RESUMO
BACKGROUND: Birth outcomes could have been affected by the COVID-19 pandemic through changes in access to prenatal services and other pathways. The aim of this study was to examine the effects of the COVID-19 pandemic on fetal death, birth weight, gestational age, number of prenatal visits, and caesarean delivery in 2020 in Colombia. METHODS: We conducted a secondary analysis of data on 3,140,010 pregnancies and 2,993,534 live births from population-based birth certificate and fetal death certificate records in Colombia between 2016 and 2020. Outcomes were compared separately for each month during 2020 with the same month in 2019 and pre-pandemic trends were examined in regression models controlling for maternal age, educational level, marital status, type of health insurance, place of residence (urban/rural), municipality of birth, and the number of pregnancies the mother has had before last pregnancy. RESULTS: We found some evidence for a decline in miscarriage risk in some months after the pandemic start, while there was an apparent lagging increase in stillbirth risk, although not statistically significant after correction for multiple comparisons. Birth weight increased during the onset of the pandemic, a change that does not appear to be driven by pre-pandemic trends. Specifically, mean birth weight was higher in 2020 than 2019 for births in April through December by about 12 to 21 g (p < 0.01). There was also a lower risk of gestational age at/below 37 weeks in 2020 for two months following the pandemic (April, June), but a higher risk in October. Finally, there was a decline in prenatal visits in 2020 especially in June-October, but no evidence of a change in C-section delivery. CONCLUSIONS: The study findings suggest mixed early effects of the pandemic on perinatal outcomes and prenatal care utilization in Colombia. While there was a significant decline in prenatal visits, other factors may have had counter effects on perinatal health including an increase in birth weight on average.
Assuntos
COVID-19 , Estatísticas Vitais , Gravidez , Feminino , Humanos , Cuidado Pré-Natal , Resultado da Gravidez/epidemiologia , Pandemias , Peso ao Nascer , Colômbia/epidemiologia , COVID-19/epidemiologiaRESUMO
Little is known about the health of infants born Venezuelan refugee women in Colombia. Using birth certificate data, we compared birth weight, gestational age, and Apgar scores between births to Venezuelan refugee women and Colombian women in 2016-2018 using logistic regression. We also compared number of prenatal visits and health insurance coverage. Infants born to Venezuelan refugee women were more likely to be preterm (OR=1.14 [95%CI:1.07,1.23]), extremely preterm (OR=1.71 [95%CI:1.19,2.46]), low birth weight (OR=1.30 [95%CI:1.18,1.42]), and very low birth weight (OR =1.80 [95%CI:1.45,2.23]) than infants born to Colombian women. There were no differences in Apgar scores. Most Venezuelan refugee women had no health insurance, and number of prenatal visits was half that of Colombian women. Pregnant Venezuelan refugee women face health care barriers and have worse birth outcomes than Colombian women, highlighting the need to further address health care and other socioeconomic barriers for this vulnerable population.
Assuntos
Nascimento Prematuro , Refugiados , Colômbia , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Resultado da Gravidez , Cuidado Pré-NatalRESUMO
Orofacial clefts (OFCs) are among the most prevalent craniofacial birth defects worldwide and create a significant public health burden. The majority of OFCs are non-syndromic, and the genetic etiology of non-syndromic OFCs is only partially determined. Here, we analyze whole genome sequence (WGS) data for association with risk of OFCs in European and Colombian families selected from a multicenter family-based OFC study. This is the first large-scale WGS study of OFC in parent-offspring trios, and a part of the Gabriella Miller Kids First Pediatric Research Program created for the study of childhood cancers and structural birth defects. WGS provides deeper and more specific genetic data than using imputation on present-day single nucleotide polymorphic (SNP) marker panels. Genotypes of case-parent trios at single nucleotide variants (SNV) and short insertions and deletions (indels) spanning the entire genome were called from their sequences using human GRCh38 genome assembly, and analyzed for association using the transmission disequilibrium test. Among genome-wide significant associations, we identified a new locus on chromosome 21 in Colombian families, not previously observed in other larger OFC samples of Latin American ancestry. This locus is situated within a region known to be expressed during craniofacial development. Based on deeper investigation of this locus, we concluded that it contributed risk for OFCs exclusively in the Colombians. This study reinforces the ancestry differences seen in the genetic etiology of OFCs, and underscores the need for larger samples when studying for OFCs and other birth defects in populations with diverse ancestry.
