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1.
Environ Int ; 132: 104957, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31324402

RESUMO

BACKGROUND: Introduction of an organic diet can significantly reduce exposure to some classes of pesticides in children and adults, but no long-term trials have been conducted. OBJECTIVES: To assess the effect of a long-term (24-week) organic produce intervention on pesticide exposure among pregnant women. METHODS: We recruited 20 women from the Idaho Women, Infants, and Children (WIC) program during their first trimester of pregnancy. Eligible women were nonsmokers aged 18-35 years who reported eating exclusively conventionally grown food. We randomly assigned participants to receive weekly deliveries of either organic or conventional fruits and vegetables throughout their second or third trimesters and collected weekly spot urine samples. Urine samples, which were pooled to represent monthly exposures, were analyzed for biomarkers of organophosphate (OP) and pyrethroid insecticides. RESULTS: Food diary data demonstrated that 66% of all servings of fruits and vegetables consumed by participants in the "organic produce" group were organic, compared to <3% in the "conventional produce" group. We collected an average of 23 spot samples per participant (461 samples total), which were combined to yield 116 monthly composites. 3-Phenoxybenzoic acid (3-PBA, a non-specific biomarker of several pyrethroids) was detected in 75% of the composite samples, and 3-PBA concentrations were significantly higher in samples collected from women in the conventional produce group compared to the organic produce group (0.95 vs 0.27 µg/L, p = 0.03). Another pyrethroid biomarker, trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, was detected more frequently in women in the conventional compared to the organic produce groups (16% vs 4%, p = 0.05). In contrast, we observed no statistically significant differences in detection frequency or concentrations for any of the four biomarkers of OP exposure quantified in this trial. DISCUSSION: To our knowledge, this is the first long-term organic diet intervention study, and the first to include pregnant women. These results suggest that addition of organic produce to an individual's diet, as compared to conventional produce, significantly reduces exposure to pyrethroid insecticides.


Assuntos
Exposição Ambiental , Alimentos Orgânicos , Inseticidas/urina , Exposição Materna/prevenção & controle , Organofosfatos/urina , Piretrinas/urina , Adolescente , Adulto , Benzoatos/urina , Biomarcadores/urina , Dieta , Exposição Ambiental/análise , Exposição Ambiental/prevenção & controle , Feminino , Frutas , Humanos , Estudos Longitudinais , Gravidez , Verduras , Adulto Jovem
2.
J Perinat Med ; 47(7): 765-770, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31348763

RESUMO

Background Bisphenol A (BPA) is an estrogenic, endocrine-disrupting compound widely used in the industry. It is also a ubiquitous environmental pollutant. Its presence was confirmed in human fetuses, which results from maternal exposure during pregnancy. The mechanisms behind maternal-fetal transfer, and relationships between pregnant women and fetal exposures remain unclear. The aim of this study was to assess the impact of maternal exposure to BPA on the exposure of the fetus. Methods Maternal plasma and amniotic fluid samples were collected from 52 pregnant women undergoing amniocentesis for prenatal diagnosis of chromosomal abnormalities. BPA was measured by gas chromatography-mass spectrometry (GC-MS). The permeability factor - a ratio of fetal-to-maternal BPA concentration - was used as a measure delineating the transplacental transfer of BPA. Results The median concentration of maternal plasma BPA was 8 times higher than the total BPA concentration in the amniotic fluid (8.69 ng/mL, range: 4.3 ng/mL-55.3 ng/mL vs. median 1.03 ng/mL, range: 0.3 ng/mL-10.1 ng/mL). There was no direct relationship between the levels of BPA in maternal plasma and amniotic fluid levels. The permeability factor, in turn, negatively correlated with fetal development (birth weight) (R = -0.54, P < 0.001). Conclusion Our results suggest that the risk of fetal BPA exposure depends on placental BPA permeability rather than the levels of maternal BPA plasma concentration and support general recommendations to become aware and avoid BPA-containing products.


Assuntos
Líquido Amniótico/química , Compostos Benzidrílicos , Peso ao Nascer/efeitos dos fármacos , Troca Materno-Fetal , Fenóis , Placenta , Adulto , Poluentes Ocupacionais do Ar/efeitos adversos , Poluentes Ocupacionais do Ar/sangue , Poluentes Ocupacionais do Ar/química , Compostos Benzidrílicos/efeitos adversos , Compostos Benzidrílicos/sangue , Compostos Benzidrílicos/química , Exposição Ambiental/prevenção & controle , Estrogênios não Esteroides/efeitos adversos , Estrogênios não Esteroides/sangue , Estrogênios não Esteroides/química , Feminino , Cromatografia Gasosa-Espectrometria de Massas/métodos , Humanos , Exposição Materna/prevenção & controle , Permeabilidade , Fenóis/efeitos adversos , Fenóis/sangue , Fenóis/química , Placenta/metabolismo , Placenta/fisiopatologia , Gravidez , Segundo Trimestre da Gravidez
3.
Occup Med (Lond) ; 69(6): 428-435, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31247109

