RESUMO
Socioeconomic position (SEP) may have different effects on cognitive development and family context could play a role in this association. This work aimed to analyse the role of socioeconomic positions, measured via various indicators collected longitudinally, in cognitive development at 7-11 years of age, evaluating the role of family context as a potential mediator. The study sample included 394 and 382 children from the INMA Gipuzkoa and Valencia cohorts, respectively. SEP indicators were assessed during pregnancy (family social class, parental education, employment, and disposable income) and at 7 (Gipuzkoa) and 11 (Valencia) years of age (At Risk of Poverty or Social Exclusion (AROPE)). Family context and cognitive development were measured with the Haezi-Etxadi Family Assessment Scale 7-11 (HEFAS 7-11) and Raven's Coloured Progressive Matrices (Raven's CPM), respectively. Linear regression models were developed to assess the relationships between (a) SEP-family context, (b) SEP-cognitive development, and (c) family context-cognitive development, adjusting for a priori-selected confounders. Simple and multiple mediation analyses were performed to explore the role of family context in the SEP-cognitive development relationship. Lower SEP was related with a lower cognitive score, this association being particularly robust for family social class. SEP indicators were related to subscales of family context, in particular those regarding cognitive stimulation, parental stress, and parenting. A relationship was also found between these three subscales and child cognitive development, mediating the effect of family social class on child cognition by 5.2, 5.5, and 10.8%, respectively, and 12.0% jointly. Conclusion: Both family SEP and context contribute to a child's cognitive development. Equalising policies and positive parenting programmes could contribute to improving cognitive development in children. What is Known: ⢠Parental social class, education, and employment status have been widely employed to measure socioeconomic position. What is New: ⢠This work focuses on standard measurements of socioeconomic position but also other economic indicators such as the EHII and AROPE, and their effect on child cognitive development and family context. ⢠Promotion of cognitive and linguistic development, parental stress and conflict, and parental profile fostering child development mediated the effect of family social class on cognitive development.
Assuntos
Desenvolvimento Infantil , Cognição , Classe Social , Humanos , Feminino , Criança , Masculino , Cognição/fisiologia , Estudos Longitudinais , Fatores Socioeconômicos , Poder Familiar/psicologiaRESUMO
Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p < 0.001), subclinical hypothyroidism (risk for antibody negativity 2.2%, isolated TgAb positivity 8.1%, isolated TPOAb positivity 14.2%, combined antibody positivity 20.0%; p < 0.001) and a treatment indication (risk for antibody negativity 0.2%, isolated TgAb positivity 2.2%, isolated TPOAb positivity 3.0%, and combined antibody positivity 5.1%; p < 0.001). Twin pregnancy was associated with a higher risk of overt hyperthyroidism (5.6% vs. 0.7%; p < 0.001). Conclusions: The risk factors assessed in this study had poor predictive ability for detecting thyroid function test abnormalities, questioning their clinical usability for targeted screening. As expected, TPOAb positivity (used as a benchmark) was a relevant risk factor for (subclinical) hypothyroidism. These results provide insights into different risk factors for gestational thyroid dysfunction.
