Impact of COVID-19 on Neonatal Anthropometrics: A Comparative

Analysis of Public and Private Hospital Admissions in Quito (2019-2020)

Impacto del COVID-19 en la antropometría neonatal: un análisis comparativo

de los ingresos hospitalarios públicos y privados en Quito (2019-2020)

Revista Ecuatoriana de Pediatría

Editorial: Sociedad Ecuatoriana de Pediatría (Núcleo de Quito, Ecuador)

Tipo de estudio: Artículo Original

Área de estudio: Odontopediatría

Páginas: 10-20

Codígo DOI: https://doi.org/10.52011/RevSepEc/e266

URL: https://rev-sep.ec/index.php/johs/article/view/266

ABSTRACT

Introduction: The health of mothers and newborns has been of particular interest during the COVID-19 pan-

demic in Quito. This study aims to compare the admissions and anthropometric data of newborns between

a public and a private Ecuadorian hospital before and during the COVID-19 pandemic. Material and Me-

thods: This study used anthropometric data from 5,375 newborns collected from medical records of “Hospital

General Docente de Calderón” (a public institution) and the “Hospital Metropolitano de Quito” (a private ins-

titution) between September 2019 and October 2020. Data on sex, gestational age, birth weight, length, and

head circumference were obtained for each newborn. The z-score and centile were calculated according to

international standards for newborns from the Intergrowth-21st Project. Results: Newborns in public hospitals

had a higher gestational age (OR=1.16, 95%CI 1.12-1.21). During the pandemic, births were more likely to occur

in private hospitals than in public hospitals (OR=0.45, 95%CI 0.38-0.54). Private hospitals were more likely to

have newborns with a lower head circumference (HC) z-score compared to public hospitals (OR=0.68, 95%CI

0.63-0.73). Conclusions: The COVID-19 pandemic has led to a higher incidence of births in private hospitals.

No diﬀerences were found in the birth weights of newborns for their gestational age between those born in

public and private hospitals.

Key Words: neonatology, parturition, SARS-CoV-2, COVID-19.

Juan Carlos Jácome1, Susana Eulalia Dueñas Matute2, Elina Yánez3, Mariuxi Chipe3, Leysi Sánchez3,

Fernando Aguinaga5, Francis Ponce4, Verónica Guzmán5, Patricia Benavides6, Alexander Gallardo1,

Luis Castillo7, Edson Zangiacomi Martínez8, Carmen Amelia Salvador Pinos1

Recibido: 10/feb/2024 - Aceptado: 12/mayo/2024 - Publicado: 30/ago/2024

1. Chair of Genetics, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador

2. Chair of Pediatrics, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador

3. Neonatology Department, Universidad Central del Ecuador, Quito, Ecuador

4. Postgraduate Pediatrics, Escuela de Medicina, Hospital General Docente de Calderón, Quito, Ecuador

5. Neonatology Department, Hospital Metropolitano, Quito, Ecuador

6. Docencia, Hospital General Docente de Calderón, Quito, Ecuador

7. Facultad de Ingeniería, Ciencias Físicas y Matemática, Universidad Central del Ecuador, Quito, Ecuador

8. Ribeirão Preto Medical School, Universidade de São Paulo (USP), Av. Bandeirantes 3900, Monte Alegre, Ribeirão Preto, SP 14049-900, Brazil.

Artículo Original

JuanJácome Navarrete https://orcid.org/0000-0003-3700-6222

Susana Eulalia Dueñas Matute https://orcid.org/0000-0002-8134-0204

Elina Yánez https://orcid.org/0000-0003-1601-9251

Mariuxi Chipe https://orcid.org/0000-0002-5316-6392

Leysi Sánchez https://orcid.org/0000-0003-1570-8936

Fernando Aguinaga https://orcid.org/0000-0001-7685-7279

Francis Ponce https://orcid.org/0000-0002-6095-0222

Verónica Guzmán https://orcid.org/0000-0003-3468-6832

Patricia Benavides https://orcid.org/0000-0003-0282-9229

Alexander Gallardo https://orcid.org/0000-0002-7738-7034

Luis Castillo https://orcid.org/0000-0003-2173-2115

Edson Zangiacomi-Martínez https://orcid.org/0000-0002-0949-3222

Carmen Amelia Salvador-Pinos https://orcid.org/0000-0002-5011-6031

Correspondencia: Carmen Salvador Pinos

Iquique N14-121 y Sodiro -Itchimbía, Sector El Dorado

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RESUMEN

Introducción: La salud de madres y recién nacidos ha sido de particular interés durante la pandemia de

