Desfechos perinatais e alterações na cavidade bucal: coortes brasileiras de Ribeirão Preto e São Luís

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Abstract

RESUMO: Estudos vêm mostrando uma possível associação das doenças bucais no período gestacional com o nascimento pré-termo (NPT) e o baixo peso ao nascer (BPN). Esses desfechos perinatais parecem se associar com defeitos de desenvolvimento do esmalte (DDE) na dentição decídua, que, por sua vez, parecem predispor ao desenvolvimento futuro de lesões de cárie nas crianças. Assim, é relevante a inclusão de variáveis de saúde bucal do binômio mãe/filho nos estudos de coorte para a compreensão de como esses fatores se associam. Os objetivos deste estudo são: 1) verificar se existe associação entre doenças da cavidade bucal da gestante e o NPT; 2) testar a hipótese de associação entre desfechos perinatais e defeitos de esmalte/cárie dentária nas crianças; 3) analisar se existem associações entre desfechos perinatais e distúrbios de erupção dentária nas crianças; 4) construir modelos teóricos para estudo das iniquidades sociais como fator comum entre os desfechos perinatais e condições bucais. Utilizou-se abordagem integrada e colaborativa entre duas cidades brasileiras com condições socioeconômicas contrastantes: São Luís, MA; e Ribeirão Preto, SP - estudo BRISA (Brazilian Birth Cohort Studies, Ribeirão Preto-São Luís ). Duas coortes foram avaliadas: uma iniciada ao nascimento, representativa da população de nascidos vivos; e outra iniciada no pré-natal. Os participantes foram reavaliados a partir do início do segundo ano de vida. Espera-se que estas coortes contribuam para fomentar o desenvolvimento e consolidação de pesquisas de seguimento, de base populacional, no Brasil.

Translated abstract

ABSTRACT: Studies have shown a possible association of oral diseases during pregnancy with preterm birth (PTB) and low birth weight (LBW). These perinatal outcomes appear to be associated with enamel defects in the primary dentition, which, in turn, seem to predispose to future development of caries in children. Therefore it is relevant to include oral health variables of the mother/child dyad in cohort studies to understand how these factors are associated. The objectives of this study are: 1) check if there is an association between diseases of the oral cavity of pregnant women and PTB, 2) test the hypothesis of association between perinatal outcomes and enamel defects/dental caries in children, 3) examine whether there are associations between perinatal outcomes and disorders of tooth eruption in children; 4) build theoretical models to study social inequities as a common factor between oral conditions and perinatal outcomes. We used an integrated, collaborative approach between two Brazilian cities with contrasting socioeconomic conditions: Sao Luis , MA, and Ribeirão Preto, SP - British Birth Cohort Studies study (BRISA Ribeirão Preto, São Luís). Two cohorts were evaluated: one initiated at birth, representative of the population of live births, and another, initiated prenatally. Participants were reassessed from the beginning of the second year of life. It is expected that these cohorts will contribute to foster the development and consolidation of population-based follow-up studies in Brazil.

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Most cited references 20

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The epidemiology of adverse pregnancy outcomes: an overview.

Michael S Kramer (2003)

This paper provides an overview of the occurrence, etiology and temporal trends of adverse pregnancy outcomes. Disparities between developed and developing countries are highlighted for maternal mortality, infant mortality, stillbirth and low birth weight. The higher rate of low birth weight in developing countries is primarily due to intrauterine growth restriction rather than preterm birth. Much of the excess intrauterine growth restriction is caused by short maternal stature, low prepregnancy body mass index and low gestational weight gain (due to low energy intake). No important contribution has been established for micronutrient intake, nor have different fetal growth trajectories been demonstrated to reflect the timing of exposure to nutritional or other etiologic factors. Infant mortality has declined substantially over time both in developed and developing countries despite no decline (and even an increase) in low birth weight. Several developed countries have reported a temporal increase in fetal growth in infants born at term, a reduction in stillbirth rates and prevention of neural tube defects. More progress is required, however, in understanding the etiology and prevention of preterm birth.