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1.
Reprod Health ; 18(1): 53, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648551

RESUMO

BACKGROUND: Approximately 2.6 million babies are stillborn each year globally, of which 98% occur in low- and middle-income countries (LMICs). A 2019 individual participant data meta-analysis of 6 studies from high-income countries found that maternal supine going-to-sleep position increased the risk of stillbirth. It is not clear whether this impact would be the same in LMICs, and the normal sleep behaviour of pregnant women in LMICs is not well understood. OBJECTIVE: Determine the prevalence of different sleeping positions among pregnant women in LMICs, and what (if any) positions were associated with stillbirth using a systematic review. SEARCH STRATEGY: We systematically searched the databases Medline, Embase, Emcare, CINAHL and Global Index Medicus for relevant studies, with no date or language restrictions on 4 April 2020. Reference lists of included studies were also screened. SELECTION CRITERIA: Observational studies of maternal sleep position during pregnancy in LMICs DATA COLLECTION AND ANALYSIS: Recovered citations were screened and eligible studies were included for extraction. These steps were performed by two independent reviewers. Risk of bias was assessed using the Newcastle-Ottawa Scale. MAIN RESULTS: A total of 3480 citations were screened but only two studies met the inclusion criteria. The studies were conducted in Ghana and India and reported on different maternal sleep positions: supine and left lateral. In Ghana, a prevalence of 9.7% for supine sleeping position amongst 220 women was found. The primary outcome could not be extracted from the Indian study as sleep position information was only reported for women who had a stillbirth (100 of the 300 participants). CONCLUSION: There is limited information on maternal sleeping position in LMICs. Since sleep position may be a modifiable risk factor for stillbirth, there is a need for further research to understand the sleep practices and behaviours of pregnant women in LMICs. PROSPERO registration: CRD42020173314.


Assuntos
Postura/fisiologia , Gravidez/fisiologia , Sono/fisiologia , Países em Desenvolvimento , Feminino , Humanos , Renda/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Natimorto/epidemiologia , Decúbito Dorsal/fisiologia
2.
PLoS One ; 16(1): e0242118, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33507927

RESUMO

Tissue mechanics is central to pregnancy, during which maternal anatomic structures undergo continuous remodeling to serve a dual function to first protect the fetus in utero while it develops and then facilitate its passage out. In this study of normal pregnancy using biomechanical solid modeling, we used standard clinical ultrasound images to obtain measurements of structural dimensions of the gravid uterus and cervix throughout gestation. 2-dimensional ultrasound images were acquired from the uterus and cervix in 30 pregnant subjects in supine and standing positions at four time points during pregnancy (8-14, 14-16, 22-24, and 32-34 weeks). Offline, three observers independently measured from the images of multiple anatomic regions. Statistical analysis was performed to evaluate inter-observer variance, as well as effect of gestational age, gravity, and parity on maternal geometry. A parametric solid model developed in the Solidworks computer aided design (CAD) software was used to convert ultrasonic measurements to a 3-dimensional solid computer model, from which estimates of uterine and cervical volumes were made. This parametric model was compared against previous 3-dimensional solid models derived from magnetic resonance frequency images in pregnancy. In brief, we found several anatomic measurements easily derived from standard clinical imaging are reproducible and reliable, and provide sufficient information to allow biomechanical solid modeling. This structural dataset is the first, to our knowledge, to provide key variables to enable future computational calculations of tissue stress and stretch in pregnancy, making it possible to characterize the biomechanical milieu of normal pregnancy. This vital dataset will be the foundation to understand how the uterus and cervix malfunction in pregnancy leading to adverse perinatal outcomes.


Assuntos
Colo do Útero , Idade Gestacional , Imageamento Tridimensional , Modelos Biológicos , Gravidez/fisiologia , Ultrassonografia Pré-Natal , Adulto , Colo do Útero/diagnóstico por imagem , Colo do Útero/fisiologia , Feminino , Humanos , Estudos Longitudinais
3.
Emerg Med Clin North Am ; 38(4): 903-917, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981625

RESUMO

Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Emergency physicians should target pregnancy-specific oxygen and ventilation goals and hemodynamics and should be prepared to perform a perimortem cesarean section, should the mother lose pulses, to increase chances for maternal and fetal survival.


