The epidemiologic paradox of low birth weight in Brazil

Abstract

O paradoxo epidemiológico do baixo peso ao nascer no Brasil ABSTRACT OBJECTIVE: To examine whether the low birth weight (LBW) paradox exists in Brazil. METHODS:LBW and cesarean section rates between 1995 and 2007 were estimated based on data from SINASC (Brazilian Live Births Database). Infant mortality rates (IMRs) were obtained using an indirect method that correct for underreporting. Schooling information was obtained from census data. Trends in LBW rate were assessed using joinpoint regression models. The correlations between LBW rate and other indicators were graphically assessed by lowess regression and tested using Spearman's rank correlation. RESULTS:In Brazil, LBW rate trends were non-linear and non-signifi cant: the rate dropped from 7.9% in 1995 to 7.7% in 2000, then increased to 8.2% in 2003 and remained nearly steady thereafter at 8.2% in 2007. However, trends varied among Brazilian regions: there were signifi cant increases in the North from 1999 to 2003 (2.7% per year), and in the South (1.0% per year) and Central-West regions (0.6% per year) from 1995 to 2007. For the entire period studied, higher LBW and lower IMRs were seen in more developed compared to less developed regions. In Brazilian States, in 2005, the higher the IMR rate, the lower the LBW rate (p=0.009); the lower the low schooling rate, the lower the LBW rate (p=0.007); the higher the number of neonatal intensive care beds per 1,000 live births, the higher the LBW rate (p=0.036). CONCLUSIONS:The low birth weight paradox was seen in Brazil. LBW rate is increasing in some Brazilian regions. Regional differences in LBW rate seem to be more associated to availability of perinatal care services than underlying social conditions.

Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data

“…After adjusting for HDI, the significant and negative association between caesarean section rate and mortality was observed when the caesarean section rate was lower than around 10%. The inflection point appears lower than the numbers reported by other investigators 4, 13, 16, 17, 18…”

“…In an attempt to identify such a caesarean section rate, several ecological studies have analysed the association between mode of delivery and maternal, neonatal and infant mortality 2, 4, 12, 13, 14, 15, 16, 17, 18. They used different statistical methods for the analysis (e.g.…”

“…This inflection point was considered as a necessary caesarean section rate from a medical viewpoint to minimise mortality; however, the results and interpretations of these studies were limited by the cross‐sectional nature of the ecological data. Moreover, most of these studies did not control for socio‐economic conditions, which can have a great impact on both the availability of caesarean section and maternal and perinatal mortality, and thus confound the association between caesarean section rates and adverse outcomes 2, 12, 13, 16, 17, 18. We therefore set out to compile available caesarean section rates worldwide at the country level, and assess the association between mode of delivery and maternal and neonatal mortality using a longitudinal approach and adjusting for socio‐economic development.…”

Morbidade neonatal near miss na pesquisa Nascer no Brasil

“…Wide availability of neonatal intensive care units (neonatal ICU) is associated with high rates of early detection of respiratory diseases and high medical intervention rates 16 . Furthermore, newborns with severe diseases tend to be referred to public neonatal intensive care units located in state capital cities.…”

Why do women in the private sector have shorter pregnancies in Brazil? Left shift of gestational age, caesarean section and inversion of the expected disparity

“…This is an "inversion of the expected disparity." The poorer results (more prematurity, lower birth weight) require more technology to compensate them, and most neonatal intensive care units are concentrated in richer areas 27 .…”