Number Of Prenatal Visits Research Articles

Temporal evolution of anemia prevalence in pregnant adolescents of a public maternity of Rio de Janeiro

To describe the evolution of the prevalence of anemia in pregnant adolescents attended at a public maternity in the city of Rio de Janeiro from 2004 to 2013. A retrospective cross-sectional study with 628 pregnant/postpartum women divided into 3 groups: Group A (2004-2006), Group B (2007-2010) and Group C (2013). Information about anthropometric, clinical, sociodemographic data and obstetric and prenatal care of adolescents was obtained from medical records of the pregnant women. A hemoglobin concentration n<11 g/dL was considered to be anemia. Data were analyzed statistically by the chi-square test, Student's t-test and ANOVA, and the post hoc Tukey test. The prevalence of gestational anemia over the years was 43% (GA=138), 36% (GB=80) and 47.1% (GC=40) and the overall prevalence for the 2004-2013 period was 41.1% (n=258). The occurrence of anemic pregnant women increased with the progression of pregnancy; however, in the 3rd quarter there was a decrease in the prevalence of anemia in GB (29.3%) compared to GA (38.7%; p=0.04). Factors associated with anemia were number of prenatal visits and prenatal nutritional assistance, place of residence, pre-pregnancy BMI, and gestational weight gain. The results showed that the prevalence of anemia among pregnant adolescents seen at a public maternity is high. There was no reduction of anemia during the study period and other factors in addition to iron deficiency were involved in the genesis of anemia in this population.

251-POS

Objectives To compare the relative risk of eclampsia and frequency of prenatal visits. Methods We evaluated the risk of gestational hypertension with the number of prenatal visits in 4,247,694 delivered women included in the CDC 2008 Vital Stats dataset. The incidence of eclampsia among subgroups of women defined by their number of prenatal visits was calculated. Relative risks were determined for each subgroup by comparing the incidence of eclampsia in each subgroup compared to those women with 13–14 visits (reference group). These groups were (1) no visits, (2) 1–2 visits, (3) 3–4 visits, (4) 5–6 visits, (5) 7–8 visits, (6) 9–10 visits, (7) 11–12 visits, (8) 13–14 visits {reference group}, (9) 15–16 visits, (10) 17–18 visits, (11) 19 or more visits. Results The relative risk of eclampsia increased as the number of prenatal visits decreased, with the highest risk among those women who had no prenatal visits (RR = 2.16, 95% CI = 1.90–2.45). The relative risk of eclampsia also increased as the number of prenatal visits increased above 13–14 visits. The highest risk was for those women with 19 or more visits (RR = 2.34, 95%, CI = 2.13–2.58). Conclusions Fewer prenatal visits may be associated with a higher risk of eclampsia. This may be due to iatrogenic preterm delivery or poor patient compliance. Eclampsia may also be associated with an increased number of prenatal visits. This may be due to close monitoring of a high risk patient. Disclosures E.T. Greeley: None. K.L. Terry: None. J.V. Spencer: None.

257-POS

Objectives To compare the relative risk of gestational hypertension and frequency of prenatal visits. Methods We estimated the incidence of gestational hypertension among subgroups of women defined by their number of prenatal visits. Relative risks were determined for each subgroup by comparing the incidence of gestational hypertension in each subgroup compared to those women with 13–14 visits. These groups were (1) no visits, (2) 1–2 visits, (3) 3–4 visits, (4) 5–6 visits, (5) 7–8 visits, (6) 9–10 visits, (7) 11–12 visits, (8) 13–14 visits {reference group}, (9) 15–16 visits, (10) 17–18 visits, (11) 19 or more visits. Results The relative risk of gestational hypertension decreased as the number of prenatal visits decreased, with the lowest risk being those women who had no prenatal visits (Relative Risk (RR) = 0.72, 95% Confidence Interval (CI) = 0.69–0.76). The relative risk continued to increase as the number of prenatal visits continued past the reference range of 13–14 visits. The highest risk was for those women with 19 or more visits (RR = 1.76, 95% CI = 1.72–1.80). Conclusions Surprisingly, fewer prenatal visits are associated with a diagnosis of gestational hypertension. This may be due to women with gestational hypertension delivering earlier and therefore having fewer prenatal visits. The increasing risk for gestational hypertension beyond 13–14 visits may indicate a patient that is being observed more closely with more scheduled visits. Limitations of this study include lack of standardized data collection across institutions and inability to control for confounding, particularly the length of gestation. However, this is a large and diverse dataset allowing robust estimates of the association. Disclosures E.T. Greeley: None. K.L. Terry: None. J.V. Spencer: None.