Assuntos
Complicações na Gravidez/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Gasometria , Cesárea , Contraindicações de Medicamentos , Estado Terminal , Serviço Hospitalar de Emergência , Feminino , Monitorização Fetal , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Intubação Intratraqueal , Troca Materno-Fetal , Ventilação não Invasiva , Circulação Placentária , Gravidez/fisiologia , Complicações na Gravidez/diagnóstico , Insuficiência Respiratória/terapia , Choque/terapia
4.
Adv Exp Med Biol ; 1252: 3-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816256

RESUMO

The mature breast is located within the anterior thoracic wall, lying atop the pectoralis major muscle. Pubertal changes lead to incomplete development of the breast , a process which is only completed during pregnancy . The incomplete breast consists mostly of adipose tissue but also lactiferous units called lobes. These eventually drain into the lactiferous ducts and then into the lactiferous sinus and then to the nipple-areolar complex. During pregnancy , the breast undergoes both anatomic and physiologic changes to prepare for lactation. During the first trimester, the ductal system expands and branches out into the adipose tissue in response to the increase of estrogen. Elevated levels of estrogen also cause a decrease in adipose tissue and ductal proliferation and elongation. Estrogen also stimulates the pituitary gland which leads to elevated levels of prolactin. By the twentieth week of gestation, mammary glands are sufficiently developed to produce components of milk due to prolactin stimulation. Milk production is inhibited by high estrogen and progesterone levels and colostrum is produced during this time. In the third trimester and then rapidly after birth, these levels decrease, allowing for milk production and eventual let-down to allow for breastfeeding. Most pregnancies cause the areola to darken, the breast to increase in size, and the Montgomery glands to become more prominent. Post-lactational involution occurs at the cessation of milk production caused by a decline in prolactin.


Assuntos
Mama/anatomia & histologia , Mama/fisiologia , Lactação/fisiologia , Gravidez/fisiologia , Estrogênios , Feminino , Humanos , Leite Humano , Parto , Prolactina
5.
Adv Exp Med Biol ; 1252: 27-32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816259

RESUMO

Breast tissue reveals some physiologic changes during pregnancy and lactation due to hormonal alterations. Whole range of breast diseases including inflammatory, benign and malignant neoplasms can be seen in pregnancy but due to concurrent physiologic changes, may lead to diagnostic challenges. This chapter reviews sampling methods and histologic features of common benign breast lesions in pregnancy and lactation periods.


Assuntos
Doenças Mamárias/patologia , Mama/citologia , Mama/patologia , Lactação/fisiologia , Complicações na Gravidez , Gravidez/fisiologia , Neoplasias da Mama/patologia , Feminino , Humanos
6.
Adv Exp Med Biol ; 1252: 165-174, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816278

RESUMO

Safety of pregnancy occurring after breast cancer treatment has been studied largely, but it is still debatable. These studies have generally showed that overall and disease-free survival in breast cancer survivors with subsequent pregnancy is not less than those without future pregnancy . Also, breast cancer survivors treated with chemotherapy , radiation therapy, or both had no increased risk of congenital anomalies, single gene disorders, or chromosomal syndromes in their offspring. However, it appears that the incidence of preterm labor, low birth weight, and fetal anomalies is higher in these cases.These issues as well as safe time interval from breast cancer treatment to pregnancy , safe contraceptive method after breast cancer, counseling about pregnancy in survivors, and how to follow up the patient for breast cancer recurrence during pregnancy are discussed in this chapter.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Gravidez/fisiologia , Aconselhamento , Intervalo Livre de Doença , Feminino , Humanos , Recém-Nascido , Recidiva Local de Neoplasia , Resultado da Gravidez
7.
Adv Exp Med Biol ; 1252: 189-193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816281

RESUMO

Breast cancer is one of the most commonly diagnosed malignancies in women of childbearing age. One of the surgeries performed in the management of the disease is mastectomy , which might negatively affect body image and quality of life, and breast reconstruction is seen as a remedy to this problem. However, for the women who are interested in having children after treatment of breast cancer, the debate is whether they can have a successful pregnancy and delivery after breast reconstruction.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia , Gravidez/fisiologia , Criança , Feminino , Humanos , Mastectomia , Resultado da Gravidez , Qualidade de Vida
8.
Arch Gynecol Obstet ; 302(4): 873-878, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32602001

