Older Age Of Mother Research Articles

A Comprehensive Review of Gestational Diabetes Mellitus: Impacts on Maternal Health, Fetal Development, Childhood Outcomes, and Long-Term Treatment Strategies.

This review article conducts a comprehensive analysis of gestational diabetes mellitus (GDM) and its ramifications for both maternal health and the well-being of their offspring. GDM is a significant pregnancy complication in which women who have never had diabetes acquire chronic hyperglycemia during their gestational period. In most cases, hyperglycemia is caused by impaired glucose tolerance caused by pancreatic beta cell dysfunction in the background of chronic insulin resistance. Being overweight or obese, having an older mother age, and having a family history of any type of diabetes are all risk factors for developing GDM. GDM consequences include a higher risk of maternal cardiovascular disease (CVD) and type 2 diabetes, as well as macrosomia and delivery difficulties in the newborn. There is also a longer-term risk of obesity, type 2 diabetes, and cardiovascular disease in the infant. Premature birth, hypoglycemia at birth, and shoulder dystocia are also a few of the fetal problems that can result from GDM. Unfortunately, there is no widely acknowledged treatment or preventative strategy for GDM at the moment, except lifestyle modification (diet and exercise) and, on occasion, insulin therapy, which is only of limited value due to the insulin resistance that is commonly present. Although new oral medications for diabetes management, such as glyburide and metformin, show potential, there are ongoing worries regarding their safety over an extended period for both the mother and the child. By identifying gaps in the research, it calls for further investigations and a multidisciplinary approach, ultimately aiming to enhance the management and care for women with GDM, which would impact these affected individuals indubitably.

Multilevel zero inflated and hurdle models for under five-child mortality in Indonesia

Introduction: Overcoming under-five mortality rate remains a great challenge for Indonesia to meet the national target despite its notable advancements and progress in reducing child mortality rate. Therefore, understanding risk factors of under-five mortality is essential to enhance the health and well-being of children. This research seeks to investigate associated factors of under-five mortality in Indonesia by using the 2017 Indonesia Demographic and Health Survey data. Methods: The multilevel zero-inflated and multilevel hurdle models are considered to handle unobserved heterogeneity that may occur at province level, and to model prevalence and risk of child death as a joint process, which are reported in terms of odds ratio (OR) and incidence ratio rate (IRR), respectively. Results: Lower number of household members (IRR = 0.803, 95% confidence interval [CI]: 0.784–0.823), older mother's age at first birth (IRR = 1.020, 95% CI: 1.007–1.032), higher number of children ever born (IRR = 1.491, 95% CI: 1.450–1.533), lower mother's education (IRR = 1.224, 95% CI: 1.013–1.479), and lower father's education (IRR = 1.232, 95% CI: 1.015–1.495) are significantly associated with higher total death numbers in children before the age of 5 years. Furthermore, the odds of no child death are significantly higher among mother who use a contraceptive method (OR = 11.088, 95% CI: 6.659–18.462) and among household in higher quantile wealth (OR = 1.133, 95% CI: 1.005–1.277). Conclusion: This evidence-based empirical highlights priority risk factors that might provide insight for policymakers, health professional, and the community in general to design appropriate intervention to help reduce the burden of under-five mortality in the country.

