Maternal depression and child development at 3 years of age: a longitudinal study in a Brazilian child development promotion program

BACKGROUND

We tested the hypothesis that children of non-depressed mothers perform better in a developmental test at 3 years than children of depressed mothers.

METHOD

Longitudinal analysis from a trial to assess the impact of a child development promotion program in 30 Brazilian municipalities. Mothers and children were appraised at first-year post-partum, 1 and 3 years after enrollment. Child development was assessed through the Ages and Stages Questionnaire (ASQ3) and maternal depression through the Edinburgh Postnatal Depression Scale (EPDS). Crude and adjusted beta coefficients were obtained by linear regression before and after multiple imputation.

RESULTS

In total, 2098 mother/child dyads were included and 8.2% of the mothers had persistent depressive symptoms. There was a decrease in ASQ3 as the number of follow-ups with EPDS ≥ 10 increased (p for trend <0.001). In adjusted analysis, the direction of the association persisted but lost statistical significance. After multiple imputation, children from mothers with EPDS ≥ 10 in three follow-ups presented a decrease of about 14 points in ASQ3 (adjusted beta coefficient = -13.79; -22.59 to -5.00) (p for trend = 0.001).

CONCLUSIONS

Identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil.

IMPACT

In our population study, almost one in every ten women presented persistent depression symptoms across the first 3 years postpartum. In adjusted analysis there was a detrimental impact of persistent maternal depression on child development at 3 years of age. The persistent exposure to maternal depression across early childhood negatively influences children's development. Considering its prevalence, identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil.

Fatores associados ao desenvolvimento infantil em crianças brasileiras: linha de base da avaliação do impacto do Programa Criança Feliz

Resumo: O objetivo deste artigo foi avaliar os fatores socioeconômicos, familiares e individuais associados ao desenvolvimento infantil no primeiro ano de vida, entre famílias em vulnerabilidade social. Trata-se de uma análise transversal, com dados da linha de base de um ensaio randomizado. O estudo incluiu 3.242 crianças < 12 meses de idade, residentes em 30 municípios de cinco regiões do Brasil. A escolha de estados e municípios foi intencional, tendo como base a implementação do Programa Criança Feliz. A amostra foi selecionada a partir de crianças elegíveis para o Programa Criança Feliz, cujo objetivo é promover a estimulação e o desenvolvimento infantil. O Ages and Stages Questionnaire (ASQ) foi utilizado para avaliação do desenvolvimento infantil. Um modelo de análise multinível em três níveis (estado, município e indivíduos), usando teste de Wald para heterogeneidade e tendência linear, estimou a média do ASQ-3 e intervalo de 95% de confiança (IC95%). Análises foram ajustadas para potenciais confundidores. Foram analisadas informações de 3.061 (94,4%) crianças com dados disponíveis para ASQ-3. Escores de desenvolvimento infantil (total e em todos os domínios) foram cerca de 12% menores em crianças nascidas pré-termo e com restrição do crescimento intrauterino (pequenas para idade gestacional). Observou-se menores escores em filhos de mães com baixa escolaridade, com sintomas de depressão, com duas ou mais crianças menores de sete anos residindo no domicílio e que não relataram autopercepção de apoio/ajuda durante a gestação. Conclui-se que características potencialmente modificáveis (escolaridade, depressão materna e prematuridade/restrição do crescimento intrauterino) apresentaram maior impacto na redução do escore de desenvolvimento em todos os domínios avaliados.

Post-partum depression: a cross-sectional study of women enrolled in a conditional cash transfer program in 30 Brazilian cities

OBJECTIVE

Investigate factors associated with symptoms of postpartum depression in mothers from families in social vulnerability.

