Socioeconomic differentials in performing urinalysis throughout prenatal care



Mariângela f SilveiraI; Aluísio J D BarrosII; Iná S SantosII; Alicia MatijasevichII; Cesar G VictoraII

IDepartamento Materno-Infantil. Universidade de Medicina. Universidade federal de Pelotas. Pelotas, RS, BrasilIIPrograma de Pós-Graduação em Epidemiologia. Universidade federal de Pelotas. Pelotas, RS, Brasil





OBJECTIVE: Urinalysis is crucial component of a prenatal routine, together urinary tract infections throughout pregnancy may cause preterm delivery and neonatal morbidity. The objective that the estude was to analysis factors connected to a solicitation that urinalysis during pregnancy.

Você está assistindo: Para que serve exame de urina

METHODS: throughout 2004, 4,163 women vida in ns urban area of Pelotas (Southern Brazil) and who had actually received prenatal care were interviewed after distribution in the maternity hospitals of ns city. Ubiquity of the non-performance the urinalysis ser estar analyzed in relationship to socioeconomic e demographic variables, and also to features of prenatal care. After naquela bivariate analysis, logistic regression was conducted to determine factors connected with ns outcome, controlling para possible confusion components at der 5% level that significance.RESULTS: The ubiquity of not having actually had the test was 3%. The multivariate evaluation showed that black skin color, poverty, short schooling, gift unmarried e having under than six prenatal visits were associated with a higher probability of not carrying lado de fora the test. Women quem were black, poor and with low schooling presented a 10% probability of no being examined, compared to 0.4% for mothers quem were white, wealthy and highly educated.CONCLUSIONS: Despite ns fact the urinalysis is essential for preventing complications for the mother e newborn, 3% of ns women were not screened. Screening coverage may cabe as an indicator to assess ns quality of prenatal care. Pregnant females who are black, poor, com low schooling e unmarried must be target in programs for improving the quality the care.

Descriptors: Pregnancy. Obstetric Labor, Premature. Prenatal Care. Urinalysis. Socioeconomic Factors. Cohort Studies.




In pregnant women, urinary tract infection, even when asymptomatic, is an essential cause the morbidity e is associated com abortion, premature delivery, short birth weight and neonatal morbidity. Anatomical e physiological changes of a urinary tract during pregnancy predispose ladies to urinary infection. Incidence varies (2% to 10%) e depends, amongst other factors, on ns socioeconomic level, parity e the existence of genital infections.*

Asymptomatic bacteriuria is composed of persistent bacterial expansion in the urinary tract without certain symptoms. It occurs in 5% to 10% that pregnancies and can add to preterm shipment (14 Urinary infections throughout pregnancy, consisting of asymptomatic bacteriuria, cystitis and pyelonephritis, might lead to der significant rise in maternal e neonatal morbidity e mortality.15

For this reason, urinalysis is naquela routine test in prenatal care. In the United States, urine culture is recommended in the first prenatal visit, ideally in between six and eight weeks" gestational age.8 Of a women who a partir de not current positive urine culture in a initial examination, 1%-2% will build bacteriuria later throughout pregnancy.1 Randomized clinical trials, cohort studies e meta-analysis have shown that the treatment of asymptomatic bacteriuria deserve to reduce a occurrence of symptom such as preterm delivery e maternal pyelonephritis.9,11 according to der recent review,5 the treatment the asymptomatic bacteriuria ser estar considered uma of ns key strategies to mitigate neonatal mortality in developing countries.

The ministry of wellness of Brazil, in its "Technical Manual ao Prenatal Care and Puerperium",* as well as in another publication concerning a "Program ao the Humanization that Prenatal Care and Birth",12 establishes that urinalysis must be requested as naquela routine test in the o primeiro dia prenatal visit and repeated in a 30th a principal of gestation. Return the idealizar frequency ao subsequent urinalyses during prenatal care is not determined, the literature agrees the at least uma test have to be lugged out.8 based upon these recommendations, ns present post aimed to describe the request ao urinalyses throughout pregnancy and its associação with maternal e healthcare characteristics.



Pelotas is a cidade of 320,000 inhabitants located in ns Southern an ar of Brazil. During a year the 2004, tudo women who lived in a urban area of Pelotas and who offered birth in a municipality were invited to participate in a study.

The parturient women who were eligible porque o the research e who agreed to get involved were interviewed ideal after delivery. The interview approached biological, demographic, reproductive, behavioral and socioeconomic characteristics, and information on a gestation.2 a interviews were carried lado de fora by trained interviewers who visited the city"s hospitals on naquela daily basis. In addition, the registros of the live Births Information system (SINASC) were tracked in order to identify e interview at casa women quem did not give birth at hospitals.2

The total number the interviewees era 4,244 puerperae, of who 195 (4.5%) did not understand whether they had been submitted to urinalysis or refuse to take part in ns study. Thus, the venenoso of participants foi ~ 4,163.

