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1.
Clin Chim Acta ; 568: 120117, 2025 Feb 15.
Article in English | MEDLINE | ID: mdl-39756773

ABSTRACT

BACKGROUND: Research into the mechanisms of growth control during birth and postnatal life has shown that adipose tissue regulates many physiological functions in the body by secreting adipokines. The aims of this study were to investigate the serum levels of visfatin and vaspin in healthy and unhealthy pregnant women and its relationship with their newborns' anthropometric measurements. MATERIALS AND METHODS: A total of 82 pregnant women were included in this study with their respective newborn, healthy pregnant women (n = 30), with obesity (n = 26) and with gestational diabetes (GD) (n = 26). We assessed differences between groups with ANOVA or Kruskal Wallis and correlation between adipokines and anthropometric measurements of the newborn with Spearman correlation. RESULTS: Visfatin serum concentrations were higher in umbilical cord serum of newborns from mothers with obesity (p = 0.006). Maternal visfatin correlated negatively with their newborn's anthropometric measurements (p < 0.05). Umbilical cord visfatin correlated positively with maternal weight and body mass index (p < 0.05). Umbilical cord vaspin correlated positively with fat mass (p = 0.036) and weight gain of infants (p = 0.046). CONCLUSIONS: These adipokines may be significant in the development of elevated adiposity in newborns. Offspring form mothers with obesity or GD are at higher risk.


Subject(s)
Nicotinamide Phosphoribosyltransferase , Serpins , Humans , Nicotinamide Phosphoribosyltransferase/blood , Female , Pregnancy , Serpins/blood , Infant, Newborn , Adult , Anthropometry , Diabetes, Gestational/blood , Obesity/blood , Pregnancy Complications/blood , Cytokines
2.
Rev Esc Enferm USP ; 58: e20240200, 2025.
Article in English, Portuguese | MEDLINE | ID: mdl-39888871

ABSTRACT

OBJECTIVE: To analyze cases of maternal near miss in a teaching hospital. METHOD: This is a cross-sectional study with a quantitative approach. The research was performed in a teaching hospital, in Mato Grosso do Sul, from June to December 2021. Data were collected from physical and electronic medical records, laboratory tests, and prenatal records, using a structured instrument. They were subsequently subjected to descriptive and inferential analysis in Epi Info 7.2.2.6. RESULTS: Fifty-nine medical records were analyzed, 49 presenting potentially life-threatening condition and ten maternal near misses. Coming from inland cities of the state, gestational risk classification, bleeding and management disorders showed a significant association with maternal near miss. CONCLUSION: It becomes necessary to plan tracking actions, such as the implementation of a flow for identifying women with potentially life-threatening conditions, and the implementation of specific protocols with preventive key interventions and notification of maternal near miss, with a view to improving care and consequently reducing the risk of serious maternal outcomes.


Subject(s)
Hospitals, Teaching , Near Miss, Healthcare , Pregnancy Complications , Cross-Sectional Studies , Humans , Female , Brazil , Pregnancy , Near Miss, Healthcare/statistics & numerical data , Adult , Young Adult , Pregnancy Complications/epidemiology , Adolescent , Prenatal Care
3.
BMC Public Health ; 25(1): 104, 2025 01 09.
Article in English | MEDLINE | ID: mdl-39789473

ABSTRACT

BACKGROUND: Abortion-related complications are difficult to measure due to lack of standardized definitions and limited available data. We describe the proportion of abortive events that result in a documented complication in Mexico's public sector hospitals. METHODS: We used ICD-10 codes from Mexico's hospital discharge system (2018-2022), Subsistema Automatizado de Egresos Hospitalarios (SAEH), to describe abortive events admitted to hospitals: complications for excessive bleeding, infection, embolism, and unspecified; patient socio-demographic and clinical characteristics; and municipality-level structural vulnerability. We estimate complications by pregnancy duration, describe types of complications, identify characteristics associated with the presence of a complication using multuvariable regression, and calculate complication rates (proportion of abortive event that result in a complication treated in a public sector hospital per 1,000 women of reproductive age) by state in 2022. FINDINGS: There were 399,405 abortive events that received hospital-based care in Secretaria de Salud (SS) hospitals between 2018-2022. Ninety-two percent had no complication reported. The adjusted predicted probability of a complication was higher among patients at > 13 weeks' gestation (8.9%; 95% CI 8.1-9.7%) compared with ≤ 13 weeks (6.6%; 95% CI 6.0-7.2%). Higher parity, care at a tertiary hospital, and high marginalization at place of residence were positively associated with presence of a complication. States with higher complication rates are primarily in the central and southern regions. CONCLUSIONS: In Mexico, 92% of patients who seek care for all abortive events (induced, spontaneous, post-abortion) in SS hospitals have no complications. Marginalized patients are more likely to have a complication and to seek care at later pregnancy durations. Routinely conflating care-seeking and complications leads to overestimates of the risk of abortion.


