A aceitação da medicina alternativa complementar por gestantes com diabetes / Acceptance of additional alternative medicine by pregnant diabetics

Objetivo: avaliar como as mulheres grávidas com diabetes compreendem e aceitam o uso de práticas integrativas e complementares na saúde, especialmente o Reiki, durante o atendimento pré-natal. Método: trata-se de um estudo qualitativo, descritivo, exploratório, de gestantes diabéticas atendidas num Centro de Investigação do Diabetes Perinatal em um centro terciário, por meio de entrevistas semiestruturadas com 12 gestantes. Audiogravaram-se e transcreveram-se as entrevistas para posterior análise cujos dados foram submetidos à técnica de Análise de Conteúdo. Resultados: demonstrou-se, pela maioria das mulheres gestantes diagnosticadas com diabetes, o conhecimento de algumas práticas integrativas e complementares na saúde. Receber-se-iam, além disso, por um grande número de entrevistadas, tais terapias se essas fossem disponíveis no Sistema Único de Saúde (SUS), porém, a terapia Reiki mostrou ser desconhecida entre as pacientes. Conclusão: serve-se este estudo como ponto de partida para profissionais de saúde introduzirem as terapias integrativas e complementares na saúde pública brasileira. Tornam-se necessários estudos adicionais em outras populações para obter uma visão mais profunda e detalhada do perfil das pacientes em diferentes regiões.(AU)

Objective: to evaluate how pregnant women with diabetes understand and accept the use of integrative and complementary health practices, especially Reiki, during prenatal care. Method: this is a qualitative, descriptive, exploratory study of diabetic pregnant women seen at a Perinatal Diabetes Research Center in a tertiary center, through semi-structured interviews with 12 pregnant women. The interviews were audio recorded and transcribed for later analysis whose data were submitted to the Content Analysis technique. Results: it was demonstrated, by most pregnant women diagnosed with diabetes, the knowledge of some integrative and complementary practices in health. In addition, a large number of respondents would receive such therapies if they were available in the Unified Health System (UHS), but Reiki therapy was unknown to patients. Conclusion: this study serves as a starting point for health professionals to introduce integrative and complementary therapies in Brazilian public health. Further studies in other populations are needed to gain a deeper and more detailed view of patients' profiles in different regions.(AU)

Objetivo: evaluar cómo las mujeres embarazadas con diabetes entienden y aceptan el uso de prácticas de salud integradoras y complementarias en salud, especialmente el Reiki, durante la atención prenatal. Método: este es un estudio cualitativo, descriptivo, exploratorio de mujeres embarazadas diabéticas atendidas en un Centro de Investigación de Diabetes Perinatal en un centro terciario, a través de entrevistas semiestructuradas con 12 mujeres embarazadas. Las entrevistas se grabaron en audio y se transcribieron para un análisis posterior cuyos datos fueron sometidos a la técnica de Análisis de Contenido. Resultados: la mayoría de las mujeres embarazadas diagnosticadas con diabetes demostraron el conocimiento de algunas prácticas integradoras y complementarias en salud. Además, un gran número de encuestados recibiría tales terapias si estuvieran disponibles en el Sistema Único de Salud (SUS), pero la terapia de Reiki era desconocida para los pacientes. Conclusión: este estudio sirve como punto de partida para que los profesionales de la salud introduzcan terapias integradoras y complementarias en la salud pública brasileña. Se necesitan más estudios en otras poblaciones para obtener una visión más profunda y detallada de los perfiles de los pacientes en diferentes regiones.(AU)

Changes in T-cell phenotype and cytokines profile in maternal blood, cord blood and colostrum of diabetic mothers.

