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Soldateli B, Silveira RC, Procianoy RS, Edwards EM, Belfort MB. Association between type of feeding at hospital discharge and nutritional status of Brazilian very preterm infants: a multicenter study. J Pediatr (Rio J) 2024:S0021-7557(24)00086-X. [PMID: 39025129 DOI: 10.1016/j.jped.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer. METHODS The authors studied 4062 surviving very preterm infants born < 32 weeks' gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years. RESULTS Infants' mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: -2.0, -1.8, and -1.5; head z: -1.3, -1.2 and -1.1 for exclusive human milk, mixed and exclusive formula respectively). CONCLUSION Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time.
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Affiliation(s)
- Betina Soldateli
- Faculdade de Medicina, Departamento de Nutrição, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Serviço de Nutrição e Dietética, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Rita C Silveira
- Faculdade de Medicina, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Neonatologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Renato S Procianoy
- Faculdade de Medicina, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Neonatologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, USA; College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, USA; The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Mandy B Belfort
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
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Torres JA, Leite TH, Fonseca TCO, Domingues RMSM, Figueiró AC, Pereira APE, Theme-Filha MM, da Silva Ayres BV, Scott O, de Cássia Sanchez R, Borem P, de Maio Osti MC, Rosa MW, Andrade AS, Filho FMP, Nakamura-Pereira M, do Carmo Leal M. An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals. Reprod Health 2024; 20:190. [PMID: 38671479 PMCID: PMC11052714 DOI: 10.1186/s12978-024-01773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 03/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. METHOD Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA-"Participation of women" and "Reorganization of care" - among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group "Exposed to the PPA model of care" and the group "Standard of care model". RESULTS PPA had a low degree of implementation in both components "Reorganization of Care" (0.17 - 0.32) and "Participation of Women" (0.21 - 0.34). The combined implementation score was 0.39-0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. CONCLUSION The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Paulo Borem
- Institute for Healthcare Improvement, Brasília, Brazil
| | | | | | | | - Fernando Maia Peixoto Filho
- Oswaldo Cruz Foundation, National Institute of Health for Women, Children and Adolescents Fernandes Figueira, Rio de Janeiro, Brazil
| | - Marcos Nakamura-Pereira
- Oswaldo Cruz Foundation, National Institute of Health for Women, Children and Adolescents Fernandes Figueira, Rio de Janeiro, Brazil
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Domingues RMSM, Rodrigues AS, Dias MAB, Saraceni V, Francisco RPV, Pinheiro RS, Coeli CM. Maternal health surveillance panel: a tool for expanding epidemiological surveillance of women's health and its determinants. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240009. [PMID: 38422233 PMCID: PMC10896238 DOI: 10.1590/1980-549720240009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To present the methodology used in the development of two products for maternal health surveillance and its determinants and discuss their possible uses. METHODS Based on a theoretical model of the determinants of maternal death and databases of Brazilian health information systems, two free products were developed: an interactive panel "surveillance of maternal health" and an educational material "Aparecida: a story about the vulnerability of Brazilian women to maternal death", both available on the website of the Brazilian Obstetric Observatory. RESULTS More than 30 indicators were calculated for the period 2012-2020, containing information on socioeconomic conditions and access to health services, reproductive planning, prenatal care, delivery care, conditions of birth and maternal mortality and morbidity. The indicators related to severe maternal morbidity in public hospitalizations stand out, calculated for the first time for the country. The panel allows analysis by municipality or aggregated by health region, state, macro-region and country; historical series analysis; and comparisons across locations and with benchmarks. Information quality data are presented and discussed in an integrated manner with the indicators. In the educational material, visualizations with national and international data are presented, aiming to help in the understanding of the determinants of maternal death and facilitate the interpretation of the indicators. CONCLUSION It is expected that the two products have the potential to expand epidemiological surveillance of maternal health and its determinants, contributing to the formulation of health policies and actions that promote women's health and reduce maternal mortality.
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Affiliation(s)
| | | | - Marcos Augusto Bastos Dias
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Rio de Janeiro (RJ), Brazil
| | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | | | - Rejane Sobrinho Pinheiro
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva - Rio de Janeiro (RJ), Brazil
| | - Claudia Medina Coeli
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva - Rio de Janeiro (RJ), Brazil
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de Carvalho VM, Chung-Filho AA, Braga FHP, Chagas-Neto P, Soares-Lima SC, Pombo-de-Oliveira MS. Interaction between birth characteristics and CRHR1, MC2R, NR3C1, GLCCI1 variants in the childhood lymphoblastic leukemia risk. Front Oncol 2024; 13:1274131. [PMID: 38348123 PMCID: PMC10859751 DOI: 10.3389/fonc.2023.1274131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/31/2023] [Indexed: 02/15/2024] Open
Abstract
Background The incidence rate of childhood acute lymphoblastic leukemia (ALL) differs worldwide, and the interplay between hemostasis actors and the maladaptive responses to environmental exposures has been explored. It has been proposed that endogenous cortisol, induced by different triggers, would eliminate pre-leukemic clones originated in utero. Herein, we tested if the interaction between CRHR1rs242941 C>A, MC2Rrs1893219 A>G, NR3C1rs41423247 G>C, and GLCCI1rs37972 C>T (players in glucocorticoid secretion) and birth characteristics would be associated with ALL risk. Methods Children aged <10 years were enrolled within the EMiLI project (period: 2012 to 2020). The study had three steps: (1) observational analysis of birth characteristics (n = 533 cases and 1,603 controls); (2) genotyping to identify single-nucleotide variants (n = 756 cases and 431 controls); and (3) case-only to test gene-environment interactions (n = 402 cases). Genetic syndromes were exclusion criteria. The controls were healthy children. The distribution of the variables was assessed through Pearson's chi-square test. Logistic regression (LR) tests were run fitted and adjusted for selected covariate models to estimate the association risk. Formal interaction analysis was also performed. Genotyping was tested by qPCR with TaqMan probes (NR3C1) or by high-resolution melting (MC2R and GLCCI1). Hardy-Weinberg equilibrium (HWE) was accessed by the chi-square test. The genotype-risk association was tested in co-dominant, dominant, and recessive models. The gene-environment interaction odds ratio (iOR) was assessed in case-only. Results Low birthweight, C-section, and low maternal schooling were associated with increased risk for ALL, adjOR 2.11, 95% CI, 1.02-4.33; adjOR 1.59, 95% CI, 1.16-2.17; and adjOR 3.78, 95% CI, 2.47-5.83, respectively, in a multiple logistic regression model. MC2R rs1893219 A>G was negatively associated with ALL (AG: OR = 0.68; 95% CI = 0.50-0.94 and GG: OR = 0.60; 95% CI = 0.42-0.85), while for GLCCI1 rs37972 C>T, TT was positively associated with ALL (OR = 1.91; 95% CI = 1.21-3.00). The combination of genotypes for MC2R (AA) and GLCCI1 (TT) increased ALL risk (OR = 2.61; 95% CI = 1.16-5.87). In a multiplicative interaction, MC2R rs1893219 A>G was associated with children whose mothers had less than 9 years of schooling (iOR = 1.99; 95% CI = 1.11-1.55). Conclusion Our study has demonstrated a significant association between MC2R rs1893219 A>G (reduced risk) and GLCCI1 rs37972 C>T variants (increased risk) and childhood ALL susceptibility. Based on this evidence, genes controlling the HPA axis activity may play a role in leukemogenesis, and further investigation is needed to substantiate our findings.
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Affiliation(s)
- Vitoria Müller de Carvalho
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Alython Araujo Chung-Filho
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Flávio Henrique Paraguassu Braga
- National Placental and Umbilical Cord Blood Bank, Instituto Nacional de Câncer (INCA), Ministério da Saúde (MS), Rio de Janeiro, Brazil
| | - Paulo Chagas-Neto
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Sheila Coelho Soares-Lima
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Maria S. Pombo-de-Oliveira
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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Pavlidou E, Antasouras G, Papadopoulou SK, Alexatou O, Papandreou D, Mentzelou M, Tsourouflis G, Louka A, Rodopaios NE, Chrysafi M, Sampani A, Giaginis C. Association of Maternal Risk Factors with the Prevalence of Caesarean Section Deliveries: A Cross-Sectional Study. Med Sci (Basel) 2023; 11:66. [PMID: 37873751 PMCID: PMC10594507 DOI: 10.3390/medsci11040066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
In the last few years, there has been a gradually increasing rate of caesarean section deliveries worldwide that negatively affects both mothers' and children's health. The present survey intended to explore the relations of common maternal risk factors with the prevalence of caesarean sections. This is a cross-sectional study including 5182 healthy mothers from geographically diverse regions of Greece, which has applied relevant inclusion and exclusion criteria. An elevated 56.4% incidence of caesarean sections was noted. The prevalence of caesarean section deliveries was estimated to be 51.5% in private hospitals and 48.5% in public hospitals. Maternal age, pre-pregnancy overweight/obesity, excess gestational weight gain, preterm birth, financial status, smoking habits, and private type of birth hospital were considerably associated with a high probability of caesarean section, regardless of several confounders. In conclusion, caesarean section rates are constantly increasing, and various maternal risk factors additively elevate its incidence, which additionally enhances the likelihood of postpartum complications for both the mothers and their infants. Public health procedures and approaches are strongly recommended to notify future mothers of the potential risk factors that may result in adverse pregnancy outcomes of caesarean section delivery, highlighting its use only for emergency medical reasons and also promoting healthier nutritional and lifestyle habits that may reduce the increasing prevalence of caesarean section deliveries.
