Sífilis congênita e recusa terapêutica da gestante: análise jurídica e bioética / Congenital syphilis and treatment refusal by pregnant women: a bioethical and legal analysis / Sífilis congénita y rechazo terapéutico por las mujeres embarazadas: análisis legal y bioético

Resumo A infecção congênita pela sífilis é uma doença que, apesar dos esforços públicos, ainda se mantém na rotina do sistema de saúde. Embora haja métodos de prevenção efetivos e muito disseminados, tratamento com alto custo-benefício e disponível no Sistema Único de Saúde, além de assistência pré-natal com alta cobertura, as taxas epidemiológicas da enfermidade continuam relevantes e preocupantes. Umas das barreiras à erradicação desse cenário é a recusa terapêutica da genitora. Com isso, indagações importantes são levantadas, como a responsabilidade médica em relação à recusa, a responsabilidade da gestante para com o nascituro e as implicações jurídicas que perpassam essa problemática. O propósito deste artigo é responder a essas questões e suas repercussões bioéticas e jurídicas.

Abstract Despite public policies, congenital syphilis infection remains a reality in the health system routine. Moreover, its epidemiological rates continue to be relevant and worrisome despite widespread and effective preventive methods, highly cost-effective treatments available in the Unified Health System, and high-coverage pre-natal care. A major obstacle to eradicating this scenario is treatment refusal by the progenitor. Important questions regarding medical responsibility in relation to refusal, the pregnant woman's responsibility towards the unborn child, and the legal implications involved arise from this context. This article seeks to answer these questions and their legal and bioethical repercussions.

Resumen La sífilis congénita es una enfermedad que aún sigue en la rutina del sistema de salud a pesar de los esfuerzos públicos. Aunque existen métodos de prevención efectivos y generalizados, los tratamientos con alto costo-beneficio y disponibles en el Sistema Único de Salud, además de la atención prenatal con alta cobertura, las tasas epidemiológicas de la enfermedad siguen siendo relevantes y preocupantes. Una de las barreras para su erradicación es el rechazo terapéutico de la madre. Por lo tanto, se plantean cuestiones importantes, como la responsabilidad médica con relación al rechazo, la responsabilidad de la mujer embarazada por el feto y las implicaciones legales que impregnan este problema. El propósito de este artículo es responder a estos interrogantes y sus repercusiones bioéticas y legales.

Crescimento no Primeiro Ano de Vida de Crianças Expostas ao HIV não Infectadas: um Estudo de Coorte Retrospectivo / Growth in the First Year of Life of HIV-Exposed Uninfected Children: a Retrospective Cohort Study

Introdução: O crescimento de crianças expostas ao HIV não infectadas pode ser prejudicado pela exposição intrauterina à terapia antirretroviral. O objetivo deste estudo é descrever o crescimento no primeiro ano de vida de crianças expostas ao HIV não infectadas. Métodos: Estudo de coorte retrospectivo realizado com crianças expostas ao HIV não infectadas nascidas e acompanhadas no Hospital de Clínicas de Porto Alegre. Foram coletados dados referentes a condições socioeconômicas, perinatais, peso e comprimento no primeiro ano de vida. Para avaliação do crescimento, as médias de Escore-Z de peso, comprimento e índice de massa corporal para idade (P/I, C/I e IMC/I, respectivamente) ao nascimento, aos quatro e aos doze meses foram comparadas através da análise de Equações de Estimativas Generalizadas (GEE). Resultados: 39 crianças foram incluídas no estudo. A média de Escore-Z de IMC/I ao nascimento foi 0,03 (-0,24 a 0,30), aos quatro de 0,34 (0,00 a 0,68) e aos 12 meses de 0,73 (0,45 a 1,01). Houve diferença significativa entre o nascimento e aos doze meses (p=0,002). Conclusão: Os resultados sugerem que crianças expostas ao HIV não infectadas apresentam crescimento adequado no primeiro ano de vida e curva ascendente ao longo do tempo.

Introduction: The growth of uninfected HIV-exposed children can be impaired by intrauterine exposure to antiretroviral therapy. The aim of this study is to describe the growth in the first year of life of uninfected HIV-exposed children. Methods: A retrospective cohort study conducted with uninfected HIV-exposed children born and followed up at the Hospital de Clínicas de Porto Alegre. Data regarding socioeconomic status, perinatal information, and weight and length in the first year of life were collected. To assess growth, the Z-score means of weight, length and body mass index for age (W/A, L/A and BMI/A, respectively) at birth, at 4 months and at 12 months were compared through analysis of Generalized Estimating Equations (GEE). Results: Thirty-nine children were included in the study. The mean Z-Score of BMI/A at birth was 0.03 (-0.24 to 0.30), at 4 months 0.34 (0.00 to 0.68) and at 12 months 0.73 (0.45 to 1.01). There was a significant difference between birth and at 12 months (p=0.002). Conclusion: The results suggest that uninfected HIV-exposed children show adequate growth in the first year of life and an ascending curve over time.

Perfil clínico e psiquiátrico de gestantes atendidas em uma unidade de saúde de Criciúma, Santa Catarina / Clinical and psychiatric profile of pregnant women treated at a health unit in Criciúma, Santa Catarina, Brazil

Introdução: A gestação é um período transacional, que faz parte do curso natural do desenvolvimento humano e da renovação geracional. Esse período representa, para a mulher, o enfrentamento de desafios diversos e pode desencadear ou exacerbar transtornos psiquiátricos, podendo ser considerada a fase de maior incidência de alterações psíquicas na mulher. Assim, o objetivo do presente estudo é conhecer o perfil clínico e psiquiátrico de gestantes atendidas em uma unidade de saúde municipal do sul catarinense. Métodos: O presente estudo é do tipo observacional, retrospectivo, transversal, descritivo, com coleta de dados secundários e abordagem quantitativa, com registros que constam em prontuários de gestantes ali atendidas. Resultados: Foram avaliadas 179 gestantes com média de idade de 25,94 (± 6,43) anos e média de IMC pré-gestacional de 27,12 (± 6,01) kg/m² (sobrepeso), casadas (42,9%), escolaridade até o ensino médio (50,5%) e que possuíam alguma comorbidade clínica, principalmente hipertensiva (34,4%) ou diabetes mellitus (34,4%), exceto gestantes de baixo peso, nas quais há maior prevalência de asma. Sobre os transtornos psiquiátricos presentes, eram majoritariamente ansiosos e depressivos, sendo a fluoxetina o psicofármaco predominante. Conclusão: O perfil clínico e psiquiátrico de gestantes do presente estudo é de mulheres jovens, casadas, com sobrepeso, hipertensas ou diabéticas, que estudaram até o ensino médio, já possuem gestação prévia e não desejam a gestação atual. Entre as que possuem transtorno psiquiátrico, a maioria sofre de transtorno depressivo ou ansioso e são tratadas com ISRS. São sugeridos estudos para avaliar o desfecho do binômio mãe-feto e maior atenção à psicoterapia cognitivo-comportamental.