Stillbirth and fetal growth restriction

Aim: to estimate the rate of early-onset and late-onset fetal growth restriction (FGR) in stillbirth, identify features of placentaassociated complications and determine respective risk factors of stillbirth (especially at early gestational age).Materials and Methods. There were retrospectively studied 61 stillbirth cases in 2016–2019 that occurred in the III level obstetric hospitals: 32 early (23–31 weeks of gestation) and late (32–39 weeks) cases; 156 live births with 8–10 Apgar scores delivered at 36–41 weeks of gestation used as controls. Quantitative parameters were compared using the mean values and standard deviation; nominal parameters were analyzed using odds ratio (OR) and adjusted OR (aOR) with 95 % confidence interval (CI).Results. More than half of stillbirths are associated with FGR with almost 60 % of early-onset phenotype of this pathology. Both in stillbirths and live births, 2/3 of FGR have extremely low weight (OR = 1.8; 95 % CI = 0.6–6.9); 1/3 of growth restricted fetuses were detected shortly before delivery (OR = 1.3; 95 % CI = 0.7–2.4); 1/4 of pregnancies complicated by placental insufficiency are not associated with FGR (OR = 1.4; 95 % CI = 0.7–2.7). Risk factors of stillbirth in pregnancy complicated by FGR are the early-onset growth restriction phenotype (aOR = 3.2; 95 % CI = 1.0–10.3), maternal age over 28 years (aOR = 6.0; 95 % CI = 1.2–29.4), miscarriages and multiple induced abortions (aOR = 3.6; 95 % CI = 1.1–11.2), non-compliance in regular clinics visiting and correction of threatening conditions (aOR = 10.9; 95 % CI = 1.3–91.6), toxoplasma infection (aOR = 6.0; 95 % CI = 1.5–24.5). Early stillbirth with FGR is associated with an older mother's age (aOR = 5.8; 95 % CI = 1.0–34.4), greater parity (aOR = 3.3; 95 % CI = 1.0–10.4), uterine diseases including endometrial polyps, endometriosis, cervix cervicitis, cervix dysplasia (aOR = 4.0; 95 % CI = 0.9–17.2), diabetes mellitus (aOR = 3.1; 95 % CI = 0.8–13.2) and preeclampsia.Conclusion. The rate of early-onset FGR in stillbirth comprises almost 60 % that is twice higher than in live birth, with the rate of late-onset phenotype being less than 30 %. In late stillbirths the early-onset phenotype also prevails. There are no prominent features for stillbirths with FGR compared to previously known risk factors regardless of hypotrophy. Early vs. late stillbirth with FGR is more associated with gynecological pathologies as well as with diabetes mellitus and preeclampsia.

Factors Associated with Delayed Initiation and Cessation of Breastfeeding Among Working Mothers in Abu Dhabi, the United Arab Emirates.

IntroductionDespite the enormous benefits of breastfeeding, working mothers face more challenges to meet the World Health Organization (WHO) recommendations regarding successful breastfeeding practices. Little research has been done to understand the breastfeeding practices among working mothers in the United Arab Emirates (UAE). Thus, the aim of this study was to investigate the prevalence and factors associated with delayed initiation and cessation of breastfeeding among working mothers with children under the age of two years in Abu Dhabi, the UAE.MethodsA cross-sectional multicenter study was conducted from March to September 2017. The study included both Emirati and non-Emirati mothers of children below the age of two years. The data were collected from seven government health care centers in Abu Dhabi as well as from the community. Mothers with young children attending the centers during the study days were approached by trained research assistants, who provided oral and written information about the study.ResultsAmong the 1610 mother–child pairs with complete data who were included in this study, 606 were working mothers giving an employment rate of 37.6%. The mean (standard deviation) of maternal age and children’s age were 30.9 (5.1) years and 8.6 (6.1) months, respectively. Of the 606 mothers, 217 (35.8%) delayed initiation of breastfeeding, and 359 (59.2%) ceased breastfeeding. In multivariable logistic regression analysis, factors associated with delayed breastfeeding initiation among working mothers were older mother age (adjusted odds ratio [AOR] 1.04, 95% confidence interval [CI]1.01, 1.08), being of non-Arab nationality (AOR 2.24, 95% CI 1.53, 3.27), caesarean section (AOR 2.70, 95% CI 1.84, 3.96), non-rooming-in (AOR 3.85, 95% CI 1.56, 9.51) and mothers with low birth weight children (AOR 2.47, 95% CI 1.23, 4.94). The main factors associated with cessation of breastfeeding were being of non-Arab nationality (AOR 1.59, 95% CI 1.09, 2.31) and mother with high-income rating (AOR 2.79, 95% CI 1.36, 5.75).ConclusionThe study highlighted the need for urgent actions to improve the working mothers’ conditions in order to promote optimal breastfeeding practices, including both early initiation and continuation of breastfeeding among all mothers in the UAE regardless of employment status. Policies to improve EBF rates among professional working mothers should include maternity leave extension to enable mothers to continue breastfeeding.