RESUMO

BACKGROUND: Amniotic fluid abnormalities may be associated with adverse perinatal outcomes, some of which are endocrine related. OBJECTIVE: To evaluate whether in utero exposure to amniotic fluid abnormalities is associated with long-term endocrine morbidity in the offspring. STUDY DESIGN: In this cohort study, the incidence of long-term endocrine disorders was compared between singletons exposed and non-exposed to oligohydramnios or polyhydramnios. RESULTS: During the study period, 195 943 newborns were included in the study, of them 2.0% (n = 4072) and 2.9% (n = 5684) were exposed to oligohydramnios and polyhydramnios, respectively. Long-term endocrine morbidity was higher among children exposed to isolated amniotic fluid disorders, as was also noted in the Kaplan-Meier survival curve (log-rank test p < 0.001). Abnormal amniotic fluid volume was found to be independently associated with long-term endocrine morbidity of the offspring according to a Cox regression model controlled for clinically related confounders. CONCLUSION: In utero exposure to isolated amniotic fluid abnormalities is independently associated with long-term endocrine morbidity in the offspring.


Assuntos
Complicações do Diabetes/etiologia , Diabetes Gestacional/fisiopatologia , Feto/fisiologia , Oligo-Hidrâmnio/fisiopatologia , Obesidade Pediátrica/etiologia , Poli-Hidrâmnios/fisiopatologia , Gravidez/fisiologia , Efeitos Tardios da Exposição Pré-Natal , Líquido Amniótico , Criança , Estudos de Coortes , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Morbidade , Oligo-Hidrâmnio/epidemiologia , Obesidade Pediátrica/epidemiologia , Poli-Hidrâmnios/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez
9.
Clin Ter ; 171(4): e328-e334, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614367

RESUMO

OBJECTIVES: The aim of this study is to analyze the quality and quantity of physical activity (PA) practiced by low-risk pregnant women before and during pregnancy. DESIGN: This cross-sectional study assesses the dietary habits, exercise habits and body mass index. We used an ad hoc health lifestyle multiple choice questionnaire. The data collection lasted 7 months, from the beginning of September 2018 to the end of March 2019. POPULATION: We recruited 175 Italian women with a singleton, low-risk pregnancy at 32-36 weeks of gestational age. RESULTS: In the periconceptional period, 52.6 % of women do not perform any PA. For the other 47.4% of women, the most practiced activities, both before and during gestation, are walking and swimming. Data on the sedentariness showed that about a quarter of the population remains inactive watching TV for more than two hours a day. Interestingly, the most statistically significant risk factor for sedentariness is the BMI > 25 kg/m². Therefore, overweight or obese women are more likely to maintain a sedentary lifestyle during pregnancy. CONCLUSIONS AND IMPLICATION FOR THE PRACTICE: Our study highlighted a high rate of sedentariness in pregnancy, especially among overweight and obese women. Thus, it is important to undertake interventions aimed at informing pregnant women of various benefits that PA can bring. In particular, because of the significant association between sedentariness and BMI greater than 25 kg/m2, it results crucial to direct these recommendations particularly to overweight/obese pregnant women, addressing them to a healthy lifestyle.


Assuntos
Atividades Cotidianas , Exercício Físico , Gravidez/fisiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Estilo de Vida Saudável , Humanos , Obesidade , Sobrepeso , Fatores de Risco , Comportamento Sedentário
10.
Nat Rev Cardiol ; 17(11): 718-731, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32518358

RESUMO

Cardiovascular disease complicates 1-4% of pregnancies - with a higher prevalence when including hypertensive disorders - and is the leading cause of maternal death. In women with known cardiovascular pathology, such as congenital heart disease, timely counselling is possible and the outcome is fairly good. By contrast, maternal mortality is high in women with acquired heart disease that presents during pregnancy (such as acute coronary syndrome or aortic dissection). Worryingly, the prevalence of acquired cardiovascular disease during pregnancy is rising as older maternal age, obesity, diabetes mellitus and hypertension become more common in the pregnant population. Management of cardiovascular disease in pregnancy is challenging owing to the unique maternal physiology, characterized by profound changes to multiple organ systems. The presence of the fetus compounds the situation because both the cardiometabolic disease and its management might adversely affect the fetus. Equally, avoiding essential treatment because of potential fetal harm risks a poor outcome for both mother and child. In this Review, we examine how the physiological adaptations during pregnancy can provoke cardiometabolic complications or exacerbate existing cardiometabolic disease and, conversely, how cardiometabolic disease can compromise the adaptations to pregnancy and their intended purpose: the development and growth of the fetus.


