Effectiveness of recruitment and retention strategies in a pregnant adolescent nutrition intervention study.

AIM: To report the methodological strategies used to recruit and retain pregnant adolescents into a nutrition-focused intervention study. BACKGROUND: An important step to meeting the developmental and healthcare needs of pregnant adolescents is to conduct high-quality research studies that generate reliable and accurate data. However, recruitment and retention of pregnant adolescents into research are challenging and time intensive. DESIGN: A quasi-experimental, one-group, pre, post, 6-week postintervention repeated measures study was conducted among inner-city pregnant adolescents. METHOD: Study participants' nutrition knowledge, eating habits, and personal self-efficacy were measured prior to pregnant adolescents' participation in the workshop, immediately after the intervention and 6-weeks following the intervention. A total of four workshops were conducted over 14 months from 2014-2015. RESULTS: Gatekeepers were influential in recruitment efforts due to trusting relationship they had with study participants. The use of texting reminders and pregnant adolescent-related incentives that included gift bags and baby items were also effective recruitment and retention strategies. Despite designing the recruitment strategies and using a developmentally tailored workshop, based on empirical evidence gleaned from pregnant adolescents that was modified to meet study participant's schedules, an adequate sample was unable to be recruited and retained for this study. CONCLUSION: High-quality research studies that generate reliable and accurate data are essential in meeting the developmental and healthcare needs of pregnant adolescents. A major barrier in developing evidence-based care practices to promote the health of these young mothers and their children involves recruiting and retaining them in research studies.

Unlike pregnant adult women, pregnant adolescent girls cannot maintain glycine flux during late pregnancy because of decreased synthesis from serine.

During pregnancy, glycine and serine become more important because they are the primary suppliers of methyl groups for the synthesis of fetal DNA, and more glycine is required for fetal collagen synthesis as pregnancy progresses. In an earlier study, we reported that glycine flux decreased by 39% from the first to the third trimester in pregnant adolescent girls. As serine is a primary precursor for glycine synthesis, the objective of this study was to measure and compare glycine and serine fluxes and inter-conversions in pregnant adolescent girls and adult women in the first and third trimesters. Measurements were made after an overnight fast by continuous intravenous infusions of 2H2-glycine and 15N-serine in eleven adolescent girls (17·4 (se 0·1) years of age) and in ten adult women (25·8 (se 0·5) years of age) for 4 h. Adolescent girls had significantly slower glycine flux and they made less glycine from serine in the third (P<0·05) than in the first trimester. Baby birth length was significantly shorter of adolescent girls (P=0·04) and was significantly associated with third trimester glycine flux. These findings suggest that the pregnant adolescent cannot maintain glycine flux in late pregnancy compared with early pregnancy because of decreased synthesis from serine. It is possible that the inability to maintain glycine synthesis makes her fetus vulnerable to impaired cartilage synthesis, and thus linear growth.

Nutritional knowledge, nutritional status and associated factors among pregnant adolescents in the West Arsi Zone, central Ethiopia.

