Use of joinpoint regressions to evaluate changes over time in conscript height.

OBJECTIVES: Cohort variation in adult height expresses both the impact of socio-economic change on human biology in a wide temporal perspective and social inequalities within populations. We aimed to test the use of joinpoint regressions to identify periods in which changes in height trends were statistically significant. METHODS: Data correspond to the height recorded in Madrid City (Spain) for 65 313 conscripts between 1936 and 1974 (cohorts from 1915 to 1953), a period of social and political turmoil. Secular trends in height were analyzed in eight districts with contrasting socio-economic conditions, grouped in two categories, lower-class and middle- and upper-class. Trends in height were evaluated by quadratic regressions and by joinpoint regressions to identify the cut-off years when trends changed significantly. RESULTS: Height increased in both socio-economic categories of districts, more among conscripts from the lower-class ones. However, results clearly show differences in trends according to district of residence. Whereas the increase in height in conscripts from the middle- and upper-class districts was steady, it was slower in those from the lower classes, with declines in height during the Civil War and first years of the Franco dictatorship. CONCLUSIONS: Joinpoint analysis reveals the association between urban living conditions and adult height, and that the disparities intensified during critical historical periods of Spain.

Biological Well-Being during the "Economic Miracle" in Spain: Height, Weight and Body Mass Index of Conscripts in the City of Madrid, 1955-1974.

Typifying historical populations using anthropometric indicators such as height, BMI and weight allows for an analysis of the prevalence of obesity and malnutrition. This study evaluates secular changes in height, weight and body mass for men cohorts at 21 years old, born between 1934 and 1954 who were called up between 1955 and 1974, in the city of Madrid, Spain. In this study we prove the hypothesis that anthropometric variables increase thanks to improvement in diet and significant investments in hygiene and health infrastructure during the 1960s. The results of our analysis show a positive secular change in the trends for height (an increase of 4.67 cm), weight (6.400 kg) and BMI (0.90 Kg/m2), the result of a recovery in standards of living following the war and the autarchy of the 1940s. We also observed a slight trend towards obesity and a reduction in underweight categories at the end of the period is also observed. In conclusion, the secular trends of anthropometric variables in the city of Madrid reflect the recovery of living standards after the deterioration of the nutritional status suffered during the Spanish Civil War (1936-1939) and the deprivation of the autarchic period.

Low birthweight prevalence among Spanish women during the economic crisis: differences by parity.

Previous studies have demonstrated a negative, significant impact on birthweight associated with the current economic crisis in Spain, which has also been reported for other European countries. Effects by parity are not known. Our aim is to compare the trends in low birthweight (LBW) by parity in Spain from 1996 to 2016. Using the National Vital Statistics data, joinpoint regression analysis was used to identify the time periods of significant changes in the prevalence of LBW by parity. Adjusted relative risk (RR) of LBW by year of birth was calculated in order to confirm that the time trend differences in LBW by parity were independent of possible confounders. The prevalence of LBW among live births to primiparous increased from 5.12% to 6.87% in 2008 and then stabilised at maximum values, while among live births to multiparous LBW increased from 3.96% to a maximum of 5.20% and then significantly reduced. Trends in adjusted RR of LBW by parity confirm that primiparous and multiparous were affected differently by the economic crisis. Older, nulliparous women may have felt more biosocial pressure to reproduce during the economic crisis, compared to women who were already mothers. This biosocial pressure may have increased the risks for LBW.

Plasticity in the growth of body segments in relation to height-for-age and maternal education in Guatemala.

OBJECTIVES: Plasticity in the growth of body segments between populations has been researched in relation to migration, temporal change and high-altitude studies. We study the within population variation in body segments, thus controlling for some of the environmental and genetic differences that could be at play in between populations studies. We test a version of the thrifty phenotype hypothesis, where the growth of head-trunk and hand are prioritized due to their functional significance over height and leg growth. MATERIALS AND METHODS: A total of 3913 Guatemalan, rural, semi-urban and urban, Maya and Ladino children 6 to 15 years old were studied. Height, sitting height, leg length, and metacarpal length were studied in relation to three proxies for living conditions: height- and leg length-for-age, and maternal education. Estimation statistics and null hypothesis significance testing were used to analyze the data. RESULTS: Metatarsal length and sitting height values were higher than height and leg length respectively. Relative metacarpal length was conserved across height-for-age groups. Females were less affected than males for metacarpal length and sitting height, but more affected for leg length. CONCLUSION: Our results agree with the thrifty phenotype hypothesis, where metacarpal and sitting height growth would be prioritized over height and leg length due to greater functional significance.

