Number Of Prenatal Care Visits Research Articles

Obstetrical Care Is Associated with Child Dietary Diversity in Indonesia: Analysis from Demographic and Health Survey 2015

Abstract Objectives Our study aimed to examine if obstetrical care factors are associated with dietary diversity score, minimum dietary diversity (4 or more out of 7 food group consumption), and consumption of seven food groups among children ages 6–23 months using the Indonesia Demographic and Health Survey 2015. Methods Univariate and multiple logistic regression were performed to assess the association between obstetrical care factors, including number of prenatal care visits, location of delivery, mode of delivery, delivery provider, timing of postnatal visit, and postnatal visit provider, with dietary diversity score, minimum dietary diversity, and consumption of seven food groups. Results Four or more prenatal care visits, delivery in a health facility, delivery assisted by trained professional, or delivery by C-section were positively associated with higher dietary diversity scores of children (All P < 0.05). Delivery in a health facility and delivery assisted by a health professional was associated with higher odds of minimum dietary diversity (OR = 1.45, 95% CI [1.18–1.79] and OR = 2.10, 95% CI [1.54–2.87]). Four or more prenatal care visits was associated with higher odds of consumption of eggs (OR = 1.28, 95% [1.01–1.63]). Four or more antenatal visits, delivering at a health facility, and having a professional delivery attendant was associated with higher odds of consumption of lentils (OR = 1.66, 95% CI [1.23–2.25], OR = 1.30, 95% CI [1.02–1.65], OR 1.79, 95% CI [1.19–2.69], respectively). Four or more antenatal visits, delivery at a health facility, and having a professional delivery attendant was associated with higher odds of consumption of other fruits and vegetables (OR = 1.70, 95% CI [1.23–2.35), OR = 1.23, 95% CI [1.03–1.61], OR = 1.90, 95% CI [1.29- 2.79]). Having a professional delivery attendant was associated with higher odds of consumption of grains, flesh, and eggs (OR 1.72, 95% CI [1.09– 2.71], OR = 1.67, 95% CI [1.26–2.21], OR = 1.71, 95% CI [1.29–2.24]). Conclusions Obstetrical care received from a health facility and professionally trained providers throughout pregnancy is positively associated with dietary diversity in children ages 6–23 months. Efforts focusing on providing nutritional education before and during birth could be encouraged, especially for mothers seeking care outside of a health facility in Indonesia. Funding Sources None.

The Prevalence of Pregnancy Hypertensive Disorders and Their Related Factors in the Second and Third Level Hospitals Affiliated to Isfahan University of Medical Sciences, Isfahan, Iran

Background & aim: Gestational hypertension is the leading cause of maternal mortality. The most effective ways to prevent this complication are the prediction and prevention of the factors accounting for the incidence of this condition. Regarding this, the present study aimed to investigate the prevalence of gestational hypertension and its associated factors. Methods: This comparative descriptive study was performed on 2,477 pregnant women referred to four secondary and tertiary care hospitals in Isfahan, Iran in 2016 using the census method. Out of 2,477 referral cases, 148 cases were found to be suffering from various types of gestational hypertensive disorders. 200 mothers who had no pregnancy complication were also randomly selected from the 2,477 referral cases. The demographic, clinical, and therapeutic data of these mothers were collected using self-structured questionnaires through making regular visits to the maternity and obstetrics wards of the hospitals under study. Data analysis was performed in SPSS (version 18) using inferential statistical methods, including Chi-square test and independent t-test. Results: The prevalence of hypertension was obtained as 6%, with preeclampsia as the most prevalent type (4.2%). The incidence of gestational hypertension showed a significant relationship with the mean number of prenatal care visits (P=0.01), type of care providers delivering preconception and prenatal care (P=0.01 and p <0.001), underlying diseases (p <0.001), and number of previous abortions (P=0.01). However, there was no significant relationship between the frequency of preconception care visits and this complication (P=0.42). Conclusion: Despite the current policies targeted toward the promotion of maternal health, in the present study, the prevalence of gestational hypertension was notably higher than the rates reported in the literature. Therefore, it is highly recommended to plan for the standardization of referral hospitals and enhancement of care services to prevent this complication.