When pregnancy occur among teenagers; there is a competition for nutrients between the still-growing adolescent mother and her fetus. Pregnant adolescents' nutrition issues are not addressed well and changes are too slow in Ethiopia. This study aimed to study, nutrition knowledge, nutritional status and associated factors among pregnant adolescents in West Arsi , central Ethiopia. We conducted a cross-sectional study of 426 pregnant adolescents between January 1 and January 25, 2023. Data were collected using kobo collect and analyzed using SPSS version 25. We performed linear regression to identify independent predictors of nutritional status and multivariable logistic regression analyses to identify nutritional knowledge. Odds ratios (ORs) with 95% confidence intervals were estimated to show the strength of the association. Magnitude of good nutrition knowledge was 23.7%, 95% CI (21.4-25.3%), and the odds of having good nutrition knowledge was 7.5 times higher among participants whose education level was above college compared with illiterate participants [(AOR = 7.5, 95% CI = (5.27-9.38)],the odds of having good nutrition knowledge was 8 times higher among adolescent who had ANC visits, [(AOR = 8, 95% CI = (3.63-13.85)], and the odds of having good nutrition knowledge was 5 times higher among adolescents who received nutrition education [(AOR = 5, 95% CI = (3.67- 13.53)]. Receiving nutrition education (ß = 0.25, P = 0.002) and good nutrition knowledge (ß = 0.08, P < 0.001) were positively associated with nutritional status; however, food insecurity (ß = - 0.93, P < 0.001) was negatively associated with nutritional status. The nutrition knowledge of pregnant adolescents was suboptimal; educational status, ANC visits and nutrition education were associated with good nutrition knowledge, whereas food insecurity, low nutrition knowledge, and not receiving nutrition education were predictors of poor nutritional status. Nutritional education interventions, increasing utilization of ANC, and interventions for improving food security are strongly recommended.

Effect of nutrition counseling on nutritional status and gestational weight gain of pregnant adolescents in West Arsi, Central Ethiopia: a cluster randomized controlled trial.

When pregnancy occurs in adolescence, the growth and development of the mother and fetus may be impaired due to strong competition for nutrients between the still-growing adolescent and the fetus. Pregnant adolescents constitute an underserved population; they lack adequate nutritional knowledge. Therefore, this study investigated the effect of nutritional behavior change communication (NBCC) through alliance for development (AFD) on the nutritional status and gestational weight gain (GWG) of pregnant adolescents. A two-arm parallel cluster randomized controlled community trial was conducted in the West Arsi Zone, central Ethiopia, from August 2022 to July 2023. The nutritional status of the pregnant adolescent was assessed using mid-upper arm circumference. Weight was measured at baseline and at the end of the intervention. A total of 207 and 219 pregnant adolescents participated in the intervention and control clusters, respectively. The intervention started before 16 weeks of gestation, and the intervention group attended four NBCC sessions. The NBCC was based on the health belief model (HBM) and was given at the participants' homes with their husbands. The NBCC intervention was delivered by AFDs and community-level health actors. Pregnant adolescents in the control group received routine nutrition education from the health care system. A linear mixed-effects model and difference in difference (DID) were used to measure the intervention effect after adjusting for potential confounders. After the implementation of the trial, the mean mid-upper arm circumference (MUAC) in the intervention arm significantly increased from baseline (p ≤ 0.001), 23.19 ± 2.1 to 25.06 ± 2.9 among intervention group and 23.49 ± 2.1 to 23.56 ± 2.0 among control group and the mean difference in the MUAC (DID) was 1.89 ± 2 cm (p ≤ 0.001); the mean GWG in the intervention arm significantly increased from baseline; 51.54 ± 4.7 to 60.98 ± 4.6 among intervention group and 52.86 ± 5.27 to 58 ± 5.3 among control group; the mean GWG in the intervention group was 9.4 kg, and that in the control group was 5.14 kg, and the difference in difference was 4.23 kg and this was statically significant p ≤ 0.001). This study demonstrated that the use of the HBM for NBCC delivered through the AFD was effective at improving the nutritional status and GWG of pregnant adolescents. These results imply the need for the design of model-based nutritional counseling guidelines.Clinical trial registration: PACTR202203696996305, Pan African Clinical Trials Registry, date of first registration: 16/03/2022.

Adolescent pregnancy and young motherhood in rural Zimbabwe: Findings from a baseline study.