Proportion of Cesarean Deliveries According to Hospital Funding in S&amp;#227;o Paulo Metropolitan Area, Brazil

Introduction: There has been an increase in the proportion of cesarean deliveries, especially in developing countries. Methods: Cross-sectional study of all hospital live births from mothers living in Sao Paulo Metropolitan Area, Brazil. Data were obtained from the Live Birth Information System, which is linked to the National Database of Health Establishments. Hospitals were classified as public, private or mixed. Descriptive analysis and exponential regression were conducted to evaluate time trends. Poisson regression was applied to analyze each hospital type to identify risk factors and the attributable risk fraction for cesarean section. Results: There was an annual increase (1.4%) of cesarean deliveries between 2000 and2013. In2009, the percentage of cesarean deliveries was 53% overall and 83% in private hospitals. The primary risk factor for cesarean delivery was delivery in a private hospital. Other risk factors that were stronger in public hospitals included the following: advanced maternal age, high maternal education, nulliparity, high number of prenatal visits, multiple pregnancy, hospital with low annual volume of deliveries, birth outside the city of residence and white skin color. Discussion: These results may be explained by the obstetric care model of private hospitals, which is not multiprofessional. Prenatal care and delivery are conducted by the same doctor and rarely include the input of another professional, such as a midwife. In addition, the mode of delivery influences the professional’s payment.

Low birth weight at term and the presence of fine particulate matter and carbon monoxide in the Brazilian Amazon: a population-based retrospective cohort study.

BackgroundAlthough studies have shown an association between air pollutants from anthropogenic sources and pregnancy outcomes, little is known regarding the association between low birth weight (LBW) and exposure to emissions of biomass burning.MethodsThis population-based retrospective cohort study assessed the effect of exposure to particulate matter and carbon monoxide (CO) from biomass burning in the Amazon and cerrado (Brazilian savanna) biomes on term LBW (<2500 g) in cities of Mato Grosso, Brazil. Data on births were obtained from the Information System on Live Births of the Ministry of Health. The exclusion criteria were a twin pregnancy, gestational age of less than 37 weeks, and congenital malformation diagnosed at birth. For exposure variables, we used a historical series of daily average concentrations of particulate matter with a diameter less than 2.5 μm (PM2.5) and CO provided by Coupled Aerosol and Trace Gases Transport Model for the Brazilian Development of the Regional Atmospheric Modeling System developed at the National Institute for Space National Center for Weather Forecasts and Climate Studies, National Institute for Space Research. Maternal exposure was estimated by the average amount of pollutants for each trimester and for the entire period of gestation. The association between air pollutants and LBW was analyzed by multiple logistic regression, adjusting for the newborn’s sex, mother’s age and education, and prenatal care.ResultsA total of 6147 full-term singleton live births were included in the study and 193 (3.1%) were LBW. In adjusted analysis, the number of prenatal visits and maternal education with 8 years or more were associated with LBW. The association between exposure to air pollutants and the risk of LBW was significant for the 4th quartile of PM2.5 concentrations in the 2nd trimester (OR = 1.51, 95% CI = 1.04 to 2.17) and in the 3rd trimester, and for the 4th quartile of CO concentrations in the 2nd trimester only, in adjusted analysis.ConclusionsThis study provides further evidence of the effect of smoke from biomass burning on the occurrence of LBW in cities of the Brazilian Amazon.

