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1.
Horm Metab Res ; 54(2): 76-83, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35130568

RESUMO

The aim of the study was to evaluate the effects of thyroperoxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) on maternal and neonatal adverse outcomes in pregnant women. A total of 296 singleton pregnant women were classified into four groups according to the thyroid auto-antibody in the first trimester. Finally, there were 97 women in TPOAb positive group (TPOAb+/TgAb-), 35 in TgAb positive group (TPOAb-/TgAb+), 85 in TPOAb and TgAb positive group (TPOAb+/TgAb+), and 79 in TPOAb and TgAb negative group (TPOAb-/TgAb-). Thyroid function, TPOAb, and TgAb were checked during pregnancy and followed up at 6 weeks, 3 months, 6 months, 9 months, and 12 months postpartum. Levothyroxine sodium tablets could be taken to maintain euthyroid antepartum. Thyroid function of women with postpartum thyroiditis (PPT) were followed up at 2 and 3 years postpartum. We observed the incidence of PPT, premature rupture of membranes (PROM), placental abruption, placenta previa, polyhydramnios, oligohydramnios, postpartum hemorrhage, preterm birth, and low birth Weight in the four groups. 19.93% of the women had PPT. The incidence of PPT in TPOAb+/TgAb-, TPOAb-/TgAb+, TPOAb+/TgAb+groups was significantly higher than that in TPOAb-/TgAb- group, respectively (16.49 vs. 6.33%, 22.86 vs. 6.33%, 35.29 vs. 6.33%, p <0.05). The incidence of PPT in TPOAb+/TgAb+group was significantly higher than that in TPOAb+/TgAb- group (35.29 vs. 16.49%, p <0.01). PPT occurred as early as 6 weeks postpartum, but mainly at 3 and 6 months postpartum in the four groups (62.50%, 75.00%, 70.00%, 80.00%). All PPT in TPOAb-/TgAb- group occurred within 6 months postpartum, while it was found at 9 months or 12 months postpartum in other three groups. There was no classical form of PPT in TPOAb-/TgAb- group, while in the other three groups, all three types (classical form, isolated thyrotoxicosis, isolated hypothyroidism) existed. At 2 years postpartum of the women with PPT, the rate of euthyroidism in TPOAb+/TgAb+group was significantly lower than that in TPOAb-/TgAb- group (p <0.05). At 3 years postpartum of the women with PPT, the rate of euthyroidism in TPOAb+/TgAb-, TPOAb-/TgAb+, and TPOAb+/TgAb+groups were significantly lower than that in TPOAb-/TgAb- group (p <0.05). The values of TPOAb and TgAb postpartum were significantly higher than those during pregnancy (p <0.05). The incidence of PROM in TPOAb+/TgAb- group was significantly higher than that in TPOAb-/TgAb- group (32.99 vs. 17.72%, p <0.05). The binary logistic regression for PPT showed that the OR value of TPOAb was 2.263 (95% CI 1.142-4.483, p=0.019). The OR value of TgAb was 3.112 (95% CI 1.700-5.697, p=0.000). In conclusion, pregnant women with positive thyroid auto-antibodies had an increased risk of PPT and a reduced rate of euthyroidism at 2 and 3 years postpartum. TPOAb is associated with the incidence of PROM. Both of TPOAb and TgAb were independent risk factors for PPT. TgAb deserves more attention when studying autoimmune thyroid disease (AITD) combined with pregnancy.


Assuntos
Hipotireoidismo , Nascimento Prematuro , Autoanticorpos , Feminino , Humanos , Hipotireoidismo/epidemiologia , Recém-Nascido , Iodeto Peroxidase , Placenta , Gravidez , Gestantes , Tireoglobulina
2.
Rev. urug. enferm ; 17(2): 1-13, dic. 2022.
Artigo em Espanhol | LILACS, BDENF - Enfermagem, BNUY | ID: biblio-1392873

RESUMO

Introducción: La noción de humanización de los cuidados en salud aparece como consecuencia del avance de las tecnologías médicas. Si bien el parto institucional generó disminución de la mor-talidad materna esto se produjo a expensas de una deshumanización de los cuidados liderada por el parto sin acompañante. Objetivo general: Implementar un modelo de asistencia humanizado en salud perinatal, en la Maternidad pública del Depto. de Rocha, Uruguay, entre los años 2014 y 2016. Objetivos específicos: generar instancias de formación a todo el equipo de la Maternidad, sensibilizar a las mujeres embarazadas y sus parejas en cuanto a los derechos reproductivos, particularmente durante el embarazo, parto y posparto, evaluar los resultados del cambio de asistencia mediante un abordaje antes-después y un estudio cualitativo de percepción de los/as actores participantes. Metodología: Se desarrolló un estudio cuasi experimental con mediciones antes y después, para evaluar los efectos de la implantación de un Programa de humanización de los cuidados en salud materna. Se utilizaron variables del SIP (Sistema informático Perinatal). Se realizó una encuesta en el puerperio para evaluar el cumplimiento del protocolo de asistencia humanizado. Se evaluó la percepción de los actores mediante entrevistas en profundidad y entrevistas grupales. Resultados: Se observa una tendencia al descenso en la proporción de cesáreas, un aumento del acompañamiento en el parto, un aumento leve del contacto piel con piel con relación a la línea de base, y de las posiciones no supinas en el parto, mejoras en el manejo del periné y un compromiso significativo de las usuarias y sus familias con la propuesta.


