Cervical neuroendocrine carcinoma in the third trimester: a rare case report and literature review.

BACKGROUND: The incidence of cervical neuroendocrine carcinoma (CNECC) during pregnancy is extremely rare. Insufficient awareness of gynecological tumor screening, as well as atypical and insidious initial clinical symptoms, may result in diagnostic delays and misdiagnosis. There is no standardized treatment for cervical cancer in pregnancy. Herein, we present a case of cervical neuroendocrine carcinoma diagnosed in the third trimester of pregnancy. CASE PRESENTATION: A 26-year-old female at 30 1/7 weeks of gestation presented with lower back and sacroiliac joint pain, abdominal distension, and lower limb dyskinesia. A pelvic examination revealed a large fungating gray mass that encompassed the entire cervix, with cervical contact bleeding testing positive. Imaging studies showed a significant cervical mass, diffuse liver changes, and metastasis to multiple sites. Biopsy results revealed poorly differentiated cervical carcinoma exhibiting high-grade neuroendocrine features, consistent with a diagnosis of large cell neuroendocrine carcinoma. The patient was diagnosed with stage IVB CNECC with HPV18 (+), and due to the gestational age of the fetus and her deteriorating condition, she underwent cesarean section delivery after receiving fetal lung maturation therapy. Following surgery, eight cycles of neoadjuvant chemotherapy were applied. Unfortunately, she succumbed to multiple tumor metastases six months post-treatment. Despite this tragic outcome, the infant was discharged in a healthy condition. CONCLUSIONS: CNECC during pregnancy, particularly the large-cell type, is an ultra-rare condition with poor prognosis. This case highlights the importance of individualized treatment approach and the need for better screening, early detection, and treatment. Given the rarity of the disease, further research is warranted to determine the prognostic factors and develop effective treatment strategies for this ultra-rare and aggressive malignancy.

HOMA-IR for predicting clinical pregnancy rate during IVF.

OBJECTIVE: To determine the cutoff values of HOMA-IR for predicting clinical pregnancy rate in normal weight patients during their first IVF. MATERIALS AND METHODS: The data was retrospectively analyzed from 329 normal-weight women aged 21-40 years with BMI <25 kg/m2 who received first IVF-ET during the period from December 2018 to June 2019.We assessed the associations between HOMA-IR and clinical pregnancy rates during IVF in the women with or without PCOS according to different BMI ranges. RESULTS: In non PCOS,clinical pregnancy rate was significantly decreased at the HOMA-IR values ranging from 2.2 to 3.15 (OR, 0.188, 95% CI, 0.084-0.42; p < .05) and at those >3.15 (OR, 0.018, 95% CI, 0.004-0.081; p < .05).In PCOS, clinical pregnancy rate significantly decreased at the HOMA-IR >3.15 (OR, 0.15, 95% CI, 0.044-0.507; p < .05). In non PCOS with BMI <21.45 kg/m2, clinical pregnancy rate was decreased with HOMA-IR >2.2, and a significant cutoff point at HOMA-IR >3.15; with 21.45 ≤ BMI <25 kg/m2, clinical pregnancy rate was declined significantly at the HOMA-IR >1.56 (OR, 0.196, 95% CI, 0.055-0.704).In PCOS with BMI <21.45 kg/m2, clinical pregnancy rate was decreased as the HOMA-IR increased, but there was no significant cutoff point; with 21.45 ≤ BMI < 25 kg/m2, clinical pregnancy rate was declined significantly at the HOMA-IR > 3.15 (OR, 0.186; 95% CI, 0.04-0.872). CONCLUSION: HOMA-IR and BMI had adverse effects on the IVF outcome of infertility women. Moreover, obesity can increase the degree of insulin resistance in infertility women. These findings suggested that only better HOMA-IR and BMI will lead to better IVF results.

Perinatal depression: Heterogeneity of disease and in animal models.

