Adequação do pré-natal e peso ao nascer: uma revisão sistemática

Assessment of the completeness of filling the pregnant woman's card from the Ministry of Health: a national, cross-sectional study

This article aims to evaluate the completeness of the pregnant woman's card filling according to a model standardized by the Ministry of Health. Hospital based, nationwide, cross-sectional study conducted between 2011 and 2012, evaluated data from pregnant women's cards. Variables related to personal, obstetric history and current pregnancy data were used to assess completeness. We used the Kotelchuck index for quantitative evaluation. We analysed 6,577 cards, equivalent to 39% of the cards presented at the time of delivery. The mean completeness was overall "bad" in Brazil and macro-regions, except in the Southern region. Nationwide, the mean completion was "regular" for personal antecedents, "good" for obstetric history, and "bad" for fields related to the current pregnancy. Prenatal care was adequate for 58% of pregnant women. We observed a reduced use of the card recommended by the Ministry of Health and failures in the completeness of filling valuable information of the pregnant woman's card, related to the current pregnancy.

[Prenatal care and risk factors associated with premature birth and low birth weight in the a capital in the Brazilian Northeast]

The main determinants of the risk of mortality in the neonatal period are low birth weight and premature birth. The study sought to analyze the adequacy of prenatal care and risk factors associated with premature birth and low birth weight in a northeastern Brazilian capital. This is a case-control study. A model for adequacy of prenatal conditions composed of four indicators was created. Descriptive statistics for univariate analysis were used; as well as Wald linear trend tests, Student's t and chi-square test for bivariate analysis and multiple logistic regression for multivariate analysis with p <0.05. Multivariate analysis showed that poor education, not performing gainful activity, caesarean section, oligohydramnios, placental abruption and pre-eclampsia are independent factors associated with premature birth and/or low birth weight. For adequacy of prenatal care, variable indicator III remained significant, showing that mothers who had inadequate prenatal care had an increased chance for the occurrence of the outcome, highlighting the need for adequate public health policies of care for pregnant women in the municipality under scrutiny.

Nutrition knowledge assessment studies in adults: a systematic review

The objective of this study is to perform a systematic review of published studies that assessed nutrition knowledge in adults, focusing on the methodology and content of these studies. An article search was performed on the Medline, Lilacs, and SciELO databases. The search limits were human studies; English, Portuguese, and Spanish languages; and age (over 19). Inclusion criteria were: cross-sectional studies performed on individuals over 18 years old that assessed the general nutrition knowledge of participants. The methodological quality of the articles was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. The initial search identified 3,623 articles. After reading the titles and the abstracts and applying the exclusion criteria, 25 articles were selected. The results showed that, in most studies, nutrition knowledge was associated with socioeconomic parameters and eating behaviour. Most studies belonged to class B (92%), meeting 50-80% of the STROBE criteria. The studies have revealed a greater tendency to assess the relationship of nutrition knowledge with sociodemographic and economic parameters.

Family health strategy and equity in prenatal care: a population based cross-sectional study in Minas Gerais, Brazil

BACKGROUND

Prenatal care coverage is still not universal or adequately provided in many low and middle income countries. One of the main barriers regards the presence of socioeconomic inequalities in prenatal care utilization. In Brazil, prenatal care is supplied for the entire population at the community level as part of the Family Health Strategy (FHS), which is the main source of primary care provided by the public health system. Brazil has some of the greatest income inequalities in the world, and little research has been conducted to investigate prenatal care utilization of FHS across socioeconomic groups. This paper addresses this gap investigating the socioeconomic and regional differences in the utilization of prenatal care supplied by the FHS in the state of Minas Gerais, Brazil.

METHODS

Data comes from a probabilistic household survey carried out in 2012 representative of the population living in urban areas in the state of Minas Gerais. The sample size comprises 1,420 women aged between 13 and 45 years old who had completed a pregnancy with a live born in the last five years prior to the survey. The outcome variables are received prenatal care, number of antenatal visits, late prenatal care, antenatal tests, tetanus immunization and low birthweight. A descriptive analysis and logistic models were estimated for the outcome variables.

