[Hospitalizations due to complications of pregnancy and maternal and perinatal outcomes in a cohort of pregnant women in the Brazilian Unified National Health System in São Paulo, Brazil]

Usefulness of the Hospital Information System for maternal mortality surveillance in Brazil

OBJECTIVE

To evaluate the capability of hospital records in the Hospital Information System (SIH) to add valuable and complementary information to the Mortality Information System (SIM) in studies on maternal mortality. We calculated and compared the maternal mortality ratio from the SIH and SIM databases, by age group and region, to highlight differences between groups and assess the coverage of maternal deaths using SIH compared with SIM.

METHODS

Obstetric hospitalizations were defined based on three sources (codes ICD-10 in diagnoses; procedures; billing information). Hospital and SIM mortality ratios were calculated by dividing maternal deaths in hospitals affiliated to the Unified Brazilian Health System (SUS) per live births (SINASC) in the same hospitals.

RESULTS

In 2019, we identified 2,497,957 obstetric admissions, 0.04% (946) with in-hospital mortality as outcome. The presence of three criteria identified 98% of obstetric hospitalizations and 83% of obstetric hospitalizations with death as outcome. The comparison of mortality ratios between SIH (45.5 MMR; 95%CI 42.7 - 48.5) and SIM (49.7 MMR; 95%CI 46.7 - 52.8) was not statistically significant (p-value: 0.053).

CONCLUSION

The analysis of SIH was able to provide additional information for the monitoring and surveillance of maternal health in Brazil. Although there are differences between the mortality rates, the SIH, as a complementary information system to the SIM, may be valid in studies on maternal mortality and morbidity.

Need for oxygen therapy and ventilatory support in premature infants in a hospital in Southern Brazil

BACKGROUND

Prematurity in newborns is a condition that is associated with worse hospital outcomes when compared to birth to term. A preterm infant (PI) is classified when gestational age (GA) < 37 wk.

AIM

To analyze prognostic indicators related to the use of oxygen therapy, non-invasive ventilation (continuous positive airway pressure) and mechanical ventilation (MV) in PI.

METHODS

This is a retrospective cohort. The sample was composed of PIs from a private hospital in southern Brazil. We included neonates with GA < 37 wk of gestation in the period of January 1, 2018 to December 31, 2018. For data collection, electronic records were used in the Tasy Philips^TM system, identifying the variables: maternal age, type of birth, prenatal information, GA, Apgar score, birth weight, neonatal morbidities, vital signs in the 1st hour at birth, need for oxygen therapy, continuous positive airway pressure and MV, hospitalization in the neonatal intensive care unit, length of stay and discharge or death.

RESULTS

In total, 90 PI records were analyzed. The median (p25-p75) of GA was 34.0 (31.9-35.4) wk, and there were 45 (50%) males. The most common morbidity among PIs was the acute respiratory discomfort syndrome, requiring hospitalization in the neonatal intensive care unit in 76 (84.4%) cases. The utilization rate of oxygen therapy, continuous positive airway pressure and MV was 12 (13.3%), 37 (41.1%) and 13 (14.4%), respectively. The median (p25-p75) length of stay was 12.0 (5.0-22.2) d, with 10 (11.1%) deaths. A statistical association was observed with the use of MV and GA < 28 wk, lower maternal age, low birth weight, Apgar < 8 and neonatal deaths.

CONCLUSION

The identification of factors related to the need for MV in prematurity may help in the indication of a qualified team and technologies to promptly meet the unforeseen events that may occur after birth.

Women's sexual health six months after a severe maternal morbidity event

OBJECTIVE

to investigate female sexual function in women six months postpartum and to compare sexual function among women who had and who did not have severe maternal morbidity (SMM).

METHOD

a cross-sectional study conducted with 110 women in the postpartum period, with and without SMM. Two instruments were used, one for the characterization of sociodemographic and obstetric variables and the Female Sexual Function Index (FSFI) for sexual function. Univariate, bivariate and regression model analyses were performed.

RESULTS

FSFI scores showed 44.5% of female sexual dysfunction, of which 48.7% were among women who had SMM and 42.0% among those who had not. There were significant differences between age (P=0.013) and duration of pregnancy (P<0.001) between women with or without SMM. Among the cases of SMM, hypertensive disorders were the most frequent (83%). An association was obtained between some domains of the FSFI and the following variables: orgasm and self-reported skin color, satisfaction and length of relationship, and pain and SMM.

CONCLUSION

white women have greater difficulty in reaching orgasm when compared to non-white women and women with more than 120 months of relationship feel more dissatisfied with sexual health than women with less time in a relationship. Women who have had some type of SMM have more dyspareunia when compared to women who have not had SMM.

Administrative Data Linkage in Brazil: Potentials for Health Technology Assessment

Health technology assessment (HTA) is the systematic evaluation of the properties and impacts of health technologies and interventions. In this article, we presented a discussion of HTA and its evolution in Brazil, as well as a description of secondary data sources available in Brazil with potential applications to generate evidence for HTA and policy decisions. Furthermore, we highlighted record linkage, ongoing record linkage initiatives in Brazil, and the main linkage tools developed and/or used in Brazilian data. Finally, we discussed the challenges and opportunities of using secondary data for research in the Brazilian context. In conclusion, we emphasized the availability of high quality data and an open, modern attitude toward the use of data for research and policy. This is supported by a rigorous but enabling legal framework that will allow the conduct of large-scale observational studies to evaluate clinical, economical, and social impacts of health technologies and social policies.

Body Mass Index and Cardiovascular Risk Factors in Children and Adolescents with High Birth Weight

BACKGROUND/AIMS

This study aimed to identify a possible association among high birth weight with overweight/obesity, high arterial blood pressure, dyslipidemia, and insulin resistance in children and adolescents.

METHODS

This is a cross-sectional study with 719 children and adolescents (6-12 years) stratified according to birth weight (low birth weight [LBW] <2,500 g, adequate birth weight [ABW] 2,500-3,999 g, and high birth weight [HBW] ≥4,000 g). Data collected were anthropometric data, arterial blood pressure levels, lipid profile, and insulin resistance (fasting glucose and insulin, used to calculate homeostatic model assessment-IR).

RESULTS

The mean age of schoolchildren was 9.5 ± 2.0 years and 371 (51.6%) were male. LBW and HBW were observed in 79 of 719 (10.9%) and 40 of 719 (55.6%) children/adolescents, respectively. There was no increased risk of overweight (OR 0.9; 95% CI 0.4-2.1; p = 0.964) and obesity (OR 1.4; 95% CI 0.6-3.5; p = 0.588) in HBW group compared to LBW and ABW groups. HBW was not associated with high blood pressure, dyslipidemia, and insulin resistance. The LBW group was independently associated with higher values of systolic (OR 1.07; 95% CI 1.05-1.10; p < 0.01) and diastolic blood pressure (OR 1.04; 95% CI 1.00-1.07; p = 0.044).

CONCLUSION

There was no association between HBW with overweight/obesity and classic cardiovascular risk factors in this group of children/adolescents. Only LBW was related to higher blood pressure levels.