Perinatal depression (PND) can have either an antepartum or postpartum onset. Although the greatest risk factor for PND is previous depression history,de novoPND occurs with the majority of cases occurring in the postpartum. Timing of depression can impact etiology, prognosis, and response to treatment. Thus, it is crucial to study the impact of the heterogeneity of PND for better health outcomes. In this review, we outline the differences between antepartum and postpartum depression onset of PND. We discuss maternal physiological changes that differ between pregnancy and postpartum and how these may differentially impact depression susceptibility. We highlight changes in the maternal steroid and peptide hormone levels, immune signalling, serotonergic tone, metabolic factors, brain morphology, and the gut microbiome. Finally, we argue that studying the heterogeneity of PND in clinical and preclinical models can lead to improved knowledge of disease etiopathology and treatment outcomes.

Pregnancy and the eye. Changes in morphology of the cornea and the anterior chamber of the eye in pregnant woman.

OBJECTIVES: The main goal of the study was to determine whether uncomplicated pregnancy and natural labor exert influence on the cornea and the anterior chamber of the eye. MATERIAL AND METHODS: The study included 114 eyes of 57 women in age of 21-35 years old. Only patients in the physiological pregnancy and giving natural birth were recruited into study. Prospective observative examination was performed. Patients were diagnosed twice: in 36 HBD and 6 weeks after labor. Using the Scheimpflug camera (Pentacam system) the following parameters were assessed: central corneal thickness (CCT), keratometric parameters: flat (K1) and steep (K2), astigmatism value and axis, anterior chamber depth (ACD), anterior chamber volume (ACV) and anterior chamber angle (ACA). The statistical analysis was carried out in the StatSoft Statistica 13 program. RESULTS: CCT value is greater in the third trimester than in 6th week after the labour. ACD and ACA values are higher in 36 HBD than in the post-partum period but the difference is not statistically important (p > 0.05). K1, K2, cylindrical refraction error, axis of cylindrical refraction error do not change. CONCLUSIONS: Authors claim that it is the result from an increase in water retention in the corneal stroma as a response to hormonal changes. The plasticity of the anterior chamber seen before delivery can be a natural adaptive mechanism of the female body, which counteracts the excessive increase in intraocular pressure in the second stage of delivery.

Pregnancy-associated osteoporosis: a case-control study.

The etiology and underlying mechanisms of pregnancy-associated osteoporosis (PAO) are still unknown, since no systematic analyses exist. Our results indicate that PAO is a heterogeneous, rare but severe disease including a substantial number of fractures with a significant delay from first symptom to diagnose. INTRODUCTION: Pregnancy-associated osteoporosis (PAO) is a rare but severe type of premenopausal osteoporosis. Most common symptom includes acute lower back pain due to vertebral fracture predominantly occurring in the last trimester of pregnancy or immediately postpartum. The exact underlining mechanisms and risk factors of PAO are still unknown, and up to date, there are no published systematic analyses. METHODS: We identified 102 PAO patients and matched them with 102 healthy controls according to age, region, and gravidity to evaluate risk factors in a large and homogenous population of women. RESULTS: The baseline characteristics and anthropometric data of the two study groups were similar. Eighty-eight percent of the patients with PAO suffered from one or more fractures with a mean of 3.3 fractures per patient. The most common fracture site was the thoracolumbar spine, whereas 29, 37, 48, and 35% of the patients reported fractures at TH11, TH12, L1, and L2, respectively. PAO patients suffered more frequently from excessive dental problems in childhood (p < 0.001). The control group performed significantly more frequently sports both before (p < 0.002) and after puberty (p < 0.01). Compared to the controls, the patients with PAO reported twice as often severe diseases during pregnancy (p < 0.029). Hereby, the frequency of immobilization was twice as often in the PAO group compared to that in the control group (p < 0.005). CONCLUSIONS: Our results indicate that PAO is a heterogeneous, rare but severe disease including a substantial number of fractures with a significant delay from first symptom to diagnose. Increased awareness is warranted to immediately start effective treatment.

[The role of T-regulatory lymphocytes in pathogenesis of preterm delivery]. / Úloha T-regulacních lymfocytu v patogenezi predcasného porodu.

