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1.
AJP Rep ; 12(1): e69-e75, 2022 Jan.
Article in English | MEDLINE | ID: mdl-35141039

ABSTRACT

Objective This study aimed to identify cardiovascular differences between pregnant people with and without obesity for trimester-specific changes in hemodynamic parameters using noninvasive cardiac output monitoring (NICOM). Study Design This study is a pilot prospective comparative cohort between pregnant people with and without obesity. Hemodynamic assessment was performed with NICOM (12-14, 21-23, and 34-36 weeks) during pregnancy. Results In first trimester, pregnant people with obesity had higher blood pressure, stroke volume (SV), total peripheral resistance index (TPRI), and cardiac output (CO). Pregnant people with obesity continued to have higher SV and cardiac index (second and third trimesters). During the first trimester, body mass index (BMI) positively correlated with SV, TPRI, and CO. Fat mass showed a strong correlation with TPRI. BMI positively correlated with CO during the second trimester and fat mass was positively associated with CO. During the third trimester, TPR negatively correlated with BMI and fat mass. Conclusion Fat mass gain in the period between the first and second trimesters in addition to the hemodynamic changes due to obesity and pregnancy contribute to some degree of left ventricular diastolic dysfunction which was manifested by lower SVs. Future work should investigate the possible causative role of obesity in the cardiovascular changes identified in people with obesity.

2.
BMC Med Educ ; 21(1): 111, 2021 Feb 17.
Article in English | MEDLINE | ID: mdl-33596885

ABSTRACT

BACKGROUND: It has been previously shown that a high percentage of medical students have sleep problems that interfere with academic performance and mental health. METHODS: To study the impact of sleep quality, daytime somnolence, and sleep deprivation on medical students, we analyzed data from a multicenter study with medical students in Brazil (22 medical schools, 1350 randomized medical students). We applied questionnaires of daytime sleepiness, quality of sleep, quality of life, anxiety and depression symptoms and perception of educational environment. RESULTS: 37.8% of medical students presented mild values of daytime sleepiness (Epworth Sleepiness Scale - ESS) and 8.7% presented moderate/severe values. The percentage of female medical students that presented ESS values high or very high was significantly greater than male medical students (p <  0.05). Students with lower ESS scores presented significantly greater scores of quality of life and perception of educational environment and lower scores of depression and anxiety symptoms, and these relationships showed a dose-effect pattern. Medical students reporting more sleep deprivation showed significantly greater odds ratios of presenting anxiety and depression symptoms and lower odds of good quality of life or perception of educational environment. CONCLUSIONS: There is a significant association between sleep deprivation and daytime sleepiness with the perception of quality of life and educational environment in medical students.


Subject(s)
Quality of Life , Students, Medical , Brazil , Female , Humans , Male , Perception , Sleep Deprivation/epidemiology , Sleepiness , Surveys and Questionnaires
3.
J Obstet Gynaecol Can ; 43(3): 306-312, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33127379

ABSTRACT

OBJECTIVE: Rates of cesarean delivery are increasing, and these procedures carry potential complications, like the risk of invasive placentation, which increases with each cesarean. A trial of labour after cesarean (TOLAC) is a viable option for patients; however, it has been associated with uterine rupture, a complication with maternal and fetal risks. To better counsel patients considering TOLAC, we aimed to determine local uterine rupture rates and maternal and neonatal outcomes with TOLAC and compare these with outcomes related to invasive placentation. METHODS: A 4-year retrospective chart review was conducted at our tertiary centre of all patients with a history of a previous cesarean delivery. We assessed rates of TOLAC, vaginal delivery after cesarean (VBAC), and uterine rupture, as well as maternal and neonatal outcomes associated with invasive placentation. Cases of uterine rupture from 1988 to the present were also reviewed, and their outcomes were compared with those of invasive placentation. RESULTS: Our uterine rupture rate was 0.44% and VBAC rate was 73.8%. We identified 8 cases of uterine rupture since 1988 and 67 invasive placentas during the 4-year chart review. Invasive placentation was associated with a significantly increased risk of neonatal respiratory morbidity, hysterectomy, maternal complications, and longer length of maternal hospital stay when compared with uterine rupture. CONCLUSION: While uterine rupture remains a potential complication of TOLAC, it is rare with overall excellent maternal and neonatal outcomes. Invasive placentation, the risk of which increases with cesarean delivery, carries potentially higher complication rates than uterine rupture. Local complication data is important for individual sites offering TOLAC. The implications of invasive placentation cannot be overlooked when counselling patients considering TOLAC.


