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Background Although marriage is associated with favourable reproductive outcomes among adult women, it is not known whether the marriage advantage applies to girls ( Methods National singleton birth registrations were used to estimate the prevalence of girl child marriage among mothers in Brazil (2011–2018, N = 23,117,661), Ecuador (2014–2018, N = 1,519,168), the USA (2014–2018, N = 18,618,283) and Canada (2008–2018, N = 3,907,610). The joint associations between marital status and maternal age groups ( Results The proportion of births to Conclusions The prevalence of births to

This study aimed to estimate the perception and frequency of abuse, disrespect and mistreatment (ADM) situations during childbirth care of 745 women from the Ribeirão Preto birt cohorts. Confidential questionnaires containing one question regarding perceived abuse during childbirth care and other questions addressing exposure to ADM situations were applied. The chi-squared test was used to compare the situations presented between women who did and did not report mistreatment using the Stata 14.0 software. Among the 745 women evaluated, 66.2% were exposed to some situation of ADM and 8.3% reported having perceived ADM. The most frequent situations were that the woman could not eat or drink (30.5%), the woman had her belly squeezed to help the child be born (27.5%), and the woman could not stay with a companion of her choice (25.5%). Women who reported to have suffered maltreatment more frequently responded positively to all situations of ADM when compared to the other participants, except for the following statements: “I was not allowed to eat or drink anything” (p = 0.975) and “I was forced to have a cesarean delivery against my will” (p = 0.073). Although most women of the Ribeirão Preto cohorts reported exposure to ADM situations during childbirth care, a minority perceived disrespect or mistreatment. Resumo O objetivo do estudo foi estimar percepção e ocorrência de situações de abuso, desrespeito e maltrato (ADM) na assistência ao parto de 745 mulheres pertencentes às coortes de nascimentos de Ribeirão Preto. Foram aplicados questionários sigilosos contendo uma pergunta sobre percepção de maltrato na assistência ao parto e outras sobre exposição a situações de ADM. Utilizou-se o teste qui-quadrado para comparar as situações apresentadas entres as mulheres que relataram ou não maltrato. A análise foi realizada por meio do programa Stata 14. Das 745 mulheres avaliadas, 66,2% foram expostas a alguma situação de ADM e 8,3% referiram ter percebido ADM. As situações mais frequentes foram: 30,5% não puderam comer nem beber nada; 27,5% tiveram sua barriga apertada para ajudar a criança a nascer; e 25,5% não puderam ficar com acompanhante de sua escolha. Mulheres que afirmaram ter sofrido maltrato apresentaram maiores frequências de respostas positivas a todas situações de ADM quando comparadas com às demais, exceto para os seguintes relatos: “Não me deixaram comer nem beber nada” (p = 0,975) e “Fui forçada a ter parto cesáreo contra minha vontade” (p = 0,073). Apesar de a maior parte das mulheres pertencentes às coortes de Ribeirão Preto relatarem exposição a situações de ADM durante a assistência ao parto, uma minoria percebeu desrespeito ou maltrato.

Preeclampsia is a multifactorial disease. Among these factors, untreated hypertension during pregnancy can result in high morbidity and mortality rates and may also be related to the future development of cardiovascular diseases.Therefore, this systematic review aimed to determine the association of previous preeclampsia with the future development of cardiovascular diseases. Studies on the association between preeclampsia and future cardiovascular diseases published in the last 10 years (2009–2019) were identified from the PubMed/Medline (207 articles), Embase (nine articles), and Cochrane (three articles) databases using the keywords ‘‘preeclampsia’’ and ‘‘future cardiovascular diseases’’, ‘‘preeclampsia’’ and ‘‘future heart attack’’, and ‘‘preeclampsia’’ and ‘‘future cardiac disease’’. After applying the inclusion and exclusion criteria, 15 articles were analyzed by systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The meta-analysis and the determination of the quality of the articles were conducted using RevMan software, version 5.3. Statistically significant differences were observed between the control and previous preeclampsia groups with respect to systolic blood pressure (mean difference [MD] 4.32; 95% confidence interval [95%CI] 3.65, 4.99; po0.001), diastolic blood pressure (MD: 2.11; 95%CI: 1.68, 2.55; po0.0001), and insulin level (MD: 2.80; 95% CI: 0.50, 5.11; po0.001). Body mass index (MD: 2.57, 95%CI: 2.06, 3.07; p=0.0001), total cholesterol (MD: 10.39; 95% CI: 8.91, 11.87; p=0.0001), HDL (MD: 2.83; 95%CI: 2.20, 3.46; p=0.0001), and LDL (MD: 1.77; 95%CI: 0.42, 3.13; p=0.0001) also differed significantly between groups. Thus, the results of the present study showed that women with a history of preeclampsia were more likely to develop cardiovascular disease.

Objective To study the association of plasma and vaginal levels of matrix metalloproteinases 2 (MMP-2) and 9 (MMP-9), determined between 20+0 and 25+6 weeks of gestation, with preterm birth and its predictive value. Study design All 129 cases of preterm birth (cases) and 258 randomly selected term patients (control group) were included in a cohort study with a nested case-control design. Inclusion criteria were living in Ribeirao Preto, Brazil, and gestational age 20+0 to 25+6 at enrollment. Exclusion criteria were multiple fetuses, congenital malformations or chromosome syndromes, and loss to follow-up. Maternal age, parity, smoking, and previous preterm birth were included as covariates. A blood sample and vaginal secretion were obtained for the determination of MMP-2 and MMP-9; the patients were screened for urinary tract infection and bacterial vaginosis, and cervical length was measured by ultrasound. The cut-off values for matrix metalloproteinases were calculated using receiver operating characteristic (ROC) curves for logistic regression analysis (crude and adjusted odds ratios). Results According to the WHO, in this study, preterm subtypes included 3.8 % extremely preterm, 6.9 % very preterm, and 89.2 % late preterm births. The plasma MMP-9 cut-off was 63.25 ng/mL and the area under the ROC curve was 0.725 (standard error 0.03; 95 % confidence interval, 0.677−0.769). The cut-off for plasma MMP-2 was 239.4 ng/mL and the area under the ROC curve was 0.585 (standard error 0.03, 95 % confidence interval, 0.521−0.649). Crude odds ratios showed an increased risk of preterm birth associated with plasma MMP-2 (odds ratio, 1.75; 95 % confidence interval, 1.14–2.68) and plasma MMP-9 (odds ratio, 3.26, 95 % confidence interval, 2.09–5.07); no association was detected for vaginal MMP-2 or 9. For plasma, adjusted odds ratios were 1.42 (95 % confidence interval, 0.80–2.53) for MMP-2 and 2.71 (95 % confidence interval, 1 .52–4.83) for MMP-9, along with an increased risk in other covariates. Conclusion Elevated plasma MMP-9 levels and decreased MMP-2 levels were positively associated with preterm birth. Plasma MMP-9 level increased nearly three times the preterm risk.

Given the increase of women with excess weight or obesity and its possible effects on birth weight, the present study aimed to investigate the association between pregestational maternal body mass index (BMI) and birth weight in a birth cohort from Ribeirão Preto, SP, Brazil. This was a prospective study conducted on 1362 mother-child pairs involving singleton births. The women were evaluated using standardized questionnaires during the second trimester of pregnancy and at the time of childbirth. Information about the newborns was obtained from their medical records. The dependent variable was birth weight, categorized as low, adequate, or high. The independent variable was pregestational maternal BMI, categorized as malnutrition, adequate weight, overweight, and obesity. A multinomial regression model was used to estimate the crude and adjusted relative risk (RR) of low and high birth weight. A high frequency of pregestational excess weight (39.6%) was detected and found to be independently associated with high birth weight (RR=2.13, 95%CI: 1.19-3.80 for overweight and RR=3.34, 95%CI: 1.80-6.19 for obese pregnant women). There was no association between pregestational malnutrition and low birth weight (RR=1.70; 95%CI: 0.81-3.55). The present data showed a high rate of women with excess pregestational weight, supporting the hypothesis that pregestational BMI may contribute to high birth weight babies and indicating the need for actions aiming to prevent excessive weight in women at reproductive age.

Gestational hypertension and pre-eclampsia are important causes of perinatal morbidity. The objective of the present study was to determine the increase in relative risk for developing hypertensive disorders of pregnancy based on the evaluation of pregnant women between 20 and 25 weeks of gestation, and to correlate the findings at this period with the outcome of pregnancy. We conducted a prospective cohort study, with a convenience sample of 1417 patients evaluated at this gestational age, of which 1306 were contacted at childbirth. We detected an increased relative risk of 2.69 (95%CI: 1.86 to 3.89) associated with pulsatility index of the uterine arteries, a 2.8 increase (95%CI: 1.58 to 5.03) in relative risk attributed to maternal age above 35 years, a 1.68 increase (95%CI: 1.17 to 2.40) attributed to parity greater than or equal to 3, and a 5.35 increase (95%CI: 4.18 to 6.85) attributed to chronic hypertension and obesity, with a progressive increase in relative risk according to the degree of overweight, i.e., grades 1, 2, 3, and morbid obesity (2.58, 3.06, 5.84, and 7.28, respectively).