OBJECTIVE: To describe the role of T-regulatory lymphocytes in pathogenesis of preterm delivery. SETTING: Department of Obstetrics and Gynecology, General University Hospital and 1st Medical Faculty, Charles University, Prague. METHOD: T-regulatory lymphocytes modulate the immune system, secure the tolerance to own antigens and prevent autoimmune disease. During pregnancy is maternal immunity in contact with the semi-allogeneic fetus due to the fetomaternal crosstalk. It seems that maternal immunity and T-regulatory lymphocytes have an effect on premature birth and other pregnancy pathologies. According to the latest data, their role in the immunomodulation of pregnant women seems to be very significant, although we still do not understand many mechanisms.

Effect of race/ethnicity on risk of complete and partial molar pregnancy after adjustment for age.

OBJECTIVE: To quantify the effect of race/ethnicity on risk of complete and partial molar pregnancy. METHODS: We conducted a cross-sectional study including women who were followed for complete or partial mole and those who had a live singleton birth in a teaching hospital in the northeastern United States between 2000 and 2013. We calculated race/ethnicity-specific risk of complete and partial mole per 10,000 live births, and used logistic regression to estimate crude and age-adjusted relative risks (RR) of complete and partial mole. RESULTS: We identified 140 cases of complete mole, 115 cases of partial mole, and 105,942 live births. The risk of complete mole was 13 cases per 10,000 live births (95% confidence interval [CI] 11-16) and that of partial mole was 11 cases per 10,000 live births (95% CI 9-13). After age-adjustment, Asians were more likely to develop complete mole (RR 2.3 95% CI 1.4-3.8, p<0.001) but less likely to develop partial mole (RR 0.2; 95% CI 0.04-0.7, p=0.02) than whites. Blacks were significantly less likely than whites to develop partial mole (RR 0.4; 95% CI 0.2-0.8, p=0.01) but only marginally less likely to develop complete mole (RR 0.6; 95% CI 0.3-1.0, p=0.07). Hispanics were less likely than whites to develop complete mole (RR 0.4; 95% CI 0.2-0.7, p=0.002) and partial mole (RR 0.4; 95% CI 0.2-0.9, p=0.02). CONCLUSION: Race/ethnicity is a significant risk factor for both complete and partial molar pregnancy in the northeastern United States.

SMFM Statement: benefit of antihypertensive therapy for mild-to-moderate chronic hypertension during pregnancy remains uncertain.

Chronic hypertension is present in up to 5% of pregnant women and constitutes a major cause of maternal and neonatal morbidity and mortality. The purpose of this document is to summarize the current recommendations regarding use of antihypertensive medications during pregnancy for women with mild-to-moderate chronic hypertension in the setting of the recently published Control of Hypertension in Pregnancy Study (CHIPS). The recently published CHIPS trial was a multicenter international randomized controlled trial comparing "less tight control" to "tight control" of blood pressure for pregnant women with hypertension. The most updated recommendations regarding management of pregnant women with hypertension are found from the American Congress of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy, which are endorsed by the Society of Maternal-Fetal Medicine (SMFM). SMFM recommends that clinicians continue to follow existing guidelines for management of pregnant women with mild-to-moderate chronic hypertension due to the fact that the benefits and risks of pharmacologic treatment for these women remain uncertain, and adequately powered randomized controlled trials are needed to address the less common but clinically significant nonsurrogate perinatal outcomes.

HIV health literacy, sexual behaviour and self-reports of having tested for HIV among students.