Assuntos
Hipotireoidismo , Complicações na Gravidez , Testes de Função Tireóidea , Humanos , Gravidez , Feminino , Fatores de Risco , Hipotireoidismo/epidemiologia , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico , Adulto , Autoanticorpos/sangue , Índice de Massa Corporal , Iodeto Peroxidase/imunologia , Estudos Prospectivos , Idade Materna , Tireotropina/sangueRESUMO
Objective: Describe the risk of poverty and social exclusion in children aged 8-11 years from Gipuzkoa and Valencia (Spain), through AROPE (At Risk of Poverty or Social Exclusion) indicators, and evaluate their associated factors in the INMA Project (Childhood and Environment). Method: Families in Gipuzkoa and Valencia (394 and 382, respectively) completed a questionnaire in 2015-2016. Low work intensity (LWI), at risk of poverty (RP) and material deprivation (MD) were estimated. AROPE consisted in meeting any of the previous sub-indicators. Socio-demographic, family and parental characteristics were considered. Frequencies, Venn's diagrams, and chi-square and Fisher tests were used in bivariate analysis and logistic regression in multivariate analysis. Results: For LWI, RP, MD and AROPE, prevalence of 2.5%, 5.6%, 2.3% and 7.2% were obtained in Gipuzkoa, and 8.1%, 31.5%, 7.8% and 34.7% in Valencia, respectively. In the multivariate analysis, the AROPE was associated in both areas with maternal social class and non-nuclear families. In Gipuzkoa, it was also related to maternal education. In Valencia, other factors were the mother's foreign origin, and paternal education and smoking. Conclusion: There is higher AROPE prevalence in Valencia. Social class and family type were shared factors, but a differential pattern is observed in other social determinants. It is essential to implement social policies to reduce this axis of inequalities in health, especially in childhood. (AU)
Objetivo: Describir el riesgo de pobreza y exclusión social en niños/as de 8-11 años de Gipuzkoa y Valencia (España), mediante los indicadores AROPE (At Risk Of Poverty or Social Exclusion), y evaluar sus factores asociados en el Proyecto INMA (Infancia y Medio Ambiente). Método: Familias de Gipuzkoa y Valencia (394 y 382, respectivamente) completaron un cuestionario en 2015-2016. Se estimaron la baja intensidad de trabajo (BIT), el riesgo de pobreza (RP) y la privación material (PM). AROPE consistió en cumplir cualquiera de estos subindicadores. Se consideraron características sociodemográficas, familiares y parentales. Se usaron diagramas de Venn, los test de Ji-cuadrado y Fisher en los análisis bivariados, y regresión logística en los análisis multivariados. Resultados: Se obtuvieron prevalencias para BIT, RP, PM y AROPE del 2,5%, 5,6%, 2,3% y 7,2% en Gipuzkoa, y del 8,1%, 31,5%, 7,8% y 34,7% en Valencia, respectivamente. En el análisis multivariado, el AROPE se asoció en ambas áreas con la clase social materna y la familia no nuclear. En Gipuzkoa, también se relacionó con la educación materna. En Valencia, otros factores fueron el origen extranjero materno y la educación y el tabaquismo paternos. Conclusión: Hay un AROPE más alto en Valencia. La clase social y el tipo de familia fueron factores compartidos, pero se observa un patrón diferencial en otros determinantes sociales. Es esencial implementar políticas sociales para reducir este eje de desigualdad en salud, especialmente en la infancia. (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Isolamento Social , Pobreza , Fatores de Risco , Classe Social , EspanhaRESUMO
OBJECTIVE: Assessing the association between socioeconomic gradient and cognitive development among children of a Spanish birth cohort aged 5-6 years from a gender perspective. METHOD: Cognitive development was assessed on 525 children aged 5-6 years in the INMA-Valencia cohort, with the Global Cognitive Score (GCS) from McCarthy Scales of Children's Abilities. Information on social class, education level and employment was collected for both parents in addition to other sociodemographic factors, parental, family and child characteristics. The relationship between maternal and paternal socioeconomic gradient and cognitive development was assessed by linear regressions and comparing the variance explained by each indicator measured in the mother and father. RESULTS: Maternal socioeconomic gradient indicators explained more variance on GCS than paternal. Maternal education and paternal social class had an important individual effect that stayed after adjusting by other parental, child and family determinants. In the multivariable analysis, maternal education, age and intelligence, paternal social class and the child's age and sex were significantly associated with cognitive development. CONCLUSIONS: Diverse socioeconomic gradient factors have an important influence on cognitive development, maternal education being the strongest determinant. Policies should be implemented to mitigate the negative effects of this gradient on child development
