Tatiana de Oliveira Vieira

Maternal obesity, environmental factors, cesarean delivery and breastfeeding as determinants of overweight and obesity in children: results from a cohort

BackgroundOverweight and obesity are a public health problem with a multifactorial aetiology. The objective of this study was to evaluate risk factors for overweight and obesity in children at 6 years of age, including type of delivery and breastfeeding.MethodsThis study relates to a cohort of 672 mother-baby pairs who have been followed from birth up to 6 years of age. The sample included mothers and infants seen at all ten maternity units in a large Brazilian city. Genetic, socioeconomic, demographic variables and postnatal characteristics were analyzed. The outcome analyzed was overweight and/or obesity defined as a body mass index greater than or equal to +1 z-score. The sample was stratified by breastfeeding duration, and a descriptive analysis was performed using a hierarchical logistic regression. P-values of <0.05 were considered significant.ResultsPrevalence rates (PR) of overweight and obesity among the children were 15.6% and 12.9%, respectively. Among the subset of breastfed children, factors associated with the outcome were maternal overweight and/or obesity (PR 1.92; 95% confidence interval “95% CI” 1.15–3.24) and lower income (PR 0.50; 95% CI 0.29–0.85). Among children who had not been breastfed or had been breastfed for shorter periods (less than 12 months), predictors were mothers with lower levels of education (PR 0.39; 95% CI 0.19–0.78), working mothers (PR 1.83; 95% CI 1.05–3.21), caesarean delivery (PR 1.98; 95% CI 1.14 – 3.50) and maternal obesity (PR 3.05; 95% CI 1.81 – 5.25).ConclusionsMaternal obesity and caesarean delivery were strongly associated with childhood overweight and/or obesity. Lower family income and lower levels of education were identified as protective factors. Breastfeeding duration appeared to modify the association between overweight/obesity and the other predictors studied.

Trends in breastfeeding indicators in a city of northeastern Brazil

OBJECTIVEnTo investigate trends in breastfeeding indicators in the city of Feira de Santana, Brazil, and to identify population characteristics that might have influenced this trend.nnnMETHODSnThree methodologically comparable cross-sectional surveys performed in 1996, 2001, and 2009 were analyzed. These involved 2,159, 2,319, and 1,471 children younger than 1 year of age who were vaccinated in national multivaccination campaigns in the respective years. A standardized questionnaire was used, containing closed questions on consumption of breast milk and other foods on the day before the survey, along with questions regarding the characteristics of the population.nnnRESULTSnThe annual growth of the breastfeeding indicators was 2.1% for breastfeeding in the first hour of life (from 52.2% to 68.9%); 1.1% for breastfeeding among children aged 9 to 12 months (from 45% to 59.6%); and 0.8% for exclusive breastfeeding among infants younger than 6 months (from 36.9% to 47.4%). The median duration of exclusive breastfeeding increased from 52.3 to 84.3 days, and overall breastfeeding from 278 to 376 days. Some changes in the characteristics of the population were observed, which may have positively influenced the evolution of the breastfeeding indicators (better schooling level among the mothers, less use of dummies/pacifiers, and lower proportions of adolescent mothers), or negatively (greater proportions of primiparous mothers and cesarean deliveries, and lower frequency of births in Baby-Friendly Hospitals).nnnCONCLUSIONnThere were significant advances in breastfeeding indicators, although they are still far from ideal. Changes observed in population characteristics may have positively or negatively influenced this evolution.

