Analysis of typing conversion and perinatal outcomes in twins with selective intrauterine growth restriction of different subtypes / 中华妇产科杂志

Objective: To retrospectively analyze the clinical data of different types of selective intrauterine growth restriction (sIUGR) pregnant women under expectant management, including the natural evolution, typing conversion and perinatal outcomes. Methods: The clinical data of 153 pregnant women with sIUGR under expected treatment in Women's Hospital, Zhejiang University School of Medicine from January 2014 to December 2018 were collected. Maternal characteristics including maternal age, gravidity, parity, method of conception, pregnancy complication, gestational age at delivery, indication for delivery, birth weight, the rate of intrauterine and neonatal death and neonatal outcomes were recorded. Pregnant women with sIUGR were divided into three types according to end-diastolic umbilical artery flow Doppler ultrasonography, and the differences of typing conversion and perinatal outcomes of sIUGR pregnant women based on the first diagnosis were compared. Results: (1) Clinical characteristics and pregnancy outcomes: among 153 pregnant women with sIUGR, 100 cases (65.3%) were diagnosed with type Ⅰ, 35 cases (22.9%) with type Ⅱ, and 18 cases (11.8%) with type Ⅲ. There were no significant differences in age, conception mode, pregnancy complications, first diagnosis gestational age, characteristics of umbilical cord insertion, delivery indications, fetal intrauterine mortality and neonatal mortality among three types of sIUGR pregnant women (all P>0.05). The average gestational age at delivery of type Ⅰ sIUGR was (33.5±1.9) weeks, which was significantly later than those of type Ⅱ and Ⅲ [(31.3±1.8), (31.2±1.1) weeks, P<0.001]. The percentage disordance in estimated fetal weight (EFW) of type Ⅰ sIUGR was significantly lower than those of type Ⅱ and type Ⅲ (P<0.001). The incidence rate of neonatal intensive care unit (NICU) admission, cerebral leukomalacia and respiratory complications of both fetus and necrotizing enterocolitis of large fetus in type Ⅰ were significantly lower than those in type Ⅱ and type Ⅲ (all P<0.05). (2) Typing conversion: in 100 cases of type Ⅰ sIUGR, 18 cases progressed to type Ⅱ and 10 cases progressed to type Ⅲ. Compared with 72 stable type Ⅰ sIUGR, those with progressed type Ⅰ sIUGR had higher incidence of NICU admission and lung disease in both fetuses, and cerebral leukomalacia and necrotizing enterocolitis in large fetus (all P<0.05). The proportion of inconsistent cord insertion was significantly higher in those type Ⅰ progressed to type Ⅲ (6/10) than in those with stable type Ⅰ (19.4%, 14/72) and type Ⅰ progressed to type Ⅱ sIUGR [0 (0/18), P=0.001]. Four cases of type Ⅱ sIUGR reversed to type Ⅰ and 6 cases reversed to type Ⅲ. Compared with type Ⅱ reversed to type Ⅰ sIUGR, those stable type Ⅱ and type Ⅱ reversed to type Ⅲ sIUGR had a higher incidence of NICU admission in large fetus (P<0.05). Two cases of type Ⅲ sIUGR reversed to type Ⅰ and 6 cases progressed to type Ⅱ. There were no significant differences in fetal serious complications in type Ⅲ sIUGR with or without doppler changes (all P>0.05). Conclusions: The different types of sIUGR could convert to each other. The frequency of ultrasound examinations should be increased for patients with the type Ⅰ sIUGR, especially when the percentage discordance in EFW is substantial or with discordant cord insersion.

Research progress on neurodevelopmental outcomes of small for gestational age infants / 中华预防医学杂志

The incidence of perinatal disease and perinatal mortality in small for gestational age infants increased significantly. This group of people is prone to a variety of long-term metabolic diseases and cardiovascular diseases, and is also prone to growth retardation and neurodevelopmental delay, which will seriously affect the long-term quality of life of children. The article studies the neurodevelopmental outcomes of small-for-gestational-age infants. By reviewing and sorting out previous literature, the neurodevelopmental disorders of small-for-gestational-age infants are analyzed according to five aspects: intellectual development, motor development, language development, sensory development, and mental illness. The classification and summary were carried out, and the influencing factors of neurodevelopmental disorders of SGA were also evaluated, so as to provide reference for promoting the improvement of neurodevelopmental outcomes of small-for-gestational-age infants.

Concentrations of Polybrominated Diphenyl Ethers in Maternal Blood, Placental Size, and Risk for Fetal Growth Restriction: A Nested Case-control Study / 生物医学与环境科学（英文）

Objective@#To explore the effects of prenatal exposure to polybrominated diphenyl ethers (PBDEs) on placental size and birth outcomes.@*Methods@#Based on the perspective Wenzhou Birth Cohort, this nested case-control study included 101 fetal growth restriction (FGR) and 101 healthy newborns. Maternal serum samples were collected during the third trimester and measured for PBDEs by gas chromatography tandem mass spectrometry. The basic information of mother-newborn pairs was collected from questionnaires, whereas the placental size and birth outcomes of newborns were obtained from hospital records.@*Results@#A total of 19 brominated diphenyle ether (BDE) congeners were detected in maternal serum samples. Higher concentrations of BDE-207, -208, -209, and ∑ @*Conclusion@#A negative association was found between PBDE levels in maternal serum and placental size and birth outcomes. Prenatal PBDE exposure may be associated with elevated risk of the incidence of FGR birth.

Factors associated with intrapartum cesarean section in women submitted to labor induction / Fatores associados à cesárea intraparto em mulheres submetidas a indução do parto

Abstract Objective To evaluate the results of induced labor and to determine the main factors associated with intrapartum cesarean section after patients being submitted to this procedure at the Hospital Universitário of the Universidade Federal de Santa Catarina (HU/UFSC, in the Portuguese acronym), Florianópolis, state of Santa Catarina, Brazil. Methods A retrospective cross-sectional study that included all the pregnancies that resulted in single-fetus births, whose gestational-age was > 22 weeks and that had been submitted to labor induction at the HU/UFSC in the period from 2013 to 2016. Results During the proposed period, 1,491 pregnant women were submitted to the labor induction protocol. In 1,264 cases (84.8%), induction resulted in labor, with 830 (65.7%) progressing to vaginal delivery. Gestational age ≥ 41 + 0 weekswas themost common indication for induced labor (55.2%), and vaginal administration of misoprostol was themost commonly usedmethod (72.0%). Among these pregnant women, the cesarean section rate was of 34.3%. Considering the cases of induction failure, the cesarean section rate rose to 44.3%. The factors associated with cesarean section were: previous history of cesarean delivery (PR [prevalence ratio] = 1.48; 95%CI [confidence interval]: 1.51-1.88), fetuses with intrauterine growth restriction (IUGR) (PR = 1.82; 95%CI: 1.32-2.19), Bishop score ≤ 6 (PR = 1.33; 95%CI: 1.01-1.82), and induction time either < 12 hours (PR = 1.44; 95%CI: 1.17-1.66) or > 36 hours (PR = 1.51; 95% CI 1.22-1.92) between the beginning of the induction and the birth. Conclusion Labor induction was successful inmost patients. In the cases in which the final outcome was a cesarean section, the most strongly associated factors were: previous history of cesarean delivery, presence of fetuses with IUGR, and either excessively short or excessively long periods of induction.

