Hydroxychloroquine with azithromycin in patients hospitalized for mild and moderate COVID-19.

OBJECTIVES: To assess the efficacy of hydroxychloroquine in combination with azithromycin in terms of clinical and biochemical outcomes in adult patients with COVID-19 hospitalized for acute respiratory distress syndrome (ARDS), and to describe the occurrence of adverse events. METHOD: Retrospective comparative study, based in a quaternary private hospital in Rio de Janeiro, Brazil, involving 193 adult patients hospitalized for mild and moderate COVID-19 related ARSD, analyzing treatment efficacy based on clinical and biochemical outcomes. RESULTS: The active group comprised 101 (52.3%) patients using hydroxychloroquine associated with azithromycin and the control group 92 (47.7%) patients who did not take these medications. Median age was 59 (47-70) in the active group and 65 (47-77) in the control group (p < 0.05). Patients in the control group had greater extent of pulmonary involvement on baseline chest CT scans (p < 0.05). All other baseline variables (BMI, comorbidities, previous use of medications and biochemical assessments) were similar between groups. In the medication group, 25% (25 out of 101) were admitted to the ICU, compared to 21% (19 out of 92) in the control group (p > 0.05). No difference in mortality, duration of non-invasive oxygen use or duration of hospitalization was seen between groups. The therapeutic regimen was well tolerated, with only eight (7.9%) patients presenting gastrointestinal symptoms and eight (7.9%) patients withdrawn treatment due to QTc prolongation. CONCLUSIONS: Patients treated with hydroxychloroquine combined with azithromycin and the control group had similar clinical outcomes. This therapeutic regimen was considered ineffective in hospitalized patients with mild to moderate COVID-19 related ARDS and was associated with few non-severe adverse events.

Hydroxychloroquine with azithromycin in patients hospitalized for mild and moderate COVID-19

ABSTRACT Objectives: To assess the efficacy of hydroxychloroquine in combination with azithromycin in terms of clinical and biochemical outcomes in adult patients with COVID-19 hospitalized for acute respiratory distress syndrome (ARDS), and to describe the occurrence of adverse events. Method: Retrospective comparative study, based in a quaternary private hospital in Rio de Janeiro, Brazil, involving 193 adult patients hospitalized for mild and moderate COVID-19 related ARSD, analyzing treatment efficacy based on clinical and biochemical outcomes. Results: The active group comprised 101 (52.3%) patients using hydroxychloroquine associated with azithromycin and the control group 92 (47.7%) patients who did not take these medications. Median age was 59 (47-70) in the active group and 65 (47−77) in the control group (p < 0.05). Patients in the control group had greater extent of pulmonary involvement on baseline chest CT scans (p < 0.05). All other baseline variables (BMI, comorbidities, previous use of medications and biochemical assessments) were similar between groups. In the medication group, 25% (25 out of 101) were admitted to the ICU, compared to 21% (19 out of 92) in the control group (p > 0.05). No difference in mortality, duration of non-invasive oxygen use or duration of hospitalization was seen between groups. The therapeutic regimen was well tolerated, with only eight (7.9%) patients presenting gastrointestinal symptoms and eight (7.9%) patients withdrawn treatment due to QTc prolongation. Conclusions: Patients treated with hydroxychloroquine combined with azithromycin and the control group had similar clinical outcomes. This therapeutic regimen was considered ineffective in hospitalized patients with mild to moderate COVID-19 related ARDS and was associated with few non-severe adverse events.

Non-Hodgkin lymphoma among Brazilian agricultural workers: A death certificate case-control study.

