Number Of Prenatal Consultations Research Articles

Social and biological determinants of growth and development in underprivileged societies

The stimulating study by da Rocha Neves et al. (in this issue)1 addresses the role of social and biological factors in growth and development of young children in a disadvantaged society. The authors assessed a group of 92 children, aged 24--36 months, who in 2011 attended the municipal early childhood education network in a town in the Vale do Jequitinhonha region. This region in the southeast of Brazil is considered economically underprivileged. The study was restricted to children with typical development, which meant that the children did not suffer from an evident congenital or acquired disability. Growth was assessed by means of standard anthropometrics, with a focus on heightfor-age, a valid tool to assess childhood malnutrition.2 Development was measured with the Bayley Scales of Infant and Toddler Development (BSITD-III),3 the gold standard to measure developmental outcome at early age. The cognitive score and the expressive language scores were used as outcome parameters. Biological risk was assessed by a few perinatal factors, such as gestational age at birth, birth weight, pregnancy complications, and the number of prenatal consultations, and a few childhood parameters, including breastfeeding, the presence of chronic diseases,

Effect of maternal periodontitis and low birth weight—A case control study

Introduction. Since the 1990s, evidence has been raised that there is an association between maternal periodontal disease and undesirable gestational events, for example low birth weight; this issue is controversial. Objective. To evaluate whether there is an association between maternal periodontitis and low birth weight (LBW). Methods. A case-control study was carried out on 951 mothers that had been cared for by the Brazilian Unified Health System in Petrolina-PE and Juazeiro-BA, Brazil. The case group (n = 269) consisted of mothers of newborns with birth weight <2500 g and a control group (n = 682) of mothers of newborns with birth weight ≥2500 g. An interview was realized, using a questionnaire as well as a full mouth examination to diagnose the periodontal condition. Women who had at least four teeth with probing depth ≥4 mm and clinical attachment loss ≥3 mm, with bleeding on probing at the same site, were diagnosed with periodontitis. The birth weight was obtained through the hospital book record. The main association was evaluated using the multivariate regression model, considering confounders. Results. The frequency of periodontitis was 16.4% (case group) and 17.4% (control group). Periodontitis did not show an association with LBW (ORcrude = 0.92; 95% CI = 0.63–1.35), even after adjustment for the following confounders: maternal age, pre-gestational body mass index, number of pre-natal consultations, number of pregnancies, maternal schooling level, smoking habit during pregnancy and hypertension (ORadjusted = 1.00; 95% CI = 0.61–1.68). Conclusion. The findings of this study showed no association between maternal periodontal disease and low birth weight, even after appropriate adjustments for confounding factors.

A influência das características socioeconômicas no perfil obstétrico de puérperas

Objetivo: examinar la relación entre el número de consultas de prenatal, tipo de parto y número de embarazos y variables socioeconómicas. Métodos: estudio transversal, cuantitativo, realizado en una Maternidad, en el municipio de São Mateus, norte del departamento de Espírito Santo (Brasil). La muestra fue de 323 puérperas. Resultados: hubo significancia estadística (p &lt; 0,05) al relacionar el número de consultas de prenatal con el rango de edad, situación conyugal, raza/color, ingresos de la familia, escolaridad, ocupación y categoría de admisión. No hubo significancia estadística entre la variable clase económica y número de consultas de prenatal (p &gt; 0,05). Se nota que no hubo asociación significante (p &gt; 0,05) entre el tipo de parto y las variables: rango de edad, raza/color y ocupación. El tipo de parto presentó significancia estadística al ser asociado con situación conyugal, ingresos de la familia, clase económica, escolaridad y categoría de admisión (p &lt; 0,05). Hubo significancia estadística al asociar el número de embarazos con la raza/color, ingresos de la familia, clase económica y categoría de admisión (p &gt; 0,05). Conclusiones: las características socioeconómicas pueden influir en el número de consultas de prenatal, número de embarazos y tipo de parto.

