Thesis advisor: Shanta Pandey / A growing body of literature, particularly from low and middle-income countries, has focused on the role of male involvement in maternal care as a crucial strategy to improve maternal and neonatal health outcomes. The purpose of this three-paper dissertation is to add to this evidence base within the context of India, and to gain an in-depth understanding of one aspect of male involvement – that is, male partner attendance in antenatal care. This dissertation utilized data from the National Family Health Survey (NFHS-3, 2005-06 and NFHS-4, 2015-16) and was framed using the Social Ecological Model, Connell’s Theory of Gender and Power and a Gender-Transformative lens. Paper 1 summarized the levels of male partner attendance in antenatal care and assessed changes over time. Further, multivariable logistic regression models were used to examine the factors influencing male partner attendance in antenatal care. The results show an overall increase in male partner attendance in India during the period of 2005-06 to 2015-16, with the Southern region reporting the highest level of male partner attendance in both years. Higher level of education and household wealth, increased knowledge of pregnancy-related complications, older age at marriage, and women’s autonomy were positively associated with male partner attendance in antenatal care. Paper 2 examined the association between male partner attendance in antenatal care and maternal health service utilization. Controlling for all socio-demographic variables and adjusting for report of pregnancy complications, the results showed that women who were accompanied by a male partner for antenatal care reported increased odds of maternal health service utilization (early initiation of antenatal care, frequency of antenatal care contacts and institutional delivery). While the place of residence (rural/urban) did not influence the association between male partner attendance and maternal health service utilization, region had a significant moderating effect. Paper 3 examined the association between antenatal care and infant birth weight, adjusting for gestational age. Further, the analysis also assessed whether the relationship between antenatal care and infant birth weight varied by male partner attendance. Findings indicate that early initiation of antenatal care and maternal immunization was associated with reduced odds of low birth weight among infants. The results showed that male partner attendance in antenatal care did not have a moderating influence. Taken together, the findings of the three papers have implications for policy and practice; further, they provide support for interventions that aim for a more inclusive and gender-transformative approach to maternal and neonatal health. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social work.

Objective: Animal literature has suggested that the impact of antenatal corticosteroids (ACS) may vary by infant sex. Our objective was to assess the impact of infant sex on the use of multiple courses versus a single course of ACS and perinatal outcomes. Study Design: We conducted a secondary analysis of the Multiple Courses of Antenatal Corticosteroids (MACS) for Preterm Birth trial. Our primary outcome was a composite of perinatal mortality or clinically significant neonatal morbidity (including neonatal death, stillbirth, severe respiratory distress syndrome, intraventricular hemorrhage [grade III or IV], cystic periventricular leukomalacia, and necrotising enterocolitis [stage II or III]). Secondary outcomes included individual components of the primary outcome as well as anthropometric measures. Baseline characteristics were compared between participants who received multiple courses versus a single course of ACS. Multivariable regression analyses were conducted with adjustment for pre-defined covariates including an interaction between exposure to ACS and infant sex. Results: Data on 2304 infants were analyzed. The interaction term between treatment status (multiple courses versus a single course of ACS) and infant sex was not significant in the adjusted model for the primary outcome (p=0.86), nor for any of the secondary outcomes. Exposure to multiple courses versus a single course of ACS was not associated with the primary outcome either before or after adjustment (aOR 0.99, 95% CI 0.67 to 1.45, n=2292 infants). However, exposure to multiple courses versus a single course of ACS resulted in significantly lower birth length (p=0.02) and head circumference at birth (p=0.04) although not birthweight (p=0.06). Conclusions: Infant sex did not modify the association between exposure to ACS and perinatal outcomes including perinatal mortality or neonatal morbidity or anthropometric outcomes. However, animal literature indicates that sex specific differences after exposure to ACS may emerge over time and thus investigating long-term sex-specific outcomes warrants further attention. / Thesis / Master of Science (MSc) / Antenatal corticosteroids (ACS) are given in pregnancies at risk of early birth. ACS help the lungs and other organs, such as the brain and kidneys to mature. ACS help improve babies’ survival and reduce the risk of other health complications. Several animal studies suggest that infant sex can affect long-term outcomes after receiving a higher dose of ACS. The goal of our study was to look at the effect of infant sex on the relationship between the use of multiple courses (i.e., a higher dose) versus a single course of ACS and short-term outcomes. These outcomes include challenges with breathing, bleeding in the brain, problems in the bowel, and infant death. Our study found that infant sex did not significantly change the relationship between ACS and short-term infant outcomes, but further study is required on long-term outcomes as sex specific differences may emerge over time as reported in animal literature.