Resumo Objetivo Avaliar os resultados da indução de trabalho de parto e determinar os principais fatores associados à realização de cesarianas intraparto em pacientes do Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brasil. Métodos Trata-se de um estudo epidemiológico transversal que incluiu todas as gestantes de feto único e comidade gestacional > 22 semanas, submetidas a indução de trabalho de parto no HU-UFSC no período de 2013 a 2016. Resultados No período proposto, 1.491 gestantes foram submetidas ao protocolo de indução. Em 1.264 casos (84,8%), a indução resultou em trabalho de parto, com 830 (65,7%) progredindo para o parto vaginal. Gestação ≥ 41 + 0 semanas foi a causa mais comumde indicação de indução de trabalho de parto (55,2%),emisoprostol foi o método mais utilizado (72,0%). Nessas gestantes, o índice de cesariana foi de 34,3%. Considerando os casos de falha de indução, o índice de cesariana sobe para 44,3%. Os fatores associados às cesarianas foram: história prévia de cesárea (RP [razão de prevalência] = 1,48; IC [índice de confiança]: 95% 1,51-1,88), fetos com restrição de crescimento intrauterino (RP = 1,82; IC95%: 1,32-2,19), índice de Bishop ≤ 6 (RP = 1,33; IC95%: 1,01-1,82) e tempo de indução < 12 horas (RP = 1,44; IC95%: 1,17-1,66), ou > 36 horas (RP = 1,51; IC95%: 1,22-1,92) entre o início da indução e o parto. Conclusão A indução de trabalho de parto foi bem-sucedida na maioria das pacientes. Naquelas em quem o desfecho final foi a cesariana, os fatores mais fortemente associados foram: história prévia de cesárea, presença de fetos com restrição de crescimento intrauterino, e tempos muito curtos ou muito longos de indução.

Antecedentes maternos prenatales y riesgo de complicaciones neonatales en productos de término de bajo peso para edad gestacional / Maternal prenatal history and neonatal risk complications for low-weight for gestacional age term newborns

Resumen Introducción: El bajo peso neonatal (< 2.5 kg o < percentil 10) se atribuye a causas constitucionales (pequeño para la edad gestacional [PEG]) o a la restricción en el crecimiento intrauterino (RCIU), con riesgos posnatales diferentes. En ausencia de una valoración fetal-placentaria prenatal adecuada, resulta difícil establecerlo. El conocer los antecedentes maternos de enfermedades gestacionales (AMEG): hipertensión arterial (HTA), hipotiroidismo, Diabetes Mellitus (DM) gestacional y otra; pudiera orientar a la diferenciación y el manejo. El objetivo de este trabajo fue determinar si la presencia de AMEG se asocia a complicaciones neonatales en productos de bajo peso neonatal. Métodos: Se realizó un estudio de cohorte retrospectivo en un grupo de 349 recién nacidos vivos de término (≥ 37 semanas de edad gestacional [SEG]), PEG, en cunero fisiológico y agrupados según los AMEG. Se determinó la frecuencia de dificultad respiratoria (DR), hipoglucemia (HG) e hiperbilirrubinemia (HBr). Resultados: El 16.6% (58/349) presentó AMEG (58.6% HTA y 41.3% hipotiroidismo, solos o combinados). Los neonatos con AMEG fueron más limítrofes (37 SEG, 55.2% vs. 35.1%; p = 0.037). Los de 37 SEG con menor peso (diferencia de ≈100 g; p = 0.028), más riesgo de HG (13.6%; intervalo de confianza al 95% [IC 95%]: −4.08-31.2) pero menos DR (diferencia de −4.7%; IC 95%: −20.6-11.05). La HG en los de 39 SEG solo se presentó en neonatos sin AMEG (diferencia 12.7%; IC 95%: 3.9 a 31.5) igual que la HBr (tres casos). Conclusiones: Indagar sobre los AMEG en un producto PEG parece ser útil en la inferencia de RCIU. Sin embargo, es insuficiente, por lo que en conjunto con otras herramientas nos ayuda a estimar posibles complicaciones y acciones preventivas.

Abstract Background: Low-birth-weight (LWB < 2.5 kg or <10 percentile) could be caused by constitutional matters or by intrauterine growth restriction (IUGR), both with different neonatal complications. Without an adequate prenatal evaluation is hard to stablish those conditions. Knowing the maternal history for gestational diseases (MHGD) such as hypertension (HTA), hypothyroidism or diabetes, among others could help clarify that difference. The aim of this work was to determine if having a MHGD is associated to neonatal complications in newborns with LWB. Methods: Retrospective cohort study, which included 349 with LWB at term (≥ 37 weeks of gestation [WG]) grouped into those with or without MHGD at a hospital nursery. The frequency of respiratory distress, hypoglycemia, and hyperbilirubinemia was determined. Results: 16.6% (58/349) had MHGD (58.6% for HTA and 41.3% hypothyroidism alone or combined). The neonate with MHGD were more borderline term (37 WGA, 55.2% vs. 35.1%; p = 0.037), and had lower weight (difference of ≈100 g; p = 0.028), had more cases with hypoglycemia (13.6%; CI 95%: −4.08 to 31.2%) but developed less respiratory distress (RD) (difference of −4.7%; CI 95%: −20.6 to 11.05%). Hypoglycemia in 39 WGA was only seen among neonates without MHGD (difference 12.7%; CI95%: 3.9 to 31.5%) just as for the hyperbilirubinemia cases (three). Conclusions: Inquiring about the MHGD on LBW term babies could be useful in the inference of IUGR, although we need other tools so that altogether can help to predict possible complications and to plan preventive actions.

