Pregnancy in adolescence Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2015;37(12):585-592
DOI 10.1590/S0100-720320150005481
To assess attitudes about eating, weight gain and body image of pregnant adolescents.
Pregnant adolescents (n=67) were assessed using the Body Image Questionnaire, the Attitude towards Weight Gain during Pregnancy scale (AWGP) and questions about risk behaviors for eating disorders and unhealthy weight control practices. Associations between variables were analyzed by ANOVA, Kruskal-Wallis test, Pearson and Spearman tests. The influence of the independent variables regarding skipping meals, body satisfaction and binge eating was evaluated by logistic regression.
The average age of the adolescents was 15.3 years (SD=1.14) and their average gestational age was 21.9 weeks (SD=6.53). The average AWGP score was 52.6 points, indicating a positive attitude towards weight gain, and 82.1% of the pregnant girls were satisfied with their bodies. Obese girls had more body dissatisfaction (p=0.001), and overweight girls thought more about food (p=0.02) and eating (p=0.03). The frequency of reported binge eating was 41.8%, and the frequency of skipping meals was 19%. Regression analysis showed that the current Body Mass Index (p=0.03; OR=1.18) and the importance of body awareness and fitness before pregnancy (p=0.03; OR=4.63) were predictors of skipping meals. Higher socioeconomic level (p=0.04; OR=0.55) and greater concern with weight gain (p=0.03; OR=0.32) predicted binge eating.
Even though the majority of the pregnant adolescents had positive attitudes toward weight gain and body satisfaction, those heavier and more concerned with weight gain had a higher risk of unhealthy attitudes, while those of lower social class, less concerned with weight gain and less embarrassed about their bodies during pregnancy, had a lower risk of unhealthy attitudes.
Summary
Rev Bras Ginecol Obstet. 2015;37(12):585-592
DOI 10.1590/S0100-720320150005481
To assess attitudes about eating, weight gain and body image of pregnant adolescents.
Pregnant adolescents (n=67) were assessed using the Body Image Questionnaire, the Attitude towards Weight Gain during Pregnancy scale (AWGP) and questions about risk behaviors for eating disorders and unhealthy weight control practices. Associations between variables were analyzed by ANOVA, Kruskal-Wallis test, Pearson and Spearman tests. The influence of the independent variables regarding skipping meals, body satisfaction and binge eating was evaluated by logistic regression.
The average age of the adolescents was 15.3 years (SD=1.14) and their average gestational age was 21.9 weeks (SD=6.53). The average AWGP score was 52.6 points, indicating a positive attitude towards weight gain, and 82.1% of the pregnant girls were satisfied with their bodies. Obese girls had more body dissatisfaction (p=0.001), and overweight girls thought more about food (p=0.02) and eating (p=0.03). The frequency of reported binge eating was 41.8%, and the frequency of skipping meals was 19%. Regression analysis showed that the current Body Mass Index (p=0.03; OR=1.18) and the importance of body awareness and fitness before pregnancy (p=0.03; OR=4.63) were predictors of skipping meals. Higher socioeconomic level (p=0.04; OR=0.55) and greater concern with weight gain (p=0.03; OR=0.32) predicted binge eating.
Even though the majority of the pregnant adolescents had positive attitudes toward weight gain and body satisfaction, those heavier and more concerned with weight gain had a higher risk of unhealthy attitudes, while those of lower social class, less concerned with weight gain and less embarrassed about their bodies during pregnancy, had a lower risk of unhealthy attitudes.
Summary
Rev Bras Ginecol Obstet. 2015;37(8):366-373
DOI 10.1590/SO100-720320150005420
To describe associations between pregnancy rates in adolescence and socioeconomic and social responsibility indicators in the municipalities of the State of Minas Gerais, Southeast of Brazil, in the year of 2010.
Ecological study using data from the Brazilian Live Birth Information System (SINASC). The percentage of live births to adolescent mothers (LBAM) for each municipality was calculated based on the quotient between number of born alive infants of mothers aged 10-19 years old and total number of live births in the year of 2010. Fully Bayesian models were used to obtain the percentages of LBAM adjusted for spatial effects and to assess possible associations with socioeconomic and social responsibility indicators.
