Relationship between Nutritional and Psychological Status of Pregnant Adolescents and Non-Adolescents in Brazil

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ABSTRACT

This study compared the nutritional and psychological status of 855 pregnant adolescents and non-adolescents and assessed their relationships at three interviews (gestational age ≤ 16 weeks, 20-26 weeks, and 30-36 weeks). The instruments used were: anthropometry, state-trait anxiety inventories (STAI), general health questionnaire (GHQ), and perceived stress scale (PSS). More adolescents were thinner, had higher scores of the trait anxiety inventory (TAI), wished to abort their children, and were worried about changes in their bodies than non-adolescents. Multiple linear regression analyses (controlling for toxic exposure, socioeconomic, demographic and obstetric factors) detected negative associations between weight gain in the first interview and distress (GHQ) for both the groups of women and weight gain in the second interview and the variable "worry about body's change" for the non-adolescent group. The negative associations between body mass index and chronic anxiety (TAI) were present in the three interviews for non-adolescents. This study detected a relationship between the nutritional and the psychological status of pregnant women, although there were more associations for non-adolescents.

Key words: Pregnancy; Stress; Distress; Anthropometry; Body mass index; Weight gain; Adolescence; Brazil

INTRODUCTION

A rise in the number of pregnant adolescents in the last century is a cause of concern in public health (1), considering that lower maternal age has been associated with a higher prevalence of low birth-weight (LBW), maternal and neonatal morbidity and mortality. However, maternal age is not an independent determinant of intrauterine growth or gestational duration, but may indirectly influence nutrition and other important risk markers of LBW (2).

Pregnancy in adolescence means an increase in nutritional requirements for the growth of the foetus and for the mother herself and is a potential determinant of lower weight gain (3). However, the biological mechanism that underlies the relationship between women.s nutritional status and reproductive outcomes is not fully understood, except in extreme situations (e.g. famine) (4).

In developing countries, many children with mild-tomoderate malnutrition survive to reach adolescence, when malnutrition tends to remain mild but chronic, being detectable only by anthropometric measurements. On the other hand, relatively well-nourished children may develop malnutrition in adolescence as a result of acquired dietary habits, influenced by obsession with thinness (5-9). Several studies, mainly from developed countries, have demonstrated that, despite the increasing trends in the prevalence of overweight and obesity, fatness phobia is common during female adolescence (10-14).

Brazil has been passing through a nutritional transition, with a dramatic shift towards obesity (15,16). Studies have shown a coexistence of malnutrition and obesity in low-income Brazilian communities (17), sometimes with these two conditions existing in the same household (18).

To examine only the nutritional aspects of pregnancy in adolescence is to take a limited approach, considering that the psychological consequences are of equal importance and may have an impact on the nutritional status of this population and on their babies (19). Adolescents are prepared neither physically nor emotionally for pregnancy. The World Health Organization considers adolescence to be the period between 10 and 20 years during which individuals undergo significant psychosexual and psychosocial development (5).

The relationship between the nutritional and the psychological status of pregnant adolescents also includes the possibility that it can be confounded by socioeconomic, demographic and obstetric factors. Stress/distress is likely to occur among adolescents who expect serious social disapproval when their condition becomes known. In this case, pregnancy is usually kept secret as long as possible, and antenatal care delayed. …