The HIV prevalence among young South African adults makes it important to understand their HIV knowledge, sexual behaviour and HIV counselling and testing (HCT) behaviour in this group. This paper presents the demographics, knowledge, sexual behaviour and cues to action as reported by sexually active students' who had HCT. A cross-sectional study conducted in 10 high schools in the eThekwini and Ugu districts, KwaZulu-Natal, surveyed students' HIV knowledge, sexual behaviour and HCT behaviour. Complete information was available from 1 114 (97.9%) students who participated in the survey. Of these, 378 (33.9%) were sexually active and were included in this analysis. Logistic regression models tested for significant associations between the independent and the dependent variables under study, nesting the students within schools and controlling for age, sex, grade and school location (urban/rural).The median age of students was 17 years (range: 14-23 years) with most being male (n=287; 75.9%). The lifetime median number of sexual partners of students was 3 (range: 1-27). Students who used condoms with their regular partners were more likely to have had counselling for HIV (OR :1.79; 95% CI: 1.06-3.01). Those students who were more likely to have been tested for HIV were female (OR: 44.90; 95% CI: 7.77-259.38), those who had always used a condom with their non-regular partner (OR: 2.75; 95% CI: 1.01-7.47), and those who knew a person who had tested for HIV (OR: 15.28; 95% CI: 5.16-45.23). Targeting students, especially males early in adolescence and reinforcing safe sex behaviour messages through their high school years, can encourage HCT among students.

Protocol for a randomized controlled trial comparing phone-based prenatal mindfulness training to usual care for pregnant people at risk for hypertensive disorders of pregnancy.

Hypertensive disorders of pregnancy (HDP) are the most common medical conditions in pregnancy and a leading cause of maternal morbidity and mortality in the United States. There are few interventions available to prevent HDP, and those currently available do not target underlying mechanisms of disease. Mindfulness training (MT) is effective at reducing blood pressure in non-pregnant patients with pre-hypertension and hypertension and has proven more effective at blood pressure reduction than other stress management interventions. MT thus holds great promise as a mind-body intervention to prevent HDP. This randomized trial will harness subjective and objective ecological momentary assessment methodology combined with wearable biosensor technology to capture psychological, physiological, and interpersonal processes through which MT may lead to improved maternal cardiovascular parameters. Pregnant women at risk for HDP will be randomized to an 8-week phone-delivered MT intervention or usual care. Through these methods, we will evaluate psychological, physiological, and interpersonal responses to daily experiences linking MT to cardiovascular parameters among women at risk for HDP.

Assessment of Visual Evoked Potential to Detect Visual Pathway Dysfunction in Gestational Diabetes Mellitus: A Longitudinal Case-Control Study With Postpartum Follow-up.

BACKGROUND: The increasing prevalence of gestational diabetes mellitus (GDM) during pregnancy has opened the opportunity to study its short- and long-term effects on maternal ophthalmic health. Visual evoked potential (VEP) is a non-invasive electrophysiological test that detects functional disturbances along the visual pathway before the physical signs of diabetic retinopathy (DR) can set in. This longitudinal study is aimed at the assessment of changes in VEP in GDM during different stages of pregnancy and 6-12 weeks after parturition by comparing it with normoglycemic controls. DESIGN AND METHOD: Diagnosed cases of GDM were recruited along with normoglycemic controls at 24-28 weeks of gestation. Each participant was required to attend two follow-up appointments at 32-38 weeks of gestation and 6-12 weeks after parturition. A blood sample was taken in a fasting state to record biochemical parameters. VEP was recorded using Neuropack S1 MEB-9400 electrodiagnostic equipment (Nihon Kohden, Tokyo, Japan) in a dark room by providing pattern reversal stimuli to each eye. RESULTS: A total of 29 participants (15 in the control group and 14 in the GDM group) completed the entire study procedure. The observed mean P100 latency of both eyes in the GDM group was recorded longer as compared to that in the control group at baseline and during late pregnancy. Although the mean P100 latency saw a significant decline in postpartum visits as compared to that in late pregnancy, the values were higher than in the control group. P100 latency at baseline correlated significantly to serum advanced glycated end products' (AGE'S) levels in the GDM group. CONCLUSION: Our study findings reflect that the diagnosis of GDM is associated with significant changes in VEP during and after pregnancy as compared to that of healthy pregnant women.

Hook effect in gestational trophoblastic disease: An emergency department case presentation.