OBJETIVO: Evaluar la asociación del gradiente socioeconómico y el desarrollo cognitivo en niños y niñas de una cohorte española a los 5-6 años de edad desde una perspectiva de género. MÉTODO: Se evaluó el desarrollo cognitivo en 525 niños/as de 5-6 años de la cohorte INMA-Valencia, mediante la Puntuación Global Cognitiva (PGC) de las Escalas McCarthy para niños y niñas. Se recogió información de ambos progenitores sobre clase social, nivel de estudios y empleo, además de otros factores sociodemográficos, características parentales, de la familia y del niño o la niña. La relación entre el gradiente socioeconómico materno y paterno y el desarrollo cognitivo se evaluó mediante modelos de regresión lineal y comparando la varianza explicada por cada uno de los indicadores medidos en la madre y en el padre. RESULTADOS: Los indicadores de gradiente socioeconómico de la madre explicaron más varianza del índice de PGC que los del padre. La educación materna y la clase social paterna tuvieron un importante efecto individual, que se mantuvo tras ajustar por otros determinantes de los progenitores, del niño o de la niña, y del entorno familiar. En el análisis multivariante, la educación, la edad y la inteligencia maternas, la clase social paterna, y la edad y el sexo del infante se asociaron significativamente con el desarrollo cognitivo. CONCLUSIONES: Distintos factores del gradiente socioeconómico tienen influencia en el desarrollo cognitivo, siendo la educación materna el determinante más fuerte. Deberían implementarse políticas para paliar los efectos negativos de este gradiente en el desarrollo infantil
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Poder Familiar/psicologia , Educação Infantil/psicologia , Cognição/classificação , Desenvolvimento Infantil/classificação , 57926/estatística & dados numéricos , Perspectiva de Gênero , Relações Mãe-Filho , Características da FamíliaRESUMO
ObjetivosDeterminar la prevalencia de nacimientos de madres adolescentes, de prematuridad y de bajo peso al nacer en mujeres españolas e inmigrantes originarias de Latinoamérica, Europa del Este, Magreb y África Subsahariana, residentes en Cataluña y en la Comunitat Valenciana, durante los años 2005 y 2006.MétodosA partir de los datos proporcionados por los registros de metabolopatías de ambas comunidades autónomas, se obtuvieron las proporciones y sus respectivos intervalos de confianza al 95% de: 1) madres menores de 20 años, 2) neonatos prematuros (<37 semanas) y muy prematuros (<32 semanas), y 3) neonatos con bajo peso al nacer (<2500g) y muy bajo peso al nacer (<1500g), diferenciando siempre nacimientos de madre autóctona o inmigrante de los principales colectivos (Latinoamérica, Europa del Este, Magreb y Subsahara). La comparación de las proporciones entre inmigrantes y españolas se realizó mediante la prueba de ji al cuadrado.ResultadosLa prevalencia de nacimientos de madre adolescente fue entre tres y cinco veces mayor en inmigrantes que en mujeres españolas, presentando las europeas del este la prevalencia más elevada. La prevalencia de nacidos prematuros, muy prematuros y con muy bajo peso fue mayor en las mujeres procedentes de Europa del Este que en las españolas. Del mismo modo, las subsaharianas presentaron una mayor prevalencia de prematuridad y bajo peso extremos que las autóctonas.ConclusionesTodas las regiones geográficas en estudio presentaron una mayor prevalencia de nacimientos de madre adolescente que las españolas. Las mujeres subsaharianas y las de Europa del Este presentaron las mayores tasas de bajo peso y prematuridad(AU)
