Early Infant Morbidity in the City of São Paulo, Brazil

Abstract

BackgroundEarly infant morbidities may produce adverse outcomes in subsequent life. A low Apgar score is a convenient measure of early infant morbidity. We study determinants of early infant morbidity (sex, plurality, mode of delivery, prior losses, gestational age, prenatal care and birth weight, parity and maternal age, race, maternal education and community development) for the 1998-birth cohort, City of São Paulo, Brazil.MethodsThis study identified all deliveries that took place in the City of São Paulo during 1998. Information was extracted from 209,628 birth records. We used multivariate logistic regression to assess the effect of each independent variable on Apgar score less than seven at one minute and Apgar score less than seven at five minutes.ResultsLow birth weight, prematurity and community development were found to be strong predictors of morbidity. Maternal education showed strong negative correlation with both Apgar scores. The negative correlations between maternal schooling and Apgar scores were observed after prenatal care, parity and maternal age were included in the model. Unmeasured proximate factors may thus be the true source of disparity between educational groups. Children of very young adolescent mothers had lower Apgar scores at one minute (but not at five minutes) than those born to mothers 15 to 19. Parity one or higher was associated with decreased odds of low Apgar scores. Cesarean section and operative delivery were associated with higher odds of early infant morbidity.ConclusionEducation may allow mothers to have better care in the peripartum period. More educated mothers may be more likely to recognize certain morbidities through the pregnancy period and the monitoring of such morbidities yields better infant outcomes. Also, having less than seven prenatal care visits was found to predict early infant morbidity and one way to increase the use of such services is to focus on aspects of care that may lead to easier accessibility and continuity of prenatal care. Physicians should inform mothers about the risks associated with high number of children for a next infant and also about the risks for the infant associated with unnecessary cesarean sections. Special attention should be paid to adolescent mothers, since much of their increased risk is likely to be minimized by counseling.

Birthweight and early neonatal health: Bangladesh perspective

“…Maternal education and exclusive breast feeding are known to lower neonate morbidity, 27,28 and our data were consistent with this.…”

Apgar score and dental caries risk in the primary dentition of five year olds

“…Population studies have shown that low 5‐minute Apgar scores were higher among males than females, twins than singletons, low or high birthweight infants than normal birthweight infants, and children of primiparous compared with multiparious women in a population‐based study of one million term births 31 . Other risk indicators are pre‐ and post‐term delivery compared with term births 32,33 and socioeconomic disadvantage 34 . Ehrenstein classifies risk factors for low Apgar scores as those pertaining to the parents and those pertaining to the child 35 .…”

Impact of Maternal Age on Birth Outcomes: A Population-Based Study of Primiparous Brazilian Women in the City of São Paulo

“…However, factors other than biological clearly played a role in the discrepancy: the youngest adolescent mothers tended to be single and display lower schooling and higher rates of forceps delivery (Ribeiro et al, 2000). A recent study has also found that children of very young adolescent mothers had lower Apgar scores at one minute (but not at five minutes) than those born to women aged 15-19 (Machado & Hill, 2003). A recent study has also found that children of very young adolescent mothers had lower Apgar scores at one minute (but not at five minutes) than those born to women aged 15-19 (Machado & Hill, 2003).…”