RESULTS

The coverage of prenatal care is almost universal in catchment urban areas of FHT of Minas Gerais state including both antenatal visits and diagnostic procedures. Due to this high level of coverage, socioeconomic inequalities were not observed. FHS supplied care for around 80% of the women without private insurance and 90% for women belonging to lower socioeconomic classes. Women belonging to lower socioeconomic classes were at least five times more likely to receive antenatal visits and any of the antenatal tests by the FHS compared to those belonging to the highest classes. Moreover, FHS was effective in reducing low birthweight. Women who had prenatal care through FHS were 40% less likely to have a child with low birthweight.

CONCLUSION

This paper presents strong evidence that FHS promotes equity in antenatal care in Minas Gerais, Brazil.

Factors associated with maternal near miss in childbirth and the postpartum period: findings from the birth in Brazil National Survey, 2011-2012

BACKGROUND

Maternal near-miss (MNM) audits are considered a useful approach to improving maternal healthcare. The aim of this study was to evaluate the factors associated with maternal near-miss cases in childbirth and the postpartum period in Brazil.

METHODS

The study is based on data from a nationwide hospital-based survey of 23,894 women conducted in 2011-2012. The data are from interviews with mothers during the postpartum period and from hospital medical files. Univariate and multivariable logistic regressions were performed to analyze factors associated with MNM, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals (95 % CI).

RESULTS

The estimated incidence of MNM was 10.2/1,000 live births (95 % CI: 7.5-13.7). In the adjusted analyses, MNM was associated with the absence of antenatal care (OR: 4.65; 95 % CI: 1.51-14.31), search for two or more services before admission to delivery care (OR: 4.49; 95 % CI: 2.12-9.52), obstetric complications (OR: 9.29; 95 % CI: 6.69-12.90), and type of birth: elective C-section (OR: 2.54; 95 % CI: 1.67-3.88) and forceps (OR: 9.37; 95 % CI: 4.01-21.91). Social and demographic maternal characteristics were not associated with MNM, although women who self-reported as white and women with higher schooling had better access to antenatal and maternity care services.

CONCLUSION

The high proportion of elective C-sections performed among women in better social and economic situations in Brazil is likely attenuating the benefits that could be realized from improved prenatal care and greater access to maternity services. Strategies for reducing the rate of MNM in Brazil should focus on: 1) increasing access to prenatal care and delivery care, particularly among women who are at greater social and economic risk and 2) reducing the rate of elective cesarean section, particularly among women who receive services at private maternity facilities, where C-section rates reach 90 % of births.

Linear growth of children attending public daycare centers in the municipality of Campina Grande, Paraíba, Brazil

OBJECTIVE

To identify variables predictors of linear growth in preschool children attending public child day care centers of Campina Grande, Paraíba.

METHODS

A cross-sectional study on a probabilistic sample of 335 children attending child day care centers. Were obtained information about socioeconomic, maternal and children's characteristics. The height/age (Z-score) was analyzed as continuous dependent variable. Anthropometric data were obtained in compliance with the recommendations of the World Health Organization. The Multicentre Growth Reference Study was used as the reference population. The data were subjected to multiple linear regression analysis using the hierarchical model.

RESULTS

Children who slept in rooms with at least two people, households without garbage collection, households with no refrigerator, rural zone, illiterate mothers, mothers of short stature, low birth weight and stay in child day care center at part time were the conditions associated with worse height/age of children.

CONCLUSION

There is a clear difference in linear growth with multicausal characteristic in which the low birth weight, as an expression of adverse history, and the socioeconomic conditions, as an expression of health inequities, profiling the genetic potential of growth.

[Telephone monitoring service for pregnant women and impact on prevalence of prematurity and associated risk factors in Piracicaba, São Paulo State, Brazil]

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.

Association between prenatal care and small for gestational age birth: an ecological study in Quebec, Canada

BACKGROUND

In Quebec, women living on low income receive a number of additional prenatal care visits, determined by their area of residence, of both multi-component and food supplementation programs. We investigated whether increasing the number of visits reduces the odds of the main outcome of small for gestational age (SGA) birth (weight < 10th percentile on the Canadian scale).

METHODS

In this ecological study, births were identified from Quebec's registry of demographic events between 2006 and 2008 (n = 156 404; 134 areas). Individual characteristics were extracted from the registry, and portraits of the general population were deduced from data on multi-component and food supplement interventions, the Canadian census and the Canadian Community Health Survey. Mothers without a high school diploma were eligible for the programs. Multilevel logistic regression models were fitted using generalized estimating equations to account for the correlation between individuals on the same territory. Potential confounders included sedentary behaviour and cigarette smoking. The odds ratios (ORs) were adjusted for mother's age, marital status, parity, program coverage and mean income in the area.