Introduction: The notion of humanization of health care appears as a consequence of the advancement of medical technologies. Although institutional delivery has led to a reduction in maternal mortality, this has occurred at the expense of a dehumanization of care, led by unattended childbirth. General objective: To implement a model of humanized care in perinatal health, in the public maternity hospital in the Department of Rocha, Uruguay, between 2014 and 2016. Specific objectives: Generate training opportunities for all the staff of the Maternity Hospital, raise awareness among pregnant women and their partners about reproductive rights, particularly during pregnancy, delivery and postpartum, evaluate the results of the change in care through a before and after approach and a qualitative study of the perception of the participating actors. Methodology: A quasi-experimental study with before and after measurements was developed to evaluate the effects of implementing a humanization of maternal health care program. A survey was conducted in the puerperium to assess compliance with the humanized care protocol. Stake-holder perceptions were assessed through in depth interviews and group interviews. Results: We observed a downward trend in the proportion of caesarean sections, an increase in follow-up during labor, a slight increase in skin-to-skin contact compared to baseline and in non-overlapping positions during labor, improvements in perineum management, and significant commitment to the proposal by users and their families.


Introdução: A noção de humanização da assistência médica aparece como conseqüência do avanço das tecnologias médicas. Embora o parto institucional tenha levado a uma redução da mortalidade materna, isto ocorreu às custas de uma desumanização dos cuidados, liderada pelo parto desacompanhado. Objetivo geral: implementar um modelo de atendimento humanizado em saúde perinatal, na maternidade pública do Departamento de Rocha, no Uruguai, entre 2014 e 2016. Objetivos específicos: gerar oportunidades de treinamento para toda a equipe da Maternidade Hospitalar, conscientizar as mulheres grávidas e seus parceiros sobre os direitos reprodutivos, particularmente durante a gravidez, parto e pós-parto, avaliar os resultados da mudança nos cuidados através de uma abordagem antes e depois e um estudo qualitativo da percepção dos atores participantes. Metodologia: Foi desenvolvido um estudo quase experimental com medições antes e depois para avaliar os efeitos da implementação de um programa de humanização da assistência à saúde materna. Foi realizada uma pesquisa no puerpério para avaliar a conformidade com o protocolo de cuidados humanizados. As percepções das partes interessadas foram avaliadas através de entrevistas em profundidade e entrevistas em grupo. Resultados: Observamos uma tendência de queda na proporção de cesarianas, um aumento no acompanhamento durante o trabalho, um leve aumento no contato pele a pele em relação à linha de base e em posições não superpostas durante o trabalho, melhorias na gestão do períneo e um compromisso significativo com a proposta por parte dos usuários e suas famílias.


Assuntos
Humanos , Uruguai , Gravidez , Parto Humanizado , Parto , Gestantes , Período Pós-Parto , Humanização da Assistência , Capacitação Profissional
3.
Nat Commun ; 13(1): 5190, 2022 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-36057724

RESUMO

Preliminary evidence from China and other countries has suggested that coronavirus disease 2019 (COVID-19) mitigation measures have caused a decline in preterm births, but evidence is conflicting. Utilising a national representative data of 11,714,947 pregnant women in China, we explored the immediate changes in preterm birth rates during the COVID-19 mitigation period using an interrupted-time-series analysis. We defined the period prior to February 1, 2020 as the baseline, followed by the COVID-19 mitigation stage. In the first month of the COVID-19 mitigation, a significant absolute decrease in preterm birth rates of 0.68% (95%CI:-1.10% to -0.26%) in singleton, and of 2.80% (95%CI:-4.51% to -1.09%) in multiple births was noted. This immediate decline in Wuhan was greater than that at the national level among singleton births [-2.21% (95%CI:-4.09% to -0.34% vs. -0.68%)]. Here we report an immediate impact of COVID-19 mitigation measures on preterm birth in China.


Assuntos
COVID-19 , Nascimento Prematuro , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Humanos , Recém-Nascido , Análise de Séries Temporais Interrompida , Gravidez , Gravidez Múltipla , Gestantes , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle
4.
Reprod Health ; 19(1): 189, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064560

RESUMO

BACKGROUND: The onset of mental illness such as depression and anxiety disorders in pregnancy and postpartum period is common. The coronavirus induced disease 2019 (COVID-19) pandemic and the resulting public policy responses represent an exceptional situation worldwide and there are hints for adverse psychosocial impact, hence, the study of psychological effects of the pandemic in women during hospitalization for delivery and in the postpartum period is highly relevant. METHODS: Patients who gave birth during the first wave of the COVID-19 pandemic in Germany (March to June 2020) at the Department of Obstetrics and Gynecology, University of Würzburg, Germany, were recruited at hospital admission for delivery. Biosamples were collected for analysis of SARS-CoV-2 infection and various stress hormones and interleukin-6 (IL-6). In addition to sociodemographic and medical obstetric data, survey questionnaires in relation to concerns about and fear of COVID-19, depression, stress, anxiety, loneliness, maternal self-efficacy and the mother-child bonding were administered at T1 (delivery stay) and T2 (3-6 months postpartum). RESULTS: In total, all 94 recruited patients had a moderate concern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at T1 with a significant rise at T2. This concern correlated with low to low-medium general psychosocial stress levels and stress symptoms, and the women showed a significant increase of active coping from T1 to T2. Anxiety levels were low and the Edinburgh Postnatal Depression Scale showed a medium score of 5 with a significant (T1), but only week correlation with the concerns about SARS-CoV-2. In contrast to the overall good maternal bonding without correlation to SARS-CoV-2 concern, the maternal self-efficiency correlated negatively with the obstetric impairment caused by the COVID-19 pandemic. CONCLUSION: Obstetric patients` concerns regarding SARS-CoV-2 and the accompanying pandemic increased during the course of the pandemic correlating positively with stress and depression. Of note is the increase in active coping over time and the overall good mother-child-bonding. Maternal self-efficacy was affected in part by the restrictions of the pandemic. Clinical trial registration DRKS00022506.