Gestational trophoblastic disease is a process that affects ≈1 of 1000 pregnancies. If left untreated, this can progress to potentially life-threatening complications with malignancy such as choriocarcinoma.  The emergency physician must be aware of the presentation and complications of this disease process, including the difficulties in diagnosis.  In this case presentation, the authors discuss the presentation and diagnostic process of a patient in the emergency department as well as the phenomenon known as the hook effect, which may complicate the decision-making process.

"It Happens, But I'm Not There": On the Phenomenology of Childbirth.

Phenomenologically grounded research on pregnancy is a thriving area of activity in feminist studies and related disciplines. But what has been largely omitted in this area of research is the experience of childbirth itself. This paper proposes a phenomenological analysis of childbirth inspired by the work of Merleau-Ponty. The paper proceeds from the conviction that the concept of anonymity can play a critical role in explicating the affective structure of childbirth. This is evident in at least two respects. First, the concept of anonymity gives structural specificity to the different levels of bodily existence at work in childbirth. Second, the concept of anonymity can play a powerful explanatory role in accounting for the sense of strangeness accompanying childbirth. To flesh these ideas out, I focus on two attributes of birth, sourced from first-person narratives of childbirth. The first aspect concerns the sense of leaving one's body behind during childbirth while the second aspect concerns the sense of strangeness accompanying the first encounter with the baby upon successful delivery. I take both of these aspects of childbirth seriously, treating them as being instructive not only of the uniqueness of childbirth but also revealing something important about bodily life more generally. Accordingly, the paper unfolds in three stages. First, I will critically explore the concept of anonymity in Merleau-Ponty; second, I will apply this concept to childbirth; finally, I will provide an outline of how childbirth sheds light on the broader nature of bodily life.

Pregnancy and thrombosis: Adrenal vein thrombosis. A retrospective descriptive study of 14 cases.

OBJECTIVES: Adrenal vein thrombosis during pregnancy is a rare thromboembolic event but is not exceptional. The objective of this study was to described the symptoms, diagnosis, treatment and follow-up of patients with this condition. STUDY DESIGN: This was a retrospective descriptive study of 14 cases (13 patients, one recurrence) that occurred in the three university maternity hospitals in Lyon (France) from 2008 to 2016. RESULTS: Adrenal vein thrombosis occurred exclusively in the third trimester (gestational age > 28 weeks), with most patients presenting unilateral lumbar pain (13/14 cases, 93%) and vomiting (8 cases, 57%), mimicking renal colic. To establish the diagnosis, all patients were examined by abdominal CT and all but three (79%) by abdominal ultrasonography. Ten patients (71%) were treated by low molecular weight heparin and the remaining four (29%) by unfractionated heparin. The delay between presentation and diagnosis, and thus before treatment was initiated, was greater than 24 h in 50% of cases. Thrombosis occurred predominantly (11 vs 3 cases) on the right adrenal vein. Labor inducing or cervical ripening agents were used after temporarily interrupting treatment for 9/14 patients (64%). Epidural anesthesia was possible for 11 patients (79%) and 2 (14%) had postpartum hemorrhage. Eleven patients received hemostatic function investigations with anomalies detected in four cases (36%). One of the six patients (16%) who had a second full-term pregnancy during the study period had a contralateral recurrence. CONCLUSIONS: Adrenal vein thromboses are rare events requiring curative anticoagulant therapy and labor management to minimize the risk of hemorrhage. Patients should receive thromboprophylaxis for subsequent pregnancies and a full thrombophilia investigation.

Targetoid form of polymorphic eruption of pregnancy: A case report.

Polymorphic eruption of pregnancy, formerly known as pruritic and urticarial papules and plaques of pregnancy, is an uncommon cutaneous eruption that can affect women during their third trimester of pregnancy. As its name implies, it has a variety of morphologies and it is important to consider other diagnoses, such as pemphigoid gestationis, which polymorphic eruption of pregnancy can mimic. Sometimes, as in this case, polymorphic eruption of pregnancy can have a targetoid morphology reminiscent of erythema multiforme. A thorough workup and conservative management plan helps reassure the patient that the correct approach is being taken during the challenging period of a pregnancy nearing completion.

