Sintomas depressivos maternos no puerpério imediato: fatores associados / Síntomas maternos de depresión en el puerperio inmediatamente posterior al parto: factores asociados / Maternal depressive symptoms during immediate postpartum: associated factors

Resumo Objetivo Investigar a prevalência e fatores de risco para sintomas depressivos maternos no puerpério imediato. Métodos Estudo transversal, realizado com 1099 puérperas. A presença de sintomas depressivos maternos foi obtida com a escala de Depressão Pós-natal de Edimburgo, aplicada no segundo dia após o parto, adotando-se como ponto de corte escore ≥10. Os dados foram coletados em Botucatu-SP, no período de janeiro a junho de 2012. Fatores associados aos sintomas depressivos foram inicialmente investigados por regressão logística múltipla e aqueles associados em nível de p<0,20 foram incluídos em modelo de regressão final, considerando-se nível crítico de significância p<0,05, com intervalo de confiança de 95%. Este estudo foi aprovado por Comitê de Ética em Pesquisa e atendeu às recomendações para pesquisas com seres humanos. Resultados A prevalência de sintomas depressivos foi de 6,7%. Uso de medicação antidepressiva na gestação, violência sofrida na gestação e cesariana associaram-se a sintomas depressivos no puerpério imediato em duas, quatro e duas vezes, respectivamente. Conclusão Especial atenção deve ser dada às mulheres usuárias de medicação antidepressiva, àquelas que sofreram violência na gestação e às que evoluíram para cesariana, visto que esses eventos foram identificados como fatores de risco de sintomas depressivos.

Resumen Objetivo Investigar la prevalencia y factores de riesgo para síntomas depresivos maternos en el período inmediatamente posterior al parto. Métodos Estudio transversal realizado con 1099 parturientas. La presencia de síntomas depresivos maternos se logró con la escala de Depresión Postnatal de Edimburgo, aplicada en el segundo día después del parto, adoptándose como punto de corte la puntuación de ≥10. Se recogieron datos en Botucatu-SP, en el período de enero a junio de 2012. Los factores asociados a los síntomas depresivos fueron investigados inicialmente por regresión logística múltiple y los asociados a nivel de p<0,20 se incluyeron en el modelo de regresión final, teniendo en cuenta el nivel crítico de significancia p<0,05 con un intervalo de confianza del 95%. Este estudio fue aprobado por el Comité de Ética en Investigación y contempló las recomendaciones para investigaciones con seres humanos. Resultados La prevalencia de síntomas depresivos fue del 6,7%. El uso de medicación antidepresiva en la gestación, violencia sufrida en la gestación y cesárea, se asociaron a síntomas depresivos en el puerperio inmediato en dos, cuatro y dos veces, respectivamente. Conclusión Se debe prestar especial atención a las mujeres usuarias de medicamentos antidepresivos, a las que han sufrido violencia durante el embarazo y a las que han tenido una cesárea, ya que estos eventos fueron identificados como factores de riesgo para síntomas depresivos.

Abstract Objective Investigate the prevalence and risk factors for maternal depressive symptoms in the immediate postpartum period. Methods Cross-sectional study, involving 1099 postpartum women. The presence of maternal depressive symptoms was measured using the Edinburgh Postnatal Depression Scale, applied on the second day after birth, adopting ≥10 as a cut-off point. The data were collected in Botucatu-SP between January and June 2012. Factors associated with the depressive symptoms were initially investigated using multiple logistic regression, and those associated at the level of p<0.20 were included in the final regression model, significance being set as p<0.05, with a 95% confidence level. This study received approval from a Research Ethics Committee and complied with the recommendations for research involving human beings. Results The prevalence of depressive symptoms amounted to 6.7%. Use of antidepressants during pregnancy, violence suffering during pregnancy and cesarean section were associated with the depressive symptoms in the immediate postpartum two, four and two times, respectively. Conclusion Women taking antidepressants, who were victims of violence during pregnancy and who gave birth through a cesarean section need particular attention, considering that these events were identified as risk factors for depressive symptoms.