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Affiliation(s)
- Eleni Pavlidou
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Georgios Antasouras
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57001 Thessaloniki, Greece;
| | - Olga Alexatou
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Dimitrios Papandreou
- Department of Clinical Nutrition & Dietetics, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
| | - Maria Mentzelou
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, 11527 Athens, Greece;
| | - Aikaterini Louka
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Nikolaos E. Rodopaios
- Department of Social Medicine, Preventive Medicine and Nutrition, Medical School, University of Crete, 70013 Heraklion, Greece;
| | - Maria Chrysafi
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Anastasia Sampani
- First Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece;
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
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6
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Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussain-Alkhateeb L, Lewin A, Okwaraji YB, Mahanani WR, Johansson EW, Lavin T, Fernandez DE, Domínguez GG, de Costa A, Cresswell JA, Krasevec J, Lawn JE, Blencowe H, Requejo J, Moran AC. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet 2023; 402:1261-1271. [PMID: 37805217 DOI: 10.1016/s0140-6736(23)00878-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Preterm birth is the leading cause of neonatal mortality and is associated with long-term physical, neurodevelopmental, and socioeconomic effects. This study updated national preterm birth rates and trends, plus novel estimates by gestational age subgroups, to inform progress towards global health goals and targets, and aimed to update country, regional, and global estimates of preterm birth for 2020 in addition to trends between 2010 and 2020. METHODS We systematically searched population-based, nationally representative data on preterm birth from Jan 1, 2010, to Dec 31, 2020 and study data (26 March-14 April, 2021) for countries and areas with no national-level data. The analysis included 679 data points (86% nationally representative administrative data [582 of 679 data points]) from 103 countries and areas (62% of countries and areas having nationally representative administrative data [64 of 103 data points]). A Bayesian hierarchical regression was used for estimating country-level preterm rates, which incoporated country-specific intercepts, low birthweight as a covariate, non-linear time trends, and bias adjustments based on a data quality categorisation, and other indicators such as method of gestational age estimation. FINDINGS An estimated 13·4 million (95% credible interval [CrI] 12·3-15·2 million) newborn babies were born preterm (<37 weeks) in 2020 (9·9% of all births [95% CrI 9·1-11·2]) compared with 13·8 million (12·7-15·5 million) in 2010 (9·8% of all births [9·0-11·0]) worldwide. The global annual rate of reduction was estimated at -0·14% from 2010 to 2020. In total, 55·6% of total livebirths are in southern Asia (26·8% [36 099 000 of 134 767 000]) and sub-Saharan Africa (28·7% [38 819 300 of 134 767 000]), yet these two regions accounted for approximately 65% (8 692 000 of 13 376 200) of all preterm births globally in 2020. Of the 33 countries and areas in the highest data quality category, none were in southern Asia or sub-Saharan Africa compared with 94% (30 of 32 countries) in high-income countries and areas. Worldwide from 2010 to 2020, approximately 15% of all preterm births occurred at less than 32 weeks of gestation, requiring more neonatal care (<28 weeks: 4·2%, 95% CI 3·1-5·0, 567 800 [410 200-663 200 newborn babies]); 28-32 weeks: 10·4% [9·5-10·6], 1 392 500 [1 274 800-1 422 600 newborn babies]). INTERPRETATION There has been no measurable change in preterm birth rates over the last decade at global level. Despite increasing facility birth rates and substantial focus on routine health data systems, there remain many missed opportunities to improve preterm birth data. Gaps in national routine data for preterm birth are most marked in regions of southern Asia and sub-Saharan Africa, which also have the highest estimated burden of preterm births. Countries need to prioritise programmatic investments to prevent preterm birth and to ensure evidence-based quality care when preterm birth occurs. Investments in improving data quality are crucial so that preterm birth data can be improved and used for action and accountability processes. FUNDING The Children's Investment Fund Foundation and the UNDP, United Nations Population Fund-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction.
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Affiliation(s)
- Eric O Ohuma
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ann-Beth Moller
- Human Reproduction Program (the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ellen Bradley
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Samuel Chakwera
- Division of Data, Analytics, Planning and Monitoring, United Nations Children's Fund, New York, NY, USA
| | - Laith Hussain-Alkhateeb
- Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexandra Lewin
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Yemisrach B Okwaraji
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Wahyu Retno Mahanani
- Department of Data and Analytics, World Health Organization, Geneva, Switzerland
| | | | - Tina Lavin
- Human Reproduction Program (the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Diana Estevez Fernandez
- Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | | | - Ayesha de Costa
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jenny A Cresswell
- Human Reproduction Program (the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Julia Krasevec
- Division of Data, Analytics, Planning and Monitoring, United Nations Children's Fund, New York, NY, USA
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer Requejo
- Division of Data, Analytics, Planning and Monitoring, United Nations Children's Fund, New York, NY, USA
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Rocha AS, Paixao ES, Alves FJO, Falcão IR, Silva NJ, Teixeira CSS, Ortelan N, Fiaccone RL, Rodrigues LC, Ichihara MY, Barreto ML, de Almeida MF, de Cássia Ribeiro-Silva R. Cesarean sections and early-term births according to Robson classification: a population-based study with more than 17 million births in Brazil. BMC Pregnancy Childbirth 2023; 23:562. [PMID: 37537549 PMCID: PMC10399022 DOI: 10.1186/s12884-023-05807-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 06/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Cesarean section (CS) rates are increasing worldwide and are associated with negative maternal and child health outcomes when performed without medical indication. However, there is still limited knowledge about the association between high CS rates and early-term births. This study explored the association between CSs and early-term births according to the Robson classification. METHODS A population-based, cross-sectional study was performed with routine registration data of live births in Brazil between 2012 and 2019. We used the Robson classification system to compare groups with expected high and low CS rates. We used propensity scores to compare CSs to vaginal deliveries (1:1) and estimated associations with early-term births using logistic regression. RESULTS A total of 17,081,685 live births were included. Births via CS had higher odds of early-term birth (OR 1.32; 95% CI 1.32-1.32) compared to vaginal deliveries. Births by CS to women in Group 2 (OR 1.50; 95% CI 1.49-1.51) and 4 (OR 1.57; 95% CI 1.56-1.58) showed the highest odds of early-term birth, compared to vaginal deliveries. Increased odds of an early-term birth were also observed among births by CS to women in Group 3 (OR 1.30, 95% CI 1.29-1.31), compared to vaginal deliveries. In addition, live births by CS to women with a previous CS (Group 5 - OR 1.36, 95% CI 1.35-1.37), a single breech pregnancy (Group 6 - OR 1.16; 95% CI 1.11-1.21, and Group 7 - OR 1.19; 95% CI 1.16-1.23), and multiple pregnancies (Group 8 - OR 1.46; 95% CI 1.40-1.52) had high odds of an early-term birth, compared to live births by vaginal delivery. CONCLUSIONS CSs were associated with increased odds of early-term births. The highest odds of early-term birth were observed among those births by CS in Robson Groups 2 and 4.
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Affiliation(s)
- Aline S Rocha
- School of Nutrition, Federal University of Bahia (UFBA), Araújo Pinho - No. 32, Canela, Salvador, Bahia, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.
| | - Enny S Paixao
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Flavia Jôse O Alves
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Ila R Falcão
- School of Nutrition, Federal University of Bahia (UFBA), Araújo Pinho - No. 32, Canela, Salvador, Bahia, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Natanael J Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Barcelona Institute for Global Health, Hospital Clínic, Barcelona, Spain
| | - Camila S S Teixeira
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Naiá Ortelan
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | | | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia (UFBA), Araújo Pinho - No. 32, Canela, Salvador, Bahia, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Kale PL, Fonseca SC. Intrauterine growth restriction, prematurity, and low birth weight: risk phenotypes of neonatal death, Rio de Janeiro State, Brazil. CAD SAUDE PUBLICA 2023; 39:e00231022. [PMID: 37377302 PMCID: PMC10547104 DOI: 10.1590/0102-311xpt231022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/27/2023] [Accepted: 03/23/2023] [Indexed: 06/29/2023] Open
Abstract
Intrauterine growth restriction and prematurity determine low birth weight. The combination of the three conditions results in different neonatal phenotypes that interfere with child survival. Neonatal prevalence, survival and mortality were estimated according to neonatal phenotypes in the cohort of live births in 2021 in the state of Rio de Janeiro, Brazil. In this study, live births of multiple pregnancies, with congenital anomalies and inconsistencies in the information of weight and gestational age were excluded. The Intergrowth curve was used to classify weight adequacy. Mortality (< 24 hours, 1-6 and 7-27 days) and survival (Kaplan-Meier) were estimated. In total, 6.8%, 5.5%, and 9.5% of the 174,399 live births were low birth weight, small for gestational age (SGA), and premature, respectively. Considering low birth weight live births, 39.7% were SGA and 70% were premature. The neonatal phenotypes were heterogeneous according to maternal, delivery, pregnancy, and newborn characteristics. The mortality rate per 1,000 live births was high for low birth weight premature newborns, both SGA (78.1) and AGA (adequate for gestational age: 61.1), at all specific ages. Reductions in the survival rate were observed when comparing non-low birth weight and AGA term live births. The estimated prevalence values were lower than those of other studies, partly due to the exclusion criteria adopted. The neonatal phenotypes identified children who were more vulnerable and at higher risk of death. Prematurity contributed more to mortality than SGA, and its prevention is necessary to reduce neonatal mortality in the state of Rio de Janeiro.