Objectives: (a) To determine the 3rd, 50th, and 97th percentiles of weight, length, and head circumference of newborns from the Ribeirão Preto BRISA cohort, according to gender and gestational age, and compare them with the Intergrowth-21st standard; (b) To estimate the small for gestational age ( < 3rd percentile), large for gestational age ( > 97th percentile), stunting (length < 3rd percentile), and wasting (body mass index < 3rd percentile). Methods: Observational study of a cohort of 7702 newborns between 01/01/2010 and 12/31/2010 in the city of Ribeirão Preto, SP, Brazil. The 3rd, 50th, and 97th percentiles were determined for the anthropometric measurements using fractional polynomial regression. Results: The weight difference between Ribeirão Preto and Intergrowth-21st was small, being more pronounced in preterm infants (mean difference between the two populations of +266 g); for full-term newborns, there was a mean difference of +66 g, and for post-term infants, of -113 g. For length, the mean variation was always 1 cm, and full-term and post-term newborns showed a variation of percentil 97), stunting (comprimento < percentil 3) e waisting (índice de massa corporal < percentil 3). Método: Estudo observacional de uma coorte de 7.702 recém-nascidos entre 01/01 e 31/12/2010 na cidade de Ribeirão Preto, SP, Brasil. Os percentis 3, 50 e 97 para as medidas antropométricas foram determinados com regressão polinomial fracionária. Resultados: A diferença de peso entre Ribeirão Preto e Intergrowth-21st foi pequena, mais acentuada nos recém-nascidos pré-termo (diferença média entre as duas populações foi de + 266 gramas); para os recém-nascidos a termo a diferença média foi de + 66 gramas e para os pós-termo de -113 gramas. Para comprimento, a variação média foi sempre < 1 cm; enquanto que para perímetro cefálico os recém-nascidos pré-termo apresentaram variação > 1 cm e os recém-nascidos a termo e pós-termo tiveram variação < 1 cm. As taxas de detecção de pequeno e grande para idade gestacional foram 2,9% e 4,3%, respectivamente. Stunting afetou 6,5% de todos os recém-nascidos e waisting 1,5%, com predomínio em meninas e em gestações a termo; ambas as condições estavam presentes em 0,4% da amostra. Conclusões: Os recém-nascidos de Ribeirão Preto, quando comparados com o padrão Intergrowth-21st, apresentam-se mais pesados, mais longos e com maior circunferência craniana até chegarem a termo.

This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.

Fertility reduction is a phenomenon observed in demographic transition. The demographic changes noted in female fertility represent a need for adjustment on health services regarding female health and family planning support. Thus, this study aimed to perform a descriptive analysis by tracing the sociodemographic profile of primiparous mothers belonging to nine Brazilian birth cohorts, in three cities from different states. Standardized questionnaires were applied to assess reproductive characteristics and covariables. Primiparous mothers were defined as women whose child included in birth cohorts was their firstborn child. Sample description was performed using analysis of variance (continuous variables) and chi-square (categorical variables). In total, 44,615 women were included in the analyses and 41.8% (95%CI: 41.3; 42.2) were categorized as primiparous. The primiparity rates were the lowest in Ribeirão Preto (São Paulo State) 1978 (32%; 95%CI: 30.9; 33.1) and the highest in most recent cohorts, reaching up to 50% of the participants (São Luís - Maranhão State 2010: 47.2%; 95%CI: 45.8; 48.6; Ribeirão Preto 2010: 50.2%; 95%CI: 49.1; 51.4); Pelotas (Rio Grande do Sul State) 2015: 49.4% (95%CI: 47.9; 50.9). Primiparous mothers’ age and schooling increased over the years in all cohorts. Maternal age at the first childbirth behaved similarly in the three studied cities. There was an increase in the proportion of first-time mothers that were older, higher educated and belonged to richer income groups. Also, the proportion of teenage mothers (aged 15 years or younger) increased until the early 2000’s and started decreasing around the years 2010, especially among women in the poorer income groups. A redução na taxa de fertilidade é um fenômeno observado na transição demográfica. As mudanças demográficas na fertilidade feminina criam a necessidade de ajustes nos serviços de saúde em termos de saúde da mulher e planejamento familiar. Assim, o estudo buscou realizar uma análise descritiva, traçando o perfil sociodemográfico de mães primíparas em nove coortes de nascimentos, de três cidades em estados diferentes do Brasil. Foram aplicados questionários padronizados para avaliar as características reprodutivas e covariáveis. As mães primíparas foram definidas como mulheres cujos filhos incluídos nas coortes de nascimentos eram os seus primogênitos. A descrição da amostra foi realizada com a análise de variância (variáveis contínuas) e qui-quadrado (variáveis categóricas). Um total de 44.615 mulheres foram incluídas nas análises, e 41,8% (IC95%: 41,3; 42,2) foram categorizadas como primíparas. As taxas de primiparidade foram mais baixas em Ribeirão Preto (São Paulo) em 1978 (32%; IC95%: 30,9; 33,1), e as mais altas foram nas coortes mais recentes, atingindo 50% das participantes (São Luís - Maranhão, 2010: 47,2%; IC95%: 45,8; 48,6; Ribeirão Preto, 2010: 50,2%; IC95%: 49,1; 51,4); Pelotas (Rio Grande do Sul) 2015: 49,4% (IC95%: 47,9; 50,9). A idade e escolaridade das primíparas aumentaram ao longo dos anos em todas as coortes. A idade materna no primeiro parto mostrou perfil semelhante nas três cidades. Houve um aumento na proporção de primíparas mais velhas, com maior escolaridade e pertencentes aos estratos econômicos mais altos. Além disso, a proporção de mães adolescentes (até 15 anos de idade) aumentou até o início da década de 2000 e começou a diminuir em torno dos anos 2010, especialmente entre mulheres nos grupos de menor renda. La reducción de la fertilidad es un fenómeno observado en la transición demográfica. Los cambios demográficos observados en la fertilidad femenina representan la necesidad de un ajuste en los servicios de salud, en términos de salud femenina y asistencia a la planificación familiar. Teniendo esto en consideración, este estudio tuvo como objetivo realizar un análisis descriptivo, mediante el seguimiento del perfil sociodemográfico de las madres primíparas, que pertenecen a nueve cohortes de brasileñas nacimiento, en tres ciudades de diferentes estados. Se aplicaron cuestionarios estandarizados para evaluar las características reproductivas y covariables. Las madres primíparas fueron definidas como mujeres cuyos hijos incluidos en las cohortes de nacimiento eran sus primogénitos. La descripción de la muestra se realizó usando un análisis de variancia (variables continuas) y chi-cuadrado (variables categóricas). Un total de 44.615 mujeres estuvieron incluidas en el análisis y un 41,8% (IC95%: 41,3; 42,2) fueron categorizadas como primíparas. La tasas de primiparidad fueron las más bajas en Ribeirão Preto (Estado de São Paulo) 1978 (32%; 95%CI: 30,9; 33,1) y las más altas en las cohortes más recientes, alcanzando hasta a un 50% de los participantes (São Luís - Estado de Maranhão 2010: 47,2%; IC95%: 45,8; 48,6; Ribeirão Preto 2010: 50,2%; IC95%: 49,1; 51,4); Pelotas (Estado de Rio Grande do Sul) 2015: 49,4% (IC95%: 47,9; 50,9). La edad de las madres primíparas y escolaridad se incrementó a lo largo de los años en todas las cohortes. La edad maternal en el momento del nacimiento del primer hijo se comportó de forma similar en las tres ciudades estudiadas. Hubo un incremento en la proporción de las madres por primera vez, que eran más viejas, con más formación educativa, y pertenecientes a los grupos con ingresos más altos. Asimismo, la proporción de las madres adolescentes (15 años o más jóvenes) se incrementó hasta principios del año 2000 y empezó a decrecer a partir del año 2010, especialmente entre mujeres en los grupos con los ingresos más bajos.

Stillbirth (SBR), perinatal (PMR), neonatal (NMR) and infant mortality rates (IMR) are declining in Brazil and the factors associated with these falls are still being investigated. The objective of the present study was to assess changes in SBR, PMR, NMR and IMR over time and to determine the factors associated with changes in NMR and IMR in eight Brazilian cohorts. All cohorts are population-based (Ribeirão Preto in 1978/79, 1994 and 2010; Pelotas in 1982, 1993 and 2004; and São Luís in 1997/98 and 2010). Were included data on 41440 children. All indicators were decreased, except in the city of Pelotas, from 1993 to 2004, and except SBR in São Luís. Sociodemographic variables seem to be able to explain reductions of NMR and IMR in Ribeirão Preto, from 1978/79 to 1994, and in São Luís. In Ribeirão Preto, from 1994 to 2010 declines in NMR and IMR seem to be explained by reductions in intrauterine growth restriction (IUGR). Newborn’s gestational age had diminished in all cohorts, preventing even greater reductions of NMR and IMR. Improved sociodemographic variables and reduction of IUGR, seem to be able to explain part of the decrease observed. NMR and IMR could have been reduced even more, were it not for the worsening in gestational age distribution.

