Adequacy of antenatal care and its relationship with low birth weight in Botucatu, Sao Paulo, Brazil: a case-control study
Adequacy of antenatal care and its relationship with low birth weight in Botucatu, Sao Paulo, Brazil: a case-control study
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DOI：
10.1186/1471-2393-14-255
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发表时间：
2014-08-01
影响因子：
3.1
通讯作者：
Puccini, Rosana Fiorini
中科院分区：
文献类型：
--
作者：
Branco da Fonseca, Catia Regina;Louzada Strufaldi, Maria Wany;Puccini, Rosana Fiorini
背景：出生体重反映了妊娠状况和胎儿期的发育。低出生体重（LBW）可能与产前保健（ANC）的充分性和质量有关。本研究的目的是分析ANC充分性及其与低出生体重的关系，在统一的卫生系统在Brazils.Methods：在Botucatu，圣保罗，巴西，2004年至2008年进行了病例对照研究。数据收集自次要来源（活产证明）和主要来源（孕妇的官方医疗记录）。研究人群包括两组，每组860名新生儿。病例组包括体重小于2,500克的新生儿，而对照组包括体重大于或等于2,500克的活新生儿。ANC的准确性根据三个测量来评估：1.根据胎龄调整ANC访视次数的准确性; 2.改良Kessner指数; 3.根据卫生部在产前和分娩护理人性化方案中定义的参数，ANC实验室研究和检查的准确性进行了汇总测量。分析显示，LBW与校正胎龄后的ANC访视次数相关（OR = 1.78，95% CI 1.32-2.34）和ANC实验室研究和检查汇总指标（OR = 4.13，95% CI 1.36-12.51）。根据修改后的Kessner指数，64.4%的产前检查中的LBW组是足够的，组间无差异Conclusions：我们的数据证实了ANC访问，实验室研究和检查，和LBW新生儿的风险增加的数量不足之间的关联。未发现改良Kessner指数作为ANC和LBW充分性的衡量指标之间存在关联。这一调查结果表明，巴西卫生系统中已经得到良好管理的基本行动的覆盖率指数很低。尽管在研究中发现了相关性，但我们不能得出结论，LBW只能通过适当的ANC来预防，因为LBW与复杂和多因素病因学因素有关。研究结果可用于计划监测措施和评估怀孕期间、分娩时和新生儿的保健援助方案，重点是降低低出生体重率。
Background: Birth weight reflects gestational conditions and development during the fetal period. Low birth weight (LBW) may be associated with antenatal care (ANC) adequacy and quality. The purpose of this study was to analyze ANC adequacy and its relationship with LBW in the Unified Health System in Brazil.Methods: A case-control study was conducted in Botucatu, Sao Paulo, Brazil, 2004 to 2008. Data were collected from secondary sources (the Live Birth Certificate), and primary sources (the official medical records of pregnant women). The study population consisted of two groups, each with 860 newborns. The case group comprised newborns weighing less than 2,500 grams, while the control group comprised live newborns weighing greater than or equal to 2,500 grams. Adequacy of ANC was evaluated according to three measurements: 1. Adequacy of the number of ANC visits adjusted to gestational age; 2. Modified Kessner Index; and 3. Adequacy of ANC laboratory studies and exams summary measure according to parameters defined by the Ministry of Health in the Program for Prenatal and Birth Care Humanization.Results: Analyses revealed that LBW was associated with the number of ANC visits adjusted to gestational age (OR = 1.78, 95% CI 1.32-2.34) and the ANC laboratory studies and exams summary measure (OR = 4.13, 95% CI 1.36-12.51). According to the modified Kessner Index, 64.4% of antenatal visits in the LBW group were adequate, with no differences between groups.Conclusions: Our data corroborate the association between inadequate number of ANC visits, laboratory studies and exams, and increased risk of LBW newborns. No association was found between the modified Kessner Index as a measure of adequacy of ANC and LBW. This finding reveals the low indices of coverage for basic actions already well regulated in the Health System in Brazil. Despite the association found in the study, we cannot conclude that LBW would be prevented only by an adequate ANC, as LBW is associated with factors of complex and multifactorial etiology. The results could be used to plan monitoring measures and evaluate programs of health care assistance during pregnancy, at delivery and to newborns, focusing on reduced LBW rates.