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Affiliation(s)
- Pauline Lorena Kale
- Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Association of maternal nationality with preterm birth and low birth weight rates: analysis of nationwide data in Japan from 2016 to 2020. Matern Health Neonatol Perinatol 2023; 9:3. [PMID: 36882805 PMCID: PMC9993667 DOI: 10.1186/s40748-023-00149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The rate of low birth weight or preterm birth is known to vary according to the birth place of mothers. However, in Japan, studies that investigated the association between maternal nationalities and adverse birth outcomes are few. In this study, we investigated the association between maternal nationalities and adverse birth outcomes. METHODS We obtained live birth data from the Vital Statistics 2016-2020 of the Ministry of Health, Labour, and Welfare. We used data on maternal age, sex, parity, gestational age, birth weight, number of fetuses, household occupation, paternal nationality, and maternal nationality for each infant. We compared the rates of preterm birth and low birth weight at term among mothers whose nationalities were Japan, Korea, China, Philippines, Brazil, and other countries. Log binomial regression model was used to investigate the association between maternal nationality and the two birth outcomes using the other infants' characteristics as covariates. RESULTS In the analysis, data on 4,290,917 singleton births were used. Mothers from Japan, Korea, China, the Philippines, Brazil, and other nations had preterm birth rates of 4.61%, 4.16%, 3.97%, 7.43%, 7.69%, and 5.61%, respectively. The low birth weight rate among Japanese mothers was 5.36% and was the highest among the maternal nationalities. Regression analysis showed that the relative risk for preterm birth among Filipino, Brazilian, and mothers from other countries (1.520, 1.329, and 1.222, respectively) was statistically significantly higher compared with Japanese mothers. In contrast, the relative risk for Korean and Chinese mothers (0.870 and 0.899, respectively) was statistically significantly lower compared with Japanese mothers. Mothers from Korea, China, the Philippines, Brazil, and other nations had a relative risk for low birth weight that was statistically significantly lower than that of Japanese mothers (0.664, 0.447, 0.867, 0.692, and 0.887, respectively). CONCLUSIONS Support for mothers from the Philippines, Brazil, and other countries are necessary to prevent preterm birth. A future study is necessary to investigate the differences in characteristics among mothers of different nationalities in order to uncover the reason for the high risk for low birth weight among Japanese mothers.
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Pombo-de-Oliveira MS, Petridou ET, Karalexi MA, Junqueira MER, Braga FHP, Bouzas LF, Murra GRC, Lopes LF, Ntzani E, Greaves M. The Interplay of Cesarean-Section Delivery and First-Birth Order as Risk Factors in Acute Lymphoblastic Leukemia. Cancer Epidemiol Biomarkers Prev 2023; 32:371-379. [PMID: 36525650 DOI: 10.1158/1055-9965.epi-22-0664] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/24/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Childhood B-cell precursor acute lymphoblastic leukemia (BCP-ALL) has been associated with early-life exposures, including birth by cesarean section (C-section), and a deficit of social exposure (first child). These exposures as proxies for microbiome acquisition in infancy are essential to prime the immune system and restrain later dysregulated immune responses that can trigger ALL in susceptible individuals. We tested risk factors pertaining to immune stimulation that may impact BCP-ALL development. METHODS Cases comprised 1,126 children (0-12 years) with ALL (BCP-ALL: 78.5%) from the EMiLI study group in Brazil (2002-2020). Age- and sex-matched controls (n = 2,252) were randomly selected from healthy children whose mothers participated in the National Placental and Umbilical Cord Blood Bank donation. Multiple logistic regression was run fitted and adjusted for selected covariates models. RESULTS C-section delivery was associated with increased risk for ALL [odds ratio (OR) ALL: 1.10; 95% confidence intervals (CI), 1.04-1.15; ORBCP-ALL: 1.09; 95% CI, 1.03-1.14], as well as being the firstborn child. Interaction analysis showed a significant effect of first birth on the observed C-section associations (P < 0.0001). Indeed, high-risk children, namely, firstborn children delivered via C-section were at increased risk for ALL (OR: 2.33; 95% CI, 2.40-4.84) compared with non-first, vaginally born children. An increased risk was found for firstborn children delivered by C-section and non-breastfed with ALL (ORALL: 2.32; 95% CI, 1.27-4.24; ORBCP-ALL: 2.37; 95% CI, 1.18-4.76). CONCLUSIONS Our observations are in accord with the prediction that exposures determining microbiome composition and adrenal pathway in infancy contribute to the risk of BCP-ALL. IMPACT These findings encourage the exploration of potential preventive interventions. See related commentary by Wiemels and Gallant, p. 292.
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Affiliation(s)
| | - Eleni Th Petridou
- Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria A Karalexi
- Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
| | | | | | - Luis Fernando Bouzas
- National Placental and Umbilical Cord Blood Bank, INCA, MS, Rio de Janeiro, Brazil
| | | | - Luiz Fernando Lopes
- Children's Cancer Hospital, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Mel Greaves
- Center for Evolution and Cancer, Institute of Cancer Research, Sutton, United Kingdom
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Bonilha EDA, Lira MMTDA, de Freitas M, Aly CMC, dos Santos PC, Niy DY, Diniz CSG. Gestational age: comparing estimation methods and live births' profile. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230016. [PMID: 36820753 PMCID: PMC9949487 DOI: 10.1590/1980-549720230016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/17/2022] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To identify factors associated with the definition of the gestational age (GA) estimation method recorded in the live birth certificate (LBC), and to compare the results obtained according to the method in the city of São Paulo (CSP), between 2012 and 2019. METHODS Cross-sectional population-based study using the Live Birth Information System. Descriptive and comparative analysis was performed according to the GA estimation method, followed by a univariate and multivariate logistic regression model to identify the predictor variables of the method used. RESULTS The estimation of GA by the date of the last menstrual period (LMP) (39.9%) was lower than that obtained by other methods (OM) (60.1%) - physical examination and ultrasound, between 2012-2019. LMP registration in the LBC increased with the mother's age, it was higher among women who were white, more educated and with partners, in cesarean sections and with private funding. In the logistic regression, public funding was 2.33 times more likely than private funding to use OM. The proportion of preterm infants (<37 weeks) with GA by LMP was 26.5% higher than that obtained by OM. Median birth weight was higher among preterm infants with GA estimated by LMP. CONCLUSION Prematurity was higher with the GA estimated by LMP in the CSP, which may indicate overestimation by this method. The source of funding was the most explanatory variable for defining the GA estimator method at the LBC. The results point to the need for caution when comparing the GA obtained by different methods.
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Affiliation(s)
- Eliana de Aquino Bonilha
- Centro Universitário São Camilo – São Paulo (SP), Brazil.,Universidade de São Paulo, School of Public Health, Grupo de Estudos Gênero, Evidências e Saúde – São Paulo (SP), Brazil
| | | | - Marina de Freitas
- Pesquisa Dias Potenciais de Gravidez Perdidos – São Paulo (SP), Brazil
| | - Célia Maria Castex Aly
- Universidade de São Paulo, School of Public Health, Grupo de Estudos Gênero, Evidências e Saúde – São Paulo (SP), Brazil
| | | | - Denise Yoshie Niy
- Universidade de São Paulo, School of Public Health – São Paulo (SP), Brazil
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12
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Bonilha EDA, Lira MMTDA, Freitas MD, Aly CMC, Santos PCD, Niy DY, Diniz CSG. Gestational age: comparing estimation methods and live births’ profile. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023. [DOI: 10.1590/1980-549720230016.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
RESUMO Objetivo: Identificar fatores associados à definição do método estimador da idade gestacional (IG) registrado na declaração de nascido vivo (DNV) e comparar os resultados obtidos segundo método no município de São Paulo, entre 2012 e 2019. Métodos: Estudo transversal de base populacional utilizando o Sistema de Informações sobre Nascidos Vivos. Realizou-se análise descritiva e comparativa segundo método de estimativa da IG, seguida de modelo de regressão logística uni e multivariada para identificar as variáveis preditoras do método utilizado. Resultados: A estimativa da IG pela data da última menstruação (DUM) (39,9%) foi inferior à obtida por outros métodos (OM) (60,1%) — exame físico e ultrassonografia, entre 2012-2019. O registro da DUM na DNV aumentou com a idade da mãe, foi maior entre as brancas, mais escolarizadas e com companheiro, nas cesarianas e nos partos realizados com financiamento privado. Na regressão logística, o financiamento público apresentou chance 2,33 vezes maior que o privado para uso de OM. A proporção de prematuros (<37 semanas) com IG pela DUM foi 26,5% maior do que a obtida por OM. A mediana de peso ao nascer foi maior entre prematuros com IG estimada pela DUM. Conclusão: A prematuridade foi mais elevada com a IG estimada pela DUM no MSP, o que pode indicar superestimação por este método. A fonte de financiamento foi a variável mais explicativa para definição do método estimador da IG na DNV. Os resultados apontam a necessidade de cautela ao comparar a IG obtida por métodos diferentes.
