Objetivo: Verificar a acurácia do Test of Infant Motor Performance (TIMP) e da ultrassonografia de crânio (USC) no diagnóstico neurológico precoce após os 10 meses de idade corrigida em recém-nascidos pré-termo (RNPT) Metodologia: Amostra não aleatória constituída por 59 RNPT (idade gestacional ao nascimento 32 semanas ou peso ao nascimento 1500 gramas) seguidos em média até os 12 meses de idade corrigida. Os resultados da USC foram agrupados em 3 intervalos: 1) de 0 a 15 dias, 2) de 16 a 30 dias e 3) de 31 a 45 dias. Os achados da USC foram classificados em normal e anormal (anormalidades moderada e grave). O TIMP foi aplicado mensalmente, do primeiro retorno após a alta hospitalar até o 4° mês de idade corrigida. As avaliações foram agrupadas em 5 intervalos, correspondentes às avaliações antes do termo, 1°, 2°, 3° e 4° meses de idade corrigida. Os resultados do TIMP foram classificados em normal (média e média baixa) ou anormal (abaixo da média e muito abaixo da média). A avaliação neurológica foi realizada em média aos 12 meses de idade corrigida, e usada como padrão-ouro. Foram calculados os valores de sensibilidade, especificidade e valores preditivos positivos (VPP) e negativos (VPN) para o TIMP e para a USC neonatal. Resultados: A paralisia cerebral foi diagnosticada em 6 crianças. Observamos que a USC apresentou alta sensibilidade (> 70%) assim como altos VPN (>88%) em todos os intervalos. Para a USC, especificidade e VPP foram baixos em todos os intervalos. A sensibilidade do TIMP foi baixa, exceto para o intervalo 0, e os VPP foram baixos em todas as idades. A escala TIMP apresentou alta especificidade (75%, 85%) no 3° e 4° meses e altos VPN (> 77%) em todos os intervalos. Conclusão: Concluímos que os RNPT com pontuação normal no 3° e 4° meses do TIMP tem grandes chances de não desenvolver PC enquanto que RNPT com anormalidades graves e persistentes à USC tem maiores chances de um prognóstico neurológico anormal / Objective: Calculate the accuracy of the Test of Infant Motor Performance (TIMP) and the cranial ultrasonography (CUS) in the neurological outcome after 10 months of corrected age of preterm infants. Methods: Non-random sample of 59 preterm newborn infants (gestational age 32weeks or birth weight1500g) were followed up to a mean of 12 months corrected age. CUS results were grouped into 3 periods: 1) from 0 to 15 days; 2) from 16 to 30 days, and 3) from 31 to 45 days of life. CUS findings were rated into two groups: normal and abnormal (moderate and severe abnormalities). TIMP was applied monthly, from the first outpatient visit after hospital discharge until four months corrected age. The evaluations were grouped into five intervals, corresponding to the assessments performed before term age, 1st, 2nd, 3rd and 4th month of corrected age. TIMP results were ranked as normal (average, low average) or abnormal (below average and far below average). A full neurological examination was performed at a mean of 12 months of corrected age, and used as gold standard. The sensitivity, specificity, positive predictive (PPV) and negative predictive (NPV) values for TIMP and CUS were calculated. Results: Cerebral palsy was diagnosed in six infants. We observed that CUS had a high sensitivity (> 70%) in all intervals as well as high NPV (>88%). For CUS, specificity and PPV were low in all intervals. TIMP sensitivity was low, except for interval 0, and PPV were low at all ages. TIMP scale showed high specificity in the 3rd and 4th month (75%, 85%) and high NPV (> 77%) at all ages. Conclusions: We conclude that preterm infants with normal score at the 3rd and 4th months of TIMP are likely to develop normally while infants with severe and persistent abnormalities in the CUS examinations are more likely to have an abnormal neurological outcome

Sabe-se que algumas alterações nutricionais maternas durante o período perinatal estão associadas com doenças metabólicas na vida adulta das proles, tais como diabetes melito tipo 2, resistência à insulina, obesidade e hipertensão arterial. O período da gestação em que estas alterações nutricionais influenciam a prole na idade adulta ainda não está elucidado. Modificações epigenéticas têm sido propostas como mecanismos responsáveis por estas desordens metabólicas. Ratas Wistar de doze semanas de idade foram alimentadas com dieta com conteúdo baixo (HO - 0,15% NaCl) ou normal (NR - 1,3% NaCl) de sódio desde o primeiro dia de gestação até o nascimento da prole ou HO durante a primeira (HO10) ou segunda (HO20) metade da gestação. O peso corpóreo e a ingestão de água e ração foram avaliados semanalmente durante a gestação. Teste de tolerância à insulina (ITT) e à glicose (GTT) e HOMA-IR foram realizados nas proles adultas. Expressão gênica por qRT-PCR e metilação do DNA na região promotora dos genes foram mapeadas utilizando tratamento com bissulfito de sódio e avaliadas por pirosequenciamento. O ganho de peso materno foi menor no HO e HO20 na terceira semana de gestação em comparação com NR e HO10. O peso ao nascimento da prole foi menor em machos e fêmeas dos grupos HO e HO20 em relação ao NR e HO10. O HOMA-IR foi maior nos machos com 12 semanas de idade do grupo HO em comparação com NR e com 20 semanas de idade do grupo HO10 em comparação com NR e HO20. Nas fêmeas com 12 semanas de idade o HOMA-IR foi maior no HO10 comparado com HO. Os níveis de insulina no soro foram maiores tanto nos machos com 20 semanas de idade do grupo HO10 comparado com NR quanto nas fêmeas com 12 semanas de idade do grupo HO10 comparado com HO. A área sob a curva do GTT indicou intolerância à glicose nos machos do grupo HO. A porcentagem de metilação das ilhas CpG no promotor dos genes de Igf1, Igf1r, Ins1, Ins2 e Insr no fígado de machos e fêmeas neonatais e no fígado, tecido adiposo branco e músculo em machos com 20 semanas de idade foi influenciada pela baixa ingestão de sal durante a gestação. Nenhuma destas alterações foi identificada nas fêmeas com 20 semanas de idade. Em conclusão, a baixa ingestão de sal na segunda metade da gestação é responsável pelo baixo peso ao nascimento em ambos os sexos. A intolerância à glicose observada na prole adulta ocorreu somente se a dieta hipossódica é dada durante a gestação inteira. Por outro lado, a resistência à insulina em resposta ao consumo de dieta hipossódica durante a gestação está relacionada com o momento em que ocorre este insulto e com o envelhecimento da prole. Também foi observado que alterações na metilação do promotor do gene Igf1 está correlacionado com o baixo peso ao nascimento em resposta a ingestão de dieta hipossódica durante a gestação / It is known that some maternal nutritional alterations during pregnancy are associated with metabolic disorders in adult offspring, such as insulin resistance, type 2 diabetes mellitus, obesity and arterial hypertension. The period of pregnancy in which these nutritional alterations influence adult offspring remains uncertain. Epigenetic changes are proposed to underlie these metabolic disorders. Twelve-week-old female Wistar rats were fed a low-salt (LS - 0.15% NaCl) or normal-salt (NS - 1.3% NaCl) diet since the first day of gestation until delivery or LS during the first (LS10) or second (LS20) half of gestation. Body weight, food and water intake were weekly evaluated during gestation. Blood glucose, insulin (ITT) and glucose (GTT) tolerance tests, HOMA-IR were performed in adult offspring. Gene expression and DNA methylation were mapped using bisulfite treatment evaluated by pyrosequencing in the male and female neonates and adult offspring. Weight gain was lower in LS and LS20 dams than in NS and LS10 dams in the third week of pregnancy. Birth weights were lower in male and female LS20 and LS rats compared with NS and LS10 neonates. HOMA-IR was higher in 12-week-old LS males compared with NS and in 20-week-old male LS10 rats compared with NS and LS20 rats. In 12-week-old LS10 females, HOMA-IR was higher than in LS. Serum insulin levels were higher in 20 week-old LS10 male compared with NS rats and in 12-week-old LS10 female compared to LS rats. The area under the curve of GTT indicated glucose intolerance in 12- and 20-week-old LS male. Methylation of CpG islands of the Insr, Igf1, Igf1r, Ins1 and Ins2 genes in liver in neonates male and female offspring and liver, white adipose tissue and muscle in 20-week-old male offspring were influenced by low-salt intake during pregnancy. None of these alterations was identified in 20-week-old females. In conclusion, low-salt diet consumption in the second half of pregnancy can result in low birth weights in the males and females offspring. Glucose intolerance observed in adult offspring occurred only if low salt intake was given throughout pregnancy. However, insulin resistance in response to low salt intake during pregnancy is related to the time at which this insult occurs and to the age of the offspring. Alterations in the DNA methylation of Igf1 were observed to be correlated with low birth weight in response to low salt feeding during pregnancy

