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1.
Natl Vital Stat Rep ; 69(9): 1-11, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33054916

RESUMO

Objective-This report presents 2017-2018 infant mortality rates in the United States by maternal prepregnancy body mass index, and by infant age at death, maternal age, and maternal race and Hispanic origin. Methods-Descriptive tabulations of infant deaths by maternal and infant characteristics are presented using the 2017-2018 linked period birth/infant death files; the linked period birth/infant death file is based on birth and death certificates registered in all states and the District of Columbia. The 2017 linked birth/infant death file is the first year that national data on maternal prepregnancy body mass index were available. Results-Total infant, neonatal, and postneonatal mortality rates were lowest for infants of women who were normal weight prepregnancy, and then rose with increasing prepregnancy body mass index. Total, neonatal, and postneonatal rates were higher for infants of women who were underweight prepregnancy compared with infants of women who were normal or overweight before pregnancy. Mortality rates for infants of underweight women were generally, but not exclusively, lower than those of infants born to women with obesity. Infants born to women of normal weight generally had lower mortality rates than infants born to women who had obesity prepregnancy for all maternal age and race and Hispanic-origin groups.


Assuntos
Índice de Massa Corporal , Mortalidade Infantil/tendências , Adulto , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Idade Materna , Estados Unidos/epidemiologia
2.
Cochrane Database Syst Rev ; 9: CD005291, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32898291

RESUMO

BACKGROUND: In in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI), selection of the most competent embryo(s) for transfer is based on morphological criteria. However, many women do not achieve a pregnancy even after 'good quality' embryo transfer. One of the presumed causes is that such morphologically normal embryos have an abnormal number of chromosomes (aneuploidies). Preimplantation genetic testing for aneuploidies (PGT-A), formerly known as preimplantation genetic screening (PGS), was therefore developed as an alternative method to select embryos for transfer in IVF. In PGT-A, the polar body or one or a few cells of the embryo are obtained by biopsy and tested. Only polar bodies and embryos that show a normal number of chromosomes are transferred. The first generation of PGT-A, using cleavage-stage biopsy and fluorescence in situ hybridisation (FISH) for the genetic analysis, was demonstrated to be ineffective in improving live birth rates. Since then, new PGT-A methodologies have been developed that perform the biopsy procedure at other stages of development and use different methods for genetic analysis. Whether or not PGT-A improves IVF outcomes and is beneficial to patients has remained controversial. OBJECTIVES: To evaluate the effectiveness and safety of PGT-A in women undergoing an IVF treatment. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (CGF) Group Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two trials registers in September 2019 and checked the references of appropriate papers. SELECTION CRITERIA: All randomised controlled trials (RCTs) reporting data on clinical outcomes in participants undergoing IVF with PGT-A versus IVF without PGT-A were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, assessed risk of bias, and extracted study data. The primary outcome was the cumulative live birth rate (cLBR). Secondary outcomes were live birth rate (LBR) after the first embryo transfer, miscarriage rate, ongoing pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, proportion of women reaching an embryo transfer, and mean number of embryos per transfer. MAIN RESULTS: We included 13 trials involving 2794 women. The quality of the evidence ranged from low to moderate. The main limitations were imprecision, inconsistency, and risk of publication bias. IVF with PGT-A versus IVF without PGT-A with the use of genome-wide analyses Polar body biopsy One trial used polar body biopsy with array comparative genomic hybridisation (aCGH). It is uncertain whether the addition of PGT-A by polar body biopsy increases the cLBR compared to IVF without PGT-A (odds ratio (OR) 1.05, 95% confidence interval (CI) 0.66 to 1.66, 1 RCT, N = 396, low-quality evidence). The evidence suggests that for the observed cLBR of 24% in the control group, the chance of live birth following the results of one IVF cycle with PGT-A is between 17% and 34%. It is uncertain whether the LBR after the first embryo transfer improves with PGT-A by polar body biopsy (OR 1.10, 95% CI 0.68 to 1.79, 1 RCT, N = 396, low-quality evidence). PGT-A with polar body biopsy may reduce miscarriage rate (OR 0.45, 95% CI 0.23 to 0.88, 1 RCT, N = 396, low-quality evidence). No data on ongoing pregnancy rate were available. The effect of PGT-A by polar body biopsy on improving clinical pregnancy rate is uncertain (OR 0.77, 95% CI 0.50 to 1.16, 1 RCT, N = 396, low-quality evidence). Blastocyst stage biopsy One trial used blastocyst stage biopsy with next-generation sequencing. It is uncertain whether IVF with the addition of PGT-A by blastocyst stage biopsy increases cLBR compared to IVF without PGT-A, since no data were available. It is uncertain if LBR after the first embryo transfer improves with PGT-A with blastocyst stage biopsy (OR 0.93, 95% CI 0.69 to 1.27, 1 RCT, N = 661, low-quality evidence). It is uncertain whether PGT-A with blastocyst stage biopsy reduces miscarriage rate (OR 0.89, 95% CI 0.52 to 1.54, 1 RCT, N = 661, low-quality evidence). No data on ongoing pregnancy rate or clinical pregnancy rate were available. IVF with PGT-A versus IVF without PGT-A with the use of FISH for the genetic analysis Eleven trials were included in this comparison. It is uncertain whether IVF with addition of PGT-A increases cLBR (OR 0.59, 95% CI 0.35 to 1.01, 1 RCT, N = 408, low-quality evidence). The evidence suggests that for the observed average cLBR of 29% in the control group, the chance of live birth following the results of one IVF cycle with PGT-A is between 12% and 29%. PGT-A performed with FISH probably reduces live births after the first transfer compared to the control group (OR 0.62, 95% CI 0.43 to 0.91, 10 RCTs, N = 1680, I² = 54%, moderate-quality evidence). The evidence suggests that for the observed average LBR per first transfer of 31% in the control group, the chance of live birth after the first embryo transfer with PGT-A is between 16% and 29%. There is probably little or no difference in miscarriage rate between PGT-A and the control group (OR 1.03, 95%, CI 0.75 to 1.41; 10 RCTs, N = 1680, I² = 16%; moderate-quality evidence). The addition of PGT-A may reduce ongoing pregnancy rate (OR 0.68, 95% CI 0.51 to 0.90, 5 RCTs, N = 1121, I² = 60%, low-quality evidence) and probably reduces clinical pregnancies (OR 0.60, 95% CI 0.45 to 0.81, 5 RCTs, N = 1131; I² = 0%, moderate-quality evidence). AUTHORS' CONCLUSIONS: There is insufficient good-quality evidence of a difference in cumulative live birth rate, live birth rate after the first embryo transfer, or miscarriage rate between IVF with and IVF without PGT-A as currently performed. No data were available on ongoing pregnancy rates. The effect of PGT-A on clinical pregnancy rate is uncertain. Women need to be aware that it is uncertain whether PGT-A with the use of genome-wide analyses is an effective addition to IVF, especially in view of the invasiveness and costs involved in PGT-A. PGT-A using FISH for the genetic analysis is probably harmful. The currently available evidence is insufficient to support PGT-A in routine clinical practice.


