Prevalence and Risk Factors for Dental Caries among Preschool Children: A Cross-sectional Study in Eastern India
Vinay K Chugh, Kushal K Sahu, Ankita Chugh
Breastfeeding, Dental caries, Oral hygiene behavior, Preschool children
Citation Information :
Chugh VK, Sahu KK, Chugh A. Prevalence and Risk Factors for Dental Caries among Preschool Children: A Cross-sectional Study in Eastern India. Int J Clin Pediatr Dent 2018; 11 (3):238-243.
Introduction: Dental caries is one of the major widespread health issues that continue to negatively affect the oral health of children globally.
Aim: To estimate the prevalence of dental caries and its risk factors among preschool children of Bhubaneswar, Odisha, India.
Materials and methods: The study was a community-based cross-sectional one among preschool children with (N = 425) participants recruited from the Anganwadi centers (AWCs) of Bhubaneswar, Odisha, India. By using a cross-sectional study design, dental caries was assessed using the World Health Organization (WHO) guidelines, and other socioeconomic and risk factors data were collected through parental interview using questionnaires. Caries was identified at both tooth and surface levels through visual dental examinations by trained and calibrated dentists. Logistic regression analyses were used to identify associations among variables and caries.
Results: The proportion of preschool children suffering from dental caries was found to be 47.29%. The multivariableadjusted model depicted that longer duration of breastfeeding was a significant predictor as follows: Those who had breastfed for more than 36 months [adjusted odds ratio (AOR): 5.41; 95% confidence interval (CI): 2.97–9.85; p = 0.001], 12 to 24 months (AOR: 2.1; 95% CI: 1.04–4.36; p = 0.037), followed by increase in age 61 to 72 months (AOR: 5.39; 95% CI: 2.72–10.67; p = 0.001), 49 to 60 months (AOR: 2.53; 95% CI: 1.41–4.52; p = 0.002), more than two children in the family (AOR: 2.70; 95% CI: 1.55–4.69; p = 0.001), and children who did not brush the teeth under the parent's supervision (AOR: 2.70; 95% CI: 1.55–4.69; p = 0.001).
Conclusion: The study highlights the need to increase awareness about the oral health and hygiene among parents of preschool children in India.
Javed F, Feng C, Kopycka-Kedzierawski DT. Incidence of early childhood caries: A systematic review and meta-analysis. J Investig Clin Dent [Internet] 2016;(August):1-6. Available from: http://doi.wiley.com/10.1111/jicd.12238.
Perera PJ, Abeyweera NT, Fernando MP, Warnakulasuriya TD, Ranathunga N. Prevalence of dental caries among a cohort of preschool children living in Gampaha district, Sri Lanka: a descriptive cross sectional study. BMC Oral Health [Internet]. BMC Oral Health 2012 Nov 13;12(1):49. Available from: http://www.biomedcentral.com/1472-6831/12/49.
Ali M. Early Childhood Caries in children 12-24 months old in Mitchell's Plain, South Africa. University of the Western Cape; 2008.
Dawani N, Nisar N, Khan N, Syed S, Tanweer N. Prevalence and factors related to dental caries among pre-school children of Saddar town, Karachi, Pakistan: a cross-sectional study. BMC Oral Health [Internet]. BMC Oral Health 2012 Dec 27;12:59. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3543838&tool=pmcentrez&rendertype=abstract.
Congiu G, Campus G, Lugliè PF. Early Childhood Caries (ECC) prevalence and background factors: a review. Oral Health Prev Dent 2014;12(1):71-76.
Yadav K, Prakash S. Dental caries: a review. Asian J Biomed Pharm Sci 2016;53(6):1-7.
Kumarihamy SL, Subasinghe LD, Jayasekara P, Kularatna SM, Palipana PD. The prevalence of Early Childhood Caries in 1-2 yrs olds in a semi-urban area of Sri Lanka. BMC Res Notes [Internet] 2011 Sep 9;4(336):1-6. Available from: http://www. pubmedcentral.nih.gov/articlerender.fcgi?artid=3228513&to ol=pmcentrez&rendertype=abstract.