Die Malaria ist heute noch immer die bedeutendste parasitäre Infektionskrankheit des Menschen. Hiervon sind in Endemiegebieten neben Kleinkindern insbesondere schwangere Frauen betroffen. P. falciparum weist eine hohe genetische Diversität auf. So sind in Endemiegebieten Infektionen mit P. falciparum in der Regel polyklonal. Man spricht in diesen Fällen von der Multiplizität der Infektion. Bei Schwangeren sequestrieren mit P. falciparum infizierte Erythrozyten, die spezifische Oberflächenproteine exprimieren, in der Plazenta. Hierdurch bedingt können pathologische Schwangerschafts-verläufe klinische Manifestationsformen der Malaria darstellen. Um die Diversität von P. falciparum und die Multiplizität der Infektion bei schwangeren Frauen zu erforschen, wurden in einer Querschnittsstudie im holoendemischen Malariagebiet von Agogo in Ghana über den Zeitraum von einem Jahr 474 Gebärende mit einer nachgewiesenen plazentaren Infektion von P. falciparum untersucht. Hierzu wurden die Gene, die für das "Merozoiten-Oberflächen-Protein-1" (msp-1) und "Merozoiten-Oberflächen-Protein-2" (msp-2) kodieren, aus peripher und plazentar gewonnen Isolaten typisiert. Plazentar gewonnene Isolate waren im Vergleich zu peripher gewonnenen mit einer signifikant höheren Prävalenz an polyklonalen Infektionen und einer höheren Multiplizität der Infektion assoziiert. Die höchste Multiplizität der Infektion wurde bei Erstgebärenden und jüngeren Patientinnen beobachtet. Mit zunehmendem Alter und einer höheren Anzahl an vorangegangenen Schwangerschaften fielen signifikant sowohl die Multiplizität der Infektion als auch die Parasitendichte. Zudem wurde eine hohe Korrelation zwischen der Multiplizität der Infektion und der Parasitendichte nachgewiesen. Weder das Alter noch die Parität beeinflussten diese Korrelation. Der Einfluss von Alter und Parität auf die Multiplizität der Infektion konnte somit nicht unabhängig von der Parasitendichte nachgewiesen werden. Multivariate Analysen zeigten aber, dass es unabhängig von der Parasitendichte bei plazentaren Infektionen mit zwei und mehr als zwei Klonen im Vergleich zu monoklonalen plazentaren Infektionen mit einer höheren Wahrscheinlichkeit zu einer Frühgeburt kam. Dies betraf insbesondere Erstgebärende und Frauen mit submikroskopischen plazentaren Infektionen. Ob bei polyklonalen Infektionen eine Sequestration von P. falciparum in der Plazenta durch alle oder nur durch einen Teil der zahlreichen Genotypen geschieht, die an einer Infektion bei Schwangeren beteiligt sind, ist nicht entgültig geklärt. Es wurden aus zusammengehörenden plazentar und peripher gewonnenen P.-falciparum-Isolaten die Verteilungsmuster der Genotypen verglichen. Zwar korrelierte die Multiplizität der Infektion plazentarer und peripherer Isolate, die Genotypenmuster der Plazenta und der Peripherie waren jedoch deutlich unterschiedlich. Nur in 12% der Fälle konnte eine Genotypisierung eines peripher gewonnenen Isolates das klonale Gesamtbild der Infektion nachweisen. In 67% der Fälle waren neben identischen Genotypen wenigstens in einem der beiden Isolate unterschiedliche Genotypen nachweisbar. Einzelne spezifische Genotypen traten in der gesamten Untersuchungsgruppe öfter in der Plazenta als in der peripheren Blutprobe auf. Bei Frauen, die mit den Genotypen der Allelfamilie FC27 infiziert waren, lagen signifikant häufiger klinischen Manifestationen der Malaria vor. So konnte in multivariaten Analysen eine Assoziation zwischen FC27 und einer Frühgeburtlichkeit nachgewiesen werden. Darüber hinaus war FC27 zumindest in univariater Analyse mit einer Anämie und einem verminderten Geburtsgewicht assoziiert. Dies konnte insbesondere für Primiparae und für Gebärende mit submikroskopischen plazentaren Infektionen beobachtet werden. / Malaria is still one of the most considerable parasite infections of the human being. Pregnant women are at an increased risk in endemic areas. P. falciparum shows a high genetic diversity. In endemic areas infections with P. falciparum are very often polyclonal. They are described as multiple Infections or as the multiplicity of infection. In pregnant women P.-falciparum-infected-erythrocytes which exprimate specific surface proteins sequester in the placental tissue. Often this is the course of preterm delivery, low birth weight and anaemia. To investigate the diversity of P. falciparum and the multiplicity of infection in pregnant women a cross-sectional study was conducted in the holoendemic area of Agogo in Ghana. In this study over a period of one year 474 labouring women infected with placental P.-falciparum where investigated. To examine the diversity and the multiplicity of infection merozoite surface protein-1 (msp1) block 2 and merozoite surface protein-2 (msp2) genotypes were determined in Isolates from peripheral and placental blood samples. The study showed that in comparision to isolates of peripheral blood samples isolates of placental blood samples where associated with a significant higher prevalence of polyclonal infections and a higher multiplicity of infection. The highest multiplicity of infection was found among primiparae and young women. With age and parity multiplicity of infection as well as parasite density decreased. In addition a high correlation between the multiplicity of infection and parasite density could be demonstrated. Age and parity did not influence this correlation. Thus the influence of age independent from parity on the multiplicity of infection could not be proved. However, multivariate analyses showed, that independently from parasite density placental Infections with two or more clones were in comparison to monoclonal Infections associated with a higher probability of preterm delivery. This was the case especially in primiparae and in women with submicroscopical placental Infection. Presently it is not clear, whether all or only a subset of co-infecting genotypes sequester in the placental tissue. To address this issue the genotype distribution of matched placental and peripheral P. falciparum isolates where investigated. While the multiplicity of infection of placental and peripheral isolates correlated the genotype pattern of the placenta and the periphery differed extensively. Only 12% genotyping of a peripheral Isolate showed the entire picture of the infection. In 67% of the cases despite finding identical genotypes differing genotypes in at least one of the two Isolates were detectable. Specific genotypes appeared more often in the placental than in the peripheral Isolate. In women, who were infected with genotypes of the allelic family FC27 clinical manifestation of malaria were observed more often. In multivariate analysis an association between FC27 and a preterm delivery was established. Beside this at least in univariate analyses FC27 was associated with low birth weight and anaemia. This was the case especially for primiparae and labouring women with submicroscopic placental infections.

