Changes in perinatal health in two birth cohorts (1997/1998 and 2010) in São Luís, Maranhão State, Brazil

Silva, Antônio Augusto Moura da; Batista, Rosângela Fernandes Lucena; Simões, Vanda Maria Ferreira; Thomaz, Erika Barbara Abreu Fonseca; Ribeiro, Cecília Cláudia Costa; Lamy Filho, Fernando; Lamy, Zeni Carvalho; Alves, Maria Teresa Seabra Soares de Britto e; Loureiro, Flávia Helen Furtado; Cardoso, Viviane Cunha; Bettiol, Heloisa; Barbieri, Marco Antonio

doi:10.1590/0102-311X00100314

person Antônio Augusto Moura da Silva

schoolCentro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Brasil.

person Rosângela Fernandes Lucena Batista

schoolCentro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Brasil.

person Vanda Maria Ferreira Simões

schoolCentro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Brasil.

person Erika Barbara Abreu Fonseca Thomaz

schoolCentro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Brasil.

person Cecília Cláudia Costa Ribeiro

schoolCentro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Brasil.

person Fernando Lamy Filho

schoolCentro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Brasil.

person Zeni Carvalho Lamy

schoolCentro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Brasil.

person Maria Teresa Seabra Soares de Britto e Alves

schoolCentro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Brasil.

person Flávia Helen Furtado Loureiro

schoolCentro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Brasil.

person Viviane Cunha Cardoso

schoolFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil.

person Heloisa Bettiol

schoolFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil.

person Marco Antonio Barbieri

schoolFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil.

Correspondence. A. A. M. Silva. Departamento de Saúde Pública, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão. Rua Barão de Itapary 155, São Luís, MA 65020-070, Brasil.
aamouradasilva@gmail.com

groupsContributors

A. A. M. Silva conceived the study, performed the statistical analysis, analyzed the data, and wrote, read and approved the final version of the manuscript. R. F. L. Batista and E. B. A. F. Thomaz performed the statistical analysis, analyzed the data, and read and approved the final version of the manuscript. V. M. F. Simões, C. C. C. Ribeiro, F. Lamy-Filho, Z. C. Lamy, M. T. S. S. B. Alves, F. H. F. Loureiro and V. C. Cardoso analyzed the data and read and approved the final version of the manuscript. H. Bettiol and M. A. Barbieri conceived the study, analyzed the data, and read and approved the final version of the manuscript.

Variables	n	%
Monthly family income (minimum wages)
≤ 1.0	764	14.8
1.1-1.9	1,244	24.1
2.0-2.9	820	15.9
3.0-4.9	656	12.7
5.0-9.9	486	9.4
≥ 10.0	267	5.2
Missing	929	18.0
Occupation of the family head
Managers and higher levels professionals	571	11.0
Medium level administrators	487	9.4
Skilled manual workers	248	4.8
Semiskilled manual workers	1,853	35.9
Unskilled manual workers	1,388	26.9
Unemployed	447	8.6
Missing	172	3.3
Number of household members
1-4	3,544	68.6
≥ 5	1,622	31.4
Economic class
A	145	2.8
B	788	15.2
C	2,603	50.4
D	1,125	21.8
E	195	3.8
Missing	310	6.0
Self-reported skin color
White	958	18.5
Black	661	12.8
Mulatto	3,469	67.2
Other	78	1.5
Religion *
Catholic	2,720	52.7
Evangelical	1,418	27.5
Spiritist	27	0.5
Other	16	0.3
None	981	19.0
Maternal job outside the home
Yes	1,737	33.6
No	3,429	66.4
Parity
1	2,443	47.3
2	1,592	30.8
3-4	948	18.4
≥ 5	183	3.5
Previous stillbirth
Yes	151	2.9
No	5,015	97.1
Previous abortion
Yes	1,115	21.6
No	4,051	78.4
Alcohol consumption during pregnancy
Yes	746	14.4
No	4,420	85.6
Maternal smoking during pregnancy
Yes	208	4.0
No	4,958	96.0
Maternal coffee consumption during pregnancy *
Yes	4,576	88.6
No	589	11.4

