturation. Many choices are available to assist in managing menstrual problems, hygiene issues, and contraception. Special considerations regarding contraceptive methods, sexual education, and improving service accessibility are explored for clinicians.