OBJECTIVE: The present study evaluated the cells and cytokine of maternal blood, cord blood and colostrum of diabetic mothers. METHODS: The women evaluated were divided according to their body mass index (BMI) and glycemic status into non-diabetic (ND - N = 15), mild gestational hyperglycemic (MGH - N = 15), diabetes mellitus gestational (DMG - N = 13) and type-2 diabetes mellitus (DM2 - N = 15) groups. The subsets of cells and cytokine profile were determined by flow cytometry. RESULTS: Maternal blood from MGH group had increase percentage of CD3(+)T cells, and DM-2 group had decrease percentage of CD4(+) T cells. The cord blood from hyperglycemic groups showed lower percentage of CD3(+) T cells expressing CD45RO(+) and higher of CD4(+) T cells and CD4(+) T cells expressing CD45RA(+). In the colostrum, the CD4(+) T cells and CD4(+) T cells expressed CD45RA(+) increase in hyperglycemic groups. The DM2 group exhibited higher IL17 levels in maternal blood. IFN-γ was lower in cord blood from MGH and DMG groups with overweight/obese. Irrespective of the glycemic status, IL6 was higher in colostrum. CONCLUSION: The results obtained suggest that maternal hyperglycemia modifies the phenotypes of T cells and cytokines profile in maternal, cord blood and colostrum.

The role of cytokines in the functional activity of phagocytes in blood and colostrum of diabetic mothers.

Immune response changes induced by diabetes are a risk factor for infections during pregnancy and may modify the development of the newborn's immune system. The present study analyzed colostrum and maternal and cord blood of diabetic women to determine (1) the levels of the cytokines IFN- γ and TGF- ß and (2) phagocytic activity after incubation with cytokines. Methods. Colostrum and maternal and cord blood samples were classified into normoglycemic (N = 20) and diabetic (N = 19) groups. Cytokine levels, superoxide release, rate of phagocytosis, bactericidal activity, and intracellular Ca(2+) release by phagocytes were analyzed in the samples. Irrespective of glycemic status, IFN- γ and TGF- ß levels were not changed in colostrum and maternal and cord blood. In maternal blood and colostrum, superoxide release by cytokine-stimulated phagocytes was similar between the groups. Compared to spontaneous release, superoxide release was stimulated by IFN- γ and TGF- ß in normoglycemic and diabetic groups. In the diabetic group, cord blood phagocytes incubated with IFN- γ exhibited higher phagocytic activity in response to EPEC, and maternal blood exhibited lower microbicidal activity. These data suggest that diabetes interferes in maternal immunological parameters and that IFN- γ and TGF- ß modulate the functional activity of phagocytes in the colostrum, maternal blood, and cord blood of pregnant diabetic women.

Transfer of maternal immunity to newborns of diabetic mothers.

This study was carried out with hyperglycemic pregnant women to investigate the transfer of antibody classes to newborns across the placenta or by colostrum and the functional activity of phagocytes in maternal blood, cord blood, and colostrum from diabetes mothers. Samples from maternal blood, cord blood, and colostrum were collected from 20 normoglycemic and 20 hyperglycemic pregnant women. We determined antibodies levels, superoxide release, phagocytosis and bactericidal activity of phagocytes. We demonstrated that IgG levels in cord blood were higher in the hyperglycemic group. IgA and IgM levels were higher in maternal than in cord blood samples. Plasma antibody levels were lower in hyper- than in normoglycemic women. The colostrum of diabetic mothers had lower IgA and IgG levels. Colostrum and maternal blood phagocytes when exposed to EPEC increased the superoxide release. Cord blood phagocytes of hyperglycemic group, independently of bacteria, had higher superoxide release. Colostrum and blood phagocytes from diabetic group exhibited some phagocytic and microbicidal activity in response to EPEC. Mononuclear phagocytes from cord blood had the lowest phagocytosis, and bactericidal activity for EPEC, regardless of glycemic status. These data showed that hyperglycemia altered IgG transfer across the placenta and decreases immunoglobulin levels in maternal blood and colostrum.

Secretory IgA-Fcα receptor interaction modulating phagocytosis and microbicidal activity by phagocytes in human colostrum of diabetics.