Pregnant adolescents and young mothers comprise a vulnerable group, particularly in low and middle income countries, yet there is limited research describing this population, particularly in rural Zimbabwe. Using tablet-administered questionnaires concerning maternal and child health, sexual and reproductive health, psychosocial well-being and parenting, we recruited 442 pregnant and young mothers (14-24 years) with the support of social workers from health facilities. We found high levels of poverty amidst increased rates of marriage, including child marriage (almost 20%). Participants had poor sexual and reproductive health knowledge and uptake of contraception was low (only 35% respondents reported current use). Although almost 60% girls had completed Form 2, 24% had only completed Grade 1 and just 4% were still engaged in schooling. Girls reported inadequate social support amidst high caretaking responsibilities and change in relocation for marriage, compromising mental health. Most of the pregnancies were unintended (approximately 60%) which had consequences on attachment and parenting where roughly 40% of our sample reported difficulties and lack of enjoyment in caring for their babies. Investments in interventions that address these vulnerabilities for pregnant adolescents and young mothers, and capitalise on available resources, are critical to improve health and interrupt cycles of risk for the next generation.

Recognising the challenges of providing care for Thai pregnant adolescents: Healthcare professionals' views.

BACKGROUND: In Thailand, maternal complications and poor neonatal outcomes are common in pregnant adolescents. There are attempts to improve outcomes for this group through specialised antenatal clinics, however, neither the way in which these clinics are provided nor the attitudes of healthcare professionals to pregnant adolescents are known. The aim of this study was to understand the experiences of healthcare professionals in caring for pregnant adolescent women in Thailand. METHODS: A qualitative descriptive design was used. Semi-structured interviews were conducted with 21 healthcare professionals involved in caring for pregnant adolescents across three public hospitals in Bangkok, Thailand. All interviews were analysed thematically. RESULTS: The core concept 'recognising the challenges of providing care for young Thai pregnant women' explained the provision of care. This concept contained three main themes: 1) having an awareness of the political and societal contexts and environment of care; 2) being aware of attitudes and the need to develop psychosocial skills in caring for adolescent women; and 3) having different approaches to caring for pregnant adolescents. A lack of continuity of care was a significant barrier in terms of structure and process. Effective communication was important to provide quality care. CONCLUSION: Healthcare professionals recognised that there were barriers to providing effective care for adolescent women. These findings may inform healthcare professionals and policymakers in Thailand in relation to the systems of care required and addressing the needs of pregnant adolescents. This would enable Thailand to meet the goal in providing a positive pregnancy experience for all women.

Antenatal Care Service Utilization Among Adolescent Pregnant Women-Evidence From Swabhimaan Programme in India.

Purpose: Pregnant adolescent girls (15-19 years) are more vulnerable to poor health and nutrition than adult pregnant women because of marginalization and lack of knowledge about the antenatal care (ANC) services. The present study aims to test this hypothesis and assess determinants of ANC service utilization among currently adolescent pregnant women. Methods: Data were drawn from the baseline survey of SWABHIMAAN project, which had been conducted in three states of India: Bihar, Chhattisgarh, and Odisha. Out of a total 2,573 pregnant women (15-49 years) included in the sample, about 10% (N = 278) were adolescent girls (15-19 years) at the time of the survey, and the rest were adults. Sample was selected from the population using simple random sampling, and information was collected using pretested questionnaires. Results: For all indicators of ANC service utilization, performance of adolescent pregnant women was better than adult pregnant women. However, significant variations were reported in the level of services received by adult pregnant women for different indicators. Religion, wealth, food insecurity, Village Health Sanitation and Nutrition Day meeting, Public Distribution System and Integrated Child Development Services entitlements, and knowledge of family planning methods had a significant effect on the ANC service utilization. Conclusion: Adolescent pregnant women have shown better utilization of selected indicators than their adult counterparts. Utilization of full ANC services starting from first trimester itself for adolescent pregnant women is an urgent need in present context. Intervention program must pay attention to such adolescent married girls who are entering into the motherhood phase of their lives.

Adolescent Pregnancy and Challenges in Kenyan Context: Perspectives from Multiple Community Stakeholders.