Subject(s)
Counseling , Placentation , Trial of Labor , Uterine Rupture/etiology , Vaginal Birth after Cesarean/adverse effects , Adult , Cicatrix/complications , Female , Humans , Outcome Assessment, Health Care , Pregnancy , Retrospective Studies , Vaginal Birth after Cesarean/statistics & numerical data
4.
Biol Reprod ; 101(2): 271-283, 2019 08 01.
Article in English | MEDLINE | ID: mdl-31175349

ABSTRACT

Preeclampsia (PE) is a common pregnancy complication affecting 3-5% of women. Preeclampsia is diagnosed clinically as new-onset hypertension with associated end organ damage after 20 weeks of gestation. Despite being diagnosed as a maternal syndrome, fetal experience of PE is a developmental insult with lifelong cognitive consequences. These cognitive alterations are associated with distorted neuroanatomy and cerebrovasculature, including a higher risk of stroke. The pathophysiology of a PE pregnancy is complex, with many factors potentially able to affect fetal development. Deficient pro-angiogenic factor expression is one aspect that may impair fetal vascularization, alter brain structure, and affect future cognition. Of the pro-angiogenic growth factors, placental growth factor (PGF) is strongly linked to PE. Concentrations of PGF are inappropriately low in maternal blood both before and during a PE gestation. Fetal concentrations of PGF appear to mirror maternal circulating concentrations. Using Pgf-/- mice that may model effects of PE on offspring, we demonstrated altered central nervous system vascularization, neuroanatomy, and behavior. Overall, we propose that development of the fetal brain is impaired in PE, making the offspring of preeclamptic pregnancies a unique cohort with greater risk of altered cognition and cerebrovasculature. These individuals may benefit from early interventions, either pharmacological or environmental. The early neonatal period may be a promising window for intervention while the developing brain retains plasticity.


Subject(s)
Child Development , Cognition/physiology , Nervous System/pathology , Placenta Growth Factor/metabolism , Pre-Eclampsia/pathology , Animals , Child , Female , Humans , Nervous System/growth & development , Placenta Growth Factor/genetics , Pregnancy
5.
Pregnancy Hypertens ; 12: 23-28, 2018 Apr.
Article in English | MEDLINE | ID: mdl-29674194

ABSTRACT

BACKGROUND: Individuals (PE-F1s) born from preeclampsia (PE)-complicated pregnancies have elevated risks for cognitive impairment. Intervals of disturbed maternal plasma angiokines precede clinical signs of PE. We hypothesized pan-blastocyst dysregulation of angiokines underlies altered PE-F1 brain vascular and neurological development. This could alter brain functional connectivity (FC) patterns at rest. MATERIALS AND METHODS: Resting-state functional MRI datasets of ten, matched child pairs (5 boys and 5 girls aged 7-10 years of age) from PE or control pregnancies were available for study. Seed-based analysis and independent component analysis (ICA) methodologies were used to assess whether differences in resting-state functional connectivity (rs-FC) were present between PE-F1s and controls. Bilateral amygdala, bilateral hippocampus, and medial prefrontal cortex (MPFC) were selected as regions of interest (ROI) for the seed-based analysis based on previous imaging differences that we reported in this set of children. RESULTS: Compared to controls, PE-F1 children had increased rs-FC between the right amygdala and left frontal pole, the left amygdala and bilateral frontal pole, and the MPFC and precuneus. PE-F1 children additionally had decreased rs-FC between the MPFC and the left occipital fusiform gyrus compared to controls. CONCLUSION: These are the first reported rs-FC data for PE-F1s of any age. Theysuggest that PE alters FC during human fetal brain development. Altered FC may contribute to the behavioural and neurological alterations reported in PE-F1s. Longitudinal MRI studies with larger sample sizes are required to confirm these novel findings.