Assuntos
Cromossomos Humanos Par 21/genética , Fenda Labial/genética , Fissura Palatina/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , População Branca/genética , Sequenciamento Completo do Genoma/métodos , Criança , Colômbia , Feminino , Estudo de Associação Genômica Ampla , Genótipo , Humanos , MasculinoRESUMO
OBJECTIVES: To examine the association between changes in contextual economic factors on childhood obesity in the US. METHODS: We combined data from 2003, 2007, and 2011/2012 National Surveys of Children's Health for 129,781 children aged 10-17 with 27 state-level variables capturing general economic conditions, labor supply, and the monetary or time costs of calorie intake, physical activity, and cigarette smoking. We employed regression models controlling for demographic factors and state and year fixed effects. We also examined heterogeneity in economic effects by household income. RESULTS: Obesity risk increased with workforce proportion in blue-collar occupations, urban sprawl, female labor force participation, and number of convenience stores but declined with median household income, smoking ban in restaurants, and full service restaurants per capita. Most effects were specific to low income households, except for density of supercenters/warehouse clubs which was significantly associated with higher overweight/obesity risk only in higher income households. CONCLUSIONS FOR PRACTICE: Changes in state-level economic factors related to labor supply and monetary or time cost of calorie intake may affect childhood obesity especially for children in low-income households. Policymakers should consider these effects when designing programs aimed at reducing childhood obesity.
Assuntos
Economia/estatística & dados numéricos , Obesidade Infantil/economia , Adolescente , Índice de Massa Corporal , Criança , Exercício Físico/psicologia , Feminino , Humanos , Masculino , Obesidade Infantil/epidemiologia , Fatores SocioeconômicosRESUMO
OBJECTIVE: To assess the association between children's oral health and academic performance using the most recent US national data, a decade after the last assessment using similar previous data. STUDY DESIGN: Data from the 2016-2017 National Survey of Children's Health for 45â711 children aged 6-17 years were analyzed. Children's oral health measures were indicators of specific oral health problems and parent-rated oral health. Academic performance measures included problems at school and missing school days. Regression models were employed adjusting for relevant demographic, socioeconomic, and health characteristics and state effects. Analyses also were conducted stratifying by child's age, sex, household income, and type of health insurance. RESULTS: We found significant associations across all the evaluated academic outcomes and oral health measures. Children with oral health problems were more likely to have problems at school (OR 1.56, 95% CI 1.32-1.85), miss at least 1 school day (OR 1.54, 95% CI 1.28-1.85), and miss more than 3 or 6 school days (OR 1.39, 95% CI 1.20-1.61 and OR 1.39, 95% CI 1.14-1.69; respectively). These associations were generally larger when using the child's oral health rating. Poor oral health was consistently related to worse academic performance across age, sex, household income, and health insurance type subgroups. CONCLUSIONS: Children's oral health status continues to be strongly linked to their academic outcomes. This evidence highlights the need for broad population-wide policies and integrated approaches to reduce academic deficits and promote children's health and development, of which oral health is an important component.
Assuntos
Desempenho Acadêmico , Saúde Bucal , Adolescente , Criança , Feminino , Humanos , Masculino , Fatores de Tempo , Estados UnidosRESUMO
Little is understood about racial/ethnic disparities in infant health in South America. We quantified the extent to which the disparity in preterm birth (PTB; <37 gestational weeks) rate between infants of Native only ancestry and those of European only ancestry in Argentina and Ecuador are explained by household socio-economic, demographic, healthcare use, and geographic location indicators. The samples included 5199 infants born between 2000 and 2011 from Argentina and 1579 infants born between 2001 and 2011 from Ecuador. An Oaxaca-Blinder type decomposition model adapted to binary outcomes was estimated to explain the disparity in PTB risk across groups of variables and specific variables. Maternal use of prenatal care services significantly explained the PTB disparity, by nearly 57% and 30% in Argentina and Ecuador, respectively. Household socio-economic status explained an additional 26% of the PTB disparity in Argentina. Differences in maternal use of prenatal care may partly explain ethnic disparities in PTB in Argentina and Ecuador. Improving access to prenatal care may reduce ethnic disparities in PTB risk in these countries.