OBJECTIVE: The key objective of this paper is to provide a phenomenological account of the mental health challenges and experiences of adolescent new mothers. We explore the role of social support and the absence of empathy plays in depression among pregnant adolescents. The project also collected data on the adolescents' caregiving environment which includes the adolescents' mothers, their partners, the community, and health care workers, as well as feedback from staff nurses at the maternal and child health centers. The caregivers provide additional insight into some of the barriers to access of mental health services and pregnancy care, and the etiology of adolescents' distress. METHODS: The interviews were conducted in two health facilities of Kariobangi and Kangemi's maternal and child health (MCH) centers that cover a huge low-income and low-middle-income formal and informal settlements of Nairobi. A grounded theory approach provided a unique methodology to facilitate discussion around adolescent pregnancy and depression among the adolescents and their caregivers. Our interviews were cut across four samples with 36 participants in total. The sample 1 comprised of eight pregnant adolescents who screened positive for depression in Kariobangi, sample 2 were six caregivers from both sites, and sample 3 were 22 new adolescent mothers from both sites. After individual interviews, we carried out one focused group discussion (FDG) in order to understand the cross-cutting issues and to gather some consensus on key issues, and the sample 4 were 20 community health workers, health workers, and nurses from both sites. We had one FGD with all health facility-based workers to understand the cross-cutting issues. The interviews in sample 1 and 2 were individual interviews with pregnant and parenting adolescents, and their caregivers. All our adolescent participants interviewed in sample 1 were screened for depression. Individual interviews followed the FGD. FINDINGS: Pregnant and parenting adolescents faced several adversities such as social stigma, lack of emotional support, poor healthcare access, and stresses around new life adjustments. We highlighted a few useful coping mechanisms and strategies that these adolescents were thinking to reduce their stress. Primary social support for pregnant and parenting teens comes from the adolescent's mother. The external family and male partners provide negligible support in the rearing of the child. While the mother's reactions to the daughters' pregnancy were empathetic sometimes, absence of food and resources made the mother distant and constraint in lending support. For those adolescents who were living with partners, in their new mother role, they had to negotiate additional challenges such as solutions to everyday childcare responsibilities and other family duties. The health care workers and community health workers confirmed that adolescent mothers have multiple needs, but there is a lack of holistic approach of service, and that their own training and capacities were very limited. CONCLUSIONS: Our paper highlights several individual stakeholder-related and system-level barriers in the MCH primary care setting that affect delivery of psychosocial support for pregnant adolescent. We have identified these knowledge, practice, and institutional gaps that need addressing through careful community and health service staff engagement using implementation strategies that are effective in low-resource settings. Pregnant adolescents are highly vulnerable group and mental health services needs to be understood better.

Development of an Interactive Pregnant Adolescent Nutrition Education Workshop.

The health of pregnant adolescents affects the well-being of future generations. Modifying unhealthy eating patterns among pregnant adolescents is critical because of their association with risk of poor pregnancy and birth outcomes. Therefore, it is important to provide age- and developmentally appropriate nutrition education during this time. To sustain healthy behavior changes, nutrition interventions must be grounded in theory and reflect both motivating factors and barriers to healthy eating. Factors such as taste preferences, personal self-efficacy, developmentally appropriate nutrition education, and hands-on meal preparation have been identified as influences on dietary patterns in this population. The purpose of this article is to describe the development of an evidence-based nutrition education program for pregnant adolescents based on Pender's health promotion model.

Cuidados prenatales de enfermería proporcionados a adolescentes embarazadas en la consulta externa del CIMIGEN / Prenatal nursing care provided to pregnant adolescents in the external consultation of CIMIGEN / Assistência pré-natal de enfermagem prestada a adolescentes grávidas em consulta externa ao CIMIGENN

