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Objective To explore the association between serum trace element levels in early pregnancy and gestational dia-betes mellitus(GDM),and the mediating effect of bile acid metabolism changes in this association.Methods A nested case-con-trol study was designed based on the Guangxi Zhuang Birth Cohort.A total of 248 pregnant women(case group=124,control group=124)were included from June 2015 to July 2019 in Nanning city.The concentrations of 8 trace elements and 31 bile acids in serum were measured in early pregnancy.Conditional logistic regression and BKMR models were used to analyze the associa-tion and combined effect between trace elements and GDM risk,respectively.Orthogonal partial least squares-discriminant anal-ysis(OPLS-DA)was used to screen potential bile acid biomarkers associated with GDM,and then conditional logistic regression was used to determine the association between specific bile acid levels and GDM risk.Multiple linear regression was used to e-valuate the association of serum trace element concentrations with differential bile acid metabolites.Mediation analysis was used to evaluate the mediating role of bile acids in the relationship between trace element exposure and GDM.Results After adjus-ting for confounding factors,serum vanadium(V)was found to be positively associated with the risk of GDM,while chromium(Cr),manganese(Mn),zinc(Zn),selenium(Se)and molybdenum(Mo)were negatively correlated with the risk of GDM(all P<0.05).The OPLS-DA model and conditional Logistic regression analysis showed that taurocholic acid(TCA),glycochenodeoxy-cholic acid 3-sulfate(GCDCA-3S),glycochenodeoxycholic acid-3-O-β-glucuronide(GCDCA-3Gln),glycoursodeoxycholic acid-3-sulfate(GUDCA-3S),taurodeoxycholic acid-3-sulfate(TDCA-3S),and chenodeoxycholic acid(CDCA)might be potential bile acid metabolic markers of GDM(all P<0.05).The concentrations of multiple trace elements were also significantly correlated with the levels of specific bile acids(all P<0.05).Mediation analysis showed that GCDCA-3Gln and TCA mediated the associa-tion between serum Zn and Se and GDM risk,respectively(all P<0.05).Conclusion Serum trace elements such as V and Cr are significantly associated with the risk of GDM in early pregnancy,and changes in bile acid metabolism may precede the occur-rence of GDM.It is suggested that the effect of trace elements on the metabolism of bile acids,especially conjugated bile acids,may be one of the mechanisms affecting the risk of GDM.
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ObjectiveTo design a prospective nested case-control study based on a city-wide birth cohort of Shanghai, so as to understand their health status and explore the influencing factors of birth defects. MethodsBased on the birth registration covering the entire city of Shanghai, the nested case-control study of children with severe birth defects was designed. Children born with severe birth defects were selected as the case group, and healthy children were matched as the control group. Basic information, health status, maternal pregnancy history, and survival outcome of children both in the case group and the control group were collected through medical history review and home visits. The logistic regression model was used for multivariate analysis. ResultsA total of 18 875 infants born between January 1, 2011, and December 31, 2021, were included, among which 11 500 (60.93%) were children with severe birth defects and 7 375 (39.07%) were healthy children. The logistic regression model analysis showed that being male (OR=1.20, 95%CI:1.13‒1.29), non-Shanghai residency (OR=1.16, 95%CI: 1.06‒1.25), multiple births (OR=8.41, 95%CI:6.25‒11.30), artificial insemination (OR=2.31, 95%CI:1.34‒3.99), in vitro fertilization (IVF) (OR=1.85, 95%CI:1.44‒2.38), maternal exposure to radiation (OR=1.83, 95%CI:1.07‒3.14), maternal illness during pregnancy (OR=1.61, 95%CI:1.49‒1.74), experiencing a traumatic event during pregnancy (OR=2.34, 95%CI:1.88‒2.92), paternal chemical exposure (OR=1.88, 95%CI:1.32‒2.69), paternal radiation exposure (OR=1.65, 95%CI: 1.18‒2.33), family history of birth defects (OR=8.18, 95%CI: 3.96‒16.89), being overweight before pregnancy (OR=1.16, 95%CI: 1.07‒1.27), being obese before pregnancy (OR=1.15, 95%CI:1.03‒1.30), and being excessively obese before pregnancy (OR=1.52, 95%CI:1.26‒1.83) were risk factors for the occurrence of birth defects. Analysis by type of birth defect found that prematurity was a risk factor for cardiac malformations and cheilopalatoschisis (OR=27.87, 95%CI: 20.84‒37.27), especially ranking first in cardiac malformations. ConclusionAfter controlling for influencing factors, maternal overweight, obesity, and excessive obesity before pregnancy, artificial insemination, and IVF are independent risk factors for the occurrence of birth defects. Choosing a healthy lifestyle, improving physical and mental health during pregnancy, and controlling BMI during pregnancy are beneficial in reducing the risk of birth defects.