The global pandemic of COVID-19 (coronavirus induced disease 2019) is challenging our society in many ways. Especially pregnant women are facing extraordinary conditions and worries, like uncertain risks for mother and fetus in case of infection, restricted prenatal classes or restricted visitor regulations in hospitals. Particularly it is known that pregnancy and the postnatal period are presenting a more psychologically vulnerable time in a woman's life. Developing the GeZeCO study, we aimed to focus on the pandemic's effects on mental health of pregnant women during this time. Women giving birth in the department of obstetrics of the University Hospital Würzburg were asked to participate in the study. In total, 94 women completed several questionnaires concerning their mental health postpartum and again after 3 to 6 months. Further, we took blood samples of the women during the delivery stay and registered sociodemographic and obstetric data. Our results showed, that the women's concern relating to COVID-19, as well as the level of depression and anxiety raised during the pandemic. In addition, the self-efficacy of the mothers was affected by the restriction measures. Despite this, the women had at large a good mother­child-bonding and their competence of active coping increased during time. In summary, we did find that the mental health of obstetric patients is impaired by the COVID-19 pandemic. This points out the importance of not only attending to physical health but also taking care of psychological stress and mental health problems of obstetric patients during this exceptional time.


Assuntos
COVID-19 , Gestantes , COVID-19/epidemiologia , Feminino , Humanos , Pandemias , Parto , Gravidez , Gestantes/psicologia , SARS-CoV-2
5.
World J Microbiol Biotechnol ; 38(12): 219, 2022 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-36070101

RESUMO

Enterococcus bacteria are studied in various sectors including fermentation, food and dairy industries,as well as studied for their probiotic properties but have limited use due to their possible pathogenic behavior. The present report talks about the metabolites produced, by the previously isolated Enterococcus strain, E.villorum SB2 (accession number KX830968), from the vaginal source. The growth of the bacteria in three types of media (M17, MRS and LAPTg) was compared, where the M17 media gave better bacterial colonies, also maximum growth rate was observed in M17 media (Td = 1.6 h & k = 0.4 h-1), and thus was selected as the metabolite production media. Further, the studied bacteria did not show any hemolytic activity, making it safe for industrial applications. The HR-LCMS results showed the production of various amino acids, organic acids, peptides, and other metabolites like flavonoids (Quercetin 3-O-Manoglucoside), terpenoids (7',8',Dihydro-8'-hydroxycitraniaxanthin, O-Methylganoderic acid O, Thalicsessine, Austinol, Valdiate), indole derivatives produced by tryptophan metabolism (5-hydroxykynurenamine, 2S,4R)-4-(9H-Pyrido[3,4-b]indol-1-yl)-1,2,4-butanetriol, Indoleacrylic acid), antimicrobial compounds (Fortimicin A) and fatty acids (Stearic acid, Myristic acid), which were earlier unreported form Enterococcus species opening new scope for discovering new industrial applications of the strain. As the studied bacteria has been reported to be a potential probiotic, the detection of these industrially important metabolites can be studied further in future studies to reveal the potential industrial applications of the strain.


Assuntos
Enterococcus , Gestantes , Bactérias/metabolismo , Feminino , Humanos , Gravidez , Vagina/microbiologia
6.
Biomed Res Int ; 2022: 1395238, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36072475

RESUMO

Background: Viral hepatitis are considered as the cause of solemn health problem for the human kind, particularly among pregnant women in the 21th century. Therefore, this study is aimed at determining the seroprevalence of HBV and HCV infection among pregnant women attending at Borumeda General Hospital, Dessie, Northeast Ethiopia. Methods: An institution-based cross-sectional study was conducted at Borumeda General Hospital from April to May, 2020. A consecutive total of 124 pregnant women who were attending at the antenatal clinic (ANC) of the hospital were included. A structured questionnaire was used to assess the associated factors and some sociodemographic characteristics. Five milliliters of venous blood was collected from each study participant, and a laboratory test using a rapid HBsAg and anti-HCV kit was done. The data were analyzed using SPSS software version 22. Results: The mean age of the study subjects was 25.81 (±5.967) years. The overall seroprevalence of either HBV or HCV infections among the study participants was 14 (11.3%). HBsAg and anti-HCV were positive among 10 (8.1%) and 4 (3.2%) study participants, respectively. There was no coinfection result between HBV and HCV among pregnant women. Pregnant women who had abortion history [AOR 5.723; 95% CI 1.100-29.785, P value = 0.038] and hospitalization history with IV medication [AOR 6.939; 95% CI 1.017-47.322, P value = 0.048] exhibited statistically significant association with HBV infection. Conclusions: Seroprevalence of HBV and HCV infections among pregnant women was high, and the rate of HBV particularly can be considered in the high endemic category of the WHO classification scheme. Continuous screening of pregnant mothers, provision of hepatitis B vaccine for females at the child-bearing age, and health education to create awareness about HBV and HCV should be implemented.