JUSTIFICATIVA E OBJETIVOS: Vários estudos têm mostrado o peso ao nascer de ambos os pais como preditor do peso de nascimento do descendente, com correlação mais fortemente transmitida através da linhagem materna, sugerindo que exposições desfavoráveis à mãe desde a sua própria vida intrauterina até os períodos de pré-concepção e gestacional, além dos genes herdados, influenciam o tamanho ao nascimento da prole. A preocupação atual se relaciona ao ciclo intergeracional do baixo peso ao nascer ou do peso ao nascer elevado entre gerações, com todos os agravos imediatos e a longo prazo que estão implicados em nascer pequeno para a idade gestacional e/ou baixo peso ou grande para a idade gestacional e/ou macrossômico. O presente trabalho tem o objetivo de estudar a correlação entre o peso ao nascer da criança com o peso ao nascer da mãe, com as condições maternas, em crianças nascidas a termo no Hospital Universitário da USP (HU-USP). MÉTODOS: Foram identificados 773 binômios mães-crianças, 773 crianças nascidas de 558 mães, com a informação documentada do peso ao nascer tanto do bebê quanto da mãe. As informações referentes aos antecedentes maternos, pré-natal e parto, e as medidas antropométricas de nascimento da criança e da mãe foram obtidas através do registro em prontuários, sendo 83,8% das mães nascidas no HU-USP. Foram constituídos grupos de estudo de peso ao nascer da criança [< 2.500 gramas (g) e >= 3.500 gramas (g)], e também foi realizado o estudo do comprimento ao nascer da criança <= 47,5cm (quartil inferior). Foram utilizados Chi-quadrado ou teste exato de Fisher, Spearman\'s Rho, e Odds-Ratio para investigar as relações entre o peso e comprimento ao nascer das crianças com variáveis maternas e das próprias crianças. RESULTADOS: As meninas (nascidas entre 1999-2014) foram mais pesadas ao nascer do que as suas mães (nascidas entre 1972-1998), com uma média no aumento do peso ao nascer de 79g entre as duas gerações. O peso ao nascer da criança < 2.500g não apresentou correlação alguma com o peso ao nascer materno < 2.500g (Fisher 0,264*; Spearman´s Rho 0,048; OR 2,1 e OR lower 0,7), e com a estatura materna na gestação no quartil inferior (< 157cm) (Chi2 sig 0,323; com Spearman´s Rho 0,036; OR 1,5 e OR lower 0,7). O baixo peso ao nascer da criança (< 2.500g) foi levemente correlacionado com o uso de drogas pela mãe durante a gestação (Fisher 0,083*; Spearman´s Rho 0,080;OR 4,9 e OR lower 1,0). O peso ao nascer da criança < 2.500g mostrou correlação acentuada com a idade gestacional menor que 38 semanas e 3 dias (Chi2 sig 0,002; Spearman´s Rho 0,113; OR 3,2 e OR lower 1,5). O peso ao nascer da criança >= 3.500g apresentou forte correlação com o peso ao nascer materno >= 3.500g (Chi2 sig 0; Spearman´s Rho +0,142; OR 0,5** e OR upper 0,7); sendo que quanto maior o IMC pré-gestacional da mãe maior a correlação com o peso de nascimento da criança >= 3.500g [(IMC materno pré gestacional >= 25,0 kg/m2 com Chi2 sig 0,013; Spearman´s Rho 0,09; OR 1,54 e OR upper 2,17) e (IMC materno pré gestacional >= 30,0 kg/m2 com Chi2 sig 0; Spearman´s Rho 0,137; OR 2,58 e OR upper 4,26)]. O peso ao nascer da criança >= 3.500g também foi correlacionado com o parto cesareano (Chi2 sig 0; Spearman´s Rho +0,132; OR 0,5** e OR upper 0,8). O comprimento ao nascer da criança no quartil inferior (<= 47,5cm) mostrou-se significante em mães que nasceram com peso < 3.500g (Chi2 sig 0; Spearman´s Rho -0,154; OR 3,2** e OR lower 1,8). O comprimento ao nascer da criança <= 47,5cm apresentou forte correlação com o uso de drogas pela mãe durante a gestação (Chi2 sig 0,004; Spearman´s Rho 0,105; OR 4,3 e OR lower 1,5). O comprimento ao nascer da criança <= 47,5cm apresentou tênue correlação com a estatura materna no quartil inferior (< 157cm) e com o tabagismo na gestação, evidenciados pelo Chi2 sig 0,012; Spearman´s Rho 0,091; OR 1,6 e OR lower 1,1 e Chi2 sig 0,012; Spearman´s Rho 0,091; OR 1,7 e OR lower 1,1, respectivamente. CONCLUSÕES: O peso de nascimento da mãe >= 3.500g e o sobrepeso ou obesidade pré-gestacional materna foram correlacionados com o peso ao nascer da criança >= 3.500g e maior comprimento ao nascer do recém-nascido, acoplado à tendência do aumento do peso ao nascer entre gerações de mães e filhas. Também, os descendentes com menores comprimentos ao nascimento são os filhos das mulheres com as mais baixas estaturas. A co-existência do ciclo intergeracional da obesidade e da \"falência do crescimento\" se mostrou presente na população estudada / BACKGROUND AND OBJECTIVES: Many studies have shown that both parents\' birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. This suggests that adverse expositions to the mother, from her own intrauterine life until the pre-conception and pregnancy periods, in addition to the inherited genes, influences the size of the offspring at birth. The current preoccupation relates to the intergenerational cycle of low birth weight or increased birth weight between the generations, with all the immediate and long term aggravations that are implied in small birth size for the gestational age and/or low birth weight or large birth size for the gestational age and/or macrosomic. The present research aims to study the correlation between the child\'s birth weight with the mother\'s birth weight, and maternal conditions, in term infants born in the \"Hospital Universitário\" from the University of São Paulo. METHODS: 773 mother-infant binomials were identified (773 children born from 558 mothers) with information on both the baby\'s and the mother\'s birth weight recorded. The information referring to maternal antecedents, pre-natal, parturition and birth anthropometric measures of the infant and the mother were obtained through the registrations of their medical recordes. 