Strategies types on precedent vertical jump stretching / Estrategias sobre los tipos de estiramientos que preceden al salto vertical / Estratégias sobre os tipos de alongamentos que precedem o salto vertical

ABSTRACT Study design: identify a better strategy for static stretching (SS), dynamic stretching (DS), and proprioceptive neuromuscular facilitation (PNF) concerning the performance of their applications in countermovement vertical jump (CVJ). A systematic literature review was conducted in May and June 2021 in the Pubmed/MEDLINE, Scopus, LILACS, SPORTDiscus, and Embase databases. The PRISMA-2020 checklist was used. The Cochrane handbook scale and the Downs and Black scale were used for risk of bias analysis. Seventeen studies were included for qualitative analysis. Motor Unit recruitment and its stimulation frequency favor neural factors and muscle strength performance during contraction. Detailed investigations are necessary on the neural factors that modify the reflex responses and motor control, considering the biological characteristics and plastic deformations. The SS is a negative predictor of vertical jump (VJ) performance. The improvements are reduced when the stretching time is longer than 60 seconds, and when associated with PNF, did not reveal significant results. Using the SS before the DS in short periods of 20 seconds and no more than 60 seconds in the pre-activity to the VJ is suggested. In short stretches, the ROM increased both in the knee and the hip, and the hamstring muscles, when in tension, are unfavorable in sports that frequently use the VJ. Therefore, PNF using the technique that involves a process of contracting and relaxing must be investigated in an isolated and specific way, advocating the antagonist group. Thus, decreasing antagonist strength may be favorable for height gain, although contemporary studies are needed to minimize lower stability and muscle control predictors. Level of Evidence II; Systematic Review Study.

RESUMEN Diseño del estudio: identificar una mejor estrategia de estiramiento estático (EE), estiramiento dinámico (ED) y facilitación neuromuscular propioceptiva (FNP) en relación con el rendimiento de sus aplicaciones en salto vertical con contramovimiento (SCM). Se realizó una revisión sistemática de la literatura en mayo y junio de 2021, en las bases de datos Pubmed/MEDLINE, Scopus, LILACS, SPORTDiscus y Embase. Se utilizó la checklist PRISMA-2020. Para el análisis del riesgo de sesgo se utilizaron la Cochrane handbook y la escala de Downs y Black. Se incluyeron 17 estudios para el análisis cualitativo. El reclutamiento de Unidad Motora y su frecuencia de estimulación favorece los factores neurales y el desempeño de la fuerza muscular durante la contracción. Son necesarias investigaciones detalladas sobre los factores neurales que modifican las respuestas reflejas y el control motor considerando las características biológicas y las deformaciones plásticas. El EE es un predictor negativo para el rendimiento de la salto vertical (SV) y las mejoras se reducen cuando el tiempo de estiramiento es mayor a 60 segundos, y cuando se asocia con FNP no revela resultados significativos. Se sugiere utilizar el EE antes del ED en periodos cortos de 20 segundos y no más de 60 segundos en la preactividad al SV. En tramos cortos, la gama de movimientos se incrementó tanto en la rodilla como en la cadera, y los músculos isquiotibiales, cuando están en tensión, son desfavorables en deportes que utilizan frecuentemente el SV. Por tanto, la FNP mediante la técnica que implica un proceso de contracción y relajación debe investigarse de forma aislada y específica, preconizando el grupo antagonista. Por lo tanto, la disminución de la fuerza del antagonista puede ser favorable para la ganancia de altura, aunque se necesitan estudios contemporáneos para minimizar los predictores de menor estabilidad y/o control muscular. Nível de Evidencia II; Estudio de Revisión Sistematica.

RESUMO Design do estudo: identificar uma melhor estratégia de alongamento estático (AE), Alongamento dinâmico (AD) e facilitação neuromuscular proprioceptiva (FNP) em relação ao rendimento de suas aplicações no salto vertical contramovimento (SCM). Desenvolveu-se uma revisão sistemática da Literatura nos meses de maio e junho de 2021, nas bases de dados Pubmed/MEDLINE, Scopus, LILACS, SPORTDiscus e Embase. Utilizou-se o checklist PRISMA-2020. Para análise de risco de viés utilizou-se a escala do Cochrane handbook e a escala de Downs and Black. 17 estudos foram incluídos para análise qualitativa. O recrutamento da Unidade Motora e a sua frequência de estimulações favorecem os fatores neurais e o desempenho da força muscular durante a contração. Investigações circunstanciadas são necessárias sobre os fatores neurais que modificam as respostas reflexas e controle motor considerando as características biológicas e deformações plásticas. O AE é um preditor negativo para o desempenho do salto vertical (SV) e, as melhorias são reduzidas quando o tempo de alongamento é superior a 60 segundos, e quando associado a FNP não revelou resultados significativos. Sugere-se a utilização do AE antes do AD em períodos curtos de 20 segundos e não mais que 60 segundos na pré-atividade ao SV. Nos alongamentos curtos a gama de movimentos aumentou tanto no joelho quanto no quadril e, a musculatura isquiotibial, quando em tensão, é desfavorável em esportes que utilizam frequentemente o SV. Portanto, a FNP com a utilização da técnica que envolve um processo de contrair e relaxar deve ser investigada de forma isolada e específica preconizando o grupo antagonista. Desta forma, diminuir a força do antagonista pode ser favorável para o ganho de altura, embora estudos atualizados sejam necessários para minimizar os preditores de menor estabilidade e/ou controle muscular. Nível de evidência II; Estudo de Revisão Sistemática.

The practice of physical exercise in the context of cognitive compromise and neuro-muscular interactions in the care of the elderly / Prática do exercício físico no comprometimento cognitivo e intercorrências neuromusculares na atenção ao idoso: uma revisão sistemática

Objective: to investigate the influence of physical exercise in the context of cognitive compromise of the elderly, and the exercise programmes of greater impact in the motor response and neuromuscular adaptations. Method: a systematic review was developed in the Pubmed/MEDLINE, Scopus, LILACS, SPORTDiscus and Embase databases. The PRISMA 2020 checklist and bias risk analysis were applied using the Cochrane handbook scale for the systematic review of interventions (Version 5.1.0). Domains in table 8.5.d. Results: 21 studies were included in the qualitative analysis. The regular practice of physical exercise causes a series of positive neuromuscular adaptations in the elderly. These adaptations are related to increases in muscle mass, strength and power, favouring cognitive and motor capacity. The change in lifestyle of the elderly has a significant impact, and 30% of the ageing process is considered natural and caused by sensory, mental and physical factors and a loss of self-control, but 70% depends absolutely on the individual lifestyle. Conclusion: The present study suggests a programme composed of combined strength, resistance and aerobic exercises. Such exercises cause increases in neurotrophic, vascular and growth factors, as well as promoting cognitive, mood and quality of life improvements during ageing. Thus, the implementation of an exercise programme involving plyometrics and greater intensities of resistance training (equal or greater to 60% of 1-MR) and an adequate and progressive volume (equal or greater to three 30-40-minute sessions per week), appears to promise improved cognitive and psychomotor outcomes in old age (AU).