Assuntos
Hepatite B , Complicações Infecciosas na Gravidez , Adulto , Instituições de Assistência Ambulatorial , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hepatite B/complicações , Antígenos de Superfície da Hepatite B , Anticorpos Anti-Hepatite C , Hospitais Gerais , Humanos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Gestantes , Fatores de Risco , Estudos Soroepidemiológicos , Adulto Jovem
7.
Comput Intell Neurosci ; 2022: 1228006, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36072747

RESUMO

Objective: The objective is to evaluate the analgesic, labor, and prognostic effects of patient-controlled epidural analgesia (PCEA) versus sufentanil in conjunction with ropivacaine in normal labor. Methods: Sixty pregnant women who had a normal delivery at our hospital between February 2019 and April 2021 were included. Pregnant women were arbitrarily assigned to a control group and a research group. Pregnant women in the control group received lidocaine analgesia and PCEA with sufentanil combined with ropivacaine in the research group. Satisfaction with care, fetal umbilical artery blood flow, VAS score, labor and bleeding, neonatal Apgar score and incidence of adverse events were analyzed. Results: First, we made a comparison of satisfactory performance of nursing care. The satisfaction rate of the research group was 100.00%, compared to 83.33% for the control group. Nursing satisfaction was higher in the research group, and the difference was statistically significant (P < 0.05). Following analgesia, PI, RI, and S/D values of umbilical artery blood flow were lower in the research group than those in the control group, but the difference was not statistically significant (P > 0.05). The VAS scores at 10 min, 20 min, and 30 min were found to be lower in the research group than in the control group after analgesia, and the difference was statistically significant (P < 0.05). Bleeding was significantly lower in the research group for all stages of labor, and the difference was statistically significant (P < 0.05). Apgar scores at 1 minute, 5 minutes, and 10 minutes postpartum were greater in the research group than in the control group, and the difference was statistically significant (P < 0.05). As a final note, the incidence of pruritus, hypotension, respiratory depression, nausea, and vomiting was found to be lower in the research group than in the control group, and the difference was statistically significant (P < 0.05). Conclusion: PCEA with sufentanil coupled with ropivacaine was used to perform labor analgesia. With significant reduction in maternal pain and assurance of labor, ropivacaine combined with sufentanil epidural labor analgesia did not reduce fetal umbilical artery blood flow without extended labor. It could not affect the labor process or the safety of the fetus, which is safe for the mother and fetus.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Amidas/efeitos adversos , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Feminino , Humanos , Recém-Nascido , Gravidez , Gestantes , Estudos Retrospectivos , Ropivacaina/efeitos adversos , Sufentanil/efeitos adversos
8.
BMC Pregnancy Childbirth ; 22(1): 675, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36056301

RESUMO

BACKGROUND: Though Ethiopia has expanded Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, the utilization rate is low. To maximize the use of MWH, policymakers must be aware of the barriers and benefits of using MWH. This review aimed to describe the evidence on the barriers and benefits to access and use of MWHs in Ethiopia. METHODS: Data were sourced from PubMed, Google Scholars and Dimensions. Thirty-one studies were identified as the best evidence for inclusion in this review. We adopted an integrative review process based on the five-stage process proposed by Whittemore and Knafl. RESULTS: The key themes identified were the benefits, barriers and enablers of MWH utilization with 10 sub-themes. The themes about benefits of MWHs were lower incidence rate of perinatal death and complications, the low incidence rate of maternal complications and death, and good access to maternal health care. The themes associated with barriers to staying at MWH were distance, transportation, financial costs (higher out-of-pocket payments), the physical aspects of MWHs, cultural constraints and lack of awareness regarding MWHs, women's perceptions of the quality of care at MWHs, and poor provider interaction to women staying at MWH. Enablers to pregnant women to stay at MWHs were availability of MWHs which are attached with obstetric services with quality and compassionate care. CONCLUSION: This study synthesized research evidence on MWH implementation, aiming to identify benefits, barriers, and enablers for MWH implementation in Ethiopia. Despite the limited and variable evidence, the implementation of the MWH strategy is an appropriate strategy to improve access to skilled birth attendance in rural Ethiopia.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde Materna , Etiópia , Feminino , Humanos , Parto , Gravidez , Gestantes , População Rural
9.
Front Public Health ; 10: 923161, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36045739