Studies focusing on obesity and asthma frequently consider the weight at a given time; thus, modeling pathways through lifetime overweight may contribute to elucidate temporal aspects in this relationship. This study modeled the pathways in the association of lifetime overweight with asthma in adult life, using data from the 1978/1979 Birth Cohort, Ribeirão Preto, São Paulo, Brazil (n = 2,063) at birth (baseline), school age (9/11 years) and adult age (23/25 years). A theoretical model was proposed to explore the effects of lifetime overweight on asthma in adult life analyzed by structural equation modeling. Parental obesity (SC - standardized coefficenttotal = 0.211, p < 0.001; SCdirect = 0.115, p = 0.007) and overweight at school age (SCtotal = 0.565, p < 0.0001; SCdirect = 0.565, p < 0.0001) were associated with overweight in adult life. Parental obesity (SCdirect = 0.105, p = 0.047) and nutritional status at birth (SCtotal = -0.124, p = 0.009; SCdirect = -0.131, p = 0.007) were associated with asthma in adult life. A higher “current adult socieconomic situation” was inversely associated to overweight (SCdirect = -0.171, p = 0.020) and to asthma in adult life (SCtotal = -0.179, p = 0.041; SCdirect = -0.182, p = 0.039). Parental obesity showed a transgenerational effect in weight, triggering to childhood and adulthood overweight. Parallel to underweight at birth, parental obesity was also a risk to asthma in adult life. While, the socioeconomic status in adult life protected from both, overweight and asthma. Os estudos sobre obesidade e asma frequentemente analisam o peso em um determinado momento; portanto, a modelagem de trajetórias de sobrepeso ao longo da vida pode ajudar a explicar os aspectos temporais dessa relação. O estudo atual modelou as trajetórias na associação entre história de sobrepeso e asma na vida adulta, utilizando dados da Coorte de Nascimento de 1978/1979, Ribeirão Preto, São Paulo, Brasil (n = 2.063), coletados ao nascer (linha de base), na idade escolar (9-11 anos) e na idade adulta (23-25 anos). Foi proposto um modelo teórico para explorar a associação entre o sobrepeso ao longo da vida e asma na vida adulta, analisada pela modelagem de equações estruturais. Obesidade dos pais (CP - coeficiente padronizadoglobal = 0,211, p < 0,001; CPdireto = 0,115; p = 0,007) e sobrepeso na idade escolar (CPglobal = 0,565; p < 0,0001; CPdireto = 0,565; p < 0,0001) mostraram associação com sobrepeso na idade adulta. Obesidade dos pais (CPdireto = 0,105; p = 0,047) e estado nutricional ao nascer (CPglobal = - 0,124; p = 0,009; CPdireto = -0,131; p = 0,007) mostraram associação com asma na idade adulta. “Condição socioeconômica” mais alta na vida adulta mostrou associação inversa com sobrepeso (CPdireto = -0,171, p = 0,020) e com asma na vida adulta (CPglobal = -0,179; p = 0,041; CPdireto = -0,182; p = 0,039). Obesidade dos pais mostrou um efeito transgeracional sobre o peso, como gatilho na infância e no sobrepeso na vida adulta. Em paralelo ao baixo peso ao nascer, a obesidade dos pais também esteve associada com asma na vida adulta. A condição socioeconômica na vida adulta mostrou efeito protetor contra sobrepeso e asma. Los estudios que se centran en la obesidad y asma frecuentemente consideran el peso en un determinado momento; por este motivo, la creación de modelos de patrones de sobrepeso a lo largo de la vida quizás puede contribuir a elucidar aspectos temporales en esta relación. Este estudio modeló los patrones en la asociación de sobrepeso a lo largo de la vida con el asma en etapa adulta, usando datos de una cohorte nacimientos de 1978/1979, en Ribeirão Preto, São Paulo, Brasil (n = 2.063), considerando: nacimiento (base de referencia), edad escolar (9-11 años) y edad adulta (23-25 años). Se propuso un modelo teórico para analizar los efectos del sobrepeso a lo largo de la vida en el asma, durante la etapa adulta, analizado mediante modelos de ecuaciones estructurales. La obesidad de los padres (CE - coeficiente estandarizadototal = 0,211, p < 0,001; CEdirecto = 0,115; p = 0,007) y sobrepeso en edad escolar (CEtotal = 0,565; p < 0,0001; CEdirecto = 0,565; p < 0,0001) estuvieron asociados con sobrepeso en la vida adulta. La obesidad de los padres (CEdirecto = 0,105; p = 0,047) y el estatus nutricional al nacer (CEtotal = - 0,124; p = 0,009; CEdirecto = -0,131; p = 0,007) estuvieron asociados con el asma en la vida adulta. Un “condición socioeconómica actual en la etapa adulta” más alto estuvo inversamente asociado con el sobrepeso (CEdirecto = -0,171; p = 0,020) y al asma en la vida adulta (CEtotal = -0,179; p = 0,041; CEdirect = -0,182; p = 0,039). La obesidad de los padres mostró un efecto transgeneracional en el peso, desencadenando sobrepeso en la infancia y etapa adulta. Junto al bajo peso al nacer, la obesidad de los padres fue también un riesgo para el asma en la etapa adulta. Mientras que el estatus socioeconómico en la etapa adulta protegía tanto ante el sobrepeso como el asma.

Introduction: Epidemiological studies have shown associations between placental measurements and perinatal and later life outcomes. Objectives: To report placental measurements and evaluate their association with birth weight in a Brazilian birth cohort. Methods: Retrospective cohort study with 958 mothers, placentas, and newborns delivered at the Ribeirão Preto Medical School Hospital, Universidade de São Paulo, Brazil, in 2010 and 2011. The information was collected from interviews, medical records, and pathology reports. The placental measurements were: weight, largest and smallest diameters, eccentricity, thickness, shape, area, and birth weight/placental weight and placental weight/birth weight ratios. We analyzed the associations between birth weight and placental measurements using multiple linear regression. Results: Placental weight alone accounted for 48% of birth weight variability (p < 0.001), whereas placental measurements combined (placental weight, largest and smallest diameters, and thickness) were responsible for 50% (p < 0.001). When adjusted for maternal and neonatal characteristics, placental measurements explained 74% of birth weight variability (p < 0.001). Conclusion: Placental measurements are powerful independent predictors of birth weight. Placental weight is the most predictive of them, followed by the smallest diameter. RESUMO: Introdução: Estudos epidemiológicos demonstraram associações entre medidas placentárias, resultados perinatais e futuros. Objetivos: Descrever medidas placentárias e avaliar suas associações com peso ao nascer numa coorte de nascimentos brasileira. Metodologia: Estudo de coorte retrospectiva de 958 mães, placentas e recém-nascidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Brasil, em 2010 e 2011. As informações foram coletadas por entrevistas, prontuários médicos e laudos de patologia. As medidas placentárias foram: peso, diâmetros maior e menor, excentricidade, espessura, forma, área, relações peso ao nascer/ peso da placenta e peso da placenta/ peso ao nascer. As associações entre peso ao nascer e medidas placentárias foram examinadas por meio de regressão linear múltipla. Resultados: O peso da placenta foi responsável por 48% da variabilidade do peso ao nascer (p < 0,001), enquanto o conjunto de medidas placentárias (peso, diâmetros maior e menor e espessura) foi responsável por 50% (p < 0,001). Quando ajustadas pelas características maternas e neonatais, as medidas placentárias explicaram 74% da variabilidade do peso ao nascer (p < 0,001). Conclusão: medidas placentárias são preditores independentes do peso ao nascer. O peso placentário é o mais forte preditor dentre elas, seguido pelo diâmetro menor.

To estimate and assess pregnancy smoking trends since 1978, according to sociodemographic characteristics, in three Brazilian sites. We used cross-sectional data from the perinatal studies of nine birth cohorts, located in the southeast (Ribeirao Preto—1978/1979, 1994, and 2010), south (Pelotas—1982, 1993, 2004, and 2015), and northeast (Sao Luis—1997/1998 and 2010) regions of Brazil. We estimated the prevalence of pregnancy smoking at each time point according to age, education, and family income, in each cohort, and evaluated smoking trends. We analyzed data of 17,275 women in Ribeirao Preto, 19,819 in Pelotas, and 7753 in Sao Luis. Smoking decreased by 59% in Ribeirao Preto (p

A prospective cohort study was conducted to determine whether an increased uterine artery pulsatility index (UtA-PI) in the second trimester of pregnancy is a risk factor for neurodevelopmental outcomes in children 2-3 years of age. A group of pregnant women with a UtA-PI below the 90th percentile (P90) and a second group with a UtA-PI ≥ P90 in the second trimester were included in this study. The children of these women were evaluated during their second or third year of life using the Bayley III Screening Test. A total of 858 pregnancies with UtA-PI P90 and 96 pregnancies with UtA-PI ≥ 90 were studied. The differences between the groups related to UtA-PI ≥ 90 were detected in relation to the variables of the Caucasian ethnicity, hypertension, newborn weight and stay in the intensive care unit after birth. However, adjusted neurodevelopmental outcomes did not differ between the groups: OR 0.53 (95% CI 0.27-1.04%). This study failed to demonstrate that the UtA-PI is a risk factor for adverse neurodevelopment in children.Impact statement

Made available in DSpace on 2019-10-06T16:49:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-04-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Introduction: Preeclampsia affects 3–5% of pregnancies worldwide and is the primary cause of maternal-fetal and neonatal mortality. Previous studies show that alterations in maternal concentrations of angiogenic factors, such as PlGF, PDGF AA, ANG-1, and ANG-2, may play fundamental roles in the pathophysiology of the disease. Objective: Determine whether the PlGF, PDGF AA, ANG-1, and ANG-2 are predictors of preeclampsia occurrence in a prenatal cohort study. Patients and methods: This is a case-control study associated with a prospective cohort of pregnant women, with gestational ages between 20 and 25 weeks, composed of 30 pregnant women with preeclampsia (PE) and 90 healthy pregnant women (HP). The plasma concentrations of the markers were determined using the ELISA method. The comparison between the case and control groups was performed using the t test on the SAS® 9.4 software. Also, ROC curves were constructed to evaluate the predictive potential of the biomarkers. Results: Differences in the concentrations of PlGF, PDGF AA, ANG-1 and ANG-2, and the ANG-1/ANG-2 ratio were not observed between the PE and the HP groups. The predictive capacity of the biomarkers was assessed using ROC curves, in which the area under the curve for PlGF AUC = 0.55; PDGF AA AUC = 0.55; ANG-1 AUC = 0.47; ANG-2 AUC = 0.51, and the ANG-1/ANG-2 ratio AUC = 0.57. Conclusion: In pregnant women, with gestational ages between 20 and 25 weeks significant differences in biomarker concentrations between groups PE and HP were not observed. The ROC curves showed that the biomarkers were ineffective as preeclampsia predictors in the analyzed cohort. Department of Gynecology and Obstetrics Ribeirão Preto Medical School University of São Paulo, 3900 Bandeirantes Avenue Department of Health Sciences Ribeirão Preto Medical School University of São Paulo, 3900 Bandeirantes Avenue Department of Pharmacology Biosciences Institute State University of São Paulo (UNESP) Department of Childcare and Pediatrics Ribeirão Preto Medical School University of São Paulo, 3900 Bandeirantes Avenue Department of Pharmacology Biosciences Institute State University of São Paulo (UNESP) FAPESP: FAPESP