RESUMO

BACKGROUND: Occupational and environmental exposures during the prenatal period may be associated with adverse pregnancy outcomes and lifelong health effects. Yet, identification and evaluation of these potential hazards is lacking in routine obstetric care. AIMS: To assess the feasibility of incorporating a self-administered occupational and environmental exposure questionnaire into obstetric clinics. METHODS: A cross-sectional survey assessed prenatal clinic patients at a public hospital who were currently employed and <20 weeks gestation. Questionnaires evaluated job characteristics, workplace and hobby exposures, protective equipment use and symptoms during pregnancy. RESULTS: Of 69 participants (96% response rate), 46% were predominantly Spanish-speaking. Primary occupations were caregiver (16%), cleaner (14%) and administrative assistant (14%). Overall, 93% were exposed to a workplace hazard, with most participants reporting physical stressors (82%) or organic solvent exposure (78%). Most women (74%) used some personal protective equipment. Nearly half (54%) reported at least one non-pregnancy symptom, and 52% were referred for follow-up with an occupational medicine practitioner. Household and hobby-related chemical exposures were common in our sample (91%). We observed moderate consistency between job task and chemical use responses: 67-99% of intentionally redundant questions were fully or partially matched. Closed- compared to open-ended activity questions identified a higher proportion of physical stressors (82% versus 12%) and cleaning product (76% versus 30%) exposures. CONCLUSIONS: A self-administered questionnaire is an effective screening tool for identifying women with occupational and hobby-related exposures during pregnancy. Consistent incorporation of exposure assessment into prenatal care can improve clinical communications and early interventions for at-risk pregnant women.


Assuntos
Poluentes Ambientais/efeitos adversos , Passatempos , Programas de Rastreamento/métodos , Exposição Materna/prevenção & controle , Exposição Ocupacional/prevenção & controle , Inquéritos e Questionários/normas , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez
5.
Basic Clin Pharmacol Toxicol ; 125 Suppl 3: 81-88, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30884144

RESUMO

Air pollution is the main urban-related environmental hazard and one of the major contributors to the global burden of disease based on its cardiovascular-respiratory impacts. In children, exposure to urban air pollution is associated, among others, with decelerated neurodevelopment early in life and increased risk of neurodevelopmental problems such as attention-deficit hyperactivity disorder, autism spectrum disorders, academic failure and the start of Alzheimer's pathogenesis. However, the evidence of the effects of air pollution on brain development is still inadequate, mainly due to the limitations in (a) characterizing brain development (most studies were based on subjective tools such as questionnaires or neuropsychological tests) and (b) air pollution exposure (most studies only used residential levels based on geographical modelling and also overlooking the variation in the mixture of air pollutants as well as the composition and hence toxicity of particulate pollutants in different settings), (c) the lack of studies during the most vulnerable stages of brain development (foetal and early life (first two years post-natally)) and (d) the lack of structural and functional imaging data underlying these effects. In mice, in utero exposure to fine particles was linked to structural brain changes and there is a need to establish the generalizability of these findings in human beings. Though scarce, current evidence in children supports the importance of the pre-natal period as a susceptible window of exposure. Two studies in schoolchildren found that pre-natal air pollution exposure might damage brain structure while exposure during childhood was not linked to any structural alteration. Another study showed that children with higher traffic-related air pollution at school had lower functional integration in key brain networks, but no changes in brain structure, possibly partly because of the time window of air pollution exposure (in utero versus childhood exposure). A key development is to discover the windows of greatest sensitivity of structural brain changes to air pollution exposure by incorporating the recent advances in non-invasive imaging to characterize natal and post-natal brain development and exploring whether and to what extend placental dysfunction could mediate such an association. Studying pre-natal life is important because effects at this time are of a potentially irreversible nature and because the largest preventive opportunities occur during these periods.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Encéfalo/embriologia , Exposição Ambiental/efeitos adversos , Transtornos do Neurodesenvolvimento/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Poluição do Ar/efeitos adversos , Poluição do Ar/prevenção & controle , Animais , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos dos fármacos , Criança , Desenvolvimento Infantil/efeitos dos fármacos , Exposição Ambiental/prevenção & controle , Monitoramento Ambiental/métodos , Monitoramento Ambiental/normas , Feminino , Humanos , Exposição Materna/efeitos adversos , Exposição Materna/prevenção & controle , Camundongos , Transtornos do Neurodesenvolvimento/induzido quimicamente , Transtornos do Neurodesenvolvimento/diagnóstico por imagem , Gravidez , Diagnóstico Pré-Natal/métodos , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/diagnóstico por imagem , Saúde da População Urbana
6.
Reprod Health ; 16(1): 11, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709402

