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      Maternal mortality in adolescents and young adults: temporal trend and correlation with prenatal care coverage in the state of Bahia, Brazil, 2000-2020 Translated title: Mortalidad materna en la adolescencia y la juventud: tendencia temporal y correlación con la cobertura prenatal en Bahia, Brasil, 2000-2020 Translated title: Mortalidade materna na adolescência e juventude: tendência temporal e correlação com cobertura pré-natal na Bahia, 2000-2020

      research-article
      1 , 1 , 2 , 1 , 3 , 1 , 1
      Epidemiologia e Serviços de Saúde : Revista do Sistema Unico de Saúde do Brasil
      Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil
      Time-Series Studies, Epidemiological Studies, Prenatal Care, Maternal Mortality, Adolescent, Young Adult., Estudios de Series Temporales, Estudios Epidemiológicos, Atención Prenatal, Mortalidad Materna, Adolescente, Adulta Joven, Estudos de Séries Temporais, Estudos Epidemiológicos, Cuidado Pré-Natal, Mortalidade Materna, Adolescente, Adulto Jovem

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          Study contributions

          Main results

          From 2000 to 2020, maternal mortality among adolescents and young adults showed a decreasing trend in the state of Bahia. It could be seen an inverse and significant correlation between the highest number of prenatal care visits and maternal mortality in the studied groups.

          Implications for services

          The study suggests the importance of quality obstetric care during prenatal, childbirth, and postpartum period for reducing maternal mortality among adolescents and young adults, especially from preventable causes.

          Perspectives

          Improving the records of causes of death on information systems, enhancing obstetric care, and investing in sexual and reproductive health policies aimed at adolescents may contribute to the reduction of maternal deaths.

          ABSTRACT

          Objective:

          to analyze the temporal trend of maternal mortality and correlate it with prenatal care coverage among adolescents and young adults, state of Bahia, Brazil, 2000-2020.

          Methods:

          this was an ecological time-series study and correlation between maternal deaths and prenatal care visits in 10-19 and 20-24 age groups, using the Mortality Information System; the trend analysis was performed by means of Prais-Winsten regression, according to race/skin color, timing and causes of death; and Spearman coefficient was used for correlation.

          Results:

          in the study period, 418 deaths among adolescents and 574 among young adults were recorded; maternal mortality ratio was 59.7 and 63.2 deaths/100,000 live births, with a significant decreasing trend (-2.2% and -2.9% respectively); it could be seen an inverse correlation between a higher number of prenatal care visits and maternal mortality in the age groups.

          Conclusion:

          maternal mortality showed a decreasing trend in the study period, but with high proportions of death; there was a significant correlation between prenatal care coverage and maternal mortality among adolescents and young adults.

          RESUMEN

          Objetivo:

          analizar la tendencia temporal de la mortalidad materna y correlacionarla con la cobertura prenatal, entre adolescentes y adultas jóvenes, en el estado de Bahía, período 2000-2020.

          Métodos:

          estudio ecológico de series temporales y correlación entre muertes maternas y atención prenatal, en grupos de edad de 10-19 y 20-24, utilizando el Sistema de Información de Mortalidad. Analizó la tendencia mediante regresión de Prais-Winsten, según raza/color de piel, causas y hora de muerte; para correlación, el coeficiente de Spearman.

          Resultados:

          en el período se registraron 418 muertes de adolescentes y 574 de adultas jóvenes; razón de mortalidad materna de 59,7 y 63,2 muertes/100.000 nacidos vivos, con importante tendencia a la baja (-2,2%; -2,9%, respectivamente). Se observó correlación inversa entre el mayor número de consultas y la mortalidad materna en grupos.

          Conclusión:

          la mortalidad materna mostró tendencia descendente en el período, pero con altas proporciones de muertes. Hubo una correlación significativa entre la cobertura prenatal y la mortalidad materna, adolescente y adulta joven.

          RESUMO

          Objetivo:

          analisar a tendência temporal da mortalidade materna e correlacioná-la com a cobertura pré-natal entre adolescentes e adultas jovens, Bahia, Brasil, 2000-2020.

          Métodos:

          estudo ecológico de série temporal e correlação entre óbitos maternos e consulta de pré-natal aos 10-19 e 20-24 anos, utilizando-se o Sistema de Informações sobre Mortalidade; a tendência foi analisada pela regressão de Prais-Winsten, segundo raça/cor da pele, causas e momento do óbito; para a correlação, utilizou-se o coeficiente de Spearman.

          Resultados:

          no período, foram registrados 418 óbitos de adolescentes e 574 de adultas jovens; razão de mortalidade materna de 59,7 e 63,2 óbitos/100 mil nascidos vivos, com tendência decrescente significante (-2,2% e -2,9% respectivamente); observou-se correlação inversa entre maior número de consultas e mortalidade materna, nos grupos etários.

          Conclusão:

          a mortalidade materna apresentou tendência de redução no período, porém com altas proporções de óbito; houve correlação significante entre cobertura pré-natal e mortalidade materna, entre adolescentes e adultas jovens.