Data introduce to prenatal treatment were offered by a parturient woman or extracted from her pregnancy card. Only women quem had had at least uma prenatal visit were had in the estude (1.9% of a women had actually not received prenatal care e were excluded).

Data input ser estar performed with a program EpiInfo 6.04 com automatic examine on consistence and amplitude. Ns analysis era carried o fim with a program SPSS 10.0 e consisted of naquela description of a prevalence of the outcome of attention (the woman was not it is registered to urinalysis during pregnancy) segue to socioeconomic e demographic variables: maternal açao (in years); quintiles of the nacional Economic Indicator (IEN), based on 12 assets e on ns level of schooling of ns head of the family3 contrasted to the reference distribution of the municipality of Pelotas; maternal schooling; skin shade of a parturient woman pointed out by ns interviewer; marital status; planned pregnancy; prenatal care detailed by sistemas Único de saúde (SUS – Brazil"s nacional Health System); the doutor who was responsible para the prenatal care; maternal work during gestation; e number of prenatal visits.

After naquela bivariate analysis, logistic regression ser estar performed to determine factors linked with a outcome, controlling ao possible man factors. Porque o the adjusted analysis, a variables were had in ns model once they reached der 20% level that significance and the associação was considered far-ranging for a value that p

Theprojeto was approved by the Ethics in pesquisar Committee of the faculdades de farmacêutico of the Universidade federal de Pelotas.



Among ns 4,163 participants, the prevalence the not having actually been submitted to urinalysis throughout pregnancy foi ~ of 120 (3%); the 10% among women who were negative (lower quintile of ns IEN), black and who had low schooling (0-4 years of studies), and of 0.4% in women quem were white, wealthy (higher quintile of the IEN) e highly education (9 or an ext years that schooling).

Table uma describes ns sociodemographic e health variables of ns studied population. Half the parturient females were in between 20 and 29 years of age; 1,836 (44.3%) of the women to be classified in ns two reduced quintiles of a IEN, i beg your pardon represent the poorest population; 15.3% had up to four years of schooling; 73.2% were white; e the bulk (83.9%) lived with ns husband/partner. In much more than fifty percent (56.3%) of a cases, a pregnancy had not to be planned; 80.9% of the pregnant women obtained prenatal treatment through SUS; 71.9% had seven prenatal access time or more; 30.2% got prenatal care a partir de more than uma professional e 40.2% worked during pregnancy.




Table 2 mostra the results of a bivariate analysis. Neither maternal açao (p=0.3) nor prenatal care noted by various professionals (p=0.8) were connected with a outcome. The socioeconomic case evaluated by ns IEN era strongly associated com the performance of urinalysis (p




In ns multivariate evaluation through logistic regression, naquela conceptual design of determination was used com three hierarchized levels: in the first level ns variables skin color, schooling e IEN in quintiles to be included; in the second level, marital status; and in the third level, the variables to plan pregnancy, prenatal care through SUS, maternal work e number the prenatal visits. Tabela 3 mostra the outcomes of ns multivariate analysis.




In the o primeiro dia level, even after mutual adjustment, a three variables stayed significant: black shade (OR=2.1; p=0.002), less than 4 year of schooling (OR=3.6; p

In ns second level, the association with the fact that ns woman walk not viver with a husband/partner remained far-reaching after adjusting para the primeiro level variables (OR=1.9; p=0.003).

In ns third level of ns analysis model, the only associação that remained far-reaching after adjusting for the previous levels was a reverse associação with a number the prenatal access time (p



The atuação of urinalysis is an indicator of the quality of prenatal care. In the 4,163 analyzed pregnant women, a prevalence that non-performance that this test foi ~ 3%. Ns multivariate analysis showed that para women quem were black, poor, single, com low schooling and who had less than seis prenatal visits, the possibilidade of not performing this test ser estar increased.

These results have to be taken within ns context that prenatal care provided in the cidade of Pelotas, where an ext than 98% of a parturient women of 2004 had actually at least 1 prenatal visit.4 ns average variety of prenatal visits ser estar 8.2; 6.8 in a lower quintile of ns IEN e 7.3 in black color women.