The crude percentage of LBAM for the total number of live births in the municipalities of Minas Gerais in 2010 ranged from 0 to 46.4%, with median percentage being 19.6% and the first and third quartiles being 15.6 and 23.1%, respectively. This study has demonstrated a close relationship between adolescent pregnancy and socioeconomic indicators. LBAM percentages were found to be higher in municipalities with low population density, low human development index and other low development indicators.
The strong relationship between LBAM percentages and socioeconomic indicators suggests that adolescent pregnancy is more a social than a biological problem. Therefore, programs and actions should go beyond sexual education and information on preventive health methods.
Summary
Rev Bras Ginecol Obstet. 2015;37(8):366-373
DOI 10.1590/SO100-720320150005420
To describe associations between pregnancy rates in adolescence and socioeconomic and social responsibility indicators in the municipalities of the State of Minas Gerais, Southeast of Brazil, in the year of 2010.
Ecological study using data from the Brazilian Live Birth Information System (SINASC). The percentage of live births to adolescent mothers (LBAM) for each municipality was calculated based on the quotient between number of born alive infants of mothers aged 10-19 years old and total number of live births in the year of 2010. Fully Bayesian models were used to obtain the percentages of LBAM adjusted for spatial effects and to assess possible associations with socioeconomic and social responsibility indicators.
The crude percentage of LBAM for the total number of live births in the municipalities of Minas Gerais in 2010 ranged from 0 to 46.4%, with median percentage being 19.6% and the first and third quartiles being 15.6 and 23.1%, respectively. This study has demonstrated a close relationship between adolescent pregnancy and socioeconomic indicators. LBAM percentages were found to be higher in municipalities with low population density, low human development index and other low development indicators.
The strong relationship between LBAM percentages and socioeconomic indicators suggests that adolescent pregnancy is more a social than a biological problem. Therefore, programs and actions should go beyond sexual education and information on preventive health methods.
Summary
Rev Bras Ginecol Obstet. 2015;37(5):208-215
DOI 10.1590/SO100-720320150005321
To describe the evolution of the prevalence of anemia in pregnant adolescents
attended at a public maternity in the city of Rio de Janeiro from 2004 to 2013.
A retrospective cross-sectional study with 628 pregnant/postpartum women divided
into 3 groups: Group A (2004-2006), Group B (2007-2010) and Group C (2013).
Information about anthropometric, clinical, sociodemographic data and obstetric
and prenatal care of adolescents was obtained from medical records of the pregnant
women. A hemoglobin concentration n<11 g/dL was considered to be anemia. Data
were analyzed statistically by the chi-square test, Student's t-test and ANOVA,
and the post hoc Tukey test.
The prevalence of gestational anemia over the years was 43% (GA=138), 36% (GB=80)
and 47.1% (GC=40) and the overall prevalence for the 2004-2013 period was 41.1%
(n=258). The occurrence of anemic pregnant women increased with the progression of
pregnancy; however, in the 3rd quarter there was a decrease in the prevalence of
anemia in GB (29.3%) compared to GA (38.7%; p=0.04). Factors associated with
anemia were number of prenatal visits and prenatal nutritional assistance, place
of residence, pre-pregnancy BMI, and gestational weight gain.
The results showed that the prevalence of anemia among pregnant adolescents seen
at a public maternity is high. There was no reduction of anemia during the study
period and other factors in addition to iron deficiency were involved in the
genesis of anemia in this population.
Summary
Rev Bras Ginecol Obstet. 2015;37(5):208-215
DOI 10.1590/SO100-720320150005321
To describe the evolution of the prevalence of anemia in pregnant adolescents
attended at a public maternity in the city of Rio de Janeiro from 2004 to 2013.
A retrospective cross-sectional study with 628 pregnant/postpartum women divided
into 3 groups: Group A (2004-2006), Group B (2007-2010) and Group C (2013).
Information about anthropometric, clinical, sociodemographic data and obstetric
and prenatal care of adolescents was obtained from medical records of the pregnant
women. A hemoglobin concentration n<11 g/dL was considered to be anemia. Data
were analyzed statistically by the chi-square test, Student's t-test and ANOVA,
and the post hoc Tukey test.