Objetivo: investigar a influência do exercício físico no comportamento cognitivo dos idosos e os programas de exercícios de maior impacto na resposta motora e adaptações neuromusculares. Método: desenvolveu-se uma revisão sistemática nas bases de dados Pubmed/MEDLINE, Scopus, LILACS, SPORTDiscus e Embase. Utilizou-se o PRISMA 2020 e análise de risco de viés através da escala Cochrane handbook para revisões sistemáticas de inter-venções (Versão 5.1.0). Domínios da tabela 8.5.d Resultados: 21 estudos foram incluídos para análise qualitativa. A prática regular de exercício físico desencadeia uma série de adaptações neuromusculares positivas em pessoas idosas. Essas adaptações estão relacionadas ao aumento da massa, força e potência muscular, favorecendo a capa-cidade cognitiva e motora. A mudança no estilo de vida do idoso apontou impacto significativo, e 30% do processo de envelhecimento é considerado natural e causado por fatores sensoriais, mentais, físicos e perda do autocontrole. No entanto, 70% dependem impreterivelmente do estilo de vida individual. Conclusão: O presente estudo sugere um programa composto por exercícios combinados de força, resistência e aeróbicos. Tais exercícios promovem o aumento dos fatores neurotróficos, vascular e de crescimento, além de promover melhorias cognitivas, de humor e qualidade de vida ao envelhecer. Para tanto, a implementação de um programa de exercícios que envolva a plio-metria e um treinamento resistido com intensidades mais altas (igual ou superior a 60% de 1-RM) e um volume adequado e progressivo (igual ou superior a 3 sessões de 30-40 minutos por semana), parece ser promissor aos melhores desfechos cognitivos e psicomotores na terceira idade (AU).

El objetivo: investigar la influencia del ejercicio físico en el comportamiento cognitivo de las personas mayores y los programas de ejercicio con mayor impacto en la respuesta motora y adaptaciones neuromusculares. Método: se realizó una revisión sistemática en las bases de datos Pubmed/MEDLINE, Scopus, LILACS, SPORTDiscus y Embase. Se utilizó el PRISMA 2020 y el análisis de riesgo de sesgo mediante la escala del manual Cochrane para revisiones sistemáticas de intervenciones (Versión 5.1.0). Dominios en la tabla 8.5.d Resultados: Se incluyeron 21 estudios para el análisis cualitativo. La práctica regular de ejercicio físico desencadena una serie de adaptaciones neuro-musculares positivas en las personas mayores. Estas adaptaciones están relacionadas con el aumento de la masa muscular, la fuerza y la potencia, favoreciendo la capacidad cognitiva y motora. El cambio en el estilo de vida de los ancianos mostró un impacto significativo, y el 30% del proceso de envejecimiento se considera natural y causado por factores sensoriales, mentales, físicos y pérdida de autocontrol. Sin embargo, el 70% depende absolutamen-te del estilo de vida individual. Conclusión: El presente estudio sugiere un programa compuesto por ejercicios combinados de fuerza, resistencia y aeróbicos. Dichos ejercicios promueven el aumento de factores neurotróficos, vasculares y de crecimiento, además de promover mejoras cognitivas, anímicas y de calidad de vida en el enveje-cimiento. Por lo tanto, la implementación de un programa de ejercicios que involucre ejercicios pliométricos y de fuerza con intensidades más altas (igual o mayor al 60% de 1-RM) y un volumen adecuado y progresivo (igual o mayor a 3 sesiones de 30-40 minutos a la semana) ), parece ser prometedor para mejores resultados cognitivos y psicomotores en la vejez (AU).

Myofascial release strategies and technique recommendations for athletic performance: A systematic review.

OBJECTIVE: To identify the effects of instrument-assisted soft tissue mobilization (IASTM) and foam roller self-myofascial release (FRSMR) strategies and verify their results in athletic performance. METHOD: Systematic review conducted in four databases from 2017. The inclusion criteria were randomized controlled trials assessing the effects of two forms of soft tissue mobilization on athletes' performance. The risk of bias was analyzed using the Cochrane Handbook scale. RESULTS: Ten studies were included for qualitative analysis. IASTM increased range of motion, knee joint kinetic force, peak torque, and angular velocity in dorsiflexion and plantar flexion. The technique increases isometric strength and isokinetic power in vertical jumping. FRSMR was relevant in counter movement jumping between the pre- and post-intervention conditions, mainly by increasing strength in the initial jumping phase. CONCLUSIONS: IASTM should be used in sports preparation to improve muscle response and explosive force production. FRSMR increases flexibility as it tends to restore tissue elasticity, but it does not improve aerobic activity. The suggested time for strategy intervention is at least 90 s per muscle group.

COVID-19 e o impacto de pacientes diabéticos e obesos durante o confinamento / COVID-19 and the impact of diabetic and obese patients during confinement

Objetivo: Identificar os aspectos relacionados à obesidade e ao diabetes de acordo com os fatores clínicos, sociais e as dificuldades de condicionamento físico na rotina de confinamento durante a COVID-19. Métodos: Utilizaram-se as bases de dados PubMed/MEDLINE, Web of Science, Scopus, LILACS, Embase e literatura cinza (Google Scholar). Foi utilizado o PRISMA, e, para análise de risco de viés, o checklist Downs and Black. Para sintetização dos resultados foram estabelecidos dois subtítulos com temas pertinentes ao objetivo da pesquisa. Resultados:Dezessete pesquisas foram incluídas para análise de síntese qualitativa: doze estudos de coorte, quatro de corte transversal e um estudo retrospectivo multicêntrico. Pacientes obesos e diabéticos aumentam as comorbidades quando infectados pela COVID-19, pois ocorre uma interação patológica comprometedora com complicações, como cetoacidose, infecção, hiperosmolaridade alta, dislipidemia e distúrbios psicológicos. Achados científicos apontam para uma maior internação de pessoas obesas em relação a diabéticos em Unidades de Terapia Intensiva (UTI), quando acometidos pelo novo coronavírus. Com a prática desportiva reduzida e a desmotivação advinda do comportamento sedentário, pessoas obesas e/ou diabéticas sugerem prognósticos desfavoráveis à saúde física e mental durante e após o término da pandemia. Conclusão: O entendimento específico sobre a abordagem imunomoduladora e de inibidores enzimáticos é de importância na atenção primária ao paciente. Estratégias com redes multidisciplinares devem acompanhar indivíduos com pré-disposição à obesidade e ao diabetes durante o confinamento social, uma vez que existe uma dificuldade de se manter um controle glicêmico e dislipidêmico que são desfavorecidos pela ansiedade, estresse e ideia de falência econômica (AU).

