Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort.

OBJECTIVE: To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS: The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS: The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4-27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25-30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women's education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION: In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women's reproductive health should be strengthened.

Why are pregnant women physically inactive? A qualitative study on the beliefs and perceptions about physical activity during pregnancy.

This study aimed to describe the beliefs and perceptions of pregnant women and healthcare providers about physical activity during pregnancy. Using a qualitative approach, 30 pregnant women and the 14 healthcare providers caring for them were interviewed in the second trimester of pregnancy. We included women who maintained, decreased, or stopped physical activity since becoming pregnant. They were divided into low (≤ 8 years) and high schooling (> 8 years). Semi-structured, in-depth interviews were conducted and guided by three key questions: (1) When does physical activity during pregnancy start to be considered a wrong behavior?; (2) What are the main barriers (biological or others) to physical activity?; and (3) Do the actions of healthcare providers and people close to pregnant women reinforce barriers? Interviews were audio recorded, transcribed, and analyzed based on recurring themes. All women changed their physical activity behavior (decreased or stopped) when they discovered their pregnancy. Fear of miscarriage, contractions, bleeding, and of causing malformations in the baby were the most reported reasons for decreasing or stopping physical activity. Participants also lacked access to consistent information and healthcare providers' support on the benefits of physical activity. Despite the current international recommendations to regular physical activity during pregnancy, uncertainty regarding its benefits remains. Interventions to promote physical activity during this period should include the training of healthcare providers so they can advise and discard ideas contrary to mother-child health benefits.

Why are pregnant women physically inactive? A qualitative study on the beliefs and perceptions about physical activity during pregnancy / Por que as gestantes não são fisicamente ativas? Um estudo qualitativo sobre as crenças e percepções em relação à atividade física durante a gestação / ¿Por qué las mujeres embarazadas no hacen actividad física? Un estudio cualitativo sobre las creencias y percepciones relacionadas con la actividad física durante el embarazo

This study aimed to describe the beliefs and perceptions of pregnant women and healthcare providers about physical activity during pregnancy. Using a qualitative approach, 30 pregnant women and the 14 healthcare providers caring for them were interviewed in the second trimester of pregnancy. We included women who maintained, decreased, or stopped physical activity since becoming pregnant. They were divided into low (≤ 8 years) and high schooling (> 8 years). Semi-structured, in-depth interviews were conducted and guided by three key questions: (1) When does physical activity during pregnancy start to be considered a wrong behavior?; (2) What are the main barriers (biological or others) to physical activity?; and (3) Do the actions of healthcare providers and people close to pregnant women reinforce barriers? Interviews were audio recorded, transcribed, and analyzed based on recurring themes. All women changed their physical activity behavior (decreased or stopped) when they discovered their pregnancy. Fear of miscarriage, contractions, bleeding, and of causing malformations in the baby were the most reported reasons for decreasing or stopping physical activity. Participants also lacked access to consistent information and healthcare providers' support on the benefits of physical activity. Despite the current international recommendations to regular physical activity during pregnancy, uncertainty regarding its benefits remains. Interventions to promote physical activity during this period should include the training of healthcare providers so they can advise and discard ideas contrary to mother-child health benefits.

Este estudo objetivou descrever as crenças e percepções de gestantes e profissionais de saúde em relação a prática de atividade física durante a gestação. Usando uma abordagem qualitativa, 30 gestantes e 14 profissionais de saúde que atendiam essas mulheres foram entrevistados durante o segundo trimestre de gravidez. Foram incluídas mulheres que mantiveram, diminuíram ou pararam de praticar atividade física desde o início gravidez. Elas foram divididas em baixa (≤ 8 anos) e alta escolaridade (> 8 anos). Foram conduzidas entrevistas semiestruturadas e aprofundadas, orientadas por três perguntas-chave: (1) Quando a atividade física durante a gestação passa a ser considerada um comportamento errado? (2) Quais as principais barreiras (biológicas ou outras) para a prática de atividade física? (3) Estas barreiras são reforçadas pelas ações dos profissionais de saúde e das pessoas próximas à gestante? As entrevistas foram gravadas em áudio, transcritas e analisadas a partir de temas recorrentes. Todas as mulheres mudaram a prática de atividade física (diminuíram ou pararam) quando souberam da gravidez. O medo de aborto espontâneo, contrações e/ou sangramento e o medo de causar malformações no bebê foram os motivos mais relatados para diminuir ou parar a atividade física. Os participantes também não tiveram acesso a informações confiáveis e apoio dos profissionais de saúde sobre os benefícios da atividade física. Apesar das recomendações internacionais atuais para a prática regular de atividade física durante a gestação, a incerteza quanto aos seus benefícios continua sendo comum. As intervenções para promover a atividade física durante esse período devem incluir o treinamento de profissionais de saúde para que eles possam aconselhar e descartar ideias contrárias aos benefícios para a saúde materna e infantil.

