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AIM: We aimed to develop national reference values for birth weight, length, head circumference, and weight for length for newborn triplets based on data from the German perinatal survey of 2007-2011. MATERIAL AND METHODS: Perinatal survey data of 3,690 newborn triplets from all the states of Germany were kindly provided to us by the AQUA Institute in Göttingen, Germany. Data of 3,567 newborn triplets were included in the analyses. Sex-specific percentile values were calculated using cumulative frequencies. Percentile values at birth were computed for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles for 21-36 completed weeks of gestation. RESULTS AND CONCLUSIONS: We present the first German reference values (tables and curves) for the anthropometric dimensions of triplet neonates and compare selected birth weight and length percentiles of triplets (after 32 and 34 completed weeks of gestation) to those of singletons and twins. The differences in the 50th birth weight percentiles between singletons and triplets after 32 completed weeks of gestation were 180 g for girls and 210 g for boys; after 34 weeks of gestation the differences were 320 and 325 g, respectively. The differences between twins and triplets after 32 weeks of gestation were 100 g for girls and 120 g for boys; after 34 weeks of gestation they were 130 and 135 g, respectively. The data presented here enable the classification of newborn triplets according to somatic parameters making reference to German perinatal data.
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Antropometria/métodos , Peso ao Nascer , Estatura , Inquéritos Epidemiológicos , Valores de Referência , Trigêmeos/classificação , Trigêmeos/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Distribuição por SexoRESUMO
BACKGROUND: The influence of physical strain on the esophageal motility has already been examined in a number of studies. It was found that high physical strain compromises the sufficient contractility of the esophagus. However, it needs more examinations to verify these findings. METHODS: To validate these results healthy volunteers were examined using gas-perfusion manometrie. Bicycle ergometry was performed to generate an exactly defined physical exercise. After a pilot study, the changing of the contraction amplitude was determined as the main variable to evaluate the esophageal motility, and the sample size was calculated. Eight subjects without esophageal diseases or symptoms were examined by simultaneous gas-perfusion esophageal manometry and bicycle ergometry. KEY RESULTS: The results showed that high physical strain during bicycle ergometry can induce a significant decrease of the contraction amplitude (α = 5%, ß = 10%). The 95% confidence interval of the quotient of contraction amplitude at rest and under physical strain is (1.074; 1.576). This effect is more pronounced in liquid acts of swallowing than in dry and is also more obvious at the middle measuring point (7.8 cm above the lower esophageal sphincter) than at the distal and proximal point (2.8 and 12.8 cm). Furthermore, a decreasing tendency of the contraction duration could be found. CONCLUSIONS & INTERFERENCES: Gas-perfusion manometry is an inexpensive examination method, which enables the evaluation of the esophageal motility in moving test subjects under conditions of physical strain. It could be proved that physical strain negatively influences the esophageal motility by a decrease of the contraction amplitude.
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Esôfago/fisiologia , Motilidade Gastrointestinal , Esforço Físico , Adulto , Esfíncter Esofágico Inferior/fisiologia , Exercício Físico , Teste de Esforço , Feminino , Voluntários Saudáveis , Humanos , Masculino , Manometria , Contração MuscularRESUMO
AIM: The aim of this study was to develop new national standards for birth weight, length, head circumference, and weight for length for newborn twins based on the German perinatal survey of 2007-2011. We also assessed trends in anthropometric measurements by comparing these new percentile values with the percentile values of 1990-1994. MATERIAL AND METHODS: Perinatal survey data of 110,313 newborn twins from all the states of Germany collected in the years 2007-2011 were kindly provided by the AQUA Institute in Göttingen, Germany. Sex specific percentile values were calculated using cumulative frequencies. Percentile values at birth were computed for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles for 21-40 completed weeks of gestation. Percentile curves and tabulated values for the years 2007-2011 were compared with the published values of 1990-1994. RESULTS AND DISCUSSION: The new percentile curves (2007-2011) closely resemble the previous ones (1990-1994). Small differences can nonetheless be found. For example, for birth weight the new values for the 10th percentile are a little higher. CONCLUSIONS: We recommend using the new percentile values instead of the old ones.