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Dias BAS, Leal MDC, Esteves-Pereira AP, Nakamura-Pereira M. Variations in cesarean and repeated cesarean section rates in Brazil according to gestational age at birth and type of hospital. CAD SAUDE PUBLICA 2022; 38:e00073621. [PMID: 35857919 DOI: 10.1590/0102-311xpt073621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/14/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to describe cesarean and repeated cesarean section rates in Brazil according to gestational age (GA) at birth and type of hospital. This is an ecologic study using data from the Brazilian Information System on Live Births and the 2017 National Registry of Health Facilities. Overall and repeated cesarean section rates were calculated and analyzed according to GA, region of residence, and type of hospital. Spearman correlations were performed between cesarean and repeated cesarean section rates by GA subgroups at birth (≤ 33, 34-36, 37-38, 39-41, and ≥ 42 weeks) and analyzed according to the type of hospital. Overall and repeated cesarean section rates were 55.1% and 85.3%, respectively. More than 60% of newborns between 37-38 weeks were delivered via cesarean section. Private hospitals in all regions showed the highest cesarean section rates, especially those in the Central-West Region, with more than 80% at all GAs. The overall cesarean section rate was highly correlated with all cesarean section rates of GA subgroups (r > 0.7, p < 0.01). Regarding repeated cesarean sections, the overall rate was strongly correlated with the rates of 37-38 and 39-41 weeks in public/mixed hospitals, differing from private hospitals, which showed moderate correlations. This finding indicates the decision for cesarean section is not based on clinical factors, which can cause unnecessary damage to the health of both the mother and the baby. Then, changes in the delivery care model, strengthening public policies, and encouragement of vaginal delivery after a cesarean section in subsequent pregnancies are important strategies to reduce cesarean section rates in Brazil.
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Affiliation(s)
| | - Maria do Carmo Leal
- Vice-Presidência de Ensino, Informação e Comunicação, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Marcos Nakamura-Pereira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Morais MBD, Toporovski MS, Tofoli MHC, Barros KVD, Ferreira CHT, Silva LR. Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity. J Pediatr (Rio J) 2022; 98:241-247. [PMID: 34508665 PMCID: PMC9432061 DOI: 10.1016/j.jped.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the type of milk used to feed infants seen in private pediatric practices in Brazil. To evaluate the relationship between breastfeeding, type of delivery, and history of prematurity. METHODS This is a cross-sectional and observational study that included 4929 infants in the first year of life seen in private pediatric practices in the five geographic regions of Brazil. Mothers provided information about the type of milk used by their infant, the type of delivery (vaginal or cesarean), and whether the birth was premature. RESULTS Breastfeeding was the only source of milk for 56.1% (1546/2755) of infants in the first six months of life and 32.9% (716/2174) in the second. Of the infants who received other types of milk besides breastfeeding, there was a predominance of infant formula in 98.6% and 93.8% of the infants, respectively, in the first and in the second six months of life. Whole cow's milk was used by 0.7% (20/2755) of infants in the first six months and by 4.1% (90/2174) of infants in the second (p < 0.001). In the first six months of life, breastfeeding as the only type of milk was associated with vaginal delivery (OR = 1.79; p < 0.001) and not having a history of prematurity (OR = 2.48; p < 0.001). CONCLUSION Breastfeeding was the only milk source for more than half of infants before 180 days of life. Birth by cesarean section and history of prematurity were negatively associated with breastfeeding as the only source of milk used in infant feeding.
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Affiliation(s)
- Mauro Batista de Morais
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Gastroenterologia Pediátrica, São Paulo, SP, Brazil.
| | | | | | | | - Cristina Helena Targa Ferreira
- Universidade Federal de Ciências da Saúde de Porto Alegre, Divisão de Gastroenterologia Pediátrica, Porto Alegre, RS, Brazil
| | - Luciana Rodrigues Silva
- Universidade Federal da Bahia, Divisão de Gastroenterologia Pediátrica, Salvador, BA, Brazil; Presidente da Sociedade Brasileira de Pediatria, Brazil
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Prevalence and Factors Associated with Low Birth Weight and Preterm Delivery in the Ho Municipality of Ghana. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/3955869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background. Low birth weight and preterm delivery are birth outcomes that can predict newborns’ survival, development, and long-term health outcomes. This study assessed the prevalence and factors associated with low birth weight and preterm delivery in the Ho Municipality of Ghana. Methods. This retrospective, cross-sectional study analysed data from 680 birth records between October and December 2018. Univariate and multivariate logistic regression models predicted low birth weight and preterm delivery factors. Results. The prevalence of low birth weight and preterm delivery was 12.9% and 14.1%, respectively. Increasing maternal age (AOR: 0.52; 95% CI: 0.28–0.98), multiparity (AOR: 0.54; 95% CI: 0.30–0.94) and increasing doses of sulphadoxine-pyrimethamine (AOR: 0.43; 95% CI: 0.22–0.84) significantly reduced the odds of low birth weight. However, caesarean section (AOR: 1.94; 95% CI: 0.1.16–3.27) and hypertension (AOR: 2.06; 95% CI: 1.27–03.33) significantly increased the likelihood of low birth weight. An increasing number of antenatal care visits (AOR: 0.38; 95% CI: 0.18–0.80) and doses of sulphadoxine-pyrimethamine (AOR: 0.43; 95% CI: 0.19–0.97) were significantly associated with decreased odds of preterm delivery, while caesarean section increased the odds of preterm delivery by two folds (AOR: 2.14; 95% CI: 1.15–3.99). Conclusion. This study shows that maternal age, parity, number of antenatal care visits, hypertension, SP/IPTp, and caesarean section were independently associated with low birth weight and preterm delivery. Education and interventions should be prioritised as vitally important on these factors to reduce the risk and complications associated with these birth outcomes.
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Suff N, Xu VX, Glazewska-Hallin A, Carter J, Brennecke S, Shennan A. Previous term emergency caesarean section is a risk factor for recurrent spontaneous preterm birth; a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2022; 271:108-111. [PMID: 35182999 DOI: 10.1016/j.ejogrb.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Emergency caesarean sections (EmCS), particularly those performed in the second stage of labour, have been associated with a risk of subsequent preterm birth. More worrying is that the risk of sPTB recurrence appears to be high in women who have had a second stage EmCS and a subsequent sPTB. However, there is a paucity of evidence regarding the risk of recurrence in women who have had a prior term EmCS at any stage of labour followed by a sPTB. This study aims to investigate the relationship between all term in labour EmCS and the risk of recurrent spontaneous preterm birth (sPTB). STUDY DESIGN This is an observational, retrospective cohort study conducted at St Thomas' Hospital, a tertiary-level maternity hospital in London, United Kingdom. 259 women were included; 59 women with a term in labour EmCS preceding a sPTB (EmCS group) and 200 women with a prior sPTB only (control group). The initial EmCS was further categorised into first stage (FS)-EmCS or second stage (SS)-EmCS. Primary outcome was sPTB in Pregnancy C < 37 weeks' gestation. Secondary outcomes included sPTB < 34 weeks' and < 24 weeks' gestation. RESULTS 54% (32/59) of the EmCS group had a recurrent sPTB < 37 weeks compared to 20% (40/200) of the control women (p < 0.0001) with a relative risk of 2.71 [95%CI 1.87-3.87]). Of women who had a SS-EmCS and a subsequent PTB, 61.9% (13/21) had a further sPTB (RR 3.0 [95%CI, 1.8-4.5] compared to control women). In addition, there is nearly a 6-fold increased risk of a recurrent sPTB or midtrimester loss < 24 weeks' gestation in these women (RR 5.65 [95%CI2.6-12.0]). CONCLUSIONS In women who have had a previous sPTB in which a term in labour EmCS is a risk factor, the risk of a further sPTB is much higher than in those women where a prior sPTB is the sole risk factor. Furthermore, EmCS at both the first and second stage of labour are associated with a increased risk of recurrent sPTB. Further work should ascertain which women who have had a prior term EmCS are at risk of sPTB and recurrence, and how best to identify and treat them.
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Affiliation(s)
- Natalie Suff
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Vicky X Xu
- Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Agnieszka Glazewska-Hallin
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jenny Carter
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Shaun Brennecke
- University of Melbourne Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia; Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Pessary Plus Progesterone to Prevent Preterm Birth in Women With Short Cervixes: A Randomized Controlled Trial. Obstet Gynecol 2022; 139:41-51. [PMID: 34856583 DOI: 10.1097/aog.0000000000004634] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the effectiveness of cervical pessary in addition to vaginal progesterone for the prevention of preterm birth in women with midpregnancy short cervixes. METHODS We performed a multicenter, open-label, randomized controlled trial in 17 perinatal centers. Asymptomatic women with singleton or twin pregnancies and cervical lengths of 30 mm or less, measured at 18 0/7-22 6/7 weeks of gestation, were randomized to cervical pessary plus vaginal progesterone (pessary plus progesterone group) or vaginal progesterone only (progesterone-only group) (200 mg/day). Treatments were used from randomization to 36 weeks of gestation or delivery. The primary outcome was a composite of neonatal mortality and morbidity. Secondary outcomes were delivery before 37 weeks and before 34 weeks of gestation. Analysis was performed according to intention to treat. RESULTS Between July 9, 2015, and March 29, 2019, 8,168 women were screened, of whom 475 were randomized to pessary and 461 to progesterone only. The composite perinatal outcome occurred in 19.2% (89/463) of the women in the pessary group compared with 20.9% (91/436) of the women in the progesterone-only group (adjusted risk ratio [aRR] 0.88, 95% CI 0.69-1.12). Delivery rates before 37 weeks of gestation were 29.1% compared with 31.4% (aRR 0.86, 95% CI 0.72-1.04); delivery rates before 34 weeks were 9.9% compared with 13.9% (aRR 0.66, 95% CI 0.47-0.93). Women in the pessary group had more vaginal discharge (51.6% [245/476] vs 25.4% [117/479] [P<.001]), pain (33.1% [157/476] vs 24.1% [111/479] [P=.002]), and vaginal bleeding (9.7% [46/476] vs 4.8% [22/479] [P=.004]). CONCLUSION In asymptomatic women with short cervixes, the combination of pessary and progesterone did not decrease rates of neonatal morbidity or mortality when compared with progesterone only. CLINICAL TRIAL REGISTRATION Brazilian Clinical Trial Registry (ReBec), UTN:U1111-1164-2636.