El objetivo de este estudio fue describir las creencias y percepciones de mujeres embarazadas y profesionales de la salud con respecto a la práctica de actividad física durante el embarazo. Utilizando un enfoque cualitativo, se entrevistaron 30 mujeres embarazadas y 14 profesionales de salud que cuidaban a estas mujeres durante el segundo trimestre del embarazo. Se incluyeron mujeres que mantuvieron, redujeron o dejaron de practicar actividad física desde el inicio del embarazo. Ellas se dividieron en baja (≤ 8 años) y alta escolaridad (> 8 años). Se realizaron entrevistas semiestructuradas y en profundidad, guiadas por tres preguntas clave: (1) ¿Cuándo se considera que la actividad física durante el embarazo es un comportamiento incorrecto? (2) ¿Cuáles son las barreras (biológicas u otras) principales para la práctica de actividad física? (3) ¿Estas barreras se refuerzan por las acciones de los profesionales de salud y de las personas cercanas a la mujer embarazada? Las entrevistas fueron grabadas en audio, transcritas y analizadas a partir de temas recurrentes. Todas las mujeres cambiaron la práctica de actividad física (redujeron o dejaron de practicarla) cuando descubrieron el embarazo. El miedo a sufrir un aborto espontáneo, contracciones y/o sangrado y el miedo a provocar malformaciones en el bebé fueron los motivos más relatados para reducir o dejar de practicar la actividad física. Los participantes también no han tenido acceso a informaciones confiables ni apoyo de los profesionales de salud sobre los beneficios de la actividad física. A pesar de las recomendaciones internacionales actuales para la práctica regular de actividad física durante el embarazo, la incertidumbre cuanto a sus beneficios sigue siendo común. Las intervenciones para promover la actividad física durante este periodo deben incluir la capacitación de profesionales de salud para que puedan aconsejar y descartar ideas contrarias a los beneficios para la salud materna e infantil.

Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort

ABSTRACT OBJECTIVE To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4-27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25-30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women's education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women's reproductive health should be strengthened.

Folic acid supplementation during pregnancy and postpartum depressive symptoms.

OBJECTIVE: To verify whether folic acid supplementation during pregnancy is associated with the occurrence of maternal depressive symptoms at three months postpartum, in the 2015 Pelotas Birth Cohort. METHODS: This study included 4,046 women, who were classified into three groups: did not use folic acid supplementation during pregnancy; used during only one trimester of pregnancy; and used for two or three trimesters. Depressive symptoms were assessed at three months postpartum using the Edinburgh Postnatal Depression Scale (EPDS), at cutoff points ≥ 10 (mild symptoms) and ≥ 13 (moderate to severe intensity). RESULTS: The overall prevalence of mild symptoms was of 20.2% (95%CI 19.0-21.5), and moderate and severe was 11% (95%CI 10.0-12.0). The prevalence of EPDS ≥ 10 was of 26.8% (95%CI 24.0-29.5) among women who did not use folic acid and 18.1% for both those who used it during one trimester of pregnancy (95%CI 16.1-20.1) and those who used it for two or three trimesters (95%CI 16.0-20.2). The prevalence of EPDS ≥ 13 was of 15.7% (95%CI 13.5-17.9) in those who did not use folic acid, 9.1% (95%CI 7.5-10.6) in those who used it for one trimester, and 9.4% (95%CI 7.8-11.0) in those who used it for two or three trimesters. In the adjusted analyses, there was no statistically significant association between the use of folic acid during pregnancy and the occurrence of depressive symptoms at three months postpartum. CONCLUSION: There was no association between folic acid supplementation during pregnancy and postpartum depression at three months.

Factors associated with periodontal diseases in pregnancy: Findings of the 2015 Pelotas Birth Cohort Study.

Although periodontal disease is common during pregnancy, little is known about socioeconomic, behavioral, or biological determinants related to clinically assessed periodontal condition during this period. We assessed the prevalence of periodontal disease and associated factors in pregnant women. This population-based survey used data used from the 2015 Pelotas Birth Cohort Study, Brazil. Pregnant women expected to give birth between December 2014 and May 2016 were interviewed and clinically examined by trained dentist, with periodontal measures collected in all teeth, six sites per tooth. Outcomes were periodontitis (using the 2012 Centers for Disease Control and Prevention and the American Academy of Periodontology criteria) and gingivitis (by the 2018 European Federation of Periodontology/ American Academy of Periodontology classification). Multivariate hierarchical Poisson regression was used to assess the associations between socioeconomic, systemic, and clinical oral factors and periodontal disease. A total of 2,474 pregnant women participated in the study. Prevalence of periodontitis and gingivitis was 14.63% and 21.67%, respectively. Lower educational level and calculus were associated with higher prevalence periodontitis and gingivitis (P<0.05). Smoking was also associated with periodontitis (P=0.05), and lower frequency of toothbrushing (P=0.005) with gingivitis. Periodontal disease, especially gingivitis, was prevalent in pregnant women and their determinants were socioeconomic, environmental, and clinical oral health factors.

Iron salt supplementation during gestation and gestational diabetes mellitus.