Characterizing Socioeconomic Inequalities in Professionally Applied Topical Fluoride Treatment Courses in Schoolchildren from a Developing Country.

The objective of the present study was to characterize socioeconomic inequalities in the patterns of professionally applied topical fluoride (PATF) in Mexican schoolchildren. A cross-sectional study was carried out on 3029 Mexican schoolchildren. A questionnaire was administered to caregivers to determine sociodemographic, socioeconomic, and behavioral variables. The dependent variable was prevalence of PATF, coded as 0 = without PATF and 1 = with PATF, at any point in life, and separately, in the previous year. Various indicators of socioeconomic position were included. Logistic regression was used in the final multivariate analysis. The prevalence of PATF any time in life was 33.8%, while in the previous year it was 11.4%. The variables associated (p < 0.05) with PATF any time in life were child's older age (OR = 1.12), older age when tooth brushing started (OR = 1.57), higher brushing frequency (OR = 1.60), having health insurance [public (OR = 1.61) or private (OR = 1.45)], if family owned a car (OR = 1.29) and better socioeconomic position [parents' education, second (OR = 1.48) and third (OR = 1.75) tertile]. For PATF in the previous year, the variables associated were older age of mother (OR = 1.03), older age when tooth brushing started (OR = 1.99), higher brushing frequency (OR = 1.68), having health insurance [public (OR = 1.62)] and better socioeconomic position (parents' education, second (OR = 1.57) and third (OR = 1.97) tertile). This study suggests the existence of socioeconomic inequalities in PATF, manifested through socioeconomic position, access to health insurance and household having a car. Identifying and addressing PATF inequalities would improve oral health in the child population.

Factors Affecting Delayed Initiation and Continuation of Medication Use for Attention-Deficit/Hyperactivity Disorder: A Nationwide Study.

Objective: This study evaluated the predictors for delayed initiation and continuation of ADHD medication use in children and adolescents with ADHD in Taiwan. Methods: This longitudinal cohort study enrolled 188,061 children and adolescents with ADHD between 2001 and 2011. Delayed initiation of ADHD medications was defined as the interval >365 days between diagnosis and first prescription, and continuation of ADHD medications was defined as ≥365 defined daily doses of ADHD medications. Results: Of the included patients, 39.2% were never treated with ADHD medications. Delayed initiation and continuation of ADHD medication use were found in 11.9% and 19.9% of the ever-treated patients, respectively. Younger age at ADHD diagnosis, male sex, older mother's age at child's ADHD diagnosis, and higher family income were associated with more delayed initiation but were also associated with more continuation of ADHD medication use. Conclusions: The initiation and continuation of ADHD medication use might be underlined by different mechanisms and warrant different strategies.

Internet-delivered cognitive behavior therapy with minimal therapist support for anxious children and adolescents: predictors of response.