ObjectivesTo determine the prevalence of teenage maternity, preterm birth and low birth weight in Spanish and immigrant mothers from Latin America, eastern Europe, Maghreb and sub-Saharan Africa resident in Catalonia and Valencia from 2005 and 2006.MethodsUsing data from congenital metabolic disorders registers in both regions, proportions and 95% confidence intervals were obtained for the following: 1) mothers aged less than 20 years; 2) preterm (<37 weeks) and very preterm (<32 weeks) births; and 3) low birth weight (<2500g) and very low birth weight (<1500g) neonates. The calculations were performed for mothers from each of the geographical areas of origin (Spain, Latin America, Eastern Europe, Maghreb and Sub-Sahara). These proportions were compared in Spanish-born and immigrant women and the significance of differences was assessed using chi-squared tests.ResultsThe prevalence of teenage mothers was between three and five times higher in immigrants than in Spanish women, the highest rate being found in women from eastern Europe. Preterm births, very preterm births and very low birth weight were more frequent in eastern European women than in Spanish women. The prevalence of prematurity and very low birth weight was higher in sub-Saharan mothers than in Spanish women.ConclusionsThe number of births in teenage mothers was higher in immigrant mothers from all origins than in Spanish women. The highest rates of low birth weight and preterm births were found in women from eastern Europe and sub-Saharan Africa(AU)
Assuntos
Humanos , Feminino , Adolescente , Indicadores Básicos de Saúde , Medicina Reprodutiva , Migrantes , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , EspanhaRESUMO
ObjetivosEvaluar la calidad de los datos sobre nacimientos recogidos en el Movimiento Natural de la Población (MNP) y en los registros de metabolopatías para el cálculo de indicadores de salud reproductiva y perinatal.MétodosComparación entre registros acerca de 1) número total de nacimientos de madre residente en Cataluña y Comunitat Valenciana registrados durante 20052006, 2) grado de cumplimentación de los datos sobre origen geográfico de la madre, y 3) grado de cumplimentación de la edad materna, peso al nacer y edad gestacional según el origen de la madre.ResultadosLos registros de metabolopatías recogen de forma exhaustiva los nacimientos registrados en el MNP. El grado de cumplimentación de los datos sobre el origen y la edad materna fue algo menor en los registros de metabolopatías, aunque la proporción de nacimientos según el origen de la madre fue muy similar a la del MNP, así como la media de edad materna según el origen. El grado de cumplimentación de los datos sobre peso al nacer y edad gestacional según el origen materno fue muy inferior en el MNP, especialmente entre los nacimientos de madre inmigrante registrados en Cataluña.ConclusionesNuestros resultados sugieren una limitación en la calidad de los datos sobre edad gestacional y peso al nacer del MNP, sobre todo de cara al cálculo y la comparación de indicadores de prematuridad y bajo peso al nacer en población autóctona e inmigrante. A la vez, apoyan la utilidad de los registros de metabolopatías como fuente para el cálculo diferencial de tales indicadores(AU)
ObjectiveTo assess the quality of data on births in the Natural Population Movement (NPM) and congenital metabolic disorders registers with regard to calculation of reproductive and perinatal health indicators.MethodsThe following comparisons between registers were made: (1) the total number of births to mothers living in Catalonia and Valencia from 2005 to 2006, (2) the percentage of missing data on the mother's geographical origin, (3) the percentage of missing data on the mother's age and the infants birthweight and gestational age according to maternal origin.ResultsThe congenital metabolic disorders registers exhaustively collected the total number of births gathered in the NPM. The percentages of missing data on material origin and age were higher in the congenital metabolic disorders registers, although the proportion of births by maternal origin and the mean maternal age in each ethnic group was fairly similar to that in the NPM. The percentages of missing data on birthweight and gestational age were much higher in the NPM data than in the congenital metabolic disorders registers, especially among births registered in Catalonia and births to foreign mothers.ConclusionsOur results suggest some limitations in the quality of the data on gestational age and birthweight provided by NPM data, especially for comparisons of preterm and low birthweight indicators in the Spanish-born and immigrant populations. Moreover, the results point to the quality of the congenital metabolic disorders registers as a source to compare reproductive and perinatal health indicators(AU)
Assuntos
