Sleep Bruxism in Puerperal Women: Data from a Population-Based Survey.

OBJECTIVE: To evaluate the self-reported SB prevalence and explore associated risk factors in puerperal women who had given birth in Rio Grande, Southern Brazil. METHODS: A single, standardized questionnaire was given within the 48 h postpartum period. Self-reported SB was the main outcome investigated. Chi-square test was used to compare proportions, and Poisson regression with robust variance adjustment was used in the multivariate analysis. RESULTS: A total of 2225 women were included. Only 79 (3.6%) of these reported clenching or grinding their teeth during sleep. Adjusted analysis showed that the higher education level of the mothers (PR = 3.07; 95% CI 1.49-6.28; P = 0.006); living with three or more persons in the household (PR = 0.54; 95% CI 0.34-0.84; P = 0.007); medication intake during pregnancy (PR = 1.68; 95% CI 1.09-2.58; P = 0.017); smoking (PR = 1.93; 1.16-3.23; P = 0.024), or ever smoked (PR = 1.82; 95% CI 0.85-3.90; P = 0.024); severe anxiety (PR = 1.36; 95% CI 0.61-3.02; P = 0.005); and headache upon waking (PR = 4.19; 95% CI 1.95-9.00; P < 0.001) were significantly associated with self-reported SB. CONCLUSION FOR PRACTICE: Our data pointed towards new factors in a specific group of women that may be relevant for preventing sleep-related behaviors in the pregnancy-puerperal cycle. The higher levels of education, medication intake, smoking or even smoked, severe anxiety, the higher the probability of puerperal woman to self-report SB. The nighttime tooth clenching strongly increased headache upon waking.

Trend and Inequality in Episiotomy in Southern Brazil, 2007-2016: Evidence of Reduced Abusive Practice.

OBJECTIVES: This study aimed to measure the prevalence, to describe the trend over time, and to evaluate socioeconomic inequalities in the occurrence of episiotomies in 2007, 2010, 2013, and 2016 in the municipality of Rio Grande, in Southern Brazil. METHODS: We included all women who had vaginal delivery in each of the studied years. All the information was obtained through a questionnaire applied at maternity wards within 48 h after delivery. The outcome consisted of episiotomy. A chi-square test was used to evaluate the linear trend. Absolute and relative inequalities were assessed from household income and schooling of the women through the Slope Index of Inequality and Relative Index of Inequality, respectively. RESULTS: This study included 4,521 parturients. The episiotomy rate in the period fell from 71.0% (95%CI: 68.4-73.5) in 2007 to 40.1% (95%CI: 37.3-42.8) in 2016, and it was more frequent among women with higher income and higher schooling. We observed a reduction in the rate of episiotomy in all income and schooling levels, and this was more evident among women in the lowest socioeconomic levels. Absolute inequality declined, while relative inequality remained unchanged. CONCLUSIONS FOR PRACTICE: Despite the significant reduction in the rate of episiotomy, its occurrence remains high. Women with higher income and education, therefore with lower risk for complications during childbirth, were the most frequently submitted to this procedure. Routine use of episiotomy must be reevaluated, especially among pregnant women with better socioeconomic status.

Antenatal care in Southern Brazil: Coverage, trends and inequalities.

We described prenatal care quality for four indicators over a 12-years period among puerperae living in Southern Brazil. Five surveys including all women giving birth between 01/01 to 31/12 in 2007, 2010, 2013, 2016, and 2019 were conducted in Rio Grande, Rio Grande do Sul state, Brazil. A single standardized questionnaire was applied within 48 h after delivery in all the city's maternity hospitals. Outcomes included the followings proportion of pregnant women who started prenatal care in the first trimester and performed at least six medical visits, completed at least two HIV, two syphilis and two qualitative urine tests. These indicators were stratified according to quartiles of household income. Absolute and relative measures of inequalities were calculated. A total of 12,645 (98% of the total) of the 12,914 mothers eligible in the five surveys were successfully interviewed. Coverage for all indicators increased substantially, especially in the poorest quartile for six prenatal care visits starting in the first trimester, and for HIV and qualitative urine tests. The slope index (SII) and the concentration index (CIX) of inequality showed clear disadvantage among the poorest for prenatal visits starting in the first trimester and performing two or more urine tests. There was a substantial increase in coverage for all variables studied in the period. The reduced inequity, mainly for the beginning of the first trimester and for visits and urine tests, was due to the higher coverage achieved in the poorest quartile.