Introduction: Pregnancy, a transactional period, is part of the natural course of human development and generational renewal. This period represents different challenges for women and can trigger or exacerbate psychiatric disorders. It can be considered the phase with the highest incidence of psychiatric changes in women. Thus, this study's objective was to determine the clinical and psychiatric profile of pregnant women treated at a municipal health unit in the southern region of Santa Catarina state. Methods: This cross-sectional, retrospective observational descriptive study involved secondary data and a quantitative approach, assessing medical records of pregnant women treated at the clinic. Results: A total of 179 pregnant women were included, whose mean age was 25.94 (SD, 6.43) years and mean pre-pregnancy BMI was 27.12 (SD, 6.01) kg/m² (ie, overweight). A total of 42.9 % were married and the education level of 50.5% was less than high school. Most had some clinical comorbidity, mainly hypertension (34.4%) or diabetes mellitus (34.4%); there was a higher prevalence of asthma among those with low weight. The psychiatric disorders were mostly anxiety and depression, with fluoxetine being the most prescribed psychotropic drug. Conclusion: The clinical and psychiatric profile of this sample of pregnant women was young, married, overweight, hypertensive or diabetic women, with a less than high school education, previous pregnancies, and an unwanted current pregnancy. Most suffered from depressexualsive or anxiety disorder and were being treated with selective serotonin reuptake inhibitors. Studies are needed to assess the outcome of the mother-fetus pair, focusing on cognitive-behavioral psychotherapy.

Abbreviated Version of the Maternal-Fetal Attachment Scale: Evidence of Validity and Reliability / Versão Abreviada da Escala de Apego Materno-Fetal: Evidências de Validade e Confiabilidade / Versión Corta de la Maternal Fetal Attachment Scale: Evidencia de Validez y Fiabilidad

Abstract The Maternal-Fetal Attachment Scale has been widely applied in research on the subject. There are no known studies that have validated a shortened version of this instrument in Brazil. This study aimed to propose a shortened version of the Maternal-Fetal Attachment Scale and examine its evidence of validity and reliability. This methodological study was carried out on a sample of 937 pregnant women in the Primary Health Care of Montes Claros, Minas Gerais - Brazil. Construct validity and reliability were measured. A trifactor version with 15 items was obtained, which presented satisfactory adjustment indexes. Convergent and discriminant validities were close to the recommended ones. The scale differentiated attachment scores according to different sample characteristics. Internal consistency (Cronbach's α = 0.878) and composite reliability (> 0.70) were appropriate. The abbreviated Brazilian version of the Maternal-Fetal Attachment Scale presented satisfactory psychometric attributes for application to pregnant women in Primary Health Care.

Resumo A Escala de Apego Materno-Fetal tem sido amplamente aplicada em pesquisas sobre a temática. Desconhecem-se investigações sobre a validade de uma versão reduzida desse instrumento no Brasil. Este estudo teve por objetivo propor uma versão abreviada da Escala de Apego Materno-Fetal e examinar suas evidências de validade e confiabilidade. Trata-se de um estudo metodológico, realizado com uma amostra de 937 gestantes no âmbito da Atenção Primária à Saúde de Montes Claros, Minas Gerais - Brasil. Obteve-se uma versão trifatorial com 15 itens, que apresentou índices satisfatórios de ajuste. As validades convergente e discriminante foram próximas do recomendado. A escala diferenciou os escores de apego segundo diferentes características da amostra. A consistência interna (α de Cronbach = 0,878) e a confiabilidade composta (> 0,70) foram apropriadas. A versão brasileira abreviada da Escala de Apego Materno-Fetal apresentou atributos psicométricos satisfatórios para aplicação a gestantes na Atenção Primária à Saúde.

Resumen La Maternal Fetal Attachment Scale es ampliamente aplicada en estudios sobre la temática. No existen investigaciones sobre la validez de una versión corta de este instrumento en Brasil. Se pretende proponer una versión corta de esta escala y examinar su validez y fiabilidad. Estudio metodológico, realizado en la Atención Primaria de Salud de Montes Claros, Minas Gerais - Brasil en una muestra de 937 mujeres embarazadas. Se midieron la validez y la fiabilidad del constructo. Se obtuvo una versión de tres factores, con 15 ítems, e índices de ajuste satisfactorios. La validez convergente y discriminante se acercó a lo recomendado. La escala diferenció las puntuaciones de vinculación según las distintas características de la muestra. La consistencia interna (α de Cronbach = 0,878) y la fiabilidad compuesta (> 0,70) fueron adecuadas. La versión corta de Maternal Fetal Attachment Scale para Brasil presentó atributos psicométricos satisfactorios para aplicarse a gestantes en Atención Primaria de Salud.

Immune system: development and acquisition of immunological competence

Abstract Objectives: To describe the ontogeny of the immune system and the adaptive mechanisms of the immune system in the neonatal period, with an emphasis on transplacental antibody transport and breastfeeding. Source of data: Non-systematic literature review in the PubMed database. Summary of the findings: The last two decades have witnessed a great advance in the knowledge of the immune system since conception. Several investigation tools have provided insight on phenomena that were previously inadequately understood. Still expanding, the functional and molecular investigation of various aspects of the immune system will make it possible to understand how intra-uterus maternal-fetal exchanges, the maternal microbiota interacting with the fetus and newborn, and the acquisition of immunological competence occur in healthy and disease scenarios. Conclusions: In-depth knowledge of the development of the immune system and of the adaptive mechanisms that allow a safer transition to the extrauterine environment are fundamental components of optimizing maternal and young infant vaccination, as well as the strategies associated with full postnatal development, and the early diagnosis and treatment of innate errors of immunity.

