scholarly journals Maternal reproductive history: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

2019 ◽  
Vol 48 (Supplement_1) ◽  
pp. i16-i25 ◽  
Author(s):  
Alicia Matijasevich ◽  
Cesar G Victora ◽  
Mariangela F Silveira ◽  
Fernando C Wehrmeister ◽  
Bernardo L Horta ◽  
...  
Keyword(s):  
Low Birthweight ◽  
White Women ◽  
Family Income ◽  
Population Based ◽  
Reproductive History ◽  
Multiple Births ◽  
Birth Cohorts ◽  
Birth Intervals ◽  
Ethnic Inequalities ◽  
Over Time

Abstract Background Brazil experienced important progress in maternal and child health in recent decades. We aimed at describing secular trends as well as socioeconomic and ethnic inequalities in reproductive history indicators (birth spacing, previous adverse perinatal outcome, parity and multiple births) over a 33-year span. Methods Four population-based birth cohort studies included all hospital births in 1982, 1993, 2004 and 2015 in Pelotas, Southern Brazil. Information on reproductive history was collected through interviews. Indicators were stratified by family income quintiles and skin colour. Absolute and relative measures of inequality were calculated. Results From 1982 to 2015, the proportion of primiparae increased from 39.2% to 49.6%, and median birth interval increased by 23.2 months. Poor women were more likely to report short intervals and higher parity, although reductions were observed in all income and ethnic groups. History of previous low birthweight was inversely related to income and increased by 7.7% points (pp) over time—more rapidly in the richest (12.1 pp) than in the poorest quintile (0.4 pp). Multiple births increased from 1.7% to 2.7%, with the highest increase observed among the richest quintile and for white women (220% and 70% increase, respectively). Absolute and relative income and ethnic-related inequalities for short birth intervals increased, whereas inequalities for previous low birthweight decreased over time. Conclusions In this 33-year period there were increases in birth intervals, multiple births and reports of previous low-birthweight infants. These trends may be explained by increased family planning coverage, assisted reproduction and a rise in preterm births, respectively. Our results show that socioeconomic and ethnic inequalities in health are dynamic and vary over time, within the same location.

scholarly journals Low birthweight and preterm birth: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

2018 ◽  
Vol 48 (Supplement_1) ◽  
pp. i46-i53 ◽  
Author(s):  
Mariangela F Silveira ◽  
Cesar G Victora ◽  
Bernardo L Horta ◽  
Bruna G C da Silva ◽  
Alicia Matijasevich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Low Income ◽  
Low Birthweight ◽  
Family Income ◽  
Preterm Births ◽  
Population Based ◽  
Skin Colour ◽  
Birth Cohorts ◽  
Maternal Risk

Abstract Background Despite positive changes in most maternal risk factors in Brazil, previous studies did not show reductions in preterm birth and low birthweight. We analysed trends and inequalities in these outcomes over a 33-year period in a Brazilian city. Methods Four population-based birth cohort studies were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, with samples ranging from 4231 to 5914 liveborn children. Low birthweight (LBW) was defined as <2500 g, and preterm birth as less than 37 weeks of gestation. Information was collected on family income, maternal skin colour and other risk factors for low birthweight. Multivariable linear regression was used to estimate the contribution of risk factors to time trends in birthweight. Results Preterm births increased from 5.8% (1982) to 13.8% (2015), and LBW prevalence increased from 9.0% to 10.1%, being higher for boys and for children born to mothers with low income and brown or black skin colour. Mean birthweight remained stable, around 3200 g, but increased from 3058 to 3146 g in the poorest quintile and decreased from 3307 to 3227 g in the richest quintile. After adjustment for risk factors for LBW, mean birthweight was estimated to have declined by 160 g over 1982–2015 (reductions of 103 g in the poorest and 213 g in the richest quintiles). Conclusions Data from four birth cohorts show that preterm births increased markedly. Mean birthweights remained stable over a 33-year period. Increased prevalence of preterm and early term births, associated with high levels of obstetric interventions, has offset the expected improvements due to reduction in risk factors for low birthweight.

