Risk factors for low birth weight in Botucatu city, SP state, Brazil: a study conducted in the public health system from 2004 to 2008

Effective factors on nutrition behaviors of pregnant women based on the beliefs, attitudes, subjective norms, and enabling factors model: A cross-sectional study

BACKGROUND

One of the useful models in health education is the Beliefs, Attitudes, Subjective Norms, and Enabling Factors (BASNEF) model. The model is used to study behavior and to plan for change it and to determine the factors that influence people's decision-making. The aim of this study was to investigate the factors affecting the nutritional behavior of pregnant women based on BASNEF model.

MATERIALS AND METHODS

This cross-sectional study was performed on 360 pregnant women referring to health centers of Tabriz-Iran by two-stage cluster sampling method from April to December 2016. Data were collected using sociodemographic, nutrition subdomain of Health Promoting Lifestyle-II (HPLP-II), and researcher-made questionnaire based on constructs of BASNEF model. Data were analyzed using the SPSS software version 21 and Pearson correlation test and General Linear Model (GLM).

RESULTS

Mean ± standard deviation (SD) of nutrition subdomain of HPLP-II was 24.65 ± 4.75 within the range 9-36. Mean ± SD of BASNEF model constructs (score range) was also obtained as 45.30 ± 10.80 (0-100), 17.98 ± 2.40 (8-24), 9.30 ± 2.82 (0-20) and 2.47 ± 1.74 (0-6) for belief, attitude, subjective norms, and enabling factors, respectively. Based on the GLM, there was significant relationships between nutritional behavior and BASNEF model constructs (belief [P < 0.001], attitude [P = 0.043], enabling factors [P < 0.001], and subjective norms [P = 0.038]) as well as the variables of job, husband's education, and job and sufficiency of income for expenses.

CONCLUSION

The results of the present study showed the impact of BASNEF model constructs and some sociodemographic variables on nutrition behaviors in pregnant women. Therefore, in order to improve nutrition behaviors of pregnant women, designing and implementation of interventions based on the BASNEF model are recommended.

Low birthweight of children is positively associated with mother's prenatal tobacco smoke exposure in Shanghai: a cross-sectional study

INTRODUCTION

Low birthweight (LBW) is a significant public health issue, and maternal smoking is the most prevalent preventable cause of LBW. But there is limited evidence on association of LBW among children and cigarette smoke exposure in mothers in China. In this cross-sectional study, we try to explore if the LBW in children is positively associated with mothers' prenatal cigarette smoke exposure.

METHODS

We selected 8, 586 mothers and their singleton children in 2018 in Songjiang district, Shanghai. Birthweight of children and gestational weeks of mother was identified by birth records in the hospital, we classified mothers' prenatal cigarette smoke status into the first-hand smoke (FHS) exposure and the second-hand smoke (SHS) exposure. We use SAS 9.1.3 software to calculate the prevalence of children's LBW and the prevalence of mothers' prenatal cigarette smoke exposure including FHS and SHS. Chi-square test and logistic regression were used to analyze the difference.

RESULTS

In 8, 586 women, The prenatal FHS and SHS exposure prevalence was 0.9 and 20.8%, respectively. The mean birthweight of children was 3315.5 g with a standard deviation of 497.2 g, the mean birthweight was 167.7 g and 66.1 g lower in children born to mothers with prenatally FHS and SHS exposure compared with those children whose mother were not exposed, respectively. The children's LBW prevalence was 4.7% in this study. By comparing with children whose mother were not exposed, the LBW prevalence was higher among children whose mother were prenatally exposed to FHS [OR (Odds Ratios) = 2.91, 95% confidence interval (CI) (1.49, 5.68)], and SHS [OR = 2.35, 95% CI (1.90, 2.89)].

CONCLUSIONS

Children's LBW is positively associated with mothers' prenatal tobacco smoke exposure both for FHS and SHS. So implementing tobacco control measures is crucial to lower smoking prevalence among women, and decrease smoking prevalence of their family members as well as work fellows.

Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health

Background

Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth.

Methods

Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI.

Results

The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy.

Conclusion

Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.

Low birth weight and its associated factors

OBJECTIVE

To calculate the frequency and evaluate the factors associated with low birth weight.

METHODS

A retrospective study, with data from pregnant women who participated in the Programa de Atenção às Gestantes do Programa Einstein na Comunidade de Paraisópolis, between 2011 and 2014, and who returned for the postpartum evaluation of their newborns. Variables related to the pregnant woman, pregnancy, and newborn were evaluated. The outcome variable was low birth weight, defined as <2.5kg. The associations between the independent variables and low birth weight were assessed by χ2 and Mann-Whitney tests. Logistic regression models analyzed the combined effects of the independent variables on low birth weight.

