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1.
BJOG ; 127(1): 70-78, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31571337

RESUMO

OBJECTIVE: To investigate preterm birth (PTB) phenotypes in women with different autoimmune rheumatic diseases in a large population-based cohort. DESIGN: Retrospective cohort study. SETTING: California, USA. POPULATION: All live singleton births in California between 2007 and 2011 were analysed. Patients with autoimmune disease at delivery were identified by International Classification of Diseases, Ninth Revision , Clinical Modification (ICD-9-CM), codes for systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), polymyositis/dermatomyositis (DM/PM), and juvenile idiopathic arthritis (JIA). METHODS: Maternally linked hospital and birth certificate records of 2 481 516 deliveries were assessed (SLE n = 2272, RA n = 1501, SSc n = 88, JIA n = 187, DM/PM n = 38). Multivariable Poisson regression models estimated the risk ratios (RRs) for different PTB phenotypes (relative to term deliveries) for each autoimmune disease compared with the general obstetric population, adjusting for maternal age, race/ethnicity, body mass index, smoking, education, payer, parity, and prenatal care. MAIN OUTCOME MEASURES: Preterm birth (PTB) was assessed overall (20-36 weeks of gestation) and by subphenotype: preterm prelabour rupture of membranes (PPROM), spontaneous birth, or medically indicated PTB. The risk of PTB overall and for each phenotype was partitioned by gestational age: early (20-31 weeks of gestation) and late (32-36 weeks of gestation). RESULTS: Risks for PTB were elevated for each autoimmune disease evaluated: SLE (RR 3.27, 95% CI 3.01-3.56), RA (RR 2.04, 95% CI 1.79-2.33), SSc (RR 3.74, 95% CI 2.51-5.58), JIA (RR 2.23, 95% CI 1.54-3.23), and DM/PM (RR 5.26, 95% CI 3.12-8.89). These elevated risks were observed for the majority of PTB phenotypes as well. CONCLUSIONS: Women with systemic autoimmune diseases appear to have an elevated risk of various PTB phenotypes. Therefore, preconception counselling and close monitoring during pregnancy is crucial. TWEETABLE ABSTRACT: This study found that women with systemic autoimmune diseases have an elevated risk of preterm birth phenotypes.


Assuntos
Doenças Autoimunes/epidemiologia , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Doenças Reumáticas/epidemiologia , Adulto , California/epidemiologia , Feminino , Idade Gestacional , Humanos , Paridade , Fenótipo , Pré-Eclâmpsia/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
2.
BJOG ; 127(1): 79-86, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31483927

RESUMO

OBJECTIVE: The present study aimed to analyse the Korean National Health Insurance Service (NHIS) cohort data to examine the safety of acupuncture therapy during pregnancy. DESIGN: Retrospective cohort. SETTING: Korea. POPULATION OR SAMPLE: Women with confirmed pregnancy between 2003 and 2012 from the 2002-13 NHIS sample cohort (n = 20 799). METHODS: Women with confirmed pregnancy were identified and divided into acupuncture or control group for comparison of their outcomes. Differences in other factors such as age, and rate of high-risk pregnancy and multiple pregnancy were examined. In the acupuncture group, the most frequent acupuncture diagnosis codes and the timing of treatment were also investigated. MAIN OUTCOME MEASURES: Incidence of full-term delivery, preterm delivery and stillbirth by pregnancy duration and among the high-risk and multiple pregnancy groups. RESULTS: Of 20 799 pregnant women analysed, 1030 (4.95%) and 19 749 were in the acupuncture and control groups, respectively. Both overall (odds ratio [OR] 1.23; 95% CI 0.98-1.54), and in the stratified analysis of high-risk pregnancies (OR 1.09; 95% CI 0.73-1.64), there was no significant difference between acupuncture and control groups in preterm deliveries. No stillbirths occurred in the acupuncture group and 0.035% of pregnancies resulted in stillbirths in the control group. CONCLUSION: No significant difference in delivery outcomes (preterm delivery and stillbirth) was observed between confirmed pregnancies in the acupuncture and control groups. Therefore, in pregnancy, acupuncture therapy may be a safe therapeutic modality for relieving discomfort without an adverse delivery outcome. TWEETABLE ABSTRACT: In pregnancy, acupuncture therapy may be a safe therapeutic modality for relieving discomfort without an adverse outcome.