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Antropometria , Tamanho Corporal/fisiologia , Pesquisas sobre Atenção à Saúde , Recém-Nascido/fisiologia , Gêmeos/estatística & dados numéricos , Peso ao Nascer/fisiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Distribuição por SexoRESUMO
AIM: The aim of this study was to derive percentile values for birth weight, length, head circumference, and weight for length for singleton neonates based on the German perinatal survey of 2007-2011 (using data from all 16 states of Germany). We also compared these new percentile values with the percentile values of 1995-2000 that so far have been considered standard values. MATERIAL AND METHODS: Data of 3 187 920 singleton neonates from the German perinatal survey of the years 2007-2011 were kindly provided to us by the AQUA Institute in Göttingen, Germany. Sex specific percentile values were calculated using cumulative frequencies. Percentile values at birth were computed for the 3(rd), 10(th), 25(th), 50(th), 75(th), 90(th), and 97(th) percentiles for 21-43 completed weeks of gestation. Percentile curves and tabulated values for the years 2007-2011 were compared with the published values of 1995-2000. RESULTS AND DISCUSSION: Overall the new percentile curves closely resemble the previous ones. Minimal differences can be found for the 10(th) percentile and generally for early weeks of gestation. Values for the 10(th) percentile in the 2007-2011 dataset are somewhat higher than values of 1995-2000 for birth weight, length, and weight for length. CONCLUSIONS: We recommend the use of these new percentile values instead of the old ones.
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Antropometria/métodos , Tamanho Corporal/fisiologia , Recém-Nascido/fisiologia , Resultado da Gravidez/epidemiologia , Coleta de Dados , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Gravidez , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Distribuição por Sexo , Fatores SexuaisRESUMO
Gastro-oesophageal reflux (GER) has a special meaning for patients with cystic fibrosis (CF). Twelve voluntary patients with CF up to the age of 25 underwent an oesophageal manometry and a 24-hour impedance-pH monitoring. These patients were without symptoms of GER. The examination proved an acid GER in 42â%. In the total population the frequency is ≤â10â%. In 11 of 12 patients a pathologically low pressure of the lower oesophageal sphincter (LES) was found. No significant correlations between the DeMeester score and the pressure of the LES, the reflux and respiratory symptomatology, the lung function as well as the quality of life could be proven. However, there was a significant correlation between the DeMeester score and the acid clearance time. 37â% of the registered cough pushes were related to a GER, of which 78â% were associated with an acid GER. Therefore, coughing in patients with CF must not necessarily be caused by the underlying disease. The timely detection of a pathological GER in patients with CF, but without symptoms of GER, and its prompt therapy could protect the lung function.
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Fibrose Cística/diagnóstico , Fibrose Cística/fisiopatologia , Junção Esofagogástrica/fisiopatologia , Esôfago/química , Esôfago/fisiopatologia , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Adulto , Fibrose Cística/complicações , Monitoramento do pH Esofágico , Feminino , Determinação da Acidez Gástrica , Refluxo Gastroesofágico/etiologia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
This study examines the quantitative changes in the somatic classification according to birth weight and duration of pregnancy of German neonates when maternal height is considered (5 maternal height groups). Our calculations were performed using data of 319 884 girls born in 2010. Overall, about 6% (18 792 girls) are classified differently (more appropriately) when group-specific norm values were used.
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Antropometria/métodos , Peso ao Nascer/fisiologia , Estatura/fisiologia , Desenvolvimento Fetal/fisiologia , Modelos Estatísticos , Mães/estatística & dados numéricos , Gravidez/fisiologia , Adolescente , Adulto , Distribuição por Idade , Feminino , Alemanha/epidemiologia , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND AND AIM: We have previously analysed neonatal characteristics and duration of pregnancy in Germany based on data from the German Perinatal Survey of 1995-1997. Here we describe neonatal characteristics and duration of pregnancy based on the German Perinatal Survey of 2007-2011. MATERIAL AND METHODS: We had been provided with data from the German Perinatal Survey of 1995-1997 by the chambers of physicians of all the states of Germany except Baden-Württemberg (1 815 318 singleton neonates). We were also provided with access to the perinatal survey data of 2007-2011 by the AQUA Institute in Göttingen, Germany (3 187 920 singleton neonates). We investigated regional differences within Germany and also compared the 2 periods of time. We used the computer programme SPSS for data analysis and performed plausibility checks on the survey data. RESULTS: Comparing the states of Germany, we found that birth weight was largest for neonates born in Schleswig-Holstein (3 407 g) and Mecklenburg-Western Pomerania (3 392 g); the lowest mean birth weight was observed in the Saarland (3 283 g). Preterm birth rate varied between 6.3% (Saxony) and 8.1% (Bremen, Saarland). Comparing 1995-1997 vs. 2007-2011, deliveries after 37 and 38 weeks of gestation were more common and deliveries after 39 and more weeks of gestation were less common in the later period of time. CONCLUSIONS: Regional differences in the anthropometric characteristics of neonates exist between the states of Germany. The proportion of deliveries after 39 and more weeks of gestation has decreased.
