Maternal and neonatal factors related to prematurity.

OBJECTIVE: To identify maternal and neonatal factors associated with prematurity in the municipality of Porto Alegre. METHOD: This was a population-based case-control study. The cases were newborns under 37 weeks of gestation and the controls were newborns over 37 weeks. The data came from the records of 19,457 births in the city of Porto Alegre in the year 2012 from the Information System on Live Births of the Municipal Health Department. The analysis was carried outand adjusted by a Logistic Regression according to a hierarchical model. The variables studied were allocated into three hierarchy levels: sociodemographic variables; reproductive history; and gestational and birth factors. RESULTS: There were 767 cases allocated and 1,534 controls in a design of a case for two controls (1:2) by simple randomization. In the final model, a statistically significant association was found for prematurity for the following variables: mother's age under 19 years old (OR=1.32; CI 95%: 1.02-1.71) or over 34 years old (OR=1.39; CI 95%: 1.12-1.72); inadequate maternal schooling for age (OR=2.11; CI 95%: 1.22-3.65); multiple pregnancies (OR=1.14; CI 95%: 1.01-1.29); C-section (OR=1.15; CI 95%: 1.03-1.29); birth weights under 2,500g (OR=4.04; CI 95%: 3.64-4.49); Apgar score at five minutes between zero and three (OR=1.47; CI 95%: 1.12-1.91); and inadequate prenatal care (OR=1.18; CI 95%: 1.02-1.36). CONCLUSION: The present study showed the most immediate consequence of prematurity for newborns by evidencing its association with worse Apgar scores and low birth weight. The following factors were also shown as possible more distal determinants of prematurity: mother's age; inadequate maternal education; multiple gestation; inadequate prenatal care; and C-section. OBJETIVO: Identificar fatores maternos e neonatais associados à prematuridade no município de Porto Alegre. MÉTODO: Estudo do tipo caso-controle de base populacional. Os casos foram recém-nascidos com menos de 37 semanas de gestação, e os controles foram os recém-nascidos com 37 semanas ou mais. Os dados provieram dos registros de 19.457 nascimentos do município de Porto Alegre, no ano de 2012, no Sistema de Informações sobre Nascidos Vivos da Secretaria Municipal da Saúde. Foi realizada análise ajustada mediante Regressão Logística segundo modelo hierárquico. As variáveis estudadas foram alocadas em três níveis de hierarquia: variáveis sociodemográficas; história reprodutiva; fatores gestacionais e de nascimento. RESULTADOS: Foram alocados 767 casos e 1.534 controles, em um desenho de um caso para dois controles (1:2), mediante randomização simples. No modelo final, foi encontrada associação estatisticamente significante para prematuridade para as seguintes variáveis: idade materna menor que 19 anos (OR=1,32; IC 95%: 1,02 - 1,71) e maior que 34 anos (OR=1,39; IC 95%: 1,12 - 1,72); escolaridade materna inadequada para a idade (OR=2,11; IC 95%: 1,22 - 3,65); gravidez múltipla (OR=1,14; IC 95%: 1,01 - 1,29); cesariana (OR=1,15; IC 95%: 1,03 - 1,29); peso ao nascer menor a 2.500g (OR=4,04; IC 95%: 3,64 - 4,49); Índice de Apgar no 5° minuto de zero a três (OR=1,47; IC 95%: 1,12 - 1,91) e pré-natal inadequado (OR=1,18; IC 95%: 1,02 - 1,36). CONCLUSÃO: O presente estudo evidenciou as consequências mais imediatas da prematuridade para os recém-nascidos ao revelar sua associação com piores escores de Apgar e baixo peso ao nascimento. Mostrou como possíveis determinantes mais distais de prematuridade: idade materna, educação materna inadequada, gestação múltipla, pré-natal inadequado e realização de cesariana.

[Participatory training of prenatal care professionals for breastfeeding promotion]. / Capacitação participativa de pré-natalistas para a promoção do aleitamento materno.