COVID-19 en Quito. Este estudio tiene como objetivo comparar las admisiones y los datos antropométricos de

los recién nacidos entre un hospital público y un hospital privado en Ecuador antes y durante la pandemia de

COVID-19. Material y Métodos: Este estudio utilizó datos antropométricos de 5,375 recién nacidos recogidos

de los registros médicos del “Hospital General Docente de Calderón” (una institución pública) y el “Hospital Me-

tropolitano de Quito” (una institución privada) entre septiembre de 2019 y octubre de 2020. Se obtuvieron datos

sobre el sexo, la edad gestacional, el peso al nacer, la longitud y la circunferencia de la cabeza del neonato.

El puntaje z y el percentil se calcularon según los estándares internacionales con el Proyecto Intergrowth-21st.

Resultados: Los recién nacidos en hospitales públicos tenían una mayor edad gestacional (OR=1.16, IC95%

1.12-1.21). Durante la pandemia, era más probable que los nacimientos ocurrieran en el hospital privado que en

hospital público (OR=0.45, IC95% 0.38-0.54). En el hospital privado tenían más probabilidades de tener recién

nacidos con un menor puntaje z de circunferencia de la cabeza (HC) en comparación con el hospital público

(OR=0.68, IC95% 0.63-0.73). Conclusiones: La pandemia de COVID-19 ha llevado a una mayor incidencia de

nacimientos en hospitales privados. No se encontraron diferencias en los pesos al nacer de los recién nacidos

según su edad gestacional entre los nacidos en hospitales públicos y privados.

Palabras Claves: neonatología, parto, SARS-CoV-2, COVID-19.

Introducción

The ﬁrst case of COVID-19 in Ecuador was

reported in Guayaquil on February 29, 2020,

concerning a citizen who had recently re-

turned from Spain1. On March 11, the Ecua-

dorian government declared a “State of

Health Emergency in all national health sys-

tem establishments”1 and by July 2024, there

were 732.038 cumulative cases of COVID-19

conﬁrmed in the country, with 34.533 dea-

ths2. In the early months of the pandemic,

the coastal regions were most aﬀected by

COVID-19, with higher mortality rates than

those reported in the highland regions3. The

concentration of the pandemic in some re-

gions of Ecuador was directly proportional

to some indicators of poverty and health4.

There was a late implementation of res-

trictive measures of social distancing and

limited capacity in health services(5). Guaya-

quil, for example, is regarded as an impor-

tant industrial and commercial center of the

coastal region and has experienced the hi-

ghest poverty rate among Ecuador’s largest

cities over the past ﬁve years4. In sum, the

literature has to highlight the associations

between socioeconomic determinants and

the dynamics of the COVID-19 spread, and

inequities in access to basic health services

can contribute to worsening the health of

people in situations of social and economic

vulnerability. The availability of vaccines for

COVID-19 has brought hope for the miti-

gation of the disease. Still, studies on the

ability of health care facilities to provide

adequate resources to the population in

times of pandemics are essential for plan-

ning new interventions that can reduce in-

equalities and improve health. Among these

facilities are those focused on maternal and

child health.

The health of mothers and newborns has

been of particular interest to the medi-

cal community, given that pregnant mo-

thers and young children are considered

a vulnerable population. The current litera-

ture supports that pregnant women with

COVID-19 may be at an increased risk of

adverse pregnancy and birth outcomes.

SARS-CoV-2 infection at the time of birth is

associated with higher fetal death rates, ia-

trogenic preterm labour, preeclampsia, and

emergency caesarean delivery6–8. The risk

of vertical transmission of COVID-19 is su-

ggested to be low and may not be aﬀec-

ted by the severity of maternal disease9–11.