Made available in DSpace on 2019-10-04T18:35:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-12-01. Added 1 bitstream(s) on 2019-10-09T18:34:30Z : No. of bitstreams: 1 S0100-72032018001200757.pdf: 930727 bytes, checksum: 2dcd425f3f3bff914d7553da4493d489 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Objective To evaluate whether the circulating level of tissue inhibitor of metalloproteinase-4 (TIMP-4) in the period between 20 and 25 weeks of gestation is a predictor of preeclampsia. Methods We have performed a case-control study, nested in a prospective study cohort in Ribeirao Preto, in the state of Sao Paulo, Brazil. Of the 1,400 pregnant women evaluated between 20 and 25 weeks of gestation, 460 delivered in hospitals outside of our institution. Of the 940 pregnant women who completed the protocol, 30 developed preeclampsia. Healthy pregnant women (controls, n = 90) were randomly selected from the remaining 910 participants. From blood samples collected between 20 and 25 weeks of gestation, we performed a screening of 55 angiogenesis-related proteins in 4 cases and 4 controls. The protein TIMP-4 was the most differentially expressed between cases and controls. Therefore, we measured this protein in all cases (n = 30) and controls selected (n = 90). Results There were no differences in the plasma TIMP-4 levels of cases compared with controls (1,144 +/- 263 versus 1,160 +/- 362 pg/mL, respectively; p > 0.05). Conclusion Plasma TIMP-4 levels were not altered at 20 to 25 weeks of gestation, before the manifestation of clinical symptoms; therefore, they are not good predictors of the development of preeclampsia. Univ Estadual Paulista, Dist Rubiao Jr S-N, BR-18618000 Botucatu, SP, Brazil Univ Sao Paulo, Ribeirao Preto, SP, Brazil Univ Mississippi, Med Ctr, Jackson, MS 39216 USA Univ Estadual Paulista, Dist Rubiao Jr S-N, BR-18618000 Botucatu, SP, Brazil FAPESP: 2015/20461-8 FAPESP: 2008/53593-0 CNPq: 2014-5/305587

In this study, we demonstrated that plasma collected from women who subsequently developed preeclampsia caused increased heme oxygenase-1 (HO-1) production and decreased levels of nitric oxide (NO) markers in endothelial cells (HUVECs). Conversely, no changes in HO-1 or NO markers were found when HUVECs were treated with plasma from women who remained healthy throughout pregnancy. These alterations in HO-1 and NO markers were prevented by cotreatment with the polyphenol resveratrol, which also improved GSH levels. In addition, we evaluated changes induced by plasma incubation in the expression of genes and their related pathways associated with antioxidant defenses, such as Nrf2, ARE activity, and GSR. Collectively, our findings suggest that even before the appearance of clinical symptoms of preeclampsia, plasma from affected women is able to induce modifications in endothelial cells with respect to HO-1 production and NO markers. We believe that this in vitro strategy may offer an attractive alternative to the exploitation of candidate markers or screening molecules, such as resveratrol, for the prevention and management of preeclampsia.

The rate of cesarean delivery (CD) is high in many parts of the world. Birth via CD has been associated with adverse later health outcomes, such as obesity, asthma, and type 1 diabetes mellitus. Few studies have focused on hypertension. We investigated the associations of CD with hypertension, systolic blood pressure (BP), and diastolic BP and tested whether body mass index (BMI; weight (kg)/height (m)2) was a mediator of these associations in a birth cohort (n = 2,020) assembled in 1978–1979 and followed up in 2002–2004 in Ribeirão Preto, Brazil. The CD rate was 32.0%. Hypertension was present in 11.7% of persons born via CD and 7.7% of those born vaginally. Being born by CD increased the odds of hypertension by 51% (odds ratio = 1.51, 95% confidence interval (CI): 1.10, 2.07). After adjustment for confounders, this estimate changed little (odds ratio = 1.49, 95% CI: 1.07, 2.06). In a mediation analysis, odds ratios for the indirect and direct effects were 1.18 (95% CI: 1.11, 1.25) and 1.31 (95% CI: 0.97, 1.65), respectively. CD also had indirect effects on both systolic and diastolic BP via BMI. Our findings suggest that CD is associated with young-adult hypertension and that this association is at least partially mediated by BMI. This has implications for countries struggling with the burden of noncommunicable diseases and where CD rates are high.

RESUMO: Estudos vêm mostrando uma possível associação das doenças bucais no período gestacional com o nascimento pré-termo (NPT) e o baixo peso ao nascer (BPN). Esses desfechos perinatais parecem se associar com defeitos de desenvolvimento do esmalte (DDE) na dentição decídua, que, por sua vez, parecem predispor ao desenvolvimento futuro de lesões de cárie nas crianças. Assim, é relevante a inclusão de variáveis de saúde bucal do binômio mãe/filho nos estudos de coorte para a compreensão de como esses fatores se associam. Os objetivos deste estudo são: 1) verificar se existe associação entre doenças da cavidade bucal da gestante e o NPT; 2) testar a hipótese de associação entre desfechos perinatais e defeitos de esmalte/cárie dentária nas crianças; 3) analisar se existem associações entre desfechos perinatais e distúrbios de erupção dentária nas crianças; 4) construir modelos teóricos para estudo das iniquidades sociais como fator comum entre os desfechos perinatais e condições bucais. Utilizou-se abordagem integrada e colaborativa entre duas cidades brasileiras com condições socioeconômicas contrastantes: São Luís, MA; e Ribeirão Preto, SP - estudo BRISA (Brazilian Birth Cohort Studies, Ribeirão Preto-São Luís ). Duas coortes foram avaliadas: uma iniciada ao nascimento, representativa da população de nascidos vivos; e outra iniciada no pré-natal. Os participantes foram reavaliados a partir do início do segundo ano de vida. Espera-se que estas coortes contribuam para fomentar o desenvolvimento e consolidação de pesquisas de seguimento, de base populacional, no Brasil.

Made available in DSpace on 2019-10-06T16:02:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 Preeclampsia is the major cause of maternal and fetal deaths worldwide. Circulating biomarker concentrations to predict preeclampsia must be determined. Therefore, the objective was to evaluate heme oxygenase-1 (HO-1) concentration in both plasma and urine samples from pregnant women before the development of preeclampsia and to identify a potential biomarker for preeclampsia development. We performed a case-control study nested in a prospective study cohort at University Hospital of the Ribeirao Preto Medical School, University of São Paulo (HCFMRP-USP), Ribeirao Preto, Brazil. Of 1400 pregnant women evaluated at 20-25 weeks of gestation, 460 delivered in hospitals outside our institution. Of 940 pregnant women who completed the protocol, 30 developed preeclampsia (cases, 14 cases of severe preeclampsia and 16 cases of mild preeclampsia). Healthy pregnant women (controls, n = 90) were randomly selected from the remaining 910 participants. HO-1 concentration was evaluated in plasma/urine samples by using a commercial enzyme-linked immunosorbent assay kit. We found similar HO-1 levels in the plasma and urine for case and control groups. In the subgrouped preeclampsia, lower plasma HO-1 levels were found in mild compared with severe preeclampsia. We conclude that plasma HO-1 levels were not altered at 20-25 weeks of gestation before the manifestation of preeclampsia symptoms. Pregnant women who subsequently develop severe preeclampsia show higher expression of HO-1. This may be indicative of important underlying pathophysiologic mechanisms that differentiate between mild and severe preeclampsia and may possibly be related to a higher prooxidative status even before the development of clinical symptoms. Department of Pharmacology Institute of Biosciences São Paulo State University (UNESP) Center of Toxicological Assistance (CEATOX) Institute of Biosciences São Paulo State University (UNESP) Department of Pediatrics Faculty of Medicine of Ribeirao Preto University of Sao Paulo Department of Obstetric and Gynecology Faculty of Medicine of Ribeirao Preto University of Sao Paulo Department of Pharmacology Institute of Biosciences São Paulo State University (UNESP) Center of Toxicological Assistance (CEATOX) Institute of Biosciences São Paulo State University (UNESP)