Assuntos
Terapia por Acupuntura/efeitos adversos , Complicações na Gravidez/etiologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Adolescente , Adulto , Distribuição por Idade , Criança , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Segurança do Paciente , Gravidez , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Natimorto/epidemiologia , Adulto Jovem
3.
BJOG ; 127(1): 8-16, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31529594

RESUMO

BACKGROUND: With expanding recreational cannabis legalisation, pregnant women and their offspring are at risk of potentially harmful consequences. OBJECTIVES: To assess the prevalence of recreational cannabis use among pregnant women, health outcomes associated with prenatal recreational cannabis use, and the potential impact of recreational cannabis legalisation on this population. SEARCH STRATEGY: Five databases and the grey literature were systematically searched (2000-2019). SELECTION CRITERIA: Human studies published in English or French reporting on the prevalence of prenatal recreational cannabis use in high-income countries. DATA COLLECTION AND ANALYSIS: Data on study characteristics, prenatal substance use, and health outcomes were extracted and qualitatively synthesised. MAIN RESULTS: Forty-one publications met our inclusion criteria. The overall prevalence of prenatal cannabis use varied substantially (min-max: 0.24-22.6%), with the greatest use in the first trimester. In the three studies with temporal data available, rates of prenatal cannabis use increased across years. Only 7/41 and 5/41 studies provided information on gestational age of exposure and frequency of use, respectively. The concomitant use of alcohol, illicit drugs, and tobacco was higher among cannabis users than nonusers. Prenatal cannabis use was associated with select neonatal, but not maternal, health outcomes. There were insufficient data to compare prenatal cannabis use between the pre- and post-legalisation periods. CONCLUSION: Cannabis use among pregnant women is prevalent and may be associated with adverse neonatal outcomes. Future studies should assess the gestational age and frequency of cannabis exposure, and usage patterns prior to and following legalisation. TWEETABLE ABSTRACT: Women who consume cannabis during pregnancy could risk predisposing their newborns to poor birth outcomes.


Assuntos
Uso da Maconha/efeitos adversos , Complicações na Gravidez/etiologia , Países Desenvolvidos , Métodos Epidemiológicos , Feminino , Idade Gestacional , Humanos , Renda , Recém-Nascido de Baixo Peso , Terapia Intensiva Neonatal/estatística & dados numéricos , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Saúde Materna , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/etiologia
4.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 281-287, jan.-dez. 2020. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047844

RESUMO

Objetivo: investigar os fatores maternos e perinatais associados aos extremos da idade reprodutiva da mulher em São Luís, Maranhão. Método: trata-se de um estudo transversal, realizado em São Luís/MA, com população de 16.474 mães. Os dados foram coletados no Sinasc disponibilizado pela Secretaria Municipal. Utilizou-se o Teste Qui-quadrado de Pearson e calculou-se a Odds Ratio com nível de significância de α = 0.05. Resultados: verificou-se que as adolescentes apresentaram maior chance de nascimentos prematuros (OR=1,37; p< 0,001 mulheres com idade avançada apresentaram maior risco para baixo peso ao nascer (OR=1,22; p=0,022). Tanto as adolescentes (OR=2,09; p< 0,001) quanto as mães com idade avançada (OR=1,85; p<0,0011) possuem chances aumentadas para realizarem menos que seis consultas de pré-natal. Conclusão: os resultados perinatais, nascimento prematuro, baixo peso ao nascer e a realização de menos de seis consultas pré-natais são elevados nas gestações de adolescentes e mulheres em idade avançada


Objective: to investigate maternal and perinatal factors associated with extremes of women's reproductive age in São Luís, Maranhão. Method: this is a cross-sectional study conducted in São Luís/MA, with a population of 16,474 mothers. The data were collected in the Sinasc provided by the Municipal Health Secretariat. We used the Pearson Chi-square test and calculated the odds ratio with a significance level of α=0.05. Results: it was verified that the adolescents had a higher chance of preterm birth (OR=1.37; p<0,001); Women aged 35 years or older were at increased risk for low birth weight (OR=1.22; p=0.022). Both adolescents (OR=2.09; p<0,001) and older mothers (OR=1.85; p<0,001) have an increased chance to perform less than six prenatal visits. Conclusion: perinatal outcomes, preterm birth, low birth weight and fewer than six prenatal visits are frequent in the pregnancies of adolescents and women of advanced age


