Violence against women and the risk of fetal and early childhood growth impairment: a cohort study in rural Bangladesh.

OBJECTIVE: To assess whether different forms of family violence against women were associated with impaired size at birth and early childhood growth. METHODS: A substudy embedded into a community-based food and micronutrient supplementation trial (MINIMat) of pregnant women in rural Bangladesh included a 2-year follow-up of the 3164 live-born children of participating women. Anthropometric data were collected from birth up to 24 months of age, and converted to WHO growth standard SD scores. Size at birth and early childhood growth were assessed in relation to women's exposure to physical, sexual and emotional violence and the level of controlling behaviour in the family. RESULTS: Fifty per cent of all women reported a lifetime experience of some form of family violence. The mean birth weight was 2701 g, 30% were low birth weight (<2500 g), mean birth length was 47.8 cm (17.5%, <or=2 SD) and at 24 months of age 37% were underweight and 50% of the children were stunted. Exposure to any form of violence was negatively associated with weight and length at birth and weight-for-age and height-for-age SD scores at 24 months of age, as well as a change in weight and height SD score from birth to 24 months of age (p<0.05, adjusted for potential confounders). CONCLUSIONS: Violence against women was associated with an increased risk of fetal and early childhood growth impairment, adding to the multitude of confirmed and plausible health consequences caused by this problem

Estimating glomerular filtration rate at the transition from pediatric to adult care

The current Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend the use of the bedside creatinine-based Chronic Kidney Disease in Children (CKiD) equation to estimate glomerular filtration rate (GFR) in children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in adults. However, this approach causes implausible changes in estimated GFR (eGFR) at the transition from pediatric to adult care. We investigated the performance of the KDIGO strategy and various creatinine-based eGFR equations in a cross-sectional dataset of 5,764 subjects (age 10-30 years), using directly measured GFR (mGFR) as reference. We also evaluated longitudinal GFR slopes in 136 subjects who transitioned to adult care. Implausible changes in eGFR resulted from the large overestimation (bias=+21 mL/min/1.73m 2 ) and poor precision of the CKD-EPI equation in the 18-20 year age group, compared to CKiD in the 16-18 year age group (bias=-2.7 mL/min/1.73m 2 ), resulting in a mean change of 23 mL/min/1.73m 2 at the transition to adult care. Averaging the CKiD and CKD-EPI estimates in young adults only partially mitigated this issue. The Full Age Spectrum equation (with and without height), the Lund-Malmö Revised equation, and an age-dependent weighted average of CKiD and CKD-EPI resulted in much smaller changes in eGFR at the transition (change of 0.6, -2.1, -0.9 and -1.8 mL/min/1.73m 2 , respectively). The longitudinal analysis revealed a significant difference in average GFR slope between mGFR and the KDIGO strategy (-2.2 vs. +2.9 mL/min/1.73 m 2 /year), which was not observed with the other approaches. These results suggest that the KDIGO recommendation for GFR estimation at the pediatric-adult care transition should be revisited