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ORIGINAL ARTICLE • Cad. Saúde. Colet. 34 (1) • 2026 • https://doi.org/10.1590/1414-462X202634010199 linkcopy

Adequacy of prenatal care in Primary Care in a municipality of northeastern Brazil

Adequação da assistência pré-natal na Atenção Básica em um município do nordeste brasileiro

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background: Prenatal care is an essential component of maternal and child health promotion, and, when it is improperly offered, it can result in adverse maternal and perinatal conditions.

Objective: To analyze the adequacy of prenatal care in Primary Care in a municipality in northeastern Brazil.

Method: Cross-sectional study with 613 puerperal women, carried out between September 2017 and May 2018. The research considered the beginning of prenatal care, number of consultations, registration of routine tests and procedures performed in consultations and maternal guidance received, according to the Ministry of Health. Simple and multiple logistic regression were used to estimate the odds ratio (OR) between sociodemographic, obstetric and service use characteristics and the outcome variable prenatal adequacy.

Results: Women aged <18 years were less likely to start early prenatal care. Belonging to the economic class B-C, having a partner and having one or two children, performing prenatal care in a traditional Basic Health Unit and having paid work increased the chances of adequacy.

Conclusions: Prenatal care in Primary Care in the municipality in question proved to be inadequate, with the persistence of socioeconomic inequalities

Keywords:
prenatal care; primary health care; quality indicators, health care; health evaluation.

Characteristics	Total n (%)	Adequacy of early start		Adequacy of number of prenatal consultations		Adequacy of tests performed		Adequacy of procedures performed		Adequacy of maternal guidelines		Prenatal adequacy*
Characteristics	Total n (%)	n (%)	p-value	n (%)	p-value	n (%)	p-value	n (%)	p-value	n (%)	p-value	n (%)	p-value
Age (years)
<18	68 (11.09)	36 (52.9)	0.017	55 (80.9)	0.104	1 (1.5)	0.709†	8 (11.8)	0.834	27 (39.7)	0.308	-	1,000†
≥18	545 (88.91)	368 (67.5)	0.017	479 (87.9)	0.104	17 (3.1)	0.709†	69 (12.7)	0.834	252 (46.2)	0.308	4 (0.7)	1,000†
Schooling (years of study)
≤8	289 (47.22)	372 (65.6)	0.655	495 (87.3)	0.582	17 (3.0)	1.000†	75 (13.2)	0.087	262(46.2)	0.167	4 (0.7)	1,000†
>8	323 (52.78)	31 (68.9)	0.655	38 (84.4)	0.582	1 (2.2)	1.000†	2 (4.4)	0.087	16 (35.6)	0.167	-	1,000†
Economic class‡
B-C	240 (39.15)	174 (72.5)	0.006	210 (87.5)	0.818	10 (4.2)	0.148	33 (13.8)	0.476	116 (48.3)	0.261	3 (1.3)	0,305†
D-E	373 (60.85)	230 (61.7)	0.006	324 (86.9)	0.818	8 (2.1)	0.148	44 (11.8)	0.476	163 (43.7)	0.261	1 (0.3)	0,305†
Skin color (self-reported)
White	163 (26.59)	111 (68.1)	0.491	142 (87.1)	0.999	8 (4.9)	0.102†	17 (10.4)	0.338	73 (44.8)	0.827	1 (0.6)	1,000†
Black	450 (73.41)	293 (65.1)	0.491	392 (87.1)	0.999	10 (2.2)	0.102†	60 (13.3)	0.338	206 (45.8)	0.827	3 (0.7)	1,000†
Paid work
Yes	234 (38.17)	166 (70.9)	0.039	208 (88.9)	0.302	10 (4.3)	0.123	28 (12.0)	0.727	123 (52.6)	0.006	3 (1.3)	0,158†
No	379 (61.83)	238 (62.8)	0.039	326 (86.0)	0.302	8 (2.1)	0.123	49 (12.9)	0.727	156 (41.2)	0.006	1 (0.3)	0,158†
Having a partner
Yes	511 (83.36)	349 (68.3)	0.005	449 (87.9)	0.212	17 (3.3)	0.334†	65 (12.72)	0.790	232 (45.4)	0.900	3 (0.6)	0,518†
No	102 (16.64)	55 (53.9)	0.005	85 (83.3)	0.212	1 (1.0)	0.334†	12 (11.76)	0.790	47 (46.1)	0.900	1 (1.0)	0,518†
Number of children
1-2	484 (78.96)	331 (68.4)	0.012	428 (88.4)	0.059	13 (2.7)	0.555†	61 (12.6)	0.951	222 (45.9)	0.733	3 (0.6)	1,000†
≥3	129 (21.04)	73 (56.6)	0.012	106 (82.2)	0.059	5 (3.9)	0.555†	16 (12.4)	0.951	57 (44.2)	0.733	1 (0.8)	1,000†
Place of prenatal care
Traditional BHU	143 (23.33)	90 (62.9)	0.392	130 (90.9)	0.125	5 (3.5)	0.583†	29 (20.3)	0.001	61 (42.7)	0.433	2 (1.4)	0,233†
FHU	470(76.02)	314 (66.8)	0.392	404 (86.0)	0.125	13 (2.8)	0.583†	48 (10.2)	0.001	218 (46.4)	0.433	2 (0.4)
Pregnancy complications
Yes	246 (40.13)	163 (66.3)	0.879	216 (87.8)	0.675	11 (4.5)	0.065	36 (14.6)	0.205	122 (49.6)	0.097	3 (1.2)	0,308†
No	367 (59.87)	241 (65.7)	0.879	318 (86.6)	0.675	7 (1.9)	0.065	41 (11.2)	0.205	157 (42.8)	0.097	1 (0.3)	0,308†
Negative outcome in pregnancy
Yes	43 (7.01)	27 (62.8)	0.655	39 (90.7)	0.467	1 (2.3)	1.00†	8 (18.6)	0.215	17 (39.5)	0.414	-	1,000†
No	570 (92.99)	377 (66.1)	0.655	495 (86.8)	0.467	17 (3.0)	1.00†	69 (12.1)	0.215	262 (46.0)	0.414	4 (0.7)	1,000†