Educational workshops about bonding with the fetus during pregnancy: a clinical trial / Talleres educativos sobre la vinculación con el feto durante el embarazo: un ensayo clínico / Oficinas educativas sobre vínculo com o feto durante a gestação: um ensaio clínico

ABSTRACT Objective: To verify if participation in educational workshops about bonding with the fetus influences the adoption of practices of interaction with the baby by pregnant women. Method: Randomized clinical trial conducted in a health clinic. The experimental group participated in educational workshops designed for the pregnant couple and the control group received usual care. The practices of interaction with the fetus were evaluated before and after the intervention. Results: 19 pregnant women participated in the study. There was a positive correlation between higher gestational age and the interaction with the fetus (p = 0.016), and between younger mothers and the practice of touching or poking the baby (p = 0.019). There was an increase in the interaction with the fetus in the control and experimental groups (p= 0.024). Conclusion: Educational workshops are strategies for sharing knowledge about fetuses' sensory skills and to foster bonding and child development since pregnancy.

RESUMEN Objetivo: Verificar si la participación en talleres educativos sobre vinculación con el feto influye en la adopción de prácticas de interacción con el bebé por parte de la mujer embarazada. Método: Ensayo clínico aleatorizado realizado en una clínica de salud. El grupo experimental participó en talleres educativos desarrollados para la pareja embarazada y el grupo control recibió monitoreo de salud regular. Las prácticas de interacción con el feto fueron evaluadas antes y después de la intervención. Resultados: 19 mujeres embarazadas participaron en el estudio. Hubo una correlación positiva entre una edad gestacional más alta y la interacción con el feto (p = 0.016), así como entre madres más jóvenes y la práctica de tocar o empujar al bebé (p = 0.019). Hubo un aumento en las prácticas de interacción con el feto tanto en el grupo control como en el experimental (p= 0.024). Conclusión: Los talleres educativos son estrategias para compartir el conocimiento sobre las habilidades sensoriales del feto y las prácticas de fortalecimiento del vínculo y el desarrollo infantil desde el embarazo.

RESUMO Objetivo: Verificar se a participação em oficinas educativas sobre vínculo com o feto influencia a adoção de práticas de interação com o bebê pelas gestantes. Método: Ensaio clínico randomizado realizado em ambulatório de saúde. O grupo experimental participou de oficinas educativas desenvolvidas para o casal grávido, e o grupo controle recebeu acompanhamento de saúde usual. As práticas de interação com o feto foram avaliadas antes e depois da intervenção. Resultados: Participaram do estudo 19 gestantes. Houve correlação positiva entre a maior idade gestacional e a interação com o feto (p=0,016), bem como com a menor a idade materna e a prática de mexer ou cutucar o bebê (p=0,019). Houve aumento das práticas de interação com o feto tanto no grupo controle quanto no experimental (p= 0,024). Conclusão: As oficinas educativas são estratégias de compartilhamento de saberes sobre as competências sensoriais do feto e as práticas fortalecedoras do vínculo e do desenvolvimento infantil desde a gestação.

Atuação da equipe de enfermagem no estabelecimento do apego entre mãe e filho: revisão integrativa / Performance of the nursing team in the establishment of addition between mother and son: integrative review / Desempeño del equipo de enfermería en el establecimiento de la afición entre madre e hijo: revisión integrativa

Objetivo: Demonstrar as evidências científicas disponíveis na literatura atual acerca da atuação da equipe de enfermagem no estabelecimento de relações de apego entre mãe e filho. Método: Revisão integrativa da literatura realizada em abril de 2020 nas bases: Biblioteca Virtual em Saúde, United State National Library of Medicine e Scientific Electronic Library Online. Utilizou-se como descritores: "Relações mãe-filho/motherchild relationships", "enfermagem/nursing" e o descritor não controlado "apego/attachment" combinados pelo operador booleano "AND". Resultados: As dificuldades no estabelecimento de apego entre mãe e filho foram destacadas quando as crianças estão hospitalizadas, quando são deixadas em instituição de ensino ou pessoas externas e quando as mães tiveram hábitos inapropriados durante o período gravídico-puerperal que possa ter afetado o crescimento e desenvolvimento do bebê. A enfermagem facilita o estabelecimento do vínculo mãe e filho, atenua fatores estressores de forma humanística baseada na integralidade. Conclusão: O estabelecimento satisfatório do comportamento de apego é essencial para a saúde mental do ser humano. Envolver-se no cuidado na hospitalização e educação de uma criança requer conhecimento dos seus condicionantes biológicos, psicológicos, sociais, ambientais, para que se compreenda a complexidade da situação de afastamento do meio familiar.

Objective: To demonstrate the scientific evidence available in the current literature about the performance of the nursing team in establishing attachment relationships between mother and child. Method: Integrative literature review conducted in April 2020 on the Virtual Health Library, United State National Library of Medicine and Scientific Electronic Library Online databases. The following descriptors were used: "Relações mãe-filho/motherchild relationships", "enfermagem/ Nursing" and the uncontrolled descriptor "apego/attachment" combined by the Boolean operator "AND". Results: The difficulties in establishing attachment between mother and child were highlighted when the children are hospitalized, when they are left in an educational institution or outside persons and when the mothers had inappropriate habits during the pregnancy-puerperal period that may have affected growth and baby development. Nursing facilitates the establishment of a mother-child bond, mitigating stressors in a humanistic manner based on comprehensiveness. Conclusion: The satisfactory establishment of attachment behavior is essential for human mental health. Getting involved in the care of a child's hospitalization and education requires knowledge of its biological, psychological, social, and environmental conditions, in order to understand the complexity of the situation of distance from the family.

