Cohort Profile

Pelotas is a city in the extreme south of Brazil, near the border of Uruguay, with 214 000 urban inhabitants in 1982. At the time, we were assistant professors, each working in one of the two medical schools in the city, and both undergoing post-graduate training at the University of London. We were inspired by the findings of the British perinatal study, and one of us (FCB) decided to do a similar study for his doctoral thesis. The lack of reliable data on perinatal mortality in Brazil, due to poor registration of births and deaths—particularly stillbirths—justified the launch of the study. Funding from the International Development Research Center (Canada) was obtained for the perinatal survey, which led to FCB's PhD thesis.1,2 While perinatal data collection was underway, we obtained a grant to visit a sub-sample of these newborns at the age of 12 months. Later funds were obtained for two visits to the entire cohort, at the approximate ages of 2 and 4 years. Little did we imagine that our study would eventually become one of the largest and longest running birth cohorts in the developing world.3 Initially, the study focus was on perinatal, infant, and early childhood morbidity and mortality. We were particularly interested in breastfeeding patterns and nutritional status, as well as social and environmental factors. Deaths of cohort members were identified by regular visits to all hospitals, cemeteries, offices of civil registrations, and local health authorities, since 1982. By mid-childhood, the study shifted in emphasis to child care, utilization of health services, selected morbidity indicators, and child development. A random sub-sample of 360 four-year-olds was selected for an in-depth study of psychomotor development. In adolescence, issues related to sexual and reproductive behaviours (including teenage pregnancies), habits such as smoking and alcohol drinking, mental health, and education became the focus of the investigation. A sub-study investigated oral health in a random sample of 900 adolescents, and an ethnographic study of 96 cohort members, stratified by sex and socioeconomic status, has included repeated in-depth visits from the age of 15 to 23 years, aimed at understanding the role of adolescent development in influencing high-risk behaviours. In more recent phases, with cohort members being young adults, the main emphasis has shifted to risk factors for chronic disease (including smoking, diet, physical exercise, and overweight), reproductive history, and mental health. During the whole of 1982, the three maternity hospitals in the city were visited daily and 7392 births were recorded. Of these, 6011 infants were born to mothers living in the urban area of Pelotas. Using data from birth registration and from a city census, we identified another 46 children who were delivered at home in 1982, so that our hospital sample accounts for 99.2% of all births in the city. The 5914 live born infants constitute our original cohort. Brazil is a country with wide social disparities, and a population-based sample covering the entire social spectrum allows the detailed study of long-term consequences of poverty on health. Follow-up procedures have been somewhat haphazard, depending on the availability of funding. Table 1 summarizes the main visits to the cohort. Earlier publications provide further details about each visit.4,5 Main phases of the Pelotas birth cohort study (reproduced with minor changes from ref. 5, with permission) This includes those known to have died for the 1983, 1984, 1986, 2000, and 2005 visits, and 27% of those known to have died for the 1997 and 2001 visits. Main phases of the Pelotas birth cohort study (reproduced with minor changes from ref. 5, with permission) This includes those known to have died for the 1983, 1984, 1986, 2000, and 2005 visits, and 27% of those known to have died for the 1997 and 2001 visits. In early 1983, the available funding was barely sufficient for visiting one-third of the cohort children. We opted for examining those born from January to April 1982, who were ∼1 year old at the time. This visit was funded by the World Health Organization. Using the addresses available from hospital records, we examined 1457 children who, added to those known to have died, comprised ∼80% of the target group (Table 1). We became quite worried about the loss of one-fifth of the cohort in a single year, and decided to change the search strategy in the next visits. The 1984 and 1986 visits were planned well in advance, and received substantial funding from the United Kingdom's Department for International Development (then known as Overseas Development Administration). The objective was to examine every cohort child who was still living in the urban area. Rather than relying on addresses, in early 1984 we decided to visit every household in the city in search of children born in 1982. This led to 87% of the original cohort being traced, a substantial improvement over the follow-up rate obtained a year earlier. Of those located, 45% of families had already changed addresses since the cohort child had been born, indicating a very high rate of mobility. The same approach was used in early 1986, leading to a follow-up rate of 84%. At that stage, we had a massive amount of data to analyse as a small research unit. Because our primary interest was in child health, we assumed that the cohort study had been completed and set out to write up our results and become involved in other studies. There was no new data collection until 1995, when we were approached by the United Nations Children's Fund (UNICEF) and Development Fund for Women (UNIFEM) to collect information on issues related to adolescent sexuality. Limited funds were available, and the addresses obtained in 1986 were used to trace a random sample of 1100 cohort members. Only 70% of them could be located. This visit renewed our interest in the cohort, and in 1997 we decided to apply a similar approach to that used in the city censuses of 1984 and 1986. As funds—this time from the Brazilian government—were not available to cover the whole city, we systematically selected 70 census tracts (27% of the total) and visited every household in those tracts. This led to 72% of the cohort members expected to be living in those tracts to be traced. A special opportunity for follow-up was provided by the compulsory Army recruitment examination, held in 2000. All cohort males who were still living in the city were legally required to attend a local Army base to undergo a physical examination in August and September. Our research team was deployed to the base and was able to examine 79% of males from the cohort. Funds from the Brazilian government supported this examination. 