Objective: Identify aspects related to obesity and diabetes according to clinical and social factors combined with physical conditioning obstacles during the COVID-19 confinement routine. Methods: Database from PubMed/MEDLINE, Web of Science, Scopus, LILACS, Embase and grey literature (Google Scholar) was used, as well as PRISMA, and Downs and Black checklist for bias risk analysis. To summarize the results, two subtitles were defined in line with the research objectives. Results: Seventeen studies were included for qualitative synthesis analysis: twelve sectional cohort studies, four cross-sectional and one multicenter retrospective. Obese and diabetic patients increased comorbidities when infected by COVID-19, due to compromising pathological interaction followed by complications such as ketoacidosis, high hyperosmolarity infection, dyslipidemia and psychological disorders. Scientific findings show a higher level of hospitalization in Intense Care Units (ICU) for obese subjects compared to diabetics when infected by the new coronavirus. With lower physical activity and lack of motivation due to sedentary behavior, obese and/or diabetics show an adverse physical and mental prognostic during and after the end of pandemics. Conclusion: The specific understanding about immunomodulatory approach and enzymatic inhibitors is important for primary patient assistance. Multidisciplinary networks strategy must track individuals with a propensity to overweight and diabetes during social confinement, once it is difficult to keep glycemic and dyslipidemic control, which are unfavorable by anxiety, stress and the idea of economic bankruptcy (AU).

Estratégias para o transtorno do espectro autista: interação social e intervenções terapêuticas / Strategies for autism spectrum disorder: social interaction and therapeutic interventions

OBJETIVO: Identificar os fatores que dificultam as intervenções terapêuticas motoras em crianças com transtorno do espectro autista. MÉTODOS: Foram utilizadas as bases de dados PubMed, Web of Science, Scopus e LILACS. Uma pesquisa de literatura cinzenta foi conduzida com acadêmico do Google. PRISMA foi usado, bem como a análise de risco de viés adaptada do Cochrane Manual para ensaios clínicos e, para outros estudos, foi utilizada a lista de verificação Downs e Black. RESULTADOS: Dezessete artigos científicos foram incluídos na análise de síntese qualitativa sobre estratégias para interação social e motora em pacientes com transtorno do espectro autista. Quatorze artigos científicos alcançaram pontuações aceitáveis na escala de Downs e Black, e três ensaios clínicos indicaram domínios satisfatórios. Pessoas com transtorno do espectro autista apresentaram percentuais acima de 30%, com dificuldades de comportamentos sociáveis, de aprendizagem e de comunicação. O diagnóstico adequado e a preconização de um plano de tratamento para o desenvolvimento da motricidade são estratégias fundamentais e de ordem prioritária, uma vez que possibilitarão uma análise quantitativa ao longo da vida do autista, assim como proporcionarão uma maior viabilidade de análise das habilidades cognitivas. CONCLUSÃO: A dificuldade de comportamento social do indivíduo com transtorno do espectro autista pode ser o ponto-alvo nas suas limitações de aprendizagem motora. Portanto, a concepção metodológica com a prática de imitação, associada a uma dinâmica prazerosa do exercício rítmico, é a melhor sugestão para contemplar o direcionamento das pesquisas contemporâneas, uma vez que, quando prevalece a inter-relação entre interação social, aprendizagem motora e percepções sensoriais, os desfechos são mais significativos para essas crianças.

OBJECTIVE: To identify the factors that hinder motor therapeutic interventions in children with autism spectrum disorder. METHODS: The PubMed, Web of Science, Scopus, and LILACS databases were used. A Grey Literature search was conducted with a Google scholar. PRISMA was used, as well as the risk analysis of bias adapted from the Cochrane Manual for clinical trials and, for other studies, the Downs and Black checklist was used. RESULTS: Seventeen scientific articles were included in the qualitative synthesis analysis on strategies for social and motor interaction in patients with autism spectrum disorder. Fourteen scientific articles achieved acceptable scores on the Downs and Black scale, and three clinical trials indicated satisfactory domains. People with autism spectrum disorder showed percentages above 30%, with difficulties in sociable behavior, learning, and communication issues. Adequate diagnosis and advocacy of a treatment plan for the development of motor skills are fundamental and priority strategies since they will enable a quantitative analysis throughout the life of the autistic person, as well as providing greater viability for the analysis of cognitive skills. CONCLUSION: The difficulty of social behavior of the individual with autism spectrum disorder may be the target point in his motor learning limitations. Therefore, the methodological conception with the practice of imitation, associated with a pleasurable dynamic of rhythmic exercise, is the best suggestion to contemplate the direction of contemporary research, since when the interrelation between social interaction, motor learning, and sensory perceptions prevails, outcomes are more significant for these children.

No effect of a low dose of metformin on the lipid profile, body mass index and weight gain in pregnant women with obesity: A randomized trial.

OBJECTIVE: Evaluate the lipid profile, Body Mass Index (BMI) and weight gain of pregnant women with obesity and the effect of a low dose (1000 mg/day) of metformin hydrochloride on these parameters. METHODS: A randomized clinical trial was performed from October 31th, 2014 to January 25th, 2018 with pregnant women diagnosed with obesity by arrival BMI ≥ 30.0 kg/m2. The participants were randomized into two groups: metformin and control. All pregnant women received standard prenatal follow-up and the same instructions of diet and physical exercise. Laboratory tests were performed at three different times: first moment with gestational age (GA) < 20 weeks, second (GA 24-28 weeks) and third (GA 32-34 weeks) measuring maternal serum levels of total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides (TG) as well as weight gain and BMI were monitored. RESULTS: A total of 424 pregnant women with obesity were evaluated. Of these, 218 (51.41%) composed the control group and 206 (48.59%) the metformin group. There was no difference of lipid profile, BMI and weight gain values between groups during the 1st, 2nd and 3rd evaluation moments. A significant difference was observed, only in the BMI, HDL and TG values from 1st to 3rd evaluation moments. CONCLUSION: Low dose (1000 mg/day) of the drug showed no effect on the lipid profile, BMI and weight gain in pregnant women with obesity in metformin group during the evaluation moments.