METHODS

Information was used from the baseline of a randomized trial to assess a child development program that enrolled 3,242 children < 12 months of age from beneficiary families of the Bolsa Família Program residing in 30 municipalities (counties) in six states of Brazil. The Edinburgh Postnatal Depression Scale (EPDS) was applied to the mothers, and depression was defined as score ≥10. Information on the mother (schooling, age, parity, marital status, skin color, smoking, number of prenatal appointments, and planning of the pregnancy), family (paternal schooling, household crowding, support from the child's father and the family during the pregnancy, and number of children under 7 years living in the household), and infant (sex, gestational age, birthweight, Apgar score, and child's age at the time of the interview) was collected. Prevalence rates for depressive symptoms were calculated with crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI), using hierarchical logistic regression, in a multilevel model.

RESULTS

The analysis included 3,174 mothers with information on EPDS. The interviews were conducted on average 7.9 months (standard deviation= 2.9) after childbirth. Overall prevalence of depressive symptoms was 26.5% (25.0-28.1%). In the adjusted analysis, higher parity was associated with higher odds of postpartum depression (p <0.001). Women with ≥3 previous deliveries showed an odds 84% higher of presenting depressive symptoms (OR= 1.84; 1.43-2.35) than primiparae. Higher maternal and paternal schooling, presence of husband or partner, and having received support from the child's father and the family during the pregnancy were protective factors against postpartum depression.

CONCLUSION

The study showed high prevalence of postpartum depressive symptoms. Promotion of parental education, alongside with the promotion of support to the woman during pregnancy by the child's father and by the family, as well as family planning leading to birth spacing are measures that may help to prevent postpartum depressive symptoms.

Factors associated with pain in the pelvic girdle in pregnant adolescents: A case-control study

BACKGROUND

Due to biological immaturity and unfavorable psychosocial conditions, it is conjectured that teenage pregnancy may be associated with disorders such as pelvic girdle pain. The evidence for risk factors for pelvic girdle pain in pregnant adolescents remains unclear.

OBJECTIVES

To evaluate the factors associated with pelvic girdle pain related to pregnancy in adolescents.

DESIGN

Case-control study.

METHOD

Seventy three pregnant women with presence of pelvic girdle pain (case group) and 331 pregnant women without pelvic girdle pain (control group) aged between 10 and 19 years, with gestational age between 28 and 40 weeks were included.

RESULTS/FINDINGS

A logistic regression model was used to identify factors associated with the occurrence of pelvic girdle pain. The following aspects were considered for the model: sociodemographic, anthropometric, gynecological and obstetrical, related to lifestyle, musculoskeletal and psychosocial factors. The results showed that suspected common mental disorder (OR: 2.27; 95% CI: 1.23 to 4.18), low back pain during menstruation (OR: 2.10; 95% CI: 1.16 to 3.80) and strenuous work (OR: 1.95; 95% CI: 1.13 to 3.35) were associated with pelvic girdle pain among pregnant adolescents.

CONCLUSIONS

Attention must be given to pregnant adolescents with suspected common mental disorder, low back pain during menstruation and strenuous work in order to ensure referral to the appropriate healthcare professional for early prevention of pelvic girdle pain.

Association between postpartum depression and the practice of exclusive breastfeeding in the first three months of life

OBJECTIVE

To investigate the association between postpartum depression and the occurrence of exclusive breastfeeding.

METHOD

This is a cross-sectional study conducted in the states of the Northeast region, during the vaccination campaign in 2010. The sample consisted of 2583 mother-child pairs, with children aged from 15 days to 3 months. The Edinburgh Postnatal Depression Scale was used to screen for postpartum depression. The outcome was lack of exclusive breastfeeding, defined as the occurrence of this practice in the 24h preceding the interview. Postpartum depression was the explanatory variable of interest and the covariates were: socioeconomic and demographic conditions; maternal health care; prenatal, delivery, and postnatal care; and the child's biological factors. Multivariate logistic regression analysis was conducted to control for possible confounding factors.

RESULTS

Exclusive breastfeeding was observed in 50.8% of the infants and 11.8% of women had symptoms of postpartum depression. In the multivariate logistic regression analysis, a higher chance of exclusive breastfeeding absence was found among mothers with symptoms of postpartum depression (OR=1.67; p<0.001), among younger subjects (OR=1.89; p<0.001), those who reported receiving benefits from the Bolsa Família Program (OR=1.25; p=0.016), and those started antenatal care later during pregnancy (OR=2.14; p=0.032).

