O impacto do baixo peso ao nascer relacionado à depressão gestacional para o financiamento federal da saúde pública: uma análise do Município de Pelotas, Rio Grande do Sul, Brasil

Abstract

Low birth weight is related to morbidity and mortality and sequelae during infant development, thereby impacting health system costs. It is thus important to evaluate factors that influence low birth weight and to estimate their impact on the Brazilian Unified National Health System (SUS). This was a nested prospective study in a cohort of pregnant women who received prenatal care and gave birth in the National Health System in hospitals with ICUs in the city of Pelotas, Rio Grande do Sul State, Brazil. Gestational depression was associated with a fourfold risk of low birth weight (PR = 3.94; CI: 1.49-10.36). Based on the population-attributable fraction, in the overall population an estimated 36.17% of low birth weight infants are born to mothers with an episode of depression during pregnancy, with an estimated cost of more than R$76 million (U$38 million) in Brazil. The study recommends the expansion of preventive and therapeutic mental health care measures for pregnant women and the adequate use of resources in the Unified National Health System to improve neonatal outcomes.

Transtornos mentais na gravidez e condições do recém-nascido: estudo longitudinal com gestantes assistidas na atenção básica

“…The presence of symptoms suggesting a diagnosis of probable depressive disorder was verified in 14.4% of the pregnant women evaluated; although this finding is lower than that of other countries, ranging from 22.0% to 34.9%, 17,19 our results are similar to the national studies performed with low socioeconomic pregnant women in the second and third trimesters of pregnancy 6,24 . The association between depression and obstetric outcomes is still poorly understood.…”

“…Studies in developed countries have shown that depression is not an independent risk factor for LBW 25,26 ; on the other hand, a positive association was found in developing countries and was influenced by low income and alcohol consumption during pregnancy. However, research that found this association identified prenatal depression as a significant predictor of LBW without gestational age control 6,27 . With regard to the probable diagnosis of generalized anxiety disorder, the frequency was elevated (19.3%), as already described in other studies with women during the gestational period 15,18 , which was also observed in a study carried out in the South of the country with pregnant women treated in 18 UBS, which found a very similar frequency (19.8%) to this study using the same screening tool 14 .…”

“…The association between depression and obstetric outcomes is still poorly understood. However, some studies have pointed to this disorder as a possible risk factor for low birth weight and prematurity 6,17,25 . In this study, no association was found between probable diagnosis of depressive disorder and LBW and prematurity.…”

“…However, it is believed that the diagnosis in this period is neglected and there is little research that seeks to identify psychological changes during pregnancy and obstetric outcomes 5 . Epidemiological studies are almost consensual in pointing out that MD, such as anxiety and depression may result in an increased risk for negative outcomes to the fetus [6][7][8] . Research has identified prevalence of depression in the gestational period of approximately 7% to 15% and anxiety around 20% 7,8 ; these untreated conditions during pregnancy also increase the risk of exposure to tobacco, alcohol and other drugs, as well as the risk of malnutrition and the difficulty of following medical guidelines in the prenatal period, even reducing the frequency of visits, which has been associated to the risk of neonatal mortality 9 .…”

Avaliação de desfechos perinatais/infantis em partos de pacientes com transtornos mentais maiores de um hospital psiquiátrico do Rio de Janeiro, Brasil

“…Em países em desenvolvimento como o Brasil, grande parte da população está exposta a condições precárias de vida, tais como desemprego, baixa renda, situação de moradia e de nutrição deficientes, dificuldades de acesso a serviços de saúde e de educação de qualidade. Esses fatores contribuem para as altas taxas de morbidade e mortalidade infantil encontradas nesses países, já que essas frequências são consideradas eficientes indicadores do desenvolvimento social e econômico de um país 21 .…”