Associated factors for accelerated growth in childhood: a systematic review.

Several studies have shown that accelerated growth in the postnatal period is critical for the development of chronic diseases. The term catch-up has been used for the accelerated growth of children who have suffered some sort of restriction of nutrition or oxygen supply. However, accelerated growth has been observed among children who have an appropriate birth weight for their gestational age (AGA) and with no apparent morbidity. Therefore, this systematic review was carried out on the associated factors of accelerated growth, or catch-up, using the Medline/Pubmed database. Only cohort studies written in Portuguese, English or Spanish, with children between zero and 12 years old who presented accelerated growth or catch-up as the outcome were included. Out of the 2,155 articles found, 9 were selected. There is no uniformity in the operational definition of accelerated growth, or in the concept of catch-up. According to this review, accelerated growth is associated with primiparity, maternal smoking during pregnancy, lower birth weight, and early weaning. The main limitations in the available literature are the high number of follow-up losses and the lack of control for confounding factors. The determinants of accelerated growth still need to be studied further, especially among AGA children.

Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria.

BACKGROUND: Two criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization (WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM (according to these criteria) and adverse outcomes. METHODS: We searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I2) > 50%. RESULTS: Data were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age (RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37;95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I2 ≥ 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.28-2.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO. CONCLUSIONS: The WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies.

Non classical risk factors for gestational diabetes mellitus: a systematic review of the literature.

Age, obesity and family history of diabetes are well known risk factors for gestational diabetes mellitus. Others are more controversial. The objective of this review is to find evidence in the literature that justifies the inclusion of these other conditions among risk factors. The MEDLINE, Cochrane, LILACS and Pan American Health Organization databases were searched, covering articles dating from between 1992 and 2006. Keywords were used in combination (AND) with gestational diabetes mellitus separately and with each one of the risk factors studied. The methodological quality of the studies included was assessed, resulting in the selection of 41 papers. Most studies investigating maternal history of low birth weight, low stature, and low level of physical activity have found positive associations with gestational diabetes mellitus. Low socioeconomic levels, smoking during pregnancy, high parity, belonging to minority groups, and excessive weight gain during pregnancy presented conflicting results. Publication bias cannot be ruled out. Standardization of techniques, cutoff points for screening and diagnosis, as well as studies involving larger sample sizes would allow future meta-analyses.

[Risk factors for gestational diabetes mellitus in the birth cohort in Pelotas, Rio Grande do Sul State, Brazil, 2004]. / Fatores de risco para diabetes mellitus gestacional na coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 2004.

Consensus statements by various countries have reported age, obesity, and family history of diabetes mellitus as risk factors for gestational diabetes mellitus. Other factors remain controversial. The aim of this study was to investigate factors associated with gestational diabetes among mothers of newborns from the birth cohort in Pelotas, Rio Grande do Sul State, Brazil, in 2004. We interviewed 4,243 postpartum women in hospital, with a 0.5% refusal rate. Diagnosis of gestational diabetes was self-reported. Prevalence of gestational diabetes was 2.95% (95%CI: 2.53-3.64). Crude analysis using the chi-square test showed a direct association with age, schooling, socioeconomic status, and body mass index (BMI) and an inverse association with maternal height. Non-white color, family history of diabetes mellitus, smoking in the first and second trimesters, and physical activity before the pregnancy and in the first trimester were associated with the outcome. Adjusted hierarchical analysis using logistic regression showed an association with age, non-white color, higher schooling, family history of diabetes, and BMI. Height showed borderline significance. Smoking in the first and second trimesters showed a protective effect.