The effects of secretory immunoglobulin A (SIgA) interaction with its specific Fcα receptors on colostral phagocytes needs further investigation, especially with respect to diabetic women. Accordingly, we studied the colostrum of hyperglycemic women to assess SIgA interactions with Fcα receptors of macrophages as well as the functional activity of these cells. The women were divided for colostrum sampling according to their glycemic status: normoglycemia (N = 51), mild hyperglycemia (N = 23), and diabetes (N = 25) groups. We determined the FcαR expression, the IgA on the surface and the surface-bound IgA in colostrum macrophages. We also evaluated the superoxide release and bactericidal killing of these cells. Colostral phagocytes expressed FcαR, contained IgA on the surface and are able to bind to purified SIgA. The bactericidal activity of colostral phagocytes from the hyperglycemic women was similar to that of normoglycemic only when SIgA was used as opsonin. Addition of a MoAb anti-human Fcα receptor resulted in a significant decrease of superoxide release and bacterial killing by macrophages when bacteria were opsonized with purified SIgA, suggesting an interaction between SIgA and FcαR. The stimulatory effects of SIgA on the functional activity of phagocytes therefore protect infants, especially of diabetic women, against intestinal infections.

Human colostral phagocytes eliminate enterotoxigenic Escherichia coli opsonized by colostrum supernatant.

BACKGROUND: Several elements in colostrum and human milk, including antibodies and nonspecific factors with bactericidal and antiviral activity, may play an important anti-infectious and protective role. In developing countries, enterotoxigenic Escherichia coli (ETEC) is the main etiological agent of diarrhea in low-socioeconomic level children. In the present work, we studied the functional activity of mononuclear (MN) and polymorphonuclear (PMN) phagocytes of human colostrum against ETEC, as well as the interactions between these cells and colostral or serum opsonins. METHODS: Colostrum samples were collected from 33 clinically healthy women between 48 and 72 hours postpartum. We verified superoxide release in colostral MN and PMN using cytochrome C reduction methods, phagocytosis, and bactericidal activity using acridine orange methods and superoxide dismutase (SOD) in the colostrum supernatants. RESULTS: Colostral MN and PMN phagocytes exposed to ETEC opsonized with colostrum supernatants caused a significant increase (p<0.05) in superoxide release. Phagocytosis by colostral PMN cells increased significantly (p<0.5) when the phagocytes were incubated with both sources of opsonins (sera and colostrum). Increases in superoxide release in the presence of opsonized bacteria triggered the bactericidal activity of the phagocytes. Phagocyte treatment with SOD decreased their ability to eliminate ETEC. Colostrum supernatant had higher SOD concentrations (p<0.05) compared with normal human sera. CONCLUSIONS: These results suggest that the ability of phagocytes to eliminate ETEC depends on the activation of cellular oxidative metabolism; moreover, activation of colostral phagocytes is likely an additional breast-feeding protection mechanism against intestinal infections in infants.

Comparison between 100-g glucose tolerance test and two other screening tests for gestational diabetes: combined fasting glucose with risk factors and 50-g glucose tolerance test.

CONTEXT AND OBJECTIVE: Lack of consensus about which screening tests to use for gestational diabetes mellitus (GDM) and difficulties in performing the gold-standard diagnostic test, the 100-g glucose tolerance test (100-g GTT), justify comparison with alternatives. The aim was to compare this with two other screening tests: combined fasting glucose with risk factors (FG + RF) and 50-g GTT. DESIGN AND SETTING: Prospective longitudinal cohort study in the Hospital School of Universidade Federal de Mato Grosso do Sul. METHODS: The three tests were performed independently on 341 pregnant women. Sensitivity (S), specificity (Sp), positive (PPV) and negative (NPV) predictive values, positive (PLR) and negative (NLR) likelihood ratios, and false-positive (FP) and false-negative (FR) rates obtained with FG + RF and 50-g GTT were compared with values from 100-g GTT. The average one-hour post-intake glucose levels (1hPG) with 50-g and 100-g were compared. Students t test was used in the statistical analysis. RESULTS: FG + RF led more pregnant women (53.9%) to diagnostic confirmation than did 50-g GTT (14.4%). The tests were equivalent for S (86.4 and 76.9%), PPV (98.7 and 98.9%), NLR (0.3 and 0.27) and FR (15.4 and 23.1%). Average 1hPG values were similar: 50-g GTT = 106.8 mg/dl and 100-g GTT = 107.5 mg/dl. CONCLUSION: Diagnostic efficiency with simplicity, practicality and low cost make FG + RF more appropriate for screening for GDM. The equivalence of 1hPG allows a new, cheaper and less uncomfortable protocol to be proposed for screening and diagnosing GDM.

Comparison between 100-g glucose tolerance test and two other screening tests for gestational diabetes: combined fasting glucose with risk factors and 50-g glucose tolerance test

CONTEXTO E OBJETIVO: A falta de consenso sobre os protocolos de rastreamento e diagnóstico do diabetes gestacional, associada às dificuldades na realização do teste oral simplificado do diabete gestacional (o teste de tolerância a 100 g de glicose, considerado padrão-ouro) justificam a comparação com alternativas. O objetivo deste trabalho é comparar o teste padrão-ouro a dois testes de rastreamento: associação de glicemia de jejum e fatores de risco (GJ + FR) e o teste oral simplificado de tolerância a 50 g de glicose (TTG 50 g), com o teste de tolerância a 100 g de glicose (TTG 100 g).TIPO DE ESTUDO E LOCAL: Estudo de coorte longitudinal, prospectivo, realizado no Serviço de Ginecologia e Obstetrícia do Hospital Universitário da Universidade Federal de Mato Grosso do Sul. MÉTODOS: 341 gestantes foram submetidas aos três testes. Calcularam-se os índices de sensibilidade (S), especificidade (E), valores preditivos (VPP e VPN), razões de probabilidade (RPP e RPN) e resultados falsos (FP e FN), positivos e negativos da associação GJ + FR e do TTG 50 g em relação ao TTG 100 g. Compararam-se as médias das glicemias de uma hora pós-sobrecarga (1hPS) com 50 e 100 g. Na análise estatística, empregou-se o teste t de Student, com limite de significância de 5%. RESULTADOS: A associação GJ + FR encaminhou mais gestantes (53,9%) para a confirmação diagnóstica que o TTG 50 g (14,4%). Os dois testes foram equivalentes nos índices de S (86,4 e 76,9%), VPN (98,7 e 98,9%), RPN (0,3 e 0,27) e FN (15,4 e 23,1%). As médias das glicemias 1hPS foram semelhantes, 106,8 mg/dl para o TTG 50 g e 107,5 mg/dl para o TTG 100 g. CONCLUSÕES: Os resultados da eficiência diagnóstica associados à simplicidade, praticabilidade e custo referendaram a associação GJ + FR como o mais adequado para o rastreamento. A equivalência das glicemias de 1hPS permitiram a proposição de um novo protocolo de rastreamento e diagnóstico do diabete gestacional, com menores custo e desconforto.

A Prática da atividade física na gestação - aspectos atuais / Regular physical activity in pregnancy - current aspects

Nos últimos anos observou-se aumento de mulheres engajadas em atividades físicas, incluindo grávidas em período próximo ao parto. O crescente número de gestantes que praticam qualquer tipo de exercício está ligado aos avanços tecnológicos e médicos, vislumbrando a estas mulheres parturição mais segura e queda nas taxas de morbimortalidade materna e fetal. Este fato amplia as expectativas da futura mãe - se até este século a maioria das mulheres ficava agradecida simplesmente por sobreviver aos múltiplos perigos da gravidez, parto e puerpério, hoje elas estudam, se preparam e treinam para isso. Acrescente-se a preocupação estética estimulada pela sociedade atual, que define padrões femininos de beleza dependentes de atividade física intensa e constante. Os profissionais de saúde, especialmente os obstetras, ao se confrontarem com esta revolução, deparam-se com muitas questões: - Quais as repercussões do exercício no organismo da mãe e do feto? Qual o tipo, a intensidade e a freqüência ideais para a gestação? Quais suas contra-indicações, ou ainda, esta prática seria realmente necessária ou desejável durante a gestação?