CONCLUSIONS

Postpartum depression contributed to reducing the practice of exclusive breastfeeding. Therefore, this disorder should be included in the prenatal and early postpartum support guidelines for breastfeeding, especially in low socioeconomic status women.

Characteristics and factors associated with health care in children younger than 1 year with very low birth weight

OBJECTIVES

To identify the characteristics of health care in infants with very low birth weight during the first year of life and the factors associated with this care.

METHODS

This was a descriptive study with an analytical component conducted in the city of Maceió, Northeastern Brazil, with a sample of 53 children with a median age of five months at the time of the interview, and their mothers. The mothers were interviewed at home regarding socioeconomic and demographic data and health care provided for the child. Health care was assessed through an index using 16 variables related to the recommended actions for this type of care.

RESULTS

Multivariate linear regression analysis showed that maternal education and family income were the variables that best explained the health care index variation (18.9%), followed by parity (6.6%), and breastfeeding at the time of the interview (6.9%).

CONCLUSIONS

Considering that families with lower socioeconomic status, women with a higher number of children, and women who did not breastfeed were factors associated with poor health care of children born with very low birth weight, these variables should be included in measures of public health planning.

Does fetal growth restriction influence body composition at school age?

OBJECTIVE

To assess the influence of low birth weight in full-term infants on body composition at school age.

METHOD

This is a cross-sectional study nested in a cohort of 375 infants recruited at birth between 1993 and 1994 in the state of Pernambuco, Brazil. At 8 years of age, the body composition of 213 children from this cohort was assessed by measurement of triceps and subscapular skinfold thickness and mid upper arm circumference. Multivariable linear regression analysis was used to identify the influence of low birth weight, socioeconomic condition, maternal nutritional status, and child morbidity on triceps skinfold thickness.

RESULTS

Mean triceps and subscapular skinfold thickness, mid upper arm circumference, and upper arm muscle and fat areas were lower in children born at term with low weight than in those with appropriate birth weight. However, these differences were not statistically significant. Multivariable linear regression analysis showed that the relative majority of variance in triceps skinfold thickness (12.3%) was explained by socioeconomic variables, particularly per capita family income (9.1%), followed by anemia and past hospitalization (which, together, explained 5.6% of variance) and maternal body mass index, which contributed toward 2.4% of this variance. Low birth weight had no influence on triceps subcutaneous fat deposition in this age group.

CONCLUSION

Socioeconomic factors and a history of morbidity had a greater influence on body composition than low birth weight in schoolchildren born at term.

Early head growth: relation with IQ at 8 years and determinants in term infants of low and appropriate birthweight

AIM

To investigate the relation between head growth at different periods and IQ at 8 years, and to identify factors associated with more rapid head growth.

METHOD

Two parallel cohorts of term low birthweight (LBW) and appropriate birthweight (ABW) infants were enrolled at birth in northeast Brazil. Anthropometric measurements were made at birth, 2 months, 6 months, 12 months, 24 months, and 8 years. Cognition was assessed at 8 years (n=164) with the Wechsler Intelligence Scale for Children. Multivariable analysis with a two-stage residual model was used to relate head growth between successive time points with IQ.

RESULTS

Mean birthweight was 2.35kg (SD 0.15) in the LBW group (33 males, 50 females), and 3.21kg (SD 0.15) in the ABW group (28 males, 53 females). Mean gestational age was 38.8 weeks (SD 1.4) and 40.0 weeks (SD 1.3) respectively. In the LBW group, head growth from birth to 2 months and from 2 to 6 months, conditional on previous size, were significant independent predictors of IQ at 8 years. Conditional head growth from 6 months to 8 years and head size at birth were unrelated to IQ. In the ABW group there was no significant relation between conditional head growth and IQ for any period. Determinants of more rapid head growth from birth to 6 months in LBW infants were maternal height and rate of infant weight gain.