83.8% of the mothers were born in the \"Hospital Universitário\". Group studies were constituted, dividing the sample according to birth weight [< 2.500 grams (g) and >= 3.500 grams (g)]. The length at birth was also studied in children <= 47,5cm (lower quartile). Chi-squared test or Fisher\'s exact test, Spearman\'s Rho and Odds-Ratio were performed in order to investigate the relation between the children\'s weight and length at birth and the mothers\' and children\'s variables. RESULTS: The girls (born between 1999 and 2014) were heavier at birth than their mothers (born between 1972 and 1998), with an average increase at birth weight between the generations of 79 grams. The child\'s birth weight < 2.500 grams did not show any correlation with maternal birth weight < 2.500 grams (Fisher 0.264*; Spearman\'s Rho 0.048; OR 2.1 and OR lower 0.7) nor with maternal stature below the lower quartile (< 157cm) (Chi2 sig 0.323; with Spearman\'s Rho 0.036; OR 1.5 and OR lower 0.7). The child\'s low birth weight (< 2.500g) was lightly correlated with drug use by the mother during pregnancy (Fisher 0.083*; Spearman\'s Rho 0.080; OR 4.9 and OR lower 1.0). The child\'s birth weight < 2.500g showed increased correlation with gestational age lower than 38 weeks and 3 days (Chi2 sig 0.002; Spearman\'s Rho 0.113; OR 3.2 and OR lower 1.5). The child\'s weight at birth >= 3.500g showed strong correlation with maternal weight at birth >= 3.500g (Chi2 sig 0; Spearman\'s Rho +0.142; OR 0.5** and OR upper 0.7). It was also revealed that the higher the maternal pre-pregnancy BMI, the stronger the correlation with child\'s birth weight >= 3.500g was [(maternal pre-pregnancy BMI >= 25,0 kg/m2 with Chi2 sig 0.013; Spearman\'s Rho 0.09; OR 1.54 and OR upper 2.17) and (maternal pre-pregnancy BMI >= 30,0 kg/m2 with Chi2 sig 0; Spearman\'s Rho 0.137; OR 2.58 and OR upper 4.26)]. The child\'s weight at birth >= 3.500g was also correlated with Caesarean section (Chi2 sig 0; Spearman\'s Rho +0.132; OR 0.5** and OR upper 0.8). Child\'s length at birth in the lower quartile (<= 47,5cm) was significant in mothers who were born with weight < 3.500g (Chi2 sig 0; Spearman\'s Rho -0.154; OR 3.2** and OR lower 1.8). The child\'s length at birth <= 47,5cm showed strong correlation with drug use by the mother during pregnancy (Chi2 sig 0.004; Spearman\'s Rho 0.105; OR 4.3 and OR lower 1.5). The child\'s length at birth <= 47,5cm showed tenuous correlation with maternal stature in the lower quartile (< 157cm) and with gestational smoking, demonstrated by Chi2 sig 0.012; Spearman\'s Rho 0.091; OR 1.6 and OR lower 1.1 and Chi2 sig 0.012; Spearman\'s Rho 0.091; OR 1.7 and OR lower 1.1, respectively. CONCLUSIONS: The mother\'s weight at birth >= 3.500g and the prenatal overweight or obesity were correlated with the child\'s weight at birth >= 3.500g and increased length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures. The coexistence of the intergenerational vicious cycle of obesity and of \"growth failure\" was found on the studied population

JUSTIFICATIVA E OBJETIVOS: Vários estudos têm mostrado o peso ao nascer de ambos os pais como preditor do peso de nascimento do descendente, com correlação mais fortemente transmitida através da linhagem materna, sugerindo que exposições desfavoráveis à mãe desde a sua própria vida intrauterina até os períodos de pré-concepção e gestacional, além dos genes herdados, influenciam o tamanho ao nascimento da prole. A preocupação atual se relaciona ao ciclo intergeracional do baixo peso ao nascer ou do peso ao nascer elevado entre gerações, com todos os agravos imediatos e a longo prazo que estão implicados em nascer pequeno para a idade gestacional e/ou baixo peso ou grande para a idade gestacional e/ou macrossômico. O presente trabalho tem o objetivo de estudar a correlação entre o peso ao nascer da criança com o peso ao nascer da mãe, com as condições maternas, em crianças nascidas a termo no Hospital Universitário da USP (HU-USP). MÉTODOS: Foram identificados 773 binômios mães-crianças, 773 crianças nascidas de 558 mães, com a informação documentada do peso ao nascer tanto do bebê quanto da mãe. As informações referentes aos antecedentes maternos, pré-natal e parto, e as medidas antropométricas de nascimento da criança e da mãe foram obtidas através do registro em prontuários, sendo 83,8% das mães nascidas no HU-USP. Foram constituídos grupos de estudo de peso ao nascer da criança [< 2.500 gramas (g) e >= 3.500 gramas (g)], e também foi realizado o estudo do comprimento ao nascer da criança <= 47,5cm (quartil inferior). Foram utilizados Chi-quadrado ou teste exato de Fisher, Spearman\'s Rho, e Odds-Ratio para investigar as relações entre o peso e comprimento ao nascer das crianças com variáveis maternas e das próprias crianças. RESULTADOS: As meninas (nascidas entre 1999-2014) foram mais pesadas ao nascer do que as suas mães (nascidas entre 1972-1998), com uma média no aumento do peso ao nascer de 79g entre as duas gerações. O peso ao nascer da criança < 2.500g não apresentou correlação alguma com o peso ao nascer materno < 2.500g (Fisher 0,264*; Spearman´s Rho 0,048; OR 2,1 e OR lower 0,7), e com a estatura materna na gestação no quartil inferior (< 157cm) (Chi2 sig 0,323; com Spearman´s Rho 0,036; OR 1,5 e OR lower 0,7). O baixo peso ao nascer da criança (< 2.500g) foi levemente correlacionado com o uso de drogas pela mãe durante a gestação (Fisher 0,083*; Spearman´s Rho 0,080;OR 4,9 e OR lower 1,0). O peso ao nascer da criança < 2.500g mostrou correlação acentuada com a idade gestacional menor que 38 semanas e 3 dias (Chi2 sig 0,002; Spearman´s Rho 0,113; OR 3,2 e OR lower 1,5). O peso ao nascer da criança >= 3.500g apresentou forte correlação com o peso ao nascer materno >= 3.500g (Chi2 sig 0; Spearman´s Rho +0,142; OR 0,5** e OR upper 0,7); sendo que quanto maior o IMC pré-gestacional da mãe maior a correlação com o peso de nascimento da criança >= 3.500g [(IMC materno pré gestacional >= 25,0 kg/m2 com Chi2 sig 0,013; Spearman´s Rho 0,09; OR 1,54 e OR upper 2,17) e (IMC materno pré gestacional >= 30,0 kg/m2 com Chi2 sig 0; Spearman´s Rho 0,137; OR 2,58 e OR upper 4,26)]. O peso ao nascer da criança >= 3.500g também foi correlacionado com o parto cesareano (Chi2 sig 0; Spearman´s Rho +0,132; OR 0,5** e OR upper 0,8). O comprimento ao nascer da criança no quartil inferior (<= 47,5cm) mostrou-se significante em mães que nasceram com peso < 3.500g (Chi2 sig 0; Spearman´s Rho -0,154; OR 3,2** e OR lower 1,8). O comprimento ao nascer da criança <= 47,5cm apresentou forte correlação com o uso de drogas pela mãe durante a gestação (Chi2 sig 0,004; Spearman´s Rho 0,105; OR 4,3 e OR lower 1,5). O comprimento ao nascer da criança <= 47,5cm apresentou tênue correlação com a estatura materna no quartil inferior (< 157cm) e com o tabagismo na gestação, evidenciados pelo Chi2 sig 0,012; Spearman´s Rho 0,091; OR 1,6 e OR lower 1,1 e Chi2 sig 0,012; Spearman´s Rho 0,091; OR 1,7 e OR lower 1,1, respectivamente. CONCLUSÕES: O peso de nascimento da mãe >= 3.500g e o sobrepeso ou obesidade pré-gestacional materna foram correlacionados com o peso ao nascer da criança >= 3.500g e maior comprimento ao nascer do recém-nascido, acoplado à tendência do aumento do peso ao nascer entre gerações de mães e filhas. Também, os descendentes com menores comprimentos ao nascimento são os filhos das mulheres com as mais baixas estaturas. A co-existência do ciclo intergeracional da obesidade e da \"falência do crescimento\" se mostrou presente na população estudada / BACKGROUND AND OBJECTIVES: Many