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Dias BAS, Leal MDC, Esteves-Pereira AP, Nakamura-Pereira M. Variations in cesarean and repeated cesarean section rates in Brazil according to gestational age at birth and type of hospital. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xen073621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
This study aimed to describe cesarean and repeated cesarean section rates in Brazil according to gestational age (GA) at birth and type of hospital. This is an ecologic study using data from the Brazilian Information System on Live Births and the 2017 National Registry of Health Facilities. Overall and repeated cesarean section rates were calculated and analyzed according to GA, region of residence, and type of hospital. Spearman correlations were performed between cesarean and repeated cesarean section rates by GA subgroups at birth (≤ 33, 34-36, 37-38, 39-41, and ≥ 42 weeks) and analyzed according to the type of hospital. Overall and repeated cesarean section rates were 55.1% and 85.3%, respectively. More than 60% of newborns between 37-38 weeks were delivered via cesarean section. Private hospitals in all regions showed the highest cesarean section rates, especially those in the Central-West Region, with more than 80% at all GAs. The overall cesarean section rate was highly correlated with all cesarean section rates of GA subgroups (r > 0.7, p < 0.01). Regarding repeated cesarean sections, the overall rate was strongly correlated with the rates of 37-38 and 39-41 weeks in public/mixed hospitals, differing from private hospitals, which showed moderate correlations. This finding indicates the decision for cesarean section is not based on clinical factors, which can cause unnecessary damage to the health of both the mother and the baby. Then, changes in the delivery care model, strengthening public policies, and encouragement of vaginal delivery after a cesarean section in subsequent pregnancies are important strategies to reduce cesarean section rates in Brazil.
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Nicolotti CA, Lacerda JTD. Avaliação da organização e práticas de assistência ao parto e nascimento em três hospitais de Santa Catarina, Brasil. CAD SAUDE PUBLICA 2022; 38:e00052922. [DOI: 10.1590/0102-311xpt052922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
O objetivo foi avaliar a assistência hospitalar ao parto e ao nascimento, analisando aspectos de gestão e assistência desde a admissão das mulheres para o parto até o pós-parto. Foi realizada uma pesquisa avaliativa dos aspectos de gestão e práticas de assistência ao parto e nascimento, desenvolvida no período de novembro de 2019 a fevereiro de 2020, em três hospitais de Santa Catarina, Brasil, com melhor desempenho em uma avaliação nacional de boas práticas de assistência ao parto e ao nascimento. A coleta de dados envolveu análise documental, observação e entrevistas com profissionais da gestão, assistência e puérperas. Foram analisados 30 indicadores, que compuseram uma matriz de análise e julgamento, agrupados nas dimensões Político-Organizacional e Tático-Operacional. O julgamento orientou-se pela comparação entre a pontuação observada e a pontuação máxima esperada em cada um dos componentes da matriz avaliativa. A assistência ao parto e ao nascimento foi parcialmente satisfatória nos hospitais 2 e 3 e insatisfatória no hospital 1. A dimensão Político-Organizacional foi classificada como insatisfatória e a Tático-Operacional parcialmente satisfatória nos três hospitais. Nenhum hospital obteve avaliação satisfatória em mais de 40% dos indicadores. Os hospitais analisados ainda não conseguiram consolidar as mudanças no modelo assistencial na perspectiva do cuidado humanizado, orientado por evidências científicas e direitos.
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Zhang J, Williams GJ, Wang G, Chen J, Zhang M, Du W, Zhu J, Zhang J, Hua J. Early-term birth and its association with universal two-child policy: a national cross-sectional study in China. BMJ Open 2021; 11:e054959. [PMID: 34876437 PMCID: PMC8655521 DOI: 10.1136/bmjopen-2021-054959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the epidemiology of early-term birth (ETB) at the national level in China, and explore the association and mediating factors between ETB and policy between universal two-child policy and ETB, so as to explain the potential reason for such a relationship and provide evidence for future ETB interventions in the era of the new birth control policy. DESIGN Cross-sectional study. PARTICIPANTS The cross-sectional study used data from China Labour and Delivery Survey between 2015 and 2016. A total of 75 132 survey data collected from 89 hospitals in 25 provinces were included in the analysis. We further explored the association between the universal two-child policy and ETB. RESULTS The weighted incidence of ETB was 30.1 per 100 all births (95% CI 30.06% to 30.14%) or 29.88 per 100 live births (95% CI 29.97% to 30.05%) between 2015 and 2016 in China. There was an association between the universal two-child policy and ETB (relative risk, RR 1.19, 95% CI 1.15 to 1.23), which was not mediated by maternal age (RR 1.17, 95% CI 1.13 to 1.22), previous uterine scars (RR 1.18, 95% CI 1.14 to 1.22), parity (RR 1.19, 95% CI 1.15 to 1.24) and other measured conditions (each p<0.05). Stratified analysis showed that the association between universal two-child policy and ETB were the strongest in multiparous young women or women without previous uterine scars (each p<0.05), and disappeared in all women of advanced maternal age (each p>0.05). CONCLUSION The incidence of ETB was high in China when compared with most of reported countries, and there might be a link between two-child policy and ETB. Obstetric practice such as selective induced labour and caesarean section should be revised with ETB risks in mind, when ETB is more likely to happen under the universal two-child policy. Preventing ETB should not be neglected in multiparous young women or those without previous uterine scars under the new policy.
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Affiliation(s)
- Jie Zhang
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Gareth J Williams
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Guanghua Wang
- Department of Obstetrics and Gynecology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingjing Chen
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Mengyu Zhang
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Jing Zhu
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Hua
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
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Nogueira da Gama SG, Martinelli KG, Soares Dias BA, Pereira-Esteves AP, do Carmo Leal M, Dos Santos-Neto ET. A population-based study of the relationship between advanced maternal age and premature/early-term birth in Brazil. Int J Gynaecol Obstet 2021; 159:173-181. [PMID: 34860423 DOI: 10.1002/ijgo.14057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/25/2021] [Accepted: 12/02/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To verify whether advanced maternal age (AMA), defined as women of ≥35 years, is associated with premature and early-term birth in Brazil, according to the onset of labor (spontaneous or provider-initiated). METHODS Cross-sectional population-based study. The "Birth in Brazil" study interviewed 23 894 puerperal women between 2011 and 2012, in all regions of Brazil. The current analysis included 17 994 adult mothers and their newborns (15 448 aged between 20-34 years, and 2536 ≥ 35 years). A propensity score was used to assess the likelihood of AMA women giving birth to premature or early-term infants (spontaneous or provider-initiated) compared to women aged 20-34 years. To balance the groups, we used maternal, prenatal, and childbirth characteristics. RESULTS The general prematurity rate was 10.24%, of which the majority of births were spontaneous (55.73%). Conversely, early-term births were more often provider-initiated (54.81%). AMA did not increase the chance of premature births, whether spontaneous or provider-initiated. However, AMA was associated with a higher rate of provider-initiated early-term birth (OR = 1.48; 95% CI: 1.23-1.77). CONCLUSION AMA alone does not contribute to premature birth; AMA's independent association with provider-initiated early-term birth may not be based solely on clinical indications.
