Cadernos Saúde Coletiva

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ORIGINAL ARTICLE • Cad. Saúde. Colet. 34 (1) • 2026 • https://doi.org/10.1590/1414-462X202634010199 linkcopiar

Adequação da assistência pré-natal na Atenção Básica em um município do nordeste brasileiro

Autoria SCIMAGO INSTITUTIONS RANKINGS

Introdução: O cuidado pré-natal é um componente essencial para a promoção da saúde materna e infantil e, quando ofertada de modo inapropriado, pode resultar em condições adversas maternas e perinatais.

Objetivo: Analisar a adequação da assistência pré-natal na Atenção Básica em um município do Nordeste do Brasil.

Método: Estudo transversal com 613 puérperas, realizado entre setembro de 2017 e maio de 2018. A pesquisa considerou o início do prénatal, número de consultas, registro de exames de rotina e procedimentos realizados nas consultas e orientações maternas recebidas, conforme o Ministério da Saúde. A regressão logística simples e múltipla foi utilizada para estimar o odds ratio (OR) entre as características sociodemográficas, obstétricas e de uso do serviço e a variável de desfecho adequação pré-natal.

Resultados: Mulheres com idade <18 anos apresentaram menor probabilidade de iniciar o pré-natal precoce. Pertencer à classe econômica B-C, ter companheiro e ter um a dois filhos, realizar pré-natal em UBS (Unidade Básica de Saúde) tradicional e ter trabalho remunerado estiveram associados a maiores chances de adequação.

Conclusões: A assistência pré-natal na Atenção Básica do município mostrou-se inadequada com a persistência das desigualdades socioeconômicas.

Palavras-chave:
cuidado pré-natal; atenção primária à saúde; indicadores de qualidade em assistência à saúde; avaliação em saúde.