RESULTS

Data of 794 pregnant women and their newborns (52.1% males) were analyzed. The age of pregnant women varied from 13 to 44 years (median of 24 years), and the majority reported being married or living in cohabitation (74.7%), and having between 9 to 11 years of schooling (53.4%). The proportion of low birth weight was 7.6% (newborn mean weight of 3.2kg) and, in multivariate analysis, presence of twinning, age group of the pregnant women (showing protection for low birth weight between ages ≥18 years and <35 years), and cesarean section were associated with low birth weight.

CONCLUSION

The proportion of low birth weight was 7.6% and twining, age of the pregnant woman, and cesarean delivery were associated with the occurrence of low birth weight.

Twin Pregnancy in Brazil: A Profile Analysis Exploring Population Information from the National Birth E-Registry on Live Births

Birth records as SINASC (Brazilian Live Birth Information System) are highlighted in uncommon conditions such as twin pregnancy whose prevalence rarely exceeds 2 to 3% of the total number of births. The objective of this study was to assess the prevalence of twin pregnancies in Brazil and their maternal and perinatal characteristics using data from the national birth e-Registry. All births in Brazil from 2011 to 2014 were assessed. Prevalence of twin pregnancies per region was assessed and correlated with the Human Development Index (HDI). Sociodemographic and obstetric factors and main perinatal outcomes were assessed for the first and second twin, in comparison to singletons, and the second twin compared to the first twin, with PR and 95%CI. A multiple logistic regression analysis was conducted to identify factors independently associated with a low 5-minute Apgar score in twin pregnancies. Twin pregnancy occurred in 1.13% in Brazil, with a higher prevalence in regions with a higher HDI. It was associated with a complete higher level of education (22.9% versus 16.3% for singles) and maternal age > 35 years (17.5% versus 11.4% for singles). Preterm birth <32 weeks (prevalence ratio-PR 12.13 [11.93 – 12.33]), low birth weight (PR 17.8 [17.6-18.0] for the first and PR 20.1 [19.8-20.3] for the second twin), and low Apgar score (PR 2.9 [2.8-3.0] for the first and PR 2.7 [2.6-2.8] for the second twin) were the most important perinatal outcomes associated with twin pregnancies. A 5-minute Apgar score < 7 among twins was associated with inadequate prenatal care, extreme preterm birth, vaginal delivery, intrapartum cesarean, and combined delivery. Twin pregnancy in Brazil is associated with worse perinatal outcomes, especially for the second twin.

Two-Year Comparison of Growth Indices of Twins with Dissimilar Weight at Birth (Low Birth Weight vs. Normal Twin)

BACKGROUND

Twin pregnancies are commonly associated with low birth weight (LBW) infants. Most studies focus on growth of LBW compared with normal infants in singleton. However, there has not been any study on twins to compare LBW with normal birth weight (NBW) infants as a match control of the same twin.

METHODS

This cohort study was conducted at Healthcare centers of Kashan, in 2013. Twins differing in birth weight (one with LBW and the other with NBW) were assessed using the care charts in Well Care program in regard to weight, height and head circumference measurements at birth and after 6, 12, 24 months of age and were compared separately between all matched pairs and in four sex-twin subgroups which was defined according to the sex of each twin in pairs; SF (Same-sex: Female), SM (Same-sex: Male), LF (LBW: Female) and LM (LBW: Male).

RESULTS

Incidence of dissimilar twins in birth weight was 28.4%. The weight of LBW was significantly lower than the NBW cohort in SF and LF subgroups up to 24 months. The height of LBW was not significantly different from NBW cohort in SM and LM subgroups up to 24 month. Head circumference was significantly higher in LBW compared to NBW cohort in LM subgroup up to 24 month. However, these indices were significantly lower in LBW compared to NBW cohort in all pairs.

CONCLUSION

Although LBW cohort was significantly lower than the NBW in growth indices at birth to 2 years old in all twins, however, highly variable results was observed in four subgroups of sex-twin.

Adequacy of antenatal care and its relationship with low birth weight in Botucatu, São Paulo, Brazil: a case-control study

BACKGROUND

Birth weight reflects gestational conditions and development during the fetal period. Low birth weight (LBW) may be associated with antenatal care (ANC) adequacy and quality. The purpose of this study was to analyze ANC adequacy and its relationship with LBW in the Unified Health System in Brazil.

