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Mariotti C, Souza LAD, Paranhos LR, Bulgareli JV, Herval ÁM. Analysis of the access of pregnant women to the first programmatic dental appointment: an ecological study. Braz Oral Res 2024; 38:e012. [PMID: 38198310 DOI: 10.1590/1807-3107bor-2024.vol38.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/21/2022] [Indexed: 01/12/2024] Open
Abstract
To plan and evaluate public health policies, it is important to understand the influence of social factors on the quality and access to dental care. This study aimed to verify the potential association between the indicators of pregnant women receiving dental care and the social and health care indicators of cities in the Brazilian state of Minas Gerais. A cross-sectional ecological study was performed with secondary data from the Brazilian Institute of Geography and Statistics and the Health Care Department of the Ministry of Health regarding the cities of Minas Gerais. The study analyzed three health care indicators (such as more than six prenatal, the proportion of syphilis and human immunodeficiency virus tests, and oral health coverage) and four social indicators (average monthly wage, illiteracy rate, proportion of employed population, and rate of adequate sanitary sewerage). Bivariate analysis (Mann-Whitney test) and logistic regression were performed using Jamovi software. All of the indicators analyzed were associated with the access of pregnant women to dental care. However, in the regression models, only health care indicators remained statistically significant. Thus, although social indicators are associated with the access of pregnant women to dental appointments, access to primary health care and the teamwork of primary health care teams may overcome social inequality in the access of pregnant women to dental care.
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Affiliation(s)
- Camila Mariotti
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Community and Preventive Dentistry, Uberlândia, MG, Brazil
| | - Leiriane Alves de Souza
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Community and Preventive Dentistry, Uberlândia, MG, Brazil
| | - Luiz Renato Paranhos
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Community and Preventive Dentistry, Uberlândia, MG, Brazil
| | - Jaqueline Vilela Bulgareli
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Community and Preventive Dentistry, Uberlândia, MG, Brazil
| | - Álex Moreira Herval
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Community and Preventive Dentistry, Uberlândia, MG, Brazil
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Lugo-Candelas C, Talati A, Glickman C, Hernandez M, Scorza P, Monk C, Kubo A, Wei C, Sourander A, Duarte CS. Maternal Mental Health and Offspring Brain Development: An Umbrella Review of Prenatal Interventions. Biol Psychiatry 2023; 93:934-941. [PMID: 36754341 PMCID: PMC10512172 DOI: 10.1016/j.biopsych.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
The idea that risk for psychiatric disorders may be transmitted intergenerationally via prenatal programming places interest in the prenatal period as a critical moment during which intervention efforts may have a strong impact, yet studies testing whether prenatal interventions also protect offspring are limited. The present umbrella review of systematic reviews and meta-analyses (SRMAs) of randomized controlled trials aimed to synthesize the available evidence and highlight promising avenues for intervention. Overall, the literature provides mixed and limited evidence in support of prenatal interventions. Thirty SRMAs were included. Of the 23 SRMAs that reported on prenatal depression interventions, 16 found a significant effect (average standard mean difference = -0.45, SD = 0.25). Similarly, 13 of the 20 SRMAs that reported on anxiety outcomes documented significant reductions (average standard mean difference = -0.76, SD = 0.95 or -0.53/0.53 excluding one outlier). Only 4 SRMAs reported child outcomes, and only 2 (of 10) analyses showed significant effects of prenatal interventions (massage and telephone support on neonatal resuscitation [relative risk = 0.43] and neonatal intensive care unit admissions [relative risk = 0.91]). Notably missing, perhaps due to our strict inclusion criteria (inclusion of randomized controlled trials only), were interventions focusing on key facets of prenatal health (e.g., whole diet, sleep). Structural interventions (housing, access to health care, economic security) were not included, although initial success has been documented in non-SRMAs. Most notably, none of the SRMAs focused on offspring mental health or neurodevelopmental outcomes. Given the possibility that interventions deployed in this period will positively impact the next generation, randomized trials that focus on offspring outcomes are urgently needed.
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Affiliation(s)
- Claudia Lugo-Candelas
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ardesheer Talati
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Caila Glickman
- New York State Psychiatric Institute, New York, New York
| | - Mariely Hernandez
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Pamela Scorza
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Catherine Monk
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ai Kubo
- Division of Research, Kaiser Permanente, Oakland, California
| | - Chiaying Wei
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Andre Sourander
- Department of Child Psychiatry, Turku University Hospital, Turku University, Turku, Finland
| | - Cristiane S Duarte
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.
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Rocha ADS, Falcão IR, Teixeira CSS, Alves FJO, Ferreira AJF, Silva NDJ, Almeida MFD, Ribeiro-Silva RDC. Determinants of preterm birth: proposal for a hierarchical theoretical model. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022278.03232022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Preterm birth (PB) is a syndrome resulting from a complex relationship between multiple factors which do not have fully understood relationships and causality. This article discusses a hierarchical theoretical model of PB determinants, considering maternal characteristics such as sociodemographic, psychosocial, nutritional, behavioral and biological aspects, traditionally associated with increased risk of PB. The variables were distributed in six dimensions within three hierarchical levels (distal, intermediate and proximal). In this model, the socioeconomic determinants of the mother, family, household and neighborhood play indirect effects on PB through variables at the intermediate level, which in turn affect biological risk factors at the proximal level that have a direct effect on PB. The study presents a hierarchical theoretical model of the factors involved in the PB determination chain and their interrelationships. Understanding these interrelationships is an important step in trying to break the causal chain that makes some women vulnerable to preterm birth.
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Affiliation(s)
| | - Ila Rocha Falcão
- Universidade Federal da Bahia, Brazil; Fundação Oswaldo Cruz, Brazil
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Rocha ADS, Falcão IR, Teixeira CSS, Alves FJO, Ferreira AJF, Silva NDJ, Almeida MFD, Ribeiro-Silva RDC. Determinants of preterm birth: proposal for a hierarchical theoretical model. CIENCIA & SAUDE COLETIVA 2022; 27:3139-3152. [PMID: 35894325 DOI: 10.1590/1413-81232022278.03232022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/05/2022] [Indexed: 11/22/2022] Open
Abstract
Preterm birth (PB) is a syndrome resulting from a complex relationship between multiple factors which do not have fully understood relationships and causality. This article discusses a hierarchical theoretical model of PB determinants, considering maternal characteristics such as sociodemographic, psychosocial, nutritional, behavioral and biological aspects, traditionally associated with increased risk of PB. The variables were distributed in six dimensions within three hierarchical levels (distal, intermediate and proximal). In this model, the socioeconomic determinants of the mother, family, household and neighborhood play indirect effects on PB through variables at the intermediate level, which in turn affect biological risk factors at the proximal level that have a direct effect on PB. The study presents a hierarchical theoretical model of the factors involved in the PB determination chain and their interrelationships. Understanding these interrelationships is an important step in trying to break the causal chain that makes some women vulnerable to preterm birth.