RESULTS

Mothers eligible for the programs remain at a higher odds of SGA than non-eligible mothers (OR = 1.40; 95% confidence interval [CI]: 1.30-1.51). Further, areas that provide more visits to eligible mothers (4-6 food supplementation visits) seem more successful at reducing the frequency of SGA birth than those that provide 1-2 or 3 visits (OR = 0.86; 95% CI: 0.75-0.99).

CONCLUSION

Further studies that validate whether an increase in the number of prenatal care interventions reduces the odds of SGA birth in different populations and evaluate other potential benefits for the children should be done.

Spatial distribution of low birthweight infants in Taubaté, São Paulo, Brazil

OBJECTIVE

To identify the spatial pattern of low birth weight infants in the city of Taubaté, São Paulo, Southeast Brazil.

METHODS

Ecological and exploratory study, developed with the data acquired from the Health Department of Taubaté, regarding the period from January 1(st) 2006 and December 31(st) 2010. Birth certificates were used to obtain the data from infants weighing less than 2500g. A digital basis of census tracts was applied and the Global Moran index ((IM)) was estimated. Thematic maps were built for the distribution of low birth weight, health centers and tracts, according to the priority care (Moran map). The adopted statistical significance was α=5% and TerraView software conducted the spatial analysis.

RESULTS

There were 18,915 live births during the study period, with 1,817 low birth weight infants (9.6%). The low birth weight infants' prevalence during the period ranged from 9.3 to 9.8%. A total of 1,185 infants with known addresses, compatible with the digital base (65.2% of low birth weight infants), were included. The I(M) for low birth weight was 0.12, with p<0.01; regarding the health centers distribution, I(M) was -0.07, with p=0.01. The Moran map identified 11 census tracts with high priority for intervention by health managers, located in the outskirts of the city.

CONCLUSIONS

The spatial analysis identified the low birth weight distribution by census tracts and the sectors with a high priority for intervention.

Evaluation of prenatal care in unit with family health strategy

We analyzed prenatal care (PN) provided at a unit of the Family Health Strategy Service in São Paulo, according to the indicators of the Program for the Humanization of Prenatal and Birth (PHPB). We compared adequacy of PN in terms of sociodemographic variables, procedures, examinations and maternal and perinatal outcomes. Cross-sectional study with data from records of 308 pregnant women enrolled in 2011. We observed early initiation of PN (82.1%), conducting of a minimum of six consultations (84.1%), puerperal consultation (89.0%); to the extent that there is a sum of the actions, there is a significant drop in the proportion of adequacy. Prenatal care was adequate for 67.9%, with a significant difference between adequacy groups in relation to gestational age and birth weight. Prenatal care deficiencies exist, especially in regards to registration of procedures, exams and immunization. The difference between adequacy groups with respect to perinatal outcomes reinforces the importance of prenatal care that adheres to the parameters of the PHPB.


Adequacy of antenatal care and its relationship with low birth weight in Botucatu, São Paulo, Brazil: a case-control study

BACKGROUND

Birth weight reflects gestational conditions and development during the fetal period. Low birth weight (LBW) may be associated with antenatal care (ANC) adequacy and quality. The purpose of this study was to analyze ANC adequacy and its relationship with LBW in the Unified Health System in Brazil.

METHODS

A case-control study was conducted in Botucatu, São Paulo, Brazil, 2004 to 2008. Data were collected from secondary sources (the Live Birth Certificate), and primary sources (the official medical records of pregnant women). The study population consisted of two groups, each with 860 newborns. The case group comprised newborns weighing less than 2,500 grams, while the control group comprised live newborns weighing greater than or equal to 2,500 grams. Adequacy of ANC was evaluated according to three measurements: 1. Adequacy of the number of ANC visits adjusted to gestational age; 2. Modified Kessner Index; and 3. Adequacy of ANC laboratory studies and exams summary measure according to parameters defined by the Ministry of Health in the Program for Prenatal and Birth Care Humanization.

RESULTS

Analyses revealed that LBW was associated with the number of ANC visits adjusted to gestational age (OR = 1.78, 95% CI 1.32-2.34) and the ANC laboratory studies and exams summary measure (OR = 4.13, 95% CI 1.36-12.51). According to the modified Kessner Index, 64.4% of antenatal visits in the LBW group were adequate, with no differences between groups.

