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CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(04): 256-263
DOI: 10.1055/s-0041-1728779
Original Article
Obstetrics

Association between Prenatal Care Adequacy Indexes and Low Birth Weight Outcome

Associação entre índices de adequação de cuidado pré-natal e desfecho de baixo peso ao nascer
Conceição Christina Rigo Vale 
1   Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, RJ, Brazil
,
Nubia Karla de Oliveira Almeida 
2   Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ, Brazil
,
Renan Moritz Varnier Rodrigues de Almeida 
1   Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Abstract

Objective To investigate the association between prenatal care (PNC) adequacy indexes and the low birth weigth (LBW) outcome.

Methods A total of 368,093 live term singleton births in the state of Rio de Janeiro (Brazil) from 2015 to 2016 were investigated using data from the Brazilian Live Birth Information System (Sistema de Informações sobre Nascidos Vivos, SINASC, in Portuguese). Seven PNC adequacy indexes were evaluated: four developed by Brazilian authors (Ciari Jr. et al., Coutinho et al., Takeda, and an index developed and used by the Brazilian Ministry of Health – MS) and three by authors from other countries (Kessner et al., the Adequacy of Prenatal Care Utilization index – APNCU, and the Graduated Prenatal Care Utilization Index – GINDEX). Adjusted odds ratios were estimated for the PNC adequacy indexes by means of multivariate logistic regression models using maternal, gestational and newborn characteristics as covariates.

Results When the PNC is classified as “inadequate”, the adjusted odds ratios to the LBW outcome increase between 42% and 132%, depending on which adequacy index is evaluated. Younger (15 to 17 years old) and older (35 to 45 years old) mothers, those not married, of black or brown ethnicity, with low schooling (who did not finish Elementary School), primiparous, with preterm births, as well as female newborns had increasing odds for LBW. The models presented areas under the receiver operating characteristic (ROC) curve between 80.4% and 81.0%, and sensitivity and specificity that varied, respectively, between 57.7% and 58.6% and 94.3% and 94.5%.

Conclusion Considering all PNC adequacy indexes evaluated, the APNCU had the best discriminatory power and the best ability to predict the LBW outcome.

Resumo

Objetivo Investigar a associação entre diferentes índices de adequação do cuidado pré-natal (PN) e o desfecho de nascimentos com baixo peso (BP).

Métodos Foram investigados 368.093 nascimentos ocorridos no estado do Rio de Janeiro entre 2015 e 2016, utilizando-se as informações do Sistema de Informações sobre Nascidos Vivos (Sinasc). Sete índices de adequação do cuidado PN foram avaliados: quatro propostos por autores nacionais (Ciari Jr et al., Coutinho et al., Takeda, e um índice atualmente em uso pelo Ministério da Saúde – MS), e três, por autores internacionais (Kessner et al., Adequacy of Prenatal Care Utilization index – APNCU, e Graduated Prenatal Care Utilization Index – GINDEX). As razões de chance ajustadas para BP foram estimadas considerando os índices de adequação do cuidado PN por meio de modelos de regressão logística, utilizando características maternas, da gravidez e do recém-nascido como variáveis de controle.

Resultados As chances ajustadas para ocorrência de BP ao nascer aumentam de 42% a 132%, a depender do índice empregado, quando o cuidado PN é considerado inadequado. Mães entre 15 e 17 anos e entre 35 e 45 anos, sem companheiro, de cor parda ou preta, com ensino fundamental incompleto, e primíparas, com gestações pré-termo, além de bebês do sexo feminino são fatores de risco para os nascimentos com BP.

Conclusão Entre os índices avaliados, o APNCU foi o que apresentou melhor poder discriminatório e capacidade de prever o desfecho de BP ao nascer.

Keywords

maternal and newborn health - low birth weight - prenatal care - perinatal epidemiology

Palavras-chave

saúde materno-infantil - baixo peso ao nascer - cuidado pré-natal - epidemiologia perinatal

Contributions

All the authors contributed equally to this paper, namely, to the conception and design, data collection or analysis, and interpretation of data, writing of the article, and review of the intellectual content. Therefore, all authors approved the final version to be published.




