Factors associated with low birthweight: a case-control study in a city of Minas Gerais

Defilipo, Érica Cesário; Chagas, Paula Silva de Carvalho; Peraro-Nascimento, Andreia; Ribeiro, Luiz Cláudio

doi:10.11606/s1518-8787.2020054002065

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Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054002065 copy

Factors associated with low birthweight: a case-control study in a city of Minas Gerais

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the many factors regarding socioeconomic and healthcare-related variables linked to maternal diseases and the possible impact of the environmental disaster of Mariana, given the prenatal exposure to different water sources for human consumption that were associated with low birthweight in full-term live births in the Municipal Hospital of Governador Valadares, Minas Gerais.

METHODS

Case-control study, carried out with live births at the Municipal Hospital of Governador Valadares, from May 2017 to July 2018. The case group consisted of full-term live births and low birthweight, and the control group consisted of full-term live births with adequate weight, matched by gender and date of birth. For each case, two controls were selected. Data collection was performed through interviews with the puerperal women, and complementary information was obtained by analyzing the prenatal card and medical records. For data analysis, logistic regression was performed.

RESULTS

The study included 65 live births from the case group and 130 from the control group. After the analysis was adjusted for other factors under study, we found that the higher risks of low birthweight are associated with the first childbirth (OR = 2.033; 95%CI = 1.047–3.948; p = 0.036), smoking during pregnancy (OR = 2.850; 95%CI = 1.013–8.021; p = 0.047) and consumption of water supplied by the municipalities affected by the tailings from the Fundão dam failure (RC = 2.444; 95%CI = 1.203–4.965; p = 0.013).

CONCLUSIONS

The variables “water consumed during pregnancy,” “previous pregnancies” and “maternal smoking” were associated with low birthweight in the population studied. The importance of epidemiological studies that assess water quality and its adverse health effects is reinforced, as well as greater prenatal control of first-time pregnant women and greater support of policies against smoking, especially during pregnancy.

Low Birth Weight Infant; Risk Factors; Environmental Exposure; Socioeconomic Factors; Case Studies and Controls; Maternal and Child Health

Variables	Cases (n = 65)		Controls (n = 130)		OR	95%CI	p

	n	%	n	%
Mother’s schooling level
Incomplete high school or under grade	32	49.2	63	48.5	Ref
Complete high school or superior grade	33	50.8	67	51.5	0.970	0.535–1.759	0.919
Mother’s age
< 20 years or ≥ 35 years	17	26.2	40	30.8	Ref	-
20 to 34 years	48	73.8	90	69.2	1.255	0.644–2.445	0.504
Mother’s race
White	11	16.9	18	13.8	Ref	-
Black or brown	54	83.1	112	86.2	0.789	0.348–1.787	0.569
Mother’s marital status
With a partner	49	75.4	101	77.7	Ref	-
Without partner	16	24.6	29	22.3	1.137	0.565–2.288	0.718
Monthly household income^b
≤ 2 minimum wages	48	78.7	93	75.0	Ref	-
> 2 minimum wages	13	21.3	31	25.0	0.813	0.389–1.695	0.580
Mother’s occupation
No paid occupation	42	64.6	84	64.6	Ref	-
With paid occupation	23	35.4	46	35.4	1.000	0.537–1.864	1.000
Father’s schooling level
Incomplete high school or under grade	32	55.2	69	59.0	Ref	-
Complete high school or superior grade	26	44.8	48	41.0	1.168	0.619–2.204	0.632
Father’s age^b
< 20 years or ≥ 35 years	15	24.2	37	28.7	Ref	-
20 to 34 years	47	75.8	92	71.3	1.260	0.629–2.526	0.514
Father’s race
White	18	27.7	32	24.6	Ref	-
Black, brown or yellow	47	72.3	98	75.4	0.853	0.435–1.673	0.643
Basic sanitation
No	10	15.4	12	9.2	Ref	-
Yes	55	84.6	118	90.8	0.559	0.228–1.373	0.200
Place of residence
Urban	50	76.9	105	80.8	Ref	-
Rural	15	23.1	25	19.2	1.260	0.611–2.597	0.531
Water consumed during pregnancy
Mineral, from mines, wells, cisterns or the supply service of non-affected municipalities	43	66.2	108	83.1	Ref	-	0.008^a
Supply services of affected municipalities	22	33.8	22	16.9	2.512	1.262–5.00