Perinatal morbidity and mortality in pregnancies that progressed with ruptured membranes at a public hospital in Northern Brazil

To identify obstetric and perinatal factors associated with perinatal morbidity and mortality in pregnancies that progressed with ruptured membranes. A cross-sectional hospital-based study with secondary data from records of patients (n=87) that evolved with the premature rupture of membranes between 24 and 42 weeks of gestation, admitted from January to April 2013 to a public hospital in Acre State, North of Brazil. Data were subjected to bivariate analysis for selection of variables to be used in a multiple regression model according to Poisson logistic regression with robust error. The prevalence of perinatal morbidity-mortality was 51.4%, including a 2.3% death rate (2 cases) and a 9.2% fetal neonatal death rate (8 cases). The variables associated with mortality in the final multiple model were: number of prenatal consultations ≥6, with a prevalence ratio (PR) of 0.5 and a 95% confidence interval (95%CI) of 0.3-0.9, gestational age ≥30 weeks (PR=0.6; 95%CI 0.4-0.8), low birth weight (PR=2.9; 95%CI 1.5-5.4), and mechanical ventilation (PR=3.8; 95%CI 2.0-7.2). Perinatal morbidity and mortality were high among cases of ruptured membranes. Morbidity and mortality were associated with factors such as fewer prenatal visits, extreme prematurity and low birth weight in this group.

Spatial distribution of C-sections within the state of São Paulo

Objective: to identify spacial patterns for cesarean deliveries per microregion in the state of São Paulo. Methods: this is an ecological and exploratory study with data on live births occurred between 2003 and 2007 in 63 microregions in the state of São Paulo. Variables analyzed included cesarean delivery rates, teenage mothers, mothers with high levels of education and who had at least seven prenatal consultations. Moran's index (I), a measure of spatial autocorrelation of rates related to the variables described above and which identifies the presence of spatial clusters, was calculated. The distributions of the variables' rates in this study were visualized using thematic maps. The Moran map was used to identify microregions with high priority need for attention. Pearson correlation coefficients among the variables were also obtained. Results: there were 3,045,293 births, being 1,636,009 (53.7 %) cesarean deliveries. It was possible to identify spatial clusters of C-sections (I = 0.58 and p &lt; 0.01) in the microregions located on the north and northwest of the state of São Paulo, as well as in Guaratinguetá; the values found for Moran index were, I = 0.32, I = 0.30 and I = 0.24, for the rates of teenage mothers, schooling and number of consultations, respectively, being all significant results (p &lt;0.01). Micro-regions with high-priority need for attention were identified. Cesarean rates were significantly correlated with high rates of maternal education and number of prenatal consultations. Conclusion: the identification of these microregion clusters with high rates of cesarean delivery allows health managers to implement policies in order to minimize these rates.

Baixo peso ao nascer em adolescentes e adultas jovens na Região Nordeste do Brasil

Objetivos: avaliar a associação entre as características sociodemográficas, do pré-natal e do parto de mães adolescentes e adultas jovens com o baixo peso ao nascer, em capitais e outros municípios da Região Nordeste do Brasil, no período de 2011 e 2012. Métodos: estudo transversal, de base hospitalar e nível regional, realizado em 2011 e 2012. As informações foram obtidas por meio de entrevista com a puérpera no pós-parto imediato e coletados dados dos prontuários maternos e dos recém-nascidos. Um modelo teórico conceitual foi estabelecido com três níveis de hierarquia e a variável dependente foi o baixo peso ao nascer (BPN). Resultados: do total de 3009 puérperas entrevistadas, 9,7% apresentaram conceptos com baixo peso. As puérperas que realizaram menos que seis consultas no pré-natal apresentaram uma chance 1,7 vezes maior de ter RN com baixo peso; ser primigesta aumentou a chance da ocorrência do BPN em 1,5 vezes; assim como a prematuridade que representou o principal fator de exposição, elevando em 21 vezes a chance desse desfecho. Conclusões: o estudo demonstrou alta frequência de baixo peso ao nascer entre mães adolescentes e adultas jovens, tendo como principais fatores associados o número insuficiente de consultas pré-natal, primigestação e prematuridade.