"El embarazo en adolescentes está expuesto a consecuencias, no sólo orgánicas sino también psicológicas, sociales, económicas, educativas y laborales. Por ello, se debe de pensar al embarazo en adolescentes en varios contextos y como fenómeno social. Sin embargo, los procedimientos de enfermería para la atención prenatal son los mismos que para toda la población de mujeres embarazadas, sin importar su edad. Objetivo: Identificar los tipos de cuidado que el personal de enfermería proporciona a las adolescentes embarazadas, es decir, los biológicos, psicológicos y sociales. Metodología: Se realizaron sesiones de observación participante, al personal de enfermería cuando brinda atención a gestantes menores de 20 años, y entrevistas semi-estructuradas a este personal. Resultados: En las consultas de enfermería los cuidados prenatales se centraron en los aspectos físicos y biológicos. Incluyeron el pesaje, la elaboración de la historia clínica prenatal, el interrogatorio sobre el desarrollo del embarazo, la toma de presión arterial, la exploración gineco-obstétrica y eventualmente, el Papanicolaou. Además, en las consultas se presentaron episodios de verificación de hábitos alimenticios y de detección de infecciones génito-urinarias, contracciones uterinas y síntomas de alarma para la prevención de riesgos y complicaciones en la salud. A pesar de que los aspectos psicosociales fueron poco evidentes en los cuidados dados por las enfermeras, sí los tomaron en cuenta: tranquilizaban a las adolescentes, les demostraban comprensión acerca de su conducta, las recriminaban por su alimentación inadecuada o por no tomar en tiempo y forma los medicamentos. Conclusión: El cuidado prenatal de enfermería a gestantes adolescentes tiene un énfasis curativo y preventivo en torno a lo físico y biológico. Aunque las enfermeras tienen potencial para realizar un cuidado prenatal más integral y de mayor calidad, los aspectos psicosociales en éste son débiles. Por ello, se recomienda fortalecerlos, mediante la formación profesional, la capacitación del personal y la modificación de algunas políticas y normas de la institución de salud, y así poder responder mejor a las necesidades de este grupo."

"A gravidez na adolescência está exposta a consequências, não apenas orgânicas, mas também psicológicas, sociais, econômicas, educacionais e trabalhistas. Portanto, a gravidez deve ser considerada em adolescentes em vários contextos e como um fenômeno social. No entanto, os procedimentos de enfermagem para o pré-natal são os mesmos de toda a população de gestantes, independentemente da idade. Objetivo: Identificar os tipos de cuidados que os enfermeiros prestam às adolescentes grávidas, isto é, biológicas, psicológicas e sociais. Metodologia: Foram realizadas sessões de observação dos participantes com a equipe de enfermagem no atendimento a gestantes menores de 20 anos e entrevistas semiestruturadas com essas equipes. Resultados: nas consultas de enfermagem, o pré-natal focado nos aspectos físicos e biológicos. Eles incluíram pesagem, preparação da história clínica pré-natal, interrogatório sobre o desenvolvimento da gravidez, aferição da pressão arterial, o exame gineco-obstétrico e, eventualmente, o exame de Papanicolaou. Além disso, as consultas apresentaram episódios de verificação dos hábitos alimentares e detecção de infecções genito-urinárias, contrações uterinas e sintomas de alarme para a prevenção de riscos e complicações à saúde. Embora os aspectos psicossociais não fossem muito evidentes nos cuidados prestados pelos enfermeiros, eles os levaram em consideração: tranquilizaram os adolescentes, mostraram compreensão sobre seu comportamento, os recriminaram por sua alimentação inadequada ou por não levá-los a tempo e a tempo. formar os medicamentos. Conclusão: A assistência pré-natal de enfermagem às adolescentes grávidas tem ênfase curativa e preventiva nos aspectos físicos e biológicos. Embora os enfermeiros tenham potencial para realizar um pré-natal mais abrangente e de maior qualidade, os aspectos psicossociais nele são fracos. Portanto, recomenda-se fortalecê-los, por meio de treinamento profissional, treinamento de pessoal e modificação de algumas políticas e padrões da instituição de saúde, para poder responder melhor às necessidades desse grupo."