Esteroides en extubación: ¿A quién? ¿Cómo? ¿Cuándo? / Steroids post-extubation: Who? How? When? / Esteróides na extubação: quem? Como e quando?

Resumen: El fracaso en la extubación es una complicación de alto riesgo para los pacientes en las Unidades de Cuidados Intensivos. El edema laríngeo y el estridor laríngeo han sido estudiados como causas que propician el fracaso en la extubación. Parte de las estrategias para la prevención del fracaso en la extubación y el manejo del estridor o edema laríngeo es el uso de esteroides. La discrepancia entre el tiempo, la dosis, el paciente candidato y el tipo de esteroide obligan a crear una propuesta que estandarice su utilización. La presente revisión se enfoca en identificar a aquellos pacientes que se benefician del uso de esteroides, el tipo de esteroide que se debe utilizar, el momento y la dosis correcta.

Abstract: Post-extubation failure is a high risk complication for patients in intensive care unit. Laryngeal edema and laryngeal stridor have been studied as causes of post-extubation failure. Part of the strategies for the prevention of post-extubation failure and management of stridor or laryngeal edema is the use of steroids. The discrepancy between the time, the dos, the patient and the type of steroid forces to create a strategy that standardizes its use. This review focuses on identify patients who benefit from the use of steroids, type of steroid that should be uses, timing and correct dose.

Resumo: O fracasso na extubação é uma complicação de alto risco para pacientes em unidades de terapias intensivas. O edema e o estridor laríngeo foram estudados como causas que propician a falha na extubação. Parte das estratégias para prevenção da falha na extubação e manejo do estridor ou edema laríngeo é o uso de esteróides. A discrepância entre o tempo, a dose, o paciente candidato e o tipo de esteróide nos obriga a criar uma proposta padrão de utilização. A presente revisão se concentra em identificar os pacientes que são beneficiados com o uso de esteróides, o tipo de esteróide que deve ser usado, o momento e a dose correta.

Estaturas generacionales y residencia por distritos en la ciudad de Madrid durante el siglo XX / Height cohorts and district of residence in the city of Madrid during the 20th century

Objetivo: en las últimas décadas se ha acumulado una interesante bibliografía sobre los niveles biológicos de vida en España a finales del siglo xix y durante el siglo xx. La talla ha sido una de las variables más estudiadas: su cambio a nivel nacional y provincial, el impacto de la Guerra Civil y de la posterior dictadura y las diferencias entre las áreas urbanas y las rurales. Queremos contribuir a este panorama general con este trabajo, una perspectiva intraurbana de la ciudad de Madrid. Métodos: presentamos el análisis comparativo del cambio temporal en la talla de los madrileños de los distritos de Salamanca y de Vallecas correspondientes al periodo 1936-1986. Resultados: en esos años, la talla total se incrementó en 5,58 cm, pasando de 166,40 a 171,98 cm, aunque se observan diferencias significativas entre ambos distritos; diferencias que se reducen (de 3,09 a 1,2 cm) entre Salamanca y Vallecas para los nacidos en 1915 y 1953, respectivamente. También se observa el efecto negativo de la Guerra Civil y de los años de autarquía. Conclusión: considerando estos primeros datos, junto a los disponibles para otras variables demográficas y socioeconómicas previas y posteriores al periodo estudiado, podemos considerar que la división por distritos representa una estratificación efectiva en los niveles biológicos de vida dentro de la ciudad de Madrid. Estos resultados constituyen una primera aproximación intraurbana con la talla al debate sobre la desigualdad y los niveles de vida en España durante el siglo XX