However, in addition to clinical factors, a

North-American multicentre cohort study

showed that high maternal social vulnerabi-

lity is associated with a higher likelihood of

neonatal test result positivity12. In this study,

2.2% of the neonates born to mothers with

SARS-CoV-2 infection had positive results

during the birth hospitalization12. The au-

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Artículo Original

thors argued that the particular pathways

by which social disadvantage may aﬀect

mother-to-child transmission of SARS-CoV-2

include diﬀerential access to care and clini-

cian bias. Therefore, the evaluation of neo-

natal outcomes during the pandemic, the

social aspects and vulnerability situation of

mothers, and the monitoring and evalua-

tion of health facilities are still needed to

prevent and protect neonatal health in ti-

mes of pandemic by COVID-19.

A retrospective medical record-based study

carried out in one of the largest public birth

clinics in Vienna, Austria, showed that the

rate of very low gestational age was sig-

niﬁcantly lower during the lockdown phase

due to COVID-19 (March to July 2020) than

during the pre-lockdown phase13. In addi-

tion, the mean birth weight was higher du-

ring the lockdown phase, and the rates of

low, very low, and extremely low birth wei-

ght were lower during the lockdown pha-

se13. Other studies also showed a decrease

in preterm births during the COVID-19 lock-

down14–18, suggesting that the stressful lock-

down phase have no signiﬁcantly negative

eﬀect on the preterm birth rates and new-

born weight among non-infected mothers.

However, Cuestas et al.19 cautioned that

most of these studies originated in high-in-

come countries and all of them assessed

a short lockdown period. As a result, more

attention must be paid to these indicators

in middle- and low-income countries in or-

der to gain a better understanding of the

potential eﬀects of COVID-19 social distan-

cing measures on neonatal health indica-

tors in diﬀerent populations. Ecuador is a

medium-income country with a Human De-

velopment Index score of 0.759 and about

25% of its population lives below the pover-

ty threshold (United Nations Development

Programme20. It was conceived as interes-

ting to think about what happened in Ecua-

dor in this period because this information

could be useful in the future.

This study aims to compare maternal and

neonatal outcomes of women who gave

birth in two Ecuadorian maternity hospitals

(a public and a private), between a pre-pan-

demic COVID-19 period (from September

2019 to February 2020) and a pandemic

period (from March to October 2020).

Methods

Design and participants

This study was designed as an observa-

tional, cross sectional study with retrospec-

tive data collection. Data were obtained

from medical records of 4,625 newborns

at the Calderón General Teaching Hospital

(CGTH), a public facility, and 750 newborns

at the Quito Metropolitan Hospital (QMH),

a private facility, between September 2019

and October 2020. Both maternity hospitals

are located in Quito, Ecuador. For compa-

risons, the study period was divided into

pre-pandemic (before March 2020) and

during pandemic (after March 2020). Neo-

nates were excluded from the study popu-

lation for missing data, gestational age less

than 24 weeks or greater than 42 weeks, or

major congenital anomalies. Twin births are

also excluded.

Ethical issues

The study protocol was approved by the

medical ethical committees of the Universi-

dad Central del Ecuador (UCE), Ministerio

de Salud Pública and Hospital General

Docente de Calderón . All mothers gave

their written informed consent for themsel-

ves and their children. After signing the con-

sent form, no personal contact was made

with any of the subjects, and all information

was obtained from medical records.

Variables

Data collected included sex, gestational

age (GA), birth weight, length, and head

circumference. The z-scores for neonatal

weight, length, and head circumference

(HC) according to sex and gestational age

at birth were determined using the online

Intergrowth-21st calculator (21,22). The neo-

nates were classiﬁed according to gesta-

tional age on admission into three groups.

The ﬁrst group included the preterm infants

(GA less than 37 weeks), the second group

included the term infants (GA ranged from

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Artículo Original

370/7 to 416/7 weeks), and the third group

included the post-term infants (GA greater

than 420/7) (23). According to the Inter-

growth-21st, infants born with a birth weight

below the 10th percentile were classiﬁed as

small for gestational age (SGA), infants with

a birth weight between the 10th and 90th

percentile for gestational age were clas-

siﬁed as appropriate for gestational age

(AGA), and infants above the 90th percen-

tile were classiﬁed as large for gestational

age (LGA).