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Affiliation(s)
| | - Katrini Guidolini Martinelli
- Federal University of Espirito Santo (UFES), Postgraduate Program in Public Health, Vitoria, Espírito Santo, Brazil
| | | | | | - Maria do Carmo Leal
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Kochhar P, Dwarkanath P, Ravikumar G, Thomas A, Crasta J, Thomas T, Kurpad AV, Mukhopadhyay A. Placental expression of miR-21-5p, miR-210-3p and miR-141-3p: relation to human fetoplacental growth. Eur J Clin Nutr 2021; 76:730-738. [PMID: 34611295 DOI: 10.1038/s41430-021-01017-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 09/06/2021] [Accepted: 09/21/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES Dysregulation of microRNAs (miRNAs) and their target genes in placental tissue is associated with foetal growth restriction. We aimed to evaluate associations of placental miR-21-5p, miR-141-3p and miR-210-3p expression with maternal, placental and newborn parameters and with placental expression of their potential target genes PTEN, VEGF, FLT and ENG in a set of well-characterized small- (SGA) and appropriate- (AGA) for gestational age full-term singleton pregnancies. SUBJECTS/METHODS Placental samples (n = 80) from 26 SGA and 54 AGA were collected from full-term singleton pregnancies. Placental transcript abundances of miR-21-5p, miR-141-3p and miR-210-3p were assessed after normalization to a reference miRNA, mir-16-5p by real-time quantitative PCR. Placental transcript abundances of PTEN, VEGF, FLT and ENG were assessed after normalizing to a panel of reference genes. RESULTS Placental miR-21-5p transcript abundance was negatively associated with placental weight (n = 80, r = -0.222, P = 0.047) and this association was specific to the AGA births (n = 54, r = -0.292, P = 0.032). Placental transcript abundances of miR-210-3p and miR-141-3p were not associated with placental weight or birth weight in all 80 births. However, placental miR-210-3p transcript abundance was positively associated with birth weight specifically in the SGA births (n = 26, r = 0.449, P = 0.021). Placental transcript abundance of miR-21-5p was negatively associated with PTEN transcript abundance (Spearman's ρ = -0.245, P = 0.028) while that of miR-141-3p was positively associated with FLT (Spearman's ρ = 0.261, P = 0.019) and ENG (Spearman's ρ = 0.259, P = 0.020) transcript abundances in all 80 births. CONCLUSION We conclude that placental miR-21-5p and miR-210-3p may be involved in fetoplacental growth. However, this regulation is unlikely to be mediated through placental expression of PTEN, VEGF, FLT or ENG.
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Affiliation(s)
- P Kochhar
- Division of Nutrition, St. John's Research Institute, A recognized research centre of University of Mysore, Bangalore, India
| | - P Dwarkanath
- Division of Nutrition, St. John's Research Institute, A recognized research centre of University of Mysore, Bangalore, India
| | - G Ravikumar
- Department of Pathology, St John's Medical College Hospital, Bangalore, India
| | - A Thomas
- Department of Obstetrics and Gynaecology, St John's Medical College Hospital, Bangalore, India
| | - J Crasta
- Department of Pathology, St John's Medical College Hospital, Bangalore, India
| | - T Thomas
- Department of Biostatistics, St. John's Medical College Hospital, Bangalore, India
| | - A V Kurpad
- Division of Nutrition, St. John's Research Institute, A recognized research centre of University of Mysore, Bangalore, India
| | - A Mukhopadhyay
- Division of Nutrition, St. John's Research Institute, A recognized research centre of University of Mysore, Bangalore, India.
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Fernandes MP, Lima NP, Barros FC, Gonçalves H, Menezes AMB, Wehrmeister FC, Hartwig FP, Horta BL. Association between cesarean section and human capital in adulthood: 1982 and 1993 Pelotas birth cohorts, Rio Grande do Sul State, Brazil. CAD SAUDE PUBLICA 2021; 37:e00235520. [PMID: 34586169 DOI: 10.1590/0102-311x00235520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022] Open
Abstract
This study aims to assess the association between mode of delivery and human capital among young adults enrolled in the 1982 and 1993 Pelotas birth cohorts, Rio Grande do Sul State, Brasil. In 1982 and 1993, the maternity hospitals of the municipality were daily visited, the births identified, and those live births, whose family lived in the urban area of Pelotas, were examined and their mothers interviewed. Information on mode of delivery, vaginal or cesarean, was provided by the mother in the perinatal study. Performance in intelligence tests achieved schooling and income were evaluated in the 30 years visit at the 1982 cohort. At the 1993 cohort, schooling and income were assessed at the 22 years visit, whereas IQ was evaluated at 18 years. Tobacco smoking in adulthood and type of school was used as negative outcomes to strength causal inference. Initially, cesarean section was positively associated with human capital at adulthood, with the exception of income in the 1993 cohort. After controlling for confounders, the magnitude of the associations was strongly reduced, and the regression coefficients were close to the null value. The negative outcome analysis showed that, after controlling for confounding variables, the mode of delivery was not associated with tobacco smoking and type of school. Suggesting that the variables included in the regression model to control for confounding, provided an adequate adjustment and it is unlikely that the results are due to residual confounding by socioeconomic status. On the other hand, considering the short- and long-term risks and the epidemic of cesarean sections, measures should be implemented to reduce its prevalence.
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Rubashkin N, Baji P, Szebik I, Schmidt E, Vedam S. Examining obstetric interventions and respectful maternity care in Hungary: Do informal payments for continuity of care link to quality? Birth 2021; 48:309-318. [PMID: 33609059 DOI: 10.1111/birt.12540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Hungary, 60% of women pay informally to secure continuity with a "chosen" provider for prenatal care and birth. It is unclear if paying informally influences quality of maternity care. This study examined associations between incentivized continuity care models and obstetric procedures and respectful care. METHODS This is a cross-sectional survey of a representative sample of Hungarian women (N = 589) in 2014. We calculated descriptive statistics comparing experiences among women who paid informally for continuity with a chosen provider with those who received care in the public health system. After adjusting for social and clinical covariates, we used logistic regression to estimate the odds of obstetric procedures and disrespectful care and linear regression to estimate the level of autonomy (MADM scale). RESULTS Of women in our sample, 317 (53%) saw a chosen doctor, 68 (11%) a chosen midwife, and 204 (33%) had care in the public system. Women who paid an obstetrician informally had the highest rates of cesarean (49.5%), induction of labor (31.2%), and epidural (15%), and reported lower rates of disrespectful care (41%) compared to public care (64%). Paying for continuity with an obstetrician significantly predicted cesarean (aOR 1.61 [95%CI 1.00-2.58]), episiotomy (2.64, [1.39-5.03]), and epidural (3.15 [1.07-9.34]), but not induction of labor (1.59 [0.99-2.57]). Informal payment continuity models predicted increased autonomy scores (doctor: 3.97, 95% CI 2.39-5.55; midwife: 7.37, 95% CI 5.36-9.34) and reduced odds of disrespectful care. There were no differences in the prevalence of scheduled cesareans or inductions performed without a medical indication. CONCLUSIONS Continuity models secured with informal payments significantly increased both women's experience of respectful care and rates of obstetric procedures. Intervention rates exceed global standards, and women do not choose elective procedures to preserve continuity.
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Affiliation(s)
- Nicholas Rubashkin
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California at San Francisco, San Francisco, California, USA.,Insitute for Global Health Sciences, University of California at San Francisco, San Francisco, California, USA
| | - Petra Baji
- Department of Health Economics, Corvinus University Budapest, Budapest, Hungary
| | - Imre Szebik
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | | | - Saraswathi Vedam
- School of Population & Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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A Cross-Sectional Study to Assess the Frequency and Risk Factors Associated with Cesarean Section in Southern Punjab, Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168812. [PMID: 34444565 PMCID: PMC8391541 DOI: 10.3390/ijerph18168812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 01/22/2023]
Abstract
The increasing frequency of cesarean section (CS) is a major public health issue, and it is on the rise in Pakistan. A cross-sectional study approach was used to assess the frequency of CS and its contributing factors, along with the assessment of knowledge in mothers who had undergone CS in one of the under-developed regions of Pakistan. Data collection was done by using a self-developed study questionnaire. The statistical package for social sciences (SPSS) was utilized for the statistical analysis. During the study period, a total of 173 (69.7%) women have given births by CS; among those, 104 (60.1%) were elective/planned CSs while 69 (39.8%) were emergency CSs. The higher CS frequency was significantly associated with younger age (p = 0.03) and pre-term gestational age (p < 0.001). Pregnancy complications, such as gestational diabetes, hypertension, preeclampsia/eclampsia, and vaginal bleeding, were the significant risk factors for CS (p < 0.001). The highlighted contributing factors to CS in the current study were preterm of gestational age, mothers of a younger age (20–24 years), and mothers that belong to urban populations. These risk factors can be addressed by implementing community-focused educational interventions during the gestational period. The sample size in this study was small; therefore, the results cannot be generalized to the whole population.
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Gomes MP, Saráty SB, Pereira AA, Parente AT, Santana MED, Cruz MDNDS, Figueira ADM. Mothers' knowledge of premature newborn care and application of Kangaroo Mother Care at home. Rev Bras Enferm 2021; 74:e20200717. [PMID: 34133670 DOI: 10.1590/0034-7167-2020-0717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/24/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify mothers' knowledge about premature newborn care and application of Kangaroo Mother Care at home. METHODS a descriptive, qualitative study carried out with 15 mothers of premature newborns in a reference Maternal and Child Hospital in northern Brazil using two semi-structured interviews with open- and closed-ended questions. The testimonies were analyzed using thematic analysis technique, proposed by Bardin. RESULTS two thematic categories originated: "Caring for a premature newborn at home: strengths and weaknesses" and "Applying Kangaroo Mother Care at home: new knowledge acquired during hospitalization". FINAL CONSIDERATIONS the speeches of the interviewed mothers pointed out their knowledge about home care of premature NBs and understanding the importance of Kangaroo Mother Care, mainly acquired and improved with the guidance of professionals during hospitalization and application of the method, in addition to fears, possible difficulties in home care and the need to be better informed at hospital discharge.