Variables	n	%
Attended prenatal care
Yes	5,063	98.0
No	103	2.0
Number of prenatal visits
None	103	2.0
1-3	537	10.5
4-5	1,149	22.2
≥ 6	3,117	60.3
Missing	260	5.0
Trimester of beginning of prenatal care
No prenatal care	103	2.0
First	3,418	66.2
Second	1,426	27.6
Third	117	2.3
Missing	102	2.0
Category of prenatal care *
No prenatal care	103	2.0
SUS	4,123	79.9
Health plan/Health insurance	702	13.6
Private	230	4.5
Type of delivery *
Vaginal	2,710	52.5
Cesarean	2,456	47.5
Tubal ligation during cesarean delivery *
Yes	502	9.8
No	4,644	90.2
Professional attending delivery *
Doctor	4,883	94.9
Nurse	200	3.9
Other	61	1.2
The same doctor provided prenatal care and attended delivery *
Yes	892	17.3
No	4,270	82.7
Category of admission *
SUS	4,345	84.1
Health insurance	656	12.7
Private	164	3.2
Total	5,166	100.0

Variables	n	%
Sex
Male	2,631	50.9
Female	2,535	49.1
Professional who attended the newborn
Pediatrician/Neonatologist	2,527	48.9
Obstetrician	1,001	19.4
Anesthesiologist	77	1.5
Nurse	917	17.8
Nurse technician	295	5.7
Other	12	0.2
Missing	337	6.5
Determination of Apgar score
Yes	5,073	98.2
No	93	1.8
Total	5,166	100.0

Variables	1997/1998		2010		p-value *
Variables	n	%	n	%	p-value *
Low birth weight					0.867
No	2,275	91.5	4,706	91.4
Yes	212	8.5	445	8.6
Preterm birth					0.764
No	2,164	86.8	4,497	87.1
Yes	329	13.2	669	12.9
Classification of weight for gestational age **					< 0.001
Small for gestational age	345	13.9	547	10.6
Adequate for gestational age	1,943	78.1	4,187	81.0
Large for gestational age	199	8.0	432	8.4
Type of delivery					< 0.001
Vaginal	1,643	65.9	2,710	52.5
Cesarean	850	34.1	2,456	47.5
Maternal age (years)					< 0.001
< 20	728	29.3	954	18.5
20-34	1,657	66.5	3,805	73.6
35 or more	106	4.3	407	7.9
Maternal schooling (years)					< 0.001
12 or more	120	4.8	779	15.1
9-11	880	35.4	2,983	57.9
5-8	1,059	42.6	1,156	22.4
1-4	273	11.0	208	4.0
0	155	6.2	26	0.5
Marital status					< 0.001
Married	717	28.8	1,126	21.8
Consensual union	1,167	46.8	3,053	59.1
Single	608	24.4	987	19.1
Prenatal care					< 0.001
No	203	8.2	103	2.0
Yes	2,262	91.8	5,063	98.0
Beginning of prenatal care					< 0.001
No prenatal care	203	8.2	103	2.0
First trimester	1,401	56.5	3,418	67.5
Second trimester	799	32.2	1,426	28.2
Third trimester	79	3.2	117	2.3
Infant mortality rate
No	2,422		5,100
Yes	71	35.8 ***	66	16.2 ***	< 0.001
Neonatal mortality rate
No	2,443		5,120
Yes	50	26.4 ***	46	11.9 ***	< 0.001
Perinatal mortality rate
No	2,448		5,128
Yes	93	44.7 ***	108	25.0 ***	< 0.001
Stillbirth rate
No	2,493		5,166
Yes	48	25.0 ***	70	16.9 ***	0.062

[TFN1] * Missing values were excluded.

Changes in perinatal health in two birth cohorts (1997/1998 and 2010) in São Luís, Maranhão State, Brazil

Mudanças na saúde perinatal em duas coortes de nascimento (1997/1998 e 2010) em São Luís, Maranhão, Brasil

Cambios en la salud perinatal en dos cohortes de nacimiento (1997-1998 y 2010) en São Luís, Maranhão, Brasil

Abstract