Simone Diniz
University of São Paulo
Simone Diniz MD, MPH, is a full professor at the Department of Maternal and Child Health at the School of Public Health of the University of São Paulo. Coordinates the Gender and evidence in maternity and health research group (GEMAS), and teaches Innovation in maternal health.
Introduction: Gestational age (GA) at birth is the main predictor of newborn health, and spontaneous birth occurs around 40 weeks. In Brazil there is a populational reduction of the GA (left shift), presently around 39 weeks,... [ view full abstract ]
Introduction: Gestational age (GA) at birth is the main predictor of newborn health, and spontaneous 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. The objective of the research was 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 São Pulo (data from Live birth information sector, SINASC) and in Southeastern Brazil (data from “Birth in Brazil National 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 São Paulo, 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.
Discussion In terms of equity, we have an inversion of the expected disparity by worse outcomes of the most privileged mothers, not because of any improvement of the services offered, but by having a negative (iatrogenic) impact on maternal and child health that can even nullify the socioeconomic advantages. When this inversion occurs, the safety of health care might be contributing to this inversion.
Conclusions: Babies born in Southern Brazil have a one week shorter pregnancy, and those born by cesarean and in the private sector lost two gestational weeks. 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 GA (in days or weeks of pregnancy lost) can contribute to a better understanding of the Brazilian perinatal paradox.
1. Studies that integrate knowledge from a range of scientific approaches and/or perspecti , Studies of and contributions to practice and/or service organisation , The identification and examination of relevant outcomes relating to labour and birth , Methodological innovations inthis and associated areas