OBJETIVE: To evaluate the association between the use of iron salts during the first two trimesters of gestation in non-anemic women and the development of gestational diabetes mellitus. METHODS: The study used maternal data from the 2015 Pelotas Birth Cohort. All non-anemic women at the 24th week of gestation (n = 2,463) were eligible for this study. Gestational diabetes mellitus was self-reported by women. Crude and adjusted logistic regression were performed considering level of significance = 0.05. RESULTS: Among the women studied, 69.7% were exposed to prophylactic iron supplementation in the first two trimesters of gestation. The prevalence of gestational diabetes mellitus among those exposed was 8.7% (95%CI: 7.4­10.1) and 9.3% (95%CI: 7.4­11.6) among those who were not exposed. Iron supplementation was not associated with increased risk of gestational diabetes mellitus in crude (OR = 0.9; 95%CI: 0,7­1,3) and adjusted analysis (OR = 1.1; 95%CI :0,8­1,6). CONCLUSIONS: The results suggest that routine iron use in non-anemic pregnant women does not increase the risk of developing gestational diabetes. This evidence supports the existing national and international guidelines, in which prophylactic iron supplementation is recommended for all pregnant women as soon as they initiate antenatal care in order to prevent iron deficiency anemia.

Detection of HPV DNA in vaginal samples self-collected by women living with HIV treated through the Brazilian public health system: Prevalence and analysis of risk factors.

BACKGROUND: Women living with human immunodeficiency virus (HIV) (WLWH) are more likely to be infected with the oncogenic human papillomavirus (HPV). We assessed the prevalence of high-risk (HR) (16/18/31/33/35/39/45/51/52/56/58/59/68/73/82), probable high-risk (pHR) (26/53/66), and low-risk (LR) (6/11/40/42/43/44/54/61/70) HPV types and their associated risk factors. METHODS: This cross-sectional study of WLWH aged 18-64 years included one laboratory and eight HIV-specialty healthcare facilities in the pilot network. Descriptive statistics were used to assess sociodemographic and behavioral characteristics. Adjusted analyses were conducted to evaluate risk factors associated with HR and/or pHR HPV infection in WLWH. RESULTS: From May/2021 to May/2022, 1,914 (92.5%) WLWH participated in the pilot study and had valid HPV-DNA results of self-collected vaginal samples. The median age of the participants was 45 years, 60.1% had ≥ 9 years of schooling, 80.5% were ≤ 18 years at first sexual intercourse, and 51.7% had > 4 sexual partners throughout life. The prevalence of any HPV type, HR HPV, pHR HPV, and LR HPV was 65.8%, 49.6%, 16.7%, and 40.0%, respectively. Age was inversely associated with pHR and/or HR-HPV (p < 0.001), and education level was inversely associated with HR-HPV (p = 0.003) types. Any HR or pHR was associated with being single (p = 0.029) and exchanging sex for drugs (p = 0.037). CONCLUSIONS: The prevalence of HPV, especially HR HPV, among WLWH is high in Brazil, highlighting the need for HPV screening in this population. Self-collection of vaginal samples is an important strategy for increasing testing access.

Demand and unmet need for modern contraception among mothers from a Pelotas Birth Cohort.

OBJECTIVE: To determine the total demand and unmet need for contraception with modern methods and their determinants among mothers participating in the 2015 Pelotas Birth Cohort. METHODS: Data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. Only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who answered the 48-month questionnaire were included in the study sample. Logistic regression and respective 95% confidence intervals were used to determine associated factors. RESULTS: The study sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and of modern contraceptives was 86.0% (95%CI: 84.8-87.1) and 84.9% (95%CI: 83.7-86.1), respectively. The prevalence of unmet need for modern contraceptives was 10.7% (95%CI: 9.7-11.7), and the total demand for contraceptives was 95.6%. The factors associated with an unmet need for modern contraception were being over 34 years of age (OR = 0.6, 95%CI: 0.5-0.8), not having a husband or partner (OR = 1.9, 95%CI: 1.4-2.6), not being the head of the household (OR = 0.6, 95%CI: 0.4-0.9), having had three or more pregnancies (OR = 1.9, 95%CI: 1.3-2.6), and having had an abortion at least once after the birth of the child participating in the cohort (OR = 1.9, 95%CI: 1.0-3.6). CONCLUSIONS: Despite the high prevalence of modern contraceptive use, one in ten women had an unmet need for modern contraception and was at risk of unplanned pregnancy.

Detection of HPV DNA in vaginal samples self-collected by women living with HIV treated through the Brazilian public health system: Prevalence and analysis of risk factors

