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      Estado nutricional y complicaciones inmediatas en neonatos de madres adolescentes

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          Abstract

          Introducción: En Venezuela, el 21% de todos los nacidos vivos, son hijos de madres adolescentes. El embarazo en adolescentes constituye un problema social, económico y de salud pública que trae un mayor riesgo de morbi-mortalidad materna, fetal y neonatal, debido a la mayor prevalencia de prematuridad, bajo peso al nacer, restricción del crecimiento intrauterino y complicaciones médicas asociadas. Considerando la influencia del embarazo en adolescentes sobre el producto de la concepción, particularmente sobre su estado nutricional, se planteó el presente trabajo. Objetivos: Determinar la influencia del embarazo durante la adolescencia sobre el estado nutricional del recién nacido, su relación con la presencia de complicaciones neonatales inmediatas e identificación de posibles factores de riesgo sociodemográficos asociados al estado nutricional del neonato. Metodos: Estudio prospectivo y descriptivo de 102 hijos de madres adolescentes entre 14 y 19 años, nacidos en el Hospital "Dr. Pastor Oropeza" (agosto - octubre 2007), evaluados antropométricamente (peso, talla, circunferencia cefálica y media del brazo) en las primeras 48 horas de vida. Se aplicó estadística descriptiva básica: medidas de tendencia central y de dispersión, pruebas de contraste de medias (t de Student) y de asociación de variables (Pearson y Chi cuadrado para p < 0,05). Resultados: La edad materna promedio fue de 17,05 años. La mayoría de los neonatos resultaron a término (11,8%, pretérmino). Del total, 79,4% clasificó como adecuados para la edad gestacional, 13,7% grandes y 6,9% pequeños para la edad gestacional, con diferencias significativas entre las distintas variables e indicadores antropométricos al clasificarlos según edad gestacional y peso para la edad gestacional. La prevalencia de bajo peso al nacer fue de 7,8%. El 33,3% de los neonatos presentaron complicaciones, siendo las más frecuentes: hipoglicemia (13,7%), ictericia (9,8%) y sepsis neonatal (7,8%). No hubo asociación entre edad materna ni edad ginecológica con las variables antropométricas estudiadas. Conclusión: En éste grupo de estudio, el embarazo en adolescentes no está asociado a alteraciones en el estado nutricional del recién nacido ni a la aparición de complicaciones neonatales inmediatas.

          Translated abstract

          Introducction: In Venezuela, 21% of all live births are born to teenage mothers. The teen pregnancy is a social, economic and public health problem resulting in a higher risk of maternal, fetal and neonatal morbidity and mortality due to the higher prevalence of prematurity, low birth weight, intrauterine growth restriction and medical complications. Objective: To determine the influence of pregnancy during adolescence on the nutritional status of the newborn, its relationship with the risk of complications and identification of potential risk factors associated with this condition. Methods: Descriptive and prospective study of 102 children of teenage mothers between ages 14-19, born in the Hospital "Dr. Pastor Oropeza" (August-October 2007), assessed anthropometrically (weight, height, head and average arm circumference) during the first 48 hours of life. Statistical analysis included: measures of central tendency and dispersion as well as evidence of contrast medium (Student t) and the association of variables (Pearson and Chi square for p < 0,05). Results: Most of the infants were born at term (only 11.8% preterm). Of the total, 79.4% classified as suitable for gestational age, followed by large 13.7% and 6.9% small, with significant differences among different variables and anthropometric indicators to classify them according to their gestational age and weight for gestational age. The prevalence of low birth weight was 7.8%. 33.3% of newborns had complications, the most common: hypoglycemia (13.7%), jaundice (9.8%) and neonatal sepsis (7.8%). There was no association between maternal age or gynecological age with anthropometric variables studied. Conclusion: In this study, teenage pregnancy is not associated with deficit in nutritional status of the newborn or the emergence of immediate neonatal complications.

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          Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study.