Humanos , Recém-Nascido , Adulto , Coeficiente de Natalidade/etnologia , Indicadores Básicos de Saúde , Doenças Metabólicas/epidemiologia , Sistema de Registros , Projetos de Pesquisa , Migrantes , Estudos Transversais , Medicina Reprodutiva , EspanhaRESUMO
ObjetivoDescribir las prevalencias de exposición declarada a riesgos laborales en mujeres embarazas y analizar su relación con características sociodemográficas y laborales a partir de la información recogida en la cohorte INMA-Valencia.MétodosLa cohorte INMA-Valencia se inicia en 2004 con 855 mujeres embarazadas residentes en la provincia de Valencia. En la semana 32 de gestación se recogió información, mediante entrevista personal con cuestionario estructurado, sobre características sociodemográficas (edad, nivel de estudios, país de nacimiento), condiciones de empleo (actividad, ocupación, tipo de contrato, tipo de jornada) y exposición laboral autorreferida a carga física y riesgos psicosociales, físicos, químicos y biológicos, en las mujeres con un trabajo remunerado durante el embarazo (n=649).ResultadosLas prevalencias de exposición laboral declarada a carga física, riesgos psicosociales y riesgos físicos (incluyendo radiaciones no ionizantes) fueron, respectivamente, del 56%, 63% y 62%. La prevalencia de exposición declarada a riesgos químicos (incluyendo productos de limpieza) fue del 22%, y del 6% a los riesgos biológicos. En general, la exposición referida a riesgos laborales fue más frecuente en las mujeres más jóvenes, con nivel educativo bajo, no españolas y trabajadoras temporales y autónomas.ConclusionesEn este estudio se cuantifica por primera vez en España la prevalencia de exposición declarada a riesgos laborales en una muestra de base poblacional de mujeres embarazadas. Según los datos obtenidos parece necesario reforzar las medidas de vigilancia y control de estas exposiciones, algunas de ellas asociadas consistentemente con efectos negativos sobre la reproducción y el desarrollo(AU)
ObjectiveTo describe the prevalence of exposure to occupational risks among pregnant women and analyze its relationship with personal and occupational characteristics using information collected in the Childhood and Environment (Infancia y Medio Ambiente [INMA])-Valencia cohort study.MethodsThe INMA-Valencia cohort study started in 2004 with 855 pregnant women living in Valencia, Spain. Data on sociodemographic variables (age, education and country of birth) and occupational conditions (activity, occupation, type of contract, working hours and self-reported occupational exposure to physical load and psychosocial, physical, chemical and biological risks) in women with paid employment during pregnancy (n=649) were collected through face-to-face interviews with a structured questionnaire in week 32 of pregnancy.ResultsThe prevalences of reported exposure to physical and psychosocial load and to physical pollutants (including non-ionizing radiations) were 56%, 63% and 62%, respectively. The prevalence of reported exposure to chemicals (including cleaning products) and biological pollutants was 22% and 6%, respectively. In general, the characteristics most closely associated with exposure to occupational risks were younger age, non-Spanish nationality, lower education, having a temporary contract or being self-employed.ConclusionsThis study is the first to quantify the prevalence of exposure to occupational risks during pregnancy in a Spanish population-based sample. According to the data observed, surveillance and control actions should be intensified in pregnant workers, as some of the observed occupational exposures have been consistently associated with detrimental reproductive and developmental effects(AU)
Assuntos
Humanos , Feminino , Gravidez , Adulto , Exposição Ocupacional/estatística & dados numéricos , Fatores de Risco , Espanha/epidemiologia , PrevalênciaRESUMO
Introducción: El proyecto INMA (Infancia y Medio Ambiente) es una red de investigación cooperativa que tiene como objetivos estudiar los efectos del medio ambiente y la dieta en el desarrollo fetal e infantil. El objetivo de este artículo es presentar el protocolo de exposición a contaminantes atmosféricos durante el embarazo y desarrollo prenatal y neonatal en el proyecto INMA. Métodos: La información para la evaluación de la exposición a contaminación atmosférica durante el embarazo se basa en mediciones de contaminantes atmosféricos en el exterior (dióxido de nitrógeno [NO2], compuestos orgánicos volátiles [COV], ozono, partículas [PM10, PM2,5] y su composición [hidrocarburos aromáticos policíclicos]), medición de contaminantes de