Head circumference and leg length are two important markers for disease outcomes in later life. It has been reported that head circumference values in childhood may be closely related to the brain development and future intellectual functioning. Short leg length in childhood is suggested to have association with an increasing risk of coronary heart disease, diabetes and cancer. Given the potential childhood length and adult disease linkage, it is important to identify the determinants of childhood head circumference and leg length. Breastfeeding is suggested to be a potential postnatal factor that affects head circumference and leg length. However, some studies examining impacts of breastfeeding on leg length and head circumference in childhood reported inconsistent or null findings, indicating that the association between breastfeeding, head circumference and leg length remains controversial. Here we reviewed several studies that investigated the relationship between breastfeeding, head circumference and leg length, and in some but not all studies there was controlling for the effects of other potential early life influences, including parental height, prenatal factors and other postnatal factors on head circumference and leg length. Collectively, the illustrations on these relationships would be useful in investigating the leg length/head circumferencelater disease outcomes associations. / text

Introdução: O perímetro cefálico (PC) é definido como o tamanho da cabeça da criança em sua maior área. O crescimento da caixa craniana está relacionado ao crescimento e volume cerebral e, por isso, deve ser rotineiramente medido e utilizado para seguimento individual, pois é um forte preditor do neurodesenvolvimento. Sabe-se que o PC é relacionado a condições ambientais e de saúde materna, e sua avaliação adquiriu grande importância após a recente epidemia de infecção pelo vírus Zika no Brasil e em outras partes do mundo, que se associou ao aumento da incidência de microcefalia. Objetivo: Avaliar a associação do perímetro cefálico de recém-nascidos com características sociodemográficas e hábitos maternos durante a gestação em duas coortes de nascimentos de Ribeirão Preto, SP, em 1978/79 e 2010. Método: foram analisados dados referentes a dois estudos de coortes de nascimento realizados em Ribeirão Preto, SP, um em 1978/79 e o outro em 2010. Foram incluídos recém-nascidos vivos de parto único hospitalar que tiveram a informação do PC ao nascer. Os dados foram coletados de forma semelhante nos dois momentos, utilizando questionário criado para o estudo e dados coletados nos prontuários. As variáveis utilizadas nas análises foram sexo do RN, restrição do crescimento intrauterino (RCIU), idade gestacional, idade e escolaridade maternas, tabagismo durante a gestação, situação conjugal, paridade, tipo de parto e tipo de hospital. Foram realizadas análises de regressão linear simples e múltipla para testar a associação da variável resposta \"perímetro cefálico\" com as variáveis independentes em cada ano, utilizando o pacote estatístico SAS 9.3. Resultados: Na coorte de 1978/79 participaram 2941 recém-nascidos e em 2010 participaram 7353. A média geral do PC em 1978/79 foi de 34,10 cm, um pouco menor do que a de 2010, de 34,29 cm. Nasceram mais meninos em 1978/79 e mais meninas em 2010. Excetuando a RCIU, as demais variáveis apresentaram mudanças na frequência nesse intervalo de tempo. A escolaridade materna aumentou, a proporção de mães adolescentes ficou estável, em torno de 12% e a de mães >=35 anos aumentou de 8,3% para 12,5%. Tabagismo materno na gestação se reduziu de 28,3% para 11,8% e a taxa de cesáreas mais que dobrou, de 27,5% para 58,6%. Todas as variáveis estudadas se associaram com o PC na análise não ajustada, exceto paridade em 1978/79. Nos dois momentos, as variáveis que foram mais fortes preditoras de maiores valores de PC foram sexo masculino e parto cesárea, e de menores valores de PC o tabagismo materno na gestação e RCIU. A RCIU foi o fator que mais impactou, sendo que essas crianças tiveram medida de PC reduzida em 1,30cm (IC95% -1,43; -1,18) em 1978/79 e em 1,74cm (IC95% - 1,87; -1,61) em 2010, quando comparadas com as nascidas sem restrição. Conclusão: Características maternas durante a gestação, apesar de terem melhorado com o passar dos anos, ainda precisam de atenção. Muitas mulheres ainda carecem de informações e de cuidados pré-natais. Esforços devem ser realizados para detecção precoce e intervenção visando a redução das taxas e dos efeitos da RCIU / Introduction: The head circumference (HC) is defined as the size of the child\'s head in its larger area. Cranial case growth is related to brain growth and volume and therefore should be routinely measured and used for individual follow-up as it is a strong predictor of neurodevelopment. It is known that HC is related to environmental and maternal health conditions, and its evaluation has acquired great importance after the recent epidemic of Zika virus infection in Brazil and in other parts of the world, which was associated with the increase in the incidence of microcephaly. Objective: To evaluate the association of the HC of newborns with sociodemographic characteristics and maternal habits during gestation period in two birth cohorts of Ribeirão Preto, State of São Paulo, Brazil, in 1978/79 and 2010. Method: Data were analyzed for two cohort studies of birth in Ribeirão Preto, SP, one in 1978/79 and the other in 2010. We included live births of single hospital delivery that had the information of the HC at birth. The data were collected in a similar way in both moments, using a questionnaire created for the study and data collected in the medical records. The variables used in the analysis were gender of the newborn, intrauterine growth restriction (IUGR), gestational age, maternal age and schooling, smoking during pregnancy, marital status, parity, type of delivery and type of hospital. Simple and multiple linear regression analyzes were performed to test the association of the response variable \"head circumference\" with the independent variables in each year, using the statistical package SAS 9.3. Results: In the 1978/79 cohort, 2941 newborns participated and 7353 participated in 2010. The general average of the HC in 1978/79 was 34.10 cm, slightly lower than that of 2010, 34.29 cm. More boys were born in 1978/79 and more girls in 2010. Except for IUGR, the other variables showed changes in the frequency in that time interval. Maternal education increased, the proportion of adolescent mothers remained stable at around 12% and that of mothers >=35 years increased from 8.3% to 12.5%. Maternal smoking in pregnancy decreased from 28.3% to 11.8% and the cesarean rate more than doubled, from 27.5% to 58.6%. All variables studied were associated with HC in the unadjusted analysis, except for parity in 1978/79. At the two moments, the variables that were the strongest predictors of higher HC values were male sex and cesarean delivery, and lower values of HC were maternal smoking in pregnancy and IUGR. The IUGR was the factor that most impacted, and these children had a HC reduced by 1.30 cm (95% CI -1.43; -1.18) in 1978/79 and 1.74 cm (CI 95% -1.87; -1.61) in 2010 when compared to those born without restriction. Conclusion: Maternal characteristics during gestation, although they have improved over the years, still need attention. Many women still lack information and prenatal care. Efforts should be made for early detection and intervention to reduce the rates and effects of IUGR.

Introdução: O perímetro cefálico (PC) é definido como o tamanho da cabeça da criança em sua maior área. O crescimento da caixa craniana está relacionado ao crescimento e volume cerebral e, por isso, deve ser rotineiramente medido e utilizado para seguimento individual, pois é um forte preditor do neurodesenvolvimento. Sabe-se que o PC é relacionado a condições ambientais e de saúde materna, e sua avaliação adquiriu grande importância após a recente epidemia de infecção pelo vírus Zika no Brasil e em outras partes do mundo, que se associou ao aumento da incidência de microcefalia. Objetivo: Avaliar a associação do perímetro cefálico de recém-nascidos com características sociodemográficas e hábitos maternos durante a gestação em duas coortes de nascimentos de Ribeirão Preto, SP, em 1978/79 e 2010. Método: foram analisados dados referentes a dois estudos de coortes de nascimento realizados em Ribeirão Preto, SP, um em 1978/79 e o outro em 2010. Foram incluídos recém-nascidos vivos de parto único hospitalar que tiveram a informação do PC ao nascer. Os dados foram coletados de forma semelhante nos dois momentos, utilizando questionário criado para o estudo e dados coletados nos prontuários. As variáveis utilizadas nas análises foram sexo do RN, restrição do crescimento intrauterino (RCIU), idade gestacional, idade e escolaridade maternas, tabagismo durante a gestação, situação conjugal, paridade, tipo de parto e tipo de hospital. Foram realizadas análises de regressão linear simples e múltipla para testar a associação da variável resposta \"perímetro cefálico\" com