Diagnóstico y manejo de la restricción del crecimiento intrauterino en fetos de gestantes provenientes de zonas endémicas para la malaria / Diagnosis and management of intrauterine growth restriction in fetuses of pregnant women from endemic areas for malaria

RESUMEN Introducción: La malaria es una enfermedad infecciosa tropical de gran impacto epidemiológico a nivel mundial; las poblaciones con mayor susceptibilidad de padecerla son los niños menores de 5 años y las gestantes, en quienes, se pude no solo comprometer la salud de la madre sino también la del producto y su desarrollo, pudiendo ocurrir diferentes desenlaces adversos entre ellos la restricción del crecimiento intrauterino (RCIU), incrementando sustancialmente las tasas de mortalidad materna y perinatal. Es importante establecer un diagnóstico preciso y oportuno de la RCIU en fetos de gestantes que padecen de malaria, con el fin de llevar a cabo un enfoque de seguimiento y de manejo que puedan disminuir las complicaciones asociadas a la enfermedad. Métodos: Se realizó una búsqueda bibliográfica en la base de datos de Cochrane y PubMed, libros de la especialidad y consensos de sociedades científicas, relativos a los términos de: malaria during pregnancy, intrauterine growth restriction y malaria and fetal growth restriction. Se seleccionaron finalmente 42 artículos para análisis completo y crítico, que justificara la elaboración de esta revisión. Conclusión: esta revisión aporta elementos para establecer un alto grado de sospecha diagnóstica de malaria durante el embarazo en zonas endémicas para la malaria; además revela la necesidad de implementar protocolos de manejo especifico ante la RCIU según sea la etiología; ya que estas medidas impactaran positivamente en los resultados adversos de la enfermedad, sin olvidar que lo primordial es proteger plenamente a las mujeres contra la malaria desde el comienzo del embarazo hasta el parto.

Caracterización de las embarazadas con restricción del crecimiento intrauterino en el servicio de ginecología y obstetricia del hospital central del instituto de previsión social, 2017 / Characterization of pregnant women with intrauterine growth restriction in the gynecology and obstetrics service of the central hospital of the social security institute, 2017

Introducción: Se considera restricción de crecimiento intrauterino al crecimiento fetal menor que el esperado para la edad gestacional. Asociado con un aumento de 6-10 veces de riesgo de muerte perinatal. Cada año nacen en el mundo más de 20 millones de niños con peso inferior a 2.500 gramos; de ellos, más del 96 % en países en desarrollo, lo cual demuestra que esta situación se asocia a condiciones socioeconómicas de pobreza. La prevalencia en Latinoamérica oscila entre el 10 a 17% de los nacidos vivos. Objetivo: Caracterizar a las embarazadas con restricción del crecimiento intrauterino en el Servicio de Ginecología y Obstetricia del Hospital Central del Instituto de Previsión Social, del año 2017. Materiales y métodos: Estudio observacional descriptivo de corte transversal. Fueron incluidas todas las embarazadas con restricción de crecimiento intrauterino que acudieron al Servicio de Ginecología y Obstetricia del Hospital Central de Instituto de Previsión Social del año 2017. Resultados: Fueron 42 embarazadas con restricción de crecimiento intrauterino. Con rango etario de 20 a 42 años, la mediana de 28 años, el 54,76% casadas, el 84,10% proceden del área urbana, y el 52,38% con estudio superior, la mitad eran multigestas, nulíparas sin antecedentes de aborto previo, el 59,62% realizaron más de 5 controles prenatales. El antecedente patológico materno más frecuente fue anemia en el 66,67%. En su mayoría con un índice de masa corporal normal, y moderada ganancia de peso materno durante el embarazo. El 81,25% son de tipo asimétrico, con diámetro biparietal y circunferencia abdominal disminuidos. Conclusión: Este estudio realizado en un centro de referencia nacional de cuarto nivel, similar a resultados de trabajos anteriores, aporta datos actuales sobre las características de las embarazadas con restricción de crecimiento intrauterino.

Maternal socioeconomic factors and adverse perinatal outcomes in two birth cohorts, 1997/98 and 2010, in São Luís, Brazil / Fatores socioeconômicos maternos e eventos perinatais adversos em duas coortes de nascimento, 1997/98 e 2010, em São Luís, Brasil

ABSTRACT: Several studies have identified social inequalities in low birth weight (LBW), preterm birth (PTB), and intrauterine growth restriction (IUGR), which, in recent years, have diminished or disappeared in certain locations. Objectives: Estimate the LBW, PTB, and IUGR rates in São Luís, Maranhão, Brazil, in 2010, and check for associations between socioeconomic factors and these indicators. Methods: This study is based on a birth cohort performed in São Luís. It included 5,051 singleton hospital births in 2010. The chi-square test was used for proportion comparisons, while simple and multiple Poisson regression models with robust error variance were used to estimate relative risks. Results: LBW, PTB and IUGR rates were 7.5, 12.2, and 10.3% respectively. LBW was higher in low-income families, while PTB and IUGR were not associated with socioeconomic factors. Conclusion: The absence or weak association of these indicators with social inequality point to improvements in health care and/or in social conditions in São Luís.

RESUMO: Vários estudos mostram desigualdades sociais no baixo peso ao nascer (BPN), nascimento pré-termo (NPT) e restrição do crescimento intrauterino (RCIU), que nos últimos anos diminuíram ou desapareceram em determinados locais. Objetivos: Estimar as taxas de BPN, NPT e RCIU em São Luís, Maranhão, Brasil, em 2010, e verificar as associações entre fatores socioeconômicos e esses indicadores. Métodos: Este estudo baseia-se em uma coorte de nascimentos realizada em São Luís. Incluiu 5.051 nascimentos únicos hospitalares em 2010. O teste do qui-quadrado foi utilizado para comparação de proporções, enquanto modelos de regressão de Poisson simples e múltipla com variância robusta foram usados para estimar riscos relativos. Resultados: As taxas de BPN, NPT e RCIU foram de 7,5, 12,2 e 10,3%, respectivamente. O BPN foi maior em famílias de baixa renda, enquanto NPT e RCIU não estiveram associados com fatores socioeconômicos. Conclusão: A ausência ou associação fraca desses indicadores com desigualdades sociais aponta para melhorias na atenção à saúde e/ou em condições sociais em São Luís.

