The Role of Annexin A1 in DNA Damage Response in Placental Cells: Impact on Gestational Diabetes Mellitus.

The functions of annexin A1 (ANXA1), which is expressed on membranes and in cytoplasmic granules, have been fully described. Nonetheless, the role of this protein in protecting against DNA damage in the nucleus is still emerging and requires further investigation. Here, we investigated the involvement of ANXA1 in the DNA damage response in placental cells. Placenta was collected from ANXA1 knockout mice (AnxA1-/-) and pregnant women with gestational diabetes mellitus (GDM). The placental morphology and ANXA1 expression, which are related to the modulation of cellular response markers in the presence of DNA damage, were analyzed. The total area of AnxA1-/- placenta was smaller due to a reduced labyrinth zone, enhanced DNA damage, and impaired base excision repair (BER) enzymes, which resulted in the induction of apoptosis in the labyrinthine and junctional layers. The placentas of pregnant women with GDM showed reduced expression of AnxA1 in the villous compartment, increased DNA damage, apoptosis, and a reduction of enzymes involved in the BER pathway. Our translational data provide valuable insights into the possible involvement of ANXA1 in the response of placental cells to oxidative DNA damage and represent an advancement in investigations into the mechanisms involved in placental biology.

Assessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review.

Gestational diabetes mellitus (GDM)is an entity with evolving conceptual nuances that deserve full consideration. Gestational diabetes leads to complications and adverse effects on the mother's and infants' health during and after pregnancy. Women also have a higher prevalence of urinary incontinence (UI) related to the hyperglycemic status during pregnancy. However, the exact pathophysiological mechanism is still uncertain. We conducted a narrative review discussing the impact of GDM on the women's pelvic floor and performed image assessment using three-dimensional ultrasonography to evaluate and predict future UI.

O diabetes gestacional (DG)é uma entidade com nuances conceituais em evolução que merecem total consideração. O DG leva a complicações e efeitos adversos na saúde da mãe e do bebê durante e após a gravidez. As mulheres também apresentam maior prevalência de incontinência urinária (IU) relacionada ao estado hiperglicêmico durante a gravidez. No entanto, o mecanismo fisiopatológico exato ainda é incerto. Realizamos uma revisão narrativa discutindo o impacto do DG no assoalho pélvico das mulheres e utilizamos o exame de ultrassonografia tridimensional para avaliar e predizer a ocorrência de IU.

Assessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review / Avaliação das desordens do assoalho pélvico decorrentes do diabetes gestacional usando a ultrassonografia tridimensional: Uma revisão narrativa

Abstract Gestational diabetes mellitus (GDM)is an entity with evolving conceptual nuances that deserve full consideration. Gestational diabetes leads to complications and adverse effects on the mother's and infants' health during and after pregnancy. Women also have a higher prevalence of urinary incontinence (UI) related to the hyperglycemic status during pregnancy. However, the exact pathophysiological mechanism is still uncertain. We conducted a narrative review discussing the impact of GDM on the women's pelvic floor and performed image assessment using three-dimensional ultrasonography to evaluate and predict future UI.

Resumo O diabetes gestacional (DG)é uma entidade com nuances conceituais em evolução que merecem total consideração. O DG leva a complicações e efeitos adversos na saúde da mãe e do bebê durante e após a gravidez. As mulheres também apresentam maior prevalência de incontinência urinária (IU) relacionada ao estado hiperglicêmico durante a gravidez. No entanto, o mecanismo fisiopatológico exato ainda é incerto. Realizamos uma revisão narrativa discutindo o impacto do DG no assoalho pélvico das mulheres e utilizamos o exame de ultrassonografia tridimensional para avaliar e predizer a ocorrência de IU.

Predictive Factors for Severe Maternal Morbidity in Brazil: A Case-Control Study.