The prevalence of gestational anemia over the years was 43% (GA=138), 36% (GB=80)
and 47.1% (GC=40) and the overall prevalence for the 2004-2013 period was 41.1%
(n=258). The occurrence of anemic pregnant women increased with the progression of
pregnancy; however, in the 3rd quarter there was a decrease in the prevalence of
anemia in GB (29.3%) compared to GA (38.7%; p=0.04). Factors associated with
anemia were number of prenatal visits and prenatal nutritional assistance, place
of residence, pre-pregnancy BMI, and gestational weight gain.
The results showed that the prevalence of anemia among pregnant adolescents seen
at a public maternity is high. There was no reduction of anemia during the study
period and other factors in addition to iron deficiency were involved in the
genesis of anemia in this population.
Summary
Rev Bras Ginecol Obstet. 2011;33(11):354-360
DOI 10.1590/S0100-72032011001100006
PURPOSE: To analyze the association of pregnancy in adolescence and prematurity. METHODS: The study included all the patients who delivered at a teaching hospital in Maranhão State, from July to December 2006. The patients were divided into two groups: adolescents (10 to 19 years old) and adults (20 to 34 years old). The variables studied were: educational level, marital status, number of prenatal visits, gestational age at the onset of prenatal care, duration of gestation, delivery route and birth weight. Statistical analysis was performed using the Epi-Info software, version 3.4.1, and the associations between variables were analyzed by the odds ratio (OR), with a 95% confidence interval (CI). Models of logistic regression were also used. The level of significance adopted was 0.05. RESULTS: The study evaluated 1,978 patients. The frequency of deliveries in adolescents was 25.4%. This group presented low educational level, no mates, low number of prenatal visits, late onset of prenatal care, low birth weight and prematurity. In the analysis of prematurity as the outcome variable, there was a clear association with low number of prenatal visits (OR 3.0; 95%CI 2.2-4.0) and late onset of prenatal care (OR 1.9; 95%CI 1.3-2.6) and low educational level (OR 1.9; 95%CI 1.4-2.5) related to adolescence (OR 1.5; 95%CI 1.1-1.9). The incidence of caesarean delivery was significantly lower among adolescents (33.3%) than among adults (49.4%), with a lower association with pre-eclampsia and cephalo-pelvic disproportion. CONCLUSIONS: Pregnancy in adolescence was associated with late onset of prenatal care and low number of visits, as well as low educational level, low birth weight, prematurity and a lower incidence of cephalo-pelvic disproportion and pre-eclampsia.
Summary
Rev Bras Ginecol Obstet. 2011;33(11):354-360
DOI 10.1590/S0100-72032011001100006
PURPOSE: To analyze the association of pregnancy in adolescence and prematurity. METHODS: The study included all the patients who delivered at a teaching hospital in Maranhão State, from July to December 2006. The patients were divided into two groups: adolescents (10 to 19 years old) and adults (20 to 34 years old). The variables studied were: educational level, marital status, number of prenatal visits, gestational age at the onset of prenatal care, duration of gestation, delivery route and birth weight. Statistical analysis was performed using the Epi-Info software, version 3.4.1, and the associations between variables were analyzed by the odds ratio (OR), with a 95% confidence interval (CI). Models of logistic regression were also used. The level of significance adopted was 0.05. RESULTS: The study evaluated 1,978 patients. The frequency of deliveries in adolescents was 25.4%. This group presented low educational level, no mates, low number of prenatal visits, late onset of prenatal care, low birth weight and prematurity. In the analysis of prematurity as the outcome variable, there was a clear association with low number of prenatal visits (OR 3.0; 95%CI 2.2-4.0) and late onset of prenatal care (OR 1.9; 95%CI 1.3-2.6) and low educational level (OR 1.9; 95%CI 1.4-2.5) related to adolescence (OR 1.5; 95%CI 1.1-1.9). The incidence of caesarean delivery was significantly lower among adolescents (33.3%) than among adults (49.4%), with a lower association with pre-eclampsia and cephalo-pelvic disproportion. CONCLUSIONS: Pregnancy in adolescence was associated with late onset of prenatal care and low number of visits, as well as low educational level, low birth weight, prematurity and a lower incidence of cephalo-pelvic disproportion and pre-eclampsia.