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Affiliation(s)
- Aline Dos Santos Rocha
- Escola de Nutrição, Universidade Federal da Bahia, Salvador. Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. R. Mundo 121, ed. Tecnocentro, sl. 315, Trobogy. 41745-715 Salvador BA Brasil.
| | - Ila Rocha Falcão
- Escola de Nutrição, Universidade Federal da Bahia, Salvador. Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. R. Mundo 121, ed. Tecnocentro, sl. 315, Trobogy. 41745-715 Salvador BA Brasil.
| | - Camila Silveira Silva Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Flávia Jôse Oliveira Alves
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Andrêa Jacqueline Fortes Ferreira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Natanael de Jesus Silva
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Global de Barcelona, Hospital Clínic. Barcelona Espanha
| | | | - Rita de Cássia Ribeiro-Silva
- Escola de Nutrição, Universidade Federal da Bahia, Salvador. Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. R. Mundo 121, ed. Tecnocentro, sl. 315, Trobogy. 41745-715 Salvador BA Brasil.
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Jones AJ, Eke UA, Eke AC. Prediction and prevention of preterm birth in pregnant women living with HIV on antiretroviral therapy. Expert Rev Anti Infect Ther 2022; 20:837-848. [PMID: 35196941 PMCID: PMC9133156 DOI: 10.1080/14787210.2022.2046463] [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: 10/10/2021] [Accepted: 02/22/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The rate of spontaneous preterm-birth among pregnant women living with HIV on antiretroviral therapy (ART) is 3- to 4-fold higher when compared to HIV-negative women. The pathophysiology of preterm-birth related to HIV or ART remains unknown, especially as women living with HIV are often excluded from preterm birth studies. AREAS COVERED This review discusses the currently available evidence on the prediction and prevention of preterm-birth in pregnant women living with HIV. A review of the literature was conducted of primary articles between 2005 and 2021 measuring the association or lack thereof between combination ART and preterm birth, as well as of other predisposing factors to preterm birth in women living with HIV, including cervical length, vaginal microbiome, and cervico-vaginal biomarkers. EXPERT OPINION Further research into the effect of ART exposure on preterm-birth risk is critical, and development of preterm-birth predictive tools in this population should be a priority. Vaginal progesterone supplementation deserves further investigation as a therapeutic option to prevent recurrent preterm birth in pregnant women living with HIV. The ProSPAR study, a multicenter randomized controlled trial studying progesterone supplementation in pregnant women on protease inhibitor-based regimens, has been designed but is not yet recruiting patients.
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Affiliation(s)
| | - Uzoamaka A Eke
- Division of Infectious Diseases and Institute of Human Virology, Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, United States of America
| | - Ahizechukwu C Eke
- Division of Maternal Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore
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Lucas ADP, de Oliveira Ferreira M, Lucas TDP, Salari P. The intergenerational relationship between conditional cash transfers and newborn health. BMC Public Health 2022; 22:201. [PMID: 35094683 PMCID: PMC8801108 DOI: 10.1186/s12889-022-12565-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022] Open
Abstract
Background Lack of nutrition, inadequate housing, low education and limited access to quality care can negatively affect children’s health over their lifetime. Implemented in 2003, the Bolsa Familia (“Family Stipend”) Program (PBF) is a conditional cash transfer program targeting poor households in Brazil. This study investigates the long-term benefits of cash transfers through intergenerational transmission of health and poverty by assessing the early life exposure of the mother to the PBF. Methods We used data from the 100M SINASC-SIM cohort compiled and managed by the Center for Data and Knowledge Integration for Health (CIDACS), containing information about participation in the PBF and socioeconomic and health indicators. We analyzed five measures of newborn health: low (less than 2,500 g) and very low (less than 1,500 g) birth weight, premature (less than 37 weeks of gestation) and very premature (less than 28 weeks of gestation) birth, and the presence of some type of malformation (according to ICD-10 codes). Furthermore, we measured the early life exposure to the PBF of the mother as PBF coverage in the previous decade in the city where the mother was born. We applied multilevel logistic regression models to assess the associations between birth outcomes and PBF exposures. Results Results showed that children born in a household where the mother received BF were less likely to have low birth weight (OR 0.93, CI; 0.92-0.94), very low birth weight (0.87, CI; 0.84-0.89), as well as to be born after 37 weeks of gestation (OR 0.98, CI; 0.97-0.99) or 28 weeks of gestation (OR 0.93, CI; 0.88-0.97). There were no significant associations between households where the mother received BF and congenital malformation. On average, the higher the early life exposure to the PBF of the mother, the lower was the prevalence of low birth weight, very low birth weight and congenital malformation of the newborn. No trend was noted for preterm birth. Conclusion The PBF might have indirect intergenerational effects on children’s health. These results provide important implications for policymakers who have to decide how to effectively allocate resources to improve child health. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12565-7.
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Esposti CDD, Santos-Neto ETD, Oliveira AE, Travassos C, Pinheiro RS. [Adequacy of prenatal dental care: social and geographical inequalities in a metropolitan region of Brazil]. CIENCIA & SAUDE COLETIVA 2021; 26:4129-4144. [PMID: 34586265 DOI: 10.1590/1413-81232021269.10542020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 06/26/2020] [Indexed: 11/22/2022] Open
Abstract
This study set out to analyze social and geographical inequalities in the adequacy of prenatal dental care in the Unified Health System (SUS) of the Greater Vitória Metropolitan Region, Espírito Santo, Brazil. A cross-sectional study was carried out with 1209 postpartum women living in the region admitted to hospital at SUS facilities for childbirth between 2010 and 2011. Data were collected on prenatal medical-dental care, the impact of oral health on the quality of life of pregnant women (Oral Health Impact Profile-14), and predisposing characteristics. Prenatal care was adequate when care corresponded to the recommended treatment. The adequacy of dental care during prenatal care was analyzed using a multivariate logistic model. Oral health was found to have an impact on the quality of life of 102 (8.4%) pregnant women and the adequacy of dental care during prenatal care was only 15.4% (n=156). There was a greater chance of adequacy of prenatal dental care in Vitória (OR=2.44; IC=1.63-3.66), in regions covered by the family health strategy (OR=1.88; IC=1.22-2.89), and in areas with a higher proportion of pregnant women with access to quality prenatal care (OR=3.59; IC=1.64-7.84). Contextual inequalities were decisive for the inadequacy of dental care in prenatal care.
