Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Intraventricular haemorrhage is associated with neurological morbidity and mortality in low birth weight infants. In spite of improvements in treatment to reduce the incidence of the haemorrhage, the condition continues to remain a major cause of long term morbidity in low birth weight infants. The evidence from the literature has shown that low birth weight infants might benefit from delayed cord clamping particularly in reducing the risk of intraventricular haemorrhage and its neurological consequences. The primary objective of this review was to assess the effects of delayed versus early cord clamping on intraventricular haemorrhage amongst low birth weight infants. The secondary objectives were to evaluate the effects of delayed versus early cord clamping on the Apgar scores, hyperbilirubinaemia and polycythaemia in infants. The following electronic databases were searched: CINAHL, MEDLINE (searched via PubMed) and Cochrane Central Register of Controlled Trials (CENTRAL). Other information was gathered from the reference lists of retrieved articles and relevant experts. The selection criteria entailed all randomised controlled trials comparing delayed versus early cord clamping following birth in infants with low birth weight. Two reviewers independently extracted the data and assessed the quality of the trials. Disagreements on studies for inclusion were resolved by discussion with the third reviewer. The review included five randomised controlled trials with 215 participants. The risk of intraventricular haemorrhage was significantly reduced in the delayed compared with early cord clamping (RR0.52, 95% CI 0.33 to 0.82, P=0.005). No statistically significant difference was shown between delayed versus early cord clamping for the risk of hyperbilirubinaemia (RR O.48, 95% CI -0.43 to 1.39, P=0.30). There was no data available for other comparisons: Polycythaemia and Apgar scores. There is growing evidence that delayed cord clamping might benefit low birth weight infants. In the included studies, delayed cord clamping for at least 30 seconds appear to have a potential in reducing the risk of intraventricular haemorrhage. The results of this review should however be interpreted with caution due to a limited number of studies with the absence of clinically important secondary outcomes in the included trials. Further research is required on large scale randomised controlled trials. / AFRIKAANSE OPSOMMING: Intraventrikulêre bloeding word geassosieer met neurologiese morbiditeit en mortaliteit in suigelinge met ’n lae geboortegewig. Ten spyte van die verbetering in die behandeling om die gevalle van bloeding te verminder, duur die toestand voort as ’n belangrike oorsaak van langtermyn morbiditeit in lae gewig geboortes. Bewyse uit die literatuur toon dat suigelinge met ’n lae geboortegewig voordeel mag trek uit vertraagde afklemming, veral deur die vermindering van die risiko van intraventrikulêre bloeding en die neurologiese gevolge daarvan. Die primêre doelwit van hierdie navorsing was om die effek van vertraagde, versus vroeë afklemming op intraventrikulêre bloeding onder suigelinge met ’n lae geboortegewig te bepaal. Die sekondêre doelwit is om die effekte van vertraagde, versus vroeë afklemming op die Apgar uitslae, hiperbilirubinaemia en polisitaemia by suigelinge te evalueer. Die volgende elektroniese databasisse is nagegaan: CINAHL, MEDLINE (soektog via PubMed); Cochrane Central Register of Controlled Trials (CENTRAL). Ander inligting is verkry uit die bronnelyste van nagevorsde artikels en van relevante deskundiges. Die seleksie kriteria behels alle ewekansige beheerde toetsing, insluitende toekomstige studies wat vertraagde, versus vroeë afklemming vergelyk by suigelinge met ’n lae geboortegewig. Twee resensente het onafhanklik data geneem en die kwalititeit van die toetse bepaal. Verskille oor insluiting van navorsing, is met ’n derde resensent deur middel van bespreking opgelos. Die navorsing het vyf ewekansige beheerde steekproewe met 215 deelnemers ingesluit. Die risiko van intraventrikulêre bloeding is beduidend verminder in die vertraagde gevalle, in teenstelling met vroeë afklemming (RR0.52, 95% CI 0.33 tot 0.82, P=0.005). Geen statistiese beduidende verskil is bewys tussen vertraagde teenoor vroeë afklemming ten opsigte van hiperbilirubinaemia nie (RR 0.48, 95% CI – 0.43 tot 1.39, P=0.30). Daar was geen data beskikbaar vir ander vergelykings nie: Polisytaemia en Apgar uitslae. Daar is groeiende bewyse dat vertraagde afklemming lae geboortegewig suigelinge mag beïnvloed. Dit wil in die ingeslote studies voor kom dat vertraagde afklemming van ten minste 30 sekondes die potensiaal het om die risiko van intraventrikulêre bloeding te verminder. Die uitslae van hierdie beskouing sal nietemin met omsigtigheid geïnterpreteer moet word, weens die beperkte aantal studies met die afwesigheid van klinies belangrike sekondêre uitkomste in die ingeslote proewe. Verdere navorsing word benodig op grootskaalse ewekansige beheerde proewe.