Background: Aboriginal peoples face disproportionate health inequalities in comparison to non-Aboriginal Canadians, especially in regards to cardiovascular disease risk factors. Evidence illustrates that the propensity to develop these chronic diseases happens during the perinatal period. Related to this are maternal health behaviours—which are influenced by grandmothers’ advice. Very few studies have explored Aboriginal grandmothers’ beliefs around perinatal health or how they translate into maternal health behaviours. Objectives: The objectives of this thesis were to: 1) Qualitatively explore the beliefs and cultural perceptions around prenatal and postnatal health behaviours from the accounts of Grandmothers from the Six Nations reserve; 2) Incorporate the emergent themes to develop a theoretical framework; 3) Design and apply culturally-respectful avenues for knowledge translation. Methods: Qualitative, semi-structured individual interviews and focus groups were conducted with grandmothers from the Six Nations reserve. Sampling of participants used non-probabilistic methods. Recruitment was achieved through the leadership of community members and continued until saturation. All interviews were audio-recorded, transcribed verbatim, and underwent thematic analysis. A Six Nations community member was involved with the coding process and additional interviews were conducted to ensure member-checking. Results: Six Nations grandmothers identified three primary perinatal beliefs: 1) Pregnancy is a natural phase of the life course that is not an illness nor a “comfort zone”; 2) Pregnancy is a sacred period where balance is key; 3) Optimal perinatal health is achieved through immunity, security, comfort, social development, and parental responsibility. This knowledge is shared via storytelling and observational teaching. In addition, the grandmothers identified local community responsibilities required to uphold optimal health. Consultation with the community resulted in an integrated knowledge translation component (short film) for key stakeholders. Conclusion: Building resilience and strength through culturally-generated interventions will guide the future of community-based programs and policies that aim to reduce cardiometabolic risk factors in this Aboriginal community. / Thesis / Master of Science (MSc)

L’objectif principal de cette thèse était de caractériser et d’analyser la présence sociale dans la / les transition(s) de femmes brésiliennes de classes aisées à la maternité, au Brésil, en France, au Portugal et en Suèdedans des années récentes. L'objectif final était de contribuer à la déconstruction du modèle hégémonique de la «bonne maternité» au Brésil, établi à partir des expériences de femmes brésiliennes blanches de la classe moyenne.en. En tant que stratégie méthodologique, elle a mis l’accent sur les expériences de présence des mères brésiliennes, en utilisant la communication par ordinateur et trois méthodes en parallèle: une recherche documentaire de rapports de travail de recherches sur la santé périnatale et les politiques familiales des institutions nationales et internationales, des entretiens biographiques et enregistrement des journaux quotidiens; les trois méthodes sont articulés dans une perspective phénoménologique. Ainsi, à partir de mon travail de terrain, j’ai cherché, comme une dérive en spirale, comment certaines rhétoriques morales associées aux normes de genre, de classe et de race sont reproduites par des mères privilégiées en transition maternelle. Au-delà de ce processus de reproduction de la représentation hégémonique de la maternité, j’ai également constaté des hésitations et des mises en oeuvre éthique de ces femmes vis-à-vis des mères marginalisées telles que les femmes racialisées, célibataires et pauvres. Enfin, cette thèse développe la manière dont l’éthique du care découle des relations parentales quotidiennes et aussi comment l'intensification de la présence sociale est importante pour la promotion de cette éthique au-delà du travail genré. / The main objective of this thesis was characterizing and analysing social presence in the transition(s) of Brazilian women from privileged classes to motherhood, in Brazil, France, Portugal and Sweden, inrecent years. As a final goal, it intended to contribute to de-construct the hegemonic model of ―good motherhood in Brazil, which is established from the experiences of middle-class white Brazilian wom-en. As methodological strategy, it focused on Brazilian mothers‘ experiences of presences, using Computer-Mediated Communication and three methods in parallel: a documentary research on official re-ports of perinatal health and family policies, biographical interviews and recording of daily diaries, articulated through a phenomenological perspective. Therefore, in my fieldwork I searched, in a spiral drift-ing, how certain moral rhetorics associated to gender, class and racial norms are reproduced by privileged mothers in maternal transitions. Beyond of this process of reproducing hegemonic representation of motherhood, I also found generating hesitations and ethical enactment among these women towards marginalized mothers such as racialized, single and poor ones. Finally, this thesis discusses how care ethics raise from daily parental relationships and how improving responsive social presence is quite significant for the promotion of such ethics beyond of feminine care work.

