Associated factors and consequences of late preterm births: results from the 2004 Pelotas birth cohort

Abstract

Although neonatal and infant mortality rates have fallen in recent decades in Brazil, the prevalence of preterm deliveries has increased in certain regions, especially in the number of late preterm births. This study was planned to investigate: (1) maternal antenatal characteristics associated with late preterm births and (2) the consequences of late preterm birth on infant health in the neonatal period and until age 3 months. A population-based birth cohort was enrolled in Pelotas, Southern Brazil, in 2004. Mothers were interviewed and the gestational age of newborns was estimated through last menstrual period, ultrasound and Dubowitz's method. Preterm births between 34 and 36 completed weeks of gestational age were classified as late preterm births. Only singleton live births from mothers living in the urban area of Pelotas were investigated. Three months after birth, mothers were interviewed at home regarding breast feeding, morbidity and hospital admissions. All deaths occurring in the first year of life were recorded. A total of 447 newborns (10.8%) were late preterms. Associations were observed with maternal age <20 years (prevalence ratio [PR] 1.3 [95% CI 1.1, 1.6]), absence of antenatal care (PR 2.4 [1.4, 4.2]) or less than seven prenatal care visits, arterial hypertension (PR 1.3 [1.0, 1.5]), and preterm labour (PR 1.6 [1.3, 1.9]). Compared with term births, late preterm births showed increased risk of depression at birth (Relative risk [RR] 1.7 [1.3, 2.2]), perinatal morbidity (RR 2.8 [2.3, 3.5]), and absence of breast feeding in the first hours after birth (PR 0.9 [0.8, 0.9]). RRs for neonatal and infant mortality were, respectively, 5.1 [1.7, 14.9] and 2.1 [1.0, 4.6] times higher than that observed among term newborns. In conclusion, in our setting, the prevention of all preterm births must be a priority, regardless of whether early or late.

Índice de massa corporal e ganho de peso gestacional como fatores preditores de complicações e do desfecho da gravidez

“…No Brasil, a partir da década de 1990, ocorreu o aumento da frequência de prematuridade que passou de 5%, em 1994, para 6,5% em 2004 18 . Entre os fatores de risco associados ao parto prematuro, estão o baixo peso materno pré-gestacional e o insuficiente ganho de peso materno 10,18,19,33 .…”

Pesquisa Nascer no Brasil: perfil da mortalidade neonatal e avaliação da assistência à gestante e ao recém-nascido

“…In that scenario, it is fundamental to invest in measures to prevent avoidable prematurity, in addition to improving care for these more vulnerable newborns. Two goals should be kept in focus: prevention in prenatal care, including control of infections and risks in pregnancy, and prevention of iatrogenic prematurity 3,29 relating to undue interruption of pregnancy, as in caesarian sections without technical indication, which are a serious problem in Brazil and contribute to the high total prevalence of caesarian sections 3,31,32 .…”

Características da sucção não-nutritiva em RN a termo e pré-termo tardio

“…Em 2005, nos Estados Unidos, 70% dos prematuros eram tardio (2) . Em 2004, um estudo em Pelotas encontrou 10,8% de RNPT tardio nesta região (3) . Por terem o peso e o tamanho de alguns recém-nascidos a termo, o prematuro tardio é considerado por muitos profissionais, como neonato com o desenvolvimento normal e baixa morbidade.…”