Objective: in recent decades, an interesting literature has accumulated regarding the biological living standard in Spain at the end of the 19th Century and during the 20th Century. Adult height has been one of the most studied variables, specifically its temporal change at the national and provincial levels, the impact of the Civil War and the subsequent dictatorship, and the differences between urban and rural areas. We want to contribute to this general overview with the presentation of a project about an intra-urban perspective of the city of Madrid. Methods: We present the stature data of the male population of two Madrid districts, Salamanca and Vallecas, for the period 1936-1986 (year of measurement). Results: In these years, height increased by 5.58 cm, from 166.40 to 171.98 cm, with significant differences observed between both districts as well as a simultaneous decrease of that difference, for those born in 1915 and 1953 from 3.09 to 1.2 cm. The negative effect of the Civil War and the years of autarky are also observed in this urban sample. Conclusion: Considering these data together with those available for other demographic and socioeconomic variables, before and after the period studied, we can conclude that the division by districts represents an effective stratification in the biological living standard of the population of the city of Madrid. These results constitute a first intra-urban approximation using height to the debate on inequality and biological living standards in Spain during the 20th Century

Social disparities in low birth weight among Spanish mothers during the economic crisis (2007-2015) / Disparidades sociales en bajo peso al nacer en madres españolas durante la crisis económica (2007-2015)

Objective: to evaluate the impact of the economic crisis on the disparities in the prevalence and risk of low birth weight (LBW) according to the maternal socioeconomic profile. Methods: the data analysed corresponds to 1,779,506 single births to Spanish mothers in the years 2007, 2009, 2011, 2013 and 2015. The temporal changes in available maternal-foetal variables are described. Secondly, the possible increase in disparities in prevalence and risk of LBW due to the occupation and education of the mother is evaluated, taking 2007 as the reference year. Results: a trend of the maternal profile is described among women who had children during this period, with an increasing contribution of highly qualified professional and educated women, a trend already existing before the economic crisis, but which was deepened by the recession. The prevalence of LBW increased in all socio-economic groups, with a marked increase in disparities during the worst years of the economic crisis. Conclusion: results confirm the persistence of social inequalities in perinatal health described prior to the economic crisis, as well as a possibly negative effect of the recession between 2007 and 2015. Results also confirm that disparities in LBW are more clearly associated with the educational level of mothers than with their occupation

Objetivo: evaluar el impacto de la crisis económica sobre las disparidades en la prevalencia y en el riesgo de bajo peso al nacer (BPN) en función del perfil socioeconómico materno. Métodos: los datos analizados corresponden a 1.779.506 partos simples de madres españolas ocurridos en los años 2007, 2009, 2011, 2013 y 2015. Se describe el cambio temporal en las variables materno-fetales disponibles. En segundo lugar, se evalúa el posible incremento de las disparidades por ocupación y educación maternas en prevalencias y riesgos relativos de BPN, considerando 2007 como el año de referencia. Resultados: se describe un cambio en el perfil de las mujeres que decidieron tener hijos durante este periodo, con una mayor presencia de madres de alta cualificación profesional y alto nivel educativo, una tendencia ya previa a la crisis económica, pero que la recesión ha radicalizado. La prevalencia de BPN aumentó en todos los grupos maternos, con un claro incremento de las disparidades durante los peores años de la crisis económica. Conclusión: se confirma la persistencia de desigualdades sociales en salud perinatal descritas antes de la crisis, así como el efecto negativo de la recesión en el periodo 2007-2015. Los resultados confirman, además, que las disparidades en BPN se asocian más claramente con el nivel educativo de las madres que con su ocupación

[Height cohorts and district of residence in the city of Madrid during the 20th century]. / Estaturas generacionales y residencia por distritos en la ciudad de Madrid durante el siglo XX.

OBJECTIVE: in recent decades, an interesting literature has accumulated regarding the biological living standard in Spain at the end of the 19th Century and during the 20th Century. Adult height has been one of the most studied variables, specifically its temporal change at the national and provincial levels, the impact of the Civil War and the subsequent dictatorship, and the differences between urban and rural areas. We want to contribute to this general overview with the presentation of a project about an intra-urban perspective of the city of Madrid. METHODS: We present the stature data of the male population of two Madrid districts, Salamanca and Vallecas, for the period 1936-1986 (year of measurement). RESULTS: In these years, height increased by 5.58 cm, from 166.40 to 171.98 cm, with significant differences observed between both districts as well as a simultaneous decrease of that difference, for those born in 1915 and 1953 from 3.09 to 1.2 cm. The negative effect of the Civil War and the years of autarky are also observed in this urban sample. CONCLUSION: Considering these data together with those available for other demographic and socioeconomic variables, before and after the period studied, we can conclude that the division by districts represents an effective stratification in the biological living standard of the population of the city of Madrid. These results constitute a first intra-urban approximation using height to the debate on inequality and biological living standards in Spain during the 20th Century.