Aas JA, Griffen AL, Dardis SR, Lee AM, Olsen I, Dewhirst FE, Leys EJ, Paster BJ. Bacteria of dental caries in primary and permanent teeth in children and young adults. J Clin Microbiol 2008 Apr;46(4):1407-1417.
Gaur S, Nayak R. Underweight in low socioeconomic status preschool children with severe early childhood caries. J Indian Soc Pedod Prev Dent [Internet] 2011 Oct-Dec;29(4):305-309. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/22016314.
Kato T, Yorifuji T, Yamakawa M, Inoue S, Saito K, Doi H, Kawachi I. Association of breast feeding with early childhood dental caries: Japanese population-based study. BMJ Open [Internet] 2015 Mar 20;5(3):e006982. Available from: http:// www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4368 903&tool=pmcentrez&rendertype=abstract.
Prakash P, Subramaniam P, Durgesh BH, Konde S. Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: a cross-sectional study. Eur J Dent 2012 Apr;6(2):141-152.
Operations District of Census, ODISHA. District census handbook; 2011. p. 24.
Dogan D, Dülgergil Ç, Mutluay A, Yildirim I, Hamidi M, Çolak H. Prevalence of caries among preschool-aged children in a central Anatolian population. J Nat Sci Biol Med [Internet] 2013 Jul;4(2):325-329. Available from: http://www.jnsbm. org/text.asp?2013/4/2/325/116995.
Prakasha Shrutha S, Vinit GB, Giri KY, Alam S. Feeding practices and early childhood caries: a cross-sectional study of preschool children in Kanpur district, India. ISRN Dent [Internet] 2013 Dec 5;2013:275193. Available from: http:// www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3870 076&tool=pmcentrez&rendertype=abstract.
Singh S, Vijayakumar N, Priyadarshini HR, Shobha M. Prevalence of early childhood caries among 3-5 year old preschoolers in schools of Marathahalli, Bangalore. Dent Res J (Isfahan) 2014;9(6):710-714.
Khatib N, Zodpey S, Zahiruddin Q, Gaidhane A, Patil M. Prevalence and determinant of early childhood caries among the children attending the Anganwadis of Wardha district, India. Indian J Dent Res [Internet] 2013 Mar- Apr;24(2):199-205. Available from: http://www.ijdr.in/text. asp?2013/24/2/199/116677.
Masumo R, Bardsen A, Mashoto K, Åstrøm AN. Prevalence and socio-behavioral influence of early childhood caries, ECC, and feeding habits among 6-36 months old children in Uganda and Tanzania. BMC Oral Health [Internet] 2012 Jul 26;12(1):24. Available from: http://www.pubmedcentral.nih. gov/articlerender.fcgi?artid=3434064&tool=pmcentrez&rend ertype=abstract.
Begzati A, Berisha M, Meqa K. Early childhood caries in preschool children of Kosovo—a serious public health problem. BMC Public Health [Internet] 2010 Dec 24;10(1):788-795. Available from: http://www.biomedcentral.com/1471- 2458/10/788.
Awooda EM. Caries prevalence among 3-5 years old children in Khartoum state—Sudan. Innov J Med Heal Sci [Internet] 2013;3(2):42-44. Available from: http://innovativejournal.in/ index.php/ijmhs/article/view/476.
Mahejabeen R, Sudha P, Kulkarni SS, Anegundi R. Dental caries prevalence among preschool children of Hubli: Dharwad city. J Indian Soc Pedod Prev Dent 2006 Mar;24(1):19-22.
Pitts NB, Boyles J, Nugent ZJ, Thomas N, Pine CM. The dental caries experience of 5-year-old children in Great Britain (2005/6). Surveys co-ordinated by the British Association for the study of community dentistry. Community Dent Health 2007 Mar;24(1):59-63.