In general, Internet-delivered cognitive behavior therapy (iCBT) produces significant reductions in child and adolescent anxiety, but a proportion of participants continue to show clinical levels of anxiety after treatment. It is important to identify demographic, clinical, and family factors that predict who is most likely to benefit from iCBT in order to better tailor treatment to individual needs. Participants were 175 young people (7-18 years) with an anxiety disorder, and at least one of their parents, who completed an iCBT intervention with minimal therapist support. Multilevel modeling (MLM) examined predictors of response to iCBT as measured by the slope for changes in the primary outcome measures of child- and parent-reported anxiety scores, from pretreatment, to 12-weeks, 6-month, and 12-month follow-ups, controlling for pretreatment total clinician severity ratings of all anxiety diagnoses. Child age, gender, father age, parental education, parental mental health, parenting style, and family adaptability and cohesion did not significantly predict changes in anxiety in the multivariate analyses. For child-reported anxiety, greater reductions were predicted by a separation anxiety disorder diagnosis (SEP) and elevated depression, with lower reductions predicted by poor couple relationship quality. For parent-reported child anxiety, greater reductions were predicted by higher pretreatment total CSRs, SEP, and lower family income, with lower reductions for children of older mothers. Irrespective of these predictors of change, children in general showed reductions in anxiety to within the normal range. Overall, children responded well to iCBT irrespective of the demographic, clinical, and family factors examined here. Poor couple relationship quality and older mother age were risk factors for less positive response to iCBT in terms of reductions in anxiety symptoms although still to within the normal range.

Identifying predictors of early childhood caries among Australian children using sequential modelling: Findings from the VicGen birth cohort study

ObjectivesThe aim of this birth cohort study was to identify concurrent associations between early childhood caries and putative risk and protective factors. MethodsData were collected in seven waves over five years. The study outcome measure, d3-6mfs, was modelled in a set of sequential negative binomial regressions that introduced the variables in steps starting from health determinants most distal to the child and ending with the more proximal ones. The goodness of fit of each model at each step was tested using the quasi-likelihood under independence model criterion (QIC). A final model included all significant factors identified in the sequential modelling. Bacterial composition of the child’s saliva was determined by 16S RNA gene sequencing. ResultsOverall, 467 children (48.6 % female) participated, of whom 419 (89.7 %) had at least one follow-up visit after baseline. Of the 419 children included in the analyses, 133 (31.7 %) had their saliva samples sequenced for microbiomic determination. Independent protectors of surface cavitation included water fluoridation, and older age of mothers. Risk for d3-6mfs was significantly higher among children whose mothers were current smokers (IRR 3.29, 95 % CI 1.09–9.88, p = 0.034), children who went to bed with a bottle (IRR 2.67, 95–6.88, p = 0.041) and whose saliva sample sequencing over time showed higher percentages of Streptococcus mutans (IRR 1.39, 95 % CI 1.11–1.74, p = 0.005). Model fit was mostly improved by child’s proximal variables. Household and mother covariates did not substantially improve model fit. ConclusionThis analysis highlights the relevance and importance of child-proximal risk factors in childhood dental cavitation. Clinical significanceThe study findings inform clinical decision making for the management of early childhood caries at both the individual and population level. At an individual and family level these risk factors should be incorporated into caries risk assessment tools for more precise identification of risk and evidence-informed interventions by health professionals.

Investigation of association between maternal 25-OH vitamin D serum levels and neonatal early onset sepsis in newborns by evaluating key factors

BackgroundThe goal of this study was to evaluate the relationship between maternal 25-OH Vitamin D serum levels and neonatal early-onset sepsis in newborns by the effective factors.MethodsA case-control study was done and 64 neonates hospitalized in Akbar Abadi Hospital (Tehran- Iran; 2016) and their mothers were enrolled. The case group consisted of 32 NICU term hospitalized neonates due to neonatal early-onset sepsis. Thirty-two term newborns that referred to hospital for rule out hyperbilirubinemia during the first 72 h of life were also considered as the control.ResultsSixty- four mothers with mean age 28.76 ± 6.60 years and mean gestational age 39.64 ± 1.62 weeks entered the study. There was a significant correlation between sepsis and older age of mothers and low Apgar score (P-value = 0.02, 0.01 respectively). The maternal vitamin D serum level was reversely correlated with neonatal sepsis occurrence (P-value = 0.03). There was a significant correlation between maternal vitamin D supplement intake during pregnancy and lower risk for neonatal sepsis (P-value = 0.003).ConclusionThe level of maternal serum Vitamin D was inversely correlated with neonatal sepsis occurrence and intake of vitamin D supplement during pregnancy could decrease the risk of early neonatal sepsis.