The maternal mortality or "maternal near miss" ratio in Brazil reflects the socioeconomic indicators as well as the healthcare quality in some areas of this country, pointing out fragile points in the health services. The aim of this study was to estimate the association of diverse variables related to pregnancy and the occurrence of Near Miss in a population of women who were cared in public maternity wards in Brazil. A case-control study was performed. The association between variables and outcomes was verified through a chi-square test. A multiple analysis was carried out, producing odds ratio (OR) estimates with values of p≤0.25 in the univariate model. The results point to the following risk factors for Severe Maternal Morbidity: non-white (<0.001, OR 2.973), family income of up to two minimum wage salaries (<0.001; OR 2.159), not having a partner (<0.001, OR 2.694), obesity (<0.001, OR 20.852), not having received pre-natal care (<0.001, OR 2.843), going to less than six prenatal appointments (<0.001, OR 3.498), undergoing an inter-hospital transfer (<0.001, OR 24.655), and the absence of labor during admission (<0.001, OR 25.205). Although the results vary, the incidence of women with potential life-threatening complications is high in Brazil, which reinforces the need to universalize more complex interventions as well as coverage of primary care. The presence of precarious socio-economic indicators and unqualified obstetric care were risk factors for Severe Maternal Morbidity.

Melatonin Hormone Acts on Cells of Maternal Blood and Placenta From Diabetic Mothers.

Changes in glucose metabolism of diabetic mothers affect immunological components, proinflammatory factors, and placental hypervascularization that can induce cell death. The hormone melatonin has been identified as a potential modulating agent. The aim of this study was to analyze the oxidative process and the apoptosis in maternal blood and placental cells modulated by melatonin from diabetic mothers. The groups were 40 pregnant women divided into non-diabetic (ND) and type 2 diabetes mellitus (T2DM) groups. Blood and placental cells were obtained by density gradient and maintained in culture treated or not with melatonin (100 ng/mL) for 24 h (37°C, 5% CO2). Oxidative stress was evaluated by superoxide release and CuZn superoxide dismutase (SOD). Apoptosis was assessed by flow cytometry. Maternal hyperglycemia increased superoxide release and apoptosis in MN cells from maternal blood and reduced SOD level and SOD/O2- ratio. Melatonin reduced oxidative stress and apoptosis rates in MN cells in the blood of diabetic mothers. There was a reduction in SOD and SOD/O2- ratio in the placental extravillous layer, and melatonin restored the concentrations of this enzyme. There was greater superoxide release, reduced SOD/O2- ratio, and apoptosis in MN cells placental villous layer. Melatonin increased apoptosis rates in the placental villous layer from hyperglycemic mothers. These data suggest that hyperglycemia altered the processes oxidative in blood and placenta from hyperglycemic mothers. These changes reflected in the mechanisms of induction of apoptosis, especially in the vascularized layers of the placenta, and were modulated by melatonin.

Altered maternal metabolism during mild gestational hyperglycemia as a predictor of adverse perinatal outcomes: A comprehensive analysis.

Mild gestational hyperglycemia (MGH), as assessed using the normal oral glucose tolerance test (OGTT) and detection of an altered glycemic profile, is associated with adverse perinatal outcome. This study described the results of 40 years of research conducted at the Perinatal Diabetes Research Centre at São Paulo State University (UNESP), Brazil, on the maternal MGH environment and placental markers. This study also described the unidirectional relationship between MGH and excessive fetal growth, also supplying moderator analysis. In addition to hyperglycemia, MGH is associated with an increased incidence of hypertension, metabolic syndrome, persistent insulin resistance after pregnancy, and high risk of developing type 2 diabetes mellitus (T2DM) after pregnancy. Structural changes and functional abnormalities resulting from MGH were observed in placenta. The fully adjusted model concluded that the predictor variable (MGH), which creates a complex environment for the fetus, has a direct effect on excessive birth weight and produces a z-score for ratios of birth weight to gestational age of ≥2. Maternal age, pre-pregnancy BMI, number of previous pregnancies, numbers of prenatal visits, and 1 h OGTT are moderator variables that impact MGH and excessive fetal growth. These results show that maternal MGH has some characteristics associated with similar long-term T2DM development and similar adverse perinatal results to those of gestational diabetes mellitus (GDM) mothers, making it an intermediate maternal and placental marker between normoglycemic and GDM mothers.

Prenatal care satisfaction: perception of caregivers with diabetes mellitus.