Shah AF, Batra M, Aggarwal V, Dany SS, Rajput P, Bansal T. Prevalence of early childhood caries among preschool children of low socioeconomic status in district Srinagar, Jammu and Kashmir. Int Arch Integr Med [Internet] 2015;2(3): 8-13. Available from: http://iaimjournal.com/wp-content/ uploads/2015/03/2-Prevalence-of-early-childhoodcaries. pdf.
Kurian J, Renganathan S, Gurusamy K, Shivashankarappa PG. Association between early childhood caries and age and gender specific height, weight and mid upper arm circumference of school children in Puducherry—“a comparative study”. Biol Med Eng Sci Rep 2016;2(1):13-17.
Hallett KB, O'Rourke PK. Social and behavioural determinants of early childhood caries. Aust Dent J 2003 Mar;48(1):27-33.
Wellappuli N, Amarasena N. Influence of family structure on dental caries experience of preschool children in Sri Lanka. Caries Res 2012;46(3):208-212.
Correa-Faria P, Martins-Junior PA, Vieira-Andrade RG, Marques LS, Ramos-Jorge ML. Factors associated with the development of early childhood caries among Brazilian preschoolers. Braz Oral Res [Internet] 2013 Jul;27(4):356-362. Available from: http://www.scielo.br/scielo.php?script=sci_ arttext&pid=S1806-83242013000400356&lng=en&nrm=iso&t lng=en.
Azevedo TD, Bezerra AC, de Toledo OA. Feeding habits and severe early childhood caries in Brazilian preschool children. Pediatr Dent 2005 Jan-Feb;27(1):28-33.
Olatosi OO, Sote EO. Association of Early childhood caries with breastfeeding and bottle feeding in Southwestern Nigerian children of preschool age. J West African Coll Surg 2014 Jan-Mar;4(1):31-53.
Ribeiro NM, Ribeiro MA. Aleitamento materno e cárie do lactente e do pré-escolar: uma revisão crítica. J Pediatr (Rio J) [Internet] 2004 Nov;80(5):s199-s210. Available from: http:// www.scielo.br/scielo.php?script=sci_arttext&pid=S0021- 75572004000700012&lng=pt&nrm=iso&tlng=pt.
Desai M, Messer LB, Calache H. A study of the dental treatment needs of children with disabilities in Melbourne, Australia. Aust Dent J 2001 Mar;46(1):41-50.
Mc Donald, RE.; Avery, DR. Dentistry for the child and adolescent. 6th ed. St. Louis (MO): Mosby-Yea Brook, Inc; 1994. pp. 601-605, 611.
Kopel HM. The autistic child in dental practice. ASDCJ Dent Child 1977 Jul-Aug;44(4):302-309.
Myers SM, Johnson CP; The American Academy of Pediatrics Council on Children with Disabilities. Management of children with autism spectrum disorders. Pediatrics 2007 Nov;120(5):1162-1182.
Shapiro M, Sgan-Cohen HD, Parush S, Melmed RN. Influence of adapted environment on the anxiety of medically treated children with developmental disability. J Pediatr 2009 Apr;154(4):546-550.
Jindal R, Karda B. Autistic child does management differ? Int J Contemp Dent 2011 Aug;2(4):31-34.
Raposa KA. Behavioral management for patient with intellectual and development disorder. Dent Clin N Am 2009 Apr;53(2):359-373.
Loo CY, Graham RM, Hughes CV. Behaviour guidance in dental treatment of patients with autism spectrum disorder. Int J Paediatr Dent 2009 Nov;19(6):390-398.
Swallow JN. The dental management of autistic children. Br Dent J 1969 Feb;126(3):128-131.
Burkhart N. Understanding and managing the autistic child in the dental office. Dent Hyg (Chic) 1984 Feb;58(2):60-63.