CLINICAL AND SOCIAL IMPACT OF BRAZILIAN TEENAGE PREGNANCY

Objectives: To verify the correlation between low birth weight, prematurity, number of prenatal visits and type of delivery and maternal age (Adolescents versus young adults), in the city of Salvador – Bahia, Brazil; and in the whole Brazilian territory, in 2011. Methods: Population based study, descriptive and comparative, based on secondary data available in the database of the Information System on Live Births (SINASC), which was generated by the Department of the Health System of Brazil (DATASUS). The group analyzed comprises all the newborn children of parturients aged between 10 and 34 years. The variables were categorized as: maternal age (10-14; 15-19 and 20-34 years-old); delivery route (vaginal or cesarean); birthweigh (&lt; 2,500g; between 2,500g and 3,999g; ≥ 4000g); number of prenatal visits (None, 1 to 6, ≥ 7). Results: There was a downward trend in vaginal delivery, in Salvador and in Brazil, among the three groups analyzed. Prematurity rates (&lt;37 weeks) as well as low birth weight rates (&lt; 2,500g) in Salvador were higher than those in Brazil in both age groups studied. In Brazil, the rates of individuals who attended the ideal minimum number of prenatal care program were 42.1% among adolescents (10-14 years old) and 65.4% among young adults (20-34 years old) women. In Salvador, those rates were 15% and 19%, respectively. Conclusion: Pregnant adolescents from Brazil, and Salvador also, had higher rates of prematurity, low birth weight and lower adherence to prenatal care program compared with women in the age range considered ideal for pregnancy.

Impact of maternal marital status on birth outcomes among young Malaysian women: a prospective cohort study.

This study evaluated the impact of maternal marital status on birth outcomes among young Malaysian women and investigated other risk factors influencing the birth outcomes. Pregnant women with and without marital ties at the point of pregnancy diagnosis were invited to participate in this study. Participants were interviewed using a structured questionnaire at pregnancy diagnosis and shortly after childbirth. From a total of 229 unmarried and 213 married women who participated, marital status was significantly associated with preterm birth (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.05-2.61) and low birth weight (OR, 3.61; 95% CI, 1.98-6.57). Other factors significantly associated with birth outcomes was prenatal care (OR, 4.92; 95% CI, 1.43-16.95), "use of drugs" (OR, 10.39; 95% CI, 1.14-94.76), age (OR, 1.12; 95% CI, 1.07-1.16), and number of prenatal visits (OR, 1.03; 95% CI, 1.00-1.07). Promoting access to prenatal care and social support programs for unmarried mothers may be important to reduce adverse pregnancy outcomes.

Maternal and birth characteristics and childhood rhabdomyosarcoma: a report from the Children's Oncology Group.

Previous assessments of childhood rhabdomyosarcoma have indicated maternal and birth characteristics may be associated with tumor development; however, much work remains to identify novel and confirm suspected risk factors. Our objective was to evaluate the associations between maternal and birth characteristics and childhood rhabdomyosarcoma. This case-control study included 322 cases and 322 pair-matched controls. Cases were enrolled in a trial run by the Intergroup Rhabdomyosarcoma Study Group. Population-based controls were identified using random digit dialing and were individually matched to cases on race, sex, and age. Families of the case and control subjects participated in a telephone interview, which captured information on maternal characteristics (birth control use, number of prenatal visits, anemia, and abnormal bleeding during pregnancy) and birth characteristics [birth weight, preterm birth, and type of delivery (vaginal vs. cesarean)]. Conditional logistic regression models were used to calculate an odds ratio (OR) and 95% confidence interval (CI) for each exposure, adjusted for age, race, sex, household income, and parental education. As the two most common histologic types of rhabdomyosarcoma are embryonal (n = 215) and alveolar (n = 66), we evaluated effect heterogeneity of these exposures. The only characteristic that was associated with childhood rhabdomyosarcoma, and statistically significant, was abnormal vaginal bleeding during pregnancy (OR 1.75, 95% CI 1.12-2.74). Birth control use (OR 1.45, 95% CI 0.96-2.18), anemia during pregnancy (OR 1.27, 95% CI 0.81-1.99), and preterm birth (OR 2.51, 95% CI 0.74-8.49) were positively associated with childhood rhabdomyosarcoma, but were not statistically significant. Low birth weight [adjusted odds ratios (aOR) 4.46, 95% CI 1.41-14.1] and high birth weight (aOR 2.41, 95% CI 1.09-5.35) were strongly associated with alveolar rhabdomyosarcoma. However, these factors did not display significant effect heterogeneity between histologic types (p > 0.15 for all characteristics). Overall, we found little evidence that these maternal and birth characteristics are strongly associated with childhood rhabdomyosarcoma.