INTERPRETATION

Head growth from birth to 6 months in term LBW infants is more important than prenatal or later postnatal head growth in predicting IQ at 8 years.

Influence of breastfeeding type and maternal anemia on hemoglobin concentration in 6-month-old infants

OBJECTIVE

To verify the influence of breastfeeding type and of maternal anemia on hemoglobin concentration in 6-month-old infants.

METHODS

This was a cross-sectional study nested in a community-based, randomized and controlled intervention study that aimed to prolong the duration of exclusive breastfeeding during the first 6 months of life. This study was conducted in four towns in the Brazilian state of Pernambuco and newborn infants were recruited from March to August of 2001. The hemoglobin concentrations of 330 mothers and infants were assayed and type of breastfeeding was assessed 6 months after delivery. Multivariate linear regression analysis was used to identify factors that independently contributed to the infants' hemoglobin concentration.

RESULTS

The type of feeding had no influence on the hemoglobin concentration in the sample as a whole, however, there was a significant difference when the "exclusive + predominant breastfeeding" subset of infants was analyzed, with the children of anemic mothers exhibiting a reduction of 0.7g/dL in median hemoglobin. Mothers' hemoglobin level, type of flooring at home, type of delivery, and birthweight all significantly contributed to the variation in the infants' hemoglobin concentration.

CONCLUSIONS

In contrast with type of breastfeeding, maternal anemia did have an influence on the hemoglobin levels of 6-month-old infants, even when only children on "exclusive + predominant breastfeeding" were analyzed. These findings highlight the need to prevent maternal anemia before conception, during pregnancy and throughout lactation.

Efetividade da suplementação semanal com ferro sobre a concentração de hemoglobina, estado nutricional e o desenvolvimento de lactentes em creches do Recife, Pernambuco, Brasil

Esse estudo teve como objetivo investigar a efetividade da suplementação semanal de ferro na concentração de hemoglobina, no estado nutricional e no desenvolvimento mental e motor de lactentes em quatro creches municipais do Recife, Pernambuco, Brasil. O estudo consistiu de uma intervenção do tipo antes-depois realizada com suplementação semanal com ferro por seis meses, em uma amostra de 76 crianças com idade entre 4 e 24 meses, no período de fevereiro a dezembro de 2005. Os desenvolvimentos mental e motor foram avaliados pela Escala de Desenvolvimento Infantil de Bayley II. Após a suplementação observou-se um aumento significante na concentração de hemoglobina, apenas no grupo de lactentes com hemoglobina inicial < 9,5g/dL (p = 0,001). Para o índice peso/comprimento também se verificou um incremento significante da média de escore z, no entanto, ocorreu o oposto para o índice comprimento/idade. Não se observou diferença nos índices de desenvolvimento. Conclui-se que a suplementação semanal de ferro foi efetiva elevando a hemoglobina nos lactentes com níveis iniciais mais baixos, não se observando impacto no desenvolvimento infantil.

[Growth of full term low and adequate birth weight infants during the first two years of life]

OBJECTIVE

To assess the growth pattern of full term low and adequate birth weight infants during the first two years of life and to identify the determinants at the time of the greatest growth deceleration.

METHODS

A prospective cohort study was conducted with 148 full term infants in five small towns of the state of Pernambuco, Northeastern Brazil. Newborns were recruited from maternities between January 1993 and January 1994 and their anthropometric measurements were taken at one, two, four, six, 12 and 24 months of life. Risk factors were analyzed using multivariable linear regression.

RESULTS

The increment of mean weight-for-age and length-for-age were more evident for low birth weight when compared with adequate weight infants, especially during the first two months after birth. From this point onward it was observed a progressive mean growth deceleration in both indexes up to 12 months of life. All infants had similar weight and length growth patterns. However, adequate birth weight infants remained in an upper level. Socioeconomic variables explained 23% of variation for weight-for-age, followed by 4% for birth weight. Socioeconomic condition was also the factor mostly affecting length-for-age, explaining 28% of its variation, followed by birth weight, maternal height and diarrhea.