Metformin for prevention of cesarean delivery and large-for-gestational-age newborns in non-diabetic obese pregnant women: a randomized clinical trial.

OBJECTIVE: To evaluate the use of metformin for preventing cesarean deliveries and large-for-gestational-age (LGA) newborn (NB) outcomes in non-diabetic obese pregnant women. SUBJECTS AND METHODS: This is a randomized clinical trial with obese pregnant women, divided into 2 groups: metformin group and control group, with followed-up prenatal routine. The gestational age of participants was less than or equal to 20 weeks and were monitored throughout entire prenatal period. For outcomes of delivery and LGA newborns, absolute risk reduction (ARR) and the number needed to treat (NNT) were calculated with a 95% confidence interval (CI). RESULTS: 357 pregnant women were evaluated. From the metformin group (n = 171), 68 (39.8%) subjects underwent cesarean delivery, and 117 (62.9%) subjects from the control group (n = 186) had intercurrence (p < 0.01). As for the mothers' general characteristics, there was significance for marital status (p < 0.01). Maternal-fetal results presented reduced preeclampsia (p < 0,01). Primary prophylactic results presented an ARR of 23.1 times (95% CI: 13.0-33.4) with NNT of 4 (95% CI: 3.0-7.7) and no significant values for LGA NB (p > 0.01). Secondary prophylactic outcomes presented decreased odds ratio for preeclampsia (OR = 0.17, 95% CI: 0.10-0.41). CONCLUSION: The use of metformin reduced cesarean section rates, resulted in a small number of patients to be treated, but it did not reduce LGA NB. Administering a lower dosage of metformin from the early stages to the end of treatment may yield significant results with fewer side effects. Arch Endocrinol Metab. 2020;64(3):290-7.

Metformin for prevention of cesarean delivery and large-for-gestational-age newborns in non-diabetic obese pregnant women: a randomized clinical trial

ABSTRACT Objective To evaluate the use of metformin for preventing cesarean deliveries and large-for-gestational-age (LGA) newborn (NB) outcomes in non-diabetic obese pregnant women. Subjects and methods This is a randomized clinical trial with obese pregnant women, divided into 2 groups: metformin group and control group, with followed-up prenatal routine. The gestational age of participants was less than or equal to 20 weeks and were monitored throughout entire prenatal period. For outcomes of delivery and LGA newborns, absolute risk reduction (ARR) and the number needed to treat (NNT) were calculated with a 95% confidence interval (CI). Results 357 pregnant women were evaluated. From the metformin group (n = 171), 68 (39.8%) subjects underwent cesarean delivery, and 117 (62.9%) subjects from the control group (n = 186) had intercurrence (p < 0.01). As for the mothers' general characteristics, there was significance for marital status (p < 0.01). Maternal-fetal results presented reduced preeclampsia (p < 0,01). Primary prophylactic results presented an ARR of 23.1 times (95% CI: 13.0-33.4) with NNT of 4 (95% CI: 3.0-7.7) and no significant values for LGA NB (p > 0.01). Secondary prophylactic outcomes presented decreased odds ratio for preeclampsia (OR = 0.17, 95% CI: 0.10-0.41). Conclusion The use of metformin reduced cesarean section rates, resulted in a small number of patients to be treated, but it did not reduce LGA NB. Administering a lower dosage of metformin from the early stages to the end of treatment may yield significant results with fewer side effects. Arch Endocrinol Metab. 2020;64(3):290-7

Physical exercise and metformin in gestational obesity and prevention on gestational diabetes mellitus: a systematic review / Exercício físico e metformina na obesidade gestacional e prevenção diabetes mellitus gestacional: revisão sistemática

Abstract Objectives: identify the action of metformin and physical activities to reduce weight gain and prevent mellitus diabetes in obese pregnant women. Methods: the electronic search was performed in PubMed / MEDLINE, LILACS, Web of Science, Scopus and Cochrane library databases between 2008 and 2018. The selection took place between April and July 2018, through the descriptors "pregnancy, obesity, metformin, treatment, exercise". A protocol was programmed and consecutively a selective research on the inclusion / exclusion phase. The "PICO" strategy was used. Population: obese pregnant women. Intervention: physical exercises and metformin. Control: The main indicator established was therapeutic outcomes with physical activity and metformin. Outcome of interest: body weight control. Results: by selecting the database, 3,983 articles were identified on the topic of interest. After selecting and eligibility, only 16 scientific studies were selected, of which 81.25% were clinical trials related to diet programs, physical activity, metformin use and possible outcomes, 18.75% were prospective cohort on causes of obesity in gestation and its association with gestational mellitus diabetes and preventive therapies. The study pointed out the possibility of adapting physical therapy programs with the correct metformin dosage for a greater control in gestational weight gain. However, there is a need for greater awareness and changes in habits for obese woman during the gestational period. Conclusions: the drug presents similarity to physical activity by activating AMPK and may be added to treatments that propose changes in pregnant women's lifestyle to reduce weight gain and prevent gestational diabetes mellitus with a better understanding of the optimal dosage. Thus, the study suggests the use of metformin is not only for the prevention and the intercurrence of gestational diabetes mellitus, but a strictly careful investigation allowing its use to non-diabetic obese pregnant women.