Body mass index and mortality among community-dwelling elderly of Southern Brazil.

This study aims to measure the association between body mass index (BMI), comparing two different classifications, and mortality among community-dwelling elderly considering myopenia in Pelotas, Brazil. This is a longitudinal study started in 2014, we followed 1451 elderly people (≥ 60 years) enrolled in the "COMO VAI?" study. BMI was classified according to the World Health Organization (WHO) and the classification with specific cutoff points for older adults. Myopenia was measured by calf circumference (≤33 cm for women and ≤34 cm for men). Cox proportional-hazards models were used to test associations controlling for sociodemographic and behavioral characteristics and number of morbidities. Nearly 10% (N = 145) of the elderly died during almost three years of follow-up. We observed a L-shaped relation between BMI and mortality. Elderly with underweight had a higher mortality risk compared to those with adequate BMI in both classifications. According to the WHO classification, overweight elderly presented protection for mortality (HR: 0.58; 95% CI 0.38-0.87) when compared to those with adequate BMI. Among elderly with myopenia, overweight by WHO continued to protect against mortality, although not significantly, while those with the specific classification underweight presented a higher risk of death compared to those with normal weight (HR: 2.09; 95% CI 1.06-4.14). In conclusion the underweight increased the risk of death in community-dwelling elderly people during a follow-up of three years. The specific classification seemed to be more adequate to indicate risk of mortality in this population. Higher BMI protect against mortality when muscle mass was not considered.

Maternal Knowledge and Unsafe Baby Sleep Position: A Cross-Sectional Survey in Southern Brazil.

Objective to evaluate women's knowledge about the best baby sleeping position and to identify factors associated with a greater probability of putting infants to sleep in an unsafe position, in Rio Grande, Southern Brazil. Method This is a cross-sectional population-based study that included all women who bore children in 2013 in this municipality. A single, standardized questionnaire was given within 48 h after delivery in the only two local maternity hospitals. The outcome was that women reported the lateral and the ventral decubitus as the best sleeping positions for babies. A Chi square test was used for proportions and Poisson regression was used with robust variance adjustment in the multivariate analysis. The prevalence ratio was the measure of effect used. Results We included 2624 women in this study. Of these, 82.1% (95% CI 80.6-83.6) stated that the baby should sleep in the lateral or ventral decubitus positions. 76.4% reported having acquired this knowledge from their mothers and 34.7% were willing to adopt the correct (supine) sleeping position for their child if recommended by doctors. The adjusted analysis showed that the lower the schooling of the mothers and the greater the number of people per bedroom and number of children, the greater the probability of women choosing an unsafe baby sleeping position. Conclusions for Practice This study showed that the percentage of women who are unaware of the correct baby sleeping position is very high, that doctors should be convinced to recommend the supine baby sleeping position, and that campaigns on this subject should also include grandparents as a priority intervention group.

Non-performance of urinalysis among pregnant women in Brazil.

PURPOSE: The purpose of this paper is to measure the prevalence, evaluate the trend and identify the factors associated with the non-performance of qualitative urine test (QUT) among pregnant women living in the extreme south of Brazil between 2007 and 2016. DESIGN/METHODOLOGY/APPROACH: All births occurred in the local maternity wards from January 1 to December 31 of 2007, 2010, 2013 and 2016. Mothers were interviewed within 48h after delivery. The outcome was the non-performance of QUT during pregnancy. χ2 test was used to compare proportions and Poisson regression with robust variance adjustment for the multivariate analysis. The effect measure used was the prevalence ratio. FINDINGS: Of the 10,331 new mothers identified, 10,004 (96.8 percent) performed at least one prenatal visit. The prevalence of non-performance of QUT was 3.3 percent (95% CI 2.9-3.7 percent), ranging from 1.5 percent in 2007 to 5.3 percent in 2016 ( p<0.001). The analysis showed that not living with a companion, having under four years of schooling, living with seven or more people in the household, having five or more children, having had one to three prenatal visits and not having been supplemented with ferrous sulfate during pregnancy showed a significantly higher prevalence rate to the non-performance of QUT. ORIGINALITY/VALUE: The rate of non-performance of this test among pregnant women has clearly increased. Mothers at higher risk of unfavorable outcomes in pregnancy were the ones with the highest probability of not performing QUT. Increasing the number of prenatal visits is a high-impact measure toward the performance of this test.