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ObjectiveTo introduce the basic design, development plan and objectives of a population-based birth cohort in Shanghai, and further present the main data and baseline characteristics of enrolled participants in the cohort, and to provide key information for reproductive health-related studies. MethodsThe Shanghai population-based birth cohort initiated on January 1, 2005, included newborns born in Shanghai every year and their parents, and collected information on reproductive health, reproductive treatment, birth characteristics, growth and development status, as well as the incidence, treatment and death of diseases by employing data linkage technology and investigations. This formed a birth cohort spanning the entire life cycle. ResultsAs of October 2022, a total of 2 978 538 newborns and their parents were included in the cohort. Among them, 2 905 135 (97.54%) were naturally conceived (NC), and 73 403 (2.46%) were born through assisted reproductive technologies (ART). The average age of parents was (32.56±4.12) years old for females and (34.62±5.34) years old for males in the ART group, which was higher than (28.02±4.71) years and (30.07±5.54) years for parents in the NC group. Among parents, females and males aged 30 and above accounted for 77.12% and 85.08%, respectively, which were higher than that of parents (35.28% for females and 49.66% for males) in the NC group. Furthermore, the percentage of parents with a college degree or above in the ART group was 73.23% for females and 73.66% for males, which were higher than those in the NC group (49.98% and 50.91%, respectively). The multiple births rate in the ART group was 33.81%, which was higher than that in the NC group (1.88%). The incidence of premature birth and low birth weight in the ART group were 24.47% and 19.08%, respectively, which was higher than that in the NC group (5.47% and 3.73%). ConclusionThe comprehensive collection of reproductive health-related information in the birth cohort in Shanghai can provide essential resources to determine the influence of genetics, environment, reproductive treatment and other related factors on the health of offspring after birth.
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ObjectiveTo establish the Shanghai twin birth cohort (STBC) and analyze the effects of genetic factors, shared environment, and non-shared environment interactions on birth health and growth and development of newborns. MethodsBased on the population-wide birth cohort in Shanghai, a comprehensive survey was conducted on the families with double and multiple babies born after January 1, 2015 to collect information on birth health, growth and development, and the family environment of the babies. ResultsBy December 31, 2021, a total of 7 195 pairs (14 405 cases) of twins were successfully included in the STBC survey. The average birth length of twins was 47.2 cm and average birth weight was 2 465.3 g. Heterozygous twins accounted for 69.05% and preterm babies accounted for 57.07%. The average age of the mothers of twins was 31.82 years, and the average age of the fathers was 33.87 years, with more than 80% of the parents having a college degree or above. 44.50% of the mothers used assisted reproductive technologies, 7.40% had illnesses during pregnancy, and 15.90% were exposed to passive smoking during pregnancy. During the survey period, the average monthly increase in the length of the twin infants was 2.09 cm, and the average monthly weight gain was 0.53 kg. ConclusionThe incidence of adverse outcomes such as maternal cesarean section rate, preterm birth, and low birth weight is higher in the twin birth population. Information on birth health as well as growth and development in childhood and adolescence in the twin birth population is collected based on STBC, which can provide a solid data foundation for studying children’s chronic non-communicable diseases, psychological and behavioral disorders and other complex health problems caused by the combined effects of genetics and the environment.
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Objective: To investigate risk factors associated with impaired attention-related executive functions (EFs) at age 11 and working memory at age 15. Methods: Data from participants of the population-based 2004 Pelotas Birth Cohort at ages 11 (n=3,582) and 15 (n=1,950) were analyzed. The study measured attentional control, cognitive flexibility, and selective attention using the Test of Everyday Attention for Children (TEA-Ch). Spatial working memory was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). Logistic regression was employed to explore the relationship between perinatal and childhood exposures and EF impairment. Results: Low maternal education had a significant negative impact on EFs. At age 11, it was associated with decreased attentional control (OR = 3.04; 95%CI 2.09-4.43), and at age 15, it was linked to impaired spatial working memory (OR = 2.21; 95%CI 1.58-3.09). Additional risk factors included low household income, black or brown maternal skin color, high parity, prematurity, low birth weight, and multiple siblings. Breastfeeding, regardless of duration, was found to be a protective factor against impaired cognitive flexibility (OR = 0.38; 95%CI 0.22-0.65). Conclusion: This study underscores the lasting impact of perinatal exposures on EF development. Policies that mitigate the negative effects of risk factors and promote EF development, especially among vulnerable populations, are needed.
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Background Exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) during pregnancy might affect thyroid-related hormone levels in pregnant women. However, most previous studies focused on the effects of PFAS containing 8-10 carbon atoms, and few studies have estimated the associations between PFAS with longer carbon chain and thyroid-related hormone levels. Objective To examine the associations between PFAS exposure and thyroid-related hormones in pregnant women. Methods The present study was based on the Jiashan Birth Cohort from September 2016 to April 2018. We analyzed 13 PFAS in maternal blood samples (n=781) by high-performance liquid chromatography-tandem mass spectrometry, as well as total triiodothyronine (T3), total thyroxine (T4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TG-Ab), and thyroid peroxidase antibody (TPOAb) by electrochemiluminescence immunoassay. PFAS were divided into three groups:low concentration, medium concentration and high concentration according to the tertile of their concentrations. We estimated the associations between PFAS concentrations and thyroid-related hormones in pregnant women by multiple linear regression. Results In the multiple linear regression models, a change in perfluorododecanoic acid (PFDoA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L−1 change in T3, −0.15 (95%CI: −0.28, −0.02) pmol·L−1 change in FT3, and −3.02 (95%CI: −5.66, −0.39) pmol·L−1 change in FT4, respectively. A change in perfluorotridecanoic acid (PFTrDA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L−1 change in T3. Compared with the low concentration group, the concentration of T4 in the medium concentration group of perfluorohexane sulfonate (PFHxS) increased by 6.10 (95%CI: 0.44, 11.75) nmol·L−1. No statistically significant associations were found between PFAS and TSH concentration. The negative associations of PFAS with thyroid-related hormones were more pronounced in pregnant women with positive TG-Ab and/or TPOAb. Conclusion Exposure to PFAS during pregnancy may affect thyroid-related hormone homeostasis in pregnant women, and the effect is stronger in TG-Ab and/or TPOAb-positive pregnant women.