2001 marked the end of adolescence for the cohort. We had special interest in investigating the high rates of teenage childbearing in the cohort, and obtained funding from the World Health Organization for this purpose. Using the national computerized birth registration system put in place in the late 1990s, we identified over 400 of cohort women who had delivered an infant up to March 2001, and visited them at home. To obtain a comparison group for a case–control analysis, we revisited all households in the 70 census tracts from the 1997 sample and examined all cohort subjects living in these tracts. An extensive interview was carried out with women and a shorter version with men, who had already been examined in the Army in 2000. The follow-up rate was 69%. At this time, it was evident that we had the largest running birth cohort outside high-income countries, and our interest was renewed. We were able to obtain substantial funding from the Wellcome Trust to visit the whole cohort once again. From October 2004 to August 2005, we visited all 98 000 households in the city and located 3924 cohort members. The system for monitoring mortality had identified 282 deaths. For those who had not been located and were not known to have died, we used the last known address and existing databases (including universities, secondary schools, telephone directories) for another attempt. This allowed us to interview 4297 subjects. Added to those known to have died, these represent a follow-up rate of ∼77% in relation to the original cohort. We have carried out several analyses of attrition rates according to baseline characteristics.5 The pattern of follow-up varies slightly according to the search strategy used, but in general subjects born to middle-class families are easier to trace than those born in either the upper or lower ends of the social distribution. There are no consistent differences in follow-up according to sex, birthweight, or skin colour. Subjects born to unmarried mothers are consistently harder to trace than those born in wedlock. The 1982 questionnaire was extremely short. Owing to our lack of experience, we worried about having several sheets of paper that might become separated and decided to used the longest sheet of paper commercially available (a bit longer than A4 size) and restrict the questionnaire to both sides of this sheet. All the information contained in this form took 80 columns in a punch card, which also made it rather convenient. Table 2 shows the main categories of variables collected in the early phases of the study. In the hospital interview, mothers answered questions on socioeconomic, demographic, and health-related variables. Their infants were weighed with regularly calibrated paediatric scales (Filizolla, Brazil) to the nearest 10 g. Birth length was not recorded. Mothers were weighed and measured. Main variables collected in the early phases of the cohort study (1982–86) (reproduced with minor changes from ref. 5, with permission) Main variables collected in the early phases of the cohort study (1982–86) (reproduced with minor changes from ref. 5, with permission) As we grew more confident, our questionnaires grew longer—possibly too much so—and the examinations more thorough. Table 3 shows the main categories of variables included in recent visits. The questionnaires now include two forms, one applied by an interviewer and another self-applied confidential form that is identified only by a questionnaire number. Main variables collected in the late phases of the cohort study (1995–2005) (reproduced with minor changes from ref. 5, with permission) Males only (Army examination in 2000). Main variables collected in the late phases of the cohort study (1995–2005) (reproduced with minor changes from ref. 5, with permission) Males only (Army examination in 2000). In 2000, biological materials were collected from males (blood samples from which sera were extracted and frozen at −70°C) and in 2005 for both sexes (extracted DNA samples as well as sera). In 2000, males were weighed with an electronic Tanita Body Fat Analyzer scale (model TBF-305; Tokyo, Japan), which also provided information on body composition through bio-impedance. These results were validated in a sub-sample of 48 subjects by comparison with total body water estimated through isotopic methods.6 Ethical requirements evolved considerably during the study period. In the early phases, verbal consent was obtained, and there were no local ethical review committees. Recent phases comply with current requirements of ethical review and include written informed consent. Special provisions are made for the ethical use of biological materials. A full list of all publications to date from the study is available as supplementary data at IJE Online. The first publications from the cohort addressed perinatal issues, highlighting the magnitude of the problems of perinatal mortality and low birthweight, and describing risk factors for these outcomes.1,7,8 The extremely high rate of caesarean sections (28%) was also highlighted in the publications,9 as were infant mortality levels, causes, and risk factors.10–12 Infant feeding patterns and their influence on health has been a major theme in our study.13–16 Given the prospective nature of our data, it has been possible to avoid some of the biases arising from using recalled breastfeeding duration in retrospective cohorts, and to investigate the long-term effects of breastfeeding on health and educational attainment, while adjusting for several early life factors.17–19 During the childhood phase, we investigated issues related to malnutrition and infection,20,21 as well as the associations between health and nutrition outcomes with maternal education22 and birth spacing.23 A cross-cutting theme in our cohort study has been the effect of social inequalities on health.24 In 1988, our book entitled ‘Epidemiology of Inequality’ came out in Portuguese, addressing social differentials in terms of perinatal, infant, and childhood outcomes.25 Five thousand copies were sold, and the Spanish version was published by the Pan-American Health Organization in 1992. More recent publications address issues of adolescent health, including the current epidemics of overweight,26 adolescent pregnancy,27 and asthma.28 Much of our current work is aimed at investigating the effects of low birthweight (which we can separate into intrauterine growth restriction and preterm delivery) and growth in childhood on several outcomes. These include blood pressure,29 overweight,26 and lung function.28 Analyses are forthcoming on blood lipids, glycaemia, body composition, oral health, and educational achievement. Cohorts from low-income and middle-income countries are needed because findings are likely to differ from those obtained in developed countries. Some exposures may have different characteristics—for example, most physical activity among males in our cohort is from occupation, rather than from leisure time activities. Another example is breastfeeding—whereas non-breastfed babies in high-income countries are likely to receive infant formula, in our setting cow's milk is the main breast milk substitute so the results of comparisons of breastfed and artificially fed infants may differ between populations. Also, some exposures—for example low birthweight or childhood malnutrition—are much more common than in developed countries, and their long-term effects can be studied with greater precision. Finally, confounding factors may act in different directions in rich and poor countries. For example, while breastfeeding tends to be associated with high socioeconomic status in wealthy populations, the reverse is often the case in low-income and middle-income countries. As a consequence, residual confounding—a critical issue in the study of the effects of breastfeeding on adult health—may operate in different directions. A review by Harpman et al.3 identified our study as the largest and longest running prospective birth cohort study in a developing country. About 4000 variables are available for subjects seen in all phases of the study, including anthropometric measurements not only at birth but also at different ages in childhood. Other strengths include the population base and relatively high follow-up rates. Although the latter are considerably lower than some of the studies from developed countries, we have had to face the challenge of tracing people actively, rather than passively through national databases. Our success is largely related to the characteristics of the city. Pelotas is a middle-size city with relatively low rates of in-migration and out-migration. The number of annual births provides sufficient statistical power for the study, while being still logistically manageable. Also, concerns with personal and home security are not as manifest as in larger Latin American cities and refusals are rare. On the negative side, there are many things that we—given the benefit of hindsight—would have done differently. At the perinatal interview, we should have measured birth length and assessed gestational age through physical examination (∼20% of the mothers were unable to recall the dates of their last menstrual period). We collected data on family income as a grouped variable rather than recording it as a continuous variable. In retrospect, obtaining information on the whole cohort at a smaller number of visits would probably have been better than using sub-samples. To date, we have data on the entire cohort for the original perinatal interview, the 1984, 1986, and 2004–05 follow-up visits, as well as for the 2000 Army examination for males. The 1983, 1995, 1997, and 2001 visits were based on sub-samples, with different sampling approaches. This means that only a few hundred subjects have complete data from all follow-up visits. Some lessons were learned from the Pelotas cohort that may be relevant to other studies. A critical issue in all cohorts is that of attrition. Two successful strategies were used in our study: household sampling and Army enlistment. The first entailed visiting all, or a sample of, the city's households to identify individuals born in 1982, and later tracing them to their cohort records. The second included taking advantage of the compulsory Army enlistment process. Attempts at locating cohort members using available addresses, both in 1983 and in 1995, led to high rates of attrition. Lessons can also be learned regarding administrative and financial aspects of the study. Funding agency fatigue means that few are prepared to support more than one to two rounds of the study. This precluded a more regular schedule of visits, and sampling fractions were sometimes determined by availability of funds rather than by scientific principles, as for example in the 1983 and 1995 follow-ups. Large birth cohort studies present specific funding issues that should deserve special treatment by grant-making agencies. As cohort members reach adult age, it is likely that they will increasingly move out of the city, where job opportunities are scarce. This may lead to higher attrition in the near future. Alternative approaches will have to be conceived, including passive follow-up through death certificates and nested case–control studies, among others. Nevertheless, the large amount of data already available from the study will certainly lead to many additional analyses on health, behaviour, and development in childhood and adolescence. Eleven years after the first cohort, we started another study—the 1993 Pelotas Birth Cohort—including all births in the city. The original plan was to launch it in 1992, a decade later than the first study, but of course funding was delayed. This study is underway and 87% of them were traced at the age of 12 years. In years the 2004 birth cohort was The of three birth cohorts is a comparison of in child health, and in the in adolescent and adult Research involved in cohort studies have that it is not to the studies while at some of the are still We are it not only to our cohorts but also to from a new one every years. this for the Pelotas Birth We analyses of the cohort We have with from the of and of and and of as well as several Brazilian Our most have been from having doctoral or to Pelotas for a few at a time, to analyse data and For interested young from Latin we a post-graduate in in 2005, which now includes and PhD from the who receive full to work on our are For further information our at or This was supported by the Wellcome entitled for Latin on Health of Earlier phases of the 1982 cohort study were funded by the International Development Research Center the World Health Organization of and Health and and the Overseas Development the United Nations Development Fund for the for of the Research and the of Health Special to who us launch the study in early We would also to our many who in the several phases of the study, particularly and