Assuntos
Etnicidade , Disparidades nos Níveis de Saúde , Nascimento Prematuro/etnologia , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal , Adulto , Argentina/epidemiologia , Equador/epidemiologia , Características da Família , Feminino , Humanos , Recém-Nascido , Vigilância da População , Gravidez , Adulto JovemRESUMO
Objective We investigate gradients (i.e. differences) in infant health outcomes by maternal education in Argentina, Brazil, Chile, and Venezuela and explore channels related to father's education, household labor outcomes, and maternal health, fertility, and use of prenatal services and technology. Methods We employ secondary interview and birth record data similarly collected across a network of birth hospitals from the early 1980s through 2011 within the Latin American Collaborative Study of Congenital Anomalies (ECLAMC). Focusing on children without birth defects, we estimate gradients in several infant health outcomes including birth weight, gestational age, and hospital discharge status by maternal education using ordinary least squares regression models adjusting for several demographic factors. To explore channels, we add as covariates father's education, parental occupational activity, maternal health and fertility history, and use of prenatal services and technology and evaluate changes in the coefficient of maternal education. We use the same models for each country sample. Results We find important differences in gradients across countries. We find evidence for educational gradients in preterm birth in three countries but weaker evidence for gradients in fetal growth. The extent to which observed household and maternal factors explain these gradients based on changes in the regression coefficient of maternal education when controlling for these factors as covariates also varies between countries. In contrast, we generally find evidence across all countries that higher maternal education is associated with increased use of prenatal care services and technology. Conclusions Our findings suggest that differences in infant health by maternal education and their underlying mechanisms vary and are not necessarily generalizable across countries. However, the positive association between maternal education and use of prenatal services and technology is more consistent across examined countries.
Assuntos
Escolaridade , Disparidades nos Níveis de Saúde , Saúde do Lactente , Mães , Criança , Características da Família , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez , Classe Social , Fatores Socioeconômicos , América do SulRESUMO
We examine disparities in early child cognitive and receptive-expressive skills by ethnic ancestry among infants aged 3-24 months from Brazil and Argentina. We employ unique data on the neurodevelopment of children who were seeking routine well-child care at a set of pediatric clinics in these countries. The sample included children who had normal birth outcomes and no major health complications, allowing us to focus on variation in neurodevelopment among children without major physical health limitations. The physicians attending the pediatric clinics were trained in administering the Bayley Infant Neurodevelopmental Screener, a standardized instrument used to screen an infant's risk of neurodevelopmental problems on various domains of abilities. We evaluate disparities in overall neurodevelopmental scores and risk for neurodevelopmental problems as well as in cognitive functioning and receptive-expressive neurodevelopment. We also examine the extent to which household demographic and socioeconomic characteristics and geographic location explain these disparities. We find large gaps in both cognitive and receptive-expressive neurodevelopment by ancestry. In Brazil, children of African ancestry have lower scores on both cognitive and receptive-expressive domains and on overall neurodevelopment than children of European ancestry. In Argentina, children of Native ancestry have lower scores on these outcomes than children of European ancestry. These gaps however are largely explained by differences in geographic location and household characteristics, highlighting the importance of policies that reduce socioeconomic and geographic disparities in social capital and economic development for eliminating ethnic disparities in infant neurodevelopment.
Assuntos
População Negra/etnologia , Cognição/fisiologia , Indígenas Sul-Americanos/etnologia , Transtornos do Neurodesenvolvimento/etnologia , População Branca/etnologia , Argentina/etnologia , População Negra/psicologia , Brasil/etnologia , Criança , Pré-Escolar , Etnicidade/psicologia , Características da Família/etnologia , Feminino , Humanos , Indígenas Sul-Americanos/psicologia , Lactente , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/psicologia , População Branca/psicologiaRESUMO
OBJECTIVES: The purpose of this study is to examine the effects of economic cycles in Argentina on infant and maternal health between 1994 and 2006, a period that spans the major economic crisis in 1999-2002. METHODS: We evaluate the effects of province-level unemployment rates on several infant health outcomes, including birth weight, gestational age, fetal growth rate, and hospital discharge status after birth in a sample of 15,000 infants born in 13 provinces. Maternal health and healthcare outcomes include acute and chronic illnesses, infectious diseases, and use of prenatal visits and technology. Regression models control for hospital and year fixed effects and province-specific time trends. RESULTS: Unemployment rise reduces fetal growth rate particularly among high educated parents. Also, maternal poverty-related infectious diseases increase, although reporting of acute illnesses declines (an effect more pronounced among low educated parents). There is also some evidence for reduced access to prenatal care and technology among less educated parents with higher unemployment. CONCLUSIONS: Unemployment rise in Argentina has adversely affected certain infant and maternal health outcomes, but several measures show no evidence of significant change.