To describe caffeine consumption during pregnancy and its association with low birth weight (LBW) and preterm birth in the birth cohort of Ribeirão Preto, state of São Paulo, Brazil, in 2010. Cohort study, with descriptive and analytical approach. Data included 7,607 women and their newborns in Ribeirão Preto, state of São Paulo, Brazil. The women answered standardized questionnaires about reproductive health, prenatal care, life habits, sociodemographic conditions, and information about coffee intake. The independent variable was high caffeine consumption (≥300 mg/day) from coffee during pregnancy, and the dependent variables were LBW (birth weight 2,500 g) and preterm birth (37 weeks of gestational age). Four adjusted polytomous logistic regression models, relative risk (RR) and 95% confidence interval (CI) were fitted: biological and sociodemographic conditions; obstetric history; current gestational conditions; and all variables included in the previous models. A total of 4,908 (64.5%) mothers consumed caffeine, 143 (2.9%) of whom reported high consumption. High caffeine intake was significantly associated with reduced education and with the occupation of the head of the family, nonwhite skin color, not having a partner, higher parity, previous abortion and preterm birth, urinary tract infection, threatened abortion, alcohol consumption and smoking. No association was found between high caffeine consumption and LBW or preterm birth in both unadjusted (RR = 1.45; 95% CI: 0.91-2.32; and RR = 1.16; 95% CI: 0.77-1.75, respectively) and adjusted analyses (RR = 1.42; 95% CI: 0.85-2.38; and RR = 1.03; 95% CI: 0.65-1.63, respectively). In this cohort, high caffeine intake was lower than in other studies and no association with LBW or preterm birth was found. Descrever a associação entre consumo de cafeína durante a gestação com baixo peso ao nascer (BPN) e nascimento pré-termo (PT) na coorte de Ribeirão Preto, estado de São Paulo, Brasil, em 2010. MéTODOS: Estudo de coorte, com abordagem descritiva e analítica. Foram incluídas 7.607 mulheres e seus recém-nascidos em Ribeirão Preto, São Paulo, Brasil. As mulheres responderam a questionários padronizados sobre saúde reprodutiva, cuidados pré-natais, hábitos de vida, condições sociodemográficas e consumo de cafeína. A variável independente foi alto consumo de cafeína (≥300 mg/dia) durante a gestação e as dependentes foram BPN (peso 2.500 g) e nascimento PT (37 semanas de gestação). Foram calculados riscos relativos (RRs) e intervalos de confiança (ICs) de 95% em quatro modelos de regressão logística: condições biológicas e sociodemográficas; história obstétrica; condições da gestação atual; e todas as variáveis incluídas nos modelos anteriores. Um total de 4.908 (64,5%) mães consumiram cafeína, e destas, 143 (2,9%) relataram alto consumo. Alto consumo de cafeína esteve associado com menor escolaridade materna, ocupação do chefe da família, cor de pele não branca, mulheres sem companheiro, maior paridade, aborto e nascimento PT anterior, infecção do trato urinário, ameaça de aborto, consumo de álcool e tabagismo. Não foi encontrada associação entre alto consumo de cafeína e BPN ou nascimento PT nas análises não ajustada (RR = 1,45; IC 95%: 0,91–2,32; e RR = 1,16; IC 95%: 0,77–1,75, respectivamente) e ajustada (RR = 1,42; IC 95%: 0,85–2,38; e RR = 1,03; IC 95%: 0,65–1,63, respectivamente). CONCLUSãO: Nessa coorte, o alto consumo de cafeína foi menor que em outros estudos e não foi encontrada associação com BPN ou nascimento PT.

Background/objectives: A number of meta-analyses suggest an association between any maternal smoking in pregnancy and offspring overweight obesity. Whether there is a dose–response relationship across number of cigarettes and whether this differs by sex remains unclear. Subject/methods: Studies reporting number of cigarettes smoked during pregnancy and offspring BMI published up to May 2015 were searched. An individual patient data meta-analysis of association between the number of cigarettes smoked during pregnancy and offspring overweight (defined according to the International Obesity Task Force reference) was computed using a generalized additive mixed model with non-linear effects and adjustment for confounders (maternal weight status, breastfeeding, and maternal education) and stratification for sex. Results: Of 26 identified studies, 16 authors provided data on a total of 238,340 mother–child-pairs. A linear positive association was observed between the number of cigarettes smoked and offspring overweight for up to 15 cigarettes per day with an OR increase per cigarette of 1.03, 95% CI = [1.02–1.03]. The OR flattened with higher cigarette use. Associations were similar in males and females. Sensitivity analyses supported these results. Conclusions: A linear dose–response relationship of maternal smoking was observed in the range of 1–15 cigarettes per day equally in boys and girls with no further risk increase for doses above 15 cigarettes.

Made available in DSpace on 2018-12-11T17:14:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-12-01 Myeloperoxidase is a proinflammatory enzyme found to be increased in patients with established preeclampsia but never investigated before the disease onset. Here we examined myeloperoxidase concentration and activity in plasma and urine samples from pregnant women who remained normotensive throughout pregnancy and those who developed preeclampsia in order to assess its potential to predict this disorder. Our sample consisted of 30 cases who developed preeclampsia (14 severe and 16 mild) and 57 controls who remained healthy throughout pregnancy, derived from the Brazilian Ribeirão Preto and São Luís prenatal cohort (BRISA). Myeloperoxidase concentration were assessed using a commercial ELISA kit and enzymatic activity through tetramethylbenzidine oxidation. No statistical differences were found in myeloperoxidase levels nor activity between plasma or urine samples from controls, severe and mild cases. Myeloperoxidase did not seem to have a potential application for preeclampsia prediction. Department of Pharmacology Institute of Biosciences of Botucatu Universidade Estadual Paulista (UNESP) Of Pediatrics Faculty of Medicine of Ribeirao Preto University of Sao Paulo Department of Gynecology and Obstetrics Faculty of Medicine of Ribeirao Preto University of Sao Paulo Department of Pharmacology Institute of Biosciences of Botucatu Universidade Estadual Paulista (UNESP)

This prospective study used data from the BRISA Cohort, São Luís, Brazil (n = 1140) and analyzed associations between environmental factors up to the first 1000 days of life and “Childhood Asthma Symptoms”. “Childhood Asthma Symptoms” was a latent variable based on the number of wheezing episodes, emergency care visit due to wheezing, diagnosis of asthma and diagnosis of rhinitis. A theoretical model that included prenatal factors (socioeconomic status, pregestational body mass index-BMI, soft drink and junk food consumption), birth factors (gestational age, smoking and diseases during pregnancy, birth weight and type of delivery), first year of life factors (breastfeeding, environmental aeroallergens and respiratory diseases) and BMI z-score in the second year of life, was analyzed by structural equation modeling. High pregestational BMI, high soft drink consumption, cesarean section without labor, chill in the first three months of life, carpeted floor and child’s exposure to tobacco were associated with higher values of “Childhood Asthma Symptoms”. In contrast, high birth weight, breastfeeding and infant’s age were associated with lower values of “Childhood Asthma Symptoms”. These findings support the hypothesis that environmental factors that are present before conception and up to the first 1000 days of life are associated with asthma.

OBJECTIVES: To estimate the baseline prevalence and risk factors for microcephaly at birth before the Zika virus epidemic in 2 Brazilian cities. METHODS: We used population-based data from the Brazilian Ribeirão Preto (RP) and São Luís (SL) birth cohort studies of 2010 that included hospital deliveries by resident mothers. The final sample was 7376 live births in RP and 4220 in SL. Gestational age was based on the date of the mother’s last normal menstrual period or obstetric ultrasonography, if available. Microcephaly at birth was classified according to the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century and the Brazilian Ministry of Health. Risk factors for microcephaly, proportionate and disproportionate microcephaly, and severe microcephaly were estimated in a hierarchized logistic regression model. RESULTS: According to the International Fetal and Newborn Growth Consortium for the 21st Century definition, the prevalence of microcephaly (>2 SDs below the mean for gestational age and sex) was higher in SL (3.5%) than in RP (2.5%). The prevalence of severe microcephaly (>3 SDs below the mean) was higher in SL (0.7%) than in RP (0.5%). Low maternal schooling, living in consensual union or without a companion, maternal smoking during pregnancy, primiparity, vaginal delivery, and intrauterine growth restriction were consistently associated with microcephaly. The number of cases of microcephaly is grossly underestimated, with an underreporting rate of ∼90%. CONCLUSIONS: The prevalence of severe microcephaly was much higher than expected in both cities. Our findings suggest that microcephaly was endemic in both municipalities before the circulation of the Zika virus.

To assess the placental morphometry in pregnancies with hypertensive disorders of pregnancy (HDP) and its relationship with birth weight (BW).Cohort study of placental morphometry and fetal outcomes of 954 pregnancies at a university hospital in Ribeirão Preto, São Paulo, Brazil, in 2010. HDP categories were: chronic (CH), gestational (GH), preeclampsia (PRE) and pre-eclampsia superimposed on chronic hypertension (CH + PRE). Associations between BW and placental measures (PM) in pregnancies were evaluated by multiple linear regression analyses.Placental weight (PW, g), largest and smallest diameters (cm), thickness (cm), eccentricity, area (cmThe frequencies of each HDP categories were 6.5% CH; 7.6% GH; 6.1% PRE, and 2.0% CH + PRE. PW, largest and smallest diameters, area and BW/PW ratio were statistically different between HDP and the normotensive group, with the lowest values for CH + PRE; the remaining measures showed no difference. BW was lower in HDP than in the normotensive group (p = 0.016). BW and PW were highly correlated in the presence of HDP (r = 0.79, p 0.001). Sixty-seven percent of BW variability was accounted for PM (p 0.001), and increased to 81% when maternal variables, gestational age and sex were added (p 0.001).Hypertensive disorders of pregnancy significantly influence the growth of both the placenta and the fetus. PM explain 67% of BW variability, and CH + PRE was the category with the strongest association to the results.