Fatores de risco para diabetes mellitus gestacional na coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 2004 / Risk factors for gestational diabetes mellitus in the birth cohort in Pelotas, Rio Grande do Sul State, Brazil, 2004

Consensus statements by various countries have reported age, obesity, and family history of diabetes mellitus as risk factors for gestational diabetesmellitus. Other factors remain controversial. The aim of this study was to investigate factors associated with gestational diabetes among mothersof newborns from the birth cohort in Pelotas, Rio Grande do Sul State, Brazil, in 2004. We interviewed 4,243 postpartum women in hospital, with a 0.5% refusal rate. Diagnosis of gestational diabetes was self-reported. Prevalence of gestational diabetes was 2.95% (95%CI: 2.53-3.64). Crude analysis using the chi-square test showed a direct association with age, schooling, socioeconomic status, and body mass index (BMI) and an inverse association with maternal height. Non-white color, family history of diabetes mellitus, smoking in the first and second trimesters, and physical activity before the pregnancy and in the first trimester were associated with the outcome. Adjusted hierarchical analysis using logistic regression showed an association with age, non-white color, higher schooling, family history of diabetes, and BMI. Height showed borderline significance. Smoking in the first and second trimesters showed a protective effect.

Consensos de diversos países referem idade, obesidade e história familiar de diabetes mellitus como fatores de risco para diabetes mellitus gestacional. Outros fatores permanecem controversos. O objetivo deste estudo foiinvestigar fatores associados ao diabetes mellitus gestacional entre mães dos recém-nascidos da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, em 2004. Foram entrevistadas 4.243 puérperas no hospital, havendo 0,5% de recusas. O diagnóstico de diabetes mellitus gestacional foi auto-referido. A prevalência de diabetes mellitus gestacional foi 2,95% (IC95%: 2,53-3,64). Análise bruta realizada por meio de testes quiquadrado mostrou associação direta com aumento da idade, escolaridade, nível econômico e índice de massa corporal (IMC) e inversa com altura materna. Cor nãobranca, história familiar de diabetes mellitus, tabagismo no primeiro e segundo trimestres e atividade físicaantes da gestação e no primeiro trimestre mostraramse associados. A análise ajustada hierarquizada realizadaatravés de regressão logística mostrou associação com maior idade, cor não branca, maior escolaridade, história familiar de diabetes mellitus e maior IMC. A altura ficou no limiar da significância. Tabagismo no primeiro e segundo trimestres foi protetor.

[Validity of self-reported gestational diabetes mellitus in the immediate postpartum]. / Validade do auto-relato de diabete mellitus gestacional no pós-parto imediato.

Studies based on self-reporting of risk factors or morbidity are useful in public health, due mainly to the low cost and ease of data collection, but the accuracy of the resulting data is important for the internal validity of the research. The aim of this study was to evaluate the agreement between self-reported gestational diabetes mellitus and prenatal care medical records (gold standard). Agreement was measured by sensitivity, specificity, accuracy, kappa statistic, and confidence intervals (95%CI). From July to December 2007, all the women who gave birth in three maternity hospitals in Pelotas, Rio Grande do Sul, Brazil, were visited in the immediate postpartum. 1,047 women were interviewed, of whom 872 were in possession of their prenatal care card; of these, 869 had their blood glucose recorded on the card. Mean age was 26.7 years. Prevalence of gestational diabetes mellitus based on the gold standard was 4.3% (95%CI: 3.0-5.8), while the self-reported rate was 4% (95%CI: 2.8-5.5). Sensitivity of self-reported gestational diabetes mellitus was 72.9% (95%CI: 55.9-86.2); specificity was 99% (95%CI: 98.1-99.6); accuracy 97.9% (95%CI: 96.7-98.7); kappa 74%. For this population, self-reported gestational diabetes mellitus is valid information and can be used in population-based studies.