Statistical methods

The variables were present in means with

standard deviations for continuous variables

or proportions for categorical variables. The

diﬀerences between pre-pandemic and du-

ring a pandemic, and between public and

private hospitals, were evaluated with a sig-

niﬁcance level of 0.05. Student t-tests were

used for variables with a no-skewed distri-

bution and chi-square tests were used to

evaluate diﬀerences in proportions.

For the purpose of classiﬁcation among

hospital types, a logistic regression model

was used with the type of hospital as the

dependent variable (classiﬁed as a dum-

my variable where 0 is a private hospital

and 1 is a public hospital). The following

independent variables were included: GA

(weeks), time (before pandemic=0, during

pandemic=1), length z-score, weight z-sco-

re, HC z-score, and sex (female=0, male=1).

First, univariate models were used with the

dependent variable with each independent

variable, with a signiﬁcance level of 0.05.

The signiﬁcant variables were used in a ﬁ-

nal logistic regression model. Results were

presented as odds ratios (OR) with their

95% conﬁdence intervals (95%CI).

In addition, three univariate linear regres-

sion models were ﬁtted, including the length

z-score, weight z-score, and HC z-score as

dependent variables. The independent va-

riables were the type of hospital (private =

0, public = 1), time (before pandemic = 0,

during pandemic = 1) and sex (female = 0,

male = 1). A ﬁnal linear regression model

was ﬁtted, considering the independent va-

riables “signiﬁcant” at a signiﬁcance level of

0.05 in the univariate models. The data was

presented as “beta” coeﬃcients with their

corresponding 95%CI. All statistical analysis

was performed using Stata version 16 (Sta-

taCorp, Cary, USA).

Results

The sample comprised an equal number of

male and female newborns, with the ge-

neral characteristics detailed in Table 1. No-

tably, the gestational age (GA) of children

born in public hospitals was higher than

those born in private hospitals (p<0.001).

Across all neonates, the mean weight was

3.03 kg and the mean height was 47.99 cm.

Although the tests comparing the means

showed relatively small p-values, no clini-

cally signiﬁcant diﬀerences were found in

the weight, height, and length of children

between the public and private hospitals.

Additionally, there was a signiﬁcant increase

in births in private institutions (73.6%) during

the pandemic (p<0.001).

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Tabla 1. Population characteristics.

Table 2. Anthropometric variables pre-pandemic and during pandemic.

Variables Total

n=5375

Public

n= 4625

Private

n= 750 p-value

Maternal delivery; % (n)

Pre-pandemic 41.9 (2254) 44.5 (2056) 26.4 (198) <0.001

During pandemic 58.1 (3121) 55.5 (2569) 73.6 (552)

Female; %(n) 49.4 (2657) 49.5 (2289) 49.1 (368) 0.829

GA; (days); mean (SD) 271.28 (11.70) 271.75 (11.78) 268.39 (10.82) <0.001

Weight; (kg); mean (SD) 3.03 (0.46) 3.03 (0.47) 2.99 (0.43) 0.011

Weight; (Z-score); mean (SD) -0.27 (0.93) -0.28 (0.95) -0.22 (0.84) 0.068

Length; (cm); mean (SD) 47.99 (2.56) 48.03 (2.55) 47.71 (2.57) 0.001

Length; (Z-score); mean (SD) -0.4 (1.14) -0.4 (1.15) -0.43 (1.06) 0.439

HC; (cm); mean (SD) 34.06 (1.45) 34.01 (1.46) 34.34 (1.40) <0.001

HC; (Z-Score); mean (SD) 0.44 (1.06) 0.38 (1.06) 0.82 (0.96) <0.001

GA= gestational age; HC=head circumference; SD=standard deviation.

