Fernandes Karayna Gil, Souza Renato Teixeira, Leal Maria Carmo, Moura Erly C, Santos Leonor M, Cecatti Jose Guilherme
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, R. Alexander Fleming, 101, Campinas, SP, 13083-891, Brazil.
National School of Public Health, FIOCRUZ, Rio de Janeiro, RJ, Brazil.
Arch Gynecol Obstet. 2017 Dec;296(6):1063-1070. doi: 10.1007/s00404-017-4530-6. Epub 2017 Sep 16.
To evaluate the association between ethnic differences and the occurrence of maternal near miss (MNM) in the Amazon and Northeast regions of Brazil.
This is a secondary analysis of a national cross-sectional study focused on the assessment of care to pregnancy, childbirth, and infants under 1 year of age. Ethnicity was classified as white, black or indigenous. Ethnic distribution by state and region, the proportion of severe maternal complications and related procedures, and the prevalence of MNM and its criteria were calculated for the ethnic groups. Risks for MNM were estimated per sociodemographic characteristics and healthcare received by ethnic group, using prevalence ratios adjusted by all predictors and by the sampling method.
76% of the 16.783 women were black, 20% white and 3.5% indigenous. Around 36% reported any complication related to pregnancy and the most frequent were hemorrhage (27-31%), and infection (7.1-9.0%). The MNM ratio was higher among indigenous (53.1) and black (28.4) than in white women (25.7). For black women, the risks of MNM were lower for private prenatal care and hospital admission for conditions other than hypertension, while higher for cesarean section and peregrination. For indigenous, the risks of MNM were lower for private prenatal care, and higher for a longer time to reach the hospital. For white women, only the low number of prenatal visits increased the risk of MNM.
The occurrence of MNM was higher for indigenous and black than for white women.
评估巴西亚马逊地区和东北部地区种族差异与孕产妇险些死亡（MNM）发生率之间的关联。
这是一项全国横断面研究的二次分析，重点是评估孕期、分娩及1岁以下婴儿护理情况。种族分为白人、黑人或原住民。计算了各州和各地区的种族分布、严重孕产妇并发症及相关手术的比例，以及各民族群体中MNM的患病率及其标准。根据社会人口学特征和各民族群体接受的医疗保健情况，使用经所有预测因素和抽样方法调整的患病率比，估算MNM的风险。
16783名女性中，76%为黑人，20%为白人，3.5%为原住民。约36%的人报告有任何与妊娠相关的并发症，最常见的是出血（27%-31%）和感染（7.1%-9.0%）。原住民（53.1）和黑人（28.4）的MNM比率高于白人女性（25.7）。对于黑人女性，除高血压外，接受私人产前护理和因其他疾病住院可降低MNM风险，而剖宫产和长途跋涉则会增加风险。对于原住民，接受私人产前护理可降低MNM风险，而到达医院的时间较长则会增加风险。对于白人女性，只有产前检查次数少会增加MNM风险。
原住民和黑人中MNM的发生率高于白人女性。
