Identification of earlier predictors of pregnancy complications through wearable technologies in a Brazilian multicentre cohort: Maternal Actigraphy Exploratory Study I (MAES-I) study protocol.

INTRODUCTION: Non-invasive tools capable of identifying predictors of maternal complications would be a step forward for improving maternal and perinatal health. There is an association between modification in physical activity (PA) and sleep-wake patterns and the occurrence of inflammatory, metabolic, pathological conditions related to chronic diseases. The actigraphy device is validated to estimate PA and sleep-wake patterns among pregnant women. In order to extend the window of opportunity to prevent, diagnose and treat specific maternal conditions, would it be possible to use actigraphy data to identify risk factors for the development of adverse maternal outcomes during pregnancy? METHODS AND ANALYSIS: A cohort will be held in five centres from the Brazilian Network for Studies on Reproductive and Perinatal Health. Maternal Actigraphy Exploratory Study I (MAES-I) will enrol 400 low-risk nulliparous women who will wear the actigraphy device on their wrists day and night (24 hours/day) uninterruptedly from 19 to 21 weeks until childbirth. Changes in PA and sleep-wake patterns will be analysed throughout pregnancy, considering ranges in gestational age in women with and without maternal complications such as pre-eclampsia, preterm birth (spontaneous or provider-initiated), gestational diabetes, maternal haemorrhage during pregnancy, in addition to perinatal outcomes. The plan is to design a predictive model using actigraphy data for screening pregnant women at risk of developing specific adverse maternal and perinatal outcomes. ETHICS AND DISSEMINATION: MAES-I has been reviewed and approved by each institutional review board and also by the National Council for Ethics in Research. Detailed information about the study is provided in the Brazilian Cohort website (www.medscinet.com/samba) and findings will be published in the scientific literature and institutional webpages.

Use of metabolomics for predicting spontaneous preterm birth in asymptomatic pregnant women: protocol for a systematic review and meta-analysis.

INTRODUCTION: Preterm birth (PTB) is the leading cause of neonatal mortality and short- and long-term morbidity. The aetiology and pathophysiology of spontaneous PTB (sPTB) are still unclear, which makes the identification of reliable and accurate predictor markers more difficult, particularly for unscreened or asymptomatic women. Metabolomics biomarkers have been demonstrated to be potentially accurate biomarkers for many disorders with complex mechanisms such as PTB. Therefore, we aim to perform a systematic review of metabolomics markers associated with sPTB. Our research question is 'What is the performance of metabolomics for predicting spontaneous preterm birth in asymptomatic pregnant women?' METHODS AND ANALYSIS: We will focus on studies assessing metabolomics techniques for predicting sPTB in asymptomatic pregnant women. We will conduct a comprehensive systematic review of the literature from the last 10 years. Only observational cohort and case-control studies will be included. Our search strategy will be carried out by two independent reviewers, who will scan title and abstract before carrying out a full review of the article. The scientific databases to be explored include PubMed, MedLine, ScieLo, EMBASE, LILACS, Web of Science, Scopus and others. ETHICS AND DISSEMINATION: This systematic review protocol does not require ethical approval. We intend to disseminate our findings in scientific peer-reviewed journal, the Preterm SAMBA study open access website, specialists' conferences and to our funding agencies. PROSPERO REGISTRATION NUMBER: CRD42018100172.

Hazards of Repeat Pregnancy during Adolescence: A Case-control Study.

OBJECTIVE: To evaluate the social, obstetric and psychological risk factors related to repeat pregnancy in teenagers. METHODS: A case control study conducted at Centro de Atenção à Saúde Integral da Mulher (Caism, in the Portuguese acronym), in Campinas, Brazil, from 2015 to 2017. Three groups were selected: a case-group of adolescents who had repeat pregnancy and two control-groups, one consisting of adolescents who had delivered at first time and another one of adult women with more than one deliveries. Participants were asked about habits, socio-demographics characteristics, reproductive and obstetric history and assessed psychological issues. RESULTS: Ninety women were enrolled, 30 in each study group. Adolescents with repeat pregnancy have lower self-esteem scores and more ineffective contraceptive use. When compared with teens at first delivery, they had less schooling level (odds ratio [OR] 4.03 [1.37-11.8]), more school abandon (OR 8.16 [2.36-28.2]) and drugs use (OR 4.97[1.39-17.8]). Non-white skin color (OR 6.2 [1.15-41.0]), drugs use (OR 17.5 [2.62-116.6]) and first sexual intercourse under 15y (OR 18.0[2.82-115.0]) were found as higher risk factors for repeat pregnancy when comparing adolescents and adults. Moreover, adolescents with more than one gestation had lower self-esteem and greater susceptibility to unplanned pregnancy. CONCLUSION: There was an association between repeat pregnancy among adolescents and lower education, early onset of sexual activity, non-white skin color, low use of contraception and increased use of drugs.