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Affiliation(s)
- Carolina Dutra Degli Esposti
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468. 29043-900 Vitória ES Brasil.
| | - Edson Theodoro Dos Santos-Neto
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468. 29043-900 Vitória ES Brasil.
| | - Adauto Emmerich Oliveira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468. 29043-900 Vitória ES Brasil.
| | - Claudia Travassos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Rejane Sobrino Pinheiro
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
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Barreto CTG, Tavares FG, Theme-Filha M, Farias YN, Pantoja LDN, Cardoso AM. Baixo peso ao nascer, prematuridade e restrição de crescimento intra-uterino: resultados dos dados de base da primeira coorte de nascimentos indígenas no Brasil (coorte de nascimentos Guarani). BMC Pregnancy Childbirth 2020; 20:748. [PMID: 33267830 PMCID: PMC7709282 DOI: 10.1186/s12884-020-03396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022] Open
Abstract
ABSTRATO FUNDO: O baixo peso ao nascer (BPN) continua sendo um importante problema de saúde global, associado a uma série de resultados adversos de saúde ao longo da vida. As evidências sugerem que o BPN é um determinante relevante de morbidade e mortalidade em grupos indígenas, que geralmente têm acesso limitado às políticas públicas de saúde e nutrição. O conhecimento da prevalência de BPN e de suas causas subjacentes pode contribuir com etapas essenciais para a prevenção de seus efeitos sobre a saúde. O estudo teve como objetivo estimar as prevalências de BPN, prematuridade e restrição de crescimento intra-uterino (RCIU) e investigar seus determinantes na primeira coorte de nascimentos indígenas no Brasil. MéTODOS: Este estudo transversal utilizou dados de linha de base coletados da primeira coorte de nascimentos indígenas no Brasil, a Coorte de Nascimentos Guarani. O Brasil é um dos países com maior diversidade étnica do mundo, com 305 povos indígenas e 274 línguas nativas. Os Guarani são uma das cinco maiores etnias, com aldeias localizadas principalmente na região sul. Todos os nascimentos únicos de 1º de junho de 2014 a 31 de maio de 2016 foram selecionados em 63 aldeias indígenas Guarani nas regiões Sul e Sudeste. Foi realizada regressão logística múltipla hierárquica. RESULTADOS As taxas de prevalência de BPN, prematuridade e RCIU foram 15,5, 15,6 e 5,7%, respectivamente. As chances de BPN foram menores em recém-nascidos de mães que vivem em casas de tijolo e argamassa (OR: 0,25; IC 95%: 0,07-0,84) e foram maiores em filhos de mães ≤20 anos de idade (OR: 2,4; IC 95%: 1,29-4,44) e com anemia crônica antes da gravidez (OR: 6,41; IC 95%: 1,70-24,16). A prematuridade foi estatisticamente associada ao tipo de fonte de energia para cozinhar (fogão a lenha - OR: 3,87; IC 95%: 1,71-8,78 e fogueiras - OR: 2,57; IC 95%: 1,31-5,01). RCIU foi associado à primiparidade (OR: 4,66; IC 95%: 1,68-12,95) e anemia materna crônica antes da gravidez (OR: 7,21; IC 95%: 1,29-40,38). CONCLUSõES: Idade materna, estado nutricional e paridade, condições de moradia e exposição à poluição interna foram associados com resultados perinatais na população indígena Guarani. Esses resultados indicam a necessidade de investir no acesso e melhoria da assistência pré-natal; também no fortalecimento do Subsistema de Saúde Indígena, e em ações intersetoriais para o desenvolvimento de políticas habitacionais e de saneamento e melhorias ambientais ajustadas às necessidades e conhecimentos dos povos indígenas.
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Affiliation(s)
- Carla Tatiana Garcia Barreto
- Universidade do Estado do Rio de Janeiro (UERJ), Av. Marechal Rondon, 381. São Francisco Xavier, Rio de Janeiro, RJ, CEP: 20950-000, Brazil.
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | - Felipe Guimarães Tavares
- Escola de Enfermagem Aurora de Afonso Costa. Faculdade de Enfermagem, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Mariza Theme-Filha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Ige J, Pilkington P, Orme J, Williams B, Prestwood E, Black D, Carmichael L, Scally G. The relationship between buildings and health: a systematic review. J Public Health (Oxf) 2020; 41:e121-e132. [PMID: 30137569 PMCID: PMC6645246 DOI: 10.1093/pubmed/fdy138] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/04/2018] [Indexed: 11/21/2022] Open
Abstract
Background The built environment exerts one of the strongest directly measurable effects on physical and mental health, yet the evidence base underpinning the design of healthy urban planning is not fully developed. Method This study provides a systematic review of quantitative studies assessing the impact of buildings on health. In total, 7127 studies were identified from a structured search of eight databases combined with manual searching for grey literature. Only quantitative studies conducted between January 2000 and November 2016 were eligible for inclusion. Studies were assessed using the quality assessment tool for quantitative studies. Results In total, 39 studies were included in this review. Findings showed consistently that housing refurbishment and modifications, provision of adequate heating, improvements to ventilation and water supply were associated with improved respiratory outcomes, quality of life and mental health. Prioritization of housing for vulnerable groups led to improved wellbeing. However, the quality of the underpinning evidence and lack of methodological rigour in most of the studies makes it difficult to draw causal links. Conclusion This review identified evidence to demonstrate the strong association between certain features of housing and wellbeing such as adequate heating and ventilation. Our findings highlight the need for strengthening of the evidence base in order for meaningful conclusions to be drawn.
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Affiliation(s)
- Janet Ige
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Paul Pilkington
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Judy Orme
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Ben Williams
- Air Quality Management Resource Centre, University of the West of England, Bristol, UK
| | - Emily Prestwood
- Air Quality Management Resource Centre, University of the West of England, Bristol, UK
| | - D Black
- Daniel Black + Associates
- db+a, Bristol, UK
| | - Laurence Carmichael
- WHO Collaborating Centre for Healthy Urban Environments, University of the West of England, Bristol, UK
| | - Gabriel Scally
- WHO Collaborating Centre for Healthy Urban Environments, University of the West of England, Bristol, UK
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Esposti CDD, Santos-Neto ETD, Oliveira AE, Travassos C, Pinheiro RS. Social and geographical inequalities in the performance of prenatal care in a metropolitan area of Brazil. CIENCIA & SAUDE COLETIVA 2020; 25:1735-1750. [PMID: 32402040 DOI: 10.1590/1413-81232020255.32852019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/07/2019] [Indexed: 11/22/2022] Open
Abstract
This study analyzed the social and geographical inequalities in the performance of prenatal medical care in the Unified Health System (SUS) in the Metropolitan Region of Grande Vitória, Espírito Santo, Brazil. A cross-sectional study was carried out with 1,209 puerperae living in this region, admitted for childbirth from 2010 to 2011. Data about prenatal care and contextual, enabling, and social characteristics were collected, following the Andersen's Behavioral Model. The performance of prenatal care was classified into five levels, including information on the number of prenatal visits, initial and repetitive examinations, tetanus vaccination, gestational risk management, and participation in educational activities. The likelihood of different levels of prenatal care performance was analyzed using a multivariate multinomial model, according to maternal social variables. High prenatal coverage (98%) and 4.4% care adequacy were identified. The likelihood of access to prenatal care was increased by enabling, contextual, and social factors. The relationship between prenatal care quality and pregnant women's social and geographical conditions must be considered in the organization of services to achieve equity and reduce maternal and perinatal morbimortality.
