Evaluation of neck circumference as a predictor of elevated cardiometabolic risk outcomes in 5–8-year-old Brazilian children

Background: Childhood overweight and obesity is a global health problem that continues to worsen in many low- and middle-income countries. Low-cost measurements for monitoring overweight and relative metabolic risk, such as neck circumference (NC), should be evaluated in different populations and age groups. / Aim: To test associations of NC and BMI with cardiometabolic parameters in 5-8-year-old Brazilian children. / Methods: This cross-sectional study carried out from 2004–2006 measured height, weight and NC by anthropometry, and estimated fat and fat-free mass by bioelectrical impedance. Cardiometabolic risk factors assessed were systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterol, triglycerides, and homeostatic model assessment of insulin resistance (HOMA). Associations of NC and BMI with cardiometabolic risk factors were tested using multiple regression and precision-recall plot analysis. / Results: Analyses included 371 children (52% female). NC associated positively with BMI, fat mass, and fat-free mass, and with systolic blood pressure and HOMA following adjustment for age in sex-stratified multiple regression models. However, the latter relationships largely disappeared following adjustment for BMI. Area under the curve for NC or BMI in association with systolic blood pressure or HOMA >90th percentile was low in the pooled sample, indicating poor classifier performance. / Conclusions: NC and BMI demonstrated similar associations with cardiometabolic risk factors, although NC mostly did not correlate with risk factors independently of BMI. In contrast to previous studies, NC was a poor classifier of cardiometabolic risk factors in children. The association of NC with both fat and fat-free mass may aid in explaining its poor performance

Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? Results from two large Western-European studies

Pfinder M, Kunst AE, Feldmann R, van Eijsden M, Vrijkotte TGM. Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? Results from two large Western-European studies. BMC Pregnancy and Childbirth. 2013;13(1): 49.BACKGROUND: Inconsistent data on the association between prenatal alcohol exposure and a range of pregnancy outcomes, such as preterm birth (PTB) and small for gestational age (SGA) raise new questions. This study aimed to assess whether the association between low-moderate prenatal alcohol exposure and PTB and SGA differs according to maternal education, maternal mental distress or maternal smoking. METHODS: The Amsterdam Born Children and their Development (ABCD) Study (N=5,238) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (N=16,301) are both large studies. Women provide information on alcohol intake in early pregnancy, 3 months postpartum and up to 17 years retrospectively. Multivariate logistic regression analyses and stratified regression analyses were performed to examine the association between prenatal alcohol exposure and PTB and SGA, respectively. RESULTS: No association was found between any level of prenatal alcohol exposure (non-daily, daily, non-abstaining) and SGA. The offspring of daily drinkers and non-abstainers had a lower risk of PTB [ABCD: odds ratio (OR) 0.31, 95% confidence interval (CI) 0.13, 0.77; KiGGS: OR 0.75, 95% CI 0.57, 0.99]. Interactions with maternal education, maternal distress or maternal smoking were not significant. CONCLUSIONS: Although these results should be interpreted with caution, both studies showed no adverse effects of low-moderate prenatal alcohol exposure on PTB and SGA, not even in the offspring of women who were disadvantaged in terms of low education, high levels of distress, or smoking during pregnancy

Stressful life events, social health issues and low birthweight in an Australian population-based birth cohort: challenges and opportunities in antenatal care

Background: Investment in strategies to promote 'a healthy start to life' has been identified as having the greatest potential to reduce health inequalities across the life course. The aim of this study was to examine social determinants of low birthweight in an Australian population-based birth cohort and consider implications for health policy and health care systems. Methods: Population-based survey distributed by hospitals and home birth practitioners to >8000 women six months after childbirth in two states of Australia. Participants were women who gave birth to a liveborn infant in Victoria and South Australia in September/October 2007. Main outcome measures included stressful life events and social health issues, perceived discrimination in health care settings, infant birthweight. Results: 4,366/8468 (52%) of eligible women returned completed surveys. Two-thirds (2912/4352) reported one or more stressful life events or social health issues during pregnancy. Women reporting three or more social health issues (18%, 768/4352) were significantly more likely to have a low birthweight infant (< 2500 grams) after controlling for smoking and other socio-demographic covariates (Adj OR = 1.77, 95% CI 1.1-2.8). Mothers born overseas in non-English speaking countries also had a higher risk of having a low birthweight infant (Adj OR = 1.85, 95% CI 1.2-2.9). Women reporting three or more stressful life events/social health issues were more likely to attend antenatal care later in pregnancy (OR = 2.06, 95% CI 1.3-3.1), to have fewer antenatal visits (OR = 2.17, 95% CI 1.4-3.4) and to experience discrimination in health care settings (OR = 2.69, 95% CI 2.2-3.3). Conclusions: There is a window of opportunity in antenatal care to implement targeted preventive interventions addressing potentially modifiable risk factors for poor maternal and infant outcomes. Developing the evidence base and infrastructure necessary in order for antenatal services to respond effectively to the social circumstances of women's lives is long overdue.Stephanie J Brown, Jane S Yelland, Georgina A Sutherland, Peter A Baghurst and Jeffrey S Robinso

Prevalência e fatores associados à prematuridade entre gestantes submetidas à inibição de trabalho de parto prematuro Prevalence and risk factors associated to preterm delivery among pregnant women submitted to preterm labor inhibition treatment