ObjeEste estudo teve como objetivo primário avaliar a estratégia de incluir o parceiro na assistência pré-natal no município de Franca-Brasil. Constituíram os objetivos secundários: 1) Detectar a prevalência de parceiros com dosagens alteradas de colesterol total, HDL-colesterol, LDL-colesterol e triglicérides; 2) Detectar a prevalência de parceiros com dosagens alteradas de glicemia de jejum; 3) Detectar a prevalência de parceiros com HAS; 4) Detectar a prevalência da sífilis, HIV, hepatites B e C entre gestantes; 5) Verificar a taxa de DMG e de DM entre as gestantes; 6) Detectar a prevalência da sífilis, HIV, hepatites B e C entre os parceiros das gestantes; 7) Avaliar a motivação da equipe de saúde em acolher a Estratégia Pré-natal do Parceiro; 8) Avaliar a aceitação materna e do parceiro sobre a estratégia de inclusão do parceiro na assistência PN. Estudo quantitativo, utilizado o teste \"t\" de Student para comparações das variáveis paramétricas e o teste Qui-quadrado para as variáveis não paramétricas, considerando significativo o valor de p< 0,05 em quaisquer dos testes. Os resultados identificaram quatro parceiros com hipertensão arterial (3,4%) e 51 (43,2%) com intolerância à glicose, verificando-se que em quatro casos, a glicemia possibilitou diagnosticar diabetes mellitus. Constatou-se que a prevalência de dislipidemias dos parceiros foi de 84,4%. No tocante às sorologias identificou-se um casal (1,5%) com sorologia discordante para sífilis (gestante com sífilis) e outro casal, no qual o parceiro foi diagnosticado como portador da infecção pelo vírus da imunodeficiência humana (HIV), cujo diagnóstico só foi possível por sua participação no PNP. Foi possível identificar que 57 parceiros (48,3%) qualificaram as equipes de saúde com não motivadoras para a adoção da estratégia PNP. No entanto, 58 (49,1%) participaram por motivação própria. A percepção paterna sobre o PNP foi referida como positiva por 77,9% dos parceiros e 93 gestantes/mães (78,8%) consideraram importante e positiva a inclusão do parceiro no PN. Foi identificado que a inclusão do parceiro no PN foi importante no diagnóstico e tratamento precoces de doenças de transmissão vertical e crônicas e que é necessário incentivar a equipe de saúde a difundir os benefícios dessa participação no PN, contribuindo com a saúde da tríade mãe, filho e parceiro. / This study\'s primary objective was to analyze the strategy of including the male partner in prenatal care in the city of Franca, Brazil. The secondary objectives were: 1) To detect the prevalence of male partners with abnormal levels of total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides; 2) To detect the prevalence of male partners with abnormal levels of fasting blood glucose; 3) To detect the prevalence of systemic hypertension among male partners; 4) To detect the prevalence of syphilis, HIV, hepatitis B and hepatitis C among pregnant women; 5) To find out the frequency of Gestational diabetes mellitus (GDM) and of Diabetes mellitus (DM) among pregnant women; 6) To detect the prevalence of syphilis, HIV, hepatitis B and hepatitis C among the pregnant women\'s male partners; 7) To gauge the health team\'s motivation to implement the strategy of male involvement in prenatal care; 8) To assess maternal acceptance and male partner acceptance of the strategy of including the male partner in prenatal care. This was a quantitative study, which used the Student\'s t-test to compare parametric variables and the Chi-squared test for the nonparametric variables and which considered a p-value < 0.05 as significant in both tests. The results identified 4 male partners with hypertension (3.4%) and 51 male partners (43.2%) with glucose intolerance, of which four had a diagnosis of Diabetes mellitus as a result of the blood glucose test. We found that the Anexos 100 prevalence of dyslipidemia among the male partners was 84.4%. Regarding serology tests, we identified a couple (1.5%) with discordant syphilis serology (pregnant woman with syphilis) and another couple in which the male partner was diagnosed with Human Immunodeficiency Virus (HIV) infection with such diagnosis only having been possible because of his participation in prenatal care. We could identify that 57 male partners (48.3%) classified the health teams as not encouraging of the male involvement in prenatal care. However, 58 male partners (49.1%) participated by selfmotivation. The fathers\' perception of their involvement in prenatal care was referred to as positive by 77.9% of the male partners and 93 pregnant women / mothers (78.8%) considered the inclusion of the male partner in prenatal care important and positive. We identified that the inclusion of the male partner in prenatal care was important in the early diagnosis and early treatment of vertical transmission diseases and chronic diseases as well as that it is crucial to encourage health teams to communicate the benefits of the inclusion of the male partner in prenatal care, thus contributing to the health of the father- mother-child triad.