Perfil bioquímico en sangre de cordón en prematuros extremos y crecimiento fetal / Intrauterine growth and biochemical levels in cord blood samples in infants less than 31 weeks gestation

Introducción: Con mayor aporte de proteínas y energía en la primera semana se ha observado hipofosfemia en prematuros extremos. Los menores niveles de fósforo se han presentado en prematuros con antecedentes de restricción de crecimiento intrauterino. Objetivos: Caracterizar los niveles plasmáticos bioquímicos en el cordón de prematuros extremos, nacidos adecuados (AEG) y pequeños para edad gestacional (PEG) y la relación con calcemia y fosfemia en la primera semana de vida. Pacientes y método: Estudio clínico realizado en Neonatología del Hospital Doctor Sótero del Río, en los años 2013 y 2014. Se analiza el perfil bioquímico en el cordón y la calcemia y fosfemia en los primeros 7 días de vida, registrados en la ficha clínica según fueran AEG o PEG, según las curvas de Alarcón-Pittaluga. Análisis con significación de p < 0,05. Resultados: Los niveles de colesterol, transaminasas, albúmina y creatinina fueron similares para los PEG y AEG. Los niveles de pH, fósforo, calcio, y fosfatasas alcalinas fueron menores en los PEG. El nitrógeno ureico, el ácido úrico y los triglicéridos fueron mayores en los PEG. Los PEG muestran marcada reducción de fosfemia en la primera semana, la calcemia tiende a subir proporcionalmente al descenso de la fosfemia. Conclusiones: En prematuros extremos la desnutrición intrauterina se expresa en modificación de los niveles plasmáticos de calcio, fósforo, fosfatasas alcalinas, nitrógeno ureico, ácido úrico y triglicéridos. Posnatalmente, al recibir aporte nutricional, se manifiesta una disminución de la fosfemia y un aumento de calcemia, concordante con aportes insuficientes de fósforo durante el período.

Introduction: The use of greater amounts of protein and energy during the first week of life is associated with hypophosphataemia in extreme preterm babies. The lowest phosphorus levels are described in intrauterine growth restricted (IUGR) babies. Objectives: To describe biochemistry levels in cord blood plasma in extreme premature, adequate and small for gestational age babies (AGA/SGA) and their relationship with plasma calcium and phosphorus levels during the first week of life. Patients and method: A descriptive clinical study was performed in the Neonatology Service at Hospital Dr. Sótero del Río during 2013 and 2014. A biochemical analysis of cord blood was performed on 43 premature babies, as well as plasma calcium and phosphorus levels during the first week. The adequacy for gestational age was obtained using Alarcón- Pittaluga growth curves. Statistical significance was P < .05. Results: Cholesterol, transaminases, albumin and creatinine levels were similar for both AGA and SGA babies. Levels of pH, phosphorus, calcium and alkaline phosphatase were significantly lower in SGA babies. Urea nitrogen, uric acid and triglycerides levels were higher in SGA. The analysis during the first week showed a strong reduction in phosphorus levels, as well as an increase in calcium levels in proportion to the decrease in phosphorus in the SGA sub- group. Conclusions: Intrauterine malnutrition in preterm babies is expressed in the modulation of plasma levels of calcium, phosphorus, alkaline phosphatase, urea nitrogen, uric acid and triglycerides. During post-natal life, when nutritional intake begins, a decrease in phosphorus and an increase in calcium levels appear, consistent with insufficient phosphorus intake during this period.

Asociación de nivel bajo de PAPP-A en primer trimestre con resultados obstétricos adversos / Association of low PAPP-A level in the first trimester with adverse obstetric outcomes

ANTECEDENTES: La PAPP-A es una proteína utilizada en obstetricia de forma rutinaria para el cribado de aneuploidías de primer trimestre. En los últimos años se está conociendo más acerca de su papel en la función placentaria. Diversos estudios están mostrando una asociación entre un nivel bajo de PAPP-A y distintos eventos obstétricos. OBJETIVO: Establecer una asociación entre PAPP-A baja y eventos obstétricos adversos. MÉTODO: Estudio retrospectivo de casos y controles anidado en una cohorte. Se han recogido las gestaciones únicas con PAPP-A inferior a percentil 5 en primer trimestre durante 2 años. Se ha recogido de la misma cohorte un grupo control, en proporción 2:1. Se compara mediante análisis estadístico la incidencia de eventos obstétricos adversos de cada grupo. RESULTADOS: Se incluyó un total de 285 pacientes en el grupo de casos y 570 pacientes en el grupo control. Se observó un aumento significativo en el grupo de casos de la incidencia de prematuridad, restricción del crecimiento, hipertensión gestacional y diabetes gestacional. Se ha correlacionado la PAPP-A baja con varios eventos obstétricos adversos, incluyendo prematuridad (OR 4,27), diabetes gestacional (OR 2,40), restricción del crecimiento (OR 2,36) e hipertensión gestacional (OR 2,22). No se observó relación con el resto de eventos obstétricos adversos. CONCLUSIÓN: Un nivel de PAPP-A bajo se asocia con aumentos significativos de prematuridad, diabetes gestacional, restricción del crecimiento e hipertensión gestacional.

BACKGROUND: PAPP-A is a placental protein used in obstetrics as a first trimester marker in aneuploidy screening. In the last few years we are knowing more about its placental function. Some studies are showing a association between low PAPP-A and obstetrical adverse events. AIM: Establish an association between low PAPP-A an obstetrical adverse events. METHOD: This is a retrospective nested case-control study. We identified each singleton pregnancy with a normal phenotype and a low PAPP-A (under percentile 5) in the last 2 years, and match it with a control group of the same population in a 2:1 proportion. It was compared the incidence of each obstetrical adverse outcomes with statistical analysis. RESULTS: We found 285 patients in the case group and match it with 570 patients from control group. It was observed a significative increase in the incidence of prematurity, intrauterine growth restriction, gestational hypertension and gestational diabetes. A low PAPP-A level was correlated with some obstetrical adverse events, like prematurity (OR 4.27), gestational diabetes (OR 2.40), intrauterine growth restriction (OR 2.36) and gestational hypertension (OR 2.22). We observe no correlation with the rest of outcomes. CONCLUSIONS: A low PAPP-A level is related with significative increases of prematurity, gestational diabetes, intrauterine growth restriction and gestational hypertension.

Programação fetal e alterações metabólicas em escolares: metodologia de um estudo caso-controle / Fetal programming and metabolic abnormalities: design of a case-control study

RESUMO: Objetivo: Descrever a metodologia de um estudo sobre associações entre crescimento intrauterino restrito (CIUR) e prevalência de sobrepeso, obesidade e hipertensão arterial em escolares. Métodos: O estudo, conduzido em dois estágios, foi desenvolvido em 2 escolas municipais de Niterói (RJ) de junho a dezembro de 2010, sendo elegíveis todos os escolares de 6 a 14 anos. O primeiro estágio consistiu em um inquérito nutricional e de potenciais fatores de risco. Foram aplicados questionários aos responsáveis e adolescentes. Concomitantemente, foram selecionados os participantes de um estudo caso-controle, com casos prevalentes definidos como todos os escolares que apresentaram excesso de peso (Z-score de índice de massa corporal -IMC/idade/sexo > +1,00). O grupo controle consistiu em uma amostra aleatória da população de estudo do inquérito, o que permitiu o cálculo de razões de prevalências. Foram realizados bioimpedância elétrica, exames de sangue, ultrassonografia da carótida e entrevistas. As variáveis proxy de CIUR foram definidas a partir de informações sobre peso ao nascer (PN) e idade gestacional (IG). Adicionalmente, foram coletadas informações sobre os dois primeiros anos de vida dos escolares a partir de seus prontuários médicos. Resultado s: Entre os 1.040 escolares elegíveis, participaram do estudo 795 escolares (76,4%). A taxa de retorno do questionário enviado para os responsáveis foi de 85,1%. Para o estudo caso-controle, 62,5% (n = 363) dos selecionados participaram, resultando em uma razão caso:controle de 1:1,8. Foram localizados 55,8% (n = 444) dos prontuários, dos quais em 65,7% (n = 292) foram coletadas informações dos primeiros anos de vida. Conclusão: O presente estudo permitirá a análise de múltiplos desfechos e exposições relacionados ao CIUR e alterações metabólicas.

