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.

Efficacy of vitamin D supplementation in gestational diabetes mellitus: Systematic review and meta-analysis of randomized trials.

BACKGROUND: Trials have examined on the benefits of vitamin D supplementation in pregnant women. OBJECTIVE: This review aimed to evaluate whether oral vitamin D supplements, when given to pregnant women with gestational diabetes mellitus (GDM), would improve maternal and neonatal outcomes, compared with no treatment or placebo. METHOD: We performed a systematic review following Cochrane methodology, and randomized trials were included where pregnant women with GDM received vitamin D supplementation versus placebo/no treatment or vitamin D and calcium versus placebo/no treatment. Primary outcomes were preeclampsia, preterm birth, cesarean delivery, gestational hypertension, and adverse events related to vitamin D supplementation. The search strategies were applied to the following databases: MEDLINE, Embase, LILACS, and CENTRAL. Similar outcomes in at least two trials were plotted using Review Manager 5.3 software. The quality of evidence was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: The total of 1224 references were identified, eleven trials were potentially eligible, and six were included in this review (totaling 456 women). The meta-analysis of frequency of cesarean deliveries did not show significant differences between groups, none of the trials evaluated the remaining primary outcomes. For secondary outcomes, our results suggest that vitamin D supplementation in pregnant women with GDM may reduce newborn complications such as hyperbilirubinemia, polyhydramnios (RR: 0.40, 95% CI: 0.23 to 0.68; RR: 0.17, 95% CI: 0.03 to 0.89; respectively), and the need for maternal or infant hospitalization (RR: 0.13; 95% CI: 0.02 to 0.98; RR: 0.40, 95% CI: 0.23 to 0.69). However, the evidence was of low or very low quality. CONCLUSION: We did not find moderate or high quality evidence indicating that vitamin D supplementation, when compared with placebo, improves glucose metabolism, adverse maternal and neonatal outcomes related to GDM in pregnant women.

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)

Is the risk of low birth weight or preterm labor greater when maternal stress is experienced during pregnancy? A systematic review and meta-analysis of cohort studies.

Antenatal stress is linked to fetal risks that increase the chances of neonatal complications and reduction of child cognitive ability. Therefore, we aimed to evaluate if maternal stress affects fetal, neonatal or child development. The following databases were searched: MEDLINE (1966 to May 2016), Embase (1980 to May 2016), LILACS (1982 to May 2016) and CENTRAL (1972 to May 2016). Observational studies published in English and Portuguese were included whether there was any relationship between fetal and neonatal outcome, such as birth weight, preterm labor, child development with pregnant women that were subjected to any stress type during at least one month of follow-up. Two independent reviewers screened eligible articles, extracted data and assessed the risk of bias. Thus, 8 cohort studies with about 8,271 pregnant women and 1,081,151 children proved eligible. Results suggested a significant association between antenatal stress exposure and increasing rates of low birth weight (Odds ratio (OR) 1.68 [95% Confidential Interval (CI) 1.19, 2.38]). However, there was no statistically significance difference between non-exposed and exposed groups related to preterm labor (OR 1.98 [95% CI 0.91 to 4.31]; I2 = 68%, p = 0.04). Although, results were inconsistent with primary analysis suggesting a significant association between antenatal stress exposure and the occurrence of higher rates of preterm birth (OR 1.42 [95% CI 1.05 to 1.91]; I2 = 68%, p = 0.04) in the sensitivity analysis. Furthermore, the current review has suggested that stress perceived during antenatal negatively influences fetal life and child development. Yet, further studies are necessary with adequate sample size and longer follow-up time to confirm our findings.

Is reiki or prayer effective in relieving pain during hospitalization for cesarean? A systematic review and meta-analysis of randomized controlled trials.