ABSTRACT Background: Women living with human immunodeficiency virus (HIV) (WLWH) are more likely to be infected with the oncogenic human papillomavirus (HPV). We assessed the prevalence of high-risk (HR) (16/18/31/33/35/39/45/51/52/56/58/59/68/73/82), probable high-risk (pHR) (26/53/66), and low-risk (LR) (6/11/40/42/43/44/54/61/70) HPV types and their associated risk factors. Methods: This cross-sectional study of WLWH aged 18-64 years included one laboratory and eight HIV-specialty healthcare facilities in the pilot network. Descriptive statistics were used to assess sociodemographic and behavioral characteristics. Adjusted analyses were conducted to evaluate risk factors associated with HR and/or pHR HPV infection in WLWH. Results: From May/2021 to May/2022, 1,914 (92.5%) WLWH participated in the pilot study and had valid HPV-DNA results of self-collected vaginal samples. The median age of the participants was 45 years, 60.1% had ≥ 9 years of schooling, 80.5% were ≤ 18 years at first sexual intercourse, and 51.7% had > 4 sexual partners throughout life. The prevalence of any HPV type, HR HPV, pHR HPV, and LR HPV was 65.8%, 49.6%, 16.7%, and 40.0%, respectively. Age was inversely associated with pHR and/or HR-HPV (p < 0.001), and education level was inversely associated with HR-HPV (p = 0.003) types. Any HR or pHR was associated with being single (p = 0.029) and exchanging sex for drugs (p = 0.037). Conclusions: The prevalence of HPV, especially HR HPV, among WLWH is high in Brazil, highlighting the need for HPV screening in this population. Self-collection of vaginal samples is an important strategy for increasing testing access.

Factors associated with periodontal diseases in pregnancy: Findings of the 2015 Pelotas Birth Cohort Study

Abstract Although periodontal disease is common during pregnancy, little is known about socioeconomic, behavioral, or biological determinants related to clinically assessed periodontal condition during this period. We assessed the prevalence of periodontal disease and associated factors in pregnant women. This population-based survey used data used from the 2015 Pelotas Birth Cohort Study, Brazil. Pregnant women expected to give birth between December 2014 and May 2016 were interviewed and clinically examined by trained dentist, with periodontal measures collected in all teeth, six sites per tooth. Outcomes were periodontitis (using the 2012 Centers for Disease Control and Prevention and the American Academy of Periodontology criteria) and gingivitis (by the 2018 European Federation of Periodontology/ American Academy of Periodontology classification). Multivariate hierarchical Poisson regression was used to assess the associations between socioeconomic, systemic, and clinical oral factors and periodontal disease. A total of 2,474 pregnant women participated in the study. Prevalence of periodontitis and gingivitis was 14.63% and 21.67%, respectively. Lower educational level and calculus were associated with higher prevalence periodontitis and gingivitis (P<0.05). Smoking was also associated with periodontitis (P=0.05), and lower frequency of toothbrushing (P=0.005) with gingivitis. Periodontal disease, especially gingivitis, was prevalent in pregnant women and their determinants were socioeconomic, environmental, and clinical oral health factors.

Folic acid supplementation during pregnancy and postpartum depressive symptoms / Suplementação de ácido fólico na gestação e sintomas depressivos pós-parto

ABSTRACT OBJECTIVE To verify whether folic acid supplementation during pregnancy is associated with the occurrence of maternal depressive symptoms at three months postpartum, in the 2015 Pelotas Birth Cohort. METHODS This study included 4,046 women, who were classified into three groups: did not use folic acid supplementation during pregnancy; used during only one trimester of pregnancy; and used for two or three trimesters. Depressive symptoms were assessed at three months postpartum using the Edinburgh Postnatal Depression Scale (EPDS), at cutoff points ≥ 10 (mild symptoms) and ≥ 13 (moderate to severe intensity). RESULTS The overall prevalence of mild symptoms was of 20.2% (95%CI 19.0-21.5), and moderate and severe was 11% (95%CI 10.0-12.0). The prevalence of EPDS ≥ 10 was of 26.8% (95%CI 24.0-29.5) among women who did not use folic acid and 18.1% for both those who used it during one trimester of pregnancy (95%CI 16.1-20.1) and those who used it for two or three trimesters (95%CI 16.0-20.2). The prevalence of EPDS ≥ 13 was of 15.7% (95%CI 13.5-17.9) in those who did not use folic acid, 9.1% (95%CI 7.5-10.6) in those who used it for one trimester, and 9.4% (95%CI 7.8-11.0) in those who used it for two or three trimesters. In the adjusted analyses, there was no statistically significant association between the use of folic acid during pregnancy and the occurrence of depressive symptoms at three months postpartum. CONCLUSION There was no association between folic acid supplementation during pregnancy and postpartum depression at three months.

RESUMO OBJETIVO Verificar se a suplementação de ácido fólico durante a gestação está associada com a ocorrência de sintomas depressivos maternos aos três meses pós-parto, na Coorte de Nascimentos de Pelotas de 2015. MÉTODOS Este estudo incluiu 4.046 mulheres, que foram classificadas em três grupos: sem suplementação de ácido fólico na gestação; uso durante apenas um trimestre da gestação;e uso durante dois ou três trimestres. Os sintomas depressivos foram avaliados aos três meses pós-parto, através da Escala de Depressão Pós-Natal de Edimburgo (EPDS), nos pontos de corte ≥ 10 (sintomas leves) e ≥ 13 (intensidade moderada a grave). RESULTADOS A prevalência geral de sintomas leves foi de 20,2% (IC95% 19,0-21,5),e moderados e graves de 11% (IC95% 10,0-12,0). Entre as mulheres que não fizeram uso de ácido fólico, a prevalência de EPDS ≥ 10 foi de 26,8% (IC95% 24,0-29,5) e 18,1% tanto entre as que utilizaram durante um trimestre da gestação (IC95% 16,1-20,1), quanto entre as que utilizaram por dois ou três trimestres (IC95% 16,0-20,2). Já a prevalência de EPDS ≥ 13 foi 15,7% (IC95% 13,5-17,9) entre as que não utilizaram ácido fólico, 9,1% (IC95% 7,5-10,6) entre as que utilizaram durante um trimestre e 9,4% (IC95% 7,8-11,0) entre as que utilizaram por dois ou três trimestres. Nas análises ajustadas, não houve associação estatisticamente significativa entre o uso de ácido fólico na gestação e a ocorrência de sintomas depressivos aos três meses pós-parto. CONCLUSÃO Não se observou associação entre a suplementação de ácido fólico na gestação e depressão pós-parto aos três meses.