ABSTRACT: Objective: To describe the methodological features of a study on the association between restricted intrauterine growth and prevalence of overweight, obesity and hypertension in school aged children. Methods: The study was conducted in two stages in two public schools in Niterói (RJ), from June through December 2010. All students aged 6 to 14 years were eligible to participate. The first stage consisted of an interview to collect information on demographic variables, diet and other variables. A sample was selected for the second stage, in order to conduct an equivalent of a case-cohort study. There was an interval of about 15 days between the two stages. Cases were overweight students, defined as a Z-score for BMI/age/sex > +1.00 in the first stage. Controls were selected by using a random schedule in which the sample frame was the whole cohort. Bioelectrical impedance analysis, carotid ultrasound to measure intimal-medial thickness, blood measurements and interviews were obtained. Gestational age and weight at birth were used to define proxy variables of restricted intrauterine growth. Early health information was obtained from medical registers. Results: The study participation was 76.4% (n = 795) out of 1,040 eligible to participate). 85.1% of parent's questionnaires were returned. 62.5% of the eligible children participated in the case-control study (case: control ratio = 1:1.8). Early life health information was obtained from 292 children. Conclusion: The present study has the potential to provide important information about multiple outcomes and exposures related to restricted intrauterine growth and metabolic abnormalities.

Caracterización y seguimiento durante seis meses de una cohorte de recién nacidos con sífilis congénita / Characterization and six-month follow-up on a cohort of newborns with congenital syphilis

Introducción. La sífilis congénita es una enfermedad prevenible cuya incidencia en Colombia ha aumentado, alcanzando la cifra de 3,28 casos por 1.000 nacidos vivos en el 2011. Objetivo. Caracterizar a los recién nacidos con sífilis congénita y describir su diagnóstico y tratamiento durante el seguimiento de seis meses. Materiales y métodos. En el periodo comprendido entre agosto de 2011 y febrero de 2012 en el Hospital La Victoria, sede Instituto Materno Infantil, se identificaron y trataron los recién nacidos con sífilis congénita, y se hizo seguimiento clínico y de laboratorio hasta la curación de la enfermedad. Las variables analizadas incluyeron las características clínicas y de laboratorio. Resultados. En este periodo se diagnosticaron 29 pacientes que cumplían con los criterios de caso de sífilis congénita, cuya frecuencia en la institución era de un caso por cada 69 nacimientos. Hubo un mortinato y una muerte neonatal, cuatro recién nacidos fueron prematuros y cinco presentaron restricción en el crecimiento. De los 28 recién nacidos vivos, 15 fueron asintomáticos. Se presentaron dos casos con neurosífilis, es decir, 15 % de los sintomáticos. Se hizo seguimiento a 18 de los 27 niños (66,6 %), incluidos la mayoría de los sintomáticos y los dos casos con neurosífilis; la disminución esperada de los títulos en la prueba del Venereal Disease Research Laboratory , VDRL, se presentó en todos los pacientes, y no hubo secuelas clínicas, con lo que se cumplieron los criterios de curación. Conclusiones. Se evidenció una gran incidencia de la enfermedad, fallas en su prevención, una variada expresión en su presentación y la efectividad del tratamiento en el periodo neonatal.

Introduction: Congenital syphilis is a preventable disease. However, the incidence in Colombia has increased and reached the figure of 3.28 cases per 1,000 live births in 2011. Objective: To characterize newborns with congenital syphilis and describe follow-up over 6 months following their diagnosis and treatment. Materials and methods: Between August, 2011, and February, 2012, in Hospital La Victoria, sede Instituto Materno Infantil , newborns with congenital syphilis were identified and treated. Clinical and laboratory follow-up was carried out for six months until it was determined that the disease was cured. The analyzed variables included patients´ clinical and laboratory characteristics. Results: In this period, we identified 29 cases that met the criteria of congenital syphilis, with a frequency in the institution of one case per 69 births. There was one stillbirth and one neonatal death, four were premature, and five had growth restriction. Of the 28 live births, 15 were asymptomatic. There were two cases with neurosyphilis, representing 15% of symptomatic newborns. Follow-up was done on 18 out of 27 children (66.6%), including most symptomatic cases and the two cases of neurosyphilis . All cases showed the expected decrease in VDRL titers without clinical sequelae, meeting the criteria of being cured. Conclusions: A high incidence of the disease, failure to prevent it, varied expression in its presentation, and the effectiveness of treatment in the neonatal period were evidenced in this study.

Physical activity in pregnancy and adverse birth outcomes / Atividade física em gestantes e desfechos perinatais adversos ao nascimento / Actividad física en gestantes y resultados perinatales adversos al nacimiento

This study focused on the association between physical activity in the second trimester of pregnancy and adverse perinatal outcomes: low birth weight (LBW), preterm birth (PTB), and intrauterine growth restriction (IUGR). The study used a sample from the BRISA cohort, São Luís, Maranhão State, Brazil, which included women with singleton pregnancy, gestational age from 22 to 25 weeks confirmed by obstetric ultrasound performed at < 20 weeks, and re-interviewed in the first 24 hours postpartum (n = 1,380). Level of physical activity was measured by the International Physical Activity Questionnaire (IPAQ), short version, categorized as high, moderate, and low. A directed acyclic graph (DAG) was used to identify minimum adjustment to control confounding. High physical activity was not associated with LBW (RR = 0.94; 95%CI: 0.54-1.63), PTB (RR = 0.86; 95%CI: 0.48-1.54), or IUGR (RR = 0.80; 95%CI: 0.55-1.15). The results support the hypothesis that physical activity during pregnancy does not result in adverse perinatal outcomes.