Although that is important, it was observed the 3% of ns puerperae reported no having had urinalysis during pregnancy. Despite being low, this pervasiveness is vital in opinião of the increased occurrence of premature birth deliveries: em ~ 8.5% in 1993 come 13.5% in 2004.4 Furthermore, the issue the unequal treatment is proved in poor, black and uneducated pregnant women: the prevalence of the non-performance of urinalysis rises to 10%, contrasted to 0.4% in white, wealthy e highly educated pregnant women.

One of a factors associated com non-performance of a test is black skin color. This characteristic has actually been associated com other indicators of inadequate health and wellness care, together as the lower ratio of atuação of a preventive check for cervicais uterine cancer.10 ns findings of the present aprender suggest that particular interventions should be target at this population, with the support of health and wellness professionals and civil organizations.

Women"s short schooling era also linked with a non-performance of urinalysis, even after adjusting ao color and socioeconomic level. A study performed at municipal health centers the Pelotas in 1998 revealed that 91% of ns pregnant ladies received inadequate prenatal care; over there was enquanto record of the potência of basic laboratory test (hemoglobin, regime urinalysis e serology porque o syphilis– VDRL) in 14.4% of a pregnant women.13

Concerning ns economic level, it era observed that ns highest risk grupo was that of the poorest quintile of ns IEN. This may be early out to issues of much less access e worse quality of care, and also to a women"s lack of info on adequate prenatal care. With ns increasing consolidation that the família Health program in a city, pregnant ladies in this risk group must be successfully tracked down and guided through health agente and professionals responsible ao prenatal care.

Regarding marital status, women who são de not viver with your husbands/partners were submitted come urinalysis com lower frequency throughout pregnancy. Women with no decorrer fixed partner usually have worse prenatal care indicators,6 i m sorry is not explained apenas um by their socioeconomic situation, since the combinação remained significant after ns adjustment.

The reality that unplanned pregnancy lost combinação with a outcome after ~ adjusting para skin color, IEN and schooling may be defined by ns fact that this occasion is an ext frequent in black females (68%) com less than 4 years of schooling (62%) e belonging to a lower quintile of the IEN (65%). It seems to be vital to broaden ns access to família planning ao black women com low schooling e low socioeconomic level.

The association with maternal work also disappeared after ns adjustment, most likely because the pregnant women with IEN in the lower quintile worked less (25%) than a average, and also those com black skin (37%) and with short schooling (25%). A study on the relationship between maternal work e children"s load gain also found naquela positive association of naquela significantly greater weight get in crianças whose mothers had paid jobs.7

The strong combinação between receiving prenatal care through SUS e the non-performance the urinalysis disappeared after a adjustment, indicating that the place of assistente does not seem to be a most important coeficiente in the type that prenatal treatment that is offered; rather, a patient"s very own characteristics toque this role: skin color, level of schooling, socioeconomic level e marital status. A pregnant woman with lower socioeconomic level may also have greater challenge regarding a physical access to the laboratories the have der partnership com SUS, as result of transportation difficulties and, also, troubles in scheduling tests v SUS for budget ceiling reasons. However, the pregnant women"s greater challenge in performing prenatal tests through SUS can, for example, be diminished if a woman can use other strategies, such together paying para the test. Black color skin color may also be associated com receiving worse assistance: 91% of the black women obtained prenatal treatment through SUS, contrasted to 79% the white women e 81% of females of various other races.

Despite a fact that the associação with a number of prenatal visits ser estar weaker, the remained far-reaching after a adjustment, showing that this result cannot be entirely explained by skin color, level that schooling, socioeconomic level and marital status. Again, a importance of attending a prenatal visits need to be emphasized to ns population.

One limitation of ns present pesquisar is the fact that a information top top urinalysis was based on ns women"s reports when their pregnancy card ser estar not obtainable or had actually been inadequately filled in. Pregnant women with low schooling may have difficulties in providing such information. This bias was reduced by the exclusion of the women who were not sure whether or no they had actually been submitted to ns test. Another limitation is associated to a variable skin color, which foi ~ based on ns observation of a interviewers, e the majority of them were white. This variable ser estar used instead of self-referred color because the latter included a higher portion of ignored values. When a analyses over were recurring using a variable self-referred color, the results were essentially identical.

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Epidemiological studies estão important come evaluate a coverage of certain actions in público health. Ns utilization of ns coverage of crucial test such together urinalysis may é perfeito com as one indicator come assess a quality that prenatal care. São de the suggest of view of SUS, ns search ao equity suggests different assistance to those quem need it most. In conclusion, a present aprender suggests that ladies who are black, poor, com low schooling e unmarried must be targeted by more specific plot so the they obtain adequate prenatal care.



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Correspondence: Mariângela Freitas da Silveira Av. Ducado de Caxias, 250 96100-000 Pelotas, RS, brasil E-mail: maris.sul