Influence of maternal excess weight before pregnancy on breastfeeding and weaning: pooled analyses of four population-based cohorts born between 1982-2015

2021 ◽  
pp. 1-20
Author(s):  
Thaynã Ramos Flores ◽  
Gregore I Mielke ◽  
Alicia Matijasevich ◽  
Iná S Santos ◽  
Mariângela Freitas da Silveira ◽  
...  
Keyword(s):  
Exclusive Breastfeeding ◽  
Post Partum ◽  
Population Based ◽  
Normal Weight ◽  
Excess Weight ◽  
Birth Cohorts ◽  
Pregnancy Weight ◽  
Recent Cohort ◽  
Weight Excess ◽  
Over Time

Abstract Purpose: To investigate the associations of maternal excess weight before pregnancy with (1) weaning at age 3mo, (2) duration of exclusive breastfeeding at age 6mo, (3) duration of any breastfeeding at age 12mo; and (4) to compare the magnitude of these associations over four decades. Methods: Data were from participants in the Pelotas (Brazil) Birth Cohorts born in 1982 (N=5,334), 1993 (N=1,442), 2004 (N=4,092) and 2015 (N=4,102). Maternal pre-pregnancy weight was collected after the delivery and breastfeeding status was assessed when children were three and 12 months old. Results: Only in the most recent cohort (2015), women with excess weight [body mass index (BMI) ≥ 25 kg/m2) before pregnancy had higher risk of discontinuing exclusive breastfeeding within the first six months post-partum than women with normal weight [HR= 1.22 (95%CI 1.15; 1.30)]. Duration of any type of breastfeeding until 12 months of age was not affected by pre-pregnancy weight. Conclusion: Excess weight before pregnancy is associated with exclusive breastfeeding only in the most recent birth cohort coinciding with increases in weight excess and breastfeeding over time.

scholarly journals Infant malnutrition and obesity in three population-based birth cohort studies in Southern Brazil: trends and differences

2008 ◽  
Vol 24 (suppl 3) ◽  
pp. s417-s426 ◽  
Author(s):  
Aluísio J. D. Barros ◽  
Cesar G. Victora ◽  
Iná S. Santos ◽  
Alicia Matijasevich ◽  
Cora L. Araújo ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Family Income ◽  
Population Based ◽  
The Other ◽  
Southern Brazil ◽  
Birth Cohorts ◽  
Growth Standards ◽  
One Year ◽  
Nutritional Deficits ◽  
Social Differentials

The aim of this study was to compare the evolution of nutritional deficits and overweight in one-year-old children from three birth cohorts started in 1982, 1993 and 2004 in Pelotas, Southern Brazil. Samples from the 1982 and 1993 cohorts and all children from 2004 were weighed and measured, and their mothers interviewed. Anthropometric deficits and overweight were assessed using both NCHS and WHO growth standards. A comparison of the existence of nutritional deficits showed that, after a decline between 1982 and 1993, its prevalence stabilized between 1993 and 2004. Across the whole period, a decrease in all deficits was observed. Obesity, on the other hand, increased. A deficit in the ratio of body length to age was found to be strongly associated with family income. The group with income below one minimum wage was the only to present a significant reduction of stunting during the study period. The most significant improvements in the reduction of nutritional deficits occurred in the first half of the study period, while social differentials remained. Fighting malnutrition is still necessary among the 40% of the population considered poor, and must be accompanied by efforts to combat overweight which is being observed in all social strata.

