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Souza RT, Brasileiro M, Ong M, Delaney L, Vieira MC, Dias MAB, Pasupathy D, Cecatti JG. Investigation of stillbirths in Brazil: A systematic scoping review of the causes and related reporting processes in the past decade. Int J Gynaecol Obstet 2022; 161:711-725. [PMID: 36373189 DOI: 10.1002/ijgo.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recognizing the causes of stillbirths and their associated conditions is essential to reduce its occurrence. OBJECTIVE To describe information on stillbirths in Brazil during the past decade. SEARCH STRATEGY A literature search was performed from January 2010 to December 2020. SELECTION CRITERIA Original observational studies and clinical trials. DATA COLLECTION AND ANALYSIS Data were manually extracted to a spreadsheet and descriptive analysis was performed. RESULTS A total of 55 studies were included; 40 studies (72.2%) used the official data stored by national public health systems. Most articles aimed to estimate the rate and trends of stillbirth (60%) or their causes (55.4%). Among the 16 articles addressing the causes of death, 10 (62.5%) used the International Classification of Diseases; most of the articles only specified the main cause of death. Intrauterine hypoxia was the main cause reported (ranging from 14.3% to 54.9%). CONCLUSION Having a national system based on compulsory notification of stillbirths may not be sufficient to provide quality information on occurrence and, especially, causes of death. Further improvements of the attribution and registration of causes of deaths and the implementation of educational actions for improving reporting systems are advisable. Finally, expanding the investigation of contributing factors associated with stillbirths would create an opportunity for further development of prevention strategies in low- and middle-income countries such as Brazil.
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Affiliation(s)
- Renato T Souza
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
| | - Mariana Brasileiro
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
| | - Melissa Ong
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Louisa Delaney
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Matias C Vieira
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Marcos A B Dias
- Fernandes Figueira Institute, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK.,Westmead Reproduction and Perinatal Medicine Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - José G Cecatti
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
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Pastor-Moreno G, Ruiz-Pérez I, Henares-Montiel J, Petrova D. Intimate partner violence during pregnancy and risk of fetal and neonatal death: a meta-analysis with socioeconomic context indicators. Am J Obstet Gynecol 2020; 222:123-133.e5. [PMID: 31394067 DOI: 10.1016/j.ajog.2019.07.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of the study was to summarize the results from observational studies examining the risk of fetal and neonatal death (perinatal death) as a function of the experience of intimate partner violence during pregnancy and examine the influence of socioeconomic context indicators on this association. DATA SOURCES Bibliographic searches were conducted in PubMed, EMBASE, CINAHL, and LILACS until March 2019. STUDY ELIGIBILITY CRITERIA We considered observational studies that provided data on the association between intimate partner violence during pregnancy and perinatal death. STUDY APPRAISAL AND SYNTHESIS METHODS Information collected included study characteristics, type, and prevalence of intimate partner violence and the reported association between intimate partner violence and perinatal death. Quality of the included studies was assessed using the Newcastle-Ottawa scale. Two reviewers independently conducted all review procedures; disagreements were resolved by a third reviewer. Meta-analyses were conducted based on the specific type of intimate partner violence (physical, psychological, sexual, unspecified) and also based on any type of intimate partner violence, considering 1 effect size per study, regardless of the type of intimate partner violence analyzed. Meta-regression analyses were performed to assess the possible effects of socioeconomic context. The proportion of deaths attributable to the exposure of intimate partner violence based on the crude data from the 3 cohort studies available also was calculated. RESULTS Seventeen studies were included. The random-effects model showed a statistically significant increase in the odds of perinatal death among women exposed to unspecified intimate partner violence (odds ratio, 3.18; 95% confidence interval, 1.88-5.38), physical intimate partner violence (odds ratio, 2.46; 95% confidence interval, 1.76-3.44), and any type of intimate partner violence during pregnancy (odds ratio, 2.89; 95% confidence interval, 2.03-4.10). Meta-regression analysis showed stronger associations in countries with higher gross domestic product (odds ratio, 1.03; 95% confidence interval, 1.02-1.04) and a higher percentage of health expenditure (odds ratio, 1.27; 95% confidence interval, 1.09-1.46). The proportion of deaths attributable to exposure to intimate partner violence in cohort studies was attributable proportion, 60%; 95% confidence interval, 15-81%. CONCLUSION Pregnant women who experience intimate partner violence during pregnancy may be about 3 times more likely to suffer perinatal death compared with women who do not experience intimate partner violence. It should be a priority to include intimate partner violence screenings or other detection strategies in pregnancy monitoring or family-planning programs because these could help avoid preventable perinatal deaths.