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Pesquisas sobre Atenção à Saúde/tendências , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Peso ao Nascer , Feminino , Alemanha/epidemiologia , Idade Gestacional , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Vigilância da População , Gravidez , Adulto JovemRESUMO
Background and Aim: We have previously presented analyses of data obtained from the German Perinatal Survey for the years 1995-1997. Here we present an analysis of data from the years 2007-2011 and compare the data to the previous data from the 1990s. Material and Methods: For the years 1995-1997, the data on 1â815â318 singleton pregnancies were provided by the Chambers of Physicians of all the states of Germany except Baden-Württemberg. For the years 2007-2011, the data on 3â187â920 singleton pregnancies from the German Perinatal Survey (all states of Germany) were obtained from the AQUA Institute in Göttingen, Germany. SPSS was used for data analysis. Plausibility checks were performed on the data. Results: Mean maternal age has increased over the years, from 28.7 years in 1995 to 30.2 years in 2011. We observed a decrease in smoking. While not all cases included data on maternal smoking after the pregnancy was known, when the cases with data on smoking were analysed, in 1995-1997 23.5â% of pregnant women were smokers compared to 11.2â% smokers in 2007-2011. Maternal body mass index (BMI) also changed; 8.2â% of women were obese (BMI: 30-40 kg/m2), while 13.0â% were obese in 2011. In 1995, 0.6â% of women were morbidly obese (BMI ≥ 40 kg/m2) compared to 1.8â% of women in 2011. The mean maternal body weight at the time of the first obstetric consultation also increased from 65.9 kg in 1995 to 68.7 kg in 2011. Conclusions: While the decrease in the number of women smoking over time is clearly a positive development, increasing maternal age and obesity present challenges in clinical practice.
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Background and Aim: The classification of weight gain during pregnancy and the somatic classification of neonates according to birth weight and duration of pregnancy can be done using percentile values. We aimed to compare such classifications using percentiles of the overall study population with classifications using percentiles that were calculated taking account of maternal height and weight. Material and Methods: Using data from the German Perinatal Survey (1995-2000, over 2.2 million singleton pregnancies) we classified weight gain during pregnancy as low (< 10th percentile), high (> 90th percentile), or medium (10th-90th percentile). Neonates were classified by birth weight as small for gestational age (SGA, < 10th percentile), large for gestational age (LGA, > 90th percentile), or appropriate for gestational age (AGA, 10th-90th percentile). Classifications were performed for 12 groups of women and their neonates formed according to maternal height and weight, either with the percentiles calculated from the total study population or with group-specific percentiles. Results: Using percentiles of the total study population there was large variability between the 12 groups in the proportions with low and high weight gain and in the proportions of SGA and LGA neonates. The variability was much lower when group-specific percentiles were used. Conclusions: Classifications of maternal weight gain during pregnancy and birth weight differ substantially, depending on whether percentiles calculated from the total study population or group-specific percentiles are used. The impact of using percentiles that take account of maternal anthropometric parameters for the medical care and health of neonates needs to be elucidated in future research.
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There is a linear relationship between maternal height and birth weight. For each 1 cm increase in maternal height, birth weight increases by 16.7 g. Birth weight percentiles should be calculated by taking maternal height into account. We present birth weight percentile values for girls and boys born after 23-43 completed weeks of gestation for 5 maternal height groups. With these percentiles "genetically" small and "genetically" large, but healthy, neonates can be classified more adequately. The calculations are based on data of about 2.2 million singleton pregnancies from the German Perinatal Survey of 1995-2000.