studies have shown that both parents\' birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. This suggests that adverse expositions to the mother, from her own intrauterine life until the pre-conception and pregnancy periods, in addition to the inherited genes, influences the size of the offspring at birth. The current preoccupation relates to the intergenerational cycle of low birth weight or increased birth weight between the generations, with all the immediate and long term aggravations that are implied in small birth size for the gestational age and/or low birth weight or large birth size for the gestational age and/or macrosomic. The present research aims to study the correlation between the child\'s birth weight with the mother\'s birth weight, and maternal conditions, in term infants born in the \"Hospital Universitário\" from the University of São Paulo. METHODS: 773 mother-infant binomials were identified (773 children born from 558 mothers) with information on both the baby\'s and the mother\'s birth weight recorded. The information referring to maternal antecedents, pre-natal, parturition and birth anthropometric measures of the infant and the mother were obtained through the registrations of their medical recordes. 83.8% of the mothers were born in the \"Hospital Universitário\". Group studies were constituted, dividing the sample according to birth weight [< 2.500 grams (g) and >= 3.500 grams (g)]. The length at birth was also studied in children <= 47,5cm (lower quartile). Chi-squared test or Fisher\'s exact test, Spearman\'s Rho and Odds-Ratio were performed in order to investigate the relation between the children\'s weight and length at birth and the mothers\' and children\'s variables. RESULTS: The girls (born between 1999 and 2014) were heavier at birth than their mothers (born between 1972 and 1998), with an average increase at birth weight between the generations of 79 grams. The child\'s birth weight < 2.500 grams did not show any correlation with maternal birth weight < 2.500 grams (Fisher 0.264*; Spearman\'s Rho 0.048; OR 2.1 and OR lower 0.7) nor with maternal stature below the lower quartile (< 157cm) (Chi2 sig 0.323; with Spearman\'s Rho 0.036; OR 1.5 and OR lower 0.7). The child\'s low birth weight (< 2.500g) was lightly correlated with drug use by the mother during pregnancy (Fisher 0.083*; Spearman\'s Rho 0.080; OR 4.9 and OR lower 1.0). The child\'s birth weight < 2.500g showed increased correlation with gestational age lower than 38 weeks and 3 days (Chi2 sig 0.002; Spearman\'s Rho 0.113; OR 3.2 and OR lower 1.5). The child\'s weight at birth >= 3.500g showed strong correlation with maternal weight at birth >= 3.500g (Chi2 sig 0; Spearman\'s Rho +0.142; OR 0.5** and OR upper 0.7). It was also revealed that the higher the maternal pre-pregnancy BMI, the stronger the correlation with child\'s birth weight >= 3.500g was [(maternal pre-pregnancy BMI >= 25,0 kg/m2 with Chi2 sig 0.013; Spearman\'s Rho 0.09; OR 1.54 and OR upper 2.17) and (maternal pre-pregnancy BMI >= 30,0 kg/m2 with Chi2 sig 0; Spearman\'s Rho 0.137; OR 2.58 and OR upper 4.26)]. The child\'s weight at birth >= 3.500g was also correlated with Caesarean section (Chi2 sig 0; Spearman\'s Rho +0.132; OR 0.5** and OR upper 0.8). Child\'s length at birth in the lower quartile (<= 47,5cm) was significant in mothers who were born with weight < 3.500g (Chi2 sig 0; Spearman\'s Rho -0.154; OR 3.2** and OR lower 1.8). The child\'s length at birth <= 47,5cm showed strong correlation with drug use by the mother during pregnancy (Chi2 sig 0.004; Spearman\'s Rho 0.105; OR 4.3 and OR lower 1.5). The child\'s length at birth <= 47,5cm showed tenuous correlation with maternal stature in the lower quartile (< 157cm) and with gestational smoking, demonstrated by Chi2 sig 0.012; Spearman\'s Rho 0.091; OR 1.6 and OR lower 1.1 and Chi2 sig 0.012; Spearman\'s Rho 0.091; OR 1.7 and OR lower 1.1, respectively. CONCLUSIONS: The mother\'s weight at birth >= 3.500g and the prenatal overweight or obesity were correlated with the child\'s weight at birth >= 3.500g and increased length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures. The coexistence of the intergenerational vicious cycle of obesity and of \"growth failure\" was found on the studied population

Cette recherche vise à décrire l’association entre certaines variables démographiques telles que l’âge de la mère, le sexe, le rang de naissance et le statut socio-économique – représenté par l’indice de Pampalon – et l’hypotrophie fœtale au Québec. L’échantillon est constitué de 127 216 naissances simples et non prématurées ayant eu lieu au Québec entre le 1er juillet 2000 et le 30 juin 2002. Des régressions logistiques portant sur le risque d’avoir souffert d’un retard de croissance intra-utérine ont été effectuées pour l’ensemble du Québec ainsi que pour la région socio-sanitaire (RSS) de Montréal. Les résultats révèlent que les enfants de premier rang et les enfants dont la mère était âgée de moins de 25 ans ou de 35 ans et plus lors de l’accouchement ont un risque plus élevé de souffrir d’hypotrophie fœtale et ce dans l’ensemble du Québec et dans la RSS de Montréal. De plus, les résultats démontrent que le risque augmente plus la mère est défavorisée. Puisque l’indice de Pampalon est un proxy écologique calculé pour chaque aire de diffusion, les intervenants en santé publique peuvent désormais cibler géographiquement les femmes les plus à risque et adapter leurs programmes de prévention en conséquence. Ainsi, le nombre de cas d’hypotrophie fœtale, voire même la mortalité infantile, pourraient être réduits. / This study describes the association between demographic variables such as the mother’s age, the child’s gender and birth order, and the socio-economic status – that can now be assessed by the Pampalon Index – with intrauterine growth restriction (IUGR) in the province of Quebec. The analyses are based on a sample of 127,216 singletons and term births that occurred in the province of Quebec between July 1st, 2000 and June 30th, 2002. Logistics regressions on the risk of having suffered from IUGR were produced for the entire province of Quebec and for the health region of Montreal. In the province of Quebec and in the health region of Montreal, the results reveal that the risk of IUGR is higher for first-born infants, and for infants whose mother was under 25 years of age or aged 35 years and older. Moreover, the risk of IUGR increases with poverty. Since the Pampalon Index is calculated for each dissemination area, public health interventions can now target the most vulnerable women and reduce the number of IUGR cases or even infant mortality.