Association between prenatal care and neonatal deaths, 2000-2009, Londrina-PR

The study aimed to analyze the prenatal care for mothers of infants who died in the neonatal period, in Londrina-PR, through a quantitative retrospective cohort study, between 2000 and 2009. Almost all women held the prenatal care (91.4 %), with 55.1 % up to six consultations. In ten years, the low number of visits (≤ 6) predominated. There was a statistically significant relationship between the number of prenatal visits and maternal sociodemographic variables (p < 0.004) and characteristics of the labor and the newborn (p < 0.001). The surgical delivery was predominant among women with ≥ 7 queries (71.3 %). Among women with ≤ 6 prenatal visits, 65.9 % of births occurred before 32 weeks of gestation, 79.8 % of the newborns had Apgar scores ≤ 6 at 1 minute and 51.7 % weight ≤ 1000 grams. Most deaths occurred in the early neonatal period (72.6 %). We highlight the necessity of qualitative and integrative prenatal care in this city, considering beyond biological conditions but also maternal socio-economic conditions in order to reduce neonatal deaths.

Adequate weight gain in pregnancy: an analysis of its determinants in a cross-sectional study.

Prenatal care is considered an important tool for promoting a healthy lifestyle, but has not been studied as a predictor for maternal weight gain during pregnancy, especially in Romania, where evidence about pregnancy and nutrition is scarce. This study has aimed to explore the relationship between pre-gestational body mass index (BMI), adequacy of prenatal care and weight gain during pregnancy. We carried a cross-sectional study on a sample of 400 pregnant women admitted at the "Cuza Voda" Obstetrics and Gynecology Hospital in Iasi. Information regarding demographic characteristics, number of prenatal visits, date of the initial hospital record, nutritional education during pregnancy were registered throughout a questionnaire filled out by means of a direct interview. The anthropometric indicators analyzed were the pre-gestational BMI and the pregnancy weight gain. Data on caloric intake were obtained using a food frequency questionnaire. Weight gain within the limits of the Institute of Medicine recommendations was noticed at 44.35% of the women who declared that they received nutritional advice compared to 40.7% of those who did not receive advice regarding diet during pregnancy. Overweight (53.1%) and obese women (66.7%) had a larger weight gain than those with a normal pre-pregnancy BMI (29.8%) (p<0.001). The variables that were identified with an effect on weight gain in this sample of pregnant women were: inadequate prenatal care, pre-gestational BMI and energy intake. Identifying the pre-gestational BMI and diet changes as predictors of weight gain underline the importance of an individualized prenatal care.

Prenatal Practices and Pregnancy Outcomes Among Primigravida Mothers in llocos Sur

The study determined the prenatal practices and pregnancy outcomes among primigravida mothers in Ilocos Sur. It looked into the significant relationship between the respondents' socio-demographic profile and prenatal practices. Significant relationship between pregnancy outcomes and prenatal practices of primigravida mothers was also determined. The study made use of a descriptive correlational type of research. A questionnaire-checklist formulated by the researchers was the main tool used to gather data. It involved 120 primigravida mothers from selected municipalities of /locos Sur, who were chosen through purposive sampling. Frequency, percentage and simple linear correlation analysis were the statistical tools used to treat the data. Majority of the respondents were 21- 25 years old, single, college graduates, plain housewives, from rural areas, with a monthly family income of Php 5,000 and below, availed of the services of the midwives for prenatal check up, at the rural health unit, once during the first trimester, twice during the second and third trimester, availed of tetanus toxoid immunization, assessment of fetal growth, fundic height measurement, iodine and iron supplementation, physical examination , laboratory examinations, and health education. Most of the respondents did not develop any complications, delivered a full term baby in the hospital through normal spontaneous delivery. Significant relationship existed between civil status and pre-natal practices along preference for health care provider; age and health education classes, occupation and physical assessment and health education classes; income and physical assessment; provision of iodine supplementation and health education: place of residence and tetanus toxoid immunization. A significant relationship also existed between provision of iodine and pregnancy outcome: hemorrhage and type of delivery; hemorrhage and health education classes; anemia and health education classes; preterm birth and abdominal palpation and health education classes. It is, then, recommended that primigravida must be encouraged to follow the desired number ofprenatal visits. Health workers in the RHU should conduct home visits to remind them of the next visits.