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Affiliation(s)
| | | | - Adauto Emmerich Oliveira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória, ES, Brazil,
| | - Claudia Travassos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Rejane Sobrino Pinheiro
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Predictors of Low Birth Weight at Lumbini Provincial Hospital, Nepal: A Hospital-Based Unmatched Case Control Study. Adv Prev Med 2020; 2020:8459694. [PMID: 32274216 PMCID: PMC7136760 DOI: 10.1155/2020/8459694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/04/2020] [Indexed: 01/23/2023] Open
Abstract
Background Low birth weight (LBW) is defined as the birth weight of live born infants below 2500 g, regardless of gestational age. It is a public health problem caused by factors that are potentially modifiable. The purpose of this study was to determine the socioeconomic, obstetric, and maternal factors associated with LBW in Lumbini Provincial Hospital, Nepal. Methods The study was conducted using case control study design with 1 : 2 case control ratio. A total of 105 cases and 210 controls were taken in this study. Data were entered on Epi data software version 3.1 and exported to Statistical Package for Social Science (SPSS) software version 25 for analysis. Characteristics of the sample were described using mean and standard deviation. Bivariate analysis was done to assess the association between dependent and independent variables. The ultimate measure of association was odds ratio. Variables found to be associated with bivariate analysis were entered into a multivariable logistic regression model to identify predictors of LBW. Results The mean age of the participants was 25.98 years with ±4.40 standard deviation. Mothers with literate educational background (AOR 0.32, 95% CI 0.13–0.81), housewife (AOR 2.63, 95% CI 1.11–6.20), vaginal mode of delivery (AOR 0.45, 95% CI 0.25–0.82), gestational age <37 weeks (AOR 2.51, 95% CI 1.15–5.48), history of LBW (AOR 5.12, 95% CI 1.93–13.60), and maternal weight <50 kilograms (AOR 2.23, 95% CI 1.23–4.02) were significantly associated with LBW. Conclusion Educational and occupational status, mode of delivery, gestational age, maternal weight, and history of LBW were found to be independent predictors of LBW. There is need of developing coordination with education sector for increasing educational status of mothers and adolescent girls. Social determinants of health need to be considered while developing interventional programs. Similarly, interventional programs need to be developed considering identified predictors of low birth weight.
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Lu C, Cao L, Norbäck D, Li Y, Chen J, Deng Q. Combined effects of traffic air pollution and home environmental factors on preterm birth in China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 184:109639. [PMID: 31525560 DOI: 10.1016/j.ecoenv.2019.109639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Although mounting evidence have linked traffic-related air pollution (TRAP) with increased risk of preterm birth (PTB), whether it can interact with indoor environmental factors remains unknown, and its window(s) susceptibility at the stage of gestation is unclear. OBJECTIVE To explore PTB risk for prenatal exposure to traffic-related air pollution and home environmental factors during pregnancy, so as to identify critical window(s) in the combined effect of traffic air pollution and main home environmental factor(s) on PTB development. METHODS A retrospective cohort study of 3,509 preschool children was performed in Changsha, China during 2011-2012. The PTB prevalence was reported by the parents based on a questionnaire. We estimated each mother's exposure to traffic-related air pollutant NO2 in different windows of gestation, including conception month, three trimesters, birth month, and whole gestation. Maternal exposure to home environmental factors was considered by renovation (new furniture/redecoration) in pregnancy, and mold/damp stains and window condensation during perinatal period. Associations of PTB with both ambient NO2 and home environmental factors, and their interactions on PTB were evaluated by logistic regression models using odds ratio (OR) with 95% confidence interval (CI). RESULTS Traffic air pollutant NO2 exposure in utero was significantly associated with PTB, with adjusted odds ratio (OR) (95% CI) of 1.41 (1.00-1.98) for an IQR increase in NO2 exposure during whole pregnancy, particularly in the conception month and 1st trimester. We further found a positive relationship between perinatal exposure to mold/damp stains in the homes and PTB, OR (95% CI) = 1.73 (1.04-2.90). Especially, we detected a significant interaction between outdoor NO2 and indoor mold/damp stains on PTB risk. Male and female foetus were respectively more susceptible to perinatal mold/dampness at home and outdoor NO2 exposure in early gestation. CONCLUSION Our finding indicates that both outdoor traffic air pollutant and indoor mold/dampness play key roles in PTB development, and their interaction effect in early pregnancy significantly increases PTB risk.
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Affiliation(s)
- Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, China; Hunan Engineering Research Center of Early Life Development and Disease Prevention, XiangYa Hospital, Central South University, Changsha, China
| | - Lanqin Cao
- Department of Gynecology, XiangYa Hospital, Central South University, Changsha, China
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Jing Chen
- School of Architecture and Art, Central South University, Changsha, China
| | - Qihong Deng
- XiangYa School of Public Health, Central South University, Changsha, China; Hunan Engineering Research Center of Early Life Development and Disease Prevention, XiangYa Hospital, Central South University, Changsha, China; School of Architecture and Art, Central South University, Changsha, China.
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Lake EA, Olana Fite R. Low Birth Weight and Its Associated Factors among Newborns Delivered at Wolaita Sodo University Teaching and Referral Hospital, Southern Ethiopia, 2018. Int J Pediatr 2019; 2019:4628301. [PMID: 31428164 PMCID: PMC6679849 DOI: 10.1155/2019/4628301] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/10/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Birth weight has a vital role in determining newborns survival in vulnerable conditions. Low birth weight is associated with fetal and neonatal morbidity and mortality, impairment of growth and development and also chronic disease later in life. This study was aimed to assess the magnitude of low birth weight and its determinants in Wolaita Sodo University teaching and referral hospital, southern Ethiopia. METHODS Institution based cross-sectional study was conducted from November to December 2018. Systematic random sampling technique was used to select study participants. Data was collected by interviewing mothers through structured questionnaire and reviewing neonates' medical records using a checklist. Multivariable binary logistic regression analyses were employed to identify factors associated with neonatal jaundice. RESULTS The proportion of low birth weight in the study area was found to be 15.8% (95% CI 11.7-19.9). Being primiparity [AOR=5.798; 95% (1.572-21.377)], anemia during pregnancy [AOR=3.808; 95% (1.513-9.586)], pregnancy induced hypertension [AOR= 6.955; 95% (2.386- 20.275)], intake herbal medication during pregnancy [AOR=35.762; 95% (4.571-279.764)], drinking alcohol during pregnancy [AOR=8.111; 95% (2.359-27. 895)] were predictors of low birth weight. CONCLUSION The proportion of low birth weight among newborns delivered at Wolaita Sodo University teaching and referral hospital was comparable with the global prevalence of low birth weight. Parity, anemia, alcohol, herbal medication, and pregnancy-induced hypertension were significantly associated with low birth weight.