Subject(s)
Abortion, Induced , Hospitals, Public , Humans , Mexico/epidemiology , Female , Hospitals, Public/statistics & numerical data , Adult , Pregnancy , Abortion, Induced/statistics & numerical data , Abortion, Induced/adverse effects , Young Adult , Adolescent , Socioeconomic Factors , Pregnancy Complications/epidemiology , Middle Aged , Sociodemographic Factors
4.
Int J Gynaecol Obstet ; 168(1): 155-166, 2025 Jan.
Article in English | MEDLINE | ID: mdl-39096017

ABSTRACT

BACKGROUND: There has been debate over whether the existing World Health Organization (WHO) criteria accurately represent the severity of maternal near misses. OBJECTIVE: This study assessed the diagnostic accuracy of two WHO clinical and laboratory organ dysfunction markers for determining the best cutoff values in a Latin American setting. METHODS: A prospective multicenter cohort study was conducted in five Latin American countries. Patients with severe maternal complications were followed up from admission to discharge. Organ dysfunction was determined using clinical and laboratory data, and participants were classified according to severe maternal outcomes. This study compares the diagnostic criteria of Latin American Centre for Perinatology, Network for Adverse Maternal Outcomes (CLAP/NAMO) to WHO standards. RESULTS: Of the 698 women studied, 15.2% had severe maternal outcomes. Most measured variables showed significant differences between individuals with and without severe outcomes (all P-values <0.05). Alternative cutoff values suggested by CLAP/NAMOs include pH ≤7.40, lactate ≥2.3 mmol/L, respiratory rate ≥ 24 bpm, oxygen saturation ≤ 96%, PaO2/FiO2 ≤ 342 mmHg, platelet count ≤189 × 109 × mm3, serum creatinine ≥0.8 mg/dL, and total bilirubin ≥0.67 mg/dL. No significant differences were found when comparing the diagnostic performance of the CLAP/NAMO criteria to that of the WHO standards. CONCLUSION: The CLAP/NAMO values were comparable to the WHO maternal near-miss criteria, indicating that the WHO standards might not be superior in this population. These findings suggest that maternal near-miss thresholds can be adapted regionally, improving the identification and management of severe maternal complications in Latin America.


Subject(s)
Near Miss, Healthcare , Pregnancy Complications , Humans , Female , Prospective Studies , Latin America , Adult , Pregnancy , Caribbean Region , Near Miss, Healthcare/statistics & numerical data , Pregnancy Complications/diagnosis , World Health Organization , Young Adult , Severity of Illness Index , Organ Dysfunction Scores , Biomarkers/blood
5.
P R Health Sci J ; 43(4): 221-225, 2024 Dec.
Article in English | MEDLINE | ID: mdl-39671416

ABSTRACT

OBJECTIVE: The objective of this study was to determine the incidence and evolution of patients with acute fatty liver of pregnancy (AFLP) over a period of 18 years in the city of Toluca, Mexico. METHODS: This was a descriptive and retrospective study of eighteen years. All women with AFLP confirmed by biopsy were included and the incidence, laboratory test values and complications were registered. RESULTS: AFLP incidence was of 1 case for every 8,451 deliveries. The main complications were bleeding, infections and neurological compromise. The mortality was of 33.33%. CONCLUSION: It can be concluded that AFLP has a slightly lower incidence in Mexico than that reported in other countries but with a higher survival. This condition deserves a multidisciplinary team to improve the survival rate.


Subject(s)
Fatty Liver , Pregnancy Complications , Humans , Mexico/epidemiology , Female , Pregnancy , Retrospective Studies , Incidence , Adult , Fatty Liver/epidemiology , Pregnancy Complications/epidemiology , Young Adult
6.
Sleep Breath ; 29(1): 54, 2024 Dec 09.
Article in English | MEDLINE | ID: mdl-39652260

ABSTRACT

OBJECTIVE: To verify the association of sociodemographic, anthropometric, obstetric, lifestyle factors, and depressive symptoms with sleep quality in pregnant adolescents. METHOD: This cross-sectional study involved pregnant adolescents aged 10 to 19 who received prenatal care in Recife, Pernambuco, Brazil. Data collection included an individual evaluation form and the administration of the Pregnancy Physical Activity Questionnaire (PPAQ), the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory (BDI). Prevalence and associations were calculated using Pearson's chi-square test or Fisher's exact test, followed by logistic regression analysis. RESULTS: The study included 386 pregnant adolescents with a mean age of 17 ± 2 years. The prevalence of poor sleep quality was 67.5%. Poor sleep quality was associated with moderate to severe depressive symptoms (OR = 2.21; 95%CI 1.27-3.85), higher education levels (OR = 2.26; 95%CI 1.43-3.57), and the presence of gestational physical symptoms (OR = 1.18; 95%CI 1.10-1.27). CONCLUSION: Pregnant adolescents exhibit a high prevalence of poor sleep quality, which is linked to depressive symptoms, higher education levels, and gestational physical symptoms. These findings highlight the importance of screening for sleep disorders in this population and emphasize the need for guidelines addressing physical symptoms and their impact on sleep, as well as the presence of depression.