OBJECTIVE: to understand the satisfaction of pregnant women with diabetes who took insulin during pregnancy and prenatal care performed through outpatient and inpatient follow-up. METHOD: a qualitative approach with analysis of 30 pregnant women who underwent prenatal care and participated in a clinical trial study carried out by the research group of the Perinatal Diabetes Research Center of the Hospital das Clínicas, of the Faculdade de Medicina de Botucatu. The data were collected through interviews and analyzed from content analysis. RESULTS: from the category Satisfaction, the following subcategories emerged: facilities and difficulties faced in prenatal care performed through outpatient or inpatient follow-up, demonstrating that the pregnant women were satisfied with the prenatal care offered regardless of the type of follow-up. CONCLUSION: there was satisfaction in both care, but in outpatient care some structural, technical and administrative difficulties were identified, requiring reassessment, in order to guarantee service agility.

Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis.

There is an ongoing discussion regarding abdominal muscle (AbM) and pelvic floor muscle (PFM) synergism. Therefore, this study aimed to investigate the cocontraction between AbMs and PFMs in women with or without pelvic floor dysfunction (PFD). The following databases were searched up to December 21, 2018: MEDLINE, EMBASE, LILACS, PEDro and CENTRAL. We included any study that assessed the cocontraction between PFMs and AbMs in women with and without PFD. Two reviewers independently screened eligible articles and extracted data. The outcomes were extracted and analyzed as continuous variables with random effect models. Twenty studies were included. A meta-analysis did not show differences in women with and without PFD. However, a sensitivity analysis suggested cocontraction of the transversus abdominis (TrA) during PFM contraction in healthy women (standardized mean difference (SMD) -1.02 [95% confidence interval (CI) -1.90 to -0.14], P=0.02; I2= not applicable; very low quality of evidence). Women with PFD during contraction of PFMs showed cocontraction of the obliquus internus (OI) (SMD 1.10 [95% CI 0.27 to 1.94], P=0.01; I2= not applicable; very low quality of evidence), and obliquus externus (OE) (SMD 2.08 [95% CI 1.10 to 3.06], P<0.0001; I2 = not applicable; very low quality of evidence). Increased cocontraction of the TrA may be associated with maximal contraction of PFMs in women without PFD. On the other hand, there is likely an increased cocontraction with the OI and OE in women with PFD.

Rastreamento e diagnóstico de diabetes mellitus gestacional no Brasil / Screening and diagnosis of gestational diabetes mellitus in Brazil

Em primeiro de agosto de 2016, considerando-se a relevância do Diabetes Mellitus Gestacional (DMG), tanto por sua prevalência como pelas consequências para o binômio materno-fetal em curto e em longo prazo, foi realizado, em São Paulo, um fórum de discussão sobre o tema, com o objetivo de definir uma proposta para o diagnóstico de DMG para o Brasil. Nesse contexto, participaram da reunião médicos especializados na assistência a mulheres com DMG: obstetras da Federação Brasileira de Ginecologia e Obstetrícia (Febrasgo), endocrinologistas da Sociedade Brasileira de Diabetes (SBD) e consultores da Organização Panamericana de Saúde (Opas/OMS Brasil) e assessores técnicos do Ministério da Saúde. Apresentamos neste documento os principais pontos debatidos visando à análise cuidadosa das possibilidades para diagnóstico de DMG, considerando-se as diferenças de acesso aos serviços de saúde existentes no Brasil.(AU)

Metabolomics for predicting hyperglycemia in pregnancy: a protocol for a systematic review and potential meta-analysis.