Smoking during pregnancy and harm reduction in birth weight: a cross-sectional study.

BACKGROUND: Different studies have shown the advantages of abstinence from cigarette smoking during pregnancy to promote full fetal development. Given that pregnant women do not always abstain from smoking, this study aimed to analyze the effect of different intensities of smoking on birth weight of the newborn. METHODS: A cross-sectional study was adopted to explore smoking in a population of pregnant women from a medium-sized city in São Paulo state, Brazil, who gave birth between January and June of 2012. Data were collected from maternal and pediatric medical files and, where data were absent, they were collected by interview during hospitalization for delivery. For data analysis, the effect of potential confounding variables on newborn birth weight was estimated using a gamma response model. The effect of the identified confounding variables was also estimated by means of a gamma response regression model. RESULTS: The prevalence of smoking during pregnancy was 13.4% in the study population. In full-term infants, birth weight decreased as the category of cigarette number per day increased, with a significant weight reduction as of the category 6 to 10 cigarettes per day. Compared with infants born to non smoking mothers, mean birth weight was 320 g lower in infants whose mothers smoked 6 to 10 cigarettes per day and 435 g lower in infants whose mothers smoked 11 to 40 cigarettes per day during pregnancy. CONCLUSIONS: Based on the study results and the principle of harm reduction, if a pregnant woman is unable to quit smoking, she should be encouraged to reduce consumption to less than six cigarettes per day.

[Immunization coverage and associated factors of women who have recently given birth in a city in São Paulo state]. / Cobertura vacinal e fatores associados em puérperas de município paulista.

The importance of immunization among actions recommended in the prenatal period raises the possibility of protecting both the mother and the fetus against certain harmful diseases. The scope of this study was to assess the immunization coverage and associated factors of mothers whose deliveries occurred in the first half of 2012 in Botucatu, state of São Paulo. It is a cross-sectional study and data collection was performed in the two municipal maternity hospitals. Of the total births during the study period, 1318 mothers (90.3%) were included The data for the characterization of participants and their vaccination status (diphtheria, tetanus and hepatitis B) were obtained from the prenatal card, hospital records or interviews. For analysis of associated factors, the Chi-square test was used, with a 95% confidence interval and critical p of <0.05. Most of the study participants were 20 years old or more (84.4%), had seven years of schooling (69%), were monitored in prenatal care (99.2%) with seven or more appointments (88.9%). Miscarriage and infant death of 17.7% and 2.4% was recorded, respectively. Vaccination coverage was 68.4%. There was no association between sociodemographic and obstetric variables relating to prenatal care and vaccination of pregnant women.

Cobertura vacinal e fatores associados em puérperas de município paulista / Immunization coverage and associated factors of women who have recently given birth in a city in São Paulo state

Resumo A importância da imunização entre as ações preconizadas no pré-natal decorre da possibilidade de proteger a mãe e o concepto contra determinadas doenças reconhecidamente prejudiciais a ambos. O objetivo do presente estudo foi avaliar a cobertura vacinal de puérperas cujos partos ocorreram no primeiro semestre de 2012 em Botucatu/SP e fatores associados. Trata-se de estudo transversal. A coleta de dados foi realizada nas duas maternidades do município. Foram incluídas 1318 puérperas, 90,3% do total de partos ocorridos no período. Os dados para a caracterização das participantes e sobre a situação vacinal (dupla adulto e contra hepatite B) foram obtidos do cartão de pré-natal, prontuário hospitalar ou por entrevista com as mesmas. Para análise dos fatores associados utilizou-se teste Qui-quadrado, considerando-se intervalo de confiança de 95% e p crítico < 0,05. A maior parte das participantes tinha 20 anos ou mais (84,4%), até sete anos de aprovação escolar (69,0%), foi acompanhada no pré-natal (99,2%) realizando sete ou mais consultas (88,9%). Tinham história de aborto e de óbito infantil 17,7% e 2,4% das puérperas, respectivamente. A cobertura vacinal foi de 68,4%. Não houve associação entre variáveis sociodemográficas, obstétricas, relativas ao pré-natal e vacinação da gestante.