The commitment with the promotion and support of breastfeeding justified the training of professionals that give prenatal care in primary health. This is a exploratory, qualitative study, based on the assumptions of participant research. It aimed to identify the thematics about breastfeeding and report the actions and strategies proposed during the meetings. Data was registraded in a field diary and analysis was done according to the categorization of data. Discussion of findings showed the lack of professionals update and lack of standardization in their conducts. The research gave the opportunity to discuss the politics and programs that were implanted by the government management, searching for alternatives inside the context of the users and workers that are involved with prenatal care.

[Bottle feeding during the first month of life: determinants and effect on breastfeeding technique]. / Uso de mamadeira no primeiro mês de vida: determinantes e influência na técnica de amamentação.

OBJECTIVE: To assess incidence rate and determinants of bottle feeding during the first month of life, and its potential effects on breastfeeding technique. METHODS: A nested cross-sectional study was conducted in a contemporary cohort in the city of Porto Alegre, Southern Brazil, between June and November 2003. A total of 211 pairs of healthy mothers and infants were followed up for a month. The effect of bottle feeding on breastfeeding technique was assessed by comparing five items unfavorable to mother-infant positioning and three items unfavorable to infant latch-on; and the average number of unfavorable items between the pairs who started bottle feeding in the first month of life and those who did not. A logistic regression analysis was carried out according to a hierarchical model. RESULTS: By Day 7, 21.3% of infants were bottle-fed and 46.9% were bottle-fed by Day 30. Living with maternal grandmother was associated with bottle feeding at Days 7 and 30. Maternal age <20 years, and nipple trauma at the maternity hospital were also associated with bottle feeding at Day 7. Other factors associated with bottle feeding at Day 3 were pacifier use at Day 7 and nipple trauma at Day 7. There was no association between the breastfeeding technique taught at the maternity hospital and subsequent bottle feeding. However, at Day 30, the breastfeeding technique was found to be more adequate among exclusively breast-fed infants than those who were also bottle fed. CONCLUSIONS: The study results showed that bottle feeding was quite widespread in the first month of life, mainly in infants born to teenage mothers, with nipple trauma, whose maternal grandmothers were living in the same household, and who were using pacifiers. Besides the already recognized negative effects, bottle feeding may negatively affect breastfeeding technique.

[Care practices for neonates while setting up a neonatal unit in a university hospital]. / Práticas de atendimento ao neonato na implantação de uma unidade neonatal em hospital universitário.

The hospitalization process of neonates makes them vulnerable to several care practices. The aim of this study was to get to know the care practices adopted by health professionals while setting up a neonatal unit at the Hospital de Clínicas of Porto Alegre, Rio Grande do Sul, Brazil. This is a qualitative study based on the New History Theory. The study collected data from October 2006 to January 2007. Fifteen health professionals responsible for the project and/or its implementation from 1972 to 1984 provided information. The thematic data analysis highlighted the concern among health professionals of making good use of technological advances, as well as unifying scientifically-based conducts. Besides, they tried to establish routines enabling neonate's parents to stay at the bedside during the whole hospitalization period. Finally, it was inferred that the main objective of these practices was to increase the survival of neonates.

[The lay midwife care to woman upon delivery and her childbirth]. / A parteira leiga no atendimento à mulher no parto e nascimento do seu filho.

It is a research aimed at finding out the lay midwives' practices while attending women upon delivery and their childbirth. The methodology was supported by the oral history of the midwives, using Bardin's thematic analysis. The findings regarding the midwives' activities reveal the domestic character of their practices, being themselves one of these resources, besides others that they have adopted to perform their practices. The rescue of those practices may lead health professionals to think about the current proposals to humanize delivery and childbirth.

[Beliefs and practices of nursing mothers and of their families in relation to breastfeeding]. / Crenças e práticas da nutriz e seus familiares relacionadas ao aleitamento materno.

This is a qualitative study of the descriptive-exploratory kind that had the objective of finding out the beliefs and practices of nursing mothers and of their families in relation to breastfeeding. The research subjects were nine nursing mothers and eight relatives from a poor section of Porto Alegre, Brazil. The data were collected through semi-structured interviews. The emerged themes concern to beliefs and practices considering the benefits of breastfeeding to the breastfed baby and to the nursing mother, many of them with origin within the family context. The study enhances the importance for health professionals to learn and to support their practices on those beliefs to reach successful breastfeeding.

