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The literature shows associations between maternal exposures to PM2.5 and adverse pregnancy outcomes. There are few data from Latin America. We have examined PM2.5 and pregnancy outcomes in Lima. The study included 123,034 births from 2012 to 2016, at three public hospitals. We used estimated daily PM2.5 from a newly created model developed using ground measurements, satellite data, and a chemical transport model. Exposure was assigned based on district of residence (n = 39). Linear and logistic regression analyzes were used to estimate the associations between air pollution exposure and pregnancy outcomes. Increased exposure to PM2.5 during the entire pregnancy and in the first trimester was inversely associated with birth weight. We found a decrease of 8.13 g (-14.0; -1.84) overall and 18.6 g (-24.4, -12.8) in the first trimester, for an interquartile range (IQR) increase (9.2 µg/m3) in PM2.5. PM2.5 exposure was positively associated with low birth weight at term (TLBW) during entire pregnancy (OR: 1.11; 95% CI: 1.03-1.20), and at the first (OR: 1.11; 95% CI: 1.03-1.20), second (OR: 1.09; 95% CI: 1.01-1.17), and third trimester (OR: 1.10; 95% CI: 1.02-1.18) per IQR (9.2 µg/m3) increase. Higher exposure to PM2.5 was also associated with increased risk of small for gestational age (SGA). There were no statistically significant associations between PM2.5 exposure and preterm births (PTB). Exposure to higher concentrations of PM2.5 in Lima may decrease birth weight and increase the frequency of TLBW and SGA. Our study was inconsistent with the literature in finding no associations with preterm birth.

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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.

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OBJECTIVE: To evaluate the association between active antenatal management and neonatal outcomes in extremely preterm newborns admitted to a neonatal intensive care unit (NICU). STUDY DESIGN: This population-based cohort study was conducted in 25 regions of France. Infants born in 2011 between 220/7 and 266/7 weeks of gestation and admitted to a NICU were included. Infants with lethal congenital malformations or death in the delivery room were excluded. A multilevel multivariable analysis was performed, accounting for clustering by mother (multiple pregnancies) and hospital plus individual characteristics, to estimate the association between the main exposure of no active antenatal management (not receiving antenatal corticosteroids, magnesium sulfate, or cesarean delivery for fetal indications) and a composite outcome of death or severe neonatal morbidity (including severe forms of brain or lung injury, retinopathy of prematurity, and necrotizing enterocolitis). RESULTS: Among 3046 extremely preterm births, 783 infants were admitted to a NICU. Of these, 138 (18%) did not receive active antenatal management. The risk of death or severe morbidity was significantly higher for infants without active antenatal management (crude OR, 2.60; 95% CI, 1.44-4.66). This finding persisted after adjustment for gestational age (OR, 2.08; 95% CI, 1.19-3.62) and all confounding factors (OR, 1.86; 95% CI, 1.09-3.20). CONCLUSIONS: The increased risk of severe neonatal outcomes for extremely preterm babies admitted to a NICU without optimal antenatal management should be considered in individual-level decision making and in the development of professional guidelines for the management of extremely preterm births.

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OBJECTIVES: To investigate whether the high rates of caesarean sections (CSs) in Brazil have impacted on the prevalence of preterm and early-term births. DESIGN: Individual-level, cross-sectional analyses of a national database. SETTING: All hospital births occurring in the country in 2015. PARTICIPANTS: 2 903 716 hospital-delivered singletons in 3157 municipalities, representing >96% of the country's births. PRIMARY AND SECONDARY OUTCOME MEASURES: CS rates and gestational age distribution (<37, 37-38, 39-41 and 42 or more weeks' gestation). Outcomes were analysed according to maternal education, measured in years of schooling and municipal CS rates. Analyses were also adjusted for maternal age, marital status and parity. RESULTS: Prevalence of CS was 55.5%, preterm prevalence (<37 weeks' gestation) was 10.1% and early-term births (37-38 weeks of gestation) represented 29.8% of all births, ranging from 24.9% among women with <4 years of schooling to 39.8% among those with >12 years of education. The adjusted prevalence ratios of preterm and early-term birth were, respectively, 1.215 (1.174-1.257) and 1.643 (1.616-1.671) higher in municipalities with≥80% CS compared with those <30%. CONCLUSIONS: Brazil faces three inter-related epidemics: a CS epidemic; an epidemic of early-term births, associated with the high CS rates; and an epidemic of preterm birth, also associated with CS but mostly linked to poverty-related risk factors. The high rates of preterm and early-term births produce an excess of newborns at higher risk of short-term morbidity and mortality, as well as long-term developmental problems. Compared with high-income countries, there is an annual excess of 354 000 preterm and early-term births in Brazil.