Subject(s)
Sleep Quality , Humans , Female , Adolescent , Pregnancy , Cross-Sectional Studies , Brazil/epidemiology , Young Adult , Pregnancy in Adolescence/psychology , Pregnancy Complications/epidemiology , Child , Depression/epidemiology , Depression/diagnosis , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/diagnosis , Surveys and Questionnaires , Adult
7.
Rev Fac Cien Med Univ Nac Cordoba ; 81(4): 734-751, 2024 12 13.
Article in Spanish | MEDLINE | ID: mdl-39670905

ABSTRACT

Introduction: Since its introduction in clinical practice in 1981, pregnancies conceived by assisted reproductive techniques (ART) are an increasing proportion of all pregnancies, presenting particular challenges. Objective: To analyze the maternal-fetal outcomes of pregnancies conceived by ART in a single center in Argentina. Material and methods: Retrospective cohort of pregnancies conceived by ART who attended their delivery in a private university hospital through a review of records. Results: The incidence of composite primary maternal outcome was 40,1% (282/703), with hypertensive disease of pregnancy (21%) being the most frequent presenting pathology.In the multivariate analysis, age > 40 (OR 2,79; 95%CI: 1,82-4,26), chronic hypertension (OR 10,59; 95% CI: 2,81-39,86), twin pregnancy (OR 8,94; 95% CI: 5,39 ­ 14,80) and oocyte donation (OR 1,54; 95% CI: 1,04 ­ 2,27) were significantly associated with the maternal primary outcome. The incidence of the composite neonatal fetal primary outcome was 56,7% (468/824), with a prematurity rate of 34,5% (252/803). In the multivariate analysis of the composite outcome of the neonatal fetus, twin pregnancy (OR 7,08; 95% CI: 3,48 ­ 14,39) and other complications related to prematurity were statistically significantly associated with the composite outcome. Conclusions: Pregnancies conceived by ART show a significant increase in adverse maternal outcomes, mainly hypertension, and fetal and neonatal outcomes (prematurity, malformations, and admission to the intensive care unit).


Introducción: Desde su introducción en 1981, los embarazos logrados por técnicas de reproducción asistida (TRA) son una proporción cada vez más grande de todas las gestaciones, presentando desafíos particulares. Objetivo: Analizar los resultados maternos-fetales de los embarazos logrados por TRA en un centro único de Argentina. Material y métodos: Cohorte retrospectiva de embarazos logrados por TRA que atendieron su parto en un hospital privado universitario mediante revisión de registros. Resultados: La incidencia del resultado materno primario compuesto fue del 40,1% (282/703), siendo la patología de presentación más frecuente la enfermedad hipertensiva del embarazo (21%)En el análisis multivariado, la edad > 40 (OR 2,79; IC95%: 1,82-4.26), la hipertensión crónica (OR 10,59; IC95%: 2,81- 39,86), el embarazo gemelar (OR 8,94; IC95%: 5,39 - 14,80) y la ovo donación (OR 1,54; IC95%: 1,04 - 2,27) se asociaron significativamente con el resultado primario materno. La incidencia del resultado primario feto neonatal compuesto fue del 56,7% (468/824), con una tasa de prematuridad del 34,5% (252/803).  En el análisis multivariado del resultado compuesto feto neonatal, el embarazo gemelar (OR 7,08; IC95%: 3,48 - 14,39) y otras complicaciones relacionadas a la prematuridad se asociaron en forma estadísticamente significativa con el resultado compuesto. Conclusion: Los embarazos logrados por TRA muestran un aumento significativo de resultados adversos tanto maternos, principalmente hipertensión; como fetales y neonatales (prematuridad, malformaciones e ingreso a unidad de cuidados intensivos).


Subject(s)
Pregnancy Outcome , Reproductive Techniques, Assisted , Humans , Pregnancy , Female , Retrospective Studies , Argentina/epidemiology , Adult , Reproductive Techniques, Assisted/statistics & numerical data , Infant, Newborn , Pregnancy, Twin , Fertilization in Vitro/statistics & numerical data , Pregnancy Complications/epidemiology
8.
Rev Fac Cien Med Univ Nac Cordoba ; 81(4): 824-841, 2024 12 13.
Article in Spanish | MEDLINE | ID: mdl-39670907

ABSTRACT

Background: Thyroid dysfunction during pregnancy negatively impacts both the woman and her offspring, with the early gestational period being critical for potential repercussions. Establishing pre-conception and during-conception care strategies is crucial for favorable pregnancy outcomes. Objective: This review aims to compile the most recent scientific evidence to guide diagnostic and therapeutic approaches based on clinical cases, including a description of thyroid physiology during pregnancy and strategies for identifying high-risk patients for treatment. Method: This bibliographic review combined DeCS and MeSH terms from the PICOT question, spanning the period from 2015 to 2022 across 5 databases. Articles in both English and Spanish were included if they addressed the PICOT question and contributed to the explanation of two case reports. Results: A total of 1452 articles were collected, which, following an initial elimination of duplicates and subsequent blind review based on inclusion and exclusion criteria by two reviewers, resulted in 32 articles included in this review. Conclusions: Overt hypothyroidism is associated with adverse maternal-fetal outcomes, and its treatment improves these complications. However, in borderline conditions such as subclinical hypothyroidism, isolated hypothyroxinemia, and thyroid autoimmune conditions, uncertainty about the treatment's impact persists due to a scarcity of controlled trials. Emphasizing the importance of all physicians being familiar with this condition during gestation.