Adherencia a métodos anticonceptivos postevento obstétrico en adolescentes / Method Adherence post-event contraceptives obstetric in adolescents

Introducción: en nuestra institución, durante el año 2019 y 2020, hubo un total de 2811 nacimientos; de ellos, el 11.2% (N=317) fueron de mujeres adolescentes de entre 10 a 19 años. Abordar a esta población desde el enfoque de su adherencia a los métodos anticonceptivos (MAC) nos permitiría poder realizar acciones tendientes a evitar los embarazos no intencionales. La importancia de este objetivo radica en que la gestación en adolescentes impacta directamente en las posibilidades de desarrollo educativo, laboral y personal de estas mujeres, ya que las posiciona en un rol de cuidado que las aleja de los principales espacios de inserción social y construcción ciudadana. Objetivo: conocer el número de mujeres adolescentes que continuaron con el MAC elegido en el alta hospitalaria, 6 meses postevento obstétrico. Establecer cuál fue el método más elegido por esta población, conocer las causas que llevaron a la discontinuidad del método elegido y determinar si hubo embarazo no deseado luego del evento obstétrico. Materiales y método: estudio de tipo descriptivo, observacional, retrospectivo y de corte transversal. Se extrajeron datos del Sistema Informático Perinatal y, luego, se realizó actividad extramural mediante llamados telefónicos para recolectar los datos sobre la adherencia de los métodos anticonceptivos. Resultados: el 41,9% de la muestra (N=148) eligió un método de larga duración al alta (implante subdérmico y dispositivo intrauterino ­DIU­). El 51,4% continúa con el método elegido, un 35,8% optó por cambiarse de método y el 12,4% refirió haber cursado algún embarazo. De las mujeres que accedieron al implante subdérmico, un 97,2% continúa con este, y de las que accedieron al DIU, un 46,2% sigue utilizándolo. Esto se contrapone a los anticonceptivos orales, cuya adherencia fue del 34.4%. Algunos de los motivos por los cuales no continuaron con el método elegido fueron: preferencia de un método de larga duración (22,6%), incomodidad por efectos adversos (17%), olvidos en a toma de los anticonceptivos orales y expulsión de DIU (20,8%), por falta de insumos (3,8%) y otros (15,1%). Conclusiones: de esta investigación, pudimos establecer que existe una fuerte aceptación de las adolescentes por los LARCs: más de un tercio los elige al momento del alta obstétrica y, de aquellas que decidieron cambiar de MAC, casi 23% nos especificó que deseaba un método de larga duración, pero reversible. Dentro de ellos, se destacó tanto la elección como la adherencia en el tiempo del implante subdérmico. Gracias a la realización de extramurales, este trabajo nos permitió volver a conectar con las mujeres a las que habíamos brindado atención determinado tiempo atrás. Este hecho nos posibilitó no solo lograr los objetivos planteados, sino también poder conocer, de primera mano, el uso de los MAC en adolescentes y todo lo que su adherencia implica, para así poder mejorar nuestra propia consejería en Salud Sexual y Reproductiva. Una estrategia posible sería la citación de ellas a los 3 y 6 meses postevento obstétrico(AU)