Differences in Prenatal Care by Presence and Type of Maternal Disability

Prior studies have found that women with disabilities are less likely to receive adequate prenatal care than women without disabilities. However, little is known about differences in patterns of prenatal care by type of disability. Therefore, this study examined timing and frequency of prenatal care among women with physical, sensory, or intellectual/developmental disabilities compared with women without disabilities. This was a retrospective cohort study using linked maternal and infant hospital discharge and birth certificate data for all births in California in 2000-2012 (N=6,745,201). Analyses were conducted in 2017-2018. Modified Poisson regression analyses compared women with each type of disability with women without disabilities on trimester of prenatal care initiation and number of prenatal care visits. Women with intellectual/developmental disabilities or with limited hearing had significantly higher RR of delaying prenatal care initiation until the second or third trimester (intellectual/developmental disabilities: adjusted RR=1.21, 95% CI=1.09, 1.33; hearing: adjusted RR=1.11, 95% CI=1.02, 1.21), whereas women with physical disabilities and limited vision had lower risk of delaying care (physical: adjusted RR=0.91, 95% CI=0.88, 0.94; vision: adjusted RR=0.85, 95% CI=0.73, 0.99). Women with limited hearing or vision or intellectual/developmental disabilities had higher risk of receiving fewer prenatal visits than recommended, compared with women without disabilities. Women with physical disabilities or intellectual/developmental disabilities had higher RR of receiving more than the typical number of visits. There were key differences in prenatal care utilization by disability type, reflective of particularly pronounced disparities for women with intellectual/developmental disabilities and women with limited hearing. Delays in receipt of prenatal care and low numbers of prenatal care visits may contribute to the poorer birth outcomes that have been observed previously in these groups. Targeted interventions are needed to improve uptake of prenatal care in these vulnerable populations.

Improved Value of Individual Prenatal Care for the Interdisciplinary Team.

Objective Innovative models of prenatal care are needed to improve pregnancy outcomes and lower the cost of care. We sought to increase the value of traditional prenatal care by using a new model (PodCare) featuring a standardized visit schedule and coordination of care within small interdisciplinary teams in an academic setting. Methods Prenatal providers and clinic staff were divided into four “Pods”. Testing and counseling topics were assigned to visits based on gestational age. Interdisciplinary weekly Pod meetings provided coordination of care. A retrospective chart review was performed. The primary endpoints were the number of prenatal care visits and number of providers seen. Results After PodCare implementation, more patients choose care with the low-risk physician team (42% compared to 26%). Study subjects included 85 women in 2013 and 165 women in 2014. The median number of visits decreased from 13 to 10 (p < 0.00004) and the median number of providers seen decreased from 7 to 5 (p < 0.0000008). Conclusion PodCare increased the value of individual prenatal care by decreasing the number of visits, increasing continuity, and providing care coordination. The model provides a robust experience in interdisciplinary care. The PodCare model may be successful at other academic institutions.

The impact of expanded health insurance coverage for unauthorized pregnant women on prenatal care utilization.

The objective of this study was to investigate the effect of expanding Medicaid health insurance coverage for unauthorized women on prenatal care utilization. A natural experiment design was used. We examined the prenatal care utilization of 20,876 unauthorized women from Nebraska, which expanded Medicaid coverage for unauthorized women, and South Carolina, which has never expanded coverage. Measurements of prenatal care utilization included adequate prenatal care using the Kotelchuck Index and the number of prenatal care visits. The policy independent variable of interest was an interaction between the policy years (2007-2009) and Nebraska residence. Demographic characteristics were included as covariates. Analysis entailed a difference-in-difference approach to compare prenatal care utilization by state, both before and after legislation was passed to fund care among unauthorized women in Nebraska. Women with insurance coverage were more likely to utilize prenatal services. Unauthorized women living in Nebraska during Medicaid expansion were 28% more likely to receive adequate prenatal care (OR=1.28, p<0.01) and had about one more prenatal care visit (IRR=1.05, p<0.01) than women who did not have expanded Medicaid coverage. Findings have important public health policy implications to support improved birth outcomes among native-born infants of unauthorized women.

