Baixo peso ao nascimento e hipertensão arterial na infância: estudo epidemiológico de base comunitária
Abstract
Introdução: Alguns estudos associam o peso ao nascimento com a ocorrência de doenças na vida adulta, designadamente a hipertensão arterial. Contudo, o mecanismo patológico subjacente ao aparecimento dessa doença não se encontra totalmente esclarecido. O objectivo deste estudo visa quantificar a associação entre o peso ao nascimento e a tensão arterial sistólica na infância. Participantes e métodos: Avaliámos uma amostra aleatória 1788 crianças com idades compreendidas entre os seis e os nove anos de idade, matriculados em 14 escolas do primeiro ciclo do ensino básico da cidade do Porto. Um questionário auto-aplicado foi enviado aos pais ou encarregados de educação,
que o devolveram à escola juntamente com o boletim de saúde infantil. O peso ao nascimento e o tempo de gestação, foram avaliados através da consulta desse boletim. Na escola, a tensão arterial sistólica foi avaliada três vezes consecutivas com recurso a um aparelho digital (Omnromâ), com a criança na posição de sentado, e posteriormente calculada a respectiva média. Considerámos o percentil 90 como ponto de corte para classificar hipertensão. O estatuto sócio-económico foi avaliado a partir da profissão paterna, agrupada em classes de acordo com o Guia Nacional de Profissões.
Resultados: Após ajuste por regressão logística não condicional, os valores mais altos de tensão arterial sistólica (superior ou igual ao percentil 90) associaram-se significativamente com o sexo masculino OR=1,4 (IC95% 1,1-1,8), a idade (sete anos OR=1,3 IC95% 1,0-1,8; oito anos OR=1,9 IC95% 1,4-2,5 e nove anos OR=3,6 IC95% 2,8-4,8), o peso ao nascimento menor que 2500g OR=1,7 (IC95% 1,0-3,2) e o consumo de tabaco pela mãe durante a gravidez OR=1,4 (IC95% 1,0-2,0). Conclusões: Este estudo mostra que as crianças nascidas com baixo peso, apresentam valores mais altos de tensão arterial sistólica. Assume consistência a hipótese proposta por Barker que associa o baixo peso ao nascimento com a ocorrência de hipertensão arterial na vida adulta.
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BARKER, D.J.P. ; OSMOND C. ; SIMMONDS, S.J.. ; WIELD G.A. - The relation of small head circumference and thinness at birth to death from cardiovascular disease. Br Med J. 306 (1993a) 422-426.
BARKER, D.J.P. ; GLUCKMAN, P.D. ; GODFREY, K.M. ; HARDING, J.E. ;
OWENS, J.A., ROBINSON, J.S. - Fetal nutrition and cardiovascular disease in adult life. Lancet. 341 (1993b) 938-941.
BARKER, D.J.P. ; WINTER, P.D. ; OSMOND, C. ; MARGETTS, B. - Weight in infancy and death from ischaemic heart disease. Lancet ii (1989) 577-580.
BARKER, D.J.P. - The fetal and infant origins of adult disease. Br Med J 301 (1990) 1111.
BARROS, H. ; TAVARES, M. ; RODRIGUES, T. - Role of prenatal care in preterm birth and low birthweight in Portugal. Journal of Public Heath Medicine. 18:3 (1996) 321-8.
BARROS, H. ; TAVARES, M. - Prenatal care use, perinatal and infant mortality in Portugal. An area-level analysis. 56 (1998) 263-73.
BRANDÃO, A.P. ; BRANDÃO, A.A. ; ARAÚJO, E.M. ; OLIVEIRA, R.C. - Familial aggregation of arterial blood pressure and possible genetic influence. Hypertension. 19 (1992) 214-217.
DANIELS, S.R. ; LOGGIE, J.M.H. ; McENERNY, P.T. ; TOWBIN, R.B. -
Clinical spectrum of intrinsic renovascular hypertension in children. Pediatrics. 80:5 (1987) 698-704.