RESUMO

BACKGROUND: Complications of exposure to second-hand smoke (SHS) are known to affect the health of pregnant women; it requires designing an educational program to reduce the exposure of pregnant women to smoke. Therefore, the purpose of this study was to design an educational program to reduce the exposure of pregnant women with the second-hand smoke of their husband. METHODS: This research-based program is designed in three phases, in the first phase of the study, the level of knowledge, attitude, and practice of men regarding SHS will be measured using a questionnaire. The questionnaire will be based on a literature review and experts opinions. In the next phase the educational program will be designed based on the results of the first phase of the study on the level of knowledge, attitude, self-efficacy, and practice of men, as well as a literature review and experts opinions, and the research team will finalize it according to priorities. To follow up the training will be sent reminders messages. Pregnant women will also be trained to protect themselves and support their husbands to quit smoking. The third phase includes the implementation of educational intervention with pretest-posttest with two intervention and control groups. DISCUSSION: The present study provides strong information and data regarding the needs and strategies for reducing the exposure to second-hand smoke in pregnant women. Therefore, designing a program, and a review article and updated evidences can lead to avoid pregnant women the exposure to second hand smoke and reducing smoking in smoker husbands. It can also reduce their medical and treatment costs. TRIAL REGISTRATION: Registration of this randomized control trial has been completed with the Iranian Registry of Clinical Trials, IRCT20180722040555N1 .


Assuntos
Educação em Saúde , Exposição Materna/prevenção & controle , Homens/psicologia , Poluição por Fumaça de Tabaco/efeitos adversos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Irã (Geográfico) , Masculino , Gravidez , Gestantes , Ensaios Clínicos Controlados Aleatórios como Assunto , Cônjuges
7.
Artigo em Inglês | MEDLINE | ID: mdl-30781450

RESUMO

Limiting exposure to environmental hazards during preconception and pregnancy is essential for preventing adverse pregnancy outcomes or developmental defects in offspring. However, the perception of environmental risk and the behavioral changes of women planning or having a pregnancy have rarely been investigated, except for a few risk factors. We thus performed a cross-sectional study of French postpartum women hospitalized in the Bordeaux University Hospital in 2017 by proposing a self-administrated survey. The main objective was to assess their level of awareness concerning a large panel of environmental hazards and modifications in their behavior during pregnancy in occupational and household environments. Among the 121 respondents, most identified the environment as a major factor for a healthy pregnancy but recognized a lack of knowledge regarding environmental risk factors. The internet, television, and magazines were their main sources of information. Most women modified some of their practices at work or home. These measures were rarely implemented in consultation with a health practitioner, which raises concerns about the relevance of the adjustments made. Our findings highlight the need to improve the quality of information available to women and to help them implement preventive measures in consultation with physicians.


Assuntos
Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Exposição Materna/prevenção & controle , Gravidez , Adulto , Estudos Transversais , Feminino , França , Humanos , Percepção , Período Pós-Parto , Fatores de Risco , Inquéritos e Questionários
8.
Environ Res ; 170: 178-186, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30583127

RESUMO

Preterm birth (PTB) is a predictor of infant mortality and later-life morbidity. Despite recent declines, PTB rates remain high in the United States. Growing research suggests a possible relationship between a mother's exposure to common air pollutants, including fine particulate matter (PM2.5), and PTB of her baby. Many policy actions to reduce exposure to common air pollutants require benefit-cost analysis (BCA), and it's possible that PTB will need to be included in BCA in the future. However, an estimate of the willingness to pay (WTP) to avoid PTB risk is not available, and a comprehensive alternative valuation of the health benefits of reducing pollutant-related PTB currently does not exist. This paper demonstrates an approach to assess potential economic benefits of reducing PTB resulting from environmental exposures when an estimate of WTP to avoid PTB risk is unavailable. We utilized a recent meta-analysis, county-level air quality data and county-level PTB prevalence data to estimate the potential health and economic benefits of a reduction in air pollution-related PTB, with PM2.5 as our case study pollutant. Using this method, a simulated nationwide 10% decrease from 2008 PM2.5 levels resulted in an estimated reduction of 5016 PTBs and benefits of at least $339 million, potentially reaching over one billion dollars when considering later-life effects of PTB.


Assuntos
Poluentes Atmosféricos , Poluição do Ar/estatística & dados numéricos , Exposição Materna/prevenção & controle , Material Particulado , Nascimento Prematuro/epidemiologia , Exposição Ambiental , Feminino , Humanos , Recém-Nascido , Exposição Materna/economia , Exposição Materna/estatística & dados numéricos , Gravidez , Estados Unidos
9.
Int Arch Occup Environ Health ; 91(8): 901-922, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30078156

RESUMO

PURPOSE: Most industrialized countries have introduced maternity protection legislation (MPL) to protect the health of pregnant workers and their unborn children from workplace exposure. This review aimed to assess this legislation's level of implementation, barriers and facilitators to it, and its expected or unexpected effects. METHODS: A realist narrative review was conducted. Keyword searches of the PubMed, CINAHL, PsycINFO, MIDIRS, Sociological abstracts and Google Scholar electronic databases were performed in March 2018. RESULTS: The 42 publications included show that the implementation of MPL is deficient in most countries. Allowing pregnant women to withdraw from work on preventive leave or sick leave is favored over workplace adaptations or worker reassignments. The publications highlight mechanisms which encourage or obstruct the enforcement of legislation at the levels of the individual, the physical and social environment, and the macrosocial context. The delay between the conception and implementation of maternity protection measures appears to be a major barrier to the efficacy of MPL. The literature also suggests that unexpected adverse effects, such as degradation in working relationships or discrimination can obstruct the implementation of protective measures. CONCLUSIONS: This study showed the need for a better implementation of MPL during pregnancy. Further research and recommendations for improvements in MPL should consider the diverse mechanisms and effects of its implementation. Barriers and adverse effects of this implementation do not only ensure a lack of information or awareness about MPL, but are also linked to contradictions between requirements to protect employment and protect pregnancy.


