Potential pregnancy days lost: an innovative measure of gestational age

Analysis of the quality of prenatal data of pregnant women attended at Healthcare Services in the city of São Paulo between 2012 and 2020

OBJECTIVE

To analyze the quality of data collected during prenatal care recorded in the Integrated Health Care Management System (SIGA) of the Municipal Department of Health of São Paulo from 2012 to 2020.

METHODS

Descriptive study using SIGA data and the variables: maternal height (cm), weight (kg) measured throughout pregnancy, gestational age at prenatal consultation, systolic (SBP) and diastolic (DBP) blood pressure (in mmHg), and body mass index (BMI) at the beginning of pregnancy (up to 8 weeks). Quality analysis was carried out by calculating the indicators: percentage of incompleteness and zero values of all variables studied, percentage of implausible values for height, weight, BMI; preference for terminal digit of weight and height, and normality of distributions.

RESULTS

The database of pregnant women made available for analysis included 8,046,608 records and 1,174,115 women. The percentage of incompleteness and zero values was low (<1%) in all original variables of the system. There are more records at the end of pregnancy. For the four original variables of interest in the database (weight, height, SBP, DBP), there is a clear preference for the terminal digit. The variables of interest did not present an approximately normal distribution during the evaluated period.

CONCLUSION

The quality analysis showed the need for improving the standardization of information collection and recording, the rounding of measurements and the need for encouraging pregnant women to start prenatal care as soon as possible, in such a way that it is important to invest in data quality, through educational resources for professionals who work in health care.

Neonatal mortality by gestational age in days in infants born at term: A cohort study in Sao Paulo city, Brazil

Birth at term comprises a period with heterogeneous neonatal outcomes that tend to be worse for infants born earlier. However, few studies have analyzed this period, in which each day can make a difference. Therefore, we aim to assess neonatal mortality (NM) according to gestational age (GA) at birth measured in days in term liveborn infants born in 2012-2017 in São Paulo, the largest city in Latin America. This population-based cohort study assessed term liveborn infants followed until the end of the neonatal period. We analyzed 7 models for NM according to GA in days: crude NM adjusted for maternal and prenatal variables, NM additionally adjusted for type of birth and type of hospital, and adjusted NM stratified by type of birth (cesarean and vaginal) and by type of hospital (public and private). We included 440,119 live infants born at 259-293 days of gestation. The median GA at birth was 274 days. In all models, NM was higher for infants born early term, decreasing in infants born full term and rising again in infants born late term. In the unadjusted model, hazard ratios of NM changed daily, decreasing from 3.34 to 1.00 on day 278 and increasing again thereafter. In the stratified analysis according to type of hospital, being born in a public hospital was associated with a reduced risk of NM for infants born at 278-283 days of pregnancy. There was a decrease in GA related to obstetric interventions, especially cesarean sections, which increased NM. The loss of days of pregnancy was larger in private hospitals. Increasing the granularity of GA to days is feasible and has the potential to drive public policies. To the best of our knowledge, this is the first Brazilian study on GA in days using a national live births database.

Syphilis Trigram: a domain-specific visualisation to combat syphilis epidemic and improve the quality of maternal and child health in Brazil

BACKGROUND

The Brazilian healthcare system is a large and complex system, specially considering its mixed public and private funding. The incidence of syphilis has increased in the last four years, in spite of the presence of an effective and available treatment. Furthermore, syphilis takes part in a group of disorders of compulsory notification to the public health surveillance. The epidemiological implications are especially important during pregnancy since it can lead to complications, related to prematurity stillbirth and miscarriage, in addition to congenital syphilis, characterized by multisystem involved in the newborn.

METHODS

The Action Research methodology was applied to address the complexity of the syphilis surveillance scenario in Pernambuco, Brazil. Iterative learning cycles were used, resulting in six cycles, followed by a formal validation of an operational version of the syphilis Trigram visualisation at the end of the process. The original data source was analyzed and prepared to be used without any new data or change in the ordinary procedure of the current system.

RESULTS

The main result of this work is the production of a Syphilis Trigram: a domain-specific infographic for presenting gestational data and birth data. The second contribution of this work is the Average Trigram, an organized pie chart which synthesizes the Syphilis Trigram relationship in an aggregated way. The visualization of both graphics is presented in an Infographic User Interface, a tool that gathers an infographic broad visualization aspect to data visualization. These interfaces also gather selections and filters tools to assist and refine the presented information. The user can experience a specific case-by-case view, in addition to an aggregated perspective according to the cities monitored by the system.

CONCLUSIONS

The proposed domain-specific visualization amplifies the understanding of each syphilis case and the overall characteristics of cases of a chosen city. This new information produced by the Trigram can help clarify the reinfection/relapse cases, optimize resource allocation and enhance the syphilis healthcare policies without the need of new data. Thus, this enables the health surveillance professionals to see the broad tendency, understand the key patterns through visualization, and take action in a feasible time.