Cohort · Cohort study · Child Nutrition and Water Access · Demography · Global Maternal and Child Health · Internal Medicine · Maternal and Neonatal Healthcare · Medicine

• International children's accelerometry database (Icad)

  Open Access•Lauren B Sherar, Pippa Griew et al.•BMC Public Health•2011

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• Socioeconomic trajectory from birth to adolescence and lung function

  Open Access•Ana M B Menezes, Ana MB Menezes et al.•BMC Public Health•2011

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• Factors associated with prevalence of oral lesions and oral self-examination in young adults from a birth cohort in Southern Brazil

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• Impact of stressful life events on central adiposity in the Pelotas Birth Cohort

  Open Access•Pamela J Surkan, Kwame S Sakyi et al.•Revista de Saúde Pública•2018

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• Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries

  Open Access•Joanne Katz, Anne CC Lee et al.•The Lancet•2013

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• Weight Gain in the First Two Years of Life Is an Important Predictor of Schooling Outcomes in Pooled Analyses from Five Birth Cohorts from Low- and Middle-Income Countries

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• Cohort Profile

  Inka Barnett, Proochista Ariana et al.•International Journal of…•2013

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  Polly Christian, Parul Christian et al.•International Journal of…•2013

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  Open Access•O Yaw Addo, Aryeh D Stein et al.•The Journal of Pediatrics•2013

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  Mark E Mcgovern, Aradhna Krishna et al.•International Journal of…•2017

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• Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age

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• Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults

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• Maternal and child undernutrition and overweight in low-income and middle-income countries

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  Open Access•Aline Alves Ferreira, J R Welch et al.•Annals of Human Biology•2016

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  Open Access•María Clara Restrepo–méndez, María C Restrepo-Méndez et al.•BMC Public Health•2011

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• Anthropometric indices for non-pregnant women of childbearing age differ widely among four low-middle income populations

  Open Access•K Michael Hambidge, Nancy F Krebs et al.•BMC Public Health•2017

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• Does objectively measured physical activity modify the association between early weight gain and fat mass in young adulthood

  Open Access•Elin Kolle, Bernardo L Horta et al.•BMC Public Health•2017

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• Change in body weight and body image in young adults

  Open Access•Gicele Costa Mintem, Denise P Gigante et al.•BMC Public Health•2015

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• Socioeconomic position and overweight among adolescents

  Open Access•Alícia Matijasevich, Cesar G Victora et al.•BMC Public Health•2009

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• Age at menarche associated with subsequent educational attainment and risk-taking behaviours

  Open Access•Lucia Calthorpe, Denise P Gigante et al.•Annals of Human Biology•2020

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• Epidemiology of interleukin-6

  Open Access•Francine Silva Dos Santos, Isabel Oliveira De Oliveira et al.•Annals of Human Biology•2021

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  Open Access•Farnaz Sabet, George C Patton et al.•PLOS Global Public Health•2026

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• Birth weight, postnatal weight gain, and adult body composition in five low and middle income countries