To estimate the non-Hodgkin lymphoma (NHL) mortality risk among agricultural workers in Brazil's southern states, we used death certificates to identify cases of NHL between the ages of 20 and 69 years from residents of nonurban municipalities between 1996 and 2005 (n = 1,317). Controls were randomly selected from those whose underlying cause of death did not include neoplasm or hematological diseases and paired with cases by sex, age, year of death, and state of residence (n = 2,634). Odds of being an agricultural worker among cases and controls were estimated by conditional logistic regression, stratified and adjusted by sex, state, education, and race. An increased risk of death by NHL was observed among agricultural workers 20-39 years old (ORadj = 2.06; 95% CI 95%, 1.20-3.14). Our results suggest that the young agricultural workers from southern Brazil were more likely to die of NHL compared to nonagricultural workers.

Projeto-piloto do primeiro inquérito nacional de populações expostas a substâncias químicas, 2008-2009 / Pilot study of the first national survey of populations exposed to chemicals, 2008-2009 / Proyecto piloto de la primera encuesta nacional de poblaciones expuestas a substancias químicas, 2008-2009

Para viabilizar a futura realização de um Inquérito Nacional de Populações Expostas a Substâncias Químicas, executou-se um projeto-piloto para examinar a exequibilidade, testar e adequar metodologias e estabelecer parcerias. Foram realizados três estudos de corte transversal, respectivamente, com doadores de sangue residentes na Região Metropolitana de São Paulo-SP, conscritos do Exército Brasileiro e crianças escolares residentes no município do Rio de Janeiro-RJ, mediante aplicação de questionários e coleta de material biológico (sangue venoso e capilar, unha e cabelo) para análise de metais e compostos organoclorados persistentes. Concluiu-se que é viável a realização de um Inquérito Nacional, embora a estratégia de obtenção das amostras biológicas deva ser definida para cada subgrupo da população. Recomenda-se aproveitar as estruturas de serviços existentes para obtenção de amostras, utilizar matrizes tradicionais para maior comparabilidade e garantir sua realização periódica.

To enable the future establishment of a National Survey of Populations Exposed to Chemical Substances, a pilot study was conducted to assess the feasibility, to test and adjust methodologies, and to establish partnerships. Three cross-sectional studies were performed: with blood donors residents in the Metropolitan Region of São Paulo, Brazilian army conscripts and schoolchildren living in the city of Rio de Janeiro, by applying a questionnaire and collecting biological material (capillary and venous blood, nail and hair) for the analysis of metals and persistent organochlorine compounds. We concluded that it is feasible to carry out a National Survey, but the strategy for obtaining the biological samples must be set for each sub-group of the population. Moreover, it is recommended to take advantage of the structures of existing services for obtaining samples to maintain the comparability and ensure their periodicity.

Para hacer viable la futura realización de una Encuesta Nacional de Poblaciones Expuestas a Sustancias Químicas, se ejecutó un proyecto piloto para examinar la posibilidad de ejecutar, probar y adecuar metodologías y establecer colaboraciones. Se realizaron tres estudios de corte transversal, respectivamente, con donantes de sangre residentes en la Región Metropolitana de São Paulo-SP, conscriptos del Ejército Brasileño y niños escolares residentes en el municipio de Rio de Janeiro-RJ, mediante aplicación de cuestionarios y colecta de material biológico (sangre venosa y capilar, uña y pelo) para análisis de metales y compuestos organoclorados persistentes. Se concluye que es viable la realización de una Encuesta Nacional, aunque la estrategia para la obtención de las muestras biológicas deba ser definida para cada subgrupo de la población. Se recomienda aprovechar las estructuras de servicios existentes para obtener las muestras, utilizar matrices tradicionales para una mejor comparación y garantizar su realización periódica.