Assuntos
Humanos , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal , Idade Materna , Saúde Materno-Infantil , Fatores de Risco , Gravidez de Alto Risco , Assistência Perinatal
5.
Z Geburtshilfe Neonatol ; 223(6): 337-349, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801168

RESUMO

As far as prehospital but in part also clinical obstetrics is concerned, the acute nature of perinatal emergencies is overshadowed by limited diagnostic and therapeutic options. The need for acute and targeted intervention may result from both maternal and fetal indications. As common in emergency services for pregnant women, prehospital primary assessment and logistics management (e.g., transport time/type, choice of destination) define the prognosis. Non-specific emergencies coincident to pregnancy are to be distinguished from perinatal emergencies caused by expecting a child (hypertensive pregnancy disorders, perinatal bleeding, thrombosis, and embolism). In order to cope with rare and unpredictable emergencies, medical teams profit from standardized algorithms to support a high quality of prehospital care. Extensive information and training concepts are essential. The presented series on obstetric emergencies introduces the required knowledge and skills.


Assuntos
Emergências/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Obstetrícia , Complicações na Gravidez/epidemiologia , Descolamento Prematuro da Placenta , Criança , Embolia Amniótica , Feminino , Humanos , Parto , Placenta Prévia , Pré-Eclâmpsia , Gravidez , Tromboembolia , Inércia Uterina
6.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 833-839, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874473

RESUMO

Objective: To examine the association of pre-pregnancy obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with the risk of large for gestational age (LGA), and assess the dynamic changes in population attributable risk percent (PAR%) for having these exposures. Methods: A retrospective cohort study was conducted to collect data on pregnant women who received regular health care and delivered in Beijing Obstetrics and Gynecology Hospital from January to December in 2011, 2014 and 2017, respectively. Information including baseline characteristics, metabolic indicators during pregnancy, pregnancy complications, and pregnancy outcomes were collected. Multivariate logistic regression model was constructed to assess their association with LGA delivery. Adjusted relative risk and prevalence of these factors were used to calculate PAR%and evaluate the comprehensive risk. Results: (1)The number of participants were 11 132, 13 167 and 4 973 in 2011, 2014 and 2017, respectively. Corresponding prevalence of LGA were 15.19% (1 691/11 132), 14.98% (1 973/13 167) and 16.21% (806/4 973). No significant change in the prevalence of LGA was observed across all years investigated (all P>0.05). (2)According to results from multivariate logistic regression model, advanced maternal age, multiparity, pre-pregnancy overweight or obesity, GWG,GDM and serum triglyceride level≥1.7 mmol/L in the first trimester were associated with high risk of LGA (all P<0.05). Among these factors, pre-pregnancy overweight or obesity, excessive GWG and multiparity were common risk factors of LGA. GDM was not associated with risk of LGA in 2017 database. (3) Dynamic change of PAR% in these years were notable. PAR% of GWG for LGA decreased (32.6%, 27.2% and 22.2% in 2011, 2014 and 2017, respectively), while PAR% of pre-pregnancy overweight or obesity showed an upward trend (4.2%, 3.3% and 8.4%). In addition, PAR% of multiparity increased as well (3.5%, 6.3% and 15.9%). (4) Further analysis showed that excessive GWG in the first and second trimesters contributed the most (20.2% and 19.0% in 2014 and 2017). Conclusions: Excessive GWG, pre-pregnancy overweight or obesity and multiparity are the important risk factors what contribute to LGA. PAR% of excessive GWG for LGA decrease in recent years. However, GWG in the first and second trimesters is a critical factor of LGA. Appropriate weight management in pre-pregnancy, the first or second trimester is the key point to reduce the risk of LGA.


Assuntos
Diabetes Gestacional/epidemiologia , Macrossomia Fetal/epidemiologia , Obesidade/complicações , Peso ao Nascer , Índice de Massa Corporal , China/epidemiologia , Feminino , Macrossomia Fetal/etiologia , Idade Gestacional , Humanos , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Ganho de Peso
7.
Medicine (Baltimore) ; 98(44): e17679, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689786