Publication History

Received: 29 May 2020

Accepted: 08 December 2020

Article published online:
12 May 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Institute of Medicine. Improving birth outcomes: meeting the challenge in the developing world. Washington (DC): National Academies Press; 2003
    Search in Google Scholar
  • 2 Barker DJ. The developmental origins of chronic adult disease. Acta Paediatr Suppl 2004; 93 (446) 26-33
    Search in Google Scholar
  • 3 Wehby GL, Murray JC, Castilla EE, Lopez-Camelo JS, Ohsfeldt RL. Prenatal care effectiveness and utilization in Brazil. Health Policy Plan 2009; 24 (03) 175-188
    CrossrefPubMedSearch in Google Scholar
  • 4 UNICEF. Low birthweight [Internet]. 2019 [cited 2020 Feb 06]. Available from: https://data.unicef.org/topic/nutrition/low-birthweight/
    PubMedSearch in Google Scholar
  • 5 Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ 1987; 65 (05) 663-737
    PubMedSearch in Google Scholar
  • 6 World Health Organization. Global nutrition targets 2025: low birthweight policy brief. Geneva: WHO; 2014
    Search in Google Scholar
  • 7 Dowswell T, Carroli G, Duley L. et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev 2010; (10) CD000934
    CrossrefPubMedSearch in Google Scholar
  • 8 Carroli G, Villar J, Piaggio G. et al; WHO Antenatal Care Trial Research Group. WHO systematic review of randomised controlled trials of routine antenatal care. Lancet 2001; 357 (9268): 1565-1570
    CrossrefPubMedSearch in Google Scholar
  • 9 Santos Neto ET, Oliveira AE, Zandonade E, Leal MdoC. Access to prenatal care: assessment of the adequacy of different indices. Cad Saude Publica 2013; 29 (08) 1664-1674
    CrossrefPubMedSearch in Google Scholar
  • 10 Leal MdoC, Gama SGN, Ratto KMN, Cunha CB. [Use of the modified Kotelchuck index in the evaluation of prenatal care and its relationship to maternal characteristics and birth weight in Rio de Janeiro, Brazil]. Cad Saude Publica 2004; 20 (Suppl. 01) S63-S72 Portuguese.
    CrossrefPubMedSearch in Google Scholar
  • 11 Silva EP, Lima RT, Costa MJC, Batista Filho M. [Development and application of a new index for assessment of prenatal care]. Rev Panam Salud Publica 2013; 33 (05) 356-362 Portuguese.
    CrossrefPubMedSearch in Google Scholar
  • 12 Silveira DS, Santos IS. [Adequacy of prenatal care and birthweight: a systematic review]. Cad Saude Publica 2004; 20 (05) 1160-1168 Portuguese.
    CrossrefPubMedSearch in Google Scholar
  • 13 Gonzaga ICA, Santos SLD, Silva ARV, Campelo V. [Prenatal care and risk factors associated with premature birth and low birth weight in the a capital in the Brazilian Northeast]. Cien Saude Colet 2016; 21 (06) 1965-1974 Portuguese.
    CrossrefPubMedSearch in Google Scholar
  • 14 Ministério da Saúde. Datasus. Sistema de Informação sobre Nascidos Vivos – SINASC [Internet]. 2020 . [cited 2020 Feb 26]. Available from: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc/cnv/nvuf.def
    PubMedSearch in Google Scholar
  • 15 Ciari Jr C, Santos JLF, Almeida PAM. [Qualitative evaluation of pre-natal care]. Rev Saude Publica 1972; 6 (04) 361-370 Portuguese.
    CrossrefPubMedSearch in Google Scholar
  • 16 Coutinho T, Teixeira MTB, Dain S, Sayd JD, Coutinho LM. [Adequacy of the prenatal care process among users of the Unified Health Care System in Juiz de Fora-MG]. Rev Bras Ginecol Obstet 2003; 25 (10) 717-772
    CrossrefPubMedSearch in Google Scholar
  • 17 Takeda S. Avaliação de unidade de atenção primária: modificação dos indicadores de saúde e qualidade da atenção [Dissertação]. Pelotas: Universidade Federal de Pelotas; 1993
    Search in Google Scholar
  • 18 Ministério da Saúde. Portaria No. 569, de 1° de junho de 2000. Estabelece o Programa de Humanização no Pré-natal e Nascimento. Diário Oficial da União. Sect. 2000; 1: 4-6
    PubMedSearch in Google Scholar
  • 19 Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994; 84 (09) 1414-1420
    CrossrefPubMedSearch in Google Scholar
  • 20 Alexander GR, Cornely DA. Prenatal care utilization: its measurement and relationship to pregnancy outcome. Am J Prev Med 1987; 3 (05) 243-253
    CrossrefPubMedSearch in Google Scholar
