Teenage pregnancy: use of drugs in the third
trimester and prevalence of psychiatric disorders
Gravidez na adolescência: uso de drogas no terceiro
trimestre e prevalência de transtornos psiquiátricos
Objective: To determine the prevalence of psychiatric disorders during pregnancy, the prevalence of cocaine and marijuana use
during the third trimester of gestation and the socio-demographic characteristics of a population of low-income teenagers.
Method: One thousand pregnant teenagers were evaluated using the Composite International Diagnostic Interview, and a socio-
demographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo, Brazil. Hair sample was
collected for analysis. Results: Of the 1000 pregnant teenagers interviewed, 53.6% were poor, 90.4% were unemployed, 92.5%
were financially dependant and 60.2% dropped out of school. Those using drugs during the third trimester of pregnancy were
equal to 6% (marijuana: 4%, cocaine: 1.7%, both: 0.3%). Those having at least one psychiatric disorder equaled 27.6%. The
most frequent diagnoses were depression (12.9%), posttraumatic stress disorder (10.0%) and anxiety disorders (5.6%). Discussion:
Unstructured families, dropping out of school, unemployment and a low level of professional training are all contributing factors
to the maintenance of an unfavorable socio-economic environment in which there is a high prevalence of cocaine and marijuana
use during the third trimester of pregnancy and an abnormally high incidence of psychiatric disorders.
Keywords: Pregnancy in adolescence; Substance-related disorders; Mental disorders; Psychosis substance-induced; Perinatal
mortality (Public Health)
Objetivo: Determinar, em adolescentes de baixa renda, a prevalência de transtornos psiquiátricos durante a gravidez, a prevalência
de uso de cocaína e maconha no terceiro trimestre de gestação e descrever suas características sociodemográficas. Método: Mil
adolescentes grávidas foram avaliadas por meio do Composite International Diagnostic Interview e de um questionário sociodemográfico
e socioeconômico no centro obstétrico de um hospital público de São Paulo. Dessas, foi colhida amostra para análise de fios de
cabelo. Resultados: Das mil pacientes entrevistadas, 53,6% têm baixa renda, 60,2% abandonaram a escola, 90,4% estão
desempregadas e 92,5% são financeiramente dependentes, 6% usaram drogas durante o terceiro trimestre da gravidez (maco-
nha: 4%, cocaína: 1,7%, ambos: 0,3%) e 27,6% tiveram ao menos um transtorno psiquiátrico. Os diagnósticos mais freqüentes
foram: depressão (12,9%), transtorno de estresse pós-traumático (10,0%) e ansiedade (5,6%). Discussão: Famílias desestruturadas,
evasão escolar, desemprego e baixa capacitação profissional são fatores que contribuem para a manutenção desta situação
socioeconômica desfavorável, cenário no qual são elementos importantes a alta prevalência de uso de cocaína e maconha no
3º trimestre da gravidez e de transtornos psiquiátricos.
Descritores: Gravidez na adolescência; Transtornos relacionados ao uso de substâncias; Transtornos mentais; Psicoses induzidas
por substâncias; Mortalidade perinatal (Saúde Pública)
1Research Unit of Alcohol and Drugs (Uniad), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP),
2Neonatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
Rev Bras Psiquiatr. 2006;28(2):122-5
Sandro Sendin Mitsuhiro,1 Elisa Chalem,1 Marina Moraes Barros,2
Ruth Guinsburg,2 Ronaldo Laranjeira1
Financing: Fundação de Amparo à Pesquisa do Estado de
São Paulo (Fapesp) – Process number: 00/10293-5
Conflict of interests: None
Submitted: 6 June 2005
Accepted: 16 November 2005
Sandro Sendin Mitsuhiro
Rua Castro Alves, 612 – ap. 21 - Aclimação
01532-000 São Paulo, SP , Brazil
Phone: (55 11) 3486-9982
Rev Bras Psiquiatr. 2006;28(2):122-5
123 Mitsuhiro SS et al.
The use of illicit drugs by pregnant teenagers is of marked
interest. Its is due to the fact that there is consistent evidence
in the scientific literature that this behavior may cause
complications to the unborn baby1 and the mother.2 This is
particularly true for the use of cocaine. On the other hand,
follow-up studies show that prenatal exposure to marijuana is
associated with injury of the prefrontal region of the brain.3
Similarly, there is growing evidence about the negative
consequences of mothers’ psychiatric disorders during
pregnancy and of its psychosocial damages for the newborn.4
The main purpose of this study is to determine, in a low-
income teenage population at the obstetric center of a public
hospital of the city of São Paulo, Brazil, the prevalence of use
of cocaine and marijuana during the third trimester of
gestation, the prevalence of psychiatric disorders during the
whole pregnancy and to describe the socio-demographic
characteristics of this population.
