Association between Prenatal Care Adequacy Indexes and Low Birth Weight Outcome

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.

Publikationsverlauf

Eingereicht: 29. Mai 2020

Angenommen: 08. Dezember 2020

Artikel online veröffentlicht:
12. Mai 2021

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