Validade do auto-relato de diabete mellitus gestacional no pós-parto imediato / Validity of self-reported gestational diabetes mellitus in the immediate postpartum

Pesquisas com base no auto-relato de fatores de risco ou morbidade são úteis em saúde pública, principalmente pelo baixo custo e facilidade de coleta, no entanto a acurácia dos dados coletados é importante para a validade interna da investigação. O objetivo deste estudo foi avaliar a concordância entre o auto-relato de diabete mellitus gestacional e registros do cartão da gestante (padrão-ouro). A concordância foi medida por meio da sensibilidade, especificidade, acurácia, estatística kappa e intervalos de 95 por cento de confiança (IC95 por cento). De julho a dezembro de 2007, todas as mulheres que tiveram filhos em três maternidades de Pelotas, Rio Grande do Sul, Brasil, foram visitadas no pós-parto imediato. Entrevistaram-se 1.047 mulheres, das quais 872 portavam a carteira de gestante; destas, 869 possuíam registro de glicemia. A média de idade foi 26,7 anos. A prevalência de diabetes mellitus gestacional conforme padrão-ouro foi 4,3 por cento (IC95 por cento: 3,0-5,8) e auto-referida, 4 por cento (IC95 por cento: 2,8-5,5). A sensibilidade do auto-relato de diabetes mellitus gestacional foi 72,9 por cento (IC95 por cento: 55,9-86,2); especificidade, 99 por cento (IC95 por cento: 98,1-99,6); acurácia, 97,9 por cento (IC95 por cento: 96,7-98,7); kappa, 74 por cento. Para esta população, auto-relato de diabetes mellitus gestacional é uma informação válida e pode ser usada em estudos de base populacional.

Studies based on self-reporting of risk factors or morbidity are useful in public health, due mainly to the low cost and ease of data collection, but the accuracy of the resulting data is important for the internal validity of the research. The aim of this study was to evaluate the agreement between self-reported gestational diabetes mellitus and prenatal care medical records (gold standard). Agreement was measured by sensitivity, specificity, accuracy, kappa statistic, and confidence intervals (95 percentCI). From July to December 2007, all the women who gave birth in three maternity hospitals in Pelotas, Rio Grande do Sul, Brazil, were visited in the immediate postpartum. 1,047 women were interviewed, of whom 872 were in possession of their prenatal care card; of these, 869 had their blood glucose recorded on the card. Mean age was 26.7 years. Prevalence of gestational diabetes mellitus based on the gold standard was 4.3 percent (95 percentCI: 3.0-5.8), while the self-reported rate was 4 percent (95 percentCI: 2.8-5.5). Sensitivity of self-reported gestational diabetes mellitus was 72.9 percent (95 percentCI: 55.9-86.2); specificity was 99 percent (95 percentCI: 98.1-99.6); accuracy 97.9 percent (95 percentCI: 96.7-98.7); kappa 74 percent. For this population, self-reported gestational diabetes mellitus is valid information and can be used in population-based studies.

Non classical risk factors for gestational diabetes mellitus: a systematic review of the literature / Fatores de risco não clássicos para diabetes mellitus gestacional: uma revisão sistemática da literatura

Age, obesity and family history of diabetes are well known risk factors for gestational diabetes mellitus. Others are more controversial. The objective of this review is to find evidence in the literature that justifies the inclusion of these other conditions among risk factors. The MEDLINE, Cochrane, LILACS and Pan American Health Organization databases were searched, covering articles dating from between 1992 and 2006. Keywords were used in combination (AND) with gestational diabetes mellitus separately and with each one of the risk factors studied. The methodological quality of the studies included was assessed, resulting in the selection of 41 papers. Most studies investigating maternal history of low birth weight, low stature, and low level of physical activity have found positive associations with gestational diabetes mellitus. Low socioeconomic levels, smoking during pregnancy, high parity, belonging to minority groups, and excessive weight gain during pregnancy presented conflicting results. Publication bias cannot be ruled out. Standardization of techniques, cutoff points for screening and diagnosis, as well as studies involving larger sample sizes would allow future meta-analyses.