Assuntos
Fenômenos Fisiológicos Cardiovasculares , Diabetes Gestacional/metabolismo , Hipertensão Induzida pela Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Gravidez/fisiologia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/terapia , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/fisiopatologia , Aneurisma Dissecante/terapia , Anti-Hipertensivos/uso terapêutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Aspirina/uso terapêutico , Débito Cardíaco , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Progressão da Doença , Endocardite/diagnóstico , Endocardite/fisiopatologia , Endocardite/terapia , Feminino , Humanos , Hipertensão/fisiopatologia , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Idade Materna , Obesidade Materna/metabolismo , Obesidade Materna/fisiopatologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Pré-Eclâmpsia/fisiopatologia , Pré-Eclâmpsia/prevenção & controle , Pré-Eclâmpsia/terapia , Gravidez/metabolismo , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Gravidez em Diabéticas/metabolismo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/fisiopatologia
11.
Enferm. clín. (Ed. impr.) ; 30(supl.5): 99-102, jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-196485

RESUMO

Gymnastics or exercise during pregnancy has a positive effect on the reduction of pain experienced by third trimester pregnant women. Preliminary study conducted at the lepolepo health center in Wundudopi, Baruga, Kendari, and the number of pregnant women for the period of January to June 2018 was 85 pregnant women, consisting of the first, second and third trimesters. Interviews were also conducted to 11 pregnant women in the third trimester, that often experience in the form of back pain, tingling, aches and fatigue, the pregnant woman also did not take any action to overcome it because according to pregnant women the problems experienced are common in pregnant women especially trimester three. The purpose of this study was to determine the relationship between knowledge and attitudes of third trimester pregnant women with the implementation of pregnancy gymnastics. This study applied quantitative using a cross sectional approach, with a population of 85 pregnant women and a sample was 46 third trimester pregnant women. Analysis method used Chi Square Test and Phi Test. The results of the study for knowledge variable showed that there was a correlation between knowledge of third trimester pregnant women with the implementation of pregnant gymnastics with a value of X2count=6.758>X2table=3.841 so that Ho was rejected or Ha was accepted. For attitudes variable from the results of the SPSS test analysis, the chi square statistical test results showed that X2count=5.073>X2table=3.841 so that Ho was rejected or Ha was accepted which means that there was a correlation between the attitude of the third trimester pregnant women and the implementation of pregnant gymnastics. Finally, it is recommended for researchers to continue the research toward other variables related to pregnancy exercise, for relevant agencies to develop services for pregnant women


No disponible


Assuntos
Humanos , Feminino , Gravidez , Adulto , Conhecimento , Conhecimentos, Atitudes e Prática em Saúde , Ginástica/fisiologia , Terceiro Trimestre da Gravidez , Gravidez/fisiologia , Gravidez/psicologia , Condicionamento Físico Humano/fisiologia
12.
Anaesthesia ; 75(10): 1307-1313, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32469423

RESUMO

Maternal cardiac dysfunction is associated with pre-eclampsia, fetal growth restriction and haemodynamic instability during obstetric anaesthesia. There is growing interest in the use of non-invasive cardiac output monitoring to guide antihypertensive and fluid therapies in obstetrics. The aim of this study was to validate thoracic bioreactance using the NICOM® instrument against transthoracic echocardiography in pregnant women, and to assess the effects of maternal characteristics on the absolute difference of stroke volume, cardiac output and heart rate. We performed a prospective study involving women with singleton pregnancies in each trimester. We recruited 56 women who were between 11 and 14 weeks gestation, 57 between 20 and 23 weeks, and 53 between 35 and 37 weeks. Cardiac output was assessed repeatedly and simultaneously over 5 min in the left lateral position with NICOM and echocardiography. The performance of NICOM was assessed by calculating bias, 95% limits of agreement and mean percentage difference relative to echocardiography. Multivariate regression analysis evaluated the effect of maternal characteristics on the absolute difference between echocardiography and NICOM. The mean percentage difference of cardiac output measurements between the two methods was ±17%, with mean bias of -0.13 l.min-1 and limits of agreement of -1.1 to 0.84; stroke volume measurements had a mean percentage difference of ±15%, with a mean bias of -0.8 ml (-10.9 to 12.6); and heart rate measurements had a mean percentage difference of ±6%, with a mean bias of -2.4 beats.min-1 (-6.9 to 2.0). Similar results were found when the analyses were confined to each individual trimester. The absolute difference between NICOM and echocardiography was not affected by maternal age, weight, height, race, systolic or diastolic blood pressure. In conclusion, NICOM demonstrated good agreement with echocardiography, and can be used in pregnancy for the measurement of cardiac function.