Introdução - A prematuridade, definida como nascimento antes de 37 semanas completas de gestação, ainda tem suas vias causais pouco explicadas. Objetivo - Analisar a prevalência de prematuridade e dos fatores do período pré-natal a ela relacionados, por meio de análise secundária dos dados da Região Sudeste, da pesquisa Nascer no Brasil. Métodos - A regressão binária de Poisson foi empregada na seleção das variáveis e as que apresentaram valor de p<0,20 foram incluídas a seguir no modelo de regressão logística hierarquizado, divididas em blocos de acordo com a proximidade temporal em relação ao desfecho, utilizando critérios clínicos e as interações atualmente já mais bem estabelecidas entre as variáveis. A análise estatística do modelo foi feita com regressão linear múltipla de Poisson, com ajuste robusto da variância. As variáveis com valor de p<0,20 foram incluídas no nível seguinte, como fator de ajuste. A medida de efeito foi o Risco Relativo (RR), calculadas com intervalos de confiança (IC) de 95 por cento e, ao final da análise, as variáveis que apresentaram valores de p<0,05 dentro de cada nível foram consideradas fatores de risco para a prematuridade. Resultados - As variáveis estatisticamente significativas foram: no nível intermediário I (bloco 2.1), a idade materna entre 12 e 19 anos (RR: 1,23; IC: 1,05 - 1,46); no nível intermediário II (bloco 2.2), a decisão pelo parto cesáreo (RR: 1,47; IC: 1,20 - 1,80); no nível proximal (bloco 3), a idade materna maior que 35 anos (RR: 1,28; IC: 1,06 - 1,54), a não decisão da via de parto (RR: 1,34; IC: 1,11 - 1,61), realizar menos de 5 consultas de PN (RR: 2,57; IC: 2,20 - 3,01), realizar 12 ou mais consultas de PN (RR: 0,74; IC: 0,55 - 0,99), cor da pele preta ou parda (RR: 0,83; IC: 0,73 - 0,95), nenhuma gestação anterior (RR: 1,43; IC: 1,17 - 1,74), baixo peso ao nascer anterior (RR: 1,35; IC: 1,01 - 1,82), prematuro anterior (RR: 2,01; IC: 1,51 - 2,68), condições clínicas prévias maternas (RR: 1,31; IC: 1,05 - 1,63), condições obstétricas na gestação atual (RR: 1,58; IC: 1,18 - 2,12), condições clínicas diagnosticadas na admissão para o parto (RR: 1,81; IC: 1,50 - 2,18) e internação durante a gestação atual (RR: 2,07; IC: 1,78 - 2,41) Conclusões - Identificados como fator de proteção contra a prematuridade: a mãe apresentar cor da pele preta ou parda e realizar mais de 12 consultas de pré-natal. Condições de maior risco para prematuridade: mãe primípara, extremos de idade materna, decisão da via de parto cesáreo ou a não participação materna na mesma, realizar menos de cinco consultas no PN, antecedentes de baixo peso ao nascer e prematuridade, ter alguma complicação clínica diagnosticada na gestação atual ou na admissão para o parto, alguma complicação obstétrica diagnosticada, hipertensão arterial ou alguma internação durante a gestação. O nascimento prematuro ainda é a maior causa de mortes em RNs no mundo, com aumento progressivo da incidência nos últimos anos, por isso a pesquisa básica visando inovar sobre o tema é tão importante / Introduction: Prematurity is defined as a birth occurring before 37 complete weeks of gestation and its causal pathways are not entirely understood. Objectives: To analyse the prevalence of prematurity and risk factors related to it in a secondary analysis of data from the Brazils Southeast region in Birth in Brazil survey. Method: Binary Poisson regression was used to select the variables and those with p<0,20 were included in the hierarchical model. The blocks of variables in the model were then structured according to variables temporal relation to the outcome, clinical plausibility and current known interactions with each other. Statistical analysis was conducted with general linear model and Poisson regression, with robust adjustment of variance. Variables with p<0,20 were included in the next level as an adjustment factor. The outcome measure was Relative Risk (RR), calculated with confidence intervals of 95 per cent . In the final model, variables with p<0,05 were considered independent risk factors for preterm birth. Results: Variables with statistical significance were: in the intermediary level I (block 2.1): age between 12 and 19 years-old (RR: 1,23; IC: 1,05 - 1,46); in the intermediary level II (block 2.2): decision for caesarean delivery (RR: 1,47; IC: 1,20 - 1,80), in the proximal level (block 3): maternal age > 35 years-old (RR: 1,28; IC: 1,06 - 1,54); not having a decision for the mode of birth (RR: 1,34; IC: 1,11 - 1,61), >5 antenatal appointments (RR: 2,57; IC: 2,20 - 3,01), >12 prenatal appointments (RR: 0,74; IC: 0,55 - 0,99), maternal black/ brown skin colour (RR: 0,83; IC: 0,73 - 0,95), no previous pregnancies (RR: 1,43; IC: 1,17 - 1,74), previous low birthweight new-born (RR: 1,35; IC: 1,01 - 1,82), previous preterm birth (RR: 2,01; IC: 1,51 - 2,68), previous clinical complications (RR: 1,31; IC: 1,05 - 1,63), obstetric complications in the current pregnancy ((RR: 1,58; IC: 1,18 - 2,12), clinical complications diagnosed at the hospital admission (RR: 1,81; IC: 1,50 - 2,18) and admission at the hospital in the current pregnancy (RR: 2,07; IC: 1,78 - 2,41). Conclusions: Variables identified as protection factors against prematurity were: maternal black or brown skin colour and >12 antenatal appointments. Variables identified as risk factors were: primiparity, maternal age 35, decision for caesarean as the mode of birth, non-participation of the mother in the decision of the mode of birth, <5 prenatal appointments, previous low birth weight new-born, previous preterm birth, having one or more clinical complication in the current pregnancy or at the admission for delivery, having one or more obstetric complications diagnosed during pregnancy, hypertension or a hospital admission at the hospital during the current pregnancy. Preterm birth is still the main cause of child death in the world, with increasing rate in the past years, which justificates the importance of basic and innovative research in this area of knowledge