Avaliação da promoção do aleitamento materno em Hospitais Amigos da Criança

Instituição: Centro de Estudos em Gastroenterologia e Hepatologia Pediátrica da Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil 1Graduado pelo Programa de Iniciação Científica oferecido pelo Centro de Estudos em Gastroenterologia e Hepatologia Pediátrica da UFBA, Salvador, BA, Brasil 2Mestre em Medicina e Saúde pela UFBA; Professora Auxiliar de Pediatria do Departamento de Medicina da Universidade Estadual de Feira de Santana (UEFS), Feira de Santana, BA, Brasil 3Doutora em Medicina e Saúde pela UFBA; Professora Adjunta do Curso de Medicina e Pós-Graduação da UEFS, Feira de Santana, BA, Brasil 4Professora Titular Doutora do Departamento de Pediatria e Líder do Grupo de Estudos em Gastroenterologia e Hepatologia Pediátrica da UFBA, Salvador, BA, Brasil ABSTRACTObjective: To evaluate the compliance to steps 4 to 10 of the Ten Steps Program to Successful Breastfeeding recommended by the Baby-Friendly Hospital Initiative (BFHI), created by World Health Organization (WHO). Methods: Cross-sectional descriptive study of 100 mothers in the immediate post-partum period admitted to both BFHI accredited hospitals in Salvador (Northeast Brazil). Newborns that could not be exclusively breastfed were not included. The mothers were questioned about obstetric history, previous breastfeeding, prenatal care, and aspectsObjective: To evaluate the compliance to steps 4 to 10 of the Ten Steps Program to Successful Breastfeeding recommended by the Baby-Friendly Hospital Initia- tive (BFHI), created by World Health Organization (WHO). Methods: Cross-sectional descriptive study of 100 mothers in the immediate post-partum period admitted to both BFHI accredited hospitals in Salvador (Northeast Brazil). Newborns that could not be exclusively breastfed were not included. The mothers were questioned about obstetric history, previous breastfeeding, prenatal care, and aspects related to The Ten Steps to Successful Breastfeeding. Interviewers used a ques- Interviewers used a ques- tionnaire based on the BFHI Global Criteria. At least 80% of the mothers had to satisfactorily answer the questions related to each step in order to consider them complied. Descriptive statistics was used to evaluate the answers. Results: The compliance was unsatisfactory for Step 4 (support to breastfeeding initiation immediately after birth - 58%), Step 5 (exclusive breastfeeding during hospitalization - 77%), and Step 10 (referral of mothers to a breastfeeding support group following discharge from hospital - 5%). Other steps showed a satisfactory result: Step 6 (offer of formula - 19%), Step 7 (practice of rooming-in - 91%) and Step 9 (no pacifiers and bottles use - 100%). Conclusions: A satisfactory compliance with some aspects of the BFHI Global Criteria was noted, but more discussions about strategies to keep the title of Baby Friendly Hospital are needed, since the compliance was poor regarding Steps 4, 5 and 10.

Acute viral bronchiolitis and risk of asthma in schoolchildren: analysis of a Brazilian newborn cohort,

OBJECTIVEnTo verify whether the occurrence of acute viral bronchiolitis in the first year of life constitutes a risk factor for asthma at age 6 considering a parental history of asthma.nnnMETHODSnCross-sectional study in a cohort of live births. A standardized questionnaire of the International Study of Asthma and Allergies in Childhood was applied to the mothers to identify asthma in children at the age of 6 years. Acute viral bronchiolitis diagnosis was performed by maternal report of a medical diagnosis and/or presence of symptoms of coryza accompanied by cough, tachypnea, and dyspnea when participants were 3, 6, 9, and 12 months. Socioeconomic, environmental data, parental history of asthma, and data related to pregnancy were collected in the first 72h of life of the newborn and in prospective home visits by trained interviewers. The association between acute viral bronchiolitis and asthma was evaluated by logistic regression analysis and potential modifier effect of parental history was verified by introducing an interaction term into the adjusted logistic regression model.nnnRESULTSnPrevalence of acute viral bronchiolitis in the first year of life was 68.6% (461). The occurrence of acute viral bronchiolitis was a risk factor for asthma at 6 years of age in children with parental history of asthma OR: 2.66, 95% CI (1.10-6.40), modifier effect p=0.002. Parental history of asthma OR: 2.07, 95% CI (1.29-3.30) and male gender OR: 1.69, 95% CI, (1.06-2.69) were other identified risk factors for asthma.nnnCONCLUSIONnAcute viral bronchiolitis in the first year of life is a risk factor for asthma in children with parental history of asthma.

Factors associated with breastfeeding maintenance for 12 months or more: a systematic review

OBJECTIVEnSynthesize the information about the factors associated with maintenance of breastfeeding for 12 months or more.nnnDATA SOURCEnA systematic review was conducted in the Pubmed/Medline, Scielo, and Lilacs databases, including articles published in Portuguese or English since 2004 on the factors associated with breastfeeding maintenance for at least 12 months; review articles and those with qualitative design were excluded. The factors were organized into four levels, according to the chronological proximity to the outcome: distal, distal intermediate, proximal intermediate, and proximal; nationality and place/area of residence were considered contextual factors.nnnSUMMARY OF DATAn1174 articles were identified, of which 19 were included in this review, comprising seven cohort studies and 12 cross-sectional studies. A total of 39 of the 75 assessed factors were associated with the outcome at least once. The factors with the highest percentages of associations with maintenance of breastfeeding for 12 months or more, considering the number of times they were tested were: children whose parents are the caregivers (100%), none type of maternal exposure to smoke (54%), children and/or parents are immigrants/foreigners (50%), live in urban areas (42.9%), older maternal age (40%), married women (37.5%), higher level of maternal education (31.3%), greater parity (30.8%), and lower income (30%).nnnCONCLUSIONSnThe maintenance of breastfeeding for 12 months or more is associated with multiple factors, emphasizing the contextual factors and those related to some maternal sociodemographic characteristics. Associations differ in effect and magnitude between the different populations studied.

