RESUMEN

This systematic review aimed to investigate the association between maternal smoking during pregnancy and birth defects in children. We performed an electronic search of observational studies in the databases ovid MEDLINE (1950 to April 2010), LILACS and SciELO. We included 188 studies with a total of 13,564,914 participants (192,655 cases). Significant positive associations were found between maternal smoking and birth defects in the following body systems: cardiovascular (OR: 1.11; 95%CI: 1.03-1.19), digestive (OR: 1.18; 95%CI: 1.07-1.30), musculoskeletal (OR: 1.27; 95%CI: 1.16-1.39) and face and neck (OR: 1.28; 95%CI: 1.19-1.37). The strength of association between maternal smoking and birth defects measured by the OR (95%CI) is significantly related to the amount of cigarettes smoked daily (χ2 = 12.1; df = 2; p = 0.002). In conclusion, maternal smoking during pregnancy is associated with congenital malformations in children and this association is dose-dependent.

Esta revisión sistemática se encargó de investigar la asociación entre el tabaquismo materno durante el embarazo y las malformaciones congénitas en los niños. Se realizó una búsqueda electrónica de los estudios de observación en las bases de datos de ovid MEDLINE (1950 hasta abril de 2010), LILACS y SciELO. 188 estudios con 13.564.914 participantes se incluyeron en esta revisión. Se encontraron asociaciones positivas significativas entre el tabaquismo materno y malformaciones de los sistemas: cardiovascular (OR: 1,11; IC95%: 1.03-1.19), digestivo (OR: 1,18; IC95%: 1,07-1,30), musculoesqueléticos (OR: 1,27; IC95%: 1,16-1,39) y de cara y cuello (OR: 1,28; IC95%: 1,19-1,37). La fuerza de la asociación entre el tabaquismo materno y los defectos de nacimiento, medidos por el OR (IC95%) está significativamente relacionada con la cantidad de cigarrillos fumados diariamente (χ2 = 12,1; p = 0,002). Llegamos a la conclusión de que el tabaquismo materno durante el embarazo se asocia con un mayor riesgo de malformaciones congénitas en los niños y esta asociación es dosis-dependiente.

Esta revisão sistemática teve como objetivo investigar a associação entre fumo materno na gestação e as malformações congênitas em crianças. Uma busca eletrônica dos estudos observacionais foi realizada nas bases de dados ovid MEDLINE (1950 até abril de 2010), SciELO e LILACS. Foram incluídos nesta revisão 188 estudos com um total de 13.564.914 participantes (192.655 casos). Foram encontradas associações positivas significativas entre fumo materno e malformações dos sistemas: cardiovascular (OR: 1,11; IC95%: 1,03-1,19), digestivo (OR: 1,18; IC95%: 1,07-1,30), musculoesquelético (OR: 1,27; IC95%: 1,16-1,39) e face e pescoço (OR: 1,28; IC95%: 1,19-1,37). A força de associação entre fumo materno e malformações medida pelo OR (IC95%) está relacionada significativamente com a quantidade diária de cigarros consumidos (χ2 = 12,1; df = 2; p = 0,002). Concluímos que fumo materno na gestação está associado com maior risco de malformações congênitas em crianças e essa associação é dose-dependente.

Asunto(s)

RESUMEN

This systematic review aimed to investigate the association between maternal smoking during pregnancy and birth defects in children. We performed an electronic search of observational studies in the databases ovid MEDLINE (1950 to April 2010), LILACS and SciELO. We included 188 studies with a total of 13,564,914 participants (192,655 cases). Significant positive associations were found between maternal smoking and birth defects in the following body systems: cardiovascular (OR: 1.11; 95%CI: 1.03-1.19), digestive (OR: 1.18; 95%CI: 1.07-1.30), musculoskeletal (OR: 1.27; 95%CI: 1.16-1.39) and face and neck (OR: 1.28; 95%CI: 1.19-1.37). The strength of association between maternal smoking and birth defects measured by the OR (95%CI) is significantly related to the amount of cigarettes smoked daily (χ2 = 12.1; df = 2; p = 0.002). In conclusion, maternal smoking during pregnancy is associated with congenital malformations in children and this association is dose-dependent.