Assuntos
Implementação de Plano de Saúde/legislação & jurisprudência , Exposição Materna/legislação & jurisprudência , Exposição Ocupacional/legislação & jurisprudência , Saúde do Trabalhador/legislação & jurisprudência , Local de Trabalho/legislação & jurisprudência , Feminino , Humanos , Exposição Materna/prevenção & controle , Exposição Ocupacional/prevenção & controle , Gravidez , Local de Trabalho/organização & administração
10.
Trop Med Int Health ; 23(8): 841-849, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29876999

RESUMO

OBJECTIVE: To investigate the relationship between prenatal geophagy, maternal prenatal haematological indices, malaria, helminth infections and cognitive and motor development among offspring. METHODS: At least a year after delivery, 552 of 863 HIV-negative mothers with singleton births who completed a clinical trial comparing the efficacy of sulfadoxine-pyrimethamine and mefloquine during pregnancy in Allada, Benin, responded to a nutrition questionnaire including their geophagous habits during pregnancy. During the clinical trial, helminth infection, malaria, haemoglobin and ferritin concentrations were assessed at 1st and 2nd antenatal care visits (ANV) and at delivery. After the first ANV, women were administered daily iron and folic acid supplements until three what? post-delivery. Singleton children were assessed for cognitive function at age 1 year using the Mullen Scales of Early Learning. RESULTS: The prevalence of geophagy during pregnancy was 31.9%. Pregnant women reporting geophagy were more likely to be anaemic (AOR = 1.9, 95% CI [1.1, 3.4]) at their first ANV if they reported geophagy at the first trimester. Overall, prenatal geophagy was not associated with maternal haematological indices, malaria or helminth infections, but geophagy during the third trimester and throughout pregnancy was associated with poor motor function (AOR = -3.8, 95% CI [-6.9, -0.6]) and increased odds of geophagous behaviour in early childhood, respectively. CONCLUSIONS: Prenatal geophagy is not associated with haematological indices in the presence of micronutrient supplementation. However, it may be associated with poor child motor function and infant geophagy. Geophagy should be screened early in pregnancy.


Assuntos
Anemia Ferropriva/prevenção & controle , Desenvolvimento Infantil , Exposição Materna/prevenção & controle , Saúde Materna , Pica/terapia , Complicações na Gravidez/prevenção & controle , Adolescente , Adulto , Pré-Escolar , Suplementos Nutricionais , Feminino , Ácido Fólico/administração & dosagem , Humanos , Recém-Nascido , Pica/prevenção & controle , Gravidez , Solo/parasitologia , Adulto Jovem
11.
Adv Ther ; 35(7): 981-992, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29923044

RESUMO

INTRODUCTION: Nimesulide is the most prescribed non-steroidal anti-inflammatory drug in Italy, and it is currently marketed in about 50 countries worldwide. The association between the use of nimesulide in early pregnancy and the risk of birth defects was investigated in a large cohort of pregnant women from Italy. METHODS: Data were from the healthcare utilization databases of the Italian region of Lombardy. The cohort of 353,081 newborns occurring in Lombardy during the period 2005-2010 was investigated. Exposure to nimesulide during the first trimester of pregnancy, and congenital malformations detected at presentation and within 90 days after birth (outcome), were investigated. Exposure-outcome association was measured by the ratio between the prevalence of congenital malformations among users and non-users of nimesulide. Propensity score stratification was used to control for potential confounders, including maternal medical comorbidities, concomitant medications and sociodemographic characteristics. RESULTS: The 627 (0.18%) women who filled prescriptions for nimesulide in the first trimester of pregnancy had a 2.6-fold risk of having children with congenital urinary tract anomalies compared to those who did not (adjusted prevalence ratio 2.6; 95% CI 1.2-5.7). Weaker and non-significant evidence for congenital malformations as a whole was found (adjusted prevalence ratio 1.2, 95% CI 0.9-1.6). CONCLUSION: Our study suggests that the use of nimesulide in early pregnancy may result in a greater risk of having births with congenital urinary tract anomalies. FUNDING: This study was funded by grants from the Italian Ministry of the Education, University and Research ('Fondo d'Ateneo per la Ricerca' portion, year 2015).