Objetivo: Demostrar la evidencia científica disponible en la literatura actual sobre el desempeño del equipo de enfermería en el establecimiento de relaciones de apego entre madre e hijo. Método: Revisión integrativa de la literatura realizada en abril de 2020 en las bases de datos de la Biblioteca Virtual em Saúde, United State National Library of Medicine y Scientific Electronic Library Online. Se utilizaron los siguientes descriptores: "Relações mãefilho/mother-child relationships", "enfermagem/ nursing" y el descriptor no controlado "apego / attachment" combinado por el operador booleano "AND". Resultados: Se destacaron las dificultades para establecer el vínculo entre madre e hijo cuando los niños son hospitalizados, cuando se les deja en una institución de enseñanza o personas ajenas y cuando las madres tenían hábitos inapropiados durante el período gestacional-puerperal que pueden haber afectado el crecimiento y desarrollo del bebé. La enfermería facilita el establecimiento de un vínculo madre-hijo, mitigando los estresores de manera humanista basada en la integralidad. Conclusión: El establecimiento satisfactorio de la conducta de apego es esencial para la salud mental humana. Involucrarse en el cuidado de la hospitalización y educación de un niño requiere el conocimiento de sus condiciones biológicas, psicológicas, sociales y ambientales, para comprender la complejidad de la situación de distanciamiento de la familia.

COVID-19: aspectos relacionados a la susceptibilidad genética y defectos congénitos / COVID-19: Aspects of genetic susceptibility and congenital defects

RESUMEN Introducción: la COVID-19 (acrónimo del inglés c oronavirus disease 2019) es una enfermedad infecciosa de reciente descripción, causada por el SARS-CoV-2, sin tratamiento efectivo. La identificación de variantes genéticas que intervienen en la respuesta a la COVID-19; así como la posibilidad de trasmisión materno-fetal del SARS-CoV-2 no solo permitirán ampliar los conocimientos sobre su fisiopatología; sino además estratificar los grupos de la población, y según su riesgo, implementar medidas preventivas y tratamientos personalizados, incluida la prioridad en el uso de vacunas. Objetivo: describir aspectos relacionados con la susceptibilidad genética y defectos congénitos en la COVID-19. Material y Métodos: se realizó una investigación tipo revisión bibliográfica; para identificar los documentos que se revisarían se consultó la base bibliográfica PubMed/Medline, incluyendo los trabajos del 2019 y 2020. Se incluyó publicaciones recomendadas por expertos, preferiblemente publicados en los últimos 10 años; luego de una valoración cualitativa, se realizó una síntesis. Desarrollo: están descritas mutaciones de los genes: ACE2, ACE1, TMPRSS2, TLR7, así como haplotipos HLA asociadas a la susceptibilidad genética a la COVID-19. Variantes de los genes: SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6 y XCR1; así como de los que codifican para el receptor de la Vitamina D y las citoquinas pro inflamatorias (como las IL-1, IL-6, IL-12, IFN-γ, y TNT-α), pudieran también estar relacionadas con un incremento de la susceptibilidad al SARS-CoV-2. Ante la posibilidad de trasmisión vertical de la COVID-19 y su posible papel teratogénico, las embarazadas constituyen un grupo de riesgo. Conclusión: variantes genéticas humanas son factores de susceptibilidad genética al virus SARS-CoV-2, que puede ser causa de defectos congénitos(AU)

ABSTRACT Introduction: COVID-19 (acronym for Coronavirus Disease 2019) is a recently described infectious disease caused by SARS-CoV-2, without effective treatment. Identification of genetic variants involved in the response to COVID-19 as well as the possibility of maternal-fetal transmission of SARS-CoV-2 will not only allow us to expand our knowledge of the pathophysiology of COVID-19, but also stratify population groups according to their risks in order to implement preventive measures and personalized treatments, including the priority in the use of vaccines. Objective: To describe aspects related to congenital defects and genetic susceptibility to the SARS-CoV-2 virus. Material and Methods: A bibliographic review was carried out. Medline and PubMed bibliographic databases were searched. Studies published between 2019 and 2020 were included as well the ones recommended by experts, preferably published within the last 10 years. After qualitative evaluation, synthesis was made. Development: Mutations in ACE2, ACE1, TMPRSS2, TLR7 genes, as well as HLA haplotypes associated with genetic susceptibility to COVID-19 are described. Variants in the genes SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6, XCR1 and in those codifying vitamin D receptor and proinflammatory cytokines (IL-1, IL-6, IL-12, IFN-γ, and TNF-α) could be related to an increased susceptibility to SARS-CoV-2. Due to the risk of vertical transmission of COVID-19 and its possible teratogenic effect, pregnant women are included in the risk group. Conclusion: Human genetic variants are factors of genetic susceptibility to the SARS-CoV-2 virus which may cause congenital defects(AU)

Convertirse en madre durante la gestación: desarrollo conceptual y validación de un nuevo instrumento para su medición / Becoming a mother during pregnancy: conceptual development and validation of a new instrument for its measurement

Objetivo: desarrollar conceptualmente y validar un nuevo instrumento para la evaluación del compromiso con la maternidad, el apego materno-fetal y la preparación para la maternidad durante el período de la gestación a partir de la teoría de Ramona Mercer. Metodología: estudio de validación de pruebas realizado en tres fases: análisis de conceptos, diseño y validación de un instrumento. Para el análisis de conceptos se utilizó el método de Walker y Avant. Se diseñó instrumento a partir de los atributos identificados en la fase de análisis y se realizó validación de contenido con expertos, validación facial a través de prueba piloto y para la validez de constructo se utilizó el análisis factorial exploratorio (AFE), adicionalmente, se hizo cálculo de la consistencia interna del instrumento. Resultados: se definieron conceptualmente los constructos de apego materno-fetal, preparación para la maternidad y compromiso con la maternidad durante la gestación. El modelo final del AFE obtuvo un KMO de 0.88 y mostró tres factores que explicaron el 68.1% de la varianza: apoyo y presencia del compañero, preparación altruista y apego cognitivo. La consistencia interna global obtenida a través del alfa de Cronbach fue de 0.90. Conclusiones: se amplió el primer estadio de la teoría Convertirse en Madre de Ramona Mercer a través del desarrollo conceptual de los constructos que lo componen. El instrumento Convertirse en Madre durante la gestación mostró ser válido y confiable y permitió que emergiera la dimensión apoyo y presencia del compañero no contemplada por Mercer en su teoría y desapareciera el compromiso con la maternidad.