Advances in neonatal nursing and medical interventions have made it possible for the very low birth weight (VLBW) infant to survive. However, it is now time to recognize the intangible costs, emotional stress, marital stress, grief, pain, sorrow, and the disruption of the role transition to parenthood. To facilitate progress in the area of neonatal nursing, systematic efforts were undertaken to examine and describe parental adaptation to the VLBW infant and potential risk for parenting problems after hospital discharge. The purpose of this study was to describe parents' method of adaptation to the problems of caring for a VLBW infant at home. Specifically this study was designed to identify: (1) What strategies parents employed during the adaptation process. (2) What resources parents combined with their strategies of adaptation. (3) What situations promoted or inhibited parental adaptation. The informants consisted of parents of VLBW infants (<1500 grams) following hospital discharge. The number of subjects for this study was 14. An exploratory design was used to conduct this study. Each subject was involved in three interview sessions, one months, three months, and five months following hospital discharge of their VLBW infant. Data were sampled theoretically, as guided by the emergent theory. The constant comparative method was used for data analysis. A basic social process, Creating Paths, was identified as the core category of the theory. Creating Paths is the continuous process experienced by parents living with a VLBW infant the first five months after hospital discharge. The process consists of three stages: Gathering, Emerging, and Affirming. Results of this investigation provide a beginning theoretical foundation for assessing the adaptation process of parents with VLBW infants the first five months at home. Neonatal nurses can utilize the model to provide anticipatory guidance and support to benefit parents and their VLBW infant.

Pasauliniu mastu suaugusių bei vaikų nutukimas jau įvardintas kaip epidemija. Todėl reikia ieškoti priežastinių ryšių tarp atskirų rodiklių ir veiksnių įtakojančių šiuos rodiklius. Darbo tikslas. Palyginti Vilniaus ir Kauno apskričių pirmokų antropometrinius rodiklius bei nustatyti jų sąsajas su tėvų antropometriniais rodikliais. Tyrimo metodika. Tyrimo objektas – Kauno ir Vilniaus apskrities pirmų klasių mokiniai. Tyrimo metodika – pirmokų antropometrinių rodiklių (ūgio, svorio, juosmens ir klubų apimčių) tyrimas, naudojant PSO patvirtintus, standartizuotus metodus. Anketinė tėvų apklausa. Statistinė duomenų analizė naudojant SPSS 14.0 bei MS Excel. Rezultatai. Nustatytas vidutinis 7 ir 8 metų berniukų ir mergaičių ūgis, svoris. Vertinant abiejų lyčių ūgio vidurkius, bei juos lyginant su 20 metų amžiaus tarpsnio vidurkiais matoma pirmokų ūgio didėjimo tendencija. Vertinant pagal IOTF standartus 17,8 proc., pirmokų turėjo antsvorį arba nutukimą. Skirtumai tarp Vilniaus ir Kauno apskričių pirmokų antropometrinių rodiklių buvo nereikšmingi. Nustatyti koreliaciniai ryšiai tarp tėvų ir vaikų antropometrinių rodiklių svyravo nuo 0,35 iki 0,15. Buvo nustatyta, kad didelis naujagimio svoris 1,8 karto didina nutukimo riziką lyginant su normalaus ir mažo gimimo svorio vaikais. Sąsajos tarp natūralaus maitinimo ir padidėjusios KMI buvo nereikšmingos. Išvados. Pirmokų antropometriniai rodikliai skiriasi priklausomai nuo amžiaus grupės ir lyties. Kauno ir Vilniaus apskrityse skirtumai... [toliau žr. visą tekstą] / Obesity of children and adults takes epidemic status. There are need to find causative factors between anthropometric measures and negative outcomes of health (gained BMI). Aim of the study. To compare anthropometric measures of the first grade students in Vilnius and Kaunas counties and to asses links with anthropometric measures of parents. Methods. The object of the study – first grade students of Kaunas and Vilnius counties. Children were weighed and measured and circumferences of waist and hip were measured, too by trained stuff using standardised equipment. Parents completed questionnaire. The main statistical criteria used in the data analysis were: Chi Square (2), Mann-Whitney U, One way ANOVA, post hoc (Bonferoni criteria) tests, and Spearman’s correlation coefficient. Results. There were estimated averages of height and weight of 7 and 8 years old boys and girls. The height averages between boys and girls were significantly different. Obesity and overweight (defined using IOTF cut-off's) prevalence was 17.8 %. The differences of anthropometric measures between Vilnius and Kaunas were not found. Parent–child correlations for height were stronger between fathers than mothers. Odds ratio of obesity/overweight risk was two fold higher in “big” (>4132 g) birth weight in comparison with normal and small birth weight. Conclusions. Anthropometric measures of first grade students varied subject to group of age and sex. There were no statistically significant differences... [to full text]