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ABSTRACT Objective: The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. Methods: A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. Results: Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. Conclusion: There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.
RESUMO Objetivo: Inquérito nacional de cobertura vacinal aos 12 e 24 meses de idade foi realizado para investigar as quedas nas coberturas a partir de 2016. Métodos: Amostra de 37.836 nascidos vivos das coortes de 2017 e 2018 residentes nas capitais, Distrito Federal (DF) e 12 cidades com mais de 100 mil habitantes, acompanhados nos primeiros 24 meses por registros nas cadernetas de vacinação. Setores censitários foram estratificados segundo condições socioeconômicas, e o mesmo número de crianças foi incluído para cada estrato. Calcularem-se coberturas vacinais de cada vacina e coberturas completas aos 12 e 24 meses, doses aplicadas, válidas e oportunas. Fatores familiares, maternos e da criança associados à cobertura foram pesquisados. Os motivos para não vacinar analisados foram: contraindicações médicas, dificuldades de acesso, problemas no funcionamento do programa e hesitação vacinal. Resultados: Os resultados preliminares mostram que menos de 1% das crianças não foram vacinadas, as coberturas pelo esquema completo são menores que 75% em todas as capitais e no DF, as vacinas com mais de uma dose perdem cobertura progressivamente, há diferenças entre os estratos socioeconômicos, favoráveis aos estratos mais altos em algumas cidades e aos estratos mais baixos em outras. Conclusão: Houve realmente redução da cobertura vacinal em todas as capitais e no DF para as crianças nascidas em 2017 e 2018, denotando piora na execução do Programa Nacional de Imunizações durante os anos de 2017 a 2019. O inquérito realizado não mensurou os impactos da pandemia de COVID-19 que podem ter reduzido ainda mais as coberturas vacinais.
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abstract This study aimed to analyze the relationships between swimming competitive events, functional classification and relative age and to detect if the relative age affects performance in Brazilian swimmers and para swimmers. Data were retrieved from public databases and birth dates were classified in four quartiles (Q1 = January-March; Q2 = April-June; Q3 = July-September; Q4 = October-December). Descriptive statistics, Chi-square tests and ANOVA were used. The 50 m freestyle is the competitive event with 2349 swimmers, followed by 100 m (n = 1817) and 200 m freestyle (n = 905), and 200 m butterfly with 42 swimmers. Para swimmers are mainly distributed to S14, S6 and S5 functional classes (n = 140, 87 and 45), and individual medley events were less represented at SM3, SM9 and SM11 (n = 1 swimmer). Most of swimming events (86.36%) and para swimming functional classes (51.43%) are represented by swimmers and para swimmers born in the first and second quartiles. Moderate associations between functional classification and relative age were observed (p < 0.0001, Cramer's V = 0.277). No effects of relative age on swimmers and para swimmers' performance were noticed (p > 0.05). The great functional class seems to be related to great para swimmers' relative age. Quartiles distribution shows the advantage of being born in the first months of the year to be registered among the most talented Brazilian swimmers and para swimmers.
resumo Este estudo teve como objetivo analisar as relações entre eventos competitivos de natação, classificação funcional e idade relativa e detectar se a idade relativa afeta o desempenho em nadadores e paranadadores brasileiros. Os dados foram recuperados de bancos de dados públicos e as datas de nascimento foram classificadas em quatro quartis (Q1 = janeiro-março; Q2 = abril-junho; Q3 = julho-setembro; Q4 = outubro-dezembro). Utilizou-se estatística descritiva, teste Qui-quadrado e ANOVA. Os 50 m livre é a prova competitiva com 2.349 nadadores, seguido de 100 m (n = 1.817) e 200 m livre (n = 905), e 200 m borboleta com 42 nadadores. Os paranadadores estão distribuídos principalmente nas classes funcionais S14, S6 e S5 (n = 140, 87 e 45), e as provas individuais de medley foram menos representadas em SM3, SM9 e SM11 (n = 1 nadador). A maioria das provas de natação (86,36%) e classes funcionais de paranatação (51,43%) são representadas por nadadores e paranadadores nascidos no primeiro e segundo quartis. Associações moderadas entre classificação funcional e idade relativa foram observadas (p < 0,0001, V de Cramer = 0,277). Não foram observados efeitos da idade relativa no desempenho de nadadores e paranadadores (p > 0,05). A grande classe funcional parece estar relacionada com a idade relativa dos grandes paranadadores. A distribuição por quartis mostra a vantagem de ter nascido nos primeiros meses do ano para ser registrado entre os mais talentosos nadadores e paranadadores brasileiros.
