Teses e Dissertações

• Teses
• Dissertações

ARTIGO 1

Is maternal periodontal disease and low birth weight association a fallacy?

Summary There is little evidence to explore the association of maternal periodontal disease and low birth weight arising from observational and experimental studies. The main issues that impair the interpretation of the majority of the studies presented are design flaws and consequent bias. The matter of the questionable quality in some of the analysis presented from both observational and experimental studies has to be considered. The lack of a conceptual framework along the majority of the presented papers may partially jeopardize the conclusions. The exclusion of solid / defined socioeconomic criteria from statistical models constitute dangerous pitfall and will / might lead to biased interpretation of results from these studies due to confounding. The known association of low socioeconomic status with periodontal disease /periodontitis and also with poor prenatal care, infections, smoking, alcohol consumption and drug abuse, among others, if not taken into account, will tend to lead to an overestimation of the effect of the exposure. Since this variable (SES) that keeps most of them as surrogates is not included in the analysis. Although data from experimental studies contributes strongly for the causal hypothesis, ethical matters may arise from the available substrate before a concrete link between exposure and outcome can be established, since biased designs are leading to overwhelmingly high effects of periodontal infection on birth outcomes. The single well designed observational study with a qualified methodological approach failed to detect the association of maternal periodontal disease and low birth weight (Davenport et al., 1998; Davenport et al., 2002). This fact leads to the assumption that better studies, with a more careful methodological base and adequate sample size are required in order to clarify this issue. In addition, properly controlled intervention studies including randomized, placebo; double-blind trials will be able to test the efficacy of periodontal treatment in reducing the incidence of pre term birth. Researchers and clinicians should be alert for the pitfalls of study designs. Promoting the use of quality data to clarify a so far tenuous, but plausible, association between periodontal events and birth outcomes, which has major epidemiological implications for the delivery of oral health care is a must. The authors consider important that women undergoing or planning pregnancy should continue to maintain high standards of oral health.

ARTIGO 2

Periodontal disease and perinatal outcomes: a case control study

ABSTRACT Recent studies addressing the relationship between oral infections and perinatal outcomes have had inconsistent results. An inclusive, matched case-control study was conducted to measure the effect of maternal periodontitis on low birth weight, pre-term low birth weight, and intra-uterine growth restriction. Subjects were examined for periodontitis and perinatal outcomes and interviewed from August to December 2002. Cases and controls had similar prevalence and severity of periodontitis. Several factors were associated with the outcome, but the crude odds ratio for periodontitis was not significant. Adjusted odds ratio for periodontitis were 0.93 (95%CI: 0.63-1.41) for low birth weight and 0.92 (95%CI:0.54–1.57) for pre-term low birth weight. Adjusting for confounders further reduced the effects, supporting a hypothesis that previous results may have been a consequence of inappropriately built models.Key words: Low birth weight, epidemiology, periodontitis.

 

ARTIGO 3

Uso indequado de serviços de atendimento pré-natal em Porto Alegre: a questão da gravidez indesejada.

Resumo O perfil de uso de serviços de pré-natal por gestantes de Porto Alegre foi avaliado em um delineamento transversal. Entrevistas clínicas, no pós parto imediato, coletaram informações a respeito do uso dos serviços oferecido pelo sistema de saúde. Questões relativas ao planejamento da gravidez, estrutura familiar de apoio, dados socioeconômicos e percepções maternas a respeito da gravidez foram abordadas e mostraram-se associadas com o uso inadequado dos serviços de pré-natal. Tercis elevados de renda apresentaram associação protetora para uso inadequado dos serviços de pré-natal (80%). Puérperas com 4 ou mais filhos (incluindo o atual) apresentaram uma razão de chances cerca de 4 vezes maior de uso de serviços de pré-natal completamente inadequado (início tardio/frequência baixa/não uso) comparado com as primíparas. Para aquelas mães em que esta gestação representava o segundo ou terceiro filho o risco de uso de serviços de pré-natal completamente inadequado foi cerca de 2 vezes maior. Independente da renda ou número de filhos, a ausência do pai biológico e o relato de insatisfação com a gravidez apresentaram razões de chances similarmente elevadas para uso de serviços de pré-natal completamente inadequado, respectivamente, 1,47 e 1,62. O sentimento de não estar satisfeita com a gravidez (pré-parto) apresentou uma razão de chances de uso de serviços de pré-natal inadequado (completamente e parcialmente) aproximadamente 40% maior comparada com as mulheres que tinham estado satisfeitas com a gestação. Inadequate use of pre-natal services in Porto Alegre: the unwanted pregnancy question.

Abstract The pattern of pre-natal care services’ utilization was evaluated, cross-sectionally, in a group of post-partum women in Porto Alegre. Clinical face-to-face interviews were administered to obtain information concerning the pattern of use of the pre-natal services offered through the health system. Data relating to the pregnancy planning, familiar structure, socio-economic data and maternal perceptions about the pregnancy (satisfaction) were collected and showed association to the inadequate use of the pre-natal care services. Higher tertiles of income protected women from inadequate service use (80%). Women with four or more children (including the new-born) presented four times higher chances of completely inadequate (late start/low frequency/no use) use of the pre-natal care service compared to primiparae. Those having the second or third complete pregnancy still had a two times higher chance of completely inadequate use compared to primiparaes. Regardless of income or parity, the absence of the father e reports of being desatisfied with the pregnancy were positively associated with inadequate use of the pre-natal services (odds ratio 1.47 and 1.62 respectively). The feeling of being de-satisfied with the pregnancy (before labor) elevated the odds of completely inadequate pre-natal service use in 40% compared to women reporting satisfaction with the pregnancy.