Assuntos
Débito Cardíaco/fisiologia , Gravidez/fisiologia , Adulto , Ecocardiografia , Feminino , Idade Gestacional , Frequência Cardíaca , Humanos , Monitorização Fisiológica , Pré-Eclâmpsia , Estudos Prospectivos , Reprodutibilidade dos Testes , Volume Sistólico , Resistência Vascular
13.
Eur J Clin Microbiol Infect Dis ; 39(7): 1209-1220, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32328850

RESUMO

To analyze the susceptibility of SARS-CoV-2 in pregnancy and the drugs that can be used to treat pregnancy with COVID-19, so as to provide evidence for drug selection in clinic. By reviewing the existing literature, this paper analyzes the susceptibility of pregnant women to virus, especially to SARS-CoV-2, from the aspects of anatomical, reproductive endocrine and immune changes during pregnancy and screens effective and fetal-safe treatments from the existing drugs. The anatomical structure of the respiratory system is changed during pregnancy, and the virus transmitted by droplets and aerosols is more easily inhaled by pregnant women and is difficult to remove. Furthermore, the prognosis is worse after infection when compared with non-pregnancy women. And changes in reproductive hormones and immune systems during pregnancy collectively make them more susceptible to certain infections. More importantly, angiotensin-converting enzyme (ACE)-2, the SARS-CoV-2 receptor, has been proven highly increased during pregnancy, which may contribute to the susceptibility to SARS-CoV-2. When it comes to treatment, specific drugs for COVID-19 have not been found at present, and taking old drugs for new use in treating COVID-19 has become an emergency method for the pandemic. Particularly, drugs that show superior maternal and fetal safety are worthy of consideration for pregnant women with COVID-19, such as chloroquine, metformin, statins, lobinavir/ritonavir, glycyrrhizic acid, and nanoparticle-mediated drug delivery (NMDD), etc. Pregnant women are susceptible to COVID-19, and special attention should be paid to the selection of drugs that are both effective for maternal diseases and friendly to the fetus. However, there are still many deficiencies in the study of drug safety during pregnancy, and broad-spectrum, effective and fetal-safe drugs for pregnant women need to be developed so as to cope with more infectious diseases in the future.


Assuntos
Fenômenos Fisiológicos Cardiovasculares , Infecções por Coronavirus/metabolismo , Pneumonia Viral/metabolismo , Complicações Infecciosas na Gravidez/metabolismo , Gravidez/fisiologia , Fenômenos Fisiológicos Respiratórios , Anti-Inflamatórios/uso terapêutico , Antimaláricos/uso terapêutico , Antivirais/uso terapêutico , Metabolismo Basal , Betacoronavirus/metabolismo , Cloroquina/uso terapêutico , Anormalidades Congênitas/epidemiologia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Suscetibilidade a Doenças/imunologia , Suscetibilidade a Doenças/metabolismo , Combinação de Medicamentos , Sistemas de Liberação de Medicamentos , Feminino , Capacidade Residual Funcional , Ácido Glicirrízico/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipoglicemiantes/uso terapêutico , Interferon Tipo I/uso terapêutico , Lopinavir/uso terapêutico , Metformina/uso terapêutico , Nanopartículas , Consumo de Oxigênio , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Gravidez/imunologia , Gravidez/metabolismo , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/imunologia , Progesterona/metabolismo , Prognóstico , Ritonavir/uso terapêutico , Glicoproteína da Espícula de Coronavírus/metabolismo , Natimorto/epidemiologia , Relação Ventilação-Perfusão
14.
Am J Physiol Heart Circ Physiol ; 318(4): H816-H819, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32142381