P-values refer to chi-square tests or Student t tests as appropriate

On the other hand, Table 2 shows that there

is no evidence of diﬀerences in the frequen-

cy of preterm or post-term births before or

during the pandemic (p=0.161). Additionally,

we did not ﬁnd signiﬁcant diﬀerences in the

frequency of births with small, adequate, or

large head circumference and weight ac-

cording to the z-score for gestational age

before and during the pandemic (p=0.471

and p=0.310, respectively). However, during

the pandemic, the number of SGA (Small

for Gestational Age) and LGA (Large for

Gestational Age) neonates increased, and

the number of AGA (Appropriate for Gesta-

tional Age) neonates decreased according

to length (p<0.001).

Variables Total

n=5375

Pre-pandemic

n= 2254

During pandemic

n= 3121 p-value

Gestational age; %(n)

Preterm 9.1 (489) 8.5 (192) 9.5 (297) 0.161

Term 90.3 (4853) 90.7 (2044) 90.0 (2809)

Post term 0.6 (33) 0.8 (18) 0.5 (15)

Weight; (Z-Score); %(n)

SGA 21.3 (1146) 21.8 (492) 21.0 (654) 0.310

AGA 70.4 (3785) 70.6 (1590) 70.3 (2195)

LGA 8.3 (444) 7.6 (172) 8.7 (272)

Length; (Z-Score); %(n)

SGA 27.4 (1475) 24.9 (562) 29.3 (913) 0.002

AGA 63.7 (3422) 66.2 (1492) 61.8 (1930)

LGA 8.9 (478) 8.9 (200) 8.9 (278)

HC; (Z-Score); %(n)

SGA 8.1 (438) 8.3 (187) 8.1 (251) 0.471

AGA 62.5 (3358) 63.2 (1425) 61.9 (1933)

LGA 29.4 (1579) 28.5 (642) 30.0 (937)

SGA=small for gestational age; AGA= adequate for gestational age; LGA= large for gestational age.

P-values refer to chi-square test

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Table 3. Results of the logistic regression model. Associations between public hospital, ges-

tational age, during pandemic, and anthropometrics z-score measurements.

Table 4. Results of the univariate and multiple regression models for neonate length z-score,

weight z-score and HC z-score with sex, gestational age, public hospital, during COVID-19

pandemic.

The logistic regression analysis reveals se-

veral key ﬁndings. Neonates born in public

hospitals are more likely to have a higher

gestational age (OR=1.16, CI=1.12-1.21). Further-

more, during the pandemic, there was a

higher likelihood of births occurring in pri-

vate hospitals compared to public hospitals

Regarding the length z-score, the regres-

sion model indicates that the z-score de-

creases by β=-0.027 (CI=-0.05; -0.01) with

each increase in gestational age, and there

was an average decrease of β=-0.102 (CI=-

0.16; -0.04) during the COVID-19 pandemic.

For the weight z-score, the model shows

an increase of β=-0.06 (CI=-0.11; -0.01) if the

newborn is male, and a change of β=-0.033

(CI=-0.05; -0.02) with each increase in gesta-

(OR=0.45, CI=0.38-0.54). Neonates born in

private hospitals also exhibited a lower HC

z-score than those born in public hospitals

(OR=0.68, CI=0.63-0.73). However, no signi-

ﬁcant associations were found with length

z-score, weight z-score, and sex. These re-

sults are detailed in Table 3.

tional age. Lastly, the HC z-score decreases

by β=-0.100 (CI=-0.16; -0.04) if the newborn

is male, changes by β=-0.05 (CI=-0.07; -0.03)

with each increase in gestational age and

increases by β=-0.417 (CI=-0.5; -0.34) if born

in a public hospital. These results are detai-

led in Table 4, which presents the ﬁndings

of the linear regression used to identify

changes in the z-scores of the newborns’

anthropometric variables.