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Peso ao Nascer/fisiologia , Estatura/fisiologia , Modelos Estatísticos , Mães , Adolescente , Adulto , Simulação por Computador , Coleta de Dados , Feminino , Alemanha/epidemiologia , Humanos , Recém-Nascido , Masculino , Estatística como Assunto , Adulto JovemRESUMO
Aim: "Late motherhood" is associated with greater perinatal risks but the term lacks precise definition. We present an approach to determine what "late motherhood" associated with "high risk" is, based on parity and preterm birth rate. Materials and Methods: Using data from the German Perinatal Survey of 1998-2000 we analysed preterm birth rates in women with zero, one, or two previous live births. We compared groups of "late" mothers (with high preterm birth rates) with "control" groups of younger women (with relatively low preterm birth rates). Data of 208â342 women were analysed. For women with zero (one; two) previous live births, the "control" group included women aged 22-26 (27-31; 29-33) years. Women in the "late motherhood" group were aged > 33 (> 35; > 38) years. Results: The "late motherhood" groups defined in this way were also at higher risk of adverse perinatal events other than preterm birth. For women with zero (one; two) previous live births, normal cephalic presentation occurred in 89â% (92.7â%; 93.3â%) in the "control" group, but only in 84.5â% (90â%; 90.4â%) in the "late motherhood" group. The mode of delivery was spontaneous or at most requiring manual help in 71.3â% (83.4â%; 85.8â%) in the "control" group, but only in 51.4â% (72.2â%; 76.4â%) in the "late motherhood" group. Five-minute APGAR scores were likewise worse for neonates of "late" mothers and the proportion with a birth weight ≤ 2499 g was greater. Conclusion: "Late motherhood" that is associated with greater perinatal risks can be defined based on parity and preterm birth rate.
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BACKGROUND: Maternal height and weight are important determinants of perinatal outcomes.Height and weight can be combined in the measure of body mass index (BMI). We aimed to investigate the utility of maternal BMI as a predictor of perinatal outcomes. MATERIALS AND METHODS: Based on data collected between 1995 and 2000 as part of the German perinatal survey, we examined singleton pregnancies of women with BMIs of 18, 24, or 30. We compared preterm birth rate, birth weight, and the somatic classification of neonates as small,appropriate, or large for gestational age (SGA,AGA, LGA) for women with heights of 150 cm and 180 cm for each BMI. RESULTS: For women with a BMI of 18 (24; 30)and a height of 150 cm, the preterm birth rate was 13.9 % (9.1 %; 12.5 %); for women with the same BMI and a height of 180 cm the preterm birth rate was 12.1 % (6.1 %; 4.4 %). Birth weight for women with a BMI of 18 (24; 30) and a height of 150 cm was 2 889 g (3 170 g; 3 147 g); for women with the same BMI and a height of 180 cm it was 3 314 g (3 629 g; 3 753 g). The LGA rate for women with a BMI of 18 (24; 30) and a height of 150 cm was 2.1 % (5.2 %; 5.2 %); for women with the same BMI and a height of 180 cm it was 7.7 %(20.5 %; 27.7 %). CONCLUSIONS: There is considerable variability in perinatal outcomes between women with the same BMI but different heights. This limits the utility of BMI as a predictor of perinatal outcomes.