Assuntos
Aneuploidia , Fertilização In Vitro , Testes Genéticos/métodos , Diagnóstico Pré-Implantação/métodos , Injeções de Esperma Intracitoplásmicas , Aborto Espontâneo/epidemiologia , Viés , Biópsia , Coeficiente de Natalidade , Blastocisto/patologia , Feminino , Humanos , Nascimento Vivo , Idade Materna , Corpos Polares/patologia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(9): 1017-1026, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-32933637

RESUMO

OBJECTIVE: To study the effect of advanced maternal age (AMA) on the development of hippocampal neural stem cells in offspring rats. METHODS: Ten 3-month-old and ten 12-month-old female Sprague-Dawley rats were housed individually with 3-month-old male rats (1:1, n=20), whose offspring rats were assigned to a control group and an AMA group. A total of 40 rats were randomly selected from each group. Immunofluorescence assay and Western blot were used to localize and determine the levels of protein expression of Nestin and doublecortin (DCX) on day 7 as well as neuronal nuclear antigen (NeuN) and glial fibrillary acidic protein (GFAP) on day 28 (n=8 for each marker). Immunofluorescence assay was also used to localize the hippocampal expression of polysialylated isoforms of neural cell adhesion molecule (PSA-NCAM) on day 14 (n=8 for each marker). RESULTS: According to the Western blot results, the AMA group had significantly lower protein expression of DCX than the control group (P<0.05), while there were no significant differences in the protein expression of Nestin, NeuN, and GFAP between the two groups (P>0.05). According to the results of immunofluorescence assay, the AMA group had significantly lower protein expression of Nestin, DCX, and PSA-NCAM in the hippocampal dentate gyrus (DG) region than the control group (P<0.05), while there were no significant differences in the above indices in the hippocampal CA1 and CA3 regions between the two groups (P>0.05). The AMA group had significantly higher expression of NeuN in the hippocampal CA1 region than the control group (P<0.01), while there were no significant differences in the expression of NeuN in the hippocampal DG and CA3 regions between the two groups (P>0.05). The AMA group had significantly lower expression of GFAP in the hippocampal CA1, CA3, and DG regions than the control group (P<0.05). CONCLUSIONS: AMA may cause inhibition of proliferation, survival, and migration of hippocampal neural stem cells. AMA may also affect their differentiation into neurons and astrocytes, which will eventually lead to developmental disorders of hippocampal neural stem cells in offspring rats.


