Composição da microbiota intestinal durante a gestação e puerpério em mulheres com diferentes intensidades de sintomas depressivos / Composition of Gut Microbiota During Pregnancy and Postpartum in Women with Varying Degrees of Depressive Symptoms

Os sintomas depressivos durante a gravidez e o período pós-parto (PP) são prevalentes e podem ter implicações profundas para o bem-estar materno e infantil. Evidências emergentes sugerem que a microbiota intestinal pode desempenhar um papel na regulação do humor. Este estudo explora a relação entre a composição da microbiota intestinal e os sintomas depressivos em mulheres grávidas e no pós-parto com diferentes intensidade de sintomas. Foram recrutadas gestantes que faziam acompanhamento nos hospitais HCFMUSP e HU- USP. A partir do preenchimento do questionário de Escala de Edimburgo as participantes foram triadas para os grupos de sintomas ausentes ou leves (AL) e sintomas graves ou moderados (MG). Para a análise de microbiota, as participantes forneceram amostras de fezes em três momentos diferentes. Uma no terceiro trimestre de gestação (G) e duas no período pós-parto. A primeira amostra deste período foi coletada durante a internação do pós-parto (P1), e a segunda durante a consulta de retorno um mês após o parto (P2). A composição da microbiota intestinal foi analisada usando técnicas de sequenciamento de alto rendimento e os ácidos graxos de cadeia curta (AGCC) foram quantificados por cromatografia gasosa acoplada à espectrometria de massas (GC-MS). Análises bioinformáticas e estatísticas foram realizadas utilizando os softwares QIIME 2 (2022.2) e R (4.3.1) para identificar possíveis associações entre a composição da microbiota intestinal e a gravidade dos sintomas depressivos. Os resultados indicam que a familia Enterobacteriacea aparece com maior abundância nas mulheres do grupo MG, especialmente durante o período P1 (p<0,05) e que há uma diminuição significativa (p<0,05) de sintomas depressivos nas participantes do grupo MG desde sua triagem até o fim do acompanhamento do estudo, indicando que conduta terapêutica está sendo eficaz. Apesar de não ter sido estabelecida diferença estatística na abundância relativa da microbiota entre os grupos durante a gestação e nos índices de alfa e beta diversidade entre grupos e entre os períodos, é possivel observar uma tendência de mudança de microbiota ao longo do tratamento com aumento do gênero Bifidobacterium, diminuição da familia Enterobacteraceae e é possivel observar uma aparente correlação inversa entre a diminuição da intensidade de sintomas depressivos e o aumento da abundância dos gêneros Bifidobacterium e Clostridium, além do aumento das concentrações de AGCC. Em conclusão, a composição da microbiota intestinal parece ser influenciada pela gravidade dos sintomas depressivos em mulheres grávidas e no pós-parto. Pesquisas adicionais são necessárias para explorar a relação entre a microbiota intestinal e a depressão perinatal e determinar as implicações clínicas dessas descobertas para a saúde materna e infantil.

Depressive symptoms during pregnancy and the postpartum period (PP) are prevalent and can have profound implications for maternal and infant well-being. Emerging evidence suggests that the gut microbiota may play a role in mood regulation. This study explores the relationship between gut microbiota composition and depressive symptoms in pregnant and postpartum women with different symptom severities. A cohort of pregnant women were recruited from HCFMUSP and HU-USP. Participants completed standardized depression assessment tools and were allocate in groups of absent or mild depressive symptoms (AL) and moderate or severe depressive symptoms (MG) and provided stool samples in three different time periods. One at the third gestation trimester (G) and two at the postpartum period. The first sample from this period was collected during postpartum hospitalization(P1), and the second during the onemonth postpartum follow-up appointment (P2). Their gut microbiota composition was analyzed using high-throughput sequencing techniques and Gas chromatography mass spectrometry (GS-MS) for quantification of short-chain fatty acids (SCFAs). Bioinformatic and statistical analyses were performed using softwares QIIME 2 (2022.2) and R (4.3.1) to identify potential associations between gut microbiota composition and depressive symptom severity. Findings that the Enterobacteriaceae family appears more abundantly in women of the MG group, especially during period P1 (p<0.05), and that there is a significant decrease (p<0.05) in depressive symptoms among the participants of the MG group from their screening to the end of the study follow-up, suggesting that the therapeutic approach is effective. Although no statistical differences in alpha and beta diversity indices were established between groups and across periods, it is possible to observe a trend of microbiota change during the treatment, with an increase in the Bifidobacterium genus, a decrease in the Enterobacteriaceae family, and an apparent inverse correlation between the reduction in the intensity of depressive symptoms and the increased abundance of the Bifidobacterium, Clostridium, and Dorea genera, as well as an increase in the concentrations of SCFAs. In conclusion, composition of gut microbiota appears to be influenced by the severity of depressive symptoms in pregnant and postpartum women. Further research is warranted to explore links between gut microbiota and perinatal depression and to determine the clinical implications of these findings for maternal and infant health