Objective: to develop conceptually and validate a new instrument to assess the commitment with the motherhood, the maternal-fetal bonding and the preparation for motherhood during pregnancy from Ramona Mercer´s theory. Methodology: validation study carried out in three phases: analysis of concept, design and validation of an instrument. For the analysis of concepts, the Walker y Avant method was used. An instrument was designed based on the attributes identified in the analysis phase and content validation was carried out with experts, facial validation through a pilot test and exploratory factor analysis (EFA) was used for the construct validity. Additionally, the calculation of the internal consistency of the instrument. Results: concepts of maternal-fetal attachment, preparation for motherhood and commitment to motherhood during pregnancy were conceptually defined. The final model of EFA obtained a KMO of 0.88 and showed three factors that explained 68.1% of the variance: support and presence of the partner, altruistic preparation and cognitive bonding. The overall internal consistency obtained through Cronbach's alpha was 0.90. Conclusions: The first stage of Ramona Mercer's theory of becoming mother was broadened through the conceptual development of the constructs that comprise it. The instrument Becoming a Mother during pregnancy proved to be valid and reliable and allowed the dimension of support and presence of the partner not contemplated by Mercer to emerge in her theory and the commitment to motherhood to disappear.

Structure and content of the maternal representations of Mexican teenagers during their first pregnancy / Estructura y contenido de las representaciones maternas de adolescentes mexicanas durante su primer embarazo

Abstract Objectives: understand the structure and content of the maternal representations of Mexican teenagers during their first pregnancy. Methods: a study was carried out with qualitative methodology based on the concept of maternal representation and the theory of social representations with 30 adolescents who attended prenatal control at the Civil Hospital of Guadalajara "Fray Antonio Alcalde", in Jalisco, Mexico. The participants were interviewed with the consent of their tutors. Classical content analysis techniques were used to obtain codes and thematic categories to develop a conceptual map that explains maternal representations. Results: the maternal representation was identified: "Pregnant but reunited, a legitimated bad decision", which was composed of social meanings towards adolescent pregnancy, family dynamics, expectations towards motherhood, and the feelings experienced by the adolescent during the pregnancy. The content of the representations was heterogeneous for most of the identified categories; however, it is identified that the desire for pregnancy guides the expectations of the adolescent about her future way of being as a mother. Conclusions: the desire of women for pregnancy, the level of participation of the couple, and the social meanings of adolescent pregnancy, have an outstanding role in the development of models of maternal representations.

Resumen Objetivos: comprender la estructura y contenido de las representaciones maternas de adolescentes mexicanas durante su primer embarazo. Métodos: se llevó a cabo un estudio con metodología cualitativa basado en el concepto de representación materna y la teoría de las representaciones sociales con 30 adolescentes que asistieron a control prenatal al Hospital Civil de Guadalajara "Fray Antonio Alcalde", ubicado en Jalisco, México. Las participantes fueron entrevistadas con previo consentimiento de sus tutores. Se utilizaron técnicas de análisis de contenido clásico para obtener códigos y categorías temáticas para desarrollar un mapa conceptual que explique las representaciones maternas. Resultados: se identificó la representación materna: "Embarazada pero juntada, una mala decisión legitimada", la cual se compuso de significados sociales hacia el embarazo adolescente, la dinámica familiar, las expectativas hacia la maternidad, y los sentimientos vividos por la adolescentedurante el embarazo. El contenido de la representación materna fue heterogéneo, empero, se identificó que el deseo por el embarazo guía las expectativas de la adolescente sobre su futura manera de ser madre. Conclusiones: el deseo de la mujer por el embarazo, el nivel de participación de la pareja, y los significados sociales del embarazo adolescente, tienen un papel sobresaliente en el desarrollo de las representaciones maternas.

Apego materno-fetal: un análisis de concepto / Maternal-fetal bonding: a concept analysis

Introducción: El apego materno-fetal es un proceso relacional que construye la mujer gestante. Objetivo: Identificar los atributos del concepto de apego materno-fetal. Material y métodos: Se utilizó la metodología de análisis de concepto propuesta por Walker y Avant. Se realizó búsqueda de artículos en las bases de datos Lilacs/BIREME, CUIDEN, EBSCO, Science Direct, Ovid, EMBASE, Pubmed/Medline y Google Scholar. Se diseñó una base de datos para consolidar la información proveniente de los artículos. La integración de la información se hizo a través de los pasos propuestos para el análisis de concepto de Walker y Avant. Desarrollo: El apego materno-fetal es un proceso que requiere la representación mental del feto como persona, puede ser manifestado en comportamientos de interacción con el feto y cuidado hacia sí misma y requiere de una red de apoyo. Son antecedentes del apego materno-fetal, las formas de vinculación de la mujer gestante con su madre y su pareja, y, como consecuencias, la intención de lactar, la sensación de competencia materna y el vínculo materno-infantil. Los atributos de este concepto se pueden agrupar en cuatro dimensiones: cognitiva, afectiva, altruista y personal/relacional. Son varios los instrumentos que se han desarrollado para medirlas, entre los que se cuentan el de Cranley, Muller y el de Condon. Conclusiones: Se concluye que el apego materno-fetal es un concepto de trascedencia para la teoría y la práctica de la enfermería materno-infantil y el cuidado prenatal, pues es pilar fundamental en la transición hacia la maternidad(AU)

Introduction: Maternal-fetal bonding is a relational process built by the pregnant woman. Objective: To identify the attributes of the concept of maternal-fetal bonding. Material and methods: The conceptual analysis approached by Walker and Avant´s was used. A detailed searched for articles in several databases such as Lilacs/BIREME, CUIDEN, EBSCO, Science Direct, Ovid, EMBASE, PubMed/Medline y Google Scholar was carried out. A database was designed to gather information from different articles. The integration of information was carried out following the steps proposed for the concept analysis outlined by Walker and Avant. Development: Maternal-fetal bonding is a process that requires the mental representation of the fetus as a person. It can be expressed as interactions with the fetus and self-care behavior, and it requires network support. Some antecedents of maternal-fetal bonding are the relation of the pregnant woman with her mother and her partner and consequently, the intention to breastfeed, the sensation of maternal competence, and maternal-infant attachment. The attributes of this concept can be grouped into four dimensions: cognitive, affective, altruistic, and personal/relational. Several instruments have been developed to carry out its measurement, including Cranley´s, Muller´s and Condon´s. Conclusions: It is concluded that maternal-fetal bonding is a concept of transcendence combining theory and practice of maternal and child nursing care and prenatal care; as it is a fundamental pillar in the transition to motherhood(AU)