A convenience sample of 1000 pregnant teenage (age
between 11 and 19) women inpatients was evaluated at the
obstetric center of the Mario de Moraes Altenfelder Silva
Maternity Hospital. It is a public hospital located in the northern
region of the city of São Paulo, the largest city in Brazil. This
hospital caters mostly to local people from a low-income
population who cannot afford private medical care. The data
collection started on July 24, 2001 and finished on November
27, 2002. No patient refused to participate.
Informed consent was given by the participants after com-
plete explanations about the procedures of the research,
purposes and possible harms. The study was approved by the
ethical committee of the hospital (Mario de Moraes Altenfelder
Silva Maternity Hospital) and the ethical committee of the
Universidade Federal de São Paulo (process no. 0931/02).
The patients were evaluated using the Composite
International Diagnostic Interview (CIDI), 2.1 version and a
socio-demographic and socio-economic questionnaire. Hair
samples were collected for analyses. The interviewers, the
patients and the researchers did not know the results of hair
analysis, CIDI or questionnaires.
1) Composite International Diagnostic Interview
The CIDI is a validated5 and fully-structured diagnostic
interview, which generates diagnoses according to the
International Classification of Diseases – 10th version (ICD-10)
and Diagnostic and the Statistical Manual of Mental Disorders
– 4th version (DSM-IV). The version to detect diagnosis in the
last 12 months, which is a period that includes the pregnancy
time, was used.
2) Hair analysis for cocaine and marijuana use detection
Each sample was composed of about 50 hairs, according to
specific standard procedures for better performance in detection
and security, with no esthetic harm, analyzing consumption
of cocaine and marijuana in the last 3 months.
Analyses of hair samples6 in this study were performed
through the combination of Enzyme-Linked Immunosorbent
Assay (ELISA) and Gas Chromatography Mass Spectrometry
(GCMS). These methods are used for tracing and confirmation
of cocaine and/or marijuana use, respectively. Analyses were
conducted at the Tricho-Tech laboratory, Cardiff, UK. Cut-off
limits (sensitivity) adopted were 0.2 ng/mg of hair for cocaine
and 0.025 ng/mg of hair for cannabis. Specificity of the tests
is 100% for both drugs.
These drugs were chosen because they are 2 of the most
common drugs in Brazil. Alcohol, inhalants and nicotine are
also frequently used, but, currently, they cannot be traced by
3) Socio-demographic questionnaire
This questionnaire was adapted to the Brazilian culture and
developed from the instrument used in Perinatal Needs
Assessment (PNA),7 a large study accomplished in California,
containing information about:
a) Identification: age, address, place of birth;
b) Marital status;
c) Schooling, rate of school dropout, employment.
4) Socio-economic classification
A Brazilian socio-economic classification was used, which
is based on the educational level of the household head, the
number of domestic electric tools in the household and family
income. It classifies individuals in 5 different categories (A to
E). This variable was recoded to three categories: high (A and
B), middle (C) and low (D and E).8
1. Socio-demographic characteristics
Table 1 shows the socio-demographic characteristics of
2. Hair analysis
Hair analysis detected use of cocaine and/or marijuana
in the third trimester of pregnancy in 6% of the patients.
Forty patients used marijuana, 17 used cocaine and 3 used
3. Distribution of psychiatric diseases in the sample
CIDI detected 276 patients with at least one psychiatric
disorder (27.6%). Of these 276 patients, some had more than
1 diagnosis. The number of detections of any psychiatric
diagnoses (357) was, therefore, larger than the number of
patients that received a psychiatric disorder diagnosis (276)
because of the existence of comorbidities.
The prevalence of psychiatric diagnosis in this sample
was 12.9% for Depression, 10.0% for Post-Traumatic Stress
Disorder, 5.6% for Anxiety Disorders, 3.5% for Psychotic
Disorders, 1.9% for Somatoform Disorders, 1.2% for Bipolar
Disorders, 0.3% for Dissociative Disorders and 0.3% for
The low frequency of formal marriage (7.2%) and high
rates of couples who live together as a consequence of
the pregnancy, without being married, found in this sample
should be highlighted. Cultural and behavioral changes
that have occurred in the last decades may explain this
fact. Formal marriage seems to be no longer necessary to
have a child. Besides, one could infer that these people
did not plan to raise a family, it just happened by chance.
