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1.
Zhonghua Fu Chan Ke Za Zhi ; 55(5): 317-321, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32464719

RESUMO

Objective: To investigate the appropriate method of labor induction in the second trimester for complete placenta previa patients. Methods: The labor induction outcomes of 85 cases with complete placenta previa in the second trimester were retrospectively analyzed. Twenty patients in group A were treated with cesarean section, 30 patients in group B were treated with ethacridine and mifepristone combined with uterine artery embolization (UAE), and 35 patients in group C were induced by using ethacridine and mifepristone. The clinical features and induction outcomes of three groups were compared. Results: The total duration of labor in group B [(28.7±30.1) hours] was significantly longer than that of group C [(24.3±21.9) hours; P<0.05]. The total amount of blood loss during induction and labor in group B [(302±271) ml] was significantly lower than those of group C [(393±523) ml] and group A [(626±487) ml; P<0.05]. The incidence of fever in group B (13%, 4/30) was significantly higher than those of group C (11%, 4/35) and group A (10%, 2/20; P<0.05). In group C, 13 patients (37%, 13/35) underwent emergency UAE, and 2 patients (6%, 2/35) underwent emergency cesarean section. As to average hemoglobin level and blood transfusion rate, there were no difference among the three groups (all P>0.05). Conclusion: Prophylactic UAE combined with drug induction in patients with complete placenta previa in the second trimester could significantly reduce the amount of bleeding during induction and reduce the risk of emergency procedures.


Assuntos
Trabalho de Parto Induzido/métodos , Placenta Prévia/fisiopatologia , Embolização da Artéria Uterina/métodos , Adulto , Cesárea , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos
2.
PLoS One ; 15(5): e0232553, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379834

RESUMO

BACKGROUND: Amniotic fluid is clinically accessible via amniocentesis and its protein composition may correspond to birth timing. Early changes in the amniotic fluid proteome could therefore be associated with the subsequent development of spontaneous preterm delivery. OBJECTIVE: The main objective of this study was to perform unbiased proteomics analysis of the association between mid-trimester amniotic fluid proteome and spontaneous preterm delivery and gestational duration, respectively. A secondary objective was to validate and replicate the findings by enzyme-linked immunosorbent assay using a second independent cohort. METHODS: Women undergoing a mid-trimester genetic amniocentesis at Sahlgrenska University Hospital/Östra between September 2008 and September 2011 were enrolled in this study, designed in three analytical stages; 1) an unbiased proteomic discovery phase using LC-MS analysis of 22 women with subsequent spontaneous preterm delivery (cases) and 37 women who delivered at term (controls), 2) a validation phase of proteins of interest identified in stage 1, and 3) a replication phase of the proteins that passed validation using a second independent cohort consisting of 20 cases and 40 matched controls. RESULTS: Nine proteins were nominally significantly associated with both spontaneous preterm delivery and gestational duration, after adjustment for gestational age at sampling, but none of the proteins were significant after correction for multiple testing. Several of these proteins have previously been described as being associated with spontaneous PTD etiology and six of them were thus validated using enzyme linked immunosorbent assay. Two of the proteins passed validation; Neutrophil gelatinase-associated lipocalin and plasminogen activator inhibitor 1, but the results could not be replicated in a second cohort. CONCLUSIONS: Neutrophil gelatinase-associated lipocalin and Plasminogen activator inhibitor 1 are potential biomarkers of spontaneous preterm delivery and gestational duration but the findings could not be replicated. The negative findings are supported by the fact that none of the nine proteins from the exploratory phase were significant after correction for multiple testing.