Background: Substantial variation exists between ethnicities in both birth weight and the prevalence of obesity-related non-communicable diseases (OR-NCDs). South Asians, who display a reduced birth weight and increased risk of developing these OR-NCDS, have been the focus of much of the research into the developmental origins of health and disease (DOHaD) paradigm. However, little research utilising ultrasonically derived estimates of fetal growth has been conducted. The use of more direct measures of fetal growth may also enable the identification of relationships between patterns of fetal growth with patterns of postnatal growth, explicitly, whether periods of restricted or rapid growth lead to postnatal catch-up or down, respectively. The known differences in birth weight existing between South Asians and White British infants may also have implications for the assessment of neonatal health in these sub-groups when using a population derived birth weight chart, such as the UK-World Health Organisation (UK-WHO). Customised charts, which adjust for maternal variables including ethnicity, have been recommended for clinical practice, yet evidence for their efficacy is varied. Objectives: The aims of this thesis were to: 1) investigate whether fetal growth patterns differ between Pakistani and White British foetuses and determine whether maternal size and demographic variables mediate any such differences; 2) produce a birth weight chart adjusting for ethnicity and compare this to the UK-WHO and customised birth weight charts to determine which chart better identifies neonates at risk of the adverse delivery and neonatal outcomes associated with small-for-gestational-age (SGA) and large-for-gestational age (LGA); 3) identify whether there is evidence of weight growth tracking between fetal and infant periods and determine whether patterns of fetal growth predict patterns of postnatal growth. Methods: All data come from the Born in Bradford (BiB) birth cohort. Objective 1: Multilevel models and fractional polynomials were employed for the modelling of fetal weight, head circumference (HC) and abdominal circumference (AC) growth. Potential mediators of the effect of being of Pakistani origin were entered into the model and the effect on the ethnicity variable was assessed. Objective 2: Ethnic specific birth weight charts (BiB) were constructed using the LMS method. SGA and LGA were defined as a birth weight <10th and >90th relative to the BiB, the UK-WHO or the customised charts. Sensitivity, specificity, positive & negative predictive values and area-under-the curve were calculated for each of the three charts SGA and LGA cut-offs, to assess the predictive ability of each chart for a range of delivery and neonatal outcomes. Objective 3: Multilevel models were employed for the modelling of fetal and postnatal growth. Fitted values were produced at 20, 30, 40 prenatal weeks & 1, 3, 6, 9, 12, 24 postnatal months in both an internal reference and the sample population. Z scores were calculated and conditional Z scores were generated to account for regression to the mean. Growth tracking was defined as change in Z score ≤ 0.67 & ≥ -0.67. Restricted and rapid fetal growth were defined as a change in Z score in the fetal period of <-0.67 and >0.67, respectively. Catch-down and catch-up growth were defined in the same way, except in the postnatal period. ANOVAs were used to test for differences in size and growth by type of fetal growth. Furthermore, logistic regression and a sensitivity and specificity analysis were employed to examine the predictive ability of the type of fetal growth. Results: Objective 1: Pakistani fetuses were significantly smaller and lighter than White British fetuses, throughout gestation. In terms of weight, Pakistani fetuses were approximately 2.25% lighter at 20 weeks, 4.13% at 30 weeks and 5.94% at 40 weeks. The differences in size for AC and HC between the two groups were not