RESUMO

To introduce the National Maternal Near Miss Surveillance System (NMNMSS) in detail and to report the composition of maternal near miss (MNM) in China.The NMNMSS was established by the National Health Commission at the end of 2010, covered over 400 health facilities from 30 provinces in China. The NMNMSS was designed to collect individual information for every pregnant woman admitted to obstetric department in the sampled health facilities. Cross tabulations and correlations were used to describe the distribution of population and sampled facilities in the NMNMSS, and to calculate the MNM mortality ratio for different complications and organ dysfunctions.The individual survey forms of 9,051,638 pregnant women were collected in the NMNMSS between 2012 and 2017. Compared with urban areas, there are very few well-quality medical resources in rural areas. Most women with pregnancy complications in rural areas can only be treated in Level 2 and lower hospitals. MNM in women with indirect obstetric complications received treatment more frequently in Level 3 hospital. The most common maternal complications in severe maternal outcomes (including maternal near miss and maternal death) are obstetrics hemorrhage (58.7%), hypertension disorder (28.0%), and severe anemia (20.6%). The overall MNM mortality ratio is 38:1. The MNM mortality ratios are lowest in amniotic fluid embolism, HIV/AIDS, heart disease, thrombophlebitis, and sepsis. For different organ dysfunctions, the ranks of the MNM mortality ratio from low to high are renal dysfunction, respiratory dysfunction, cardiovascular dysfunction, hepatic dysfunction, neurologic dysfunction, uterine dysfunction, coagulation dysfunction.The NMNMSS is a well-established hospital-based surveillance system for maternal complications in China. It can identify the maternal complications that need to improve health care immediately in China through a powerful longitudinal real-world evidence.


Assuntos
Near Miss/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Vigilância em Saúde Pública/métodos , China/epidemiologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos
8.
Pan Afr Med J ; 33: 306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692846

RESUMO

Introduction: An effective referral system is considered as a key to saving mothers' and children's lives. The aims of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian tertiary care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme (NPP) guidelines. Methods: A descriptive study was undertaken among women referred to Farhat Hached University Hospital in Sousse, Tunisia with antenatal complications requiring urgent delivery and those referred while in labour or with immediate post partum complications. The ICD-10 was used to code recorded indications and diagnoses for referrals. Results: Referrals represents 15.23% of the obstetric activity in this facility. There were 32 reasons for referrals with the most common being premature rupture of membranes (14.1%) and fetal distress (13.5%). A fifth of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (95.8%) did not conform to the list of referral indications of the NPP. Twenty eight diagnoses were retained after referrals: the most common of which were prolonged pregnancy (29.5%) and premature rupture of membranes (19.3%). In 41% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital. Conclusion: The current referral system in the region of Sousse still faces several challenges that need to be addressed in order to make it more effective.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Humanos , Trabalho de Parto , Guias de Prática Clínica como Assunto , Gravidez , Atenção Terciária à Saúde , Tunísia , Adulto Jovem
9.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1147-1151, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683403

RESUMO

Objective: To examine the association of pre-pregnancy body mass and weight gain during pregnancy with macrosomia. Methods: From January 2015 to December 2015, a total of 20 477 pregnant women were recruited by probabilistic proportional scale sampling with simple randomization in Sichuan, Yunnan and Guizhou Provinces. Basic information of pregnant women, weight gain during pregnancy and weight of newborn were collected. A multiple logistic regression model was used to assess the association between the pre-pregnancy body mass and gestational weight gain indicators with macrosomia. Results: 20 321 mother-infant were included in the final analysis. 20 321 pregnant women were (30.09±4.10) years old and delivered at (39.20±1.29) weeks, among which 12 341 (60.73%) cases were cesarean delivery. The birth weight of 20 321 infants were (3 292.26±431.67) grams, and 970 (4.77%) were macrosomia. The multiple logistic regression model showed that after adjusting for the age of women, compared to the normal weight group in the pre-pregnancy, the overweight and obesity group elevated the risk of macrosomia, with OR (95%CI) about 1.99 (95%CI: 1.69-2.35) and 4.05 (95%CI: 3.05-5.39), respectively. After adjusting for the age, the pre-pregnancy BMI, delivery weeks, delivery mode and infant's gender, compared to the weight-gain appropriate group, higher weight gain rate in the mid-pregnancy and excessive total gestational weight gain elevated the risk of macrosomia, with OR (95%CI) about 1.99 (95%CI: 1.66-2.39) and 1.80 (95%CI: 1.55-2.08), respectively. Conclusion: The overweight before pregnancy, obesity before pregnancy, the rate of weight gain in the second trimester and the high total weight gain during pregnancy could increase the risk of macrosomia.