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ABSTRACT OBJECTIVE: To investigate birth-to-childhood tracking of linear growth and weight gain across the distribution of length/height and weight for age z-scores and according to household wealth. METHODS: Data from 614 children from the MINA-Brazil Study with repeated anthropometric measurements at birth and up to age five years were used. Z-scores were calculated for length/height (HAZ) and weight (WAZ) according to international standards. Birth-to-childhood tracking was separately estimated using quantile regression models for HAZ and WAZ, extracting coefficients and 95% confidence intervals (95%CI) at the 25th, 50th, and 75th quantiles. In a subgroup analysis, we estimated tracking between birth and age two years, and between ages two and five years. To investigate disparities in tracking, interaction terms between household wealth indexes (at birth and age five years) and newborn size z-scores were included in the models. RESULTS: Tracking coefficients were significant and had similar magnitude across the distribution of anthropometric indices at age five years (HAZ, 50th quantile: 0.23, 95%CI: 0.11 to 0.35; WAZ, 50th quantile: 0.31, 95%CI: 0.19 to 0.43). Greater tracking was observed between ages two and five years, with coefficients above 0.82. Significantly higher tracking of linear growth was observed among children from wealthier households, both at birth, at the lower bounds of HAZ distribution (25th quantile: 0.30, 95%CI: 0.13 to 0.56), and during childhood, in the entire HAZ distribution at five years. For weight gain, stronger tracking was observed at the upper bounds of WAZ distribution at age five years among children from wealthier households at birth (75th quantile: 0.59, 95%CI: 0.35 to 0.83) and during childhood (75th quantile: 0.54, 95%CI: 0.15 to 0.93). CONCLUSION: There was significant tracking of HAZ and WAZ since birth, with indication of substantial stability of nutritional status between ages two and five years. Differential tracking according to household wealth should be considered for planning early interventions for preventing malnutrition.
RESUMO OBJETIVO: Investigar a autocorrelação do crescimento linear e ganho de peso do nascimento até a infância considerando a distribuição de escores z de comprimento/estatura e peso por idade e de acordo com a riqueza domiciliar. MÉTODOS: Foram utilizados dados de 614 crianças do Estudo MINA-Brasil com medições antropométricas realizadas do nascimento até os cinco anos de idade. Escores z foram calculados para comprimento/estatura (HAZ) e peso (WAZ) seguindo padrões internacionais. A autocorrelação ou estabilidade da adequação do estado nutricional do nascimento à infância foi estimada por meio de modelos de regressão quantílica para HAZ e WAZ, separadamente, extraindo-se coeficientes e intervalos de confiança de 95% (IC95%) nos quantis 25, 50 e 75. Em uma análise de subgrupo, estimou-se a autocorrelação entre o nascimento até os dois anos de idade, e entre dois e cinco anos de idade. Para investigar disparidades na autocorrelação, termos de interação entre índices de riqueza familiar (ao nascer e aos cinco anos de idade) e escores z de tamanho do recém-nascido foram incluídos nos modelos. RESULTADOS: Os coeficientes de autocorrelação foram significantes e tiveram magnitude semelhante ao longo da distribuição dos índices antropométricos aos cinco anos de idade (HAZ, quantil 50: 0,23, IC95%: 0,11 a 0,35; WAZ, quantil 50: 0,31, IC95%: 0,19 a 0,43). Maior estabilidade do estado nutricional foi observada entre dois e cinco anos, com coeficientes acima de 0,82. Autocorrelação significantemente maior do crescimento linear foi observada entre as crianças de domicílios mais ricos, tanto ao nascer, nos limites inferiores da distribuição HAZ (quantil 25: 0,30, IC95%: 0,13 a 0,56) e durante a infância, em toda a distribuição HAZ aos cinco anos. Para o ganho de peso, observou-se uma autocorrelação mais forte nos limites superiores da distribuição do WAZ aos cinco anos de idade entre as crianças de domicílios mais ricos ao nascer (quantil 75: 0,59, IC95%: 0,35 a 0,83) e durante a infância (quantil 75: 0,54, IC95%: 0,15 a 0,93). CONCLUSÃO: Houve autocorrelação significante de HAZ e WAZ desde o nascimento, com indicação de substancial estabilidade do estado nutricional entre os dois e cinco anos de idade. A autocorrelação diferencial de acordo com a riqueza domiciliar deve ser considerada para o planejamento de intervenções precoces para prevenir a má nutrição.
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Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Socioeconomic Factors , Weight Gain , Child , Nutritional Status , Birth Cohort , GrowthРеферат
En los últimos tiempos, la praxis de la cesárea en los centros hospitalarios se ha incrementado notablemente, el cual es ha sido corroborado según fuentes del INEI, por su parte, la OMS estandarizó que la variabilidad máxima es el 15%, superado aquello genera un grave problema al estado en cuestiones económicos, para constatar la problemática se tuvo en cuenta el objetivo de caracterizar a las mujeres de parto por cesárea a través de variables obstétricas desde la perspectiva de Robson, por lo que la investigación correspondió al enfoque cuantitativo, tipo no experimental y diseño descriptivo, la muestra representada por 1365 mujeres registradas en el base de datos correspondientes al 2019. El análisis de los resultados obedeció al método inductivo-deductivo, la misma que permitió diferenciar la tasa global de cesárea, el modelo de Robson mostró como resultado el 53%, cifra que supera en 38% a lo que establece la OMS, mientras que los grupos con mayor contribución a la tasa global de cesáreas fueron los grupos: 5, 1, 3 y 10. Finalmente, se concluye que la mayor cantidad de las mujeres han sido sometida al parto por cesárea, siendo mayor la tasa global durante el año indicado, en consecuencia generó mayor gasto al estado, exigiendo incrementar presupuesto al sector salud, cabe precisar que existe la posibilidad de controlar a través de la inducción a las mujeres embarazadas para el parto vaginal aplicación de los métodos y técnicas eficaces que permitan generar confianza a la mayor población de mujeres gestantes.