L’asthme est connu comme l’une des maladies chroniques les plus fréquentes chez la femme enceinte avec une prévalence de 4 à 8%. La prévalence élevée de l’asthme fait en sorte qu’on se préoccupe de l’impact de la grossesse sur l’asthme et de l’impact de l’asthme sur les issus de la grossesse. La littérature présente des résultats conflictuels concernant l’impact de l’asthme maternel sur les issus périnatales comme les naissances prématurées, les bébés de petit poids et les bébés de petit poids pour l’âge gestationnel (PPGA). De plus, les données scientifiques sont rares concernant l’impact de la sévérité et de la maîtrise de l’asthme durant la grossesse sur les issus périnatales. Donc, nous avons mené cinq études pour réaliser les objectifs suivants: 1. Le développement et la validation de deux indexes pour mesurer la sévérité et la maîtrise de l’asthme. 2. L’évaluation de l’impact du sexe du fœtus sur le risque d’exacerbation de l’asthme maternel et l’utilisation de médicaments antiasthmatiques durant la grossesse; 3. L’évaluation de l’impact de l’asthme maternel sur les issus périnatales; 4. L’évaluation de l’impact de la sévérité de l’asthme maternel durant la grossesse sur les issus périnatales; 5. L’évaluation de l’impact de la maîtrise de l’asthme maternel durant la grossesse sur les issus périnatales. Pour réaliser ces projets de recherche, nous avons travaillé avec une large cohorte de grossesse reconstruite à partir du croisement de trois banques de données administratives du Québec recouvrant la période entre 1990 et 2002. Pour les trois dernières études, nous avons utilisé un devis de cohorte à deux phases d’échantillonnage pour obtenir, à l’aide d’un questionnaire postal, des informations complémentaires qui ne se trouvaient pas dans les banques de données, comme la consommation de cigarettes et d’alcool pendant la grossesse. Nous n’avons trouvé aucune différence significative entre les mères de fétus féminins et de fétus masculins pour les exacerbations de l’asthme pendant la grossesse (aRR=1.02; IC 95%: 0.92 to 1.14). Par contre, nous avons trouvé que le risque de bébé PPGA (OR: 1.27, IC 95%: 1.14-1.41), de bébé de petit poids (OR: 1.41, IC 95%:1.22-1.63) et de naissance prématurée (OR: 1.64, IC 95%:1.46-1.83) était significativement plus élevés chez les femmes asthmatiques que chez les femmes non asthmatiques. De plus, nous avons démontré que le risque d’un bébé PPAG était significativement plus élevé chez les femmes avec un asthme sévère (OR:1.48, IC 95%: 1.15-1.91) et modéré (OR: 1.30, IC 95%:1.10-1.55) que chez les femmes qui avaient un asthme léger. Nous avons aussi observé que les femmes qui avaient un asthme bien maîtrisé durant la grossesse étaient significativement plus à risque d’avoir un bébé PPAG (OR:1.28, IC 95%: 1.15-1.43), un bébé de petit poids (OR: 1.42, IC 95%:1.22-1.66), et un bébé prématuré (OR: 1.63, IC 95%:1.46-1.83) que les femmes non asthmatiques. D’après nos résultats, toutes les femmes asthmatiques même celles qui ont un asthme bien maîtrisé doivent être suivies de près durant la grossesse car elles courent un risque plus élevé d’avoir des issus de grossesses défavorables pour leur nouveau-né. / Asthma is known as one of the most frequent chronic diseases encountered during pregnancy with prevalence estimated between 4 and 8%. The high prevalence of asthma during pregnancy results in some concerns about the impact of pregnancy on maternal asthma and also the impact of maternal asthma on perinatal outcomes. The literature presents conflicting results concerning the impact of maternal asthma during pregnancy on perinatal outcomes, such as preterm birth, low-birth-weight (LBW) infant and small-for-gestational-age (SGA) infant. Also, scientific evidence is scarce regarding the impact of asthma severity and control during pregnancy on these perinatal outcomes. We thus conducted a research project composed of five studies to achieve the following objectives: 1. to develop and validate two database indexes, one to measure the control of asthma and the other to measure asthma severity; 2. to evaluate the effect of fetal gender on maternal asthma exacerbations and the use of asthma medications during pregnancy; 3. to evaluate the impact of maternal asthma on adverse perinatal outcomes; 4. to evaluate the impact of the severity of asthma during pregnancy on adverse perinatal outcomes; 5. to evaluate the impact of adequately controlled maternal asthma during pregnancy on adverse perinatal outcomes. A large population-based cohort was reconstructed through the linking of three of Quebec’s (Canada) administrative databases covering the period between 1990 and 2002. A two-stage sampling cohort design was used to collect additional information on the women’s life-style habits by way of a mailed questionnaire for the three last studies. We have observed no significant differences between mothers of a female and male fetus as to the occurrence of asthma exacerbations (aRR=1.02; 95% CI: 0.92 to 1.14). We have found that the risk of SGA (OR: 1.27, 95% CI: 1.14-1.41), LBW (OR: 1.41, 95% CI:1.22-1.63) and preterm delivery (OR: 1.64, 95%CI:1.46-1.83) was significantly higher among asthmatic than non-asthmatic women. Moreover, our results showed that the risk of SGA was significantly higher among severe (OR:1.48, 95%CI: 1.15-1.91) and moderate asthmatic women (OR: 1.30, 95%CI:1.10-1.55) than mild asthmatic women. Also, mothers with adequately controlled asthma during pregnancy were found to be at higher risk of adverse perinatal outcomes than non-asthmatic women (SGA (OR:1.28, 95%CI: 1.15-1.43), LBW (OR: 1.42, 95%CI:1.22-1.66), and preterm deliveries (OR: 1.63, 95%CI:1.46-1.83)). According to our results, all asthmatic women even those with adequately controlled asthma should be closely monitored during pregnancy because they are at increased risk of adverse perinatal outcomes.