Stomach cancer mortality among agricultural workers: results from a death certificate-based case-control study / Mortalidade por câncer de estômago em agricultores: resultados de estudo caso-controle baseado em certificado óbito

INTRODUCTION: Pesticide consumption is very high in Brazil. OBJECTIVE: The present study investigated the stomach cancer mortality among Brazilian agricultural workers in Rio de Janeiro state. METHODS: In this case-control study, cases were individuals of both genders, aged ≥20 years, for whom cause of death was ascertained as stomach cancer. Controls were individuals with causes of death other than neoplasm and diseases of the digestive system. Crude and adjusted analyses were carried out. Stomach cancer mortality risk was then estimated for the agricultural workers according to the pesticide expenditures per municipality. RESULTS: Agricultural workers showed an elevated risk of stomach cancer mortality (adjusted OR=1.42; 95%CI: 1.33-1.78). This risk was higher among male workers, aged 50-69 years, white, and among workers with 1-7 years of education. Results also showed increasing stomach cancer mortality along with the increase of pesticide expenditure per agricultural worker. CONCLUSION: Stomach cancer risk among agricultural workers may be associated with pesticide exposure. .

INTRODUÇÃO: O consumo de agrotóxicos é muito alto no Brasil. OBJETIVO: O presente estudo teve por objetivo investigar o risco de morte por câncer de estômago em trabalhadores agrícolas residentes no estado do Rio de Janeiro. MÉTODOS: Neste estudo do tipo caso-controle, casos consistiram em indivíduos de ambos os sexos com 20 anos ou mais, cuja causa de morte foi câncer de estômago. Controles foram indivíduos cuja causa de morte não tenha consistido em qualquer neoplasia ou doenças do sistema digestivo. Análises brutas e ajustadas foram realizadas. O risco de morte por câncer de estômago foi, em seguida, estimado para trabalhadores agrícolas de acordo com a exposição a agrotóxicos e local de residência. RESULTADOS: Trabalhadores agrícolas apresentaram um aumento no risco de morte por câncer de estômago: OR ajustada=1,42 (IC95%: 1,33-1,78). Esse risco foi ainda maior entre homens brancos entre 50 a 69 anos e entre trabalhadores agrícolas com 1 a 7 anos de estudo. Os resultados também mostraram um aumento no risco de morte por câncer de estômago em trabalhadores agrícolas com o aumento da exposição a agrotóxicos. CONCLUSÃO: O risco de morte por câncer de estômago entre trabalhadores agrícolas pode estar associado com exposição a agrotóxicos. .

Pesticide use and non-Hodgkin's lymphoma mortality in Brazil.

INTRODUCTION: Brazil is one of the major pesticide consumers in the world. The continuous exposure to these substances may be etiologically associated with the development of Non-Hodgkin's Lymphoma (NHL). OBJECTIVE: Estimate the correlation between the per capita sales of pesticides in 1985 (exposure) and NHL mortality rates between 1996 and 2005 (outcome), by Brazilian micro-regions. METHOD: In this ecological descriptive study, the per capita consumption of pesticides in 1985 was used as a proxy of the population exposure to these chemicals in Brazil. All deaths by NHL occurred in the 446 non-urban micro-regions, between 1996 and 2005, among individuals with ages between 20 and 69, of both sexes, were retrieved from the Brazilian Mortality Information System. Micro-regions were then categorized into low, medium, high and very high pesticide consumption, according to the quartiles of per capita consumption of pesticides. NHL mortality rates and rate ratios for each quartile were obtained using the lowest quartile as reference. In addition, the Spearman's correlation coefficient between pesticide consumption and NHL mortality rates was estimated. RESULTS: A moderate correlation between per capita pesticides consumption and standardized mortality rate for NHL was observed (r=0.597). In addition, using the lowest quartile of pesticide consumption as a reference, the higher the quartile of pesticide consumption, the higher was NHL mortality risk: men - (second quartile - MRR=1.69, CI 95% 1.68-1.84; third quartile - MRR=2.41, CI 95% 2.27-2.57; fourth quartile - MRR=2.92, CI 95% 2.74-3.11) and females (second quartile - MRR=1.87, CI 95% 1.69-2.06; third quartile - MRR=2.28, IC 95% 2.10-2.47; fourth quartile - MRR=3.20; CI 95% 2.98-3.43). CONCLUSION: Our results suggest that pesticide exposure may play a role in the etiology of NHL.