as great, with the AC and HC of Pakistani fetuses being approximately 4.1% and 1.25% smaller, respectively, at 40 weeks. Despite these significant differences in size the pattern of growth for HC and weight was not significantly different between the two groups. There was a trend for Pakistani fetuses to display a greater deceleration of growth in the final trimester (figure 4-12). The biggest mediators of the effect of being of Pakistani origin were maternal height and weight. Objective 2: Classifying infants as SGA or LGA by the BiB, UK-WHO or customised charts had low predictive utility for the outcomes under investigation. Despite the fact that the BiB ethnic specific birth weight reference provided significantly better prediction for more outcomes than both the UK-WHO and customised charts in both White British and Pakistani infants, with the exception of shoulder dystocia, AUROC values for all three charts were all below 0.61. Objective 3: The prevalence of tracking within the same centile band from 20 weeks gestation to 2 years was 10.82%. Infants who experienced restricted fetal growth remained significantly lighter than those who had not, for the duration of infancy. In this group however, there was a pattern of greater growth than expected during infancy. This was opposite to the pattern observed in infants who had experienced rapid fetal growth, who exhibited less growth than expected during infancy. However, the ability of the type of fetal growth to predict the pattern of postnatal growth was minimal, with only rapid fetal growth being significantly associated with increased odds of catch-down growth in infancy. Conclusions: No ethnic difference in the pattern of growth was found in terms of the whole body (weight) or in HC. The trend for reduced growth of the AC in Pakistanis may be a result of a reduced growth of the visceral organs during the third trimester, which may lead to both an altered liver metabolism and impaired renal function in post-natal life. Although being small or large at birth may increase the risk of an adverse neonatal outcome, size alone is not sensitive or specific enough with current detection to be a useful clinical tool. The finding that neither restricted nor rapid fetal growth predicted postnatal catch-up growth may suggest that the timing of canalisation is outside of the fetal period. If infant catch-up and down growth are not associated with periods of restricted or rapid fetal growth, the definitions of these growth patterns may need revising.

Identifying the relationship between fat oxidation and insulin resistance (IR) may provide vital clues to the mechanisms behind the development of metabolic disease in prepubertal children. The purpose of this study was to examine the association of fat oxidation with insulin resistance (IR) and insulin sensitivity (SI) in prepubertal children. A total of 34 prepubertal 7-9 year olds (18 females, 16 males, 13 non-Caucasian, 21 Caucasian, 8.0±0.8 years, 36.5±12.1 kg) were observed. Subjects participated in indirect calorimetry to obtain respiratory quotient (RQ) and a blood test to obtain fasting insulin and glucose to calculate IR by homeostatic model assessment (HOMA). A subset (n=16) participated in Frequently Sampled Intravenous Glucose Tolerance Testing (FSIGTT) to obtain insulin sensitivity. Pearson correlations between RQ and IR and RQ and SI were performed. Partial correlations with respect to physical activity, breastfeeding, and birth weight were also performed. A general linear model was used to examine RQ with IR, and separately SI with respect to physical activity, breastfeeding, birth weight, race and sex. Respiratory quotient and IR were significantly associated when adjusted for physical activity, sex and race and breastfeeding, sex and race. In regards to birth weight, RQ and IR were significantly associated when adjusted for breastfeeding, birth weight, and race, but not when breastfeeding was removed from the model. The results of this study suggest lack of physical activity and breastfeeding may be the most influential risk for factors in the development of IR via a mechanism of impaired fat oxidation. Further research is needed to examine the role of physical activity, breastfeeding, and birth weight on fat oxidation and the development of insulin resistance in prepubertal children, however, the results of this study support the promotion of physical activity, breastfeeding, and good maternal nutrition.

