Browsing by Author "Correia, Sofia"
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- Childhood circumstances and mode of deliveryPublication . Teixeira, Cristina; Correia, Sofia; Barros, HenriqueObjective To assess the influence of social circumstances at 12 yrs on c-section delivery. Methods Women (n¼6827) were consecutively recruited during the assembling of a birth-cohort. Interviews were used to obtain data on social and demographic characteristics and current pregnancy events. Financial childhood circumstances were classified as low (LF) or high (HF) based on the number of amenities reported. Parents’ education was defined as low (#6 years, LPE) and high (HPE). The effect of participants’ financial socioeconomic conditions on csection risk was computed using logistic regression stratified by parents ‘education. Methods Women (n=6827) were consecutively recruited during the assembling of a birth-cohort. Interviews were used to obtain data on social and demographic characteristics and current pregnancy events. Financial childhood circumstances were classified as low (LF) or high (HF) based on the number of amenities reported. Parents' education was defined as low (≤6 years, LPE) and high (HPE). The effect of participants' financial socioeconomic conditions on c-section risk was computed using logistic regression stratified by parents ‘education. Results Women with both high financial and educational childhood circumstances were significantly older, more educated and more frequently primiparous, with normal or underweight and reporting private antenatal care. The overall c-section rate was 35.6% varying from 32.2% (LF-LE) to 41.3% (HF-HE). After adjustment and considering women in LF-LPE as reference, we obtained OR=0.92; 95% CI 0.66 to 1.28 for LF-HPE group, OR=1.19; 95% CI 1.04 to 1.37 for HF-LPE group and OR=1.38; 95% CI 1.16 to 1.64) for HF-HPE group. Stratifying by parents' education and compared with women in LF group, those in HF group showed higher risk of c-section either in the LPE group (OR=1.19; 95% CI 1.04 to 1.37) or in the HPE group (OR=1.42; 95% CI 0.99 to 2.02). Conclusions Our results suggest that, independently of the parents' education and the current socio-demographic conditions, the childhood financial environment may influence the mode of delivery.
- Differences on risk of cesarean section after labour induction according different portuguese hospitalsPublication . Teixeira, Cristina; Rodrigues, Teresa; Correia, Sofia; Barros, HenriqueTo assess if the risk of caesarean section (CS) after labour induction (LI) differs between hospitals and which extent this association may explain differences in CS rates. Methods: Participants (6688 Portuguese women) were consecutively recruited in five public hospitals (level III) during the assembling of a birth-cohort. Personal interviews were used to obtain data on socio-demographic characteristics, gynecological history and obstetric events. The risk (computed as odds ratio (OR) and 95% confidence Interval (95%CI)) of CS were considered according to hospital and adjusted for socio-demographic and obstetric characteristics. An interaction term (hospital and LI) was considered in the final model. Results: The proportion of LI by hospital ranged from 15.8% to 53.5% (p<0.001) and the proportion of CS varied between 22.2% and 35.6% (p<0.001). Women with LI presented an higher adjusted rate of CS (OR=1.71; 95%CI:1.48-1.99). There was a statistically significant interaction between hospital and IL on the risk of CS (p=0.002). After stratification by hospital and adjustment to characteristics of mother, the risk of CS for women with LI in comparison with those without LI was higher for three hospitals (OR=3.15; 95%CI:1.98-5.04, OR=1.84; 95% CI:1.38-2.46 and OR=2.04; 95%CI:1.52-2.73) but no such effect was found in the remaining two. Conclusions: Different associations between LI and CS across hospitals probably result from different management of LI. These differences may partially explain discrepancies in CS rates across hospitals.