  Open Access•Christopher W Kuzawa, Bernardo L Horta et al.•American Journal of Human Biology•2012

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• Parental childhood growth and offspring birthweight

  Open Access•O Yaw Addo, Aryeh D Stein et al.•American Journal of Human Biology•2015

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• Growth patterns in early childhood and final attained stature

  Open Access•Aryeh D Stein, Meng Wang et al.•American Journal of Human Biology•2010

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• Life course weight gain and C‐reactive protein levels in young adults

  Open Access•Aydin Nazmi, David Gonzalez et al.•American Journal of Human Biology•2009

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• Ocorrência de síndrome metabólica em adultos jovens e desigualdades segundo sexo, cor da pele e posição socioeconômica

  Open Access•Ana Paula Oliveira Rosses, Gabriela Ávila Marques et al.•Cadernos de Saude Publica•2026

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• Occurrence of metabolic syndrome in young adults and inequalities according to sex, skin color, and socioeconomic status

  Open Access•Ana Paula Oliveira Rosses, Gabriela Ávila Marques et al.•Cadernos de Saude Publica•2026

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• Adolescent Sex and Psyche in Brazil

  Open Access•Dominque P Behague•Culture Medicine and Psychiatry•2019

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• Sociodemographic and lifestyle characteristics in relation to dietary patterns among young Brazilian adults

  Open Access•Maria Teresa Anselmo Olinto, Walter C Willett et al.•Public Health Nutrition•2011

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• Life-course socio-economic factors, skin colour and abdominal obesity in adulthood in a Brazilian birth cohort

  Open Access•David Alejandro González, Aydin Nazmi et al.•Public Health Nutrition•2009

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• Association of family income with BMI from childhood to adult life

  Open Access•Denise P Gigante, Cesar G Victora et al.•Public Health Nutrition•2013

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• Association of socioeconomic position with maternal pregnancy and infant health outcomes in birth cohort studies from Brazil and the UK

  Open Access•Alícia Matijasevich, Cesar G Victora et al.•Journal of Epidemiology and…•2012

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• Gestational age and newborn size according to parental social mobility

  Open Access•Denise P Gigante, Bernardo L Horta et al.•Journal of Epidemiology and…•2015

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• Early life diarrhoea and later blood pressure in a developing country

  Open Access•George David Batty, Bernardo L Horta et al.•Journal of Epidemiology and…•2009

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• The Influence of Family Income Trajectories From Birth to Adulthood on Adult Oral Health

  Marco A Peres, Karen Glazer De Anselmo Peres et al.•American Journal of Public Health•2011

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• Consumption of ultra-processed foods and their impact on the diet of young adults

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• Growth patterns in early childhood and the onset of menarche before age twelve

  Open Access•Jeovany Martinez-Mesa, Jeovany Martínez et al.•Revista de Saúde Pública•2010

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• Prevalência e determinantes precoces dos transtornos mentais comuns na coorte de nascimentos de 1982, Pelotas, RS

  Open Access•Luciana Anselmi, Fernando C Barros et al.•Revista de Saúde Pública•2008

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• Fatores associados ao sedentarismo no lazer de adultos na coorte de nascimentos de 1982, Pelotas, RS

  Open Access•Mario R Azevedo, Bernardo L Horta et al.•Revista de Saúde Pública•2008

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• Utilização de serviços de saúde por adultos da coorte de nascimentos de 1982 a 2004-5, Pelotas, RS

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• Educação e trabalho na coorte de nascimentos de 1982 a 2004-5, Pelotas, RS

  Open Access•Fernando C Barros, Denise P Gigante et al.•Revista de Saúde Pública•2008

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• Determinantes precoces da glicemia casual em adultos da coorte de nascimentos de 1982, Pelotas, RS

  Open Access•Bernardo L Horta, Denise P Gigante et al.•Revista de Saúde Pública•2008

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• Maternidade e paternidade na coorte de nascimentos de 1982 a 2004-5, Pelotas, RS

  Open Access•Denise P Gigante, Fernando C Barros et al.•Revista de Saúde Pública•2008

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• Prevalência de chiado no peito em adultos da coorte de nascimentos de 1982, Pelotas, RS

  Open Access•Ana M B Menezes, Rosângela C Lima et al.•Revista de Saúde Pública•2008

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• Avaliação nutricional de adultos da coorte de nascimentos de 1982, Pelotas, RS

  Open Access•Denise P Gigante, Gicele C Minten et al.•Revista de Saúde Pública•2008