Assuntos
Recessão Econômica , Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Adolescente , Adulto , Argentina , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Adulto JovemRESUMO
OBJECTIVES: We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. METHODS: We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. RESULTS: The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. CONCLUSIONS: Public policies to improve children's health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil.
Assuntos
Disparidades nos Níveis de Saúde , Recém-Nascido de Baixo Peso , Nascimento Prematuro/etnologia , Cuidado Pré-Natal/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , População Negra/estatística & dados numéricos , Brasil/epidemiologia , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Prevalência , Fatores Socioeconômicos , População Branca/estatística & dados numéricosRESUMO
OBJECTIVE: We assessed the associations between developmental disabilities and indicators of socioeconomic outcomes (i.e., educational attainment, employment status, occupation type, subjective perception of socioeconomic status [SES], income, and wage rate) among young U.S. adults aged 24-33 years. METHODS: We used data from the National Longitudinal Study of Adolescent Health (n=13,040), a nationally representative study of U.S. adolescents in grades 7-12 during the 1994-1995 school year. Young adult outcomes (i.e., educational attainment, employment status, income, occupation, and subjective SES) were measured in Wave IV (2008 for those aged 24-33 years). Multivariate methods controlled for sociodemographic characteristics and other relevant variables. RESULTS: Nearly 12% of this sample presented with a physical or cognitive disability. Respondents with physical disabilities had lower educational attainment (odds ratio [OR] = 0.69, 95% confidence interval [CI] 0.57, 0.85) and ranked themselves in lower positions on the subjective SES ladder (OR=0.71, 95% CI 0.57, 0.87) than those without a physical disability. Compared with individuals without disabilities, young adults with a cognitive disability also had lower educational attainment (OR=0.41, 95% CI 0.33, 0.52) and, when employed, were less likely to have a professional/managerial occupation (OR=0.50, 95% CI 0.39, 0.64). Young adults with disabilities also earned less annually (-$10,419.05, 95% CI -$4,954.79, -$5,883.37) and hourly (-$5.38, 95% CI -$7.64, -$3.12) than their non-disabled counterparts. CONCLUSION: This study highlights the importance of considering multiple developmental experiences that may contribute to learning and work achievements through the transition from adolescence to young adulthood.
Assuntos
Deficiências do Desenvolvimento/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Adolescente , Adulto , Criança , Crianças com Deficiência/estatística & dados numéricos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoas com Deficiência Mental/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos , Adulto JovemRESUMO
OBJECTIVES: We examine disparities in birth weight and gestational age by ethnic ancestry in 2000-2011 in eight South American countries. METHODS: The sample included 60,480 singleton live births. Regression models were estimated to evaluate differences in birth outcomes by ethnic ancestry controlling for time trends. RESULTS: Significant disparities were found in seven countries. In four countries-Brazil, Ecuador, Uruguay, and Venezuela-we found significant disparities in both low birth weight and preterm birth. Disparities in preterm birth alone were observed in Argentina, Bolivia, and Colombia. Several differences in continuous birth weight, gestational age, and fetal growth rate were also observed. There were no systematic patterns of disparities between the evaluated ethnic ancestry groups across the study countries, in that no racial/ethnic group consistently had the best or worst outcomes in all countries. CONCLUSIONS: Racial/ethnic disparities in infant health are common in several South American countries. Differences across countries suggest that racial/ethnic disparities are driven by social and economic mechanisms. Researchers and policymakers should acknowledge these disparities and develop research and policy programs to effectively target them.