Assuntos
Células-Tronco Neurais , Animais , Feminino , Hipocampo , Masculino , Idade Materna , Neurônios , Ratos , Ratos Sprague-Dawley
4.
Ecotoxicol Environ Saf ; 205: 111331, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32977287

RESUMO

In China, many studies have been carried out on pesticide residues in human milk, yet all of them are on organochlorine pesticides (OCPs) and mostly focused on large, economically developed cities. In this study, 27 pesticides including OCPs, pyrethroid pesticides (PYRs) and organophosphate pesticides (OPPs) in human milk were investigated in Jinhua, an inland and medium sized city in China. Method based on QuEChERS extraction and gas chromatography-mass spectrometer (GC-MS) determination was adopted to analyze the above pesticide residues. The influencing factors as well as the health risks were also evaluated. Results show that PYRs and OPPs in human milk samples were both undetectable. Regarding OCPs, the detection rate of hexachlorobenzene (HCB), ß-hexachlorocyclohexane (ß-HCH) and p,p'-dichlorodiphenyl-dichloroethylene (p,p'-DDE) were 83.6%, 36.4% and 58.2%, respectively, and their mean value were 29.4, 32.0 and 85.2 ng/g lipid, respectively. p,p'-DDE levels in human milk was significantly (p < 0.05) related to maternal age, but no association was detected between OCPs residues and other factors (living environment, dietary habit, living style, etc.), suggesting that OCPs in human milk in Jinhua were originated from nonspecific source. All estimated daily intake of pesticides (EDIpesticides) by infants were under the guideline suggested by Food and Agriculture Organization (FAO) and China Ministry of Health (CMH). Yet 9% of EDIsHCB and 16% of EDIsHCHs exceeded the guideline recommended by Health Canada. The associations between DDE residues and the delivery way as well as HCBs residues and the birth weight were seemly significant, yet the significance disappeared when consider age or gestational age as a cofounder, indicating that OCPs residue in mother's body in Jinhua has no obvious influence on fetus development and the delivery way.


Assuntos
Hidrocarbonetos Clorados/análise , Leite Humano/química , Organofosfatos/análise , Resíduos de Praguicidas/análise , Adulto , China , Cidades , Diclorodifenil Dicloroetileno/análise , Feminino , Hexaclorobenzeno/análise , Hexaclorocicloexano/análise , Humanos , Lactente , Inseticidas/análise , Idade Materna , Medição de Risco
5.
Zhonghua Fu Chan Ke Za Zhi ; 55(8): 505-509, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32854473

RESUMO

Objective: To compare the preterm birth rate among different age groups and analyze relative high-risk factors of preterm birth. Methods: A retrospective analysis was conducted on clinical data of single pregnant women ≥28 gestational weeks from January 2013 to May 2019 in the First Affiliated Hospital of Chongqing Medical Hospital. All involved women were divided into three groups according to age, Group 1 (aged<35 years), Group 2 (aged 35-39 years), and Group 3 (aged ≥40 years). The preterm birth rate among 3 groups was compared and their high-risk factors were analyzed. Results: There were 48 288 singleton pregnancies during the study period, of which 3 351 were preterm births, preterm birth rate was 6.94% (3 351/48 288). In Group 1, there were 42 020 women, of which 2 699 were preterm births (6.42%, 2 699/42 020); in Group 2, there were 5 061 women, of which 491 were preterm births (9.70%, 491/5 061); and in Group 3, there were 1 207 women, of which 161 were preterm births (13.34%, 161/1 207). Comparing the spontaneous preterm birth rates among the three groups, Group 1 was the lowest one and Group 3 was the highest one (3.72% vs 4.51% vs 5.88%); comparing the medical preterm birth rates among the three groups, Group 1 also was the lowest one and Group 3 also was the highest one (2.70% vs 5.20% vs 7.46%); the differences were statistically significant (P<0.05). The incidence of spontaneous and medical preterm birth according gestational weeks were compared among three groups and there were no significant differences (P>0.05). Comparing and analyzing the high-risk factors of medical preterm birth, the incidence of intrahepatic cholestasis of pregnancy and fetal distress in Group 1 were higher than those in Group 2 and 3; the incidence of placenta praevia were significantly higher in Group 2 and 3 than that in Group 1; the differences were statistically significant (P<0.05). Conclusions: Maternal age is a significant high-risk factor of both spontaneous preterm birth and medical preterm birth, and the risk of preterm birth increases with age. For medical preterm birth, compared with right-age pregnant women, placenta praevia is the high-risk factor for women in advanced maternal age(AMA), which have great effect on medical preterm birth rate of AMA.


Assuntos
Idade Materna , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Distribuição por Idade , Fatores Etários , Colestase Intra-Hepática/epidemiologia , Feminino , Sofrimento Fetal/epidemiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Placenta Prévia/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
6.
Adv Exp Med Biol ; 1252: 75-79, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816264

RESUMO

Breast cancer diagnosed during pregnancy or lactation up to 1 year post-partum is often referred to as pregnancy-associated breast cancer (PABC) , although the definition varies with length of post-partum period. The incidence rate has been reported to range from 17.5 to 39.9 per 100,000 births, but the rate is substantially lower during pregnancy (ranging from 3.0 to 7.7) than during the post-partum period (ranging from 13.8 to 32.2). The PABC incidence rate is increasing in many populations, and higher maternal age at birth is a likely explanation. Linkable population-based data on pregnancies and cancer are required to obtain reliable estimates of PABC incidence. In studies comparing outcomes in women with PABC to other young breast cancer patients, it is crucial to adjust for age, since the age distribution of PABC depends both on age at pregnancy and age at breast cancer. Large studies have shown similar prognosis for women with PABC compared to other young women with breast cancer, when accounting for differences in age, stage and other tumour characteristics.