In recent times, the practice of cesarean section in hospital centers has increased notably, which has been corroborated according to INEI sources, on the other hand, the WHO standardized that the maximum variability is 15%, exceeding this generates a serious problem for the state in economic matters, In order to verify the problem, the objective of characterizing women who give birth by cesarean section through obstetric variables from Robson's perspective was taken into account, so the research corresponded to the quantitative approach, non-experimental type and descriptive design, the sample represented by 1365 women registered in the database corresponding to 2019. The analysis of the results obeyed the inductive-deductive method, the same that allowed differentiating the global rate of cesarean section, Robson's model showed as a result 53%, a figure that exceeds by 38% what the WHO establishes, while the groups with the highest contribution to the global rate of cesarean section were the groups: 5, 1, 3 and 10. Finally, it is concluded that most women have been subjected to cesarean delivery, being higher the overall rate during the year indicated, consequently generated greater expenditure to the state, requiring increased budget to the health sector, it should be noted that there is the possibility of controlling through the induction of pregnant women for vaginal delivery application of effective methods and techniques to generate confidence to the largest population of pregnant women.
Nos últimos tempos, a prática da cesárea nos centros hospitalares tem aumentado notavelmente, o que tem sido corroborado de acordo com fontes do INEI, enquanto a OMS padronizou que a variabilidade máxima é de 15%, o que gera um grave problema para o Estado em questões econômicas, A fim de verificar o problema, foi levado em conta o objetivo de caracterizar as mulheres que dão à luz por cesárea através de variáveis obstétricas da perspectiva de Robson, de modo que a pesquisa correspondeu à abordagem quantitativa, tipo não experimental e desenho descritivo, a amostra representada por 1365 mulheres registradas no banco de dados correspondente a 2019. A análise dos resultados obedeceu ao método indutivo-dedutivo, que nos permitiu diferenciar a taxa geral de cesárea, o modelo de Robson mostrou um resultado de 53%, que é 38% maior do que o estabelecido pela OMS, enquanto os grupos com maior contribuição para a taxa geral de cesárea foram os grupos 5, 1, 3 e 10. Finalmente, conclui-se que a maioria das mulheres passou por cesarianas, sendo a taxa geral mais alta durante o ano em questão, e como resultado, o Estado gastou mais dinheiro, exigindo um aumento no orçamento do setor de saúde. Deve-se notar que é possível controlar as mulheres grávidas através da indução ao parto vaginal, aplicando métodos e técnicas eficazes que gerarão confiança na população maior de mulheres grávidas.
Тема - темы
Parturition , Labor, Induced , Delivery, Obstetric , Pregnant WomenРеферат
Background: There is minimal information about the association of head growth at different stages of childhood with cognitive ability. Objective: To determine the relationship of newborn head size and head growth during infancy, childhood and adolescence with attained education, a proxy for cognitive ability. Study design: Prospective birth cohort study. Setting: Married women living in South Delhi between 1969 and 1973. Participants: The New Delhi Birth Cohort study followed up 8030 newborns born in 1969-1973 with head circumference, weight and height measurements at birth and 6-12 monthly until adulthood. Of these, 1526 men and women were followed up at the age of 26-32 years. Outcomes: Association between years of schooling, as an indicator of cognitive ability, and newborn head circumference and conditional measures of head growth during infancy, childhood and adolescence. Results: In unadjusted analyses, newborn head size was positively associated with years of education [(? (95% CI)=0.30 (0.14 to 0.47) years per SD head circumference], as was head growth from birth to 6 months [? (95% CI)=0.44 (0.28 to 0.60) years per SD conditional head growth], 6 months to 2 years [? (95% CI)=0.31 (0.15 to 0.47) years per SD conditional head growth] and 2 to 11 years [? (95% CI)=0.20 (0.03 to 0.36) years per SD conditional head growth]. There were similar findings for height and body mass index (BMI). In the adjusted model containing all growth measures, gestational age, and socioeconomic status (SES) at birth as predictors, only SES was positively associated with educational attainment. Conclusion: Educational attainment in this population is positively associated with socioeconomic status and its influence on inter-related early life (fetal, infant and childhood) factors like nutritional status and brain growth.
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Objective @#To investigate the association between adiposity rebound and metabolic abnormalities in pre- schools.@*Methods @#A prospective cohort study was designed on the basis of the Maanshan birth cohort. Venous blood samples were collected at 5 to 6 years of age to detect metabolic indicators.2022 children aged 0 to 6 years with ≥8 consecutive measurements were enrolled. χ2 test and Logistic regression model were used to analyze the data. @*Results @#The detection rate of abnormal metabolism in preschool children was 16. 9% ,and the risk of meta- bolic abnormalities in preschool children with high BMI level at the AR time point and earlier AR time phase was 2. 59 and 1. 82 times that of the normal group respectively.@*Conclusion @#High AR level and earlier AR phase can increase the prevalence of metabolic abnormalities in preschool children.
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Here we try to explore the nutrition issues in existing birth cohort studies, and give suggestions to future cohorts, which including pregnant and lactating mothers and their babies, on nutritional survey, the way to collect breast milk samples, breast milk composition analysis and breastfeeding patterns. Also, we put forward some aspects for researchers to consider on the follow-up timepoints of children, design of mother-child dyads, and dietary intake and feeding or eating behavior of those babies in relevant cohort studies.