Assuntos
Líquido Amniótico/metabolismo , Idade Gestacional , Segundo Trimestre da Gravidez/metabolismo , Nascimento Prematuro/metabolismo , Proteoma/análise , Adulto , Amniocentese , Líquido Amniótico/química , Estudos de Coortes , Feminino , Humanos , Masculino , Gravidez
3.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(5): 711-715, 2020 May 10.
Artigo em Chinês | MEDLINE | ID: mdl-32447912

RESUMO

Objective: To investigate sleep quality in pregnant women during their first and second trimester and to identify risk factors. Methods: Data was from the Chinese Pregnant Women Cohort Study. A total of 3 618 pregnant women were included, with the exclusion 346 women who had missing information. Sociodemographic, health-related behavior, depression and sleep quality information were collected and analyzed. Logistic regression analysis were used to explore the influencing factors of sleep quality in pregnant women. Results: Among the 3 618 pregnant woman 28.2% had poor sleep quality in their first trimester and 28.7% in the second trimester. 15.2% pregnant women had progressively worse sleep and 13.0% had persistently poor sleep had pregnant women were generally suffered from poor sleep quality, difficulty falling asleep, sleep disorders and daily fatigue. Regular diet (OR=0.75, 95%CI: 0.62-0.92) and work (OR=0.84,95%CI: 0.71-0.99) in the first trimester were protective factors of sleep quality in pregnant women. Age ≥30 year old (OR=1.19, 95%CI: 1.03-1.37), passive smoking (OR=1.18, 95%CI: 1.02-1.36) and depression (OR=2.25, 95%CI: 1.95-2.61) in the first trimester were risk factors. Conclusions: The rate of poor sleep quality are high among Chinese pregnant woman during their first and second trimester. The risk factors of sleep quality are multiple. Regular diet and work, reduction of tobacco exposure, alleviation of depression symptom may help improve sleep quality among pregnant women.


Assuntos
Gestantes , Sono , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez
5.
Rinsho Ketsueki ; 61(3): 228-233, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32224582

RESUMO

Development of acute myeloid leukemia (AML) during pregnancy is rare, and the available data are limited to small retrospective reports. Currently, no guidelines exist for the management of AML during pregnancy in Japan. A 26-year-old female was diagnosed with AML at 19 weeks of gestation, received chemotherapy with daunorubicin and cytarabine, and achieved complete remission. Following the first consolidation therapy, she gave birth to a 1964-g female infant by cesarean section at 33 weeks of gestation. One week later, she was initiated on the second consolidation therapy; however, she developed a pelvic abscess during neutropenia. She underwent urgent surgery for open drainage and recovered soon after surgery. She has been in complete remission for eight months, and the daughter is healthy. Chemotherapy delivered after the second trimester rarely causes congenital malformations and may not require the termination of pregnancy. The clinical course of the present case suggests that chemotherapy can be performed safely and effectively in pregnant patients with AML after the trimester and babies.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Leucemia Mieloide Aguda , Complicações Neoplásicas na Gravidez , Adulto , Cesárea , Citarabina , Daunorrubicina , Feminino , Humanos , Japão , Leucemia Mieloide Aguda/tratamento farmacológico , Gravidez , Segundo Trimestre da Gravidez , Indução de Remissão , Estudos Retrospectivos
6.
PLoS One ; 15(4): e0231340, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32267897

RESUMO

BACKGROUND: Women's participation in decision-making in the household is an indicator of women's empowerment. Few studies have compared domestic decision-making power and its effect on postpartum health between immigrant and native-born women. This study aimed to examine the effect of domestic decision-making power and social support during pregnancy on predicting postpartum depressive and physical symptoms among immigrant and native-born mothers in Taiwan. METHODS AND FINDINGS: This prospective study recruited 177 marriage-based immigrant mothers and 230 native-born women who were at least twelve weeks pregnant from hospitals, clinics and health centers. Data were collected in the 2nd or 3rd trimester of pregnancy and at 3 months postpartum from March 2013 to March 2015. Postpartum depression and the severity of postpartum physical symptoms were measured using the Edinburgh Postnatal Depression Scale, and a 17-item, 4-point Likert scale, respectively. Linear regression was used to examine the relationship between "domestic decision-making power and social support during pregnancy" and "depressive and physical symptoms at 3 months postpartum." Women who had lower domestic decision-making power and social support during pregnancy had higher postpartum depressive and physical symptoms. Those women with full-time employment and insufficient family income had higher postpartum depressive symptoms. Though immigrant women scored lower in domestic decision-making power and social support than native-born women, they had lower mean scores in postpartum depressive and physical symptoms. After accounting for the abovementioned factors, immigrant women remained at lower risk for postpartum depressive and physical symptoms than native-born women. There was significant interaction between domestic decision-making power and immigrant status, suggesting that the association between domestic decision-making and postpartum depressive and physical symptoms was smaller for immigrants than for native women. CONCLUSIONS: Domestic decision-making power and social support during pregnancy are protective predictors of postpartum depressive and physical symptoms. However, the effect of domestic decision-making power appeared to be less salient for immigrants, probably due to the "healthy immigrant effect" and/or lower expectations toward domestic decision-making power among immigrants. The finding that immigrant women demonstrated a lower level of domestic decision-making power suggests that empowerment issues need to be addressed among immigrants.


Assuntos
Tomada de Decisões , Depressão Pós-Parto/patologia , Emigrantes e Imigrantes/psicologia , Apoio Social , Adulto , Emprego , Empoderamento , Feminino , Humanos , Modelos Lineares , Período Pós-Parto , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Fatores Socioeconômicos , Adulto Jovem
7.
Harefuah ; 159(4): 242-246, 2020 Apr.
Artigo em Hebraico | MEDLINE | ID: mdl-32307958

RESUMO

INTRODUCTION: Obstetrics Gynecology Department, "Shamir" ("Assaf Harofeh") Medical Center, Tzrifin There are 2 methods to perform amniocentesis in twin pregnancy. The widespread method is the two-punctures technique (1 for each sac). The other is a single uterine puncture through the intertwin membrane. No method is known to be superior. The main procedure-related complications are increased risk for fetal loss, amniotic fluid leakage and infection. The information regarding complications in twin pregnancy is limited and the method is not described. OBJECTIVES: To demonstrate whether a single uterine puncture is an acceptable alternative to the double uterine puncture method. METHODS: A retrospective cohort study of 112 twin pregnancies which underwent amniocentesis by a single operator at "Shamir" ("Assaf Harofeh") Medical Center between the years 2010-2018. We compared a single uterine puncture (intervention group) to a double uterine puncture (control group). RESULTS: Eighty-six patients (76.7%) underwent a single uterine puncture and 26 (23.3%) underwent a double uterine puncture. Most pregnancies were uncomplicated in both groups (80.2% vs. 76.9% respectively); no statistical difference was seen in any complication. The most common complication was seeking medical help due to bleeding or contraction (12.8% in single puncture group vs 19.2% in double puncture group). PPROM, infection and loss of pregnancy were rare. CONCLUSIONS: Only a few studies have related to the method of amniocentesis and compared the results of these 2 methods. A single uterine puncture does not bear an increased risk of complications compared to the double puncture.


Assuntos
Amniocentese , Gravidez de Gêmeos , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Punções , Estudos Retrospectivos , Gêmeos
8.
Medicine (Baltimore) ; 99(17): e19663, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332610

RESUMO

Hyperglycemia in pregnancy (HIP) is related to adverse pregnancy outcomes. However, women with hyperglycemia in the second and third trimester of pregnancy (HISTTP) were not been observed. We aim to reveal associations between HISTTP and prematurity. To confirm which risk factor is better in predicting preterm delivery.This retrospective study included 660 patients, of which 132 have HISTTP and 528 have euglycemia. Univariate analysis was used to extract risk factors and multivariates logistic regression analysis to obtain odds ratio (OR) for prematurity. Mean decrease gini (MDG) in random forest algorithm was used to rank the risk factors.HISTTP women have higher prepregnancy BMI and a higher percentage of family history of hypertension, maternal adiposity, maternal anemia, gestational diabetes mellitus (GDM), prematurity, neonatal asphyxia in 1-minute (P < .05). Univariate analysis of prematurity showed that preterm women had higher rate of HISTTP (P < .01), second births, elderly pregnancy, hypertention, family history of hypertention and multiple perinatal infant (P < .05). Multivariate logistic regression analysis indicates that HISTTP (OR = 2.984, P = .0017), maternal hypertension (OR = 5.208, P = .001) and multiple perinatal infants (OR = 59.815, P < .0001) are independent risk factors for prematurity. After ranked the MDG, the top 3 risk factors were multiple perinatal infants, maternal hypertension, HISTTP. MDG of HISTTP is higher than that of GDM.Women with HISTTP deserve to be concerned, whose prematurity rate are increased. HISTTP is an independent risk factor and a better predictor of prematurity.


Assuntos
Hiperglicemia/complicações , Adulto , Índice de Massa Corporal , Feminino , Idade Gestacional , Humanos , Hiperglicemia/sangue , Hiperglicemia/fisiopatologia , Recém-Nascido , Modelos Logísticos , Razão de Chances , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Segundo Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/metabolismo , Terceiro Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/metabolismo , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas
9.
PLoS One ; 15(3): e0229500, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160214

RESUMO

OBJECTIVE: HIV-infected women on antiretroviral therapy have a higher risk of preterm birth than HIV-uninfected women in Botswana. To better understand the mechanism for preterm birth among HIV-infected women, we evaluated whether mid-trimester cervical length differed by HIV status as cervical shortening is associated with an increased risk for preterm birth. METHODS: We conducted a prospective cohort study among pregnant women receiving care at the Scottish Livingstone Hospital in Molepolole, Botswana. Consecutive women referred for routine obstetrical ultrasound were consented and enrolled if between 22w0d and 24w6d by ultrasound biometry. Blinded to maternal HIV status, an obstetrician measured transvaginal cervical length using standardized criteria. Cervical length, as well as the proportion of women with a short cervix (<25mm), were compared among HIV-infected and HIV-uninfected women. The acceptability of transvaginal ultrasound was also evaluated. RESULTS: Between April 2016 and April 2017, 853 women presenting for obstetric ultrasound were screened, 187 (22%) met eligibility criteria, and 179 (96%) were enrolled. Of those enrolled, 50 (28%) were HIV-infected (86% on antiretroviral therapy), 127 (71%) were HIV-uninfected, and 2 (1%) had unknown HIV status. There was no significant difference in mean cervical length between HIV-infected and HIV-uninfected women (32mm vs 31mm, p = 0.21), or in the proportion with a short cervix (10% vs 14%, p = 0.44). Acceptability data was available for 115 women who underwent a transvaginal ultrasound exam. Of these, 112 of 115 (97%) women deemed the transvaginal scan acceptable. CONCLUSIONS: The increased risk of preterm birth observed among HIV-infected women receiving antiretroviral therapy in Botswana is unlikely associated with mid-trimester cervical shortening. Further research is needed to understand the underlying mechanism for preterm birth among HIV-infected women.


Assuntos
Colo do Útero/diagnóstico por imagem , Infecções por HIV/patologia , Trabalho de Parto Prematuro/prevenção & controle , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal , Adulto , Botsuana , Medida do Comprimento Cervical , Estudos de Coortes , Feminino , HIV , Humanos , Gravidez , Complicações na Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Adulto Jovem
10.
AJR Am J Roentgenol ; 214(6): 1417-1423, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32208011

RESUMO

OBJECTIVE. The purpose of this study is to determine whether MRI parameters of placenta accreta spectrum correlate with pathologic and surgical outcomes in high-risk pregnancies. MATERIALS AND METHODS. This retrospective study evaluated second- and third-trimester pregnancies assessed by MRI from 2007 to the present. Women were included in the study if placental invasion was suspected on the basis of a clinical history of cesarean delivery, ultrasound findings, or both. MR images were reviewed by an experienced radiologist who was blinded to the clinical outcomes. Eighteen MRI parameters were assessed and compared with four clinical outcomes: surgical impression of invasion, need for cesarean hysterectomy, pathologic findings, and need for blood transfusion. RESULTS. Of 64 women, 43 required cesarean hysterectomy, 20 underwent cesarean delivery, and one delivered vaginally. There was no statistical difference among the women in terms of maternal age, gestational age, or the number of prior cesarean deliveries. Eight of the 18 MRI parameters assessed showed statistical significance. The five variables with the highest odds ratios were bulge (7.432), placenta previa (7.283), low-attenuation T2 linear bands (5.985), placental heterogeneity near the scar (4.384), and fibrin deposition (4.322), with additional significant variables including interruption of the bladder-serosa interface, the radiologist's interpretation of invasion, and the largest dimension of invasion. Some previously described parameters, such as the degree of maternal pelvic vascularity, were not statistically significant. CONCLUSION. MRI parameters are associated with placental invasion and correlate with the need for cesarean hysterectomy, as well as pathologic and surgical impressions of invasion. From these parameters, an organized template can be created to standardize reporting of placental invasion.


Assuntos
Imagem por Ressonância Magnética/métodos , Placenta Acreta/diagnóstico por imagem , Gravidez de Alto Risco , Adulto , Cesárea , Feminino , Humanos , Histerectomia , Interpretação de Imagem Assistida por Computador , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal
11.
Br J Radiol ; 93(1110): 20191011, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32160003

RESUMO

OBJECTIVE: Our study was conducted with an attempt to investigate the diagnostic analysis of abnormal increase of fetal pulmonary artery systolic pressure (PASP) in middle and late pregnancy by color Doppler echocardiography. METHODS: From August 2017 to January 2019, 52 fetuses with moderate or greater tricuspid high-speed regurgitation were retrospectively analyzed and selected as Group A. 88 fetuses with full-color blood flow of the two ventricles and symmetrical sizes of the cardiac cavities on both sides harboring tricuspid valve and mild regurgitation or a small amount of regurgitation were selected as Group B. The pulmonary artery blood flow acceleration time (AT) and right ventricular ejection time (ET) was measured, and the PASP was calculated. RESULTS: The tricuspid regurgitation velocity, tricuspid regurgitation pressure difference and PASP in Group A were higher than those in Group B (p < 0.05), and the AT and AT/ET values in Group A were lower than those in Group B (p < 0.05). Gestational age, tricuspid regurgitation velocity and tricuspid regurgitation pressure difference were positively correlated with PASP. However, AT/ET and AT value were negatively correlated with PASP. CONCLUSION: The abnormal increase of pulmonary artery can be assessed by color Doppler echocardiography of fetal tricuspid regurgitation, which is worth popularizing and applying in clinic. ADVANCES IN KNOWLEDGE: It was suggested that the middle- and late-stage fetuses with moderate or greater tricuspid regurgitation and with >20 mmHg regurgitation pressure difference should be followed up in clinic. If PASP was ≥70 mmHg with symptoms of right heart failure, fetuses should be closely observed until 35-36 weeks old to ensure fetal safety and early delivery would be recommended.


Assuntos
Ecocardiografia Doppler em Cores , Doenças Fetais/diagnóstico por imagem , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Adulto , Pressão Arterial/fisiologia , Feminino , Doenças Fetais/fisiopatologia , Idade Gestacional , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Hipertensão Arterial Pulmonar/fisiopatologia , Artéria Pulmonar/fisiopatologia , Estudos Retrospectivos , Volume Sistólico , Insuficiência da Valva Tricúspide/fisiopatologia
12.
Chemosphere ; 244: 125499, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32050328

RESUMO

Thallium (Tl) is a highly toxic heavy metal that has been suggested to be responsible for oxidative stress and mitochondrial dysfunction. However, few studies have focused on the relationship of prenatal Tl exposure with children's neurobehavioural development. The purpose of our study was to investigate the association between prenatal Tl exposure and attention-deficit/hyperactivity disorder (ADHD) symptoms in 36-month-old children. We used data from 2851 mother-newborn pairs from the Ma'anshan Birth Cohort Study (MABC); serum Tl concentration was assessed in the first, second and third trimesters of pregnancy as well as in the umbilical cord blood. We assessed ADHD symptoms in the children using the Chinese version of the Conners abbreviated symptom questionnaire (C-ASQ). The adjusted odds ratio (OR) for the risk of ADHD symptoms was 2.00 [95% confidence interval (CI): 1.20, 3.32] and 2.08 (95% CI: 1.26, 3.43) for the third (60.25-75.21 ng/L) and fourth quartiles of serum Tl (>75.21 ng/L), respectively, in the second trimester of pregnancy, in comparison with the first quartile of serum Tl (<50.86 ng/L). The risk of ADHD symptoms was elevated among boys exposed to the fourth quartile of serum Tl in the second trimester of pregnancy (adjusted OR 2.08, 95% CI: 1.13, 3.83). Our results demonstrated that high levels of Tl exposure in the second trimester of pregnancy were related to a higher risk of ADHD symptoms in 36-month-old children, and the association of higher serum Tl exposure in the second trimester with ADHD symptoms was only found in boys.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/sangue , Efeitos Tardios da Exposição Pré-Natal/sangue , Tálio/sangue , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Pré-Escolar , Estudos de Coortes , Feminino , Sangue Fetal , Humanos , Recém-Nascido , Masculino , Mães , Gravidez , Segundo Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/sangue , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Fatores Sexuais , Tálio/toxicidade
13.
Artigo em Inglês | MEDLINE | ID: mdl-32074216

RESUMO

For pregnant women with high viral load, antiviral therapy has been administered in addition to active and passive immune prophylaxis as a crucial adjunctive therapy to interrupt mother-to-child hepatitis B virus (HBV) transmission (MTCT). However, the time of antiviral therapy onset remains controversial. A systematic review and meta-analysis was conducted to compare the efficacy of antiviral therapy during the second or the third trimester for prevention of HBV vertical transmission. We searched nine databases for observational studies and randomized controlled trials that enrolled pregnant women with positive HBsAg treated with antivirals. The outcomes of interest were maternal HBV-DNA levels prior to delivery and the rates of HBV MTCT. We included nine studies that enrolled 1,502 pregnant women. The average HBV-DNA level before treatment was approximately 8 log10 copies/mL. Compared to the onset of antiviral intervention in the third trimester, the beginning of treatment in the second trimester distinctly reduced maternal predelivery HBV-DNA levels. However, no significant difference in HBV MTCT was found between the second and third trimester groups. Furthermore, the subgroup analysis showed that there were no significant differences between groups beginning treatment at different times (second or third trimester) with regard to HBV MTCT or other evaluated endpoints. For pregnant women with HBV-DNA levels less than or equal to 8 log10 copies/mL, the beginning of antiviral treatment can be delayed until the third trimester.


Assuntos
Antivirais/administração & dosagem , Hepatite B/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Feminino , Hepatite B/prevenção & controle , Hepatite B/transmissão , Humanos , Recém-Nascido , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Carga Viral
14.
PLoS One ; 15(2): e0229079, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32069319

RESUMO

AIM: To analyse i) the association of physical fitness during early second trimester and late pregnancy with maternal and neonatal outcomes; and ii) to investigate whether physical fitness is associated with the type of birth (vaginal or caesarean section). METHODS: Pregnant women from the GESTAFIT Project (n = 159) participated in this longitudinal study. Maternal physical fitness including upper- and lower-body strength, cardiorespiratory fitness (CRF) and flexibility were measured through objective physical fitness tests at the 16th and 34th gestational weeks. Maternal and neonatal outcomes were collected from obstetric medical records. Umbilical arterial and venous blood gas pH and partial pressure of carbon dioxide (PCO2) and oxygen (PO2), were assessed. RESULTS: At the 16th week, greater upper-body muscle strength was associated with greater neonatal birth weight (r = 0.191, p<0.05). Maternal flexibility was associated with a more alkaline arterial pH (r = 0.220, p<0.05), higher arterial PO2 (r = 0.237, p<0.05) and lower arterial PCO2 (r = -0.331, p<0.01) in umbilical cord blood. Maternal CRF at the 16th gestational week was related to higher arterial umbilical cord PO2 (r = 0.267, p<0.05). The women who had caesarean sections had lower CRF (p<0.001) at the 16th gestational week and worse clustered overall physical fitness, both at the 16th (-0.227, p = 0.003, confidence interval (CI): -0.376, -0.078) and 34th gestational week (-0.223; p = 0.018; CI: -0.432, -0.015) compared with the women who had vaginal births. CONCLUSION: Increasing physical fitness during pregnancy may promote better neonatal outcomes and is associated with a decrease in the risk of caesarean section. This trial was registered at ClinicalTrials.gov (NCT02582567) on October 20, 2015.


Assuntos
Peso ao Nascer/fisiologia , Cesárea/estatística & dados numéricos , Recém-Nascido/fisiologia , Aptidão Física/fisiologia , Gravidez/fisiologia , Adulto , Dióxido de Carbono/análise , Feminino , Sangue Fetal/química , Humanos , Estudos Longitudinais , Oxigênio/análise , Pressão Parcial , Segundo Trimestre da Gravidez/fisiologia , Autorrelato
16.
Nat Med ; 26(4): 599-607, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32094926

RESUMO

Mucosal immunity develops in the human fetal intestine by 11-14 weeks of gestation, yet whether viable microbes exist in utero and interact with the intestinal immune system is unknown. Bacteria-like morphology was identified in pockets of human fetal meconium at mid-gestation by scanning electron microscopy (n = 4), and a sparse bacterial signal was detected by 16S rRNA sequencing (n = 40 of 50) compared to environmental controls (n = 87). Eighteen taxa were enriched in fetal meconium, with Micrococcaceae (n = 9) and Lactobacillus (n = 6) the most abundant. Fetal intestines dominated by Micrococcaceae exhibited distinct patterns of T cell composition and epithelial transcription. Fetal Micrococcus luteus, isolated only in the presence of monocytes, grew on placental hormones, remained viable within antigen presenting cells, limited inflammation ex vivo and possessed genomic features linked with survival in the fetus. Thus, viable bacteria are highly limited in the fetal intestine at mid-gestation, although strains with immunomodulatory capacity are detected in subsets of specimens.


Assuntos
Bactérias/crescimento & desenvolvimento , Feto/microbiologia , Microbioma Gastrointestinal , Intestinos/microbiologia , Viabilidade Microbiana , Autopsia , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Técnicas de Tipagem Bacteriana , Feminino , Feto/patologia , Feto/ultraestrutura , Microbioma Gastrointestinal/genética , Idade Gestacional , Humanos , Recém-Nascido , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Mucosa Intestinal/ultraestrutura , Intestinos/ultraestrutura , Lactobacillus/classificação , Lactobacillus/genética , Lactobacillus/isolamento & purificação , Mecônio/microbiologia , Micrococcaceae/classificação , Micrococcaceae/genética , Micrococcaceae/isolamento & purificação , Gravidez , Segundo Trimestre da Gravidez , RNA Ribossômico 16S/genética
17.
PLoS One ; 15(1): e0227246, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923230