BACKGROUND: Hyperglycemia in pregnancy (HIP) has been recently differentiated between diabetes in pregnancy (DIP) and gestational diabetes mellitus (GDM). The proposed protocol is relevant, and clinical concern is due to the higher risk of adverse pregnancy outcomes (APO) and long-term effects on both the mother and the fetus. Fasting plasma glucose level (FPG) and oral glucose tolerance test (OGTT) are current diagnostic tools. However, controversy persists concerning diagnostic criteria, cut-off points, and even selective or universal screening. The objective of this systematic review is to assess the performance of metabolomic markers in the prediction of HIP. METHODS: This is a protocol for a systematic review with potential meta-analysis. The primary outcome is GDM, defined as glucose intolerance identified in the second and third trimesters of pregnancy (any FPG ≥ 92 mg/dL and < 126 mg/dL OR when 75-g OGTT shows one altered value among these: FPG ≥ 92 mg/dL or 1-h post glucose load ≥ 180 mg/dL or 2-h post glucose load ≥ 153 mg/dL); the secondary outcome is HIP, defined as hyperglycemia detected in the first trimester of pregnancy (any FPG ≥ 126 mg/dL). A detailed systematic literature search will be carried out in electronic databases and conference abstracts, using the keywords "gestational diabetes mellitus," "metabolomics," "pregnancy," and "screening" (and their variations). We will include original peer-reviewed articles published from Jan 1, 1999, to Dec 31, 2018. Original studies including diabetes diagnosed before pregnancy (T2DM and T1DM), multiple pregnancies, and congenital malformations will be excluded. All results regarding samples, participant characteristics, metabolomic techniques, and diagnostic accuracy measures will be retrieved and analyzed. Since this is a systematic review, no ethical approval is necessary. DISCUSSION: This systematic review may have the potential to provide significant evidence-based findings on the prediction performance of metabolomics. There are short and long-term repercussions for the mother and the newborn. Therefore, both may benefit from an accurate prediction technique for HIP. SYSTEMATIC REVIEW REGISTRATION: This protocol was registered in the PROSPERO platform under number CRD42018100175 .

Prenatal care satisfaction: perception of caregivers with diabetes mellitus / Satisfacción en el seguimiento prenatal: percepción de gestantes portadoras de diabetes mellitus / Satisfação no acompanhamento pré-natal: percepção de gestantes portadoras de diabetes mellitus

ABSTRACT Objective: to understand the satisfaction of pregnant women with diabetes who took insulin during pregnancy and prenatal care performed through outpatient and inpatient follow-up. Method: a qualitative approach with analysis of 30 pregnant women who underwent prenatal care and participated in a clinical trial study carried out by the research group of the Perinatal Diabetes Research Center of the Hospital das Clínicas, of the Faculdade de Medicina de Botucatu. The data were collected through interviews and analyzed from content analysis. Results: from the category Satisfaction, the following subcategories emerged: facilities and difficulties faced in prenatal care performed through outpatient or inpatient follow-up, demonstrating that the pregnant women were satisfied with the prenatal care offered regardless of the type of follow-up. Conclusion: there was satisfaction in both care, but in outpatient care some structural, technical and administrative difficulties were identified, requiring reassessment, in order to guarantee service agility.

RESUMEN Objetivo: comprender la satisfacción de las gestantes portadoras de diabetes que utilizaron insulina en el período gestacional, durante la asistencia prenatal realizada por acompañamiento ambulatorial y hospitalario. Método: abordaje cualitativo, con análisis de 30 gestantes que realizaban seguimiento prenatal y participar en un estudio de ensayo clínico realizado por el grupo de investigación del Centro de Investigación del Diabete Perinatal del Hospital das Clínicas de la Faculdade de Medicina de Botucatu. Los datos fueron recolectados por medio de entrevistas y analizados a partir del análisis de contenido. Resultados: de la categoría Satisfacción, se constituyen las subcategorías: facilidades y dificultades encontradas con la asistencia prenatal realizada por acompañamiento ambulatorial o hospitalario, demostrando que las gestantes quedaron satisfechas con la asistencia prenatal ofrecida, independientemente del tipo de seguimiento. Conclusión: hubo satisfacción en ambos atendimientos, pero en la atención ambulatoria algunas dificultades de orden estructural, técnico y administrativo fueron identificadas, necesitando de reevaluación, a fin de garantizar agilidad del servicio.