SUMMARY Introduction: in our Institution, during 2019 and 2020, there were a total of 2811 births, of which 11.2% (N = 317) were of adolescent women between 10 and 19 years of age. Addressing this population from the approach of their adherence to contraceptive methods (MAC) would allow us to carry out actions aimed at avoiding unintended pregnancies. The importance of this objective lies in the fact that pregnancy in adolescents has a direct impact on the possibilities of educational, work and personal development of these women since it positions them in a caring role that distances them from the main spaces of social insertion and civic construction. Objective: to know the number of adolescent women who continued with the chosen MAC at hospital discharge 6 months after obstetric event, to establish which was the method most chosen by this population, to know the causes that led to the discontinuity of the chosen method and to determine if there was an unwanted pregnancy after the obstetric event. Materials and method: descriptive, observational, retrospective and crosssectional study. Data were extracted from the Perinatal Computer System and then extramural activity was carried out through telephone calls to collect data on adherence to contraceptive methods. Results: 41.9% of the sample (N = 148) chose a long-term method at discharge (subdermal implant and intrauterine device -DIU-). 51.4% continued with the chosen method, 35.8% opted to change the method and 12.4% reported having had a pregnancy. Of the women who accessed the subdermal implant, 97.2% continue with it and of those who accessed the IUD, 46.2% continue to use it, in contrast to oral contraceptives, whose adherence was 34.4%. Some of the reasons why they did not continue with the chosen method were: preference for a long-term method (22.6%), discomfort due to adverse effects (17%), forgetting to take oral contraceptives and expulsion of IUD (20.8%), for lack of inputs (3.8%) and others (15.1%). Conclusions: from this research we were able to establish that there is a strong acceptance of adolescents by LARCs: more than a third choose them at the time of obstetric discharge and of those who decided to change MAC, almost 23% specified that they wanted a long-lasting but reversible method . Among them, both the choice and the adherence over time of the subdermal implant stood out. Thanks to the performance of extramurals, this work allowed us to reconnect with the women to whom we had provided care a certain time ago. This fact enabled us not only to achieve the objectives set, but also to know first-hand the use of MAC in adolescents and all that their adherence implies, in order to improve our own counseling on Sexual and Reproductive Health (AU)

COVID-19 e as repercussões na saúde mental de gestantes: revisão integrativa / COVID-19 y las repercusiones en la salud mental de mujeres embarazadas: revisión integradora / COVID-19 and the repercussions on pregnant women's mental health: integrative review

Resumo Objetivo Identificar, a partir das evidências presentes na literatura, os impactos da COVID-19 na saúde mental de mulheres grávidas. Métodos Trata-se de uma revisão integrativa da literatura, realizada nas bases de dados/biblioteca eletrônica MEDLINE, CINAHL, PUBCOVID19 e MEDRXIV. A busca aconteceu de forma pareada no mês de dezembro de 2020, com artigos disponíveis na íntegra abordando a saúde mental das grávidas na pandemia. Resultados Os estudos que compuseram a amostra foram publicados entre os meses de abril e dezembro de 2020 e nos 10 estudos incluídos, a depressão e a ansiedade são apontados como fatores impactantes na saúde das gestantes, tendo como elementos contribuintes o medo da COVID-19, estresse e preocupações associadas à pandemia. Conclusão Houve impacto na saúde mental das gestantes na pandemia com repercussões de ordem psicossocial, socioeconômica e de assistência à saúde. Nesse contexto, a abordagem do componente psicológico na consulta de enfermagem pode fazer a diferença na atenção à gestação.

Resumen Objetivo Identificar, a partir de evidencias presentes en la literatura, los impactos del COVID-19 en la salud mental de mujeres embarazadas. Métodos Se trata de una revisión integradora de la literatura, realizada en las bases de datos/biblioteca electrónica MEDLINE, CINAHL, PUBCOVID19 y MEDRXIV. La búsqueda se realizó de forma pareada en el mes de diciembre de 2020, con artículos con texto completo disponible que abordaban la salud mental de embarazadas en la pandemia. Resultados Los estudios que formaron la muestra fueron publicados entre los meses de abril y diciembre de 2020. En los diez estudios incluidos, la depresión y la ansiedad son señaladas como factores impactantes en la salud de las mujeres embarazadas, donde los elementos contribuyentes son el miedo al COVID-19, el estrés y las preocupaciones relacionadas con la pandemia. Conclusión Hubo impacto en la salud mental de las mujeres embarazadas en la pandemia, con repercusiones de orden psicosocial, socioeconómica y de atención a la salud. En este contexto, el enfoque del componente psicológico en la consulta de enfermería puede marcar una diferencia en la atención al embarazo.