RESUMO

Background: Gestational hypertension (GH) is a common disease that seriously threatens the safety and health of pregnant women and their newborns. Physical exercise (PE) is widely recognized as a health maintenance method and it has numerous benefits. Studies on the association between PE and the risk of GH in obese and overweight pregnant women have generated controversial findings. This updated meta-analysis was performed to reassess the effects of PE on GH. Methods: The articles from inception to April 2022, presenting studies investigating exercise intervention and pregnancy outcomes were explored across several online databases. Heterogeneity among the included studies was estimated and tested by Q test and I 2 statistic. Risk ratios (RRs) and 95% confidence intervals (CI) were calculated through either random-effect or fixed-effect models. Subgroup analyses, sensitivity analyses, and publication bias diagnoses were also conducted. Results: Twelve with 1,649 subjects were included. PE was associated with a reduced risk of GH in obese and overweight pregnant women (Pooled RR = 0.58, 95% CI = 0.42-0.81, P = 0.001; I 2 = 24.3%). Subgroup analysis found significant trends amongst Eastern countries (RR = 0.59, 95% CI = 0.36-0.96, P = 0.033). Sensitivity analysis suggested the results were stable. No publication bias was detected based on Begg's test and Egger's test. Conclusion: PE was associated with reduced risk of GH in obese and overweight pregnant women, especially in Eastern countries. More well-designed studies are still needed to further elaborate on these associations. Systematic review registration: CRD42022326183.


Assuntos
Hipertensão Induzida pela Gravidez , Sobrepeso , Exercício Físico , Feminino , Humanos , Recém-Nascido , Obesidade/complicações , Sobrepeso/terapia , Gravidez , Gestantes
10.
Infect Dis Obstet Gynecol ; 2022: 8061112, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36046178

RESUMO

Background: Vertical transmission of several viruses during pregnancy has been shown to cause adverse fetal outcomes. The question about the possibility of a similar outcome in association with SARS-CoV-2 has been raised in recently published articles. Indeed, the rate of transmission through the placenta to the fetus reported in women with COVID-19 has been shown to form a minority. The aim of this study was to explore the possible histopathological changes in the placenta of pregnant women with COVID-19 after delivery and those changes in the umbilical cord. Methods: A case-control study including a total of 50 full-term pregnant women with COVID-19 and 60 control pregnant females. Histopathological evaluation of placental tissues and umbilical cords were reported. Results: The main findings in the umbilical cord were increased thickness of vessels, thrombus formation, endothelins, and narrow lumen; except for the increased thickness of blood vessels, these findings were more frequently seen in women with COVID-19, in comparison with control women in a significant manner (p < 0.05). Increased thickness of blood vessels was more significantly observed in the control group compared to the COVID-19 group (p < 0.01). Findings of the placenta included avascular villi, fibrin, thrombosis, and meconium macrophage in various combinations. Except for fibrin as the sole findings, all other findings including combinations were more frequently encountered in the study group in comparison to the control group (p < 0.05). Conclusion: Pregnant women with COVID-19 have significant pathological alterations in the placenta and umbilical cord. These findings reflect the capability of SARS-CoV-2 in causing immunological reactions to the placenta, either directly or indirectly, and these pathologies may be linked to the higher rate of adverse neonatal outcomes and maternal admission to the intensive care unit.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Estudos de Casos e Controles , Feminino , Fibrina , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Placenta/patologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Gestantes , SARS-CoV-2
11.
BMC Infect Dis ; 22(1): 719, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36050648

RESUMO

BACKGROUND: Oral daily preexposure prophylaxis (PrEP) using emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) is recommended as standard of care for prevention in individuals at high risk for HIV infection, including pregnant and postpartum cisgender women. FTC/TDF is also active against hepatitis B virus (HBV); however, concern has been raised that providing PrEP to individuals infected with HBV could lead to hepatitis flares and liver injury, especially in the setting of suboptimal PrEP use. METHODS: We conducted a cross-sectional analysis of baseline data from the PrEP in pregnant and postpartum women (PrEP-PP) cohort study from February 2020-March 2022 in one antenatal care clinic in Cape Town, South Africa (SA) to evaluate: (1) the field performance of a point of care test (POCT) (Determine II, Abbott Inc., Japan) for diagnosis of hepatitis B surface antigen (HBsAg) in a maternity setting, (2) the prevalence of HBV in a cohort of pregnant women not living with HIV. RESULTS: We enrolled 1194 HIV sero-negative pregnant women at their first antenatal visit. Median age was 26 years (IQR = 22-31 years); 52% were born before 1995 (before universal HBV vaccination had started in South Africa). Median gestational age was 22 weeks (IQR = 16-30 weeks). There were 8 POCT and laboratory confirmed HBV cases among 1194 women. The overall prevalence of 0.67% (95% CI = 0.34-1.32%). In women born before 1995, 8 of 622 women were diagnosed with HBsAg; the prevalence was 1.29% (95% CI = 0.65-2.52%), and in women born in 1995 or after (n = 572); the prevalence was 0% (95% CI = 0.0-0.67%). We confirmed the test results in 99.8% of the rapid HBsAg (Determine II). Sensitivity was 100% (95% CI = 68-100%). Specificity was 100% (95% CI = 99.67-100%). CONCLUSION: The prevalence of HBV was very low in pregnant women not living with HIV and was only in women born before the HBV vaccine was included in the Expanded Program of Immunization. The Determine II POCT HBsAg showed excellent performance against the laboratory assay. HBV screening should not be a barrier to starting PrEP in the context of high HIV risk communities.