Diagnósticos/resultados de enfermagem para parturientes e puérperas utilizando a Classificação Internacional para Prática de Enfermagem / Nursing diagnoses/outcomes for parturient and puerperal women using the International Classification for Nursing Practice / Diagnósticos/resultados de enfermería para parturientas y puérperas utilizando la Clasificación Internacional para la Práctica de Enfermería

O objetivo deste estudo foi desenvolver afirmativas de diagnósticos de enfermagem para parturientes e puérperas, utilizando o modelo dos setes eixos da Classificação Internacional para Prática de Enfermagem. Foram elaboradas 68 afirmativas de diagnóstico de enfermagem, as quais foram agrupadas de acordo com as necessidades humanas básicas de Horta. A formulação de diagnósticos de enfermagem expressa o julgamento clínico do enfermeiro acerca dos fenômenos pelos quais é responsável para atingir resultados de enfermagem, após realizar uma intervenção. A utilização da linguagem padronizada para construção desses diagnósticos e resultados favorece a documentação de enfermagem, que por sua vez, contribui para evidenciar os conceitos importantes para prática profissional na atenção à saúde materna.

The objective of this study was to develop nursing diagnosis statements for parturient and puerperal women, using the seven axis model of the International Classification for Nursing Practice. Sixty-eight nursing diagnosis statements were created, which were grouped according to Horta?s basic human needs. The formulation of nursing diagnoses expresses nurses? clinical judgment regarding a phenomenon, through which it is possible to achieve nursing outcomes after performing a nursing intervention. The utilization of standardized language to construct these diagnoses and outcomes improves nursing documentation, which contributes to defining concepts considered important for the provision of professional health care to mothers.

El objetivo de este estudio fue desarrollar afirmaciones de diagnósticos de enfermería para parturientas y puérperas utilizando el modelo de siete ejes de la Clasificación Internacional para la Práctica de Enfermería. Fueron elaboradas 68 afirmaciones de diagnóstico de enfermería, las cuales fueron agrupadas de acuerdo con las necesidades humanas básicas de Horta. La formulación de diagnósticos de enfermería expresa el juicio clínico del enfermero acerca de los fenómenos por los cuales es responsable, para alcanzar resultados de enfermería después de realizar una intervención. La utilización de lenguaje estandarizado para la construcción de tales diagnósticos y resultados ofrece ayuda a la documentación de enfermería, que a su vez, contribuye a evidenciar los conceptos importantes para la práctica profesional en la atención a la salud materna.

Prenatal and birth complications in autism.

OBJECTIVES: Prenatal and birth history as potential sources of risk factors in relation to the onset of autism were examined. METHODS: A cohort of 164 families of autistic children referred to The Autism Center at New Jersey Medical School-UMDNJ, Newark, New Jersey, over a two-year period was studied. Intake prenatal and birth history information was obtained from each family and reviewed by a clinician. RESULTS: Prevalence rates in this cohort for vaginal bleeding, prolonged labor and prematurity were higher than comparable rates reported nationally and in New Jersey. Clustering of multiple prenatal risk factors was observed. This clustering was associated with the age of the mother, but uncorrelated with birth order. CONCLUSIONS: These findings support the general hypothesis that systemic problems at the prenatal stage may form a distinct dimension of risk associated with autism.

The influence of maternal weight and glucose tolerance on infant birthweight in Latino mother-infant pairs.

OBJECTIVES: We assessed the influence of maternal anthropometric and metabolic variables, including glucose tolerance, on infant birthweight. METHODS: In our prospective, population-based cohort study of 1041 Latino mother-infant pairs, we used standardized interviews, anthropometry, metabolic assays, and medical record reviews. We assessed relationships among maternal sociodemographic, prenatal care, anthropometric, and metabolic characteristics and birthweight with analysis of variance and bivariate and multivariate linear regression analyses. RESULTS: Forty-two percent of women in this study entered pregnancy overweight or obese; at least 36% exceeded weight-gain recommendations. Twenty-seven percent of the women had at least some degree of glucose abnormality, including 6.8% who had gestational diabetes. Maternal multiparity, height, weight, weight gain, and 1-hour screening glucose levels were significant independent predictors of infant birthweight after adjustment for gestational age. CONCLUSION: Studies of birthweight should account for maternal glucose level. Given the increased risk of adverse maternal and infant outcomes associated with excessive maternal weight, weight gain, and glucose intolerance, and the high prevalence of these conditions and type 2 diabetes among Latinas, public health professionals have unique opportunities for prevention through prenatal and postpartum interventions.

