The Determinants of Complementary Feeding Introduction Vary According to the Type of Food and Infants' Ages: A Cohort Study-ClaB, Brazil.

INTRODUCTION: Food inadequacies in the first 6 months of life are considered a global problem, with an emphasis on early complementary feeding introduction (CFI). This study aimed to identify the determinants of CFI. METHODS: A birth cohort study (N = 641). Data on infant feeding was collected before 30 days, and at 2, 4, and 6 months of age and, at baseline, data regarding socioeconomic status, demographics, maternal and infant health, obstetric history, and infant care. The hypothesis was that the risk determinants for early CFI vary according to the type of food and the age range of this introduction. Twelve Cox regression models were fit with four outcomes (formula; other types of milk; other beverages; and solid/semi-solid foods) considering three different age ranges of the infant at their introduction (< 2 months, 2-4 months, and 4-6 months). RESULTS: The introduction of the four food groups analyzed was early (median ages of introduction: formulas = 45 days; other milks = 135 days; other beverages = 120 days; solids and semi-solids = 135 days). The determinants that increased the risk of introducing formulas before 2 months were: primiparity, employed without maternity leave, mothers with unsatisfactory prenatal counseling and those who had cesarean sections. Not living with a partner, infant pacifier use at 2 months of age had a higher risk of introducing formula between 2 and 4 months of age. Non-white skin color, more than 35 years old, low maternal education, and lower family income increased the risk of introducing other types of milk between 2 and 4 months of age. Between 4 and 6 months of age, adolescent and low education level mothers had a higher risk of introducing other types of milk, unemployed was a protective factor against the introduction of other foods and beverages in this age group. CONCLUSIONS: The determinants of early CFI varied according to the type of food and the age of introduction.

Vaginal Microbiome Components as Correlates of Cervical Human Papillomavirus Infection.

BACKGROUND: Interplay between vaginal microbiome and human papillomavirus (HPV) remains unclear, partly due to heterogeneity of microbiota. METHODS: We used data from 546 women enrolled in a cross-sectional study in 5 Brazil. We genotyped vaginal samples for HPV and sequenced V3-V4 region of 16S rRNA gene for vaginal microbiome analysis. We used stepwise logistic regression to construct 2 linear scores to predict high-risk HPV (hrHPV) positivity: one based exclusively on presence of individual bacterial taxa (microbiome-based [MB] score) and the other exclusively on participants' sociodemographic, behavioral, and clinical (SBC) characteristics. MB score combined coefficients of 30 (of 116) species. SBC score retained 6 of 25 candidate variables. We constructed receiver operating characteristic curves for scores as hrHPV correlates and compared areas under the curve (AUC) and 95% confidence intervals (CI). RESULTS: Overall, prevalence of hrHPV was 15.8%, and 26.2% had a Lactobacillus-depleted microbiome. AUCs were 0.8022 (95% CI, .7517-.8527) for MB score and 0.7027 (95% CI, .6419-.7636) for SBC score (P = .0163). CONCLUSIONS: The proposed MB score is strongly correlated with hrHPV positivity-exceeding the predictive value of behavioral variables-suggesting its potential as an indicator of infection and possible value for clinical risk stratification.

Smoking during pregnancy and harm reduction in birth weight: a cross-sectional study.

BACKGROUND: Different studies have shown the advantages of abstinence from cigarette smoking during pregnancy to promote full fetal development. Given that pregnant women do not always abstain from smoking, this study aimed to analyze the effect of different intensities of smoking on birth weight of the newborn. METHODS: A cross-sectional study was adopted to explore smoking in a population of pregnant women from a medium-sized city in São Paulo state, Brazil, who gave birth between January and June of 2012. Data were collected from maternal and pediatric medical files and, where data were absent, they were collected by interview during hospitalization for delivery. For data analysis, the effect of potential confounding variables on newborn birth weight was estimated using a gamma response model. The effect of the identified confounding variables was also estimated by means of a gamma response regression model. RESULTS: The prevalence of smoking during pregnancy was 13.4% in the study population. In full-term infants, birth weight decreased as the category of cigarette number per day increased, with a significant weight reduction as of the category 6 to 10 cigarettes per day. Compared with infants born to non smoking mothers, mean birth weight was 320 g lower in infants whose mothers smoked 6 to 10 cigarettes per day and 435 g lower in infants whose mothers smoked 11 to 40 cigarettes per day during pregnancy. CONCLUSIONS: Based on the study results and the principle of harm reduction, if a pregnant woman is unable to quit smoking, she should be encouraged to reduce consumption to less than six cigarettes per day.