Prevalence and factors associated with cracked nipples in the first month postpartum

BackgroundTo assess the prevalence and factors associated with the occurrence of cracked nipples in the first month postpartum.MethodsThis was a cross-sectional study nested in a cohort of mothers living in Feira de Santana, state of Bahia, northeastern Brazil. Data from 1,243 mother-child dyads assessed both at the maternity ward and 30xa0days after delivery were analyzed. The association between cracked nipples as reported by mothers and their possible determinants was analyzed using Poisson regression in a model where the variables were hierarchically organized into four levels: distal (individual characteristics), distal intermediate (prenatal characteristics), proximal intermediate (delivery characteristics), and proximal (postnatal characteristics).ResultsThe prevalence of cracked nipples was 32xa0% (95xa0% confidence interval [95 % CI] 29.4–34.7) in the first 30xa0days postpartum. The following factors showed significant association with the outcome: poor breastfeeding technique (prevalence ratio [PR]u2009=u20093.18, 95 % CI 2.72–3.72); breast engorgement (PRu2009=u20091.70, 95 % CI 1.46–1.99); birth in a maternity ward not accredited by the Baby-Friendly Hospital Initiative (PRu2009=u20091.51, 95 % CI 1.15–1.99); cesarean section (PRu2009=u20091.33, 95 % CI 1.13–1.57); use of a feeding bottle (PRu2009=u20091.29, 95 % CI 1.06–1.55); and higher maternal education level (PRu2009=u20091.23, 95 % CI 1.04–1.47).ConclusionsThe prevalence of cracked nipples was high in our sample. Most of the factors associated with cracked nipples were related to postnatal characteristics, especially poor breastfeeding technique, which could be improved to help prevent the condition.

Increased risk of allergic rhinitis among children delivered by cesarean section: a cross-sectional study nested in a birth cohort.

BackgroundFew studies have evaluated the association between delivery by cesarean section (CS) and asthma, allergic rhinitis and chronic rhinitis and whether this association is different in children with and without a family history of asthma. This study aims to investigate whether children born by CS have a higher chance to develop asthma, allergic rhinitis and chronic rhinitis and to evaluate the influence of parental history of asthma on these associations.MethodsThis is a cross-sectional study of 672 children nested in a birth cohort evaluated at 6-years of age. Asthma and chronic/allergic rhinitis were identified by means of the mother’s responses to the ISAAC questionnaire. The association between CS, asthma, chronic rhinitis and allergic rhinitis was evaluated by multivariable logistic regression. The evidence of effect modification of parental history of asthma on the association CS and outcomes was examined by introducing interactions terms in the logistic regression models adjusting for confounders.ResultsAsthma was not associated with birth by CS irrespective of parental history of asthma (odds ratio (OR) 1.03; 95 % CI 0.61–1.74). Chronic rhinitis and allergic rhinitis were both significantly associated with birth by CS but only in the subgroup of children with by parental history of asthma (OR 1.56; 95 % CI 1.04–2.34) and (OR 1.60; 95 % CI 1.01–2.55) respectively, after adjustment for confounders. The parental history of asthma was a effect modifier in the association between CS, chronic rhinitis and allergic rhinitis (p for effect modification = 0.10 and 0.02, respectively).ConclusionCS increases the risk of chronic rhinitis and allergic rhinitis in children at 6xa0years of age with parental history of asthma. Health professionals must be alerted with regard to the increased risk of allergic rhinitis and made aware this is another reason to avoid unnecessary CS.

Factors associated to nipple trauma in lactation period: a systematic review

Abstract Objectives: To identify the characteristics associated to nipple trauma in nursing mothersand propose a theoretical model explaining in hierarchical levels its determining factors.Methods: a systematic review of the literature based on the search of epidemiologicalstudies of factors associated to nipple trauma in the databases of Medical Literature Analysisand Retrieval System Online/Pubmed, Literatura Latino-Americana and Caribe em Cienciasda Saude (Latin American Literature and Caribbean Health Sciences) and ScienceDirect. Theconduct on searching articles occurred until June 2016.Results: 17 articles were selected which investigated 27 variables and found a signifi-cant association between 16 of these variables and nipple trauma. The factors associated tonipple trauma reported in two or more studies were: mother of race/color white or yellow,primiparity, inadequate position between mother and child during breastfeeding and handlingthe infant incorrectly to the mother’s breast. Guidance received on handling and positioningthe infant during prenatal care was a protective factor against nipple trauma.Conclusions: in the theoretical model explaining the factors associated to nipple traumain hierarchical levels, the variables classified at the proximal level were the most investi-gated and were identified as risk factors in selected studies, indicating that in the postpartumcare period is an important protective factor against nipple trauma.