Assuntos
Neoplasias da Mama/epidemiologia , Complicações Neoplásicas na Gravidez/epidemiologia , Feminino , Humanos , Incidência , Lactação , Idade Materna , Gravidez
7.
Proc Biol Sci ; 287(1932): 20200972, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32781953

RESUMO

Maternal senescence is the detrimental effect of increased maternal age on offspring performance. Despite much recent interest given to describing this phenomenon, its distribution across animal species is poorly understood. A review of the published literature finds that maternal age affects pre-adult survival in 252 of 272 populations (93%) representing 97 animal species. Age effects tended to be deleterious in invertebrates and mammals, including humans, confirming the presence of senescence. However, bird species were a conspicuous exception, as pre-adult survival tended to increase with maternal age in surveyed populations. In all groups, maternal-age effects became more negative in older mothers. Invertebrates senesced faster than vertebrates, and humans aged faster than non-human mammals. Within invertebrates, lepidopterans demonstrated the most extreme rates of maternal-effect senescence. Among the surveyed studies, phylogeny, life history and environment (e.g. laboratory versus wild populations) were tightly associated; this made it difficult to make confident inferences regarding the causes of diversity for the phenomenon. However, we provide some testable suggestions, and we observe that some differences appear to be consistent with predictions from evolutionary theory. We discuss how future work may help clarify ultimate and proximate causes for this diversity.


Assuntos
Evolução Biológica , Idade Materna , Animais , Biodiversidade , Feminino , Humanos , Invertebrados , Mamíferos , Herança Materna
8.
PLoS One ; 15(8): e0236955, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764770

RESUMO

BACKGROUND: Childhood vaccination plays a key role in reducing morbidity and mortality from vaccine-preventable diseases. Numerous studies have assessed the influence of demographic and socioeconomic factors on child immunization around the world. There are few such studies in Afghanistan, however. Therefore, this study aimed to identify factors influencing vaccination status among children age 12-23 months in Afghanistan. MATERIALS AND METHODS: Nationally representative data from the 2015 Afghanistan Demographic and Health Survey were used for this study. A sample of 5,708 children age 12-23 months with a vaccine card and immunization history was analyzed. Multinomial logistic regression was used to identify significant relationships between cofactors and vaccination status. RESULTS: In the study, 51% the subjects were boys, 48% were born at home, and 76% were residents of rural areas. Background characteristics positively associated with vaccination status included delivery in a health facility (RRR = 2.5, 95% CI = 1.9-3.3), maternal age of 30-39 years (RRR = 2.2, 95% CI = 1.2-4.1), attending at least four visits for antenatal care (RRR = 2.7, 95% CI = 1.7-4.5), health facility visit in the past 12 months (RRR = 1.9, 95% CI = 1.4-2.5), paternal professional occupation (RRR = 4.9, 95% CI = 2.0-12.3), family with richer wealth index (RRR = 2.4, 95% CI = 1.4-4.1), and living in the northeast region (RRR = 2.2, 95% CI = 1.2-3.9)were positively associated with vaccination status. Living in the southern region (RRR = 0.3, 95% CI = 0.2-0.5) was negatively associated with vaccination status. CONCLUSION: This study identified maternal age, ANC visits, place of delivery, health facility visits in past 12 months, paternal occupation, wealth quintile, and geographic region as the factors influencing child's vaccination status in Afghanistan.


Assuntos
Cobertura Vacinal/estatística & dados numéricos , Adulto , Afeganistão , Estudos Transversais , Demografia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Programas de Imunização/estatística & dados numéricos , Lactente , Modelos Logísticos , Masculino , Idade Materna , Pessoa de Meia-Idade , Fatores Socioeconômicos , Vacinação/estatística & dados numéricos , Adulto Jovem
9.
PLoS One ; 15(8): e0237224, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817647

RESUMO

AIM: The addition of maternal age to fasting plasma glucose (FPG) at 24-28 gestational weeks improves the performance of GDM screening as maternal age increases. However, this method delays the diagnosis of GDM. Since FPG at the first prenatal visit (FPV) is a screening option for pre-existing diabetes, we evaluated the performance of age plus FPG at the FPV to reduce the need for the OGTT. METHODS: Pregnant women were recruited consecutively in 2013-2018 (the training cohort) and 2019 (the validation cohort). We excluded women with twin pregnancies, unavailable FPG at the FPV or OGTT data, pre-pregnancy diabetes, or a history of GDM. All participants underwent FPG and haemoglobin A1c (HbA1c) at the FPV and received 75-g OGTT at 24-28 gestational weeks if FPG at the FPV was <92 mg/dL. GDM was diagnosed by the IADPSG criteria. Two algorithms were developed with the cutoffs determined when the percentage requiring OGTT (OGTT%) was the lowest and the sensitivity was ≥90%. RESULTS: The incidence of GDM increased with age. The "FPG at the FPV" algorithm reduced OGTT% to 68.8% with the FPG cutoff at 79 mg/dl. The "age plus FPG at the FPV" algorithm, with the cutoff of 114, further reduced OGTT% to 58.3%, with the sensitivity of 90.7% (9.3% GDM missed) and the specificity of 100%. These findings were replicated in the validation cohort. CONCLUSIONS: Screening GDM by maternal age plus FPG at the FPV can reduce OGTT%, especially in populations with a significant proportion of pregnant women with advanced ages.