Iron salt supplementation during gestation and gestational diabetes mellitus

ABSTRACT OBJETIVE To evaluate the association between the use of iron salts during the first two trimesters of gestation in non-anemic women and the development of gestational diabetes mellitus. METHODS The study used maternal data from the 2015 Pelotas Birth Cohort. All non-anemic women at the 24th week of gestation (n = 2,463) were eligible for this study. Gestational diabetes mellitus was self-reported by women. Crude and adjusted logistic regression were performed considering level of significance = 0.05. RESULTS Among the women studied, 69.7% were exposed to prophylactic iron supplementation in the first two trimesters of gestation. The prevalence of gestational diabetes mellitus among those exposed was 8.7% (95%CI: 7.4-10.1) and 9.3% (95%CI: 7.4-11.6) among those who were not exposed. Iron supplementation was not associated with increased risk of gestational diabetes mellitus in crude (OR = 0.9; 95%CI: 0,7-1,3) and adjusted analysis (OR = 1.1; 95%CI :0,8-1,6). CONCLUSIONS The results suggest that routine iron use in non-anemic pregnant women does not increase the risk of developing gestational diabetes. This evidence supports the existing national and international guidelines, in which prophylactic iron supplementation is recommended for all pregnant women as soon as they initiate antenatal care in order to prevent iron deficiency anemia.

Demand and unmet need for modern contraception among mothers from a Pelotas Birth Cohort

ABSTRACT OBJECTIVE To determine the total demand and unmet need for contraception with modern methods and their determinants among mothers participating in the 2015 Pelotas Birth Cohort. METHODS Data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. Only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who answered the 48-month questionnaire were included in the study sample. Logistic regression and respective 95% confidence intervals were used to determine associated factors. RESULTS The study sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and of modern contraceptives was 86.0% (95%CI: 84.8-87.1) and 84.9% (95%CI: 83.7-86.1), respectively. The prevalence of unmet need for modern contraceptives was 10.7% (95%CI: 9.7-11.7), and the total demand for contraceptives was 95.6%. The factors associated with an unmet need for modern contraception were being over 34 years of age (OR = 0.6, 95%CI: 0.5-0.8), not having a husband or partner (OR = 1.9, 95%CI: 1.4-2.6), not being the head of the household (OR = 0.6, 95%CI: 0.4-0.9), having had three or more pregnancies (OR = 1.9, 95%CI: 1.3-2.6), and having had an abortion at least once after the birth of the child participating in the cohort (OR = 1.9, 95%CI: 1.0-3.6). CONCLUSIONS Despite the high prevalence of modern contraceptive use, one in ten women had an unmet need for modern contraception and was at risk of unplanned pregnancy.

Ultra-processed food consumption by children from a Pelotas Birth Cohort.

OBJECTIVE: Assessing the regular consumption of ultra-processed foods by children at 24 months of age from the 2015 Pelotas Birth Cohort and the main demographic, socioeconomic, and behavioral factors related to the consumption of these products. METHODS: Population-based cohort in the city of Pelotas, RS, where 4,275 children were assessed at birth and 95.4% of them were followed up until 24 months of age. Food consumption was assessed by a questionnaire on regular consumption of ultra-processed foods, which collected information regarding sex, household income, maternal skin color, schooling level, and age, the child attending day care and having siblings, breastfeeding status, and obesity. The outcome was the sum of ultra-processed foods regularly consumed by a child. A multivariate Poisson regression analysis was used to calculate the association between the regular consumption of ultra-processed foods and exposure variables. RESULTS: The mean number of ultra-processed foods consumed was 4.8 (SD = 2.3). The regular consumption of ultra-processed foods was positively associated with black skin color and having siblings, and negatively associated with household income and maternal schooling level and age. CONCLUSION: The mean regular consumption of ultra-processed foods by children from the 2015 Pelotas Birth Cohort is high, which can negatively affect the children's diet. The risk of consuming this kind of food was higher among children from families of lower socioeconomic status, whose mothers present lower education level, black skin color, and younger age.

[Mask use during the COVID-19 pandemic in Brazil: results of the EPICOVID19-BR study]. / Uso de máscara durante a pandemia de COVID-19 no Brasil: resultados do estudo EPICOVID19-BR.