Abstract Objective To identify the impacts of COVID-19 on pregnant women's mental health from evidence in the literature. Methods This is an integrative literature review performed in MEDLINE, CINAHL, PUBCOVID19 and MEDRXIV databases/electronic libraries. The search took place in pairs in December 2020, with articles available in full addressing pregnant women's mental health in the pandemic. Results The studies that made up the sample were published between April and December 2020 and in the ten studies included, depression and anxiety were identified as factors exerting impact on pregnant women's health, and the fear of COVID-19, stress and worries associated with the pandemic as contributing elements. Conclusion There was an impact on pregnant women's mental health in the pandemic with psychosocial, socioeconomic and health care repercussions. In this context, the approach to the psychological component in the nursing consultation can make a difference in pregnancy care.

Secular trends in smoking during pregnancy according to income and ethnic group: four population-based perinatal surveys in a Brazilian city.

OBJECTIVES: To assess socioeconomic and ethnic inequalities in smoking during pregnancy over three decades (1982-2011). SETTING: Population-based study in Pelotas City, Brazil. PARTICIPANTS: All urban women giving birth in the city hospitals in 1982 (5909), 1993 (5223) and 2004 (4201), plus all urban and rural women delivering from January 2011 to April 2012 (6275). PRIMARY OUTCOME: Self-reported smoking during pregnancy. RESULTS: The prevalence of smoking during pregnancy fell from 35.7% in 1982 to 21.0% in 2011. In each survey, prevalence decreased with increasing income (p<0.001). In the poorest quintile, smoking fell by 27.4% in the period studied compared to 67.1% in the wealthiest quintile. In all surveys, prevalence was lower among white women than among those who classified themselves as black or brown (p<0.001). Over time, smoking declined by 50.0% among the former and 30.7% among the latter. Absolute and relative inequalities both increased over time. CONCLUSIONS: The reduction in smoking during pregnancy was primarily due to a decline among white, high-income women. Further efforts are needed to reduce smoking among all population groups.

Unintended Pregnancies in Brazil - A Challenge for the Recommendation to Delay Pregnancy Due to Zika.

Because of the potential link between the ongoing Zika virus outbreak and a surge in the number of cases of congenital microcephaly, officials in Latin America have recommended that women postpone pregnancy until this association is firmly established or the outbreak subsides. However, in all these countries a large proportion of babies are still born out of unplanned pregnancies. Teenage girls are particularly at high risk, as they often lack access to preventive contraception methods, or the knowledge to use them appropriately. To gauge the magnitude of the barriers preventing the implementation of such a recommendation in Brazil, the country so far most affected by the Zika epidemic, we evaluated pregnancy rates in teenage girls, and their spatial heterogeneity in the country, in recent years (2012-2014). Nearly 20% of children born in Brazil today (~560,000 live births) are by teenage mothers. Birth incidence is far higher in the tropical and poorer northern states. However, in absolute terms most births occur in the populous southeastern states, matching to a large extent the geographic distribution of dengue (an indicator of suitable climatic and sociodemographic conditions for the circulation of Aedes mosquitoes). These findings indicate that recommendation to delay pregnancy will leave over half a million pregnant adolescents in Brazil vulnerable to infection every year if not accompanied by effective education and real access to prevention.

Substance use during pregnancy.

Prenatal substance use is a critical public health concern that is linked with several harmful maternal and fetal consequences. The most frequently used substance in pregnancy is tobacco, followed by alcohol, cannabis and other illicit substances. Unfortunately, polysubstance use in pregnancy is common, as well as psychiatric comorbidity, environmental stressors, and limited and disrupted parental care, all of which can compound deleterious maternal and fetal outcomes. There are few existing treatments for prenatal substance use and these mainly comprise behavioral and psychosocial interventions. Contingency management has been shown to be the most efficacious of these. The purpose of this review is to examine the recent literature on the prenatal use of tobacco, alcohol, cannabis, stimulants, and opioids, including the effects of these on maternal and fetal health and the current therapeutic options.