Obesity is one of the rising public health problems characterized as a risk factor for many chronic diseases in adulthood. Early life events such as intrauterine growth restriction, as well as life style, are associated with an increased prevalence of this disease. The present study was performed to determine if intrauterine growth restriction interacts with overweight at primary school age to affect body mass index (BMI) in young adults. From June 1, 1978 to May 31, 1979, 6827 singleton liveborns from Ribeirão Preto, São Paulo State, Brazil, corresponding to 98% of all births at the 8 maternity hospitals, were examined and their mothers were interviewed. Samples from the initial cohort were examined again at primary school age (8 to 11 years of age) and at the time of military service (18 years of age). There were 519 male individuals with complete measurements taken in the three surveys. Intrauterine growth-restricted individuals had a BMI 0.68 kg/ m 2 lower than that of individuals who were not restricted (95%CI = -1.34 to -0.03) and overweight at primary school age showed a positive and strong effect on BMI at 18 years of age (coefficient 5.03, 95%CI = 4.27 to 5.79). However, the increase in BMI was much higher -6.90 kg/m 2 -when the conscript had been born with intrauterine growth restriction and presented overweight at primary school age (95%CI = 4.55 to 9.26). These findings indicate that the effect of intrauterine growth restriction on BMI at 18 years of age is modified by later weight gain during school age.

The objective of the present study was to estimate and compare social inequality in terms of three indicators, i.e., low birth weight (LBW), preterm birth (PTB) and small for gestational age (SGA) birth, in three birth cohorts. Two cohorts were from the city of Ribeirão Preto, where data were collected for all 6748 live born singletons in 1978/79 and for one third of live born singletons (2846) in 1994. The third cohort consisted of 2443 singletons born in São Luís over a period of one year (1997/98). In Ribeirão Preto, LBW and PTB rates increased in all social strata from 1978/79 to 1994. Social inequalities regarding LBW and PTB disappeared since the increase in these rates was more accelerated in the groups with higher educational level. The percentage of SGA infants increased over the study period. Social inequality regarding SGA birth increased due to a more intense increase in SGA births in the strata with lower schooling. In São Luís, in 1997/98 there was no social inequality in LBW or PTB rates, whereas SGA birth rate was higher in mothers with less schooling. We speculate that the more accelerated increase in medical intervention, especially due to the increase in cesarean sections in the more privileged groups, could be the main factor explaining the unexpected increase in LBW and PTB rates in Ribeirão Preto and the decrease or disappearance of social inequality regarding these perinatal indicators in the two cities. Correspondence

Few studies are available about racial inequalities in perinatal health in Brazil and little is known about whether the existing inequality is due to socioeconomic factors or to racial discrimination per se. Data regarding the Ribeirão Preto birth cohort, Brazil, whose mothers were interviewed from June 1, 1978 to May 31, 1979 were used to answer these questions. The perinatal factors were obtained from the birth questionnaire and the ethnic data were obtained from 2063 participants asked about self-reported skin color at early adulthood (23-25 years of age) in 2002/2004. Mothers of mulatto and black children had higher rates of low schooling (≤4 years, 27.2 and 38.0%) and lower family income (≤1 minimum wage, 28.6 and 30.4%). Mothers aged less than 20 years old predominated among mulattos (17.0%) and blacks (14.0%). Higher rates of low birth weight and smoking during pregnancy were observed among mulatto individuals (9.6 and 28.8%). Preterm birth rate was higher among mulattos (9.5%) and blacks (9.7%) than whites (5.5%). White individuals had higher rates of cesarean delivery (34.9%). Skin color remained as an independent risk factor for low birth weight (P < 0.001), preterm birth (P = 0.01), small for gestational age (P = 0.01), and lack of prenatal care (P = 0.02) after adjustment for family income and maternal schooling, suggesting that the racial inequalities regarding these indicators are explained by the socioeconomic disadvantage experienced by mulattos and blacks but are also influenced by other factors, possibly by racial discrimination and/or genetics. Correspondence

Background Worldwide, more than five million babies have been born as a result of assisted reproduction technology. Safety aspects are therefore crucial to consider. Aim By review of the literature to assess if children conceived by assisted reproduction technology are at increased risk of somatic morbidity after the newborn period compared with spontaneously conceived children. Methods Medline/Pubmed, Embase and The Cochrane Library were searched on May 20, 2013. Studies on assisted reproduction technology and post-neonatal somatic diseases were included in the systematic review. Furthermore, health care contacts, chronic illnesses, surgery, medication and mortality were considered. Cohort and case-control studies were included. To assess the risk of bias in the individual studies, quality of all studies were evaluated independently by two of the authors, using the Newcastle-Ottawa Scale. The PRISMA statement for systematic reviews was followed. Results Thirty-eight studies, out of 819 identified studies, were included. Results indicate that children conceived by assisted reproduction technology are at increased risk of leukaemia and retinoblastoma, asthma and obstructive bronchitis, genitourinary diseases, and epilepsy or convulsions when compared with spontaneously conceived children. Furthermore, it appears that children conceived by assisted reproduction technology are hospitalised longer per admission, compared with spontaneously conceived children. Conclusion Children conceived by assisted reproduction technology may be at increased risk of various somatic diseases in childhood compared with spontaneously conceived children. Background and aims Birthweight and weight gain have been associated with high adult blood pressure (BP). Less well known is the association between height gain across the life cycle and hypertension (HT). The objective of the present study is to assess the independent association of body mass index (BMI) and length at birth and BMI and height gains from birth to childhood, and from childhood to adulthood with adult blood pressure and HT. Methods A prospective cohort of all living born in Ribeirão Preto, Brazil, was assessed at birth (1978/79), school-age (1987/ 89) and adulthood (2002/04). Data on neonatal variables, socioeconomic position and anthropometry of all three moments as well as adult risk factors for HT were present for 1141 subjects. Conditional weight analysis was performed to assess the independent association of BMI and height repeated-in-time measurements on adult HT. Results After adjustments BMI at birth (inversely: RR = 0.58; 95% CI 0.35-0.96), BMI gain in adolescence (RR = 3.39; 95% CI 1.87-6.16) and height gain in childhood (RR = 1.95; 95% CI 1.12-3.38) were associated with adult HT. Adult systolic BP was associated with BMI at birth, BMI and height gains in PS-355