Assuntos
Índice de Massa Corporal , Macrossomia Fetal/epidemiologia , Sobrepeso/epidemiologia , Ganho de Peso , Adulto , Peso ao Nascer , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Obesidade/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Segundo Trimestre da Gravidez , Fatores de Risco
10.
Afr Health Sci ; 19(2): 1924-1929, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656475

RESUMO

Background: Neanatal comploications are the commonest problems facing babies in Tanzania. An attempt has been made to investigate determinants of neonatal outcomes among postnatal women. Methods: Using a case-contrrol study design, 165 women were selected from 3 health facilities, where they had had antenatal care (ANC), labour, delivery and post natal care. Results: Chi- square test revealed that gestational age (p-value, 0.01), HIV status (p-value, 0.000) and malaria (p-value, 0.001<0.05) were significantly associated with adverse neonatal outcomes. Conclusion: The study concluded that implementation of community-based intervention is needed to ensure survival of newborns.


Assuntos
Infecções por HIV/epidemiologia , Complicações na Gravidez/epidemiologia , Natimorto/epidemiologia , Adolescente , Adulto , Anemia/epidemiologia , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Transmissão Vertical de Doença Infecciosa , Malária/epidemiologia , Idade Materna , Paridade , Cuidado Pós-Natal/organização & administração , Gravidez , Adulto Jovem
11.
Afr Health Sci ; 19(2): 1930-1937, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656476

RESUMO

Background: Stillbirth is a death before the complete expulsion or extraction from the mother. The burden is severe and high in developing countries. Risk factors for stillbirth are not yet studied in Ethiopia. Objective: To identify risk factors of stillbirth among mothers delivered in public hospitals of Central Zone Tigray, Ethiopia. Methods: A case-control study design was used. Data collection period was from January to April 2018. Study subjects 63 cases and 252 controls were selected using systematic random sampling technique from respective hospitals. The interviewer-administered questionnaire, observational, and chart analysis were used to collect the data. A binary logistic regression model was employed. Results were presented at significance level P-value <0.05. Results: Maternal hypertension [AOR=12.83; 95% CI 3.38, 48.83], low birth weight [AOR=5.6; 95% CI 2.39, 13.38], pre-term [AOR=2.6;95%CI 1.12,6.16], alcohol intake [AOR=7.56; 95% CI 1.68, 34.04], polyhydramnios [AOR=13.43; 95% CI 3.63, 49.67], and meconium stained amniotic fluid [AOR=7.88; 95% CI 1.73, 8.18] were risk factors of stillbirth. Conclusion: The risk of stillbirth is increased with increasing maternal complication like maternal hypertension, alcohol consumption, polyhydramnios, and meconium-stained amniotic fluid. The occurrence of preterm and low birth weight of the fetus had an effect on the risk of stillbirth.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Natimorto/epidemiologia , Adulto , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Mães , Poli-Hidrâmnios/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/etiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
12.
Einstein (Sao Paulo) ; 18: eAO4682, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664330

RESUMO

OBJECTIVE: To investigate the epidemiological data of hypertension in pregnant women, as well as to identify its possible associated events. METHODS: Data collection was performed at the high-risk prenatal outpatient clinic and in the maternity ward at a public hospital in the São Paulo city, during the morning and afternoon periods, from October 2015 to July 2016. A questionnaire with 22 questions prepared by the researchers was used. The margin of error was 5% and the confidence level was 95%. For the calculation, the two-proportion equality, Pearson correlation and ANOVA tests were used. RESULTS: Among the interviewees, 43% had chronic hypertension, 33.3% presented with up to 20 weeks of gestation, 23.7% presented after the 20th week of gestation, 62.3% were between 18 and 35 years of age, 78.1% had a family history of hypertension, and among those aged 36 to 45 years, 11.4% were in the first gestation, and 26.3% in the second gestation. Considering the associated conditions, diabetes prevailed with 50%; obesity with 22.2%, and the most selected foods for consumption among pregnant women, 47.5% had high energy content (processed/ultraprocessed). CONCLUSION: After an epidemiological analysis of the prevalence of hypertension, pregnant women with chronic hypertension, preexisting hypertension diagnosed during pregnancy, and hypertensive disease of pregnancy were identified. Regarding the possible factors associated with arterial hypertension, higher age, family history of hypertension, preexistence of hypertension, late pregnancies, diabetes, obesity and frequent consumption of processed/ultraprocessed foods were found.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Preferências Alimentares , Humanos , Idade Materna , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Gravidez , Gravidez em Diabéticas/epidemiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
13.
Medicine (Baltimore) ; 98(38): e17309, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568016