Summary
Rev Bras Ginecol Obstet. 2011;33(10):286-291
DOI 10.1590/S0100-72032011001000003
PURPOSES: To determine the rate of low birth weight and some of the risk factors associated with this event among adolescents. METHODS: A cross-sectional study conducted between October 1994 and December 2009 at a maternity in Campinas, in Brazil, using information generated from the computerized obstetric form. After selection of adolescents who delivered at this hospital, two groups were created, with and without low birth weight, respectively. Relative risk and 95% confidence interval for all independent variables (risk factors) and the Χ2 test for some perinatal results were performed. The level of significance was set at 5%. RESULTS: During the study period, 24,000 births occurred at CAISM. Of these, 2,404 occurred among 2,357 teenagers (10.02%) and the frequency of low birth weight was 15.1%. Adolescent pregnancy recurred in 294 (8.2%). Age less than 15 years-old, anemia, smoking, and hypertension were not significantly associated with low birth weight. Antecedent of miscarriage and association with systemic lupus erythematosus increased the risk of low birth weight. Cesarean section and an Apgar score below seven were more prevalent among adolescents with low birth weight, and 85% of all adolescents had less than six prenatal visits. CONCLUSIONS: The prevalence of low birth weight is higher among adolescents than among adult women, and there was a large number of adolescents with less than six prenatal visits . The antecedent of miscarriage and the presence of systemic lupus erythematosus were risk factors associated with the occurrence of low birth weight among adolescents.
Summary
Rev Bras Ginecol Obstet. 2011;33(10):286-291
DOI 10.1590/S0100-72032011001000003
PURPOSES: To determine the rate of low birth weight and some of the risk factors associated with this event among adolescents. METHODS: A cross-sectional study conducted between October 1994 and December 2009 at a maternity in Campinas, in Brazil, using information generated from the computerized obstetric form. After selection of adolescents who delivered at this hospital, two groups were created, with and without low birth weight, respectively. Relative risk and 95% confidence interval for all independent variables (risk factors) and the Χ2 test for some perinatal results were performed. The level of significance was set at 5%. RESULTS: During the study period, 24,000 births occurred at CAISM. Of these, 2,404 occurred among 2,357 teenagers (10.02%) and the frequency of low birth weight was 15.1%. Adolescent pregnancy recurred in 294 (8.2%). Age less than 15 years-old, anemia, smoking, and hypertension were not significantly associated with low birth weight. Antecedent of miscarriage and association with systemic lupus erythematosus increased the risk of low birth weight. Cesarean section and an Apgar score below seven were more prevalent among adolescents with low birth weight, and 85% of all adolescents had less than six prenatal visits. CONCLUSIONS: The prevalence of low birth weight is higher among adolescents than among adult women, and there was a large number of adolescents with less than six prenatal visits . The antecedent of miscarriage and the presence of systemic lupus erythematosus were risk factors associated with the occurrence of low birth weight among adolescents.
Summary
Rev Bras Ginecol Obstet. 2009;31(10):480-484
DOI 10.1590/S0100-72032009001000002
PURPOSE: to evaluate epidemiological aspects in recurrent adolescence pregnancy. METHODS: cohort study including 187 pregnant adolescents attended and followed-up for five years after delivery in an adolescent's attendance service in Ceará state. Age group, being or not at school, living with parents, schooling, marital status and the present partner's condition were analyzed. Data were processed by the EPI-INFO program. Statistical analysis of the independent variables (age, schooling, being at school, having a job, living with parents, marital status and switching partners) was done and compared to the dependent variable (being or not pregnant after five years). The Fisher's exact test was used to evaluate the association among factors which could influence the pregnancy recurrence, the association being present when p<0.05. Risks related to schooling, marital status and multiple partners have been calculated, since these were significant factors for pregnancy recurrence. RESULTS: 61% of the adolescents got pregnant in the five years after the first delivery. Factors such as age, school, work or living with parents were not protective. Nevertheless, when the adolescents had eight or less years of schooling, the risk of getting pregnant has almost duplicated (relative risk (RR)=1.8 (CI95%=1.3-2.6)). New pregnancies were more frequent among the single adolescents without a stable partner (RR=1.3 (CI95%=1.1-1.6) and among the ones who had multiple partners (RR=1.4 (CI95%=1.1-1.7)). CONCLUSIONS: low schooling, multiple partners and non-stable bonds were risk factors for pregnancy recurrence.