Factors explaining inadequate prenatal care utilization by first and second generation non-western women in The Netherlands

Background: In many industrialized western countries non-western women constitute a substantial part of the prenatal care client population. In The Netherlands, these women have also been shown to be more likely to make inadequate use of prenatal care. Explanatory factors for this include, among others, poor language proficiency, lower education and teenage pregnancies. However, these studies did not take into account the number of prenatal visits, and did not distinguish between first and second generation non-western women. By taking both prenatal care initiation and the number of prenatal visits into account, this quantitative study aims to provide a more in depth understanding of the factors explaining first and second generation non-western women’s inadequate prenatal care utilization in The Netherlands. Methods: Data on prenatal care utilization and possible explaining factors were derived from the national DELIVER study, a cohort of 7907 women recruited between September 2009 and February 2011 from 20 primary midwifery care practices in The Netherlands. To assess prenatal care utilization, the Kotelchuck index was modified to the Dutch primary midwifery care context. Possible explanatory variables were grouped according to an elaborated version of the Andersen model of healthcare utilization. After initial descriptive and univariate analysis, logistic block wise regression analyses were conducted and percentage change in odds ratio calculated. Results: Preliminary results show that whether or not having a partner, the partner’s ethnic origin and the language spoken at home, explain a substantial part of second generation non-western women’s inadequate prenatal care utilization. Explanatory factors for first generation women are: the two earlier mentioned factors plus planning and wantedness of pregnancy and socioeconomic status. Conclusions: These results demonstrate that there are similarities and differences between first and second generation non-western women who make inadequate use of prenatal care. These insights need to be taken into account when developing measures to improve prenatal care utilization by non-western women in The Netherlands and other industrialized western countries.

Fatores socioeconômicos, obstétricos, demográficos e psicossociais como risco ao desenvolvimento infantil

OBJETIVO: investigar a associação de fatores de risco obstétricos, demográficos, socioeconômicos e psicossociais com a presença de risco ao desenvolvimento infantil nas faixas etária de um a dezoito meses de idade. MÉTODO: a amostra inicial foi constituída de 182 díades mãe-bebê e final de 58 díades. A coleta de dados ocorreu por meio da análise da interação mãe-bebê feita com base no Protocolo de Indicadores de Risco ao Desenvolvimento Infantil e de uma entrevista que investigou aspectos socioeconômicos, demográficos, obstétricos e psicossociais na primeira etapa da pesquisa. Os dados foram organizados em uma planilha eletrônica e posteriormente convertidos para os aplicativos computacionais para análise estatística. RESULTADOS: os fatores de risco significantes para as quatro fases do protocolo foram, na faixa de zero a quatro meses o estado civil da mãe e o número de filhos; na faixa de quatro a oito meses o número de consultas pré-natal e a renda per capita; na faixa de oito a doze meses o planejamento da gestação; e na faixa de doze a dezoito meses o histórico de depressão materna, a idade da mãe e a profissão da mãe. CONCLUSÃO: a pesquisa demonstrou que as condições socioeconômicas, obstétricas, psicossociais e demográficas podem oferecer risco ao desenvolvimento infantil.