Delli K, Reichart PA, Bornstein MM, Livas C. Management of children with autism spectrum disorder in the dental setting: Concerns, behavioural approaches and recommendations. Med Oral Patol Oral Cir Bucal 2013 Nov;18(6):e862-e868.
American Acaedemy of pediatric Dentistry: Clinical affairs committee. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent 2008-2009;30(7 Suppl):125-133.
Klingberg, G. Behavior management—children and adolescents. In: Nunn J, editor. Disability and oral care. London: FDI Dental Press; 2000. pp. 82-92.
Lowe O, Jedrychowski JR. A sedation technique for autistic patients who require dental treatment. Spec Care Dentist 1987 Nov;7(6):267-270.
Glandin T. Calming effect of deep touch pressure in patients with Autistic disorder. J Child Adolesc Psychopharmacol 1992 Spring;2(1):63-72.
Grandin, T. Thinking in pictures. New York: Doubleday; 1995.
Depalma, AM.; Roposa, KA. Building bridges—part 2: understanding and guiding the dental patients with autism. Chesterland (OH): Academy of Dental Therapeutics and Stomatology; 2012. [cited 2012 Jun 2]. Available from: www. ineedce.com.
Stein LI, Polido JC, Mailloux Z, Coleman GG, Cermak SA. Oral care and sensory sensitivities in children with autism spectrum disorders. Spec Care Dentist 2011 May-Jun;31(3):102-110.
Hernandez P, Ikkanda Z. Applied behavior analysis: behavior management of children with autism spectrum disorders in dental environments. J Am Dent Assoc 2011 Mar;142(3): 281-287.
Newton JT, Shah S, Patel H, Sturmey P. Non-pharmacological approaches to behaviour management in children. Dent Update 2003 May;30(4):194-199.
Brill WA. Parent's assessment and children's reactions to a passive restraint device used for behavior control in a private pediatric dental practice. J Dent Child 2002 Sep-Dec;69(3):310-313.
Leung CM, Lai LSW, Wong WH, Chan KH, Luk YW, Lai JY, Yeung YW, Hui WM. Non-alcoholic fatty liver disease: an expanding problem with low levels of awareness in Hong Kong. J Gastroenterol Hepatol 2009 Nov;24(11):1786-1790.
Grattagliano I, D'Ambrosio G, Palmieri VO, Moschetta A, Palasciano G, Portincasa P; “Steatostop Project” Group. Improving nonalcoholic fatty liver disease management by general practitioners: a critical evaluation and impact of an educational training program. J Gastrointest Liver Dis 2008 Dec;17(4):389-394.
Kallman JB, Arsalla A, Park V, Dhungel S, Bhatia P, Haddad D, Wheeler A, Younossi ZM. Screening for hepatitis B, C and non-alcoholic fatty liver disease: a survey of communitybased physicians. Aliment Pharmacol Ther 2009 May; 29(9):1019-1024.
Singh SP, Misra B, Misra D, Pati GK, Singh A, Kar SK, Panigrahi MK, Meher C, Agrawal O. P841 Awareness and opinion of nonalcoholic fatty liver disease (NAFLD) patients about obesity and its consequences. J Hepatol 2014 Apr;60(1):S352.
Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001 May;344(18):1343-1350.
Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002 Feb;346(6):393-403.
Bae JC, Suh S, Park SE, Rhee EJ, Park CY, Oh KW, Park SW, Kim SW, Hur KY, Kim JH, et al. Regular exercise is associated with a reduction in the risk of NAFLD and decreased liver enzymes in individuals with NAFLD independent of obesity in Korean adults. PLoS One 2012 Oct;7(10):e46819.
Perseghin G, Lattuada G, De Cobelli F, Ragogna F, Ntali G, Esposito A, Belloni E, Canu T, Terruzzi I, Scifo P, et al. Habitual physical activity is associated with intrahepatic fat content in humans. Diabetes Care 2007 Mar;30(3):683-688.