Abstract The importance of immunization among actions recommended in the prenatal period raises the possibility of protecting both the mother and the fetus against certain harmful diseases. The scope of this study was to assess the immunization coverage and associated factors of mothers whose deliveries occurred in the first half of 2012 in Botucatu, state of São Paulo. It is a cross-sectional study and data collection was performed in the two municipal maternity hospitals. Of the total births during the study period, 1318 mothers (90.3%) were included The data for the characterization of participants and their vaccination status (diphtheria, tetanus and hepatitis B) were obtained from the prenatal card, hospital records or interviews. For analysis of associated factors, the Chi-square test was used, with a 95% confidence interval and critical p of <0.05. Most of the study participants were 20 years old or more (84.4%), had seven years of schooling (69%), were monitored in prenatal care (99.2%) with seven or more appointments (88.9%). Miscarriage and infant death of 17.7% and 2.4% was recorded, respectively. Vaccination coverage was 68.4%. There was no association between sociodemographic and obstetric variables relating to prenatal care and vaccination of pregnant women.

Early and late pregnant adolescents and neonatal results: a cohort study / Adolescentes embarazadas precoces y tardías y resultados neonatales: estudio de cohorte / Gestantes adolescentes precoces e tardias e resultados neonatais: estudo de coorte

Aim: To identify the profile of precocious (under 16 years of age) and late pregnant adolescents (17-19 years) by comparing neonatal results. Method: This is a unique cohort in which potential confounders of a biological and socio-demographic nature were identified (p<0.05), with subsequent analysis of adverse neonatal results in both studied groups, using the chi-square test. Results: We identified differences in the workplace, first pregnancy, income, labor in the Unified Health System, and cohabitation with a partner. Low Apgar scores and respiratory disorders were more frequent in early adolescents. The need for resuscitation and admission to an intensive care unit did not differ between groups. Discussion: The studied adolescents revealed that they live in social risk. A relationship was found between Apgar scores and respiratory disorders in the fetuses of early adolescents. Conclusion: We suggest the need for investment to prevent pregnancy in this age group, and for prenatal care and skilled birth support, especially for precocious adolescents.

Objetivo:Identificar el perfil de las adolescentes embarazadas precoces (hasta 16 años) y tardías de (17-19 años),comparando los resultados neonatales.Métodos: Se trata de cohorte único en que fueron identificados potenciales de factores de confución de naturaleza biológica y sociodemográfica ( p<0,05), con un análisis posterior de resultados de neonatal adversos en los dos grupos estudiados, desde la prueba qui-cuadrado. Resultados: Se identificaron diferencias relativas al trabajo,del primer embarazo, ingresos,parto en el SUS y convivencia con compañero. Bajos índices de Apgar y trastornos respiratorios fueron más frecuentes en adolescentes precoces. La necesidad de reanimación e internación en la unidad de terapia intensiva no fue diferido entre los grupos. Discusión: Las adolescentes estudiadas mostraron estar en riesgo social. Se encontró una relación entre índices de Apgar y trastornos respiratorios en los conceptos de adolescentes precoces. Conclusión: Se sugieren inversiones para la prevención del embarazo en esta edad, asistencia prenatal y al parto calificado, especialmente para adolescentes precoces.

Objetivo: Identificar o perfil das gestantes adolescentes precoces (até 16 anos) e tardias (17-19 anos), comparando os resultados neonatais. Método: Trata-se de coorte única, em que foram identificados potenciais confundidores de natureza biológica e sociodemográfica (p<0,05), com posterior análise de resultados neonatais adversos nos dois grupos estudados, a partir do teste qui-quadrado. Resultados: Identificaram-se diferenças relativas ao trabalho, primigestação, renda, parto no SUS e convivência com companheiro. Baixos índices de Apgar e distúrbios respiratórios foram mais frequentes em adolescentes precoces. A necessidade de reanimação e internação em unidade de terapia intensiva não diferiu entre os grupos. Discussão: As adolescentes estudadas evidenciaram estar em risco social. Encontrou-se relação entre índices de Apgar e distúrbios respiratórios nos conceptos de adolescentes precoces. Conclusão: Sugerem-se investimentos para prevenção da gravidez nesta faixa etária, assistência pré-natal e ao parto qualificado, especialmente para adolescentes precoces.