Objetivo: en las últimas décadas se ha acumulado una interesante bibliografía sobre los niveles biológicos de vida en España a finales del siglo XIX y durante el siglo XX. La talla ha sido una de las variables más estudiadas: su cambio a nivel nacional y provincial, el impacto de la Guerra Civil y de la posterior dictadura y las diferencias entre las áreas urbanas y las rurales. Queremos contribuir a este panorama general con este trabajo, una perspectiva intraurbana de la ciudad de Madrid.Métodos: presentamos el análisis comparativo del cambio temporal en la talla de los madrileños de los distritos de Salamanca y de Vallecas correspondientes al periodo 1936-1986.Resultados: en esos años, la talla total se incrementó en 5,58 cm, pasando de 166,40 a 171,98 cm, aunque se observan diferencias significativas entre ambos distritos; diferencias que se reducen (de 3,09 a 1,2 cm) entre Salamanca y Vallecas para los nacidos en 1915 y 1953, respectivamente. También se observa el efecto negativo de la Guerra Civil y de los años de autarquía.Conclusión: considerando estos primeros datos, junto a los disponibles para otras variables demográficas y socioeconómicas previas y posteriores al periodo estudiado, podemos considerar que la división por distritos representa una estratificación efectiva en los niveles biológicos de vida dentro de la ciudad de Madrid. Estos resultados constituyen una primera aproximación intraurbana con la talla al debate sobre la desigualdad y los niveles de vida en España durante el siglo xx.

[Social disparities in low birth weight among Spanish mothers during the economic crisis (2007-2015)]. / Disparidades sociales en bajo peso al nacer en madres españolas durante la crisis económica (2007-2015).

OBJECTIVE: to evaluate the impact of the economic crisis on the disparities in the prevalence and risk of low birth weight (LBW) according to the maternal socioeconomic profile. METHODS: the data analysed corresponds to 1,779,506 single births to Spanish mothers in the years 2007, 2009, 2011, 2013 and 2015. The temporal changes in available maternal-foetal variables are described. Secondly, the possible increase in disparities in prevalence and risk of LBW due to the occupation and education of the mother is evaluated, taking 2007 as the reference year. RESULTS: a trend of the maternal profile is described among women who had children during this period, with an increasing contribution of highly qualified professional and educated women, a trend already existing before the economic crisis, but which was deepened by the recession. The prevalence of LBW increased in all socio-economic groups, with a marked increase in disparities during the worst years of the economic crisis. CONCLUSION: results confirm the persistence of social inequalities in perinatal health described prior to the economic crisis, as well as a possibly negative effect of the recession between 2007 and 2015. Results also confirm that disparities in LBW are more clearly associated with the educational level of mothers than with their occupation.

Objetivo: evaluar el impacto de la crisis económica sobre las disparidades en la prevalencia y en el riesgo de bajo peso al nacer (BPN) en función del perfil socioeconómico materno. Métodos: los datos analizados corresponden a 1.779.506 partos simples de madres españolas ocurridos en los años 2007, 2009, 2011, 2013 y 2015. Se describe el cambio temporal en las variables materno-fetales disponibles. En segundo lugar, se evalúa el posible incremento de las disparidades por ocupación y educación maternas en prevalencias y riesgos relativos de BPN, considerando 2007 como el año de referencia. Resultados: se describe un cambio en el perfil de las mujeres que decidieron tener hijos durante este periodo, con una mayor presencia de madres de alta cualificación profesional y alto nivel educativo, una tendencia ya previa a la crisis económica, pero que la recesión ha radicalizado. La prevalencia de BPN aumentó en todos los grupos maternos, con un claro incremento de las disparidades durante los peores años de la crisis económica. Conclusión: se confirma la persistencia de desigualdades sociales en salud perinatal descritas antes de la crisis, así como el efecto negativo de la recesión en el periodo 2007-2015. Los resultados confirman, además, que las disparidades en BPN se asocian más claramente con el nivel educativo de las madres que con su ocupación.