DEAN, A.G. ; DEAN, J.A. ; COULOMBIER, D. [et al.] Epi-Info, version 6,04a : a word processing, database, and statistics for epidemiology on microcomputers. Centers for Disease Control and Prevention Atlanta, 1994.
DILLON, M.J. - Investigation and management of hypertension in children. A personal perspective. Pediatr Nephrol. 1:1 (1987) 59-68.
DWYER, T. - Within pair association between birth weight and blood pressure at age 8 in twins from a cohort study. Br Med J. 319 (1999) 1325-1329.
ERIKSSON, M. ; TIBBLIN, G. ; CNATTINGIUS, S. - Low birth weight and
ischemic heart disease. Lancet. (1994) 343:731.
FIXLER, D.E. ; LAIRD, W.P. - Validity of mass blood pressure screening in children. Pediatrics. 72:4 (1983) 459-63.
GLIKSMAN, M.D. ; KAWACHI, I. ; HUNTER, D. ; COLDITZ, G.A. ; MANSON, J.E. ; STAMPFER, M.J. - Childhood socioeconomic status and risk of cardiovascular disease in middle aged US women: a prospective study. J Epidemiol Community Health. 49 (1995) 1015.
HAHN, L. - The relation of blood pressure to weight, height and body surface area in school boys aged 11 years. Arch Dis Child. 27 (1992) 43-53.
HALES, C.N. - Non-insulin-dependent diabetes mellitus. Brit Med Bull. 53 (1997)109-122.
HOFMAN, P.L. ; CUTFIELD, W.S. ; ROBINSON, E.M. ; BERGMAN, R.N. ;
MENON, R.K. ; SPERLING, M.A. - Insulin resistance in short children with intrauterine growth retardation. J Clin Endocrinol Metab. 82 (1997) 402-406.
HOUDE, S.C. ; MELILLO, K.D. - Cardiovascular health and physical activity in older adults: an integrative review of research methodology and results. J Adv Nurs. 38:3 (2002) 219-34.
JEE, S.H. ; SUH, I. ; WON, S.Y. ; KIM, M.Y. - Familial correlation and heritability for cardiovascular risk factors. Yonsei Med J. 43:2 (2002) 160-4.
JOSEPH, K.S. ; KRAMER, M.S. - Review of the evidence of fetal and early childhood antecedents of adult chronic disease. Epidemiol Rev. 18 (1996) 158-74.
KHOURY, M. ; BEATY, T. ; COHEN, B. - The impact of genetics and epidemiology. J Chron Dis. 39 (1986) 963-978.
KRAMER, M.S. - Determinants of low birth weight: methodological assessment and meta-analysis. WHO. 65 (1987) 663737.
LAATIKAINEN, T. ; DELONG, L. ; POKUSAJEVA, S. ; UHANOV, M. ;
VARTIAINEN, E. ; PUSKA, P. - Changes in cardiovascular risk factors and health behaviours from 1992 to 1997 in the Republic of Karelia, Russia. Eur J Public Health. 12:1 (2002) 37-43.
LANGLEY-EVANS, S.C. ; GARDNER, D.S. ; WELHAM, S.J. - Intrauterine
programming of cardiovascular disease by maternal nutritional status. Nutrition. 14 (1998) 39-47.
LAW, C.M. ; de SWIET, M. ; OSMOND, C. ; FAYERS, P.M. ; CRUDDAS, A.M. ; FALL, C.H. - Initiation of hypertension in utero and amplification throughout life. Br Med J. 306 (1993) 24-27.
LEON, D. ; LITHELL, H. ; VAGERÖ, D. [et al.] - Reduced fetal growth rate and increased risk of death from ischaemic heart disease : cohort study of 15 000 Swedish men and women born 1915-29. Br Med J. 317 (1998) 241-24.
LUCAS, A. - Programming by early nutrition: an experimental approach. J Nutr. 128 (1998) 40146S.
MARMOT, M. - Coronary heart disease: rise and fall of a modern epidemic. In MARMOT, M. ; ELLIOT, P. - Coronary heart disease epidemiology : from aetiology to public heath. New York : Oxford University Press, 1992. 3-9.