as variáveis independentes em cada ano, utilizando o pacote estatístico SAS 9.3. Resultados: Na coorte de 1978/79 participaram 2941 recém-nascidos e em 2010 participaram 7353. A média geral do PC em 1978/79 foi de 34,10 cm, um pouco menor do que a de 2010, de 34,29 cm. Nasceram mais meninos em 1978/79 e mais meninas em 2010. Excetuando a RCIU, as demais variáveis apresentaram mudanças na frequência nesse intervalo de tempo. A escolaridade materna aumentou, a proporção de mães adolescentes ficou estável, em torno de 12% e a de mães >=35 anos aumentou de 8,3% para 12,5%. Tabagismo materno na gestação se reduziu de 28,3% para 11,8% e a taxa de cesáreas mais que dobrou, de 27,5% para 58,6%. Todas as variáveis estudadas se associaram com o PC na análise não ajustada, exceto paridade em 1978/79. Nos dois momentos, as variáveis que foram mais fortes preditoras de maiores valores de PC foram sexo masculino e parto cesárea, e de menores valores de PC o tabagismo materno na gestação e RCIU. A RCIU foi o fator que mais impactou, sendo que essas crianças tiveram medida de PC reduzida em 1,30cm (IC95% -1,43; -1,18) em 1978/79 e em 1,74cm (IC95% - 1,87; -1,61) em 2010, quando comparadas com as nascidas sem restrição. Conclusão: Características maternas durante a gestação, apesar de terem melhorado com o passar dos anos, ainda precisam de atenção. Muitas mulheres ainda carecem de informações e de cuidados pré-natais. Esforços devem ser realizados para detecção precoce e intervenção visando a redução das taxas e dos efeitos da RCIU / Introduction: The head circumference (HC) is defined as the size of the child\'s head in its larger area. Cranial case growth is related to brain growth and volume and therefore should be routinely measured and used for individual follow-up as it is a strong predictor of neurodevelopment. It is known that HC is related to environmental and maternal health conditions, and its evaluation has acquired great importance after the recent epidemic of Zika virus infection in Brazil and in other parts of the world, which was associated with the increase in the incidence of microcephaly. Objective: To evaluate the association of the HC of newborns with sociodemographic characteristics and maternal habits during gestation period in two birth cohorts of Ribeirão Preto, State of São Paulo, Brazil, in 1978/79 and 2010. Method: Data were analyzed for two cohort studies of birth in Ribeirão Preto, SP, one in 1978/79 and the other in 2010. We included live births of single hospital delivery that had the information of the HC at birth. The data were collected in a similar way in both moments, using a questionnaire created for the study and data collected in the medical records. The variables used in the analysis were gender of the newborn, intrauterine growth restriction (IUGR), gestational age, maternal age and schooling, smoking during pregnancy, marital status, parity, type of delivery and type of hospital. Simple and multiple linear regression analyzes were performed to test the association of the response variable \"head circumference\" with the independent variables in each year, using the statistical package SAS 9.3. Results: In the 1978/79 cohort, 2941 newborns participated and 7353 participated in 2010. The general average of the HC in 1978/79 was 34.10 cm, slightly lower than that of 2010, 34.29 cm. More boys were born in 1978/79 and more girls in 2010. Except for IUGR, the other variables showed changes in the frequency in that time interval. Maternal education increased, the proportion of adolescent mothers remained stable at around 12% and that of mothers >=35 years increased from 8.3% to 12.5%. Maternal smoking in pregnancy decreased from 28.3% to 11.8% and the cesarean rate more than doubled, from 27.5% to 58.6%. All variables studied were associated with HC in the unadjusted analysis, except for parity in 1978/79. At the two moments, the variables that were the strongest predictors of higher HC values were male sex and cesarean delivery, and lower values of HC were maternal smoking in pregnancy and IUGR. The IUGR was the factor that most impacted, and these children had a HC reduced by 1.30 cm (95% CI -1.43; -1.18) in 1978/79 and 1.74 cm (CI 95% -1.87; -1.61) in 2010 when compared to those born without restriction. Conclusion: Maternal characteristics during gestation, although they have improved over the years, still need attention. Many women still lack information and prenatal care. Efforts should be made for early detection and intervention to reduce the rates and effects of IUGR.