Pesticide exposure and low birth weight prevalence in Brazil.

INTRODUCTION: Brazil is one of the major global consumers of pesticides and exposure to these substances can affect fetal growth. OBJECTIVE: To estimate the correlation between pesticide sales in 1996 and the prevalence of low birth weight during the period 1996-1998 in Brazil. METHOD: This ecological study employed secondary data aggregated at the level of Brazilian micro-regions (cluster of cities). Prevalence of low birth weight in 1996, 1997, and 1998 was obtained from the Brazilian health databases, and per capita pesticides sales in 1996 obtained from the Brazilian Institute of Geography and Statistics were utilized as an indirect measure of population exposure to these chemicals. Spearman correlation coefficient and Prevalence Ratio by quartiles were estimated, considering per capita pesticide sales and the prevalence of low birth weight. RESULTS: A total of 552 micro-regions were analyzed (446 non-urban and 106 urban). In rural areas, the per capita pesticide sales were directly associated with higher prevalence of children born with low birth weight (r=0.403), with birth weights between 1500 and 2500 grams (r=0.366), and very low birth weight birth (r=0.476). All correlations were statistically significant (p<0.001). On the other hand, in urban areas there was no significant correlation. There was a gradual increase in the prevalence of low birth weight according to the quartiles of pesticide consumption. CONCLUSIONS: Pesticide per capita sales may affect the prevalence of newborns with low birth weight in non-urban micro-regions of Brazil, indicating the need to strengthen policies and actions to protect the health of populations exposed to pesticides.

Mortalidade em agricultores residentes em microrregiões produtoras de soja no Brasil / Mortality among residents of farmers in soybean producing micro in Brazil

O Brasil é o segundo maior produtor de soja no mundo. Atualmente a soja tem grande importância para economia Brasileira. Este grão é um dos principais produtos de exportação do país. É uma cultura altamente mecanizada e também responsável pelo consumo de 40 por cento dos agrotóxicos utilizados no Brasil, em especial herbicidas. Em 2010, o Brasil atingiu a posição de maior consumidor de agrotóxicos no mundo. Embora a produção de soja tenha sofrido grande impulso ao longo das últimas décadas e seja um dos principais alvos do intenso consumo de agrotóxicos, poucos estudos, até o momento, avaliaram a saúde de agricultores de soja frente à intensa exposição a estes compostos químicos. Desta forma, este estudo teve como objetivo avaliar a mortalidade por suicídio e câncer entre os trabalhadores agrícolas residentes em microrregiões de intensa produção de soja, em relação à mortalidade de três populações de referência: população não agrícola residente na mesma área, trabalhadores agrícolas e população não agrícola residente em microrregiões não produtoras de soja. Para tanto, calculou-se a Razão de Chance de Mortalidade (RCM) por suicídio (códigos CID-10: x64-67) e pelas principais neoplasias (capítulo II) da 10ª edição da Classificação Internacional de Doenças (CID-10),estratificada por sexo e idade. Como principais resultados, observou-se que agricultores residentes em regiões de intensa produção de soja apresentaram um maior risco de morrer por suicídio, quando comparados com as três populações de referência. (...) Estes resultados sugerem que trabalhadores agrícolas das regiões de intensa produção de soja apresentaram maior risco de morte tanto para suicídios quanto para algumas neoplasias em relação às populações de referência estudadas...