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Affiliation(s)
- Guadalupe Pastor-Moreno
- Biomedical Research Center in Network of Epidemiology and Public Health (CIBERESP), Madrid; Andalusian School of Public Health, Granada
| | - Isabel Ruiz-Pérez
- Biomedical Research Center in Network of Epidemiology and Public Health (CIBERESP), Madrid; Andalusian School of Public Health, Granada.
| | | | - Dafina Petrova
- Biomedical Research Center in Network of Epidemiology and Public Health (CIBERESP), Madrid; Andalusian School of Public Health, Granada; Instituto de Investigación Biosanitaria ibs.Granada, Granada
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Barros PDS, Aquino ÉCD, Souza MRD. Fetal mortality and the challenges for women's health care in Brazil. Rev Saude Publica 2019; 53:12. [PMID: 30726493 PMCID: PMC6390672 DOI: 10.11606/s1518-8787.2019053000714] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE: To establish a historical series of fetal mortality in Brazil and regions between 1996 and 2015, identifying its behavior and trend. METHODS: A descriptive study on cases of fetal deaths in Brazil and in each region reported from 1996 to 2015, registered in DATASUS and classified by ICD-10. Maternal age and schooling, duration of gestation and type of delivery were considered. We calculated the fetal mortality rate between 1996 and 2015 to build historical series. RESULTS: The time series shows a steady chart of the fetal mortality rate (FMR) from 2000 in Brazil and in all regions. The country's fetal mortality rate rose from 8.19 in 1996 to 9.50 per 1,000 births in 2015. There was an increasing trend in fetal deaths whose root cause appears in chapter XVII of ICD-10 in Brazil and in all regions. Deaths from Chapter XVI causes showed a trend of increase only in the Northeast region, while other basic causes showed a trend of increase in the Southeast and South regions. In the Brazilian scope, there was an increasing trend of fetal deaths in mothers in the 10-14 and 25-44 years age groups. In Brazil and in all regions, there was an increase of the FMR in women with more than 8 years of schooling. Fetal deaths predominated between 28 and 36 weeks of gestation, with a growing trend in Brazil and all regions, except in the South (steady). Vaginal delivery prevailed, with a steady trend, while cesarean sections showed an increasing trend in Brazil and in all regions. CONCLUSIONS: The quality of information about fetal deaths, investments in research committees, and improvement in the quality of prenatal care should be prioritized to enable more effective coping and to reduce the fetal mortality rate in Brazil.