RESUMO

Recent evidence suggests an elevated risk of cardiovascular disease development in multiparous women. Therefore, we investigated the effects of multiparity on within-pregnancy sympathetic neural regulation in normotensive, pregnant women. We retrospectively analyzed heart rate (HR), blood pressure (BP), and muscle sympathetic nerve activity (MSNA; n = 8) data from 10 women whom participated in microneurographic research studies during two sequential pregnancies (i.e., PREG1 and PREG2). There was no difference in resting BP between pregnancies (P > 0.05), whereas HR trended higher in PREG2 versus PREG1 (P = 0.06). MSNA burst frequency was greater in PREG2 versus PREG1 after adjusting for age (32 ± 12 vs. 22 ± 12 bursts/min; P = 0.049), whereas burst incidence did not differ (40 ± 16 vs. 34 ± 17 bursts/100 heartbeats; P = 0.21). Sympathetic baroreflex sensitivity was not different between PREG1 and PREG2 (P > 0.05). Our results may highlight a possible role of altered within-pregnancy sympathetic neural regulation in the observed relationship in women between parity and future cardiovascular disease risk.NEW & NOTEWORTHY To our knowledge, this is the first study to investigate the effects of multiparity on within-pregnancy sympathetic neural regulation. We observed augmented muscle sympathetic nerve activity in women's second studied pregnancy versus their first. Conversely, blood pressure and sympathetic baroreflex sensitivity did not differ, whereas a trend for increased heart rate was observed. Our results highlight a possible role of altered within-pregnancy sympathetic neural regulation in the relationship between increased parity and cardiovascular disease development.


Assuntos
Paridade , Gravidez/fisiologia , Sistema Nervoso Simpático/fisiologia , Adulto , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Músculo Liso Vascular/fisiologia
15.
Proc Natl Acad Sci U S A ; 117(11): 5938-5942, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-32123078

RESUMO

Reproduction in mammals requires distinct cycles of ovulation, fertilization, pregnancy, and lactation often interspersed with periods of anoestrus when breeding does not occur. Macropodids, the largest extant species of marsupials, the kangaroos and wallabies, have a very different reproductive strategy to most eutherian mammals whereby young are born at a highly altricial stage of development with the majority of development occurring over a lengthy lactation period. Furthermore, the timings of ovulation and birth in some species occurs within a very short interval of each other (sometimes hours). Female swamp wallabies have an oestrous cycle shorter than their pregnancy length and were, therefore, speculated to mate and form a new embryo before birth thereby supporting two conceptuses at different stages of pregnancy. To confirm this, we used high-resolution ultrasound to monitor reproduction in swamp wallabies during pregnancy. Here, we show that females ovulate, mate, and form a new embryo prepartum while still carrying a full-term fetus in the contralateral uterus. This embryo enters embryonic diapause until the newborn leaves the pouch 9 mo later. Thus, combined with embryonic diapause, females are continuously pregnant and lactating at the same time throughout their reproductive life, a unique reproductive strategy that completely blurs the normal staged system of reproduction in mammals.


Assuntos
Macropodidae/fisiologia , Gravidez/fisiologia , Reprodução/fisiologia , Áreas Alagadas , Animais , Embrião de Mamíferos/citologia , Embrião de Mamíferos/fisiologia , Ciclo Estral , Feminino , Lactação , Macropodidae/embriologia , Ovulação , Parto , Ultrassonografia , Vitória
16.
PLoS One ; 15(2): e0229079, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32069319