Brazil is the second largest soybean producer in the world. Currently, soybean has a greatimportance to the Brazilian economy. This grain is one of the major export products of thecountry. Its production is highly mechanized, and it is also responsible for 40% of all pesticidesconsumed in Brazil, especially herbicides. In 2010, Brazil was the largest consumer of pesticidesworldwide. Although soybean production has increased over the last decades and is a majortarget of intense pesticide use, so far, few studies have assessed the health of soybean agriculturalworkers facing intensive exposure to these chemicals. Therefore, this study aimed to assessmortality from suicide and cancer among agricultural workers living in micro-regions of intensivesoybean production versus the mortality in three reference populations: non-agriculturalpopulation residing in the same area, agricultural workers and people residing in micro-regionsthat do not produce soybeans. In order to that, we calculated the mortality odds ratio (MOR),stratified by sex and age, for suicides (codes: x64-67) and the sites of cancers in Chapter II of the10th edition of International Classification of Diseases (ICD-10). Results showed that agriculturalworkers of intensive-production soybeans displayed a higher risk of dying by suicide, comparedwith three reference populations. Stratified analysis revealed that the highest risk of death bysuicide occurred among male younger farmers (10-19 years) compared to non-farmers living inmicro-regions that do not produce soybean (MOR: 3.17; 95 percent CI: 2.31 to 4.24). (...) Theseresults suggest that workers in regions of intense production of soybeans had higher risk of deathfor both suicides and for some cancers in relation to the reference populations studied...

Informação sobre ocupação em registros hospitalares de câncer no estado do Rio de Janeiro / Information on occupation in hospital cancer records in Rio de Janeiro State

O câncer representa atualmente a terceira causa de morte no mundo, constituindo-se assim em fundamental questão de saúde pública. O objetivo do presente artigo foi caracterizar a população de estudo por neoplasias e avaliar o percentual de preenchimento das informações contidas nos prontuários, com destaque para a ocupação, dos pacientes residentes nos municípios, das microrregiões II e III, da Região Serrana do Estado do Rio de Janeiro, diagnosticados no ano de 2006. Neste estudo de série de casos hospitalares, foram coletadas informações sobre casos incidentes de câncer, no ano de 2006, entre indivíduos maiores de 18 anos, residentes em municípios, das microrregiões II e III, da Região Serrana. Tais indivíduos foram atendidos em hospitais públicos e conveniados com o Sistema Único de Saúde (SUS) dos municípios de Nova Friburgo, Teresópolis e Rio de Janeiro. Nosso estudo observou que, em homens, 50% dos tumores hematológicos avaliados ocorreram em trabalhadores do setor industrial. Além disso, também foi observada a ocorrência de 25% dos casos de câncer nos órgãos digestivos em trabalhadoras do sexo feminino do setor agropecuário. Este estudo teve como principal contribuição apontar a necessidade de melhoria no preenchimento dos prontuários hospitalares, pois eles são uma importante fonte de pesquisa para o melhor entendimento da etiologia do câncer no que tange aos fatores ocupacionais.

Esophageal cancer among Brazilian agricultural workers: case-control study based on death certificates.

Several studies suggest that agricultural workers are at higher risk to develop and die by certain types of cancer. Esophageal cancer is not commonly listed among these types. However, some recent studies indicated that if there is an association between agricultural working and esophageal cancer, it s more likely to be observed among workers highly exposed to pesticides. In the present study, the magnitude of the association between agricultural working and esophageal cancer mortality was evaluated in a high pesticide use area in Brazil, through a death certificate-based case-control study. Cases were individuals from both genders, 30-59 years old, for whom basic cause of death was ascertained as cancer of the esophagus. For each case, one control was randomly selected from all possible controls for which the basic cause of death was ascertained as different from neoplasm and diseases of the digestive system. In addition, controls matched their cases by sex, age, year of death, and state of residence. Crude and adjusted odds ratios were then calculated to estimate the magnitude of the risk. Results showed that, in general, agricultural workers were at significantly higher risk to die by esophageal cancer, when compared to non-agricultural workers. Stratified analysis also revealed that the magnitude of such risk was slightly higher among illiterate agricultural workers, and simultaneous adjustment for several covariates showed that the risk was quantitatively higher among younger southern agricultural workers. These results suggest the esophageal cancer may be included among those types of cancer etiologically associated to agricultural working.