Resumo Objetivos: identificar a ação da metformina e da atividade física para redução do ganho de peso e prevenção do diabetes mellitus em gestantes obesas. Métodos: a busca eletrônica foi realizada nas bases de dados PubMed/MEDLINE, LILACS, Web of Science, Scopus e biblioteca Cochrane entre 2008 e 2018. A seleção ocorreu entre abril e julho de 2018, através dos descritores "gravidez, obesidade, metformina, tratamento, exercício". Programou-se um protocolo e consecutivamente uma etapa seletiva de inclusão/exclusão das pesquisas. Utilizou-se a estratégia "PICO". População: gestantes obesas. Intervenção: exercícios fisicos e metformina. Controle: o principal comparador estabelecido foi o desfecho terapêutico com atividade fisica e metformina. Desfecho de interesse: controle do peso corporal. Resultados: através da seleção do banco de dados, 3.983 artigos foram identificados sobre o tema de interesse. Após as etapas de seleção e elegibilidade, apenas 16 estudos científicos foram selecionados, dos quais 81,25% ensaios clinicos referentes aos programas de dieta, atividade física, uso da metformina e possíveis desfechos, 18,75% coorte prospectiva sobre as causas da obesidade na gestação e sua associação com o diabetes mellitus gestacional e terapêutica preventiva. O estudo apontou a possibilidade de se adequar programas de terapias físicas com a dosagem correta de metformina para um maior controle no ganho de peso gestacional. No entanto, existe a necessidade de uma maior concientização e mudanças de hábitos da mulher obesa durante o período gestacional. Conclusões: a droga apresenta semelhança com a atividade física ao ativar o AMPK e pode somar aos tratamentos que propõem mudanças no estilo de vida das gestantes para reduzir o ganho de peso e prevenir o diabetes mellitus gestacional com a necessidade de um melhor entendimento sobre a dosagem ideal. Desta forma, o estudo sugere que o uso da metformina não seja apenas para prevenção e intercorrências do DMG, mas também com uma investigação estritamente cuidadosa para possibilitar o seu uso em grávidas obesas não diabéticas.

Mobility impact and methods of diaphragm monitoring in patients with chronic obstructive pulmonary disease: a systematic review.

The objectives of the study were to identify the factors that limit diaphragmatic mobility and evaluate the therapeutic results of the monitoring methods previously used in patients with chronic obstructive pulmonary disease. The PubMed, Web of Science, Scopus, and LILACS databases were used. A gray literature search was conducted with Google scholar. PRISMA was used, and the bias risk analysis adapted from the Cochrane Handbook for clinical trials and, for other studies, the Downs and Black checklist were used. Twenty-five articles were included in the qualitative synthesis analysis on physiotherapeutic techniques and diaphragmatic mobility. Eight clinical trials indicated satisfactory domains, and on the Downs and Black scale, 17 cohort studies were evaluated to have an acceptable score. Different conditions must be observed; for example, for postoperative assessments the supine position is suggested to be the most appropriate position to verify diaphragm excursion, although it has been shown to be associated with difficulty of restriction and matching in samples. Therefore, we identified the need for contemporary adjustments and strategies that used imaging instruments, preferably in the dorsal position. Therapeutic evidence on the association between the instrumental method and diaphragmatic mobility can be controversial. The ultrasound measurements indicated some relevance for different analyses, for pulmonary hyperinflation as well as diaphragm thickness and mobilization, in COPD patients. In particular, the study suggests that the ultrasound technique with B-mode for analysis and M-mode for diaphragmatic excursion be used with a 2 - 5 MHz with the patient in the supine position. However, the methods used to monitor diaphragm excursion should be adapted to the conditions of the patients, and additional investigations of their characteristics should be performed. More selective inclusion criteria and better matching in the samples are very important. In addition, more narrow age, sex and weight categories are important, especially in patients with chronic obstructive pulmonary disease.

Perinatal mortality: epidemiological profile, causes and avoidable factors at a reference public maternity hospital in the State of Santa Catarina, Brazil, 2011-2015.

Background This study aimed to identify the perinatal mortality coefficient, the epidemiological profile, causes and avoidable factors at a reference public maternity hospital in southern Brazil. Methods In this cross-sectional study, 334 medical records of postpartum women and newborns were evaluated between January 1st, 2011 and December 31st, 2015. The Expanded Wigglesworth Classification was used to assess the causes of perinatal mortality and the International Statistical Classification of Diseases and Related Health Problems (ICD-10/SEADE Foundation) was used for the preventable perinatal mortality analysis. Absolute numbers and percentages were used for data analysis. The perinatal mortality formula was used to calculate the perinatal mortality rate. Results The perinatal mortality rate was 13.2/1000 total births, with a predominance of white race/color; mothers were 21-30 years of age, had experienced their first pregnancy and had completed their high school education. Conclusion The main factors associated with perinatal death were antepartum fetal death in 182 (54.49%) cases, and avoidable death through appropriate prenatal care in 234 (70.05%) cases.

O impacto do uso da metformina para gestantes obesas na prevenção da pré-eclâmpsia / The impact of the use of metformine for obese pregnant women in prevention

Objetivos: o artigo objetiva avaliar o uso de metformina em gestantes obesas na prevenção da pré-eclâmpsia. Métodos: trata-se de um ensaio clínico randomizado com mulheres grávidas obesas com índice de massa corporal superior ou igual a 30 kg/m2 divididos em dois grupos ­ um grupo de estudo, que utilizou metformina, e um grupo controle, que seguiu a rotina de pré-natal. As gestantes entraram no estudo com idade gestacional menor que 20 semanas e foram acompanhadas durante todo o período pré-natal. O diagnóstico de pré-eclâmpsia foi feito de acordo com os critérios da Organização Mundial de Saúde. Resultados: verificou-se a redução de risco absoluto e o número necessário para tratar em um intervalo de confiança de 95% para o resultado pré-eclâmpsia. Nos resultados, 272 gestantes foram avaliadas. No grupo de estudo (n = 127), oito (6,3%) desenvolveram pré-eclâmpsia. No grupo controle (n = 145), 31 (21,4%) tiveram a doença (p <0,01). Conclusão: o estudo apontou uma redução de risco absoluto de 15,1 vezes (IC95%: 7,1-22,9) e número necessário para tratar de sete (IC95%: 4,4-13,9). O uso de 1000 miligramas diárias de metformina indicou uma redução de 15,1 vezes no risco absoluto de pré-eclâmpsia na população estudada, com a necessidade de tratar sete gestantes para evitar um desfecho.

Aims: The article aims to evaluate the use of metformin in obese pregnant women in the prevention of pre-eclampsia. Methods: This is a randomized clinical trial with obese pregnant women with a body mass index greater than or equal to 30 kg / m2 divided into two groups: a study group that used metformin and a control group that followed the prenatal routine. The pregnant women entered the study with gestational age less than 20 weeks and were followed throughout the prenatal period. The diagnosis of pre-eclampsia was made according to World Health Organization criteria. Results: The absolute risk reduction and number needed to treat in a 95% confidence interval for the preeclampsia result were checked. In the results, 272 pregnant women were evaluated. In the study group (n = 127) eight (6.3%) developed preeclampsia, in the control group (n = 145) 31 (21.4%) obtained the disease (p <0.01). Conclusions: The study indicated an absolute risk reduction of 15.1 times (95% CI: 7.1-22.9) and number needed to treat of 7 (95%CI: 4.4-13.9). The use of 1000 milligrams daily metformin indicated a 15.1 x reduction in the absolute risk of preeclampsia in the study population, with the need to treat seven pregnant women to avoid an outcome.