Thyroid dysfunction is one of the most common endocrine disorders in women of childbearing age and the obstetric consequences of abnormal thyroid hormone levels during pregnancy have been established. Less understood is the implication of the presence of maternal thyroid autoantibodies on infant outcomes among women who are euthyroid during pregnancy. The objective of this study was two-fold: 1) to examine the influence of antenatal thyroperioxidase (TPO) status on fetal/infant brain and body growth measurements at delivery and 2) to explore the relationship of antenatal TPO status and maternal postpartum thyroid dysfunction (PPTD) on early infant growth and neurocognitive development. Six-hundred thirty-one (631) euthyroid pregnant women were recruited from prenatal clinics in Tampa Bay, Florida and the surrounding area between November 2007 and December 2010. TPO status was determined during pregnancy and fetal/infant brain and body growth variables were assessed at delivery. A subsample of forty-one (41) mother-infant dyads participated in a 6-month longitudinal supplemental study. Infant growth assessments were conducted at 3, 4, 5 and 6 months postpartum. Regression analysis revealed maternal TPO positivity was significantly associated with smaller head circumference, reduced brain weight and lower brain-body-ratio; however maternal race/ethnicity was identified as an effect modifier in the relationship. No significant differences were noted in birth weight, birth length, abdominal circumference or chest circumference measurements among infants born to TPO positive mothers of any racial/ethnic group as compared to their negative counterparts. Mixed model analysis of the smaller subset (n=41) revealed infants of TPO+ mothers were smaller at birth but experienced accelerated growth between birth to 3 months when compared to infants born to TPO- mothers. This acceleration led to their catch-up in growth to their TPO negative counterparts by 3 months of age. No significant differences were noted in neurocognitive outcomes between infants born to TPO+ mothers compared to those born to TPO- mothers. The findings in this dissertation indicate that maternal/race ethnicity modifies the relationship between TPO positivity and reduced fetal/infant brain growth. Additionally, the analyses suggest that maternal autoantibody status could lead to variations in early infant growth and development. The end-result of these variations is unclear. Further research is needed to determine the potential impact of reduced head circumference and accelerated growth as it relates to long-term neurocognitive consequences. Currently, TPO antibody status is not assessed as part of the standard prenatal care laboratory work-up, but findings from this study suggest that fetal brain growth may be impaired by TPO positivity among certain populations, therefore autoantibody screening among high-risk sub-groups may be useful for clinicians to determine whether prenatal thyroid treatment is warranted.

Σκοπός: Η μεταγεννητική αύξηση των παιδιών που εκτέθηκαν στον καπνό του τσιγάρου ενδομητρίως δεν είναι πλήρως κατανοητή. Σκοπός της παρούσας μελέτης είναι να ερευνήσει την αύξηση παιδιών των οποίων οι μητέρες κάπνιζαν στη διάρκεια της εγκυμοσύνης, κατά τα πρώτα έξι χρόνια της ζωής τους. Μέθοδοι: Το βάρος σώματος, το μήκος σώματος και η περίμετρος κεφαλής μετρήθηκαν στη γέννηση και κατόπιν ετησίως για έξι έτη σε 100 παιδιά των οποίων οι μητέρες κάπνιζαν (ομάδα μελέτης) και 100 παιδιά των οποίων οι μητέρες δεν κάπνιζαν (ομάδα ελέγχου). Αποτελέσματα: Το βάρος και η περίμετρος κεφαλής ήταν σημαντικά μικρότερα στα νεογνά των οποίων οι μητέρες κάπνιζαν >15 τσιγάρα την ημέρα, αλλά η διαφορά έχασε τη στατιστική σημαντικότητα στον τρίτο χρόνο της ζωής. Το μήκος ήταν σημαντικά μικρότερο στα νεογνά της ομάδας μελέτης στη γέννηση και ακολουθούσε αύξηση της διαφοράς από το φυσιολογικό έως το δεύτερο έτος, οπότε η μέση διαφορά των παιδιών που οι μητέρες τους κάπνιζαν >15 τσιγάρα την ημέρα από τα παιδιά της ομάδας ελέγχου ήταν -3,4 εκατοστά (p<0,0001). Στη συνέχεια, τα παιδιά των καπνιστριών μητέρων παρουσίασαν επιτάχυνση του ρυθμού αύξησης και η διαφορά από την ομάδα ελέγχου στα 3, 4, 5 και 6 χρόνια ζωής ήταν -2,5 (p<0,0001), -2,2 (p=0,005), -2,1 (p=0,013), και -1,9 εκατοστά (p=0,055), αντίστοιχα. Η καθυστερημένη αύξηση σχετιζόταν με