La santé des enfants demeure une question prioritaire en Afrique sub-saharienne. Les disparités en matière de mortalité entre pays et au sein des pays persistent et se sont fortement accrues durant la dernière décennie. En dépit de solides arguments théoriques voulant que les variables contextuelles soient des déterminants importants de la santé des enfants, ces facteurs, et particulièrement les influences du contexte local, ont été étudiées beaucoup moins souvent que les caractéristiques individuelles. L'objectif principal de la présente thèse est d’identifier les déterminants individuels et contextuels associés à la mortalité des enfants de moins de 5 ans en Afrique sub-saharienne. L’analyse systématique est basée sur les données les plus récentes des enquêtes démographiques et de santé (DHS/EDS). Deux questions spécifiques sont examinées dans cette thèse. La première évalue la mesure dans la quelle le contexte local affecte la mortalité infanto-juvénile, net des caractéristiques individuelles. La seconde question est consacrée à l’examen de l’effet du faible poids à la naissance sur le risque de décès avant 5 ans. Par rapport à la première question, les analyses multi-niveaux confirment pour plusieurs pays étudiés l’importance simultanée de l’environnement familial et du contexte local de résidence dans l’explication des différences de mortalité infanto-juvénile. Toutefois, par comparaison au contexte familial, l’ampleur de l’effet de l’environnement local paraît assez modeste. Il apparaît donc que le contexte familial reste un puissant déterminant de la mortalité des enfants de moins de 5 ans en Afrique sub-saharienne. Les résultats indiquent en outre que certains attributs du contexte local de résidence influencent le risque de décès des enfants avant 5 ans, au-delà des facteurs individuels dans plusieurs pays. Cette thèse confirme l’effet contextuel de l’éducation sur la mortalité des enfants. Cet effet s’ajoute, dans certains pays, à l'effet positif du niveau individuel d’éducation de la mère sur la survie de l'enfant. Les résultats montrent aussi que le degré d’homogénéité ethnique de la localité influence fortement la probabilité de mourir avant 5 ans dans certains pays. Globalement, les résultats de cette thèse suggèrent que le défi de réduire la mortalité des enfants va au-delà des stratégies visant uniquement les facteurs individuels, et nécessite une meilleure compréhension de l’influence des facteurs contextuels. Par rapport à la deuxième question, les résultats montrent également que les facteurs individuels restent aussi très importants dans l’explication des différences de mortalité des enfants dans plusieurs pays étudiés. Nos résultats indiquent que les différences de mortalité selon le poids à la naissance sont significatives dans tous les pays inclus dans l’analyse. Les enfants nés avec un faible poids (moins de 2500 grammes) courent presque 2 à 4 fois plus de risques de mourir au cours des cinq premières années de vie que les enfants de poids normal, même après correction pour l’hétérogénéité non observée. Ce résultat suggère qu’en plus des mesures visant à réduire la pauvreté et les inégalités de revenus, la réduction de l’incidence du faible poids à la naissance pourrait apporter une contribution majeure aux Objectifs du Millénaire pour le développement; spécialement comme une stratégie efficace pour réduire le niveau de mortalité parmi les enfants de moins de cinq ans. / Child health remains a priority area for health policy in sub-Saharan Africa. Disparities in child mortality between and within countries have persisted and widened considerably during the last few decades. While researchers have devoted considerable attention to the impact of individual-level factors on child mortality, less is known about how community characteristics and institutions affect health outcomes for children, even though they have a prominent role in theoretical models. The aim of this thesis is to identify individual and contextual effects of child mortality by using data from the latest round of Demographic Health Surveys for all countries in sub-Saharan Africa. Two sets of questions are addressed in this research. First, we evaluate the impact of contextual factors on the risk of dying before age 5 net of the effect of individual factors. The results indicate that some attributes of the community influence the mortality risks of children, over and above the intermediate factors included in this investigation. For instance, in half of the countries under study a 1% increase in the proportion of children fully immunized in the community is associated with a decrease of 17-79% in the odds of dying before age 5. The proportion of women in the community completing secondary school also significantly increases child survival. This effect is, in some countries, in addition to the positive individual-level effect of the child’s own mother being educated. Net of individual and household characteristics, higher community-level ethnic homogeneity is associated with decreased odds of dying before age 5 in some countries. Overall, the results of this study therefore suggest that the challenge to reduce under-five mortality goes beyond addressing individual factors, and requires a better understanding of contextual factors. Second, the study exploits recent national survey data for nine countries in sub-Saharan Africa to investigate the association of LBW and mortality not only in infancy but also during childhood, using a standardized methodology to adjust missing birth weight data from household surveys while accounting for unobserved family-level factors (genetic or behavioral) that may modify the relationship between birth weight and under-five-years mortality. We find evidence of the impact of birth weight on the risk of dying not only in infancy but also during childhood, which remains strong and significant in all countries even after controlling for potential confounding factors. The main policy implication of our findings is that reducing the incidence of LBW may be an important prevention strategy to combating child mortality in sub-Saharan Africa countries.