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Crianças prematuras podem estar mais propensas a apresentarem dificuldade de praticar o aleitamento natural e consequentemente ficam vulneráveis à introdução de chupetas e/ou mamadeiras no seu dia a dia. O objetivo do presente trabalho foi avaliar a associação entre a prematuridade, hábito de sucção de chupeta e tipos de aleitamento infantil, em crianças de 3 a 5 anos de idade, pertencentes a um ambulatório hospitalar universitário e duas escolas de educação infantil da cidade de Belo Horizonte, Brasil. Foi desenvolvido um estudo epidemiológico transversal retrospectivo comparativo, com 250 crianças na faixa etária de 3 a 5 anos. A amostra incluiu dois grupos: o grupo pré-termo, formado pelos prematuros acompanhados pelo projeto ACRIAR (Ambulatório da Criança de Risco, Hospital das Clinicas da Universidade Federal de Minas Gerais) e o grupo a termo, formado por pré-escolares nascidos a termo pertencentes a uma escola pública e uma particular, escolhidas por conveniência. Foi utilizado nas escolas, um questionário pré-testado para a seleção do grupo controle e preenchimento dos dados relacionados ao nascimento, aos métodos de aleitamento infantil, hábito de sucção de chupeta e aspectos sociodemográficos. Este questionário foi enviado junto ao para-casa das crianças, respondido pelos pais/responsáveis e devolvido à escola. Os dados dos prematuros foram coletados nos prontuários clínicos do projeto ACRIAR. O mesmo modelo de questões foi adotado para os dois grupos: prematuros e a termo. A análise dos dados foi realizada utilizando-se o software Statistical Package for the Social Sciences (SPSS), versão 21.0. Para verificar se houve associação entre a variável dependente idade gestacional ao nascimento (prematuro ou nascidos a termo) e as varáveis independentes, foi utilizado o Teste Qui-quadrado. Valores da razão de prevalência foram estimados para cada variável independente por Regressão de Poisson Múltipla. Variáveis com valor de p < 0,05 na análise de Poisson bivariada foram incluídas na análise multivariada. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG (protocolo #49803115400005149). A maioria das crianças era do sexo feminino (54,8%), com 5 anos de idade (46,8%) e pertenciam a famílias com renda maior que 2 salários mínimos (48,4%). O grupo de mães de prematuros era mais jovem e (67,7%) tinha idade menor que 30 anos, diferente daquelas com filhos nascidos a termo cuja maioria (78,2) tinha idade maior que 30 anos. O modelo de regressão múltiplo final demonstrou que a renda mensal menor que 2 salários mínimos (RP= 2,068; 95%IC= 1,418- 3,016), o uso de chupeta (RP= 1,730; 95%IC= 1,100-2,721) e aleitamento no peito por menos de 6 meses (RP= 1,010; 95%IC= 1,302-2,829) foram mais prevalentes entre os prematuros. Concluiu-se que o uso de chupeta, o menor tempo de aleitamento materno e a baixa renda familiar foram fatores associados a prematuridade

Preterm infants might experience more difficult in breastfeeding and therefore are more vulnerable to the use of pacifiers and/or bottles in their life. This research aimed to evaluate the association between prematurity, pacifier sucking habit and types of infant feeding in children aged 3 to 5 years old attended at the University Hospital Clinic and two preschools in the city of Belo Horizonte, Brazil. Two hundred and fifty children took part in this retrospective crosssectional epidemiological study with control group. The sample was divided intro two groups: the case group was formed by preterm infants attended at ACRIAR project (Risk Child Clinic, Clinic Hospital of the Federal University of Minas Gerais- UFMG) and the control group were preschool children enrolled at a public school and a private school, chosen by convenience who were full term infants. A pre-tested questionnaire was used for collecting data of full term children. Parents answered a structured questionnaire related to prematurity, infant feeding methods, pacifier sucking habits and demographic aspects. Parents or responsible received the questionnaire attached to the children's homework. They answered it at home and sent it back to the school. Collection of data of the preterm children was based on the clinical records of ACRIAR project. The same questionnaires of questions were adopted for both groups: preterm and full term children. Data were entered the Statistical Package for the Social Sciences Software (SPSS) version 21.0 for statistical analysis. Chi-square test was used to test the association between the dependent variable (gestational age at birth: preterm or full term children) and the independent variables. Prevalence ratio values were estimated for each independent variable by using multiple Poisson regression. Variables with p <0.05 in the bivariate Poisson regression analysis were included in the multivariate analysis. The Research Ethics Committee of UFMG approved the research (protocol # 49803115400005149). Most of the children were female (n=137; 54.8%), aged 5 years old (n=117; 46.8%) and belonged to families with monthly income higher than 2 minimum wages (n=121; 48.4%). Mothers of preterm children were younger and the majority had less than 30 years old (n=44; 67.7%); while mothers of full term children were older than 30 years old (n=104; 78.2%). The final multiple Poisson regression model showed that monthly income lower than two minimum wages (PR = 2.068; 95% CI = 1.418-2.016), the use of pacifier (PR = 1.730; 95% CI = 1.100-2.721) and breastfeeding for less than 6 months (PR = 1.010; 95% CI = 1.302-2.829) were more prevalent among preterm infants. The use of pacifiers, the shorter breastfeeding duration and low family income were factors associated with prematurity in children

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