O objetivo do estudo foi avaliar a influência da implantação do projeto Pré-natal do parceiro (PNP) no município de Ribeirão Preto sobre: 1) as taxas das infecções pelo vírus da imunodeficiência humana (HIV), vírus das hepatites B e C (VHB, VHC) e pelo Treponema pallidum (TP) entre gestantes; 2) as taxas de transmissão vertical (TV) dos VHB, VHC, do HIV e do TP; 3) os indicadores de qualidade do pré-natal (número de consultas; idade gestacional (IG) na primeira consulta; desfecho gestacional); 4) os indicadores perinatais (peso ao nascer; prematuridade; índice de Apgar no 1º e 5º minutos) e 5) as taxas das infecções pelos VHB, VHC, do HIV e do TP nos parceiros que aderiram ao projeto. Estudo transversal do grupo de gestantes (G) e nascidos vivos (NV) que tiveram seus parceiros participantes do projeto PNP (denominados G1 e NV1) e do grupo de gestantes e NV que não tiveram seus parceiros participantes do projeto PNP (denominados G2 e NV2). Os grupos de gestantes e parceiros foram incluídos no estudo no período de 1º de Julho de 2013 a 30 de Junho de 2014 e os grupos de NV, entre 1º de Julho de 2013 a 31 de Dezembro de 2014. Foram selecionadas 5391 gestantes (1781 do G1 e 3610 do G2), 1781 parceiros e 4044 NV (1376 do NV1 e 2668 do NV2). Utilizado o teste Quiquadrado de Pearson com um nível de significância de 5%. Os resultados demonstraram prognósticos estatisticamente mais favoráveis no grupo onde houve a participação do parceiro no pré-natal (G1 e NV1). Encontraram-se menores taxas de TV (0,7% no NV1 e 1,5% no NV2 com p= 0,04); início mais precoce do PN (com até 120 dias de gestação 88,3% no G1 e 84,5% no G2 com p< 0,01); mais de sete consultas no PN (80,8% no G1 e 74,3% no G2 com p< 0,01); desfecho gestacional favorável (95,9% no G1 e 94,2% no G2 com p= 0,01); menores taxas de prematuridade (10,3% no NV1 e 12,9% no NV2 com p= 0,01), menor ocorrência de baixo peso ao nascer (8,7% no NV1 e 11,4% no NV2 com p< 0,01) e melhores índices de Apgar no 5º minuto (2,5% de Apgar <= 7 no NV1 e 3,8% no NV2 com p= 0,03). Frente a estes dados foi possível concluir que a estratégia de inclusão do parceiro no PN foi importante na identificação e tratamento da sífilis reduzindo significativamente a taxa de TV do TP. A adesão do parceiro ao PNP foi fundamental para a adesão da gestante ao PN associando-se também à melhora significativa dos indicadores de saúde perinatal / The goal of these study was to evaluate of the influence of the implementation of the project \"Male Partner in the Prenatal Care (MPPC)\" in Ribeirao Preto city on: 1) the rates of infection by the human immunodeficiency virus (HIV), hepatitis virus B and C (HBV, HCV), and Treponema pallidum (TP) among pregnant women; 2) the vertical transmission (VT) rates of HBV, HCV, HIV and TP; 3) the prenatal care quality indicators (number of visits, gestational age (GA) at the first visit, gestational outcome); 4) the perinatal indicators (birth weight, prematurity, Apgar score at 1 and 5 minutes) and 5) the rates of infection with HIV, HBV, HCV and TP in partners that have joined the project. It is a cross-sectional study of group of the pregnant women (G) and born alive (BA) who had their partners participating MPPC project (called G1 and NV1) and the group of pregnant women and BA who have not had their partners participants (called G2 and NV2). The pregnant women groups and the male partners group were surveyed in the period from July 1, 2013 to June 30, 2014 and the BA groups, between July 1, 2013 to December 31, 2014. Were selected 5391 pregnant women (1781 of the G1 and 3610 of the G2), 1781 partners and 4044 BA (1376 of the NV1 and 2668 of the NV2). Used the Chi-square test of Pearson with a 5% significance level. The results showed statistically more favorable prognosis in the group where there was the partner\'s participation in prenatal care (G1 and NV1). The lower VT rate was found (0.7% in NV 1 and 1.5% in NV2 p= 0.04); earlier initiation of PN (up to 120 days of gestation 88.3% in G1 and 74.3% in G2 with p< 0.01); more than seven consultations in PNC (80.8% in G1 and 74.3% in G2 with p< 0.01); favorable pregnancy outcome (95.9% in G1 and 94.2% in G2 with p= 0.01); lower prematurity rates (10.3% in the NV1 and 12.9% in the NV2 with p= 0.01); lower incidence of low birth weight (8.7% in NV1 and 11.4% in NV2 with p< 0.01) and better Apgar scores at five minutes (2.5% Apgar <= 7 in NV1 and 3.8% in NV2 with p= 0.03). Considering these data it was concluded that the male partner\'s inclusion strategy in prenatal care was important in the identification and treatment of syphilis reducing significantly the VT rate of the TP. The partner\'s adherence to MPPC project was essential to the mother\'s adherence to PNC and it was also associated with significant improvement in perinatal health indicators.