RESUMO

Pregnancy and inflammatory bowel disease (IBD) are independent risk factors for venous thromboembolism (VTE). Nevertheless, the optimal VTE prevention strategy for women with IBD in pregnancy and postpartum period has not been established yet. We assessed VTE risks during pregnancy and the postpartum period in women with IBD through systematic review and meta-analysis.Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Tomson Reuters) from the database inception till May 2017 to identify relevant studies reporting the risk of VTE during pregnancy and/or the postpartum period in women with IBD. Random effect meta-analyses were performed to compare VTE-related outcomes between women with IBD and without IBD. Our protocol was registered: CRD 42017060199 in the PROSPERO International prospective register of systematic reviews.In the analysis of 5 studies reviewed, IBD population (n = 17,636) had a significantly increased risk of VTE during pregnancy (pooled risk ratio (RR) 2.13, 95% confidence interval (CI) 1.66-2.73) and postpartum (RR 2.61, 95% CI 1.84-3.69), comparing to the non-IBD population (n = 11,251,778). According to the location of VTE, the risk of deep vein thrombosis increased significantly by RR of 2.74 (95% CI 1.73-4.36) during pregnancy, whilst risk increase of pulmonary embolism was not statistically significant. In the subgroup analysis, the degree of VTE risk was higher in both periods in the UC group than in the CD group, as compared to that in the non-IBD population (UC group, during pregnancy: RR 2.24, 95% CI 1.6-3.11; postpartum period: RR 2.85, 95% CI 1.79-4.52).Significantly increased risks of VTE during pregnancy were found in the women with IBD, according to the periods and type of IBD, which might support a detailed strategy regarding administration of prophylactic anticoagulants to women with IBD.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Período Pós-Parto , Complicações na Gravidez/epidemiologia , Tromboembolia Venosa/etiologia , Feminino , Humanos , Gravidez , Fatores de Risco
14.
Int J Gynaecol Obstet ; 147(3): 389-396, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31539164

RESUMO

OBJECTIVE: To assess the consistency of maternal near-miss incidence and mortality index between two definitions across 104 facilities in Tanzania and Uganda. METHODS: Based on WHO guidance, cross-sectional near-miss data were collected in Tanzania (July 2015 to October 2016) and Uganda (June 2016 to September 2017). Prepartum hemorrhage and abortion were included as additional screening events and the number of blood units transfused was recorded. Near-miss incidence and mortality index were determined by using two near-miss definitions: the WHO standard definition, and a modified definition including women receiving at least 1 unit of blood. A sensitivity analysis excluded the additional screening events. RESULTS: Near-miss incidence differed between Tanzania and Uganda (1.79 and 4.00, respectively, per 100 deliveries) when estimated by the standard definition, but was similar (5.24 and 4.94, respectively) by the modified definition. The mortality index was higher in Tanzania than in Uganda when estimated by the standard definition (8.56% vs 3.54%), but was similar by the modified definition (3.10% vs 2.89%). CONCLUSION: The modified definition provided a more consistent estimate of near-miss incidence and mortality index. Lowering the threshold for units of blood transfusion might improve comparability between settings, but more research is needed.


Assuntos
Near Miss/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Incidência , Mortalidade Materna , Pobreza , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Tanzânia/epidemiologia , Uganda/epidemiologia
15.
MMWR Morb Mortal Wkly Rep ; 68(36): 777-783, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31513558

RESUMO

Since 1999, the rate of opioid use disorder (OUD) has more than quadrupled, from 1.5 per 1,000 delivery hospitalizations to 6.5 (1), with similar increases in incidence of neonatal abstinence syndrome (NAS) observed for infants (from 2.8 per 1,000 live births to 14.4) among Medicaid-insured deliveries (2). CDC's response to the opioid crisis involves strategies to prevent opioid overdoses and related harms by building state capacity and supporting providers, health systems, and payers.* Recognizing systems gaps in provision of perinatal care and services, CDC partnered with the Association of State and Territorial Health Officials (ASTHO) to launch the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community (OMNI LC). OMNI LC supports systems change and capacity building in 12 states.† Qualitative data from participating states were analyzed to identify strategies, barriers, and facilitators for capacity building in state-defined focus areas. Most states focused on strategies to expand access to and coordination of quality services (10 of 12) or increase provider awareness and training (nine of 12). Fewer states focused on data, monitoring, and evaluation (four of 12); financing and coverage (three of 12); or ethical, legal, and social considerations (two of 12). By building capacity to strengthen health systems, state-identified strategies across all focus areas might improve the health trajectory of mothers, infants, and families affected by the U.S. opioid crisis.