CONCLUSIONS

Our data corroborate the association between inadequate number of ANC visits, laboratory studies and exams, and increased risk of LBW newborns. No association was found between the modified Kessner Index as a measure of adequacy of ANC and LBW. This finding reveals the low indices of coverage for basic actions already well regulated in the Health System in Brazil. Despite the association found in the study, we cannot conclude that LBW would be prevented only by an adequate ANC, as LBW is associated with factors of complex and multifactorial etiology. The results could be used to plan monitoring measures and evaluate programs of health care assistance during pregnancy, at delivery and to newborns, focusing on reduced LBW rates.

[Evidence-based practices published in Brazil: identification and analysis studies about human health prevention]

Integrative review of Brazilian studies about evidence-based practices (EBP) about prevention in human health, published in Web of Science/JCR journals, between October 2010 and April 2011. The aim was to identify the specialties that most accomplished these studies, their foci and methodological approaches. Based on inclusion criteria, 84 studies were selected, mainly published in public health journals, focusing on primary care and also addressing clinical issues and different specialties. Prevention foci and methodological approaches also varied, with a predominance of systematic reviews without meta-analysis. The results indicate that there is no single way to conceptualize and practice EBP in the field of prevention, and that its application may not only serve to obtain indisputable evidence to equip intervention actions. This endless knowledge area is under construction, with a view to the analysis and further understanding of health phenomena.

Avaliação da adequação da assistência pré-natal na rede SUS do Município do Rio de Janeiro, Brasil

A persistência de desfechos perinatais negativos no Município do Rio de Janeiro, Brasil, sugere problemas na qualidade da assistência pré-natal. A última investigação realizada nessa cidade mostrou adequação de apenas 38% dessa assistência. O objetivo deste estudo é avaliar a adequação da assistência pré-natal na rede do SUS do Município do Rio de Janeiro. Foi realizado um estudo transversal, em 2007-2008, por meio de entrevistas com 2.422 gestantes em atendimento nos serviços de pré-natal de baixo risco. Para avaliação da adequação da assistência, foi utilizado o índice PHPN, com as recomendações do Programa de Humanização do Pré-natal e Nascimento, do Ministério da Saúde, e um índice PHPN ampliado, em que foram acrescentados procedimentos clinico-obstétricos, prescrição de sulfato ferroso suplementar e ações educativas. Foi encontrada adequação de 38,5% para o PHPN e 33,3% para o PHPN ampliado. Estratégias de ampliação da captação precoce das gestantes e melhor utilização dos contatos com os serviços para a realização de ações de atenção à saúde são prioritárias para a reversão desse quadro.

[Differences in prenatal care between health services under the Family Health Strategy and traditional primary care clinics in Rio Grande, Rio Grande do Sul State, Brazil]

This study aimed to evaluate differences in prenatal care between services under the Family Health Strategy (FHS) and traditional public primary care clinics in Rio Grande, Rio Grande do Sul State, Brazil. A cross-sectional study was performed with all women who gave birth from January 1st to December 31st, 2007, and who received prenatal care in the municipal health system. The procedures recommended by the Ministry of Health were compared according to model of care. Among the 961 pregnant women, those treated under the FHS received a higher percentage of some forms of care (use of ferrous sulfate, tetanus vaccination, and HIV and syphilis tests). Other procedures were also more frequent under the FHS, but failed to reach the recommended levels (breast examination and Pap smear). Measurement of blood pressure, uterine height, and weight were quite frequent in both groups. Identification of pregnant women in the first trimester failed to reach 70%. Women under the FHS received better care, but some procedures still fell short of expected levels, and efforts are thus needed to improve the quality of prenatal care.