High Level of Maternal Glycated Hemoglobin and Low Birth Weight

Background: The present study investigated the possible association between elevated maternal glycated haemoglobin levels (HbA1c%) and infants with low birth weight (LBW). Methods: This case-control study included 1,142 women admitted to three public hospitals in the northeast region of Brazil. The participants were classified based on their glycaemic levels, using glycated haemoglobin measurement: Group 1 (HbA1c% <5.6%), Group 2 (HbA1c% ≥ 5.6% and <6.5%), Group 3 (HbA1c% ≥ 6.5% and <7.0%) and Group 4 (HbA1c% ≥ 7.0%). The main association was assessed via a logistic regression, considering Group 1 (HbA1c <5.6%) as the reference. Results: No association between glycated haemoglobin levels and LBW for any of the groups, even after adjustment for the following confounders: maternal age, arterial hypertension, smoking during pregnancy, primiparity, body mass index before pregnancy, number of prenatal care visits, and maternal occupation during pregnancy (Group 2 - ORadjusted: 0.83 IC95%: 0.59-1.16; Group 3-ORadjusted: 0.27 IC95%: 0.34-1.26; Group 4- ORadjusted: 2.39 IC95%: 0.70-8.19) Conclusion: These results showed that elevated maternal glycated hemoglobin levels are not a risk factor for low birth weight.

Attendance at prenatal care and adverse birth outcomes in China: A follow-up study based on Maternal and Newborn's Health Monitoring System

Objectiveto evaluate the independent association between attendance at prenatal care and adverse birth outcomes in China, measured either as the occurrence of preterm birth or low birth weight. Designa follow-up study. Settingthe data was collected from maternal and newborn's health monitoring system at 6 provinces in China. Participantsall pregnant women registered in the system at their first prenatal care visit. We included 40152 registered pregnant women who had delivered between October 2013 and September 2014. Measurementsattendance at prenatal care was evaluated using Kessner index. χ2 tests were used to examine the correlations between demographic characteristics and preterm birth or low birth weight. The associations between attendance at prenatal care and birth outcomes were explored using multilevel mixed-effects logistic regression models. Findingsthe prevalence for preterm birth and low birth weight was 3.31% and 2.55%. The null models showed region clustering on birth outcomes. Compared with women who received adequate prenatal care, those with intermediate prenatal care (adjusted OR 1.62, 95%CI 1.37–1.92) or inadequate prenatal care (adjusted OR 2.78, 95%CI 2.24–3.44) had significantly increased risks for preterm birth, and women with intermediate prenatal care (adjusted OR 1.31, 95%CI 1.10–1.55) or inadequate prenatal care (adjusted OR 1.70, 95%CI 1.32–2.19) had significantly increased risks for low birth weight. We found very significant dose-response patterns for both preterm birth (p-trend<0.001) and low birth weight (p-trend = 0.001). Key conclusions and implication for practiceThis study shows that attendance at prenatal care in China has independent effects on both preterm birth and low birth weight. Appropriate timing and number of prenatal care visits can help to reduce the occurrence of preterm birth or low birth weight.

Lessons from Prenatal Care Provider-Based Recruitment into the National Children's Study.

In response to recruitment difficulties experienced by the National Children’s Study, alternatives to the door-to-door recruitment method were pilot tested. This report describes outcomes, successes, and challenges of recruiting women through prenatal care providers in Benton County, Arkansas, USA. Eligible women residing in 14 randomly selected geographic segments were recruited. Data were collected during pregnancy, at birth, and at 3, 6, 9, 12, 18, and 24 months postpartum. Participants were compared to non-enrolled eligible women through birth records. Of 6402 attempts to screen for address eligibility, 468 patients were potentially eligible. Of 221 eligible women approached to participate, 151 (68%) enrolled in the 21-year study. Enrolled women were similar to non-enrolled women in age, marital status, number of prenatal care visits, and gestational age and birth weight of the newborn. Women enrolled from public clinics were more likely to be Hispanic, lower educated, younger and unmarried than those enrolled from private clinics. Sampling geographic areas from historical birth records failed to produce expected equivalent number of births across segments. Enrollment of pregnant women from prenatal care providers was successful.