By March 3, 2022, the COVID-19 pandemic has caused more than 399 million infections and claimed the lives of more than five million people worldwide. To reduce infection rates, a series of prevention measures indicated by the World Health Organization (WHO) were adopted by countries, including the use of masks. This study aims to describe mask use in Brazil via data analysis from the EPICOVID19-BR, a population-based study conducted in 133 cities in the country in four phases between March and August 2020. The proportion of individuals who reported wearing a mask when they left their homes was 97.9% (95%CI: 97.8-98.0). The interviewer did not see interviewees' mask in 50% (95%CI: 49.9-51.1) of the cases at the time of the interview. However, between phase one and four of the survey, we observed a 4.4% decrease in the proportion of interviewees who failed to wear masks at the time of the interview. Mask non-visualization was more prominent in women, participants aged 10-19 and 20-29 years of indigenous, black, and brown skin color, and those with elementary and high school education and in the Central-West Region. The use of cloth masks showed a 91.4% predominance (95%CI: 91.2-1.5) with a 4.9% increase between phases 1 and 4. The results of the study bring important information to reinforce COVID-19 control policies in Brazil. The high percentage of people who failed to wear masks at the time of the interview suggests that it is still important to reinforce prevention and self-care, rather than relating mask wear to a mandatory measure.

A pandemia de COVID-19 já causou mais de 399 milhões de infecções e custou a vida de mais de cinco milhões de pessoas no mundo, até 3 de março de 2022. Para reduzir a taxa de infecção, uma série de medidas de prevenção indicadas pela Organização Mundial da Saúde (OMS) foram adotadas pelos países, entre elas, o uso de máscara. O objetivo deste estudo é descrever a utilização de máscara na população brasileira, através da análise de dados do EPICOVID19-BR, um estudo de base populacional realizado em 133 cidades do país, em quatro fases entre março e agosto de 2020. A proporção de indivíduos que preferiram usar máscara quando saíam de casa foi de 97,9% (IC95%: 97,8-98,0). O entrevistador não visualizou a máscara do entrevistado em 50% (IC95%: 49,9-51,1) dos casos no momento da entrevista, no entanto, entre a fase uma e quatro da pesquisa, observou-se uma diminuição de 4,4 pontos percentuais na proporção de entrevistados que não usaram máscara no momento da entrevista. A não visualização da máscara foi mais observada em mulheres, participantes com idade entre 10-19 e 20-29 anos, de cor de pele indígena, preta, e parda, entre as pessoas com Ensinos Fundamental e Médio e na Região Centro-oeste. O uso de máscara de tecido foi predominante 91,4% (IC95%: 91,2-91,5) com um aumento de 4,9 pontos percentuais entre as fases 1 e 4. Os resultados do estudo trazem informações importantes para reforçar as políticas de controle de COVID-19 no Brasil. O alto percentual de pessoas sem máscara na hora da entrevista sugere que ainda é importante reforçar o aspecto preventivo e de autocuidado, não fazendo do uso da máscara algo apenas ligado à obrigatoriedade.

La pandemia del COVID-19 ha provocado más de 399 millones de infecciones y se ha cobrado la vida de más de cinco millones de personas en todo el mundo hasta el 3 de Marzo de 2022. Para reducir la tasa de contagios, los países adoptaron una serie de medidas de prevención indicadas por la Organización Mundial de la Salud (OMS), entre ellas el uso de mascarillas. El objetivo de este estudio es describir el uso de mascarillas en la población brasileña, utilizando el análisis de datos de EPICOVID19-BR, un estudio de base poblacional realizado en 133 ciudades del país, en cuatro fases entre marzo y agosto de 2020. La proporción de personas que informaron usar mascarillas al salir de casa fue del 97,9% (IC95%: 97,8-98,0). El entrevistador no vio la mascarilla del entrevistado en el 50% (IC95%: 49,9-51,1) de los casos al momento de la entrevista, sin embargo entre las fases uno y cuatro de la investigación se observó una disminución de 4,4 puntos porcentuales en la proporción de los encuestados que no llevaban mascarilla durante la entrevista. Se observó una mayor visualización de falta de uso de mascarillas en las mujeres, en participantes con edades entre 10-19 y 20-29 años, de color de piel indígena, negra y parda, entre personas con educación primaria y secundaria y en la Región Centro-oeste. Hubo un mayor predominio de uso de mascarillas de tela en el 91,4% (IC95%: 91,2-91,5) con un aumento de 4,9 puntos porcentuales entre las fases 1 y 4. Los resultados muestran la importancia de fortalecer las políticas de prevención del COVID-19 en Brasil. El alto porcentaje de personas sin mascarilla al momento de la entrevista sugiere que es importante reforzar la prevención y el autocuidado en general no solo relacionado a la obligatoriedad en el uso de mascarillas.

Factors associated with neonatal-near miss: birth cohorts in three Brazilian cities - Ribeirão Preto, Pelotas and São Luís, Brazil.