Carcinoma ductal infiltrante na gestação, desafio diagnóstico e terapêutico: relato de caso / Infiltrating ductal carcinoma during pregnancy, diagnostic and therapeutic challenge: a case report

Introdução: O câncer de mama é a neoplasia mais frequentemente diagnosticada no mundo, sendo a segunda que mais afeta a mulher no ciclo gravídico-puerperal e a principal causa de morte por câncer em mulheres. O câncer de mama associado à gravidez refere-se àquele diagnosticado durante a gravidez ou no primeiro ano pós-parto. A incidência está aumentando à medida que as mulheres atrasam a primeira gestação. Descrição: O artigo traz o relato do caso de uma gestante com câncer de mama na cidade de Juiz de Fora, MG. Discussão: A gestação deve ser considerada como agravante do câncer de mama, sendo o tratamento semelhante ao da população geral. Prematuridade e baixo peso ao nascer são os eventos indesejáveis mais comuns. Conclusão: A abordagem multidisciplinar é fundamental para estabelecer um plano de tratamento individualizado e a paciente ser acolhida, orientada e participar de todo o processo de decisão terapêutica.(AU)

Introduction: Breast cancer is the most frequently diagnosed cancer in the world, being the second that most affects women in the pregnancy-puerperal cycle and the leading cause of cancer death in women. Pregnancy-associated breast cancer refers to cancer diagnosed during pregnancy or in the first year postpartum. The incidence is increasing as women delay first pregnancy. Description: The article reports the case of a pregnant woman with breast cancer in the city of Juiz de Fora, MG. Discussion: Pregnancy should be considered as aggravating breast cancer, being the treatment similar to the general population. Prematurity and low birth weight are the most common undesirable events. Conclusion: The multidisciplinary approach is fundamental to establish an individualized treatment plan and the patient to be welcomed, guided and to participate in the whole therapeutic decision process.(AU)

Correlations among Perceptions and Practice of Taegyo and Maternal-Fetal Attachment in Pregnant Women

PURPOSE: This study was conducted to examine the relationships among the perceptions and practice of taegyo (a traditional set of practices and beliefs related to healthy fetal development) and maternal-fetal attachment in pregnant women.METHODS: The participants were 136 pregnant women who visited a public health center or maternity hospital for prenatal care. The collected data were analyzed using descriptive statistics, the t-test, analysis of varience, and Pearson correlation coefficients with SPSS version 22.0.RESULTS: The mean age of the pregnant women was 32.24±3.99 years. The mean scores for perceptions of taegyo, practice of taegyo, and maternal-fetal attachment were 3.96±0.53, 3.74±0.64, and 3.94±0.49, respectively. Perceptions of taegyo were significantly correlated with the practice of taegyo (r=.72, p<.001), and maternal-fetal attachment (r=.55, p<.001). A significant correlation was also found between the practice of taegyo and maternal-fetal attachment (r=.65, p<.001).CONCLUSION: Perceptions of taegyo affected the practice of taegyo, and had a positive effect on maternal-fetal attachment. These findings suggest that primary care nurses at hospitals and public health centers should provide nursing intervention programs to improve the perceptions of taegyo, the practice of taegyo, and maternal-fetal attachment.

Estimulación prenatal en gestantes de alto riesgo obstétrico: una mirada desde la ocupación / Prenatal Stimulation in Pregnant Women with High Obstetric Risk: A Perspective from Activity / Estimulação pré-natal em manipuladores obstétricos de alto risco: um olhar da ocupação

RESUMEN Objetivo: reeducar gestantes de alto riesgo obstétrico en prácticas de estimulación prenatal y ocuparlas en actividades que mejoren su calidad de vida mientras están hospitalizadas. Materiales y métodos: estudio cualitativo de investigación acción participativa durante el segundo semestre de 2015 y el primer semestre de 2016, mediante caracterización sociodemográfica, grupos focales de conocimiento de experiencias y prácticas de las madres, negociación de talleres educativos de estimulación prenatal, ejecución de actividades ocupacionales y evaluación de cambios. Resultados: participaron 35 gestantes entre 18 y 41 años, de las cuales el 80 % fueron diagnosticadas con preeclampsia, y el 50 % tenían menos de 33 semanas gestacionales. Se encontraron diferencias y similitudes en los conocimientos y las prácticas sobre estimulación prenatal, así como la necesidad de mejorarlos. La negociación de los talleres educativos propició la realización e incorporación de prácticas como actividad ocupacional con significado; la elaboración de un juguete para el bebé generó curiosidad, exploración, habilidades o formas ocupacionales y desempeño consistente en respuesta a demandas del ambiente. Conclusiones: al realizar actividades con sentido y propósito, las gestantes incorporaron la capacidad, eficacia y goce en los procesos adquiridos y realizados. Estar ocupadas les permitió implementar nuevas formas de saber y hacer, así como motivarse por encontrar actividades significativas en el reaprendizaje de la estimulación prenatal.

ABSTRACT Objectives: To reeducate pregnant women with high obstetric risk in prenatal stimulation practices and to involve them in activities that improve their quality of life while hospitalized. Materials and methods: Qualitative study with a participatory action research approach conducted during the second half of 2015 and the first half of 2016, through sociodemographic characterization, focus groups of knowledge of mothers' experiences and practices, negotiation of educational prenatal stimulation workshops, performance of occupational activities, and evaluation of changes. Results: Thirty-five pregnant women between 18 and 41 years old participated. 80 % were diagnosed with preeclampsia and 50 % were less than 33 weeks pregnant. Differences and similarities were found in prenatal stimulation knowledge and practices, as well as the need to improve them. Negotiating educational workshops promoted the use and incorporation of practices as meaningful occupational activities; making a toy for the baby caused curiosity, exploration, occupational skills and consistent performance in response to environmental demands. Conclusions: In carrying out activities with sense and purpose, pregnant women incorporated ability, effectiveness and enjoyment in the processes conducted. Being busy allowed them to implement new ways of knowing and doing and motivated them to find meaningful activities in relearning prenatal stimulation.