Physical exercise and metformin in the prevention of pre-eclampsia: systematic review / Exercício físico e metformina na prevenção a pré-eclâmpsia: revisão sistemática

Abstract Introduction: Pre-eclampsia is a disorder that may occur during pregnancy but is still unknown and / or multifactorial causes. Objective: To verify whether physical exercise and metformin may be helpful in preventing preeclampsia. Method: This is a systematic review of the literature in PubMed / MEDLINE, Web of Science, Scopus, LILACS and Cochrane. This review followed the critiques of the PRISMA checklist. Bias assessment was used for the Cochrane Handbook for Systematical Reviews of Interventions (Version 5.1.0) for clinical trials and the Downs and Black scale for cohort and case-control studies. Results: 17 studies were within the established criteria. The subjects evaluated were: pre-eclampsia, cardiovascular metabolic factors, physiotherapeutic therapies and the effects of physical exercise and metformin on the circulatory system. Conclusion: There is a need for adapted techniques and new protocols according to the contingencies and complications of pregnancy. During pregnancy, it is suggested a greater interdisciplinarity of knowledge among professionals and that the therapy receives adjustments against the metabolic alterations of the reproductive system. In order to prevent preeclampsia, the study suggests a program of individual exercises that include greater assistance, verification and / or comprehension of possible changes and their limits during pregnancy. As well as, the adjuvant use of metformin of 1000 mg/d in the initial phase, with the purpose of maintaining the effects of the drug due to renal clearance during pregnancy, until reaching a maximum of 1500 mg/d, to avoid side effects of the drug.

Resumo Introdução: A pré-eclâmpsia é uma desordem que pode ocorrer durante a gravidez, sendo ainda de etiologia desconhecida e/ou de causas multifatoriais. Objetivo: Verificar se o exercício físico terapêutico e a metformina podem ser coadjuvantes na prevenção da pré-eclâmpsia. Método: Trata-se de uma revisão sistemática da literatura nas bases de dados PubMed/MEDLINE, Web of Science, Scopus, LILACS e Cochrane. Esta revisão seguiu os critérios do cheklist PRISMA. Na avaliação de viés utilizou-se o Cochrane Handbook for Systematical Reviews of Interventions (Version 5.1.0) para os ensaios clínicos e a escala de Downs e Black para os estudos de coorte e caso-controle. Resultados: 17 estudos estavam dentro dos critérios estabelecidos. Os temas avaliados foram: pré-eclâmpsia, fatores metabólicos cardiovasculares, terapêuticas fisioterápicas e os efeitos do exercício físico e da metformina no sistema circulatório. Conclusão: Existe a necessidade de técnicas adaptadas e novos protocolos de acordo com as contingências e intercorrências da gestação. Durante a gravidez, sugere-se uma maior interdisciplinaridade de conhecimento entre os profissionais e que a terapêutica receba ajustes de encontro às alterações metabólicas do sistema reprodutor. O estudo sugere para prevenção a pré-eclâmpsia um programa de exercícios individuais que contemplem uma maior assistência, verificação e/ou compreensão sobre as possíveis alterações e seus limites durante a gestação. Bem como, o coadjuvante uso da metformina de 1000 mg/d na fase inicial, com o propósito de se manter os efeitos do fármaco em razão da depuração renal durante a gestação, até atingir no máximo 1500 mg/d, para evitar as decorrências colaterais da droga.

Mobility impact and methods of diaphragm monitoring in patients with chronic obstructive pulmonary disease: a systematic review

The objectives of the study were to identify the factors that limit diaphragmatic mobility and evaluate the therapeutic results of the monitoring methods previously used in patients with chronic obstructive pulmonary disease. The PubMed, Web of Science, Scopus, and LILACS databases were used. A gray literature search was conducted with Google scholar. PRISMA was used, and the bias risk analysis adapted from the Cochrane Handbook for clinical trials and, for other studies, the Downs and Black checklist were used. Twenty-five articles were included in the qualitative synthesis analysis on physiotherapeutic techniques and diaphragmatic mobility. Eight clinical trials indicated satisfactory domains, and on the Downs and Black scale, 17 cohort studies were evaluated to have an acceptable score. Different conditions must be observed; for example, for postoperative assessments the supine position is suggested to be the most appropriate position to verify diaphragm excursion, although it has been shown to be associated with difficulty of restriction and matching in samples. Therefore, we identified the need for contemporary adjustments and strategies that used imaging instruments, preferably in the dorsal position. Therapeutic evidence on the association between the instrumental method and diaphragmatic mobility can be controversial. The ultrasound measurements indicated some relevance for different analyses, for pulmonary hyperinflation as well as diaphragm thickness and mobilization, in COPD patients. In particular, the study suggests that the ultrasound technique with B-mode for analysis and M-mode for diaphragmatic excursion be used with a 2 - 5 MHz with the patient in the supine position. However, the methods used to monitor diaphragm excursion should be adapted to the conditions of the patients, and additional investigations of their characteristics should be performed. More selective inclusion criteria and better matching in the samples are very important. In addition, more narrow age, sex and weight categories are important, especially in patients with chronic obstructive pulmonary disease.

Factors Associated with the Need for Insulin as a Complementary Treatment to Metformin in Gestational Diabetes Mellitus.

OBJECTIVE: To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM). METHODS: A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes. RESULTS: A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG) < 90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235-0.815]; p = 0.009], as well as primiparity (OR: 0.280 [0.111-0.704]; p = 0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063-4,039]; p = 0,032). CONCLUSION: Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG < 90 mg/dL and primiparity were protective factors.