Unplanned pregnancy in the extreme South of Brazil: prevalence, trends, and associated factors. / Gravidez não planejada no extremo Sul do Brasil: prevalência, tendência e fatores associados.

The study aims to estimate the proportion of puerperae with an unplanned pregnancy, evaluate trends and identify factors associated with its occurrence in Rio Grande-RS, Brazil. Trained interviewers applied a single, standardized questionnaire to all puerperae residing in the municipality in 2007, 2010, 2013, 2016 and 2019. The chi-square test compared proportions and the Poisson regression with robust variance adjustment in the multivariate analysis. The prevalence ratio (PR) was the effect measure employed. The study includes 12,415 puerperae (98% of the total). The unplanned pregnancy rate was 63.3% (95%CI: 62.5%-64.1%). After adjusting, the highest PR for not planning pregnancy were observed among younger, black women, living without a partner, with more significant household agglomeration, lower schooling, and household income, multiparous and smokers. The rate of unplanned pregnancy is high and stable, with a higher propensity among women those with the highest risk of unfavorable events during pregnancy and childbirth. Reaching these women in high schools, companies, services and health professionals, in addition to the mass media, can be strategies to prevent unplanned pregnancy.

Este estudo estimou a proporção de puérperas que não planejaram a gravidez, avaliou tendência e identificou fatores associados à sua ocorrência no município de Rio Grande-RS. Entre 01/01 e 31/12 de 2007, 2010, 2013, 2016 e 2019 entrevistadoras treinadas aplicaram questionário único e padronizado a todas as puérperas residentes neste município. Utilizou-se teste qui-quadrado para comparar proporções e regressão de Poisson com ajuste da variância robusta na análise multivariável. A medida de efeito utilizada foi razão de prevalências (RP). O estudo incluiu 12.415 puérperas (98% do total). A prevalência de não planejamento foi 63,3% (IC95%: 62,5%-64,1%). Após ajuste, as maiores RP para não planejamento da gravidez foram observadas entre mulheres de menor idade, cor da pele preta, com companheiro, maior aglomeração domiciliar, pior escolaridade e renda familiar, maior paridade e tabagistas. Houve pequeno aumento na prevalência de não planejamento da gravidez no final do período principalmente entre àquelas com maiores riscos de eventos desfavoráveis na gestação e parto. Alcançar estas mulheres nas escolas de ensino médio, empresas, serviços e profissionais de saúde, além de meios de comunicação de massa, pode auxiliar na prevenção desse tipo de gravidez.

Knowledge about sudden infant death syndrome prevention among postpartum women in Southern Brazil, 2019: a cross-sectional survey.

OBJECTIVE: To assess knowledge on sudden infant death syndrome (SIDS) prevention among postpartum women who received prenatal care in public and private services in Rio Grande, Rio Grande do Sul, Brazil, in 2019. METHODS: A cross-sectional study was conducted with postpartum women who gave birth in that municipality in 2019; the outcome was the indication of incorrect sleeping position (side/supine position) to prevent SIDS; the chi-square test was used to compare proportions between those who underwent prenatal care in public and private services. RESULTS: Among all 2,195 postpartum women, 67.7% (95%CI 65.7;69.6) were unaware of the position that prevents SIDS, 71.6% were public care service users; 77.8% of them feared choking/suffocation; 1.9% were informed about SIDS during prenatal care; doctors/nurses (70.5%) and grandmothers (65.1%) were influential regarding the baby's sleeping position. CONCLUSION: Most postpartum women were unaware of the sleeping position that prevents SIDS, especially those receiving care in the public sector; in general, this subject is not discussed in prenatal care. MAIN RESULTS: Two out of three mothers believed the newborn should sleep in the side or prone position, which does not prevent but rather facilitates sudden infant death syndrome (SIDS); lack of knowledge was significantly greater when prenatal care took place in public services. IMPLICATIONS FOR SERVICES: SIDS should be addressed in prenatal care. Guidance from a doctor/nurse during consultations can be essential for mothers to change their mind and adopt a safe sleeping position (supine position) for their child. PERSPECTIVES: SIDS prevention campaigns are relevant in the context of prenatal care, as is conducting research that aims to evaluate potential impacts of interventions on the correct sleeping position for babies.

Gender Division of Housework and Intimate Partner Violence Among Mothers of Toddlers During the COVID-19 Pandemic: Findings from the 2019 Rio Grande (Brazil) Birth Cohort.