Investigou-se a associação entre atividade física durante o segundo trimestre gestacional e os desfechos perinatais adversos: baixo peso ao nascer (BPN), nascimento pré-termo (NPT) e restrição de crescimento intrauterino (RCIU). Foi utilizada amostra da coorte BRISA, São Luís, Maranhão, Brasil, que incluiu mulheres com gravidez única, idade gestacional de 22 a 25 semanas confirmada por ultrassonografia obstétrica realizada com < 20 semanas, reentrevistadas nas primeiras 24 horas após o parto (n = 1.380). O nível de atividade física foi medido pelo Questionário Internacional de Atividade Física (IPAQ), versão curta, e categorizado em alto, moderado e baixo. Gráfico acíclico direcionado (DAG) foi utilizado para identificar ajuste mínimo para o controle de confundimento. Nível alto de atividade física não foi associado ao BPN (RR = 0.94; IC95%: 0,54-1,63), NPT (RR = 0,86; IC95%: 0,48-1,54) ou RCIU (RR = 0,80; IC95%: 0,55-1,15). Os resultados fortalecem a hipótese de que a prática de atividade física na gestação não parece resultar em desfechos adversos ao nascimento.

Se investigó la asociación entre actividad física durante el segundo trimestre gestacional y los desenlaces perinatales adversos: bajo peso al nacer (BPN), nacimiento pretérmino (NPT) y restricción de crecimiento intrauterino (RCIU). Se utilizó una muestra de la cohorte BRISA, São Luís, Maranhão, Brasil, que incluyó mujeres con un embarazo único, edad gestacional de 22 a 25 semanas, confirmada por ultrasonografía obstétrica realizada con < 20 semanas, reentrevistadas en las primeras 24 horas tras el parto (n = 1.380). El nivel de actividad física fue medido por el Cuestionario Internacional de Actividad Física (IPAQ), versión corta, y categorizado en alto, moderado y bajo. El gráfo acíclico dirigido (DAG) se utilizó para identificar un ajuste mínimo para el control de confusores. Un nivel alto de actividad física no se asoció al BPN (RR = 0,94; IC95%: 0,54-1,63), NPT (RR = 0,86; IC95%: 0,48-1,54) o RCIU (RR = 0,80; IC95%: 0,55-1,15). Los resultados fortalecen la hipótesis de que la práctica de actividad física en la gestación no parece resultar en desenlaces adversos al nacimiento.

Preterm birth add fetal growth restriction in hiv-infected Brazilian pregnant women / Nascimento pré-termo e restrição de crescimento fetal em gestantes brasileiras infectadas pelo HIV

Introduction: Maternal HIV infection and related co-morbidities may have two outstanding consequences to fetal health: mother-to-child transmission (MTCT) and adverse perinatal outcomes. After Brazilian success in reducing MTCT, the attention must now be diverted to the potentially increased risk for preterm birth (PTB) and intrauterine fetal growth restriction (IUGR). Objective: To determine the prevalence of PTB and IUGR in low income, antiretroviral users, publicly assisted, HIV-infected women and to verify its relation to the HIV infection stage. Patients and Methods: Out of 250 deliveries from HIV-infected mothers that delivered at a tertiary public university hospital in the city of Vitória, state of Espírito Santo, Southeastern Brazil, from November 2001 to May 2012, 74 single pregnancies were selected for study, with ultrasound validated gestational age (GA) and data on birth dimensions: fetal weight (FW), birth length (BL), head and abdominal circumferences (HC, AC). The data were extracted from clinical and pathological records, and the outcomes summarized as proportions of preterm birth (PTB, < 37 weeks), low birth weight (LBW, < 2500g) and small (SGA), adequate (AGA) and large (LGA) for GA, defined as having a value below, between or beyond the ±1.28 z/GA score, the usual clinical cut-off to demarcate the 10th and 90th percentiles. Results: PTB was observed in 17.5%, LBW in 20.2% and SGA FW, BL, HC and AC in 16.2%, 19.1%, 13.8%, and 17.4% respectively. The proportions in HIV-only and AIDS cases were: PTB: 5.9 versus 27.5%, LBW: 14.7% versus 25.0%, SGA BW: 17.6% versus 15.0%, BL: 6.0% versus 30.0%, HC: 9.0% versus 17.9%, and AC: 13.3% versus 21.2%; only SGA BL attained a significant difference. Out of 15 cases of LBW, eight (53.3%) were preterm only, four (26.7%) were SGA only, and three (20.0%) were both PTB and SGA cases. A concomitant presence of, at least, two SGA dimensions in the same fetus was frequent. Conclusions: ...

Introdução: A infecção materna pelo HIV e comorbidades associadas podem ter duas consequências para a saúde fetal, a transmissão vertical e o desfecho perinatal adverso. Após o sucesso em reduzir a transmissão vertical, deve-se dar atenção ao risco potencial de nascimento pretermo (PRT) e de restrição de crescimento fetal (RCF). Objetivo: Determinar a prevalência de PRT e RCF em gestantes de baixa renda, infectadas pelo HIV, usuárias de terapia antirretroviral atendidas em hospital público terciário e verificar sua relação com o estágio da infecção viral. Casuística e métodos: Dentre os 250 partos de gestantes infectadas pelo HIV, ocorridos em um hospital universitário na cidade de Vitória, estado do Espírito Santo, Sudeste do Brasil, entre novembro de 2001 e maio de 2012, foram selecionadas 74 gestações não-gemelares, com idade gestacional confirmada por ultrassonografia e as dimensões neonatais: peso ao nascer (PN), comprimento (CN) e perímetros cefálico (PC) e abdominal (PA). Os dados foram extraídos dos prontuários clínicos e laboratoriais e o desfecho sumarizado como nascimento pretermo (PRT < 37 semanas), baixo peso ao nascer (BPN < 2500g) e como pequeno (PIG), adequado (AIG) e grande (GIG) para a IG, definido como tendo um menor valor, entre e maior que ± 1.28 z/IG escore, o critério clínico usual para demarcar os percentis 10 e 90. Resultados: PRT foi observado em 17,5%, BPN em 20,2% e PN, CN, PC e PA PIG em 16,2%, 19,1%, 13,8% e 17,4%, respectivamente. As respectivas proporções observadas nos casos de HIV e AIDS foram: PRT: 5,9 versus 27,5%, BPN: 14,7% versus 25,0%, PFN PIG: 17,6% versus 15,0%, CN: 6,0% versus 30,0%, PC: 9,0% versus 17,9% e PA: 13,3% versus 21,2%; somente a diferença de CN PIG foi estatisticamente significativa. Dentre 15 neonatos com BPN, oito (53,3%) eram somente PRT, quatro (26,7%) PIG somente e três (20,0%) PRT e PIG. Concomitância no mesmo caso de pelo menos duas dimensões PIG foi observada frequentemente. ...

Intrauterine growth restriction in monochorionic-diamniotic twins / Restrição de crescimento intrauterino em gêmeos monocoriônicos diamnióticos.

Objective: to evaluate neonatal morbidity and mortality in monochorionic- -diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). Methods: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10th percentile on twins’ growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16). Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. Results: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). Conclusion: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR. .