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Affiliation(s)
- Patrícia de Sá Barros
- Universidade Federal de Goiás, Regional Jataí. Unidade Acadêmica Especial Ciências da Saúde. Curso de Fisioterapia. Jataí, GO, Brasil
| | - Érika Carvalho de Aquino
- Universidade Federal de Goiás. Instituto de Patologia Tropical e Saúde Pública. Programa de Pós-Graduação em Medicina Tropical e Saúde Pública. Goiânia, GO, Brasil
| | - Marta Rovery de Souza
- Universidade Federal de Goiás. Instituto de Patologia Tropical e Saúde Pública. Departamento de Saúde Coletiva. Goiânia, GO, Brasil
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Carvalho TS, Pellanda LC, Doyle P. Stillbirth prevalence in Brazil: an exploration of regional differences. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Carvalho TS, Pellanda LC, Doyle P. Stillbirth prevalence in Brazil: an exploration of regional differences. J Pediatr (Rio J) 2018; 94:200-206. [PMID: 28802822 DOI: 10.1016/j.jped.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/17/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Brazil is a large, heterogeneous, and diverse country, marked by social, economic, and regional inequalities. Stillbirth is a global concern, especially in low- and middle-income countries. This study investigated the prevalence and possible determinants of stillbirth in different regions of Brazil. METHODS This is a cross-sectional study including all women of reproductive age who had had a pregnancy in the last five years, enrolled in the most recent Brazilian Demographic and Health Survey (DHS/PNDS-2006/07). Logistic regression was used to assess the association between region and other maternal characteristics and stillbirth risk. RESULTS The prevalence of stillbirth in Brazil was 14.82 per 1000 births, with great variation by region of the country, and a higher prevalence among the most deprived. The North and Northeast regions had the highest odds of stillbirth compared to the Center-West, which persisted after adjustment for multiple confounders - including deprivation level and ethnicity. Low maternal age and maternal obesity were also related to higher odds of stillbirth. CONCLUSION In Brazil, the region influences stillbirth risk, with much higher risk in the North and Northeast. Variation in socioeconomic level does not explain this finding. Further research on the subject should explore other possible explanations, such as antenatal care and type of delivery, as well as the role of the private and public health systems in determining stillbirth. Preventive strategies should be directed to these historically disadvantaged regions, such as guaranteeing access and quality of care during pregnancy and around the time of birth.
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Affiliation(s)
- Taiana Silva Carvalho
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
| | | | - Pat Doyle
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lima JC, Oliveira Júnior GJD, Takano OA. Factors associated to fetal death in Cuiabá, Mato Grosso. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2016. [DOI: 10.1590/1806-93042016000300008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to investigate the causes and the factors associated to fetal death in Cuiaba, Mato Grosso, 2006-2010. Methods: a population based case-control study in a ratio of 1:3 (300:900), was based on secondary data on Live Births and Mortality Information Systems. A hierarchical logistic regression was used. Results: remains independently associated to fetal death: low maternal schooling (OR=1.58, CI95%=1.02;2.47), low weight (OR=5.59, CI95%=3.22;9.70) gestational age <37 weeks (OR=9.34, CI95%=5.38;16.21), previous fetal death (OR=6.65, CI95%=4.35;10.15). The type of cesarean delivery remained as a protective factor (OR=0.35, CI95%=0.24;0.54). The main causes of fetal deaths were by unspecified cause (15.4%), followed by maternal hypertensive disorders (14.7%). The fetal mortality rate (TMF) decreased from 10.0 in 2006 to 7.5 deaths per thousand births in 2010 (decreased 24.5%). The TMF during the study period was below the goal set for 2030 by the World Health Organization. Conclusions: approximately one third of fetal deaths causes were potentially avoidable. Factors such as low maternal schooling, low birth weight, prematurity and previous fetal death history constitute as main determinants for fetal deaths in Cuiaba and suggests that socioeconomic situation still determines quality care for pregnant women and that actions should be directed to improve prenatal care.