exposición individual (en el interior de la vivienda y captadores personales [COV y NO2]), determinación de un marcador biológico de exposición a hidrocarburos (1-hidroxipireno), en información recogida mediante cuestionarios y en la utilización de sistemas de información geográfica. Esta información permite elaborar índices de exposición individual a contaminación atmosférica con los que analizar su posible relación con el desarrollo fetal y la salud del recién nacido. Discusión: El protocolo que se presenta y el tipo de estudio permiten obtener una aproximación a la exposición individual a contaminantes atmosféricos. Por último, el elevado número de participantes (n = 4.000), así como la heterogeneidad de las características ambientales y sociodemográficas, acrecienta el potencial del estudio
Introduction: The INMA (INfancia y Medio Ambiente [Spanish for Environment and Childhood]) project is a cooperative research network. This project aims to study the effects of environment and diet on fetal and early childhood development. This article aims to present the air pollutant exposure protocol during pregnancy and fetal and early childhood development of the INMA project. Methods: The information to assess air pollutant exposure during pregnancy is based on outdoor measurement of air pollutants (nitrogen dioxide [NO2], volatile organic compounds [VOC], ozone, particulate matter [PM10, PM2,5 ] and of their composition [polycyclic aromatic hydrocarbons]); measurement of indoor and personal exposure (VOC and NO2); urinary measurement of a biological marker of hydrocarbon exposure (1-hydroxypyrene); and data gathered by questionnaires and geographic information systems. These data allow individual air pollutant exposure indexes to be developed, which can then be used to analyze the possible effects of exposure on fetal development and child health. Conclusion: This protocol and the type of study allow an approximation to individual air pollutant exposure to be obtained. Finally, the large number of participants (N = 4,000), as well as their geographic and social diversity, increases the study's potential
Assuntos
Feminino , Gravidez , Humanos , Exposição Materna/efeitos adversos , Exposição Ambiental/efeitos adversos , Poluição do Ar/efeitos adversos , Desenvolvimento Embrionário e Fetal , Desenvolvimento Embrionário e Fetal/efeitos da radiação , Estudos de Coortes , Poluentes Ambientais/urinaRESUMO
Fundamento y objetivos: Analizar la ingesta dietética y de suplementos de ácido fólico (AF) durante el embarazo y los factores asociados al incumplimiento de la ingesta recomendada (IR) de 600μg/d y al incumplimiento de 400μg/d de suplementos para prevenir los defectos del tubo neural. Pacientes y método: Se incluyeron a 782 embarazadas de la cohorte INMA-Valencia. La ingesta dietética se estimó mediante un cuestionario de frecuencia alimentaria en 2 períodos de embarazo, desde preconcepción al mes 2 y desde el mes 37. También se recogió información de la suplementación y se estimó la ingesta total de AF (dieta+suplementos). Usando regresión logística múltiple se exploraron los factores asociados al incumplimiento de las recomendaciones. Resultados: La ingesta dietética media periconcepcional de AF fue de 304μg/d. Un 19,2%, 30,2% y 66,2% de embarazadas tomaron suplementos de AF en preconcepción, primer y segundo mes, respectivamente. Por otra parte, alrededor del 30% de las mujeres que tomaban suplementos de AF en periconcepción superó el límite superior tolerable de 1.000μg/d. El ser no española, de bajo nivel de estudios, fumadora, no planificar el embarazo, no haber visitado a ginecólogo privado, haber tenido hijos y no haber tenido antecedentes médicos previos, se asoció al incumplimiento de la IR. Conclusiones: La dieta sola es insuficiente para alcanzar las IR de AF, puesto que la suplementación se hace tarde y mal. La situación se agrava en mujeres jóvenes, de menor nivel educativo y embarazo no planificado (AU)