Adolescent Pregnancy Risks in a City of Average Size in Northeastern Brazil

Introduction: Pregnancy in adolescence is a frequent public health problem worldwide, because it is associated with increased clinical and social complications affecting both mothers and newborn/infants. Materials and Method: An analytical prospective study was conducted, comparing 200 pregnant women followedup during pre-natal care in the city of Cruz das Almas-Bahia-Brazil, in the period between November, 2009 and October, 2010. Women were divided into two groups: adolescents (between 10 and 19 years old) and adults (between 20 and 36 years old). The following socio-demographic variables were analyzed: self-declared color, educational level, marital status, family income. The maternal clinical variables evaluated were: parity, gestational age, gynecological age, weight, height, number of pre-natal consultations, weight gain during pregnancy, mode of birth and complications at birth. The clinical variables described for the newborn were: prematurity, birth weight, Apgar Score in first and fifth minute post-birth. Results: The socio-economic characteristics differed between the groups. Among adolescent group, there were more single women; family income was lower; first sexual intercourse took place earlier than adult group. There was no difference in maternal and newborn clinical outcomes between the groups, with exception of birth weight, which was lower in adolescent group than adult group. Conclusion: Pregnancy in adolescence is associated with greater social vulnerability, and not with biologic risk when compared with pregnancy at adult age. General Context: The results founded herein demonstrated that pregnancy in adolescence was not associated with unfavorable perinatal or obstetric results, but was associated with greater social vulnerability when compared with those of adult pregnant women.

Deficiência de Vitamina A em mães e filhos no Estado de Pernambuco

The prevalence and risk factors associated with vitamin A deficiency (VAD) were analyzed in 664 mothers and their 790 children under the age of five in Pernambuco in 2006. A population-based cross-sectional study, with a representative sample in urban and rural areas was conducted. VAD was defined as serum retinol levels < 20 mg/dL for both groups (mothers and children). Bi and multivariate analysis were performed using the complementary log-log model as a link function adopting a model of explanatory hierarchical order of VAD to children and a logistic model for mothers. The prevalence of VAD was 6.9% in mothers and 16.1% in their children, with similar statistics for urban and. rural groups. In the urban area, the housing occupation regime had a significant association with VAD in mothers. After the final adjustment of the model for urban children, the mother's age, the number of pre-natal consultations and birth weight were featured as predictive variables. In rural areas, VAD in mothers is associated with VAD in children; PR= 3.99 (95% CI:1.73-9.19), with their birth weight and the incidence of diarrhea in the previous 15 days. VAD continues to be a public health issue in the state of Pernambuco, with marked variations in prevalence and associated factors in mothers and children.

HIV exposure and related newborn morbidity and mortality in the University Teaching Hospital of Yaoundé, Cameroon

Few studies have established the role of maternal HIV infection on neonatal disease and death. In order to determine whether neonatal morbidity and mortality were associated to maternal HIV infection, a case-control study was conducted in the neonatal unit of the University Teaching Hospital of Yaoundé from July 2006 to December 2007. Babies born from HIV positive mothers were recruited as cases. For each case, two babies born from HIV negative mothers were selected as controls. Informed verbal consent was obtained from the mother before inclusion of the newborn in the study. Information on demographics, history of pregnancy, diseases and outcome of the newborns were extracted from patients' files. The distribution of these parameters between cases and control was analyzed using chi-square. Association of demographics, clinical and paraclinical parameters with mortality was explored using univariate analysis and logistic regression. Data were analyzed using Epi Info version 3.5.1 Windows. Out of 240 newborns enrolled, 80 were cases and were 160 controls. The mean age of cases was 1.69±2.73 days compared to 1.46±2.36 days for controls (p=0.26). Cases significantly differed from controls on mother's marital status (p=0.02), level of education (p<0.001), number of prenatal consultations (p<0.001), anemia chemoprophylaxis (p=0.01) and drug abuse (p<0.001). Cases and controls were similar for prematurity, respiratory distress, sepsis, meningitis and urinary tract infection. The death rate was identical in both groups (p=0.52). Using Univariate analysis, risk factors associated to mortality in both groups were prematurity (p<0.001) and low birth weight (p<0.001). This study showed no statistical difference in morbidity and mortality between newborns from HIV positive and HIV negative mothers.

SP4-33 Risk factors for low birth weight in the municipalities of Juazeiro and Petrolina (Brazil): a case-control study

The aim of this study was to evaluate the association between maternal characteristics and low birth weight (LBW). An exploratory case-control investigation was conducted in two hospital that provide attendance...