During the COVID-19 pandemic, we evaluated the association between gender division of housework and intimate partner violence (IPV) victimization in a population-based cohort of mothers. We collected data on psychological, physical, and sexual IPV using an adapted version of the World Health Organization Violence Against Women instrument and division of housework using a validated questionnaire. We used logistic regression to calculate adjusted odds ratios. We found that in mothers who reported an unequal gender division of housework (higher load), the odds of suffering psychological, physical, or sexual IPV were higher during the first and second years of the pandemic.

Sleep and its association with depressive and anxiety symptoms during the last weeks of pregnancy: A population-based study.

OBJECTIVE: To evaluate the association between sleep characteristics and depressive and anxiety symptoms during the immediate postpartum period. METHODS: People who had hospital births during 2019 in the municipality of Rio Grande (southern Brazil) were assessed with a standardized questionnaire concerning sociodemographic (eg, age and self-reported skin color) and health-related variables (eg, parity and stillbirth) (n = 2314) 24-48 hours after birth. We used the Munich Chronotype Questionnaire to assess sleep latency, inertia, duration, and chronotype; the Edinburgh Postpartum Depression Scale for depressive symptoms; and the General Anxiety Disorder 7-Item Scale to evaluate anxiety symptoms. We used logistic regression models to calculate odds ratios. RESULTS: The prevalence of depressive symptoms was 13.7%, and of anxiety symptoms was 10.7%. Depressive symptoms were more likely in those with vespertine chronotype (odds ratios = 1.63; 95% CI: 1.14-2.35) and those with a sleep latency of more than 30 minutes (OR = 2.36; 95% CI: 1.68-3.32). The probability of depressive symptoms decreased by 16% for each additional hour of sleep (OR = 0.84; 95% CI: 0.77-0.92). Sleep inertia of 11-30 minutes increased the probability of anxiety on free days (OR = 1.73; 95% CI: 1.27-2.36) and increased the probability of depressive (OR = 2.68; 95% CI: 1.82-3.83) and anxiety symptoms (OR = 1.69; 95%CI: 1.16-2.44) on workdays. CONCLUSION: Participants with vespertine chronotype or shorter sleep duration were more likely to have depressive symptoms. Those who took more time to fall asleep or get out of bed were more likely to have both anxiety and depressive symptoms, but the association was stronger for depressive symptoms.

Pap smears in the extreme South of Brazil: low coverage and exposure of the most vulnerable pregnant women.

OBJECTIVE: To estimate prevalence, assess trends and identify factors associated with non-performance of Pap smears among postpartum women residing in Rio Grande, Southern Brazil. METHODS: Between 01/01 and 12/31 of 2007, 2010, 2013, 2016 and 2019, previously trained interviewers applied a single standardized questionnaire at the hospital to all postpartum women residing in this municipality. It was investigated from the planning of pregnancy to the immediate postpartum period. The outcome consisted of not performing a Pap smear in the last three years. The chi-square test was used to compare proportions and assess trends, and Poisson regression with robust variance adjustment in the multivariate analysis. The measure of effect was the prevalence ratio (PR). RESULTS: Although 80% of the 12,415 study participants had performed at least six prenatal consultations, 43.0% (95%CI 42.1-43.9%) had not been screened in the period. This proportion ranged from 64.0% (62.1-65.8%) to 27.9% (26.1-29.6%). The adjusted analysis showed a higher PR for not performing Pap smears among younger puerperal women, living without a partner, with black skin color, lower schooling, and family income, who did not have paid work during pregnancy or planned pregnancy, who attended fewer prenatal consultations. smoked during pregnancy and were not being treated for any illness. CONCLUSION: Despite the improvement in coverage, the observed rate of non-performance of Pap smears is still high. Women most likely to have cervical cancer were those who had the highest PR for not having this test.

Age is the most important factor for change in body mass index and waist circumference in older people in southern Brazil.

