Assisted reproductive technology: prevalence and associated factors in Southern Brazil

OBJECTIVE: To assess the prevalence of successful assisted reproductive technology and to identify the associated factors. METHODS: This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression. RESULTS: Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology. CONCLUSIONS: The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries

Peso medio al nacer entre recién nacidos a término : tendencia, magnitud y factores asociados

A trend towards increasing birth weight has been shown, but factors that explain these trends have not been elucidated. The objectives of this study were to evaluate changes in mean birth weight of term newborns and to identify factors associated with them. All cohorts are population-based studies in which random samples of births (Ribeirão Preto, São Paulo State in 1978/1979, 1994 and 2010; Pelotas, Rio Grande do Sul State in 1982, 1993 and 2004; and São Luís, Maranhão State in 1997/1998 and 2010, Brazil). A total of 32,147 full-term, singleton live births were included. Mean birth weight reduced in the first study period (-89.1g in Ribeirão Preto from 1978/1979 to 1994, and -27.7g in Pelotas from 1982 to 1993) and increased +30.2g in Ribeirão Preto from 1994 to 2010 and +24.7g in São Luís from 1997 to 2010. In the first period, in Ribeirão Preto, mean birth weight reduction was steeper among mothers with high school education and among those born 39-41 weeks. In the second period, the increase in mean birth weight was steeper among mothers with low schooling in Ribeirão Preto and São Luís, females and those born 37-38 weeks in Ribeirão Preto and cesarean section in São Luís. Birth weight decreased in the first study period then increased thereafter. The variables that seem to have been able to explain these changes varied over time.Existem evidências de uma tendência de aumento do peso ao nascer, mas pouco se sabe sobre os fatores que explicam essa tendência. Avaliar as mudanças na média de peso ao nascer e identificar os fatores associados. Foram incluídas todas as coortes de base populacional com amostras aleatórias de nascimentos (Ribeirão Preto, São Paulo em 1978/1979, 1994 e 2010; Pelotas, Rio Grande do Sul em 1982, 1993 e 2004; São Luís, Maranhão em 1997/1998 e 2010, Brasil). Foi incluído um total de 32.147 nascidos vivos a termo, de feto único. A média de peso ao nascer diminuiu no primeiro período estudado (-89,1g entre 1978/1979 e 1994 em Ribeirão Preto e -27,7g entre 1982 e 1993 em Pelotas) e aumentou no segundo período, +30,2g entre 1994 e 2010 em Ribeirão Preto e +24,7g entre 1997 e 2010 em São Luís. No primeiro período, em Ribeirão Preto, a redução na média de peso ao nascer foi maior entre mães com escolaridade mais alta e crianças nascidas com 39-41 semanas de idade gestacional. No segundo período, o aumento na média de peso ao nascer foi maior entre mães com escolaridade mais baixa em Ribeirão Preto e São Luís, crianças do sexo feminino e nascidas com 37-38 semanas em Ribeirão Preto e crianças nascidas de cesárea em São Luís. O peso ao nascer diminuiu no primeiro período e aumentou desde então. As variáveis que parecem explicar essas mudanças variaram ao longo do tempo.Se ha mostrado una tendencia de aumento de peso al nacer, pero los factores que explican esta tendencia todavía no han sido elucidados. Evaluar los cambios en el peso medio al nacer de los recién nacidos a término e identificar factores asociados. Se trata de un estudio de todas las cohortes basadas en población, donde existe una muestra aleatoria simple de nacimientos (Ribeirão Preto, São Paulo en 1978/1979, 1994 y 2010; Pelotas, Rio Grande do Sul en 1982, 1993 y 2004; y São Luís, Maranhão en 1997/1998 y 2010, Brasil). Se incluyeron un total de 32.147 de nacimientos a término completo con embarazo de un único feto. El peso medio al nacer se redujo en el primer estudio del período (-89,1g en Ribeirão Preto desde 1978/1979 a 1994 y -27,7g en Pelotas desde 1982 a 1993) y se incrementó +30,2g en Ribeirão Preto desde 1994 a 2010 y +24.7g en São Luís desde 1997 a 2010. En el primer periodo, en Ribeirão Preto, la reducción del peso medio al nacer fue más pronunciada entre madres con una escolarización más alta y entre aquellos nacidos con 39-41 semanas. En el segundo período, el incremento en el peso medio al nacer fue más pronunciado entre las madres con una escolarización más baja en Ribeirão Preto y São Luís, mujeres y aquellos que nacieron con 37-38 semanas en Ribeirão Preto y en el área de cesáreas en São Luís. Disminuyó el peso al nacer durante el primer período de estudio y se vio incrementado después. Las variables que parecen capaces de explicar estos cambios varían a lo largo del tiempo

