Mortalidad materna en la adolescencia y la juventud: tendencia temporal y correlación con la cobertura prenatal en Bahia, Brasil, 2000-2020

Galvão, Lorena Ramalho; Costa, Maria Conceição Oliveira; Gama, Silvana Granado Nogueira da; Amaral, Magali Teresópolis Reis; Santos, Djanilson Barbosa dos; Barros, Naysa Farias; Rosario, Wanessa Oliveira

doi:10.1590/S2237-96222023000200022

person Lorena Ramalho Galvão

conception and design · data extraction · analysis and interpretation · drafting · integrity

schoolUniversidade Estadual de Feira de Santana, Programa de Pós-Graduação em Saúde Coletiva, Feira de Santana, BA, Brazil

0000-0002-4643-8994

person Maria Conceição Oliveira Costa

conception and design · data extraction · analysis and interpretation · drafting · integrity

schoolUniversidade Estadual de Feira de Santana, Programa de Pós-Graduação em Saúde Coletiva, Feira de Santana, BA, Brazil

0000-0001-6695-7268

person Silvana Granado Nogueira da Gama

design · data interpretation · writing · integrity

schoolFundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, RJ, Brazil

0000-0002-9200-0387

person Magali Teresópolis Reis Amaral

analysis and interpretation · reviewing · integrity

schoolUniversidade Estadual de Feira de Santana, Programa de Pós-Graduação em Saúde Coletiva, Feira de Santana, BA, Brazil

0000-0003-1474-9154

person Djanilson Barbosa dos Santos

design · data interpretation · writing · integrity

schoolUniversidade Federal do Recôncavo da Bahia, Centro de Ciências da Saúde, Santo Antônio de Jesus, BA, Brazil

0000-0002-6128-1155

person Naysa Farias Barros

design · data interpretation · writing · integrity

schoolUniversidade Estadual de Feira de Santana, Programa de Pós-Graduação em Saúde Coletiva, Feira de Santana, BA, Brazil

0000-0001-8079-4581

person Wanessa Oliveira Rosario

design · data interpretation · writing · integrity

schoolUniversidade Estadual de Feira de Santana, Programa de Pós-Graduação em Saúde Coletiva, Feira de Santana, BA, Brazil

0000-0001-9141-6551

personCorresponding author: Lorena Ramalho Galvão.
emaile-mail: loregalvao20@gmail.com

groupsAUTHOR 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

Groups of causes	ICD-10^th codes
1 - Pregnancy with abortive outcome	O00-O07
2 - Hypertensive disorders in pregnancy, childbirth and the puerperium	O11-O16
3 - Obstetric hemorrhage	O20; O43-O46; O67; O71.0; O71.1, O71.3, O71.4, O71.7; O72
4 - Infections during pregnancy	O23; O41.1; O75.3; O85-O86; O91
5 - Other obstetric complications	O21.1, O21.2; O22; O24.4; O26.6, O26.9; O30-O36^b; O40^b; O41.0, O41.8, O41.9^b; O42^b; O60-061^b; O62; 063-066^b; O71.2, O71.5, O71.6, O71.8, O71.9; O73; O75.0-O75.2, O75.4-O75.9; O87.1, O87.3, O87.9; O88; O90
6 - Unanticipated complications (related to anesthesia)	O29; O74; O89
7 - Non-obstetric complications	O10; O24.0, O24.2, O24.3, O24.9; O98 (inclui B20-24) e O99
8 - Unspecified cause	O95

Variable	10 to 19 years old						20 to 24 years old
Variable	n	Total MMR^a	APC^b	_95% CI ^c	p-value	Trend	N	Total MMR^a	APC^b	_95% CI ^c	p-value	Trend
Total number of deaths	418	59.7^d	-2.2	-4.3;-0.01	0.049	Decreasing	574	63.2^d	-2.9	-4,5;-1.4	0.001	Decreasing
Race/skin color
White	70	83.6	1.5	-2.3;5.5	0.413	Stability	79	66.4	-2.9	-18.1;15.1	0.722	Stability
Black	37	68.4	-16.5	-30.6;0.5	0.056	Stability	89	118.9	-31.5	-12.5;7.2	0.518	Stability
Mixed-race	259	34.4	2.8	0.3;5.4	0.031	Increasing	334	35.2	-0.1	-2.2;2.1	0.913	Stability
Direct causes	266	26.4	0.8	-1.1;2.7	0.393	Stability	360	27.7	-0.8	-2.2;0.6	0.254	Stability
Abortion	52	5.2	-4.7	-13.7;5.1	0.316	Stability	57	4.4	-0.5	-8.9;8.7	0.910	Stability
Hypertension	86	8.5	0.2	-7.7;8.9	0.951	Stability	112	8.6	-7.3	-13.7;-0.4	0.039	Decreasing
Hemorrhage	26	2.6	1.9	-9.7;15.0	0.746	Stability	61	4.7	-4.7	-15.1;7.0	0.397	Stability
Infections	40	4.0	9.5	-3.1;23.8	0.138	Stability	40	3.1	0.8	-7.1;9.5	0.837	Stability
Other obstetric complications	60	6.0	-0.08	-4.34;4.37	0.970	Stability	87	6.7	1.46	-1.67;4.70	0.345	Stability
Indirect causes	140	13.9	0.8	-3.9;5.6	0.740	Stability	192	14.8	-0.1	-4.4;4.4	0.969	Stability
Non-obstetric complications	140	13.9	0.8	-3.9;5.6	0.740	Stability	192	14.8	-0.1	-4.4;4.4	0.969	Stability
Unspecified cause	12	1.2	2.6	-9.2;16.0	0.662	Stability	22	1.7	21.2	11.2;32.0	0.000	Increasing
Unknown causes	12	1.2	2.6	-9.2;16.0	0.662	Stability	22	1.7	21.2	11.2;32.0	< 0.001	Increasing
Time of death
During pregnancy, childbirth or abortion	146	14.5	2.9	-2.5;8.7	0.280	Stability	198	15.3	3.0	-6.5;13.5	0.532	Stability
Up to 42 days postpartum	133	13.2	11.0	5.1;17.3	0.001	Increasing	212	16.3	7.2	0.05;14.9	0.049	Increasing

Variable	10 to 19 years old			20 to 24 years old
Variable	Mean	Standard deviation	p-value	Mean	Standard deviation	p-value
Total MMR^a	57.9	18.7		61	16.5
Race/skin color^b
White	88.4	43.8	0.015	69.8	44.9	< 0.001
Black	132.9	176.8		194.1	235.4
Mixed race	35.1	10.8		35.1	8.2
Type of causes^b
Direct	26.6	7.0	< 0.001	27.6	5.4	< 0.001
Indirect	13.8	5.9		14.6	6.8
Unspecified	1.2	1.2		1.9	1.8
Time of death^c
During pregnancy, childbirth or abortion	14.6	7.00	0.906	15.2	8.7	0.439
Up to 42 days postpartum	14.3	8.3	0.906	17.4	9.6	0.439

Variable	CSMMR^a
	10 to 19 years old		20 to 24 years old
	r^b	p-value	r^b	p-value
Prenatal care coverage
Did not have any prenatal care visits	0.34	0.138	0.42	p-value	0.057
≤ 6 prenatal care visits	0.32	0.151	0.81	< 0.001
> 6 prenatal care visits	-0.52	0.017	-0.73	< 0.001

[TFN1] Source: adapted from the World Health Organization.¹⁵

[TFN2] a) ICD-10 = International Statistical Classification of Diseases and Related Health Problems - 10^th Revision -; b) Unlikely causes of maternal death, included in the group of other obstetric complications.