RESUMO
El presente estudio se diseñó con el fin de conocer las condiciones en las que se realiza el control prenatal en la ciudad fronteriza de Tijuana, Baja California, México y de estudiar las posibles asociaciones entre ese tipo de atención y el resultado neonatal en términos de peso al nacer, estado de salud del neonato y prematuridad. Se seleccionaron siete hospitales que atienden a personas de diferentes estratos socioeconómicos y entre diciembre de 1993 y marzo de 1994 se entrevistó en ellos a 279 mujeres que cursaban las primeras 24 a 48 horas del puerperio. En la entrevista se recogieron datos sobre nivel socioeconómico; conceptos, actitudes y prácticas de las madres respecto de la salud obstétrica; percepción materna de acceso a los servicios de atención prenatal; calidad de las consultas de control prenatal (evaluada según la realización de pruebas de sangre y orina y la medición de la tensión arterial y del peso); y antecedentes ginecobstétricos y de salud de la madre. Se elaboró una base de datos con el paquete estadístico SPSS y se exploraron posibles asociaciones entre la atención prenatal como variable independiente y las diferentes variables dependientes mediante tablas de contingencia y la prueba de Fisher de dos colas. No se encontraron neonatos prematuros, enfermos o con un peso al nacer <2 500g. Por este último motivo se optó por dicotomizar la variable correspondiente al peso al nacer en <3 000 g. y >3 000g. Se observó una asociación significativa (P<0,00038) entre la ausencia de control prenatal y un menor peso al nacer. La ausencia de control prenatal a su vez se asoció con bajos ingresos familiares; dependencia económica materna; convivencia de la madre en unión libre; poca comunicación con la pareja; falta de seguro médico; presencia de un embarazo no deseado; y haber acudido al Hospital General para la atención del parto. De la muestra total (n=15), 5,4 por ciento no recibió atención prenatal. Ninguna de las mujeres que no recibieron atención declaró haber enfrentado dificaultades que le impidieran el acceso, pero de las 15 solamente 7 contestaron la pregunta
This study was intended to explore the conditions under which prenatal care is delivered in the border city of Tijuana, Baja California, Mexico, and to assess the possible associations between that care and neonatal results in terms of birthweight, health of the neonate, and prematurity. Seven hospitals serving persons from different socioeconomic strata were chosen, and between December 1993 and March 1994 interviews were conducted with 279 women who were in the first 24 to 48 hours of puerperium. During the interviews data were collected on socioeconomic level; the mothers' knowledge, attitudes, and practices concerning obstetric health; the mothers' perceptions of access to prenatal care; the quality of prenatal care visits (evaluated in terms of having blood and urine tested and weight and blood pressure measured); and the gynecological and obstetric and health history of the mother. A database was created using the SPSS statistics software package. Possible associations were explored, with prenatal care as the independent variable and various dependent variables, by means of contingency tables and a two-tailed Fisher's exact test. None of the neonates was premature, ill, or had a birthweight of £ 2 500 g. For this reason it was decided to divide the variable corresponding to birthweight into two groupings, £ 3 000 g and > 3 000 g. A significant (P < 0.00038) relationship was found between a lack of prenatal care and low birthweight. In addition, a lack of prenatal care was associated with: low family income; the mother's financial dependence on the father; the mother being in an unmarried relationship; little communication with the partner; having no medical insurance; an unwanted pregnancy; and giving delivery at the General Hospital. Out of the total sample of 279 women, 15 (5.4%) had received no prenatal care. None of these 15 women reported they had encountered difficulties that prevented them from obtaining prenatal care, but only 7 of those women answered that question. The prenatal care was of good quality in 190 of the cases (68%). Both the number and the timing of the prenatal visits were adequate in 142 of the cases (50%). The mother's having worked during pregnancy or before had a positive predictive value in terms of utilization of prenatal care services. Additional studies are needed to evaluate the possible relationship between domestic violence and the lack of prenatal care or a delay in seeking such care.