A Population-Based Study of Grade 12 Academic Performance in Adolescents with Childhood-onset Chronic Rheumatic Diseases

2021 ◽  
pp. jrheum.201514
Author(s):  
Lily Siok Hoon Lim ◽  
Okekchukwu Ekuma ◽  
Ruth Ann Marrie ◽  
Marni Brownell ◽  
Christine Peschken ◽  
...  
Keyword(s):  
Mental Health ◽  
Language Arts ◽  
Rheumatic Diseases ◽  
Family Income ◽  
Multivariable Analysis ◽  
Population Based ◽  
Administrative Databases ◽  
Birth Cohorts ◽  
Population Based Study ◽  
Chronic Rheumatic Diseases

Objective 1) To compare grade 12 standards tests results of patients diagnosed with childhoodonset chronic rheumatic diseases (ChildCRD) and unaffected peers. 2) To identify factors associated with test results of ChildCRD patients and unaffected peers. Methods This was a population-based retrospective cohort study. All ChildCRD patients (juvenile arthritis and systemic autoimmune rheumatic diseases) from the only pediatric rheumatology centre in Manitoba for birth cohorts January 1979 to December 1998 were linked to the provincial administrative databases containing records of healthcare use and education outcomes Patients were matched by age, sex and postal codes to their peers who did not have ChildCRD. The primary outcomes were the grade 12 language arts achievement index (LAI) and the math achievement index (MAI) scores. ChildCRD, sociodemographic and mental health factors were tested for their associations with LAI and MAI scores using multivariable linear regression. Results 541 ChildCRD patients were matched to 2713 unaffected peers. ChildCRD patients had lower LAI and MAI scores compared to their peers. More ChildCRD patients failed or did not take the language arts (51% vs 41%, p<0.001) and maths (61% vs 55%, p=0.017) tests. On multivariable analysis, ChildCRD, lower socioeconomic status, younger maternal age at first childbirth, family income assistance, involvement with child welfare services, and mental health morbidities (between ChildCRD diagnosis and standards testing), were associated with worse LAI and MAI results. Conclusion This population-based study showed that ChildCRD patients performed less well than their peers on grade 12 standards tests results, independent of sociodemographic and mental health comorbidities.

Twin Births In The Pelotas (Brazil) 2004 And 2015 Birth Cohorts 

2020 ◽  
Author(s):  
Ina Santos ◽  
Neiva C. J. Valle ◽  
Mariangela F. Silveira ◽  
Alicia Matijasevich ◽  
Andréa D. Bertoldi ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Infant Mortality ◽  
Skin Color ◽  
Low Birthweight ◽  
Family Income ◽  
Infant Mortality Rate ◽  
Multiple Pregnancies ◽  
Birth Cohorts ◽  
Maternal Characteristics ◽  
Maternity Hospitals

Abstract Background: In the last decade, there has been an increase in the number of multiple pregnancies. Our aim was to describe the prevalence and duration of multiple pregnancies and compare first- and second-born twins to each other and to singletons, in terms of unfavorable perinatal outcomes and infant mortality rate (IMR). Methods: The 2004 and 2015 Pelotas Birth Cohorts are population-based studies that enrolled all newborns of mothers living in the urban area of Pelotas, South Brazil. All five maternity hospitals in Pelotas were visited daily by the research team, from January 1st to December 31st in 2004 and 2015. A monitoring system was assembled to detect all deaths of cohort participants in the years 2004, 2005, 2015, and 2016. Twinning rate was described according to maternal characteristics (family income, schooling, age, skin color, and morbidity) and parity. First- and second-born twins were compared to each other and to singletons, according to low birthweight (LBW), 5-minute Apgar <7, admission to neonatal intensive care unit (NICU), and IMR:1000 live births (LB). Results: Among 4,187 pregnancies in 2004 and 4,220 in 2015, respectively, 42 (1.0%) and 56 (1.3%) were multiple. Eighty-four twins were born alive in 2004 and 111 in 2015. In the two cohorts, no maternal characteristics were associated with the occurrence of multiple pregnancies. Twin births <34 weeks gestational age more than doubled from 2004 (19.0%) to 2015 (42.1%) (p=0.03). In both cohorts, LBW and admission to the NICU were more frequent in twins than in singletons, with no difference between first- and second-born twins. There was no difference between first-born and second-born twins at the two cohorts nor between twins and single-born infant mortality at the 2004 cohort. Among second-born twins in 2015, the post-neonatal mortality rate was 8 times higher than in singletons (37.7:1,000 LB versus 4.8:1,000 LB), and infant mortality rate (IMR) was 6 times higher (75.4:1,000 LB versus 12.5:1,000 LB). Conclusion: More than one out of 50 births in Pelotas was a twin, generally born prematurely and with a risk six times higher than singletons of dying alongside the first year of life.