Impacto del seguimiento farmacoterapéutico para identificar los errores de medicación y disminuir eventos adversos en pacientes de terapia intensiva del Hospital H+ Querétaro / Impact of pharmacotherapeutic follow-up to identify the medication errors and decrease adverse events in patients of intensive care at H+ Querétaro Hospital / Impacto do seguimento farmacoterapêutico para identificar erros de medicação e diminuir eventos adversos em pacientes na Terapia Intensiva do Hospital H+ Querétaro

Resumen: Introducción: El error de medicación es toda desviación en el proceso del uso de medicamentos que son administrados al paciente. Los errores de medicación son una causa frecuente de eventos adversos en el paciente. Objetivo: Identificar la relación del seguimiento farmacoterapéutico en la detección de errores de medicación con el incremento del número de intervenciones para la prevención de eventos adversos en pacientes de la unidad de terapia intensiva (UTI). Material y método: Se determinó la tasa de errores de medicación con el fin de obtener el valor basal (periodo 1), posteriormente se evaluó un segundo periodo (periodo 2), en el cual el seguimiento farmacoterapéutico se incrementó con la búsqueda intencionada de los errores de medicación. La identificación, clasificación y registro se llevó a cabo de acuerdo con la taxonomía de NCC MERP con ayuda del seguimiento farmacoterapéutico en cada uno de los pacientes. Resultados: En el periodo 1 se identificó un total de 107 errores de medicación, mismos que representaron una tasa de errores de 514.42 por 1,000 días/paciente, con una tasa de intervenciones de 52.88 por 1,000 días/paciente. En el periodo 2 se observó una tasa de 950.76 por 1,000 días/paciente, con una tasa de intervenciones de 132.58 por 1,000 días/paciente. En ninguno de los dos periodos se identificaron errores que produjeran daño en los pacientes. Conclusiones: La búsqueda intencionada de errores de medicación e intervenciones farmacéuticas favorecen la seguridad del uso de medicamentos, lo que ayuda a prevenir los eventos adversos asociados en pacientes de la unidad de terapia intensiva.

Abstract: Introduction: Medication error is all deviation in the process of using medications that are administered to the patient; the medication errors are a frequent cause of adverse events in the patient. Objective: To identify the relationship of pharmacotherapeutic monitoring in the detection of medication errors with the increase in the number of interventions for the prevention of adverse events in patients of the Intensive Care Unit. Material and method: The medication error rate was determined in order to obtain the baseline value (period 1), then a second period (period 2) was evaluated in which the pharmacotherapeutic follow-up was increased with the intentional search for medication errors. The identification, classification and registration were carried out according to the NCC MERP taxonomy with the help of the pharmacotherapeutic follow-up to each of the patients. Results: In period 1, a total of 107 medication errors were identified, representing an error rate of 514.42 per 1,000 days/patient, with a rate of interventions of 52.88 per 1,000 days/patient. For period 2 a rate of 950.76 per 1,000 days/patient was found, with a rate of interventions of 132.58 per 1,000 days/patient. In either period, an error was identified that caused damage in the patients. Conclusions: The intentional search for medication errors and pharmaceutical interventions favor the safety in the use of the drugs helping to prevent the adverse events associated with its use in patients of the intensive care unit.

Resumo: Introdução: O erro de medicação é qualquer desvio no processo de utilização de medicamentos que são administrados aos pacientes, os erros de medicação são uma causa comum de eventos adversos no paciente. Objetivo: Identificar a relação do seguimento farmacoterapêutico na detecção de erros de medicação com o aumento do número de intervenções para a prevenção de eventos adversos em pacientes na unidade de terapia intensiva. Material e método: Determinou-se a taxa de erros de medicação a fim de obter a linha de base (período 1), avaliou-se posteriormente um segundo período (período 2) em que o acompanhamento farmacoterapêutico aumentou com a busca deliberada de erros de medicação. A identificação, classificação e registo foram realizados de acordo com a taxonomia do NCC MERP com ajuda do seguimento farmacoterapêutico para cada um dos pacientes. Resultados: No período 1, identificamos um total de 107 erros de medicação, o que representou uma taxa de 514.42 erros por 1,000 dias/paciente, com uma taxa intervenção de 52.88 por 1,000 dias/paciente. Para o período 2 foi encontrada 950.76 para 1,000 dias/paciente, com uma taxa de intervenção de 132.58 por 1,000 dias/pacientes. Não identificamos em nenhum dos dois períodos um erro que produzisse danos aos pacientes. Conclusões: A busca intencional por erros de medicação e intervenções farmacêuticas favorecem a segurança no uso de medicamentos, ajudando a prevenir os eventos adversos associados ao seu uso em pacientes na unidade de terapia intensiva.