Assuntos
Anormalidades Induzidas por Medicamentos , Exposição Materna , Sulfonamidas , Sistema Urinário/anormalidades , Anormalidades Induzidas por Medicamentos/diagnóstico , Anormalidades Induzidas por Medicamentos/epidemiologia , Anormalidades Induzidas por Medicamentos/etiologia , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Itália/epidemiologia , Exposição Materna/prevenção & controle , Exposição Materna/estatística & dados numéricos , Gravidez , Primeiro Trimestre da Gravidez/efeitos dos fármacos , Medição de Risco , Sulfonamidas/administração & dosagem , Sulfonamidas/efeitos adversos
12.
BMJ Open ; 8(6): e023532, 2018 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-29903801

RESUMO

INTRODUCTION: Like most industrialised countries, Switzerland has introduced legislation to protect the health of pregnant workers and their unborn children from workplace exposure. This legislation provides for a risk assessment, adaptations to workplaces and, if the danger is not eliminated, preventive leave (prescribed by a gynaecologist). This study's first objective is to analyse the degree to which companies, gynaecologists and midwives implement the law. Its second objective is to understand the obstacles and resources of this implementation, with a focus on how relevant stakeholders perceive protective measures and their involvement with them. METHODS AND ANALYSIS: Data will be collected using mixed methods: (1) online questionnaires for gynaecologists and midwives; telephone questionnaires with company human resources (HR) managers in the healthcare and food production sectors; (2a) case studies of 6-8 companies in each sector, including interviews with stakeholders such as women workers, HR managers and occupational health physicians; (2b) two focus groups, one involving occupational physicians and hygienists, one involving labour inspectors.Quantitative data will be analysed statistically using STATA software V.15. Qualitative data will be transcribed and thematically analysed using MaxQDA software. ETHICS AND DISSEMINATION: The Human Research Ethics Committee of the Canton Vaud (CER-VD) has certified that this research study protocol falls outside of the field of application of the Swiss Federal Act on Research Involving Humans.The publications and recommendations resulting from this study will form the starting point for future improvements to the protection of pregnant women at work and their unborn children.This study started in February 2017 and will continue until January 2020.


Assuntos
Implementação de Plano de Saúde/legislação & jurisprudência , Exposição Materna/legislação & jurisprudência , Exposição Ocupacional/legislação & jurisprudência , Saúde do Trabalhador/legislação & jurisprudência , Local de Trabalho/legislação & jurisprudência , Feminino , Grupos Focais , Pessoal de Saúde/psicologia , Implementação de Plano de Saúde/organização & administração , Recursos em Saúde , Humanos , Exposição Materna/prevenção & controle , Gravidez , Projetos de Pesquisa , Inquéritos e Questionários , Suíça , Local de Trabalho/organização & administração
13.
Sci Total Environ ; 615: 1379-1389, 2018 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-29751442

RESUMO

BACKGROUND: Portable HEPA filter air cleaners can reduce indoor fine particulate matter (PM2.5), but their use has not been adequately evaluated in high pollution settings. We assessed air cleaner effectiveness in reducing indoor residential PM2.5 and second hand smoke (SHS) exposures among non-smoking pregnant women in Ulaanbaatar, Mongolia. METHODS: We randomized 540 participants to an intervention group receiving 1 or 2 HEPA filter air cleaners or a control group receiving no air cleaners. We followed 259 intervention and 253 control participants to the end of pregnancy. We measured one-week indoor residential PM2.5 concentrations in early (~11weeks gestation) and late (~31weeks gestation) pregnancy and collected outdoor PM2.5 data from centrally-located government monitors. We assessed blood cadmium in late pregnancy. Hair nicotine was quantified in a subset (n=125) to evaluate blood cadmium as a biomarker of SHS exposure. We evaluated air cleaner effectiveness using mixed effects and multiple linear regression models and used stratified models and interaction terms to evaluate potential modifiers of effectiveness. RESULTS: The overall geometric mean (GM) one-week outdoor PM2.5 concentration was 47.9µg/m3 (95% CI: 44.6, 51.6µg/m3), with highest concentrations in winter (118.0µg/m3; 110.4, 126.2µg/m3). One-week indoor and outdoor PM2.5 concentrations were correlated (r=0.69). Indoor PM2.5 concentrations were 29% (21, 37%) lower in intervention versus control apartments, with GMs of 17.3µg/m3 (15.8, 18.8µg/m3) and 24.5µg/m3 (22.2, 27.0µg/m3), respectively. Air cleaner effectiveness was greater when air cleaners were first deployed (40%; 31, 48%) than after approximately five months of use (15%; 0, 27%). Blood cadmium concentrations were 14% (4, 23%) lower among intervention participants, likely due to reduced SHS exposure. CONCLUSIONS: Portable HEPA filter air cleaners can lower indoor PM2.5 concentrations and SHS exposures in highly polluted settings.


Assuntos
Filtros de Ar , Poluentes Atmosféricos/análise , Poluição do Ar/prevenção & controle , Exposição Materna/estatística & dados numéricos , Poluição do Ar/estatística & dados numéricos , Poluição do Ar em Ambientes Fechados , Feminino , Filtração , Humanos , Exposição Materna/prevenção & controle , Mongólia , Gravidez , Poluição por Fumaça de Tabaco/análise , Poluição por Fumaça de Tabaco/prevenção & controle , Poluição por Fumaça de Tabaco/estatística & dados numéricos
14.
J Natl Compr Canc Netw ; 16(5S): 660-662, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29784750

RESUMO

Estimates suggest that nearly 30% of patients diagnosed with chronic myeloid leukemia (CML) are aged <49 years, with approximately half being women. For many of these women, childbearing concerns are a major factor as they initiate treatment with tyrosine kinase inhibitors, which are known to be teratogenic. During her presentation at the NCCN 23rd Annual Conference, Dr. Berman identified the challenges in helping women undergoing treatment for CML who want to have children, and emphasized the importance of an individualized and multidisciplinary approach to management. In addition, she encouraged NCCN to create a pregnancy registry of this patient population to enable clinicians to collect firm data to guide clinical decision-making.


Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Fertilização In Vitro , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Anormalidades Induzidas por Medicamentos/etiologia , Feminino , Humanos , Masculino , Exposição Materna/efeitos adversos , Exposição Materna/prevenção & controle , Troca Materno-Fetal , Exposição Paterna/efeitos adversos , Gravidez , Primeiro Trimestre da Gravidez/efeitos dos fármacos , Segundo Trimestre da Gravidez/efeitos dos fármacos , Inibidores de Proteínas Quinases/administração & dosagem , Espermatozoides/efeitos dos fármacos , Fatores de Tempo
15.
S Afr Med J ; 108(5): 439-443, 2018 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-29843860

RESUMO

BACKGROUND: In African settings, where there is a high disease burden, there is a need to improve the science of documenting and analysing accurate information regarding medicine exposures in women immediately before and during pregnancy to assess the extent of use and safety in pregnant women and their unborn children. OBJECTIVES: To compare evidence of medicine use during pregnancy, as documented in paper-based clinical records (maternity case records (MCRs)) against electronic health information resources (Provincial Health Data Centre (PHDC)) and assess the level of concordance between the two as part of baseline investigations before piloting a provincial pregnancy exposure registry and birth defect surveillance system. The PHDC consolidates electronic clinical and pharmacy data. METHODS: A folder review of completed pregnancies between November 2013 and January 2016 was conducted on randomly selected MCRs from midwife-run obstetric units and a secondary maternity hospital in Cape Town, South Africa. Medication exposures in the MCR were captured and compared with a customised PHDC data extract. The type and timing of drug exposures were compared. Total exposures were compiled from all data sources. RESULTS: Two hundred and six MCRs from three facilities were sampled: 83 women had documented antiretroviral therapy (ART) exposure; all but 1 (1%) had been recorded in the PHDC extract. There was no evidence of ART use in the MCRs of 4 (5%) cases, despite evidence in the PHDC. There were imprecise drug names in the MCRs of 14 (17%) ART patients, discordant dates of onset between the MCRs and PHDC extracts in 10/83 (12%) and inaccurate medicine names and incorrect dates in 1 (1%) case each. Nine of 10 (90%) women who were administered antituberculosis medication were recorded in the PHDC extract. Ten of 21 (48%) isoniazid preventive therapy treatments appeared in the MCRs and PHDC; 9 (42%) in the PHDC only and 2 (10%) in the MCRs only. Half (n=18/36) of all antibiotic use was reflected only in the MCRs, while 13/36 (36%) appeared only in the PHDC extract. In the former cases, antibiotics used for treatment of sexually transmitted infections and urinary tract infections were dispensed from ward stock and not captured electronically. Antibiotics reflected only in the PHDC were either dispensed at a referral facility or before the first recorded antenatal clinic visit. Folic acid and iron were mostly documented in the MCR only (n=79/99 (80%) and n=107/128 (84%), respectively). However, analgesics and antihistamines more often appeared in the PHDC extract only (n=11/16 (73%) and n=5/5 (100%), respectively). CONCLUSIONS: The PHDC extract provided a better and more complete reflection of chronic drug exposures compared with the MCRs, especially when women sought care at facilities other than the antenatal care unit where they first attended, or when exposures occurred before the initial antenatal visit. The exception was antibiotics dispensed from ward stock to treat sexually transmitted and urinary tract infections.


Assuntos
Anti-Infecciosos , Bases de Dados de Produtos Farmacêuticos , Exposição Materna , Complicações Infecciosas na Gravidez/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Adulto , Anti-Infecciosos/classificação , Anti-Infecciosos/uso terapêutico , Confiabilidade dos Dados , Coleta de Dados/normas , Coleta de Dados/estatística & dados numéricos , Bases de Dados de Produtos Farmacêuticos/normas , Bases de Dados de Produtos Farmacêuticos/estatística & dados numéricos , Feminino , Humanos , Exposição Materna/prevenção & controle , Exposição Materna/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Gravidez , Complicações Infecciosas na Gravidez/classificação , Complicações Infecciosas na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Melhoria de Qualidade , África do Sul/epidemiologia
16.
Ther Drug Monit ; 40(2): 166-185, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29419722