Pesticide sales and adult male cancer mortality in Brazil.

In Brazil, where the use of pesticide grows rapidly, studies that evaluate the impact of pesticide exposure on cancer incidence and mortality are very scarce. In this study, we evaluated the degree of correlation between pesticide sales in 1985 in eleven Brazilian states and cancer mortality rates during 1996-1998. Information of all cancer deaths occurred in men 30-69 years old from 1996 to 1998 were collected from National Mortality System. Single and multiple linear regression coefficients were obtained to assess the relationship between per capita sales of pesticides in 1985, specific-site cancer mortality rates (prostate, soft tissue, larynx, leukemia, lip, esophagus, lung, pancreas, bladder, liver, testis, stomach, brain, non-Hodgkin's lymphoma, and multiple myeloma) during 1996-1998, and several covariates. In addition, states were stratified into three groups according to tertiles of pesticides sales and cancer mortality rate ratios (MRR) were then calculated using first tertile as reference. Finally, a factor analysis was performed to reveal unapparent relationships between pesticide use and cancer mortality. Pesticide sales showed statistically significant correlation with the mortality rates for the cancers of prostate (r=0.69; p=0.019), soft tissue (r=0.71; p=0.015), leukemia (r=0.68; p=0.021), lip (r=0.73; p=0.010), esophagus (r=0.61; p=0.046), and pancreas (r=0.63; p=0.040). Moderate to weak correlations were observed for the cancers of larynx, lung, testis, bladder, liver, stomach, brain, and NHL and multiple myeloma. In addition, correlation between pesticide sales and specific-site cancer mortality rates was reinforced by multiple regression analysis. For all specific-sites, cancer mortality rates were significantly higher in the states of moderate (2nd tertile) and high (3rd tertile) pesticide sales, with MRR ranging from 1.11 to 5.61. Exploring hidden relationships between pesticide sales and cancer mortality in Brazil, through a factor analysis, revealed that affluence; public policies and lifestyle behaviors may explain almost 70% of the variance of the studied association. The results suggest that population exposure to pesticides in the 1980s in some Brazilian States may have been associated with selected cancer sites observed a decade later.

Mortalidade por câncer em agricultores do estado do Paraná / Câncer mortality among agricultural workers from state of Paraná

Neste estudo, investigamos a mortalidade por câncer entre agricultores do estado do Paraná, um importante estado agrícola brasileiro. Todos os óbitos por câncer ocorridos entre 1979 e 1998, entre agricultores, homens, com idades entre 20 e 69 anos, residentes em duas microrregiões do Paraná foram coletados a partir do Sistema de Informação de Mortalidade. Utilizou-se a Razão de Chance de Mortalidade como estimativa do risco, calculada para duas populações de referência distintas e estratificada por faixa etária e período de morte. Observou-se um excesso significativo no risco de morte para os cânceres de estômago, fígado, próstata e pâncreas entre os agricultores.Agricultores mais jovens apresentaram uma mortalidade significativamente maior por câncer de fígado na década de 80 e por câncer de estômago e fígado na década seguinte. Agricultores mais velhos, morreram mais por câncer de estômago na primeiradécada e por câncer de estômago e mieloma múltiplo nos anos 90. O risco de morte para os cânceres de esôfago, estômago, mieloma múltiplo, pâncreas, testículo e pulmão aumentou significativamente entre os agricultores no período de 1979 a 1998. Estes resultados sugerem que a atividade agrícola pode ter contribuído para o aumento no risco de alguns tipos específicos de câncer na população estudada. Observamos tambémum aumento no risco de morte por tipos específicos de câncer entre os trabalhadores agrícolas ao longo das duas décadas de estudo.