Antecedentes: La disfunción tiroidea durante la gestación impacta negativamente a la mujer y su descendencia, siendo el periodo temprano de gestación crítico para posibles repercusiones. Establecer estrategias de atención previas y durante la concepción es crucial para resultados favorables en el embarazo. Objetivo: Esta revisión es recopilar la evidencia científica más reciente para orientar el abordaje diagnóstico y terapéutico basado en casos clínicos, incluyendo la descripción de la fisiología tiroidea durante el embarazo y estrategias de identificación de pacientes de alto riesgo para tratamiento. Método: Esta revisión bibliográfica combinó términos DeCs y MeSH de la pregunta PICOT, abarcando el periodo entre 2015 y 2022 en 5 bases de datos. Se incluyeron artículos en inglés y español que respondieran a la pregunta PICOT y contribuyeran a la explicación de dos reportes de caso. Resultados: Se recolectaron 1452 artículos, los cuales posterior a una eliminación por duplicidad en primera instancia y posterior filtración según criterios de inclusión y exclusión realizada por 2 revisores de manera ciega se obtuvieron 32 artículos los cuales fueron incluidos en esta revisión. Conclusión: el hipotiroidismo manifiesto se relaciona con desenlaces negativos materno-fetales y su tratamiento mejora estas complicaciones. Sin embargo, en estados limítrofes como hipotiroidismo subclínico, hipotiroxinemia aislada y autoinmunidad tiroidea, la incertidumbre sobre el impacto del tratamiento persiste debido a la escasez de ensayos controlados. Se subraya la importancia de que todos los médicos estén familiarizados con esta condición durante la gestación.


Subject(s)
Hypothyroidism , Pregnancy Complications , Humans , Pregnancy , Female , Hypothyroidism/drug therapy , Thyroid Diseases , Pregnancy Outcome
9.
Rev Gaucha Enferm ; 45: e20230304, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-39699433

ABSTRACT

OBJECTIVE: To estimate the prevalence and factors associated with excess weight, hypertension and diabetes among pregnant women in the northern region of Brazil. METHOD: This is a cross-sectional, retrospective study with secondary data conducted with pregnant women living in the northern region of Brazil who took part in the Telephone Survey for Surveillance of Risk and Protective Factors for Chronic Diseases. The chi-square and Kruskal-Wallis tests were used for analysis, as well as the Binomial Logistic Regression model. RESULTS: A total of 21,652.1 women self-reported being pregnant. The prevalence rates were: 42.4% excess weight, 2.65% hypertension and 9% diabetes. The variables associated with the outcomes were: for overweight, watching television and using a computer/tablet/cell phone for up to 3 hours a day, for hypertension, watching television for 3 hours a day or more and using a computer/tablet/cell phone for more than 6 hours a day, for diabetes, 29 years old, 13 years of schooling, and consumption of more than 4 glasses/cans of soda daily. CONCLUSION: The prevalence rates found in this study are similar to those found in other contexts. The unfavorable outcomes are associated with age, years of schooling, dietary habits, and maternal lifestyle.


Subject(s)
Diabetes, Gestational , Hypertension , Overweight , Humans , Female , Pregnancy , Brazil/epidemiology , Cross-Sectional Studies , Diabetes, Gestational/epidemiology , Adult , Retrospective Studies , Overweight/epidemiology , Prevalence , Hypertension/epidemiology , Young Adult , Adolescent , Risk Factors , Pregnancy Complications/epidemiology
10.
Article in English | MEDLINE | ID: mdl-39669310

ABSTRACT

Objective: An in-depth evaluation of the published evidence is needed on self-medication, specifically the evidence focusing on vulnerable groups, such as pregnant women. This scoping review aims to provide an overview of the differences in self-medication prevalence and study characteristics among different groups, while identifying gaps in the literature. Methods: A literature search was performed in PubMed and Web of Science, including articles published in the last 10 years for the pregnant women group (PWG) and the general population group (GPG). Data on study design, self-medication prevalence, medications used, and other variables were collected, tabulated, and summarized. Results: From 2888 screened articles, 75 were considered including 108,559 individuals. The self-medication (SM) in the PWG ranged from 2.6 to 72.4% and most studies had an SM prevalence between 21 and 50% and in the GPG, 32 from 50 studies had a SM prevalence higher than 50%. The reviewed studies varied considerably in methodology, requiring careful interpretation. While most of the studies assessed self-medication during the entire pregnancy, self-medication definition was often inconsistent between studies. Acetaminophen was the most used medication and headache was the most frequent symptom leading to self-medication initiation in the PWG. Conclusions: Self-medication among pregnant women showed a lower prevalence when compared to the general population. The medications used and symptoms reported were similar between groups. However, methodological differences must be carefully considered. Pregnant women should carefully follow their physicians' advice before initiating self-medication to avoid preventable maternal and fetal adverse effects.