          Whether the association between teenage pregnancy and adverse birth outcomes could be explained by deleterious social environment, inadequate prenatal care, or biological immaturity remains controversial. The objective of this study was to determine whether teenage pregnancy is associated with increased adverse birth outcomes independent of known confounding factors. We carried out a retrospective cohort study of 3,886,364 nulliparous pregnant women <25 years of age with a live singleton birth during 1995 and 2000 in the United States. All teenage groups were associated with increased risks for pre-term delivery, low birth weight and neonatal mortality. Infants born to teenage mothers aged 17 or younger had a higher risk for low Apgar score at 5 min. Further adjustment for weight gain during pregnancy did not change the observed association. Restricting the analysis to white married mothers with age-appropriate education level, adequate prenatal care, without smoking and alcohol use during pregnancy yielded similar results. Teenage pregnancy increases the risk of adverse birth outcomes that is independent of important known confounders. This finding challenges the accepted opinion that adverse birth outcome associated with teenage pregnancy is attributable to low socioeconomic status, inadequate prenatal care and inadequate weight gain during pregnancy.
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            Association of young maternal age with adverse reproductive outcomes.

            Pregnancy in adolescence is associated with an excess risk of poor outcomes, including low birth weight and prematurity. Whether this association simply reflects the deleterious sociodemographic environment of most pregnant teenagers or whether biologic immaturity is also causally implicated is not known. To determine whether a young age confers an intrinsic risk of adverse outcomes of pregnancy, we performed stratified analyses of 134,088 white girls and women, 13 to 24 years old, in Utah who delivered singleton, first-born children between 1970 and 1990. Relative risk for subgroups of this study population was examined to eliminate the confounding influence of marital status, educational level, and the adequacy of prenatal care. The adjusted relative risk for the entire study group was calculated as the weighted average of the stratum-specific risks. Among white married mothers with educational levels appropriate for their ages who received adequate prenatal care, younger teenage mothers (13 to 17 years of age) had a significantly higher risk (P < 0.001) than mothers who were 20 to 24 years of age of delivering an infant who had low birth weight (relative risk, 1.7; 95 percent confidence interval, 1.5 to 2.0), who was delivered prematurely (relative risk, 1.9; 95 percent confidence interval, 1.7 to 2.1), or who was small for gestational age (relative risk, 1.3; 95 percent confidence interval, 1.2 to 1.4). Older teenage mothers (18 or 19 years of age) also had a significant increase in these risks. Even though sociodemographic variables associated with teenage pregnancy increase the risk of adverse outcomes, the relative risk remained significantly elevated for both younger and older teenage mothers after adjustment for marital status, level of education, and adequacy of prenatal care. In a study of mothers 13 to 24 years old who had the characteristics of most white, middle-class Americans, a younger age conferred an increased risk of adverse pregnancy outcomes that was independent of important confounding sociodemographic factors.
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              Nutrition in adolescent pregnancy.

              Prevention of unintended adolescent pregnancy is a primary goal of the American Academy of Pediatrics and of many health providers. Nevertheless, many adolescents become pregnant every year in America. Pediatricians therefore should be aware of nutritional recommendations for pregnant adolescents to provide optimal care. The importance of nutrition during pregnancy is here reviewed from a pediatric perspective. Pregnancy, particularly during adolescence, is a time of extreme nutritional risk. The adolescents most likely to become pregnant are often those with inadequate nutritional status and unfavorable socio-economic background. There is increasing evidence of competition for nutrients between the growing pregnant adolescent and her fetus. Also, the prenatal environment has been implicated in the development of obesity, cardiovascular disease, and diabetes in both the mother and her offspring. Many adolescents have poor diet quality and poor knowledge of appropriate nutrition; these habits may not change during pregnancy. Current knowledge and recommendations regarding the intake of energy, calcium, and folate are discussed in detail.
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                Author and article information

                Contributors
                Role: ND
                Journal
                avpp
                Archivos Venezolanos de Puericultura y Pediatría
                Arch Venez Puer Ped
                Sociedad Venezolana de Puericultura y Pediatría (Caracas )
                0004-0649
                June 2008
                : 71
                : 2
                : 34-41
                Affiliations
                [1 ] Hospital Materno Infantil Dr. Pastor Oropeza Venezuela
                Article
                S0004-06492008000200002
                b7e426ad-1251-4a77-a109-ad2ee41bde46

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0004-0649&lng=en
                Categories
                HEALTH CARE SCIENCES & SERVICES
                HEALTH POLICY & SERVICES
                PEDIATRICS

                Pediatrics,Health & Social care,Public health
                adolescence pregnancy,embarazo en adolescentes,recién nacido,estado nutricional,complicaciones neonatales,newborn,nutritional status,neonatal complications

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