Determinants of prenatal care use: evidence from 32 low-income countries across Asia, Sub-Saharan Africa and Latin America

While much has been written on the determinants of prenatal care attendance in low-income countries, comparatively little is known about the determinants of the frequency of prenatal visits in general and whether there are separate processes generating the decisions to use prenatal care and the frequency of use. Using the Demographic and Health Surveys data for 32 low-income countries (across Asia, Sub-Saharan Africa and Latin America) and appropriate two-part and multilevel models, this article empirically assesses the influence of a wide array of observed individual-, household- and community-level characteristics on a woman's decision to use prenatal care and the frequency of that use, while controlling for unobserved community level factors. The results suggest that, though both the decision to use care and the number of prenatal visits are influenced by a range of observed individual-, household- and community-level characteristics, the influence of these determinants vary in magnitude for prenatal care attendance and the frequency of prenatal visits. Despite remarkable consistency among regions in the association of individual, household and community indicators with prenatal care utilization, the estimated coefficients of the risk factors vary greatly across the three world regions. The strong influence of household wealth, education and regional poverty on the use of prenatal care suggests that safe motherhood programmes should be linked with the objectives of social development programmes such as poverty reduction, enhancing the status of women and increasing primary and secondary school enrolment rate among girls. Finally, the finding that teenage mothers and unmarried women and those with unintended pregnancies are less likely to use prenatal care and have fewer visits suggests that safe mother programmes need to pay particular attention to the disadvantaged and vulnerable subgroups of population whose reproductive health issues are often fraught with controversy.

Não adesão às diretrizes para rastreamento do câncer do colo do útero entre mulheres que frequentaram o pré-natal

To estimate the prevalence and identify the factors associated with delayed pap smear test of the cervix (carried out more than three years ago) among mothers with sons under two years of age, who attended the prenatal care. Cross-sectional, population-based household survey. Women with sons under two years old, living in the northern area of the city of Juiz de Fora (MG), Brazil, were interviewed. Stratification and clustering were used in a complex sampling procedure. We applied a survey questionnaire to capture women's demographic and socioeconomic characteristics of women and information about prenatal and practices for preventing cancer of the cervix. For statistical analysis of the possible bivariate association of factors, we used χ² test and a logistic regression model with the explanatory variables that had a significance less than or equal to 0.05 in the bivariate analysis. We found a delayed test prevalence of 26.6% (95%CI 21.3 - 32.6), including women who were never submitted to the exam. The variables associated with the non-adherence to the examination within the stipulated time were: to be married (OR 0.5; 95%CI 0.2 - 0.9), and divorced/widowed (OR 0.1; 95%CI 0.02 - 0,8), having performed gynecological examination in prenatal care (OR 0.3; 95%CI 0.1 - 0.6) and number of prenatal visits (OR 0.09; 95%CI 0.03 - 0.25 for more than 11 visits), being all protection factors. The prevalence of adherence to Pap smear guidelines is slightly lower than the percentage recommended by the World Health Organization. Apart from that, the fact that the woman was submitted to the prenatal care did not guarantee the adherence to Pap smear frequency guidelines.

173: The relationship between gestational diabetes and postpartum depression

Patients with gestational diabetes mellitus (GDM) are at increased risk of obstetrical and perinatal complications. In studies of non-pregnant women and men, rates of any depression are significantly higher in patients with diabetes relative to the general population. There are several proposed mechanisms of how depression and diabetes are interrelated: hypothalamic-pituitary-adrenal axis dysregulation, pro-inflammatory state, serotonin system dysregulation, and behavioral issues. We sought to identify if this association held true in pregnant women. Does a diagnosis of GDM convey an increased risk of postpartum depression (PPD)? The Pregnancy Risk Assessment Monitoring System (PRAMS) data, a survey of new mothers identified by the birth certificate files of 37 participating states for deliveries between 2004-2008, was used for this analysis (n=102,540). Logistic regression analyses were used to estimate the association between GDM and PPD, adjusting for maternal demographics, low birthweight, birth defects, number of prenatal visits, gestational age at delivery, NICU admission, and co-morbid medical conditions. We also evaluated the relationship between pre-existing diabetes and PPD. PPD was noted in 16.9% of women with GDM vs. 13.7% without GDM. Adjusting for covariates, women with GDM are more likely to have PPD (aOR: 1.14, 95% CI: 1.02-1.27). When we added preexisting diabetes to the model, there was no association between preexisting diabetes and postpartum depression (aOR: 1.08, 95% CI: 0.85-1.36), while the association of GDM and PPD remained statistically significant (aOR: 1.13, 95% CI: 1.01-1.27). This data suggests an association between GDM and PPD. Physicians should consider increased depression screenings for women with GDM and education regarding the signs of depression and the risk of developing PPD.

