[Characteristics of pregnant women and routine antenatal care in Barcelona, 1994-1999]

[Maternal occupation, pregnancy length and low birth weight]

OBJECTIVE

To assess the association between maternal occupation during pregnancy with the presence of low birth weight and preterm delivery.

METHOD

The sample consisted of 1,341,686 preterm infants and 1,217,897 low birth weight infants in Spain (1996-2000) with valid information on maternal occupation from the National Registry of Births. Maternal occupation was the main exposure variable coded according to groups of occupation (CNO-79) and outcomes were low birth weight (<2500 g) and preterm birth (<37 weeks). Crude and adjusted odds ratios (OR) and 95% confidence interval (CI) were calculated through the maximum verisimilitude method.

RESULTS

The highest prevalence of preterm infants was found in mothers working in agriculture (10.8%) and the lowest in professional women (6.6%). The highest prevalence of low birth weight was observed in the women working in the services sector (3.5%) and manual workers in industry and construction (3.4%) while the lowest prevalence was found in professional women (2.5%). Women working in agriculture had a higher risk of preterm birth than professional women (aOR=1.68; 95%CI: 1.57-1.80). The risk of low birth weight was higher in women working in the service sector (aOR=1.36; 95%CI: 1.30-1.42), housewives (aOR=1.30; 95%CI: 1.28-1.38), agricultural laborers (aOR=1.29; 95%CI: 1.14-1.44) and manual workers in industry and construction (aOR=1.29; 95%CI: 1.21-1.36).

CONCLUSIONS

The results of this study suggest that belonging to certain occupational groups during pregnancy could affect the risk of low birth weight and preterm birth.

Influence of the wars in Croatia and Bosnia and Herzegovina on the incidence and outcome of singleton premature births in the Split University Hospital

To investigate the influence of the wars in Croatia and Bosnia and Herzegovina on incidence and perinatal outcome of singleton preterm births at the Department of Gynecology and Obstetrics in the Split University Hospital. Data were collected by reviewing patients’ files at the Department of Gynecology and Obstetrics from three periods: the three years before the war (1988–1990), during the war (1992–1994), and after the war (1996–1998). A total of 2,358 patients’ files of singleton preterm delivery were analyzed. Singleton preterm delivery rate decreased during the war (5.02%) and post-war period (4.74%) compared to the pre-war period (6.19%). Stillbirth and early neonatal mortality rates of singleton premature babies significantly increased during the war to 226%, compared to 193% before the war and 134% after the war. Early neonatal mortality rate was 215% during the war, 209% in the pre-war period, and 156% after the war. Despite the continuous decrease in singleton preterm birth rate throughout the observed periods, the increase in stillbirth rate and early neonatal mortality rate during the war might have been caused by the war. This may be due to primary gynecological care being inadequate for many pregnant women.

Maternal smoking, social class and outcomes of pregnancy

Exposure to tobacco during pregnancy is an important risk factor for infant health. Recently the prevalence of smoking during pregnancy has declined in our area. The objective of this study was to analyse the association between several social variables and the fetal exposure to smoking, as well as the association between maternal smoking and some adverse gestational outcomes. Data collection was cross-sectional. The study population were women in the city of Barcelona (Catalonia, Spain) delivering a child without birth defects. The sample corresponded to the controls of the Birth Defects Registry of Barcelona, 2% of all pregnancy deliveries in the city from 1994 to 2003 (n = 2297). Information sources were hospital records and a personal interview of mothers. The analysis measured first the association between independent variables (instruction level, social class, occupation, nationality, planned pregnancy, parity, hospital funding and smoking status of the mother's partner) with two dependent variables: smoking at the initiation of pregnancy and quitting during pregnancy. Second, the persistence of smoking over pregnancy and all independent variables were studied with three variables indicating adverse outcomes of pregnancy: low gestation, low birthweight and intrauterine growth restriction (IUGR). Finally, the joint association between the persistence of smoking over pregnancy and social class taken as independent variables was determined with the three variables indicating adverse outcomes of pregnancy. Logistic regression models were fitted, adjusting for maternal age. Results are presented as odds ratios with their 95% confidence intervals. The prevalence of smoking at the onset of gestation was 41%, and 40% of these women quit during pregnancy, so that 25% delivered as active smokers. Fewer women with higher educational levels and from families with non-manual jobs smoked, as did immigrants, those planning pregnancy and women whose partner did not smoke. Smoking immigrants quit more frequently than nationals, as did those planning pregnancy, primiparae, and women whose partner did not smoke. Low gestation, low birthweight and IUGR were more frequent among smokers and women with a manual occupation, but manual occupation lost its significance when adjusting for smoking. The association between smoking and adverse results was higher for IUGR. In conclusion, the prevalence of smoking and quitting during pregnancy varied according to social factors. The influence of social factors on the outcome of pregnancy was mediated strongly by smoking in a country that provides access to health care free of cost. A priority in reducing inequalities in health is to help women from manual work backgrounds quit smoking.

[Socioeconomic inequalities in the provision and uptake of prenatal care]

OBJECTIVE

To describe socioeconomic inequalities in the provision and uptake of prenatal care among women in Barcelona (Spain) between 1994 and 2003.