Abnormal vaginal flora in low-risk pregnant women cared for by a public health service: prevalence and association with symptoms and findings from gynecological exams.

This study identifies the prevalence of vaginal flora alterations in low-risk pregnant women and their association with reported symptoms and gynecological exams. This quantitative, descriptive, cross-sectional study was conducted in public primary care service units in Botucatu, SP, Brazil from 2006 to 2008 with 289 pregnant women from a stratified sample obtained by sampling by care unit. Tests of vaginal content were performed using Gram's method and testing for Trichomonas vaginalis using Diamond's medium. The prevalence of altered vaginal flora was 49.5%, of which bacterial vaginosis (20.7%), vaginal candidiasis (11.8%) and intermediate flora (11.1%) were the most frequent, not considering associations. Results revealed a high prevalence of vaginal flora alterations with little relation to symptoms, but in agreement with findings from the gynecological exams. Considering undesirable maternal and perinatal outcomes and feasible laboratory practices, the establishment of a routine for diagnosing vaginal flora alterations in low-risk pregnant women is suggested.

Accuracy of simple urine tests for diagnosis of urinary tract infections in low-risk pregnant women.

Anatomic and physiological alterations during pregnancy predispose pregnant women to urinary tract infections (UTI). This study aimed to identify the accuracy of the simple urine test for UTI diagnosis in low-risk pregnant women. Diagnostic test performance was conducted in Botucatu, SP, involving 230 pregnant women, between 2006 and 2008. Results showed 10% UTI prevalence. Sensitivity, specificity and accuracy of the simple urine test were 95.6%, 63.3% and 66.5%, respectively, in relation to UTI diagnoses. The analysis of positive (PPV) and negative (NPV) predictive values showed that, when a regular simple urine test was performed, the chance of UTI occurrence was small (NPV 99.2%). In view of an altered result for such a test, the possibility of UTI existence was small (PPV 22.4%). It was concluded that the accuracy of the simple urine test as a diagnostic means for UTI was low, and that performing a urine culture is essential for appropriate diagnosis.

Factors associated with exclusive breastfeeding in children under four months old in Botucatu-SP, Brazil.

This study aimed to identify factors associated with exclusive breastfeeding (AME) and the reasons mothers presented to introduce complementary feeding in the first four months of life. A total of 380 mothers (92.2%) of children under four months old vaccinated in a Multi-vaccination Campaign were interviewed. To identify factors associated to AME, univariate and multiple logistic regressions analyses were performed. Thirty-eight percent of the children were on AME; 33.4% consumed cow milk; 29.2% tea; and 22.4% water. The mothers justified introduction of cow milk by factors related to quantity/quality of maternal milk and "necessity" of the child. The use of a pacifier (odds ratio=2.63; CI95%=1.7-4.06) and difficulty to breastfeed (odds ratio=1.57; CI95%=1.02-2.41) were associated with the absence of AME. The populational attributable risk percentage for the use of a pacifier was estimated at 46.8 %. Thus, modifiable risk factors were associated with AME interruption.

[Breast feeding in a population attended by the family health program--FHP]. / Situação do aleitamento materno em população assistida pelo programa de saúde da família--PSF.

This study aimed to identify the prevalence of different types of breastfeeding and how they relate to maternal variables in the municipality of Conchas, São Paulo, Brazil, which is fully covered by the family health program. We collected information about the current eating habits of children under one year old who were attended during the 2003 Multivaccination Campaign. Associations were submitted to the chi-square test, adopting p<0.05 as the critical level. The prevalence rates for exclusive breastfeeding (EB) and predominant breastfeeding (PB) in 4-month-olds and younger were 25.4% and 44.4%, respectively, and 66.7% of the children under one were still being breastfed. Prevalence for EB in 6-month-olds and younger was heterogeneous, ranging from 7.4 to 41.2% according to the children's region of origin in the FHP. Difficulties at the beginning of breastfeeding were associated with lower prevalence rates for EB and PB. These results show a situation far from WHO recommendations and from that situation in which there is evidence that children's health receives maximum protection, reiterate the need to support mothers in the early puerperal period and demonstrate the importance of diagnoses separated per regions for actions aimed at promoting breastfeeding.