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Peso ao Nascer , Índice de Massa Corporal , Macrossomia Fetal/epidemiologia , Recém-Nascido Pequeno para a Idade Gestacional , Trabalho de Parto Prematuro/epidemiologia , Nascimento Prematuro/epidemiologia , Estatura , Estudos Transversais , Feminino , Alemanha , Humanos , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez/epidemiologia , Prognóstico , Estatística como AssuntoAssuntos
Granuloma Anular/diagnóstico por imagem , Dermatoses da Perna/diagnóstico por imagem , Pré-Escolar , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Feminino , Gadolínio DTPA , Humanos , Imageamento por Ressonância Magnética , Sensibilidade e Especificidade , Tíbia/diagnóstico por imagem , UltrassonografiaRESUMO
X-Linked hypophosphatemic rickets (HYP, XLH) is a disorder of phosphate homeostasis, characterized by renal phosphate wasting and hypophosphatemia, with normal to low 1,25-dihydroxy vitamin D3 serum levels. The purpose of our study was the detection of inactivating mutations in the PHEX gene, the key enzyme in the pathogenesis of XLH. The 16 patients, representing eight families, presented with suspected XLH from biochemical and clinical evidence. All 16 were referred for mutational analysis of the PHEX gene. We detected three novel disease-causing mutations, C59S, Q394X, and W602, for which a loss of function can be predicted. A G28S variation, found in two healthy probands, may be a rare polymorphism. Another mutation, A363 V, is localized on the same allele as the C59S mutation, thus its functional consequences cannot be proven. Furthermore, we detected a deletion of three nucleotides in exon 15 which resulted in the loss of amino acid threonine 535. Heterozygosity of this mutation in a male patient without any chromosomal aberrations suggests its presence as a mosaic. Novel large deletions were detected using multiplex ligation-dependent probe amplification (MLPA) analysis. Two of these deletions, loss of exon 22 alone or exons 21 and 22 together, may result in the translation of a C-terminal truncated protein. Two large deletions comprise exons 1-9 and exons 4-20, respectively, and presumably result in a nonfunctional protein. We conclude that molecular genetic analysis confirms the clinical diagnosis of XLH and should include sequence analysis as well as the search for large deletions, which is facilitated by MLPA.
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Raquitismo Hipofosfatêmico Familiar/diagnóstico , Raquitismo Hipofosfatêmico Familiar/genética , Deleção de Genes , Doenças Genéticas Ligadas ao Cromossomo X , Predisposição Genética para Doença/genética , Endopeptidase Neutra Reguladora de Fosfato PHEX/genética , Mutação Puntual/genética , Sequência de Aminoácidos/genética , Pré-Escolar , Análise Mutacional de DNA , Éxons/genética , Raquitismo Hipofosfatêmico Familiar/fisiopatologia , Feminino , Frequência do Gene/genética , Marcadores Genéticos/genética , Genótipo , Humanos , Lactente , Masculino , Biologia Molecular/métodos , Polimorfismo Genético/genética , Treonina/genéticaRESUMO
BACKGROUND: Recent studies from predominantly rural areas in Germany show that neonatal outcome of very low birth weight (VLBW) neonates is (on average) inferior with lower NICU (neonatal intensive care unit) volume. However, there are no data available which show that study results of one specific region can be transferred to other areas with possibly different medical infrastructure and needs. AIM: It was investigated whether a systematic difference of treatment quality between smaller (1000-2000 births/year; < or =20 neonatal beds) vs. larger neonatal centres in Berlin (>3000 births/year; >20 neonatal beds) exists. Furthermore, the results are compared to data from a rural region in order to discuss transferability between regions. METHODS: Retrospectively, completely, and for the first time, the data of all centres which treat VLBW neonates (< or =1500 g birth weight) in the city-state of Berlin, Germany, from the years 2003/2004 were reviewed. RESULTS: Our study showed no difference in the treatment quality of smaller vs. larger neonatal units in Berlin. This result differs from those of a study in Baden-Württemberg, a predominantly rural state, with different medical infrastructure than Berlin. CONCLUSION: The present study suggests that regional investigations on the infrastructure vs. treatment outcome are not transferable between areas. Patient volume/unit appears inadequate for predicting the future treatment quality of neonatal departments. Direct quality indicators are stable for the assessed departments and should be preferably used to organize medical infrastructure.
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Bem-Estar do Lactente , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Qualidade da Assistência à Saúde , População Rural , População Urbana , Feminino , Alemanha , Humanos , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: The number of live births in Germany has decreased by 46.7 % from 1 261 614 in 1960 to 672 675 in 2006. The causes for this are manifold. This study attempts to address the possible causes for the delay of birth in Germany in an east-west comparison. METHOD: Within the "Kinderwunschstudie" (survey of desired/intended fertility) 5 143 women in childbed have been interviewed between 1998 and 2000. They were asked questions concerning the delay of this particular birth. Only women and their spouses who were born in Germany, respectively, were included into the analysis. Berlin women in childbed were excluded from the analysis due to the problematic east-west classification. The number of analysable cases finally added up to 2 020 cases in East Germany and 2 193 cases in West Germany. RESULTS: 24.4 % of the interviewed women in the East admitted a delay of the last birth compared to 21.2 % of those in the West. There are clear differences concerning the reasons for this delay between the old (west) and the new (east) federal states. 34 % of the east German women agreed that an insecure income situation was the reason for the delayed realisation of the desired pregnancy / birth, whereas it was only 16 % in the west. CONCLUSION: This survey ("Kinderwunschstudie") in fact indicates differences regarding the reasons for a delay of birth between east and west German women (in childbed). However, it also highlights the generally negative influence of the given social and economic conditions on the number of births and underlines the prospects for an ongoing decrease. As a result, society will in future have to face problems of unknown dimensions.