Variables	Cases (n = 65)		Controls (n = 130)		OR	95%CI	p

	n	%	n	%
Section 2

Interval between pregnancies
≤ 2 years	5	7.7	15	11.5	Ref	-	0.302
2 years	21	32.3	52	40.0	1.212	0.391–3.758	0.740
First child	39	60.0	63	48.5	1.857	0.626–5.513	0.265
Previous abortion
No	54	83.1	110	84.6	Ref	-
Yes	11	16.9	20	15.4	1.120	0.501–2.505	0.782
Previous case of stillbirth
No	64	98.5	128	98.5	Ref	-
Yes	1	1.5	2	1.5	1.000	0.089–11.236	1.000
Child’s death in under 1 year
No	64	98.5	126	96.9	Ref	-
Yes	1	1.5	4	3.1	0.492	0.54–4.495	0.666
Previous premature child
Non-premature previous child	25	38.5	60	46.2	Ref	-	0.218
Premature previous child	1	1.5	7	5.4	0.343	0.040–2.933	0.328
First child	39	60.0	63	48.5	1.486	0.804–2.746	0.206
Previous child with low birthweight
Previous child with adequate weight	21	32.3	63	48.5	Ref	-	0.063*
Previous child with low weight	5	7.7	4	3.1	3.750	0.921–15.275	0.065*
First child	39	60.0	63	48.5	1.857	0.984–3.505	0.056*

Section 3

Alcohol dependence
No	58	89.2	119	91.5	Ref	-
Yes	7	10.8	11	8.5	1.306	0.481–3.543	0.600
Smoking habit
No	55	84.6	122	93.8	Ref	-
Yes	10	15.4	8	6.2	2.773	1.038–7.408	0.036*
Drug use
No	64	98.5	129	99.2	Ref	-
Yes	1	1.5	1	0.8	2.016	0.124–32.750	1.000
Victim of violence against pregnant women
No	57	87.7	122	93.8	Ref	-
Yes	8	12.3	8	6.2	2.140	0.765–5.990	0.140*
Stressful event in pregnancy
No	40	61.5	89	68.5	Ref	-
Yes	25	38.5	41	31.5	1.357	0.729–2.526	0.335

Variables	Cases (n = 65)		Controls (n = 130)		OR	95%CI	p

	n	%	n	%
Number of prenatal appointments
< 6 appointments	18	27.7	27	20.8	Ref	-
≥ 6 appointments	47	72.3	103	79.2	0.684	0.344–1.363	0.279
First prenatal appointment*
≤ 16 weeks	52	81.3	105	80.8	Ref	-
> 16 weeks	12	18.8	25	19.2	0.969	0.451–2.082	0.936
Pre-natal care institution*
Public	54	84.4	103	79.2	Ref	-
Private	10	15.6	27	20.8	0.706	0.318–1.567	0.391
Vaccination during pregnancy
No	4	6.2	10	7.7	Ref	-
Yes, or immunized	61	93.8	120	92.3	1.271	0.383–4.218	0.695
Residence with FHS coverage
No	5	7.7	7	5.4	Ref	-
Yes	60	92.3	123	94.6	0.683	0.208–2.241	0.527
Type of delivery
Vaginal	40	61.5	89	68.5	Ref	-
Cesarean section	25	38.5	41	31.5	1.357	0.729–2.526	0.335

Variables	Cases (n = 65)		Controls (n = 130)		OR	95%CI	p

	n	%	n	%
Gestational diabetes
No	63	96.9	126	96.9	Ref	-
Yes	2	3.1	4	3.1	1.000	0.178–5.608	1.000
Gestational hypertension
No	54	83.1	114	87.7	Ref	-
Yes	11	16.9	16	12.3	1.451	0.631–3.339	0.379
Chronic hypertension
No	63	96.9	129	99.2	Ref	-
Yes	2	3.1	1	0.8	4.095	0.364–46.022	0.258
Preeclampsia
No	62	95.4	128	98.5	Ref	-
Yes	3	4.6	2	1.5	3.097	0.504–19.012	0.336
Urinary tract infection
No	37	56.9	90	69.2	Ref	-
Yes	28	43.1	40	30.8	1.703	0.919–3.153	0.089*
Vaginal bleeding in the 1st trimester
No	52	80.0	115	88.5	Ref	-
Yes	13	20.0	15	11.5	1.917	0.851–4.316	0.112*
Oligohydramnios
No	62	95.4	125	96.2	Ref	-
Yes	3	4.6	5	3.8	1.210	0.280–5.226	1.000
Anemia
No	49	75.4	91	70.0	Ref	-
Yes	16	24.6	39	30.0	0.762	0.387–1.500	0.431
Syphilis
No	63	96.9	125	96.2	Ref	-
Yes	2	3.1	5	3.8	0.794	0.150–4.206	1.000

Sections	Variables	OR	95%CI	p
Section 1	Water consumed during pregnancy
	Mineral, from mines, wells, cisterns or the supply service of non-affected municipalities	Ref	-
	Supply services of affected municipalities	2.444	1.203–4.965	0.013*

Section 2	Previous child with low birthweight
	Previous child with adequate weight	Ref	-	0.052
	Previous child with low weight	3.729	0.860–16.167	0.079
	First child	2.033	1.047–3.948	0.036*

Section 3	Smoking habit
	No	Ref	-
	Yes	2.850	1.013–8.021	0.047*

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E-mail: revsp@usp.br

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[1] Correspondence: Érica Cesário Defilipo Clínica Escola de Fisioterapia Rua Leonardo Cristino, 3.400 35012-000 Governador Valadares, MG, Brasil E-mail: erica.defilipo@ufjf.edu.br