Sisprenatal como instrumento de avaliação da qualidade da assistência à gestante

OBJETIVO: Avaliar a cobertura do Programa de Humanização do Pré-natal e Nascimento segundo o cumprimento dos seus requisitos mínimos e indicadores de processo, comparando as informações do cartão da gestante com os do Susprenatal. MÉTODOS: Estudo transversal com dados do pré-natal de 1.489 puérperas internadas para parto pelo Sistema Único de Saúde entre novembro de 2008 e outubro de 2009 no município de São Carlos, SP. Os dados foram coletados no cartão da gestante e depois no Sistema de Acompanhamento do Programa de Humanização no Pré-Natal e Nascimento (Sisprenatal). As informações das duas fontes foram comparadas utilizando o teste de Χ² de McNemar para amostras relacionadas. RESULTADOS: A cobertura de pré-natal em relação ao número de nascidos vivos foi de 97,1% de acordo com o cartão de pré-natal e de 92,8% segundo o Sisprenatal. Houve diferença significativa entre as fontes de informação para todos os requisitos mínimos do Programa de Humanização do Pré-natal e Nascimento, e também na comparação dos indicadores de processo. Com exceção da primeira consulta de pré-natal, o cartão de pré-natal sempre apresentou registro de informações superior ao do Sisprenatal. A proporção de mulheres com seis ou mais consultas de pré-natal e com todos os exames básicos foi de 72,5% pelo cartão de pré-natal e de 39,4% pelo sistema oficial. Essas diferenças mantiveram-se para as cinco áreas regionais de saúde do município. CONCLUSÕES: O Sisprenatal não foi uma fonte segura para avaliação da informação disponível sobre acompanhamento na gestação. Houve grande adesão ao Programa de Humanização do Pré-natal e Nascimento, mas a documentação da informação foi insuficiente quanto a todos os requisitos mínimos e indicadores de processo. Após dez anos da criação do programa, cabe agora aos municípios adequar a qualidade da assistência e capacitar seus profissionais para a correta documentação de informação em saúde.

Desenvolvimento neuropsicomotor: o teste de Denver na triagem dos atrasos cognitivos e neuromotores de pré-escolares

O objetivo deste estudo foi verificar a prevalência e fatores associados no que se refere ao desempenho anormal do desenvolvimento neuropsicomotor de crianças matriculadas na educação infantil pública em Feira de Santana, Bahia, Brasil, em 2009 (n = 438). Esta é uma pesquisa epidemiológica de corte transversal, com amostragem por conglomerado e sorteio das escolas e crianças. Foram verificados os fatores associados por meio de aplicação de questionário às mães e de teste Denver II ao filho. A análise estatística realizou o teste χ2 com intervalo de 95% de confiança e α = 5%. A prevalência de desempenho anormal do desenvolvimento foi 46,3%. Na análise de regressão logística, as variáveis estatisticamente significantes associadas foram: sexo masculino (RP = 1,43; p = 0,00), cinco anos de idade (RP = 1,42; p = 0,00), não realização de pré-natal (RP = 1,41; p = 0,00), início do pré-natal > 3 meses (RP = 1,25; p = 0,00) e consumo alcoólico na gestação (RP = 1,55; p = 0,00). A prevalência foi elevada, apontando a necessidade de pré-natal precoce, alertando sobre o consumo alcoólico, e de vigilância nos primeiros anos de vida, visando a prevenir ou tratar precocemente as alterações.

[Evidence-based practices published in Brazil: identification and analysis of their types and methodological approches]

This is an integrative review of Brazilian studies on evidence-based practices (EBP) in health, published in ISI/JCR journals in the last 10 years. The aim was to identify the specialty areas that most accomplished these studies, their foci and methodological approaches. Based on inclusion criteria, 144 studies were selected. The results indicate that most EBP studies addressed childhood and adolescence, infectious diseases, psychiatrics/mental health and surgery. The predominant foci were prevention, treatment/rehabilitation, diagnosis and assessment. The most used methods were systematic review with or without meta-analysis, protocol review or synthesis of available evidence studies, and integrative review. A strong multiprofessional expansion of EBP is found in Brazil, contributing to the search for more selective practices by collecting, recognizing and critically analyzing the produced knowledge. The study also contributes to the analysis itself of ways to do research and new research possibilities.

Caracterização da cobertura do pré-natal no Estado do Maranhão, Brasil

O objetivo do estudo foi caracterizar a cobertura do pré-natal no Estado do Maranhão. Um estudo de base populacional em 30 municípios do Maranhão, com 2.075 mulheres em idade fértil, com gravidez prévia, de julho de 2008 a janeiro de 2009. Os resultados mostraram que as unidades de saúde da família foram responsáveis por 45,9% dos atendimentos de gestantes sendo que 46,8% relataram a realização de seis consultas ou mais de pré-natal durante a última gravidez e 64,6% iniciaram o pré-natal ainda no 1º trimestre. A cobertura do pré-natal foi de 85,6%, no entanto, ao se considerar a cobertura de pré-natal adequado, este foi de 43,4%, de acordo com o preconizado pelo Ministério da Saúde (Brasil). Apesar de uma cobertura de pré-natal acima de 80%, menos da metade é considerada adequada, demonstrando um descompasso na atenção primária com qualidade.

Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

BACKGROUND

The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil.

METHODS

A survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression.

RESULTS

Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use.

CONCLUSION

Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

Atenção pré-natal na cidade de Pelotas, Rio Grande do Sul, Brasil

OBJETIVOS: identificar as características da assistência pré-natal na da cidade de Pelotas, Rio Grande do Sul, Brasil. MÉTODOS: estudo transversal aninhado a uma coorte de 2741 mães, entrevistadas nas maternidades da cidade, no período de setembro de 2002 a maio de 2003. As pacientes incluídas responderam a um questionário padronizado que obteve dados referentes a fatores demográficos e socioeconômicos e características do pré-natal. O desfecho analisado foi pré-natal adequado ou inadequado conforme o número de consultas, sendo definido como adequado, a realização de seis ou mais consultas. RESULTADOS: observou-se que 77% das gestantes fizeram seis ou mais consultas de pré-natal, porém, existem falhas no cumprimento e no manejo das normas de assistência pré-natal, como tratamento de problemas ginecológicos e orientações educativas. O risco de não realizar um pré-natal adequado foi maior para as gestantes de cor negra ou parda (RO=1,7), com menor escolaridade (RO=3,3) e menor renda (RO=3,0); assim como para as gestantes sem companheiro (RO=2,0) e fumantes (RO=1,5). CONCLUSÕES: os resultados condizem com os achados na literatura, na qual existe uma inversão de cuidados. As pacientes com piores condições econômicas e pouca escolaridade apresentam um maior risco para a realização de um pré-natal inadequado e suas conseqüências.

Avaliação nutricional antropométrica de gestantes brasileiras: uma revisão sistemática

Trata-se de uma revisão sistemática objetivando a identificação de métodos de avaliação nutricional de gestantes adotados no Brasil e sua associação com desfechos obstétricos. A busca bibliográfica foi feita nas bases Medline, Lilacs e Scielo, no período de 1980 a 2006. Os descritores utilizados em combinação foram pregnant, pregnancy nutritional assessment, anthropometric state, weight gain. Foram identificados 26 estudos, sendo o método proposto por Rosso (1985) o mais adotado. Alguns autores usaram apenas a avaliação do estado nutricional pré-gestacional com base no método proposto pelo Institute of Medicine (1990) ou a avaliação do ganho de peso gestacional segundo a Organização Mundial da Saúde (1995). Os resultados indicam a inexistência de metodologia apropriada para avaliação nutricional de gestantes brasileiras, o que pode estar contribuindo para a desvalorização desse procedimento nos serviços de assistência pré-natal. A maior parte dos estudos considerou o peso ao nascer como o principal desfecho do peso gestacional na validação dos métodos de classificação antropométrica. Os resultados encontrados no estudo demonstram a escassez de informações, em quantidade e qualidade, que possam contribuir para analisar a efetividade dos métodos de avaliação nutricional antropométrica para as gestantes brasileiras. O desenvolvimento de estudos com rigor metodológico neste campo é premente, e deverá contemplar as diferenças etárias e os fatores biológicos, socioeconômicos e ambientais das gestantes.

Determinantes do baixo peso ao nascer a partir das Declarações de Nascidos Vivos

Este estudo teve como objetivos conhecer a distribuição do peso de nascimento das crianças de Campinas (SP) e indicar fatores de risco para baixo peso. Realizou-se estudo transversal no qual foram utilizados dados das 14.444 Declarações de Nascidos Vivos de 2001. A variável dependente foi o peso de nascimento, e as independentes as características maternas, gestacionais, do parto e do recém-nascido. Na avaliação da associação entre variáveis empregou-se teste de qui-quadrado e calculou-se valores de odds ratio brutos (OR) e ajustados (ORaj). A média do peso de nascimento foi 3.142g, variando de 285 a 5.890g; 65,1% das crianças pesaram 3.000g ou mais, 25,7% entre 2.500 e 2.999g e 9,1% menos de 2.500g. Os determinantes para baixo peso em prematuros foram cesariana, gemelaridade, recém-nascidos femininos e os de mulheres com menos de sete consultas de pré-natal. Para crianças a termo os riscos foram gestação dupla, tripla ou mais, filhos de mulheres com mais de 34 anos, das com até sete anos de estudo, com oito a onze e das com menos de sete consultas de pré-natal. A distribuição de peso de nascimento em Campinas foi inadequada e a proporção de baixo peso foi mais que o dobro dos países desenvolvidos. Os recém-nascidos prematuros que nasceram por cesariana, os prematuros e os a termo de gestação múltipla, os femininos, os de mulheres com pré-natal inadequado e os a termo daquelas com maior idade e baixa escolaridade apresentaram maior chance de nascer com baixo peso.