Made available in DSpace on 2018-11-26T17:51:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-04-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Preeclampsia is a major cause of maternal and fetal morbidity and mortality worldwide. It is a multisystem pregnancy syndrome characterized by general endothelial dysfunction caused mainly by plasma factors and debris in endothelial cells. It is widely accepted that endothelin-1 (ET-1) is involved in the pathophysiology of preeclampsia, and so it is of interest to ascertain whether the ET-1 gene (EDN1) can be targeted with tools such as miRNAs. Therefore, we investigated the relationship between the expression of miRNAs that putatively target EDN1 (and so affect ET-1 levels) in HUVECs incubated with plasma from preeclamptic women. EDN1 expression and ET-1 levels in HUVECs incubated with plasma from women with preeclampsia were similar to those in plasma from healthy pregnant women. Expression of miRNAs let-7a, -7b, and -7c, and to a lesser degree 125a and 125b, was increased in preeclampsia. Expression of miRNAs of the let-7 family was significantly negatively correlated with ET-1 levels in preeclampsia. Transfection of the preeclampsia cultures with mimic miRNA let-7 decreased ET-1 levels. Our findings show that preeclamptic plasma stimulates the expression of miRNAs in HUVECs, leading to a decrease in ET-1levels, which suggests that therapeutic miRNAs may aid in the management of preeclampsia. Sao Paulo State Univ UNESP, Inst Biosci Botucatu, Dept Pharmacol, BR-18618000 Botucatu, SP, Brazil Sao Paulo State Univ UNESP, Cell Engn Lab, Blood Transfus Ctr, Botucatu Med Sch, Botucatu, SP, Brazil Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Pharmacol, Ribeirao Preto, SP, Brazil Sao Paulo State Univ UNESP, Inst Biosci Botucatu, Dept Morphol, Botucatu, SP, Brazil Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Pediat, Ribeirao Preto, SP, Brazil Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Gynecol & Obstet, Ribeirao Preto, SP, Brazil Sao Paulo State Univ UNESP, Inst Biosci Botucatu, Dept Pharmacol, BR-18618000 Botucatu, SP, Brazil Sao Paulo State Univ UNESP, Cell Engn Lab, Blood Transfus Ctr, Botucatu Med Sch, Botucatu, SP, Brazil Sao Paulo State Univ UNESP, Inst Biosci Botucatu, Dept Morphol, Botucatu, SP, Brazil CNPq: 131125/2014-1 CNPq: 305587/2014-5 FAPESP: 2013/12919-9

Introduction The placenta, translates how the fetus experiences the maternal environment and is a principal influence on birth weight (BW). Objective To explore the relationship between placental growth measures (PGMs) and BW in a public maternity hospital. Methods Observational retrospective study of 870 singleton live born infants at Hospital Maternidad Sardá, Universidad de Buenos Aires, Argentina, between January 2011 and August 2012 with complete data of PGMs. Details of history, clinical and obstetrical maternal data, labor and delivery and neonatal outcome data, including placental measures derived from the records, were evaluated. The following manual measurements of the placenta according to standard methods were performed: placental weight (PW, g), larger and smaller diameters (cm), eccentricity, width (cm), shape, area (cm2), BW/PW ratio (BPR) and PW/BW ratio (PBR), and efficiency. Associations between BW and PGMs were examined using multiple linear regression. Results Birth weight was correlated with placental weight (R2 =0.49, p < 0.001), whereas gestational age was moderately correlated with placental weight (R2 =0.64, p < 0.001). By gestational age, there was a positive trend for PW and BPR, but an inverse relationship with PBR (p < 0.001). Placental weight alone accounted for 49% of birth weight variability (p < 0,001), whereas all PGMs accounted for 52% (p < 0,001). Combined, PGMs, maternal characteristics (parity, pre-eclampsia, tobacco use), gestational age and gender explained 77.8% of BW variations (p < 0,001). Among preterm births, 59% of BW variances were accounted for by PGMs, compared with 44% at term. All placental measures except BPR were consistently higher in females than in males, which was also not significant. Indices of placental efficiency showed weakly clinical relevance. Conclusions Reliable measures of placental growth estimate 53.6% of BW variances and project this outcome to a greater degree in preterm births than at term. These findings would contribute to the understanding of the maternal-placental programming of chronic diseases. Resumo Introdução Aplacenta traduz como o feto experimenta o ambientematerno, alémde ser a principal influência sobre o peso ao nascer (PN). Objetivo Explorar a relação entre medidas de crescimento da placenta (MCPs) e PN em uma maternidade pública. Métodos Estudo retrospectivo observacional de 870 recém-nascidos vivos únicos na Maternidade Sardá, Universidade de Buenos Aires, Argentina, entre janeiro de 2011 e agosto de 2012 com os dados completos das MCPs. Foram avaliados dados da história clínica e obstétricamaterna, trabalho de parto e resultados neonatais, incluindomedidas da placenta derivadas dos registrosmédicos. Foramrealizadas as seguintesmediçõesmanuais da placenta: peso da placenta (PP, g), diâmetros maior e menor (cm), excentricidade, espessura (cm), forma, área (cm2), razões PN/PP e PP/PN e eficiência. Associações entre PN e MCPs foram examinadas por meio de regressão linear múltipla. Resultados Peso ao nascer foi correlacionado com peso placentário (R2 = 0,49, p < 0,001), enquanto idade gestacional foi moderadamente correlacionada com peso placentário (R2 = 0,64, p < 0,001). Por idade gestacional, houve uma tendência positiva para a relação PP e PN/PP, mas uma relação inversa com a razão PP/PN (p < 0,001). Somente peso da placenta respondeu por 49% da variabilidade do peso ao nascer (p < 0,001), ao passo que todas as MCPs foram responsáveis por 52% (p < 0,001). Combinados, MCPs, características maternas (paridade, pré-eclâmpsia, fumo), idade gestacional e sexo explicaram 77,8% da variação do peso ao nascer (p < 0,001). Entre nascimentos pré-termo, 59% da variância do PN foi contabilizada pelas MCPs, emcomparação com44% a termo. Todas asmedidas placentárias, exceto a razão PN/PP, foram consistentemente maiores em mulheres do que em homens, mas não significativas. Índices de eficiência placentária mostraram fraca relevância clínica. Conclusões medidas confiáveis de crescimento placentário estimam 53,6% da variância do peso ao nascer, e projetamesse resultado a ummaior grau emnascimentos pré-termo do que a termo. Estes resultados contribuiriam para a compreensão da programação materno-placentária de doenças crónicas.

CONTEXT AND OBJECTIVE: Alcohol consumption during pregnancy is a significant social problem that may be associated with adverse perinatal outcomes. The aim of this study was to describe alcohol consumption during pregnancy and to study its association with low birth weight, newborns small for gestational age and preterm birth. DESIGN AND SETTING: Nested cohort study, in the city of Ribeirão Preto, São Paulo, Brazil. METHODS: 1,370 women and their newborns were evaluated. A standardized questionnaire on health and lifestyle habits was applied to the mothers. Anthropometry was performed on the newborns. Alcohol consumption was defined as low, moderate or high, as defined by the World Health Organization. Adjusted logistic regression analysis was used. RESULTS: 23% of the women consumed alcohol during pregnancy. Consumption mainly occurred in the first trimester (14.8%) and decreased as the pregnancy progressed. The median alcohol intake was 3.89 g (interquartile range, IQR = 8 g) per day. In the unadjusted analysis, alcohol consumption increased the risk of low birth weight almost twofold (odds ratio, OR 1.91; 95% confidence interval, CI: 1.25-2.92). The risk was lower in the adjusted analysis (OR 1.62; 95% CI: 1.03-2.54). Alcohol consumption did not show associations with small for gestational age or preterm birth. There was greater risk of low birth weight and newborns small for gestational age and preterm birth among mothers who were both smokers and drinkers. CONCLUSIONS: The alcohol consumption rate during pregnancy was 23% and was independently associated with low birth weight, but there was no risk of newborns small for gestational age or preterm birth. RESUMO CONTEXTO E OBJETIVO: O consumo de álcool durante a gravidez é um problema social significativo que pode estar associado a resultados perinatais adversos. O objetivo deste estudo foi descrever o consumo de álcool na gestação e avaliar sua associação com recém-nascido de baixo peso, pequeno para idade gestacional e pré-termo. TIPO DE ESTUDO E LOCAL: Estudo de coorte aninhado, na cidade de Ribeirão Preto, São Paulo, Brasil. Foram avaliadas 1.370 mulheres e seus recém-nascidos. Foi aplicado às mães um questionário padronizado sobre saúde e hábitos de vida. Antropometria foi realizada nos recém-nascidos. MÉTODOS:Consumo de álcool foi definido como baixo, moderado e elevado segundo a Organização Mundial de Saúde. Foi utilizada análise de regressão logística ajustada. RESULTADOS: 23% das gestantes consumiram álcool durante a gravidez. A maior parte do consumo ocorreu no primeiro trimestre (14,8%) e diminuiu conforme progredia a gravidez. A mediana de ingestão de álcool foi de 3,89 g (interval interquartil, IIQ = 8 g) por dia. Na análise não ajustada, o consumo de álcool aumentou em quase duas vezes (odds ratio , OR 1,91, intervalo de confiança, IC 95%; 1,25-2,92) o risco de baixo peso, que se reduziu após ajuste (OR 1,62; IC 95%; 1,03-2,54). Não houve associação entre consumo de álcool e pequeno para idade gestacional ou pré-termo. Observou-se maior risco de baixo peso, neonato pequeno para idade gestacional e pré-termo em gestantes simultaneamente fumadoras e bebedoras. CONCLUSÕES: O consumo de álcool na gestação foi de 23% e esteve associado independentemente com o baixo peso ao nascer, mas não houve risco para neonato pequeno para idade gestacional e pré-termo.

Se investigo la asociacion entre actividad fisica durante el segundo trimestre gestacional y los desenlaces perinatales adversos: bajo peso al nacer (BPN), nacimiento pretermino (NPT) y restriccion de crecimiento intrauterino (RCIU). Se utilizo una muestra de la cohorte BRISA, Sao Luis, Maranhao, Brasil, que incluyo mujeres con un embarazo unico, edad gestacional de 22 a 25 semanas, confirmada por ultrasonografia obstetrica realizada con < 20 semanas, reentrevistadas en las primeras 24 horas tras el parto (n = 1.380). El nivel de actividad fisica fue medido por el Cuestionario Internacional de Actividad Fisica (IPAQ), version corta, y categorizado en alto, moderado y bajo. El grafo aciclico dirigido (DAG) se utilizo para identificar un ajuste minimo para el control de confusores. Un nivel alto de actividad fisica no se asocio 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 hipotesis de que la practica de actividad fisica en la gestacion no parece resultar en desenlaces adversos al nacimiento.