Rede de apoio para o aleitamento materno na prematuridade tardia / Support network for breastfeeding in late prematurity

Objective: To analyze the support network of mothers of late preterm infants as to breastfeeding. Method: Descriptive-exploratory study with qualitative approach, founded on the Support Network theoretical methodological framework. The informants were 15 mothers, and the interviews were held at the hospital and on the 15th day of life of the child. Data were collected between November 2016 and February 2017. The analysis comprehended support network maps and the type of support the mothers received. Results: The support networks were small and fragile; the support received was centered on house chores and care for the newborn, with breastfeeding support being neglected. Professional support for breastfeeding was identified as fragile. Further considerations: The support network of women need to be included in their assistance and combined with household follow-up, so that they are provided the care they need for breastfeeding promotion.

Objetivo: Analisar a rede de apoio das mães de prematuros tardios para o aleitamento materno. Método: Estudo exploratório-descritivo, com abordagem qualitativa, apoiada no referencial teórico metodológico de Rede de Apoio. As informantes foram 15 mães e as entrevistas, realizadas no hospital e no 15º dia de vida da criança. Os dados foram coletados entre novembro de 2016 e fevereiro de 2017. Analisaram-se os mapas da rede de apoio e o tipo de apoio recebido pelas mães. Resultados: As redes de apoio eram pequenas e frágeis, o apoio recebido centrou-se nos afazeres domésticos e cuidados com o recém-nascido, excetuando-se o apoio ao aleitamento materno. O suporte profissional ao aleitamento materno foi identificado como frágil. Considerações finais: É necessária a inserção da rede de apoio das mulheres no seu atendimento e acompanhamento domiciliar para que estas obtenham o auxílio de que necessitam para a promoção do aleitamento materno.

[Home delivery as voiced by women: a perspective at the light of humanization]. / Parto no domicílio na voz das mulheres: uma perspectiva à luz da humanização.

This paper is a descriptive exploratory study developed with the objective of getting acquainted with life experiences, preparation,feelings and motivations of women who have chosen home childbirth. The subjects of the research comprised ten women who had at least one experience of home childbirth in Porto Alegre, in the last five years. The data was gathered through semi-structured interviews, which were analyzed according to Minayo's proposal. It indicates that the women who opted for home childbirth don't accept what the hospital system offers to women in labor at present time, but they do recognize that, for a few women, hospital delivery is the best choice, whether for reasons that involve personal decisions or health ones.

[Rooming-in: the father's expectations regarding the care of his wife and child]. / Alojamento conjunto: expectativas do pai com relação aos cuidados de sua mulher e filho.

Qualitative research with convergent approach kind with an objective to know the father's expectations regarding their participation women's and children's care for the health staff in the rooming-in. Nine fathers participate in the sample at the obstetric hospitalization unit of a university hospital in Porto Alegre, Brazil. The study finding showed his expectations and father's desire to stay together with his family and participate on that which is also his. The data warning for the health staff include the father in the cares on the rooming-in.

[Skin care in newborns]. / O cuidado com a pele do recém-nascido.

This article is based on brief recent revision of the scientific literature about the care with the skin of the newborn. The text deals with the anatomo-physiology aspects of the skin culminating with the specific care of the skin of newborn in Neonatal Intensive Care Unit. Considering the highest risk of the pre-term newborn to acquire infections, a special nursing care is proposed regarding the skin function as a protective barrier of the organism.

Ações de cuidado na maternidade para prematuros tardios / Care actions at maternity wardsfor late preterms

Objective: To reflect about care actions toward late preterms and their mothers, based on good practices for newborn care. Methods: Reflexive-theoretical essay that discusses care actions in the first 24 hours of life of late preterms and the connection of said actions with good practices for newborn care. Results: It is worth highlighting the importance of care in the first hour of life of late preterms, especially stimulation through skin-to-skin contact, breastfeeding and thermoregulation. Further Considerations: Informing families about late prematurity is an aspect of great relevance to these newborns' health, along with including assistance-oriented actions to be taken by several professionals in view of the specific care needs of late preterms.