The aim of this study was to investigate the association of sociodemographic factors, lifestyle, maternal reproductive profile and prenatal and childbirth care with neonatal near miss (NNM) morbidity in four birth cohorts. This study involved four population-based birth cohorts: Ribeirão Preto (RP) and São Luís (SL) (2010), Pelotas 2004 (PEL04) and 2015 (PEL15). NNM was defined when one or more of the following conditions were present: birthweight <1,500 g, 5-minute Apgar score <7, gestational age <32 weeks, and report of congenital malformations. The covariates were obtained with questionnaires applied to the puerperal women. Some particularities between cohorts were identified. In the RP and SL cohorts, factors of the more distal levels (sociodemographic, lifestyle, and reproductive profile) were associated with NNM. On the other hand, proximal factors related to healthcare were more significant for the occurrence of NNM in PEL. Only the absence of prenatal care was associated with NNM in all cohorts: RP (OR=4.27, 95%CI 2.16-8.45), SL (OR=2.32, 95%CI 1.09-4.94), PEL04 (OR=4.79, 95%CI 1.59-14.46), and PEL15 (OR=5.10, 95%CI 2.60-9.97).

Potential of LARC to recover loss in satisfied demand for modern contraception after the COVID-19 pandemic: a case scenario analysis of Brazil and Mexico

[ABSTRACT]. Objectives. To estimate inequalities in demand for family planning satisfied with modern methods among women in Latin America and the Caribbean, with an emphasis on Brazil and Mexico, and to calculate the scenario for recovery of modern contraceptive coverage by expanding access to long-acting contraceptives (LARC) after the COVID-19 pandemic. Methods. National health surveys from 2006 to 2018 were used to estimate the demand for family planning satisfied with modern methods and how it was affected by the COVID-19 pandemic. The scenario included three variables: coverage, health outcomes, and costs. Considering coverage, United Nations Population Fund data were used to estimate the impact of COVID-19 on access to contraception in Latin America and the Caribbean. Health outcomes were assessed with the Impact 2 tool. Direct investment was used to evaluate cost-effectiveness. Results. Substantial inequalities were found in the use of modern contraceptive methods before the pandemic. We showed the potential cost-effectiveness of avoiding maternal deaths by introducing LARCs. Conclusions. In the scenario predicted for Brazil and Mexico, the costs of modern family planning and averted disability-adjusted life years are modest. Governments in Latin America and the Caribbean should consider promoting LARCs as a highly efficient and cost-effective intervention.

[RESUMEN]. Objetivos. Estimar las desigualdades en la demanda de planificación familiar satisfecha con métodos anticonceptivos modernos entre las mujeres de América Latina y el Caribe, especialmente en Brasil y México, y analizar el escenario de recuperación de la cobertura de los anticonceptivos modernos mediante la ampliación del acceso a los anticonceptivos de acción prolongada tras la pandemia de COVID-19. Métodos. Se emplearon encuestas nacionales de salud desde el año 2006 hasta el año 2018 para estimar la demanda de planificación familiar satisfecha con métodos modernos y el impacto de la pandemia de COVID-19. El escenario comprendía tres variables: cobertura, resultados en materia de salud y costos. En lo respectivo a la cobertura, se emplearon datos del Fondo de Población de las Naciones Unidas para evaluar la repercusión de la COVID-19 en el acceso a los anticonceptivos en América Latina y el Caribe. Los resultados en materia de salud se examinaron con la herramienta Impact 2. Se empleó la inversión directa para evaluar la costo-efectividad. Resultados. Se encontraron desigualdades sustanciales en el uso de métodos anticonceptivos modernos antes de la pandemia. Se demostró la posible costo-efectividad de evitar muertes maternas mediante la introducción de anticonceptivos de acción prolongada. Conclusiones. De acuerdo con el escenario previsto para Brasil y México, los costos de la planificación familiar moderna y los años de vida ajustados en función de la discapacidad evitados son moderados. Los gobiernos de América Latina y el Caribe deberían considerar la posibilidad de p

[RESUMO]. Objetivos. Estimar as desigualdades na demanda por planejamento familiar atendida por métodos contraceptivos modernos em mulheres da América Latina e do Caribe, com ênfase no Brasil e no México, e calcular o cenário de recuperação da cobertura por métodos contraceptivos modernos por meio da ampliação do acesso a métodos contraceptivos reversíveis de longa duração (LARC) após a pandemia de COVID-19. Métodos. Foram usadas pesquisas nacionais de saúde de 2006 a 2018 para estimar a demanda por planejamento familiar atendida por métodos contraceptivos modernos e como ela foi afetada pela pandemia de COVID-19. O cenário incluiu três variáveis: cobertura, desfechos de saúde e custos. Para cobertura, os dados do Fundo de População das Nações Unidas foram usados para estimar o impacto da COVID-19 no acesso à contracepção na América Latina e no Caribe. Desfechos de saúde foram avaliados com a ferramenta Impact 2. O investimento direto foi usado para avaliar a relação custo-benefício. Resultados. Foram constatadas desigualdades importantes no uso de métodos contraceptivos modernos antes da pandemia. Demonstramos a potencial relação custo-benefício de evitar mortes maternas mediante a introdução de LARC. Conclusões. No cenário previsto para o Brasil e o México, os custos do planejamento familiar moderno e dos anos de vida ajustados por incapacidade por ele evitados são modestos. Os governos da América Latina e do Caribe devem considerar a promoção dos LARC como uma intervenção altamente eficiente e custo-efetiva.