Feelings and Perceptions of Women in the Pregnancy-Puerperal Cycle Who Survived Severe Maternal Morbidity / Sentimentos e percepções de mulheres no ciclo gravídico puerperal que sobreviveram à morbidade materna grave / Sentimientos y percepciones de mujeres en el ciclo embarazo-puerperio que sobrevivieron a una morbosidad materna grave

This study aimed to understand severe maternal morbidity from the perspective of women who experienced it. The methodological precepts of qualitative research were adopted and the Collective Subject Discourse was the methodological framework chosen. A total of 16 women who experienced severe maternal morbidity were interviewed. Results were discussed based on four themes: describing the desire and plan for having a child; acknowledging the health problem and its influence on pregnancy and on the conceptus; overcoming the initial shock postpartum, and experiencing the risk situation: desires, frustration, and overcoming. This study will contribute to qualifying nursing care, specifically acknowledging the diversity and breadth of the needs presented by women in situations of severe morbidity during the pregnancy-puerperal cycle.

Objetivou-se compreender a experiência relativa à morbidade materna grave, a partir de um grupo de mulheres que vivenciou esse problema. Adotaram-se os preceitos metodológicos da pesquisa qualitativa, sendo o Discurso do Sujeito Coletivo o referencial metodológico. Foram entrevistadas 16 mulheres que vivenciaram a morbidade materna grave. Os resultados foram discutidos a partir de quatro temas: descrevendo o desejo e o planejamento para ter um filho, percebendo seu problema de saúde, sua influência na gestação e para o concepto, passando pelo choque inicial no pós-parto e experienciando a situação de risco: desejos, frustrações e superação. Espera-se que este trabalho possa contribuir para qualificar a assistência de enfermagem, especialmente para reconhecer a diversidade e amplitude de necessidades que mulheres apresentam em situações de morbidade grave, durante o ciclo gravídico puerperal.

Se tuvo por objetivo comprender la experiencia relativa a morbosidad materna grave, a partir de un grupo de mujeres que experimentó ese problema. Se adoptaron los preceptos metodológicos de la investigación cualitativa, siendo el Discurso del Sujeto Colectivo el referencial metodológico. Fueron entrevistadas 16 mujeres que experimentaron morbosidad materna grave. Los resultados fueron discutidos a partir de cuatro temas: describiendo el deseo y la planificación para tener un hijo; percibiendo su problema de salud, su influencia en la gestación y en el concepto; pasando por el choque inicial del post-parto; y, experimentando la situación de riesgo: deseos, frustraciones y superación. Se espera que este trabajo pueda contribuir para calificar la asistencia de enfermería, especialmente reconocer la diversidad y amplitud de las necesidades que las mujeres presentan en situaciones de morbosidad grave durante el ciclo de embarazo y puerperio.

Feelings and perceptions of women in the pregnancy-puerperal cycle who survived severe maternal morbidity.

This study aimed to understand severe maternal morbidity from the perspective of women who experienced it. The methodological precepts of qualitative research were adopted and the Collective Subject Discourse was the methodological framework chosen. A total of 16 women who experienced severe maternal morbidity were interviewed. Results were discussed based on four themes: describing the desire and plan for having a child; acknowledging the health problem and its influence on pregnancy and on the conceptus; overcoming the initial shock postpartum, and experiencing the risk situation: desires, frustration, and overcoming. This study will contribute to qualifying nursing care, specifically acknowledging the diversity and breadth of the needs presented by women in situations of severe morbidity during the pregnancy-puerperal cycle.