Objetivo: Refletir acerca das ações de cuidados aos prematuros tardios e suas mães apoiado nas boas práticas para a atenção ao recém-nascido. Métodos: Ensaio teórico-reflexivo, o qual discute as ações de cuidado nas primeiras 24 horas de vida dos prematuros tardios e sua relação com as boas práticas para a atenção ao recém-nascido.Resultados: Destaca-se a importância do cuidado na primeira hora de vida de prematuros tardios, especialmente o estímulo ao contato pele a pele e à amamentação, e a termorregulação. Considerações Finais: Fornecer informação à família sobre a prematuridade tardia é um dos aspectos de grande relevância no cuidado a estes recém-nascidos e incluir ações assistenciais de diversos profissionais frente à necessidade dos cuidados aos prematuros tardios.

Temporal evolution and spatial distribution of maternal death.

OBJECTIVE: To analyze the temporal evolution of maternal mortality and its spatial distribution. METHODS: Ecological study with a sample made up of 845 maternal deaths in women between 10 and 49 years, registered from 1999 to 2008 in the state of Rio Grande do Sul, Southern Brazil. Data were obtained from Information System on Mortality of Ministry of Health. The maternal mortality ratio and the specific maternal mortality ratio were calculated from records, and analyzed by the Poisson regression model. In the spatial distribution, three maps of the state were built with the rates in the geographical macro-regions, in 1999, 2003, and 2008. RESULTS: There was an increase of 2.0% in the period of ten years (95%CI 1.00;1.04; p = 0.01), with no significant change in the magnitude of the maternal mortality ratio. The Serra macro-region presented the highest maternal mortality ratio (1.15, 95%CI 1.08;1.21; p < 0.001). Most deaths in Rio Grande do Sul were of white women over 40 years, with a lower level of education. The time of delivery/abortion and postpartum are times of increased maternal risk, with a greater negative impact of direct causes such as hypertension and bleeding. CONCLUSIONS: The lack of improvement in maternal mortality ratio indicates that public policies had no impact on women's reproductive and maternal health. It is needed to qualify the attention to women's health, especially in the prenatal period, seeking to identify and prevent risk factors, as a strategy of reducing maternal death.

[Mothers' knowledge about exclusive breastfeeding]. / Conhecimento de puérperas sobre amamentação exclusiva.

This is a descriptive study, with a qualitative approach, aimed to identify the knowledge of puerperal women on exclusive breastfeeding. Data were collected between September-October 2011, through semi-structured interview. Thirteen puerperal women, interned in a rooming unit of a public institution in the city of Caxias do Sul-RS, participated in the study. Data analysis was performed using thematic analysis. From the interpretation of information three categories emerged: the knowledge about exclusive breastfeeding, the breastfeeding process and the influences of received information. Even getting information from health professionals in the prenatal period, it is possible to understand that there is a need to improve communication and monitoring of mothers, as a continuity of professional care in the postpartum period, and also later, in the remote.

[Epidemiological profile of maternal deaths in Rio Grande do Sul, Brazil: 2004-2007]. / Perfil epidemiológico das mortes maternas ocorridas no Rio Grande do Sul, Brasil: 2004-2007.

This study analyzed the epidemiological profile of maternal deaths that occurred from 2004 to 2007 in Rio Grande do Sul, by means of Maternal Mortality Rates and Specific Maternal Mortality Ratio. Data was obtained from the Health Information System database and 323 maternal deaths were identified. In order to analyze indicators, Poisson regression and statistical tests were carried out. A decrease in maternal mortality rates (0.98) was identified, although there was no difference in estimate measures (CI95% 0.87-1.10). Maternal deaths were more frequent in women who were over 40 years old, had low schooling, black skin and no partners. The period of highest risk of maternal death was during pregnancy and birth, and the main direct causes were arterial hypertension and bleeding. Maternal mortality is an important issue to be confronted and reduced, given most maternal deaths could have been avoided.