Lawlor DA, Sat tar N, Smith GD, Ebrahim S. The associations of physical activity and adiposity with alanine aminotransferase and gamma-glutamyltransferase. Am J Epidemiol 2005 Jun;161(11):1081-1088.
Zelber-Sagi S, Nitzan-Kaluski D, Goldsmith R, Webb M, Zvibel I, Goldiner I, Blendis L, Halpern Z, Oren R. Role of leisuretime physical activity in nonalcoholic fatty liver disease: a population-based study. Hepatology 2008 Dec;48(6):1791-1798.
Dalle Grave R, Calugi S, Centis E, El Ghoch M, Marchesini G. Cognitive-behavioral strategies to increase the adherence to exercise in the management of obesity. J Obesity 2011 Oct;2011:348293.
National Heart, Lung, and Blood Institute. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Bethesda (MD): National Institutes of Health; 2000.
Trovato FM, Martines GF, Brischetto D, Catalano D, Musumeci G, Trovato GM. Fatty liver disease and lifestyle in youngsters: diet, food intake frequency, exercise, sleep shortage and fashion. Liver Int 2016 Mar;36(3):427-433.
Park HS, Jang JE, Ko MS, Woo SH, Kim BJ, Kim HS, Park HS, Park IS, Koh EH, Lee KU. Statins increase mitochondrial and peroxisomal fatty acid oxidation in the liver and prevent non-alcoholic steatohepatitis in mice. Diabetes Metab J 2016 Oct;40(5):376-385.
Athyros VG, Boutari C, Stavropoulos K, Anagnostis P, Imprialos KP, Doumas M, Karagiannis A. Statins: an underappreciated asset for the prevention and the treatment of NAFLD or NASH and the related cardiovascular risk. Curr Vasc Pharmacol 2017 Jun;15:1-28.
Kostapanos MS, Kei A, Elisaf MS. Current role of fenofibrate in the prevention and management of non-alcoholic fatty liver disease. World J Hepatol 2013 Sep;5(9):470-478.
Shiri-Sverdlov R, Wouters K, van Gorp PJ, Gijbels MJ, Noel B, Buffat L, Staels B, Maeda N, van Bilsen M, Hofker MH. Early diet-induced non-alcoholic steatohepatitis in APOE2 knock-in mice and its prevention by fibrates. J Hepatol 2006 Apr;44(4):732-741.
Brandi G, De Lorenzo S, Candela M, Pantaleo MA, Bellentani S, Tovoli F, Saccoccio G, Biasco G. Microbiota, NASH, HCC and the potential role of probiotics. Carcinogenesis 2017 Mar;38(3):231-240.
Anderson EL, Howe LD, Fraser A, Callaway MP, Sattar N, Day S, Tilling K, Lawlor DA. Weight trajectories through infancy and childhood and risk of non-alcoholic fatty liver disease in adolescence: the ALSPAC study. J Hepatol 2014 Sep;61(3):626-632.
Ayonrinde OT, Olynyk JK, Marsh JA, Beilin LJ, Mori TA, Oddy WH, Adams LA. Childhood adiposity trajectories and risk of nonalcoholic fatty liver disease in adolescents. J Gastroenterol Hepatol 2015 Jan;30(1):163-171.
Sandboge S, Perala MM, Salonen MK, Blomstedt PA, Osmond C, Kajantie E, Barker DJ, Eriksson JG. Early growth and non-alcoholic fatty liver disease in adulthood-the NAFLD liver fat score and equation applied on the Helsinki Birth Cohort Study. Ann Med 2013 Sep;45(5-6):430-437.
Zimmermann E, Gamborg M, Holst C, Baker JL, Sørensen TI, Berentzen TL. Body mass index in school-aged children and the risk of routinely diagnosed non-alcoholic fatty liver disease in adulthood: a prospective study based on the Copenhagen School Health Records Register. BMJ Open 2015 May;5(4):e006998.