CONCLUSIONS

The study results suggest that interventions aiming to adequate growth should focus on prenatal care and social and environmental factors during childhood as a way of ensuring full expression of the genetic potential of this population.

Impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status of anemic infants

OBJECTIVE

To evaluate the impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status in a sample of anemic infants from Zona da Mata Meridional in the state of Pernambuco, Brazil.

METHODS

A controlled, community-based intervention was carried out with 378 infants who were followed-up for 18 months. Hemoglobin level was measured at 12 months in a total of 245 children randomly selected. Participating infants were divided into three groups: two received 45 mg of elemental iron weekly, from 12 to 18 months of life (69 children with moderate/severe anemia, and 111 with mild anemia); the third group was composed of 65 non-anemic children, who received no intervention. The remaining 133 children constituted the control group, for comparisons on nutritional status and morbidity.

RESULTS

The prevalence of anemia was 73.5% at 12 months of life. After 6 months of treatment, 42.3% of anemic children reached hemoglobin levels >or= 11.0 g/dL. The mean increase was 1.6 g/dL, being higher (2.5 g/dL) in the group with lower levels of hemoglobin at baseline. Children without anemia at baseline received no treatment, and 40.3% of them became anemic at the end of follow-up, with a mean decrease of 0.5 g/dL in hemoglobin levels. A significantly greater weight gain was observed in the two treated groups, while no significant improvements were seen in linear growth and duration of diarrhea.

CONCLUSIONS

The fact that less than half the children receiving ferrous sulfate recovered from anemia at the end of follow-up, along with the development of anemia in many untreated, previously non-anemic infants, suggests the need for effective control strategies.

Development and behaviour of low-birthweight term infants at 8 years in northeast Brazil: a longitudinal study

AIM

To investigate the development and behaviour of low-birthweight (LBW) term infants compared with matched term infants of appropriate birthweight (ABW).

METHODS

Two parallel cohorts of LBW infants (1500-2499 g) and ABW controls (3000-3499 g) were enrolled at birth in northeast Brazil. At 8 y, 164 children were assessed using clinical and psychological tests.

RESULTS

The LBW group had lower IQ scores than ABW children on the Weschler Intelligence Scale for Children; differences were larger on the performance (5 points, p = 0.04) than the verbal scale (3 points, p = 0.11). LBW children had poorer dynamic balance (p = 0.03) and eye-hand coordination (p = 0.02), but better selective attention (p = 0.02). Hyperactivity and conduct problems were common in both groups, but fewer LBW children had peer problems (p = 0.04). After controlling for social background, IQ was not significantly associated with birthweight (p = 0.10). Significant determinants were maternal education, home stimulation and type of school attended. The effect of birthweight on coordination and selective attention remained significant. Birth head circumference and growth in head size in the first 6 mo had independent effects on IQ.

CONCLUSION

After controlling for social background, LBW term infants did not differ from ABW infants in cognition at school age. Head circumference at birth and 6 mo was a better predictor than birthweight of IQ.

The therapeutic effects of music in children following cardiac surgery

OBJECTIVE

To investigate, both objectively and subjectively, the effect of music on children in a pediatric cardiac intensive care unit following heart surgery, in conjunction with standard care.

METHODS

Randomized clinical trial with placebo, assessing 84 children, aged 1 day to 16 years, during the first 24 hours of the postoperative period, given a 30 minute music therapy session with classical music and observed at the start and end of the session, recording heart rate, blood pressure, mean blood pressure, respiratory rate, temperature and oxygen saturation, plus a facial pain score. Statistical significance was set at 5%.

RESULTS

Five of the initial 84 patients (5.9%) refused to participate. The most common type of heart disease was acyanotic congenital with left-right shunt (41% of cases: 44.4% of controls). Statistically significant differences were observed between the two groups after the intervention in the subjective facial pain scale and the objective parameters heart rate and respiratory rate (p < 0.001, p = 0.04 and p = 0.02, respectively).