- Geographic origin and risk of cesarean section in PortugalPublication . Teixeira, Cristina; Correia, Sofia; Barros, HenriqueTo assess the influence of pregnant’s country of birth on the risk of cesarean-section (CS) in singleton deliveries in Portugal. Methods Participants (7435 women) were consecutively recruited during the procedure of assembling a birth-cohort. Clinical records were used for data on delivery and personal interviews were used to obtain a large set of data on social and demographic characteristics, gynecological history and current pregnancy events. Participants were classified according origin country as PT (Portuguese-born, 90%), ENA (from other European and North-American countries, 3.3%), AF (from African countries, 3.7%) and SA (from South-American countries, 3.0%) The risk of CS according the country of birth and adjusted for socio-demographic and obstetric characteristics was computed using logistic regression. Results When compared with PT, AF women were older (35.2 vs. 17.4, p<0.001), more frequently multiparous (61.9% vs. 51.3%, p<0.001) and showing higher prevalence of maternal pathology (61.9% vs. 51.3%, p<0.001). Both, ENA and AF used more frequently private antenatal care (52.5% vs. 36.8%, p<0.001 and 51.8 vs. 36.8, p<0.001, respectively) than PT women. All groups of foreign-born showed a higher proportion of more educated women than Portuguese-born. Compared with PT, SA had higher risk of CS (OR=1.63; 95%CI: 1.24-2.12), followed by the AF women (OR=1.26; 95%CI: 0.99-1.61). Higher risk remains among SA women after adjustment for socio-demographic and obstetric characteristics (OR=1.75; 95%CI: 1.29-2.39). Among foreign-born, when compared with ENA, SA women reveal higher risk, after adjustment for duration of stay (OR=1.93; 95%CI: 1.14 – 3.26). Conclusions After adjustment for known risk factors, the risk of CS was higher for SA women when compared with PT and ENA women. Our results suggest that origin country plays an important role on CS deliveries independently the duration of stay in Portugal.
- Risk of caesarean section after induced labour: do hospitals make a difference?Publication . Teixeira, Cristina; Correia, Sofia; Barros, HenriqueBackground: There is a well-known relationship between induced labour and caesarean rates. However, it remains unknown whether this relationship reflects the impact of more complex obstetric conditions or the variability in obstetric practices. We sought to quantify the independent role of the hospital as a variable that can influence the occurrence of caesarean section after induced labour. As part of the Portuguese Generation XXI birth cohort, we evaluated 2041 consecutive women who underwent singleton pregnancies with labour induction, at five public level III obstetric units (April 2005-August 2006). The indications for induction were classified according to the guidelines of the American and the Royal Colleges of Obstetricians and Gynaecologists. Poisson regression models were adjusted to estimate the association between the hospital and surgical delivery after induction. Crude and adjusted prevalence ratios (PR) and a 95% confidence interval (95% CI) were computed. The proportion of women who were induced without formal clinical indications varied among hospitals from 20.3% to 45.5% (p < 0.001). After adjusting for confounders, the risk of undergoing a caesarean section after induced labour remained significantly different between the hospitals, for the cases in which there was no evident indication for induction [the highest PR reaching 1.86 (95% CI, 1.23–2.82)] and also when at least one such indication was present [1.53 (95% CI, 1.12–2.10)]. This pattern was also observed among the primiparous cephalic term induced women [the highest PR reaching 2.06 (95% CI, 1.23–2.82) when there was no evident indication for induction and 1.61 (95% CI, 1.11–2.34) when at least one such indication was present]. Caesarean section after induced labour varied significantly across hospitals where similar outcomes were expected. The effect was more evident when the induction was not based on the unequivocal presence of commonly accepted indications.
- The brazilian preference: cesarean delivery among immigrants in PortugalPublication . Teixeira, Cristina; Correia, Sofia; Victora, César; Barros, HenriqueTo evaluate how the country of origin affects the probability of being delivered by cesarean section when giving birth at public Portuguese hospitals. STUDY DESIGN: Women delivered of a singleton birth (n = 8228), recruited from five public level III maternities (April 2005-August 2006) during the procedure of assembling a birth cohort, were classified according to the country of origin and her migration status as Portuguese (n = 7908), non-Portuguese European (n = 84), African (n = 77) and Brazilian (n = 159). A Poisson model was used to evaluate the association between country of birth and cesarean section that was measured by adjusted prevalence ratio (PR) and respective 95% confidence intervals (95%CI). RESULTS: The cesarean section rate varied from 32.1% in non-Portuguese European to 48.4% in Brazilian women (p = 0.008). After adjustment for potential confounders and compared to Portuguese women as a reference, Brazilian women presented significantly higher prevalence of cesarean section (PR = 1.26; 95%CI: 1.08-1.47). The effect was more evident among multiparous women (PR = 1.39; 95%CI: 1.12-1.73) and it was observed when cesarean section was performed either before labor (PR = 1.43; 95%CI: 0.99-2.06) or during labor (PR = 1.30; 95%CI: 1.07-1.58). CONCLUSIONS: The rate of cesarean section was significantly higher among Brazilian women and it was independent of the presence of any known risk factors or usual clinical indications, suggesting that cultural background influences the mode of delivery overcoming the expected standard of care and outcomes in public health services.