RESUMO

AIM: To analyse i) the association of physical fitness during early second trimester and late pregnancy with maternal and neonatal outcomes; and ii) to investigate whether physical fitness is associated with the type of birth (vaginal or caesarean section). METHODS: Pregnant women from the GESTAFIT Project (n = 159) participated in this longitudinal study. Maternal physical fitness including upper- and lower-body strength, cardiorespiratory fitness (CRF) and flexibility were measured through objective physical fitness tests at the 16th and 34th gestational weeks. Maternal and neonatal outcomes were collected from obstetric medical records. Umbilical arterial and venous blood gas pH and partial pressure of carbon dioxide (PCO2) and oxygen (PO2), were assessed. RESULTS: At the 16th week, greater upper-body muscle strength was associated with greater neonatal birth weight (r = 0.191, p<0.05). Maternal flexibility was associated with a more alkaline arterial pH (r = 0.220, p<0.05), higher arterial PO2 (r = 0.237, p<0.05) and lower arterial PCO2 (r = -0.331, p<0.01) in umbilical cord blood. Maternal CRF at the 16th gestational week was related to higher arterial umbilical cord PO2 (r = 0.267, p<0.05). The women who had caesarean sections had lower CRF (p<0.001) at the 16th gestational week and worse clustered overall physical fitness, both at the 16th (-0.227, p = 0.003, confidence interval (CI): -0.376, -0.078) and 34th gestational week (-0.223; p = 0.018; CI: -0.432, -0.015) compared with the women who had vaginal births. CONCLUSION: Increasing physical fitness during pregnancy may promote better neonatal outcomes and is associated with a decrease in the risk of caesarean section. This trial was registered at ClinicalTrials.gov (NCT02582567) on October 20, 2015.


Assuntos
Peso ao Nascer/fisiologia , Cesárea/estatística & dados numéricos , Recém-Nascido/fisiologia , Aptidão Física/fisiologia , Gravidez/fisiologia , Adulto , Dióxido de Carbono/análise , Feminino , Sangue Fetal/química , Humanos , Estudos Longitudinais , Oxigênio/análise , Pressão Parcial , Segundo Trimestre da Gravidez/fisiologia , Autorrelato
17.
Med Sci Sports Exerc ; 52(7): 1538-1548, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31977635

RESUMO

PURPOSE: This study aimed to examine the influence of prenatal exercise on maternal cardiorespiratory health and fitness during pregnancy. METHODS: Online databases were searched up to February 25, 2019. Studies of randomized controlled trials (RCTs) were eligible, which contained information on the relevant population (pregnant women), intervention (subjective or objective measures of frequency, intensity, duration, volume, or type of exercise), comparator (no exercise intervention), and outcomes (maternal cardiorespiratory fitness, including V˙O2max, submaximal V˙O2, V˙O2 at anaerobic threshold, and cardiorespiratory health, including resting heart rate, and resting systolic and diastolic blood pressures during pregnancy). RESULTS: From 2699 unique citations, 26 RCTs (N = 2292 women) were included. Of these, one study reported measured V˙O2max, seven reported predicted V˙O2max, three reported submaximal V˙O2, and two studies reported VO2AT. "Low"- to "high"-certainty evidence revealed that exercise was associated with improved predicted/measured V˙O2max (5 RCTs, n = 430; mean difference [MD], 2.77 mL·kg·min; 95% confidence interval [CI], 0.32 to 5.21 mL·kg·min; I = 69%), reduced resting heart rate (9 RCTs, n = 637; MD, -1.71 bpm; 95% CI, -3.24 to -0.19 bpm; I = 13%), resting systolic blood pressure (16 RCTs, n = 1672; MD, -2.11 mm Hg; 95% CI, -3.71 to -0.51 mm Hg; I = 69%), and diastolic blood pressure (15 RCTs, n = 1624; MD, -1.77 mm Hg; 95% CI, -2.90 to -0.64 mm Hg; I = 60%). CONCLUSION: Prenatal exercise interventions improve maternal predicted/measured V˙O2max and reduce resting heart rate and blood pressure. This review highlights the need for additional high-quality studies of cardiorespiratory fitness (namely, V˙O2max and V˙O2 peak) in pregnancy.PROSPERO registration number: CRD42019131249.


Assuntos
Aptidão Cardiorrespiratória , Exercício Físico/fisiologia , Gravidez/fisiologia , Limiar Anaeróbio , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Consumo de Oxigênio
18.
Reprod Domest Anim ; 55(4): 523-529, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31986225

RESUMO

Pregnancy is a complex process in which significant changes occur continually in both the corpora lutea and in the endometrium of the females and varies depending on the embryonic, pre-implantation or foetal stages. In the embryonic stages, the majority of genes expressed in the pig embryo correspond to the loss of cellular pluripotency. In contrast, the implantation consists of three phases: elongation of the conceptus, adhesion and union of the embryo to the endometrial epithelium. During these phases, many factors are expressed, including growth factors, molecules that facilitate adhesion and cytokines. All these changes are ultimately regulated by different lipid and hormonal substances, specifically by progesterone, oestradiol and prostaglandins, which regulate the expression of many proteins necessary for the development of the embryo, endometrial remodelling and embryo-maternal communication. This paper is a review of primary gene regulatory mechanisms in pigs during different stages of implantation.