Repercussões maternas e perinatais da hidroterapia na gravidez / Maternal and perinatal effects of hydrotherapy in pregnancy

Objetivo: estudar os efeitos maternos (composiçäo corporal e capacidade cardiovascular) e perinatais (peso e prematuridade) da prática da hidroterapia na gestaçäo. Métodos: estudo prospectivo, coorte, aleatorizado, com 41 gestantes de baixo risco e gestaçäo única, praticantes (grupo estudo, n=22) e näo-praticantes (grupo controle, n=19) de hidroterapia. Avaliações antropométricas definiram-se os índices de peso corporal, massa magra e gordura absoluta e relativa. Por teste ergométrico, definiu-se os índices de consumo máximo de oxigênio (VO2máx), volume sistólico (VS) e débito cardíaco (DC). Como resultado perinatal observaram-se ocorrência de prematuridade e recém-nascidos pequenos para a idade gestacional. Compararam-se os índices iniciais e finais entre e dentro de cada grupo. As variáveis maternas foram avaliadas pelo teste t para amostras dependentes e independentes e empregou-se o X² para estudo das proporções. Resultados: a comparaçäo entre os grupos näo evidenciou diferença significativa nas variáveis maternas no início e no final da hidroterapia. A comparaçäo dentro de cada grupo confirmou efeito benéfico da hidroterapia: no grupo estudo os índices de gordura relativa foram mantidos (29,0 por cento) e no grupo controle aumentaram de 28,8 para 30,7 por cento; o grupo estudo manteve os índices de VO2máx (35,0 por cento) e aumentou VS (106,6 para 121,5) e DC de (13,5 para 15,1); no grupo controle observaram-se queda nos índices de VO2máx e manutençäo de VS e de DC. A hidroterapia näo interferiu nos resultados perinatais, relacionados à prematuridade e baixo peso ao nascimento. Conclusões: a hidroterapia favoreceu adequada adaptaçäo metabólica e cardiovascular materna à gestaçäo e näo determinou prematuridade e baixo peso nos recém-nascidos

[Effect of acetylsalicylic acid on the reproductive performance and on offspring from wistar rats]. / Efeito do ácido acetilsalicílico na performance reprodutiva e na prole de ratas wistar.

UNLABELLED: The aim of this paper was to perform a randomized, controlled and blinded study to investigate if a therapeutic dose of acetylsalicylic acid (ASA), taken by pregnant women, may also cause embryotoxic or congenital abnormalities on experimental animal. METHODS: Females were confirmed to have mated by observations of sperm in a vaginal smear. The day on which spermatozoa were found in the vaginal smear was considered as day 1 of gestation (GD1). After randomization, mated females were assigned to experimental groups and individually caged, were given 50 mg/kg/day of acetylsalicylic acid, by needle gavage once daily, during two different periods of pregnancy. One group of dams (n=11) received aspirin from day 1 to 4 of pregnancy (before embryonic implantation) for evaluation of the blastocysts, and another group received aspirin from day 6 to 15 of pregnancy (organogenic period) for fetal evaluation. Control groups (n=12) received distilled water in same volume and during same periods as their respective experimental groups. RESULTS AND CONCLUSION: The treatment of the dams with ASA, according to minimal therapeutic dose used for humans, did not cause embryotoxic or major malformations on experimental animal but was responsible for rate increased of fetuses presenting ureteric dilatation. After analysis of the data, it appears that, although direct conclusive evidence of adverse effects in humans is lacking, a potential hazard dose exists and thus the indiscriminate use of acetylsalicylic acid (aspirin) is contraindicated.