RESUMO Objetivo: compreender a satisfação das gestantes portadoras de diabetes que utilizaram insulina no período gestacional durante a assistência pré-natal realizada por acompanhamento ambulatorial e hospitalar. Método: abordagem qualitativa, com análise de 30 gestantes que faziam acompanhamento pré-natal e participaram de um estudo de ensaio clínico realizado pelo grupo de pesquisa do Centro de Investigação do Diabetes Perinatal do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Os dados foram coletados por meio de entrevista, e analisados a partir da análise de conteúdo. Resultados: da categoria Satisfação, constituiu-se a subcategoria: facilidades e dificuldades encontradas com a assistência pré-natal realizada por acompanhamento ambulatorial ou hospitalar demonstrando que as gestantes ficaram satisfeitas com a assistência pré-natal oferecida, independentemente do tipo de acompanhamento. Conclusão: houve satisfação em ambos os atendimentos, porém, no atendimento ambulatorial, dificuldades de ordem estrutural, técnica e administrativa foram identificadas, necessitando de reavaliação, a fim de garantir agilidade do serviço.

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)

Score Establishment and Brazilian Portuguese version of the Pregnancy Sexual Response Inventory (PSRI).

OBJECTIVE: To establish the Pregnancy Sexual Response Inventory (PSRI) scores for each domain before and during pregnancy, and to publish the Brazilian Portuguese version of the PSRI. METHODS: Pregnant women were recruited during antenatal care; the PSRI was administered to 244 women prenatally at Faculdade de Medicina de Botucatu, at Universidade do Estado de São Paulo (UNESP, in the Portuguese acronym). The PSRI scores were estimated based on the Kings Health Questionnaire (KHQ) and the Medical Outcomes Study 36-item short form survey (SF-36). The raw scale type was used to standardize the minimal value and amplitude of each domain. For each domain, the score varied from 0 to 100, and the composite score was obtained as the domain average. The composite score before and during pregnancy was determined by the sum of the scores of all specific domains for each divided by the full domain number. The categorization of the scale into quartiles was established when all PSRI-specific and composite scores were combined. RESULTS: The composite and specific scores for each domain were categorized into quartiles: 0 < 25 as "very bad;" 25 < 50 as "bad;" 50 < 75 as "good" and 75 to 100 as "excellent." The mean scores were lower during pregnancy than before pregnancy in 8 of the 10 domains. The Brazilian Portuguese PSRI version is presented. CONCLUSION: This study allowed the establishment of the PSRI composite and specific scores for each domain, and the categorization of scores into quartiles: very bad, bad, good and excellent. In addition, the Brazilian Portuguese version of the PSRI is presented in full for application in the Brazilian population.

OBJETIVO: Estabelecer os escores do Inventário da Resposta Sexual na Gestação (PSRI) para cada domínio antes e durante a gravidez, e publicar a versão do PSRI em português brasileiro. MéTODOS: Gestantes foram recrutadas durante o cuidado pré-natal; o PSRI foi administrado a 244 mulheres no pré-natal na Faculdade de Medicina de Botucatu da Universidade do Estado de São Paulo (UNESP). Os escores do PSRI foram estimados com base no Kings Health Questionnaire (KHQ) e Medical Outcomes Study36-item short form survey (SF-36). O tipo de escala bruta foi utilizado para padronizar o valor mínimo e a amplitude de cada domínio. Para cada domínio, a pontuação variou de 0 a 100, e o escore composto foi obtido pela média do domínio. O escore composto antes e durante a gravidez foi determinado pela somatória dos escores de todos os domínios específicos para cada período dividido pelo número total do domínio. A escala de categorização em quartil foi estabelecida quando todos os escores específicos e compostos do PSRI foram reunidos. RESULTADOS: Os escores compostos e específicos para cada domínio foram categorizados em quartis: 0 < 25 como "muito ruim;" 25 < 5 0 como "ruim;" 50 < 75 como "bom" e 75 a 100 como "excelente." As médias dos escores foram menores durante a gravidez do que antes da gravidez em 8 dos 10 domínios. Foi apresentada a versão PSRI em português brasileiro. CONCLUSãO: Este estudo permitiu o estabelecimento dos escores compostos e específicos do PSRI para cada domínio e a categorização dos escores em quartis: muito ruim, ruim, bom e excelente. Além disso, a versão em português do PSRI é apresentada integralmente para aplicação na população brasileira.