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Affiliation(s)
- Eyasu Alem Lake
- Department of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Robera Olana Fite
- Department of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Schwab FCBDS, Ferreira L, Martinelli KG, Esposti CDD, Pacheco KTDS, Oliveira AE, Santos Neto ETD. [Factors associated with educational guidance regarding oral health during prenatal care]. CIENCIA & SAUDE COLETIVA 2019; 26:1115-1126. [PMID: 33729364 DOI: 10.1590/1413-81232021263.12902019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/20/2019] [Indexed: 11/21/2022] Open
Abstract
The scope of this article is to verify the factors associated with providing educational guidance related to oral health during prenatal care in the Metropolitan Region of Greater Vitória - ES, Brazil. It involved a cross-sectional study of 1,035 postpartum women in public or affiliated private hospitals in the SUS in 2010. A descriptive analysis of the main educational information and binomial logistic regression was conducted to test the association between individual and contextual variables and "receiving educational guidance through meetings and/or pregnant mother groups in the health unit and/or through home visits". The information given most during prenatal care was "the advantage of exclusive breastfeeding until six months of life" (52.0%) and least was "the importance of fluoride use in health" (18.9%). Being attended by the Family Health Strategy (FHS) (OR=1.94), having adequate living conditions for women and children (OR=1.73) and an additional prenatal visit (OR=1.08), increased the chance of providing educational guidance in prenatal care. Frequent pre-natal visits, coverage of health services in line with the FHS, and adequate conditions of housing were factors that were positively associated with educational guidance during prenatal care.
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Affiliation(s)
| | - Lorena Ferreira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo (UFES). Vitória ES Brasil
| | | | | | | | - Adauto Emmerich Oliveira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo (UFES). Vitória ES Brasil
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Belfort GP, Santos MMADS, Pessoa LDS, Dias JR, Heidelmann SP, Saunders C. Determinants of low birth weight in the children of adolescent mothers: a hierarchical analysis. CIENCIA & SAUDE COLETIVA 2018; 23:2609-2620. [PMID: 30137130 DOI: 10.1590/1413-81232018238.13972016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/18/2016] [Indexed: 11/22/2022] Open
Abstract
This study aimed to identify the determinants of low birth weight (LBW) amongst children of adolescent mothers through a hierarchical approach in a cross-sectional study of 751 adolescents attended at a public hospital in Rio de Janeiro. Sociodemographic data, prenatal care, and biological and maternal obstetric conditions were analyzed. Possible determinants of LBW were identified in the bivariate analysis and then hierarchical logistic regression models were tested, considering as taggered hierarchy of distal, intermediate, and proximal levels. Variables with p < 0.05 at each level of analysis were kept in the model, and the adjusted odds ratio (OR) and 95% confidence interval (CI) were estimated. The prevalence of low birth weight was 10%. The determinants of LBW were: distal level - non-acceptance of pregnancy (OR = 10.19, 95% CI = 1.09 to 39.53); intermediate level - having fewer than six prenatal consultations (OR = 4.29; 95% CI = 1.55 to 11.83) and not having standardized nutritional care (OR = 3.18; 95% CI = 1.18 to 8.55); and proximal level - preterm delivery (OR = 10.19, 95% CI = 2.12 to 49.01). The determinants of LBW were maternal characteristics, prenatal care, and birth conditions, which contain certain modifiable social characteristics.
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Affiliation(s)
- Gabriella Pinto Belfort
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373/CCS/Bloco J/2º andar, Ilha do Fundão. 21941-902 Rio de Janeiro RJ Brasil. belfortgabriella@hotmailcom
| | - Marta Maria Antonieta de Souza Santos
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373/CCS/Bloco J/2º andar, Ilha do Fundão. 21941-902 Rio de Janeiro RJ Brasil. belfortgabriella@hotmailcom
| | - Lidiane da Silva Pessoa
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373/CCS/Bloco J/2º andar, Ilha do Fundão. 21941-902 Rio de Janeiro RJ Brasil. belfortgabriella@hotmailcom
| | - Juliana Rebelo Dias
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373/CCS/Bloco J/2º andar, Ilha do Fundão. 21941-902 Rio de Janeiro RJ Brasil. belfortgabriella@hotmailcom
| | - Sonaly Petronilho Heidelmann
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373/CCS/Bloco J/2º andar, Ilha do Fundão. 21941-902 Rio de Janeiro RJ Brasil. belfortgabriella@hotmailcom
| | - Cláudia Saunders
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373/CCS/Bloco J/2º andar, Ilha do Fundão. 21941-902 Rio de Janeiro RJ Brasil. belfortgabriella@hotmailcom
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Harville EW, Rabito FA. Housing conditions and birth outcomes: The National Child Development Study. ENVIRONMENTAL RESEARCH 2018; 161:153-157. [PMID: 29149678 DOI: 10.1016/j.envres.2017.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/27/2017] [Accepted: 11/04/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Despite their importance to respiratory and other health outcomes, housing conditions have been little-studied with respect to perinatal outcomes. METHODS 1927 participants in the British National Child Development Study reported on housing conditions and pregnancy outcomes, including presence/severity of mold/dampness; type of heating; and whether remodeling of various sorts had been conducted. Crowding, based on the number of people in the residence and the number of rooms, was also considered. Outcomes assessed were low birthweight (< 2500g), preterm birth (< 37 weeks), and small-for-gestational-age (< 10th percentile for gestational age). Multiple logistic regression with adjustment for maternal, sociodemographic, and housing factors was conducted. RESULTS Women who reported serious problems with mold were more likely to give birth to a low birthweight (adjusted OR 1.98, 95% CI 1.13-3.47) or small-for-gestational-age (2.06, 1.25-3.38) baby; no consistent associations were seen with preterm birth. Crowding was associated only with small-for-gestational-age (1.73, 1.11-2.76). CONCLUSIONS Exposure to mold or dampness, and housing conditions generally, is a potentially important but under-investigated aspect of women's lives during pregnancy. Future studies should more thoroughly investigate housing characteristics and their relationship with birth outcomes.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States.