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Domingues RMSM, Luz PM, da Silva Ayres BV, Torres JA, do Carmo Leal M. Cost-effectiveness analysis of a quality improvement program to reduce caesarean sections in Brazilian private hospitals: a case study. Reprod Health 2021; 18:93. [PMID: 33964941 PMCID: PMC8106214 DOI: 10.1186/s12978-021-01147-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 05/02/2021] [Indexed: 12/02/2022] Open
Abstract
Background In 2015, a quality improvement project of childbirth care called Adequate Childbirth Project (“Projeto Parto Adequado”- PPA) was implemented in Brazilian public and private hospitals, aiming to improve the quality of childbirth care and to reduce caesarean sections without clinical indications. The objective of this study is to conduct an economic analysis of two models of care existing in a private Brazilian hospital—the model following the recommendations of the PPA and the standard of care model—in reducing the proportion of caesarean sections. Methods We conducted a cost-effectiveness analysis using data from one of the private hospitals included in the PPA project. The main outcome was the proportion of caesarean section. We used total cost of hospitalization for women and newborns, from the health care sector perspective, during the length of the observed hospital stay. We did not apply discount rates and inflation rate adjustments due to the short time horizon. We conducted univariate sensitivity analysis using the minimum and maximum costs observed in hospitalizations and variation in the probabilities of caesarean section and of maternal and neonatal complications. Results 238 puerperal women were included in this analysis. The PPA model of care resulted in a 56.9 percentage point reduction in the caesarean section probability (88.6% vs 31.7%, p < 0.001) with an incremental cost-effectiveness ratio of US$1,237.40 per avoided caesarean section. Women in the PPA model of care also had a higher proportion of spontaneous and induced labor and a lower proportion of early term births. There were no maternal, fetal or neonatal deaths and no significant differences in cases of maternal and neonatal near miss. The cost of uncomplicated vaginal births and caesarean sections was the parameter with the greatest impact on the cost-effectiveness ratio of the PPA model of care. Conclusion The PPA model of care was cost-effective in reducing caesarean sections in women assisted in a Brazilian private hospital. Moreover, it reduced the frequency of early term births and did not increase the occurrence of severe negative maternal and neonatal outcomes. Caesarean section is a safe intervention to save the lives of women and newborns. However, it is associated with negative health consequences for women and children in the short, medium and long term. Therefore, its harmful effects can outweigh its benefits when used excessively. Caesarean rates are increasing globally. In Brazil, caesarean section is the most frequent type of birth since 2009. In 2015, a quality improvement project, called “Adequate Childbirth Project” (PPA), was implemented in Brazilian public and private hospitals with the aim of improving the quality of childbirth care and reducing caesarean sections without clinical indications. In this study, we compared the caesarean rate and the hospitalization costs of women assisted in this new model of care and in the standard of care model. The women attended in the PPA model of care had a lower rate of caesarean section (31.7% vs 88.6% in the standard of care model), with no differences in severe negative maternal and neonatal outcomes. Women in the PPA model of care also had a higher frequency of spontaneous or induced labor and a lower frequency of early term births, that is, less than 39 weeks of gestation. The PPA model of care was considered cost-effective, that is, it produced good results for the amount of money spent. This is a promising result for services that face the problem of increasing numbers of caesarean sections and are looking for strategies to improve the quality of childbirth care.
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Affiliation(s)
- Rosa Maria Soares Madeira Domingues
- Fundação Oswaldo Cruz, Laboratório de Pesquisa Clínica Em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, CEP 21040-360, Brazil.
| | - Paula Mendes Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | | | | | - Maria do Carmo Leal
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sérgio Arouca, Rio de Janeiro, Brazil
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Leal M. Being born and growing up in the Ribeirão Preto and São Luís cohorts. Braz J Med Biol Res 2021; 54:e11274. [PMID: 33729311 PMCID: PMC7945877 DOI: 10.1590/1414-431x202111274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/19/2021] [Indexed: 11/22/2022] Open
Abstract
This thematic issue consists of 14 articles derived from studies of the BRISA birth cohort (Ribeirão Preto, State of São Paulo and São Luís, State of Maranhão, northeastern Brazil, a socially and economically less developed region). In these more than 40 years of existence, these cohorts have been able to document the increase in women's education, the improvement of health conditions, the creation of a public Unified Health System (SUS) that provides universal and free access to health care, eradication of hunger, and transition of the nutritional status characterized by a decrease in malnutrition rates and an increase in obesity in Brazil. Particularly in reproductive health, the country experienced a significant drop in fertility, a decrease in maternal and child mortality, and an increase in breastfeeding rates. Universal access to prenatal care and hospital delivery was accompanied by an excessive number of cesareans without clinical indication and early-term births and premature births, largely due to scheduled cesareans. Articles with a longitudinal and transversal methodological approach are presented, using structural equation analysis and propensity score, together with multivariate regressions, which gave a robust analytical treatment to articles in this thematic issue.
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Affiliation(s)
- M.C. Leal
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Diniz CSG, Reis-Queiroz J, Kawai CA, Queiroz MR, Bonilha EDA, Niy DY, Lansk S, Sena B. Potential pregnancy days lost: an innovative measure of gestational age. Rev Saude Publica 2020; 54:88. [PMID: 32876302 PMCID: PMC7446763 DOI: 10.11606/s1518-8787.2020054002098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/19/2019] [Indexed: 01/30/2023] Open
Abstract
In Brazil, the excess of interventions that anticipate childbirth, such as cesarean sections and labor inductions, has resulted in the shortening of pregnancy, with negative consequences on maternal-infant outcomes. This commentary presents a novel way to measure gestational age: the continuous variable "Potential pregnancy days lost." Using data from the Live Birth Information System (SINASC), we counted the missing days between the period until childbirth and the average duration of pregnancy (280 days), or the lost weeks. This measure can be used as an outcome variable (socioeconomic-demographic characteristics of the mother, type of childbirth, financing, etc.) or exposure variable (for neonatal, infant, and maternal outcomes). The indicator can be used in municipal and national cohorts and intervention studies to analyze hospitals and regions. We discuss the limits and scope of gestational age measures and, given their inaccuracies, the importance of studying their trends.
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Affiliation(s)
- Carmen Simone G Diniz
- Departamento de Saúde, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | | | - Sonia Lansk
- Departamento de Saúde, prefeitura de Belo Horizonte, Belo Horizonte, MG, Brasil
| | - Brena Sena
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Njim T, Tanyitiku BS, Mbanga C. Prevalence, indications and neonatal complications of caesarean deliveries in Cameroon: a systematic review and meta-analysis. Arch Public Health 2020; 78:51. [PMID: 32514347 PMCID: PMC7268214 DOI: 10.1186/s13690-020-00430-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 05/14/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The trend of increasing caesarean deliveries in developed countries over the past three decades is now being observed in sub-Saharan African. This rise might be associated with an increase in the complications that could arise from this surgical intervention. We therefore sought to assess the prevalence, indications and complications of caesarean deliveries in Cameroon. METHODS We systematically searched online databases: Medline; Global Health and the CINAHL from 01st January 1966 to 25th July 2019. We reviewed published cohort studies, retrospective register analysis and cross-sectional studies that described cohorts of pregnant women presenting at delivery facilities in Cameroon; and included those that had an estimate of the proportion of women who delivered by caesarean sections. RESULTS There were 126 articles initially identified by the search and 88 articles were retained after removal of duplicates. After screening of the titles and abstracts, and full text review, we identified 16 articles describing 22 cohorts of women presenting for delivery in health facilities in Cameroon. The overall estimate for the prevalence of caesarean deliveries was 9.9% (95% CI: 7.4, 12.8%, I2 = 99.68%, χ2 = 315.9, p < 0.001). The prevalence of caesarean deliveries increased progressively from 3.4% (95% CI: 2.2, 4.8%) before the year 2000, to 9.8% (95% CI: 7.4, 12.8%) between 2000 and 2009 and 14.7% (95% CI: 8.8, 21.7%) from 2010 to 2019. The three commonest indications for caesarean deliveries were: cephalopelvic disproportion (27.5%; 95% CI: 17.5, 38.7%); previous caesarean deliveries (13.2%; 95% CI: 7.4, 20.3%) and foetal distress (11.2%; 95% CI: 4.8, 19.5%). Neonates who were born by caesarean delivery were more likely to have neonatal asphyxia when compared with neonates born from vaginal deliveries (OR: 6.5; 95% CI: 2.5, 16.5). CONCLUSION The rates of caesarean deliveries in Cameroon falls just within the recommended 10-15% range proposed by the World Health Organisation but have however been increasing progressively in the past decades. There is a strong need to assess the various indications of caesarean deliveries in Cameroon in order to curb its associated complications.