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ABSTRACT Objective: To analyze the causes of age-specific neonatal deaths and death-associated factors in the 2021 state of Rio de Janeiro birth cohort. Methods: Retrospective cohort of live births (LB) followed up to 27 days of delivery (<24hs, 1-6 and 7-27 days). Data obtained from the Information Systems on Live Births (2021) and Mortality (2021/2022). We described the distributions of maternal and newborn characteristics and causes of death. We used multinomial regression models with hierarchical levels of determination of neonatal death. Results: Of the 179,837 LB, 274 died within 24 hours, 447 within 1-6 days and 324 within 7-27 days. The neonatal mortality rate was 5.8‰ LB (CI 95%: 5.5-6.2). Neonatal survivors and deaths were heterogeneous according to the analyzed characteristics, except for the reproductive history (p<0,05). 78% of causes of death were avoidable. Causes reducible by adequate care for pregnant women (<24 hours and 1-6 days) and newborns (7-27 days) predominated. Low schooling showed a significant association for deaths between 7-27 days (ORajusted=1.3); mixed race, for deaths between 1-6 days (ORajusted=1.3), and black color for both age groups (1-6 days: ORajusted=1.5 and 7-27 days: ORajusted=1.8). Health care and biological factors of LB (intermediate and proximal levels) remained strongly associated with neonatal death, regardless of age. Conclusion: Causes of death, factors associated with neonatal death, and strength of association differed according to death-specific age. Preventive actions for neonatal death should consider sociodemographic vulnerabilities and intensify adequate prenatal and perinatal care.
RESUMO Objetivo: Analisar a magnitude dos óbitos neonatais (ON), as causas de morte e os fatores associados por idade específica na coorte de nascidos vivos em 2021, no estado do Rio de Janeiro. Métodos: Coorte retrospectiva de nascidos vivos (NV) seguidos até 27 dias do parto (<24 horas, 1-6 e 7-27 dias). Dados obtidos dos Sistemas de Informações sobre Nascidos Vivos (2021) e Mortalidade (2021/2022). Foram descritas as distribuições das características maternas e do recém-nascido, causas de mortes e evitabilidade. Foram utilizados modelos de regressão multinomial com níveis hierárquicos de determinação do ON. Resultados: Dos 179.837 NV, morreram 274 até 24 horas, 447 de 1 a 6 dias e 324 de 7 a 27 dias. A taxa de mortalidade neonatal foi 5,8‰ NV (intervalo de confiança — IC95%: 5,5-6,2). Sobreviventes e ON foram heterogêneos segundo caraterísticas analisadas, exceto história reprodutiva (p<0,05). Das causas de morte, 78% eram evitáveis. Predominaram causas reduzíveis por adequada atenção à gestante (<24 horas e 1-6 dias) e ao recém-nascido (7-27 dias). No nível distal, baixa escolaridade mostrou associação significante para óbitos entre 7 e 27 dias (ORajustado=1,3), cor parda, para óbitos de 1-6 dias (ORajustado=1,3) e cor preta, para ambas as idades (1-6: ORajustado=1,5; 7-27 dias: ORajustado=1,8). Fatores assistenciais e biológicos do NV (níveis intermediário e proximal) mantiveram-se fortemente associadas aos ON, independentemente da idade. Conclusão: As causas de morte, os fatores associados ao ON e a força de associação diferiram conforme a idade do óbito. Ações preventivas do ON devem considerar vulnerabilidades sociodemográficas e intensificar uma assistência adequada pré-natal e perinatal.
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Background Global warming may increase the frequency of compound hot extreme (CHE).However, there is still a lack of studies assessing the associations between CHE and preterm birth (PTB), and the underlying biological mechanisms remain unclear. Objective To estimate the association of exposure to CHE during pregnancy with PTB, and to explore the roles of inflammatory, endothelial dysfunction, and oxidative stress in the association between CHE and PTB. Methods All participants were selected from the Prenatal Environments and Offspring Health (PEOH), a prospective birth cohort conducted in Guangzhou. In this study, a total of 2449 participants who gave birth from May to October in 2014 to 2017 were enrolled, and among them blood samples were collected from 311 preterm (n=43) and full-term (n=268) pregnant women at the time of delivery. A hot day/night was identified as a day when the daily maximum temperature/minimum temperature was higher than its 90th percentile in the study period, and a CHE was defined as having both a hot night and a following hot day. The meteorological data were obtained from the China Meteorological Data Sharing Service System. Anusplin was used to assess the daily maximum temperature, daily minimum temperature, and relative humidity of the participant residence. Enzyme-linked immunosorbent assay (ELISA) was used to measure C reactive protein (CRP), endothelin-1 (ET-1), and malondialdehyde (MDA) levels in maternal serum, and their results were transformed by natural logarithm. A distributed lag nonlinear model was used to investigate the associations of exposures to hot day, hot night, and CHE during pregnancy with PTB at different lag days, and a logistic regression model was used to investigate the associations of CRP, ET-1, and MDA with PTB. Results The incidence rate of PTB was 6.2% in all selected participants. Compared with the non-hot day, the RRs (95%CIs) of CHE in lag 3, 7, and 14 days on PTB were 1.43 (1.12-1.84), 1.24 (1.08-1.43), and 1.17 (1.05-1.30), respectively, and the cumulative effects (% difference) (95%CI) of CHE in lag 14 days on maternal serum CRP, ET-1, and MDA were 0.33% (−0.45%-1.12%), 0.59% (0.11%-1.07%), and 0.57% (0.09%-1.05%), respectively. Compared with the Q1 (lowest quartile) for CRP, ET-1 and MDA, the RRs (95%CIs) of Q4 (highest quartile) for PTB were 1.27 (0.50-3.22), 1.51 (0.61-3.72), and 2.07(0.81-5.27), respectively. Conclusion Maternal exposure to CHE during pregnancy might be associated with an increased risk of PTB. Prenatal exposure to CHE is positively associated with maternal serum CRP, ET-1, and MDA, and the three biochemical indicators are also positively associated with PTB. However, the above conclusions still need further confirmation.