The objective of this study was to analyze changes in perinatal health in two birth cohorts started in 1997/1998 and 2010, respectively, in São Luís, Maranhão State, Brazil. A total of 2,493 live born infants were included in 1997/1998 and 5,166 in 2010. Low birth weight (LBW) rate did not change (8.5% in 1997/1998 and 8.6% in 2010). Preterm birth (PTB) rate also remained stable (13.2% in 1997/1998 and 13% in 2010). Teenage deliveries and births to single mothers decreased. Maternal schooling and prenatal care coverage increased. Intrauterine growth restriction (IUGR) decreased from 13.3% to 10.6% (p < 0.001). The perinatal mortality rate decreased from 36.6 to 20.7 per 1,000 (p < 0.001) and the infant mortality rate (IMR) dropped from 28.5 to 12.8 per 1,000 (p < 0.001). The cesarean rate increased from 34.1% to 47.5% (p < 0.001). In conclusion, despite favorable changes in socio-demographic, behavioral, and health service factors and decreasing rates of IUGR and perinatal and infant mortality, LBW and PTB remained stable, while the cesarean rate increased. O objetivo deste estudo foi analisar as mudanças na saúde perinatal em duas coortes de nascimento realizadas em 1997/1998 e 2010, em São Luís, Maranhão, Brasil. Um total de 2.493 nascidos vivos foi incluído em 1997/1998 e 5.166 em 2010. A taxa de baixo peso ao nascer (BPN) não se modificou (8,5% em 1997/1998 e 8,6% em 2010). A taxa de nascimento pré-termo (NPT) também permaneceu estável (13,2% em 1997/1998 e 13% em 2010). Nascimentos em adolescentes e em mulheres sem companheiro decresceram. A escolaridade materna e a cobertura do pré-natal aumentaram. A taxa de restrição de crescimento intrauterino (RCIU) diminuiu de 13,3% para 10,6% (p < 0,001). A taxa de mortalidade perinatal foi reduzida de 36,6 para 20,7 por mil (p < 0,001) e a taxa de mortalidade infantil diminuiu de 28,5 para 12,8 por mil (p < 0,001). A taxa de cesárea (TC) aumentou de 34,1% para 47,5% (p < 0,001). Apesar das mudanças favoráveis nas variáveis sociodemográficas, comportamentais e de serviços de saúde e da redução nas taxas de RCIU, mortalidade perinatal e infantil, as taxas de BPN e NPT permaneceram estáveis, enquanto a TC aumentou. El objetivo de este estudio fue analizar los cambios de la salud perinatal en dos cohortes de nacimiento realizadas en 1997/1998 y 2010 en São Luís, Maranhão, Brasil. Un total de 2.493 niños nacidos vivos fueron incluidos en 1997/1998 y 5.166 en 2010. La tasa de bajo peso al nacer (BPN) no cambió (8,5% y 8,6%). La tasa del nacimiento prematuro (TNP) también se mantuvo estable (13,2% y 13%). Los nacimientos entre adolescentes y madres solteras disminuyeron. La escolaridad de la madre y la cobertura de atención prenatal aumentaron. La tasa de restricción del crecimiento intrauterino (RCIU) se redujo de un 13,3% a un 10,6% (p < 0,001). La tasa de mortalidad perinatal disminuyó de 36,6 a 20,7 por mil (p < 0,001), y la tasa de mortalidad infantil (TMI) se redujo de 28,5 a 12,8 por mil (p < 0,001). La tasa de cesárea (TC) aumentó de 34,1% a 47,5% (p < 0,001). A pesar de los cambios favorables en factores sociodemográficos, de conducta y de servicios de salud, y de la reducción de RCIU, mortalidad perinatal e infantil, las tasas de BPN y el PTB se mantuvieron estables, mientras que la TC aumentó.

Objectives: To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). Methods: This was a cohort study with retrospective data collection (2001–2010, n = 11.991) from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. Results: The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p = 0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). Conclusions: VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC. Resumo: Objetivos: Comparar mortalidade e morbidade em crianças de muito baixo peso (MBP) filhas de mães com e sem diabetes mellitus (DM). Métodos: Estudo de coorte com coleta retrospectiva de dados (2001 - 2010, n = 11.991) da rede NEOCOSUR. Odds ratios ajustados foram calculados para mortalidade e morbilidade neonatal em função da DM materna. Mulheres sem DM serviram como grupo de referência. Resultados: A taxa de DM materna foi 2,8% (IC 95% 2,5-3,1), mas um aumento significativo (p = 0,019) entre 2001-2005 (2,4%) e 2006-2010 (3,2%) foi observado. As mães com DM eram mais propensas a terem recebido um curso completo de esteróides pré-natais que as sem DM. Os bebês de mães diabéticas tinham uma idade gestacional e peso ao nascer um pouco maior do que crianças filhas de não DM. Distribuição dos z escores de peso ao nascer, pequeno para idade gestacional e escores de Apgar foram semelhantes. Não houve diferenças significativas entre os dois grupos em termos de síndrome do desconforto respiratório, displasia broncopulmonar, hemorragia intraventricular, leucomalácia periventricular e persistência do ductus arteriosus. Mortalidade na sala de parto, mortalidade total, necessidade de ventilação mecânica e as taxas de sepse neonatal precoce foram significativamente menores no grupo diabético, enquanto enterocolite necrosante (NEC) foi significativamente maior em recém-nascidos de mães diabéticas. Em análises de regressão logística NEC foi a única condição independentemente associada com DM (OR ajustado 1,65 [IC 95% 1,21 -2,27]). Conclusões: Crianças de MBP de mães com DM não têm aumento do risco de mortalidade ou morbidade precoce, exceto NEC. Keywords: Very low birth weight, Diabetes mellitus, Morbidity, Mortality, Neonatal, Network, Palavras-chave: Muito baixo peso, Diabetes mellitus, Morbilidade, Mortalidade, Neonatal, Redes

Studies have shown a possible association of oral diseases during pregnancy with preterm birth (PTB) and low birth weight (LBW). These perinatal outcomes appear to be associated with enamel defects in the primary dentition, which, in turn, seem to predispose to future development of caries in children. Therefore it is relevant to include oral health variables of the mother/child dyad in cohort studies to understand how these factors are associated. The objectives of this study are: 1) check if there is an association between diseases of the oral cavity of pregnant women and PTB, 2) test the hypothesis of association between perinatal outcomes and enamel defects/dental caries in children, 3) examine whether there are associations between perinatal outcomes and disorders of tooth eruption in children; 4) build theoretical models to study social inequities as a common factor between oral conditions and perinatal outcomes. We used an integrated, collaborative approach between two Brazilian cities with contrasting socioeconomic conditions: Sao Luis , MA, and Ribeirão Preto, SP - British Birth Cohort Studies study (BRISA Ribeirão Preto, São Luís). Two cohorts were evaluated: one initiated at birth, representative of the population of live births, and another, initiated prenatally. Participants were reassessed from the beginning of the second year of life. It is expected that these cohorts will contribute to foster the development and consolidation of population-based follow-up studies in Brazil.

Background Pregnancy in adolescence tends to repeat over generations. This event has been little studied in middle and low-income societies undergoing a rapid epidemiological transition. To assess this association it is important to adjust for socioeconomic conditions at different points in lifetime. Therefore, the aim of this study is to analyze the independent effect of adolescent childbearing in a generation on its recurrence in the subsequent generation, after adjusting for socioeconomic status at different points in life. Methods The study was conducted on a prospective cohort of singleton liveborn females from the city of Ribeirão Preto, Brazil, evaluated in 1978/79, and their daughters assessed in 2002/04. A total of 1059 mother-daughter pairs were evaluated. The women who had their first childbirth before 20 years of age were considered to be adolescent mothers. The risk of childbearing in adolescence for the daughter was modeled as a function of the occurrence of teenage childbearing in her mother, after adjustment for socio-demographic variables in a Poisson regression model. Results The rate of childbearing during adolescence was 31.4% in 1978/79 and 17.1% in 2002/04. Among the daughters of the 1st generation adolescent mothers, this rate was 26.7%, as opposed to 12.7% among the daughters of non adolescent mothers. After adjustments the risk of adolescent childbearing for the 2nd generation was 35% higher for women whose mothers had been pregnant during adolescence – RR = 1.35 (95% CI 1.04-1.74). Conclusion Adolescent childbearing in the 1st generation was a predictor of adolescent childbearing in the 2nd, regardless of socioeconomic factors determined at different points in lifetime.

In the late 1980's child malnutrition was still prevalent in Brazil, and child obesity was beginning to rise in the richest regions of the country. To assess the extent of the nutritional transition during the period and the influence of birth weight and maternal smoking on the nutritional condition of schoolchildren, we estimated the prevalence of excess weight and malnutrition in a cohort of Brazilian schoolchildren from 1987 to 1989. We calculated the body mass index (BMI) of 8- to 10-year-old schoolchildren born in Ribeirão Preto in 1978/79. We considered children with a BMI5th percentile (P5) to be malnourished, children with P5or = BMIP85 to be thin and normal, and children with BMIor = P85 to be overweight. We evaluated the association of these nutritional disorders with birth factors (infant weight, sex, preterm delivery, number of pregnancies, maternal smoking during pregnancy, marital status, and schooling) and type of school using nominal logistic regression. A total of 2797 schoolchildren were evaluated. There was a significant prevalence of malnutrition (9.5%) and excess weight already tended to increase (15.7%), while 6.4% of the children were obese. Excess weight was more prevalent among children attending private schools (odds ratio, OR = 2.27) and firstborn children (OR = 1.69). Maternal smoking during pregnancy protected against malnutrition (OR = 0.56), while children with lower birth weight were at higher risk for malnutrition (OR = 4.23). We conclude that a nutritional transition was under way while malnutrition was still present, but excess weight and related factors were already emerging.