OBJETIVO: Avaliar a associação entre fatores de risco sociais, obstétricos e psicológicos relacionados a repetição da gravidez em adolescentes. MéTODOS: Estudo caso-controle realizado num Hospital Universitário de Campinas, Brasil, de 2015 a 2017. Foram selecionados três grupos: um grupo-caso de adolescentes com repetição de gravidez, e dois grupos controles, um de adolescentes primíparas e outro de mulheres adultas com mais de um parto. Foram coletados dados referentes a aspectos sociodemográficos, história reprodutiva e obstétrica e fatores psicológicos. RESULTADOS: Foram incluídas 90 mulheres, 30 em cada grupo de estudo. Adolescentes com repetição de gravidez apresentaram menor autoestima e mais uso inadequado de contraceptivos. Quando comparadas a adolescentes primíparas, tiveram menor nível escolar (razão de probabilidades [RP] 4.03 [1.37­11.8]), maior interrupção dos estudos (RP 16.3 [3.61­73.6]) e maior uso de drogas (RP 4.97[1.39­17.8]). A comparação entre adolescentes com repetição de gestação e mulheres adultas revelou maior risco para cor da pele não-branca (RP 6.2 [1.15­41.0]), uso de drogas (RP 17.5 [2.62­116.6]) e primeira relação sexual com menos de 15 anos 15y (RP 18.0 [2.82­115.0]). Além disso, as adolescentes com segunda gravidez apresentam menor autoestima, baixo uso de contracepção e maior suscetibilidade a gravidez não planejada. CONCLUSãO: Houve associação entre repetição de gravidez na adolescência e menor tempo de estudo, início precoce de atividade sexual, cor da pele não branca e maior uso de drogas.

Hazards of repeat pregnancy during adolescence: A case-control study / Riscos da repetição da gestação na adolescência: um estudo de caso-controle

Abstract Objective To evaluate the social, obstetric and psychological risk factors related to repeat pregnancy in teenagers. Methods A case control study conducted at Centro de Atenção à Saúde Integral da Mulher (Caism, in the Portuguese acronym), in Campinas, Brazil, from 2015 to 2017. Three groups were selected: a case-group of adolescents who had repeat pregnancy and two control-groups, one consisting of adolescents who had delivered at first time and another one of adult women with more than one deliveries. Participants were asked about habits, socio-demographics characteristics, reproductive and obstetric history and assessed psychological issues. Results Ninety women were enrolled, 30 in each study group. Adolescents with repeat pregnancy have lower self-esteem scores and more ineffective contraceptive use. When compared with teens at first delivery, they had less schooling level (odds ratio [OR] 4.03 [1.37-11.8]), more school abandon (OR 8.16 [2.36-28.2]) and drugs use (OR 4.97[1.39-17.8]). Non-white skin color (OR 6.2 [1.15-41.0]), drugs use (OR 17.5 [2.62-116.6]) and first sexual intercourse under 15y (OR 18.0[2.82-115.0]) were found as higher risk factors for repeat pregnancy when comparing adolescents and adults.Moreover, adolescents withmore than one gestation had lower self-esteem and greater susceptibility to unplanned pregnancy. Conclusion There was an association between repeat pregnancy among adolescents and lower education, early onset of sexual activity, non-white skin color, low use of contraception and increased use of drugs.

Resumo Objetivo Avaliar a associação entre fatores de risco sociais, obstétricos e psicológicos relacionados a repetição da gravidez em adolescentes. Métodos Estudo caso-controle realizado num Hospital Universitário de Campinas, Brasil, de 2015 a 2017. Foram selecionados três grupos: um grupo-caso de adolescentes com repetição de gravidez, e dois grupos controles, umde adolescentes primíparas e outro demulheres adultas com mais de umparto. Foram coletados dados referentes a aspectos sociodemográficos, história reprodutiva e obstétrica e fatores psicológicos. Resultados Foram incluídas 90 mulheres, 30 em cada grupo de estudo. Adolescentes comrepetição de gravidez apresentaram menor autoestima e mais uso inadequado de contraceptivos. Quando comparadas a adolescentes primíparas, tiveram menor nível escolar (razão de probabilidades [RP] 4.03 [1.37-11.8]), maior interrupção dos estudos (RP 16.3 [3.61-73.6]) e maior uso de drogas (RP 4.97[1.39-17.8]). A comparação entre adolescentes com repetição de gestação e mulheres adultas revelou maior risco para cor da pele não-branca (RP 6.2 [1.15-41.0]), uso de drogas (RP 17.5 [2.62-116.6]) e primeira relação sexual com menos de 15 anos 15y (RP 18.0 [2.82-115.0]). Além disso, as adolescentes com segunda gravidez apresentam menor autoestima, baixo uso de contracepção e maior suscetibilidade a gravidez não planejada. Conclusão Houve associação entre repetição de gravidez na adolescência e menor tempo de estudo, início precoce de atividade sexual, cor da pele não branca e maior uso de drogas.