Assuntos
Glicemia/análise , Diabetes Gestacional/sangue , Adulto , Diabetes Gestacional/diagnóstico , Jejum/sangue , Feminino , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Humanos , Programas de Rastreamento , Idade Materna , Gravidez , Estudos Prospectivos
10.
PLoS One ; 15(8): e0236435, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760090

RESUMO

BACKGROUND: Obesity is a major health problem in low and middle income countries (LMICs) and is associated with miscarriage. This study aims to examine the association between obesity and miscarriage among reproductive age women (15-49 years) in Nepal. METHODS: The combined 19160 cross-sectional pregnancy data from the Nepal Demographic and Health Survey (NDHS) for the years 2001, 2006, 2011 and 2016 was utilized. Miscarriage was defined as a spontaneous loss of pregnancy that occurred before the foetus reached 7 months of gestational age. Logistic regression analyses that adjusted for clustering, stratification and sampling weights were used to examine the association between obesity and miscarriage among women of reproductive age. RESULTS: The odds of miscarriage were 1.45 times higher (Adjusted odds ratio (AOR) = 1.45; 95%Cl: 1.06, 1.98, P = 0.021) among women with obesity. Women who did not use contraception, younger (15-19 years), and older women (35 years or more) were significantly more likely to have miscarriage. Women who smoked tobacco reported higher odds of miscarriage than women who did not smoke tobacco (AOR = 1.27; 95%Cl: 1.07,1.50, P = 0.006). Stratification of maternal smoking status by maternal Body Mass Index (BMI), after adjusting for contraception, mother age and year of survey revealed that tobacco smoking and obesity are associated with miscarriage (AOR = 1.46; 95%Cl: 1.05,2.04, P = 0.025). CONCLUSIONS: Findings from this study show that obesity and tobacco smoking are associated with miscarriage. Smoking cessation, pregnancy planning and counselling on healthy weight for women of reproductive age in Nepal may help promote healthy behaviours and decrease the likelihood of miscarriage.


Assuntos
Aborto Espontâneo , Obesidade , Fumar Tabaco/efeitos adversos , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Estilo de Vida Saudável , Humanos , Idade Materna , Pessoa de Meia-Idade , Nepal/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Gravidez , Fatores de Risco , Adulto Jovem
11.
Mutat Res ; 785: 108320, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32800274

RESUMO

It is well established that maternal age is associated with a rapid decline in the production of healthy and high-quality oocytes resulting in reduced fertility in women older than 35 years of age. In particular, chromosome segregation errors during meiotic divisions are increasingly common and lead to the production of oocytes with an incorrect number of chromosomes, a condition known as aneuploidy. When an aneuploid oocyte is fertilized by a sperm it gives rise to an aneuploid embryo that, except in rare situations, will result in a spontaneous abortion. As females advance in age, they are at higher risk of infertility, miscarriage, or having a pregnancy affected by congenital birth defects such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), and Turner syndrome (monosomy X). Here, we review the potential molecular mechanisms associated with increased chromosome segregation errors during meiosis as a function of maternal age. Our review shows that multiple exogenous and endogenous factors contribute to the age-related increase in oocyte aneuploidy. Specifically, the weight of evidence indicates that recombination failure, cohesin deterioration, spindle assembly checkpoint (SAC) disregulation, abnormalities in post-translational modification of histones and tubulin, and mitochondrial dysfunction are the leading causes of oocyte aneuploidy associated with maternal aging. There is also growing evidence that dietary and other bioactive interventions may mitigate the effect of maternal aging on oocyte quality and oocyte aneuploidy, thereby improving fertility outcomes. Maternal age is a major concern for aneuploidy and genetic disorders in the offspring in the context of an increasing proportion of mothers having children at increasingly older ages. A better understanding of the mechanisms associated with maternal aging leading to aneuploidy and of intervention strategies that may mitigate these detrimental effects and reduce its occurrence are essential for preventing abnormal reproductive outcomes in the human population.