| | - Felicia A Rabito
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
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Yaya S, Bishwajit G, Ekholuenetale M, Shah V. Inadequate Utilization of Prenatal Care Services, Socioeconomic Status, and Educational Attainment Are Associated with Low Birth Weight in Zimbabwe. Front Public Health 2017; 5:35. [PMID: 28321391 PMCID: PMC5337889 DOI: 10.3389/fpubh.2017.00035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/20/2017] [Indexed: 11/22/2022] Open
Abstract
Background Globally, low birth weight (LBW) remains a leading cause of neonatal and infant mortality and poses significant challenges toward the progress of achieving infant mortality-related goals. Experience from developed countries shows that two major causes of LBW (premature delivery and intrauterine growth restriction) can be averted to a great extent by adequate utilization of maternal health-care services, during pregnancy. In this study, we attempt to measure the prevalence of LBW in Zimbabwe and explore the association between adequate utilization of prenatal care (PNC) services and LBW in Zimbabwe. We also explore other possible associations with LBW. Methodology This study was based on nationally representative, cross-sectional data from Multiple Indicator Cluster Survey round 5, conducted in 2014. Participants included 3,221 mothers from both rural and urban areas. The participants were selected regardless of their current pregnancy status. Sample characteristics were presented using descriptive statistics. Association between utilization status of ANC and LBW was measured by chi-square (bivariate) test and logistic regression methods. Results Prevalence of LBW was 12.8%. There was 11% reduction in the odds of having LBW babies for participants from urban area when compared with rural area (AOR = 0.897; 95% CI = 0.707–1.138). When compared to women with higher education, those having primary/below primary and secondary level qualification had higher odds of experiencing LBW babies by 73 and 56%, respectively. Participants who had less than four PNC/ANC visits had 34% higher odds (AOR = 1.340; 95% CI = 1.065–1.685) than those with at least four visits, and those who had given birth more than once, had 38% lower odds (AOR = 0.620; 95% CI = 0.493–0.780) of giving birth to LBW babies when compared to those who had given birth only once. Conclusion The findings of this study have programmatic and policy implications for low-resource nations and suggest that promoting access to ANC services especially in the rural areas is likely to reduce prevalence of LBW in Zimbabwe. This is important as LBW babies consume lot of health resources per se and not only in terms of hospitalization but also in terms of outpatient and physician visits during the first year of their life.
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Affiliation(s)
- Sanni Yaya
- Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa , Ottawa, ON , Canada
| | - Ghose Bishwajit
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | | | - Vaibhav Shah
- Interdisciplinary School Health Sciences, University of Ottawa , Ottawa, ON , Canada
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Salehi K, Mahmoodi Z, Kabir K, Dolatian M. Pathways of job style and preterm low birth weight. Electron Physician 2016; 8:2888-2896. [PMID: 27790340 PMCID: PMC5074746 DOI: 10.19082/2888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/28/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Preterm and low birth weight tend to occur as a direct result of prenatal risky behaviors, diseases, as well as fetal exposure to harmful social and environmental factors. The present study aimed to investigate the relationship between job style and preterm low birth weight. Methods The present case-control study was conducted in the Kamali hospital, Teheran, Iran in 2014. Participants included 156 mothers having a gestational age of less than 37 weeks and infants weighing less than 2500 gm. Additionally, the control group consisted of 433 mothers with a gestational age of over 37 weeks and having infants weighing between 2500–4000 gm. The data were collected using the Mother’s Lifestyle Scale (MLS) during pregnancy based on recognized social determinants of health and those developed by the researchers. The domain of the mother’s job style was assessed using a questionnaire consisting of 18 items on topics such as working conditions, job satisfaction, and perceived employer empathy. Higher overall scores in this instrument indicate the mother’s poorer job style. The data were analyzed using SPSS version 16 and Lisrel version 8.8 through a statistical path analysis. Results The model fit indices indicated that there was found to be high favorability, demonstrated that the model fit and that there were rational relationships (CFI=1, RMSEA=0.00), and showed that on the direct path that the mother’s job style had the most adverse effect (B=−0.3) with weight gain during pregnancy showing the most positive effect (B=0.16) on PLBW. The mother’s level of education was found to be the only variable that affected PLBW negatively in both the direct and indirect paths through the mother’s job style and household income (B=−0.17). Conclusion According the path analysis model, job style has a direct influence on preterm low birth weight. Thus, special consideration should be placed on aspects surrounding a mother’s job situation in order to prevent any adverse effects.
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Affiliation(s)
- Katayoun Salehi
- M.Sc. in Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Zohreh Mahmoodi
- Ph.D. of Social Determinant of Health, Assistant Professor of Social Determinant of Health Research Center and Nursing & Midwifery Faculty of Alborz University of Medical Sciences, Karaj, Iran
| | - Kourosh Kabir
- National Board in Social Medicine, Assistant Professor of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahrokh Dolatian
- Ph.D. of Social Determinant of Health, Assistant Professor of Department of Midwifery and Reproductive Health, Faculty Member of Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tuon RA, Ambrosano GMB, Silva SMCVE, Pereira AC. [Telephone monitoring service for pregnant women and impact on prevalence of prematurity and associated risk factors in Piracicaba, São Paulo State, Brazil]. CAD SAUDE PUBLICA 2016; 32:S0102-311X2016000705001. [PMID: 27462851 DOI: 10.1590/0102-311x00107014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 05/23/2016] [Indexed: 11/22/2022] Open
Abstract
This study aims to assess the impact of a telephone monitoring service on prevalence of prematurity and to analyze associated risk factors using data on 2,739 pregnant women. Estimation was based on hierarchical multiple logistic regression, with p ≤ 0.05 for variables to remain in the model. Prevalence of preterm birth was 8.34% in monitored pregnant women and 10.18% in unmonitored women (p = 0.0058). Prevalence of preterm birth was inversely proportional to the number of monitoring calls (p < 0.0001). Variables associated with prematurity were maternal age < 19 years, history of death of two or more children, multiple pregnancy, diabetes, hypertension, fewer monitoring calls, extended standing or lifting heavy weights at work, smoking, fewer prenatal visits, no ultrasound examination, gestational diabetes, multiple pregnancy, and fetal abnormality. This low-cost strategy proved effective for reducing the preterm birth rate.
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Affiliation(s)
- Rogerio Antonio Tuon
- Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, Brasil.,Secretaria Municipal de Saúde de Piracicaba, Piracicaba, Brasil
| | | | | | - Antonio Carlos Pereira
- Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, Brasil
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Dolatian M, Mahmoodi Z, Alavi-Majd H, Moafi F, Ghorbani M, Mirabzadeh A. Psychosocial factors in pregnancy and birthweight: Path analysis. J Obstet Gynaecol Res 2016; 42:822-30. [PMID: 27098096 DOI: 10.1111/jog.12991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/20/2016] [Accepted: 02/17/2016] [Indexed: 12/01/2022]
Abstract
AIM Birthweight is known to be affected by several factors. In the present study a relationship model of psychological and economic determinants of birthweight was designed and tested. METHODS This prospective study involved 400 pregnant women in four districts of Tehran, Iran. The subjects were selected through a multistage sampling method. Seven questionnaires (socioeconomic status; Holmes and Rahe Stress Scale; Perceived Stress Scale; 21-item Depression, Anxiety, and Stress Scale [DASS-21]; perceived social support; pregnancy-related anxiety scale; and domestic violence questionnaire) were used to assess participant psychosocial and economic conditions. In order to collect post-partum information about the mother and the infant, the women were followed up until delivery. Data were analyzed using SPSS-16 and Lisrel-8.8. RESULTS Based on the obtained path diagram, the greatest adverse effects on birthweight were exerted directly by DASS-21 score (B = -0.14) and indirectly by stressful life events (B = -0.037). Among variables that affected birthweight in both paths, socioeconomic status and perceived stress had the strongest overall effects on birthweight (B = 0.203 and -0.1024, respectively). CONCLUSION According to the path analysis model, psychosocial and economic factors can directly/indirectly affect birthweight.