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Intervalo entre Nascimentos , Comportamento Reprodutivo/psicologia , Mudança Social , Meio Social , Inquéritos e Questionários , Adulto , Coeficiente de Natalidade , Feminino , Alemanha , Inquéritos Epidemiológicos , Humanos , Ilegitimidade/psicologia , Ilegitimidade/estatística & dados numéricos , Recém-Nascido , Idade Materna , Gravidez , Comportamento Reprodutivo/estatística & dados numéricos , Pais Solteiros/psicologia , Pais Solteiros/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
INTRODUCTION: We investigated the sex-specific risk of maternal smoking during pregnancy on the birth weight and the proportion of small-for-gestational-age (SGA) newborns in 888,632 (49.9%) of 1,815,318 singleton births (ca. 80% of all singleton births in Germany from 1995 to 1997) in whom data on maternal cigarette consumption were available. RESULTS AND DISCUSSION: Newborns below the 10th percentile for weight and duration of pregnancy were classified SGA. Maternal smoking during pregnancy lowers the mean birth weight and increases the risk of SGA newborns. The negative effect depends on the daily number of cigarettes consumed, and is greater in girls than in boys. In non-smokers, 9.8% of the newborns were SGA, with a sex-ratio of females:males=1, but this percentage increased with increasing number of cigarettes consumed (p<0.001), as did the sex-ratio, i.e. the negative effect of smoking on growth was greater in girls than in boys. In mild smokers (1-5 cigarettes/day), the risk of giving birth to an SGA girl was 1.7275-fold (95% CI: 1.7266-1.7284) above normal, but was 1.7143-fold (95% CI: 1.7137-1.7150) in boys. More than 21 cigarettes/day increased the risk of SGA 3.15-fold for a boy, but 3.51-fold for a girl (p<0.001). CONCLUSION: In conclusion, particularly in heavy smokers, the negative effect of maternal smoking during pregnancy on the mean birth weight and risk of SGA is significantly greater in newborn girls than in newborn boys.
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Peso ao Nascer/efeitos dos fármacos , Retardo do Crescimento Fetal/etiologia , Recém-Nascido Pequeno para a Idade Gestacional , Fumar/efeitos adversos , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido , Masculino , Razão de Chances , Gravidez , Fatores de Risco , Fatores SexuaisRESUMO
BACKGROUND AND OBJECTIVE: To investigate the burden and the financial and professional consequences for mothers and fathers after the onset of diabetes in their child in relationship to age at onset and family structure. PATIENTS AND METHODS: All families of children with an age at onset < 14 years and a diabetes duration < 10 years treated at four large pediatric diabetes centers received a structured questionnaire (burden of diabetes, professional position and career development, financial consequences for both parents, demographic data). RESULTS: 580 families with 583 children with type 1 diabetes (46 % girls, diabetes duration 5.0 +/- 3.2 years, age at onset 6.9 +/- 3.9 years) participated. 42 % of the children had an age at onset below 6 years. 11 % had single parents. Before the onset of diabetes in their children 93 % of the fathers worked full-time, thereafter 4 % changed their employment. Mothers worked at onset full-time in 22 % and part-time in 38 %; thereafter 31 % reduced their working time or stopped working. 33 % of the mothers reported handicaps in their professional career development, especially those with a child with age at onset below 6 years (44 %). Negative financial consequences were present in 44 % of the families. The day to day burden on a scale from 1 to 5 decreased both in mothers and in fathers with increasing age at onset. The individual burden was higher in mothers (3.6 +/-1.1) than in fathers (2.8 +/- 1.1) (p = 0.000). CONCLUSIONS: Initiatives to reduce the burden on families with a child with diabetes are urgently needed. Particularly the social and professional integration of mothers with younger children at diabetes onset need to be improved through support measures outside the family.