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
DOI:
https://doi.org/10.7322/jhgd.113712Palabras clave:
Midwifery. Cesarean section. Premature infant. Equity. Women’s health.Resumen
Introduction: Gestational age (GA) at birth is the main predictor of newborn health, and pontaneous birth occurs around 40 weeks. In Brazil there is a populational reduction of the GA (left shift), presently around 39 weeks, due to interventions in childbirth. Objective: To analyze the left shift of gestational age (LDGA) in São Paulo City (SP) and in Southeastern Brazil, and associated factors. Methods: Epidemiological descriptive study of LDGA in SP (data from Live birth information sector, SINASC) and in Southeastern Brazil (data from “Birth in Brazil Survey”). Differences in GA were estimated, by type of birth (vaginal or cesarean) and payment source (public or private), using GA distribution curves in weeks. Results: In SP, the peak of the curve for GA for vaginal births was 39 weeks, while for cesarean was 38 weeks. Most vaginal births were full term (39-406/7) while most cesarean were early term (37-386/7). In the private sector, there were more caesarean sections and lower GA at birth, with more preterm newborns and 60.4% being born early term, while in the public sector, 58.7% of births were full term, and a much higher proportion reaching 40 weeks. Conclusions: Babies born by cesarean and in the private sector lost one additional gestational week. There was an inversion in the expected disparity, with well-off women achieving poorer outcomes compared to the disadvantaged mothers. The use of continuous variables to estimate the IG (in days or weeks of pregnancy lost) can contribute to a better understanding of the Brazilian perinatal paradox.
Descargas
Referencias
Nassar N, Schiff M, Roberts CL. Trends in the distribution of gestational age and contribution of planned births in New South Wales, Australia. PLoS One. 2013;8(2):e56238. DOI: http://dx.doi.org/10.1371/journal.pone.0056238
Spong CY. Defi ning “Term” Pregnancy. Recommendations From the Defi ning “Term” Pregnancy. Workgroup. JAMA. 2013;309(23):2445-6. DOI: http://dx.doi.org/10.1001/jama.2013.6235.
Loftin RW, Habli M, Snyder CC, Cormier CM, Lewis DF, DeFranco EA. Late preterm birth. Rev Obs Gynecol. 2010;3(1):10-19.
Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller A-B, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a sectoratic analysis and implications. Lancet. 2012; 79(9832):2162-72. DOI: http://dx.doi.org/10.1016/S0140-6736(12)60820-4.
The American College of Obstetricians and Gynecologists (ACOG). Committee on Obstetric Practice Society for Maternal-Fetal Medicine. Defi nition of term pregnancy. Obstet Gynecol. 2013;122:1139-40.
Engle WA. Morbidity and mortality in late preterm and early term newborns: a continuum. Clin Perinatol. 2011;38(3):493-516. DOI: http://dx.doi.org/10.1016/j.clp.2011.06.009
Wu CS, Sun Y, Nohr EA, Olsen J. Trends in All-Cause Mortality across Gestational Age in Days for Children Born at Term. PLoS One. 2015; 10(12):e0144754. DOI: http://dx.doi.org/10.1371/journal.pone.0144754
Diniz SG, d’Oliveira AF, Lansky S. Equity and women’s health services for contraception, abortion and childbirth in Brazil. Reprod Health Matters. 2012;20(40):94-101. DOI: http://dx.doi.org/10.1016/S0968-8080(12)40657-7
Leal MC, Pereira APE, Domingues RMSM, Theme Filha MM, Dias MAB, Nakamura-Pereira M, et al. Intervenções obstétricas durante o trabalho de parto e parto em mulheres brasileiras de risco habitual. Cad Saude Publica. 2014; 30(suol.1):17-32. DOI: http://dx.doi.org/10.1590/0102-311X00151513
Hillman N, Kallapur SG, Jobe A. Physiology of transition from intrauterine to extrauterine life. Clin Perinatol. 2012;39(4):769-83. DOI: http://dx.doi.org/10.1016/j.clp.2012.09.009
Sakala C, Romano AM, Buckley SJ. Hormonal physiology of childbearing, an essential framework for maternal–newborn nursing. J Obstet Gynecol Neonatal Nurs. 2016; S0884-2175(15)00052-0. DOI: http://dx.doi.org/10.1016/j.jogn.2015.12.006
Engle WA, Kominiarek MA. Late preterm infants, early term infants, and timing of elective deliveries. Clin Perinatol. 2008; 35(2):325-41. DOI: http://dx.doi.org/10.1016/j.clp.2008.03.003
Pereira APE, Leal MC, Gama SGN, Domingues RMSM, Schilithz AOC, Bastos MH. Determinação da idade gestacional com base em informações do estudo Nascer no Brasil. Cad Saude Publica. 2014;30(supl.1):S59-70. DOI: http://dx.doi.org/10.1590/0102-311X00160313
Leal MC, da Silva AA, Dias MA, da Gama SG, Rattner D, Moreira ME, et al. Birth in Brazil: national survey into labour and birth. Reprod Health. 2012; 9:15. DOI: http://dx.doi.org/10.1186/1742-4755-9-15
Vasconcellos MTL, Silva PLN, Pereira APE, Schilithz AOC, Souza Junior PRB, Szwarcwald CL. Desenho da amostra Nascer no Brasil: Pesquisa Nacional sobre Parto e Nascimento. Cad Saude Publica. 2014;30(supl.1): S49-58. DOI: http://dx.doi.org/10.1590/0102-311X00176013
World Health Organization (WHO). WHO statement on caesarean section rates. Geneva: World Health Organization; 2015.