Factores de riesgo para el neonato pequeño para la edad gestacional en un hospital de Lima, Perú

Identify risk factors for at-term small for gestational age newborns. Retrospective cohort study using data from the Maternal Perinatal Information System of the Maria Auxiliadora Hospital of Lima, from the period 2000-2010. Maternal age, parity, education level, marital status, pregestational body mass index, number of prenatal care visits, presence of conditions such as preeclampsia, eclampsia, urinary tract infection and gestational diabetes as risk factors in small for gestational age newborns were evaluated. The weight for gestational age was calculated based on Peruvian percentiles. Crude relative risk (RR) and adjusted (ARR) were calculated with confidence intervals of 95% using log-binomial generalized linear models. 64,670 pregnant women were included. The incidence for small for gestational age was 7.2%. Preeclampsia (ARR 2.0, 95% CI: 1.86 to 2.15), eclampsia (ARR 3.22, 95% CI: 2.38 to 4.35), low maternal weight (ARR 1.38; 95% CI: 1.23 to 1.54), nulliparity (ARR 1.32, 95% CI: 1.23 to 1.42), age ≥35 years (ARR 1.16, 95% CI: 1.04 -1.29), having prenatal care visits from 0 to 2 (ARR 1.43, 95% CI: 1.32 to 1.55) and 3 to 5 (ARR 1.22, 95% CI: 1.14 to 1.32) were risk factors for small for gestational age. It is necessary to identify pregnant women with risk factors such as those found to decrease the condition of small for gestational age. Actions should emphasize modifiable factors, such as the frequency of prenatal care visits.

Perceptions of focused prenatal care among women attending two tertiary centers in Nigeria.

To determine women's perceptions and expectations of focused prenatal care visits. The present questionnaire-based, cross-sectional survey was performed among pregnant women in their third trimester attending two tertiary health centers in southern Nigeria between January and March 2012. Obstetric data, histories, and information on preferences for prenatal visits were obtained using questionnaires. A total of 353 questionnaires were appropriately completed. Among 277 participants who stated a preference for the number of prenatal care visits, 241 (87.0%) reported a preference of more than four. Among 203 parous women, 132 (65.0%) had no previous negative obstetric experience. Only previous stillbirth (odds ratio [OR] 2.67, 95% confidence interval [CI] 1.05-6.77; P = 0.039) among multiparous women, and HIV/AIDS (OR 0.27, 95% CI 0.06-1.17; P = 0.048) among all women were significantly associated with a preference for more prenatal visits. Previous negative obstetric experiences did not generally affect preference for prenatal visits. However, pregnant women expressed dissatisfaction with a reduced number of visits.

The effectiveness of interventions to improve access to and utilization of prenatal care: a systematic review protocol.

REVIEW QUESTION/OBJECTIVES: The quantitative objective is to identify the effectiveness of novel or innovative interventions designed to improve access to and utilization of prenatal care. More specifically, the objective is to identify: The effectiveness of novel or innovative interventions designed to improve access to and utilization of prenatal care on the timing of the initial prenatal care visit and the total number of prenatal care visits in pregnant women. INCLUSION CRITERIA Types of participants: This review will consider studies that include pregnant women. Types of intervention(s)/phenomena of interest: The review will consider studies that evaluate novel and innovative interventions designed to increase accessibility and utilization of prenatal care and comparing these programs against the regular existing programs. Studies evaluating group prenatal care and/or CenteringPregnancy© will be excluded from this review, because four systematic reviews have already examined the outcomes of these studies. The interventions of interest involve novel or innovative programs or specific interventions (e.g. incentives, enablers) intended to improve accessibility and utilization of prenatal care. Types of outcomes: This review will consider studies that include the following outcome measures: timing of initiation of prenatal care, number of prenatal care visits or use of a utilization index to measure adequacy of care. Definition A utilization index is defined as a measurement tool designed to categorize PNC utilization as being adequate or inadequate based on timing of initiation of care and number of visits with adjustments made for gestational age at delivery.