OBJECTIVES: The aim of this study is to assess the changes in body mass index and waist circumference (WC) and their associations with sociodemographic, behavioral, and health characteristics in non-institutionalized older people in southern Brazil over a period of ≤6 y. METHODS: This is a prospective study, with interviews conducted in 2014 and in 2019 to 2020. Of the 1451 individuals from Pelotas, Brazil, aged >60 y and interviewed in 2014, 537 were reevaluated in 2019 to 2020. An increase or decrease was defined as a variation of ≥5% in body mass index and WC in the second visit compared with the first. The association with changes in outcomes was assessed according to sociodemographic, behavioral, and health characteristics using multinomial logistic regression. RESULTS: Approximately 29% of the older participants lost body mass. Regarding WC, there was an increase in 25.6% in the older participants. The older participants ages ≥80 y had greater odds of losing body mass (odds ratio [OR] = 4.73; 95% confidence interval [CI], 2.29-9.76) and of reducing WC (OR = 2.84; 95% CI, 1.59-6.94). Former smokers had, on average, 41% and 64% lower odds of losing and gaining body mass (95% CI, 0.37-0.95 and 95% CI, 0.19-0.68, respectively), and those who were on ≥5 medications had greater odds of gaining body mass (OR = 1.92; 95% CI, 1.12-3.28) and WC (OR = 1.79; 95% CI, 1.18-2.74). CONCLUSIONS: Despite the high proportion of older people who kept their body mass index and WC stable during this period, many of them lost body mass and gained WC. The findings also highlighted the importance of age in the nutritional changes observed in the population.

The association between maternal fears about their infant/ toddler during the COVID-19 pandemic and depression and anxiety: a birth cohort study.

OBJECTIVE: To assess the association between maternal fears about their infant/toddler and depression and anxiety during the COVID-19 pandemic. METHODS: In 2019, all mothers who gave birth in hospitals in Rio Grande, RS, Brazil were asked to respond to a standardized questionnaire (baseline). We followed them between May-June 2020 (first follow-up point), August-December 2020 (second follow-up point), and from October 2021 to March 2022 (third follow-up point), and asked them if they were: (1) afraid that their infant/toddler would become infected with COVID or get sick (yes/no), (2) afraid that they would contaminate their own child with COVID, and/or (3) worried about the pandemic's effects on their child's future. At baseline and at all follow-up points, we assessed depressive symptoms using the Edinburgh Postnatal Depression Scale and anxiety symptoms using the Generalized Anxiety Disorder Scale, creating symptom trajectories using group-based trajectory modelling. We used multinomial logistic regression to calculate adjusted relative risk ratios (RRR). RESULTS: A total of 1,296 mothers participated. Worrying about the pandemic's effects on their child's future and the fear of contaminating their own child with COVID-19 increased the risk of raising depressive symptoms to a clinical level (RRR = 4.97, 95%CI 2.32-10.64 and RRR = 3.87, 95%CI 1.58-9.47, respectively) and anxiety to a moderate level (RRR = 2.91, 95%CI 1.69-5.01 and RRR = 1.86, 95%CI 1.03-3.35, respectively). CONCLUSION: Fear for their children increased maternal depressive and anxiety symptoms during the pandemic.

[Ferrous sulfate supplementation in pregnant women: a time series study in the far South of Brazil]. / Suplementação de sulfato ferroso entre gestantes: um estudo de série temporal no extremo Sul do Brasil.

The objective of this study was to assess the effect of some maternal characteristics on the use of ferrous sulfate among postpartum women from five perinatal studies in the Municipality of Rio Grande, Rio Grande do Sul State, Brazil. From January 1 to December 31 in the years 2007, 2010, 2013, 2016, and 2019, previously trained interviewers applied a standardized interview within 48 hours after childbirth to all postpartum women, while still in hospital, residing in the municipality and who had given birth in the only two local hospitals. The questionnaire included demographic, socioeconomic, and healthcare data during pregnancy and childbirth. Chi-square test was used to compare proportions and Poisson regression with robust variance was used in the multivariate analysis. The measure of effect was prevalence ratio. Among the 12,645 participants (98.1% of the total), 74.5% (95%CI: 74.7-76.0) had taken ferrous sulfate during the pregnancy. Prevalence varied from 61.7% (95%CI: 59.7-63.6) in 2007 to 81.1% (95%CI: 79.5-82.7) in 2019 (p-value for trend < 0.001). After adjustment, iron supplementation was significantly higher among adolescent pregnant women and those with less schooling (0-8 year), in the lowest income quartile, and who had received adequate prenatal care and care in the public healthcare sector (p < 0.05). There was a major improvement in the prevalence of ferrous sulfate supplementation during the period analyzed, but without achieving equity. To address this issue, healthcare professionals should prioritize older pregnant women, those with higher socioeconomic status, and those using the private healthcare sector for prenatal care.