Assuntos
Peso ao Nascer , Etnicidade/estatística & dados numéricos , Idade Gestacional , Nascimento Prematuro/etnologia , Disparidades nos Níveis de Saúde , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , América do Sul/epidemiologiaRESUMO
There has been little work that comprehensively compared the relationship between prenatal care and infant health across multiple countries using similar data sources and analytical models. Such comparative analyses are useful for understanding the background of differences in infant health between populations. We evaluated the association between prenatal care visits and fetal growth measured by birth weight (BW) in grams or low birth weight (<2500 grams; LBW) adjusted for gestational age in eight South American countries using similarly collected data across countries and the same analytical models. OLS and logistic regressions were estimated adjusting for a large set of relevant infant, maternal, and household characteristics and birth year and hospital fixed effects. Birth data were acquired from 140 hospitals that are part of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) network. The analytical sample included 56,014 live-born infants (â¼69% of total sample) with complete data born without congenital anomalies in the years 1996-2011 in Brazil, Argentina, Chile, Venezuela, Ecuador, Colombia, Bolivia, and Uruguay. Prenatal care visits were significantly (at p<.05) and positively associated with BW and negatively associated with LBW for all countries. The OLS coefficients ranged from 9 grams per visit in Bolivia to 36 grams in Uruguay. The association with LBW was strongest for Chile (ORâ=â0.87 per visit) and lowest for Argentina and Venezuela (ORâ=â0.95). The association decreased in the recent decade compared to earlier years. Our findings suggest that estimates of association between prenatal care and fetal growth are population-specific and may not be generalizable to other populations. Furthermore, as one of the indicators for a country's healthcare system for maternal and child health, prenatal care is a highly variable indicator between countries in South America.
Assuntos
Cuidado Pré-Natal/estatística & dados numéricos , Peso ao Nascer , Anormalidades Congênitas/epidemiologia , Feminino , Idade Gestacional , Pesquisa sobre Serviços de Saúde , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Razão de Chances , Gravidez , Nascimento Prematuro/epidemiologia , Análise de Regressão , América do SulRESUMO
BACKGROUND: Oral clefts are among the most common birth defects with numerous impacts on affected individuals and families. However, little is known about how being at a greater risk of having an affected child affects subsequent maternal fertility decisions. We investigated differences in fertility preferences and behavior between mothers who are themselves affected with cleft lip with/without cleft palate but have had no affected children and unaffected mothers of an affected child. We also compared these outcomes between unaffected mothers of a first versus another affected child. METHODS: The sample included 1475 Brazilian women interviewed between 2004 and 2009. The outcomes were wanting more children, contraceptive use and type, and maternal age at first child. Comparisons between the various maternal groups were performed using regression analysis adjusting for conceptually relevant demographic, socioeconomic, and geographic factors. RESULTS: Affected mothers of unaffected children were less likely to use contraceptives than unaffected mothers of affected children by 31% (95% confidence interval, 1-53%). Among unaffected mothers, those who had a first affected child were 67% (95% confidence interval, 15-144%) more likely to use contraceptives. CONCLUSION: The results suggest that having an affected child represents a stronger signal of recurrence risk to the mother than her own cleft status, and that cleft status of the first child is especially important in influencing subsequent maternal fertility decisions in affected families. These findings highlight the importance of adequate counseling of at-risk women about recurrence risks and available care resources and policies that improve access to quality cleft care.
Assuntos
Fenda Labial/psicologia , Fissura Palatina/psicologia , Fertilidade , Predisposição Genética para Doença , Mães/psicologia , Adulto , Brasil , Criança , Fenda Labial/genética , Fenda Labial/patologia , Fissura Palatina/genética , Fissura Palatina/patologia , Comportamento Contraceptivo/psicologia , Aconselhamento , Escolaridade , Serviços de Planejamento Familiar , Feminino , Humanos , Padrões de Herança , Masculino , Idade Materna , Educação de Pacientes como Assunto , Análise de Regressão , RiscoRESUMO
Several studies report socioeconomic inequalities in child health and consequences of early disease. However, not much is known about inequalities in health capital accumulation in the womb in response to fetal health shocks, which is essential for finding the earliest sensitive periods for interventions to reduce inequalities. We identify inequalities in birth weight accumulation as a result of fetal health shocks from the occurrence of one of the most common birth defects, oral clefts, within the first 9 weeks of pregnancy, using quantile regression and two datasets from South America and the USA. Infants born at lower birth weight quantiles are significantly more adversely affected by the health shock compared with those born at higher birth weight quantiles, with overall comparable results between the South American and US samples. These results suggest that fetal health shocks increase child health disparities by widening the spread of the birth weight distribution and that health inequalities begin in the womb, requiring interventions before pregnancy.