Uncertainty, hope, and coping efficacy among mothers of children with Duchenne/Becker muscular dystrophy.

Uncertainty is a challenging aspect of caring for children with Duchenne/Becker muscular dystrophies (DBMD). Although uncertainty is often perceived as a state to be avoided, hope may influence caregivers' perceptions of uncertainty as opportunity. The goal of this cross-sectional quantitative study was to pilot a novel measure of state-based hope, and test relationships among uncertainty, hope, spirituality, and coping efficacy in mothers of children with DBMD. Mothers (n = 202) were recruited through DuchenneConnect, Parent Project Muscular Dystrophy, and Cincinnati's Children Hospital. A one-component solution for the novel Parent Hope Scale explained 44.3% of the variance, and the measure showed high internal consistency. Higher hope (P < 0.001), further disease progression (P = 0.042), and older mother's age (P = 0.001) were significantly associated with lower perceptions of uncertainty. Mothers reporting less hope (P < 0.001), higher perceptions of uncertainty (P < 0.001), and less spirituality (P = 0.001) reported lower coping efficacy. As such, hope appears to be a key variable in shaping uncertainty appraisals and facilitating coping efficacy. While further research is needed, counseling aimed at bolstering hope, particularly among less-hopeful mothers, and interventions to reappraise uncertainty, may be helpful in promoting coping efficacy.

Prevalence of and factors associated with under-5 mortality in South Asia.

This study investigated the prevalence of and the factors associated with under-5 mortality across five South Asian countries. Cross-sectional pooled data from 1999 through 2014 collected from the Demographic and Health Survey (DHS) in five South Asian countries (Bangladesh, India, Maldives, Nepal and Pakistan) were used. Associations of under-5 mortality with sociodemographic characteristics and maternal and child factors were studied using the Cox proportional-hazard method. The estimates were presented as hazard ratios (HR) and their 95% CIs. Kaplan-Meier survival curves were used to describe time-to-event of under-5 survival patterns. Overall, 15-year prevalence of under-5 mortality in South Asian countries was 10%, with Nepal having the highest prevalence (11.1%) and the Maldives the lowest (5%). In a multivariable model in pooled data, older age of mother (HR 0.70, 95% CI 0.68-0.72), being employed (HR 1.09, 95% CI 1.07-1.12), having a higher level of education (HR 0.36, 95%, CI 0.32-0.40) and having a husband with higher level of education (HR 0.74, 95% CI 0.70-0.78) were significantly associated with under-5 mortality. Factors associated with under-5 mortality were mostly common across countries. The prevalence of under-5 mortality is still high in South Asia. Most of the studied sociodemographic factors were associated with under-5 mortality and were common across South Asian countries.

Evaluating The Impact of Risk Factors on Birth Weight and Gestational Age: A Multilevel Joint Modeling Approach.