Subject(s)
Blood Pressure , Brain/physiopathology , Child Development , Cognition Disorders/etiology , Cognition , Pre-Eclampsia/physiopathology , Age Factors , Brain/diagnostic imaging , Brain/growth & development , Brain Mapping/methods , Case-Control Studies , Child , Child, Preschool , Cognition Disorders/diagnostic imaging , Cognition Disorders/physiopathology , Cognition Disorders/psychology , Female , Humans , Magnetic Resonance Angiography , Male , Neural Pathways , Pilot Projects , Pre-Eclampsia/diagnosis , Pregnancy
6.
Pregnancy Hypertens ; 10: 1-6, 2017 Oct.
Article in English | MEDLINE | ID: mdl-29153658

ABSTRACT

BACKGROUND: Offspring whose mothers developed preeclampsia (PE-F1s) show developmental effects that are now being identified, such as cognitive, behavioural, and mood differences compared to offspring from non-complicated pregnancies. We hypothesize that the progressive angiokine dysregulation associated with development of preeclampsia (PE) reflects gene dysregulation in pre-implantation conceptuses, and manifests in all developing fetal tissues rather than exclusively to the placenta. This hypothesis predicts that fetal cerebrovascular and brain development are deviated by fetal-intrinsic, brain-based mechanisms during what is currently considered a placentally-induced maternal disease. Due to our initial results from brain-imaging and cognitive screening in a child pilot PE-F1 cohort, we developed this systematic review to answer the question of whether any consistent neurological measurements have been found to discriminate between brain functions in offspring of mothers who experienced a hypertensive pregnancy vs. offspring of mothers that did not. METHODS: Relevant studies were searched systematically up to June 2017 in MEDLINE, PsycINFO, EMBASE and the grey literature. RESULTS: Following predetermined inclusion and exclusion criteria, our search identified 27 out of 464 studies reporting on neurological function in offspring born to preeclamptic and hypertensive mothers. CONCLUSION: The current literature strongly supports the conclusion of the behavioural and cognitive deviations in PE-F1s. However, only three studies associated their findings with brain measurements via magnetic resonance imaging (MRI) in both healthy and at-risk pediatric populations. PE-F1s should be identified as an at-risk pediatric population during brain development and studied further as a defined group, perhaps stratified by maternal plasma angiokine levels.


Subject(s)
Brain/growth & development , Pre-Eclampsia , Child , Child of Impaired Parents , Cognition Disorders/etiology , Developmental Disabilities/etiology , Female , Humans , Pregnancy
7.
Rev. bras. ginecol. obstet ; 38(8): 416-422, Aug. 2016. tab, graf
Article in English | LILACS | ID: lil-796935

ABSTRACT

Abstract Preeclampsia (PE) is a significant gestational disorder that causes complications in 3- 5% of all human pregnancies. Apart from the immediate risks and complications for mother and fetus, both additionally carry elevated lifelong risks for specific complications. Offspring of PE pregnancies (PE-F1) have higher risks for hypertension, stroke and cognitive impairment compared with well-matched offspring (F1) fromuncomplicated pregnancies. Prior to the clinical onset of PE, placental angiokines secreted into the maternal plasma are deviated. In many PE patients this includes deficits in placental growth factor (PGF). Our laboratory found that mice genetically-deleted for PGF (PGF - / -) have altered cerebrovascular and brain neurological development detectable from midgestation to adulthood. We hypothesized that the PGF deficits seen in human PE, deviate fetal cerebrovascular and neurological development in a manner that impairs cognitive functions and elevates stroke risk. Here we summarize the initial analytical outcomes from a pilot study of 8-10 year old male and female PE-F1s and matched controls. Our studies were the first to report magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and functional brain region assessment by eyemovement control and clinical psychometric testing in PE-F1s. Further studies in larger cohorts are essential to define whether there are image-based biomarkers that describe unique anatomical features in PE-F1 brains.


Resumo A pré-eclampsia (PE) é importante doença gravídica complicando 3-5% de todas as gestações humanas. Além dos riscos imediatos e complicações para a mãe e o feto, a PE associa-se a outros riscos materno-fetais elevados em longo prazo. Nascituros de gestações complicadas por PE (PE-F1) apresentam maiores riscos de desenvolver hipertensão, acidente vascular cerebral e disfunção cognitiva em comparação com prole (F1) de gestações sem complicações. Antes do aparecimento clínico da PE, angiocitocinas placentárias secretadas no plasma materno apresentam-se alteradas. Em muitos pacientes com PE, isso inclui valores plasmáticos reduzidos de Fator de Crescimento Placentário (PGF). Nosso laboratório identificou que camundongos geneticamente não produtores de PGF (PGF- / - ) apresentam alterações vasculares e de desenvolvimento cerebral detectáveis do período gestacional à idade adulta. Nossa hipótese é que os déficits de PGF identificados em mulheres que desenvolveram PE podem desviar o desenvolvimento neurológico e vascular cerebral fetal, de maneira a prejudicar funções cognitivas, elevando o risco de AVC. Aqui resumimos os resultados analíticos iniciais de um estudo piloto comcrianças do sexomasculino e feminino de 8- 10 anos de idade nascidas de mães que tiveram PE (PE-F1s) comparadas com crianças controle pareadas por idade e sexo. Nossos estudos são os primeiros a relatar a ressonância magnética (RNM), a angiorressonância e a avaliação funcional do cérebro pelo controle de movimento dos olhos e pelo teste clínico psicotécnico em PE-F1s. Estudos adicionais em coortes maiores são essenciais para definir se há biomarcadores com base em imagens que possam descrever características anatômicas únicas em cérebros de crianças PE-F1.