Características maternas na ocorrência da prematuridade tardia / Maternal characteristics on the occurrence of late prematurity

Objetivo: caracterizar fatores sociodemográficos, obstétricos e intercorrências obstétricas das mães de prematuros tardios por faixas etárias maternas. Método: estudo descritivo, transversal e retrospectivo, de abordagem quantitativa, realizado em hospital universitário com 288 mulheres e seus 318 filhos prematuros tardios, com 34 a 36 semanas e seis dias de idade gestacional, nascidos em 2013. Os dados foram coletados em prontuários eletrônicos e foi realizada a análise estatística descritiva dos dados. Resultados: foram encontradas particularidades referentes à realização do pré-natal, uso de substâncias na gestação, intercorrências obstétricas, tipo de gravidez, via de parto e peso dos recém-nascidos nos grupos estudados. Conclusão: quanto à caracterização das mulheres, destaca-se: atendimento na rede pública, menos de oito anos de estudo e intercorrências gestacionais. As intercorrências mais frequentes na prematuridade tardia podem ser minimizadas. Assim, o atendimento pré-natal deve ser direcionado às necessidades próprias da faixa etária materna.

Contexto da atenção pré-natal na prematuridade tardia / Context of antenatal care in late prematurity / Contexto de la atención prenatal en la prematuridad tardía

Objetivo: conhecer o cuidado na gestação de mulheres que tiveram prematuros tardios, e seus atendimentos no âmbito do Sistema Único de Saúde. Metodologia: trata-se de um estudo descritivo, realizado em três unidades de estratégia da saúde de família em Porto Alegre-RS, de novembro de 2011 a dezembro de 2012, com 13 mulheres submetidas a entrevistas semiestruturadas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Prefeitura Municipal de Porto Alegre/RS, sob número 001.039956.11.3. Resultados: na análise temática etnográfica constituíram-se dois temas: negligência no cuidado durante a gestação e insuficiência do atendimento pré-natal. Os padrões observados foram: preenchimento inadequado das carteiras de pré-natal; situações potencialmente evitáveis como favorecedoras da prematuridade tardia; e dificuldade na comunicação entre gestante e profissional pré-natalista. Conclusão: conhecer os cuidados pré-natais dessas mulheres pode representar as concepções que as mesmas têm sobre a gestação, sendo uma referência importante para os profissionais que trabalham com essa população

Objective: to learn about pregnancy care for women who gave late premature birth, and their treatment in the Unified Health System. Methodology: this descriptive study was conducted at three Family Health Strategy clinics in Porto Alegre, Rio Grande do Sul, from November 2011 to December 2012, by semi-structured interviews of 13 women. The project was approved by the Porto Alegre City government's Research Ethics Committee (No. 001.039956.11.3). Results: two themes emerged in ethnographic thematic analysis: negligence in care during pregnancy and inadequacy of antenatal care. The patterns observed were: failure to complete antenatal records properly; potentially avoidable situations favoring late prematurity; and difficulty in communication between mothers and antenatal care professionals. Conclusion: learning about these women's antenatal care can represent the conceptions they hold about pregnancy, which are an important point of reference for professionals working with this population.

Objetivo: conocer el cuidado durante el embarazo a las mujeres que tuvieron niños prematuros tardíos y la atención en el Sistema Único de Salud. Metodología: se trata de un estudio realizado en tres unidades de la estrategia de salud de la familia en Porto Alegre-RS, de noviembre 2011 a diciembre 2012, junto a 13 mujeres sometidas a entrevistas semiestructuradas. El proyecto fue aprobado por el Comité de Ética en Investigación de la Municipalidad de Porto Alegre/RS, bajo el número 001.039956.11.3. Resultados: el análisis temático etnográfico se constituyó de dos temas: negligencia en el cuidado durante el embarazo; e insuficiencia en la atención prenatal. Los patrones observados fueron: registros inadecuados en los cuadernos de prenatal; situaciones potencialmente evitables como favorecedoras de la prematuridad tardía; y dificultad en la comunicación entre la madre y el profesional del prenatal. Conclusión: conocer los cuidados prenatales de estas mujeres puede representar los puntos de vista que tienen sobre el embarazo, siendo una referencia importante para los profesionales que trabajan con esta población.