O objetivo deste estudo foi avaliar o efeito de algumas características maternas sobre o uso do sulfato ferroso entre puérperas pertencentes a cinco estudos perinatais do Município de Rio Grande, Rio Grande do Sul, Brasil. Entre 1º de janeiro e 31 de dezembro dos anos 2007, 2010, 2013, 2016 e 2019, entrevistadoras previamente treinadas aplicaram, em até 48 horas após o parto, ainda no hospital, questionário padronizado a todas as puérperas residentes nesse município e que tiveram parto nos dois únicos hospitais locais. Foram investigadas características demográficas, socioeconômicas e cuidados recebidos durante a gestação e o parto. Teste qui-quadrado foi utilizado para comparar proporções e regressão de Poisson com ajuste robusto da variância na análise multivariável. A medida de efeito utilizada foi razão de prevalências. Dentre as 12.645 participantes (98,1% do total), 74,5% (IC95%: 74,7-76,2) utilizaram o sulfato ferroso durante a gestação. Essa prevalência variou de 61,7% (IC95%: 59,7-63,6) em 2007 a 81,1% (IC95%: 79,5-82,7) em 2019 (valor de p para tendência < 0,001). Após ajuste, verificou-se que a suplementação de sulfato ferroso foi significativamente maior entre gestantes adolescentes, de menor escolaridade (0-8 anos), pertencentes ao menor quartil de renda, que realizaram pré-natal considerado adequado e no setor público de saúde (p < 0,05). Houve grande melhora na prevalência de uso de sulfato ferroso no período estudado, no entanto ainda falta atingir a equidade. Recomenda-se que os profissionais de saúde priorizem as mulheres com mais idade, com melhor nível socioeconômico e que utilizam o setor privado de saúde durante o pré-natal.

El objetivo de este estudio fue evaluar la utilización y el efecto de algunas características maternas sobre el uso del sulfato ferroso entre puérperas, pertenecientes a cinco estudios perinatales del Municipio de Río Grande, estado de Rio Grande do Sul, Brasil. Entre el 1er de enero al 31 de diciembre de los años 2007, 2010, 2013, 2016 y 2019, entrevistadoras previamente entrenadas aplicaron, tras hasta 48 horas después del parto, estando todavía en el hospital, un cuestionario estandarizado a todas las puérperas residentes en este municipio, que dieron a luz en los dos únicos hospitales locales. Se investigaron características demográficas, socioeconómicas y cuidados recibidos durante la gestación y el parto. Se utilizó un test chi-cuadrado para comparar proporciones y regresión de Poisson con ajuste robusto de la varianza en el análisis multivariable. La medida de efecto utilizada fue la razón de prevalencias. Entre las 12.645 participantes (98,1% del total), 74,5% (IC95%: 74,7-76,2) utilizaron el sulfato ferroso durante la gestación. Esta prevalencia varió de un 61,7% (IC95%: 59,7-63,6) en 2007 a un 81,1% (IC95%: 79,5-82,7) en 2019 (valor de p para tendencia < 0,001). Tras el ajuste, se verificó que la suplementación con sulfato ferroso fue significativamente mayor entre gestantes adolescentes, de menor escolaridad (0-8 años), pertenecientes al menor cuartil de renta y, que realizaron un proceso prenatal considerado adecuado y lo hicieron en el sector público de salud (p < 0,05). Hubo una gran mejora en la prevalencia de uso de sulfato ferroso durante el período estudiado, no obstante, todavía falta alcanzar la equidad. Se recomienda que los profesionales de salud prioricen a las mujeres con más edad, con mejor nivel socioeconómico y las que utilizan el sector privado de salud durante el período prenatal.

Recent trends in cesarean section reduction in extreme south of Brazil: a reality only in the public sector?

This study aimed to describe changes in cesarean section (C-section) prevalence from 2007 to 2019, in public and private sectors, according to maternal characteristics. We included all puerperal women who gave birth in Rio Grande, Rio Grande do Sul, Brazil, at years 2007, 2010, 2013, 2016 and 2019. A questionnaire was applied up to 48 hours after delivery. We assessed C-section rates over time and described the prevalence according to independent variables. Poisson regression was used. A total of 12.415 puerperal women were included. The prevalence of C-section increased between 2007-2013 (from 51.2% to 61.2%) and decreased between 2013-2019 (48.9% in 2019). This decrease was observed only in the public sector and was higher among the youngest (-10.0 percentual points) and high educated women (-10.3 percentual points). While in the private sector C-section occurrence increased even more (95.7% in 2019). In the public sector, women that were older, with a partner, primiparous, who performed prenatal care in the private system and with adequate prenatal assistance presented higher prevalence of C-section. In the private sector the prevalence was high independently of the maternal characteristics. In order to reduce C-section rates, efficient delivery care policies mainly focused on the private sector are necessary.