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Affiliation(s)
- Mahrokh Dolatian
- Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Zohreh Mahmoodi
- Faculty of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Hamid Alavi-Majd
- Department of Biostatistics, Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Farnoosh Moafi
- Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Maryam Ghorbani
- Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Arash Mirabzadeh
- Department of Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran.,Department of Psychiatric, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran
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Brentani A, Grisi SJFE, Taniguchi MT, Ferrer APS, de Moraes Bourroul ML, Fink G. Rollout of community-based family health strategy (programa de saude de familia) is associated with large reductions in neonatal mortality in São Paulo, Brazil. SSM Popul Health 2016; 2:55-61. [PMID: 29349127 PMCID: PMC5757818 DOI: 10.1016/j.ssmph.2016.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/27/2015] [Accepted: 01/02/2016] [Indexed: 01/08/2023] Open
Abstract
Rationale Several recent studies suggest that Brazil’s Estratégia Saude de Familia (Family Health Strategy-FHS) has contributed to declines in mortality at the national and regional level. Comparatively little is known whether this approach is effective in urban populations with relatively easy access to health services. Objectives To use detailed medical data collected as part of São Paulo’s Western Region project to examine whether the FHS program had an impact on child health in São Paulo, Brazil. Results No associations were found between FHS and birth weight (OR 1.03, 95% CI 0.93–1.29), gestational length (OR 0.98, 95% CI 0.83–1.15) or stillbirth (OR 1.51, 95% CI 0.75–3.03). FHS eligibility was associated with a 42% reduction in the odds of child mortality (OR 0.58, 95% CI 0.34, 0.91), with largest effect sizes for the early neonatal period (OR 0.18, 95% CI 0.04–0.79). Conclusions Community based health delivery platforms may be a highly effective way to reduce neonatal mortality in urban areas of low and middle income countries, even when access to general health services is almost universal. Brazil is currently transitioning from a health-center-based to a community-based model We find large neonatal mortality reductions in areas with the community based model. Community based programs may be effective even in areas with easy healthcare access.
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Affiliation(s)
- Alexandra Brentani
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Mauro T Taniguchi
- CEINFO Secretaria Municipal de Saúde, Prefeitura de São Paulo, São Paulo, SP, Brazil
| | - Ana Paula Scoleze Ferrer
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Günther Fink
- Department of International Health Economics, Harvard School of Public Health, Cambridge, MA, USA
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Vettore MV, Dias M, Vettore MV, Leal MDC. Avaliação da qualidade da atenção pré-natal dentre gestantes com e sem história de prematuridade no Sistema Único de Saúde no Rio de Janeiro, Brasil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2013. [DOI: 10.1590/s1519-38292013000200002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: avaliar adequação, acompanhamento pré-natal, satisfação e riscos gestacionais das gestantes com história de prematuridade. MÉTODOS: estudo seccional com 1239 gestantes, 259 com história de prematuridade no Sistema Único de Saúde (SUS) do RJ em 2007/2008. Informações demográficas, socio-econômicas, história obstétrica, adequação pré-natal e satisfação foram coletadas através de entrevistas e do cartão pré-natal. Utilizou-se teste χ² para comparar o grupo com história de prematuridade com os grupos de baixo risco e sem história de prematuridade. RESULTADOS: não houve diferenças na adequação e no cuidado pré-natal entre as gestantes com história de prematuridade comparadas às de baixo risco gestacional. Houve insatisfação com tempo de espera pelas consultas, horário de funcionamento das unidades de saúde e explicações dos profissionais de saúde. CONCLUSÕES: a presença de história de prematuridade não influenciou para que essas gestantes tivessem um pré-natal de melhor qualidade. As unidades de saúde apresentaram problemas, segundo a percepção das gestantes, em relação ao modo de funcionamento. As explicações dos profissionais de saúde sobre risco da prematuridade não atenderam às expectativas das gestantes.
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Common variants of the mineralocorticoid and glucocorticoid receptor genes may contribute to pregnancy-related anxiety: a pilot study. Open Med (Wars) 2013. [DOI: 10.2478/s11536-012-0101-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe hypothalamic-pituitary-adrenal (HPA) axis overactivity is thought to contribute to increased vulnerability to maternal stress. We hypothesize that functionally relevant polymorphic variants of the glucocorticoid (NR3C1) and mineralocorticoid (NR3C2) receptor genes mediating biological effects of cortisol, a major stress hormone, could also modulate the capacity to cope with pregnancy-related anxiety. Genomic DNA from the blood of 42 women with pregnancy-related anxiety and 42 age-matched women with normal pregnancy (5–6th months of gestation) were genotyped for markers rs6195 and rs10482605 of NR3C1 and two NR3C2 polymorphisms (rs5522 and rs2070951) using a Taqman allele discrimination assay. Serum total cortisol was measured using an ELISA technique. The allele Ser363 of rs6195 (the N363S polymorphism of NR3C1) was found to be associated with a higher risk of maternal stress (odds ratio (OR)=5.27; P=0.001). For NR3C2, the allele Val180 of rs5522 (I180V) also showed association with increased risk of neonatal stress (OR=1.97; P=0.038). Both predisposing gene variants were also associated with significantly elevated levels of cortisol in normally pregnant women and females with pregnancy-related anxiety. Our results suggest that pregnancy-related anxiety can be modulated by variants of NR3C1 and NR3C2 associated with increased basal cortisol levels. Thus, our findings provide evidence in support of the suggestion that elevated cortisol levels and HPA axis hyperactivity are implicated in pregnancy-related anxiety.
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Dolatian M, Mirabzadeh A, Forouzan AS, Sajjadi H, Alavi Majd H, Moafi F. Preterm delivery and psycho-social determinants of health based on World Health Organization model in Iran: a narrative review. Glob J Health Sci 2012; 5:52-64. [PMID: 23283036 PMCID: PMC4777007 DOI: 10.5539/gjhs.v5n1p52] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 11/04/2012] [Accepted: 10/22/2012] [Indexed: 12/03/2022] Open
Abstract
Background: Preterm delivery is still the primary cause of mortality and morbidity in infants, which shows a problematic condition in the care of pregnant women all over the world. This review study describes prevalence and psycho - socio-demographic as well as obstetrical risk factors related to live preterm delivery (PTD) in the recent decade in Iran. Methods: A narrative review was performed in Persian and international databases including PubMed, SID, Google Scholar, Iran Medex, Magiran and Irandoc from 2001 to 2010 with following keywords: preterm delivery and pregnancy outcomes with (prevalence, socioeconomic condition, structural determinant, Intermediary determinants, Psychosocial factor, Behavioral factor and Maternal circumstance, Health system) All of article was reviewed then categorized based on WHO model. Results: Totally 52 article were reviewed and 35 articles were selected, of which 26 were cross-sectional or longitudinal, 9 were analytical (cohort or case-control). The prevalence rates of preterm delivery in different cities of Iran were reported between 5.6% in Quom to 39.4% in Kerman. The most common social factors in structural determinant were educational level of mother, and in intermediary determinants were Psychosocial factor (maternal anxiety and stress during pregnancy), Behavioral factor and Maternal circumstance (violation and trauma) and in Health system, lack of prenatal care. Conclusion: The prevalence rate of preterm delivery is a matter of concern. Since many psycho-social factors may affect on the condition and its high rate in poor communities might reveals a causal relationship among biological and psychosocial factors, performing etiological investigations is recommended.