METHODS

Cross-sectional study of women in Barcelona who delivered a child without birth defects. Information was obtained from hospital medical records and a personal interview with women included in the Barcelona Birth Defects Registry, containing a random sample of 2% of all pregnant women in the city (n = 2299).

DEPENDENT VARIABLES

number of obstetric visits, the trimester of the first visit, the number of obstetric ultrasound scans, the fifth-month diagnostic ultrasound scan, invasive procedures, prenatal folic acid intake, pregnancy planning, smoking and smoking cessation. The independent variables were maternal age and social class. Logistic regression models were filted for each dependent variable.

RESULTS

In social classes with manual occupations, there was a higher proportion of pregnant women who attended less than six obstetric visits and who attended the first obstetric visit after the first trimester. Moreover, these women were less likely to have undergone an invasive procedure, to have taken folic acid supplements, to have planned the pregnancy, to be non-smokers and to stop smoking. In the more privileged classes, there was a higher proportion of women who attended more than 12 obstetric visits and who underwent more than three ultrasound scans.

CONCLUSIONS

Socioeconomic inequalities were found in the provision and uptake of prenatal care in Barcelona. Uptake was greater in the more advantaged social classes but excessive medicalization was found in all classes. Rationalizing the use of healthcare resources and reducing excessive medicalization would reduce inequalities in prenatal care in Barcelona.

Satisfacción de las mujeres con el seguimiento del embarazo. Diferencias entre los dispositivos asistenciales

OBJECTIVES

To determine women's satisfaction with pregnancy follow-up and to evaluate possible differences among healthcare levels.

METHODS

Cross-sectional study in women who had given birth in the University Hospital of Salamanca (Spain) between November 2002 and April 2003. Satisfaction was measured by a self-completed questionnaire after delivery. The questionnaire contained 28 items, with five optional answers (1, not satisfied; 5, highly satisfied), distributed in four dimensions: accessibility, equipment, organization of the consultation, and professional competence. Social demographic and healthcare-related variables were also included. Student's t-test, variance analysis, Pearson's correlation coefficient and logistic regression were used to study the association between these variables and satisfaction.

RESULTS

A total of 27.1% of pregnancies were followed-up in primary care. The mean global satisfaction was 3.92 (95% CI, 3.88-3.97), and satisfaction was higher in women followed-up in primary care than those followed-up in specialized care. All dimensions obtained a global satisfaction of more than 3; "accessibility" received the worst score and "professional competence" the highest. The factors significantly associated with satisfaction were age, educational level, the presence of risk factors and complications, and the possibility of choosing the physician.

CONCLUSIONS

General satisfaction was good. Because satisfaction was higher in women followed-up in primary care than in those followed-up in specialized care, pregnancy follow-up at this level of healthcare should be supported.

Increasing detection rates of birth defects by prenatal ultrasound leading to apparent increasing prevalence. Lessons learned from the population-based registry of birth defects of Barcelona

OBJECTIVE

To assess the evolving trends in prenatal ultrasound detection of birth defects and to suggest a method to avoid the bias generated by an increasing detection rate, when comparing different time periods.

METHODS

In the population-based registry of birth defects of Barcelona (REDCB), 1976 cases with birth defects (1462 newborns and 514 terminations of pregnancy) were observed among 99 753 pregnancies, from 1992 to 1999. Detection rates for isolated birth defects by anatomical systems were evaluated. Since an increasing prevalence was observed in some birth defects systems, adjustment for detection rates was suggested.

RESULTS

A rise in prevalence was observed in isolated birth defects involving internal organs (central nervous, respiratory, digestive, and urinary systems). Ultrasound detection rates increased in all system groups of isolated birth defects during the study period, except for cardiovascular defects. Early detection rates (before 23 weeks of pregnancy) increased in all but three systems (cardiovascular, genital and tegument).

CONCLUSIONS

The apparent rise in the observed prevalence of certain birth defects may be largely due to improvements in prenatal detection methods. Population-based registries are able to measure the impact of evolving prenatal diagnosis in order to avoid biases and establish the prevalence of birth defects more accurately.

[Exposure to smoking during pregnancy: Barcelona (Spain) 1994-2001]

BACKGROUND

Exposure to smoking during pregnancy is an important risk factor for child health. In the last few decades, the prevalence of smoking among fertile women has increased in Spain.

OBJECTIVES

To assess fetal exposure to smoking in a representative sample of pregnant women and its trends.

METHODS

The prevalence of smoking and smoking cessation were analyzed in a representative sample of women who gave birth in the city of Barcelona, extracted from a population-based registry of birth defects. The sample consisted of 1,801 women and covered the period 1994 to 2001.

RESULTS

Among pregnant women, 43.4 % smoked before pregnancy, and 42.2 % of these quit. At the time of giving birth, 25.2 % of the women were smokers. Over the period studied the prevalence of smoking among pregnant women clearly decreased. Although the proportion of cessations showed no significant changes, fetal exposure to tobacco decreased.

CONCLUSIONS

The prevalence of smoking among pregnant women was high, although many quit during pregnancy. Over the period studied, fetal exposure to smoking decreased. There is a need for more systematic interventions.