Episiotomy in Southern Brazil: prevalence, trend, and associated factors.

OBJECTIVE: To identify and analyze the prevalence, trend, and factors associated with episiotomy in Rio Grande, in the state of Rio Grande do Sul, Southern Brazil. METHODS: A single, standardized questionnaire was applied to all pregnant women, residents in the municipality of Rio Grande, who had children in local hospitals between January 1 and December 12 of the years 2007, 2010, 2013, 2016 e 2019. Demographic and socioeconomic characteristics were investigated, as well as the assistance received during pregnancy and delivery. Chi-square test was used to compare proportions and Poisson regression with robust variance adjustment was used for multivariable analysis. Prevalence ratio (PR) was used as effect measure. RESULTS: Among the 12,645 births that occurred in the five years, 5,714 (45.2%) were vaginal delivery. Of these mothers, 2,930 (51.3%; 95%CI: 50.0%-52.6%) underwent episiotomy. Over this period, the episiotomy rate decreased from 70.9% (68.4-73.5) in 2007 to 19.4% (17.1-21.7) in 2019. Adjusted analysis showed a high PR of episiotomy occurrence among women who were young (PR = 2.23; 95%CI: 1.89-2.63), had higher education (PR = 1.21; 95%Cl: 1.03-1.42), had a higher family income (PR = 1.25; 95%CI: 1.10-1.41), were primiparous (PR = 3.41; 95%CI: 2.95-3.95), had prenatal care in the private sector (PR = 1.25; 95%CI: 1.07-1.46), had oxytocin-induced labor (PR = 1.18; 95%CI:1.09-1.27), underwent forceps (PR = 1.32; 95%CI: 1.16-1.50), and whose newborn weighed 4,000 g or more (PR = 1.43; 95%CI: 1.14-1.80). CONCLUSION: Although the prevalence of episiotomy fell sharply within the studied period, its occurrence is more likely among women at lower risk of birth complications.

Evolution of care during pregnancy and childbirth in the extreme south of Brazil.

OBJECTIVES: To describe the evolution of care during pregnancy and childbirth among postpartum women living in the municipality of Rio Grande, Southern Brazil, using data from surveys carried out every three years between 2007 and 2019. METHODS: Within 48 hours after delivery, a single, standardized questionnaire was applied to all mothers who had children in local hospitals and met the inclusion criteria. Demographic and reproductive characteristics, lifestyle habits, socioeconomic level of the family, and care received during pregnancy and childbirth were investigated. In the analysis, the chi-square test for linear trend was used to assess the distribution of indicators per survey. RESULTS: A total of 12,645 parturients were interviewed (98% of the women eligible to participate in the surveys). In the period evaluated, the proportion of births fell 35% among adolescents and increased 25% among women aged 35 years and over. Mothers gained, on average, two years of schooling, and their families experienced an important economic improvement, followed by loss of income in the last survey. Maternal smoking, before and during pregnancy, fell by half. The rate of mothers who started prenatal care in the first trimester and the number of consultations and laboratory tests increased. Almost 60% of prenatal consultations and 80% of births took place in the Brazilian Unified Health System. In 2019, vaginal delivery was once again the most common. The rates of low birth weight (9%) and prematurity (17%) virtually remained unchanged. CONCLUSIONS: We found an important change in the reproductive profile and increased coverage of various prenatal care and delivery services. Children continue to be born well, but low birth weight and prematurity remain endemic.

Maternal mental health before and during the COVID-19 pandemic in the 2019 Rio Grande birth cohort.

