Diferenças regionais e fatores associados ao número de consultas de pré-natal no Brasil: análise do Sistema de Informações sobre Nascidos Vivos em 2013

Abstract

ABSTRACT:Objective: To investigate factors associated with seven or more prenatal visits, in Brazil, in 2013. Methods: Cross-sectional study from the database of Information System on Live Births. The association of explanatory variables was tested with prenatal visits by means of the analysis of single and multiple multinomial regressions. The spatial distribution of prenatal visits according to the Brazilian municipalities was also analyzed. Results: It was found that 2.7% of pregnant women attended no prenatal visit and 63.1% attended 7 or more. The chance to attend 7 or more prenatal visits was higher among pregnant women aged 40 years or more, with 12 years or more of schooling, living with a roommate, living in the South and Southeast regions, who had a triplet or more pregnancy, with gestational age of 42 weeks or more, and who had children with normal birth weight. Significant regional disparities were identified in the prevalence of women with seven or more prenatal visits. Conclusion: Although Brazil has a Unified Health System that provides universal prenatal care, the use of this service is uneven according to geographic, demographic, and socioeconomic characteristics. Keywords 836Rev BRas epidemiol oUT-deZ 2016; 19(4): 835-850 INTRODUCTIONAccess to prenatal care is associated with better health outcomes for pregnant women and newborns. This care is essential to prevent and/or early detect maternal and fetal pathologies, promoting the healthy development of the baby and reducing the risk to the pregnant women 1 . By monitoring the pregnancy since the first quarter there is greater possibility of the mother undergo laboratory tests, reducing maternal and child morbidity and mortality. Consequently, the results are better intrauterine growth, higher birth weight, fewer occurrences of prematurity and neonatal mortality, and, for the mother, lower rate of complications during pregnancy and at delivery 1 . Studies show that the higher the number of prenatal visits, the lower the neonatal 2 and maternal 3,4 mortality rates, the prevalence of prematurity 3 , the low birth weight 5,6 , and the hypertension during pregnancy 3,4 . In this scenario, the anti-tetanus vaccination coverage 7 and supplementation with ferrous sulfate 7 are also greater. Owing to these benefits indicated by the literature and in order to improve access, coverage, and quality of prenatal care in Brazil, the Ministry of Health launched, in 2000, the Program of Humanization in Prenatal and Birth (PHPN). Among other guidelines, the document recommends that pregnant women attend at least six prenatal visits during pregnancy: one in the first quarter, two in the second, and three in the third 1 . Studies that analyzed the factors associated with low number of prenatal care visits found that this negative outcome is more common among women with low education 8 , pregnant adolescents 2,8 , with high parity 6,8 , and living without a partner 6 . However, in Brazil, RESUMO: Objetivo: Investigar os fatores associados à realização de sete ou ma...

Brazilian regional differences and factors associated with the prevalence of cesarean sections

“…Anjos and Boing [18] analyzed that the level of education was a factor significantly associated with the practice of an increased number of prenatal consultations (seven or more). Similarly, Joshi et al [25], in a study carried out in Nepal verified that as the level of education of pregnant women increased, their chances of having four or more prenatal consultations also increased, being seven times higher when compared to the extreme groups of schooling.…”

“…This finding was seen for all Brazilian regions, especially in the North, Northeast and South, where the chances of a C-section in women with a higher level of education were quite significant over the years (Table 3). The Northeast region, according to study by Silva et al [16], shows disparities in the efficiency of public spending and receive less public resources for health care compared to the Southeast, South and Midwest regions, as well as presenting lower health insurance coverage rates [1], fewer prenatal consultations by pregnant women, with inadequate prenatal care in less favored areas [18]. Therefore, these facts may lead to greater risks and/or maternal-infant complications during pregnancy due to the lack of adequate follow-up, resulting in the indication of C-sections to avoid more serious risks for mother and baby.…”

Evolução das desigualdades socioeconômicas na realização de consultas de pré-natal entre parturientes brasileiras: análise do período 2000-2015*

“…Using a cross-sectional approach, studies carried out in Brazil with regional 13 or national samples 10 have identified higher levels of schooling associated with greater likelihood of having the appropriate number of prenatal consultations. Studies have also found and described that increased uptake of prenatal care is more common among people with better living conditions and better jobs.…”

Anthropometrical measurements and maternal visceral fat during first half of pregnancy: a cross-sectional survey

“…Aligned with the Brazilian Ministry of Health recommendations on resolute prenatal care [ 26 ] and the isolated capacity of MUAC and SBSF to detect the increase in amounts of maternal central fat, the inclusion of clinical anthropometry during the first 20 weeks of pregnancy can contribute to accurate maternal metabolic risk prediction. Thus, their complementary use in clinical practice is justified, as well as their possible inclusion in protocols for nutritional assessment during pregnancy.…”