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Affiliation(s)
- Tsi Njim
- Health and Human Development (2HD) Research Group, Douala, Littoral region Cameroon
| | - Bayee Swiri Tanyitiku
- Higher Institute of Commerce and Management, University of Bamenda, Bamenda, North west region Cameroon
| | - Clarence Mbanga
- Mankon Sub-divisional Hospital, Bamenda, North west region Cameroon
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Factors Associated with Preterm Birth and Low Birth Weight in Abu Dhabi, the United Arab Emirates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041382. [PMID: 32098043 PMCID: PMC7068537 DOI: 10.3390/ijerph17041382] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/21/2022]
Abstract
Both preterm birth and low birth weight (LBW) represent major public health problems worldwide due to their association with the catastrophic effects of morbidity and mortality. Few data exist about such adverse pregnancy outcomes. The current study aimed to investigate the prevalence of and factors associated with preterm birth and LBW among mothers of children under two years in Abu Dhabi, United Arab Emirates. Data were collected in clinical and non-clinical settings across various geographical areas in Abu Dhabi. The data were analyzed using both descriptive and inferential statistics. A total of 1610 mother–child pairs were included in the current study. Preterm birth rate was 102 (6.3%) with a 95% confidence interval [CI] (6.1%, 6.5%) and the LBW rate was 151 (9.4%) with a 95% CI (9.3%, 9.5%). The mean (SD) of gestational age (GA) and birth weight at delivery was 39.1 (1.9) weeks and 3080.3 (518.6) grams, respectively. Factors that were positively associated with preterm birth were Arab mothers, maternal education level below secondary, caesarean section, and LBW. LBW was associated with female children, caesarean section (CS), first child order, and preterm birth. The current study highlighted the need for further interventional research to tackle these public health issues such as reducing the high CS rate and improving maternal education.
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Bavaresco T, Menolli RA, Frizon BJZ, Viera CS, Conterno JR, Guimarães ATB, Grassiolli S. Hypertension and maternal urinary tract infection and the metabolic conditions of preterm infants. Rev Bras Enferm 2019; 72:3-8. [PMID: 31851228 DOI: 10.1590/0034-7167-2017-0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/08/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The present study evaluated the anthropometric and metabolic profiles of preterm infants (PT) born from mothers with urinary tract infections (UTI) and mothers with hypertensive disorders (HD). METHOD This was a longitudinal prospective study conducted between May 2015 and August 2016. First, 59 mothers with premature birth were included; after excluding 29 mothers, two subgroups were created: UTI-mothers (n=12) and HD-mothers (n=18). The anthropometric and metabolic variables of mothers and their respective PT were analyzed at birth and at 6 months of corrected age (CA). RESULTS Plasma triglyceride levels were higher among HD-mothers and their respective PT in comparison with UTI-mothers and their PT at 6 m of CA. CONCLUSION Plasma triglyceride level is an important metabolic biomarker in HD-mothers resulting in higher triglyceride levels among PT at the CA of 6 m, suggesting an early programming effect of maternal hypertension.
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Affiliation(s)
- Talita Bavaresco
- Universidade Estadual do Oeste do Paraná. Cascavel, Paraná, Brazil
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Salgado HDO, Queiroz MR, Dos Santos HG, Andreucci CB, Diniz CSG. Using the Maternity Safety Thermometer to estimate harm-free care in Southeast Brazil: A hospital-based cohort. Birth 2019; 46:583-591. [PMID: 31579979 DOI: 10.1111/birt.12454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND High rates of unnecessary cesareans and interventions in vaginal births contribute to stagnant maternal and neonatal mortality rates in Brazil. We used the Maternity Safety Thermometer (MST) to assess the prevalence of harm during maternity care. METHODS This secondary analysis of the "Birth in Brazil" survey included a representative sample of 10 155 women who gave birth in public and private hospitals in southeastern Brazil. The main outcomes were perineal and abdominal trauma, maternal infection and hemorrhage, newborn vitality, and women's perception of safety. We calculated the odds ratios (OR) for the number of MST harms (dependent variable). RESULTS About 81.6% of the women with vaginal births had sutures for perineal trauma (87.7% of these due to episiotomies). Poor perception of safety was reported by 83.1% of women, and 69.5% of all infants not admitted to the NICU were separated from their mother after birth. The overall rate of cesarean birth was 52.6%, and 7.5% of term infants were admitted to the NICU. In public settings, having an intrapartum cesarean significantly increased the chances of one (OR 2.21; 95% CI 1.20-4.07), or two or more (4.08 [2.27-7.32]) harms. In private settings, cesarean deliveries without labor were also associated with higher chances of one (4.26 [2.65-6.85]), or two or more (4.60 [2.35-9.02]) harms. Only 2% of the women had harm-free care. CONCLUSIONS In southeastern Brazil, there is a high prevalence of preventable harm during maternity care.
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Affiliation(s)
| | | | | | - Carla Betina Andreucci
- Department of Medicine - Center for Biological and Health Sciences, Federal University of Sao Carlos, São Paulo, Brazil
| | - Carmen Simone Grilo Diniz
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo, Brazil
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Taha Z, Ali Hassan A, Wikkeling-Scott L, Papandreou D. Prevalence and Associated Factors of Caesarean Section and its Impact on Early Initiation of Breastfeeding in Abu Dhabi, United Arab Emirates. Nutrients 2019; 11:nu11112723. [PMID: 31717627 PMCID: PMC6893450 DOI: 10.3390/nu11112723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/12/2022] Open
Abstract
The World Health Organization (WHO) recommends the early initiation of breastfeeding. Research shows that factors such as mode of delivery may interfere with the early initiation of breastfeeding. However, data in the United Arab Emirates (UAE) on these findings is limited. Thus, the aim of this study was to describe the prevalence of caesarean sections (CSs) and evaluate their effect on breastfeeding initiation among mothers of children under the age of two years in Abu Dhabi. Data were collected in clinical and non-clinical settings across various geographical areas in Abu Dhabi during 2017 using consent and structured questionnaires for interviews with mothers. Data analysis included both descriptive and inferential statistics. Among the 1624 participants, one-third (30.2%) reportedly delivered by CS, of which 71.1% were planned, while 28.9% were emergency CS. More than half of all mothers (62.5%) initiated early breastfeeding. Multivariable logistic regression indicated factors that were associated positively with CS included advanced maternal age, nationality, and obesity. However, gestational age (GA) was negatively associated with CS. This study shows that the prevalence of CS is high in Abu Dhabi, UAE. CS is associated with lower early initiation rates of breastfeeding. The early initiation rates of breastfeeding were 804 (79.2%) 95% confidence interval (CI) (76.4, 82.0), 162 (16.0%) 95% CI (10.4, 21.6), and 49 (4.8%) 95% CI (1.2, 10.8) among vaginal delivery, planned CS, and emergency CS, respectively. Regarding the mode of delivery, vaginal were 2.78 (Adjusted Odd Ratio (AOR)): CI (95%), (2.17–3.56, p < 0.001) times more likely related to an early initiation of breastfeeding. CS in general, and emergency CS, was the main risk factor for the delayed initiation of breastfeeding. The study provides valuable information to develop appropriate strategies to reduce the CS rate in UAE. Maternal literacy on CS choices, the importance of breastfeeding for child health, and additional guidance for mothers and their families are necessary to achieve better breastfeeding outcomes.
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Affiliation(s)
- Zainab Taha
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi, P.O. Box 144534, UAE; (L.W.-S.); (D.P.)
- Correspondence: ; Tel.: +971-2-599-3111
| | | | - Ludmilla Wikkeling-Scott
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi, P.O. Box 144534, UAE; (L.W.-S.); (D.P.)
| | - Dimitrios Papandreou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi, P.O. Box 144534, UAE; (L.W.-S.); (D.P.)
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Leal MDC, Bittencourt SDA, Esteves-Pereira AP, Ayres BVDS, Silva LBRADA, Thomaz EBAF, Lamy ZC, Nakamura-Pereira M, Torres JA, Gama SGND, Domingues RMSM, Vilela MEDA. Avanços na assistência ao parto no Brasil: resultados preliminares de dois estudos avaliativos. CAD SAUDE PUBLICA 2019; 35:e00223018. [DOI: 10.1590/0102-311x00223018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/06/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo: Este artigo tem como objetivo descrever os primeiros resultados de dois estudos avaliativos, um sobre a Rede Cegonha e outro sobre o projeto Parto Adequado, denominados, respectivamente, de avaliação da Rede Cegonha e Nascer Saudável, e identificar possíveis melhorias em comparação ao estudo Nascer no Brasil. Ambos os estudos têm desenho seccional, realizados em 2017. O estudo avaliação da Rede Cegonha incluiu todas as 606 maternidades públicas e mistas envolvidas na Rede Cegonha e um total de 10.675 puérperas. O estudo Nascer Saudável incluiu uma amostra de conveniência de 12 hospitais da rede privada e um total de 4.798 mulheres. Os indicadores de atenção ao parto e nascimento avaliados foram: presença de acompanhante, atendimento por enfermeira obstétrica, preenchimento de partograma, uso de métodos não farmacológicos, deambulação, alimentação, uso de cateter venoso periférico, analgesia, posição da mulher para o parto, episiotomia e manobra de Kristeler. Esses indicadores foram comparados aos encontrados no Nascer no Brasil, estudo de base nacional realizado em 2011-2012, antes do início dos dois programas de intervenção. Para as comparações utilizamos o teste do qui-quadrado para amostras independentes e nível de 95% de confiança. Houve um aumento significativo do número de mulheres com acesso à tecnologia apropriada ao parto entre os anos de 2011 e 2017 e redução de práticas consideradas prejudiciais. No setor privado, observou-se também redução nas taxas de cesariana e aumento da idade gestacional ao nascer. Os resultados deste estudo mostram que políticas públicas bem conduzidas podem mudar o cenário da atenção ao parto e nascimento, promovendo a redução de desfechos maternos e neonatais negativos.
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Batista Filho M, Santos CCD. Cesarean section surgeries: the temporal evolution, epidemic tendency, the WHO proposals and recommendations, current doubts and challenges. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000400010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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