Subject(s)
Humans , Male , Female , Pregnancy , Child , Brain/growth & development , Pre-Eclampsia , Placenta Growth Factor/physiology
8.
Rev Bras Ginecol Obstet ; 38(8): 416-22, 2016 Aug.
Article in English | MEDLINE | ID: mdl-27420777

ABSTRACT

Preeclampsia (PE) is a significant gestational disorder that causes complications in 3-5% of all human pregnancies. Apart from the immediate risks and complications for mother and fetus, both additionally carry elevated lifelong risks for specific complications. Offspring of PE pregnancies (PE-F1) have higher risks for hypertension, stroke and cognitive impairment compared with well-matched offspring (F1) from uncomplicated pregnancies. Prior to the clinical onset of PE, placental angiokines secreted into the maternal plasma are deviated. In many PE patients this includes deficits in placental growth factor (PGF). Our laboratory found that mice genetically-deleted for PGF (PGF - / - ) have altered cerebrovascular and brain neurological development detectable from midgestation to adulthood. We hypothesized that the PGF deficits seen in human PE, deviate fetal cerebrovascular and neurological development in a manner that impairs cognitive functions and elevates stroke risk. Here we summarize the initial analytical outcomes from a pilot study of 8-10 year old male and female PE-F1s and matched controls. Our studies were the first to report magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and functional brain region assessment by eye movement control and clinical psychometric testing in PE-F1s. Further studies in larger cohorts are essential to define whether there are image-based biomarkers that describe unique anatomical features in PE-F1 brains.


Subject(s)
Brain/growth & development , Pre-Eclampsia , Child , Female , Humans , Male , Placenta Growth Factor/physiology , Pregnancy
12.
Am J Obstet Gynecol ; 212(5): 624.e1-17, 2015 May.
Article in English | MEDLINE | ID: mdl-25582098

ABSTRACT

OBJECTIVE: We performed an individual participant data (IPD) metaanalysis to calculate the recurrence risk of hypertensive disorders of pregnancy (HDP) and recurrence of individual hypertensive syndromes. STUDY DESIGN: We performed an electronic literature search for cohort studies that reported on women experiencing HDP and who had a subsequent pregnancy. The principal investigators were contacted and informed of our study; we requested their original study data. The data were merged to form one combined database. The results will be presented as percentages with 95% confidence interval (CI) and odds ratios with 95% CI. RESULTS: Of 94 eligible cohort studies, we obtained IPD of 22 studies, including a total of 99,415 women. Pooled data of 64 studies that used published data (IPD where available) showed a recurrence rate of 18.1% (n=152,213; 95% CI, 17.9-18.3%). In the 22 studies that are included in our IPD, the recurrence rate of a HDP was 20.7% (95% CI, 20.4-20.9%). Recurrence manifested as preeclampsia in 13.8% of the studies (95% CI,13.6-14.1%), gestational hypertension in 8.6% of the studies (95% CI, 8.4-8.8%) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome in 0.2% of the studies (95% CI, 0.16-0.25%). The delivery of a small-for-gestational-age child accompanied the recurrent HDP in 3.4% of the studies (95% CI, 3.2-3.6%). Concomitant HELLP syndrome or delivery of a small-for-gestational-age child increased the risk of recurrence of HDP. Recurrence increased with decreasing gestational age at delivery in the index pregnancy. If the HDP recurred, in general it was milder, regarding maximum diastolic blood pressure, proteinuria, the use of oral antihypertensive and anticonvulsive medication, the delivery of a small-for-gestational-age child, premature delivery, and perinatal death. Normotensive women experienced chronic hypertension after pregnancy more often after experiencing recurrence (odds ratio, 3.7; 95% CI, 2.3-6.1). CONCLUSION: Among women that experience hypertension in pregnancy, the recurrence rate in a next pregnancy is relatively low, and the course of disease is milder for most women with recurrent disease. These reassuring data should be used for shared decision-making in women who consider a new pregnancy after a pregnancy that was complicated by hypertension.


