Marizélia Rodrigues Costa Ribeiro

Early Growth and Neurologic Outcomes of Infants with Probable Congenital Zika Virus Syndrome

We report the early growth and neurologic findings of 48 infants in Brazil diagnosed with probable congenital Zika virus syndrome and followed to age 1–8 months. Most of these infants had microcephaly (86.7%) and craniofacial disproportion (95.8%). The clinical pattern included poor head growth with increasingly negative z-scores, pyramidal/extrapyramidal symptoms, and epilepsy.

Effects of Socioeconomic Status and Social Support on Violence against Pregnant Women: A Structural Equation Modeling Analysis.

Few studies have used structural equation modeling to analyze the effects of variables on violence against women. The present study analyzed the effects of socioeconomic status and social support on violence against pregnant women who used prenatal services. This was a cross-sectional study based on data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA). The sample of the municipality of São Luís (Maranhão/Brazil) consisted of 1,446 pregnant women interviewed in 2010 and 2011. In the proposed model, socioeconomic status was the most distal predictor, followed by social support that determined general violence, psychological violence or physical/sexual violence, which were analyzed as latent variables. Violence was measured by the World Health Organization Violence against Women (WHO VAW) instrument. The São Luis model was estimated using structural equation modeling and validated with 1,378 pregnant women from Ribeirão Preto (São Paulo/Brazil). The proposed model showed good fit for general, psychological and physical/sexual violence for the São Luís sample. Socioeconomic status had no effect on general or psychological violence (p>0.05), but pregnant women with lower socioeconomic status reported more episodes of physical/sexual violence (standardized coefficient, SC = -0.136; p = 0.021). This effect of socioeconomic status was indirect and mediated by low social support (SC = -0.075; p<0.001). Low social support was associated with more episodes of general, psychological and physical/sexual violence (p<0.001). General and psychological violence indistinctly affected pregnant women of different socioeconomic status. Physical/sexual violence was more common for pregnant women with lower socioeconomic status and lower social support. Better social support contributed to reduction of all types of violence. Results were nearly the same for the validation sample of Ribeirão Preto except that SES was not associated with physical/sexual violence.

Confirmatory factor analysis of the WHO Violence Against Women Instrument in pregnant women: results from the BRISA Prenatal Cohort

Background Screening for violence during pregnancy is one of the strategies for the prevention of abuse against women. Since violence is difficult to measure, it is necessary to validate questionnaires that can provide a good measure of the phenomenon. The present study analyzed the psychometric properties of the World Health Organization Violence Against Women (WHO VAW) instrument for the measurement of violence against pregnant women. Methods Data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA) were used. The sample consisted of 1,446 pregnant women from São Luís and 1,378 from Ribeirão Preto, interviewed in 2010 and 2011. Thirteen variables were selected from a self-applied questionnaire. Confirmatory factor analysis was used to investigate whether violence is a uni-or-multidimensional construct consisting of psychological, physical and sexual dimensions. The mean-and-variance-adjusted weighted least squares estimator was used. Models were fitted separately for each city and a third model combining data from the two settings was also tested. Models suggested from modification indices were tested to determine whether changes in the WHO VAW model would produce a better fit. Results The unidimensional model did not show good fit (Root mean square error of approximation [RMSEA]  = 0.060, p<0.001 for the combined model). The multidimensional WHO VAW model showed good fit (RMSEA = 0.036, p = 0.999 for the combined model) and standardized factor loadings higher than 0.70, except for the sexual dimension for SL (0.65). The models suggested by the modification indices with cross loadings measuring simultaneously physical and psychological violence showed a significantly better fit compared to the original WHO model (p<0.001 for the difference between the model chi-squares). Conclusions Violence is a multidimensional second-order construct consisting of psychological, physical and sexual dimensions. The WHO VAW model and the modified models are suitable for measuring violence against pregnant women.

A gravidade da cárie está associada à desnutrição proteico-calórica em pré-escolares?

An analysis was conducted to evaluate if the severity of caries is associated with protein-calorie malnutrition in preschool children. The cross-sectional study was performed on a retrospective cohort of 625 children aged 24-71 months attending daycare centers in Sao Luis, Maranhao. A hierarchical model was evaluated at five levels: 1.) Socio-economic variables (economic group, mothers educational level and skin color); 2) Access variables; 3) Low birth weight (LBW) and exclusive breastfeeding; 4) Weight per height at 12 months; and 5) Severity of caries and albumin (Alb) levels. The outcome was protein-calorie malnourishment (weight per height z score < -2). The prevalence of outcome was 5.0% and the prevalence of caries was 32%. At the first level, the variables were not associated with the outcome, but the economic group was maintained until the final model. The variables in the second and third levels were not significant. At the fourth level, weight for height at 12 months was not significant, but was maintained until the final model. In the last level, severity of caries was positively associated with malnourishment. The association between severity of caries and malnourishment suggest that oral health should be integrated with public health care policies for children.