scholarly journals Infant nutrition and growth: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

2019 ◽  
Vol 48 (Supplement_1) ◽  
pp. i80-i88 ◽  
Author(s):  
Helen Gonçalves ◽  
Fernando C Barros ◽  
Romina Buffarini ◽  
Bernardo L Horta ◽  
Ana M B Menezes ◽  
...  
Keyword(s):  
Family Income ◽  
Infant Nutrition ◽  
Nutrition Transition ◽  
Population Based ◽  
Overweight And Obesity ◽  
World Health ◽  
Skin Colour ◽  
Birth Cohorts ◽  
Growth Standards ◽  
Z Scores

Abstract Background Levels of child undernutrition have declined in many middle-income countries, whereas overweight and obesity have increased. We describe time trends in nutritional indicators at age 1 year in the 1982, 1993, 2004 and 2015 Pelotas (Brazil) Birth Cohorts. Methods Each study included all children born in the urban area of the city, with over 4 200 births in each cohort. Children were measured at approximately 12 months of age. Anthropometric indicators were calculated according to World Health Organization Growth Standards. Stunting and wasting were defined as &lt;-2 Z scores for length for age and weight for length, and overweight as &gt;2 Z scores for weight for length. Prevalence was stratified by sex, maternal skin colour and family income. Results The prevalence of stunting declined by 53% (from 8.3% to 3.9%) from 1982 to 2015. Wasting prevalence remained stable at low levels (1.8% in 1982 and 1.7% in 2015), whereas overweight increased by 88% (6.5% to 12.2%). Undernutrition was more common among boys, those born to mothers with brown or black skin colour and in the poorest quintile of families. Socioeconomic inequalities in undernutrition decreased markedly over time. Overweight was markedly more common among the rich in 1982, but fast increase among the poor eliminated socioeconomic differences by 2015, when all groups showed similar prevalence. Conclusions Our results confirm the rapid nutrition transition in Brazil, with marked reduction in levels and inequalities in undernutrition in parallel with a rapid increase in overweight, which became the main nutritional problem for children.

scholarly journals Breastfeeding exclusivity and duration: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

2019 ◽  
Vol 48 (Supplement_1) ◽  
pp. i72-i79 ◽  
Author(s):  
Iná S Santos ◽  
Fernando C Barros ◽  
Bernardo L Horta ◽  
Ana M B Menezes ◽  
Diego Bassani ◽  
...  
Keyword(s):  
Exclusive Breastfeeding ◽  
Family Income ◽  
Population Based ◽  
Black Mothers ◽  
Birth Cohorts ◽  
Socioeconomic Groups ◽  
Breastfeeding Practices ◽  
Poor Women ◽  
Duration Of Breastfeeding ◽  
The City

Abstract Background Brazil has made substantial improvements in the duration of breastfeeding. We use data from four population-based cohorts to examine how trends and inequalities in breastfeeding indicators changed over time in a Brazilian city. Methods Data from four birth cohorts, each including all births in a calendar year (1982, 1993, 2004 and 2015) in the city of Pelotas were used. Information on breastfeeding was collected when children were aged between 3 and 20 months. The prevalences of continued breastfeeding at 1 year of age and of exclusive breastfeeding at 3 months were calculated according to family income, maternal skin colour and sex. Results Prevalence of breastfeeding at 12 months increased from 16% to 41% in the 33-year period. The prevalence of exclusive breastfeeding at 3 months increased from 7% in 1993 to 45% in 2015. Increases in exclusive breastfeeding at 3 months were seen in all socioeconomic groups, but the 2015 rates remain highest (57.2%) among the women in the richest quintile, and lowest among those in the poorest quintile (34.6%). Black mothers were more likely to breastfeed at 12 months than Whites in the four cohorts. In the earlier cohorts, breastfeeding at 12 months was more common among the poor, but by 2015 these differences had disappeared. Conclusions There were important positive changes in breastfeeding practices during this period, but less than half of the children in 2015 were receiving the full benefits of breast milk. Improved breastfeeding practices are being adopted by high-income women to a greater extent than by poor women.