Therefore, it is probable these children will not be born
into an ideal environment.
High rates of school dropout (67.3%) as well as
unemployment, associated to a low level of professional
Teenage pregnancy: drugs and psychopathology 124
Rev Bras Psiquiatr. 2006;28(2):122-5
training in spite of the intention manifested to have some
kind of qualification, largely contribute to this unfavorable
socio-economic situation. The relation between teenage
pregnancy and a low level of education has outstood in the
Other papers focusing on the prevalence of use of drugs among
teenage students in Brazil show frequent use rates. These rates
are around 2.6% for marijuana and 0.3% for cocaine when
considering both genders10 and 2.5% and 1.3%, for marijuana
and cocaine when considering lifetime use in female students.11
Therefore, prevalence of cocaine and marijuana use in the 3rd
trimester of pregnancy found in this study (6%) can be
considered high due to a series of circumstances involving
pregnancy status. According to Ebrahim & Gfroerer, after the
recognition of the pregnancy state, the rates of consumption of
illicit drugs decreased from 6.4% to 2.8%, with more significant
indexes of abstinence in the last quarter of pregnancy.12 Such
behavior can be extended to the population of this study, because
the psychological mechanism of protection of the baby that rules
it seems to be the same.
A study in Sweden on pregnant adult women13 found that
Psychiatric disorders were present in 14.1%, Depression in
10.2% and Anxiety disorders in 6.6% of patients. In non-
pregnant teenagers, prevalence of Depression found in another
study that took place in France14 was 5.0%. Thus, prevalence
of psychiatric disorders in teenage pregnant women in the
population studied (27.6%) can be considered high and
extremely alarming considering the fact that most of them had
never been treated at all.
There is consistent evidence in the literature about the
correlation between poverty, low education, poor social and
family support, teenage pregnancy, use of drugs and
psychopathology.15 In our sample, poor education and low level
of professional training may play an important role in
unemployment. These factors largely contribute to this
unfavorable socio-economic status, creating a situation of lack
of perspectives in life. Using drugs and getting pregnant may
be an attempt to change their reality and psychiatric disorders
may be a reaction outcome.
Inferences of causality cannot be accomplished because of
the design of this study (cross-sectional). For the same reason,
there is a risk of a recall bias.
The sample used in this research belongs to a single social
class and a specific population. Generalization of the results
must be carefully performed.
Some conditions like Conduct Disorders, Attention-Deficit/
Hyperactivity Disorder and Oppositional Defiant Disorder were
not investigated in this study, despite their importance in
adolescence, because the instrument selected is not able to
Of note also, hair analysis does not determine dependence
or harmful use of the illegal drug, it only detects consumption
during the period analyzed.
This research shows socio-demographic characteristics of
low-income pregnant women that live in the northern zone of
São Paulo - Brazil, predominantly poor, with low educational
levels and high exposure to serious life events. These factors
contribute to the higher vulnerability of this population to the
onset of psychiatric diseases, such as depression, anxiety, PTSD
and to the use of drugs (cocaine and marijuana). Our results
of prevalence of use of marijuana and cocaine during the
third trimester and of psychiatric disorders during the whole
pregnancy concur with the scientific evidence found in
international literature about the correlation between these
conditions. School dropout, to have no professional
qualification, being unemployed and being part of a low-income
unstructured family seem to play an important role in this
negative outcome. Controlled studies, however, should be
performed to properly evaluate this subject.
This complex phenomenon, which is related to a great number
of economical, educational and behavioral factors, has to be
tackled as an important public health issue due to the existence
of many kinds of possible harm both to the mother and to the
newborn. This phenomenon requires the implementation of
preventive public policies in order to reduce risk behaviors.
We gratefully acknowledge Jorge Luiz Bazan Guzman, PhD, Lolita
Tsanaclis, PhD, Maria Inês Quintana, PhD, Miriam Ribeiro de Faria
Silveira, MD and Nelson Sass, PhD (in alphabetical order) for the
technical support provided.
Rev Bras Psiquiatr. 2006;28(2):122-5 Download full-text
125 Mitsuhiro SS et al.
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