Abstract
ABSTRACTIn Brazil, the excess of interventions that anticipate childbirth, such as cesarean sections and labor inductions, has resulted in the shortening of pregnancy, with negative consequences on maternal-infant outcomes. This commentary presents a novel way to measure gestational age: the continuous variable “Potential pregnancy days lost.” Using data from the Live Birth Information System (SINASC), we counted the missing days between the period until childbirth and the average duration of pregnancy (280 days), or the lost weeks. This measure can be used as an outcome variable (socioeconomic-demographic characteristics of the mother, type of childbirth, financing, etc.) or exposure variable (for neonatal, infant, and maternal outcomes). The indicator can be used in municipal and national cohorts and intervention studies to analyze hospitals and regions. We discuss the limits and scope of gestational age measures and, given their inaccuracies, the importance of studying their trends.
Highlights
We are developing an innovative measure of gestational age (GA), a continuous variable named “potential pregnancy days lost” (PPDL), counting the missing days from the date of childbirth to the date when the average duration of pregnancy (280 days) would be completed, using data from birth records of the Live Birth Information System (SINASC)
This is the case in Brazil, where GA in childbirth has decreased, as a result of the overestimation of the safety of interventions associated with the abbreviation of pregnancy[6,7]
The reasons why cesarean section is highly accepted in Brazil constitute a complex issue, including cultural, political, and economic aspects related to the barriers faced by the health system in offering a positive experience of childbirth, with humanized and evidence-based care
Summary
The health promotion of mothers and newborns and the health of generations is a priority worldwide. When the proportion of cesarean sections in a population exceeds the level between 10% and 15%, these intervention disadvantages tend to outweigh the potential benefits for mothers and infants, especially when performed before the spontaneous onset of labor and the 39 full weeks of gestation[4,5]. Even with the confirmed pulmonary maturity, early term childbirth is associated with worse neonatal respiratory and hepatic outcomes compared with full-term births[10,11] This increase in preventable morbidity and mortality burdens financially and logistically a health system already quite deficient.
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