scholarly journals Hospital admissions in the first year of life: inequalities over three decades in a southern Brazilian city

2019 ◽  
Vol 48 (Supplement_1) ◽  
pp. i63-i71 ◽  
Author(s):  
Fernando C Wehrmeister ◽  
Cesar G Victora ◽  
Bernardo L Horta ◽  
Ana M B Menezes ◽  
Iná S Santos ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Family Income ◽  
Hospital Admissions ◽  
Population Based ◽  
Income Quintile ◽  
First Year ◽  
Birth Cohorts ◽  
Admission Rates ◽  
Hospital Births ◽  
First Year Of Life

Abstract Background Hospital admissions in infancy are declining in several countries. We describe admissions to neonatal intensive care units (NICU) and other hospitalizations over a 33-year period in the Brazilian city of Pelotas. Methods We analysed data from four population-based birth cohorts launched in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. NICU and other hospital admissions during infancy were reported by the mothers in the perinatal interview and at the 12-month visit, respectively. We describe these outcomes by sex of the child, family income and maternal skin colour. Results In 1982, NICUs did not exist in the city; admissions into NICUs increased from 2.7% of all newborns in 1993 to 6.7% in 2015, and admission rates were similar in all income groups. Hospitalizations during the first year of life fell by 29%, from 23.7% in 1982 to 16.8% in 2015, and diarrhoea admissions fell by 95.2%. Pneumonia admissions fell by 46.3% from 1993 to 2015 (no data available for 1982). Admissions due to perinatal causes increased during the period. In the poorest income quintile, total admissions fell by 33% (from 35.7% to 23.9%), but in the richest quintile these remained stable at around 10%, leading to a reduction in inequalities. Over the whole period, children born to women with black or brown skin were 30% more likely to be admitted than those of white-skinned mothers. Conclusions Whereas NICU admissions increased, total admissions in the first year of life declined by nearly one-third. Socioeconomic disparities were reduced, but important gaps remain.

Ethnic Differences in Self-Poisoning Across South London

Crisis ◽  
2014 ◽  
Vol 35 (4) ◽  
pp. 268-272
Author(s):  
Sean Cross ◽  
Dinesh Bhugra ◽  
Paul I. Dargan ◽  
David M. Wood ◽  
Shaun L. Greene ◽  
...  
Keyword(s):  
Black Women ◽  
Data Collection ◽  
White Women ◽  
Population Based ◽  
Care Services ◽  
Self Harm ◽  
Managing Risk ◽  
The Uk ◽  
Incident Cases ◽  
Minority Ethnic

Background: Self-poisoning (overdose) is the commonest form of self-harm cases presenting to acute secondary care services in the UK, where there has been limited investigation of self-harm in black and minority ethnic communities. London has the UK’s most ethnically diverse areas but presents challenges in resident-based data collection due to the large number of hospitals. Aims: To investigate the rates and characteristics of self-poisoning presentations in two central London boroughs. Method: All incident cases of self-poisoning presentations of residents of Lambeth and Southwark were identified over a 12-month period through comprehensive acute and mental health trust data collection systems at multiple hospitals. Analysis was done using STATA 12.1. Results: A rate of 121.4/100,000 was recorded across a population of more than half a million residents. Women exceeded men in all measured ethnic groups. Black women presented 1.5 times more than white women. Gender ratios within ethnicities were marked. Among those aged younger than 24 years, black women were almost 7 times more likely to present than black men were. Conclusion: Self-poisoning is the commonest form of self-harm presentation to UK hospitals but population-based rates are rare. These results have implications for formulating and managing risk in clinical services for both minority ethnic women and men.

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