Reece EA, Hagay Z, Roberts AB, DeGennaro N, Homko CJ, Connolly-Diamond M, Sherwin R, Tamborlane WV, Diamond MP. Fetal Doppler and behavioral responses during hypoglycemia induced with the insulin clamp technique in pregnant diabetic women. Am J Obstet Gynecol 1995 Jan;172(1 Pt 1):151-155.
Patrick J, Campbell K, Carmichael L, Natale R, Richardson B. Patterns of gross fetal body movements over 24-hour observation intervals during the last 10 weeks of pregnancy. Am J Obstet Gynecol 1982 Feb;142(4):363-371.
Ornoy A, Ratzon N, Greenbaum C, Peretz E, Soriano D, Dulitzky M. Neurobehavior of school age children born to diabetic mothers. Arch Dis Child Fetal Neonatal Ed 1998 Sep;79(2):F94-F99.
Wolf, A. Developmental evaluation on early school age children born to gestational diabetic mothers. Israel: Hebrew University; 1997.
Mulder EJ, Leiblum DM, Visser GH. Fetal breathing movements in late diabetic pregnancy: relationship to fetal heart rate patterns and Braxton Hicks’ contractions. Early Hum Dev 1995 Nov;43(3):225-232.
Schulte FJ, Michaelis R, Nolte R, Albert G, Parl U, Lasson U. Brain and behavioral maturation in newborn infants of diabetic mothers. I. Nerve conduction and EEG patterns. Neuropadiatrie 1969 Jan-Jul;1(1):24-35.
Devoe LD, Youssef AA, Castillo RA, Croom CS. Fetal biophysical activities in third-trimester pregnancies complicated by diabetes mellitus. Am J Obstet Gynecol 1994 Aug;171(2):298-303.
Dierker LJ Jr, Pillay S, Sorokin Y, Rosen MG. The change in fetal activity periods in diabetic and nondiabetic pregnancies. Am J Obstet Gynecol 1982 May;143(2):181-185.
Doherty NN, Hepper PG. Habituation in fetuses of diabetic mothers. Early Hum Dev 2000 Aug;59(2):85-93.
Kainer F, Prechtl HF, Engele H, Einspieler C. Assessment of the quality of general movements in fetuses and infants of women with type-1 diabetes mellitus. Early Hum Dev 1997 Nov;50(1):13-25.
Mulder EJ, O'Brien MJ, Lems YL, Visser GH, Prechtl HF. Body and breathing movements in near-term fetuses and newborn infants of type-1 diabetic women. Early Hum Dev 1990 Nov;24(2):131-152.
Mulder EJ, Visser GH. Growth and motor development in fetuses of women with type-1 diabetes. I. Early growth patterns. Early Hum Dev 1991 May;25(2):91-106.
Mulder EJ, Visser GH. Growth and motor development in fetuses of women with type-1 diabetes. II. Emergence of specific movement patterns. Early Hum Dev 1991 May;25(2):107-115.
Mulder EJ, Visser GH. Impact of early growth delay on subsequent fetal growth and functional development: a study on diabetic pregnancy. Early Hum Dev 1992 Dec;31(2):91-95.
Mulder EJ, Visser GH, Bekedam DJ, Prechtl HF. Emergence of behavioral states in fetuses of type-1 diabetic women. Early Hum Dev 1987 Jul;15(4):231-251.
Mulder EJ, Visser GH, Morssink LP, de Vries JI. Growth and motor development in fetuses of women with type-1 diabetes. III. First trimester quantity of fetal movement patterns. Early Hum Dev 1991 May;25(2):117-133.
Aberg A, Westbom L, Kallen B. Congenital malformations among infants whose mothers had gestational diabetes or preexisting diabetes. Early Hum Dev 2001 Mar;61(2):85-95.