The impact of delayed maternity on foetal growth in Spain: An assessment by population attributable fraction.

BACKGROUND: Delayed childbearing is considered a risk factor for maternal-foetal health. As in other higher-income countries, in Spain age at maternity has steadily increased during the last two decades. AIM: To quantify the impact of the delay in the age at maternity on small for gestational age (SGA) categories of <3rd, 3rd-5th and 5th-10th percentiles. METHODS: 2,672,350 singleton live births born to Spanish mothers in 2007-2015 were analysed. Adjusted relative risk was calculated to estimate the adjusted partial population attributable fractions (PAFp) for mothers aged 35-39 and ≥40 years for each category of SGA considering the interaction between age at maternity and parity. FINDINGS: Primipara 35-39 years old mothers have the highest PAFp in the three categories of SGA, with the maximum value for SGA <3rd percentile (2.57%, 95% CI 2.25, 2.88). PAFp for both primipara and multipara ≥40 years old mothers were less than 1%. PAFp for primipara older mothers increased significantly in 2007-2015 for the three categories of SGA, more clearly among those aged 35-39 years. The contribution of multipara mothers of both age groups did not increase significantly during the period. CONCLUSION: Delayed maternity is a significant adjusted risk factor for SGA, contributing to the increase of its prevalence. However, results also suggest a limited clinical impact of delayed maternity on foetal growth. Positive changes in maternal profile associated with the shift in maternal age might contribute to explain the limited impact of mothers aged 35 years and older on negative birth outcome in Spain.

New birthweight charts according to parity and type of delivery for the Spanish population / Nuevas curvas de peso al nacer por paridad y tipo de parto para la población española

Objective: Birthweight by gestational age charts enable fetal growth to be evaluated in a specific population. Given that maternal profile and obstetric practice have undergone a remarkable change over the past few decades in Spain, this paper presents new Spanish reference percentile charts stratified by gender, parity and type of delivery. They have been prepared with data from the 2010-2014 period of the Spanish Birth Statistics Bulletin. Methods: Reference charts have been prepared using the LMS method, corresponding to 1,428,769 single, live births born to Spanish mothers. Percentile values and mean birth weight are compared among newborns according to gender, parity and type of delivery. Results: Newborns to primiparous mothers show significantly lower birthweight than those born to multiparous mothers (p<0.036). Caesarean section was associated with a substantially lower birthweight in preterm births (p<0.048), and with a substantially higher birthweight for full-term deliveries (p<0.030). Prevalence of small for gestational age is significantly higher in newborns born by Caesarean section, both in primiparous (p<0.08) and multiparous mothers (p<0.027) and, conversely, the prevalence of large for gestational age among full-term births is again greater both in primiparous (p<0.035) and in multiparous mothers (p<0.007). Conclusions: Results support the consideration of establishing parity and type of delivery-specific birthweight references. These new charts enable a better evaluation of the impact of the demographic, reproductive and obstetric trends currently in Spain on fetal growth (AU)

Objetivo: Las tablas de peso al nacer por edad gestacional permiten evaluar el crecimiento fetal en una población específica. Dado que el perfil materno y la práctica obstétrica han experimentado un sustancial cambio en las últimas décadas en España, este trabajo propone nuevas tablas de referencia de percentiles estratificadas por sexo, paridad y tipo de parto, elaboradas con los datos del periodo 2010-2014 del Boletín Estadístico de Partos. Métodos: Las curvas de referencia han sido elaboradas mediante el método LMS, correspondientes a 1.428.769 nacidos vivos de partos simples y madres españolas. Se comparan los valores por percentiles y la media del peso al nacer, por sexo, paridad y tipo de parto. Resultados: Los nacidos de madres primíparas muestran un peso menor que los nacidos de multíparas (p<0,036). Los nacidos pretérmino por cesárea tienen un peso menor que los nacidos pretérmino por parto vaginal (p<0,048), mientras que ocurre lo contrario en los nacidos a término (p<0,030). La prevalencia de nacidos pequeños para la edad gestacional es mayor entre los nacidos por cesárea de madres tanto primíparas (p<0,08) como multíparas (p<0,027), y la prevalencia de nacidos grandes para la edad gestacional es mayor entre los nacidos a término de madres tanto primíparas (p<0,035) como multíparas (p<0,007). Conclusiones: Los resultados apoyan establecer referencias de peso al nacer por paridad y tipo de parto. Estas nuevas curvas permiten una mejor evaluación del impacto de las actuales tendencias demográficas, reproductivas y obstétricas en España sobre el crecimiento fetal (AU)