CONCLUSIONS

A beneficial effect from music was observed with children during the postoperative period of heart surgery, by means of certain vital signs (heart rate and respiratory rate) and in reduced pain (facial pain scale). Nevertheless, there are gaps to be filled in this area, and studies in greater depth are needed.

[The impact of training based on the Baby-Friendly Hospital Initiative on breastfeeding practices in the Northeast of Brazil]

OBJECTIVE

To evaluate the impact of training based on the Baby Friendly Hospital Initiative on breastfeeding practices in maternity wards and during the first 6 months of life.

METHODS

Ninety percent of nursing auxiliaries and midwives were trained at two institutions (A and B) in Palmares, Pernambuco state. Three hundred and thirty-four mothers were interviewed within the first 48 hours and 10 days after childbirth to evaluate breastfeeding practices at the maternities and fulfillment of steps 4 through 10 of the Baby Friendly Hospital Initiative. A subset of 166 mothers received seven home visits to evaluate breastfeeding practices throughout the first 6 months of life and to compare results with those of a cohort study conducted in the area in 1998.

RESULTS

The performance of maternity B was significantly better than that of maternity A, from steps 4 to 10 and also in terms of exclusive breastfeeding and offering less water or tea to infants (p < 0.001). The comparison with a previous cohort study demonstrated an improvement in breastfeeding practices at the maternity wards and an increase of exclusive breastfeeding prevalence (from 21.2 to 70%), during the first 48 hours after delivery and throughout the first six months.

CONCLUSIONS

The training promoted partial change to some practices related to breastfeeding, having a positive effect on total and exclusive breastfeeding at the maternity wards. However, there was no significant change to these practices over the first 6 months of life, suggesting the need for effective interventions to support exclusive breastfeeding in the health sector and in the community.

Determinants of mental and motor development at 12 months in a low income population: a cohort study in northeast Brazil

AIM

To identify biological and environmental factors associated with poorer mental and motor development at age 12 mo in urban communities in northeast Brazil.

METHODS

A cohort of 245 infants born during January August 1998 in six hospitals in the interior of Pernambuco was followed twice weekly from birth until 12 mo of age. Socio-economic, demographic and environmental data were collected, together with daily information on morbidity and feeding patterns. Gestational age, birth anthropometry and nutritional status at 12 mo were measured. Multiple linear regression analysis was used to identify variables that had independent effects on mental and motor development assessed at 12 mo of age with the Bayley Scales of Infant Development.

RESULTS

Environmental factors explained about 21% and 19% of the variance in mental and motor development, respectively. Of these, the most important were poverty-related. Significant biological factors associated with mental development were birthweight and infant sex. For motor development, the biological factors were weight-for-age and haemoglobin concentration. Biological factors explained only 6% and 5% of the variance in mental and motor development, respectively.

CONCLUSION

Of the variables examined, environmental factors had a greater detrimental effect on child development than biological factors in this population. Interventions that enhance social capital and alleviate poverty are advocated.

Fatores de risco para doença diarréica no lactente: um estudo caso-controle

O objetivo deste estudo foi identificar os fatores de risco associados à presença de episódios diarréicos em lactentes menores de seis meses, residentes na Zona da Mata Meridional do Estado de Pernambuco, Brasil. O desenho do estudo foi do tipo caso-controle, aninhado numa coorte. Foi estudado um total de 397 crianças, sendo 239 casos e 158 controles (1,5:1). Foi calculado o odds ratio(OR), intervalo de confiança (IC) de 95%, e realizada análise de regressão logística para identificar fatores preditores da variável a ser explicada. Na análise multivariada, a ausência de água canalizada (OR = 3,60; IC95% 1,49-8,74) e aleitamento materno por menos de 6 meses (OR = 2,06; IC95% 1,26-3,38) foram os fatores significantemente associados com a ocorrência de diarréia, após o ajuste pelas demais variáveis.