Postdischarge surveillance following cesarean section: The incidence of surgical site infection and associated factors

The rate of surgical site infections (SSI) and their associated risk factors was identified by performing postdischarge surveillance following cesarean section at a public university teaching hospital in Brazil. The study was conducted at the Center for Women's Integrated Health Care in Brazil between May 2008 and March 2009. Women were contacted by telephone 15 and 30 days after cesarean section. During hospitalization, a form was completed on factors associated with post-cesarean SSI. The chi(2) test and Fisher exact test were used to analyze categorical variables and the Mann-Whitney test for numerical variables. Relative risks (RR) and their respective 95% confidence intervals (95% CI) were calculated for factors associated with SSI. P values < .05 were considered significant. The final sample consisted of 187 women. SSI was detected in 44 cases (23.5%). In 42 of 44 women (95%), SSI appeared following discharge from hospital, becoming evident within the first 15 days following surgery. Number of prenatal consultations < or =7 (RR, 2.09; 95% CI: 1.26-3.48) and hypertension (RR, 2.07; 95% CI: 1.25-3.43) were significantly associated with SSI in the bivariate analysis. In the multivariate analysis, only hypertension (RR, 2.47; 95% CI: 1.21-5.04) remained significant. Postdischarge surveillance is essential for ensuring accurate estimates of post-cesarean section SSI. A 15-day postdischarge follow-up was shown to be sufficient. Hypertension was a factor associated with SSI.

Postpartum women's knowledge about breastfeeding - a descriptive study

Introduction: Some mothers do not comply with breastfeeding due to unawareness of the practice. Aims: To characterize the demographic and obstetrical profile of postpartum women and to verify the influence of their instruction level and the number of prenatal consultations on breastfeeding knowledge. Design: Descriptive and quantitative study. Method: Individual interviews were carried out with 150 postpartum women at a public maternity rooming-in. The data were processed in the SPSS, version 13.0. Results: Most women were between 18 and 35 years old, less than eight schooling years; 91 (60.7%) were multiparae and 87 (58%) had not breastfed previously. Increased knowledge was verified on breastfeeding protection against ovarian and breast cancer (n=66; 89.2%), child development and promotion of mother and baby bonds (n=74; the 100%) and protection against child infections (n=73; 98.6%) among postpartum women with eight schooling years. The largest number of prenatal consultations positively influenced the understanding of maternal milk as an optimum food for children (n=109; 100%), the baby's bottle use to worsen breast suckling (n=88; 80.7%), the introduction of other foods affecting the child health (n=93; 85.3%) and painless breastfeeding of mothers who follow correct handling (n=74; 67.9%). Conclusion: The study reveals that factors such as instruction and number of prenatal consultations influence the knowledge level on breastfeeding, therefore reinforces the need for prenatal care promotion and educative approaches toward breastfeeding. Relevance for the clinical practice: This study brings to attention factors related to mother’s knowledge about breastfeeding. Thus, women awareness must be raised toward exclusive breastfeeding as the best health practice to the mother-baby binomial.

Adolescent pregnancy: a comparative study between mothers who use public and private health systems

This is a comparative and descriptive study of adolescent mothers who were attended in three maternities of the public health system and three private maternities in a city in São Paulo, Brazil, between 2000 and 2002. This study aimed to compare the profile of mothers attended in both systems. The database of Ribeirão Preto was used and 5,286 adolescent mothers between 10 and 19 years old were selected according to type of delivery, level of instruction, number of prenatal consultations and parity. We found that the users of the public health system had less prenatal consultations, lower level of education, higher parity and the vaginal delivery was most frequent. The users of the private health system, on the contrary, had more prenatal consultations, higher level of instruction, and primiparity and cesarean sections were more frequent.

Factors associated with duration of breastfeeding

To determine rates of exclusive breastfeeding and of complementary feeding and to identify variables that interfere with breastfeeding in the municipality of Itaúna, MG, Brazil. A longitudinal study was undertaken enrolling 246 women who gave birth at the maternity unit of the Manoel Gonçalves Hospital, in Itaúna, MG. The mothers and their infants were seen monthly for the first 12 months after birth or until they stopped breastfeeding. Survival analysis procedures were used to study the duration of exclusive breastfeeding and of complementary feeding. The impact on breastfeeding duration of a series of co-variables was assessed by means of Cox regression modeling. The prevalence of exclusive breastfeeding at 6 months was 5.3%, and for breastfeeding at 12 months it was 33.7%. The median duration of exclusive breastfeeding was 40 days, and median breastfeeding duration was 237 days. Multivariate analysis demonstrated a negative association (p<0.05) between duration of exclusive breastfeeding and the following variables: intended breastfeeding duration (<12 months), birth weight of child (<2,500 g) and use of a pacifier. Shorter breastfeeding duration was associated (p<0.05) with maternal age (< 20 years), number of prenatal consultations (<5 and >9 consultations), use of alcohol or tobacco, delay before first feed (>6 hours) and use of a pacifier. Breastfeeding rates in Itaúna (MG) are well below those recommended by the World Health Organization. The principal variables with a negative relationship with duration of exclusive breastfeeding and of complementary feeding are related to mother and baby health care and, therefore, interventions are possible.

