The hypothesis of similarity between the extreme degrees of social distribution, translated by maternal education level in relation to the proportion of low birth weight, was not confirmed.

The article assessed the quality of completion of the maternal school variable in Brazilian state capitals and its regional distribution, based on the Brazilian Information System on Live Births (SINASC) with processed data from live birth certificates. A descriptive study was conducted in the time series from 1996 to 2013, with a total de 12,062,064 births, of which 11,442,494 (94.86%) had valid information on the maternal schooling variable. The results were calculated as the number of incomplete results in the variable per 1,000 live births, and the trend was assessed with the Joinpoint software, version 4.3.1. According to regional analysis, the South of Brazil showed a downward trend in incompleteness of maternal schooling throughout the study in all the state capitals of that region. Most of the country's other state capitals also showed improvement in the variable's completeness. However, there were different trends in some state capitals, even with greater incompleteness at the end of the period when compared to the beginning. SINASC proved to be a valuable source of data on mothers and their newborns, besides information on conditions in labor, delivery, and birth in the country. Maternal schooling, considered an important factor for obstetric and neonatal outcomes, is particularly useful for elaborating and evaluating policies and measures in maternal and child health. Thus, to achieve maximum completeness in data on this variable requires joint effort by health professionals and administrators, thereby guaranteeing the data's trustworthiness.

Maternal education represents one of the most important social determinants of inequality in birth weight (BW) in developing countries. The present study sought to investigate secular trends in health inequality considering the difference in mean BW between extremes of maternal educational attainment in Brazil. Using a time-series design, data from 6,452,551 live births which occurred in all Brazilian state capitals from 1996 to 2013 were obtained from the Information System on Live Births. Secular trends of the difference in mean birth weight between low (<8 years of schooling) and high (≥12 years of schooling) educational attainment were analyzed. The main finding was that differences in mean birth weight between the two extremes of maternal educational attainment decreased over time. There was a significant decrease in mean BW in neonates born to mothers with higher educational attainment, and a slight increase in those born to mothers with lower educational attainment. One of the key factors involved in decreasing inequality was an increase in the number of antenatal visits. In view of these results, we conclude, that despite a slight increase of mean birth weight among mothers with low education, the reduction of inequality in pregnancy outcomes over time in Brazil is attributable to a worsening scenario for mothers who are better off rather than to improvements for the most vulnerable group of mothers. Socioeconomic status is considered an important predictor of health inequalities. Individuals in unfavorable socioeconomic conditions are more vulnerable to adverse physical and mental health outcomes compared to those who are better off 1. Several demographic and socioeconomic conditions influence birth outcomes. Among them, ethnicity, education, occupation, income, social class, the availability of housing, urban infrastructure, social support, and exposure to crime have all been described 2. The impact of social inequalities on human health is well established, and has shown increasing relevance in developing countries. Thus, in these countries, it is important to encourage social and economic development policies which, together with public health programs, may favorably influence perinatal outcomes, particularly birth weight 3,4. At the individual level, access to health care, medical practices, behavioral factors, and stress are also related to birth weight 5,6. Maternal education is a strong determinant of birth weight acting through a number of mediators such as adequate access to information, health care and nutrition 7. In Brazil, we have shown in a previous study, despite significant improvements in maternal education, the rate of LBW remained stable around 8.5% of all life births during the last 15 years 8. In Brazil, this situation regarding LBW is considered an epidemiological paradox and, according to some researchers, it can be explained by several factors, among them, the underreporting in the registry of low birth weight in the poorest and most vulnerable regions and, at the same time, the i...

Several recent studies have demonstrated the exposure of social groups to bad health conditions. That puts individuals at the risk of experiencing adverse outcomes, which includes mostly transgenerational effects [1][2][3].Concerning the mother's and the newborn's health, their socioeconomic conditions contribute to the occurrence Low Birth Weight (LBW) and preterm cases. According to the World Health Organization (WHO), among all the births in the world, around 20.6 million (15.5%) of babies are born with LBW.Most of these cases are in developing countries (e.g. 27% in Asia against 6.4% in Europe), in which the rate of child mortality is similar to the maternal mortality, with a great incidence particularly in Africa and Asia [4].Although the mothers' and newborns' access to health has improved in many countries, there are still huge inequalities between developing and developed countries and also regional differences inside them, evidencing the uneven health conditions of the population.LBW rates in developing countries have been associated with adverse socioeconomic conditions, in which there are a great number of newborns with Intrauterine Growth Restriction (IGR), while in developed countries LBW is primarily related to preterm delivery [5].This situation can be verified in Brazil, a medium-income developing country administratively organised in five regions with distinctive environmental, cultural and socio-economic circumstances.Over the last decades, health social determinants have improved and access to health and technology has certainly enhanced; nonetheless, a disproportionate distribution of perinatal characteristics in the country can still be observed. Empirical results show a decrease in the child mortality rates and an increase in LBW and premature newborns in all regions, although with lower increase in less developed regions [3].In terms of maternal characteristics and assistance in prenatal care and during delivery, data from the National Information System of Live Births [6] (SINASC), established in 1990, show an increase in the mother's education level and pregnancy in women over 35 years old, as well as a greater access to prenatal care, and an increase in the number of caesarean deliveries (over 50% in more developed regions).These data reveal that mother's education level and prenatal care represent protective factors for LBW, mostly because the rate of mothers who have never been to school and the ones that do not take any antenatal care has decreased, therefore positively influencing a decrease in the rates of LBW in less developed regions.However, the more developed regions of Brazil, with better antenatal care coverage and the mother's higher educational level, have shown higher LBW rates; in the less developed regions, despite their current lower rates, LBW has increased linearly [7].These results suggest that low LBW rates in less economically developed regions are probably related to improved antenatal care access and to mother`s education; while in more economically developed reg...

No abstract