"Teen pregnancy is exposed to consequences, not only organic but also psychological, social, economic, educational and labor. Therefore, pregnancy should be considered in adolescents in various contexts and as a social phenomenon. However, the nursing procedures for prenatal care are the same as for the entire population of pregnant women, regardless of their age. Objective: To identify the types of care that nurses provide to pregnant adolescents, that is, biological, psychological and social. Methodology: Participant observation sessions were held to the nursing staff when providing care to pregnant women under 20 years of age, and semi-structured interviews with these staff. Results: In nursing consultations, prenatal care focused on physical and biological aspects. They included weighing, the preparation of the prenatal clinical history, the interrogation on the development of pregnancy, the taking of blood pressure, the gyneco-obstetric examination and, eventually, the Pap smear. In addition, the consultations presented episodes of verification of eating habits and detection of genitourinary infections, uterine contractions and alarm symptoms for the prevention of health risks and complications. Although the psychosocial aspects were not very evident in the care given by the nurses, they did take them into account: they reassured the adolescents, showed them understanding about their behavior, recriminated them for their inadequate feeding or for not taking them in time and form the medications. Conclusion: Prenatal nursing care for pregnant teenagers has a curative and preventive emphasis on the physical and biological aspects. Although nurses have the potential to perform a more comprehensive and higher quality prenatal care, the psychosocial aspects in it are weak. Therefore, it is recommended to strengthen them, through professional training, staff training and the modification of some policies and standards of the health institution, and thus be able to better respond to the needs of this group."

Significado de las prácticas de cuidado cultural de sí y de su hijo por nacer, de un grupo de gestantes adolescentes de Barranquilla / Meaning of the practices of cultural care of oneself and of their unborn child, of a group of pregnant adolescents from Barranquilla

Introducción: La adolescencia es una etapa importante en el ciclo vital de la mujer, que puede hacerse difícil cuando va acompañada de un evento muchas veces no esperado. Diversos estudios han explorado el impacto de la gestación en la salud materna y neonatal, y han encontrado que es más relevante en la adolescente; situación que resalta la vulnerabilidad de esta población. La literatura evidencia que el cuidado de la gestante adolescente, involucra a la familia, sus creencias y prácticas tradicionales como elementos culturales; por tanto, deben ser reconocidos por Enfermería. Esta investigación tuvo como objetivo: describir el significado de las prácticas de cuidado cultural de sí y de su hijo por nacer en un grupo de gestantes adolescentes asistentes al control prenatal del Hospital Niño Jesús de Barranquilla. Metodología: Estudio cualitativo de tipo etnográfico, en el que se utilizó el método de la Etnoenfermería propuesto por Leininger. Las participantes fueron: 10 gestantes adolescentes entre 15 y 19 años, y 12 enfermeras con experiencia en el área. Las primeras como informantes clave, y las segundas como informantes generales. Resultados: Se encontró que el significado de las prácticas de cuidado cultural, para las gestantes adolescentes, se clasifica en tres grandes temas: 1) Prácticas de cuidado transmitidas de generación en generación predominando la línea femenina, 2) La confianza en Dios y el apoyo de la familia como una forma de cuidarse, y 3) Dar a luz un hijo sano. Discusión y Conclusiones: Las prácticas de cuidado de las gestantes adolecentes están fuertemente enraizadas en sus creencias, mitos y valores culturales heredados de generación en generación; mostrando así, patrones de cuidado cultural. Aspecto que debe ser identificado por Enfermería, para ofrecer cuidados que sean culturalmente congruentes a esta población.