Factors associated with Hb concentration in children aged 6-59 months in the State of Pernambuco, Brazil

In 1997, the prevalence of anaemia was 40.9 % among children aged 6-59 months in the State of Pernambuco, north-east Brazil. Using the same sample of children, we have investigated possible reasons for this high prevalence. A representative sample was selected through a three-stage process: proportional systematic random sampling of municipalities in the State, systematic random sampling of census sectors within these municipalities, and finally, simple random sampling of households with children aged 6-59 months to obtain the sample of 650 children. Data collection included demographic, environmental, socio-economic and maternal variables, and nutritional status and dietary intakes of the children. Multiple linear regression analysis was based on a hierarchical model of factors associated with Hb concentration. The mean Hb concentration of children aged 6-23 months was 10 g/l lower than that of older children. In the regression analysis, child age explained 8.3 % of the variance in Hb concentration. The intake of bioavailable Fe explained a further 3.3, serum retinol 2.7, diarrhoea 2.4, water treatment 1.7, sanitation 1.3 and low birth-weight 0.5 %. The final model explained 23.4 % of the variance in Hb concentration. We conclude that child age, bioavailable-Fe intake, serum retinol concentration, diarrhoea, water treatment, sanitation and low birth-weight are independently associated with Hb concentration. In north-east Brazil, anaemia prevention programmes among children should focus on those aged <2 years and should consider feasible strategies to improve intakes of bioavailable Fe and vitamin A, and reduce infection. Supplemental Fe should be given to low birth-weight infants.

Improved cognitive and motor development in a community-based intervention of psychosocial stimulation in northeast Brazil

The aim of the study was to compare the development of children with and without a programme of psychosocial stimulation in 'control' and 'intervention' sites in a poorly resourced area of northeast Brazil. The sample (n = 156, born 1998) was from a larger cohort. The cohort was tested at 12 months (baseline) with the Bayley Scales of Infant Development. All children in the intervention site with a mental development index (MDI) and/or psychomotor development index (PDI) < or = 100 were enrolled. Each time such a child was enrolled, the next child tested in that site of the same sex and with an index of 101 to 115 was also enrolled, and the next two children matched for sex and scores of < or = 100 and 101 to 115 in the control sites were recruited in parallel. The intervention comprised 14 contacts between 13 and 17 months of age. All children were tested again at age 18 months. The intervention and control groups were similar at baseline for a range of socioeconomic, demographic, environmental, and biological variables, and their MDI and PDI were also similar. At 18 months, the mean differences between the intervention and control groups were + 9.4 points for MDI and + 8.2 points for PDI (p < 0.001 in each case). For children with an initial score of < or = 100, the mean difference between the intervened and control groups was + 11.2 points for MDI (p < 0.001), and + 10.8 points for PDI (p = 0.001). The intervention was thus associated with significant improvements in cognitive and motor development.

Cord blood essential fatty acid and alpha-tocopherol in full-term newborns in a Northeast Brazil area

Malnutrition of children during the first two years of life constitutes a public health concern in Brazil, particularly in the Northeast. Most of the nutrition data are concerned with protein-energy malnutrition and hypovitaminosis A. The purpose of this cross-sectional study was to assess the essential fatty acid (EFA) status, which is crucial in physical and mental development, and that of vitamin E which prevents against the oxidative loss of EFA physiological properties, in 81 full-term newborns. Blood samples were obtained from the residual blood of the umbilical cord (UC) at delivery. Fatty acid composition of UC plasma did not show any sign of EFA deficiency. The levels of docosahexanoic (DHA) and arachidonic acid (AA) appeared to be quite similar to those obtained in European populations. UC plasma vitamin E content was 6.31 +/- 1.99 mumol/L whereas the lipid-normalized vitamin E was 2.36 mumol/mmol of lipids. An interesting point was that newborns with vitamin E inferior to the median value (5.80 mumol/L) revealed significantly lower contents of linoleic acid and DHA in UC than newborns superior to the median value. Together with the absolute or normalized plasma level of vitamin E, this supports the observation that one quarter of the community's newborns is deficient in vitamin E.