Made available in DSpace on 2014-06-11T19:27:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-07-06Bitstream added on 2014-06-13T18:56:27Z : No. of bitstreams: 1 carmo_mp_me_araca.pdf: 1035553 bytes, checksum: 409c6ef8b77a04f318a52d399f74a835 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A manifestação da Doença Periodontal durante a gestação, em conjunto com variáveis sócio-econômico-demográficas e de assistência à saúde, tem sido citadas como importantes fatores de risco para o parto prematuro (PP) e recém-nascido de baixo peso (BP). Através de ações que intensificam a atenção básica em saúde, o Programa Saúde da Família (PSF) tem adotado como princípio norteador a intervenção nos fatores que colocam em risco a saúde da população. Os objetivos deste estudo foram avaliar a condição periodontal de gestantes, analisar a influência de variáveis sócio-econômicas e a existência do PSF na prevalência da doença periodontal e verificar a associação desta condição e do PSF com a prevalência de PP e BP. Trata-se de estudo de coorte, abrangendo gestantes e crianças, desenvolvido em dois municípios do Estado de São Paulo, sendo um deles com PSF implantado. Foram realizados exames bucais, utilizando-se o Índice Periodontal Comunitário (IPC) e o de Perda de Inserção Periodontal (PIP) e entrevistas semi-estruturadas com as gestantes (n=119) cadastradas nos serviços públicos de saúde de ambos os municípios e o acompanhamento das mesmas até o nascimento da criança. Os resultados foram verificados por meio de análises estatísticas bivariadas (α=0,05). A idade média foi 24,7 anos; 61,4% pertenciam à raça negra/parda e 38,7% branca. A maioria (65,5%) recebia entre 2-3 salários mínimos. Somente 35,3% completaram o ensino médio. Apenas 8% das pacientes examinadas mostraram periodonto saudável (IPC=0). Sangramento e cálculo (IPC=1-2) foram observados em 66% do total, bolsas periodontais rasas em 16% e profundas em 4%, enquanto a perda de inserção periodontal superior a 4mm foi verificada em 24%. A gengivite foi a alteração periodontal mais recorrente neste grupo, visto que na gestação a mulher está mais susceptível... / The disease‟s appearing during pregnancy, along with other socio-economic-demographical varieties and health care, has been pointed out as the main risk factor to premature birth (PB) and underweight newborns (UN). Through actions that reinforce basic health care and assistance, the Health Family Program (HFP) has made an intervention in those factors which may threat health as a whole. The aims of this work were to assess the pregnant women‟s periodontal conditions, analyze socio-economical varieties influences and the existence of HFP in the periodontal disease prevalence, besides checking the possible relation to this condition and PB and UN prevalence. The present is a study comprehending pregnant women and children, held in two cities of São Paulo State. In one city, the HFP is on duty. Odontological exams were done having the Community Periodontal Index (CPI) and the Periodontal Insertion Loss (PIL) as references, in addition to interviews with the mothers. There was continuous patients‟ aid on pregnant women registered in health programs in both cities until child‟s birth. Results were evaluated through bivaried statistical analyzes (α=0.05). The average age was 24,7 years old; 61,4% belonging to black/yellow race and 38,7% to the white one. Most of them (65,5%) made between 2-3 minimum wages a month. Only 35,5% had their high-school degree. Only 8% of the examined patients presented healthy paradenitum (CPI=0). Bleeding and calculus (CPI=1-2) were observed in 66% of the total, shallow periodontal pockets in 16% and deep ones in 4%, while the four-mm superior periodontal insertion loss was observed in 24%. Gingivitis was the most recurrent periodontal alteration in this group, once during the pregnancy period women are more susceptible to periodontal inflammations. Premature children were observed in 15,8% and underweight ones in 10,5% of the population... (Complete abstract click electronic access below)

Sabe-se que algumas alterações nutricionais maternas durante o período perinatal estão associadas com doenças metabólicas na vida adulta das proles, tais como diabetes melito tipo 2, resistência à insulina, obesidade e hipertensão arterial. O período da gestação em que estas alterações nutricionais influenciam a prole na idade adulta ainda não está elucidado. Modificações epigenéticas têm sido propostas como mecanismos responsáveis por estas desordens metabólicas. Ratas Wistar de doze semanas de idade foram alimentadas com dieta com conteúdo baixo (HO - 0,15% NaCl) ou normal (NR - 1,3% NaCl) de sódio desde o primeiro dia de gestação até o nascimento da prole ou HO durante a primeira (HO10) ou segunda (HO20) metade da gestação. O peso corpóreo e a ingestão de água e ração foram avaliados semanalmente durante a gestação. Teste de tolerância à insulina (ITT) e à glicose (GTT) e HOMA-IR foram realizados nas proles adultas. Expressão gênica por qRT-PCR e metilação do DNA na região promotora dos genes foram mapeadas utilizando tratamento com bissulfito de sódio e avaliadas por pirosequenciamento. O ganho de peso materno foi menor no HO e HO20 na terceira semana de gestação em comparação com NR e HO10. O peso ao nascimento da prole foi menor em machos e fêmeas dos grupos HO e HO20 em relação ao NR e HO10. O HOMA-IR foi maior nos machos com 12 semanas de idade do grupo HO em comparação com NR e com 20 semanas de idade do grupo HO10 em comparação com NR e HO20. Nas fêmeas com 12 semanas de idade o HOMA-IR foi maior no HO10 comparado com HO. Os níveis de insulina no soro foram maiores tanto nos machos com 20 semanas de idade do grupo HO10 comparado com NR quanto nas fêmeas com 12 semanas de idade do grupo HO10 comparado com HO. A área sob a curva do GTT indicou intolerância à glicose nos machos do grupo HO. A porcentagem de metilação das ilhas CpG no promotor dos genes de Igf1, Igf1r, Ins1, Ins2 e Insr no fígado de machos e fêmeas neonatais e no fígado, tecido adiposo branco e músculo em machos com 20 semanas de idade foi influenciada pela baixa ingestão de sal durante a gestação. Nenhuma destas alterações foi identificada nas fêmeas com 20 semanas de idade. Em conclusão, a baixa ingestão de sal na segunda metade da gestação é responsável pelo baixo peso ao nascimento em ambos os sexos. A intolerância à glicose observada na prole adulta ocorreu somente se a dieta hipossódica é dada durante a gestação inteira. Por outro lado, a resistência à insulina em resposta ao consumo de dieta hipossódica durante a gestação está relacionada com o momento em que ocorre este insulto e com o envelhecimento da prole. Também foi observado que alterações na metilação do promotor do gene Igf1 está correlacionado com o baixo peso ao nascimento em resposta a ingestão de dieta hipossódica durante a gestação / It is known that some maternal nutritional alterations during pregnancy are associated with metabolic disorders in adult offspring, such as insulin resistance, type 2 diabetes mellitus, obesity and arterial hypertension. The period of pregnancy in which these nutritional alterations influence adult offspring remains uncertain. Epigenetic changes are proposed to underlie these metabolic disorders. Twelve-week-old female Wistar rats were fed a low-salt (LS - 0.15% NaCl) or normal-salt (NS - 1.3% NaCl) diet since the first day of gestation until delivery or LS during the first (LS10) or second (LS20) half of gestation. Body weight, food and water intake were weekly evaluated during gestation. Blood glucose, insulin (ITT) and glucose (GTT) tolerance tests, HOMA-IR were performed in adult offspring. Gene expression and DNA methylation were mapped using bisulfite treatment evaluated by pyrosequencing in the male and female neonates and adult offspring. Weight gain was lower in LS and LS20 dams than in NS and LS10 dams in the third week of pregnancy. Birth weights were lower in male and female LS20 and LS rats compared with NS and LS10 neonates. HOMA-IR was higher in 12-week-old LS males compared with NS and in 20-week-old male LS10 rats compared with NS and LS20 rats. In 12-week-old LS10 females, HOMA-IR was higher than in LS. Serum insulin levels were higher in 20 week-old LS10 male compared with NS rats and in 12-week-old LS10 female compared to LS rats. The area under the curve of GTT indicated glucose intolerance in 12- and 20-week-old LS male. Methylation of CpG islands of the Insr, Igf1, Igf1r, Ins1 and Ins2 genes in liver in neonates male and female offspring and liver, white adipose tissue and muscle in 20-week-old male offspring were influenced by low-salt intake during pregnancy. None of these alterations was identified in 20-week-old females. In conclusion, low-salt diet consumption in the second half of pregnancy can result in low birth weights in the males and females offspring. Glucose intolerance observed in adult offspring occurred only if low salt intake was given throughout pregnancy. However, insulin resistance in response to low salt intake during pregnancy is related to the time at which this insult occurs and to the age of the offspring. Alterations in the DNA methylation of Igf1 were observed to be correlated with low birth weight in response to low salt feeding during pregnancy