Is there an association between periodontal disease, prematurity and low birth weight? A population‐based study

The relationship between periodontal diseases in pregnancy and children born prematurely or with low birth weight has been increasingly investigated, showing inconclusive results. To test the link between periodontal disease in pregnant women and low birth weight or prematurity. A population-based, cross-sectional study was carried out in Southern Brazil. The sample consisted of 449 parturients who were interviewed and examined up to 48 h post-partum. Three outcomes were investigated: low birth weight, prematurity and prematurity and/or birth weight. Periodontal disease, the exposure, was defined as (i) at least one site with a periodontal pocket; (ii) the presence of pockets at four or more sites. Socio-demographic information relating to health and maternal habits was collected through a questionnaire and by hospital medical records. Simple and multiple regression analysis was performed. There was no statistically significant association between periodontal disease and low birth weight. Periodontal pocket was not associated with low birth weight and/or pre-term birth after being adjusted. A periodontal pocket in at least one site was associated with prematurity (odds ratio=2.6; 95% confidence interval 1.0-6.9) even after adjusting for maternal schooling, parity, number of previous children of low birth weight, number of pre-natal consultations and body mass index. After the introduction of variables relating to maternal health during pregnancy, this association disappeared. No association was found between periodontal disease in the mother and the low birth weight. An association between prematurity and periodontal pockets was found but it was confounded by maternal health variables.

Avaliação da assistência às gestantes: o caso do município de São José do Rio Preto, São Paulo, Brasil

OBJETIVOS: detectar mudanças em indicadores de qualidade da assistência às mulheres que tiveram filhos no município de São José do Rio Preto, entre 1997 e 2001, a partir da fixação de percentual máximo de cesarianas. MÉTODOS: a população alvo foi de mulheres residentes e que tiveram filhos nos hospitais do município em 1997 e 2001 e em especial aquelas atendidas por hospitais cuja maioria de leitos era financiada pelo Sistema Único de Saúde. Trata-se de estudo descritivo com desenho de corte transversal que utilizou dados primários e secundários. Os primários foram coletados através de inquérito domiciliar realizado por amostragem e os secundários obtidos das Declarações de Nascidos Vivos do Sistema de Nascidos Vivos. RESULTADOS: entre 1997 e 2001 constatou-se redução da gravidez na adolescência e aumento da escolaridade das mulheres. Observou-se que as proporções de cesárea diminuíram nos hospitais selecionados e que houve aumento no número de consultas no pré-natal. Não houve alterações no peso ao nascer, Apgar, idade gestacional e nas proporções das mulheres que achavam o parto normal o mais indicado. Os indicadores relacionados com a amamentação apresentaram melhoria. CONCLUSÕES: verificou-se a melhoria em alguns dos indicadores avaliados, embora o acolhimento nos serviços mereça ser problematizado em São José do Rio Preto.

Risk factors for low birth weight in a rural community in southern Brazil

This paper reports a study assessing risk factors for low birth weight (LBW), preterm and intrauterine growth retardation (IUGR) in a sample of 936 mothers who delivered babies in the Canguçu Hospital, a rural area of southern Brazil. Traditional risk factors for delivering LBW, preterm and IUGR were examined. The relative importance of the risk factors was studied through risk calculation and logistic regression analysis. Some risk factors for LBW such as low maternal education and number of prenatal consultations were not associated with the risk of delivering babies in any of the three risk groups. Hospitalization during pregnancy and maternal age less than 20 years were confirmed as risk factors for LBW. In the preterm group, low maternal weight and hospitalization during pregnancy showed significant association after control for confounders. The results suggest that there are specific targets for intervention in each of the three groups, and some traditional risk factors must be redefined according to the characteristics of each population.