Maternal and neonatal factors related to prematurity / Factores Maternos y Neonatales Relacionados con la Prematuridad / Fatores maternos e neonatais relacionados à prematuridade

ABSTRACT OBJECTIVE To identify maternal and neonatal factors associated with prematurity in the municipality of Porto Alegre. METHOD This was a population-based case-control study. The cases were newborns under 37 weeks of gestation and the controls were newborns over 37 weeks. The data came from the records of 19,457 births in the city of Porto Alegre in the year 2012 from the Information System on Live Births of the Municipal Health Department. The analysis was carried outand adjusted by a Logistic Regression according to a hierarchical model. The variables studied were allocated into three hierarchy levels: sociodemographic variables; reproductive history; and gestational and birth factors. RESULTS There were 767 cases allocated and 1,534 controls in a design of a case for two controls (1:2) by simple randomization. In the final model, a statistically significant association was found for prematurity for the following variables: mother's age under 19 years old (OR=1.32; CI 95%: 1.02-1.71) or over 34 years old (OR=1.39; CI 95%: 1.12-1.72); inadequate maternal schooling for age (OR=2.11; CI 95%: 1.22-3.65); multiple pregnancies (OR=1.14; CI 95%: 1.01-1.29); C-section (OR=1.15; CI 95%: 1.03-1.29); birth weights under 2,500g (OR=4.04; CI 95%: 3.64-4.49); Apgar score at five minutes between zero and three (OR=1.47; CI 95%: 1.12-1.91); and inadequate prenatal care (OR=1.18; CI 95%: 1.02-1.36). CONCLUSION The present study showed the most immediate consequence of prematurity for newborns by evidencing its association with worse Apgar scores and low birth weight. The following factors were also shown as possible more distal determinants of prematurity: mother's age; inadequate maternal education; multiple gestation; inadequate prenatal care; and C-section.

RESUMEN OBJETIVO Identificar factores maternos y neonatales asociados con la prematuridad en el municipio de Porto Alegre. MÉTODO Estudio del tipo caso control de base poblacional. Los casos fueron recién nacidos con menos de 37 semanas de gestación, y los controles fueron los recién nacidos con 37 semanas o más. Los datos provinieron de los registros de 19.457 nacimientos del municipio de Porto Alegre, en el año de 2012, en el Sistema de Informaciones acerca de Nacidos Vivos de la Secretaría Municipal de Salud. Se llevó a cabo el análisis ajustado mediante Regresión Logística según modelo jerárquico. Las variables estudiadas fueron ubicadas en tres niveles de jerarquía: variables sociodemográficas; historia reproductiva; factores gestacionales y de nacimiento. RESULTADOS Fueron ubicados 767 casos y 1.534 controles, en un diseño de un caso para dos controles (1:2), mediante aleatorización simple. En el modelo final, fue encontrada asociación estadísticamente significativa para prematuridad para las siguientes variables: edad materna menor que 19 años (OR=1,32; IC 95%: 1,02 - 1,71) y mayor que 34 años (OR=1,39; IC 95%: 1,12 - 1,72); escolaridad materna inadecuada para la edad (OR=2,11; IC 95%: 1,22 - 3,65); embarazo múltiple (OR=1,14; IC 95%: 1,01 - 1,29); cesárea (OR=1,15; IC 95%: 1,03 - 1,29); peso al nacer menor que 2.500g (OR=4,04; IC 95%: 3,64 - 4,49); Índice de Apgar en el 5° minuto de cero a tres (OR=1,47; IC 95%: 1,12 - 1,91) y pre natal inadecuado (OR=1,18; IC 95%: 1,02 - 1,36). CONCLUSIÓN El presente estudio evidenció las consecuencias más inmediatas de la prematuridad para los recién nacidos al revelar su asociación con peores puntajes de Apgar y bajo peso al nacimiento. Mostró como posibles determinantes más distales de prematuridad: edad materna, educación materna inadecuada, gestación múltiple, pre natal inadecuado y realización de cesárea.