Characteristics	Total n (%)	Adequacy of early start		Adequacy of number of prenatal consultations		Adequacy of tests performed		Adequacy of procedures performed		Adequacy of maternal guidelines		Prenatal adequacy*
Characteristics	Total n (%)	n (%)	p-value	n (%)	p-value	n (%)	p-value	n (%)	p-value	n (%)	p-value	n (%)	p-value
Age (years)
<18	68 (11.09)	36 (52.9)	0.017	55 (80.9)	0.104	1 (1.5)	0.709†	8 (11.8)	0.834	27 (39.7)	0.308	-	1,000†
≥18	545 (88.91)	368 (67.5)	0.017	479 (87.9)	0.104	17 (3.1)	0.709†	69 (12.7)	0.834	252 (46.2)	0.308	4 (0.7)	1,000†
Schooling (years of study)
≤8	289 (47.22)	372 (65.6)	0.655	495 (87.3)	0.582	17 (3.0)	1.000†	75 (13.2)	0.087	262(46.2)	0.167	4 (0.7)	1,000†
>8	323 (52.78)	31 (68.9)	0.655	38 (84.4)	0.582	1 (2.2)	1.000†	2 (4.4)	0.087	16 (35.6)	0.167	-	1,000†
Economic class‡
B-C	240 (39.15)	174 (72.5)	0.006	210 (87.5)	0.818	10 (4.2)	0.148	33 (13.8)	0.476	116 (48.3)	0.261	3 (1.3)	0,305†
D-E	373 (60.85)	230 (61.7)	0.006	324 (86.9)	0.818	8 (2.1)	0.148	44 (11.8)	0.476	163 (43.7)	0.261	1 (0.3)	0,305†
Skin color (self-reported)
White	163 (26.59)	111 (68.1)	0.491	142 (87.1)	0.999	8 (4.9)	0.102†	17 (10.4)	0.338	73 (44.8)	0.827	1 (0.6)	1,000†
Black	450 (73.41)	293 (65.1)	0.491	392 (87.1)	0.999	10 (2.2)	0.102†	60 (13.3)	0.338	206 (45.8)	0.827	3 (0.7)	1,000†
Paid work
Yes	234 (38.17)	166 (70.9)	0.039	208 (88.9)	0.302	10 (4.3)	0.123	28 (12.0)	0.727	123 (52.6)	0.006	3 (1.3)	0,158†
No	379 (61.83)	238 (62.8)	0.039	326 (86.0)	0.302	8 (2.1)	0.123	49 (12.9)	0.727	156 (41.2)	0.006	1 (0.3)	0,158†
Having a partner
Yes	511 (83.36)	349 (68.3)	0.005	449 (87.9)	0.212	17 (3.3)	0.334†	65 (12.72)	0.790	232 (45.4)	0.900	3 (0.6)	0,518†
No	102 (16.64)	55 (53.9)	0.005	85 (83.3)	0.212	1 (1.0)	0.334†	12 (11.76)	0.790	47 (46.1)	0.900	1 (1.0)	0,518†
Number of children
1-2	484 (78.96)	331 (68.4)	0.012	428 (88.4)	0.059	13 (2.7)	0.555†	61 (12.6)	0.951	222 (45.9)	0.733	3 (0.6)	1,000†
≥3	129 (21.04)	73 (56.6)	0.012	106 (82.2)	0.059	5 (3.9)	0.555†	16 (12.4)	0.951	57 (44.2)	0.733	1 (0.8)	1,000†
Place of prenatal care
Traditional BHU	143 (23.33)	90 (62.9)	0.392	130 (90.9)	0.125	5 (3.5)	0.583†	29 (20.3)	0.001	61 (42.7)	0.433	2 (1.4)	0,233†
FHU	470(76.02)	314 (66.8)	0.392	404 (86.0)	0.125	13 (2.8)	0.583†	48 (10.2)	0.001	218 (46.4)	0.433	2 (0.4)
Pregnancy complications
Yes	246 (40.13)	163 (66.3)	0.879	216 (87.8)	0.675	11 (4.5)	0.065	36 (14.6)	0.205	122 (49.6)	0.097	3 (1.2)	0,308†
No	367 (59.87)	241 (65.7)	0.879	318 (86.6)	0.675	7 (1.9)	0.065	41 (11.2)	0.205	157 (42.8)	0.097	1 (0.3)	0,308†
Negative outcome in pregnancy
Yes	43 (7.01)	27 (62.8)	0.655	39 (90.7)	0.467	1 (2.3)	1.00†	8 (18.6)	0.215	17 (39.5)	0.414	-	1,000†
No	570 (92.99)	377 (66.1)	0.655	495 (86.8)	0.467	17 (3.0)	1.00†	69 (12.1)	0.215	262 (46.0)	0.414	4 (0.7)	1,000†