Intenção materna de amamentar: revisão sistemática

Resumo O presente estudo tem como objetivo identificar os fatores associados a intencao materna para amamentar (IMA) em gestantes. Foi realizada revisao sistematica de estudos de bases de dados Medical Literature Analysis and Retrieval System Online (PubMed/Medline) e Literatura Latino-Americana e do Caribe em Ciencias da Saude (Lilacs). Dois revisores independentes buscaram artigos, com os “Medical Subject Headings” e os “Descritores em Ciencia e Saude”, referentes: ao aleitamento materno, a intencao e as gestantes. Foram incluidas pesquisas que apresentavam IMA como desfecho, em ingles, portugues e espanhol; e classificadas, quanto a qualidade metodologica, de acordo com criterios de validade interna e externa de uma pesquisa, com pontuacao maxima de 30 pontos. Selecionou-se nove artigos, com qualificacao metodologica entre 12 e 21 pontos, que investigaram 68 variaveis; 35 dessas se associaram a IMA. As caracteristicas associadas a IMA em gestantes, relatadas em dois ou mais estudos, foram: primeira gestacao, maior escolaridade e idade materna, experiencia previa com a amamentacao, ausencia do habito de fumar e residir com o companheiro. O conhecimento das caracteristicas associadas a IMA representa um passo fundamental no delineamento de acoes que visem maior duracao do aleitamento materno.

Evaluation of breastfeeding promotion in Baby-Friendly Hospitals

Instituição: Centro de Estudos em Gastroenterologia e Hepatologia Pediátrica da Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil 1Graduado pelo Programa de Iniciação Científica oferecido pelo Centro de Estudos em Gastroenterologia e Hepatologia Pediátrica da UFBA, Salvador, BA, Brasil 2Mestre em Medicina e Saúde pela UFBA; Professora Auxiliar de Pediatria do Departamento de Medicina da Universidade Estadual de Feira de Santana (UEFS), Feira de Santana, BA, Brasil 3Doutora em Medicina e Saúde pela UFBA; Professora Adjunta do Curso de Medicina e Pós-Graduação da UEFS, Feira de Santana, BA, Brasil 4Professora Titular Doutora do Departamento de Pediatria e Líder do Grupo de Estudos em Gastroenterologia e Hepatologia Pediátrica da UFBA, Salvador, BA, Brasil ABSTRACTObjective: To evaluate the compliance to steps 4 to 10 of the Ten Steps Program to Successful Breastfeeding recommended by the Baby-Friendly Hospital Initiative (BFHI), created by World Health Organization (WHO). Methods: Cross-sectional descriptive study of 100 mothers in the immediate post-partum period admitted to both BFHI accredited hospitals in Salvador (Northeast Brazil). Newborns that could not be exclusively breastfed were not included. The mothers were questioned about obstetric history, previous breastfeeding, prenatal care, and aspectsObjective: To evaluate the compliance to steps 4 to 10 of the Ten Steps Program to Successful Breastfeeding recommended by the Baby-Friendly Hospital Initia- tive (BFHI), created by World Health Organization (WHO). Methods: Cross-sectional descriptive study of 100 mothers in the immediate post-partum period admitted to both BFHI accredited hospitals in Salvador (Northeast Brazil). Newborns that could not be exclusively breastfed were not included. The mothers were questioned about obstetric history, previous breastfeeding, prenatal care, and aspects related to The Ten Steps to Successful Breastfeeding. Interviewers used a ques- Interviewers used a ques- tionnaire based on the BFHI Global Criteria. At least 80% of the mothers had to satisfactorily answer the questions related to each step in order to consider them complied. Descriptive statistics was used to evaluate the answers. Results: The compliance was unsatisfactory for Step 4 (support to breastfeeding initiation immediately after birth - 58%), Step 5 (exclusive breastfeeding during hospitalization - 77%), and Step 10 (referral of mothers to a breastfeeding support group following discharge from hospital - 5%). Other steps showed a satisfactory result: Step 6 (offer of formula - 19%), Step 7 (practice of rooming-in - 91%) and Step 9 (no pacifiers and bottles use - 100%). Conclusions: A satisfactory compliance with some aspects of the BFHI Global Criteria was noted, but more discussions about strategies to keep the title of Baby Friendly Hospital are needed, since the compliance was poor regarding Steps 4, 5 and 10.