RESUMO OBJETIVO Identificar fatores maternos e neonatais associados à prematuridade no município de Porto Alegre. MÉTODO Estudo do tipo caso-controle de base populacional. Os casos foram recém-nascidos com menos de 37 semanas de gestação, e os controles foram os recém-nascidos com 37 semanas ou mais. Os dados provieram dos registros de 19.457 nascimentos do município de Porto Alegre, no ano de 2012, no Sistema de Informações sobre Nascidos Vivos da Secretaria Municipal da Saúde. Foi realizada análise ajustada mediante Regressão Logística segundo modelo hierárquico. As variáveis estudadas foram alocadas em três níveis de hierarquia: variáveis sociodemográficas; história reprodutiva; fatores gestacionais e de nascimento. RESULTADOS Foram alocados 767 casos e 1.534 controles, em um desenho de um caso para dois controles (1:2), mediante randomização simples. No modelo final, foi encontrada associação estatisticamente significante para prematuridade para as seguintes variáveis: idade materna menor que 19 anos (OR=1,32; IC 95%: 1,02 - 1,71) e maior que 34 anos (OR=1,39; IC 95%: 1,12 - 1,72); escolaridade materna inadequada para a idade (OR=2,11; IC 95%: 1,22 - 3,65); gravidez múltipla (OR=1,14; IC 95%: 1,01 - 1,29); cesariana (OR=1,15; IC 95%: 1,03 - 1,29); peso ao nascer menor a 2.500g (OR=4,04; IC 95%: 3,64 - 4,49); Índice de Apgar no 5° minuto de zero a três (OR=1,47; IC 95%: 1,12 - 1,91) e pré-natal inadequado (OR=1,18; IC 95%: 1,02 - 1,36). CONCLUSÃO O presente estudo evidenciou as consequências mais imediatas da prematuridade para os recém-nascidos ao revelar sua associação com piores escores de Apgar e baixo peso ao nascimento. Mostrou como possíveis determinantes mais distais de prematuridade: idade materna, educação materna inadequada, gestação múltipla, pré-natal inadequado e realização de cesariana.

Uso do crack na gestação: vivências de mulheres usuárias / Crack use during pregnancy: the experience of women users / Uso del crack en la gestación: vivencias de mujeres usuarias

Objetivo: conhecer vivências de mulheres que fizeram uso do crack durante a gestação. Método: estudo qualitativo, do tipo estudo de caso, realizado em 2014. Foram entrevistadas três mulheres em tratamento, em um Centro de Atenção Psicossocial Álcool e Drogas III, de um município do Oeste Catarinense. As informações foram coletas por meio de entrevistas semiestruturadas e interpretadas seguindo a técnica de análise de conteúdo na modalidade Temática. Resultados: as mulheres relataram que o uso da substância impactou de forma negativa o período gestacional. Revelaram dificuldades enfrentadas e que se colocavam em situações de risco para a obtenção da droga. Ressaltaram a importância de uma rede social de apoio fortalecida e de alternativas de tratamento que auxiliem no processo de recuperação, permitindo um acompanhamento contínuo. Conclusão: há necessidade de uma equipe multidisciplinar no atendimento integral a estas mulheres.(AU)

Objective: to learn the experience of women who made use of crack during pregnancy. Method: qualitative study of case study type carried out in 2014. Three women undergoing treatment at a Psychosocial Care Center Alcohol and Drugs III, from a municipality of Santa Catarina West, were interviewed. The information was collected through semi-structured interviews and interpreted following the content Analysis technique in the Thematic modality. Results: women reported that the use of crack negatively impacted pregnancy. They revealed difficulties faced, and that they used to put themselves at risk to obtain the drug. They stressed the importance of a strengthened social network of support and alternatives of treatment to assist in the recovery process, allowing continuous monitoring. Conclusion: there is a need for a multidisciplinary team to provide comprehensive care to these women.(AU)