Adequação da assistência pré-natal em gestantes atendidas em dois hospitais de referência para gravidez de alto risco do Sistema Único de Saúde, na cidade de Recife, Estado de Pernambuco

OBJETIVOS: investigar a adequação da assistência pré-natal realizada por gestantes usuárias do Sistema Único de Saúde (SUS) da cidade do Recife, Pernambuco. MÉTODOS: estudo de corte transversal de 612 mulheres atendidas por ocasião do parto em duas unidades do SUS, referências para gravidez de alto risco no Recife, no período de junho a outubro de 2004. A avaliação do Pré-Natal foi baseada nos critérios do Programa de Humanização do Pré-Natal e Nascimento do Ministério da Saúde. RESULTADOS: a cobertura de pré-natal foi de 96,1%, sendo a média de consultas de 5,3. Apenas 38,0% das mulheres iniciaram o pré-natal até o quarto mês de gestação e realizaram seis ou mais consultas. Dentre as entrevistadas, 31% tiveram peso, pressão arterial, altura uterina e os batimentos cardiofetais aferidos em todas as consultas. A atenção pré-natal foi considerada adequada em 17,8% e não-adequada em 82,2% dos casos. CONCLUSÕES: A assistência pré-natal disponível para as gestantes na cidade do Recife, apesar de apresentar elevada cobertura, deve ser revista do ponto de vista qualitativo.

Associação entre peso ao nascer e o excesso de peso na infância: revisão sistemática

O peso ao nascer tem sido associado à obesidade/sobrepeso na infância. Contudo, os resultados são controversos. O objetivo desta revisão sistemática é identificar pontos concordantes e contraditórios sobre a associação entre o peso ao nascer e o excesso de peso em crianças de até sete anos de idade. Os primeiros oito artigos foram selecionados de uma revisão anterior que avaliou a associação entre fatores de risco e obesidade infantil. A busca na biblioteca PubMed, no período de 1993 a dezembro de 2004, com as palavras-chaves "birth weight AND childhood", "obesity" e "overweight", permitiu identificar outros artigos que enfocavam a associação entre o peso ao nascer e a obesidade infantil. Um total de 20 artigos preencheu os critérios para esta revisão. Apesar da heterogeneidade dos estudos, foi possível identificar associação predominantemente positiva entre o peso ao nascer e algum tipo de obesidade na infância. Por outro lado, a inconsistência de alguns aspectos relacionados ao peso ao nascer e à obesidade infantil sugere uma abordagem que incorpore o efeito do contexto no quadro de componentes associados à obesidade infantil.

Perfil das gestantes cadastradas nas equipes de saúde da família da 13ª Coordenadoria Regional de Saúde do Estado do Rio Grande do Sul

Esta pesquisa objetiva descrever o perfil das gestantes na 13ª Coordenadoria Regional de Saúde (2003) nas dimensões do acompanhamento de pré-natal, imunizações e gestantes com menos de 20 anos. O estudo é do tipo descritivo-exploratório. Dentre as mulheres grávidas menores de 20 anos, destacam-se as dos municípios de Candelária (53,3%), Herveiras (50,0%), Venâncio Aires (30%) e Santa Cruz do Sul (28,9%). Quanto ao percentual de realização de imunizações, exceto Santa Cruz do Sul (74,7%) e Venâncio Aires (72,5%), os outros foram superiores a 85%. Santa Cruz do Sul e Venâncio Aires também apresentaram os mais baixos percentuais para pré-natal. Na realização de pré-natal no 1º trimestre, exceto Mato Leitão e Herveiras (94,1% e 94,6%, respectivamente), o restante dos municípios apresentaram percentuais abaixo de 77%. Estes dados sugerem ações mais eficazes no campo da saúde preventiva, o que poderia atenuar os níveis elevados de gestantes menores de 20 anos nesta região.