Introduction: Adolescence is an important stage in the life cycle of women, which can be difficult when accompanied by an event often unexpected. Several studies have explored the impact of pregnancy on maternal and neonatal health, and have found that it is more relevant in the adolescent, a situation that highlights the vulnerability of this population. The literature shows that the pregnant adolescent care, involving the family, their beliefs and practices as cultural elements, therefore, should be recognized for Nursing. This research aimed to: explore the meaning of cultural care practices themselves and their unborn child in a group of pregnant adolescents in Barranquilla Methodology: qualitative ethnographic study in which we used the method proposed by Leininger Ethnonursing. Participants were 10 pregnant adolescents between 15 and 19 years, who attended the prenatal control a public hospital in Barranquilla, and 12 nurses with experience in the area. The first as key informants, and the latter as general informants. Results: We found that the meaning of cultural care practices for pregnant teens, is classified into three major themes: 1) care practices handed down from generation to generation dominate the female line, 2) Trust in God and the support family as a form of care, and 3) Give birth to a healthy child. Discussion and Conclusions: The care practices of pregnant adolescents are strongly rooted in their beliefs, myths and cultural values inherited from generation to generation, thus showing, cultural care patterns. Aspect that must be identified by Nursing, to provide care that is culturally congruent to this population.

Factores de riesgo del embarazo, parto y recién nacido en adolescentes embarazadas / Pregnancy, labor and newborn risk factors in pregnant adolescents

La atención de adolescentes embarazadas necesita de programas basados en el riesgo obstétrico y perinatal. La determinación de estos riesgos de morbilidad deberán ser aplicados antes de la ocurrencia de los episodios de enfermedad, en forma predictiva. El objetivo de este estudio es la determinación de estos riesgos para lo cual se desarrolló un estudio de comparación grupos prospectivos en 652 adolescentes embarazadas con y sin morbilidad durante los períodos prenatal, parto, puerperio y recién nacido. La muestra se registró entre 1981 y 1986 en el Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, (CEMERA), de la Facultad de Medicina de la Universidad de Chile y se coordinó con tres consultorios materno-infantiles de Atención Primaria del sector norte de la ciudad de Santiago, todos los partos fueron atendidos en el Hospital Clínico Universitario José Joaquin Aguirre. Se hizo un análisis bifactorial para determinar las variables asociadas a la morbilidad en cada período y luego un análisis multifactorial. Se determinó un total de 7 factores de Riesgo Predictivo: Pareja Estudiante o en el Servicio Militar o con Trabajo ocasional, estatura de la adolescente de 1,50 m o menos, embarazo consecuencia de seducción o violación, dos años de educación media, menarquia a los 11 años o menos, estado nutricional de enflaquecidad medida por area muscular braquial, actitud indiferente o negativa al inicio del embarazo. Con estos factores se diseña un instrumento aplicativo para determinar la población de "Alto Riesgo" y de "Riesgo No Predicible". Se sugiere un esquema de atención por niveles de complejidad

Pregnant adolescents need a medical care program based on predictive high risk factors of perinatal morbidity. These factors should be applied before the ocurrence of the morbidity episodes, as predictive system. The objective of this study was to determine these factors. A prospective study of 652 pregnant adolescents clasiffied in two groups. One group with pathology during pregnancy or delivery or post partum or the New Born period. The other group without pathology.The total sample was recruited and studied between 1981 and 1986 at the Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, (CEMERA), of the Faculty of Medicine of University of Chile. and coodinated with 3 maternal and child primary health care clinics in the north of Santiago city. All deliveries, were attended at the University Clinical, Hospital José Joaquín Aguirre. A bifactorial analysis was performed to isolate the most significant associated factors to morbidity in each of the periods described before. These factors were analyzed with a multivariate model, using the SAS software. Seven factors were isolated Partner: student or in military service or unemployed, pregnant adolescent stature of 1.50 m. or less , pregnancy as result of rape or sexual seduction , first two years of high school, menarche at 11 years old or less, undernourrished measured by muscular brachial area and indifferent or negative attitude at the begining of pregnancy. These factors were ordered by level of statistical significance and a model was built to classify the pregnant teenagers as " High Risk" or "Not Predictive Risk". It is suggested a model by different levels of health care complexity