Characteristics	Adequacy of early start		Adequacy of number of prenatal consultations		Adequacy of tests performed		Adequacy of procedures performed		Adequacy of maternal guidelines
Characteristics	OR_b (95%CI)	p-value	OR_b(95%CI)	p-value	OR_b(95%CI)	p-value	OR_b(95%CI)	p-value	OR_b(95%CI)	p-value
Age (years)
<18	0.54 (0.33–0.90)	0.018	0.58 (0.30–1.12)	0.107	0.46 (0.06–3.54)	0.459	0.92 (0.42–2.00)	0.834	0.77 (0.46–1.28)	0,309
≥18	1	0.018	1	0.107	1	0.459	1	0.834	1	0,309
Schooling (years of study)
≤8	0.86 (0.45–1.66)	0.655	1.27 (0.55–2.54)	0.583	1.36 (0.18–10.46)	0.768	3.28 (0.78–13.81)	0.106	1.56 (0.83–2.93)	0,170
>8	1	0.655	1	0.583	1	0.768	1	0.106	1	0,170
Economic class#
B-C	1.64 (1.15–2.33)	0.006	1.06 (0.65–1.72)	0.818	1.98 (0.77–5.10)	0.155	1.19 (0.73–1.93)	0.477	1.21 (0.87–1.67)	0,261
D-E	1	0.006	1	0.818	1	0.155	1	0.477	1	0,261
Skin color (self-reported)
White	1.14 (0.78–1.68)	0.491	1.00 (0.59–1.71)	0.999	2.27 (0.88–5.86)	0.090	0.76 (0.43–1.34)	0.339	0.96 (0.67–1.38)	0,827
Black	1	0.491	1	0.999	1	0.090	1	0.339	1	0,827
Paid work
Yes	1.45 (1.02–2.05)	0.039	1.30 (0.79–2.15)	0.303	2.07 (0.81–5.32)	0.131	0.95 (0.56–1.50)	0.727	1.58 (1.14–2.20)	0,006
No	1	0.039	1	0.303	1	0.131	1	0.727	1	0,006
Having a partner
Yes	1.84 (1.20–2.84)	0.006	1.45 (0.81–2.60)	0.214	3.48 (0.46–26.41)	0.229	1.09 (0.57–2.11)	0.790	0.97 (0.64–1.50)	0,900
No	1	0.006	1	0.214	1	0.229	1	0.790	1	0,900
Children number
1–2	1.66 (1.12–2.47)	0.012	1.66 (0.98–2.82)	0.061	0.69 (0.24–1.96)	0.479	1.02 (0.57–1.83)	0.951	1.07 (0.72–1.58)	0,733
≥3	1	0.012	1	0.061	1	0.479	1	0.951		0,733
Place of prenatal care
Traditional BHU	0.84 (0.57–1.25)	0.393	1.63 (0.87–3.06)	0.125	1.27 (0.45–3.06)	0.651	2.24 (1.35–3.71)	0.002	0.86 (0.59–1.26)	0,434
FHU	1	0.393	1	0.125	1	0.651	1	0.002	1	0,434
Pregnancy complications
Yes	1.03 (0.73–1.44)	0.879	1.11 (0.68–1.80)	0.675	2.41 (0.92–6.30)	0.073	1.36 (0.84–2.20)	0.206	1.32 (0.95–1.82)	0,097
No	1	0.879	1	0.675	1	0.073	1	0.206	1	0,097
Negative outcome in pregnancy
Yes	0.86 (0.46–1.64)	0.655	1.48 (0.51–4.25)	0.469	0.78 (0.10–5.96)	0.806	1.66 (0.74–3.72)	0.219	0.77 (0.41–1.45)	0,415
No	1	0.655	1	0.469	1	0.806	1	0.219	1	0,415