OBJETIVO: Avaliar os fatores associados à necessidade de insulina como tratamento complementar à metformina em gestantes com diabetes mellitus gestacional (DMG). MéTODOS: Um estudo caso-controle foi realizado de abril de 2011 a fevereiro de 2016 com gestantes portadoras de DMG que necessitaram de tratamentos complementares além de dieta e exercícios físicos. Aquelas tratadas com metformina foram comparadas com aquelas que, além da metformina, também precisaram de combinação com insulina. Foram avaliadas as características maternas e de controle glicêmico. Modelos de regressão logística multinomial foram construídos para avaliar a influência das diferentes terapias nos desfechos neonatais. RESULTADOS: Foram avaliadas 475 gestantes que necessitaram de terapia farmacológica. Destas, 366 (77,05%) utilizaram terapia única com metformina, e 109 (22,95%) necessitaram de insulina como tratamento complementar. Na análise da razão de possibilidades (RP), a glicemia de jejum (GJ) < 90 mg/dL reduziu as chances de necessidade da combinação (RP: 0,438 [0,235­0,815]; p = 0,009), bem como a primiparidade (RP: 0,280 [0,111­0,704]; p = 0,007). Em gestantes obesas, foi observada uma chance maior de necessidade da combinação (RP: 2.072 [1.063­4.039]; p = 0,032). CONCLUSãO: A obesidade resultou em um aumento na chance de a mãe precisar de insulina como tratamento complementar à metformina, enquanto a GJ < 90 mg/dL e a primiparidade foram fatores de proteção.

Factors associated with the need for insulin as a complementary treatment to metformin in gestational diabetes mellitus / Fatores associados à necessidade de insulina como tratamento complementar à metformina na diabetes mellitus gestacional

Abstract Objective To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM). Methods A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes. Results A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG)<90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235-0.815]; p=0.009], as well as primiparity (OR: 0.280 [0.111-0.704]; p=0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063-4,039]; p=0,032). Conclusion Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG<90 mg/dL and primiparity were protective factors.

Resumo Objetivo Avaliar os fatores associados à necessidade de insulina como tratamento complementar à metformina em gestantes com diabetes mellitus gestacional (DMG). Métodos Um estudo caso-controle foi realizado de abril de 2011 a fevereiro de 2016 comgestantes portadoras de DMG que necessitaram de tratamentos complementares além de dieta e exercícios físicos. Aquelas tratadas commetformina foram comparadas com aquelas que, além da metformina, também precisaram de combinação com insulina. Foram avaliadas as características maternas e de controle glicêmico. Modelos de regressão logística multinomial foram construídos para avaliar a influência das diferentes terapias nos desfechos neonatais. Resultados Foram avaliadas 475 gestantes que necessitaram de terapia farmacológica. Destas, 366 (77,05%) utilizaram terapia única com metformina, e 109 (22,95%) necessitaram de insulina como tratamento complementar. Na análise da razão de possibilidades (RP), a glicemia de jejum (GJ)<90mg/dL reduziu as chances de necessidade da combinação (RP: 0,438 [0,235-0,815]; p=0,009), bem como a primiparidade (RP: 0,280 [0,111-0,704]; p=0,007). Em gestantes obesas, foi observada uma chance maior de necessidade da combinação (RP: 2.072 [1.063-4.039]; p=0,032). Conclusão A obesidade resultou em um aumento na chance de a mãe precisar de insulina como tratamento complementar à metformina, enquanto a GJ<90 mg/dL e a primiparidade foram fatores de proteção.

Resultados e reconhecimento das terapias fisioterápicas no período pré e pós-operatório de cirurgia cardíaca: uma revisão sistemática / Results and recognition of physiotherapy in the preoperative and postoperative period of cardiac surgery: a systematic review

Os fisioterapeutas, no pré e pós-operatório das cirurgias cardíacas, necessitam métodos inovadores para melhor caracterizar seus resultados terapêuticos e atuação do profissional? Realizou-se uma busca de artigos publicados nas bases Medline, Lilacs, Embase e da biblioteca Cochrane. Através dos achados científicos observou-se que no pré-operatório necessita-se de novos parâmetros comparativos despadronizados levando em consideração o tempo de tratamento. Existe uma contraposição quanto à eficiência do trabalho da Fisioterapia. Todavia, estudos demonstraram valores de impacto após o treinamento muscular respiratório intensificado para o pós-operatório das cirurgias cardíacas. Sugere-se uma inovadora metodologia, relacionando características específicas do paciente e aspectos clínicos da doença com o propósito de gerar motivação para adoção da intervenção e, consecutivamente, melhorar a concepção e impacto das terapias fisioterápicas e qualidade de evidência científica para os diferentes estudos a serem desenvolvidos. (AU)

Do physiotherapists in the preoperative cardiac surgery and postoperative period of cardiac surgeries require innovative methods to better characterize their therapeutic and professional performance? A search of articles published between the years 2000 and 2017 was carried out on the Medline, Lilacs, Embase and Cochrane databases. Through the scientific findings it was observed that in the preoperative cardiac it needs new unbalanced comparative parameters taking into consideration the time of treatment. There is a contraposition as to the efficiency of physiotherapy work. However, studies have shown impact values following intensified respiratory muscle training for postoperative period of cardiac. We suggest an innovative methodology, relating specific patient characteristics and clinical aspects of the disease with the purpose of generating motivation to adopt the intervention and, consecutively, to improve the conception and impact of physiotherapeutic therapies and quality of scientific evidence for the different studies to be developed. (AU)

Evaluation of Preeclampsia Results after Use of Metformin in Gestation: Systematic Review and Meta-analysis.

OBJECTIVE: Does the use of metformin have an influence on the outcomes of preeclampsia (PE)? SOURCES OF DATA: The descriptors pregnancy, metformin, treatment, and preeclampsia associated with the Boolean operators AND and OR were found in the MEDLINE, LILACS, Embase and Cochrane databases. A flowchart with exclusion criteria and inclusion strategy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, and eligibility criteria was used. Data were extracted regarding the type of study, the applied dosage, treatment time, segment, bias risks, and the Patient, Intervention, Comparison and Outcome (PICO) strategy to identify the quality of the study. SELECTION OF STUDIES: Total number of journals in the initial search (n = 824); exclusions from repeated articles on different search engines (n = 253); exclusions after reading the titles, when the title had no correlations with the proposed theme (n = 164); exclusions due to incompatibility with the criteria established in the methodological analysis (n = 185), exclusion of articles with lower correlation with the objective of the present study (n = 187); and final bibliographic selection (n = 35). DATA COLLECTION: At first, a systematic review of the literature was performed. Subsequently, from the main selection, randomized and non-randomized trials with metformin that presented their results in absolute and relative numbers of PE outcomes were selected. The variables were treated statistically in the meta-analysis with the Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region. SYNTHESIS OF DATA: The study showed that metmorfin presented greater preventive effects for pregnancy-induced hypertension and was less effective for PE. CONCLUSION: Metformin may gain place in preventive treatments for PE, once the dosages, the gestational age, and treatment time are particularly evaluated. A methodological strategy with an improved perspective of innovative and/or carefully progressive dosages during pregnancy to avoid side effects and the possibility of maternal-fetal risks is suggested.