BackgroundAbnormalities in birth weight and gestational age cause several adverse maternal and infant out- comes. Our study aims to determine the potential factors that affect birth weight and gestational age, and their association.Materials and MethodsWe conducted this cross-sectional study of 4415 pregnant women in Tehran, Iran, from July 6-21, 2015. Joint multilevel multiple logistic regression was used in the analysis with demographic and obstetrical variables at the first level, and the hospitals at the second level.ResultsWe observed the following prevalence rates: preterm (5.5%), term (94%), and postterm (0.5%). Low birth weight (LBW) had a prevalence rate of 4.8%, whereas the prevalence rate for normal weight was 92.4, and 2.8% for macrosomia. Compared to term, older mother’s age [odds ratio (OR)=1.04, 95% confidence interval (CI): 1.02-1.07], preeclampsia (OR=4.14, 95% CI: 2.71-6.31), multiple pregnancy (OR=18.04, 95% CI: 9.75- 33.38), and use of assisted reproductive technology (ART) (OR=2.47, 95% CI: 1.64-33.73) were associated with preterm birth. Better socioeconomic status (SES) was responsible for decreased odds for postterm birth com- pared to term birth (OR=0.53, 95% CI: 0.37-0.74). Cases with higher maternal body mass index (BMI) were 1.02 times more likely for macrosomia (95% CI: 1.01-1.04), and male infant sex (OR=1.78, 95% CI: 1.21-2.60). LBW was related to multiparity (OR=0.59, 95% CI: 0.42-0.82), multiple pregnancy (OR=17.35, 95% CI: 9.73-30.94), and preeclampsia (OR=3.36, 95% CI: 2.15-5.24).ConclusionMaternal age, SES, preeclampsia, multiple pregnancy, ART, higher maternal BMI, parity, and male infant sex were determined to be predictive variables for birth weight and gestational age after taking into consideration their association by using a joint multilevel multiple logistic regression model

Evaluation of Common Risk Factors for Breast Carcinoma in Females: a Hospital Based Study in Karachi, Pakistan.

Breast malignancies are one of the leading causes of deaths in females worldwide. There are a number of risk factors associated with breast cancer but in Karachi Pakistan there are insufficient data available. A case control study was conducted on females in age group between 30-80 years. This study was accomplished by retrospective data collection in Aga Khan University Hospital Karachi, Pakistan. A total of 108 females with primary malignancy of breast were included along with 108 matched controls. Relationship of various factors with disease was studied using logistic regression to calculate odds ratios with 95 % confidence intervals. A total of 14 variables were analyzed and based on and 7 were found to be risk factors: old age, family history of breast cancer, family history of other carcinomas, personal history of breast carcinoma, early age of menarche, older age of mother at first delivery and lower number of children. Five factors, parity, breast feeding, history of oral contraceptive pills intake, past history of oophorectomy and hysterectomy showed protective associations. One variable, use of hormonal replacement therapy, showed a controversial link and one other, marital status, was not significant in this study. It is concluded that most of the well-known risk factors for breast cancer are also associated with the disease in the female population of Karachi, Pakistan. High risk patients should be the focus with the help of this study so that screening can be more effective for early diagnosis before clinically evident breast malignancy.

Gerakan sarapan sehat anak sekolah (sarasehan) untuk peningkatan pengetahuan ibu tentang sarapan sehat anak sekolah

Background: Breakfast can meet energy requirement of school children to conduct their daily activity all day. But, in reality, there are many school children who do not behave in a healthy breakfast that can meet the needs of 30% of energy. One of reason is a lack of knowledge and practice of the mother in preparing a healthy breakfast for their children.Objective: To assess the influence of media outreach breakfast (booklets, flipchart, and short films) on the mothers' knowledge of healthy breakfast schoolchildren.Method: Design of quasi-experimental one group pre-post test used in the study towards 186 mothers from ten the selected elementary school at Depok City. Mother's knowledge was measured through a questionnaire pre-post test.Results: There was increased in knowledge of mothers at the end of the study with correct answers given by the mother on the question of the type of food that should be avoided at breakfast. Increased knowledge of the mother before and after the study was differed significantly according to age groups (p &lt;0.05). Older age of mother has better knowledge than younger.Conclusion: Knowledge of mothers on healthy breakfast can be improved through counseling using flipcharts, booklets, and short film.