Objetivo: conocer vivencias de mujeres que usaron crack durante la gestación. Método: estudio cualitativo, de tipo estudio de caso, realizado en 2014. Fueron entrevistadas tres mujeres en tratamiento en un Centro de Atención Psicosocial Alcohol y Drogas III, de un municipio del Oeste Catarinense. Las informaciones fueron recogidas por medio de entrevistas semi-estructuradas e interpretadas siguiendo la técnica de análisis de contenido en la modalidad Temática. Resultados: las mujeres relataron que el uso de la sustancia impactó de forma negativa en el período gestacional. Revelaron dificultades enfrentadas y que se colocaban en situaciones de riesgo para obtener la droga. Resaltaron la importancia de una red social de apoyo fortalecida y de alternativas de tratamiento que auxilien en el proceso de recuperación, permitiendo un acompañamiento continuo. Conclusión: hay necesidad de un equipo multidisciplinar en el atendimiento integral a estas mujeres.(AU)

Implicações das restrições alimentares na vida diária de mulheres com diabete melito gestacional / Implications of diet restrictions in the daily lives of women with gestational Diabetes Mellitus / Implicaciones de las restricciones alimentares en la vida diaria de mujeres con Diabetes Mellitus en la gestación

A dieta é um dos principais focos do tratamento das gestantes diabéticas, constituindo-se em estratégia recomendada para um acompanhamento gestacional adequado e o nascimento de um bebê saudável. Trata-se de uma pesquisa qualitativa, do tipo descritivo, que objetivou conhecer as implicações das restrições alimentares na vida diária de mulheres com diabete melito gestacional. O estudo foi realizado em um hospital universitário do município de Porto Alegre/RS, por meio de entrevistas com 25 gestantes diabéticas em acompanhamento ambulatorial, entre os meses de julho a novembro de2010. A análise de dados foi do tipo temática. As mulheres apresentam dificuldades em seguir o plano alimentar prescrito, fato que provoca implicações negativas nas suas vidas diárias. A orientação nutricional deve ser flexível e respeitar a condição social de cada gestante. Há necessidade de elaboração de estratégias e propostas de cuidados que auxiliem essas mulheres no enfrentamento dos obstáculos relacionados à dieta alimentar.

Diet is one of the main focuses of treatment for diabetic pregnant women, and constitutes a recommended strategy for appropriate gestational monitoring and healthy childbirth. This qualitative, descriptive study examined the implications of diet restrictions in the daily lives of women with gestational diabetes mellitus. The study was performed between July and November 2010 at a university hospital in the city of Porto Alegre, Rio Grande do Sul, by means of interviews of 25 diabetic pregnant women in outpatient care. Data assessment was thematic. The women had difficulty sticking to the prescribed diet plan, which has adverse implications for their daily lives. Nutritional counseling should be flexible and contemplate the social condition of each pregnant woman. Care strategies and proposals should be developed to help these women surmount diet-related obstacles.

La dieta es un aspecto importante del tratamiento de las mujeres diabéticas embarazadas, que constituye una estrategia recomendada para un adecuado seguimiento del embarazo y el nacimiento de un hijo sano. Se trata de una pesquisa cualitativa, del tipo descriptivo que tuvo el objetivo de conocer las implicaciones de las restricciones alimentares en la vida diaria de las mujeres con Diabetes Mellitus en la gestación. El estudio fue realizado en un hospital universitario de la municipalidad de Porto Alegre/RS - Brasil, por medio de entrevistas con 25 gestantes diabéticas en acompañamiento ambulatorio,entre los meses de julio a noviembre de 2010. El análisis de datos fue del tipo temático. Las mujeres tienen dificultades para seguir el plan de la dieta prescrita, lo que provoca consecuencias negativas en sus vidas diarias. Asesoramiento nutricional debe ser flexible y respetar la condición social de cada mujer embarazada. Existe la necesidad de desarrollar estratégias y propuestas que ayuden esas mujeres a enfrentaren los obstáculos relacionados con la alimentación.