OBJETIVOS: identificar a prevalência de parto prematuro em gestantes submetidas ao tratamento de inibição de trabalho de parto prematuro e analisar os fatores associados. MÉTODOS: estudo transversal, com dados coletados de 163 prontuários de gestantes submetidas a tratamento de inibição de trabalho de parto prematuro atendidas em 1995-2000, no Hospital Universitário da Universidade de São Paulo, Brasil. A variável dependente constituiu-se na ocorrência de parto prematuro e as independentes foram: idade, escolaridade, ocupação, paridade, companheiro, tabagismo, infecção urinária prévia, número de consultas pré-natal e intervalo interpartal. A análise foi feita pelo teste de associação pelo Qui-quadrado e modelos de regressão logística univariado e múltiplo. RESULTADOS: 66,3% das gestantes tiveram filhos prematuros e, em 22,7% dos casos, o parto ocorreu antes de 34 semanas. Houve associação estatística significativa entre parto prematuro e ser nulípara e apresentar número baixo de consultas pré-natal. CONCLUSÕES: atenção especial deve ser dada às gestantes nulíparas e com número reduzido de consulta pré-natal submetidas ao tratamento de inibição de trabalho de parto prematuro, com a finalidade de prevenir esse evento.<br>OBJECTIVES: to identify preterm delivery prevalence in pregnant women submitted to preterm delivery inhibition treatment and to analyze associated factors. METHODS: cross sectional study with data collected from 163 pregnant women medical files seen from 1995-2000 at the University Hospital of the University of São Paulo, Brazil. The dependent variable was preterm delivery and the independent ones were: age, education, job, parity, companion, smoking, prior urinary infection, number of prenatal medical visits and birth interval. Analysis was performed through association by the Chi-square test and univariate and multiple logistic regression models. RESULTS: 66.3% of the women had preterm deliveries and in 22.7% of the cases, delivery occurred before 34 weeks. There was a statistically significant association between preterm birth and no partner, nulliparity and a low number of prenatal visits. CONCLUSIONS: special attention should be given to nulliparous pregnant women with reduced numbers of prenatal medical visits submitted to preterm delivery inhibition treatment with the objective of preventing premature births

Aumento da prematuridade no Brasil: revisão de estudos de base populacional

OBJETIVO: A maior causa de mortalidade infantil no Brasil são condições perinatais, associadas em sua maioria à prematuridade. O objetivo do estudo foi avaliar a evolução das taxas de prematuridade no Brasil. MÉTODOS: Foi realizada revisão nas bases de dados Medline e Lilacs, incluindo estudos publicados em periódicos, teses e dissertações, desde 1950. Os critérios de exclusão foram: estudos que se referiam a temas clínicos, com complicações da prematuridade e gestação, bem como cuidados com prematuros. Os critérios de inclusão foram: estudos de base populacional sobre prevalência de prematuridade com dados do Brasil, com amostra representativa do local do estudo e com dados primários. De 71 estudos encontrados, a análise foi realizada com 12. RESULTADOS: A prevalência de prematuridade variou de 3,4% a 15,0% nas regiões Sul e Sudeste, entre 1978 e 2004, sugerindo tendência crescente a partir da década de 1990. Estudos na região Nordeste, entre 1984 e 1998, encontraram prevalências de prematuridade de 3,8% a 10,2%, também com tendência a aumentar. CONCLUSÕES: Dados do Sistema de Informações de Nascidos Vivos não corroboram este aumento, pois mostram diferenças entre as taxas de prematuridade informadas por esse Sistema e as taxas medidas nos estudos incluídos nesta revisão. Devido ao importante papel da prematuridade na mortalidade infantil no Brasil é importante identificar as causas deste aumento e planejar intervenções que diminuam sua ocorrência

Prevalência de anemia ferropriva em gestantes brasileiras: uma revisão dos últimos 40 anos Prevalence of iron-deficiency anemia in Brazilian pregnant women: a review of the last 40 years

A anemia ferropriva é conhecida como uma das principais deficiências nutricionais em todo o mundo e sua ocorrência pode ser observada em diversas populações. Alguns grupos populacionais ainda apresentam altas prevalências de anemia ferropriva, comprometendo diversas funções do organismo. Dentre esses grupos de risco, podem ser citadas as gestantes, que merecem especial atenção devido à sua vulnerabilidade à carência e ao aumento significativo de suas necessidades, que não são acompanhados por aumento suficiente no consumo ou na absorção de ferro. Este artigo analisa dados de artigos publicados nos últimos 40 anos nas línguas inglesa, espanhola ou portuguesa nos bancos de dados Lilacs e Medline sobre prevalência de anemia ferropriva na gestação. Em todas as pesquisas verificadas, a prevalência de anemia ferropriva na gestação apresenta valores elevados, o que caracteriza essa situação como um problema de saúde pública para o Brasil, mesmo com as políticas nacionais atuais de combate à deficiência.<br>Iron-deficiency anemia is known as one of the main nutritional deficiencies around the world and its occurrence can be observed in many populations. Some groups still present a high prevalence of iron-deficiency anemia, compromising many body functions. Pregnant women are among the groups at risk given their vulnerability to deficiencies and the significant increase in their requirements, which are not accompanied by a sufficiently higher iron intake or absorption. This paper analyzes data from articles published in the last 40 years in English, Spanish or Portuguese found in the Lilacs and Medline databases about the prevalence of iron-deficiency anemia during pregnancy. Every paper found reports a high prevalence of anemia in pregnant women, characterizing this situation as a public health problem in Brazil, despite current Brazilian policies to fight iron deficiency