OBJECTIVE: To describe and compare measures of maternal depression, anxiety, and posttraumatic stress symptoms before and during the coronavirus disease 2019 (COVID-19) pandemic in a Brazilian birth cohort. METHODS: All hospital births occurring in the municipality of Rio Grande (southern Brazil) during 2019 were identified. Mothers were invited to complete a standardized questionnaire on sociodemographic and health-related characteristics. Between May and July 2020, we tried to contact all cohort mothers of singletons, living in urban areas, to answer a standardized web-based questionnaire. They completed the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder 7-item (GAD-7) in both follow-ups, and the Impact of Event Scale (IES) in the online follow-up. RESULTS: We located 1,136 eligible mothers (n=2,051). Of those, 40.5% had moderate to severe stress due to the current pandemic, 29.3% had depression, and 25.9% had GAD. Mothers reporting loss of income during the pandemic (57.2%) had the highest proportions of mental health problems. Compared to baseline, the prevalence of depression increased 5.7 fold and that of anxiety increased 2.4-fold during the pandemic (both p < 0.001). CONCLUSION: We found a high prevalence of personal distress due to the ongoing COVID-19 pandemic, and a clear rise in both maternal depression and anxiety.

Urinary incontinence among pregnant women in Southern Brazil: A population-based cross-sectional survey.

Urinary incontinence (UI) is a common condition that causes significant harm to the well-being and quality of life of pregnant women. This cross-sectional population-based study aimed to estimate the prevalence and identify factors associated with the occurrence of UI during pregnancy in women living in the municipality of Rio Grande (RS), Southern Brazil, between January 1 and December 31 of 2016, and included all puerperae living in this municipality that had a child in one of the two local maternity hospitals. The previously trained interviewers used a single standardized questionnaire, within 48 hours after delivery to retrieve information on maternal demographic, behavioral and reproductive/obstetric history, as well as socioeconomic status of the household and care received during pregnancy and childbirth. The multivariate analysis followed a previously defined hierarchical model using Poisson regression with robust variance adjustment and prevalence ratio (PR) as a measure of effect. As a result, 2,716 puerperae were identified, of which 2,694 (99.2%) participated in this study. The prevalence of urinary incontinence in the gestational period was 14.7% (95%CI: 13.4%-16.1%). After adjusted analysis, the likelihood of UI occurring varied significantly as per women's characteristics. For example, the PR for the occurrence of UI among women over 30 years of age was 2.05 (95% CI: 1.39-3.01) compared to adolescents. In two other groups of women who had their first pregnancy before the age of 20 or after the age of 30, the PR for UI was 1.36 (95% CI: 1.04-1.76) and 1.59 (95% CI: 1.01-2.51), respectively, when compared to those who became pregnant for the first time between 20 and 29 years of age. Finally, in two other groups of women, namely, those who reached 90 kg and over at the end of pregnancy and those who performed regular physical exercise and reported frequent urinary urgency, the PR was 2.49 (95% CI: 1.74-3.57), and 2.90 (95% CI: 2.10-4.00) compared to those who did not exercise and did not report urinary urgency, respectively. The authors concluded that UI showed a high prevalence in the study population. The identified risk factors can be well administered at primary health care level. The recommendation of regular physical exercise in pregnancy must be reviewed and better investigated with more robust designs because of possible facilitators for the occurrence of UI in this period.

On-demand cesarean section: assessing trends and socioeconomic disparities.

OBJECTIVE: to measure prevalence, evaluate trends and identify socioeconomic differences of on-demand cesarean section in the municipality of Rio Grande (RS), extreme south of Brazil, in 2007, 2010, 2013 and 2016. METHODS: all the puerperae residing in this municipality who had cesarean deliveries in one of the only two local maternity hospitals in the period 01/01-31/12 of the aforementioned years were part of this transversal study. Puerperae were interviewed using a single, standardized questionnaire at the hospital within 48 hours after delivery. The outcome was assessed based on the mothers' report that the cesarean section was performed according to their request. The analysis consisted of the observation of the outcome's frequency in each year and the evaluation of its prevalence throughout this period through the chi-square linear trend test. Socioeconomic inequalities were assessed based on household income and women's schooling using the Slope Index of Inequality and the Relative Index of Inequality. RESULTS: In these four years, 5,721 cesarean deliveries were recorded among mothers living in this municipality (1,309 in 2007, 1,341 in 2010, 1,626 in 2013 and 1,445 in 2016). In this period, the rate of on-demand cesarean sections increased by 107%, from 10.5% (95%CI: 8.9% -12.2%) of the deliveries in 2007 to 21.7% (95%CI: 19.5% -23.8%) in 2016. This increase was more evident among those with lower household income and schooling level. Absolute inequality also increased, especially regarding schooling, while relative inequality sharply declined when assessed by household income. CONCLUSIONS: The increased on-demand cesarean sections in the study location is unsettling, despite the decreasing gap between extreme categories as a consequence of higher levels of this procedure among women of lower income and worse schooling.