RESUMO Objetivo: reeducar gestantes de alto risco obstétrico nas práticas de estimulação pré-natal e realizar atividades que melhorem a qualidade de vida durante a internação. Materiais e métodos: estudo qualitativo da Pesquisa Ação Participativa, durante o segundo semestre de 2015 e o primeiro semestre de 2016. Por meio de caracterização sóciodemográfica, grupos focais de conhecimento de experiências e práticas de mães, negociação de oficinas educativas de estimulação pré-natal, execução de atividades ocupacionais e avaliação de mudanças. Resultados: participaram 35 gestantes, entre 18 e 41 anos, das quais 80% foram diagnosticadas com pré-eclâmpsia e 50% tinham menos de 33 semanas de gestação. Além disso, diferenças e semelhanças foram encontradas no conhecimento e nas práticas de estimulação pré-natal, bem como na necessidade de aprimorá-las. A negociação de oficinas educativas levou à realização e incorporação de práticas como: atividade ocupacional com significado; a elaboração de um brinquedo para o bebê; exploração, habilidades e/ou formas ocupacionais e desempenho consistente em resposta às demandas ambientais. Discussão e conclusão: ao realizar atividades com significado e propósito, as gestantes incorporaram a capacidade, a eficácia e o prazer nos processos adquiridos e realizados. O fato de estarem ocupadas permitiu que elas implementassem novas formas de conhecer e fazer, bem como que estivessem motivadas para encontrar atividades significativas na reaprendizagem da estimulação pré-natal.

Clinical analysis of 66 cases of neonates born to mother with systemic lupus erythematosus / 中国新生儿科杂志

Objective To investigate the influence of newborns born to mother with systemic lupus erythematosus (SLE).Method The clinical data of SLE mothers and their infants bern in the obstetric and were admitted to the neonatal ward ward of the First Affiliated Hospital of Guangxi Medical University from July 2012 to March 2015 were studied retrospectively.The infants were divided into active SLEactivity group and stable SLE group.The incidence of preterm birth,small for gestational age (SGA),cardiac conduction block,anemia,and thrombocytopenia were compared between the two groups of SLE mothers.Result A total of 66 infants were included in SLE mothers,including 14 cases (21.2％) of preterm infants and 18 cases of SGA (27.3％).14 cases belonged to the active SLE group while 52 cases belonged to the SLE stable group.When comparing the 2 groups,there were no differences found on the rates of preterm infant and small for gestational age (P ＞ 0.05).The cardiac conduction block,anemia and thrombocytopenia happened separately in three cases of the active group,which had not seen in the SLE stable group.There was no statistically significant difference between the two groups (P ＞ 0.05).Of the 66 cases,2 were diagnosed with neonatal lupus erythematosus (NLE) with an incidence of 3％.Conclusion SLE mothers with an active disease 10 days before delivery did not significantly increase the incidence of preterm infants and SGA,but were at risk of NLE.

The effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction: a cohort study / 中华预防医学杂志

Objective@#To investigate the effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction.@*Methods@#From May 2013 to September 2014, a total of 3 474 pregnant women who took their first antenatal care and willing to undergo their prenatal care and delivery in Ma 'anshan Maternity and Child Care Centers were recruited in the cohort study. Excluding subjects without weight data before delivery (n=54), pregnancy termination (n=162), twins live births (n=39), without fetal birth weight data (n=7), 3 212 maternal-singleton pairs were enrolled for the final data analysis. Demographic information of pregnant woman, pregnancy history, disease history, height and weight were collected. In the 24th-28th, 32nd-36th gestational week and childbirth, three follow-up visits were undertaken to collect data of pregnancy weight, pregnancy vomiting, gestational hypertension, gestational diabetes mellitus, newborn gender and birth weight. χ2 test was used to compare the detection rate of fetal growth restriction in different groups. Multivariate unconditional logistic regression model and spreadsheet were used to analyze the independent and interaction effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction.@*Results@#The incidence of fetal growth restriction was 9.7%(311/3 212). The incidence of fetal growth restriction in pre-pregnancy underweight group was 14.9% (90/603), higher than that in normal pre-pregnancy weight group (8.7% (194/2 226)) (χ2=24.37, P<0.001). The incidence of fetal growth restriction in inadequate increase of gestational weight group was 17.9% (50/279), higher than the appropriate increase of weight group (11.8% (110/932)) (χ2=36.89, P<0.001). Multivariate unconditional logistic regression analysis showed that compared with normal pre-pregnancy weight group, pre-pregnancy underweightwas a risk factor for fetal growth restriction, with RR (95%CI) at 1.76 (1.34-2.32); Compared with the appropriate increase of gestational weight group, inadequate weight increase during pregnancy was a risk factor for fetal growth restriction, with the RR (95%CI) at 1.70 (1.17-2.48). No additive model interaction [relative excess risk of interaction, attributable proportions of interaction, the synergy index and their 95%CI were 0.75 (-2.14-3.63), 0.21 (-0.43-0.86) and 1.43 (0.45-4.53), respectively] or multiplication model interaction (RR (95%CI): 1.00 (0.44-2.29)) existed between pre-pregnancy underweight and inadequate increase of gestational weight on fetal growth restriction.@*Conclusion@#Pre-pregnancy underweight and inadequate increase of gestational weight would increase the risk of fetal growth restriction without interaction.

Apego materno-fetal, ansiedade e depressão em gestantes com gravidez normal e de risco: estudo comparativo / Maternal-fetal attachment, anxiety, and depression in normal and high-risk pregnancies: a comparative study

Este estudo teve como objetivo verificar as possíveis diferenças nos comportamentos de apego materno-fetal, bem como nos níveis de ansiedade e depressão apresentados por gestantes com e sem risco na gravidez, durante o segundo trimestre gestacional. Participaram da pesquisa 25 mulheres com gravidez sem risco e 23 com gravidez de risco, sendo que quatro delas tiveram fetos malformados. A Escala de Apego Materno-fetal e os Inventários de Ansiedade e Depressão de Beck foram utilizados. Os resultados mostram que não há diferenças no nível de apego materno-fetal entre os dois grupos de gestantes, os quais apresentaram valores máximos. Os índices de ansiedade e depressão mostraram-se mais elevados, mas não estatisticamente significativos, entre as gestantes de risco, principalmente para aquelas que tinham suspeita de fetos malformados. Conclui-se que a gravidade da realidade vivida por essas mães implica em níveis mais elevados de ansiedade e depressão, porém, não impede a formação da relação de apego entre elas e seus filhos.