Subject(s)
Self Medication , Humans , Pregnancy , Female , Self Medication/statistics & numerical data , Pregnancy Complications/drug therapy , Pregnancy Complications/epidemiology
11.
Int J Mol Sci ; 25(23)2024 Dec 08.
Article in English | MEDLINE | ID: mdl-39684916

ABSTRACT

Pregnancy increases the demand for essential metal ions to support fetal development, making the maternal metal ion status a critical determinant of perinatal outcomes. This prospective cohort study examined changes in metal ion levels across the three trimesters, evaluated the influence of preexisting metabolic conditions on the metal ion status, and assessed the associations between maternal metal ion levels and perinatal outcomes in 206 pregnant women from the Biochemical and Epigenetic Origin of Overweight and Obesity (OBESO) cohort receiving care at the Instituto Nacional de Perinatología in Mexico City from 2017 to 2020. Six essential metal ions (iron, zinc, copper, calcium, magnesium, and phosphorus) were measured in blood samples using inductively coupled plasma optic emission spectrometry. Significant variations in the metal ion levels were observed across the trimesters, with notable decreases in iron and magnesium and increases in copper as pregnancies progressed. Maternal hypothyroidism was associated with significantly low levels of zinc and magnesium during pregnancy. Regression analyses revealed robust associations between maternal metal ion levels and perinatal outcomes. For instance, declining magnesium levels as pregnancies progressed were positively associated with gestational diabetes (OR: 2.92, p = 0.04; OR: 2.72, p = 0.03). The maternal metal ion status significantly influences perinatal outcomes.


Subject(s)
Pregnancy Outcome , Humans , Female , Pregnancy , Mexico/epidemiology , Adult , Metals/blood , Prospective Studies , Pregnancy Complications/blood , Pregnancy Complications/epidemiology , Magnesium/blood , Zinc/blood , Copper/blood , Iron/blood , Calcium/blood , Young Adult
12.
Medwave ; 24(11): e2961, 2024 Dec 27.
Article in English, Spanish | MEDLINE | ID: mdl-39729403

ABSTRACT

Introduction: Maternal mortality remains a significant challenge for public health globally, particularly in developing areas such as Ica, Peru. This study aims to analyze the risk factors contributing to maternal mortality in reference hospitals in Ica during the period of 2010 to 2020. Methods: A case-control study was conducted, including 49 cases of maternal deaths and 98 controls, applying multivariate logistic regression to analyze data collected from hospital records. Results: The absence of a partner (adjusted OR: 12.3; 95% CI: 2.6 to 58.8), history of anemia (adjusted OR: 5.8; 95% CI: 1.5 to 21.3), delays of more than two hours in accessing medical care (adjusted OR: 10.2; 95% CI: 2.0 to 51.1), and lack of knowledge of warning signs such as unrecognized vaginal bleeding by companions (adjusted OR: 7.4; 95% CI: 1.2 to 46.7) were associated with an increased risk of maternal mortality. Conclusions: The identification of these factors highlights the urgent need to develop comprehensive strategies that optimize access to maternal health services and strengthen education on warning signs. To reduce preventable maternal mortality, it is essential to collaborate between the Ministry of Health of Peru and regional governments, aiming to expand coverage and improve the quality of prenatal care. Additionally, awareness should be increased and transportation availability ensured 24 hours a day for women experiencing obstetric complications. The main limitation of this study is the generalization of results due to the regional focus and exclusive use of hospital data.


Introducción: La mortalidad materna sigue siendo un reto considerable para la salud pública a nivel mundial, particularmente en áreas en desarrollo como Ica, Perú. Este estudio tiene como finalidad analizar los factores de riesgo que contribuyen a la mortalidad materna en hospitales de referencia en Ica durante el período de 2010 a 2020. Métodos: Se realizó un estudio de casos y controles, incluyendo 49 casos de muertes maternas y 98 controles, aplicando regresión logística multivariante para analizar datos recopilados de historias clínicas y registros hospitalarios. Resultados: Los factores significativamente asociados con un aumento en el riesgo de mortalidad materna incluyen la ausencia de pareja (odds ratio ajustado [OR]: 12,3; IC 95%: 2,6 a 58,8), antecedentes de anemia (OR ajustado: 5,8; IC 95%: 1,5 a 21,3), demoras superiores a dos horas en acceder a atención médica (OR ajustado: 10,2; IC 95%: 2,0 a 51,1), y el desconocimiento de signos de alarma como el sangrado vaginal no reconocido por los acompañantes (OR ajustado: 7,4; IC 95%: 1,2 a 46,7). Conclusiones: La identificación de estos factores subraya la necesidad urgente de desarrollar estrategias integrales que optimicen el acceso a los servicios de salud materna y fortalezcan la educación sobre los signos de alarma. Para disminuir la mortalidad materna evitable, es esencial la colaboración entre el Ministerio de Salud del Perú y los gobiernos regionales, con el objetivo de ampliar la cobertura y mejorar la calidad de la atención prenatal. Además, se debe aumentar la concienciación y asegurar la disponibilidad de transporte las 24 horas para mujeres que enfrenten complicaciones obstétricas. La principal limitación es la generalización restringida por el enfoque regional y el uso exclusivo de datos hospitalarios.