Idade, obesidade e história familiar de diabetes são fatores de risco bem conhecidos para diabetes mellitus gestacional. Outros são controversos. O objetivo desta revisão é encontrar evidências na literatura que justifiquem a inclusão dessas condições entre os fatores de risco. Bases de dados MEDLINE, Cochrane, LILACS e Organização Pan-Americana da Saúde foram procuradas. A revisão incluiu artigos de 1992 a 2006. Palavras-chave foram usadas em combinação com diabetes mellitus gestacional separadamente e com cada um dos fatores de risco estudados. A qualidade metodológica dos estudos incluídos foi medida, totalizando 41 estudos. A maioria dos trabalhos que investigaram história materna de baixo peso, baixa estatura e baixa atividade física encontrou associação positiva com diabetes mellitus gestacional. Baixo nível sócio-econômico, fumo durante a gestação, alta paridade, pertencer a minorias e excessivo ganho de peso apresentam resultados conflitantes. Padronização de técnicas, pontos de corte para rastreamento e diagnóstico, assim como estudos envolvendo maiores amostras podem permitir futuras metanálises.

Hospitalizations during infancy in three population-based studies in Southern Brazil: trends and differentials.

Three cohort studies of children born in the urban area of Pelotas, Southern Brazil, were carried out in 1982, 1993, and 2004. The aim of these studies was to measure the occurrence of hospitalization in the first year of life and to examine the association between hospitalization and the cause of admission and sex, birth weight, and family income. Cause of admission was categorized as "diarrhea" and "all other causes". The frequency of children hospitalized at least once during their first year of life was 19.6% in 1982, 18.1% in 1993, and 19.2% in 2004. There was a marked reduction in hospitalizations due to diarrhea, but the frequency of hospitalization for all causes remained constant. In all three cohorts, infants from poorer families and those born weighing under 2,000g showed the highest frequencies of hospitalization due to diarrhea and all other causes, and the latter also showed a marked increase in hospitalizations due to all causes. These findings could be explained by an epidemic of preterm births in the study population.

Hospitalizations during infancy in three population-based studies in Southern Brazil: trends and differentials / Internações hospitalares durante a infância em três estudos de base populacional no Sul do Brasil: tendências e diferenciais

Three cohort studies of children born in the urban area of Pelotas, Southern Brazil, were carried out in 1982, 1993, and 2004. The aim of these studies was to measure the occurrence of hospitalization in the first year of life and to examine the association between hospitalization and the cause of admission and sex, birth weight, and family income. Cause of admission was categorized as "diarrhea" and "all other causes". The frequency of children hospitalized at least once during their first year of life was 19.6 percent in 1982, 18.1 percent in 1993, and 19.2 percent in 2004. There was a marked reduction in hospitalizations due to diarrhea, but the frequency of hospitalization for all causes remained constant. In all three cohorts, infants from poorer families and those born weighing under 2,000g showed the highest frequencies of hospitalization due to diarrhea and all other causes, and the latter also showed a marked increase in hospitalizations due to all causes. These findings could be explained by an epidemic of preterm births in the study population.

Foram organizadas três coortes de crianças nascidas na área urbana de Pelotas, Rio Grande do Sul, em 1982, 1993 e 2004. O presente estudo teve como objetivos medir a ocorrência de hospitalização no primeiro ano de vida e estudar a associação entre hospitalização e causa de internação e sexo, peso ao nascer e renda familiar. As causas de internação eram categorizadas como "diarréia" e "todas as outras causas". As proporções de crianças hospitalizadas pelo menos uma vez durante o primeiro de ano de vida foram 19,6 por cento em 1982, 18,1 por cento em 1993 e 19,2 por cento em 2004. Houve uma redução marcante nas internações por diarréia, enquanto permanecia constante a freqüência de internações por todas as causas. Nas três coortes, as crianças de famílias mais pobres e aquelas que nasceram com peso abaixo de 2000g mostraram as freqüências mais elevadas de internações por diarréia e por todas as outras causas, e a coorte de 2004 também mostrou um aumento marcante nas internações por todas as causas. Os achados podem ser explicados por uma epidemia de nascimentos prematuros na população estudada.

