Page 26 - IJPS-10-3

International Journal of
Population Studies Prenatal care in Santa Catarina, Brazil

syphilis test, qualitative urine test, blood glucose, human 2.4. Statistical analysis
immunodeficiency virus (HIV) test, and toxoplasmosis The data were tabulated in a Microsoft Excel spreadsheet
test. Inadequacy was determined by the beginning of and analyzed using the Jamovi 2.2.5 and Stata 16.0 Software
prenatal care after 28 weeks and <3 physician office visits packages. Quantitative variables were described using
with no record of examinations. Intermediate status was measures of central tendency and data dispersion, while
applied to other situations. Level 4 encompassed adequacy qualitative variables were presented as absolute (n) and
and inadequacy across all three levels. Intermediate status relative (%) frequencies. To verify associations between
was applied to all other situations. Since Anversa’s level 4 variables of interest, Pearson’s Chi-square test was applied
is the most comprehensive one, it will be the level used to for qualitative variables, Student’s t-test for quantitative
describe the quality of prenatal care in this criterion.
variables, or non-parametric correspondents, based on data
Additionally, recommendations of the MoH (Brasil, normality. Binary comparisons were performed based on
2012a, 2012b) that were considered essential for prenatal the dichotomization of variables and/or the definition of a
care include: reference category (dummy). When the normative criteria
(i) Initiating prenatal care before 12 weeks of gestation had more than two categories for the classification of the
and attending six or more physician office visits outcome (adequacy of prenatal care), the intermediate
(ii) Administering vaccination (Tdap vaccine and category was aggregated as inadequate. According to the
Hepatitis B vaccine) recommendations of the MoH and the municipality of
(iii) Conducting laboratory examinations (first trimester: São José, criteria were classified as complete, incomplete,
blood type and Rh factor, hemoglobin and hematocrit, or absent. The results were expressed as prevalence
indirect Coombs test, qualitative urine test, blood ratios (PR), with 95% confidence intervals (CI) and a
glucose, syphilis test, screening for Hepatitis B 5% significance level. The prevalence was adjusted for
and C, HIV test, and toxoplasmosis test; second confounding variables detected through a multivariate
trimester: indirect Coombs test, oral glucose tolerance Poisson regression model with robust variance, considering
test; third trimester: hemoglobin and hematocrit, statistical (p < 0.20) and variables of epidemiological
indirect Coombs test, qualitative urine test, blood relevance. Poisson regression is a generalized linear model
glucose, syphilis test, screening for Hepatitis B, and with a log link and a Poisson distribution. When the
toxoplasmosis test) outcome is binary, the exponentiated coefficients are risk/
(iv) Conducting physical examination (gestational age, BP, PR instead of incidence-rate ratios (Cummings, 2009). The
body mass index, edema, uterine fundal height, fetal Poisson regression model has been used in epidemiologic
heart rate, fetal movement, fetal presentation) studies to estimate the PR, as the prevalence of the
(v) Providing iron and folic acid supplementation condition studied is countable in the sample, and the use of
(vi) Offering guidance on prenatal care, childbirth, logistic models can overestimate the relationship between
postpartum period, breastfeeding, newborn care, exposure and outcome measures. The best-fit model,
healthy habits, and emotional and bodily changes. determined by the coefficient of determination (R ) and
2
In this study, we evaluated whether prenatal care AIC value, incorporated variables such as age, education,
followed all the recommendations (complete) or not and referral to HRPN.
(incomplete). Data collection commenced only after obtaining
The recommendations of the municipality of São José informed consent from the involved institutions and
(2015) that was considered essential for prenatal care approval from the Comitê de Ética em Pesquisa (CEP,
include the laboratory examinations (first trimester: blood Research Ethics Committee) of the University of
type and Rh factor, hemoglobin and hematocrit, indirect Southern Santa Catarina, under registration CAAE:
Coombs test, thyroid-stimulating hormone-TSH test, 51583121.0.0000.5369 and Opinion number 5,022,991,
qualitative urine test, blood glucose, syphilis test, screening dated October 6, 2021.
for Hepatitis B and C, HIV test, and toxoplasmosis test; 3. Results
second trimester: indirect Coombs test, oral glucose
tolerance test, toxoplasmosis test; third trimester: During the data collection period, 1647 deliveries (vaginal
hemoglobin and hematocrit, indirect Coombs test, or cesarean) occurred in the maternity hospital. Out of
qualitative urine test, blood glucose, syphilis test, screening these, 372 women met the inclusion criteria; 100 were
for Hepatitis B, HIV test, and toxoplasmosis test). We excluded due to prematurity; eight did not accept to
evaluated if the prenatal care fulfilled these requirements participate in the survey; three were in isolation due to
(complete) or not (incomplete). COVID-19; 16 were not located in their beds; and eight

Volume 10 Issue 3 (2024) 20 https://doi.org/10.36922/ijps.1422