Subject(s)
HELLP Syndrome/epidemiology , Hypertension/epidemiology , Pre-Eclampsia/epidemiology , Adult , Anticonvulsants/therapeutic use , Antihypertensive Agents/therapeutic use , Chronic Disease , Cohort Studies , Female , HELLP Syndrome/drug therapy , Humans , Hypertension, Pregnancy-Induced/drug therapy , Hypertension, Pregnancy-Induced/epidemiology , Infant, Newborn , Infant, Small for Gestational Age , Postpartum Period , Pre-Eclampsia/drug therapy , Pregnancy , Premature Birth/epidemiology , Recurrence , Severity of Illness Index , Young Adult
14.
Int J Gynaecol Obstet ; 116(3): 214-8, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22196994

ABSTRACT

OBJECTIVE: To determine perinatal outcome and epidemiologic, clinical, and obstetric characteristics among pregnant women infected with the H1N1 virus admitted to a Brazilian university hospital. METHODS: A cross-sectional study was conducted of pregnant women infected with H1N1 who were admitted to the University Hospital at the School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil, during the 2009 pandemic. Data were obtained via a questionnaire, which was administered during the hospital evaluation of patients' medical records. RESULTS: Thirty-one patients were included in the study. Antiviral therapy was initiated within 48 hours of the onset of symptoms in 64.5% of cases. Infection with the H1N1 virus was associated with severe clinical complications in 22.6% of patients and adverse perinatal outcomes in 41.9% of cases. The rate of maternal and perinatal mortality was 9.7%. There was a statistically significant association between late treatment with oseltamivir and increase in systemic complications in pregnancy (odds ratio 22.80 [95% confidence interval, 2.20-235.65]; P=0.007). CONCLUSION: Early treatment with oseltamivir may prevent serious complications associated with H1N1 infection in pregnant women but it does not affect perinatal outcome.


Subject(s)
Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human , Pregnancy Complications, Infectious , Adolescent , Adult , Antiviral Agents/therapeutic use , Brazil/epidemiology , Cross-Sectional Studies , Female , Humans , Influenza, Human/diagnosis , Influenza, Human/drug therapy , Influenza, Human/epidemiology , Maternal Mortality , Oseltamivir/therapeutic use , Pandemics , Perinatal Mortality , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Treatment Outcome , Young Adult
15.
Arch Gynecol Obstet ; 278(1): 13-6, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18087708

ABSTRACT

OBJECTIVES: Because of the large number of cases of visceral leishmaniasis (VL) recorded in Brazil over the last few years, this disease has been showing characteristics different from previously known ones. We report cases of pregnant women treated for VL, describing their course and outcome and the chemotherapeutic medication used according to the clinical signs and symptoms of each patient. STUDY DESIGN: We report five cases of pregnant women treated for VL in a central-western region of Brazil. RESULTS: No case of vertical transmission was observed, even in patients who were treated after delivery. One of the patients with a late diagnosis made after the onset of symptoms died. Thus, the treatment of VL during pregnancy reduces maternal mortality and the rate of vertical transmission of the disease, being safe and effective as long as the disease is diagnosed early. CONCLUSION: At present, amphotericin B and its derivatives appear to be the best therapeutic option for the mother-child binomial.


Subject(s)
Leishmaniasis, Visceral/drug therapy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Outcome , Adult , Amphotericin B/therapeutic use , Animals , Antimony Sodium Gluconate/therapeutic use , Antiprotozoal Agents/therapeutic use , Brazil , Deoxycholic Acid/therapeutic use , Drug Combinations , Female , Fever/parasitology , Hepatomegaly/parasitology , Humans , Leishmaniasis, Visceral/diagnosis , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Splenomegaly/parasitology
16.
DST j. bras. doenças sex. transm ; 19(3/4): 139-143, nov. 25, 2007. tab, graf
Article in Portuguese | LILACS | ID: lil-530219