Europe. An Analysis of Changes in the Consumption of Alcoholic Beverages: The Interaction Among Consumption, Related Harms, Contextual Factors and Alcoholic Beverage Control Policies

This AMPHORA study's aim was to investigate selected factors potentially affecting changes in consumption of alcoholic beverages in 12 European countries during the 1960s–2008 (an average increase in beer, decreases in wine and spirits, total alcohol drinking decrease). Both time series and artificial neural networks-based analyses were used. Results indicated that selected socio-demographic and economic factors showed an overall major impact on consumption changes; particularly urbanization, increased income, and older mothers’ age at their childbirths were significantly associated with consumption increase or decrease, depending on the country. Alcoholic beverage control policies showed an overall minor impact on consumption changes: among them, permissive availability measures were significantly associated with consumption increases, while drinking and driving limits and availability restrictions were correlated with consumption decreases, and alcohol taxation and prices of the alcoholic beverages were not significantly correlated with consumption. Population ageing, older mother's age at childbirths, increased income and increases in female employment, as well as drink driving limitations were associated with the decrease of transport mortality. Study's limitations are noted.

Adverse Socioeconomic Conditions and Oocyst-Related Factors Are Associated with Congenital Toxoplasmosis in a Population-Based Study in Minas Gerais, Brazil

ObjectiveCongenital toxoplasmosis is a public health problem in Brazil. This study aimed to determine risk factors associated with congenital toxoplasmosis in Minas Gerais which is the second largest Brazilian State based on number of inhabitants, and its territorial extension is larger than that of France. Methods: Population-based case-control study to assess the association between congenital toxoplasmosis and maternal exposure to infection risk factors. The study included mothers/children participating in the Minas Gerais Newborn Screening Program. The cases consisted of 175 mothers of infected children, and the controls consisted of 278 mothers of children without suspected infection. The associations were assessed through binomial logistic regression with p≤0.05.ResultsThe variables associated with lower probability of toxoplasmosis were: older mother age (OR = 0.89; CI95% = 0.85–0.93), higher level of education (OR = 0.85; CI95% = 0.78–0.92), access to potable water (OR = 0.21; CI95% = 0.08–0.51), and home with flush toilet (OR = 0.18; CI95% = 0.04–078). The variables associated with higher probability of infection were: cats in the neighborhood (OR = 2.27; CI95% = 1.27–4.06), owning or visiting homes with domestic cats (OR = 1.90; CI95% = 1.09–3.31), handling the soil (OR = 2.29; CI95% = 1.32–3.96), and eating fresh meat not previously frozen (OR = 3.97; CI95% = 2.17–7.25). After stratification according region of residence (rural or urban/peri-urban), home with flush toilet and consumption of treated water were protective against the disease only in the rural stratum.ConclusionsIn Minas Gerais, congenital toxoplasmosis has been associated with poor socioeconomic conditions. Considering maternal exposure to sources of Toxoplasma gondii, the predominating risk factors were those related to the ingestion of oocysts. It is expected that these results will contribute to development of a program for prevention of congenital toxoplasmosis adapted to the reality of the population of Minas Gerais. The differences between populations living in rural and urban areas regarding the main risk factors for toxoplasmosis point to the need of considering regional specificities in planning strategies to control congenital toxoplasmosis.

Tracking ancient pathways to a modern epidemic: Diabetic end-stage renal disease in Saskatchewan aboriginal people

Saskatchewan aboriginal people are experiencing an epidemic of type 2 diabetes (T2DM) and diabetic end-stage renal disease (DESRD). The purpose of these investigations was to study the role of the intrauterine environment in the emergence of these diseases. Epidemiologic studies were carried out using data from the Provincial Department of Health databases, the Saskatoon Health Region obstetrical unit, the Saskatchewan Renal Transplant Program, surveys of Saskatchewan aboriginal communities, and the Canadian Organ Replacement Registry. Parameters analyzed included rates, risk factors, and outcomes of T2DM, gestational diabetes (GDM), and DESRD; birth registration information; anthropometric measurements; and human leukocyte antigen profiles. Aboriginal ethnicity is an independent predictor of GDM. High rates of GDM appear in remote aboriginal communities before the significant appearance of T2DM and are associated with increasing rates of high birth weight. A significant relationship between high-birth-weight rates and T2DM has strengthened over several decades. Finally, higher birth weights and older mother's age (both associated with GDM), and increased frequencies of the human leukocyte antigen-A2/DR4 and A2/DR8 haplotypes are associated with DESRD among aboriginal people. It is likely that diabetic pregnancies play a key role in the initiation, progression, and perpetuation of the T2DM epidemic among Canadian aboriginal peoples, and may additionally increase the risk for DESRD. We speculate that an ancient survival advantage that promoted caloric conservation in young women and their unborn children is now a risk factor for prepregnancy obesity, GDM, and excess fetal nutrition. Infants are often large and have an increased risk for T2DM and its complications (hefty fetal-type hypothesis).

