title: Adequacy of antenatal care and its relationship with low birth weight in Botucatu, São Paulo, Brazil: a case-control study.
abstract: 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.
authors.affiliation: Department of Pediatrics, Botucatu Medical School, Paulista State University, UNESP, Botucatu, São Paulo, Brazil. catiafonseca@fmb.unesp.br.
authors.forename: Cátia Regina Branco
authors.initials: CR
authors.lastname: da Fonseca
authors.forename: Maria Wany Louzada
authors.initials: MW
authors.lastname: Strufaldi
authors.forename: Lídia Raquel
authors.initials: LR
authors.lastname: de Carvalho
authors.forename: Rosana Fiorini
authors.initials: RF
authors.lastname: Puccini
mesh_terms: D001724:Birth Weight; D001938:Brazil; D016022:Case-Control Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D009819:Office Visits / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D012307:Risk Factors; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data
references.citation: N Engl J Med. 2010 Feb 11;362(6):529-35
references.pmid: 20147718
references.citation: Rev Lat Am Enfermagem. 2013 Mar-Apr;21(2):546-53
references.pmid: 23797548
references.citation: Cad Saude Publica. 2004;20 Suppl 1:S20-33
references.pmid: 16636732
references.citation: Cad Saude Publica. 2012 Mar;28(3):425-37
references.pmid: 22415175
references.citation: Cad Saude Publica. 2008 Aug;24(8):1783-90
references.pmid: 18709219
references.citation: Am J Prev Med. 1987 Sep-Oct;3(5):243-53
references.pmid: 3452362
references.citation: Lancet. 2011 Jun 4;377(9781):1898-900
references.pmid: 21561653
references.citation: Cad Saude Publica. 2007 Sep;23(9):2167-77
references.pmid: 17700951
references.citation: Am J Public Health. 2004 Aug;94(8):1366-71
references.pmid: 15284045
references.citation: Rev Lat Am Enfermagem. 2007 Sep-Oct;15 Spec No:792-8
references.pmid: 17934587
references.citation: Am J Obstet Gynecol. 2010 Aug;203(2):122.e1-6
references.pmid: 20471628
references.citation: Reprod Health. 2012 Aug 22;9:15
references.pmid: 22913663
references.citation: BMC Pregnancy Childbirth. 2009 Jul 22;9:31
references.pmid: 19622174
references.citation: JAMA. 1998 May 27;279(20):1623-8
references.pmid: 9613911
references.citation: BMC Pregnancy Childbirth. 2008 May 01;8:15
references.pmid: 18452623
references.citation: BMC Res Notes. 2012 Jan 23;5:60
references.pmid: 22270068
references.citation: Rev Saude Publica. 2010 Oct;44(5):767-75
references.pmid: 20835496
references.citation: Rev Saude Publica. 2004 Feb;38(1):24-9
references.pmid: 14963538
references.citation: BMC Pregnancy Childbirth. 2010 Feb 23;10 Suppl 1:S3
references.pmid: 20233384
references.citation: Health Policy Plan. 2009 May;24(3):175-88
references.pmid: 19282483
references.citation: BMC Public Health. 2007 Sep 27;7:268
references.pmid: 17900359
references.citation: Lancet. 2011 Jun 11;377(9782):2042-53
references.pmid: 21561659
references.citation: Am J Public Health. 1994 Sep;84(9):1414-20
references.pmid: 8092364
references.citation: Bull World Health Organ. 2005 Mar;83(3):178-85
references.pmid: 15798841
references.citation: Rev Bras Ginecol Obstet. 2008 May;30(5):224-31
references.pmid: 19142497
references.citation: J Clin Epidemiol. 2009 Apr;62(4):438-45
references.pmid: 18945589
references.citation: Cad Saude Publica. 1998 Apr;14(2):367-79
references.pmid: 9658222
references.citation: Aust N Z J Obstet Gynaecol. 2007 Apr;47(2):122-7
references.pmid: 17355301
references.citation: Lancet. 2011 May 28;377(9780):1863-76
references.pmid: 21561656
references.citation: Cad Saude Publica. 2004 Sep-Oct;20(5):1160-8
references.pmid: 15486658