Assuntos
Embrião de Mamíferos/metabolismo , Desenvolvimento Embrionário/genética , Regulação da Expressão Gênica no Desenvolvimento , Gravidez/fisiologia , Animais , Implantação do Embrião/genética , Endométrio/metabolismo , Feminino , Troca Materno-Fetal , Suínos
19.
Gait Posture ; 76: 389-395, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31927359

RESUMO

BACKGROUND: One in four pregnant women falls at least once during her pregnancy. During pregnancy, the body undergoes tremendous vascular, hormonal, physiological, and psychological changes to accommodate the growing fetus. The pregnancy-induced mass gain of 10 to 25 kg is not evenly distributed and results in a large change in mass distribution and shift in segmental centers of mass. To accurately understand how the change in mass distribution leads to an increase in fall events, a musculoskeletal model of the pregnant body is necessary. Generic musculoskeletal models cannot accurately represent the morphology of pregnant women and the study of postural stability of pregnant women is limited by the lack of adapted musculoskeletal models. RESEARCH QUESTION: Could a model reflecting the change in segmental inertia during pregnancy explain the pregnancy-related risk of falling? METHODS: We built a musculoskeletal model of the pregnant women, combining literature anthropomorphic measurements with generic models. We optimized the dimensions of the anthropomorphic model shapes to fit the average measurements of 25 pregnant women. The mass, center of mass, and inertia of each segment are then computed throughout pregnancy. Finally, the stance phase of a gait cycle was modeled using the pregnancy-specific and the generic models. The ankle, knee, hip and lumbar joint moments during gait were compared between the two models. RESULTS: The built musculoskeletal model of the pregnant woman includes changes in mass and geometry of the thorax, pelvis, thighs, and legs. The model reproduces the change in lumbar curvature during pregnancy. Gait simulation results show a limited impact of pregnancy on the ankle, knee, and hip moment, but a large impact on the lumbar moment. SIGNIFICANCE: Such a musculoskeletal model will help elucidate the mechanisms leading to falls or low back pain during pregnancy.


Assuntos
Articulação do Tornozelo/fisiologia , Simulação por Computador , Marcha/fisiologia , Articulação do Quadril/fisiologia , Articulação do Joelho/fisiologia , Vértebras Lombares/fisiologia , Equilíbrio Postural , Gravidez/fisiologia , Acidentes por Quedas , Fenômenos Biomecânicos , Feminino , Humanos , Pelve , Tórax
20.
Am J Primatol ; 82(1): e23085, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31875991

RESUMO

Rhesus monkeys are typically seasonal breeders but can be induced to extend the timing of their mating and births under captive conditions. The following analyses evaluated the potential impact of extending their pregnancies and deliveries year-round. Birth records from a large breeding colony housed in an indoor facility with a constant 14-hr light/10-hr dark cycle were analyzed across 25 years to examine seasonal trends in monkeys that mated in one of two ways: spontaneous in social groups or with a scheduled, timed-mating protocol. The dates of delivery and birth weights for 2,084 infants were used in these analyses. Younger nulliparous females mating in social groups evinced a clear seasonal peak when birthing their first infant. However, older females, both primiparous and multiparous, could be bred continuously, which enable the birth of infants in every month of the year. Based on the live birth rate, infant birth weights, high survival rates, and the normal sex ratio of infants birthed year-round, there were no adverse effects of breeding rhesus monkeys in this way. The continuous availability of infant births can be very advantageous for many types of research programs.


Assuntos
Cruzamento/métodos , Macaca mulatta/fisiologia , Gravidez/fisiologia , Criação de Animais Domésticos/métodos , Animais , Coeficiente de Natalidade , Peso ao Nascer , Feminino , Masculino , Estações do Ano , Razão de Masculinidade
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