The effectiveness of interventions to improve access to and utilization of prenatal care: a systematic review protocol

The effectiveness of interventions to improve access to and utilization of prenatal care: a systematic review protocol

Effect of Insurance Type on Perinatal Outcomes Among Women With Type 1 Diabetes [277

INTRODUCTION: Compared with the general population, women with diabetes are at increased risk of various adverse perinatal outcomes. The objective of this study is to examine associations between type of maternal insurance and peripartum and fetal outcomes in women with pregestational type 1 diabetes mellitus (DM). METHODS: Retrospective cohort study of 2,082 singleton births among women with type 1 DM in California from 2005 to 2008. Maternal insurance status was classified as Medicaid or private insurer. Statistical analysis included χ2 tests and multivariable logistic regressions. RESULTS: Compared with women with private insurance, women with Medicaid insurance had a higher prevalence of adverse peripartum and neonatal outcomes in bivariate analysis. Medicaid-insured patients had a higher prevalence of intrauterine fetal demise (2.9% compared with 1.2%, P=.005), fetal anomalies (14.8% compared with 10.1%, P=.001), small for gestational age (7.5% compared with 4.6%, P=.005), and large for gestational age (16.3% compared with 20.0%, P=.030). Preterm births less than 28 weeks of gestation were significantly higher in those with Medicaid insurance (2.3% compared with 1.1%, P=.035); however, this finding was not statistically significant when looking at preterm births less than 37 or 32 weeks of gestation. In multivariate analysis controlling for age, race, chronic hypertension, nulliparity, and number of prenatal care visits, fetal anomalies (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.11–2.10) and intrauterine fetal demise (adjusted OR 2.8, 95% CI 1.0–8.1) remained statistically significant. CONCLUSION: Perinatal outcomes among women with type 1 DM differ by insurance status with a higher prevalence of adverse outcomes observed in women with type 1 DM with Medicaid insurance compared with private insurance.

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Objectives Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. Chronic hypertension occurs in up to 5% of pregnant women with special challenges to health care providers. Complications depend on the hypertension etiology, duration and severity. Chronic hypertension is a known risk factor for superimposed preeclampsia, with worse maternal-fetal outcomes. Objective: to describe maternal and perinatal outcomes of pregnancies complicated by chronic hypertension followed at the State University of Campina’s high risk outpatient clinic during an 18 months period. Methods Retrospective study with chart review of pregnancies complicated by chronic hypertension at the State University of Campinas (from January/2012 to June/2013). Results 113 women were considered, with mean age of 33 years, mostly white (56%), with partner (82%), multiparous (76%), education over elementary (62%). Mean duration of hypertension was 7 years and most women used anti-hypertensive drugs prior to pregnancy (65%) and were obese (53%). The majority used low dose aspirin and calcium during prenatal care (95%). Over 90% used anti-hypertensive drugs during pregnancy. Mean number of prenatal care visits was 9, with mean referral to high-risk clinic around 16 weeks. The majority of women were evaluated by a cardiologist (83%) with only 3.5% cardiac disease diagnosed. Superimposed preeclampsia occurred in 21% of all cases, with 13% of Intensive Care Unit admissions. Fetal assessment by Doppler velocimetry was systematically performed after 28 weeks of gestation, and only 9 pregnancies (8%) presented fetal distress. Mean gestational age at resolution was 37 weeks and mean fetal weight at birth 2960 g. C-section was performed in 68% of all cases and 58 women underwent postpartum tubal sterilization. Conclusions Pregnancies complicated by chronic hypertension should be referred to high-risk prenatal care assistance. There is increased risk of superimposed preeclampsia and clinical and fetal surveillance are essential to guarantee adequate outcomes. Disclosures M.T. Moreno: None. A.C. Cortez: None. F. Cavichiolli: None. M.A. Parpinelli: None. F.G. Surita: None. M. Costa: None.

Illicit drug use by pregnant women infected with HIV

To determine if illicit drug use increases the vertical transmission of HIV, to identify the risk factors involved in mother and child health and the prevalence of illicit drug use among these pregnant women. Sixty-four (7.6%) of 845 pregnant women from the metropolitan region of Belo Horizonte, Minas Gerais, Brazil, attended in the service between October 1997 and February 2012 reported the use of illicit drugs. Cases were HIV-positive drug users (n=64) and controls were women who did not use drugs (n=192). Three controls were selected for each case. Several conditions of exposure were considered in the control group such as tobacco use, alcohol use, alcohol and tobacco use, maternal age, educational level, ethnicity, and marital status. Problems during the prenatal period, delivery and postpartum, vertical HIV transmission and neonatal outcomes were also investigated. Univariate analysis showed as significant variables: maternal age, tobacco use, number of prenatal care visits, antiretroviral therapy, mode of infection, and viral load at delivery. Logistic regression revealed as significant variables: maternal age (less than 25 years); tobacco use, and number of prenatal care visits (less than 6). The vertical transmission of HIV was 4,8% (95%CI 1.7-13.3) among drug users and 2,1% (95%CI 0.8-5.2) in the control group, with no statistically significant difference between groups. Neonatal complications were more frequent among drug users, but also with no statistically significant difference between groups. The use of illicit drug is frequent during pregnancy among HIV-infected women. The approach to illicit drug use should be routine during prenatal care visits. These women are more discriminated against and tend to deny their habits or do not seek prenatal care. There was no difference in vertical virus transmission between groups, probably indicating adherence to antiretroviral use for antiretroviral therapies during pregnancy.