This study aimed to determine possible differences in the maternal-fetal attachment behavior and in the levels of anxiety and depression during the second trimester of pregnancy in women with or without pregnancy complications. Twenty-five women with normal, healthy pregnancy and 23 with high-risk pregnancy, among which there were 4 with malformed fetuses, participated in this study. The Maternal-Fetal Attachment Scale and the Beck Anxiety Inventory and Depression Inventory were used. The results showed no differences in the levels of maternal-fetal attachment between the two groups of pregnant women investigated; both had maximum values. The anxiety and depression levels were higher, but not statistically significant, between the women with high-risk pregnancies, especially in those with suspected fetal malformation. It was concluded that the harsh reality faced by these mothers leads to higher levels of anxiety and depression; however, it does not prevent the development of attachment between them and their babies.

O vínculo mãe-bebê da gestação ao pós-parto: uma revisão sistemática de artigos empíricos publicados na língua portuguesa / The bond mother-baby from pregnancy to postpartum: a systematic review of empirical articles published in portuguese

O vínculo, definido como uma relação afetiva singular e duradoura, representa uma base importante para o desenvolvimento da criança, pois é no estabelecimento dos primeiros laços da criança com sua mãe que se produzem os alicerces da vida psíquica e da saúde mental. O objetivo desta revisão foi levantar os estudos empíricos sobre a formação do vínculo mãe-bebê desde a gestação ao pós-parto. Foram encontradas produções científicas publicadas entre 1984 a 2014 nas bases de dados indexadas na Biblioteca Virtual de Saúde (BVS). Para o levantamento bibliográfico foram utilizados os descritores "relação mãe-filho" e "relação materno-fetal". Foram encontrados 887 publicações científicas e, após aplicados os critérios de inclusão e exclusão, restaram 22 artigos que foram analisados na íntegra. Dentre os temas investigados, destacam-se: desejo de ser mãe; vínculo materno-fetal; gravidez e sentimentos ambivalentes; contato físico e precoce; rede de apoio; amamentação e vínculo; investimento afetivo; ansiedade de separação; nascimento em situações adversas e; parto e assistência humanizada . Considera-se que os aspectos identificados sugerem uma reflexão das medidas intervencionistas que separam mãe e recém-nascido no pós-parto imediato, visto que esse primeiro contato é crucial para o desenvolvimento do vínculo mãe-filho.(AU)

The bond, defined as a natural and lasting loving relationship, is an important basis for the child development because it is in the establishment of the first baby's ties to his mother where the foundations of psychic life and child mental health are created. The purpose of this study is identifying the empirical studies on the formation of the mother-baby bond, from pregnancy to postpartum. There were found in the scientific databases studies published between 1984-2014 indexed in Virtual Health Library (VHL). The descriptor used was "mother-child relation" and "maternal-fetal relation". There were found 887 scientific papers and, after filter of inclusion and exclusion criteria, 22 remaining articles were fully analyzed. From among the research topics are pointed out: desire to be a mother; maternal-fetal attachment; pregnancy and ambivalent feelings; physical and early contact; network support; breastfeeding and bonding; affective investment; separation anxiety, birth in adverses situations and; childbirth and human assistance. The studies suggests a reflection of interventionist measures that separate mother and baby immediately after birth, since that first contact is crucial to the development of the mother-child bond.(AU)

Maternal-Fetal Attachment and Maternal Identity according to Type of Stress Coping Strategies on Immigration Pregnancy Women

PURPOSE: The purpose of this descriptive survey study was designed to identify the stress coping types of married immigrant pregnant women and find out the differences in maternal-fetal attachment and maternal identity based on each types. METHODS: 151 married immigrant women who visited 3 women's hospitals located in J-do for pre-pregnancy checkup were selected as study objects. Data were analyzed by dsecriptive statistics, cluster analysis, t- test, ANOVA, and Scheffe multiple comparison test. RESULTS: Cluster analysis revealed 4 distinct stress coping styles; low stress-coping involvement social support-oriented type, high stress-coping involvement hopeful thinking type, low stress-coping involvement type, effective stress coping types. Women frequently using effective stress coping type among the four types reported higher maternal-fetal attachment. The group of active coping styles got significantly higher score on maternal identity. CONCLUSION: Proper stress coping of married immigrant pregnant women regarding pregnancies proved to result in high levels of maternal-fetal attachment and maternal identity. Studies measuring the stress coping styles that affect pregnancies should be continuously conducted.

The Contribution of Maternal-Fetal Attachment: Taegyo, Maternal Fatigue and Social Support during Pregnancy

PURPOSE: Maternal-fetal attachment in a pregnant woman is important for her health and for her child's emotional stability. This study was done to identify the contribution of maternal fatigue, social support, and Taegyo to maternal-fetal attachment based on a survey of pregnant women. METHODS: The study was a descriptive correlation study. Participants were 211 from two women's health clinic centers. Data were analyzed using t-test, ANOVA, Pearson correlation coefficients and stepwise multiple regression. RESULTS: Mean scores for maternal-fetal attachment, Taegyo, maternal fatigue, and social support were 93.74 (range 25-125), 64.76 (17-85), 24.12 (10-40), and 54.43 (22-132), respectively. There were significant differences in maternal-fetal attachment according to parity, breast feeding experience, and putting prenatal education into practice. Multiple regression analysis showed that the key determinants of maternal-fetal attachment, were Taegyo (beta=.67), maternal fatigue (beta=.21), and social support (beta=.13), and these explained 55% of the total variance of attachment. CONCLUSION: The results suggest a need to encourage Taegyo in prenatal management program and provide methods for fatigue resolution and promotion of social support.