Subject(s)
Health Services Accessibility , Maternal Health Services , Maternal Mortality , Humans , Peru/epidemiology , Female , Case-Control Studies , Pregnancy , Adult , Risk Factors , Young Adult , Maternal Health Services/standards , Pregnancy Complications/mortality , Pregnancy Complications/epidemiology , Health Knowledge, Attitudes, Practice , Anemia/mortality , Anemia/epidemiology , Prenatal Care/statistics & numerical data , Adolescent
13.
BMC Pregnancy Childbirth ; 24(1): 746, 2024 Nov 13.
Article in English | MEDLINE | ID: mdl-39538141

ABSTRACT

BACKGROUND: Gestational weight gain (GWG) is a critical issue related to postpartum health in newborns and mothers. In Brazil, pregnant women's public health recommends monitoring GWG. Therefore, the objective of this study is to evaluate gestational weight gain and associated health factors of pregnant women monitored at Unified Health System (SUS) in the city of São Paulo between 2012 and 2020. METHODS: This is a retrospective cohort study of pregnant women seen from 2012 to 2020 in São Paulo, Brazil. The database used was from the Integrated Health Care Management System related to the Live Birth Information System. Data distribution was assessed using the Kolmogorov-Smirnov test. Comparisons between groups according to weight gain (LWG vs. AWG vs. EWG) were performed using analysis of variance (ANOVA) with Tukey post hoc. Inclusion criteria considered that pregnant women had a recorded initial weight before 13 weeks and up to 15 days before delivery and a single pregnancy. The final database includes 276.220 pregnant women. RESULTS: The frequency of women according to initial body mass index (BMI) was 12.004 (4.4%) underweight, 132.049 (48.3%) normal weight, 78.856 (28.8%) overweight, and 50.660 (18.5%) living with obesity. The population consisted of 59.881 (21.9%), 37.217 (13.6%) and 176.471 (64.5%) women with LWG, AWG and EWG, respectively. Weight gain was associated with initial BMI, type of birth, color/ethnicity, marital status, women's age and antenatal care visits. CONCLUSION: The proportion of pregnant women with inadequate weight gain is high, relating initial BMI, type of birth, color/ethnicity, marital status, women's age and antenatal care visits. Interventions such as nutritional education should be suggested to help achieve adequate GWG.


Subject(s)
Body Mass Index , Gestational Weight Gain , Nutritional Status , Humans , Female , Retrospective Studies , Pregnancy , Brazil/epidemiology , Adult , Young Adult , Overweight/epidemiology , Thinness/epidemiology , Obesity/epidemiology , Pregnancy Complications/epidemiology , Prenatal Care/statistics & numerical data , Cohort Studies
14.
BMC Pregnancy Childbirth ; 24(1): 733, 2024 Nov 08.
Article in English | MEDLINE | ID: mdl-39516752

ABSTRACT

BACKGROUND: Gestational weight gain (GWG) is a critical factor influencing maternal and fetal health. Excessive or insufficient GWG can lead to various complications, including gestational diabetes, hypertension, cesarean delivery, low birth weight, and preterm birth. This study aims to develop and evaluate machine learning models to predict GWG categories: below, within, or above recommended guidelines. METHODS: We analyzed data from the Araraquara Cohort, Brazil, which comprised 1557 pregnant women with a gestational age of 19 weeks or less. Predictors included socioeconomic, demographic, lifestyle, morbidity, and anthropometric factors. Five machine learning algorithms (Random Forest, LightGBM, AdaBoost, CatBoost, and XGBoost) were employed for model development. The models were trained and evaluated using a multiclass classification approach. Model performance was assessed using metrics such as area under the ROC curve (AUC-ROC), F1 score and Matthew's correlation coefficient (MCC). RESULTS: The outcomes were categorized as follows: GWG within recommendations (28.7%), GWG below (32.5%), and GWG above recommendations (38.7%). The XGBoost presented the best overall model, achieving an AUC-ROC of 0.79 for GWG within, 0.76 for GWG below, and 0.65 for GWG above. The LightGBM also performed well with an AUC-ROC of 0.79 for predicting GWG within recommendations, 0.76 for GWG below, and 0.624 for GWG above. The most important predictors of GWG were pre-gestational BMI, maternal age, glycemic profile, hemoglobin levels, and arm circumference. CONCLUSION: Machine learning models can effectively predict GWG categories, offering a valuable tool for early identification of at-risk pregnancies. This approach can enhance personalized prenatal care and interventions to promote optimal pregnancy outcomes.