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Abstract Objectives: to investigate the factors associated with continued breastfeeding (BF). Methods: All the parturients at a local maternity from July 2015 to June 2016 were invited to participate in a cohort study in Cruzeiro do Sul, Acre. Data on socioeconomic, demographic, obstetric and neonatal of the babies were obtained for the interview. Multiple Poisson regression models with robust variance were used to estimate the prevalence ratio (PR) and 95% confidence intervals (95%CI). Results: among the 1551 mothers contacted, 305 lived in the rural area, leaving 1,246 eligible mothers living in urban area. For the 1-year cohort follow-up, 74 non-twin babies were assessed. Most of the mothers reported to have mixed skin color (79%), are over 21 years old (72°%o), more than 10 years of schooling (72%>) and with unpaying job (54%). The children's age ranged from 10 to 15 months. The frequency of continued breastfeeding was 69,4%> (95%oCI=66.0-72.6). The factors negatively associated with continued breastfeeding were the use of bottle feeding (PR=1.44; CI95%> =1,33-1.56) and pacifier (PR=2.54; CI95%> =1.98-3.27), after adjusting for maternal age and socioeconomic variables. Conclusion: the frequency of continued breastfeeding in Cruzeiro do Sul was higher than the national estimates, but below the WHO recommendations for breastfeeding up to two years of age.
Resumo Objetivos: investigar frequência e fatores associados ao aleitamento materno (AM) continuado. Métodos: estudo de coorte em Cruzeiro do Sul, Acre. Na maternidade, todas as parturientes de julho de 2015 a junho de 2016 foram convidadas à participação. Dados socioeconómicos, demográficos, obstétricos e neonatais dos bebês foram obtidos por entrevista. As razões de prevalência (RP) e intervalos com 95% de confiança (IC95%) foram estimados utilizando modelos múltiplos de regressão de Poisson com variância robusta. Resultados: dentre 1551 mães contatadas, 305 residiam em área rural, sendo elegíveis 1246 mães residentes em área urbana. No seguimento de 1 ano da coorte, 774 bebês não gemelares foram avaliados. A maioria das mães referiu ser de cor parda (79%o), maior de 21 anos (72%), >10 anos de escolaridade (72%) e não exercer atividade remunerada (54%). A idade dos bebês variou de 10 a 15 meses. A frequência do AM continuado foi de 69,4%o (IC950%= 66,0-72,6). Os fatores inversamente associados ao AM continuado foram uso de mamadeira (RP= 1,44; IC95% 1,33-1,57) e chupeta (RP= 2,55; IC95%= 1,99-3,28), após ajuste por idade materna e variáveis socioeconómicas. Conclusão: a frequência de AM continuado em Cruzeiro do Sul foi superior às estimativas nacionais, porém aquém das recomendações da OMS para amamentação até dois anos de idade.
Тема - темы
Humans , Female , Pregnancy , Infant, Newborn , Infant , Socioeconomic Factors , Breast Feeding/statistics & numerical data , Maternal and Child Health , Risk Factors , Infant Nutrition , Brazil/epidemiology , Rural Areas , Cohort Studies , Urban AreaРеферат
【Objective】 To describe the BMI growth trajectories from birth to 24 months and examine the effects of fully breastfeeding time and breastfeeding duration on the BMI growth trajectories. 【Methods】 We conducted a follow-up study of a cohort of 1 388 eligible births. Height and weight were measured at birth, every 3 months to 12 months, and every 6 months to 24 months. Detailed demographic, feeding, activity and diseases data were also collected prospectively. Latent growth mixture modeling was conducted to model the BMI growth trajectories from birth to 24 months. Mixed-effects logistic regression analyses were made to examine the impacts of breastfeeding on this outcome. 【Results】 We identified six BMI trajectory patterns in the 1 285 infants analyzed and labeled them as follows: "normative growth" (26.6%), "normal-accelerating growth" (8.7%), "normal-decelerating growth" (11.7%), "lower-persistent growth" (6.6%), "rapid growth" (26.8%), and "rapid-accelerating growth" (19.5%). Mixed-effects logistic regression analyses revealed that fully breastfeeding ≥ 3 months could significantly decrease the risk of "rapid growth" (OR=0.71, 95% CI 0.51-0.98) and "rapid-accelerating growth" (OR=0.53, 95% CI 0.37-0.75). After adjustment for confounding factors, the relationship remained significant (OR=0.61, 95% CI 0.41-0.89; OR=0.46, 95% CI 0.31-0.68). Weaning before 6 months could significantly increase the risk of "rapid growth" (OR=1.76, 95% CI 1.19-2.61) and "rapid-accelerating growth" (OR=2.08, 95% CI 1.38-3.14). These associations persisted after adjustment for confounding factors (OR=1.69, 95% CI 1.08-2.71; OR=1.88, 95% CI 1.18-2.99). 【Conclusion】 In rural Western China, the main BMI growth trajectory patterns include "normative growth" , "rapid growth" , and "rapid-accelerating growth" . Prolonging breastfeeding may reduce excess weight gain during infancy.