Evaluación del riesgo materno neonatal durante el embarazo / Evaluation of Maternal Neonatal Risks During Pregnancy

El país no cuenta con un instrumento validado para la identificación del riesgo obstétrico. El control prenatal es un programa de tamizaje multifásico, en el que se identifica el riesgo obstétrico de la paciente, con el fin de generar la atención específica que ésta necesite con base en el riesgo identificado. El control prenatal es la prueba tamiz para detectar el alto riesgo obstétrico durante el embarazo. No se ha validado con criterio científico la consulta prenatal como herramienta de tamizaje del riesgo obstétrico. El contenido de las consultas prenatales parece ser más ritualista que el producto de un programa de control de salud racional. Para complicar aún más la evaluación del control prenatal, hay un efecto variable según las poblaciones. No existe ninguna duda sobre la amplia aceptación que tiene el control prenatal en el país. Aunque existe un consenso general sobre muchos factores prenatales y perinatales que aumentan el riesgo obstétrico, no se encuentra en la literatura un acuerdo que permita calcular tal grado de riesgo. Algunos de los registros disponibles comercialmente se han incorporado a los sistemas de puntuación de alto riesgo con el fin de clasificar a las pacientes en categorías de alto y bajo riesgo.

The relationship between self-reported emotional health, demographics, and perceived satisfaction with prenatal care.

Aims to describe pregnant women with poor emotional health and the relationship between self-reported emotional health and prenatal care satisfaction. To this end, 1,265 women who delivered a live-born singleton infant were interviewed and information abstracted from prenatal records. Concludes that patient assessment of satisfaction with prenatal care may be related to both self-reported emotional health and delivery of medical care. Identifying and addressing emotional health of prenatal patients may improve compliance with medical recommendations, ultimately improving health outcomes.

A risk assessment screening test for very low birth weight.

OBJECTIVES: To develop a risk-assessment screening tool for very low birth weight (VLBW) and to compare our empirically derived tool to the nonempirically derived screening tool used by the State of Florida. METHODS: Birth records from the State of Florida Vital Statistics between 04/01/92 and 12/07/94 were matched with State Healthy Start prenatal records, reported from 04/01/92 through 03/31/94. Known and additional potentially important risk factors were identified from both sources. Generalized Linear Modeling techniques were used to estimate associations between risk factors and VLBW. A risk assessment system was then developed using the estimated model. The resulting screening test was compared with the one used by the Florida State Department of Health in terms of sensitivity and specificity on an independent validation sample. RESULTS: The proposed screening tool had comparable specificity to the Healthy Start screening tool but significantly better sensitivity. Both instruments are simple and easy to implement. CONCLUSIONS: Identification of women at high risk for VLBW would be improved using the model-based screening tool developed in this paper. Public health policy makers should use statistical methods in addition to expert opinion to improve existing risk assessment methods. The actual value of an improved screening instrument is dependent on the availability of effective intervention programs.

Reproductive health indicators for China's rural areas.

We report community-based development of reproductive health indicators for China's rural areas. To generate these indicators, we sequenced two participatory techniques known as nominal group process and Delphi survey methodology. Nominal group process entailed grassroots reproductive health workers' generating indicators, followed by refinement and prioritization of these indicators through a consensus-building Delphi process among nationally and internationally known reproductive health experts. Major criteria for the indicators were practicality, feasibility, and measurability within China's rural areas. We explain the importance of establishing these indicators for application in rural China and other developing countries as a complement to the World Health Organization's reproductive health indicators for global monitoring; present the identified indicators; and describe lessons learned from field testing in low-, middle-, and high-income counties of China's countryside.

Outcome measurement in HEDIS: can risk adjustment save the low birth weight measure?

OBJECTIVE: To evaluate whether adjusting the Health Plan Employer Data and Information Set (HEDIS) low birth weight (LBW) measure for maternal risk factors is feasible and improves its validity as a quality indicator. DATA SOURCE: The Washington State Birth Event Record Data for calendar years 1989 and 1990, including birth certificate data matched with mothers' and infants' hospital discharge records, with 5,837 records of singlet on infants identified as LBW (< 2,500 g) and a 25 percent sample ( n = 31,570) of the normal-weight births (

Atención materno infantil y condición e vivienda de la parroquia de San José de Minas, 1994

El resente comprende un estudio de cada uno de los barrios de la parroquia de San José de Minas, donde se realizó una serie de encuestas durante el mes de septiembre de 1994, además de recabar información de las Unidades de Salud, utilizamos un modelo de encuestas casa por casa y por los 25 barrios de la parroquia, recabando el 99 por ciento de la información. Se encontró que en relación al esquema de vacunación en menores de cinco años, un 73.9 por ciento que corresponde a 380 lo completaron, con un esquema incompleto el 99 por ciento de la información. Se encontró que en relación al esquema de vacunación en menores de cinco años, un 73.9 por ciento corresponde a 380 lo completaron, con un equema incompleto un 26.1 por ciento. En relación al cáncer de cervix, el 12.8 por ciento (=182) contestaron positivamente, en tanto que un 87.2 por ciento (n=1236) nunca habían realizado un control, o simplemente lo desconocían. Respecto a anticoncepción el 6.9 por ciento (n=78) utilizan algún método anticonceptivo, en tanto que el 93.1 por ciento (n=1061) de mujeres desconocen o simplemente no es de agrado la utilización una de las causas de morbilidad es el hacinamiento, encontrándose con un 27.4 por ciento de familias de riesgo...