το κάπνισμα αυτό καθ’εαυτό και δείχθηκε ότι η καθυστέρηση της αύξησης είναι ανεξάρτητη από πολλούς συμπαράγοντες. Επίσης, στη γέννηση υπήρχε σημαντική αρνητική συσχέτιση μεταξύ του αριθμού των τσιγάρων που καπνίζονταν ημερησίως και των παραμέτρων αύξησης που μελετήθηκαν. Η αρνητική συσχέτιση παρέμεινε σημαντική έως τον έκτο χρόνο ζωής μόνο για το ύψος. Συμπέρασμα: Το μήκος παρουσιάζει την πιο επίμονη καθυστέρηση της αύξησης από τις παραμέτρους που μελετήθηκαν, δηλαδή το βάρος σώματος και την περίμετρο κεφαλής, αλλά μετά το δεύτερο έτος της ζωής συμβαίνει επιτάχυνση της αύξησης, και έτσι η ενδομήτρια έκθεση στον καπνό του τσιγάρου φαίνεται να μην έχει μόνιμη επίδραση στην τελική αύξηση των παιδιών. / Objectives: Postnatal growth in children exposed in utero to tobacco smoke is not well understood. This study investigated growth during the first 6 years in children whose mothers smoked during pregnancy. Materials and Methods: Weight, length, and head circumference were measured annually for 6 years in 100 children in each group of smoking (study) and non smoking (control) mothers. Results: Weight and head circumference were significantly smaller in the neonates whose mothers smoked >15 cigarettes/day, but the difference disappeared by 3 years of life. Length was significantly smaller in the study neonates at birth, followed by increasing divergence from normality up to 2 years, when the mean difference of children whose mothers smoked >15 cigarettes/day from control children was -3.4 cm (p<0.0001). Subsequently, they manifested catch-up growth, and the difference from the controls at 3, 4, 5, and 6 years was -2.5 cm (p<0.0001), -2.2 cm (p=0.005), -2.1 cm (p=0.013), and -1.9 cm (p=0.055), respectively. Discussion: The delayed growth was related to smoking per se and appeared to be independent of several confounding factors. At birth, there was a significant negative correlation between the number of cigarettes smoked per day and the growth parameters studied; it remained significant up to the sixth year only for length. Conclusion: Length exhibits the most persistent growth delay of the parameters studied, but catch-up growth occurs after the second year of life, and thus, intrauterine exposure to tobacco smoke seems to have no permanent effect on children’s growth.

Objective: The aim of this study was to investigate if the head circumference of stunted quilombolas children differs from that other children with adequate linear growth and if the insufficient birth weight and exclusive breastfeeding in the first month of life intervene with this relation. Methods: The work followed a transversal studying involving all the children of 12 to 60 months (n=725) pertaining to the quilombolas community of Alagoas (n=39). Variables demographics, socioeconomics, of the health and anthropometrics indices had been collected. These had been compared with the curves of the standard of reference of the of WHO 2006. The children had been categorized into two groups in agreement with the presence or not of the malnutrition (stunted/eutrophic), diagnosed by means of the height deficit (height-for-age < -2,0 SD). Each group was divided in two sub-groups agreements the insufficient birth weight (IBW < 3000g). Finally, each sub-group formed two other categories according to the exposition or not to the exclusive breastfeeding in the first month of life (breastfeeding/ not breastfeeding). Thus, eight groups of studies were formed, which, for the statistics analysis, had been expresses as ordinary category variables (1 a 8), group 1 was formed for the children submitted to worst conditions (undernutrition, with IBW and that weren t to breastfed) and group 8 for the best ones (eutrophic with adequate birth weight and that was to breastfed). The average of the head circumferencefor- age (HC) was compared using ANOVA and the Turkey test as pos-hoc. For this, group 8 was assumed as control. To investigate the principal risk factors associated to the occurrence of the deficit of HC (z < 1.5), regression logistic analyze was used, remaining in the last model the independent variables which associations presented p<0.05. Results: The prevalence of nutritional deficits for indicators height-for-age, weight-forage, weight-for-height and head circumference-for-age was respectively of 10.8%, 1.9%, 1.3% e 10.5%. The overweight (weigh-for-age > 2 SD) represents 6.4%. The averages of Z-score of the head circumference for the groups 1, 2, 3, 4, 5, 6, 7 e 8 was -1.67*, -1.09, - 0.97, -0.94, -1.02, -0.69, -0.68 e -0.53 respectively. Group 1 was the unique that presented statistics differences (p< 0,05) compared to the control group, suggesting the protective role of breasting against reduction of the HC, when the presence of the chronic malnutrition (express for height deficit) in children that were born with IBW, because the exposition to exclusive breastfeeding was the unique differential used on the formation of the groups 1 and 2. On the multivaried analyzis, the factors that were significantly associated to deficit of HC were the stunted, the insufficient birth weight, the feminine sex and the increase of chronological age in one month increase the chances of occurrence these outcomes in 119%, 77%, 63% e 2% respectively. But the increase of time of the exclusive breastfeeding in one month reduces the possibilities in 10%. Conclusions: The children who are stunted, are born with insufficient weight and that they had not been was exposed to exclusive breastfeeding for one month, demonstrate consistently the worst averages of Z-score of head circumference when compared to children not submitted to stress . In this context, the exposition of breastfeeding per for one month possibly, of the central nervous system. Although traditional population have been considered, the average time of the exclusive breastfeeding was behind of the praised for the WHO. Thus, it was suggested the more investments on the direction of the increase the period of the exposition to exclusive breastfeeding between the quilombolas children of the Alagoas state. / Objetivo: Investigar se o perímetro cefálico de crianças quilombolas com déficit estatural difere daquela observado em crianças com crescimento linear adequado e se o peso insuficiente ao nascer e o aleitamento materno exclusivo no primeiro mês de vida interfere nessa relação. Métodos: Estudo transversal envolvendo todas as crianças de 12 a 60 meses (n=725) pertencentes às comunidades quilombolas (n=39) de Alagoas. Coletaram-se dados demográficos, socioeconômicos, de saúde e antropométricos. Estes foram comparados às curvas do padrão de referência da OMS-2006. As crianças foram categorizadas em 2 grupos conforme a presença ou não da desnutrição (desnutrida/eutrófica), diagnosticada por meio do déficit estatural (estatura-para-idade < - 2,0 desvio-padrão). Cada grupo foi subdivido em 2 sub-grupos conforme o Peso Insuficiente ao Nascer (PIN < 3000g). Finalmente, cada sub-grupo formou duas outras categorias segundo a exposição ou não ao aleitamento materno exclusivo por 30 ou mais dias (mamou/não mamou). Assim, formaram-se oito grupos de estudos, os quais, para a análise estatística, foram expressos como variáveis categóricas ordinais (1 a 8), de modo que o grupo 1 fora formado pelas crianças submetidas às piores condições (desnutridas, com PIN e que não mamaram) e o grupo 8 pelas melhores (eutróficas, com peso adequado ao nascer e que mamaram). A média do perímetro cefálico-para-idade (PC) foi comparada utilizando ANOVA e o teste de Tukey como pos-hoc. Para isso, assumiu-se o grupo 8 como controle. Para investigar os principais fatores de risco associados à ocorrência do déficit de PC (z < -1,5), utilizou-se a análise de regressão logística, mantendo-se no modelo final as variáveis independentes cujas associações apresentaram p<0,05. Resultados: As prevalências de déficits nutricionais para os índices altura-para-idade, peso-para-idade, peso-para-altura e PC foram, respectivamente, 10,8%, 1,9%, 1,3% e 10,5%. O sobrepeso (peso-para-altura > 2 DP) representou 6,4%. As médias de escore Z do perímetro cefálico para os grupos 1, 2, 3, 4, 5, 6, 7 e 8 foram -1,67*, -1,09, -0,97, -0,94, - 1,02, -0,69, -0,68 e -0,53, respectivamente. O grupo 1 foi o único que apresentou diferença estatisticamente significativa (p < 0,05) em relação ao grupo controle, sugerindo um papel protetor do aleitamento materno contra a redução do PC, quando da vigência da desnutrição crônica (expressa pelo déficit estatural) em crianças nascidas com PIN, haja vista que a exposição ao aleitamento materno foi o único diferencial utilizado na formação dos grupos 1 e 2. Na análise multivariada, os fatores que se