CONTEXT AND OBJECTIVE:: This systematic review compared reiki and prayer with drug use for relieving pain during hospitalization for cesarean, given that the popularity of integrative medicine and spiritual healing has been increasing. It had the aim of evaluating whether reiki or prayer is effective in relieving pain during cesarean section. DESIGN AND SETTING:: Systematic review with meta-analysis conducted at Botucatu Medical School, UNESP, São Paulo, Brazil. METHODS:: The following databases were searched up to March 2016: MEDLINE, Embase, LILACS and CENTRAL. Randomized controlled trials published in English or Portuguese were included in the review. Two reviewers independently screened eligible articles, extracted data and assessed the risk of bias. A GRADE table was produced to evaluate the risk of bias. RESULTS:: There was evidence with a high risk of bias showing a statistically significant decrease in pain score through use of reiki and prayer, in relation to the protocol group: mean difference = -1.68; 95% confidence interval: -1.92 to -1.43; P < 0.00001; I2 = 92%. Furthermore, there was no statistically significant difference in heart rate or systolic or diastolic blood pressure. CONCLUSION:: Evidence with a high risk of bias suggested that reiki and prayer meditation might be associated with pain reduction.

Is reiki or prayer effective in relieving pain during hospitalization for cesarean? A systematic review and meta-analysis of randomized controlled trials / O reiki ou a oração são efetivos no alívio da dor durante a internação da cesariana? Uma revisão sistemática e metanálise de ensaios clínicos randomizados

ABSTRACT CONTEXT AND OBJECTIVE: This systematic review compared reiki and prayer with drug use for relieving pain during hospitalization for cesarean, given that the popularity of integrative medicine and spiritual healing has been increasing. It had the aim of evaluating whether reiki or prayer is effective in relieving pain during cesarean section. DESIGN AND SETTING: Systematic review with meta-analysis conducted at Botucatu Medical School, UNESP, São Paulo, Brazil. METHODS: The following databases were searched up to March 2016: MEDLINE, Embase, LILACS and CENTRAL. Randomized controlled trials published in English or Portuguese were included in the review. Two reviewers independently screened eligible articles, extracted data and assessed the risk of bias. A GRADE table was produced to evaluate the risk of bias. RESULTS: There was evidence with a high risk of bias showing a statistically significant decrease in pain score through use of reiki and prayer, in relation to the protocol group: mean difference = -1.68; 95% confidence interval: -1.92 to -1.43; P < 0.00001; I2 = 92%. Furthermore, there was no statistically significant difference in heart rate or systolic or diastolic blood pressure. CONCLUSION: Evidence with a high risk of bias suggested that reiki and prayer meditation might be associated with pain reduction.

RESUMO CONTEXTO E OBJETIVO: Esta revisão sistemática comparou o reiki e a oração ao uso de medicamentos, a fim de aliviar a dor durante a internação para cesariana, visto que há um aumento na popularidade da medicina integrativa e cura espiritual. Esta revisão teve como objetivo avaliar se o reiki ou oração são eficazes no alívio da dor durante a cesariana. TIPO DE ESTUDO E LOCAL: Revisão sistemática com metanálise realizada na Faculdade de Medicina de Botucatu UNESP, São Paulo, Brasil. MÉTODOS: As seguintes bases de dados foram pesquisadas até março de 2016: MEDLINE, Embase, LILACS e CENTRAL. Nesse sentido, foram incluídos ensaios clínicos randomizados publicados em inglês e português. Dois revisores rastrearam independentemente artigos elegíveis, extraíram dados e avaliaram o risco de viés. A tabela GRADE foi realizada para avaliar o risco de viés. RESULTADOS: Evidências com alto índice de viés encontraram uma diminuição estatisticamente significativa na redução da dor (diferença média = -1,68; intervalo de confiança de 95%: -1,92 a -1,43; P < 0,00001; I2 = 92%), com o uso de reiki e oração comparado com o grupo protocolar. Além disso, não houve diferença estatisticamente significativa na frequência cardíaca, pressão arterial sistólica e diastólica. CONCLUSÃO: Evidência com alto risco de viés sugeriu que reiki e meditação oração podem ser associadas com a redução da dor.