Score establishment and brazilian portuguese version of the pregnancy sexual response inventory (PSRI) / Definição de escores e versão em português brasileiro do inventário da resposta sexual na gestação (PSRI)

Abstract Objective To establish the Pregnancy Sexual Response Inventory (PSRI) scores for each domain before and during pregnancy, and to publish the Brazilian Portuguese version of the PSRI. Methods Pregnant women were recruited during antenatal care; the PSRI was administered to 244 women prenatally at Faculdade de Medicina de Botucatu, at Universidade do Estado de São Paulo (UNESP, in the Portuguese acronym). The PSRI scores were estimated based on the Kings Health Questionnaire (KHQ) and the Medical Outcomes Study 36-item short form survey (SF-36). The raw scale type was used to standardize the minimal value and amplitude of each domain. For each domain, the score varied from 0 to 100, and the composite score was obtained as the domain average. The composite score before and during pregnancy was determined by the sum of the scores of all specific domains for each divided by the full domain number. The categorization of the scale into quartiles was established when all PSRI-specific and composite scores were combined. Results The composite and specific scores for each domain were categorized into quartiles: 0 < 25 as "very bad;" 25 < 50 as "bad;" 50 < 75 as "good" and 75 to 100 as "excellent." The mean scores were lower during pregnancy than before pregnancy in 8 of the 10 domains. The Brazilian Portuguese PSRI version is presented. Conclusion This study allowed the establishment of the PSRI composite and specific scores for each domain, and the categorization of scores into quartiles: very bad, bad, good and excellent. In addition, the Brazilian Portuguese version of the PSRI is presented in full for application in the Brazilian population.

Resumo Objetivo Estabelecer os escores do Inventário da Resposta Sexual na Gestação (PSRI) para cada domínio antes e durante a gravidez, e publicar a versão do PSRI emportuguês brasileiro. Métodos Gestantes foram recrutadas durante o cuidado pré-natal; o PSRI foi administrado a 244 mulheres no pré-natal na Faculdade de Medicina de Botucatu da Universidade do Estado de São Paulo (UNESP). Os escores do PSRI foram estimados com base no Kings Health Questionnaire (KHQ) e Medical Outcomes Study 36-item short form survey (SF-36). O tipo de escala bruta foi utilizado para padronizar o valor mínimo e a amplitude de cada domínio. Para cada domínio, a pontuação variou de 0 a 100, e o escore composto foi obtido pelamédia do domínio. O escore composto antes e durante a gravidez foi determinado pela somatória dos escores de todos os domínios específicos para cada período dividido pelo número total do domínio. A escala de categorização em quartil foi estabelecida quando todos os escores específicos e compostos do PSRI foram reunidos. Resultados Os escores compostos e específicos para cada domínio foram categorizados em quartis: 0 < 25 como "muito ruim;" 25 < 5 0 como "ruim;" 50 < 75 como "bom" e 75 a 100 como "excelente." As médias dos escores foram menores durante a gravidez do que antes da gravidez em 8 dos 10 domínios. Foi apresentada a versão PSRI em português brasileiro. Conclusão Este estudo permitiu o estabelecimento dos escores compostos e específicos do PSRI para cada domínio e a categorização dos escores emquartis:muito ruim, ruim, bom e excelente. Além disso, a versão em português do PSRI é apresentada integralmente para aplicação na população brasileira.

Robson 10-groups classification system to access C-section in two public hospitals of the Federal District/Brazil.

BACKGROUND: The global increase in C-section rates is real. In Brazil, these indices correspond to 58.94% in the Midwest region and 52.77% in the Federal District. OBJECTIVE: To evaluate the C-section rates and identify the groups with the greatest risk at two reference hospitals in the public network of Federal District/Brazil, using 10-Group Robson System. METHOD: A cross-sectional study of 6579 births assisted at the Hospital A (HA) and the Hospital B (HB) during 2013. The C-section rates in each group and its respective contribution to the total hospital C-sections was compared between HA and HB. To this, was used the proportion difference test (similar to chi-square test), with RR and 95% CI, and the logistic regression analysis (OR; 95% CI) among the groups with higher C-section/total C-section. The significance limit of p < 0.05 was defined for all tests. RESULTS: The C-section rates were 50.8% at the HA and 42.3% at the HB, with 1.20 RR (95%CI = 1.13-1.28) at the HA. The highest rates were observed in Robson groups G5, G1, and G2. At the HA, G1 had a 21.5% C-section rate, which was greater than at the HB (13.8%; p < 0.05); the cesarean rates for groups G2 and G5 were higher at the HB (respectively, 18.6 and 38.1%) than at the HA (14.8 and 32.5%, respectively; p < 0.05). CONCLUSION: These results point out specific goals to be achieved in order to reduce abusive cesarean rates in both A and B hospitals, especially in the primigravida and in those with previous C-section.