apresentaram significativamente associados ao déficit de PC foram o déficit estatural, o PIN, o sexo feminino e o aumento da idade cronológica em um 1 mês, as quais, elevaram as chances de ocorrência desse desfecho em, respectivamente, 119%, 77%, 63% e 2%. O aumento do tempo de aleitamento materno exclusivo em um mês, reduziram essas chances em 10%. Conclusões: As crianças que apresentam baixa estatura, nascem com peso insuficiente e que não foram expostas ao aleitamento materno exclusivo por pelo menos 1 mês apresentam menores valores de perímetro cefálico, quando comparadas a crianças não submetidas a esses estresses. Nesse contexto, a exposição ao aleitamento materno exclusivo por 30 ou mais dias constitui-se num importante fator de proteção, no sentido de preservar o crescimento do perímetro cefálico e possivelmente, do sistema nervoso central. Apesar de tratar-se de uma população dita tradicional, o tempo médio de aleitamento materno exclusivo ficou aquém do preconizado pela OMS. Diante desses resultados, sugere-se maiores investimentos no sentido de aumentar entre as crianças quilombolas de Alagoas, o período de exposição ao aleitamento materno exclusivo.

Les objectifs de cette thèse étaient de définir le retard de croissance intra-utérin chez le nouveau-né prématuré, d’étudier ses conséquences en terme de morbidité néonatale et de pronostic à long terme et d’évaluer les liens existant entre retard de croissance intra-utérin, croissance extra-utérine et pronostic des prématurés. Nous avons mis en évidence dans un premier temps que le seuil strict de définition d’un « nouveau-né petit pour l’âge gestationnel» ne pouvait se limiter dans le cadre de la prématurité au 10ème percentile mais s’étendre au-delà, au moins jusqu’au 20ème percentile. Par ailleurs, se limiter au poids n’était pas suffisant et qu’une définition par l’association entre poids et périmètre crânien était pertinente en terme de pronostic tant à court qu’à long terme.Nous avons montré que la restriction de croissance intra-utérine était associée au pronostic neurologique des grands prématurés en terne de déficience cognitive et difficultés scolaires essentiellement et ce même pour des prématurés modérés et une restriction de croissance peu sévère et que l’effet du retard de croissance était modulé selon l’âge gestationnel de naissance. Concernant la croissance extra-utérine, nous avons montré qu’elle était elle-même associée au pronostic neurologique des prématurés mais que cet effet était variable selon la croissance anténatale.Enfin, nous nous sommes interrogés sur les conséquences à court terme des efforts faits par les néonatologistes afin d’optimiser la croissance post-natale des prématurés par une revue de la littérature et montré qu’ils existaient des anomalies métaboliques engendrées par une nutrition agressive qu’il convenait de surveiller. / Our main objectives were to define intrauterine growth restrictions in preterm infants to study its consequences in terms of neonatal morbidity and long-term prognosis and also assessment to study the relationship between intrauterine growth restriction, extra-uterine growth and neurological outcomes.We showed initially that strict threshold definition of a "small for gestational age" preterm could not be limited in the context of prematurity in the 10th percentile, but extend beyond, at least to the 20th percentile. Furthermore, to define growth restriction studying, weight was not enough. A definition by the association between weight and head circumference was relevant in terms of prognosis in both the short and long term.We found that growth restriction in very preterm and neurological outcome were significantly associated. Small for gestational age preterm infants were more likely to have cognitive impairment and school difficulties even for moderate preterm and moderate growth restriction. Gestational age was an important factor that modulates the association between growth restriction and outcome. Concerning extra-uterine growth, we have shown that it was associated with neurological outcome but this effect varied with antenatal growth pattern.Finally, we studied by literature review, the short-term consequences of optimized postnatal growth of premature infants and showed metabolic abnormalities caused by an aggressive nutrition that required necessary monitoring.