Characteristics	Adequacy of early start		Adequacy of number of prenatal consultations		Adequacy of tests performed		Adequacy of procedures performed		Adequacy of maternal guidelines
Characteristics	OR_b (95%CI)	p-value	OR_b(95%CI)	p-value	OR_b(95%CI)	p-value	OR_b(95%CI)	p-value	OR_b(95%CI)	p-value
Age (years)
<18	0.54 (0.33–0.90)	0.018	0.58 (0.30–1.12)	0.107	0.46 (0.06–3.54)	0.459	0.92 (0.42–2.00)	0.834	0.77 (0.46–1.28)	0,309
≥18	1	0.018	1	0.107	1	0.459	1	0.834	1	0,309
Schooling (years of study)
≤8	0.86 (0.45–1.66)	0.655	1.27 (0.55–2.54)	0.583	1.36 (0.18–10.46)	0.768	3.28 (0.78–13.81)	0.106	1.56 (0.83–2.93)	0,170
>8	1	0.655	1	0.583	1	0.768	1	0.106	1	0,170
Economic class#
B-C	1.64 (1.15–2.33)	0.006	1.06 (0.65–1.72)	0.818	1.98 (0.77–5.10)	0.155	1.19 (0.73–1.93)	0.477	1.21 (0.87–1.67)	0,261
D-E	1	0.006	1	0.818	1	0.155	1	0.477	1	0,261
Skin color (self-reported)
White	1.14 (0.78–1.68)	0.491	1.00 (0.59–1.71)	0.999	2.27 (0.88–5.86)	0.090	0.76 (0.43–1.34)	0.339	0.96 (0.67–1.38)	0,827
Black	1	0.491	1	0.999	1	0.090	1	0.339	1	0,827
Paid work
Yes	1.45 (1.02–2.05)	0.039	1.30 (0.79–2.15)	0.303	2.07 (0.81–5.32)	0.131	0.95 (0.56–1.50)	0.727	1.58 (1.14–2.20)	0,006
No	1	0.039	1	0.303	1	0.131	1	0.727	1	0,006
Having a partner
Yes	1.84 (1.20–2.84)	0.006	1.45 (0.81–2.60)	0.214	3.48 (0.46–26.41)	0.229	1.09 (0.57–2.11)	0.790	0.97 (0.64–1.50)	0,900
No	1	0.006	1	0.214	1	0.229	1	0.790	1	0,900
Children number
1–2	1.66 (1.12–2.47)	0.012	1.66 (0.98–2.82)	0.061	0.69 (0.24–1.96)	0.479	1.02 (0.57–1.83)	0.951	1.07 (0.72–1.58)	0,733
≥3	1	0.012	1	0.061	1	0.479	1	0.951		0,733
Place of prenatal care
Traditional BHU	0.84 (0.57–1.25)	0.393	1.63 (0.87–3.06)	0.125	1.27 (0.45–3.06)	0.651	2.24 (1.35–3.71)	0.002	0.86 (0.59–1.26)	0,434
FHU	1	0.393	1	0.125	1	0.651	1	0.002	1	0,434
Pregnancy complications
Yes	1.03 (0.73–1.44)	0.879	1.11 (0.68–1.80)	0.675	2.41 (0.92–6.30)	0.073	1.36 (0.84–2.20)	0.206	1.32 (0.95–1.82)	0,097
No	1	0.879	1	0.675	1	0.073	1	0.206	1	0,097
Negative outcome in pregnancy
Yes	0.86 (0.46–1.64)	0.655	1.48 (0.51–4.25)	0.469	0.78 (0.10–5.96)	0.806	1.66 (0.74–3.72)	0.219	0.77 (0.41–1.45)	0,415
No	1	0.655	1	0.469	1	0.806	1	0.219	1	0,415

	OR_a (95%CI)	p-value
	Adequacy of early start	p-value
Age (years)
<18	0.55 (0.32–0.93)	0.026
≥18	1	0.026
Economic class
B-C	1.45 (1.01–2.09)	0.044
D-E	1	0.044
Paid work
Yes	1.241 (0.86–1.79)	0.247
No	1	0.247
Having a partner
Yes	1.68 (1.08–2.61)	0.021
No	1	0.021
Number of children
1–2	1.70 (1.12–2.57)	0.012
≥3	1	0.012
Adequacy of number of prenatal consultations
Age (years)
<18	0.52 (0.26–1.02)	0.059
≥18	1	0.059
Number of children
1–2	1.83 (1.06–3.16)	0.031
≥3 or more	1	0.031
Prenatal care location
Traditional BHU	1.54 (0.82–2.89)	0.184
FHU	1	0.184
Adequacy of examinations performed
Economic class
B-C	1.764 (0.68–4.61)	0.247
D-E	1	0.247
Skin color (self-reported)
White	2.23 (0.85–5.81)	0.102
Black	1	0.102
Paid work
Yes	1.67 (0.64–4.40)	0.296
No	1	0.296
Pregnancy complications
Yes	2.34 (0.88–6.18)	0.087
No	1	0.087
Adequacy of procedures performed
Schooling (years of study)
≤8	3.14 (0.74–13.28)	0.121
>8	1	0.121
Place of prenatal care
Traditional BHU	2.20 (1.33–3.65)	0.002
FHU	1	0.002
Adequação orientações maternas
Schooling time (years of study)
≤8	1.60 (0.85–3.02)	0.149
>8	1	0.149
Paid work
Yes	1.55 (1.11–2.16)	0.009
No	1	0.009
Pregnancy complications
Yes	1.28 (0.92–1.77)	0.144
No	1	0.144

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