Subject(s)
Gestational Weight Gain , Machine Learning , Humans , Female , Pregnancy , Adult , Brazil , Young Adult , Body Mass Index , Pregnancy Complications/diagnosis , ROC Curve
15.
Rev Assoc Med Bras (1992) ; 70(10): e20240634, 2024.
Article in English | MEDLINE | ID: mdl-39536251

ABSTRACT

OBJECTIVE: The aim of this study was to assess obstetric and perinatal outcomes in women with hyperprolactinemia according to the type of treatment indicated, with cabergoline or bromocriptine. METHODS: A retrospective cohort study with 464 women diagnosed with hyperprolactinemia was undertaken at the endocrine gynecology outpatient clinic of a tertiary hospital from May 2002 to February 2022. All women diagnosed with hyperprolactinemia who were being treated with dopamine agonists (cabergoline or bromocriptine) and who became pregnant during the follow-up were included. Women whose medical records did not provide data related to pregnancy and delivery were excluded. The women were divided into two groups according to the type of treatment: bromocriptine or cabergoline. Clinical and laboratory characteristics and obstetric and perinatal outcomes, such as complications during pregnancy, type of delivery, and intrapartum complications, were evaluated in both groups. RESULTS: Of the 464 women evaluated, 72 became pregnant during the follow-up, 66 of them were using dopamine agonists, while 6 were not using medication. The mean age of the women was 28.3±6.8 years. Among the causes of hyperprolactinemia, 48.6% were idiopathic, 45.7% were tumoral, and 3.7% had other causes. Most women with idiopathic hyperprolactinemia used bromocriptine, while those with tumoral hyperprolactinemia used cabergoline (p=0.04). There was no difference in obstetric outcomes according to the type of treatment used. The majority of women did not have any complications during pregnancy (76.3%) or intrapartum (86.8%). CONCLUSION: Regardless of the type of previous drug treatment with dopamine agonists, hyperprolactinemia does not alter obstetric outcomes.


Subject(s)
Bromocriptine , Cabergoline , Dopamine Agonists , Hyperprolactinemia , Pregnancy Complications , Pregnancy Outcome , Humans , Female , Hyperprolactinemia/drug therapy , Pregnancy , Adult , Retrospective Studies , Cabergoline/therapeutic use , Bromocriptine/therapeutic use , Dopamine Agonists/therapeutic use , Dopamine Agonists/adverse effects , Pregnancy Complications/drug therapy , Young Adult , Infant, Newborn
16.
Nutrients ; 16(21)2024 Oct 26.
Article in English | MEDLINE | ID: mdl-39519482

ABSTRACT

BACKGROUND/OBJECTIVES: To collect evidence from studies that explored the associations between serum vitamin D (25[OH]D) concentrations/status and the presence of depressive/anxiety symptoms in the ante- and/or postnatal periods (PROSPERO-CRD42023390895). METHODS: Studies that assessed serum 25[OH]D concentrations in adult women during the ante/postnatal periods and those that used valid instruments to identify the experience/severity of depressive/anxiety symptoms were included. Independent researchers performed the identification/selection of studies, data extraction, risk of bias (RoB) assessment, and bibliometric analysis steps. RESULTS: Of the total of 6769 eligible records, 15 cohort studies [high (n = 3), moderate (n = 7), and low (n = 5) RoB], nine cross-sectional studies [moderate (n = 3) and low (n = 6) RoB], and one case-control study [moderate RoB] were included (n = 25). Depression (n = 24) and anxiety (n = 4) symptoms were assessed. A significant difference in antenatal serum 25[OH]D concentrations between the groups of women with and without depression was identified (mean difference: -4.63 ng/mL; 95% confidence interval [95% CI]: -8.88; -0.38). Postnatal serum 25[OH]D concentrations were found to be, on average, -2.36 ng/mL (95% CI: -4.59; -0.14) lower in women with postnatal depression than in those without. Maternal antenatal anxiety was associated with significantly lower concentrations/deficiency of 25[OH]D in only one included study. CONCLUSIONS: Based on very low/low-quality evidence, it was observed that reduced serum 25[OH]D concentrations in the ante- and postnatal period are associated with the presence of ante- and postnatal depressive symptoms, respectively. Low/deficient antenatal serum 25[OH]D concentrations may not be related to the presence of anxiety symptoms before childbirth. Well-designed longitudinal studies are needed to explore the estimated pooled effect of these associations.


Subject(s)
Anxiety , Depression , Vitamin D , Adult , Female , Humans , Pregnancy , Anxiety/blood , Anxiety/epidemiology , Anxiety/etiology , Depression/blood , Depression/epidemiology , Depression/etiology , Depression, Postpartum/blood , Depression, Postpartum/epidemiology , Depression, Postpartum/etiology , Postpartum Period/blood , Postpartum Period/psychology , Pregnancy Complications/blood , Pregnancy Complications/epidemiology , Pregnancy Complications/etiology , Pregnancy Complications/psychology , Vitamin D/blood , Vitamin D/analogs & derivatives , Vitamin D Deficiency/blood , Vitamin D Deficiency/complications , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/psychology
17.
Nutrients ; 16(21)2024 Oct 31.
Article in English | MEDLINE | ID: mdl-39519558

