Desigualdades sociodemográficas e suas conseqüências sobre o peso do recém-nascido

Abstract

OBJECTIVE:To analyze sociodemographic inequalities in prenatal and childbirth care and their consequences on birth weight. METHODS:The study was based on a sample of 10,072 postpartum women treated at public (those outsourced by the National Health System) and private maternity hospitals in Rio de Janeiro, Brazil, from 1999 to 2001. To test the association between birth weight and maternal sociodemographic and biological characteristics and prenatal care (modified Kotelchuck index), postpartum women were stratified by level of schooling and two multiple linear regressions were performed. The bootstrap technique was used in addition to accurate confidence intervals for the estimated effects. RESULTS:For nearly all of the variables analyzed in the bivariate analysis, birth weight was lower among children of mothers with low schooling. In the multivariate analysis, among women with low schooling, there was a direct association between birth weight and the modified Kotelchuck index and gestational age. The variables black skin color, smoking, and history of premature birth were negatively associated with birth weight, while maternal age and parity showed distinct behaviors from the central range of data at the extremes. In the group with high schooling, only parity, gestational age, and modified Kotelchuck index were significant and directly associated with birth weight. The protective effect of prenatal care was observed, as well as the negative effect of smoking, regardless of the mother's level of schooling. CONCLUSIONS:The variables associated with neonates' birth weight of mothers with high schooling in Rio de Janeiro were biological, in contrast to the social determinants in the group with low schooling. KEYWORDS: Birth weight. Social inequity. Health inequity. Equity in access. Maternal and child health. Prenatal care.

Factors associated with iron deficiency in pregnant women seen at a public prenatal care service

“…Furthermore, anemia impairs mental development and the ability to work and study productively 9 . During pregnancy, anemia is associated with a higher rate of mother/fetus morbidity and mortality, and the most common complications are early labor, low birth weight, preeclampsia, and higher risk of miscarriage 10 .…”

Factors associated to maternal and child's health in Rio Grande do Sul, Brazil

“…14 The birth weight represents an important factor in determining the immediate and future pattern of the child's health. 25 In this study, most of the newborns presented adequate weight, followed by newborns with low birth weight and in a smaller proportion of newborns with 4,000g or more. These results showed to be consistent with the values found in a study in Campinas, São Paulo, based on the data from Sinasc, in which 90.4% of the live births weighed more than 2,500g and 9.6% presented low weight.…”

“…26 It is known that low birth weight is related to morbidity and mortality and its frequency is related to the factors of maternal health and the family's social conditions. 25 It is noteworthy that four CRS (Passo Fundo, Caxias do Sul, Palmeiras das Missões and Ijuí) presented proportions of newborns with low birth weight exceeding the value below 10% accepted internationally, 27 indicating the presence of problems in maternal and child healthcare in these regions. The four regions presented a high Socioeconomic Development Index.…”

Socioeconomic and gestational determinants of birth weight of term infants

“…Leal et al, 18 em estudo com mais de 10 mil puérperas atendidas em maternidades públicas conveniadas ao Sistema Único de Saúde (SUS) no município do Rio de Janeiro, encontraram que a assistência pré-natal inadequada, a história de filho prematuro e a necessidade de procurar mais de uma maternidade para receber atendimento para o parto estiveram associadas a menores médias de peso ao nascer. 18 No que se refere à saúde materno-infantil, vale assinalar alguns aspectos fundamentais ao bem estar e saúde do binômio mãe e filho, sendo a atenção pré-natal um importante indicador do estado de saúde e evolução gestacional essencial para redução do risco de complicações obstétricas e neonatais.…”

“…18 No que se refere à saúde materno-infantil, vale assinalar alguns aspectos fundamentais ao bem estar e saúde do binômio mãe e filho, sendo a atenção pré-natal um importante indicador do estado de saúde e evolução gestacional essencial para redução do risco de complicações obstétricas e neonatais. O pré-natal adequado tem apresentado impacto positivo sobre os resultados obstétricos, pois constitui um dos principais fatores de prevenção de baixo peso ao nascer, prematuridade e óbito perinatal.…”