Prevalence and Risk Factors for Microcephaly at Birth in Brazil in 2010

Before the Zika virus epidemic, microcephaly was endemic in Brazil and was associated with IUGR and sociodemographic, reproductive, and lifestyle variables. OBJECTIVES: To estimate the baseline prevalence and risk factors for microcephaly at birth before the Zika virus epidemic in 2 Brazilian cities. METHODS: We used population-based data from the Brazilian Ribeirão Preto (RP) and São Luís (SL) birth cohort studies of 2010 that included hospital deliveries by resident mothers. The final sample was 7376 live births in RP and 4220 in SL. Gestational age was based on the date of the mother’s last normal menstrual period or obstetric ultrasonography, if available. Microcephaly at birth was classified according to the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century and the Brazilian Ministry of Health. Risk factors for microcephaly, proportionate and disproportionate microcephaly, and severe microcephaly were estimated in a hierarchized logistic regression model. RESULTS: According to the International Fetal and Newborn Growth Consortium for the 21st Century definition, the prevalence of microcephaly (>2 SDs below the mean for gestational age and sex) was higher in SL (3.5%) than in RP (2.5%). The prevalence of severe microcephaly (>3 SDs below the mean) was higher in SL (0.7%) than in RP (0.5%). Low maternal schooling, living in consensual union or without a companion, maternal smoking during pregnancy, primiparity, vaginal delivery, and intrauterine growth restriction were consistently associated with microcephaly. The number of cases of microcephaly is grossly underestimated, with an underreporting rate of ∼90%. CONCLUSIONS: The prevalence of severe microcephaly was much higher than expected in both cities. Our findings suggest that microcephaly was endemic in both municipalities before the circulation of the Zika virus.

Overweight, obese, underweight, and frequency of sugar consumption as risk indicators for early childhood caries in Brazilian preschool children.

BACKGROUND A possible association between being overweight or obese and early childhood caries (ECC) remains controversial. AIM To investigated this association in a developing country testing the confounding effects of socioeconomic factors and frequency of sugar consumption. METHODS Historical cohort study, 388 children (aged 24-71 months) living in São Luís, Brazil. A theoretical model adjusted according to income, birthweight, and nutritional status at twelve months and frequency of sugar consumption was generated with directed acyclic graphs to analyze this association. Caries were considered a discrete variable in the Poisson regression models; incidence density ratios (IRs) and 95% confidence intervals (95% CIs) were estimated. RESULTS Being overweight or obese (IR = 1.52; 95% CI: 1.03-2.22) was independently associated with ECC. Being thin or very thin (IR = 1.97; 95% CI: 1.52-2.54), a high frequency of sugar consumption (IR = 1.83; 95% CI: 1.42-2.38), and age (IR = 3.62; 95% CI: 2.58-5.08) were associated with ECC. CONCLUSIONS Children overweight or obese, as well as children exhibiting being thin/very thin, were associated with ECC independent of socioeconomic variables and a high frequency of sugar consumption.

Low weight at birth and unfavorable socioeconomic background: effects on language and fluid intelligence

ABSTRACT Low birthweight (<2500 g), associated with low socioeconomic status, has a negative effect on cognition and development. This is especially true for fluid intelligence and language. This study aimed to examine and identify (1) fluid intelligence and language in low- and adequate-birthweight children in a low-income Brazilian neighborhood and (2) the environmental factors that could account for potential group differences. There were 100 children participated in the study, of whom 53 had low birthweight and 47 had adequate birthweight. The children completed a battery of tests for fluid cognition and language. Their socioeconomic background and home environment were explored through a caregiver questionnaire. The results indicated significant group differences in fluid intelligence but not in language. Environmental factors partially explained the results. The variables ‘years of preschool’ and ‘number of learning games/books’ predicted better test results. Furthermore, the children underperformed in naming speed but not in accuracy, and the low-birthweight children also underperformed in fluid intelligence. It is concluded that environmental factors affect both birthweight groups and may compromise child development.

Maternal socioeconomic factors and adverse perinatal outcomes in two birth cohorts, 1997/98 and 2010, in São Luís, Brazil

Several studies have identified social inequalities in low birth weight (LBW), preterm birth (PTB), and intrauterine growth restriction (IUGR), which, in recent years, have diminished or disappeared in certain locations. OBJECTIVES Estimate the LBW, PTB, and IUGR rates in São Luís, Maranhão, Brazil, in 2010, and check for associations between socioeconomic factors and these indicators. METHODS This study is based on a birth cohort performed in São Luís. It included 5,051 singleton hospital births in 2010. The chi-square test was used for proportion comparisons, while simple and multiple Poisson regression models with robust error variance were used to estimate relative risks. RESULTS LBW, PTB and IUGR rates were 7.5, 12.2, and 10.3% respectively. LBW was higher in low-income families, while PTB and IUGR were not associated with socioeconomic factors. CONCLUSION The absence or weak association of these indicators with social inequality point to improvements in health care and/or in social conditions in São Luís.