Deregnier RA, Nelson CA, Thomas KM, Wewerka S, Georgieff MK. Neurophysiologic evaluation of auditory recognition memory in healthy newborn infants and infants of diabetic mothers. J Pediatr 2000 Dec;137(6):777-784.
Nelson CA, Wewerka S, Thomas KM, Tribby-Walbridge S, deRegnier R, Georgieff M. Neurocognitive sequelae of infants of diabetic mothers. Behav Neurosci 2000 Oct;114(5):950-956.
Reece EA, Homko CJ. Infant of the diabetic mother. Semin Perinatol 1994 Oct;18(5):459-469.
Reece EA, Homko CJ. Why do diabetic women deliver malformed infants? Clin Obstet Gynecol 2000 Mar;43(1):32-45.
Rizzo T, Metzger BE, Burns WJ, Burns K. Correlations between antepartum maternal metabolism and intelligence of offspring. N Engl J Med 1991 Sep;325(13):911-916.
Rizzo TA, Metzger BE, Dooley SL, Cho NH. Early malnutrition and child neurobehavioral development: insights from the study of children of diabetic mothers. Child Dev 1997 Feb;68(1):26-38.
Schwartz R, Teramo KA. Effects of diabetic pregnancy on the fetus and newborn. Semin Perinatol 2000 Apr;24(2):120-135.
Vaarasmaki MS, Hartikainen A, Anttila M, Pramila S, Koivisto M. Factors predicting peri- and neonatal outcome in diabetic pregnancy. Early Hum Dev 2000 Jul;59(1):61-70.
Robertson SS, Dierker LJ. Fetal cyclic motor activity in diabetic pregnancies: sensitivity to maternal blood glucose. Dev Psychobiol 2003 Jan;42(1):9-16.
Accardo PJ, Blondis TA, Whitman BY. Disorders of attention and activity level in a referral population. Pediatrics 1990 Mar;85(3 Pt 2):426-431.
Ornoy A, Uriel L, Tennenbaum A. Inattention, hyperactivity and speech delay at 2-4 years of age as a predictor for ADDADHD syndrome. Isr J Psychiatry Relat Sci 1993;30(3):155-163.
Smyth TR. Impaired motor skill (clumsiness) in otherwise normal children: a review. Child Care Health Dev 1992 Sep-Oct;18(5):283-300.
Petersen MB, Pedersen SA, Greisen G, Pedersen JF, Mølsted- Pedersen L. Early growth delay in diabetic pregnancy: relation to psychomotor development at age 4. Br Med J (Clin Res Ed) 1988 Feb;296(6622):598-600.
Sells CJ, Robinson NM, Brown Z, Knopp RH. Long-term developmental follow-up of infants of diabetic mothers. J Pediatr 1994 Jul;125(1):S9-S17.
Vladareanu R, Lebit D, Constantinescu S. Ultrasound assessment of fetal neurobehaviour in high risk pregnancies. DSJUOG 2012 Apr-Jun;6(2):132-147.
Talic A, Kurjak A, Ahmed B, Stanojevic M, Predojevic M, Kadic AS, Di Renzo GC. The potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies. J Matern Fetal Neonatal Med 2011 Jul;24(7):948-954.
Bekedam DJ, Visser GH, de Vries JJ, Prechtl HF. Motor behaviour in the growth retarded fetus. Early Hum Dev 1985 Nov;12(2):155-165.
Cioni G, Prechtl HF. Preterm and early postterm motor behaviour in low-risk premature infants. Early Hum Dev 1990 Sep;23(3):159-191.
Seme-Ciglenecki P. Predictive value of assessment of general movements for neurological development of highrisk preterm infants: comparative study. Croat Med J 2003 Dec;44(6):721-727.
Abo-Yaqoub S, Kurjak A, Mohammed AB, Shadad A, Abdel-Maaboud M. The role of 4-D ultrasonography in prenatal assessment of fetal neurobehaviour and prediction of neurological outcome. J Matern Fetal Neonatal Med 2012 Mar;25(3):231-236.