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• Tabagismo na coorte de nascimentos de 1982

  Open Access•Ana M B Menezes, Gicele C Minten et al.•Revista de Saúde Pública•2008

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• Oral health studies in the 1982 Pelotas (Brazil) birth cohort

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• Premenstrual symptoms and syndrome according to age at menarche in a 1982 birth cohort in southern Brazil

  Open Access•Celene Maria Longo Da Silva, Denise P Gigante et al.•Cadernos de Saude Publica•2008

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• Methods used in the 1982, 1993, and 2004 birth cohort studies from Pelotas, Rio Grande do Sul State, Brazil, and a description of the socioeconomic conditions of participants' families

  Open Access•Aluísio J D Barros, Iná S Santos et al.•Cadernos de Saude Publica•2008

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• The 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

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• Perfil lipídico na adolescência

  Open Access•María Clara Restrepo, María Clara Restrepo–méndez et al.•Cadernos de Saude Publica•2009

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• Efeitos das condições climáticas no trimestre de nascimento sobre asma e pneumonia na infância e na vida adulta em uma coorte no Sul do Brasil

  Open Access•David Alejandro González, Cesar G Victora et al.•Cadernos de Saude Publica•2008

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• Excesso de peso/obesidade no ciclo da vida e composição corporal na idade adulta

  Open Access•Gabriela Callo, Denise P Gigante et al.•Cadernos de Saude Publica•2016

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• Evolução do excesso de peso e obesidade até a idade adulta, Pelotas, Rio Grande do Sul, Brasil, 1982-2012

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• Breastfeeding and cardiometabolic risk factors in adulthood

  Open Access•Natália Peixoto Lima, Janaína Vieira Dos Santos Motta et al.•Cadernos de Saude Publica•2025

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• Association of breastfeeding, maternal anthropometry and body composition in women at 30 years of age

  Open Access•Natália Peixoto Lima, Diego G Bassani et al.•Cadernos de Saude Publica•2019

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• Social and racial inequity in self-rated oral health in adults in Southern Brazil

  Open Access•Sarah Arangurem Karam, Helena Silveira Schuch et al.•Cadernos de Saude Publica•2022

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• RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís)

  Open Access•Susana Cararo Confortin, Marizélia Rodrigues Costa Ribeiro et al.•Cadernos de Saude Publica•2021

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• Birth conditions nutritional status in childhood associated with cardiometabolic risk factors at 30 years of age

  Open Access•Vânia Pereira Oliveira, Mariane Da Silva Dias et al.•Cadernos de Saude Publica•2023

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• Lifecourse socioeconomic trajectories and C-reactive protein levels in young adults

  Open Access•Aydin Nazmi, Isabel O Oliveira et al.•Social Science & Medicine•2010

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• Taming troubled teens

  Open Access•Dominque P Behague, Helen Denise Gonçalves Da Silva et al.•Social Science & Medicine•2012

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• Psychiatry, bio-epistemes and the making of adolescence in southern Brazil

  Open Access•Dominque P Behague, Dominique Pareja Béhague•História Ciências Saúde-Manguinhos•2016

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• Epidemic of caesarean sections in Brazil

  Open Access•Fernando C Barros, Cesar G Victora et al.•The Lancet•1991

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• The challenge of reducing neonatal mortality in middle-income countries

  Open Access•Fernando C Barros, Cesar G Victora et al.•The Lancet•2005

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• Explaining trends in inequities

  Open Access•Cesar G Victora, J Patrick Vaughan et al.•The Lancet•2000

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• Risk factors for childbearing during adolescence in a population-based birth cohort in southern Brazil

  Open Access•Denise P Gigante, Cesar G Victora et al.•Revista Panamericana de Salud…•2004

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• Do Risk Factors for Childhood Infections and Malnutrition Protect Against Asthma? A Study of Brazilian Male Adolescents

  Rosângela C Lima, Cesar G Victora et al.•American Journal of Public Health•2003

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• Estudo longitudinal das crianças nascidas em 1982 em Pelotas, RS, Brasil

  Open Access•Cesar G Victora, Fernando C Barros et al.•Revista de Saúde Pública•1985

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• The Pelotas birth cohort study, Rio Grande do Sul, Brazil, 1982-2001

  Open Access•Cesar G Victora, Fernando C Barros et al.•Cadernos de Saude Publica•2003

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• Maternal education in relation to early and late child health outcomes

  Open Access•Cesar G Victoria, Sharon R A Huttly et al.•Social Science & Medicine•1992

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