Assuntos
Infecções por HIV , Hepatite B , Profilaxia Pré-Exposição , Adulto , Estudos de Coortes , Estudos Transversais , Emtricitabina , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Antígenos de Superfície da Hepatite B , Vírus da Hepatite B , Humanos , Lactente , Gravidez , Gestantes , Prevalência , África do Sul/epidemiologia , Tenofovir/uso terapêutico
12.
Trop Med Int Health ; 27(9): 803-814, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36053884

RESUMO

OBJECTIVES: First, to describe the implementation process, benefits and challenges of a multidisciplinary service for pregnant women with cardiac disease in Namibia. Second, to assess pregnancy outcomes in this population. METHODS: In a tertiary hospital in Namibia, a multidisciplinary service was implemented by staff of obstetric and cardiology departments and included preconception counselling, provision of antenatal care and reliable contraception. Management guidelines developed for high-income settings were used, since no locally adapted guidelines were available. A cohort study was performed to assess cardiac, obstetric and fetal outcomes. Included were pregnant women with cardiac disease, referred to this service between 1 August 2016 and 31 July 2018. RESULTS: Important benefits of this service were the integrated approach, improved access to reliable contraception and insight into drivers of poor outcome. Several challenges with use of available guidelines were encountered, as contextual factors specific to lower-income settings were not taken into consideration, such as higher rates of infection or barriers to access care. The cohort consisted of 65 women. Cardiac disease was diagnosed for the first time in 16 (24.6%) women, of whom 11 had pre-existing cardiac disease. These women presented more often with heart failure than women with known heart disease (75.0% vs. 6.1%, RR 12.5, 95% CI 3.9-38.0). Five women died. Cardiac events occurred in twenty-two women of whom eight developed thromboembolic events and two endocarditis. The majority had no indication for prophylaxis, based on available guidelines. Fetal events occurred in 36 pregnancies. After pregnancy more than half of women (35/65, 53.8%) were using long-acting reversible contraception. CONCLUSIONS: Despite several barriers, it was possible to implement a multidisciplinary service in a high-burden setting. Cardiac and fetal event rates in this cohort were high. To improve outcomes the focus should be on availability of context-specific guidelines and better detection of cardiac disease.


Assuntos
Cardiopatias , Serviços de Saúde Materna , Estudos de Coortes , Feminino , Cardiopatias/terapia , Humanos , Masculino , Namíbia/epidemiologia , Gravidez , Resultado da Gravidez , Gestantes
13.
Trials ; 23(1): 763, 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36076211

RESUMO

BACKGROUND: Anaemia in pregnancy is highly prevalent in African countries. High-dose oral iron is the current recommended treatment for pregnancy-related iron deficiency anaemia (IDA) in Nigeria and other African countries. This oral regimen is often poorly tolerated and has several side effects. Parenteral iron preparations are now available for the treatment of IDA in pregnancy but not widely used in Africa. The IVON trial is investigating the comparative effectiveness and safety of intravenous ferric carboxymaltose versus oral ferrous sulphate standard-of-care for pregnancy-related IDA in Nigeria. We will also measure the implementation outcomes of acceptability, feasibility, fidelity, and cost-effectiveness for intravenous ferric carboxymaltose. METHODS: This is an open-label randomised controlled trial with a hybrid type 1 effectiveness-implementation design, conducted at 10 health facilities in Kano (Northern) and Lagos (Southern) states in Nigeria. A total of 1056 pregnant women at 20-32 weeks' gestational age with moderate or severe anaemia (Hb < 10g/dl) will be randomised 1:1 into two groups. The interventional treatment is one 1000-mg dose of intravenous ferric carboxymaltose at enrolment; the control treatment is thrice daily oral ferrous sulphate (195 mg elemental iron daily), from enrolment till 6 weeks postpartum. Primary outcome measures are (1) the prevalence of maternal anaemia at 36 weeks and (2) infant preterm birth (<37 weeks' gestation) and will be analysed by intention-to-treat. Maternal full blood count and iron panel will be assayed at 4 weeks post-enrolment, 36 weeks' gestation, delivery, and 6 weeks postpartum. Implementation outcomes of acceptability, feasibility, fidelity, and cost will be assessed with structured questionnaires, key informant interviews, and focus group discussions. DISCUSSION: The IVON trial could provide both effectiveness and implementation evidence to guide policy for integration and uptake of intravenous iron for treating anaemia in pregnancy in Nigeria and similar resource-limited, high-burden settings. If found effective, further studies exploring different intravenous iron doses are planned. TRIAL REGISTRATION: ISRCTN registry ISRCTN63484804 . Registered on 10 December 2020 Clinicaltrials.gov NCT04976179 . Registered on 26 July 2021 The current protocol version is version 2.1 (080/080/2021).