Introdução - A prematuridade, definida como nascimento antes de 37 semanas completas de gestação, ainda tem suas vias causais pouco explicadas. Objetivo - Analisar a prevalência de prematuridade e dos fatores do período pré-natal a ela relacionados, por meio de análise secundária dos dados da Região Sudeste, da pesquisa Nascer no Brasil. Métodos - A regressão binária de Poisson foi empregada na seleção das variáveis e as que apresentaram valor de p<0,20 foram incluídas a seguir no modelo de regressão logística hierarquizado, divididas em blocos de acordo com a proximidade temporal em relação ao desfecho, utilizando critérios clínicos e as interações atualmente já mais bem estabelecidas entre as variáveis. A análise estatística do modelo foi feita com regressão linear múltipla de Poisson, com ajuste robusto da variância. As variáveis com valor de p<0,20 foram incluídas no nível seguinte, como fator de ajuste. A medida de efeito foi o Risco Relativo (RR), calculadas com intervalos de confiança (IC) de 95 por cento e, ao final da análise, as variáveis que apresentaram valores de p<0,05 dentro de cada nível foram consideradas fatores de risco para a prematuridade. Resultados - As variáveis estatisticamente significativas foram: no nível intermediário I (bloco 2.1), a idade materna entre 12 e 19 anos (RR: 1,23; IC: 1,05 - 1,46); no nível intermediário II (bloco 2.2), a decisão pelo parto cesáreo (RR: 1,47; IC: 1,20 - 1,80); no nível proximal (bloco 3), a idade materna maior que 35 anos (RR: 1,28; IC: 1,06 - 1,54), a não decisão da via de parto (RR: 1,34; IC: 1,11 - 1,61), realizar menos de 5 consultas de PN (RR: 2,57; IC: 2,20 - 3,01), realizar 12 ou mais consultas de PN (RR: 0,74; IC: 0,55 - 0,99), cor da pele preta ou parda (RR: 0,83; IC: 0,73 - 0,95), nenhuma gestação anterior (RR: 1,43; IC: 1,17 - 1,74), baixo peso ao nascer anterior (RR: 1,35; IC: 1,01 - 1,82), prematuro anterior (RR: 2,01; IC: 1,51 - 2,68), condições clínicas prévias maternas (RR: 1,31; IC: 1,05 - 1,63), condições obstétricas na gestação atual (RR: 1,58; IC: 1,18 - 2,12), condições clínicas diagnosticadas na admissão para o parto (RR: 1,81; IC: 1,50 - 2,18) e internação durante a gestação atual (RR: 2,07; IC: 1,78 - 2,41) Conclusões - Identificados como fator de proteção contra a prematuridade: a mãe apresentar cor da pele preta ou parda e realizar mais de 12 consultas de pré-natal. Condições de maior risco para prematuridade: mãe primípara, extremos de idade materna, decisão da via de parto cesáreo ou a não participação materna na mesma, realizar menos de cinco consultas no PN, antecedentes de baixo peso ao nascer e prematuridade, ter alguma complicação clínica diagnosticada na gestação atual ou na admissão para o parto, alguma complicação obstétrica diagnosticada, hipertensão arterial ou alguma internação durante a gestação. O nascimento prematuro ainda é a maior causa de mortes em RNs no mundo, com aumento progressivo da incidência nos últimos anos, por isso a pesquisa básica visando inovar sobre o tema é tão importante / Introduction: Prematurity is defined as a birth occurring before 37 complete weeks of gestation and its causal pathways are not entirely understood. Objectives: To analyse the prevalence of prematurity and risk factors related to it in a secondary analysis of data from the Brazils Southeast region in Birth in Brazil survey. Method: Binary Poisson regression was used to select the variables and those with p<0,20 were included in the hierarchical model. The blocks of variables in the model were then structured according to variables temporal relation to the outcome, clinical plausibility and current known interactions with each other. Statistical analysis was conducted with general linear model and Poisson regression, with robust adjustment of variance. Variables with p<0,20 were included in the next level as an adjustment factor. The outcome measure was Relative Risk (RR), calculated with confidence intervals of 95 per cent . In the final model, variables with p<0,05 were considered independent risk factors for preterm birth. Results: Variables with statistical significance were: in the intermediary level I (block 2.1): age between 12 and 19 years-old (RR: 1,23; IC: 1,05 - 1,46); in the intermediary level II (block 2.2): decision for caesarean delivery (RR: 1,47; IC: 1,20 - 1,80), in the proximal level (block 3): maternal age > 35 years-old (RR: 1,28; IC: 1,06 - 1,54); not having a decision for the mode of birth (RR: 1,34; IC: 1,11 - 1,61), >5 antenatal appointments (RR: 2,57; IC: 2,20 - 3,01), >12 prenatal appointments (RR: 0,74; IC: 0,55 - 0,99), maternal black/ brown skin colour (RR: 0,83; IC: 0,73 - 0,95), no previous pregnancies (RR: 1,43; IC: 1,17 - 1,74), previous low birthweight new-born (RR: 1,35; IC: 1,01 - 1,82), previous preterm birth (RR: 2,01; IC: 1,51 - 2,68), previous clinical complications (RR: 1,31; IC: 1,05 - 1,63), obstetric complications in the current pregnancy ((RR: 1,58; IC: 1,18 - 2,12), clinical complications diagnosed at the hospital admission (RR: 1,81; IC: 1,50 - 2,18) and admission at the hospital in the current pregnancy (RR: 2,07; IC: 1,78 - 2,41). Conclusions: Variables identified as protection factors against prematurity were: maternal black or brown skin colour and >12 antenatal appointments. Variables identified as risk factors were: primiparity, maternal age 35, decision for caesarean as the mode of birth, non-participation of the mother in the decision of the mode of birth, <5 prenatal appointments, previous low birth weight new-born, previous preterm birth, having one or more clinical complication in the current pregnancy or at the admission for delivery, having one or more obstetric complications diagnosed during pregnancy, hypertension or a hospital admission at the hospital during the current pregnancy. Preterm birth is still the main cause of child death in the world, with increasing rate in the past years, which justificates the importance of basic and innovative research in this area of knowledge