Characterization of Natural Killer Cells and Cytokines in Maternal Placenta and Fetus of Diabetic Mothers.

The present study characterized natural killer cells and cytokines in diabetic mothers, their placenta, and fetus. In the maternal blood from the hyperglycemic groups, the CD16(+)CD56(-) NK cells increased, whereas that of CD16(+)CD56(+) decreased in gestational diabetes mellitus [GDM] group. Cord blood from type 2 diabetes [DM-2] showed a higher proportion of CD16(+)CD56(-) and CD16(-)CD56(+). The placental extravillous layer of GDM and DM-2 showed an increase of CD16(+)CD56(-) cells and, irrespective of region, the proportion of CD16(-)CD56(+) cells was higher in mild gestational hyperglycemia [MGH] and GDM and lower in DM-2. IL-2 was lower in maternal blood and IFN-γ higher in maternal and cord blood from the GDM group. IL-17 was higher in maternal and cord blood from the DM-2 group. The placental extravillous layer of the MGH showed high levels of IL-4, IL-6, IL-10, IL-17, and IFN-γ and low levels of IL-1ß and IL-8, whereas the placental villous layer contained high levels of IL-17 and IFN-γ. The GDM group, irrespective of region, showed higher levels of IL-8. The DM-2 group, irrespective of region, placenta showed high levels of TNF-α, IL-17, and IFN-γ. The hyperglycemia produces an inflammatory environment with a high content of inflammatory cytokines and cells expressing CD16(+).

Depression and anxiety in pregnant women with diabetes or mild hyperglycemia.

INTRODUCTION: A number of physical and psychological changes that occur during pregnancy can stimulate the development of psychological disorders such as anxiety and depression. The study evaluated psychological aspects related to maternal depression and anxiety in pregnant women with diabetes mellitus or hyperglycemia, contrasting the results with those of non-diabetic pregnant women. METHOD: In a prospective and longitudinal approach, two questionnaires were applied and validated for use in Brazil, the Beck depression inventory and the State-Trait Anxiety Inventory. The questionnaires were applied to pregnant women at the first prenatal visit or at the time of disease diagnosis (T1) and reapplied at admission for delivery (T2). Regardless of the degree of hyperglycemia, both at first and in the second stage most women had severe anxiety trait. In early pregnancy (T1), however, severe state anxiety was more frequent in women with hyperglycemia than in those from the NG group. RESULTS: Most pregnant women showed moderate state anxiety over their pregnancy, regardless of glycemic status. In early pregnancy, however, severe state anxiety was more prevalent in hyperglycemic women than in those with normal glycemic status. Most women showed moderate trait anxiety and mild depression in both early and late pregnancy, irrespective of glycemic status. CONCLUSION: The incidence of severe state anxiety in early pregnancy is more frequent in women with diabetes or hyperglycemia, but their levels of trait anxiety and depression are not affected by glycemic status.

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.

Oxidative DNA damage in diabetic and mild gestational hyperglycemic pregnant women.