Assuntos
Fissura Palatina/economia , Desenvolvimento Fetal , Disparidades nos Níveis de Saúde , Complicações na Gravidez/economia , Fissura Palatina/epidemiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Gravidez , Complicações na Gravidez/epidemiologia , Análise de Regressão , Fatores Socioeconômicos , América do Sul/epidemiologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Several countries have implemented mandatory folic acid fortification of wheat flour and selected grain products to increase the folate intake of reproductive-aged women. Brazil implemented a folic acid fortification program in 2004. No previous studies have examined folate differences among Brazilian women following the mandate. OBJECTIVE: We evaluate differences in serum and red blood cell (RBC) folate concentrations between two samples of women of childbearing age from selective communities in Brazil, one tested before (N = 116) and the other after the mandate (N = 240). METHODS: We compared the baseline folate levels of women enrolled in a prevention study shortly before the fortification mandate was implemented, to baseline levels of women from the same communities enrolled in the same study shortly after fortification began. The participants were women enrolled in a folate supplementation clinical trial, at a hospital specializing in treating craniofacial anomalies in the city of Bauru from January 29, 2004 to April 27, 2005. We only compared baseline folate levels before the women received oral cleft prevention program (OCPP) folic acid supplements. RESULTS: Women enrolled after the fortification mandate had higher means of serum folate (20.3 versus 11.2 nmol/L; p < 0.001) and RBC folate (368.3 versus 177.6 nmol/L; p < 0.001) than women enrolled before the mandate. Differences in folate levels between the two groups remained after adjusting for several co-variables. CONCLUSIONS: The results suggest that serum and RBC folate levels among women of childbearing age increased after implementing the folic acid fortification mandate in Brazil.
Assuntos
Ácido Fólico/sangue , Ácido Fólico/farmacologia , Alimentos Fortificados , Adulto , Brasil , Relação Dose-Resposta a Droga , Feminino , Ácido Fólico/administração & dosagem , Humanos , Adulto JovemRESUMO
OBJECTIVE: We report on the risk of miscarriage with high- and low-dosage periconceptional folic acid (FA) supplementation from a double-blind randomized clinical trial for prevention of orofacial cleft recurrence in Brazil. METHODS: Women at risk of recurrence of orofacial clefts in their offspring were randomized into high (4 mg/day) and low (0.4 mg/day) doses of FA supplementation. The women received the study pills before pregnancy, and supplementation continued throughout the first trimester. Miscarriage rates were compared between the two FA groups and with the population rate. RESULTS: A total of 268 pregnancies completed the study protocol, with 141 in the 4.0-mg group and 127 in the 0.4-mg group. The miscarriage rate was 14.2% in the low-dose FA group (0.4 mg/day) and 11.3% for the high-dose group (4 mg/day) (P=0.4877). These miscarriage rates are not significantly different from the miscarriage rate in the Brazilian population, estimated to be around 14% (P=0.311). CONCLUSIONS: These results indicate that high-dose FA does not increase miscarriage risk in this population and add further information to the literature on the safety of high FA supplementation for prevention of birth defect recurrence.
Assuntos
Aborto Espontâneo/etiologia , Fenda Labial/prevenção & controle , Fissura Palatina/prevenção & controle , Ácido Fólico/administração & dosagem , Cuidado Pré-Concepcional/métodos , Aborto Espontâneo/epidemiologia , Adulto , Brasil/epidemiologia , Método Duplo-Cego , Feminino , Ácido Fólico/efeitos adversos , Humanos , Recém-Nascido , Masculino , Gravidez , Recidiva , Adulto JovemRESUMO
OBJECTIVES: We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. METHODS: We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. RESULTS: The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. CONCLUSIONS: Public policies to improve children's health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil.