Maternal and child health intervention to promote behaviour change: a population-level cluster-randomised controlled trial in Honduras.

OBJECTIVES: To assess the efficacy of a sustained educational intervention to affect diverse outcomes across the pregnancy and infancy timeline. SETTING: A multi-arm cluster-randomised controlled trial in 99 villages in Honduras' Copán region, involving 16 301 people in 5633 households from October 2015 to December 2019. PARTICIPANTS: Residents aged 12 and older were eligible. A photographic census involved 93% of the population, with 13 881 and 10 263 individuals completing baseline and endline surveys, respectively. INTERVENTION: 22-month household-based counselling intervention aiming to improve practices, knowledge and attitudes related to maternal, neonatal and child health. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were prenatal/postnatal care behaviours, facility births, exclusive breast feeding, parental involvement, treatment of diarrhoea and respiratory illness, reproductive health, and gender/reproductive norms. Secondary outcomes were knowledge and attitudes related to the primary outcomes. RESULTS: Parents targeted for the intervention were 16.4% (95% CI 3.1%-29.8%, p=0.016) more likely to have their newborn's health checked in a health facility within 3 days of birth; 19.6% (95% CI 4.2%-35.1%, p=0.013) more likely to not wrap a fajero around the umbilical cord in the first week after birth; and 8.9% (95% CI 0.3%-17.5%, p=0.043) more likely to report that the mother breast fed immediately after birth. Changes in knowledge and attitudes related to these primary outcomes were also observed. We found no significant effect on various other practices. CONCLUSION: A sustained counselling intervention delivered in the home setting by community health workers can meaningfully change practices, knowledge and attitudes related to proper newborn care following birth, including professional care-seeking, umbilical cord care and breast feeding. TRIAL REGISTRATION NUMBER: NCT02694679.

Elements of fatherhood involved in the gestational period: a scoping review.

OBJECTIVE: To identify in the literature and summarize the elements and characteristics of fatherhood involved during pregnancy. METHOD: Scoping review that used PRISMA-ScR guide to report this review. Searches were carried out in PubMed, CINAHL, PsycInfo, LILACS and Scopus. Google search engines and public health agency websites assisted in searches of gray literature and Rayyan in screening studies. RESULTS: A total of 406 articles were identified, of which 16 made up the final sample. Five elements make up an involved fatherhood: feeling like a father, being a provider and protector, being a partner and participant in pregnancy, participating in prenatal appointments and feeling prepared to take care of a baby. CONCLUSION: Fathers want to be involved in prenatal care, but feel excluded from this process. Public policies that encourage paternal involvement and healthcare professional training to better welcome and promote paternal involvement are of paramount importance.

Effect of Prenatal Care on Perinatal Outcomes of Pregnant Women with Diabetes Mellitus: A Systematic Review.

Objective: to evaluate the effect of prenatal care (PC) on perinatal outcomes of pregnant women with diabetes mellitus (DM). Methods: systematic review developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines and conducted through the population, intervention, control, and outcomes (PICO) strategy. Clinical trials and observational studies were selected, with adult pregnant women, single-fetus pregnancy, diagnosis of DM, or gestational DM and who had received PC and/or nutritional therapy (NT). The search was carried out in PubMed, Scopus, and BIREME databases. The quality of the studies was evaluated using the tools of the National Heart, Lung and Blood Institute-National Institutes of Health (NHLBI-NIH). Results: We identified 5972 records, of which 15 (n=47 420 pregnant women) met the eligibility criteria. The most recurrent outcomes were glycemic control (14 studies; n=9096 participants), hypertensive disorders of pregnancy (2; n=39 282), prematurity (6; n=40 163), large for gestational age newborns (4; n=1556), fetal macrosomia (birth weight >4kg) (6; n=2980) and intensive care unit admission (4; n=2022). Conclusions: The findings suggest that PC interferes with the perinatal outcome, being able to reduce the risks of complications associated with this comorbidity through early intervention, especially when the NT is an integral part of this assistance.

Effectiveness of nutritional counseling with overweight pregnant women on child growth at 6 months: A randomized controlled trial.

OBJECTIVE: Studies that have investigated the effect of nutritional counseling during the prenatal period on the follow-up outcomes of children at 6 mo have produced inconclusive results. The present study aimed to investigate the effect of nutritional counseling, based on the NOVA food classification, encouraging the consumption of fresh and minimally processed foods, with overweight adult pregnant women on infant growth at 6 mo of age. METHODS: A randomized controlled trial with 195 pairs of pregnant overweight women and their infants at 6 mo of age was conducted in a Brazilian municipality. The pregnant women were allocated to the control group (CG) or intervention group (IG) at the beginning of the pregnancy. The IG received three sessions of nutrition counseling throughout the pregnancy. Linear regression models were used to investigate the effect of the nutritional counseling on infant growth. RESULTS: One hundred ninety-five mother-infant pairs with complete data were included (96 CG, and 99 IG). The mean ± SD infant weight (g) at 6 mo was 7856.1 ± 1.1, and length (cm) was 67.0 ± 2.9. There were no differences in maternal and newborn characteristics between the groups. In the linear regression models, the counseling had no effect on anthropometric parameters of the infants at 6 mo of age: weight-for-length Z-score (ß 0.089 [95% CI -0.250; 0.427], P = 0.61); length-for-age Z-score (ß 0.032 [95% CI -0.299; 0.363], P = 0.85); weight-for-age Z-score (ß 0.070 [95% CI -0.260; 0.400], P = 0.68); BMI-age Z-score (ß 0.072 [95% CI -0.270; 0.414], P = 0.68). CONCLUSIONS: There was no effect on infant growth at 6 mo of age after the nutritional counseling during pregnancy. Future studies are needed to confirm this hypothesis.

Cost-utility analysis of prenatal supplementation with long-chain n-3 fatty acids to reduce the incidence of wheezing and asthma in neonates.

INTRODUCTION: Recent evidence indicates that Maternal Supplementation with Long-Chain n-3 Fatty Acids During Pregnancy Substantially Mitigates Offspring's Asthma. Adding information regarding its cost-utility will undoubtedly allow its adoption, or not, in clinical practice guidelines. This research aimed to determine the cost-utility of LCPUFA supplementation in the third trimester of pregnancy to reduce the risk of wheezing and asthma in infants in Colombia. METHODS: A Markov model was formulated to estimate the cost and quality-adjusted life-years (QALYs) attributed to individuals with severe asthma in Colombia, with a time horizon of five years and a cycle length of two weeks. Probabilistic sensitivity analysis and a value of information (VOI) analysis were conducted to evaluate the uncertainties in the case base. Cost-utility was assessed at a willingness-to-pay (WTP) value of US$5180. All costs were adjusted to 2021 with a 5% annual discounting rate for cost and QALYs. RESULTS: The mean incremental cost of LCPUFA supplementation versus no supplementation was US-43.65. The mean incremental benefit of LCPUFA supplementation versus no supplementation was 0.074 QALY. The incremental cost-utility ratio was estimated at US$590.68 per QALY. The outcomes derived from our primary analysis remained robust when subjected to variations in all underlying assumptions and parameter values. CONCLUSION: Supplementation strategy supplementation with long-chain n-3 fatty acids during pregnancy is cost-effective in reducing the risk of developing asthma during childhood in Colombia.

Factors affecting the implementation of calcium supplementation strategies during pregnancy to prevent pre-eclampsia: a mixed-methods systematic review.

OBJECTIVES: Daily calcium supplements are recommended for pregnant women from 20 weeks' gestation to prevent pre-eclampsia in populations with low dietary calcium intake. We aimed to improve understanding of barriers and facilitators for calcium supplement intake during pregnancy to prevent pre-eclampsia. DESIGN: Mixed-method systematic review, with confidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research approach. DATA SOURCES: MEDLINE and EMBASE (via Ovid), CINAHL and Global Health (via EBSCO) and grey literature databases were searched up to 17 September 2022. ELIGIBILITY CRITERIA: We included primary qualitative, quantitative and mixed-methods studies reporting implementation or use of calcium supplements during pregnancy, excluding calcium fortification and non-primary studies. No restrictions were imposed on settings, language or publication date. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias. We analysed the qualitative data using thematic synthesis, and quantitative findings were thematically mapped to qualitative findings. We then mapped the results to behavioural change frameworks to identify barriers and facilitators. RESULTS: Eighteen reports from nine studies were included in this review. Women reported barriers to consuming calcium supplements included limited knowledge about calcium supplements and pre-eclampsia, fears and experiences of side effects, varying preferences for tablets, dosing, working schedules, being away from home and taking other supplements. Receiving information regarding pre-eclampsia and safety of calcium supplement use from reliable sources, alternative dosing options, supplement reminders, early antenatal care, free supplements and support from families and communities were reported as facilitators. Healthcare providers felt that consistent messaging about benefits and risks of calcium, training, and ensuring adequate staffing and calcium supply is available would be able to help them in promoting calcium. CONCLUSION: Relevant stakeholders should consider the identified barriers and facilitators when formulating interventions and policies on calcium supplement use. These review findings can inform implementation to ensure effective and equitable provision and scale-up of calcium interventions. PROSPERO REGISTRATION NUMBER: CRD42021239143.

Maternal diet and interactions with nutritional evaluation during pregnancy.

This narrative review aims to describe the knowledge regarding nutritional evaluation and monitoring in pregnant women. We discuss care provided by non-specialists in nutrition, regarding dietary information and risks during pregnancy, from a theoretical or conceptual viewpoint. A narrative review was conducted following a literature search when scientific databases were investigated, including SciELO, LILACS, Medline, PubMed, theses, government reports, books, and chapters in books. Finally, the material was fully read, categorized, and critically analyzed. National and international protocols of prenatal nutritional care were included and discussed. Different protocols describe the complexity of evaluating and monitoring nutrition among pregnant women during the prenatal period according to each country. The understanding of social conditions and eating habits has an important role in providing nutritional advice during pregnancy. The lack of dietitians in care overwhelms the healthcare workers and characterizes a missed opportunity. Therefore, it is important to consider rapid support tools that can track adverse nutritional status, and ways to recommend a diet that meets eating habit dynamics, according to the reality of each public health system.

Understanding the Impact of the COVID-19 Pandemic on the Prenatal Care of a Group of Pregnant Hispanic Women living in Puerto Rico.

OBJECTIVE: To understand the impact of the COVID-19 pandemic on the prenatal care of pregnant Hispanic women living in Puerto Rico. METHODS: This was a cross-sectional study. The participants' profiles were determined through an online questionnaire to analyze COVID-19 related behaviors and experiences. RESULTS: Our sample comprised 131 women with an average age of 28 years (±5.3 years). Most of the population was pregnant at the time of the interview (74.8%; n = 98), and the rest were in their post-partum period. Overall, 46.5% (n = 61) of the patients indicated that their prenatal care did not change during the pandemic. In addition, 92.50% (n = 111) reported not altering their plans for breastfeeding their babies. Overall, 77.86% of the participants reported feeling scared or overwhelmed due to the current pandemic, and 97% agreed that COVID testing should be performed as a screening method in all pregnant females. CONCLUSION: Our findings describe the characteristics of pregnant Hispanic females living in Puerto Rico. The majority reported adhering adequately to their health services, with few or no changes in their prenatal care.

Assistência pré-natal pelo enfermeiro na atenção primária à saúde: visão da usuária / Prenatal care provided by nurses in primary health care: the user's perspective / La atención prenatal prestada por las enfermeras en la atención primaria de salud: la perspectiva del usuário

Objetivo: Avaliar a assistência prestada na consulta pré-natal pelo enfermeiro na atenção primária à saúde na visão da usuária. Métodos: Estudo transversal, quantitativo, com 80 gestantes em um município de Minas Gerais. Coleta de dados nas unidades de saúde, com instrumento validado conforme Técnica Delphi e teste-piloto. Análise dos dados pelo software R versão 3.5.3, aplicando os testes Qui-Quadrado, Teste G e Exato de Fisher. Resultados: Observou-se início do pré-natal até 12 semanas, com anotações de altura uterina, pressão arterial, batimentos cardiofetais, exames e vacinação. Informaram deficiência do exame clínico das mamas e testes rápidos. A maioria estava em uso de ácido fólico e sulfato ferroso, sem anotação. Obtiveram-se como facilitadores acolhimento na unidade, sentiu-se bem na consulta e linguagem esclarecedora e como principal barreira recebimento de atividade educativa. Conclusão: Embora a assistência realizada pelo enfermeiro seja avaliada como facilitadora em vários aspectos, observa-se deficiência no atendimento de ações indispensáveis. (AU)

Objective: To evaluate prenatal care provided by nurses in primary health care from the perspective of the user. Methods: cross-sectional, quantitative study, with 80 pregnant women in a city of Minas Gerais. Data collection in health units, with a validated instrument according to Delphi technique and pilot test. Data analysis in R software version 3.5.3, applying the Chi-square, G-test and Fisher's Exact tests. Results: Prenatal care was observed to begin by 12 weeks, with notes of uterine height, blood pressure, fetal heartbeat, exams and vaccinations. They reported deficiency of clinical breast exam and rapid tests. Most were taking folic acid and ferrous sulfate, with no annotation. Obtiveram-se como facilitadores acolhimento na unidade, se sente bem na consulta e linguagem esclarecedora e como principal barreira recebimento de atividade educativa. Conclusão: Embora a assistência realizada pelo enfermeiro é avaliada como facilitadora em vários aspectos, observa-se deficiência no atendimento de ações indispensáveis. (AU)

Objetivo: Evaluar la asistencia prestada en la consulta prenatal por las enfermeras de atención primaria desde la perspectiva de la usuaria. Métodos: Estudio transversal, cuantitativo, con 80 gestantes en un municipio de Minas Gerais. Recogida de datos en unidades de salud, con instrumento validado según la técnica Delphi y prueba piloto. Análisis de datos en el software R versión 3.5.3, aplicando las pruebas de Chi-cuadrado, G-test y exacta de Fisher. Resultados: Se observó el inicio de la atención prenatal a las 12 semanas, con anotaciones de la altura del útero, la presión arterial, los latidos del corazón del feto, los exámenes y la vacunación. Informaron de la deficiencia del examen clínico de las mamas y de las pruebas rápidas. La mayoría utilizaba ácido fólico y sulfato de hierro, sin anotar. Se obtienen como facilitadores de acolhimento en la unidad, se ven bien en la consulta y el lenguaje esclarecedor y como principal barrera de recepción de la actividad educativa. Conclusión: A pesar de que la asistencia realizada por el enfermero está avalada como facilitadora en varios aspectos, se observa una deficiencia en la atención de las acciones indispensables. (AU)

Antenatal care as a risk factor for caesarean section: a case study in Brazil.

BACKGROUND: Antenatal care is an important tool to prevent complications and decrease the incidence of maternal and antenatal morbidity and mortality. In Brazil, quality, access, and coverage of antenatal care are described as insufficient. Consequently, high rates of caesarean section, congenital morbidities such as syphilis, maternal and early neonatal mortality occur, as well as obstetric violence and dissatisfaction with healthcare. It is important to reflect on health disparities in antenatal care. This study aimed to carry out a critical analysis of antenatal care in one city of São Paulo state in Brazil. METHODS: A case study was performed, structured in a descriptive cross-sectional epidemiological study and two qualitative studies. Data for the epidemiological study was obtained from the Informatics Department of the Unified Health System (DATASUS) of Brazil, which was processed in the Epi-info v software 7.2. and treated descriptively and by the Mantel-Haenszel or Fisher's exact tests. Qualitative data was collected through semi-structured interviews with 30 pregnant women and 8 nurses in the primary healthcare service of one city in São Paulo. The qualitative data analysis was based on thematic content analysis. RESULTS: The data revealed a limited quality of antenatal care. More than six antenatal visits increased the probability of a caesarean section by 47% and babies born vaginally had a lower Apgar score. There was little participation of nurses in antenatal care and women described it as "a quick medical appointment", limited by protocols, based on procedures and insufficient in dialogue. Antenatal care appeared to be fragmented and permeated by challenges that involve the need for change in management, performance, and ongoing training of professionals, as well as in the guarantee of women's rights. CONCLUSIONS: Caesarean section was statistically related to the number of antenatal care visits. Interactions between professionals and pregnant women were poor and resulted in dissatisfaction. There is an urgent need to connect health indicators with the findings from professionals and women's experiences to improve the quality of antenatal care.

Anemia en madres adolescentes y su relación con el controlprenatal / Anemia in adolescent mothers and its relationship with prenatalcare

Introducción: La OMS recomienda tener controles prenatales de forma oportuna para realizar acciones de promoción y prevención de salud en enfermedades como la anemia. Objetivo: Determinar la asociación entre el control prenatal y la anemia en las gestantes adolescentes en etapa tardía. Métodos: Estudio de tipo analítico, retrospectivo con diseño casos y controles realizado en el Instituto Nacional Materno Perinatal de Lima, Perú, entre el 1ro. de enero de 2015 y el 31 de diciembre de 2019. Se utilizó la base de datos institucional de adolescentes embarazadas de 15 a 19 años con un universo de 5408 distribuidos en 1490 casos y 3918 controles. Las variables clínicas estudiadas fueron primer control prenatal y número de controles prenatales. Los resultados se expresaron en números absolutos y porcentajes y para la relación entre variables se estimó el odds ratio ajustado con intervalo de confianza de 95 por ciento. Resultados: La población tuvo una mediana de 18 años, 25,2 por ciento con una edad gestacional ≤12 semanas en el primer control prenatal, 24,2 por ciento contaba con controles prenatales≥ 8. El 27,6 por ciento tenía anemia y entre ellas, 20,0 por ciento anemia leve, 7,4 % anemia moderada y 0,2 % anemia severa. El primer control prenatal después de 12 semanas de gestación (OR ajustado: 3,48, IC 95 por ciento: 2,87-4,22) constituyó un factor de riesgo de anemia. Conclusiones: El control prenatal después de 12 semanas de gestación incide de forma significativa en la aparición de la anemia en las gestantes adolescentes en etapa tardía(AU)

Introduction: The WHO recommends having prenatal controls in a timely manner to carry out health promotion and prevention actions in diseases such as anemia. Objective: To determine the association between prenatal control and anemia in pregnant adolescents in late stage. Methods: Analytical, retrospective study with case-control design conducted at the National Maternal Perinatal Institute of Lima, Peru, between the January 1st 2015 and December 31, 2019. The institutional database of pregnant adolescents aged 15 to 19 years was used with a universe sample of 5408 distributed in 1490 cases and 3918 controls. The clinical variables studied were first prenatal control and number of prenatal controls. The results were expressed in absolute numbers and percentages and for the relationship between variables the adjusted odds ratio was estimated with a 95% confidence interval. Results: The population had a median age of 18 years, 25.2 percent with a gestational age ≤12 weeks in the first prenatal control, percent had prenatal controls≥ 8. 27.6 percent had anemia and among them, 20.0 percent mild anemia, 7.4 percent moderate anemia and 0.2 percent severe anemia. The first antenatal check-up after 12 weeks' gestation (adjusted OR: 3.48, 95 percent CI: 2.87-4.22) was a risk factor for anemia. Conclusions: Prenatal control after 12 weeks of gestation significantly affects the appearance of anemia in pregnant adolescents in late stage(AU)

Low-Risk Antenatal Care Enhanced by Telemedicine: A Practical Guideline Model.

OBJECTIVE: To develop a protocol for hybrid low-risk prenatal care adapted to Brazilian guidelines, merging reduced face-to-face consultations and remote monitoring. METHODS: The PubMed, Embase, and Cochrane Library databases were systematically searched on telemedicine and antenatal care perspectives and adaptation of the low-risk prenatal care protocols recommended by the Ministry of Health and by the Brazilian Federation of Gynecology and Obstetrics Associations. RESULTS: Five relevant articles and three manuals were included in the review, for presented criteria to develop this clinical guideline. We identified, in these studies, that the schedule of consultations is unevenly distributed among the gestational trimesters, and ranges from 7 to 14 appointments. In general, the authors propose one to two appointments in the first trimester, two to three appointments in the second trimester, and two to six appointments in the third trimester. Only three studies included puerperal evaluations. The routine exams recommended show minimal variations among authors. To date, there are no validated Brazilian protocols for prenatal care by telemedicine. The included studies showed that pregnant women were satisfied with this form of care, and the outcomes of interest, except for hypertensive diseases, were similar between the groups exposed to traditional and hybrid prenatal care. CONCLUSION: The presented guideline comprises the Ministry of Health recommendations for low-risk prenatal care and reduces exposure to the hospital environment and care costs. A randomized clinical trial, to be developed by this group, will provide real-world data on safety, effectiveness, satisfaction, and costs.

OBJETIVO: Desenvolver uma diretriz clínica híbrida para atendimento pré-natal de baixo risco, mesclando consultas presenciais e remotas por telemedicina, adapta às recomendações brasileiras. MéTODOS: Revisão sistemática da literatura nas bases de dados PubMed, Embase e Cochrane e adaptação dos protocolos de atenção ao pré-natal de baixo risco preconizados pelo Ministério da Saúde e pela Federação Brasileira das Associações de Ginecologia e Obstetrícia. RESULTADOS: Cinco artigos relevantes e três manuais foram incluídos na revisão por preencherem critérios para o desenvolvimento desta diretriz clínica. Nos estudos incluídos, identificou-se que o cronograma de consultas se distribui de forma desigual entre os trimestres gestacionais, variando entre 07 e 14 encontros. De forma geral, os autores propõem uma a duas consultas no primeiro trimestre, duas a três consultas no segundo trimestre e duas a seis consultas no terceiro trimestre. Somente três estudos incluíram avaliações puerperais. A rotina de exames preconizada apresenta mínimas variações entre os autores. Até o momento, não existem protocolos brasileiros validados para atendimento pré-natal por telemedicina. Os estudos incluídos evidenciaram a satisfação das gestantes em relação a esta forma de atendimento, e os desfechos de interesse, excetuando doenças hipertensivas, foi semelhante entre os grupos expostos ao pré-natal tradicional e ao pré-natal híbrido. CONCLUSãO: A diretriz apresentada contempla as recomendações do Ministério da Saúde para atendimento pré-natal de gestantes de baixo risco, reduz a exposição ao ambiente hospitalar e os custos de atendimento. Seu emprego em um ensaio clínico randomizado, a ser desenvolvido por este grupo, proporcionará dados de mundo real, relativos à segurança, efetividade, satisfação e custos.

Efficacy of Brief Intervention for Alcohol Consumption during Pregnancy in Argentinean Women: A Randomized Controlled Trial.

INTRODUCTION: Although Brief Intervention (BI) has proven to reduce alcohol consumption during pregnancy in high income countries, there is no evidence from the Southern Cone of America. Thus, we conducted a study to assess BI efficacy among Argentinean pregnant women. METHOD AND MATERIALS: We collected data on pregnant women receiving prenatal care at the public health system in Mar del Plata, Argentina. Women with less than 26 weeks of gestation (n = 486) were randomized to brief advice (BA) or BI. Three months later they were re-assessed; women with more than 26 weeks of gestation constituted a screening only control group (SC) (n = 154). Self-reported quantity and frequency of alcohol consumption, frequency of binge drinking, and related problems after three months were used as outcomes. We performed generalized estimating equations and clinical significance analyses. Also, we obtained newborn health indicators from the city's health system database to use as objective outcomes. Women who did not participate in any of the three former conditions were randomly selected to constitute a non-screening control group (NSC) (n = 150). We compared objective outcomes among BI, BA, and NSC groups using the Wilcoxon rank test. RESULTS: In comparison with SC, BI and BA reduced alcohol consumption, without differences between the latter two. Newborns of women who received BI and BA had better health indicators compared with the NSC group. CONCLUSIONS: performing either a BI or BA reduces alcohol consumption among Argentinean pregnant women and might lead to healthier newborns.

Percepciones de madres sobre vivencias de la maternidad y el cuidado del bebé / Perceptions of Mothers about Maternity Experiences and Baby Care

Introducción: La llegada de un hijo es un momento notable, sobre todo en la vida de las mujeres, quienes experimentan grandes cambios en su cuerpo y mente durante el período gestacional, que está rodeado de expectativas sobre el bebé. Objetivo: Comprender las experiencias y percepciones de las madres sobre vivencias de la maternidad y el cuidado del bebé en los primeros días de vida. Métodos: Estudio descriptivo, con abordaje cualitativo, realizado por medio de entrevistas, con 13 madres atendidas por los grupos de cuidado infantil de una Unidad Básica de Salud, en el sur de Brasil, entre los meses de julio y agosto de 2019. Las declaraciones fueron grabadas, transcritas y sometidas a un análisis de contenido, modalidad temática. Resultados: Se notó que los sentimientos de miedo e inseguridad estaban presentes en la vida diaria de las entrevistadas, interfiriendo en el cuidado del bebé. Las redes de apoyo social fueron identificadas como factores de suma importancia en el puerperio. La prematuridad, las dificultades para amamantar y la falta de ayuda son temas que generaban frustración en las madres, mientras que la atención prenatal y de cuidado infantil se consideraban como aspectos facilitadores del cuidado. Conclusión: Aunque las madres son orientadas en el cuidado prenatal sobre temas relacionados con el recién nacido, muchas aún tienen dificultades para cuidar a su hijo, pero, estas dificultades se ven agravadas por la falta de asistencia adecuada(AU)

Introduction: The arrival of a child is a remarkable moment, especially in the lives of women, who experience great changes in their body and mind during the gestational period, in turn surrounded by expectations about the baby. Objective: To understand the experiences and perceptions of mothers concerning motherhood and baby care in the first days of life. Methods: Descriptive study, with qualitative approach, carried out through interviews, with thirteen mothers attended by the infant care groups of a basic health unit in southern Brazil, between July and August 2019. The statements were recorded, transcribed and submitted to content analysis, under the thematic modality. Results: Feelings of fear and insecurity were noted to be present in the daily life of the interviewees, thus interfering in baby care. Social support networks were identified as very important factors in the puerperium. Prematurity, breastfeeding difficulties and lack of help are issues that generated frustration in mothers, while prenatal and infant care were considered as facilitating aspects of care. Conclusion: Although mothers are oriented during prenatal care on issues related to the newborn, many still have difficulties in caring for their child; such difficulties are aggravated by the lack of adequate assistance(AU)

Experiencias de madres adolescentes en un programa de maternidad segura de Cartagena, Colombia / Experiences of Adolescents Mothers from a Safe Maternity Program in Cartagena, Colombia

Introducción: La atención prenatal es esencial para proveer cuidado obstétrico que permita un parto seguro, buscando minimizar riesgos para madre e hijo. Objetivo: Analizar las experiencias de madres adolescentes en relación con la importancia de control prenatal en el Programa de Maternidad Segura del Hospital Canapote, Cartagena, haciendo énfasis en la primera etapa del embarazo. Métodos: Estudio cualitativo, fenomenológico en el Hospital Canapote en Cartagena, Colombia, durante el período comprendido entre diciembre del 2019 y diciembre del 2020, basado en grupos focales de 14 madres adolescentes. La entrevista contó con aspectos sociodemográficos y experiencias en los controles prenatales, de las que emergieron los conceptos que se organizaron en categorías y subcategorías de análisis. Resultados: Las adolescentes tenían como promedio entre 16 y 17 años, solteras, de familias nucleares, bachilleres, del régimen subsidiado. Las experiencias fueron favorables, sobre todo en relación a la atención del médico y el trato empático de las enfermeras, esto ha transfigurado sentimientos negativos a positivos. Conclusiones: La experiencia de las madres adolescentes se caracterizó por la percepción positiva, lo que aportó un sentimiento de temor hasta llegar a la alegría y tranquilidad al final de los controles durante el embarazo(AU)

Introduction: Prenatal care is essential to provide obstetric care that allows a safe delivery, seeking to minimize risks for the mother and her child. Objective: To analyze the experiences of adolescent mothers regarding the importance of prenatal care in the safe motherhood program of Canapote Hospital, Cartagena. Methods: A qualitative and phenomenological study was carried out at Canapote Hospital in Cartagena, Colombia, during the period from December 2019 to December 2020, based on focus groups of fourteen adolescent mothers. Sociodemographic aspects and experiences regarding prenatal checkups were included in the interview, from which concepts emerged that were organized into categories and subcategories of analysis. Results: The adolescents were 16-17 years old on average, single, from nuclear families, senior high school graduates, under subsidized regime. The experiences were favorable, especially in relation to the doctor's care and the nurses' kind treatment, which has turned negative feelings into positive ones. Conclusions: The experience of adolescent mothers was characterized by positive perception, which brought a feeling of fear until reaching joy and tranquility at the end of the checkups during pregnancy(AU)

Impact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial.

OBJECTIVE: To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control, maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM). METHODS: Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DM and received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n = 51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n = 38), was guided by the traditional method (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes and analysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test, was used to assess postprandial blood glucose. RESULTS: Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2nd (p = 0.00) and 3rd (p = 0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2nd trimester (p = 0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p = 0.047). CONCLUSION: Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention. REBEC CLINICAL TRIALS DATABASE: The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).

OBJETIVO: Avaliar o efeito do método de contagem de carboidratos no controle glicêmico, desfechos maternos e perinatais de gestantes com diabetes mellitus (DM) pré-gestacional. MéTODOS: Ensaio clínico controlado não randomizado realizado com 89 gestantes com DM pré-gestacional atendidas em hospital público do Rio de Janeiro, RJ, Brasil, entre 2009 e 2014, divididas em grupo controle histórico e grupo intervenção. O grupo intervenção (n = 51) recebeu orientação nutricional com base no método de contagem de carboidratos (CCM) e o grupo controle histórico (n = 38) foi orientado pelo método tradicional (MT). Os testes de Mann-Whitney ou de Wilcoxon foram usados para comparar os desfechos intra- e intergrupos e, para avaliar a glicemia pós-prandial, análise de variância (ANOVA, na sigla em inglês) para medidas repetidas foi usada. RESULTADOS: Somente o grupo com método CCM apresentou redução da glicemia de jejum. A glicemia pós-prandial diminuiu no 2° (p = 0,00) e 3° (p = 0,00) trimestres gestacionais no grupo com método CCM, e no grupo com método tradicional, a redução ocorreu apenas no 2° trimestre (p = 0,015). Para os resultados perinatais e distúrbios hipertensivos da gravidez, não houve diferenças entre os grupos. O parto cirúrgico foi realizado em 82% das gestantes e esteve associado a distúrbios hipertensivos gestacionais (p = 0,047). CONCLUSãO: Ambos os métodos de orientação nutricional contribuíram para a redução da glicemia pós-prandial e não foram observadas diferenças para os resultados maternos e perinatais. No entanto, o método CCM apresentou melhor efeito sobre a glicemia pós-prandial e foi o único que induziu redução da glicemia de jejum.

Corticosteroids in Pregnancy for Preventing RDS: Overview of Systematic Reviews.

The objective of this study was to analyze the available evidence of systematic reviews that evaluated the efficacy of antenatal corticosteroids in order to contribute to a reduction in magnitude and transcendence of respiratory distress syndrome of the newborn (RDS). Thus, an overview was conducted including all systematic reviews of randomized controlled trials (RCTs) that evaluated women who received corticosteroid treatment during pregnancy to prevent RDS. Therefore, a search strategy was developed using the terms "respiratory distress syndrome, newborn," "corticosteroids," "perinatal death," "neonatal death," "neonate," and "pregnancy." The electronic databases searched were MEDLINE, EMBASE, Cochrane Library, LILACS, and Google Scholar, for studies published until June 2020. We identified 354 references, 38 of which were relevant after the initial screening. Ten systematic reviews met the inclusion criteria. For RDS, 1522 cases occurred in the control group composed of 8716 participants, while in the intervention group was 1088 in 8740 participants (RR = 0.67, 95% CI 0.60-0.75). For neonatal death, 343 cases occurred in 5248 participants of the control group, while in the intervention group, there were 227 cases in 5246 participants (RR = 0.66, 95% CI 0.56-0.78). For perinatal death, there were 344 cases in 3345 participants in the control group, while in the intervention group, the number of cases was 264 in 3384 participants (RR = 0.72, 95% CI 0.58-0.89). Thus, the use of corticosteroids during pregnancy in women at risk of preterm birth is effective for the prevention of RDS in neonates and reducing the number of neonatal and perinatal deaths in preterm. PROSPERO protocol no: CRD42017074604.

Prenatal origins of productivity and quality of beef

The productive traits of beef cattle are orchestrated by their genetics, postnatal environmental conditions, and also by the intrauterine background. Both under- or overnutrition, as specific dietary components, are able to promote persistent effects on the offspring. This occurs because dietary factors act not only affecting the availability of substrates for fetal anabolism and oxidative metabolism, but also as signals that regulate several events toward fetal development. Therefore, this study aimed to summarize the gestational nutrition effects on the offspring performance and meat quality in a long term. Overall, studies have shown that many of these alterations are under the control of epigenetic mechanisms, as DNA methylation, histones modification, and non-coding RNA. The current knowledge has indicated that the fetal programming responses are dependent on the window of fetal development in which the dietary treatment is applied, the intensity of maternal nutritional stimuli, and the treatment application length. Collectively, studies demonstrated that muscle cell hyperplasia is impaired when maternal requirements were not achieved in the second third of gestation, which limits the formation of a greater number of muscle fibers and the offspring growth potential in a long term. Changes in muscle fibers metabolism and in collagen content were also reported as consequence of a dietary perturbation during pregnancy. In contrast, a maternal overnutrition during the late pregnancy has been associated with beneficial responses on meat quality. In summary, ensuring an adequate maternal environment during the fetal development is crucial to enhance the productive responses in beef cattle operations.(AU)

Massagem perineal pré-natal para prevenção do trauma: piloto de ensaio clínico randomizado / Masaje perineal prenatal para la prevención del trauma: piloto de ensayo clínico aleatorizado / Antenatal perineal massage for trauma prevention: a pilot randomized clinical trial

Resumo Objetivo Avaliar a adesão de gestantes e acompanhantes à realização da massagem perineal digital durante a gestação e seu efeito na prevenção do trauma perineal no parto e na redução de morbidade associada nos 45 e 90 dias pós-parto. Métodos Estudo piloto de ensaio clínico randomizado com 153 gestantes de risco habitual, 78 mulheres no grupo de intervenção realizaram a massagem perineal digital e 75 mulheres do grupo controle receberam os cuidados habituais. Para a análise do desfecho principal (trauma perineal) e dos desfechos secundários, permaneceram em cada grupo 44 mulheres que tiveram parto vaginal. A intervenção foi realizada pela gestante ou acompanhante de sua escolha, diariamente, a partir de 34 semanas de gestação, por 5 a 10 minutos. Resultados A massagem perineal foi fator de proteção para edema nos primeiros 10 dias pós-parto (RR 0,64 IC95%0,41-0,99) e perda involuntária de gases nos 45 dias pós-parto (RR0,57 IC95%0,38-0,86). O ajuste residual ≥ 2 observado na análise das condições do períneo pós-parto mostrou uma tendência das mulheres do grupo intervenção terem períneo íntegro. As mulheres e os acompanhantes que realizaram a massagem perineal aceitaram bem a prática, recomendariam e fariam novamente em futura gestação. Conclusão A massagem perineal digital realizada diariamente, a partir de 34 semanas de gestação, foi uma prática bem aceita pelas mulheres e acompanhantes deste estudo. Apesar de não proteger a mulher de trauma perineal, esta prática reduziu o risco de edema 10 dias pós-parto e incontinência de gases 45 dias pós-parto. Registro Brasileiro de ensaio clínico: RBR-4MSYDX

Resumen Objetivo Evaluar la participación de mujeres embarazadas y acompañantes en la realización del masaje digital perineal durante el embarazo y su efecto en la prevención del trauma perineal durante el parto y en la reducción de la morbilidad asociada con los 45 y 90 días post parto. Métodos Estudio piloto de ensayo clínico aleatorizado con 153 mujeres embarazadas con riesgo normal, 78 mujeres en el grupo de intervención realizaron el masaje digital perineal y 75 mujeres del grupo control recibieron los cuidados habituales. Para el análisis del desenlace principal (trauma perineal) y de los desenlaces secundarios, permanecieron en cada grupo 44 mujeres que tuvieron parto vaginal. La intervención la realizó la mujer embarazada o el acompañante por ella elegido, diariamente, a partir de las 34 semanas de embarazo, por 5 a 10 minutos. Resultados El masaje perineal fue factor de protección para el edema en los primeros 10 días postparto (RR 0,64 IC95%0,41-0,99) y la pérdida involuntaria de gases en los 45 días post parto (RR0,57 IC95%0,38-0,86). El ajuste residual ≥ 2 observado en el análisis de las condiciones del perineo postparto mostró una tendencia en las mujeres del grupo intervención a que tengan el perineo íntegro. Las mujeres y los acompañantes que realizaron el masaje perineal recibieron bien la práctica, la recomendarían y la harían nuevamente en un futuro embarazo. Conclusión El masaje digital perineal realizado diariamente, a partir de las 34 semanas de embarazo, fue una práctica bien recibida por las mujeres y acompañantes de este estudio. Pese a que no protege a la mujer de un trauma perineal, esta práctica redujo el riesgo de edema a los 10 días post parto y la incontinencia de gases 45 días post parto.

Abstract Objective To evaluate the adherence of pregnant women and companions to the performance of digital perineal massage during pregnancy and its effect on the prevention of perineal trauma during childbirth and on the reduction of associated morbidity at 45 and 90 days postpartum. Methods A pilot study of a randomized clinical trial with 153 normal risk pregnant women; 78 women in the intervention group underwent digital perineal massage and 75 women in the control group received usual care. For the analysis of the main outcome (perineal trauma) and secondary outcomes, 44 women who had vaginal delivery remained in each group. The intervention was performed daily by the pregnant woman or the companion of her choice from 34 weeks of gestation during 5-10 minutes. Results Perineal massage was a protective factor for edema in the first 10 days postpartum (RR 0.64 95%CI 0.41-0.99) and involuntary gas loss at 45 days postpartum (RR0.57 95%CI 0.38-0.86). The residual adjustment ≥ 2 observed in the analysis of perineal conditions postpartum showed a trend of women in the intervention group having an intact perineum. The women and companions who performed perineal massage accepted the practice well, recommended it and would do it again in a future pregnancy. Conclusion The digital perineal massage performed daily from 34 weeks of gestation was a practice well accepted by women of this study and their companions. Although not protecting women from perineal trauma, this practice reduced the risk of edema at 10 days postpartum and gas incontinence at 45 days postpartum. Brazilian Clinical Trial Registry: RBR-4MSYDX