For my dissertation, I have chosen to monitor and research growing children in Prague and in the Central Bohemian Region. Primarily, I am interested in the growth period of the younger school age (which corresponds to the first degree of compulsory school attendance). However, I also monitored and worked with the growth data of infant and pre-school aged children. The reason for this is that I needed the growth data from a longer period of time for a better assessment. I am really interested in the area of child anthropology because I belive the growth of every child is essential for their future. The final height and weight of the individual, specifically his/her total body proportions, can have a significant influence on their next life. I am convinced that this can have a major influence on the health, social application and self-confidence for each of us. Thanks to a very willing approach of a Prague pediatrician I managed to accumulate the growth data of children living in Prague. I would like to compare the obtained data with the data of children living in the Central Bohemian Region. I was able to gain the growth data of the children thanks to the friendly cooperation of my pupils'parents, my acquaintances and friends. Children were selected according to their health cards. On these cards...

No description available.

Objetivos: Diversos trabalhos documentaram a associação entre o fumo ativo na gestação e a redução no peso,comprimento e perímetro cefálico dos recémnascidos. Porém, existem controvérsias quanto aos efeitos do fumo passivo. Esse estudo buscou colaborar na elucidação sobre os efeitos da exposição da gestante ao fumo nas medidas antropométricas do recém-nascido. Métodos: Estudo transversal, que incluiu 200 parturientes, identificando a intensidade da exposição das mesmas ao fumo através da mensuração da cotinina urinária e do auto-relato sobre seu hábito tabágico e de seus familiares,o que possibilitou categorizá-las em não fumantes, fumantes passivas e fumantes ativas e posterior comparação com as medidas antropométricas dos recémnascidos. Resultados: Encontramos uma diferença estatisticamente significativa no peso,quando comparamos as fumantes passivas às não fumantes, -152g (IC95%: -285 a -18;P=0,026) e a diferença encontrada nas fumantes ativas foi de - 159g (IC95%: -301 a -16; P=0,029), em relação às não fumantes. Na medida do comprimento, observou-se uma diferença significativa entre as fumantes passivas, -0,8cm (IC95%: -1,4 a -0,2;P=0,012) em relação às não fumantes, e entre as fumantes ativas a diferença foi de -1,0cm (IC95%: -1,6 a -0,3;P=0,003), quando comparado às não fumantes. Quanto à medida do perímetro cefálico, não foram observadas diferenças significativas quando os grupos, das fumantes passivas e fumantes ativas, foram comparados ao grupo das não fumantes. Conclusões: Os resultados sugerem que o fumo passivo durante a gestação pode apresentar efeitos semelhantes aos do fumo ativo nas medidas antropométricas dos recém-nascidos. / Objectives: Several studies have documented the association between active smoking during pregnancy to weight, height and head circumference reduction on newborns. However, there are controversies about the passive smoking. The present study sough the elucidation of the effects of tobacco exposition of pregnant women on anthropometric measurements of newborns. Methods: Cross-sectional study, including 200 in labor women, identifying the intensity of their exposition to tobacco through the measurement of urine cotinine and the self reported information about the smoking habit of their relatives and themselves, what allowed us to classify them as non-smokers, passive smokers and active smokers and later the comparison with the anthropometric measurements of newborns. Results: We found a statistically significant difference in weight when comparing passive smokers to non-smokers, -152g (CI 95%: -285 to –18; P=0.026) and the difference found on active smokers was - 159g (CI 95%: -301 to 16; P=0.029) when compared to non-smokers. On the height measurements, a significant difference was found within the group of passive smokers, -0,8 cm (CI 95%: -1,4 to -0.2; P=0.012) comparing to the non-smokers group, within the smokers group the difference was -1,0 cm (CI 95%: -1,6 to -0.3; P=0.003) when compared to nonsmokers. About the measurements of head circumference, no was found a significant difference when the passive smokers and active smokers group was compared to non-smokers group. Conclusions: The results suggest that the passive smoking during pregnancy may present similar effects as the active smoking on the anthropometric measurements of newborns.