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Alencar GP, da Silva ZP, Santos PC, Raspantini PR, Moura BLA, de Almeida MF, do Nascimento FP, Rodrigues LC. What is the impact of interventions that prevent fetal mortality on the increase of preterm live births in the State of Sao Paulo, Brazil? BMC Pregnancy Childbirth 2015. [PMID: 26201726 PMCID: PMC4512015 DOI: 10.1186/s12884-015-0572-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background There is a global growing trend of preterm births and a decline trend of fetal deaths. Is there an impact of the decline of fetal mortality on the increase of preterm live births in State of Sao Paulo, Brazil? Methods The time trends were evaluated by gestational age through exponential regression analysis. Data analyzed included the fetal mortality ratio, proportion of preterm live births, fertility rate of women 35 years and over, prenatal care, mother's education, multiple births and cesarean section deliveries. A survival analysis was carried out for 2000 and 2010. Results Preterm births showed the highest annual increase (3.2 %) in the less than 28 weeks of gestation group and fetal mortality ratio decreased (7.4 %) in the same gestational age group. There was an increase of cesarean section births and it was higher in the < 28 weeks group (6.1 %). There was a decreased annual trend of mothers with inadequate prenatal care (6.1 %) and low education (8.8 %) and an increased trend in multiple births and fertility rates of women of 35 years and over. The variables were highly correlated to which other over time. In 2000, 8.2 % of all pregnancies resulted in preterm births (0.9 % in fetal deaths and 7.3 % in live births). In 2010, the preterm birth increased to 9.4 % (0.8 % were preterm fetal deaths and 8.6 % preterm live births). Conclusions The results suggest that 45.2 % could be the maximum contribution of successful interventions to prevent a fetal death on the increase in preterm live births. This increasing trend is also related to changes of the women reproductive profile with the change of the women reproductive profile and access to prenatal care.
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Affiliation(s)
- Gizelton Pereira Alencar
- Department of Epidemiology, University of São Paulo, School of Public Health, São Paulo, Brazil.
| | - Zilda Pereira da Silva
- Department of Epidemiology, University of São Paulo, School of Public Health, São Paulo, Brazil.
| | - Patrícia Carla Santos
- Department of Epidemiology, University of São Paulo, School of Public Health, São Paulo, Brazil.
| | | | | | | | | | - Laura C Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Barbeiro FMDS, Fonseca SC, Tauffer MG, Ferreira MDSS, da Silva FP, Ventura PM, Quadros JI. Fetal deaths in Brazil: a systematic review. Rev Saude Publica 2015; 49:22. [PMID: 25902565 PMCID: PMC4390075 DOI: 10.1590/s0034-8910.2015049005568] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 08/07/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To review the frequency of and factors associated with fetal death in the Brazilian scientific literature. METHODS A systematic review of Brazilian studies on fetal deaths published between 2003 and 2013 was conducted. In total, 27 studies were analyzed; of these, 4 studies addressed the quality of data, 12 were descriptive studies, and 11 studies evaluated the factors associated with fetal death. The databases searched were PubMed and Lilacs, and data extraction and synthesis were independently performed by two or more examiners. RESULTS The level of completeness of fetal death certificates was deficient, both in the completion of variables, particularly sociodemographic variables, and in defining the underlying causes of death. Fetal deaths have decreased in Brazil; however, inequalities persist. Analysis of the causes of death indicated maternal morbidities that could be prevented and treated. The main factors associated with fetal deaths were absent or inadequate prenatal care, low education level, maternal morbidity, and adverse reproductive history. CONCLUSIONS Prenatal care should prioritize women that are most vulnerable (considering their social environment or their reproductive history and morbidities) with the aim of decreasing the fetal mortality rate in Brazil. Adequate completion of death certificates and investment in the committees that investigate fetal and infant deaths are necessary.