BACKGROUND: Pregnant women with mild gestational hyperglycemia present high risk for hypertension, obesity and hyperglycemia, and appeared to reproduce the model of metabolic syndrome in pregnancy, with hyperinsulinemia and insulin resistance. Our clinical studies showed that mild gestational hyperglycemia or gestational diabetes are related to similar adverse maternal and perinatal outcomes. Hyperglycemia and other factors associated with diabetes generate reactive oxygen species that increase DNA damage levels. The aim of this study was to evaluate oxidative DNA damage in lymphocytes of pregnant women with diabetes or mild gestational hyperglycemia. METHODS: The study included 111 pregnant women distributed into three groups based on oral glucose tolerance test (OGTT) and glycemic profiles (GP), as follows: Normal OGTT and GP (control group); Normal OGTT and abnormal GP (mild gestational hyperglycemia group); Abnormal OGTT and GP (diabetic group). Maternal blood samples (5-10 mL) were collected and processed for determination of oxidative DNA damage by the comet assay, using Fpg and Endo III enzymes. Urine samples were also collected for determination of 8-OHdG concentrations by ELISA. RESULTS: Subjects in the diabetes group presented increased amount of oxidized purines, while mild gestational hyperglycemia women presented with increased oxidized pyrimidines, compared to the control group. CONCLUSION: Gestational, overt diabetes and mild gestational hyperglycemia, were all related to increased oxidative DNA damage. Diabetic pregnant women showed increased level of oxidative DNA damage, perhaps mainly due to hyperglycemia. On the other hand, oxidative DNA damage detected in women with mild gestational hyperglycemia might be associated with repercussions from obesity, hypertension and/or insulin resistance. Interestingly, the type of DNA base affected seemed to be dependent on the glycemic profile or oxidative stress.

QUALIS EVALUATION OF MEDICINE III: ANALYSIS OF ANESTHESIOLOGY AND GYNECOLOGY AND OBSTETRICS JOURNALS.

OBJECTIVE: To know the current publication of Anesthesiology and Obstetrics and Gynecology subareas, to support the updating of Qualis Journals criteria in these specific subareas. METHOD: Cross-sectional, descriptive study in which was evaluated in quantitatively and qualitatively way the bibliographic production of Anesthesiology and Obstetrics and Gynecology subareas, from January 2010 to December 2012. Were investigated the values ​​of the impact factor; calculated (i) the number (n) and the percentage of journals in each stratum Qualis A1, A2, B1, B2, B3, B4 and B5, and (ii) the median values ​​and their extreme limits (minimum values ​​and maximum) and quartiles (p25; p50; p75; p90) of the impact factors in the different strata. RESULTS: The bibliographic production of the three-year period 2010-2012 was published in 69 journals in Anesthesiology subarea and in 345 in Gynecology and Obstetrics. In Anesthesiology, 44% were within the limits of impact factor of superior A1, A2 and B1; in Obstetrics and Gynecology, 42.4% were in those limits and strata. CONCLUSIONS: Despite lagging behind by international standards, publications of Anesthesiology and Obstetrics and Gynecology showed tendency to improve the quality. In these sub-areas, the median of journals impact factor is beyond the limits defined by the area in the last assessment. Therefore, it must be reconsidered new indicators to assess this aspect. OBJETIVO: Conhecer a publicação atual das subáreas Anestesiologia e Ginecologia e Obstetrícia, para subsidiar a atualização dos critérios Qualis-periódicos, específicos dessas subáreas. MÉTODO: Estudo de corte transversal, descritivo, onde avaliou-se, de modo quantitativo e qualitativo, a produção bibliográfica das subáreas Anestesiologia e Ginecologia e Obstetrícia, no período de janeiro de 2010 a dezembro de 2012. Foram definidos os valores do fator de impacto das revistas; foram calculados (i) o número (n) e percentual de periódicos em cada um dos estratos Qualis - A1, A2, B1, B2, B3, B4 e B5 e (ii) os valores de mediana e respectivos limites extremos (valores mínimo e máximo) e quartis (p25; p50; p75; p90) dos fatores de impacto nos diferentes estratos. RESULTADOS: A produção bibliográfica do triênio 2010-2012 foi divulgada em 69 periódicos na subárea Anestesiologia e em 345 na subárea Ginecologia e Obstetrícia. Na subárea Anestesiologia, 44% dessa produção estava nos limites de fator de impacto dos estratos superiores A1, A2 e B1; na subárea Ginecologia e Obstetrícia, 42,4% estavam nesses limites e estratos. CONCLUSÕES: Apesar de aquém do desejado para os padrões internacionais, as publicações das subáreas Anestesiologia e Ginecologia e Obstetrícia mostram tendência para melhorar a qualidade. Nessas subáreas, a mediana do fator de impacto dos periódicos está além dos limites definidos pela área na última avaliação. Impõe-se, portanto, novos indicadores para a avaliação desse quesito.