Cobertura, foco, fatores associados à participação e vinculação à Campanha Nacional de Detecção de Diabetes em uma cidade no Sul do Brasil / Coverage, focus, risk factors associated with participation, and linkage to the National Campaign for Diabetes Detection in a city in Southern Brazil

Medir cobertura, foco, fatores associados à participação e vinculação à Campanha Nacional de Detecção de Diabetes Mellitus em Pelotas, sul do Brasil. Foram entrevistadas 3.100 pessoas na zona urbana de Pelotas, em estudo transversal de base populacional. Utilizaram-se diferentes critérios para cobertura: utilização, cobertura entre usuários estimados, cobertura entre usuários declarados. O foco foi a proporção dos testes realizados em pessoas que atendiam a critérios de inclusão. As coberturas encontradas foram: utilização 45,8 por cento (IC95 por cento: 43,0-48,5), cobertura entre usuários estimados 37,7 por cento (IC95 por cento: 35,1-40,5), cobertura entre usuários declarados 38,5 por cento (IC95 por cento: 35,2-41,9). O foco foi de 46,5 por cento (IC95 por cento: 42,8-50,2). Sexo feminino, maior idade e menor escolaridade foram associados com aderência à campanha. Dentre aqueles com rastreamento positivo e sem diagnóstico prévio, 42,4 por cento foram mais tarde vistos por médico e metade confirmou diagnóstico. A campanha teve baixa cobertura e foi pouco focalizada. Esforços devem ser concentrados em melhor atendimento aos já diagnosticados, vinculando-os aos serviços através de oferta regular de medicações e estratégias educativas.

The objective of this study was to measure coverage, focus, factors associated with participation, and linkage to the National Campaign for the Detection of Diabetes Mellitus in Pelotas, Southern Brazil. 3,100 individuals living within the city limits of Pelotas were interviewed in a cross-sectional study. Coverage was calculated based on different criteria: utilization, coverage among estimated users, and coverage among self-declared users. The focus was the proportion of tests performed in individuals who had met the inclusion criteria. Coverage rates were: utilization, 45.8 percent (95 percentCI: 43.0-48.5), among estimated users, 37.7 percent (95 percentCI: 35.1-40.5), and among self-declared users, 38.5 percent (95 percentCI: 35.2-41.9). Focus was 46.5 percent (95 percentCI: 42.8-50.2). Female gender, older age, and lower schooling were associated with adherence to the campaign. A total of 42.4 percent of individuals with positive screening tests but without prior diagnoses were subsequently examined by physicians, and half of the diagnoses were confirmed. The campaign showed a low coverage and poor focus. Efforts should be concentrated on improving care for individuals who have already been diagnosed, linking them to services by offering regular medication and educational strategies.

[Coverage, focus, risk factors associated with participation, and linkage to the National Campaign for Diabetes Detection in a city in Southern Brazil]. / Cobertura, foco, fatores associados à participação e vinculação à Campanha Nacional de Detecção de Diabetes em uma cidade no Sul do Brasil.

The objective of this study was to measure coverage, focus, factors associated with participation, and linkage to the National Campaign for the Detection of Diabetes Mellitus in Pelotas, Southern Brazil. 3,100 individuals living within the city limits of Pelotas were interviewed in a cross-sectional study. Coverage was calculated based on different criteria: utilization, coverage among estimated users, and coverage among self-declared users. The focus was the proportion of tests performed in individuals who had met the inclusion criteria. Coverage rates were: utilization, 45.8% (95%CI: 43.0-48.5), among estimated users, 37.7% (95%CI: 35.1-40.5), and among self-declared users, 38.5% (95%CI: 35.2-41.9). Focus was 46.5% (95%CI: 42.8-50.2). Female gender, older age, and lower schooling were associated with adherence to the campaign. A total of 42.4% of individuals with positive screening tests but without prior diagnoses were subsequently examined by physicians, and half of the diagnoses were confirmed. The campaign showed a low coverage and poor focus. Efforts should be concentrated on improving care for individuals who have already been diagnosed, linking them to services by offering regular medication and educational strategies.