ABSTRACT

Introdução: estima-se em 3,5% as gestantes portadoras de sífilis no Brasil, com risco de transmissão vertical em 50% a 85% dos casos e a taxa de mortalidade perinatal em torno de 40%. Entre os fatores de risco, inclui-se a falta de adequada assistência pré-natal. Objetivo: verificar a prevalência de sífilis congênita (SC) na cidade de Campo Grande e descrever os dados epidemiológicos, obstétricos e perinatais da população estudada, destacando seu papel como fator de qualidade de assistência pré-natal. Métodos: estudo observacional transversal dos casos de sífilis congênita ocorridos em 512 puérperas, no período de 1º de fevereiro a 30 de abril de 2006. O diagnóstico baseou-se nos critérios propostos pelo Ministério da Saúde. Utilizaram-se a entrevista ao leito com puérperas e a verificação dos exames realizados durante o pré-natal ou no ato da internação. Resultados: o coeficiente de SC encontrado foi de 23,4 casos por 1.000 nascidos vivos. Conforme os critérios do CDC, a totalidade dos casos foi de SC presumível. O coeficiente de mortalidade perinatal por SC foi zero. Das gestantes com sífilis, 75% relataram acompanhamento pré-natal prévio. Em apenas 42% dos casos, o diagnóstico de sífilis materna foi realizado antes do parto. Somente 33% foram adequadamente tratadas durante o pré-natal. Os parceiros das gestantes infectadas não foram adequadamente tratados em aproximadamente 60% dos casos. Os filhos das pacientes foram rastreados para sífilis em apenas 40% dos casos. Conclusão: a prevalência de SC observada foi de 2,3%. Houve a constatação de elevada prevalência de puérperas infectadas, tratamento inadequado das pacientes e de seus parceiros e rastreamento inadequado dos filhos. Os dados expostos reforçam a importância do pré-natal na redução da sífilis congênita, enfatizando a melhoria da qualidade desta assistência para a população avaliada.


Introduction: three point five percent of pregnant women with syphilis in Brazil, who represent the risk of vertical transmission of 50-85% and perintal mortality rate of 40% were estimated. Among the risk factors, the lack of regular prenatal assistance is punctuated. Objective: verifying congenital syphilis (CS) prevalence in Campo Grande and describing epidemiological, obstetrical and perinatal data of the studied population, highlighting its role as a marker of prenatal quality assistance. Methods: observational and transversal study of CS cases occurred in 512 post-partum women from February 1st to April 30th 2006. The diagnosis was based on Ministry of Health criteria. An interview during delivery hospitalization was madeto obtain the data. Results: the CS coefficient found was 23.4/1.000 births. The CS rate was presumed according to the criteria of CDC. The neonatal coefficient was zero. Out of the pregnant women with syphilis, 75% informed regular prenatal assistance, 33% were correctly treated during prenatal period. Pregnant women’s partners were not treated in 60% of the cases. The children that the infected women already had were screened for syphilis only in 40% of the cases. Conclusion: the prevalence of CS observed was 2.3%. A high puerperal prevalence of syphilis infection, not adequate treatment of the women and their partners and inadequate screening of the children those women already had were observed. The exposed dataenhance the prenatal importance in reducing the CS, emphasizing the best regular prenatal assistance to the studied population.


Subject(s)
Humans , Prenatal Diagnosis , Syphilis, Congenital/epidemiology , Sexually Transmitted Diseases , Prevalence , Pregnant Women , Cross-Sectional Studies , Infectious Disease Transmission, Vertical , Perinatal Mortality
17.
Clinics (Sao Paulo) ; 60(3): 207-12, 2005 Jun.
Article in English | MEDLINE | ID: mdl-15962081