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Affiliation(s)
- Mahrokh Dolatian
- Social Determinants of Health Research Center , University of Social Welfare and Rehabilitation Sciences, Tehran , Iran.
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Assunção PL, Novaes HMD, Alencar GP, Melo ASDO, Almeida MFD. Fatores associados ao nascimento pré-termo em Campina Grande, Paraíba, Brasil: um estudo caso-controle. CAD SAUDE PUBLICA 2012; 28:1078-90. [DOI: 10.1590/s0102-311x2012000600007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 03/27/2012] [Indexed: 11/22/2022] Open
Abstract
Estudo caso-controle (2008-2009) de base populacional que analisou fatores de risco para nascimento pré-termo em Campina Grande, Paraíba, Brasil. Foram incluídos 341 nascimentos pré-termo e 424 controles. Utilizou-se regressão logística múltipla. Foram fatores de risco: idade materna de 35 ou mais (OR = 2,00; IC95%: 1,00-4,03), pré-termo prévio (OR = 2,32; IC95%: 1,25-4,29), pré-natal inadequado (OR = 2,15; IC95%: 1,40-3,27), ganho ponderal materno insuficiente (OR = 2,33; IC95%: 1,45-3,75), dano físico materno (OR = 2,10; IC95%: 1,22-3,60), hipertensão arterial com eclampsia (OR = 17,08; IC95%: 3,67-79,43) e sem eclampsia (OR = 6,42; IC95%: 3,50-11,76), internação (OR = 5,64; IC95%: 3,47-9,15), alteração do volume amniótico (OR = 2,28; IC95%: 1,32-3,95); sangramento vaginal (OR = 1,54; IC95%: 1,01-2,34) e gestação múltipla (OR = 22,65; IC95%: 6,22-82,46). Elevada e homogênea prevalência de pobreza e baixa escolaridade pode ter contribuído para que as variáveis socioeconômicas não permanecessem com associação significativa para o nascimento pré-termo.
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da Fonseca CRB, Strufaldi MWL, de Carvalho LR, Puccini RF. Risk factors for low birth weight in Botucatu city, SP state, Brazil: a study conducted in the public health system from 2004 to 2008. BMC Res Notes 2012; 5:60. [PMID: 22270068 PMCID: PMC3285524 DOI: 10.1186/1756-0500-5-60] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/28/2011] [Accepted: 01/23/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Low birth weight (LBW), defined as birth weight less than 2500 g, has a complex etiology and may be a result of premature interruption of pregnancy or intrauterine growth restriction. The objective of this study was to provide information on determinants of LBW and contribute to the understanding of the problem in Brazil. METHODS A case-control study was conducted in Botucatu city, SP state, Brazil. The study population consisted of 2 groups with 860 newborns in each group as follows: low weight newborns (LWNB) and a control group (weight ≥ 2500 g). Secondary data from 2004 to 2008 were collected using the Live Birth Certificate (LBC) and records from medical charts of pregnant women in Basic Health Units (BHU) and in the Public University Hospital (UH). Variables were as follows: maternal socio-demographic characteristics, pregnancy and birth conditions including quality of prenatal care according to 3 criteria. They were based on parameters established by the Ministry of Health (MH), one of them, the modified Kessner Index. The multivariable analysis by logistic regression was used to evaluate the association between variables and LBW. RESULTS According to the analysis, the factors associated with LBW were as follows: prematurity (OR = 56.98, 95% CI 29.52-109.95), twin pregnancy (OR = 20.00, 95% CI 6.25-100.00), maternal smoking (OR = 2.12, 95% CI 1.33-3.45), maternal malnourishment (OR = 2.30, 95% CI 1.08-5.00), maternal obesity (OR = 2.30, 95% IC 1.18-4.48), weight gain during pregnancy less than 5 kg (OR = 2.63, 95% CI 1.35-5.00) and weight gain during pregnancy more than 15 kg (OR = 2.26, 95% CI 1.16-4.41). Adequacy of prenatal care visits adjusted to gestational age was less frequent in the LBW group than in the control group (68.7% vs. 80.5%, x2 p < 0.001). According to the modified Kessner Index, 64.4% of prenatal visits in the LWNB group were adequate. CONCLUSION LWNB are a quite heterogeneous group of infants concerning their determinants and prevention actions against LBW and the follow-up of these infants have also been very complex. Therefore, improvement in the quality of care provided should be given priority through concrete actions for prevention of LBW.
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Affiliation(s)
- Cátia Regina Branco da Fonseca
- Department of Pediatrics, Julio de Mesquita Filho São Paulo State University, Botucatu Medical School, Botucatu, SP, Brasil
| | | | - Lídia Raquel de Carvalho
- Department of Biostatistics, Julio de Mesquita Filho São Paulo State University, Institute of Biosciences, Botucatu, SP, Brasil
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de Almeida MF, Alencar GP, Schoeps D, Novaes HMD, Campbell O, Rodrigues LC. [Survival and risk factors for neonatal mortality in a cohort of very low birth weight infants in the southern region of São Paulo city, Brazil]. CAD SAUDE PUBLICA 2011; 27:1088-98. [PMID: 21710006 DOI: 10.1590/s0102-311x2011000600006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 04/18/2011] [Indexed: 11/22/2022] Open
Abstract
Population studies can help identify the complex set of risk factors for neonatal mortality among very low birth weight infants. A cohort (2000-2001) of 213 live newborns with birth weight < 1,500g in the southern region of São Paulo city, Brazil, was studied (112 neonatal deaths and 101 survivors). Data were obtained from home interviews and hospital records. Survival analysis and multiple Cox regression were performed. The high mortality in the delivery room and in the first day of life among neonates < 1,000g and < 28 weeks gestational age and the absence of survival in neonates < 700g suggest that care was actively oriented towards newborns with better prognosis. Increased risk of neonatal mortality was associated with maternal residence in slum areas, history of previous cesarean(s), history of induced abortion(s), adolescent motherhood, vaginal bleeding, and lack of prenatal care. Cesarean section and referral of the newborn to the hospital nursery showed protective effects. Birth weight less than 1,000g and Apgar index < 7 were associated with increased risk. The high mortality was due to poor living conditions and to maternal and neonatal characteristics. Improvement in prenatal and neonatal care could reduce neonatal mortality in these infants.
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