Risk factors for low birth weight in Rio Grande do Sul State, Brazil: classical and multilevel analysis

The objective of this study was to identify risk factors for low birth weight in singleton live born infants in Rio Grande do Sul State, Brazil, in 2003, based on data from the Information System on Live Births. The study used both classical multivariate and multilevel logistic regression. Risk factors were evaluated at two levels: individual (live births) and contextual (micro-regions). At the individual level the two models showed a significant association between low birth weight and prematurity, number of prenatal visits, congenital anomalies, place of delivery, parity, sex, maternal age, maternal occupation, marital status, schooling, and type of delivery. In the multilevel models, the greater the urbanization of the micro-region, the higher the risk of low birth weight, while in less urbanized micro-regions, single mothers had an increased risk of low birth considering all live births. Low birth weight varied according to micro-region and was associated with individual and contextual characteristics. Although most of the variation in low birth weight occurred at the individual level, the multilevel model identified an important risk factor in the contextual level.

Risk factors for infant mortality in a municipality in southern Brazil: a comparison of two cohorts using hierarchical analysis

This study compared risk factors for infant mortality in 2000-2001 and 2007-2008 in Londrina, Paraná State, Brazil. Data on live births and infant deaths were linked in a single database, and a hierarchical regression model was used. Distal risk factors for infant mortality in 2000-2001 were maternal age < 20 or ≥ 35 years and lower maternal schooling. In 2007-2008, maternal age ≥ 35 or < 20 years were risk factors, while low schooling appeared as a protective factor. The following intermediate factors were associated with increased infant mortality in 2000-2001: multiple pregnancy, history of stillbirth, and insufficient number of prenatal visits, while cesarean delivery was a protective factor. Multiple pregnancy was the only intermediate risk factor in 2007-2008. All of the proximal factors were associated with higher infant mortality in 2000-2001, but only gestational age and 5-minute Apgar in 2007-2008. The risk factors for infant mortality changed from the first to the second cohort, which may be related to the expansion of social policies and primary care and changes in the reproductive and social patterns of Brazilian women.

Análise comparativa das gestações e da frequência de prematuridade e baixo peso ao nascer entre filhos de mães adolescentes e adultas

To perform a comparative analysis between the frequency of prematurity and low birth weight among newborns of adolescent and adult mothers, and to evaluate selected maternal data. A comparative cohort study involving 703 pregnant women and their newborns at a public hospital in the city of São Paulo (270 mothers aged 10-19 years, and 433 aged 20-35 years), during the period from March to August 2003. The birth of premature or low birth weight children was not prominent in any of the age groups; the small differences found were not statistically significant. However, significant differences were found between the two age groups in the items: number of gestations, with a predominance of first pregnancies among adolescents (70.3%), and a greater number of second or third pregnancies among adults (26.9 and 53.3%, respectively); in the prenatal period, fewer clinic visits among adolescents and more visits among adults (45.1% and 63.3%, respectively). The group of pregnant adolescents in the population studied did not differ from the group of adults as to frequency of prematurity and low birth weight. Among adolescents, there was a significantly higher number of primiparous patients compared to adults, and a lower number of prenatal visits.

Risk factors for cognitive impairment in school-age children born preterm: application of a hierarchical model

The purpose was to analyze factors associated with cognitive impairment in very low birth weight (VLBW) children born preterm. A prospective cohort of 65 VLBW children was assessed at the age of eight years using the Wechsler Intelligence Scale for Children. A model for the relationship of variables with the cognitive impairment outcome attributed hierarchical levels: distal (socioeconomic variables), intermediate I and II (perinatal and neonatal variables, post-neonatal variables) and proximal (child health and psychosocial stimulation). A multivariate logistic regression was performed. In the multivariate hierarchical logistic regression, the maternal education (OR=0.77, 95%CI 0.63-0.94) and number of prenatal visits (OR=0.73, 95%CI 0.54-0.99) showed a protective association, but the male (OR=7.3, 95%CI 1.54-35.3) was associated with worse results. The VLBW children cognitive performance in the age of eight years benefits from more educated mothers, better prenatal care, and the baby gender as female.