Summary
Rev Bras Ginecol Obstet. 2009;31(10):480-484
DOI 10.1590/S0100-72032009001000002
PURPOSE: to evaluate epidemiological aspects in recurrent adolescence pregnancy. METHODS: cohort study including 187 pregnant adolescents attended and followed-up for five years after delivery in an adolescent's attendance service in Ceará state. Age group, being or not at school, living with parents, schooling, marital status and the present partner's condition were analyzed. Data were processed by the EPI-INFO program. Statistical analysis of the independent variables (age, schooling, being at school, having a job, living with parents, marital status and switching partners) was done and compared to the dependent variable (being or not pregnant after five years). The Fisher's exact test was used to evaluate the association among factors which could influence the pregnancy recurrence, the association being present when p<0.05. Risks related to schooling, marital status and multiple partners have been calculated, since these were significant factors for pregnancy recurrence. RESULTS: 61% of the adolescents got pregnant in the five years after the first delivery. Factors such as age, school, work or living with parents were not protective. Nevertheless, when the adolescents had eight or less years of schooling, the risk of getting pregnant has almost duplicated (relative risk (RR)=1.8 (CI95%=1.3-2.6)). New pregnancies were more frequent among the single adolescents without a stable partner (RR=1.3 (CI95%=1.1-1.6) and among the ones who had multiple partners (RR=1.4 (CI95%=1.1-1.7)). CONCLUSIONS: low schooling, multiple partners and non-stable bonds were risk factors for pregnancy recurrence.
Summary
Rev Bras Ginecol Obstet. 2009;31(8):404-410
DOI 10.1590/S0100-72032009000800006
PURPOSE: to identify factors associated with gestation in adolescence in a State of the northeast of Brazil. METHODS: a case-control study in the ratio of one 10 to 19-year-old adolescent (case) for two 20 to 35-year-old women (controls), with a total of 168 cases and 337 controls. The variables analyzed were: schooling, marital status, origin, family income per capita in Brazilian currency, paid job, mother's schooling, and presence of adolescent's father at home. Reproductive variables such as age at the first intercourse, mother's history of adolescence pregnancy, gynecological appointments before the pregnancy, knowledge, access and use of contraceptive methods were also included in the analysis. RESULTS: the following variables were associated with gestation in adolescence: schooling lower than eight years, lack of a regular mate, and maternal history of adolescence gestation. Also, the age at the first intercourse was significantly lower among the adolescents and that they had a lower rate of gynecological appointments. Knowledge of hormonal methods and access to contraceptive methods were also less frequent among the adolescents. After the multiple logistic regression analysis, risk factors for pregnancy at adolescence were: low schooling (OR=2.3; CI95%=1.3-3.8), age at the first intercourse lower than 15 years old (OR=3.6; CI95%=2.2-5.7), history of maternal pregnancy at adolescence (OR=2.6; CI95%=1.7-3.4). The history of previous gynecological appointments (OR=0.3; CI95%=0.2-0.4) and the use of hormonal methods (OR=0.6; CI95%=0.4-0.9) were protecting variables. CONCLUSIONS: the main factors associated with pregnancy in adolescence were: the adolescent's low schooling, maternal history of adolescence gestation, lack of previous gynecological appointments and lack of access to contraceptive methods.
Summary
Rev Bras Ginecol Obstet. 2009;31(8):404-410
DOI 10.1590/S0100-72032009000800006
PURPOSE: to identify factors associated with gestation in adolescence in a State of the northeast of Brazil. METHODS: a case-control study in the ratio of one 10 to 19-year-old adolescent (case) for two 20 to 35-year-old women (controls), with a total of 168 cases and 337 controls. The variables analyzed were: schooling, marital status, origin, family income per capita in Brazilian currency, paid job, mother's schooling, and presence of adolescent's father at home. Reproductive variables such as age at the first intercourse, mother's history of adolescence pregnancy, gynecological appointments before the pregnancy, knowledge, access and use of contraceptive methods were also included in the analysis. RESULTS: the following variables were associated with gestation in adolescence: schooling lower than eight years, lack of a regular mate, and maternal history of adolescence gestation. Also, the age at the first intercourse was significantly lower among the adolescents and that they had a lower rate of gynecological appointments. Knowledge of hormonal methods and access to contraceptive methods were also less frequent among the adolescents. After the multiple logistic regression analysis, risk factors for pregnancy at adolescence were: low schooling (OR=2.3; CI95%=1.3-3.8), age at the first intercourse lower than 15 years old (OR=3.6; CI95%=2.2-5.7), history of maternal pregnancy at adolescence (OR=2.6; CI95%=1.7-3.4). The history of previous gynecological appointments (OR=0.3; CI95%=0.2-0.4) and the use of hormonal methods (OR=0.6; CI95%=0.4-0.9) were protecting variables. CONCLUSIONS: the main factors associated with pregnancy in adolescence were: the adolescent's low schooling, maternal history of adolescence gestation, lack of previous gynecological appointments and lack of access to contraceptive methods.
