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Resumo: Objetivou-se verificar o impacto do monitoramento telefônico na prevalência da prematuridade e identificar os fatores de risco associados ao parto prematuro através de estudo transversal, de universo de gestantes monitoradas nos anos de 2010, 2011 e 2012 (n = 2.739). Utilizou-se estimação de modelos de regressão logística múltipla hierarquizada, considerando permanência no modelo p ≤ 0,05. A prevalência de prematuridade foi de 8,34% nas gestantes monitoradas e de 10,18% nas não monitoradas (p = 0,0058), sendo inversamente proporcional ao número de monitoramentos (p < 0,0001). As variáveis associadas foram: idade materna menor que 19 anos, antecedentes de dois ou mais filhos mortos, gestação múltipla, diabetes e hipertensão arterial, menor número de monitoramentos telefônicos, atividades laborais em pé e/ou carga de peso, fumo, número de consultas pré-natal, sem ultrassonografia, diabetes gestacional, gravidez múltipla e anomalia fetal. Com custos baixos, a estratégia demonstrou ser efetiva na redução da ocorrência do parto prematuro.

This study aims to assess the impact of a telephone monitoring service on prevalence of prematurity and to analyze associated risk factors using data on 2,739 pregnant women. Estimation was based on hierarchical multiple logistic regression, with p ≤ 0.05 for variables to remain in the model. Prevalence of preterm birth was 8.34% in monitored pregnant women and 10.18% in unmonitored women (p = 0.0058). Prevalence of preterm birth was inversely proportional to the number of monitoring calls (p0.0001). Variables associated with prematurity were maternal age19 years, history of death of two or more children, multiple pregnancy, diabetes, hypertension, fewer monitoring calls, extended standing or lifting heavy weights at work, smoking, fewer prenatal visits, no ultrasound examination, gestational diabetes, multiple pregnancy, and fetal abnormality. This low-cost strategy proved effective for reducing the preterm birth rate.

Trata-se de estudo ecológico analítico, retrospectivo, composto pelos 645 municípios do Estado de São Paulo, cujo objetivo foi verificar a relação entre variáveis socioeconômicas, demográficas e modelo de atenção, em relação ao coeficiente de mortalidade infantil, no período de 1998 a 2008. Foi calculada a proporção de variação média anual para cada indicador por estrato de cobertura. A mortalidade infantil foi analisada segundo modelo de medidas repetidas no tempo, ajustado para as variáveis de correção: população do município, proporção de PSF implantado, proporção de PACS implantado, PIB per capita e IPRS (índice paulista de responsabilidade social). A análise foi realizada por modelos lineares generalizados, considerando a distribuição gama. Comparações múltiplas foram realizadas pela razão de verossimilhança com distribuição aproximada qui-quadrado, considerando-se nível de significância de 5%. Houve diminuição da mortalidade infantil no decorrer dos anos (p < 0,05), não havendo diferença significativa de 2004 a 2008 (p > 0,05). A proporção de PSF implantado (p < 0,0001) e o PIB per capita (p < 0,0001) foram significativos no modelo. A queda da mortalidade infantil no período analisado foi influenciada pelo crescimento do PIB per capita e pelo modelo Saúde da Família. This is an ecological, analytical and retrospective study comprising the 645 municipalities in the State of São Paulo, the scope of which was to determine the relationship between socioeconomic, demographic variables and the model of care in relation to infant mortality rates in the period from 1998 to 2008. The ratio of average annual change for each indicator per stratum coverage was calculated. Infant mortality was analyzed according to the model for repeated measures over time, adjusted for the following correction variables: the city's population, proportion of Family Health Programs (PSFs) deployed, proportion of Growth Acceleration Programs (PACs) deployed, per capita GDP and SPSRI (São Paulo social responsibility index). The analysis was performed by generalized linear models, considering the gamma distribution. Multiple comparisons were performed with the likelihood ratio with chi-square approximate distribution, considering a significance level of 5%. There was a decrease in infant mortality over the years (p < 0.05), with no significant difference from 2004 to 2008 (p > 0.05). The proportion of PSFs deployed (p < 0.0001) and per capita GDP (p < 0.0001) were significant in the model. The decline of infant mortality in this period was influenced by the growth of per capita GDP and PSFs.

This is an ecological, analytical and retrospective study comprising the 645 municipalities in the State of São Paulo, the scope of which was to determine the relationship between socioeconomic, demographic variables and the model of care in relation to infant mortality rates in the period from 1998 to 2008. The ratio of average annual change for each indicator per stratum coverage was calculated. Infant mortality was analyzed according to the model for repeated measures over time, adjusted for the following correction variables: the city's population, proportion of Family Health Programs (PSFs) deployed, proportion of Growth Acceleration Programs (PACs) deployed, per capita GDP and SPSRI (São Paulo social responsibility index). The analysis was performed by generalized linear models, considering the gamma distribution. Multiple comparisons were performed with the likelihood ratio with chi-square approximate distribution, considering a significance level of 5%. There was a decrease in infant mortality over the years (p0.05), with no significant difference from 2004 to 2008 (p0.05). The proportion of PSFs deployed (p0.0001) and per capita GDP (p0.0001) were significant in the model. The decline of infant mortality in this period was influenced by the growth of per capita GDP and PSFs.