https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X%2814%2970227-X.pdf

Global causes of maternal death: a WHO systematic analysis

Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks and costs. We present the latest CS rates and trends over the last 24 years. Methods We collected nationally-representative data on CS rates between 1990 to 2014 and calculated regional and subregional weighted averages. We conducted a longitudinal analysis calculating differences in CS rates as absolute change and as the average annual rate of increase (AARI). Results According to the latest data from 150 countries, currently 18.6% of all births occur by CS, ranging from 6% to 27.2% in the least and most developed regions, respectively. Latin America and the Caribbean region has the highest CS rates (40.5%), followed by Northern America (32.3%), Oceania (31.1%), Europe (25%), Asia (19.2%) and Africa (7.3%). Based on the data from 121 countries, the trend analysis showed that between 1990 and 2014, the global average CS rate increased 12.4% (from 6.7% to 19.1%) with an average annual rate of increase of 4.4%. The largest absolute increases occurred in Latin America and the Caribbean (19.4%, from 22.8% to 42.2%), followed by Asia (15.1%, from 4.4% to 19.5%), Oceania (14.1%, from 18.5% to 32.6%), Europe (13.8%, from 11.2% to 25%), Northern America (10%, from 22.3% to 32.3%) and Africa (4.5%, from 2.9% to 7.4%). Asia and Northern America were the regions with the highest and lowest average annual rate of increase (6.4% and 1.6%, respectively). Conclusion The use of CS worldwide has increased to unprecedented levels although the gap between higher- and lower-resource settings remains. The information presented is essential to inform policy and global and regional strategies aimed at optimizing the use of CS.

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The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014.

High-quality health systems in the Sustainable Development Goals era: time for a revolution

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00838-7.pdf

Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group

Introduction: In high-income countries, mortality rates have a twofold increment in subjects with diabetes compared to the general population. Few prospective studies have evaluated the impact of d...

Abstract P073: Diabetes and All Cause and Cause-specific Mortality in 111,300 Mexican Women With Healthcare Coverage

Background: Mexico is undergoing a fast-paced epidemiological and nutritional transition. Evaluating the presence of early cardiovascular disease and understanding risk factors leading to it in thi...

Abstract P112: Peripheral Arterial Disease and Carotid Atherosclerosis among Middle-aged Women Living in Chiapas, Mexico: Preliminary Results

Diabetes is associated with a higher risk of mortality among women in a middle-income country: Results form the Mexican Teacher's cohort study.

Introduction: Evidence from developed countries suggests that adult short stature may be associated with cardiometabolic disease in women. However, this association in low and middle-income settings remains unclear. Hypothesis: We assessed the hypothesis that stature is inversely associated with diabetes (DM) and high-blood pressure (hBP) in the Mexican setting. Methods: We conducted a cross-sectional analysis in a sample of 93,481 middle-aged Mexican female teachers, participants of the Mexican Teacher′s Cohort. In 2008 we asked all cohort participants to self report current height following specific measurement instructions. In a validation study we observed a person correlation coefficient of 0.84 between self-report and standardized measurement made by technician. We used a logistic multivariable regression models to estimate the Odds Ratio of self-reported DM or hBP in each stature quintile using the tallest quintile as the reference category. Results: After adjusting for birth cohort, ethnicity, fam...

Abstract P140: Association of Adult Stature With High Blood Pressure and Diabetes: A Cross-Sectional Study in Middle-Aged Mexican Women

Background and aims Sugar-sweetened soda consumption is associated with most cardiometabolic risk factors. The role of artificially-sweetened beverages in cardiovascular disease (CVD) is inconclusive, but their consumption correlates with health impairment. Little is known about the contribution of soda consumption in subclinical stages of atherosclerosis. Therefore, we evaluated the relation between sugar- and artificially-sweetened soda consumption and carotid intima-media thickness (IMT) among Mexican women. Methods and results We cross-sectionally evaluated 1093 women enrolled in the Mexican Teachers’ Cohort who were free of CVD, diabetes or cancer. Sugar- and artificially-sweetened soda consumption was estimated from a validated 140-item food frequency questionnaire in 2008 and all women underwent a carotid ultrasound assessment three years later. Participants were categorized into tertiles of soda consumption in servings/week. Subclinical atherosclerosis was defined as a mean left and/or right IMT ≥0.8 mm or the presence of plaque on either common carotid artery. In multivariable regression models, women in the highest tertile of sugar-sweetened soda consumption had 2.6% (95%CI: 0.8, 4.5) mean increased IMT, and had 2-fold the risk of carotid atherosclerosis (PR: 2.0, 95%CI: 1.3, 3.2) compared to those in the lowest tertile. In stratified analyses, older and postmenopausal women who consumed sugar-sweetened soda had an increased IMT and atherosclerosis risk. Artificially-sweetened soda consumption was not associated with IMT or carotid atherosclerosis. Conclusions Sugar-sweetened soda consumption was associated with subclinical atherosclerosis among disease-free Mexican women. Public health strategies to decrease CVD should consider the impact of sugar-sweetened soda consumption, particularly in older women. 

Eduardo Ortiz-Panozo

Papers

Abstract P073: Diabetes and All Cause and Cause-specific Mortality in 111,300 Mexican Women With Healthcare Coverage

Abstract P112: Peripheral Arterial Disease and Carotid Atherosclerosis among Middle-aged Women Living in Chiapas, Mexico: Preliminary Results

Diabetes is associated with a higher risk of mortality among women in a middle-income country: Results form the Mexican Teacher's cohort study.

Abstract P140: Association of Adult Stature With High Blood Pressure and Diabetes: A Cross-Sectional Study in Middle-Aged Mexican Women

Sugar- and artificially-sweetened soda consumption and subclinical atherosclerosis among Mexican women.