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Affiliation(s)
- Fernanda Morena dos Santos Barbeiro
- Programa de Pós-Graduação em Saúde Coletiva. Instituto de Estudos em Saúde Coletiva. Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
| | - Sandra Costa Fonseca
- Programa de Pós-Graduação em Saúde Coletiva. Departamento de Epidemiologia e Bioestatística. Instituto de Saúde Coletiva. Universidade Federal Fluminense. Rio de Janeiro, RJ, Brasil
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Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG 2014; 121 Suppl 4:141-53. [PMID: 25236649 DOI: 10.1111/1471-0528.12995] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Annually, 2.6 million stillbirths occur worldwide, 98% in developing countries. It is crucial that we understand causes and contributing factors. METHODS We conducted a systematic review of studies reporting factors associated with and cause(s) of stillbirth in low- and middle-income countries (2000-13). Narrative synthesis to compare similarities and differences between studies with similar outcome categories. MAIN RESULTS A total of 142 studies with 2.1% from low-income settings were investigated; most report on stillbirths occurring at health facility level. Definition of stillbirth varied; 10.6% of studies (mainly upper middle-income countries) used a cut-off point of ≥22 weeks of gestation and 32.4% (mainly lower income countries) used ≥28 weeks of gestation. Factors reported to be associated with stillbirth include poverty and lack of education, maternal age (>35 or <20 years), parity (1, ≥5), lack of antenatal care, prematurity, low birthweight, and previous stillbirth. The most frequently reported cause of stillbirth was maternal factors (8-50%) including syphilis, positive HIV status with low CD4 count, malaria and diabetes. Congenital anomalies are reported to account for 2.1-33.3% of stillbirths, placental causes (7.4-42%), asphyxia and birth trauma (3.1-25%), umbilical problems (2.9-33.3%), and amniotic and uterine factors (6.5-10.7%). Seven different classification systems were identified but applied in only 22% of studies that could have used a classification system. A high percentage of stillbirths remain 'unclassified' (3.8-57.4%). CONCLUSION To build capacity for perinatal death audit, clear guidelines and a suitable classification system to assign cause of death must be developed. Existing classification systems may need to be adapted. Better data and more data are urgently needed.
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Affiliation(s)
- M Aminu
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Anversa ETR, Bastos GAN, Nunes LN, Dal Pizzol TDS. Qualidade do processo da assistência pré-natal: unidades básicas de saúde e unidades de Estratégia Saúde da Família em município no Sul do Brasil. CAD SAUDE PUBLICA 2012; 28:789-800. [DOI: 10.1590/s0102-311x2012000400018] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 12/12/2011] [Indexed: 11/21/2022] Open
Abstract
O processo da atenção pré-natal em unidades básicas de saúde tradicionais (UBS) e unidades de Estratégia Saúde da Família (ESF) foi avaliado em Santa Maria, Rio Grande do Sul, Brasil. Foram entrevistadas 795 puérperas que realizaram pré-natal nas UBS ou ESF. Utilizou-se quatro níveis de qualidade: nível 1 (índice de Kessner modificado por Takeda); nível 2, que adiciona ao nível 1 procedimentos clinico-obstétricos; nível 3, que acrescenta ao nível 1 exames laboratoriais; e nível 4, que considera todos os parâmetros anteriores. A atenção pré-natal realizada na ESF foi superior a das UBS em todos os níveis, com diferenças estatisticamente significativas nos níveis 1 e 2. As gestantes da ESF receberam mais orientações. A atenção pré-natal foi favorável à ESF, devendo ser melhorada em relação aos procedimentos e exames, a fim de aprimorar a assistência pré-natal e fortalecer a atenção primária à saúde.