Model: Private=0 Univariate Multiple model

Public=1 OR (95%CI); p-value OR (95%CI); p-value

GA (weeks) 1.164 (1.12, 1.21), p = 0.001 1.143 (1.09, 1.19), p = 0.001

During pandemic 0.448 (0.38, 0.53), p = 0.001 0.451 (0.38, 0.54), p = 0.001

Length z-score 1.027 (0.96, 1.10), p = 0.439 --

Weight z-score 0.932 (0.86, 1.01), p = 0.094 --

HC z-score 0.672 (0.62, 0.72), p = 0.001 0.678 (0.63, 0.73), p = 0.001

Male 0.983 (0.84, 1.15), p = 0.829 --

GA= gestational age; HC=head circumference; CI=conﬁdence interval

Models

Male

β; (95%CI)

p-value

GA (weeks)

β; (95%CI)

p-value

Public

β; (95% CI)

p-value

During pandemic

β; (95% CI)

p-value

Length z-score

Univariate -0.018 (-0.08, 0.04) 0.552 -0.025 (-0.04, -0.01) 0.007 0.035 (-0.05, 0.12) 0.439 -0.097 (-0.16, -0.04) 0.002

Multiple -- -0.027 (-0.05, -0.01) 0.004 -- -0.102 (-0.16, -0.04) 0.001

Weight z-score

Univariate -0.056 (-0.11, -0.01) 0.028 -0.032 (-0.05, -0.02) 0.001 0.061 (-0.13, 0.01) 0.094 0.025 (-0.03, 0.08) 0.337

Multiple -0.06 (-0.11, -0.01) 0.019 -0.033 (-0.05, -0.02) 0.001 -- --

HC z-score

Univariate -0.093 (-0.15, -0.04) 0.001 -0.057 (-0.07, -0.04) 0.001 -0.44 (-0.52, -0.36) 0.001 0.022 (-0.04, 0.08) 0.447

Multiple -0.100 (-0.16, -0.04) 0.001 -0.05 (-0.07, -0.03) 0.001 -0.417 (-0.5, -0.34) 0.001 --

GA= gestational age; HC=head circumference; CI=conﬁdence interval

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Finally, Figure 1 shows the z-score varies for

the weight, height, and brain circumference

of the newborn depending on the month

of gestation. It is observed that before the

pandemic of COVID-19, the weight z-score

of children born up to week 36 has more

variation, but after this point it stabilizes. This

trend is also observed for the z-scores of

height and head circumferences. During the

pandemic, the z-score is less variable throu-

ghout the weeks of gestation. For this rea-

son, diﬀerences in weight, height, and brain

circumference were not observed, although

quantitative analysis showed that the num-

ber of SGA and LGA newborns increased

according to the height z-score.

Figure 1. The variation of the Z-score for weight, height and HC for -2SD, -1SD, mean, 1SD

and 2SD is shown. Solid Line = before pandemic; broken Line = during pandemic.

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Discussion

Our results showed that the increase in

deliveries performed in a private hospital

was higher than that observed for the pu-

blic hospital. A possible explanation is that,

because of the pandemic, many mothers

are afraid of contagion during care in the

public system, so they prefer private care.

This increase has been more evident in

Ecuador, according to data from Alfredo

Paulson Hospital, of the Guayaquil Board

of Charity. Evidence shows that the private

sector handles a lower incidence of CO-

VID-19 positive patients as compared to the

public sector24, mainly due to the Ecuado-

rian government’s plan to centralize those

infected with COVID-19 in public hospitals.

In this study, the average weight of new-

borns was 3.03 kg and the average length

was 47.99 cm, with no clinically important

diﬀerences when comparing between the

public and private hospitals. These avera-

ges are similar despite the lower proportion

of caesarean sections (C-sections) in the

public sector of Ecuador when compared

to the private one.

No signiﬁcant diﬀerences were found in the

weight, height, and length of the neonates

in Ecuador. The Sanitary Regulation for the

Certiﬁcation of Health Facilities as Mother

and Child Friendly (ESAMyN), adapted from

the WHO Baby-Friendly Hospital Initiative, is

in force and mandatory for both public and

private hospitals, ensuring quality standards

in maternal and neonatal care(25). A 2019

study in second-level hospitals showed that

obstetrics and medical interns largely com-

ply with these standards, although there is

a need to improve the practice of cutting

the umbilical cord at the appropriate time26.

