Abstract
OBJECTIVE: To examine whether the low birth weight (LBW) paradox exists in Brazil. METHODS: LBW and cesarean section rates between 1995 and 2007 were estimated based on data from SINASC (Brazilian Live Births Database). Infant mortality rates (IMRs) were obtained using an indirect method that correct for underreporting. Schooling information was obtained from census data. Trends in LBW rate were assessed using joinpoint regression models. The correlations between LBW rate and other indicators were graphically assessed by lowess regression and tested using Spearman's rank correlation. RESULTS: In Brazil, LBW rate trends were non-linear and non-significant: the rate dropped from 7.9% in 1995 to 7.7% in 2000, then increased to 8.2% in 2003 and remained nearly steady thereafter at 8.2% in 2007. However, trends varied among Brazilian regions: there were significant increases in the North from 1999 to 2003 (2.7% per year), and in the South (1.0% per year) and Central-West regions (0.6% per year) from 1995 to 2007. For the entire period studied, higher LBW and lower IMRs were seen in more developed compared to less developed regions. In Brazilian States, in 2005, the higher the IMR rate, the lower the LBW rate (p=0.009); the lower the low schooling rate, the lower the LBW rate (p=0.007); the higher the number of neonatal intensive care beds per 1,000 live births, the higher the LBW rate (p=0.036). CONCLUSIONS: The low birth weight paradox was seen in Brazil. LBW rate is increasing in some Brazilian regions. Regional differences in LBW rate seem to be more associated to availability of perinatal care services than underlying social conditions.
Highlights
Low birth weight (LBW) rate is defined as the proportion of live births < 2,500 grams and it has been classically considered a marker of social development
LBW rate is increasing in some Brazilian regions
In some Brazilian cities with improving life conditions, LBW rate is increasing, e.g., it increased in Ribeirão Preto from 7.6% in 1978–1979 to 10.6% in 1994.17 In the Southern city of Pelotas, LBW rate increased from 9.0% in 1982 to 10.4% in 2004.3 Increasing LBW rates have been reported in other countries such as the USA where it rose from 6.8% in 1980 to 7.6% in 2000.4
Summary
Low birth weight (LBW) rate is defined as the proportion of live births < 2,500 grams and it has been classically considered a marker of social development. LBW rates are expected to be lower in more developed settings[16] and the lower the LBW rates the lower the infant mortality rates (IMR). In Brazil, in the 1960s and 1970s, LBW rate (≤ 2,500 g) was lower in Ribeirão Preto (8.7% in 1968–1970), a more developed city in Southeast Brazil,[16] than in three maternity hospitals in Recife (14.6% in 1974), a less developed city in Northeast Brazil,[14,16] whereas IMR was higher in Recife (91.2 per thousand in 1969) than in Ribeirão Preto (52.5 per thousand in 1968–1970).[12,15] In addition, LBW rate tended to decrease as economic development and life conditions improved, as seen in Recife, where it dropped from 14.6% in 197414 to 9.1% in 2005.a. LBW rates have been recently found to be higher in more developed (South and Southeast) than in less developed regions (North and Northeast) in Brazil. In some Brazilian cities with improving life conditions, LBW rate is increasing, e.g., it increased in Ribeirão Preto from 7.6% in 1978–1979 to 10.6% in 1994.17 In the Southern city of Pelotas, LBW rate increased from 9.0% in 1982 to 10.4% in 2004.3 Increasing LBW rates have been reported in other countries such as the USA where it rose from 6.8% in 1980 to 7.6% in 2000.4
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