OBJETIVO: O uso de metformina tem influência nos resultados da pré-eclâmpsia (PE)? FONTES DE DADOS: Os descritores gravidez, metformina, tratamento e pré-eclâmpsia associados aos operadores booleanos AND e OR foram encontrados nas bases de dados MEDLINE, LILACS, Embase e Cochrane. Foi utilizado um fluxograma com critérios de exclusão e estratégia de inclusão, utilizando o protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA e critérios de elegibilidade. Os dados foram extraídos quanto ao tipo de estudo, dosagem aplicada, duração do tratamento, segmento, riscos de viés e estratégia Patient, Intervention, Comparison and Outcome (PICO) para identificar a qualidade do estudo. SELEçãO DE ESTUDOS: Número total de periódicos na busca inicialmente realizada (n = 824); exclusões de artigos repetidos nos diferentes sites de busca (n = 253); exclusões após a leitura dos títulos, quando o titulo não apresentava correlações com o tema proposto (n = 164); exclusões por incompatibilidade com os critérios estabelecidos na análise metodológica (n = 185), exclusão de artigos com menor correlação com o objetivo do presente estudo (n = 187); e seleção bibliográfica final (n = 35). COLETA DE DADOS: Inicialmente, foi realizada uma revisão sistemática da literatura. Posteriormente, a partir da seleção principal, foram selecionados estudos randomizados e não randomizados com metformina, os quais apresentaram em seus resultados números absolutos e relativos de desfechos de PE. As variáveis foram tratadas estatisticamente na metanálise por meio do Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region. SíNTESE DOS DADOS: O estudo demonstrou que a metmorfina apresenta maiores efeitos preventivos para a hipertensão induzida pela gravidez e é menos eficaz para a PE. CONCLUSãO: A metformina pode conquistar seu espaço nos tratamentos preventivos da PE, uma vez que as dosagens, a idade gestacional e o tempo de tratamento são particularmente avaliados. Sugere-se uma estratégia metodológica com uma perspectiva aprimorada de doses inovadoras e/ou cuidadosamente progressivas durante a gravidez, a fim de evitar efeitos colaterais e a possibilidade de riscos materno-fetais.

Evaluation of preeclampsia results after use of metformin in gestation: systematic review and meta-analysis / Avaliação dos resultados da pré-eclâmpsia após o uso da metformina na gestação: revisão sistemática e metanálise

Abstract Objective Does the use of metformin have an influence on the outcomes of preeclampsia (PE)? Sources of Data The descriptors pregnancy, metformin, treatment, and preeclampsia associated with the Boolean operators AND and OR were found in the MEDLINE, LILACS, Embase and Cochrane databases. A flowchart with exclusion criteria and inclusion strategy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, and eligibility criteria was used. Data were extracted regarding the type of study, the applied dosage, treatment time, segment, bias risks, and the Patient, Intervention, Comparison and Outcome (PICO) strategy to identify the quality of the study. Selection of Studies Total number of journals in the initial search (n= 824); exclusions from repeated articles on different search engines (n= 253); exclusions after reading the titles, when the title had no correlations with the proposed theme (n= 164); exclusions due to incompatibility with the criteria established in the methodological analysis (n= 185), exclusion of articles with lower correlation with the objective of the present study (n= 187); and final bibliographic selection (n= 35). Data Collection At first, a systematic review of the literature was performed. Subsequently, from the main selection, randomized and non-randomized trials with metformin that presented their results in absolute and relative numbers of PE outcomes were selected. The variables were treated statistically in the meta-analysis with the Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region. Synthesis of Data The study showed that metmorfin presented greater preventive effects for pregnancy-induced hypertension and was less effective for PE. Conclusion Metformin may gain place in preventive treatments for PE, once the dosages, the gestational age, and treatment time are particularly evaluated. A methodological strategy with an improved perspective of innovative and/or carefully progressive dosages during pregnancy to avoid side effects and the possibility of maternal-fetal risks is suggested.

Resumo Objetivo O uso de metformina tem influência nos resultados da pré-eclâmpsia (PE)? Fontes de Dados Os descritores gravidez, metformina, tratamento e pré-eclâmpsia associados aos operadores booleanos AND e OR foram encontrados nas bases de dados MEDLINE, LILACS, Embase e Cochrane. Foi utilizado um fluxograma com critérios de exclusão e estratégia de inclusão, utilizando o protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA e critérios de elegibilidade. Os dados foram extraídos quanto ao tipo de estudo, dosagem aplicada, duração do tratamento, segmento, riscos de viés e estratégia Patient, Intervention, Comparison and Outcome (PICO) para identificar a qualidade do estudo. Seleção de Estudos Número total de periódicos na busca inicialmente realizada (n= 824); exclusões de artigos repetidos nos diferentes sites de busca (n= 253); exclusões após a leitura dos títulos, quando o titulo não apresentava correlações com o tema proposto (n= 164); exclusões por incompatibilidade com os critérios estabelecidos na análise metodológica (n= 185), exclusão de artigos com menor correlação com o objetivo do presente estudo (n= 187); e seleção bibliográfica final (n= 35). Coleta de Dados Inicialmente, foi realizada uma revisão sistemática da literatura. Posteriormente, a partir da seleção principal, foram selecionados estudos randomizados e não randomizados com metformina, os quais apresentaram em seus resultados números absolutos e relativos de desfechos de PE. As variáveis foram tratadas estatisticamente na metanálise por meio do Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region. Síntese dos Dados O estudo demonstrou que a metmorfina apresenta maiores efeitos preventivos para a hipertensão induzida pela gravidez e é menos eficaz para a PE. Conclusão A metformina pode conquistar seu espaço nos tratamentos preventivos da PE, uma vez que as dosagens, a idade gestacional e o tempo de tratamento são particularmente avaliados. Sugere-se uma estratégia metodológica com uma perspectiva aprimorada de doses inovadoras e/ou cuidadosamente progressivas durante a gravidez, a fim de evitar efeitos colaterais e a possibilidade de riscos materno-fetais.