What is the impact of interventions that prevent fetal mortality on the increase of preterm live births in the State of Sao Paulo, Brazil?

Abstract

BackgroundThere 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?MethodsThe 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.ResultsPreterm 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).ConclusionsThe 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.

Factors associated with low birth weight at term: a population-based linkage study of the 100 million Brazilian cohort

“…It is worth noting that a demographic transition is well underway in Brazil, as evidenced by increasing fertility trends in women over 35 years of age, mainly in highly urbanized areas. This combined with the late onset of reproductive activity has led to an increase in the proportion of primiparous women in this age group [40]. In addition to delayed pregnancy, these results may also be explained by a lack of rigor in accurately recording live births at regional centers, as well as the precarious availability of health services and lack of early medical intervention [38].…”

Cervical Incompetence;

“…The mean age of our patients was27.33, which is in keeping with 29.28 reported previously by Rodrigues LC. 11 The gestation period in our population ranged from 13 to 22 weeks, with majority falling between 13-18 weeks as the cervical incompetence is mostly diagnosed in the second trimester when the amniotic sac fills the uterine cavity. Rodrigues has reported an average gestational period of 18.29 weeks, which compares well with our findings.…”

Factors associated to fetal death in Cuiabá, Mato Grosso

“…It is important to emphasize that there is a growing world trend of premature births and declines on fetal deaths. 21 It is possible that premature babies are dying at a later time and elevating neonatal mortality rate, especially early neonatal which was responsible for 48.1% of all infant deaths in the period of 2006 to 2010 in Cuiabá. 22 As for the reproductive risk in confirming the association between previous episode of fetal death and new occurrence of death as observed in other national and international studies, as the history of fetal death may characterize current pregnancy as high risk.…”