Prenatal Care in Combination with Maternal Educational Level Has a Synergetic Effect on the Risk of Neonatal Low Birth Weight: New Findings in a Retrospective Cohort Study in Kunshan City, China

ObjectivesTo investigate the dose-response relationship and synergetic effect of the maternal educational level and two measures of prenatal care on neonatal low birth weight (LBW) risk.MethodsData were derived from the Perinatal Health Care Surveillance System (PHCSS) from January 2001 to September 2009 in Kunshan City, Jiangsu province, eastern China, which included data on 31412 women with a normal birth weight delivery and 640 women with a LBW delivery. Logistic modelling was performed to estimate the association including the joint effects with odds ratio (OR) and 95% confidence interval (CI) between the prenatal care measures and LBW risk after adjusting for the potential confounders. The dose-response relationship between the number of prenatal care visits and the risk of LBW was investigated by modeling the quantitative exposure with restricted cubic splines (RCS).ResultsThere was a significant synergetic effect on the LBW risk between maternal educational attainment and the number of prenatal care visits (χ2 = 4.98, P = 0.0257), whereas no significant maternal educational attainment interaction was found with the week of initiation of prenatal care after adjusting for relevant confounding factors (χ2 = 2.04, P = 0.1530), and the LBW risk displayed a ‘U-shape’ curve tendency among the different number of prenatal care visits (P for nonlinearity = 0.0002) using RCS. In particular, the ORs were approaching the curve’s bottom when the women had 9 or 10 prenatal care visits. Comparing with 5 prenatal care visits, the ORs and 95%CI of LBW risk for 7, 9, 11 and ≥13 visits were 0.92 (0.82–1.03), 0.50 (0.38–0.66), 0.62 (0.47–0.82), and 0.99 (0.61–1.60), respectively.ConclusionsOur findings suggest that appropriate prenatal care, in combination with a higher maternal educational level, can produce a protective interaction effect on LBW risk. Reasonable health resource assignment for different social statuses should be taken into account by policy-makers in developing countries.

The effect of social health insurance on prenatal care: the case of Ghana.

Many developing countries have introduced social health insurance programs to help address two of the United Nations' millennium development goals-reducing infant mortality and improving maternal health outcomes. By making modern health care more accessible and affordable, policymakers hope that more women will seek prenatal care and thereby improve health outcomes. This paper studies how Ghana's social health insurance program affects prenatal care use and out-of-pocket expenditures, using the two-part model to model prenatal care expenditures. We test whether Ghana's social health insurance improved prenatal care use, reduced out-of-pocket expenditures, and increased the number of prenatal care visits. District-level differences in the timing of implementation provide exogenous variation in access to health insurance, and therefore strong identification. Those with access to social health insurance have a higher probability of receiving care, a higher number of prenatal care visits, and lower out-of-pocket expenditures conditional on spending on care.