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OBJECTIVE@#To describe the distribution and trend of infantile epilepsy among infants under 36 months in Ningbo, Zhejiang Province.@*METHODS@#Using the birth cohort design, we retrospectively collected the local born infants in Ningbo national health information platform from 2015 to 2019, and took the first visit of epilepsy in the electronic medical record of the platform as the new case. The incidence density and 95% confidence interval (CI) of epilepsy were estimated by Poisson distribution.@*RESULTS@#From 2015 to 2019, a total of 294 900 children were born in Ningbo, with male accounting for 51.92%. The total person-years of observation were 595 300, while the median follow-up person-years was 2.31 [interquartile range (IQR): 1.90]. There were 575 new onset epilepsy patients during the whole observation period. The total number of visits was 2 599, with an average of 4.52. The total incidence density was 96.59/100 000 person-years (95%CI: 88.85-104.82). The median age of onset was 13 months (IQR: 15), 0-12 months old infants had the highest incidence density (102.18/100 000 person-years), 25-36 months old infants had the lowest incidence density (89.68/100 000 person-years), and the difference was not statistically significant (P>0.05). The incidence density of male was 97.58/100 000 person-years, female was 95.53/100 000 person-years, and the difference was not statistically significant (P>0.05). Fenghua was the highest (130.54/100 000 person-years, 95%CI: 94.47-175.83) and Ninghai was the lowest (66.44/100 000 person-years, 95%CI: 47.02-91. 19), with significant difference (P < 0.05). There was no significant difference in the incidence density in different birth years (P>0.05). There was significant difference in the incidence density between 0-12 months old infants in different calendar years (Ptrend < 0.05). In this age group, the incidence density was the lowest in 2015 (69.41/100 000 person-years, 95%CI: 41.79-108.39), and the highest in 2019 (225.61/100 000 person-years, 95%CI: 186.10-271.03). There was no significant difference in the incidence density between 13-24 and 25-36 months old infants in different calendar years (P>0.05).@*CONCLUSION@#The incidence density of epilepsy in 0-36 months old infants in Ningbo City from 2015 to 2019 was low as a whole, and there was no difference in age group, gender, and year of birth. The incidence density of 0-12 months old infants increased with the year.
Тема - темы
Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Cities , Epilepsy/epidemiology , Incidence , Retrospective StudiesРеферат
Abstract This study aimed to investigate the occurrence of behavior problems in 3750 four years old children from a birth cohort. Children were followed from birth to four years old through home visits, and questionnaires on child health and development and the Child Behavior Checklist 4-18/CBCL were applied. Prevalence rates were high (total problems 35.6%), particularly externalizing problems, which occurred in 44.4 % of children (48.3% girls; 40.6% boys; p < 0.001). Internalizing problems were less prevalent, occurring in 15.5 % of children (19.1% boys; 11.6% girls; p < 0.001). Regardless of sex, there was a higher prevalence of behavioral problems in children with younger siblings, whose mothers had less education and had no partner.
Resumo Este estudo objetivou investigar a ocorrência de problemas de comportamento em 3750 crianças pertencentes a uma coorte de nascimentos. As crianças foram acompanhadas do nascimento aos quatro anos de idade, por meio de visitas domiciliares, tendo sido aplicados instrumentos sobre saúde e desenvolvimento infantil e o Child Behavior Checklist 4-18/CBCL. As prevalências encontradas foram altas (total de problemas de comportamento: 35,6%), com destaque para problemas de externalização, que ocorreram em 44,4% das crianças (48,3% meninas; 40,6% meninos; p < 0,001). Problemas de internalização foram menos prevalentes, ocorrendo em 15,5% das crianças (19,1% meninos; 11,6% meninas; p < 0,001). Independente do sexo, houve maior prevalência de problemas de comportamento em crianças com maior número de irmãos mais novos, cujas mães tinham menor escolaridade e não tinham companheiro.
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Objective: To introduce how to build a data platform of data collection and data management for multi-center birth cohort study by using REDCap. Methods: After the REDCap electronic data capture system was installed and set up, the electronic case report forms (eCRFs) were programmed to collect data in multi-centers. The rules of data quality control were programmed, and different levels of user right for access to data platform were assigned to the data managers and data clerks based on their role in research project. Results: With REDCap system being installed, the example project was created, and a series of eCRFs were established for each stage of preconception, pregnancy and childhood through follow-up. After intensive testing to improve and achieve a stable data platform, standardized trainings were provided to data-related team. The REDCap eCRFs were then put in use online. By assigning different user right of access to data platform, data entry can be from multi- research centers and survey sites. This REDCap data platform supported the cohort project on data collection and data management. Conclusion: The data platform established by using REDCap provides strong support to birth cohorts on data collection and data management. This example project of data platform can be applied to other epidemiological studies.