Assuntos
Aneuploidia , Proteínas de Ciclo Celular/genética , Proteínas Cromossômicas não Histona/genética , Segregação de Cromossomos/genética , Anormalidades Congênitas/genética , Idade Materna , Anormalidades Congênitas/prevenção & controle , Feminino , Humanos , Pontos de Checagem da Fase M do Ciclo Celular/genética , Meiose/genética , Mitocôndrias/fisiologia , Oócitos/fisiologia
12.
PLoS One ; 15(8): e0236290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785214

RESUMO

High and variable pre-weaning mortality is a persistent problem in laboratory mouse breeding. Assuming a modest 15% mortality rate across mouse strains, means that approximately 1 million more pups are produced yearly in the EU to compensate for those which die. This paper presents the first large study under practical husbandry conditions to determine the risk factors associated with mouse pre-weaning mortality. We analysed historical records from 219,975 pups from two breeding facilities, collected as part of their management routine and including information on number of pups born and weaned per litter, parents' age and identification, and dates of birth and death of all animals. Pups were counted once in their first week of life and at weaning, and once every one or two weeks, depending on the need for cage cleaning. Dead pups were recorded as soon as these were found during the daily cage screening (without opening the cage). It was hypothesized that litter overlap (i.e. the presence of older siblings in the cage when new pups are born), a recurrent social configuration in trio-housed mice, is associated with increased newborn mortality, along with advanced dam age, large litter size, and a high number and age of older siblings in the cage. The estimated probability of pup death was two to seven percentage points higher in cages with litter overlap compared to those without. Litter overlap was associated with an increase in death of the entire litter of five and six percentage points, which represent an increase of 19% and 103% compared to non-overlapped litters in the two breeding facilities, respectively. Increased number and age of older siblings, advanced dam age, small litter size (less than four pups born) and large litter size (over 11 pups born) were associated with increased probability of pup death.


Assuntos
Animais de Laboratório/fisiologia , Cruzamento/métodos , Ciência dos Animais de Laboratório/métodos , Tamanho da Ninhada de Vivíparos/fisiologia , Camundongos Endogâmicos C57BL/fisiologia , Fatores Etários , Animais , Feminino , Masculino , Idade Materna , Camundongos , Gravidez , Reprodução/fisiologia , Desmame
13.
Reprod Biomed Online ; 41(3): 428-430, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32753362

RESUMO

RESEARCH QUESTION: Discontinuation of IVF cycles has been part of the radical transformation of healthcare provision to enable reallocation of staff and resources to deal with the COVID-19 pandemic. This study sought to estimate the impact of cessation of treatment on individual prognosis and US population live birth rates. DESIGN: Data from 271,438 ovarian stimulation UK IVF cycles was used to model the effect of age as a continuous, yet non-linear, function on cumulative live birth rate. This model was recalibrated to cumulative live birth rates reported for the 135,673 stimulation cycles undertaken in the USA in 2016, with live birth follow-up to October 2018. The effect of a 1-month, 3-month and 6-month shutdown in IVF treatment was calculated as the effect of the equivalent increase in a woman's age, stratified by age group. RESULTS: The average reduction in cumulative live birth rate would be 0.3% (95% confidence interval [CI] 0.3-0.3), 0.8% (95% CI 0.8-0.8) and 1.6% (95% CI 1.6-1.6) for 1-month, 3-month and 6-month shutdowns. This corresponds to a reduction of 369 (95% CI 360-378), 1098 (95% CI 1071-1123) and 2166 (95% CI 2116-2216) live births in the cohort, respectively. Th e greatest contribution to this reduction was from older mothers. CONCLUSIONS: The study demonstrated that the discontinuation of fertility treatment for even 1 month in the USA could result in 369 fewer women having a live birth, due to the increase in patients' age during the shutdown. As a result of reductions in cumulative live birth rate, more cycles may be required to overcome infertility at individual and population levels.


Assuntos
Betacoronavirus , Coeficiente de Natalidade , Infecções por Coronavirus/epidemiologia , Fertilização In Vitro/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Nascimento Vivo/epidemiologia , Idade Materna , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
14.
PLoS One ; 15(8): e0237611, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32797105

RESUMO

OBJECTIVE: Acute respiratory infections (ARI) are the leading causes of neonatal and child mortality. Despite several national efforts to reduce the incidence of mortality among children, India is one of the largest contributors to under-five mortality in the world. In this study, we examined the effects of indoor pollution on ARI among under-five children in India. METHODS: A cross-sectional study was carried using nationally representative data from the 2015-2016 National Family Health Survey (NFHS-4). This study is based on 247,743 living children under the age of five years. Bivariate and multivariate analyses were performed to assess the impact of indoor air pollution on children's ARI. RESULTS: Almost two-thirds of households (65.2%) used biomass fuels for cooking, 54.9% of households had a separate kitchen, and 47.2% of households had a smoker. About 2.7% of children suffered from ARI in the past two weeks preceding the survey. The use of biomass fuels (OR [odds ratio]: 1.10, 95% CI: 1.01-1.20), households having no separate kitchen (OR: 1.22, 95% CI: 1.14-1.30), and smoking behavior of household members (OR: 1.06, 95% CI: 1.00-1.12) were associated with greater risk of ARI among under-five children even after adjusting for age of child, sex of child, birth order, maternal age, maternal education, caste, religion, wealth quintile, any HH members suffer from tuberculosis (TB), and household crowding. Furthermore, the results revealed that the combined effects of biomass fuels and households without separate kitchen increased the likelihood of children's ARI by 36% (Adjusted OR: 1.35, 95% CI: 1.21-1.51). CONCLUSION: The findings of this study suggest policy interventions to reduce the exposure of indoor air pollution, particularly among the impoverished groups. The government should ensure cleaner fuels for cooking, such as LPG and electricity, to minimize the risk of respiratory diseases among children.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Infecções Respiratórias/epidemiologia , Adolescente , Adulto , Poluição do Ar em Ambientes Fechados/análise , Pré-Escolar , Culinária , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Idade Materna , Pessoa de Meia-Idade , Infecções Respiratórias/induzido quimicamente , Fatores Socioeconômicos , Adulto Jovem
15.
PLoS One ; 15(7): e0235262, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716927