A research report submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Masters of Science Degree in Occupational Therapy, by course work. Johannesburg, 1992. / The incidence of learning problems in a group of Normal and At-Risk preterm children was deterlined in this study. The children were allocated to Normal and At- Risk groups using the Neurodevelopmental Assessment Scale (NDS). The NOS was designed by Muriel Goodman for her thesis, "Evaluation of Physiotherapy on Preterm Infants", submitted to the Faculty of Medicine, University of he Witwatersrand, Johannesburg, in fulfilment of the requirements for the Degree of Doctor of Philosophy, 1987. [Abbreviated Abstract. Open document to view full version]

O presente estudo tem por objetivo estudar a aplicabilidade de modelos de regressão binária com resposta contínua na análise de dados do SINASC (Sistema de Informações de Nascidos Vivos), analisando suas vantagens, limitações e estratégias na estimação de parâmetros ao identi…car os fatores de riscos para baixo peso ao nascer. Muitos autores vêm utilizando os dados do SINASC para estudar as variáveis que estão associadas ao baixo peso ao nascer. Estes autores geralmente utilizam o modelo usual de regressão logística, o qual analisa somente respostas binárias (a variável resposta é codi…cada como 1: baixo peso ao nascer, 0: caso contrário). O modelo de regressão com resposta contínua foi utilizado para estudar as variáveis associadas aos recém-nascidos com maior propensão a um peso ao nascer inferior ao ponto de corte 2500g, ou seja, a resposta é expressa em uma variável contínua. Nesta situação, uma extensão do modelo tradicional foi utilizada visando a possibilidade de obter-se estimativas mais precisas. Para a estimação de parâmetros do modelo de regressão binária com resposta contínua, foi utilizado o método da máxima verossimilhança. Os resultados obtidos a partir da metodologia proposta possui as seguintes vantagens em relação ao modelo usual: (a) o modelo de regressão proposto foi capaz de predizer o baixo peso ao nascer com maior precisão; (b) o modelo proposto evita problemas de separação persistentes em modelos usuais. Desta forma, o modelo estudado poderá oferecer signi…cativas contribuições à Saúde Coletiva, ao trazer uma nova possibilidade de análise de dados desta área. / The objective of this dissertation is to study the applicability of binary regression models for continuous outcomes in the data analysis from SINASC (Brazilian Live Births Information System), analyzing its advantages, limitations and strategies in the estimation of parameters, when identifying the risk factors for low-birth-weight. Many authors have been using data from SINASC to study the variables that are associated with the low-birth-weight. These authors typically use the usual logistic regression model, which analyzes only binary responses (the dependent variable is coded as 1 for low-birth-weight and 0 for otherwise). The regression model with continuous response was proposed and used to study the variables associated with the newborns with higher propensity to a birth weight below the cutoff point of 2500 g, that is, the answer is expressed as a continuous variable. In this situation, an extension method of the traditional model was used in order to enable obtaining more accurate estimates. For the estimation of the parameters from binary regression model with continuous response, the maximum likelihood method was used. The results obtained from the proposed methodology brought these following advantages comparing with the usual model: (A) the proposed regression model was capable for predicting low birth weight with a bettter precision; (B) the proposed model can process the persistent problems of separation present in the conventional models. Thus, the studied method may offer significant contributions to the Public Health, bringing new possibilities for data analysis in this area.