Objectives The association between increased resistance to flow in the uterine artery and adverse pregnancy outcomes has been demonstrated, but there are no studies evaluating their relationship with outcomes after birth. Our aim was to evaluate the relationship of the pulsatility index of the uterine artery in the second trimester of pregnancy with the neurodevelopment of children in the second year of life. Methods A cohort study was performed involving 1370 women with singleton pregnancies. Pulsatility index of the uterine artery between 20 and 25 weeks was obtained. The psychomotor development of the children of these women was evaluated in the second year of life with the Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III Screening). Results The mean age of pregnant women was 25.8 years and the mean gestational age of 23.6 weeks review. The average pulsatility index of the uterine artery was 0.89 and 1.47 for the 95th percentile. Evaluation of children, showed no increased risk associated with delay in pulsatility index of uterine artery greater than or equal to the 95th percentile development (cognitive performance: RR 0.76, 95% CI 0.3–1.96, receptive communication: RR 1.17, 95% CI 0.46–3.01, expressive communication: RR 0.66, 95% CI 0 0.67–1, 36, fine motor: RR 1.26, 95% CI 0.5–3.27, gross motor: RR 1.14 95% CI 0.44–2.94). Conclusions The high flow resistance of the uterine artery in the second quarter, without deleting other perinatal factors, cannot be considered as a risk factor for the delay in child development. Additional studies should be performed excluding the perinatal risk factors such as prematurity that may adversely affect psychomotor performance of children. Disclosures M.M. Okido: None. L.B. Martins: None. T.V. Bertagnolli: None. M.A. Barbieri: None. H. Bettiol: None. V.C. Cardoso: None. R.C. Cavalli: None.

Objectives Gestational hypertension and pre-eclampsia are important causes of perinatal morbidity. In this study we propose to study pregnant women between 20 and 25 weeks of gestation to evaluate the increase in relative risk for developing gestational hypertensive disorders, and correlating the findings with pregnancy outcome. Methods This was a prospective cohort study of convenience. A total of 1417 patients in this gestational age and greater were identified. Of these, 1306 patients were identified at birth. Results Relative risk assigned to each risk variable was calculated through log-binomial regression. Identified as major risk factors were: obesity, with a progressive increase in the relative risk according to the degree, (relative risk of overweight, grade 1, grade 2, and morbid obesity 2.58, 3.06, 5.84 and 7.28 respectively); maternal age above 35 years (2.8, 95% CI 1.58–5.03); parity greater or equal to 3 (1.68, 95% CI 1.17–2.40); chronic hypertension (5.35, 95% CI 4.18–6.85); increase in mean arterial pressure at 20–25 weeks of gestation (4.58, 95% CI 3.12–5.16), and increased pulsatility index of the uterine arteries (2.69, 95% CI 1.86–3.89). Conclusions This study concludes that the clinical evaluation of pregnant women predicts the development of hypertension during pregnancy. These results also demonstrate that even without advanced features, patients at risk can be predicted in order to establish adequate prenatal care. Disclosures L.B. Martins: None. M.M. Okido: None. M.A. Barbieri: None. V.C. Cardoso: None. H. Bettiol: None. M.S. Machado: None. S.M. Quintana: None. R.C. Cavalli: None.

Background and aims The association between caffeine consumption and adverse perinatal outcomes is still controversial. This study aimed to evaluate the association between caffeine consumption during pregnancy and preterm birth (PT, Methods A convenience cohort of 1370 pregnant women living in the city was evaluated between 22–25 weeks of gestation and their respective newborns. Standardised questionnaires were applied during pregnancy and soon after birth and anthropometric information of the newborn was obtained from medical records. The independent variable was the consumption of caffeine during pregnancy (high consumption ≥300 mg caffeine/day), considering the informed consumption of coffee, tea, cola and chocolate milk. The dependent variables were LBW and PT. Logistic regression was used to evaluate the association of caffeine consumption and PT and LBW, adjusting for maternal biological and sociodemographic variables. Results Caffeine intake in this cohort was 96.2%, being 5.6% of high consumption. In unadjusted analysis, women who consumed caffeine ≥300 mg/day had twice the risk of LBW (OR = 2.82; confidence interval 95%, CI95% 1.49–5.34) than those who consumed Conclusions In this cohort, the frequency of high caffeine consumption was low; however, it was independently associated with LBW, but not with preterm birth. Supported: FAPESP, FAEPA.

Background & Aims: It has been demonstrated in the last years that chronic diseases (CD) are associated not only with adult risk factors (RF), but also with predictors that occurred decades before the onset of disease. The pathway through which these early RF influence adult outcomes is not clear. Among the CD hypertension (HT) is the most prevalent one. Recently it has been suggested that systolic pressure between 120-140 of mm Hg and a diastolic pressure between 80-90 mm Hg - pre-hypertension (PHT) - are linked to a higher health risk. The objective of this study is to assess the independent association of early life and adult risk factors for PHT and HT.

Background: Several studies have reported that disorders of fetal growth are associated with non-communicable chronic diseases in adulthood, among them hypertension (HT), according to the hypothesis of the fetal origin of adult diseases. The aim was to describe the prevalence of borderline blood pressure (BBP) and HT among young adults born in the 1978/79 Ribeirao Preto cohort, and to assess the risk of BBP and HT in young adults associated with size at birth, adjusted for birth and adult life characteristics. Methods: Of the 6827 singletons born in hospitals, 2060 were assessed at 23/25 years. Blood was collected, anthropometric assessment was performed and information was obtained regarding occupation, schooling, life habits and chronic diseases. Blood pressure (BP) was classified as: Results: BBP prevalence was 13.5% (men 82.8%) and HT prevalence 9.5% (men 89.8%). BBP was associated with male gender (aRR 9.11; 95% CI 6.23-13.32), BMI>30 kg/m2 (aRR 3.01; 95% CI 1.87-4.85) and altered waist circumference (aRR 1.68; 95% CI 1.17-2.40), whilst HT was associated with the same variables plus high fasting glycemia (aRR 2.86; 95% CI 1.42-5.76). Conclusions: The prevalence of BP and HT among young adults of this cohort is elevated, with no relation with size at birth but associated to altered body adiposity and glycemia.

Background: adolescent pregnancy is highly prevalent in developing countries. It is associated with poverty, induced abortion, low maternal schooling, and maternal and infant mortality. Objective: To verify whether women born to adolescent mothers are also prone to become adolescent mothers and to what extent this association is due to shared socioeconomic circumstances. Methods: questionnaires were applied to women who gave birth to a singleton female liveborn in 1978/79 in Ribeirao Preto, Brazil (first generation mothers). Their daughters were interviewed in 2002/04 (second generation mothers). The questions comprised information on first generation mother variables (age at first delivery - adolescent or not - and family income) and second generation mother variables (schooling level, childhood work and age at menarche). The association between first generation mother's age at first delivery and second generation mother's adolescent pregnancy (yes, compared to older mothers plus women who were not yet mothers) was assessed by means of univariable and multivariable Poisson regression models. The other variables listed above were considered as confounders. Results: 1059 first and second generation woman pairs were interviewed. 181 second generation mothers also gave birth to a child while being an adolescent. If a first generation mother was an adolescent at her first delivery, her daughter presented a relative risk (RR) of being also an adolescent mother of 2.10 (95% Confidence Interval 1.58, 2.82). After adjustment, the association was no longer observed, whilst low first generation mother's family income (p=0.003), second generation mother's low schooling level (p

Background Preterm birth is the main cause of morbidity and mortality during the perinatal period. Classical risk factors are held responsible for only 1/3 of preterm births and no current intervention has produced an appreciable reduction of this event. It is necessary to explore new hypotheses and mechanisms of causality by using an integrated approach, collaboration among research groups and less fragmented theoretical-methodological approaches in order to detect new risk factors and to formulate more effective intervention strategies. Methods The study will be conducted on a convenience cohort of Brazilian pregnant women recruited at public and private prenatal health services. A total of 1500 pregnant women in São Luís, and 1500 in Ribeirão Preto, will be invited for an interview and for the collection of biological specimens from the 22nd to the 25th week of gestational age (GA). At the time of delivery they will be reinterviewed. GA will be determined using an algorithm based on two criteria: date of last menstruation (DLM) and obstetric ultrasound (OUS) performed at less than 20 weeks of GA. Illicit drug consumption during pregnancy will be determined using a self-applied questionnaire and the following instruments will be used: perceived stress scale, Beck anxiety scale, screening for depression of the Center of Epidemiological Studies (CES-D), experiences of racial discrimination, social network and social support scale of the Medical Outcomes Study and violence (Abuse Assessment Screening and violence questionnaire of the WHO). Bacterial vaginosis, urinary tract infection and periodontal disease will also be identified. Neuroendocrine, immunoinflammatory and medical intervention hypotheses will be tested. The occurrence of elective cesarean section in the absence of labor will be used as a marker of medical intervention. Conclusion Psychosocial, genetic and infectious mechanisms will be selected, since there are indications that they influence preterm birth (PTB). The studies will be conducted in two Brazilian cities with discrepant socioeconomic conditions. The expectation is to identify risk factors for PTB having a greater predictive power than classically studied factors. The final objective is to propose more effective interventions for the reduction of PTB, which, after being tested, might subsidize health policies. Electronic supplementary material The online version of this article (doi:10.1186/1742-4755-11-79) contains supplementary material, which is available to authorized users.