Objetivo: avaliar a morbidade e mortalidade neonatal em gestações monocoriônicas e diamnióticas (MCDA) acometidas pela restrição de crescimento fetal seletiva (RCFS) e não seletiva (RCFNS). Métodos: os parâmetros de morbidade e mortalidade neonatais foram avaliados em 34 gêmeos com RCF (abaixo do percentil 10 de uma curva de crescimento para gêgêmeos): 18 com RCFS e 16 com RCFNS. O grupo com RCFS teve origem em 18 gestações, em que somente um feto apresentava RCF. O grupo com RCFNS teve origem em 8 gestações em que ambos os fetos apresentavam RCF. Foram excluídos deste estudo casos da síndrome da transfusão feto-fetal e malformações fetais. Resultados: os gêmeos de gestações MCDA com RCFS apresentaram maior frequência de entubação orotraqueal (p=0,001), ventilação mecânica (p=0,0006) e maior tempo em jejum durante internação (p=0,014), quando comparados aos gêmeos de gestações MCDA com RCFNS. No grupo com RCFS, também foram observados maior frequência de tipos II e III de dopplervelocimetria de artéria umbilical (p=0,002). Não houve diferença significativa entre os grupos quanto à mortalidade neonatal (p=0,09). Conclusão: em gestações gemelares MCDA, a RCFS representa maior frequência de alterações severas na velocimetria Doppler da artéria umbilical e piores resultados na morbidade neonatal. .

Maternal age and adverse perinatal outcomes in a birth cohort (BRISA) from a Northeastern Brazilian city / Idade materna e desfechos perinatais adversos em uma coorte de nascimentos (BRISA) de uma cidade do Nordeste brasileiro

PURPOSE: To verify the existence of associations between different maternal ages and the perinatal outcomes of preterm birth and intrauterine growth restriction in the city of São Luís, Maranhão, Northeastern Brazil. METHODS: A cross-sectional study using a sample of 5,063 hospital births was conducted in São Luís, from January to December 2010. The participants comprise the birth cohort for the study "Etiological factors of preterm birth and consequences of perinatal factors for infant health: birth cohorts from two Brazilian cities" (BRISA). Frequencies and 95% confidence intervals were used to describe the results. Multiple logistic regression models were applied to assess the adjusted odds ratio (OR) of maternal age associated with the following outcomes: preterm birth and intrauterine growth restriction. RESULTS: The percentage of early teenage pregnancy (12–15 years old) was 2.2%, and of late (16–19 years old) was 16.4%, while pregnancy at an advanced maternal age (>35 years) was 5.9%. Multivariate analyses showed a statistically significant increase in preterm births among females aged 12–15 years old (OR=1.6; p=0.04) compared with those aged 20–35 years. There was also a higher rate in preterm births among females aged 16–19 years old (OR=1.3; p=0.01). Among those with advanced maternal age (>35 years old), the increase in the prevalence of preterm birth had only borderline statistical significance (OR=1.4; p=0.05). There was no statistically significant association between maternal age and increased prevalence of intrauterine growth restriction. .

OBJETIVOS: Verificar a existência de associaçoes entre diferentes idades maternas e desfechos de nascimentos pré-termo e restrição de crescimento intrauterino no município de São Luís, no Maranhão. MÉTODOS: Estudo transversal no qual se utilizou uma amostra composta de 5.063 nascimentos hospitalares em São Luís, região Nordeste do Brasil, de janeiro a dezembro de 2010. As participantes compõem a coorte de nascimentos da pesquisa "Fatores etiológicos do nascimento pré-termo e consequências dos fatores perinatais na saúde da criança: coortes de nascimento em duas cidades brasileiras" (BRISA). Para a descrição dos resultados, utilizaram-se medidas de frequência e intervalo de confiança de 95%. Modelos de regressão logística múltipla foram aplicados para avaliar o odds ratio (OR) ajustado da idade materna associado com os seguintes desfechos: nascimento pré-termo e restrição de crescimento intrauterino. RESULTADOS: O percentual de gestantes adolescentes precoces (12 a 15 anos) foi de 2,2%, e daquelas tardias (16 a 19 anos) de 16,4%, enquanto o de grávidas com idade avançada (>35 anos) foi de 5,9%. As análises multivariadas demonstraram um aumento estatisticamente significante na ocorrência de partos pré-termo entre as mulheres na faixa etária dos 12 aos 15 anos (OR=1,6; p=0,04) quando comparadas àquelas de 20 a 35 anos. Também houve aumento entre as mulheres dos 16 aos 19 anos (OR=1,3; p=0,01). Entre aquelas com idade materna avançada (acima de 35 anos), apesar do aumento na prevalência de parto pré-termo, houve significância estatística limítrofe (OR=1,4: p=0,05). Não houve associação estatisticamente significativa entre a faixa etária maternal e o aumento da prevalência de restrição ...

Creatinina plasmática, filtración glomerular y presión arterial en niños con bajo peso por crecimiento intrauterino retardado / Plasma creatinine, glomerular filtration and blood pressure in children with low birth weight due to intrauterine growth retardation

INTRODUCCIÓN: el bajo peso resultante del crecimiento intrauterino retardado (CIUR), puede inducir modificaciones funcionales renales que condicionen la aparición de Hipertensión Arterial. OBJETIVO: valorar la presión arterial en niños normotensos con antecedentes personales de bajo peso al nacer por CIUR. MÉTODOS: estudiamos la creatinina plasmática, filtración glomerular y presión arterial en 19 niños normotensos, con antecedentes de bajo peso al nacer por CIUR (Grupo 1 CIUR) y sus controles (Grupo 2 Controles), todos entre 4 y 5 años de edad. RESULTADOS: encontramos en los del Grupo 1 menor concentración de creatinina plasmática (0,691 vs 0,751) con una (p=0,001*) y similares valores de presión arterial (80.0 vs 78.5) y de intensidad de filtración glomerular (86,1 vs 83,4) con (p<0.05). CONCLUSIONES: no puede descartarse la existencia de modificaciones funcionales renales previas a las etapas estudiadas.

INTRODUCTION: Low birth weight due to intrauterine growth retardation (IUGR) may induce renal function modifications leading to arterial hypertension. OBJECTIVE: Assess blood pressure in normotensive children with a personal history of low birth weight due to IUGR. METHODS: A study was conducted of plasma creatinine, glomerular filtration and blood pressure in 19 normotensive children aged 4-5 years with a history of low birth weight due to IUGR (Group 1: IUGR) and their controls (Group 2: Controls). RESULTS: A lower plasma creatinine concentration was found in Group 1 (0.691 vs. 0.751) with p=0.001*, whereas similar values were found for blood pressure (80.0 vs. 78.5) and glomerular filtration intensity (86.1 vs. 83.4) with p<0.05. CONCLUSIONS: Renal function modifications occurring before the study period may not be discarded.

