Pap smears among pregnant women in Southern Brazil: A representative cross-sectional survey

Abstract

PURPOSE: To determine the prevalence and risk factors associated with failure of voluntary screening for cervical cancer during the gestational period in Rio Grande, Rio Grande do Sul State, Southern Brazil. METHODS: Previously trained interviewers applied a standardized questionnaire in the maternity to all mothers from this municipality who had delivered from January 1st to December 31st 2010 to obtain information about the demographic characteristics of the pregnant women, family socioeconomic status, and prenatal care received. The χ2 test was used to compare proportions and Poisson regression with robust adjustment of variance was used in the multivariate analysis. RESULTS: Among the 2,288 respondents, 33% were not submitted to the Pap smear during pregnancy. Two thirds of these women stated that they were not aware of the need to perform it, 18% were not screened out of fear or shame, and the rest for other reasons. After adjustment, the highest prevalence ratios (PR) for noncompliance with the Pap smear occurred among young women (PR=1.5; 95%CI 1.25-1.80), with lower educational level (PR=1.5; 95%CI 1.12-2.12), who were living without a partner (PR=1.4; 95%CI 1.24-1.62), smokers (PR=1.2; 95%CI 1.07-1.39), who did not plan the current pregnancy (PR=1.3; 95%CI 1,21-1.61), who had attended less than six medical visits during the prenatal period (PR=1.4; 95%CI 1.32-1.69) and among users of oral contraceptives (PR=1.2; 95%CI 1.04-1.38). CONCLUSIONS: The higher the risk for uterine cervical cancer, the less likely a pregnant woman is to undergo a Pap smear. This definitely contributed to the increased morbidity and mortality from this disease in this setting.