Page 33 - IJPS-10-3

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

below the national average seen in studies reporting values Anversa et al. (2012) at level 4, women under 20 years of age
above 95% (Oliveira & Cavalcanti Filho, 2021; Tomasi et al., exhibited a 50% higher adequacy frequency, while using the
2022; Pedraza & Gomes, 2021). Guidance on pregnancy Kessner index modified by Takeda (1993) and the APNCU
and the puerperium was fully reported in 17.7% of prenatal index (Kotelchuck, 1994), approximately 20% greater fit
care cases, a frequency found in a study conducted in Santa was seen for women as of 35 years of age. It is assumed
Catarina, which is lower than in other studies reporting that older women may be more attentive and concerned
ranges from 55.7 to 59.3% (Oliveira & Cavalcanti Filho, about their pregnancy (Oliveira & Cavalcanti Filho, 2021;
2021; Tomasi et al., 2022). The guidelines recommended by Tomasi et al., 2022), due to greater gestational risk. In other
the MoH aim to minimize the risk factors that compromise studies (Oliveira & Cavalcanti Filho, 2021; Tomasi et al.,
maternal and fetal health (Pedraza & Gomes, 2021). The 2022), worse quality of prenatal care for adolescents was
recommendations constitute relatively accessible actions, noted, which may be related to inexperience or a certain
which do not require additional resources and depend immaturity to perceive the gestational risks, which are
only on the health professional; thus, it is an important even greater for this population. On the other hand, this
point to be improved (Pedraza & Gomes, 2021). The deficit group, requiring more attention, may have had better
in this regard may be associated with inadequate training access to health services and received more guidance from
of health-care professionals, high service demand limiting health-care professionals, leading to an improvement in
patient education, or disruptions in health care during the quality of prenatal care.
the COVID-19 pandemic (Pilau et al., 2014; Oliveira &
Cavalcanti Filho, 2021). Based on the results of our study, awareness regarding
the gestational risk appears to significantly influence the
This investigation revealed that only 15.6% of women adequacy of prenatal care. Patients referred to the HRPR
were invited to participate in prenatal groups at primary showed a higher prevalence of adequate prenatal care for all
health units. It is important to point out that data collection indexes and, after adjusting the variables, this relationship
was carried out during the same period of the COVID-19 was maintained for the modified Kessner index by Takeda
pandemic, and the health system was globally affected and (1993) (20% higher prevalence of adequacy) and for the
was still suffering from its residual effects. It is believed that adapted APNCU index (Kotelchuck, 1994) (18% higher
this low percentage is a reflection of physical isolation and prevalence of adequacy). This relationship has been noted
the decrease in social activities, especially those at higher risk in the literature (Martin et al., 2022); however, it is not
for COVID-19 (Martin et al., 2022; Pinkhasov et al., 2022). widely discussed since many studies exclude HRPR from
In the clinical-obstetric evaluation, certain the analysis (Vaichulonis et al., 2021), due to different
procedures such as uterine height, fetal movement, guidelines based on pathology (Brasil, 2012b). This
and fetal presentation that should be performed during variable was included in this study because evaluating
the physician’s office visits actually occurred at a level the quality of prenatal care according to the minimum
below expectations. As verified in other national studies criteria is even more important for this population, which
(Camargo et al., 2021), examinations relying on devices requires greater investment in health. HRPN, performed
(scales, sphygmomanometer, and Doppler sonar) were by specialized teams with a higher frequency of medical
more frequently performed than clinical examinations, visits, may explain the greater observed adequacy. In the
possibly due to the practicality or the confidence that these study by Martin et al. (2022), with each increase in the
technological instruments provide. BP and weight were the number of prenatal physician office visits, the chance of
most frequently measured and/or recorded, both crucial adequacy increased by 34%.
for patients’ care because obesity, excessive weight gain, Our findings revealed that planned pregnancies
and BP changes can cause direct complications during increased the frequency of adequacy by more than 20% for
pregnancy, worsening the maternal and perinatal outcome both the Kessner index modified by Takeda (1993) and the
(Camargo et al., 2021). adapted APNCU index (Kotelchuck, 1994). When planning
The population profile is an important factor since it pregnancy, it is expected that the woman starts prenatal
may influence prenatal outcomes (Mario et al., 2019). care in a timely manner, an important variable for these
The mean age was similar to other studies of the same two indices. It is unfortunate that this information was
nature (Camargo et al., 2021; Vaichulonis et al., 2021). It not recorded in 37.6% of the booklets assessed. Screening
was observed that age was related to prenatal quality, as of this information by the health professional is relevant
described in existing literature (Oliveira & Cavalcanti to encourage patients to pursue prenatal care, visit the
Filho, 2021; Domingues et al., 2015; Tomasi et al., 2017), physician’s office, and perform the examinations requested,
but in different ways. According to the classification by to reduce gestational morbidities (Camargo et al., 2021).

Volume 10 Issue 3 (2024) 27 https://doi.org/10.36922/ijps.1422