ABSTRACT

PURPOSE: To study the effect of antiretroviral drugs administered during pregnancy on CD4 lymphocyte counts and HIV-1 RNA levels of pregnant women and on the anthropometric parameters of their neonates. METHODS: A prospective study was conducted on 57 pregnant women and their neonates divided into 3 groups: ZDV Group, HIV-infected mothers taking zidovudine (n=20); triple therapy (TT) Group, mothers taking zidovudine+lamivudine+nelfinavir (n=25), and Control Group, normal women (n=12). CD4 lymphocyte counts and HIV-1 RNA levels of pregnant women were analyzed during two periods of pregnancy. The perinatal prognosis took into account preterm rates, birth weight, intrauterine growth restriction, perinatal death, and vertical transmission of HIV-1. Data were analyzed statistically using the nonparametric chi-square, Mann-Whitney, Friedman, Kruskal-Wallis, and Wilcoxon matched pairs tests, with the level of significance set at P<.05. RESULTS: The major maternal demographic and anthropometric data were homogeneous for the various groups. HIV-1 viral burden, which was initially elevated, median of 14,370 copies/mL, was significantly reduced in the TT group, reaching 40 copies/mL. With respect to T-CD4+ lymphocyte counts, there was a significant recovery in Group TT at the end of pregnancy, this value being significantly different from that for the ZDV group (P=0052). There was no difference between groups regarding gestation length, Apgar scores, or neonatal anthropometric classification. There was no case of vertical HIV-1 transmission. CONCLUSIONS: The results obtained for the present series demonstrate the efficiency and suggest safety of the use of antiretroviral drugs during pregnancy as revealed by anthropometric parameters of the neonate.


Subject(s)
Anti-HIV Agents/therapeutic use , Birth Weight/drug effects , Fetal Development/drug effects , HIV Infections/drug therapy , Pregnancy Complications, Infectious/drug therapy , Adolescent , Adult , CD4 Lymphocyte Count , Case-Control Studies , Female , HIV Infections/transmission , HIV-1/genetics , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Lamivudine/therapeutic use , Nelfinavir/therapeutic use , Pregnancy , Prospective Studies , RNA, Viral/analysis , Zidovudine/therapeutic use
18.
Clinics ; 60(3): 207-212, June 2005. tab
Article in English | LILACS | ID: lil-402750

ABSTRACT

OBJETIVOS: Estudar o efeito das drogas anti-retrovirais sobre a quantificação dos linfócitos TCD4 e RNA do HIV-1 de gestantes portadoras do HIV-1 e parâmetros antropométricos de seus neonatos. MÉTODOS: Estudo prospectivo avaliando 57 gestantes e seus neonatos em três grupos: Grupo AZT, gestantes portadoras do HIV utilizando zidovudina (n=20); Grupo TT, mães utilizando zidovudina+lamivudina+nelfinavir (n=25), e Grupo Controle, mulheres saudáveis (n=12). A quantificação dos linfócitos TCD4 e RNA do HIV-1 de gestantes portadoras do HIV foi analisada em dois períodos durante a gestação. O prognóstico perinatal levou em consideração as taxas de pré-termos, restrição de crescimento intra-útero, mortalidade perinatal e transmissão vertical do HIV-1. Os dados foram analisados utilizando-se testes não paramétricos de qui-quadrado, Mann-Whitney, Friedman, Kruskal-Wallys e Wilcoxon para amostras pareadas, considerando-se significativos valores associados a p<0,05. RESULTADOS: Observou-se homogeneidade entre os dados demográficos e antropométricos de realce. A carga viral, inicialmente elevada (14.370 cópias/ml), reduziu-se significativamente no grupo com tratamento tríplice , chegando a 40 cópias/ml. Quanto à contagem de linfócitos CD4, observou-se recuperação significativa nas pacientes do grupo TT, no final da gestação, sendo esse valor significativamente diferente em comparação ao grupo AZT (p = 0,0052). Não se observou diferença entre os grupos quanto à duração da gestação, aos índices de Apgar, e à classificação antropométrica neonatal. Não houve nenhum caso de transmissão vertical do HIV-1. CONCLUSÕES: Os resultados obtidos na presente casuística demonstram eficiência e sugerem segurança no uso de anti-retrovirais na gestação sobre parâmetros antropométricos dos neonatos.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adolescent , Adult , Anti-HIV Agents/therapeutic use , Birth Weight/drug effects , Embryonic and Fetal Development/drug effects , HIV Infections/drug therapy , Pregnancy Complications, Infectious/drug therapy , Anthropometry , Case-Control Studies , HIV Infections/transmission , HIV-1 , Infectious Disease Transmission, Vertical , Lamivudine/therapeutic use , Nelfinavir/therapeutic use , Prognosis , Prospective Studies , RNA, Viral/analysis , Viral Load , Zidovudine/therapeutic use
19.
Diabetes Care ; 28(4): 856-9, 2005 Apr.
Article in English | MEDLINE | ID: mdl-15793185