Orígenes fetales de la patología del adulto: la restricción del crecimiento intrauterino como factor de riesgo / Fetal origins of adult disease: intrauterine growth restriction as a risk factor

Antecedentes: Barker formuló la hipótesis que la restricción del crecimiento intrauterino (RCIU) representaba un factor de riesgo para el desarrollo de enfermedades durante la vida adulta. Objetivo: Conocer la existencia de alguna relación entre las enfermedades cardiovasculares y enfermedades endocrinas del adulto con el antecedente de RCIU mediante la revisión de estudios publicados de enero de 1990 a diciembre de 2013. Método: Se efectuó una revisión de la literatura existente en las bases de datos PubMed, MEDLINE, ProQuest y Ebsco. Se incluyeron investigaciones en español, inglés o portugués. Resultados: Se incluyeron siete investigaciones uno de casos y controles y seis de cohortes. Para diabetes dos de tres estudios mostraron una asociación significativa (RR=2,10; IC95 por ciento 1,29-3,41; RR=1,43 IC 95 por ciento 0,53-3,87; HR=1,64; IC 95 por ciento 1,26-2,14). Para hipertensión, dos no observaron relación estadísticamente significativa (RR=0,95; IC 95 por ciento 0,81-1,11 y RR=1,03; IC 95 por ciento 0,71-1,49). Para enfermedad coronaria uno mostró asociación significativa (HR=1,9; IC 95 por ciento 1,0-3,8). Para obesidad, un estudio no observó relación (Hombres, RR=1,07; IC 95 por ciento 0,63-2,29 y mujeres RR=1,07; IC 95 por ciento 0,53-2,14). Para síndrome metabólico un estudio observó asociación significativa (RR=1,29; IC 95 por ciento 1,00-1,68). Conclusiones: RCIU muestra una relación inconsistente con enfermedades adultas en estudios observaciones que implican seguimiento. Se necesitan estudios longitudinales que corroboren la asociación entre RCIU y enfermedades en la vida adulta observada en algunos análisis previos.

Background: Barker hypothesized that intrauterine growth restriction (IUGR) represents a risk factor for developing diseases during adulthood. Objective: To determine the relationship between IUGR and cardiovascular and endocrine diseases in adults reviewing studies published between January 1990 and December 2013. Method: A review of the literature in PubMed, MEDLINE, ProQuest and Ebsco database. Papers in Spanish, English or Portuguese were included. Results: Seven studies were included, one case-control and six cohort design. For diabetes two of three studies showed a significant association (RR=2.10, 95 percent CI 1.29-3.41; RR=1.43, 95 percent CI 0.53-3.87; HR=1.64, 95 percent CI 1.26-2.14) For hypertension, two found no statistically significant (RR=0.95, 95 percent CI 0.81-1.11 and RR=1.03, 95 percent CI 0.71-1.49). For coronary disease one showed significant association (HR=1.9, 95 percent CI 1.0 to 3.8). For obesity, a study found no relationship (men, RR=1.07, 95 percent CI 0.63-2.29; and women RR=1.07, 95 percent CI 0.53-2.14). For metabolic syndrome one study found significant association (RR=1.29, 95 percent CI 1.00-1.68). Conclusions: IUGR shows an inconsistent relationship with adult diseases in follow up observational researches. Longitudinal studies that corroborate the association between IUGR and adult diseases observed in some previous analyzes are needed.

Social Inequality in Birth Outcomes in Korea, 1995-2008

Social inequality in adverse birth outcomes has been demonstrated in several countries. The present study examined the separate and joint effects of parental education and work in order to investigate the causal pathways of social class effects on adverse birth outcomes in Korea. The occurrence of low birth weight, preterm births, and intrauterine growth retardation was examined among 7,766,065 births in Korea from 1995 to 2008. The effect of social inequality, as represented by parental education and work, was examined against adverse birth outcomes using multivariate logistic regression after controlling for other covariates. Parental education had the most significant and greatest effect on all three adverse outcomes, followed by parental work and employment, which had lesser effects. For adverse birth outcomes, the gap between educational levels increased steadily in Korea from 1995 to 2008. Throughout the analysis, the effect of maternal manual work on adverse birth outcomes was apparent in the study results. Given this evidence of social inequality in education and employment, social interventions should aim at more in-depth and distal determinants of health.

Frecuencia de riesgo neurobiológico en recién nacidos / Neurobiological risk frequency on newborns

Introducción: Los niños de alto riesgo o vulnerabilidad neurobiológica son aquellos que por sus antecedentes pre, peri o postnatales tienen una mayor probabilidad de presentar alteraciones en su desarrollo psicomotor. La evidencia sugiere que estos niños deben ingresar a Programas de Atención Temprana. objetivo: Describir la frecuencia de niños de alto riesgo neurobiológico que nacieron en hospitales públicos del Servicio de Salud Vina del Mar Quillota, durante al ano 2008. Paciente y Método: Se utilizó un diseno descriptivo a partir del análisis de información existente en los libros de registros de los servicios de maternidad y neonatología, del universo de niños nacidos vivos en hospitales públicos de la red de este servicio. Resultados: Los niños de alto riesgo representaron un 21,01 por ciento del total de recién nacidos vivos. Los factores de riesgo biológico más frecuentes fueron la prematurez (11,4 por ciento), el retardo de crecimiento intrauterino (9,0 por ciento) y el bajo peso de nacimiento (7,8 por ciento). Conclusión: Este estudio epidemiológico, representa el punto de partida para explorar la necesidad existente de disponer de registros estadísticos de los distintos factores de riesgo biológico y contar con espacios formales para realizar atención temprana en el servicio de salud Vina del Mar Quillota con el propósito de prevenir y tratar alteraciones del desarrollo psicomotor en todos los niños con riesgo neurobiológico.

Introduction: High-risk or neurobiological vulnerable children are those who are more likely to have alterations in their psychomotor development during their pre-, peri-, or post-natal periods. Evidence suggests that these children must have early medical care. objective: To describe the frequency of high-risk neuro-biological infants born during 2008 in Vina del Mar Quillota public health hospitals. Methods: A descriptive design was used based on the analysis of existing information in the maternity and neonatology record books regarding live births in public hospitals of this service network. Results: The high-risk children accounted for 21.01 percent of all live births. The most frequent biological risk factors were prematurity (11.4 percent), intrauterine growth retardation (9.0 percent) and low birth weight (7.8 percent). Conclusion: This epidemiological study represents the starting point for exploring the existing need to have statistical records of the various risk factors as well as have formal spaces for early treatment in the Quillota Vina del Mar health service to prevent and treat abnormal psychomotor development in all children with neurobiological risk.