Coorte de nascimentos de Pelotas, 2004: metodologia e descrição

OBJECTIVE: To describe a birth cohort which started in 2004, aiming to assess pre and perinatal conditions of the newborns, infant morbimortality, early life characteristics and outcomes, and access, use and financing of health care. METHODS: All children born in the urban area of Pelotas and Capão do Leão municipalities (Southern Brazil) in 2004 were identified and their mothers invited to join the study. In the first year of the study the children were seen at birth, at three and 12 months of age. These visits involved the application of a questionnaire to the mothers including questions on health; life style; use of health services; socioeconomic situation; estimation of gestational age; anthropometric measurements on the newborn (weight, length, head, chest and abdominal circumferences); anthropometric measurements on the mother (weight and height) and assessment of infant development. RESULTS: Out of the eligible infants (4,558), more than 99% were recruited to the study at birth. Follow-up rates were 96% at three months and 94% at 12 months of age. Among the initial results we highlight the following. Infant mortality rate was 19.7 per thousand, with 66% of infant deaths occurring in the neonatal period. There were frequencies of 15% premature babies and 10% low birthweight. Cesarean sections represented 45% of deliveries. CONCLUSIONS: The third Pelotas birth cohort showed an infant mortality rate similar to that of 11 years ago, with most deaths occurring in the neonatal period. The rates of prematurity and cesarean sections increased substantially.OBJETIVO: Descrever uma coorte de nascimentos que teve início em 2004, para avaliar condições pré e perinatais dos recém-nascidos, morbi-mortalidade infantil, características e desfechos do início da vida e acesso, utilização e financiamento da atenção à saúde. MÉTODOS: Todas as crianças nascidas na zona urbana dos municípios de Pelotas e Capão do Leão (bairro Jardim América), no ano de 2004, foram identificadas e suas mães convidadas a fazer parte do estudo. No seu primeiro ano foram realizadas visitas às mães por ocasião do nascimento das crianças, aos três e aos 12 meses de idade. Nessas visitas um questionário foi aplicado às mães, com perguntas sobre saúde; hábitos de vida; utilização de serviços de saúde; situação socioeconômica; estimativa de idade gestacional; medidas antropométricas do recém-nascido (peso, comprimento, perímetros cefálico, torácico e abdominal); medidas antropométricas da mãe (peso e altura) e avaliação de desenvolvimento infantil. RESULTADOS: Do total de crianças elegíveis (4.558), mais de 99% foram recrutadas para o estudo logo após o nascimento. A taxa de seguimento foi de 96% aos três meses e de 94% aos 12 meses. Dentre os resultados iniciais destacaram-se: a taxa de mortalidade infantil de 19,7 por mil, sendo 66% dos óbitos infantis no período neonatal; freqüência de 15% de prematuros e 10% de baixo peso ao nascer; as cesarianas representaram 45% dos partos. CONCLUSÕES: A terceira coorte de nascimentos em Pelotas mostrou uma situação de estabilidade da mortalidade infantil nos últimos 11 anos, com predomínio da mortalidade neonatal, além de aumento da prematuridade e partos cesarianos

Assisted reproductive technology: prevalence and associated factors in Southern Brazil

ABSTRACT OBJECTIVE: To assess the prevalence of successful assisted reproductive technology and to identify the associated factors. METHODS: This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression. RESULTS: Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology. CONCLUSIONS: The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries

Physical activity during pregnancy and maternal-child health (PAMELA): study protocol for a randomized controlled trial

Abstract Background Preterm birth is associated with most cases of neonatal deaths and negative health outcomes, and hypertensive disorders. Hypertension is influenced by maternal behavior, such as physical activity. Physical activity is associated with better outcomes for mother and fetus, besides healthier weight gains during pregnancy. Few women are physically active during pregnancy and few clinical trials have been carried out with pregnant women. The aim of this paper is to describe the protocol of a controlled trial evaluating whether regular exercise during pregnancy may result in improved maternal-child health and neonatal outcomes. Methods/Design The PAMELA (Physical Activity for Mothers Enrolled in Longitudinal Analysis) trial is a randomized controlled trial nested in a birth cohort study. Eligible women belonging to the birth cohort will be invited (between the 16th and 20th week of gestation) to enroll in the trial. Baseline data (blood and urine samples, anthropometry and pulmonary function) will be collected at enrollment. The same assessments will be repeated eight and 16 weeks after baseline. After randomization, women will be allocated into either one of these groups: control, 426 women who will be advised to keep their usual daily activities; and intervention, 213 women who will engage in an exercise program, three sessions a week. At least 70 % attendance over 16 weeks will be required to be considered compliant to the intervention. Exercise protocol will include aerobics, strength and flexibility training. Maternal and child outcomes will be measured at the 36th week of gestation, at birth and at three, 12, 24 and 48 months postpartum. An intention-to-treat analysis will be performed. Discussion Few women are active during pregnancy and a vast majority decrease their activities or even quit exercising. We present a population-based regular exercise intervention focused on the prevention of hypertension, pre-eclampsia and preterm birth. Data on the underlying cohort will allow future analysis using different outcomes with low probability of recall bias or misclassification of exposure status. Results will potentially influence prenatal care counseling in regards to physical activity. Trial registration Clinicaltrials.gov identifier: NCT02148965 , registered on 22 May 2014