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the effect of antiretroviral drugs on neonatal serum insulin levels. RESEARCH DESIGN AND METHODS: A prospective study was conducted on 57 pregnant women divided into three groups: the zidovudine (ZDV) group, HIV-infected women taking ZDV (n = 20); the triple treatment group, HIV-infected women taking triple antiretroviral agents ZDV + lamivudine + nelfinavir (n = 25); and the control group, pregnant women considered normal from a clinical and laboratory standpoint (n = 12). Blood was collected from the umbilical cord of newborn infants upon delivery for measurement of insulin level. The insulin measurements were performed in duplicate by radioimmunoassay. RESULTS: Demographic and anthropometric data were homogeneous, and pregnant women with a personal and family history of diabetes were excluded. There was no difference between groups regarding glycemia in the newborn. Median newborn insulin doses were 2.9, 4.8, and 6.5 muU/ml for the triple treatment, ZDV, and control groups, respectively (P < 0.05). CONCLUSIONS: Use of triple therapy during pregnancy induced a significant decrease in serum levels of neonatal insulin compared with the control group. Active surveillance of short- and long-term adverse events is imperative to issue a definitive statement regarding the impact that use of protease inhibitors during pregnancy will have on infant metabolism.


Subject(s)
Anti-HIV Agents/therapeutic use , Infant, Newborn/blood , Insulin/blood , Pregnancy Complications, Infectious/drug therapy , Prenatal Exposure Delayed Effects , Zidovudine/therapeutic use , Adolescent , Adult , Blood Glucose/analysis , Cohort Studies , Female , Fetal Blood/chemistry , Humans , Pregnancy
20.
DST j. bras. doenças sex. transm ; 17(4): 281-287, 2005. tab, graf
Article in Portuguese | LILACS | ID: lil-432239

ABSTRACT

Introdução: a infeccao HIV-1 em gestantes muitas vezes é subdiagnosticada, devido à caracteristica assintomática ou sub-clínica inicial durante a gestação. O conhecimento da realidade local, bem como do perfil epidemiológico da infecção HIV-1 durante o período gestacional é importaute em pupulações brasileiras. Objetivo: avaliar a freqüência, o perfil epidemiológico e a associação da infecção HIV-I com a idade materna em gestantes submetidas à triagem pré-natal de um estado da região Centro-Oeste brasileira. Métodos: estudo prospectivo de 71 gestantes com diagnóstico de infecção pelo vírus HIV-1 de 32.512 gestantes submetidas à triagem pré-natal no período de novembro de 2002 a outubro de 2003. Esta triagem inclui uma investigação sorológica de 10 infecções através da técnica de papel-filtro, utilizando a metodologia ELISA, sendo a infecção pelo vírus HIV-1 triada pelo método ELISA e confirmada por Western-Blot. A mensuração das variáveis foi expressa pelas médias, ao passo que a associação entre algumas variáveis foi avaliada pelo teste do x² em tabelas de contingência de dupla entrada. Resultados: dentre as 32.512 gestantes triadas, foi encontrada uma freqüência de 0,2 por cento (71) para infecção pelo vírus HIV-I, sendo que a maioria das pacientes desconhecia ser portadora do vírus HIV- I previamente ao pré-natal. A média de idade ao diagnóstico foi de 24,4±5,3 anos, sendo que as gestantes provenientes do interior do Estado representaram 62 po cento da amostra. Não houve asso-ciação estatística significante entre a freqüência dos casos e faixa etária das gestantes. Quanto à paridade, a maioria das gestantes se encontrava na terceira gestação, sendo o segundo trimestre o período gestacional mais prevalente da realização do diagnóstico. 0 tipo de parto predominante foi cesárea a termo, havendo um aborto e um óbito fetal. Conclusão: a freqüência da infecção HIV- I em gestantcs de estado da região Centro-Oeste brasileira ficou abaixo da encontrada em outros estudos nacionais e próxima da observada em estudos internacionais. Não há na literatura mundial ampla triagem pré-natal comparativamente ao presente trahalho. A importância da triagem sorológica do vírus HIV-1 durante o pré-natal o mais precocemente possível deve ser enfatizada, uma vez que no presente estudo, a maioria absoluta das gestantes descobriu-se portadora do vírus HIV pela primeira vez durante o período gestacional...


Subject(s)
Humans , Female , Pregnancy , HIV-1 , Infectious Disease Transmission, Vertical , Pregnancy , Sexually Transmitted Diseases
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