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Affiliation(s)
| | - Gisele Alsina Nader Bastos
- Universidade Federal do Rio Grande do Sul, Brasil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
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Wendland EM, Duncan BB, Mengue SS, Schmidt MI. Lesser than diabetes hyperglycemia in pregnancy is related to perinatal mortality: a cohort study in Brazil. BMC Pregnancy Childbirth 2011; 11:92. [PMID: 22078268 PMCID: PMC3241204 DOI: 10.1186/1471-2393-11-92] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 11/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gestational diabetes related morbidity increases along the continuum of the glycemic spectrum. Perinatal mortality, as a complication of gestational diabetes, has been little investigated. In early studies, an association was found, but in more recent ones it has not been confirmed. The Brazilian Study of Gestational Diabetes, a cohort of untreated pregnant women enrolled in the early 1990's, offers a unique opportunity to investigate this question. Thus, our objective is to evaluate whether perinatal mortality increases in a continuum across the maternal glycemic spectrum. METHODS We prospectively enrolled and followed 4401 pregnant women attending general prenatal care clinics in six Brazilian state capitals, without history of diabetes outside of pregnancy, through to birth, and their offspring through the early neonatal period. Women answered a structured questionnaire and underwent a standardized 2-hour 75-g oral glucose tolerance test (OGTT). Obstetric care was maintained according to local protocols. We obtained antenatal, delivery and neonatal data from hospital records. Odds ratios (OR) were estimated using logistic regression. RESULTS We ascertained 97 perinatal deaths (67 fetal and 31 early neonatal). Odds of dying increased according to glucose levels, statistically significantly so only for women delivering at gestational age ≥34 weeks (p < 0.05 for glycemia-gestational age interaction). ORs for a 1 standard deviation difference in glucose, when analyzed continuously, were for fasting 1.47 (95% CI 1.12, 1.92); 1-h 1.55 (95% CI 1.15, 2.07); and 2-h 1.53 (95% CI 1.15, 2.02). The adjusted OR for IADPSG criteria gestational diabetes was 2.21 (95% CI 1.15, 4.27); and for WHO criteria gestational diabetes, 3.10 (95% CI 1.39, 6.88). CONCLUSIONS In settings of limited detection and treatment of gestational diabetes mellitus, women across a spectrum of lesser than diabetes hyperglycemia, experienced a continuous rise in perinatal death with increasing levels of glycemia after 34 weeks of pregnancy. Current GDM diagnostic criteria identified this increased risk of mortality.
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Affiliation(s)
- Eliana M Wendland
- Post-Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Almeida MFD, Alencar GP, Schoeps D, Minuci EG, Silva ZPD, Ortiz LP, Novaes HMD, Alencar AP, Raspantini PR, Santos PCD. Qualidade das informações registradas nas declarações de óbito fetal em São Paulo, SP. Rev Saude Publica 2011; 45:845-53. [DOI: 10.1590/s0034-89102011005000058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 05/13/2011] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a qualidade da informação registrada nas declarações de óbito fetal. MÉTODOS: Estudo documental com 710 óbitos fetais em hospitais de São Paulo, SP, no primeiro semestre de 2008, registrados na base unificada de óbitos da Fundação Sistema Estadual de Análise de Dados e da Secretaria de Estado da Saúde de São Paulo. Foi analisada a completitude das variáveis das declarações de óbito fetal emitidas por hospitais e Serviço de Verificação de Óbitos. Os registros das declarações de óbito de uma amostra de 212 óbitos fetais de hospitais do Sistema Único de Saúde foram comparados com os dados dos prontuários e do registro do Serviço de Verificação de Óbitos. RESULTADOS: Dentre as declarações de óbito, 75% foram emitidas pelo Serviço de Verificação de Óbitos, mais freqüente nos hospitais do Sistema Único de Saúde (78%). A completitude das variáveis das declarações de óbito emitidas pelos hospitais foi mais elevada e foi maior nos hospitais não pertencentes ao Sistema Único de Saúde. Houve maior completitude, concordância e sensibilidade nas declarações de óbito emitidas pelos hospitais. Houve baixa concordância e elevada especificidade para as variáveis relativas às características maternas. Maior registro das variáveis sexo, peso ao nascer e duração da gestação foi observada nas declarações emitidas no Serviço de Verificação de Óbitos. A autópsia não resultou em aprimoramento da indicação das causas de morte: a morte fetal não especificada representou 65,7% e a hipóxia intrauterina, 24,3%, enquanto nas declarações emitidas pelos hospitais foi de 18,1% e 41,7%, respectivamente. CONCLUSÕES: É necessário aprimorar a completitude e a indicação das causas de morte dos óbitos fetais. A elevada proporção de autópsias não melhorou a qualidade da informação e a indicação das causas de morte. A qualidade das informações geradas de autópsias depende do acesso às informações hospitalares.
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