RESUMO

Maternal substance abuse during pregnancy is a growing problem with major public health and legal concerns. In utero substance exposure may adversely affect neonatal development; pregnancy outcome; and the long-term behavioral, cognitive, and developmental abilities of the child. Also, serious legal implications are associated with substance abuse during pregnancy, including charges of child abuse and neglect that may result in the removal of the neonate from parental care and loss of custodial rights. Timely detection of in utero drug exposure is necessary for early identification and effective management of exposed newborns. Accurate identification of drug-exposed newborns relies on maternal history; clinical presentation of the newborn; and laboratory testing of biological maternal matrices (ie, urine, blood, oral fluid, sweat, hair, and breast milk), neonatal matrices (ie, urine, meconium, hair, and umbilical cord blood and tissue), and/or matrices from both the mother and neonate (ie, placenta and amniotic fluid). Evaluation of biological matrices can account for in utero exposure at various stages of gestation and approximate the period (recent versus chronic use) of substance exposure. Each matrix has its own unique advantages and limitations in terms of ease of collection, the window of gestational exposure represented, and sensitivity for different parent drug analytes and metabolites, which must be carefully considered for accurate interpretation of results. Analytical approaches to sample preparation and analysis vary based on the complexity of these biological matrices. Immunoassays are routinely used for screening, and chromatographic separation coupled to mass spectrometry detection method is commonly used for definitive (confirmatory) testing. Some laboratories use a single technology for all testing. This review provides a discussion on approaches used to detect drug-exposed newborns, biological specimens that have been studied to identify and characterize drug exposures, example analytical methods for meconium and umbilical cord tissue as well as considerations surrounding the interpretation of results. A possible algorithm for testing is also proposed.


Assuntos
Exposição Materna/prevenção & controle , Preparações Farmacêuticas/metabolismo , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Feminino , Humanos , Recém-Nascido , Gravidez
17.
Qual Life Res ; 27(4): 905-912, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29327094

RESUMO

PURPOSE: Secondhand smoke (SHS) exposure is prevalent and could damage the health of non-smokers, especially that of pregnant women (PW) and postpartum women (PPW). Nevertheless, there is no study on the impact of SHS during pregnancy on the quality of life (QOL) of PW and PPW. The study's purpose is to study the effects of exposure to SHS on the QOL of pregnant and postpartum women and health of the newborns. METHODS: Self-reports and urine tests for cotinine were used to obtain data on SSH exposure in 296 women in the second trimester of pregnancy and 106 women in the postpartum period at the Obstetrics & Gynecology Clinic located in a university hospital. The WHOQOL-BREF-THAI and the Edinburgh Postnatal Depression Scale were used to assess QOL and postpartum depression, respectively. RESULTS: Of the participants, 88.2% of PW and 62.3% of PPW reported exposure to SHS during pregnancy. Of the PPW, 5.7% had postpartum depression. PW with good QOL were less likely to have family member who smoked (p = 0.007) or to be exposed to SHS in public parks (p = 0.037) or in the household or workplace (p = 0.011). Likewise, PPW with good QOL in the psychological domain were less likely to be exposed to SHS during pregnancy, as shown in both verbal report (p = 0.010) and objective measure of urine cotinine test (p = 0.034). In addition, maternal exposure to SHS during pregnancy is associated with low birth weight and other health problems in the newborns (p < 0.05). CONCLUSIONS: Exposure to SHS during pregnancy is associated with a lower QOL and a poorer health condition in the newborns.


Assuntos
Exposição Materna/prevenção & controle , Período Pós-Parto/psicologia , Gestantes/psicologia , Qualidade de Vida/psicologia , Poluição por Fumaça de Tabaco/prevenção & controle , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Prevalência , Autorrelato , Adulto Jovem
18.
Ann Glob Health ; 84(2): 274-280, 2018 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-30873792

RESUMO

BACKGROUND: The Child-Mother binomial is potentially susceptible to the toxic effects of pollutants because some chemicals interfere with placental transfer of nutrients, thus affecting fetal development, and create an increased the risk of low birth weight, prematurity and intrauterine growth restriction. OBJECTIVE: To evaluate the impact of prenatal exposure to nitrogen oxides (NOx) on birth weight in a cohort of Mexican newborns. METHODOLOGY: We included 745 mother-child pair participants of the POSGRAD cohort study. Information on socio-demographic characteristics, obstetric history, health history and environmental exposure during pregnancy were readily available and the newborns' anthropometric measurements were obtained at delivery. Prenatal NOx exposure assessment was evaluated using a Land-Use Regression predictive models considering local monitoring from 60 sites on the State of Morelos. The association between prenatal exposure to NOx and birth weight was estimated using a multivariate linear regression models. RESULTS: The average birth weight was 3217 ± 439 g and the mean of NOx concentration was 21 ppb (Interquartile range, IQR = 6.95 ppb). After adjusting for maternal age and other confounders, a significant birthweight reduction was observed for each IQR of NOx increase (ß = -39.61 g, 95% CI: -77.00; -2.21; p = 0.04). CONCLUSIONS: Our results provides evidence that prenatal NOx exposure has a negative effect on birth weight, which may influence the growth and future development of the newborn.


