Project Summary: This project has two principal objectives: 1) Improve health system and research capacity in the community of Santa Cruz, which is located in the region of Northeast Brazil and 2) Apply that capacity in order to conduct epidemiological research investigating pathways that may explain how and why adolescent childbirth is associated to chronic conditions and mobility loss in middle-aged and older women. Such information is vital to developing preventative public health interventions to address non-communicable diseases across the life-course. Lessons learned from this research would add to the research evidence-base for policy and action on adolescent pregnancy and, more broadly, women's health in Latin America. Specifically, this project aims to: 1) Train students from the Santa Cruz campus of the Federal University of Rio Grande do Norte (Brazil) to conduct epidemiological interviews, collect biological samples, and take anthropometric and clinical measures. It will also provide in-depth, specialized training on ethical research conduct when working with pregnant and adolescent women; 2) Develop and validate epidemiological questionnaires adapted to a low-education, rural, adolescent, Portuguese-speaking population; 3) Prospectively follow a pilot cohort of adolescent and adult women, pregnant for the first time, from the 1st trimester of pregnancy to 6-weeks postpartum. This pilot would collect questionnaire data (baseline), clinical measurements, and biomarker concentrations (baseline, 3rd trimester, 6-weeks postpartum). The proposed pilot study, which is the 3rd study aim, will lay the foundation for a more expansive and comprehensive research program investigating hypothesized mechanisms behind previously documented associations between adolescent childbirth and poor later-life health. Overall, the capacity built and sustained from this project will contribute to advancing health research in one of the most underserved regions of Brazil. It will provide training to the next generation of Brazilian researchers and establish long-term networks between Brazilian and United States researchers.

This proposed study will examine the long-term effects of adolescent pregnancy, such as disease and disability, among women in Northeast Brazil, a population that suffers from economic, gender, and health inequities at a higher rate than those in urban areas in Brazil. This will include collaborating with the newly-established Santa Cruz campus of the Federal University of Rio Grande do Norte to build their infrastructure and training capacity to carry out public health and epidemiological research studies.