Summary
Rev Bras Ginecol Obstet. 2008;30(5):224-231
DOI 10.1590/S0100-72032008000500004
PURPOSE: to analyze the association of pregnancy in adolescence with low birth weight (LBW). METHODS: all the patients who gave birth in a teaching Hospital at Maranhão State from July to December 2006 were included in the study and were split in two groups: adolescents (ten to 19 years old) and adults (20 to 34 years old). The variables studied were: skin color, schooling, marital status, family income, number of pre-natal appointments, gestational age at the onset of pre-natal assistance, place where they spend that period, gestation duration, delivery route and birth weight. Data were processed by the Epi-Info program, 3.4.1 version, and the associations between variables were analyzed by the Odds Ratio (OR), with a confidence interval (CI) of 95%. Models of logistic regression were also used. The significance level adopted was 0.05. RESULTS: 1,978 patients were evaluated. A ratio of 25.4% of deliveries in adolescents was observed; they presented low level of schooling, no mates, low number of pre-natal appointments, late onset of pre-natal assistance, low birth weight and prematurity. In the analysis of LBW as end variable, associated to prematurity (OR=29.0), it was clear the association with low number of pre-natal appointments (OR=2.98; 95%CI=2.23-4.00), pre-natal late onset (OR=1.91; 95%CI=1.3-2.6) and low schooling (OR=1.95; 95%CI=1.4-2.5) related to adolescence (OR=1.50; 95%CI=1.1-1.9). Similar results were obtained when the prematurity variable was excluded. Adolescents showed lower incidence of caesarean section (33.3%) than adults (49.4%), a significant difference, besides lower association with pre-eclampsia and cephalo-pelvic disproportion. CONLUSIONS: pregnancy in adolescence was associated to pre-natal late onset and low number of appointments, besides low schooling, low birth weight and a lower incidence of cephalo pelvic disproportion and pre-eclampsia.
Summary
Rev Bras Ginecol Obstet. 2008;30(5):224-231
DOI 10.1590/S0100-72032008000500004
PURPOSE: to analyze the association of pregnancy in adolescence with low birth weight (LBW). METHODS: all the patients who gave birth in a teaching Hospital at Maranhão State from July to December 2006 were included in the study and were split in two groups: adolescents (ten to 19 years old) and adults (20 to 34 years old). The variables studied were: skin color, schooling, marital status, family income, number of pre-natal appointments, gestational age at the onset of pre-natal assistance, place where they spend that period, gestation duration, delivery route and birth weight. Data were processed by the Epi-Info program, 3.4.1 version, and the associations between variables were analyzed by the Odds Ratio (OR), with a confidence interval (CI) of 95%. Models of logistic regression were also used. The significance level adopted was 0.05. RESULTS: 1,978 patients were evaluated. A ratio of 25.4% of deliveries in adolescents was observed; they presented low level of schooling, no mates, low number of pre-natal appointments, late onset of pre-natal assistance, low birth weight and prematurity. In the analysis of LBW as end variable, associated to prematurity (OR=29.0), it was clear the association with low number of pre-natal appointments (OR=2.98; 95%CI=2.23-4.00), pre-natal late onset (OR=1.91; 95%CI=1.3-2.6) and low schooling (OR=1.95; 95%CI=1.4-2.5) related to adolescence (OR=1.50; 95%CI=1.1-1.9). Similar results were obtained when the prematurity variable was excluded. Adolescents showed lower incidence of caesarean section (33.3%) than adults (49.4%), a significant difference, besides lower association with pre-eclampsia and cephalo-pelvic disproportion. CONLUSIONS: pregnancy in adolescence was associated to pre-natal late onset and low number of appointments, besides low schooling, low birth weight and a lower incidence of cephalo pelvic disproportion and pre-eclampsia.