O objetivo do estudo foi avaliar a influência da implantação do projeto Pré-natal do parceiro (PNP) no município de Ribeirão Preto sobre: 1) as taxas das infecções pelo vírus da imunodeficiência humana (HIV), vírus das hepatites B e C (VHB, VHC) e pelo Treponema pallidum (TP) entre gestantes; 2) as taxas de transmissão vertical (TV) dos VHB, VHC, do HIV e do TP; 3) os indicadores de qualidade do pré-natal (número de consultas; idade gestacional (IG) na primeira consulta; desfecho gestacional); 4) os indicadores perinatais (peso ao nascer; prematuridade; índice de Apgar no 1º e 5º minutos) e 5) as taxas das infecções pelos VHB, VHC, do HIV e do TP nos parceiros que aderiram ao projeto. Estudo transversal do grupo de gestantes (G) e nascidos vivos (NV) que tiveram seus parceiros participantes do projeto PNP (denominados G1 e NV1) e do grupo de gestantes e NV que não tiveram seus parceiros participantes do projeto PNP (denominados G2 e NV2). Os grupos de gestantes e parceiros foram incluídos no estudo no período de 1º de Julho de 2013 a 30 de Junho de 2014 e os grupos de NV, entre 1º de Julho de 2013 a 31 de Dezembro de 2014. Foram selecionadas 5391 gestantes (1781 do G1 e 3610 do G2), 1781 parceiros e 4044 NV (1376 do NV1 e 2668 do NV2). Utilizado o teste Quiquadrado de Pearson com um nível de significância de 5%. Os resultados demonstraram prognósticos estatisticamente mais favoráveis no grupo onde houve a participação do parceiro no pré-natal (G1 e NV1). Encontraram-se menores taxas de TV (0,7% no NV1 e 1,5% no NV2 com p= 0,04); início mais precoce do PN (com até 120 dias de gestação 88,3% no G1 e 84,5% no G2 com p< 0,01); mais de sete consultas no PN (80,8% no G1 e 74,3% no G2 com p< 0,01); desfecho gestacional favorável (95,9% no G1 e 94,2% no G2 com p= 0,01); menores taxas de prematuridade (10,3% no NV1 e 12,9% no NV2 com p= 0,01), menor ocorrência de baixo peso ao nascer (8,7% no NV1 e 11,4% no NV2 com p< 0,01) e melhores índices de Apgar no 5º minuto (2,5% de Apgar <= 7 no NV1 e 3,8% no NV2 com p= 0,03). Frente a estes dados foi possível concluir que a estratégia de inclusão do parceiro no PN foi importante na identificação e tratamento da sífilis reduzindo significativamente a taxa de TV do TP. A adesão do parceiro ao PNP foi fundamental para a adesão da gestante ao PN associando-se também à melhora significativa dos indicadores de saúde perinatal / The goal of these study was to evaluate of the influence of the implementation of the project \"Male Partner in the Prenatal Care (MPPC)\" in Ribeirao Preto city on: 1) the rates of infection by the human immunodeficiency virus (HIV), hepatitis virus B and C (HBV, HCV), and Treponema pallidum (TP) among pregnant women; 2) the vertical transmission (VT) rates of HBV, HCV, HIV and TP; 3) the prenatal care quality indicators (number of visits, gestational age (GA) at the first visit, gestational outcome); 4) the perinatal indicators (birth weight, prematurity, Apgar score at 1 and 5 minutes) and 5) the rates of infection with HIV, HBV, HCV and TP in partners that have joined the project. It is a cross-sectional study of group of the pregnant women (G) and born alive (BA) who had their partners participating MPPC project (called G1 and NV1) and the group of pregnant women and BA who have not had their partners participants (called G2 and NV2). The pregnant women groups and the male partners group were surveyed in the period from July 1, 2013 to June 30, 2014 and the BA groups, between July 1, 2013 to December 31, 2014. Were selected 5391 pregnant women (1781 of the G1 and 3610 of the G2), 1781 partners and 4044 BA (1376 of the NV1 and 2668 of the NV2). Used the Chi-square test of Pearson with a 5% significance level. The results showed statistically more favorable prognosis in the group where there was the partner\'s participation in prenatal care (G1 and NV1). The lower VT rate was found (0.7% in NV 1 and 1.5% in NV2 p= 0.04); earlier initiation of PN (up to 120 days of gestation 88.3% in G1 and 74.3% in G2 with p< 0.01); more than seven consultations in PNC (80.8% in G1 and 74.3% in G2 with p< 0.01); favorable pregnancy outcome (95.9% in G1 and 94.2% in G2 with p= 0.01); lower prematurity rates (10.3% in the NV1 and 12.9% in the NV2 with p= 0.01); lower incidence of low birth weight (8.7% in NV1 and 11.4% in NV2 with p< 0.01) and better Apgar scores at five minutes (2.5% Apgar <= 7 in NV1 and 3.8% in NV2 with p= 0.03). Considering these data it was concluded that the male partner\'s inclusion strategy in prenatal care was important in the identification and treatment of syphilis reducing significantly the VT rate of the TP. The partner\'s adherence to MPPC project was essential to the mother\'s adherence to PNC and it was also associated with significant improvement in perinatal health indicators.