Athanasiadis AP, Mikos T, Tambakoudis GP, Theodoridis TD, Papastergiou M, Assimakopoulos E, Tarlatzis BC. Neurodevelopmental fetal assessment using KANET scoring system in low and high-risk pregnancies. J Matern Fetal Neonatal Med 2013 Mar;26(4):363-368.
Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, Carmina E, Chang J, Yildiz BO, Laven JS, et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2012 Jan;97(1):28-38.e25
Sirmans SM, Pate KA. Epidemiology, diagnosis and management of polycystic ovary syndrome. Clin Epidemiol 2014; 6:1-13.
Fauser BC, Diedrich K, Bouchard P, Domínguez F, Matzuk M, Franks S, Hamamah S, Simón C, Devroey P, Ezcurra D, et al. Contemporary genetic technologies and female reproduction. Human Reproduction Update 2011 Nov;17(6):829-847.
Balen A, Conway G, Kaltsas G. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995 Aug;10(8):2107-2111.
Azziz R, Sanchez L, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, Taylor K, Boots LR. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab 2004 Feb;89(2):453-462.
Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at longterm follow-up: a retrospective cohort study. Clin Endocrinol (Oxf) 2000 May;52(5):595-600.
Hollinrake E, Abreu A, Maifeld M, Van Voorhis BJ, Dokras A. Increased risk of depressive disorders in women with polycystic ovary syndrome. Fertil Steril 2007 Jun;87(6): 1369-1376.
Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome. In: Givens JHF, Merriman G, editors. The polycystic ovary syndrome. Cambridge, MA: Blackwell Scientific; 1992. p. 377-384.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004 Jan;81(1):19-25.
Azziz R, Carmina E, DeWailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, et al. Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 2006 Nov;91(11):4237-4245.
Lujan ME, Jarrett BY, Brooks ED, Reines JK, Peppin AK, Muhn N, Haider E, Pierson RA, Chizen DR. Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod 2013 May;28(5):1361-1368.
Badawy A, Elnashar A. Treatment options for polycystic ovary syndrome. Int J Womens Health 2011 Feb;3:25-35.
ACOG Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No 108: Polycystic ovary syndrome. Obstet Gynecol 2009 Oct;114(4):936-949.
Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril 2008 Mar;89(3): 505-522.
Balen AH. Ovulation induction in the management of anovulatory polycystic ovary syndrome. Mol Cell Endocrinol 2013 Jul;373(1-2):77-82.
Berridge DL, Winter TC. Saline infusion sonohysterography: technique, indications, and imaging findings. J Ultrasound Med 2004 Jan;23(1):97-112.
Allison SJ, Horrow MM, Kim HY, Lev-Toaff AS. Salineinfused sonohysterography: tips for achieving greater success. Radiographics 2011 Nov-Dec;31(7):1991-2004.
O'Neill MJ. Sonohysterography. Radiol Clin North Am 2003 Jul;41(4):781-797.
Bonnamy L, Marret H, Perrotin F, Body G, Berger C, Lansac J. Sonohysterography: a prospective survey of results and complications in 81 patients. Eur J Obstet Gynecol Reprod Biol 2002 Apr;102(1):42-47.
Lindheim SR, Adsuar N, Kushner DM, Pritts EA, Olive DL. Sonohysterography: a valuable tool in evaluating the female pelvis. Obstet Gynecol Surv 2003 Nov;58(11):770-784.
Lindheim SR, Sprague C, Winter TC. Hysterosalpingography and sonohysterography: lessons in technique. AJR Am J Roentgenol 2006 Jan;186(1):24-29.
Jeanty P, Besnard S, Arnold A, Turner C, Crum P. Air-contrast sonohysterography as a first step assessment of tubal patency. J Ultrasound Med 2000 Aug;19(8):519-527.