RESUMO

Generally, dietary patterns (DP)s have been linked to the risk of diabetes mellitus, however, only few studies examined the associations between DPs in early pregnancy and the risk of gestational diabetes mellitus (GDM). This study aims to determine the association between DPs before and during pregnancy and risk of GDM in Malaysian pregnant women. DPs were derived using principal component analysis of consumed 126 food and beverage items assessed using a validated semi-quantitative food frequency questionnaire collecting data retrospectively for pre-pregnancy, but prospectively for the first and second trimester. Three different DPs were identified at each time point and labelled as DP 1-3 (pre-pregnancy), DP 4-6 (first trimester), and DP 7-9 (second trimester). About 10.6% (n = 48) of pregnant women were diagnosed with GDM in our cohort. Women with high adherence (HA) to DP 2 (adjusted OR: 0.45, 95% CI: 0.20-0.91) and DP 5 (adjusted OR: 0.28, 95% CI: 0.11-0.68) showed a significantly reduced risk of GDM compared to women with low adherence (LA). Other DPs were not significantly associated with GDM risk. Compared to women with GDM, non-GDM women showed HA scores for all DPs throughout pregnancy. Overall, a relative low percentage of women with GDM was found in this cohort. The risk was lower in women with HA to a relatively unhealthy dietary pattern, i.e. DP 2 and DP 5. The lower body mass index (BMI) status and energy intake of women showing a HA to DP 2 in the first trimester may underlie the observed association with a lower GDM risk. Additionally, genetic variance might explain the less susceptibility to GDM despite HA to unhealthy DPs among non-GDM women.


Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Dieta , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Fenômenos Fisiológicos da Nutrição Pré-Natal , Adulto , Índice de Massa Corporal , Ingestão de Energia , Feminino , Seguimentos , Humanos , Malásia/epidemiologia , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
18.
Am J Obstet Gynecol ; 222(5): 495.e1-495.e8, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31926951

RESUMO

BACKGROUND: Although in 2013 the American College of Obstetricians and Gynecologists recommended early screening for gestational diabetes in obese women, no studies demonstrate an improvement in perinatal outcomes with this strategy. OBJECTIVE: We sought to determine whether early screening for gestational diabetes improves perinatal outcomes in obese women. MATERIALS AND METHODS: Randomized controlled trial comparing early gestational diabetes screening (14-20 weeks) to routine screening (24-28 weeks) in obese women (body mass index ≥30 kg/m2) at 2 tertiary care centers in the United States. Screening was performed using a 50-g, 1-hour glucose challenge test followed by a 100-g, 3-hour glucose tolerance test if the initial screen was ≥135 mg/dL. Gestational diabetes was diagnosed using Carpenter-Coustan criteria. Women not diagnosed at 14 to 20 weeks were rescreened at 24 to 28 weeks. Exclusion criteria were pre-existing diabetes, major medical illness, bariatric surgery, and prior cesarean delivery. The primary outcome was a composite of macrosomia (>4000 g), primary cesarean delivery, hypertensive disease of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia (assessed within 48 hours of birth). RESULTS: A total of 962 women were randomized, and outcomes were available for 922. Of these 922 women, 459 (49.8%) were assigned to early screen and 463 (50.2%) to routine screen. Baseline characteristics were balanced between groups. In the early screening group, 69 (15.0%; 95% confidence interval, 11.9-18.6%) were diagnosed with gestational diabetes: 29 (6.3%; 95% confidence interval, 4.3-8.9%) at <20 weeks and 40 (8.7%; 95% confidence interval, 6.3-11.7%) at >24 weeks. Of those randomized to routine screening, 56 (12.1%; 95% confidence interval, 9.3-15.4%) had gestational diabetes. Early screening did not reduce the incidence of the primary outcome (56.9% in the early screen versus 50.8% in the routine screen, P = .07; relative risk, 1.12; 95% confidence interval, 0.99-1.26). CONCLUSION: Early screening for gestational diabetes in obese women did not reduce the composite perinatal outcome.


Assuntos
Diabetes Gestacional/diagnóstico , Obesidade/complicações , Adulto , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Programas de Rastreamento , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Adulto Jovem
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