ObjeEste estudo teve como objetivo primário avaliar a estratégia de incluir o parceiro na assistência pré-natal no município de Franca-Brasil. Constituíram os objetivos secundários: 1) Detectar a prevalência de parceiros com dosagens alteradas de colesterol total, HDL-colesterol, LDL-colesterol e triglicérides; 2) Detectar a prevalência de parceiros com dosagens alteradas de glicemia de jejum; 3) Detectar a prevalência de parceiros com HAS; 4) Detectar a prevalência da sífilis, HIV, hepatites B e C entre gestantes; 5) Verificar a taxa de DMG e de DM entre as gestantes; 6) Detectar a prevalência da sífilis, HIV, hepatites B e C entre os parceiros das gestantes; 7) Avaliar a motivação da equipe de saúde em acolher a Estratégia Pré-natal do Parceiro; 8) Avaliar a aceitação materna e do parceiro sobre a estratégia de inclusão do parceiro na assistência PN. Estudo quantitativo, utilizado o teste \"t\" de Student para comparações das variáveis paramétricas e o teste Qui-quadrado para as variáveis não paramétricas, considerando significativo o valor de p< 0,05 em quaisquer dos testes. Os resultados identificaram quatro parceiros com hipertensão arterial (3,4%) e 51 (43,2%) com intolerância à glicose, verificando-se que em quatro casos, a glicemia possibilitou diagnosticar diabetes mellitus. Constatou-se que a prevalência de dislipidemias dos parceiros foi de 84,4%. No tocante às sorologias identificou-se um casal (1,5%) com sorologia discordante para sífilis (gestante com sífilis) e outro casal, no qual o parceiro foi diagnosticado como portador da infecção pelo vírus da imunodeficiência humana (HIV), cujo diagnóstico só foi possível por sua participação no PNP. Foi possível identificar que 57 parceiros (48,3%) qualificaram as equipes de saúde com não motivadoras para a adoção da estratégia PNP. No entanto, 58 (49,1%) participaram por motivação própria. A percepção paterna sobre o PNP foi referida como positiva por 77,9% dos parceiros e 93 gestantes/mães (78,8%) consideraram importante e positiva a inclusão do parceiro no PN. Foi identificado que a inclusão do parceiro no PN foi importante no diagnóstico e tratamento precoces de doenças de transmissão vertical e crônicas e que é necessário incentivar a equipe de saúde a difundir os benefícios dessa participação no PN, contribuindo com a saúde da tríade mãe, filho e parceiro. / This study\'s primary objective was to analyze the strategy of including the male partner in prenatal care in the city of Franca, Brazil. The secondary objectives were: 1) To detect the prevalence of male partners with abnormal levels of total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides; 2) To detect the prevalence of male partners with abnormal levels of fasting blood glucose; 3) To detect the prevalence of systemic hypertension among male partners; 4) To detect the prevalence of syphilis, HIV, hepatitis B and hepatitis C among pregnant women; 5) To find out the frequency of Gestational diabetes mellitus (GDM) and of Diabetes mellitus (DM) among pregnant women; 6) To detect the prevalence of syphilis, HIV, hepatitis B and hepatitis C among the pregnant women\'s male partners; 7) To gauge the health team\'s motivation to implement the strategy of male involvement in prenatal care; 8) To assess maternal acceptance and male partner acceptance of the strategy of including the male partner in prenatal care. This was a quantitative study, which used the Student\'s t-test to compare parametric variables and the Chi-squared test for the nonparametric variables and which considered a p-value < 0.05 as significant in both tests. The results identified 4 male partners with hypertension (3.4%) and 51 male partners (43.2%) with glucose intolerance, of which four had a diagnosis of Diabetes mellitus as a result of the blood glucose test. We found that the Anexos 100 prevalence of dyslipidemia among the male partners was 84.4%. Regarding serology tests, we identified a couple (1.5%) with discordant syphilis serology (pregnant woman with syphilis) and another couple in which the male partner was diagnosed with Human Immunodeficiency Virus (HIV) infection with such diagnosis only having been possible because of his participation in prenatal care. We could identify that 57 male partners (48.3%) classified the health teams as not encouraging of the male involvement in prenatal care. However, 58 male partners (49.1%) participated by selfmotivation. The fathers\' perception of their involvement in prenatal care was referred to as positive by 77.9% of the male partners and 93 pregnant women / mothers (78.8%) considered the inclusion of the male partner in prenatal care important and positive. We identified that the inclusion of the male partner in prenatal care was important in the early diagnosis and early treatment of vertical transmission diseases and chronic diseases as well as that it is crucial to encourage health teams to communicate the benefits of the inclusion of the male partner in prenatal care, thus contributing to the health of the father- mother-child triad.