Concentraciones de DDT/DDE y riesgo de hipospadias: un estudio piloto de casos y controles

To evaluate the association between maternal serum DDT/DDE levels and risk of hypospadias. A case-control study in Mexico City was conducted during 1997-1999 among 41 subjects with hypospadias and 28 controls. Blood samples were obtained from study subjects. Information was obtained using a standardized questionnaire. Data were analyzed using multivariate logistic regression models. Maternal DDT and DDE levels showed no association with hypospadias (OR 1.13; 95% CI 0.24-5.29 and OR = 0.48; 95% CI 0.15-1.60, respectively). Associated factors were older age of mothers (OR 8.69; 95% CI 1.69-44.9), and working during pregnancy (OR 4.68; 95% CI 1.15-18.9). Information about the endocrine effects of different levels of DDT/DDE in human subjects is scarce; dosage may be a determinant factor of the type of effect. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Fetal alcohol syndrome: maternal and neonatal characteristics.

Alcohol is the most common identifiable teratogenic cause of mental retardation in North America. Fetal Alcohol Syndrome (FAS) is a major public health problem, which is frequently under diagnosed by physicians. To identify and quantify the maternal risk factors and neonatal characteristics of children with FAS. A retrospective case-control study using birth certificate data of North Dakota children diagnosed with FAS. Five controls were selected for each patient. Controls were selected from the computerized birth registry and matched by gender, year and month of birth. A list of all the children diagnosed with FAS from the North Dakota FAS Registry was sent to the State Health Department. We were able to locate the birth certificates for 132 (56%) of the 228 cases on the registry. Of the 132 FAS cases, 106 (80.3%) were Native Americans and 24 (18.2%) were Caucasians. In this sample 51 (38.6%) of the cases were male and 81 (61.4%) were female. Statistically significant maternal characteristics at p < 0.01 were: older mother's age, lower education level, fewer months of prenatal care, fewer prenatal visits, lower gestational age at time of delivery and less prenatal weight gain. Significant neonatal differences at p < 0.01 were lower birth weight and Apgar scores and higher incidence of congenital malformations. FAS is a completely preventable developmental disability. Consumption of alcohol during pregnancy can result in lifelong physical and mental impairments on the fetus. All pregnant women should be screened for alcohol use during prenatal visits. Women with positive screens or at high risk should be identified early by the primary care physician and referred for treatment and counseling.

Family planning and the health of women and children

Use of family planning has the potential to produce reductions of 10–20% in infant and child mortality. Similar reductions in the mortality rate associated with pregnancy can be expected for mothers. A larger impact on maternal mortality is possible through fertility reduction with decreased exposure to the risks of pregnancy. First births carry excess risks for mothers and children, but these are, by definition, unavoidable. Births to young mothers also pose increased risks for mothers and children. High birth order and older age of mothers probably have been overemphasized as risk factors for children. Very high parity does pose risks to mothers. Poor spacing of births is associated with increased health risks to children. Estimation of mortality reduction through family planning requires knowledge of risk distribution as well as relative risk. High-risk births are relatively rare, and most deaths occur to mothers and babies at average or low risk. Family planning does not avert all high-risk pregnancies because of a lack of acceptance and imperfect use.