Background and objectives: We examined the dietary intake and the use of supplements of folic acid (FA) in a cohort of pregnant women. We also explored the factors associated with non-compliance of both the recommended intake (RI) of 600μg/day and the supplement use of 400μg/day provided to prevent neural tube defects (NTD). Pacients and methods: We studied 782 pregnant women from the INMA-Valencia cohort. The dietary intake was estimated using a food frequency questionnaire in two periods of pregnancy; from preconception to the second month and from the 3rd to the 7th month. Information on supplement use was also collected which allowed us to estimate the total FA intake (diet+supplements). We explored factors associated with non-compliance of the recommendations by logistic regression. Results: The periconceptional mean daily FA intake was 304μg/day. FA supplements were taken by 19.2, 30.2 and 66.2% of women in preconception, first and second month of pregnancy, respectively. Among women using supplements in periconception, 30% exceeded the tolerable upper intake level (UL) of 1.000μg/day. Non-compliance with RI was more common among women of foreign origin, of low educational level, who smoked, with unplanned pregnancy, who did not visit a private gynaecologist, who had had children or without previous medical illness. Conclusions: Diet by itself is not sufficient to reach RI for FA during pregnanc and many women initiate supplement use after the recommended period and inadequately. The youngest women, with lowest educational attainment and unplanned pregnancies are more likely not to comply (AU)
Assuntos
Humanos , Feminino , Gravidez , Adulto , Ácido Fólico/farmacologia , Suplementos Nutricionais , Nutrição da Gestante , Defeitos do Tubo Neural/prevenção & controle , Ácido Fólico/administração & dosagem , Complicações na Gravidez/prevenção & controle , Anormalidades Congênitas/prevenção & controle , Deficiência de Ácido Fólico/complicações , Deficiência de Ácido Fólico/prevenção & controle , Efeito de Coortes , Fatores SocioeconômicosRESUMO
Cada vez existe mayor evidencia de la influencia de la dieta y dela exposición a dosis bajas de tóxicos durante la etapa prenatal y primerainfancia sobre la salud y el bienestar en etapas posteriores de lavida. Siguiendo las recomendaciones de la OMS y de la Unión Europeaen el año 2003 se constituyó la Red de Investigación CooperativaInfancia y Medio Ambiente para estudiar los efectos del medioambiente y la dieta en el desarrollo fetal e infantil en diversas zonasgeográficas en España. La Red integra diversos grupos multidisciplinaresde investigación y está constituida por seis cohortes, trespreexistentes y tres de novo, que seguirán de forma prospectiva a3.600 mujeres embarazadas, desde el inicio del embarazo hasta los 4-6 años del niño. Los objetivos generales de la red son: (1) Describirla exposición individual a tóxicos ambientales durante la gestación yla primera infancia. (2) Evaluar los efectos de la exposición a tóxicosy de la dieta en el desarrollo fetal e infantil. (3) Evaluar la interacciónentre factores tóxicos, nutricionales y genéticos en el desarrollo fetale infantil. El seguimiento se realiza en cada trimestre de la gestación,al nacimiento, al año y hasta los cuatro o seis años del niño. La información se recoge mediante cuestionarios, datos clínicos, exploración física, ecografías, biomarcadores y mediciones ambientales. Eneste trabajo se presentan las características generales de la red y sedescribe la situación actual de cada una de las cohortes
Increasingly greater evidence exists as to the influence whichdiet and exposure to low doses of toxic substances during the prenatalstage and early childhood has on health and well-being throughoutlater stages of life. Following the WHO and European Unionrecommendations in 2003, the Cooperative Environment and ChildhoodResearch Network was set up to study the effects of the environmentand diet on fetal and early childhood development in differentgeographical areas of Spain. This Network integrates differentmultidisciplinary research groups and is comprised of six cohorts -three pre-existing and three de novo - which will follow up prospectively3,600 pregnant women, from the start of pregnancy up to age4-6 years of the child. This network's general objectives are: (1) Todescribe individual exposure to toxic substances in the environmentduring gestation and early childhood. (2) To evaluate the effects ofexposure to toxic substances and diet on fetal and early childhooddevelopment. (3) To evaluate the interaction among toxic, nutritionaland genetic factors in fetal and early childhood development. Thefollow-up is done every three months during gestation, at birth, atage one and up to age four or six. The information is gathered bymeans of questionnaires, clinical data, physical examinations, echographs,biomarkers and environmental measurements. The generalcharacteristics of the network and a description of the current situationof each one of the cohorts are provided in this study