RESUMO

OBJECTIVE: Public insurance (Medicaid) covered 42% of all U.S. births in 2018. This paper describes and analyzes the self-reported experiences of women with Medicaid versus commercial insurance relating to autonomy, control and respectful treatment in maternity care. METHODS: The sampling frame for the Listening to Mothers in California survey was drawn from 2016 California birth certificate files. The 30-minute survey had a 55% response rate. A secondary multivariable analysis of results from the survey included 2,318 women with commercial private insurance (1,087) or public (Medi-Cal) (1,231) coverage. Results were weighted and were representative of all births in 2016 in California. The multivariable analysis of variables related to maternal agency included engagement in decision making regarding interventions such as vaginal birth after cesarean and episiotomy, feeling pressured to have interventions and sense of fair treatment. We examined their relationship to insurance status adjusted for maternal age, race/ethnicity, education, nativity and attitude toward birth as well as type of prenatal provider, type of birth attendant and pregnancy complications. RESULTS: Women with Medi-Cal had a demographic profile distinct from those with commercial insurance. In multivariable analysis, women with Medi-Cal reported less control over their maternity care experience than women with commercial insurance, including less choice of prenatal provider (AOR 1.61 95%C.I. 1.20, 2.17), or a vaginal birth after cesarean (AOR 2.93 95%C.I. 1.49, 5.73). Mothers on Medi-Cal were also less likely to be consulted before experiencing an episiotomy (AOR 0.30 95%C.I. 0.09, 0.94). They were more likely to report feeling pressure to have a primary cesarean (AOR 2.54 95%C.I. 1.55, 4.16) and less likely to be encouraged by staff to make their own decisions (AOR 0.63 95%C.I. 0.47, 0.85). CONCLUSIONS: Childbearing women with public insurance in California clearly and consistently reported less opportunity to choose their care than women with private insurance. These inequities are a call to action for increased accountability and quality improvement relating to care of the many childbearing women with Medicaid coverage.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Relações Profissional-Paciente , Respeito , Adulto , California , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Humanos , Cobertura do Seguro/economia , Idade Materna , Serviços de Saúde Materna/economia , Medicaid/economia , Medicaid/estatística & dados numéricos , Gravidez , Autorrelato/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
16.
Natl Vital Stat Rep ; 69(5): 1-18, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32600516

RESUMO

Objectives-This report assesses the contributions of the changing maternal age distribution and maternal age-specific infant mortality rates on overall and race and Hispanic origin-specific infant mortality rates in the United States from 2000 to 2017. Methods-The analyses used 2000-2017 linked birth and infant death data from the National Vital Statistics System. Age-adjusted infant mortality rates, based on the 2000 U.S. maternal age distribution, were calculated for each year. These rates were compared with crude rates for all births and for specific race and Hispanic-origin groups. Decomposition analysis was used to estimate the proportion of the decline due to changes in maternal age distribution and in age-specific mortality rates. Results-During 2000-2017, the age of women giving birth rose as infant mortality rates declined, although unevenly across maternal age groups. The maternal age-adjusted infant mortality rate in 2017 was 6.13 compared with the crude rate of 5.79, resulting in a 0.34 percentage point difference. Changes in the maternal age distribution accounted for 31.3% of the decline in infant mortality rates for all births and for births to non-Hispanic white women, and for 4.8% of the decline in births to non-Hispanic black women. Declines in age-specific mortality rates accounted for the remainder of the decline for these groups and for all of the decline in births to Hispanic women. Conclusion-Changes in the age distribution of women giving birth accounted for about one-third of the decline in infant mortality rates from 2000 through 2017; declines in maternal age-specific mortality rates accounted for about two-thirds of this decline. These patterns varied by race and Hispanic origin.