The widespread compliance with ESAMyN

regulations might explain the lack of sig-

niﬁcant diﬀerences in the anthropometric

measurements of neonates, ensuring similar

health conditions at birth. However, other

factors such as genetic predispositions,

environmental inﬂuences, maternal health

conditions during pregnancy, and access to

postnatal care should be considered. Futu-

re research should explore these additional

variables to provide a more comprehensive

understanding of the factors aﬀecting neo-

natal health and development in Ecuador.

The C-section rate in Ecuador was 41.3%

from 2015 to 202227. Many C-sections are

planned for convenience rather than me-

dical necessity28, leading to earlier births

compared to vaginal delivery, which allows

neonates more time to gain weight and

length29–31. Studies in Ecuador indicate that

women giving birth in private sectors tend

to have higher incomes than those in pu-

blic sectors32,33, inﬂuencing their dietary ha-

bits and maternal nutritional status, which

aﬀects fetal nutrition. Private sector care of-

ten includes nutritional counseling, unlike the

public sector, where such counseling may

be brief or absent34. Additionally, higher-in-

come mothers can aﬀord healthier diets,

while those in the public sector may rely on

low-cost, carbohydrate-based diets35. Ex-

cessive and inadequate maternal nutrition

can lead to excessive weight gain, poten-

tially linked to a sedentary lifestyle during

lockdown or online work. High birth weight

in newborns has been associated with mo-

thers with gestational diabetes who may

not have had adequate preventive care36.

In this study, no signiﬁcant diﬀerences were

found in the percentage of preterm or term

births between before the pandemic and

during it (p = 0.161). This is noteworthy be-

cause the pandemic’s drastic changes in

lifestyle had the potential to change the

frequency in either direction: a decrease

in preventive controls in pregnant women

could have resulted in more pregnancy

problems ; on the other hand, the more

relaxed conditions of improved nutrition,

home rest, and less workload could have

resulted in a lower rate of preterm delive-

ries37. It was previously mentioned that the

anecdotal experience observed by some

physicians pointed towards a reduction in

the percentage of preterm babies. Howe-

ver, no evidence of this assertion was found

in this study. This may be due to its scope,

which covered only one private hospital

and one public hospital. Both are big and

serve a large population of patients, as evi-

Revista Ecuatoriana de Pediatría | ISSNe: 2737-6494

Pagína 18 | VOL.25 N°2 (2024) Mayo-Agosto

Artículo Original

denced by the sample size, so there is high

conﬁdence in the results, though the results

at a national level may certainly be diﬀe-

rent. Another, national-scale study would be

necessary to conﬁrm this.

The limitations of the present study include

a lack of information on important variables

such as the C-section rate in each facility

and maternal socioeconomic characteris-

tics. Due to the cross-sectional design of

the study, no conclusions on causality can

be drawn.

Contribución de los autores

JJ, SD, CA: Concepción y diseño del

trabajo.

JJ, SD, CA: Recolección de datos y obten-

ción de resultados.

JJ, SD, CA: Análisis e interpretación de datos

JJ, SD, CA: Redacción del manuscrito.

JJ, SD, CA: Revisión crítica del manuscrito.

JJ, SD, CA: Aprobación de su versión ﬁnal.

JJ, SD, CA: Aporte de pacientes o material

de estudio.

JJ, SD, CA: Obtención de ﬁnanciamiento.

JJ, SD, CA: Asesoría estadística.

JJ, SD, CA: Asesoría técnica o administrativa.

Aspectos éticos

El trabajo de investigación fue desarrolla-

do, bajo el método descriptivo con la tabu-

lación de las historias clínicas, para lo cual

no se necesitó la aprobación del Comité

de Ética al no tener intervenciones huma-

nas si no estadísticas.

Financiamiento

Se trabajó con fondos propios.

Conﬂictos de interés

Los autores reportaron no tener ningún

conﬂicto de interés, personal, ﬁnanciero, in-

telectual, económico y de interés corpora-

tivo.

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Para referenciar aplique esta cita:

Jácome Navarrete J, Dueñas Matute SE, Yánez E, Chipe M, Sánchez L, Aguinaga F, Ponce F, Guzmán V,

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