In the present study, we investigated cancer mortality among agricultural workers from Paraná, an important agricultural state of Brazil. Data on all cancer deaths occurred between 1979 and 1998, among agricultural workers, who had 20 to 69 years old, with residence stablished in two specific regions in the State of Paraná, were retrieved from the Brazilian Mortality Information System. Mortality Odds Ratio was used as the measure of association, calculated using two distinct reference populations, and stratified by age and period of death. Agricultural workers were at higher risk to die by the cancers of stomach, liver, prostate and pancreas. Stratified analysis revealed that younger agricultural workers displayed higher mortality by liver cancer in the80´s, and by stomach and liver cancers in the following decade. On the other hand, older agricultural workers were at higher risk to die of stomach cancer in the 80´s, and by multiple myeloma and stomach cancer in the 90´s. Time trend analysis also showed that mortality risk for cancers of esophagus, stomach, multiple myeloma, pancreas, testicles, and lung has increased among agricultural workers during 1979 to 1998. Our results suggest that agricultural activities may increase the risk of certain types of cancer.

Avaliação da contaminação por agrotóxicos em mulheres grávidas residentes no município de Nova Friburgo, Rio de Janeiro / Assessment of contamination by pesticides in pregnant women residing in the municipality of Nova Friburgo, Rio de Janeiro

O consumo de agrotóxicos no Brasil vem crescendo de forma acelerada nas últimas décadas, de tal forma que hoje ocupamos a terceira colocação no consumo mundial de pesticidas. Ainda assim, são raros os estudos que investigam os possíveis efeitos, especialmente os crônicos. Dentre os principais efeitos crônicos relatados na literatura, deve-se ressaltar os efeitos adversos na gravidez, tais como baixo peso, prematuridade, aborto espontâneo e malformações. Estes desfechos acompanhados por desnutrição e não acompanhamento pré-natal e puerpério contribuem para o aumento da mortalidade infantil. Desta forma, frente o exposto acima o presente estudo tem como objetivo avaliar o nível de exposição ambiental e/ou ocupacional a agrotóxicos em mulheres grávidas no município de Nova Friburgo, RJ. Para tanto foram realizados dois estudos: um estudo de prevalência onde se levantou os desfechos adversos da gravidez (baixo peso, malformação, índice de apgar baixo e prematuridade), durante o período de 2004 a 2006, através dos dados do SINASC no município de Nova Friburgo. O outro estudo realizado, foi um estudo transversal nas grávidas de Nova Friburgo, durante o ano de 2007 na policlínica localizada no centro deste município, através da aplicação de questionários e análise sanguíneas dasatividades da AChE e BChE. Os resultados do estudo de prevalência demonstraram um maior risco em nascimentos com apgar baixo 1o min. em gestantes da zona rural com graude escolaridade de 1 a 7 anos de estudo quando comparadas a gestantes, com mesmo grau de instrução, da zona urbana (RP:1,394; IC95 por cento: 1,039-1,749) e um aumento no risco de MBP ao nascer em gestantes, com 8 a 11 anos de estudo, da zona rural em relação a zona urbana (RP:2,924; IC95 por cento: 1,195-4,653). Em mulheres que tiveram o parto cesárea foi observado um aumento no risco de MBP ao nascer e malformação (RP: 1,306; IC:1,018-1,594 e RP: 2,141; IC95 por cento: 1,669-2,163, respectivamente) em mulheres da zona rural em relação a zona urbana. A análise transversal sobre a exposição a agrotóxicos demonstrou uma redução dos níveis da AChE em 20,33 por cento nas grávidas da zona rural em relação a zona urbana (p-valor= 0,044), quando foram retirados da análise gestantes que possuíam fatores que auxiliavam na redução desta atividade. A atividade da BChE apresentou efeito rebote, sendo maior nas gestantes da zona rural em 10 por cento quando relacionada as da zona urbana. Portanto, este estudo traz resultados importantes na avaliação da exposição ambiental a agrotóxicos em mulheres grávidas e as possíveis conseqüências durante a gravidez e nopós-parto em pequenas comunidades rurais do Brasil.