Assuntos
Anemia Ferropriva , Anemia , Deficiências de Ferro , Nascimento Prematuro , Anemia/diagnóstico , Anemia/tratamento farmacológico , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/tratamento farmacológico , Feminino , Compostos Férricos/efeitos adversos , Humanos , Recém-Nascido , Ferro , Nigéria/epidemiologia , Gravidez , Gestantes , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
BMJ Open ; 12(9): e058883, 2022 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-36115665

RESUMO

INTRODUCTION: A growing number of international studies have highlighted the adverse consequences of lived experience in the first thousand days of pregnancy and early life on the probability of stillbirth, child mortality, inadequate growth and healthy development during both childhood and adulthood. The lived experience of the fetus inside the womb and at the birth is strongly related to both maternal health during pregnancy and maternal exposure to a set of environmental factors known as 'exposome' characteristics, which include environmental exposure, health behaviours, living conditions, neighbourhood characteristics and socioeconomic profile. The aim of our project is to explore the relationships between exposome characteristics and the health status of pregnant women and their newborns. We are particularly interested in studying the relationships between the social inequality of adverse pregnancy outcomes and (1) short-term exposure to atmospheric pollution (MobiFem project) and (2) pregnancy lifestyle (EnviFem project). METHODS AND ANALYSIS: Ours is a prospective, observational and multisite cohort study of pregnant women, involving one teaching hospital across two sites in the Strasbourg metropolitan area.The research team at University Hospital of Strasbourg (HUS) Health collects data on outcomes and individual characteristics from pregnancy registries, clinical records data and questionnaires administered via email to study participants. Recruitment began in February 2021 and will be complete by December 2021. Participants are recruited from first trimester antenatal ultrasound examinations (conducted on weekdays across both sites); each woman meeting our inclusion criteria enters the cohort at the end of her first trimester. Study participants receive a total of three online questionnaires covering sociodemographic characteristics, travel behaviour patterns and lifestyle. Participants complete these questionnaires at recruitment, during the second and third trimester. The level of personal exposure to air pollution is characterised using a dynamic spatiotemporal trajectory model that describes the main daily movements of pregnant women and the time spent in each place frequented. Univariate, multilevel and Bayesian model will be used to investigate the relationships between exposome characteristics and the health status of pregnant women and their newborns. ETHICS AND DISSEMINATION: Our research was approved by the Commission de Protection des Personnes (CPP) Ile de France VI (Paris) on 9 December 2020 (File reference No. 20.09.15.41703 ID RCB: 2020-A02580-39 and No. 20 080-42137 IDRCB 2020-A02581-38). The Agence Nationale de Sécurité du Médicament was informed of it on 15 December 2020. Findings from the study will be disseminated through publications and international conferences and through presentation at meetings with local stakeholders, researchers and policy-makers. TRIAL REGISTRATION NUMBERS: NCT04705272, NCT04725734.


Assuntos
Exposição Ambiental , Gestantes , Adulto , Teorema de Bayes , Criança , Estudos de Coortes , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Recém-Nascido , Estilo de Vida , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos
15.
BMJ Open ; 12(9): e066382, 2022 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-36115679

RESUMO

INTRODUCTION: Maternal sepsis remains a leading cause of death in pregnancy. Physiological adaptations to pregnancy obscure early signs of sepsis and can result in delays in recognition and treatment. Identifying biomarkers that can reliably diagnose sepsis will reduce morbidity and mortality and antibiotic overuse. We have previously identified an immune-metabolic biomarker network comprising three pathways with a >99% accuracy for detecting bacterial neonatal sepsis. In this prospective study, we will describe physiological parameters and novel biomarkers in two cohorts-healthy pregnant women and pregnant women with suspected sepsis-with the aim of mapping pathophysiological drivers and evaluating predictive biomarkers for diagnosing maternal sepsis. METHODS AND ANALYSIS: Women aged over 18 with an ultrasound-confirmed pregnancy will be recruited to a pilot and two main study cohorts. The pilot will involve blood sample collection from 30 pregnant women undergoing an elective caesarean section. Cohort A will follow 100 healthy pregnant women throughout their pregnancy journey, with collection of blood samples from participants at routine time points in their pregnancy: week 12 'booking', week 28 and during labour. Cohort B will follow 100 pregnant women who present with suspected sepsis in pregnancy or labour and will have at least two blood samples taken during their care pathway. Study blood samples will be collected during routine clinical blood sampling. Detailed medical history and physiological parameters at the time of blood sampling will be recorded, along with the results of routine biochemical tests, including C reactive protein, lactate and white blood cell count. In addition, study blood samples will be processed and analysed for transcriptomic, lipidomic and metabolomic analyses and both qualitative and functional immunophenotyping. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Wales Research Ethics Committee 2 (SPON1752-19, 30 October 2019). TRIAL REGISTRATION NUMBER: NCT05023954.


Assuntos
Pré-Eclâmpsia , Complicações Infecciosas na Gravidez , Sepse , Adolescente , Adulto , Antibacterianos , Biomarcadores , Proteína C-Reativa , Cesárea , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Lactatos , Estudos Observacionais como Assunto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Gestantes , Estudos Prospectivos
17.
J Infect Dev Ctries ; 16(8): 1243-1251, 2022 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-36099366