New birthweight charts according to parity and type of delivery for the Spanish population.

OBJECTIVE: Birthweight by gestational age charts enable fetal growth to be evaluated in a specific population. Given that maternal profile and obstetric practice have undergone a remarkable change over the past few decades in Spain, this paper presents new Spanish reference percentile charts stratified by gender, parity and type of delivery. They have been prepared with data from the 2010-2014 period of the Spanish Birth Statistics Bulletin. METHODS: Reference charts have been prepared using the LMS method, corresponding to 1,428,769 single, live births born to Spanish mothers. Percentile values and mean birth weight are compared among newborns according to gender, parity and type of delivery. RESULTS: Newborns to primiparous mothers show significantly lower birthweight than those born to multiparous mothers (p<0.036). Caesarean section was associated with a substantially lower birthweight in preterm births (p<0.048), and with a substantially higher birthweight for full-term deliveries (p<0.030). Prevalence of small for gestational age is significantly higher in newborns born by Caesarean section, both in primiparous (p<0.08) and multiparous mothers (p<0.027) and, conversely, the prevalence of large for gestational age among full-term births is again greater both in primiparous (p<0.035) and in multiparous mothers (p<0.007). CONCLUSIONS: Results support the consideration of establishing parity and type of delivery-specific birthweight references. These new charts enable a better evaluation of the impact of the demographic, reproductive and obstetric trends currently in Spain on fetal growth.

Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003-2012).

BACKGROUND: There is growing evidence of the impact of the current European economic crisis on health. In Spain, since 2008, there have been increasing levels of impoverishment and inequality, and important cuts in social services. AIM: The objective is to evaluate the impact of the economic crisis on underweight at birth in Spain. METHOD: Trends in underweight at birth were examined between 2003 and 2012. Underweight at birth is defined as a singleton, term neonatal weight lesser than -2 SD from the median weight at birth for each sex estimated by the WHO Standard Growth Reference. Using data from the Statistical Bulletin of Childbirth, 2 933 485 live births born to Spanish mothers have been analysed. Descriptive analysis, seasonal decomposition analysis and crude and adjusted logistic regression including individual maternal and foetal variables as well as exogenous economic indicators have been performed. RESULTS AND CONCLUSIONS: Results demonstrate a significant increase in the prevalence of underweight at birth from 2008. All maternal-foetal categories were affected, including those showing the lowest prevalence before the crisis. In the full adjusted logistic regression, year-on-year GDP per capita remains predictive on underweight at birth risk. Previous trends in maternal socio-demographic profiles and a direct impact of the crisis are discussed to explain the trends described.

Altitude effect on birth weight and prematurity in the Province of Catamarca (Argentina).

OBJECTIVES: To analyze the effect of altitude on weight and prematurity at birth in the Province of Catamarca (Argentina), between the years 1994 and 2003. METHODS: Records of 22,628 newborns were collected from the vital statistics of the census of Catamarca. Weight was recategorized to include low birth weight (<2,500 g), and gestational age was divided into births that had occurred before or after 37 weeks (preterm or at term births). Altitude was also recategorized (<1,500 m, 1,500-2,000 m, and > 2,000 m). Nonparametric statistical tests were performed. RESULTS: Differences were found in birth weight between sexes and in the incidence of low birth weight depending on altitude. This pattern changed according to gestational age, because those sexual differences were nonexistent or lower in preterm neonates with certain advantages for females. Moreover, it was found that the effects of hypoxia were not reflected in birth weight until later stages of intrauterine development. CONCLUSIONS: To be female appears to be a benefit under conditions of prematurity and high altitude. The increased incidence of prematurity due to altitude increase may reflect an adaptive advantage of preterm birth under these conditions.