METHODS

A case-control study was conducted in Botucatu, São Paulo, Brazil, 2004 to 2008. Data were collected from secondary sources (the Live Birth Certificate), and primary sources (the official medical records of pregnant women). The study population consisted of two groups, each with 860 newborns. The case group comprised newborns weighing less than 2,500 grams, while the control group comprised live newborns weighing greater than or equal to 2,500 grams. Adequacy of ANC was evaluated according to three measurements: 1. Adequacy of the number of ANC visits adjusted to gestational age; 2. Modified Kessner Index; and 3. Adequacy of ANC laboratory studies and exams summary measure according to parameters defined by the Ministry of Health in the Program for Prenatal and Birth Care Humanization.

RESULTS

Analyses revealed that LBW was associated with the number of ANC visits adjusted to gestational age (OR = 1.78, 95% CI 1.32-2.34) and the ANC laboratory studies and exams summary measure (OR = 4.13, 95% CI 1.36-12.51). According to the modified Kessner Index, 64.4% of antenatal visits in the LBW group were adequate, with no differences between groups.

CONCLUSIONS

Our data corroborate the association between inadequate number of ANC visits, laboratory studies and exams, and increased risk of LBW newborns. No association was found between the modified Kessner Index as a measure of adequacy of ANC and LBW. This finding reveals the low indices of coverage for basic actions already well regulated in the Health System in Brazil. Despite the association found in the study, we cannot conclude that LBW would be prevented only by an adequate ANC, as LBW is associated with factors of complex and multifactorial etiology. The results could be used to plan monitoring measures and evaluate programs of health care assistance during pregnancy, at delivery and to newborns, focusing on reduced LBW rates.

Maternal Weight Gain during Pregnancy and Somatic Classification of Neonates According to Birth Weight and Duration of Pregnancy Taking Account of Maternal Body Weight and Height

Background and Aim: The classification of weight gain during pregnancy and the somatic classification of neonates according to birth weight and duration of pregnancy can be done using percentile values. We aimed to compare such classifications using percentiles of the overall study population with classifications using percentiles that were calculated taking account of maternal height and weight. Material and Methods: Using data from the German Perinatal Survey (1995-2000, over 2.2 million singleton pregnancies) we classified weight gain during pregnancy as low (< 10th percentile), high (> 90th percentile), or medium (10th-90th percentile). Neonates were classified by birth weight as small for gestational age (SGA, < 10th percentile), large for gestational age (LGA, > 90th percentile), or appropriate for gestational age (AGA, 10th-90th percentile). Classifications were performed for 12 groups of women and their neonates formed according to maternal height and weight, either with the percentiles calculated from the total study population or with group-specific percentiles. Results: Using percentiles of the total study population there was large variability between the 12 groups in the proportions with low and high weight gain and in the proportions of SGA and LGA neonates. The variability was much lower when group-specific percentiles were used. Conclusions: Classifications of maternal weight gain during pregnancy and birth weight differ substantially, depending on whether percentiles calculated from the total study population or group-specific percentiles are used. The impact of using percentiles that take account of maternal anthropometric parameters for the medical care and health of neonates needs to be elucidated in future research.

The effect of the season of birth and of selected maternal factors on linear enamel thickness in modern human deciduous incisors

OBJECTIVE

Development of human tooth enamel is a part of a foetus's development; its correctness is the outcome of genetic and maternal factors shaping its prenatal environment. Many authors reported that individuals born in different seasons experience different early developmental conditions during pregnancy. In this study, we investigated the effects of season of birth and selected maternal factors on enamel thickness of deciduous incisors.

DESIGN

Dental sample comprises 60 deciduous incisors. The parents who handed over their children's teeth for research fill in questionnaires containing questions about the course of pregnancy. All teeth were sectioned in the labio-linqual plane using diamond blade (Buechler IsoMet 1000). The final specimens were observed by way of scanning electron microscopy at magnifications 80× and 320×. The thickness of total enamel (TE), prenatally (PE) and postnatally (PSE) formed enamel was measured.

RESULTS

Children born in summer and in spring (whose first and second foetal life fall on autumn and winter) have the thinnest enamel. Season of birth, number of children in family, diseases and spasmolytic medicines using by mother during pregnancy explained almost 13% of the variability of TE. Regression analysis proved a significant influence of the season of birth and selected maternal factors on the PE thickness - these factors explained over 17% of its variability. Neither of analysed variables had influenced PSE.

CONCLUSIONS

Our findings suggests that the thickness of enamel of deciduous incisors depends on the season of birth and some maternal factors. The differences were observed only in the prenatally formed enamel.