Asunto(s)

RESUMEN

INTRODUÇÃO: O coeficiente de mortalidade infantil vem apresentando tendência ao declínio no Brasil nos últimos anos, porém, a proporção de óbitos por malformações congênitas tende a aumentar à medida que o componente pós-neonatal da mortalidade infantil diminui. Sendo assim, este estudo tem por objetivo avaliar o comportamento dos óbitos em menores de um ano de idade por anomalias congênitas durante o período de 1996 a 2008 no Brasil. MÉTODOS: Foi um estudo ecológico, de séries temporais, que se baseou no banco de dados do Departamento de Informática do Sistema Único de Saúde. Foram extraídos o número de nascidos vivos, o número total de óbitos em menores de um ano de idade e o número de óbitos por malformações congênitas. As principais variáveis estudadas foram os coeficientes de mortalidade infantil e de mortalidade por malformações congênitas. Utilizou-se o teste de regressão linear para avaliar a tendência temporal de mortalidade. RESULTADOS: O coeficiente de mortalidade infantil apresentou tendência decrescente no período de 1996 a 2008, com uma redução média anual de 0,81 (p<0,0001). No mesmo período, houve uma elevação significativa no coeficiente de mortalidade por malformações congênitas, com um aumento médio anual de 0,03 (p=0,001). A proporção de óbitos infantis atribuíveis às malformações congênitas subiu de 9,74% em 1996, para 18,22% em 2008, com um aumento médio anual de 0,71% (p<0,0001). CONCLUSÃO: Houve redução significativa no coeficiente de mortalidade infantil no Brasil, porém, ocorreu aumento de mortalidade por malformações congênitas no período compreendido entre 1996 e 2008

INTRODUCTION: The infant mortality rate has shown a tendency to decline in Brazil in recent years, but the proportion of deaths due to congenital malformations tends to increase as the post-neonatal component of infant mortality decreases. Thus, this study aims to evaluate the behavior of the deaths in children under one year of age due to congenital anomalies during the 1996-2008 period in Brazil. METHODS: This was an ecological study, of temporal sequences, based on the database of the Information Department of the National Health System. We extracted the number of live births, total number of deaths in children under one year of age, and number of deaths due to congenital malformations. The main variables were the rates of infant mortality and of mortality from congenital malformations. We used linear regression to assess the temporal trend of mortality. RESULTS: The infant mortality rate showed a declining trend over the 1996-2008 period, with an average annual reduction of 0.81 (p <0.0001). In the same period there was a significant increase in the mortality rate due to congenital malformations, with an average annual increase of 0.03 (p = 0.001). The proportion of infant deaths attributable to congenital malformations rose from 9.74% in 1996 to 18.22% in 2008, with an average annual increase of 0.71% (p <0.0001). CONCLUSION: There was a significant reduction in infant mortality in Brazil, but with increased mortality due to congenital malformations in the 1996-2008 period

Asunto(s)

RESUMEN

OBJECTIVE: To compare the prevalence of depression among mothers of children with asthma and mothers of children without asthma and to investigate the influence of severity and duration of childhood asthma on maternal depression. METHOD: A cross-sectional study including 80 mothers of children with asthma and 160 mothers of children without asthma who attended the pediatric outpatient clinics of a teaching hospital in Southern Brazil. The main outcome measure was the presence of depression in these mothers, measured by the Beck Depression Inventory. RESULTS: The prevalence of depression was higher among mothers of asthmatic children compared with mothers of non-asthmatic children (43.8% vs. 17.5%, p < 0.001), with an adjusted prevalence ratio of 2.74 (95% confidence interval [CI] 1.76-4.25). Mothers of children with persistent asthma had a higher prevalence of depression than mothers of children with intermittent asthma (62.8% vs. 21.6%, p < 0.001), with an adjusted prevalence ratio of 2.77 (95% CI: 1.46-5.27). No significant association was observed between duration of childhood asthma and maternal depression. CONCLUSION: Mothers of children with asthma have a higher prevalence of depression than mothers of children without asthma. The severity but not duration of childhood asthma is associated with maternal depression.

Asunto(s)