	OR_a (95%CI)	p-value
	Adequacy of early start	p-value
Age (years)
<18	0.55 (0.32–0.93)	0.026
≥18	1	0.026
Economic class
B-C	1.45 (1.01–2.09)	0.044
D-E	1	0.044
Paid work
Yes	1.241 (0.86–1.79)	0.247
No	1	0.247
Having a partner
Yes	1.68 (1.08–2.61)	0.021
No	1	0.021
Number of children
1–2	1.70 (1.12–2.57)	0.012
≥3	1	0.012
Adequacy of number of prenatal consultations
Age (years)
<18	0.52 (0.26–1.02)	0.059
≥18	1	0.059
Number of children
1–2	1.83 (1.06–3.16)	0.031
≥3 or more	1	0.031
Prenatal care location
Traditional BHU	1.54 (0.82–2.89)	0.184
FHU	1	0.184
Adequacy of examinations performed
Economic class
B-C	1.764 (0.68–4.61)	0.247
D-E	1	0.247
Skin color (self-reported)
White	2.23 (0.85–5.81)	0.102
Black	1	0.102
Paid work
Yes	1.67 (0.64–4.40)	0.296
No	1	0.296
Pregnancy complications
Yes	2.34 (0.88–6.18)	0.087
No	1	0.087
Adequacy of procedures performed
Schooling (years of study)
≤8	3.14 (0.74–13.28)	0.121
>8	1	0.121
Place of prenatal care
Traditional BHU	2.20 (1.33–3.65)	0.002
FHU	1	0.002
Adequação orientações maternas
Schooling time (years of study)
≤8	1.60 (0.85–3.02)	0.149
>8	1	0.149
Paid work
Yes	1.55 (1.11–2.16)	0.009
No	1	0.009
Pregnancy complications
Yes	1.28 (0.92–1.77)	0.144
No	1	0.144

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E-mail: cadernos@iesc.ufrj.br

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