  • 21 Kessner DM, Singer J, Kalk CE, Schlesinger ER. Infant death: an analysis by maternal risk and health care. Washington (DC): Institute of Medicine/National Academy of Sciences; 1973
    Search in Google Scholar
  • 22 Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde, [Health Brazil 2017: an analysis of the health situation and challenges to the achievement of the sustainable development goals]. Brasília (DF): Ministério da Saúde; 2018. . Portuguese.
  • 23 Hosmer Jr DW, Lemeshow S. Applied logistic regression. 2nd ed.. New York: Wiley-Interscience; 2000
    CrossrefSearch in Google Scholar
  • 24 Meyers LS, Gamst G, Guarino AJ. Applied multivariate research: design and interpretation. London: Sage; 2006
    Search in Google Scholar
  • 25 Guimarães EAA, Velásquez-Meléndez G. [Low birth weight determinants from the Born Alive National Surveillance System in Itaúna, Minas Gerais]. Rev Bras Saúde Mater Infant 2002; 2 (03) 283-290 Portuguese.
    CrossrefPubMedSearch in Google Scholar
  • 26 Giglio MRP, Lamounier JA, Morais Neto OL, César CC. [Low birth weight in a cohort of newborns in Goiânia-Brazil in 2000]. Rev Bras Ginecol Obstet 2005; 27 (03) 130-136 Portuguese.
    CrossrefPubMedSearch in Google Scholar
  • 27 Goldenberg P, Figueiredo MdoC, Silva RdeS. [Adolescent pregnancy, prenatal care, and perinatal outcomes in Montes Claros, Minas Gerais, Brazil]. Cad Saude Publica 2005; 21 (04) 1077-1086 Portuguese.
    CrossrefPubMedSearch in Google Scholar
  • 28 Minuci EG, Almeida MF. [Birth weight intra-urban differentials in the city of São Paulo]. Rev Saude Publica 2009; 43 (02) 256-266
    CrossrefPubMedSearch in Google Scholar
  • 29 Nair NS, Rao RSP, Chandrashekar S, Acharya D, Bhat HV. Socio-demographic and maternal determinants of low birth weight: a multivariate approach. Indian J Pediatr 2000; 67 (01) 9-14
    CrossrefPubMedSearch in Google Scholar
  • 30 Kamala BA, Mgaya AH, Ngarina MM, Kidanto HL. Predictors of low birth weight and 24-hour perinatal outcomes at Muhimbili National Hospital in Dar es Salaam, Tanzania: a five-year retrospective analysis of obstetric records. Pan Afr Med J 2018; 29: 220
    CrossrefPubMedSearch in Google Scholar
  • 31 Paz-Zulueta M, Llorca J, Sarabia-Lavín R. et al. The role of prenatal care and social risk factors in the relationship between immigrant status and neonatal morbidity: a retrospective cohort study. PLoS One 2015; 10 (03) e0120765
    CrossrefPubMedSearch in Google Scholar
  • 32 Bell JF, Zimmerman FJ. Selection bias in prenatal care use by Medicaid recipients. Matern Child Health J 2003; 7 (04) 239-252
    CrossrefPubMedSearch in Google Scholar
  • 33 Huang A, Wu K, Zhao W, Hu H, Yang Q, Chen D. Attendance at prenatal care and adverse birth outcomes in China: A follow-up study based on Maternal and Newborn's Health Monitoring System. Midwifery 2018; 57: 26-31
    CrossrefPubMedSearch in Google Scholar
  • 34 Heaman MI, Newburn-Cook CV, Green CG, Elliott LJ, Helewa ME. Inadequate prenatal care and its association with adverse pregnancy outcomes: a comparison of indices. BMC Pregnancy Childbirth 2008; 8: 15
    CrossrefPubMedSearch in Google Scholar
  • 35 do Carmo Leal M, da Gama SG, da Cunha CB. [Consequences of sociodemographic inequalities on birth weight]. Rev Saude Publica 2006; 40 (03) 466-473
    CrossrefPubMedSearch in Google Scholar
  • 36 Kale PL, Lordelo CVM, Fonseca SC. et al. [Adequacy of birth weight for gestational age according to INTERGROWTH-21st curve and factors associated with the small for gestational age]. Cad Saude Colet 2018; 26 (04) 391-399 Portuguese.
    CrossrefPubMedSearch in Google Scholar
  • 37 Koroukian SM, Rimm AA. The “Adequacy of Prenatal Care Utilization” (APNCU) index to study low birth weight: is the index biased?. J Clin Epidemiol 2002; 55 (03) 296-305
    CrossrefPubMedSearch in Google Scholar
  • 38 Reichman NE, Teitler JO. Timing of enhanced prenatal care and birth outcomes in New Jersey's HealthStart program. Matern Child Health J 2005; 9 (02) 151-158
    CrossrefPubMedSearch in Google Scholar
  • 39 Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs 2008; 61 (03) 244-260
    CrossrefPubMedSearch in Google Scholar