MINISTÉRIO DO EMPREGO E DA SEGURANÇA SOCIAL. Classificação
Nacional das Profissões. Lisboa, 1994.
MOORE, V.M. ; MILLER, A.G. ; BOULTON, T.J. ; COCKINGTON, R.A. ;
CRAIG, I.H. ; MAGAREY, A.M. - Placental weight, birth measurements, and blood pressure at age 8 years. Arch Dis Child. 74 (1996) 538-541.
MOTA-HERNANDEZ, F. ; FEIMAN, R. ; GORDILLO-PANIAGUA, G. - Predictive value of fractionaL excretion of filtered sodium for hypertension in acute post-streptococcal glomerulonephritis. J Pediatr. 104:4 (1984) 560-3.
OSMOND, C. ; BARKER, D.J.P. ; WINTER, P.D. ; FALL, C.H.D. ; SIMMONDS, S.J. - Early growth and death from cardiovascular disease in women. Br Med J. 307 (1993) 1519-1524.
PANETH, N. ; SUSSER, M. - Early origin of coronary heart disease (the “Barker hypothesis”). Br Med J. 310 (1995) 411-412.
PHILLIPS, D.I. - Insulin resistance as a programmed response to fetal
undernutrition. Diabetologia. 39 (1996) 1119-1122.
PRINEAS, R.J. - The Minneapolis children’s blood pressure study. Part 2 : multiple determinants of children's blood pressureH. ypertension. 2 (1980) 24-8.
RAMES, L.K. ; CLARKE, W.R. ; REITER, M.A. - Normal blood pressure and the evaluation in childhood-The Muscatine Study. Pediatrics. 61 (1978) 245-257. Report of the Second Task Force on Blood Pressure Control in Children. Pediatrics. 79 (1987) 1-25.
RICH-EDWARDS JW, STAMPFER MJ, MANSON JE, ROSNER B, HANKINSON SE, COLDITZ GA. Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976. Br Med J 1997;315:396-400.
STEIN, C.E. ; FALL, C.H.D. ; KUMARAN, K. ; OSMOND, C. ; COX, V. ;
BARKER, D.J.P. - Fetal growth and coronary heart disease in South India. Lancet. 348 (1996) 1269-1273.
TAYLOR, S.J. ; WHINCUP, P.H. ; COOK, D.G. ; PAPACOSTA, O. ; WALKER, M. - Size at birth and blood pressure: cross sectional study in 8-11 year old children. Br Med J. 314 (1997) 475-480.
UHARI, M. ; KOSTINIES, O. - A surveyof 164 Finnish children and adolescents with hypertension. Acta Paediatr Scand. 68:2 (1979) 193-8.
Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. A working group report from the National High Blood Pressure Education Program. Pediatrics. 98 (1996) 649-658.
VOLOZH, O. ; SOLODKAYA, E. ; ABINA, J. ; KAUP, R. ; GOLDSTEINE, G. ;
OLFERIEV, A. ; DEEV, A. - Some biological cardiovascular risk factors and diet in samples of the male population of Tallinn, Estonia in 1984/1985 and 1992/1993. Eur J Public Health. 12:1 (2002) 16-21.
WHINCUP, P. ; COOK, D. ; PAPACOSTA, O. ; WALKER, M. - Birth weight and blood pressure : cross sectional and longitudinal relations in childhood. Br Med J. 311 (1995).
WHINCUP, P.H. ; COOK, D.G. ; SHAPER, A.G. - Early influences on blood
pressure : a study of children aged 5-7 years. Br Med J. 299 (1989) 587- 591.
WOELK, G. ; EMANUEL, I. ; WEISS, N.S. ; PSATY, B.M. - Birth weight and blood pressure among children in Harare, Zimbabwe. Arch Dis Child Fetal
Neonatal Edition. 79 (21998) 119-225.
YAJNIK, C.S. ; FALL, C.H. ; VAIDYA, U. ; PANDIT, A.N. ; BAVDEKAR, A. ;
BHAT, D.S. - Fetal growth and glucose and insulin metabolism in four-year-old Indian children. Diabet Med. 12 (1995) 330-336.
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