ABSTRACT

BACKGROUND: More than 70% of pregnant adolescents in developing countries experience inappropriate gestational weight gain (GWG). OBJECTIVE: To determine the association of the number of antenatal care visits (ANC) with GWG, birth weight, and their differences between two countries. METHODS: A prospective study was conducted in two cohorts of adolescents, one from Mexico and one from Colombia. The study calculated pregestational body mass index (BMI), obtained GWG and birth weight, and collected socioeconomic characteristics. Birth weight was categorized according to gestational age. A total of 690 mother-child pairs were included, of which 42.6% were Colombian and 57.4% Mexican. RESULTS: The study found no association between socioeconomic characteristics and GWG or birth weight. Colombian adolescents were more likely to experience insufficient GWG (68%), compared with 36% of Mexican adolescents. Colombian adolescents who attended fewer than eight ANC visits were at increased risk of insufficient GWG, whereas Mexican adolescents were at increased risk of excessive GWG. Mexican adolescents who began their pregnancies overweight or obese were at increased risk of excessive GWG. Fewer than eight ANC visits were associated with small for gestational age (SGA) in the Mexican cohort. CONCLUSIONS: Inadequate numbers of ANC visits were associated with excessive and insufficient GWG, and SGA. Promoting ANC in adolescent pregnancy is essential to prevent suboptimal GWG and SGA. This study highlights the need for interventions targeting pregnant adolescents from low socioeconomic backgrounds, prioritizing early initiation of prenatal care (first trimester) and a drastic reduction in the high rates of cesarean sections in this group.


Subject(s)
Birth Weight , Gestational Weight Gain , Prenatal Care , Humans , Female , Colombia/epidemiology , Mexico/epidemiology , Adolescent , Pregnancy , Prenatal Care/statistics & numerical data , Prospective Studies , Pregnancy in Adolescence/statistics & numerical data , Body Mass Index , Infant, Newborn , Socioeconomic Factors , Infant, Small for Gestational Age , Mothers/statistics & numerical data , Pregnancy Complications/epidemiology , Young Adult , Male , Gestational Age , Cohort Studies
18.
Reumatol Clin (Engl Ed) ; 20(9): 490-510, 2024 Nov.
Article in English | MEDLINE | ID: mdl-39505612

ABSTRACT

Herein we present the update for the Mexican Guidelines for the Treatment of Systemic Lupus Erythematosus. It involves the participation of several experts along the country, following the GRADE system. We included aspects regarding vaccines, pregnancy and cardiovascular risk which were not presented in the previous guidelines in 2017.


Subject(s)
Lupus Erythematosus, Systemic , Lupus Erythematosus, Systemic/therapy , Humans , Mexico , Pregnancy , Female , Pregnancy Complications/therapy , Immunosuppressive Agents/therapeutic use
19.
PLoS One ; 19(11): e0309822, 2024.
Article in English | MEDLINE | ID: mdl-39495733

ABSTRACT

Electromyography is a widely used instrument in clinical practice to evaluate and treat pelvic floor disorders in pregnant and postpartum women. The objective of this study is to analyze the scientific evidence on the electromyography parameters used for treatment of pelvic floor disorders in pregnant women in any gestational week and postpartum women up to 12 months after delivery. A systematic review of randomized controlled experimental studies (clinical trials) and quasi-experimental studies in English, Portuguese or Spanish, which used electromyography as an intervention for treatment of pelvic floor disorders in pregnant or postpartum women up to 12 months after delivery will be performed in online databases (Scopus, Medline, Pedro, Scielo and Pubmed),. Risk of bias assessment will be performed using Cochrane group tools. The Rob 2.0 tool will be used for experimental studies and the Robins-I tool for non-experimental studies. The protocol was registered in PROSPERO (no.433510). The quality of the evidence will be analyzed using the GRADE System Methodological Guide and the systematic review structure will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.


Subject(s)
Electromyography , Pelvic Floor Disorders , Postpartum Period , Humans , Female , Pregnancy , Electromyography/methods , Postpartum Period/physiology , Pelvic Floor Disorders/therapy , Pelvic Floor Disorders/physiopathology , Systematic Reviews as Topic , Pelvic Floor/physiopathology , Pregnancy Complications/therapy , Pregnancy Complications/physiopathology
20.
J Bras Nefrol ; 46(4): e20240067, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-39514687

ABSTRACT

Women with chronic kidney disease are less likely to become pregnant and are more susceptible to pregnancy complications when compared to patients with normal kidney function. As a result, these are considered high-risk pregnancies, both maternal and fetal. Over the years, there has been an increase in the incidence of pregnancies in dialysis patients, and an improvement in maternal and fetal outcomes. It is believed that the optimization of obstetric and neonatal care, the adjustment of dialysis treatment (particularly the increase in the number of hours and weekly frequency of dialysis sessions), and the use of erythropoiesis-stimulating agents have provided better metabolic, volume, blood pressure, electrolyte, and anemia control. This review article aims to analyze pregnancy outcomes in chronic kidney disease patients undergoing dialysis and to review nephrological medical management in this scenario. Due to the growing interest in the subject, clinical recommendations for care practice have become more consistent in both drug and dialysis management, aspects that are addressed in this review.


Subject(s)
Pregnancy Complications , Pregnancy Outcome , Renal Dialysis , Renal Insufficiency, Chronic , Humans , Pregnancy , Female , Renal Insufficiency, Chronic/therapy , Renal Insufficiency, Chronic/complications , Pregnancy Complications/therapy
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