Assuntos
Síndrome de Abstinência Neonatal/terapia , Transtornos Relacionados ao Uso de Opioides/terapia , Complicações na Gravidez/terapia , Efeitos Tardios da Exposição Pré-Natal/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Síndrome de Abstinência Neonatal/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Período Pós-Parto , Gravidez , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Estados Unidos/epidemiologia
16.
Bratisl Lek Listy ; 120(9): 690-694, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31475556

RESUMO

AIM: Severe acute maternal morbidity (SAMM) is a state of the woman, when she nearly died, but survived. The aim of study was to find out the exact incidence of SAMM in Slovakia, establishment of functional surveillance system and improve quality of health care. MATERIALS AND METHODS: The regular annual analyses of SAMM cases in Slovakia from January 1st 2012 to December 31st 2016. Observed SAMM included: peripartum haemorrhage, peripartum hysterectomy, uterine rupture, abnormally invasive placenta, HELLP syndrome, eclampsia, sepsis, transport to intensive care unit or anaesthesiology and non-fatal amniotic fluid embolism. RESULTS: The response rate of questionnaires was 84.8 %. The overall confirmed incidence of SAMM was 6.35/1,000 births (95% CI 6.03-6.67). The most often causes of SAMM were: peripartum haemorrhage (2.1/1,000 births), transport to intensive care unit or anaesthesiology (1.46/1,000 births), peripartum hysterectomy (0.84/1,000 births) and HELLP syndrome (0.63/1,000 births). The average age of women with SAMM was 30.3 years (14-46) and average parity was 1.16 (0-15). CONCLUSION: The incidence of SAMM and especially incidence of peripartum haemorrhage and peripartum hysterectomy in Slovakia is one of the highest in Europe. To decrease incidence and improve management and outcome of patients, regular audit of SAMM is needed (Tab. 3, Fig. 2, Ref. 30).


Assuntos
Saúde Materna/estatística & dados numéricos , Morbidade/tendências , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Hemorragia , Humanos , Histerectomia , Pessoa de Meia-Idade , Período Periparto , Placenta Acreta , Gravidez , Sepse , Eslováquia , Ruptura Uterina , Adulto Jovem
17.
Pan Afr Med J ; 33: 109, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489087

RESUMO

Introduction: "Calabar chalk" is a lead-laden pica mostly consumed by pregnant women worldwide as a remedy for morning sickness. This clay material has been shown to have lead levels of up to 40mg per kilogram. Meanwhile blood lead levels, even at doses less than 10µg/dl will be toxic to humans and even worse-off to the fetus as it crosses the placenta. We, therefore, sort to determine the prevalence of "Calabar chalk" consumption amongst pregnant women and if it translates to higher umbilical cord blood lead levels. Methods: We carried out a cross-sectional study by prospectively and consecutively enrolling 300 pregnant women from December 2014 through February 2015. A questionnaire was administered to ascertain "Calabar chalk" consumption. The levels of lead in the umbilical cord blood of 51 participants of each group of those who consumed and didn't consume "Calabar chalk" were measured by spectrometry and compared using the T-test (p<0.05). Results: The prevalence of "Calabar chalk" consumption was 43.33%. This was mostly consumed during pregnancy only (46.34%), with higher rates observed amongst primigravidas. The mean umbilical blood lead levels amongst those who consumed and those who did not consume "Calabar chalk" was 39.19µg/dl and 25.33µg/dl respectively (P=0.111). Conclusion: The prevalence of "Calabar chalk" consumption was high in the pregnant women population. The overall umbilical cord blood lead levels were extremely high in both consumers and non-consumers. We recommend health education and chelation therapy to be considered.