RESUMO

INTRODUCTION: Vulvovaginal candidiasis (VVC) is a yeast infection of the vulva, which is caused by Candida species and affects women worldwide. Pregnant women are more vulnerable to VVC due to certain risks. Moreover, their offspring are also exposed to the risk of preterm birth. In this context, ascertaining the burden of VVC is of paramount importance and this meta-analysis was conducted to estimate the occurrence of VVC among pregnant women in Africa. METHODOLOGY: Database search was carried out through PubMed, Scopus, Science-Direct, and Google Scholar from the date of inception until December 2020. All the studies on the prevalence of VVC among African pregnant women were included in the analysis. The pooled prevalence was estimated based on the Random-effect model DerSimonian-Laird approach with Freeman- Tukey double arcsine transformed proportion. Heterogeneity was assessed using I2 test and subsequently explored using subgroup and meta-regression analysis. RESULTS: A total of Sixteen records having a sample size 4,185 were included in this study. The overall prevalence of VVC was pooled at 29.2% (CI 95%: 23.4 - 33.0). Subgroup analysis revealed a higher prevalence in Eastern Africa, followed by Western Africa and North Africa (35%, 28%, and 15% respectively). Moderator analysis indicated that the studies that used advanced methods of detection had a higher prevalence (p = 0.048). In addition, the large sample size was associated with higher prevalence (p ≤ 0.001). No other moderators were found to be statistically significant. CONCLUSIONS: The overall prevalence of VVC among African pregnant women is comparable to other studies worldwide. However, appropriate identification techniques and larger sample size could likely be associated with an increased prevalence. Our findings necessitate the need for further investigations to determine the geographical distribution of VVC across African regions.


Assuntos
Candidíase Vulvovaginal , Nascimento Prematuro , África/epidemiologia , Candidíase Vulvovaginal/epidemiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Gestantes , Prevalência
19.
J Clin Pharmacol ; 62 Suppl 1: S18-S29, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36106788

RESUMO

Medicines and vaccines prescribed to pregnant women often have not had pregnant women or lactating women included in clinical trials and products are often not approved by regulatory agencies for use in pregnant women. As a result, practitioners may need to prescribe medicines and give vaccines to this special population with limited drug efficacy and safety information available. Multiple regulatory guidance documents regarding the development of medications for pregnant and lactating women have been developed to encourage drug development and the investigation of medicines and vaccines used in this population. However, clinical, regulatory, ethical, and drug development challenges are encountered when designing clinical trials that include pregnant women and their fetuses, in which innovative methods and trial designs are essential. This article provides an overview of an industry perspective on maternal-fetal drug development that includes a review of the regulatory landscape for developing medicines for pregnant women and their fetuses, trial designs that include pregnant women, identification of gaps and challenges, and strategies for potential maternal-fetal drug development considerations for the future development of medicines and vaccines for pregnant women. Early involvement and discussion of drug and vaccine products with multiple stakeholders, including therapeutic experts, patients, physicians, and regulators, is encouraged to optimize the development of safe and effective medicines and vaccines for pregnant women and their fetuses.


Assuntos
Lactação , Vacinas , Ensaios Clínicos como Assunto , Feminino , Feto , Humanos , Gravidez , Gestantes
20.
Enferm. clín. (Ed. impr.) ; 32(5): 334-343, Sep-Oct 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-207828

RESUMO

Objetivo: Este estudio tiene como objetivo explorar la percepción de las mujeres y sus maridos sobre la vulnerabilidad de las mujeres embarazadas a los trastornos de salud mental. Método: Estudio cualitativo con enfoque fenomenológico. Los criterios de inclusión fueron mujeres embarazadas en el segundo y tercer trimestre de gestación (13-35 semanas). Los criterios de exclusión fueron las embarazadas con complicaciones y las que tenían antecedentes familiares de trastornos mentales. Los datos se recogieron mediante grupos de discusión y entrevistas en profundidad en cuatro centros de atención primaria de Surakarta (Indonesia). A continuación, los datos se analizaron mediante un análisis temático, con el apoyo del programa OpenCode 4.02®. Resultados: Este estudio descubrió dos temas principales: en primer lugar, los factores que desencadenan la vulnerabilidad de las mujeres embarazadas a experimentar trastornos mentales y, en segundo lugar, las barreras percibidas para gestionar la salud mental durante el embarazo y el posparto. Las mujeres embarazadas y los maridos reconocen que necesitan obtener información sobre salud mental. Conclusión: Las emociones inestables durante el embarazo son consideradas normales y son desatendidas por el entorno. El desconocimiento sobre salud mental en el embarazo justifica la necesidad de aumentar la educación en esta área con el fin de prevenir la depresión prenatal y posparto.(AU)


Objective: This study aims to explore the perception of women and their husbands on the vulnerability of pregnant women to mental health disorders. Method: Qualitative study using a phenomenological approach. The inclusion criteria were pregnant women of the second and third-trimester gestation (13–35 weeks). The exclusion criteria were pregnant women with complications and who had a family record of mental disorders. Data was collected using focus group discussion and in-depth interviews at four Primary Health Cares in Surakarta, Indonesia. Then, the data were analyzed through thematic analysis, which was supported by the OpenCode 4.02® software. Results: This study uncovered two main topics, firstly the factors that trigger the vulnerability of pregnant women to experience mental disorders and secondly perceived barriers to managing mental health during pregnancy and postpartum. Pregnant women and husbands recognize that they need to get mental health information. Conclusion: Unstable emotions during pregnancy are considered normal and neglected by their surroundings. Lack of knowledge about mental health in pregnancy justifies the need to increase education in this area in order to prevent prenatal and postpartum depression.(AU)


Assuntos
Humanos , Feminino , Saúde Mental/etnologia , Gestantes , Cônjuges , Percepção , Transtornos Mentais , Anamnese , Gravidez , Período Pós-Parto , Serviços Preventivos de Saúde , Conscientização , Indonésia , Enfermagem
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