Bordner K, Wierrani F, Grünberger W, Bodner-Adler B. Infl uence of the mode of delivery on maternal and neonatal outcomes: a comparison between elective cesarean section and planned vaginal delivery in a low-risk obstetric population. Arch Gynecol Obstet. 2011;283(6):1193-8. DOI: http://dx.doi.org/10.1007/s00404-010-1525-y
Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ. 2008;336:85-7. DOI: http://dx.doi.org/10.1136/bmj.39405.539282.BE
Cho CE, Norman M. Cesarean section and development of the immune sector in the offspring. Am J Obstet Gynecol. 2013; 208(4):249-54. DOI: http://dx.doi.org/10.1016/j.ajog.2012.08.009
Darmasseelane K, Hyde MJ, Santhakumaran S, Gale C, Modi N. Mode of Delivery and Offspring Body Mass Index, overweight and obesity in adult life: a systematic review and meta-analysis. PLoS One. 2014;9(5):e97827. DOI: http://dx.doi.org/10.1371/journal.pone.0097827
Rodrigues OMPR, Bolsoni-Silva AT. Effects of the prematurity on the development of lactentes. Rev Bras Crescimento Desenvolv Hum. 2011;21(14):111-21.
Domingues RMSM, Dias MAB, Nakamura-Pereira M, Torres JA, d’Orsi E, Pereira APE, et al. Processo de decisão pelo tipo de parto no Brasil: da preferência inicial das mulheres à via de parto fi nal. Cad Saude Publica. 2014;S101-16. DOI: http://dx.doi.org/10.1590/0102-311X00105113
Lino HC, Diniz SG.You take care of the baby’s clothes and i take care of the delivery” – communication between professionals and patients and decisions about the mode of delivery in the private sector in São Paulo, Brazil. J Hum Growth Dev. 2015;25(1):117-24. DOI: http://dx.doi.org/10.7322/jhgd.96825
Victoria CG, Aquino EML, do Carmo Leal M, Monteiro CA, Barros FC, Szwarcwald CL, et al. Maternal and child health in Brazil: progress and challenges. Lancet. 2011; 377(9780):1863-76. DOI: http://dx.doi.org/10.1016/S0140-6736(11)60138-4
Barros FC, Rossello JLD, Matijasevich A, Dumith SC, Barros AJD, Santos IS, et al. Gestational age at birth and morbidity, mortality, and growth in the fi rst 4 years of life: fi ndings from three birth cohorts in Southern Brazil. BMC Pediatr. 2012;12(1):169. DOI: http://dx.doi.org/10.1186/1471-2431-12-169
Silveira MF, Santos IS, Barros AJD, Matijasevich A, Barros FC, Victora CG. Aumento da prematuridade no Brasil: revisão de estudos de base populacional. Rev Saude Publica. 2008; 42(5):957-64. DOI: http://dx.doi.org/10.1590/S0034-89102008000500023
Silva AAM, Silva LM, Barbieri MA, Bettiol H, Carvalho LM, Ribeiro VS, et al. The epidemiologic paradox of low birth weight in Brazil. Rev Saúde Pública. 2010; 44(5):767-75. DOI: http://dx.doi.org/10.1590/S0034-89102010005000033
Diniz CSG. Gênero, saúde materna e o paradoxo perinatal. Rev Bras Crescimento Desenvolv Hum. 2009;19(2):313-26.
Descargas
Publicado
Número
Sección
Licencia
CODE OF CONDUCT FOR JOURNAL PUBLISHERS
Publishers who are Committee on Publication Ethics members and who support COPE membership for journal editors should:
- Follow this code, and encourage the editors they work with to follow the COPE Code of Conduct for Journal Edi- tors (http://publicationethics.org/files/u2/New_Code.pdf)
- Ensure the editors and journals they work with are aware of what their membership of COPE provides and en- tails
- Provide reasonable practical support to editors so that they can follow the COPE Code of Conduct for Journal Editors (http://publicationethics.org/files/u2/New_Code.pdf_)
Publishers should:
- Define the relationship between publisher, editor and other parties in a contract
- Respect privacy (for example, for research participants, for authors, for peer reviewers)
- Protect intellectual property and copyright
- Foster editorial independence
Publishers should work with journal editors to:
- Set journal policies appropriately and aim to meet those policies, particularly with respect to:
– Editorial independence
– Research ethics, including confidentiality, consent, and the special requirements for human and animal research
– Authorship
– Transparency and integrity (for example, conflicts of interest, research funding, reporting standards
– Peer review and the role of the editorial team beyond that of the journal editor
– Appeals and complaints
- Communicate journal policies (for example, to authors, readers, peer reviewers)
- Review journal policies periodically, particularly with respect to new recommendations from the COPE
- Code of Conduct for Editors and the COPE Best Practice Guidelines
- Maintain the integrity of the academic record
- Assist the parties (for example, institutions, grant funders, governing bodies) responsible for the investigation of suspected research and publication misconduct and, where possible, facilitate in the resolution of these cases
- Publish corrections, clarifications, and retractions
- Publish content on a timely basis