Assuntos
Sangue Fetal/química , Chumbo/sangue , Pica/complicações , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Camarões/epidemiologia , Estudos Transversais , Feminino , Humanos , Pica/epidemiologia , Placenta/metabolismo , Gravidez , Prevalência , Estudos Prospectivos , Adulto Jovem
18.
Pan Afr Med J ; 33: 119, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489097

RESUMO

Introduction: The prison population in low-income countries is a group vulnerable to undernutrition, particularly incarcerated women. The aim of the study is to assess the nutritional status of women in prison and to determine the social profile and prison conditions related to undernutrition. Methods: A cross-sectional study was conducted among 125 women prisoners in Antanimora prison located in the city of Antananarivo, Madagascar. All women detained for 3 months or more at the time of the survey were included in the study. Data collection was conducted in May and June 2013. A survey of women and anthropometric measurements were carried out to collect the data. Results: The proportion of undernourished female prisoners is 38.4%. Five percent of pregnant and lactating women and 44.3% of non-lactating and non-pregnant women are undernourished. The factors related to undernutrition of women prisoners are: taking two meals a day instead of three meals (p = 0.003), insufficient energy intake (p < 0.001), incarceration duration of more than 10 months (p < 0.001), absence of family visits (p = 0.013) and lack of financial assistance from family (p = 0.013). Conclusion: Improving the prisoners' diets and assistance from family both help to fight against prisoner undernutrition in prisons.


Assuntos
Ingestão de Energia/fisiologia , Desnutrição/epidemiologia , Estado Nutricional , Prisioneiros/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Dieta , Feminino , Humanos , Lactação/fisiologia , Madagáscar/epidemiologia , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/epidemiologia , Adulto Jovem
19.
Int J Gynaecol Obstet ; 147(3): 368-374, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31502667

RESUMO

OBJECTIVE: To evaluate drug use among mothers during the postpartum period after a severe pregnancy-related complication. METHODS: A retrospective cohort study of maternal morbidity including maternal near-miss and control groups conducted in a tertiary hospital in Campinas, Brazil, between July 2008 and June 2012. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess drug use during lifetime, pregnancy, and in the previous 3 months. RESULTS: Of 638 women evaluated, drug use was reported by 165 (25.8%). Alcohol was the most common substance used (n=133, 20.6%), followed by tobacco (n=85, 13.2%), and cocaine (n=15, 2.3%). The highest risk for postpartum drug use was among those using drugs during pregnancy. There were no differences between the morbidity and control groups, but there was a significant difference in the need for intervention to reduce alcohol consumption in the severe maternal morbidity group. Risk for substance abuse intervention increased three-fold in women with PTSD criteria, and all aspects of quality of life were worse among drug users. CONCLUSION: Drug use during pregnancy and maternal complications are linked to postpartum drug abuse. These women should be managed during pregnancy; postpartum follow-up requires updated guidance and must go beyond family planning.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Complicações na Gravidez/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Morbidade , Período Pós-Parto , Gravidez , Complicações na Gravidez/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/psicologia
20.
Pain Res Manag ; 2019: 6985164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31485284

RESUMO

Pregnant women with chronic pain present a unique clinical challenge for both chronic pain and obstetrical providers, and clinical guidelines do not exist. The present study describes the prevalence and management of chronic pain during pregnancy in a perinatal mood disorder clinic. A retrospective chart review of pregnant women who presented to the Women's Mental Health Program at the University of Arkansas for Medical Sciences (UAMS) for an initial evaluation from July 2013 to June 2016 was conducted to obtain demographic and medical information, including pharmacological exposures. Data are described using the mean and standard deviation for continuous data and frequency for categorical data. Pain complaints and medications are presented as counts and percentages. Differences between women with and without chronic pain were assessed by t-tests for continuous variables and chi-square analysis for categorical variables. Of the 156 pregnant women, chronic pain conditions were reported by 44 (28.2%). The most common chronic pain complaints included neck and/or back pain (34.1%) and headaches (31.8%). Of subjects with chronic pain, 95.5% were taking at least one prescription medication (mean = 2.6 ± 2.1, range of 0-10). Acetaminophen (43.2%) and opioids (43.2%) were the most common. The complexity of managing maternal benefits of treatment with the risks of fetal exposures presents a uniquely challenging clinical scenario for healthcare providers.


Assuntos
Analgésicos/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Adulto , Feminino , Humanos , Gravidez , Prevalência , Estudos Retrospectivos
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