Impacto do parto vaginal após uma cesárea prévia sobre os resultados perinatais

To analyze the impact of vaginal delivery after a previous cesarean section on perinatal outcomes. Case-control study with selection of incident cases and consecutive controls. Maternal and perinatal variables were analyzed. We compared secundiparas who had a vaginal delivery after a previous cesarean delivery (VBAC) (n=375) with secundiparas who had a second cesarean section (CS) (n=375). Inclusion criteria were: secundiparas who underwent a cesarean section in the previous pregnancy; singleton and term pregnancy; fetus in vertex presentation, with no congenital malformation; absence of placenta previa or any kind of bleeding in the third quarter of pregnancy. The rate of vaginal delivery was 45.6%, and 20 (5.3%) women had forceps deliveries. We found a significant association between VBAC and mothers younger than 19 years (p<0.01), Caucasian ethnicity (p<0.05), mean number of prenatal care visits (p<0.001), time of premature rupture of membranes (p<0.01), labor duration shorter than 12 hours (p<0.04), Apgar score lower than seven at 5th minute (p<0.05), fetal birth trauma (p<0.01), and anoxia (p<0.006). In the group of newborns delivered by cesarean section, we found a higher frequency of transient tachypnea (p<0.014), respiratory disorders (p<0.048), and longer time of stay in the neonatal intensive care unit (p<0.016). There was only one case of uterine rupture in the VBAC group. The rate of neonatal mortality was similar in both groups. Vaginal delivery in secundiparas who had previous cesarean sections was associated with a significant increase in neonatal morbidity. Further studies are needed to develop strategies aimed at improving perinatal results and professional guidelines, so that health care professionals will be able to provide their patients with better counseling regarding the choice of the most appropriate route of delivery.

Ingestão de energia e de nutrientes e baixo peso ao nascer: estudo de coorte com gestantes adolescentes

OBJETIVO: Avaliar a ingestão de energia, de macro e de micronutrientes por adolescentes no primeiro e no segundo trimestres de gestação e estimar sua associação com o peso do concepto ao nascer. MÉTODOS: Estudo longitudinal, incluindo 139 gestantes adolescentes atendidas em serviço de pré-natal de maternidade pública, acompanhadas desde o primeiro trimestre gestacional até o puerpério imediato. Aplicou-se um questionário de frequência de consumo alimentar no primeiro e no segundo trimestres de gestação. O peso e a idade gestacional ao nascer dos recém-nascidos foram coletados dos prontuários hospitalares. Foram estimados médias e intervalo de confiança de 95%. O método dos resíduos foi utilizado para ajustar o consumo de nutrientes pelo consumo energético total. Modelos de regressão linear múltipla foram desenvolvidos para identificar os fatores associados ao peso ao nascer. RESULTADOS: O consumo médio de proteínas (p=0,02), lipídeos (p=0,02), ácidos graxos saturados (p=0,02) e monoinsaturados (p=0,05), colesterol (p=0,01), cálcio (p&lt;0,01), potássio (p=0,01) e fósforo (p&lt;0,01) foi mais elevado entre gestantes que tiveram filhos com peso ao nascer acima de 2500g. Idade gestacional ao parto (β=105,8; p&lt;0,01), número de consultas de pré-natal (β=34,1; p=0,04), consumo de ácidos graxos poli-insaturados (β=7,5; p=0,04) e de ômega-3 (β=74,3; p=0,05) e de colesterol (β=0,4; p=0,04) foram variáveis preditoras do peso ao nascer em modelos de regressão linear múltipla. CONCLUSÃO: O perfil lipídico da dieta da mãe foi o principal preditor do peso do concepto ao nascer, e os resultados sugerem que o acompanhamento nutricional deva ser incluído na rotina dos serviços de atenção pré-natal.

Young child complementary food diversity in the East African region: cross‐country differences, geographic distribution and relationship with health‐care utilization

We utilized available demographic health survey data, between 2000 and 2011, to assess the geographical distribution of complementary food diversity and examine the relationship between health‐care utilization indicators and complementary food diversity within countries in the East African region. Complementary food diversity score (DDS) was calculated for children between 6 and 24 months old with a possible maximum diversity score of six. At least 1691 children in Kenya, 730 in Uganda, 2352 in Tanzania, 1332 in Ethiopia and 1674 in Malawi were included in the analysis. Ethiopian children experienced the least diversified complementary food diet. Across time, complementary food diversity increased in Tanzania and Malawi, remained relatively unchanged in Kenya and decreased in Ethiopia and Uganda. Low DDS were found in large parts of Ethiopia, the north and north‐eastern regions of Kenya. Tanzania and Malawi had fairly consistent DDS, with only pockets of low values. Uganda had fairly consistent DDS across the country with DDS with no extreme DDS values. Number of prenatal care visits, hospital‐based births and receipt of vitamin A supplements were each shown to have a positive relationship with complementary food diversity score in at least one of the countries. This analysis contributes to the understanding of geography and determinants of complementary food quality in the East African region.