Identification of pregnant patients at risk of delivering low birthweight infants in urban areas of Guatemala

A prospective epidemiologic study of pregnant women obtaining prenatal care at a social security hospital in Guatemala City was the basis for an attempt to develop a method of identifying early in pregnancy women at risk of having low birth weight infants. Existing classifications of risk are not completely satisfactory for low income women in urban areas of developing countries. The sample included 17135 women seen between April 1984 and January 1986. Women who had no prenatal care or who obtained it elsewhere were excluded. Social workers interviewed each woman at the 1st prenatal visit to obtain sociodemographic data. The nurses or physicians attending the women completed forms based on perinatal records developed by the Latin American Center for Perinatology and Human Development and adapted to local needs. A final visit was made just after delivery to complete the information in each file. Great care was taken to assure that the 24 examiners used the same standards for all measurement variables. The standardized data collection techniques were evaluated in a study of agreement between observers. The study was conducted in 4 sections covering sociodemographic variables obstetric history prenatal variables and labor and delivery. Taking into account the size of the sample and the number of observers it was concluded that the data were of acceptable quality. It is strongly recommended that periodic evaluation of the quality of data collected be included in all perinatal epidemiologic studies. It was also concluded that longitudinal studies of perinatal risk factors might not be needed in all regions or health areas; the association between the best known risk factors and the evolution of pregnancy has been established and with few exceptions it appears to be relatively constant in all populations. It is recommended that perinatal services reduce the amount of data routinely collected to a minimum and apply the quality control and standardization procedures to a sample of patients and to all personnel completing records. This would assure an acceptable quality of data as a basis for medical or public health decision making. Relevant additional variables could be added as needed