A gestação traz diversas alterações metabólicas, fisiológicas e no estilo de vida da mulher, que podem influenciar o ganho ponderal durante a gestação. O ganho ponderal durante a gestação é composto por: massa livre do gordura e tecido adiposo (materno), placenta, fluido amniótico e feto - entretanto não estão claros quais fatores estão associados à composição corporal materna, e se a gordura ou água (principal componente do tecido magro) estão associados ao peso ao nascer. Objetivo. Avaliar o efeito das mudanças da composição corporal durante a gestação sobre o peso ao nascer e os fatores potencialmente modificáveis associados (atividade física). Metodologia. Foi estudada uma coorte de 152 gestantes clientes do Hospital Amparo Maternal, São Paulo. As informações foram obtidas através de entrevistas com as gestantes, em três momentos para investigar a atividade física. O exame antropométrico foi realizado a cada consulta pré-natal, sendo o exame constituído de medidas de peso, altura, circunferência de braço, coxa e panturrilha, e pregas cutâneas de coxa e das regiões subescapular e tricipital, e bioimpedância. A análise de dados longitudinais foi realizada através de análises de regressão linear mista para verificar impactos das variáveis independentes sobre o a composição corporal. Para relacionar o efeito das mudanças na composição corporal durante a gestação sobre o peso ao nascer, foram utilizados modelos GAMLSS (modelo aditivo generalizado para locação, escala e forma), que permitem considerar ajuste para os parâmetros de dispersão. Foi considerado nível de significância inferior a 5%. Resultados. Os ganhos semanais de Água Corporal Total (ACT), Massa Livre de Gordura (MLG) não são diferentes entre os estados nutricionais. A velocidade de ganho semanal de Peso e Massa Gordurosa (MG) são menores para gestantes obesas (-14g/sem p=0,008 e -22g/sem p<0,001, respectivamente). Para cada aumento do nível de atividade física, há diminuição da velocidade de ganho de peso (- 25g/sem, p=0,001); ACT (-13g/sem, p=0,046) e MG (-13g/sem, p=0,049). As mulheres brancas apresentaram 1,5kg (p=0,027) a menos de MG comparadas com outras raças (negras, mulatas, amarelas). O peso padronizado do recém-nascido aumenta em média 9,44g/sem (p=0,017) se a taxa de MLG aumenta em uma unidade; a taxa de MG quase mostrou associação, o acréscimo do peso padronizado seria de 12,04g/sem (p=0,051) se a taxa de MG aumentasse em uma unidade. Em outro modelo, o peso padronizado do recém-nascido aumenta em 10,17g/sem (p=0,022) conforme a taxa de Água corporal (kg/sem) aumenta em uma unidade. Novamente, a taxa de massa gordurosa quase mostrou associação, o peso padronizado do recém-nascido aumentaria em 12,20g/sem (p=0,051) conforme a taxa de Massa gordurosa (kg/sem) aumentasse em uma unidade. Conclusão. A gestação é um período em que ocorrem diversas modificações na composição corporal, na qual a mulher pode ganhar peso em excesso. A atividade física pode ser benéfica para diminuir a velocidade de ganho de peso e massa gordurosa. O peso do recém-nascido está associado à MLG e MG, e ganhos excessivos podem ser prejudiciais ao feto / Pregnancy is a period of metabolic, physiological, and lifestyle changes, that may influence gestational weight gain. Weight gain during pregnancy is composed of fat free mass and fat mass (maternal), placenta, amniotic fluid and fetus. However, it is unclear what factors are associated with maternal body composition, and it is unclear if fat or water (major component of lean tissue) is associated with birth weight. Objective. Evaluate changes in body composition during pregnancy, potentially modifiable associated factors (physical activity) and its effect on birth weight. Methods. A cohort study of 152 healthy low-income pregnant women of one hospital clinics of São Paulo city. Data of biological, obstetrical and socioeconomic variables were obtained from interviews, and in three moments to investigate physical activity. Maternal weight, height, skinfold thickness (thigh, subscapular and triceps), circumferences (thigh, arm, calf) and bioelectrical impedance were measured at each prenatal visit. Longitudinal data were analysed using mixed models to assess the impact of independent variables on body composition. GAMLSS (Generalized Additive Models for Location, Scale and Shape) was used to evaluate the effect of body composition changes on birth weight. Results. Weekly gains of Total Body Water (TBW) and Fat Free Mass (FFM) were not different among the four nutritional states (BMI). The velocity of weekly gain of Weight and Fat Mass (FM) were smaller for obese women (-14g/week, p=0.008 and -22g/wk p<0.001, respectively). For each increase in physical activity level, the speed of weight, TBW and FM gains decrease (- 25g/wk, p=0.001; -13g/wk, p=0.046; -13g/wk, p=0.049, respectively). White women had 1.5kg less FM than other races (black, mullato, asian). The standardized birth weight increase 9.44g/wk (p=0.017) if the rate of FFM increase one unit; the rate of FM almost was significant, for each increase of one unit of rate of FM, it would be an increase of 12.04g/wk (p=0.051) on standardized birth weight. In another model, the standardized birth weight increase 10.17g/wk (p=0.022) and 12.20g/wk (p=0.051) if the rate of TBW and FM increase in one unit. Conclusion. Pregnancy is a period of many body composition changes, and the women can have excess of weight gain. Physical activity may be beneficial to decrease the velocity of weight and fat mass gains. The birth weight is associated with FFM and FM, and excessive gains may be harmful to the fetus

Introdução - O baixo peso ao nascer (BPN) é considerado um dos mais importantes problemas de saúde pública em todo o mundo, contribuindo, substancialmente, para a morbi-mortalidade infantil. Objetivos Estimar a proporção de baixo peso ao nascer e identificar a presença de associações entre o baixo peso ao nascer e fatores relacionados à gestação, ao parto, ao recém-nascido e a características sócio-demográficas maternas. Métodos Estudo transversal onde se analisaram 3220 declarações de nascidos vivos referentes aos partos ocorridos no município de Cruzeiro do Sul, Estado do Acre, no período de 2006 e 2007, de mães residentes nesta localidade. Na análise, utilizou-se regressão linear generalizada família Poisson ligação logarítmica com variância robusta, simples e múltipla. Adotou-se nível de significância de 0,10. Resultados - A proporção de baixo peso ao nascer foi 9,13%. Os fatores associados ao baixo peso ao nascer foram: prematuridade; nascimento no domicílio; sexo feminino; idades maternas entre 12 e 13 anos, 16 e 17 anos, 18 e 19 anos, 35 e mais anos; realização de 1 a 3 consultas de pré-natal, crianças não brancas, mães sem ocupação fora do lar e mães solteiras. Conclusão São poucos (ou nenhum) os fatores suscetíveis de mudança ou controle com ações isoladas de saúde. Estratégias de ampla abrangência são necessárias para a redução da proporção de BPN em Cruzeiro do Sul, Acre e, uma vez ocorrido baixo peso ao nascer, atenção especial deve ser proporcionada à criança. / Introduction - The low birth weight (LBW) is considered one of the most important public health problems around the world, contributing substantially to infantile morbidity and mortality. Objectives - To estimate the proportion of low birth weight and identify the presence of associations between low birth weight and factors related to pregnancy, chilbirth, newborn baby and maternal socio-demographic characteristics. Methods - Cross-sectional study which examined 3220 statements of births relating to births occurring in the city of Cruzeiro do Sul, Acre, in the period 2006 to 2007, of resident mothers in this locality. In the analysis, was used linear regression generalized with Poisson family logarithmic linking robust variance, simple and multiple. It was used a significance level of 0,10. Results - The proportion of low birth weight was 9,13%. Factors associated with low birth weight were: prematurity, birth at home, female, maternal age between 12 and 13 years, 16 and 17 years, 18 and 19 years, more than 34 years, achieving 1-3 pre-natal consultations, non-white children, mothers with no occupation outside home and single mothers. Conclusion- Few (or none) the factors susceptible to change or control with isolated actions health. Wide variety of strategies are needed to reduce the proportion of LBW in the city of Cruzeiro do Sul, Acre, and once occurred low birth weight, attention should be given to the child.