Medication use in children from the 2015 Pelotas (Brazil) birth cohort aged between three months and four years.

Medication use is an important part of the health process and prevalence of its use among infants can reach up to 65% in their first months of life. The excessive use of medication could lead to an increase in their potential harm, surpassing their benefits. Considering this, this study aimed to describe medication use in children aged 3, 12, 24, and 48 months. Standardized questionnaires were applied to assess patterns and covariables of medication use. Medication use was investigated as an outcome and defined as the receipt of any medication within 15 days before the interview. Prevalence of medication use and 95% confidence intervals (95%CI) were described using chi-squared tests. Prescription source and frequency of use were also reported, along with the most frequent medication in each follow-up. Medication use prevalence was 67.2% (95%CI: 65.8; 68.6), 68.2% (95%CI: 66.8; 69.6), 52.4% (95%CI: 50.9; 54.0), 47.2% (95%CI: 45.7; 48.8), at 3, 12, 24, and 48 months, respectively. We observed a decrease in the proportion of medically prescribed medications and an increase in self-medication over the years. Drugs for gastrointestinal disorders (A03), vitamins (A11), analgesics (N02), anti-inflammatories (M01), and nasal formulations (R01) were the most frequently used medications. We found that children under four years of age comprised over 50% of the total use of medications and self-medication. These results highlight the need to warn caregivers on the importance of proper professional examination and prescription before they administer medications to children.

HIV, Hepatitis B, Hepatitis C, and Syphilis: prevalence and serodiscordance between women and their partners / HIV, hepatite B, hepatite C e sífilis: prevalência e sorodiscordância entre mulheres e seus companheiros

Introduction: The prevention of vertical transmission of sexually transmitted diseases is the object of research by several authors, who reinforce the importance of knowing the serological status of a woman's sexual partner. Objective: To evaluate the prevalence and serodiscordance of HIV, hepatitis B, hepatitis C, and syphilis infections among women admitted to a maternity hospital in southern Brazil and their partners. Methods: 350 women and their partners were interviewed in a service-based cross-sectional study conducted from August 16 to November 23, 2018. Results: 4.0% of the women and 4.3% of the men had one of the infections studied. Among women, 2.0% already knew they were HIV positive, 2.0% had a positive rapid test for syphilis and there was no positive result for hepatitis B or C. A total of 299 (85.4%) partners were located. Of these, 293 (98.0%) agreed to answer the study questionnaire. Of all men interviewed, 281 (95.9%) agreed to undergo an rapid test. Among men, 1.4% already knew they were HIV positive and 0.4% had chronic hepatitis B disease. There was a similar percentage of men with a positive rapid test for syphilis and hepatitis C (1.4%). Regarding couples, 6.8% had some positive test. Most of the positive test subjects were in a serodiscordant relationship (16 serodiscordant couples and 3 positive concordant couples). Conclusion: These results reinforce the importance of testing men to prevent the infection of a negative partner and the vertical transmission of sexually transmitted infections. The high acceptance, by men, to undergo an rapid test at the time of the woman's hospitalization demonstrated the viability of this strategy in the maternity ward.

Introdução: A prevenção da transmissão vertical de doenças sexualmente transmissíveis é objeto de pesquisa de diversos autores, os quais reforçam a importância do status sorológico do parceiro sexual da mulher. Objetivo: Avaliar a prevalência e a sorodiscordância de infecções por HIV, hepatite B, hepatite C e sífilis em mulheres internadas em uma maternidade localizada no Sul do Brasil e seus parceiros. Métodos: Foram entrevistadas 350 mulheres e seus parceiros em um estudo transversal de base de serviço realizado de 16 de agosto a 23 de novembro de 2018. Resultados: Do grupo consultado, 4,0% das mulheres e 4,3% dos homens apresentaram alguma das infecções estudadas. Entre as mulheres, 2% já sabiam ser HIV positivas e 2% apresentaram teste rápido positivo para sífilis. Para hepatite B ou C, não se registrou nenhum resultado positivo. Foram localizados 299 (85,4%) companheiros, destes, 293 (98,0%) aceitaram responder ao questionário do estudo. Do total de homens entrevistados, 281 (95,9%) concordaram em se submeter aos testes rápidos, entre eles, 1,4% já sabiam ser HIV positivos, 0,4% eram portadores crônicos de hepatite B e 1,4% apresentaram testes rápidos positivos para sífilis e hepatite C. Em relação aos casais, 6,8% possuíam algum teste positivo, a maioria (16) era formada de indivíduos sorodiscordantes e 3 de concordantes positivos. Conclusão: Esses resultados reforçam a importância da testagem masculina com a intenção de evitar a infecção do cônjuge negativo e a transmissão vertical das infecções sexualmente transmissíveis. A alta aceitação masculina de se submeter ao teste rápido durante a internação da mulher demonstrou a viabilidade dessa estratégia de testagem na maternidade.