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          Most cited references35

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

          In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015.
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Uso da análise de séries temporais em estudos epidemiológicos

            Esse artigo visa introduzir e cativar o interesse sobre a análise de séries temporais em estudos epidemiológicos. São descritos aspectos conceituais desse tipo de análise e sistematizadas indicações metodológicas. Foram definidos os principais conceitos da análise de séries temporais (tendência, variação cíclica e sazonal, associação e variação aleatória), e operacionalizada sua aplicação epidemiológica. Foram apresentados os métodos para avaliação da tendência (porcentagem de modificação anual), baseados em modelos de regressão de Prais-Winsten, e para quantificação da variação sazonal, segundo o modelo de Serfling. Foi, ainda, introduzida a modalidade de análise de regressão segmentada para séries temporais interrompidas, como estratégia de avaliação do efeito de intervenções em saúde.
              • Record: found
              • Abstract: found
              • Article: not found

              Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States: A Systematic Review

              To synthesize the literature on associations between social determinants of health and pregnancy-related mortality and morbidity in the US and to highlight opportunities for intervention and future research. We performed a systematic search using Medline Ovid, CINAHL, Popline, Scopus and ClinicalTrials.gov (1990–2018) using MeSH terms related to maternal mortality, morbidity, and social determinants of health, and limited to the United States. Selection criteria included studies examining associations between social determinants and adverse maternal outcomes including pregnancy-related death, severe maternal morbidity, and emergency hospitalizations or readmissions. Using Covidence, three authors screened abstracts and two screened full articles for inclusion. Two authors extracted data from each article and the data were analyzed using a descriptive approach. A total of 83 studies met inclusion criteria and were analyzed. Seventy eight out of 83 studies examined socioeconomic position or individual factors as predictors, demonstrating evidence of associations between minority race and ethnicity (58/67 studies with positive findings), public or no insurance coverage (21/30), and lower education levels (8/12) and increased incidence of maternal death and severe maternal morbidity. Only 2/83 studies investigated associations between these outcomes and socioeconomic, political and cultural context (e.g. public policy); and 20/83 studies investigated material and physical circumstances (e.g. neighborhood environment, segregation), limiting the diversity of social determinants of health studied as well as evaluation of such evidence. Empirical studies provide evidence for the role of race and ethnicity, insurance, and education in pregnancy-related mortality and severe maternal morbidity risk, although many other important social determinants, including mechanisms of effect, remain to be studied in greater depth. Studies demonstrate the role of race, ethnicity, insurance, and education in pregnancy-related mortality and morbidity risk but lack inclusion of mechanisms and other social determinants.

                Author and article information

                Contributors
                Role: conception and design Role: data extraction Role: analysis and interpretation Role: drafting Role: integrity
                Role: conception and design Role: data extraction Role: analysis and interpretation Role: drafting Role: integrity
                Role: design Role: data interpretation Role: writing Role: integrity
                Role: analysis and interpretation Role: reviewing Role: integrity
                Role: design Role: data interpretation Role: writing Role: integrity
                Role: design Role: data interpretation Role: writing Role: integrity
                Role: design Role: data interpretation Role: writing Role: integrity
                Journal
                Epidemiol Serv Saude
                Epidemiol Serv Saude
                ress
                Epidemiologia e Serviços de Saúde : Revista do Sistema Unico de Saúde do Brasil
                Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil
                1679-4974
                2237-9622
                18 September 2023
                2023
                : 32
                : 2
                : e2023103
                Affiliations
                [1 ]Universidade Estadual de Feira de Santana, Programa de Pós-Graduação em Saúde Coletiva, Feira de Santana, BA, Brazil
                [2 ]Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, RJ, Brazil
                [3 ]Universidade Federal do Recôncavo da Bahia, Centro de Ciências da Saúde, Santo Antônio de Jesus, BA, Brazil
                Author notes
                [Corresponding author: ] Lorena Ramalho Galvão. [e-mail: ] loregalvao20@ 123456gmail.com

                AUTHOR CONTRIBUTIONS: Galvão LR and Costa MCO collaborated with the study conception and design, data extraction, analysis and interpretation, and drafting of the first version of the manuscript. Gama SGN, Santos DB, Barros NF and Rosario WO collaborated with the study design, data interpretation and critical reviewing of scientific writing. Amaral MTR collaborated with data analysis and interpretation, and critical reviewing of the manuscript content. All authors have approved the final version of the manuscript and declared themselves to be responsible for all aspects of the work, including ensuring its accuracy and integrity.

                CONFLICTS OF INTEREST: The authors declare they have no conflicts of interest.

                Associate editor: Alberto Madeiro - orcid.org/0000-0002-5258-5982

                Author information
                http://orcid.org/0000-0002-4643-8994
                http://orcid.org/0000-0001-6695-7268
                http://orcid.org/0000-0002-9200-0387
                http://orcid.org/0000-0003-1474-9154
                http://orcid.org/0000-0002-6128-1155
                http://orcid.org/0000-0001-8079-4581
                http://orcid.org/0000-0001-9141-6551
                Article
                00312
                10.1590/S2237-96222023000200022
                10510614
                37729264
                dcdd7201-630a-4b79-a7b6-875fce03dd5c

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 02 March 2023
                : 06 June 2023
                Page count
                Figures: 2, Tables: 8, Equations: 0, References: 30
                Categories
                Original Article

                time-series studies,epidemiological studies,prenatal care,maternal mortality,adolescent,young adult.,estudios de series temporales,estudios epidemiológicos,atención prenatal,mortalidad materna,adolescente,adulta joven,estudos de séries temporais,estudos epidemiológicos,cuidado pré-natal,mortalidade materna,adulto jovem

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