Introdução: O processo de envelhecimento reprodutivo ocorre em virtude do declínio progressivo na quantidade e qualidade de óvulos que se inicia após a puberdade, se mantém ao longo da menacme, com redução gradual da fertilidade, e termina na menopausa, caracterizada pelo esgotamento do número de folículos e, consequentemente, da reserva ovariana funcional (ROF). A vida pré-natal constitui um importante período para o desenvolvimento dos órgãos genitais internos femininos e mudanças nessa fase podem ter repercussões futuras: quando o feto é submetido a condições adversas intrauterinas, mecanismos metabólicos e endócrinos de adaptação podem mudar o eixo metabólico pós-natal predispondo a certas doenças na vida adulta. Com base nesses dados, postulou-se que condições desfavoráveis de vida intrauterina que poderiam se refletir com alterações do peso ao nascer (PN) poderiam levar à reprogramação de genes envolvidos no controle da ROF e que talvez nascer pequeno para idade gestacional (PIG) ou grande (GIG) possibilitaria a interferência com a ROF estimada por meio das concentrações séricas do hormônio antimülleriano (AMH). Objetivos: O objetivo deste estudo foi avaliar a relação do PN com a ROF, estimada por meio da concentração sérica do AMH em mulheres na menacme com 34 a 35 anos de idade. Pacientes e Métodos: Trata-se de um estudo transversal aninhado a uma coorte de mulheres que nasceram no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), no período de 01 de junho de 1978 e 31 de maio de 1979. O desfecho primário avaliado foi a concentração sérica de AMH, um marcador da ROF, e sua correlação com o PN, divididos em três grupos: PIG, adequado para a idade gestacional (AIG) e GIG. Resultados: Das 274 pacientes incluídas no estudo, 19 foram classificadas como PIG, 238 como AIG e 17 como GIG. As concentrações médias de AMH não foram significativamente diferentes (p=0,11) entre mulheres na menacme nascidas PIG, AIG e GIG (2,14 ng/mL, 2,13 ng/mLe 2,57 ng/mL, respectivamente). Conclusão: Não se observou diferença nas concentrações séricas de AMH entre mulheres nascidas PIG, AIG e GIG avaliadas entre 34 e 35 anos de idade. A casuística avaliada permitiu detectar ou descartar uma grande diferença entre os grupos (effectsize de 0,7). Dessa forma, evidenciou-se que o PN não apresenta grande influência sobre a ROF, estimada pelas concentrações séricas do AMH, em mulheres na menacme, entre 34 e 35 anos de idade. Caso novos estudos evidenciem que diferenças pequenas ou moderadas nas concentrações séricas do AMH possam apresentar relevantes repercussões clínicas em mulheres nesta faixa etária, outras pesquisas serão necessárias, sendo os dados do presente estudo úteis para o cálculo amostral. / Background: The reproductive aging process occurs by a progressive decline in the quantity and quality of oocyte, starting after pubertal onset, remaining through menacme with gradual reduction of fertility and ends with menopause, which is the depletion of ovarian follicles and hence the depletion of functional ovarian reserve (FOR). Prenatal life corresponds to a critical window for the development of female internal genitalia and changes at this stage may have future repercussions: when the fetus is submitted to intra uterine adverse conditions, adaptive metabolic and endocrine mechanisms will change the metabolic axis in the postnatal period thereafter predisposing to several diseases in adulthood. Based on this correlation, we postulate that unfavorable conditions of intrauterine life that could reflect on birth weight (BW) could lead to the reprogramming of genes involved in the control of FOR and that maybe being born small for gestational age (SGA) or large for gestational age (LGA) could interfere with the FOR estimated through serum concentrations of Anti-Müllerian hormone (AMH). Objective: To investigate the relationship between BW and ROF estimated through AMH serum concentration in menacme women with 34-35 years old. Patients and Methods: This is a prospective birth cohort assessing all women who were born in Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) between June 1, 1978 and May 31, 1979. The primary endpoint was to evaluate serum AMH concentration, a marker of FOR and its correlation with BW divided into three groups: SGA, adequate for gestational age (AGA) and LGA. Results: Out of the 274 patients included in the study: 19 were classified as SGA, 238 as AGA, and 17 as LGA. The average of AMH concentrationwas not significantly different (p=0.11) among women in reproductive age born SGA, AGA and LGA (2.14 ng/mL, 2.13 ng/mL, and 2.57 ng/mL respectively. A variance analysis between the three groups and OR did not find a significant different between them (p=0.11). Conclusion: There was no difference in serum AMH concentration in women born SGA, AGA and LGA with 34 to 35 years old. This sample also allowed to detect or rule out a major difference between the groups (effect size of 0.7). In conclusion, BW does not have a great influence on FOR, estimated through serum AMH concentration in menacmewomen, between 34 and 35 years old. If new studies show clearly that small or moderate differences in serum AMH concentration could impact clinical outcomes in women at this age, further studies will be needed, and the data of this study could be useful for sample size calculation.