Assuntos
Exposição Ambiental , Retardo do Crescimento Fetal , Exposição Materna , Óxidos de Nitrogênio/toxicidade , Nascimento Prematuro , Efeitos Tardios da Exposição Pré-Natal , Adulto , Peso ao Nascer/efeitos dos fármacos , Estudos de Coortes , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Exposição Ambiental/prevenção & controle , Feminino , Desenvolvimento Fetal/efeitos dos fármacos , Retardo do Crescimento Fetal/induzido quimicamente , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/prevenção & controle , Humanos , Recém-Nascido , Masculino , Exposição Materna/efeitos adversos , Exposição Materna/prevenção & controle , Exposição Materna/estatística & dados numéricos , México/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , Gravidez , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Medição de Risco
19.
Ann Glob Health ; 84(2): 212-224, 2018 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-30873799

RESUMO

BACKGROUND: Children are susceptible to environmental contaminants and are at risk of developing diseases, more so if the exposure begins at an early age. Epidemiological studies have postulated the hypothesis of the fetal origin of disease, which is mediated by epigenetic changes. Epigenetic marks are inheritable; they modulate the gene expression and can affect human health due to the presence of environmental factors. OBJECTIVE: This review focuses on DNA-methylation and its association with environmental-related diseases in children. METHODS: A search for studies related to DNA-methylation in children by pre- or post-natal environmental exposures was conducted, and those studies with appropriate designs and statistical analyses and evaluations of the exposure were selected. FINDINGS: Prenatal and early life environmental factors, from diet to exposure to pollutants, have been associated with epigenetic changes, specifically DNA-methylation. Thus, maternal nutrition and smoking and exposure to air particulate matter, polycyclic aromatic hydrocarbons, arsenic, heavy metals, persistent organic pollutants, and some endocrine disrupters during pregnancy have been associated with genomic and gene-specific newborns' DNA-methylation changes that have shown in some cases sex-specific patterns. In addition, these maternal factors may deregulate the placental DNA-methylation balance and could induce a fetal reprogramming and later-in-life diseases. CONCLUSIONS: Exposure to environmental pollutants during prenatal and early life can trigger epigenetic imbalances and eventually the development of diseases in children. The integration of epigenetic data should be considered in future risk assessments.


Assuntos
Saúde da Criança , Exposição Ambiental , Saúde Ambiental , Epigênese Genética , Criança , Metilação de DNA/genética , Exposição Ambiental/efeitos adversos , Exposição Ambiental/prevenção & controle , Saúde Ambiental/métodos , Saúde Ambiental/organização & administração , Feminino , Humanos , Exposição Materna/efeitos adversos , Exposição Materna/prevenção & controle , Fatores de Risco
20.
Folia Morphol (Warsz) ; 77(2): 201-209, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29064543

RESUMO

BACKGROUND: Valproic acid (VPA), one of the most important antiepileptic drugs, proved to be inevitable for epileptic pregnant women to limit the hazards of convulsions on the foetuses and mothers. Periconceptional folic acid supple-mentation was investigated to protect against several birth defects. However, its role against VPA cerebellar toxicity was not properly investigated. The present study was conducted to evaluate the protective effect of folic acid against VPA cerebellar neurotoxicity. MATERIALS AND METHODS: Twenty-four pregnant female albino rats were divided into three groups; group I (control group, did not receive any drugs), group II (given VPA at a dose of 50 mg/kg body weight once daily) and group III (given the same dose of VPA and 400 µg/kg of body weight folic acid once daily). Ten male offspring from each group were sacrificed at two ages: at 2 and 12 weeks after birth. Samples of cerebellar cortex were taken and prepared for light, electron microscopic examination, glial fibrillary acidic protein (GFAP) immunohistochemical study and histomorphometric analysis. RESULTS: The present study confirmed the neurotoxic effect of prenatal VPA on the cerebellar cortex, especially on Purkinje cells. The cells appeared shrunken, reduced in density, disorganised and surrounded by empty haloes. Nuclear damage and axon degeneration in the form of vacuolation, loss of organelles and absence of neurofilaments with myelin sheath depletion were detected. Concomitant supply of folic acid was shown to retain the normal architecture of Purkinje cells with their axons and nuclei. In many animals receiving folic acid, the thickness of all layers of the cortex increased up to that of the control groups, after being markedly reduced in VPA-treated groups. GFAP immunoreaction was also improved against the strong positive gliosis detected in VPA-treated groups. CONCLUSIONS: The present study confirmed the protective role of folic acid against the cerebellar neurotoxic effects of VPA prenatal exposure. It is recommended that folic acid supplements should be given to every epileptic pregnant mother treated with VPA. (Folia Morphol 2018; 77, 2: 201-209).


Assuntos
Anticonvulsivantes/efeitos adversos , Córtex Cerebelar/embriologia , Ácido Fólico/farmacologia , Exposição Materna , Células de Purkinje/metabolismo , Ácido Valproico/efeitos adversos , Animais , Anticonvulsivantes/farmacologia , Córtex Cerebelar/patologia , Feminino , Exposição Materna/efeitos adversos , Exposição Materna/prevenção & controle , Gravidez , Células de Purkinje/patologia , Ratos , Ratos Sprague-Dawley , Ácido Valproico/farmacologia
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