Mid-upper arm circumference in pregnant women and its relation to birth weight.

OBJECTIVE: In order to determine the relationship between some maternal anthropometric indicators and birth weight, crown-heel length and newborn's head circumference, 92 pregnant women were followed through at the prenatal service of hospital in S. Paulo, Brazil. MATERIAL AND METHOD: The following variables were established for the mother: weight, height, mid-upper arm circumference, pre-pregnancy weight, gestational weight gain and Quetelet's index. For the newborn the following variables were recorded: birth weight, crown-heel length, head circumference and gestational age by Dubowitz's method. RESULTS: Significant associations were noted between gestational age and newborn variables. In addition, maternal mid-arm circumference (MUAC) and pre-pregnancy weight were found to be positively correlated to birth weight (r = 0.399; r = 0.378, respectively). The multivariate linear regression shows that gestational age, mother's arm circumference and pre-pregnancy weight continue to be significant predictors of birth weight. On the other hand, only gestational age and mother's age was associated with crown-heel length. Similarly MUAC was significantly associated with crown-heel length (r = 0.306; P = 0.0030). CONCLUSION: Maternal mid-upper arm circumference is a potential indicator of maternal nutritional status. It could be used in association with other anthropometric measurements, instead of pre-pregnancy weight, as an alternative indicator to assess women at risk of poor pregnancy outcome.

[Pregnancy in adolescents: a comparative study]. / Gravidez na adolescência: estudo comparativo.

A population of 349 women who gave birth, in an Obstetric Clinic in Greater S. Paulo, Brazil, during the period from 01/05/86 to 31/07/86 were studied. The results show that the group of pregnant adolescents (22.2%) received inadequate prenatal assistance, as the large majority of them (70.6%) started consultations during the second trimester of their pregnancy, and had an average of two consultations. During pregnancy this group presented a lower incidence of pathological disorders leading to out-patient and hospital treatment (39.3% and 7.9%, respectively) than did the adult pregnant women (44.4% and 14.7%, respectively). With regard to the type of delivery, the adolescents underwent a larger proportion of surgical deliveries, 25.7% of forceps births and 22.9% of cesarean sections, as compared with 14.7% and 19.7%, respectively, for the adult pregnant women. A larger proportion of intra-parturition intercurrencies was registered for the pregnant adolescents (12.9%, as against 8.2% for the adult pregnant women), hemorrhage and toxemia being the most important. During the puerperium there were complications in 15.7% of the pregnant adolescents and 11.8% of the adults post partum anemia, toxemia and puerperal infection being the commonest disorders.

[Maternal and perinatal health status in the State of São Paulo, Brazil]. / Situação de saúde materna e perinatal no Estado de São Paulo, Brasil.

The assistance offered during pregnancy and labour as also to the newborn child, and its relationship to maternal and perinatal mortality in the State of S. Paulo in 1984, is analysed on the basis of official available data. With respect to prenatal care the number of visits per woman was considered to be "sufficient" though of doubtful quality. The proportion of cesarean sections was very high (46.2%). Maternal mortality was found to be 4.86 deaths per 10,000 live births, but despite its being high, this figure is certainly too low and the correct figure is probably twice as high. The principal cause of maternal deaths is toxemia in pregnancy, followed by hemorrhage and abortion. Most of these deaths could have been avoided with care during pregnancy and labour. The rate of perinatal mortality was found to be 29.2 deaths per thousand births in 1984. This figure is also very high. The analysis of the causes of death for this period showed that the disorders which arose during the perinatal period were responsible for 90 per cent of the total number of deaths. The main causes of death in this group were the intra-uterine hypoxias and anoxias, asphyxia, respiratory distress syndrome and massive aspiration syndrome. These data bring to light the poor quality of the care offered to this group. The authors trust that the new policy of the Decentralized and Unified System of Health will take the quality of care as much as the integration of services into consideration with a view to overcoming the precarious maternal and perinatal health situation in S. Paulo.

[Maternal mortality in Brazil, 1980]. / Mortalidade materna no Brasil, 1980.

PIP: The authors studied Brazilian maternal mortality by examining official statistics from the country's various geographical regions, including the state of Sao Paulo, Brazil. 1980 was selected because of the possibility of working with data from the Population Census of that year. The principal causes of death in Brazil were hypertension, hemorrhage, puerperal infection, and abortion. In Sao Paulo, where the 4th digit of the IDC is used, the main cause of death was eclampsia. The 2nd was hemorrhage, and the 3rd was infection, whether due to or associated with pregnancy. As for age, the lowest maternal mortality rate occurred in the 20-29 year old age group, the rate was slightly higher for those ages 15-19, and increasing gradually in those ages 30-39 and 40-49. It was not possible to analyze the rates for those ages 10-14 and over age 50 because of lack of data on livebirths. However, there were 18 deaths and 4 deaths respectively in those groups which shows that at opposite poles of the reproductive span, there exists a considerably high mortality rate. In comparing these data with those of other countries, it was found that the majority of deaths are avoidable and that it should be possible to reduce the number considerably by means of better health care for women and by using techniques and resources which are already available. (author's modified)^ieng