Assuntos
Mortalidade Infantil/tendências , Idade Materna , Adulto , Distribuição por Idade , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Gravidez , Estados Unidos/epidemiologia , Estatísticas Vitais , Adulto Jovem
17.
PLoS Med ; 17(7): e1003089, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32649668

RESUMO

INTRODUCTION: Inequalities in maternal and newborn health persist in many high-income countries, including for women of refugee background. The Bridging the Gap partnership programme in Victoria, Australia, was designed to find new ways to improve the responsiveness of universal maternity and early child health services for women and families of refugee background with the codesign and implementation of iterative quality improvement and demonstration initiatives. One goal of this 'whole-of-system' approach was to improve access to antenatal care. The objective of this paper is to report refugee women's access to hospital-based antenatal care over the period of health system reforms. METHODS AND FINDINGS: The study was designed using an interrupted time series analysis using routinely collected data from two hospital networks (four maternity hospitals) at 6-month intervals during reform activity (January 2014 to December 2016). The sample included women of refugee background and a comparison group of Australian-born women giving birth over the 3 years. We describe the proportions of women of refugee background (1) attending seven or more antenatal visits and (2) attending their first hospital visit at less than 16 weeks' gestation compared over time and to Australian-born women using logistic regression analyses. In total, 10% of births at participating hospitals were to women of refugee background. Refugee women were born in over 35 countries, and at one participating hospital, 40% required an interpreter. Compared with Australian-born women, women of refugee background were of similar age at the time of birth and were more likely to be having their second or subsequent baby and have four or more children. At baseline, 60% of refugee-background women and Australian-born women attended seven or more antenatal visits. Similar trends of improvement over the 6-month time intervals were observed for both populations, increasing to 80% of women at one hospital network having seven or more visits at the final data collection period and 73% at the other network. In contrast, there was a steady decrease in the proportion of women having their first hospital visit at less than 16 weeks' gestation, which was most marked for women of refugee background. Using an interrupted time series of observational data over the period of improvement is limited compared with using a randomisation design, which was not feasible in this setting. CONCLUSIONS: Accurate ascertainment of 'harder-to-reach' populations and ongoing monitoring of quality improvement initiatives are essential to understand the impact of system reforms. Our findings suggest that improvement in total antenatal visits may have been at the expense of recommended access to public hospital antenatal care within 16 weeks of gestation.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adolescente , Adulto , Feminino , Maternidades/estatística & dados numéricos , Humanos , Recém-Nascido , Análise de Séries Temporais Interrompida , Idade Materna , Gravidez , Segundo Trimestre da Gravidez , Melhoria de Qualidade , Fatores Socioeconômicos , Vitória/epidemiologia , Adulto Jovem
18.
Am J Perinatol ; 37(11): 1077-1083, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32615621

RESUMO

OBJECTIVE: This study aimed to determine the rate of preterm birth (PTB) during hospitalization among women diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 23 and 37 weeks of gestation and whether this rate differs by gestational age at diagnosis of infection. STUDY DESIGN: Retrospective, cross-sectional study of all women diagnosed with SARS-CoV-2 infection between 23 and 37 weeks of gestation within a large integrated health system from March 13 to April 24, 2020. Cases with severe fetal structural malformations detected prior to infection were excluded. Women were stratified into two groups based on gestational age at diagnosis: early preterm (230/7 to 336/7 weeks) versus late preterm (34 to 366/7 weeks). We compared the rate of PTB during hospitalization with infection between the two groups. Statistical analysis included use of Wilcoxon rank sum and Fisher exact tests, as well as a multivariable logistic regression. Statistical significance was defined as a p-value <0.05. RESULTS: Of the 65 patients included, 36 (53.7%) were diagnosed in the early preterm period and 29 (46.3%) were diagnosed in the late preterm period. Baseline demographics were similar between groups. The rate of PTB during hospitalization with infection was significantly lower among women diagnosed in the early preterm period compared with late preterm (7/36 [19.4%] vs. 18/29 [62%], p-value = 0.001). Of the 25 patients who delivered during hospitalization with infection, the majority were indicated deliveries (64%, 16/25). There were no deliveries <33 weeks of gestation for worsening coronavirus disease 2019 and severity of disease did not alter the likelihood of delivery during hospitalization with SARS-CoV-2 infection (adjusted odds ratio [aOR]: 0.64; 95% confidence interval [CI]: 0.24-1.59). Increased maternal age was associated with a lower likelihood of delivery during hospitalization with SARS-CoV-2 infection (aOR: 0.77; 95% CI: 0.58-0.96), while later gestational age at diagnosis of infection was associated with a higher likelihood of delivery during hospitalization (aOR: 2.9; 95% CI: 1.67-8.09). CONCLUSION: The likelihood of PTB during hospitalization with SARS-CoV-2 infection is significantly lower among women diagnosed in the early preterm period compared with late preterm. Most women with SARS-CoV-2 infection in the early preterm period recovered and were discharged home. The majority of PTB were indicated and not due to spontaneous preterm labor. KEY POINTS: · Preterm delivery is less likely among women diagnosed in the early preterm compared with late preterm.. · Most women infected in the early preterm period recovered and were discharged home undelivered.. · The majority of preterm birth were indicated and not due to spontaneous preterm labor..


Assuntos
Betacoronavirus/isolamento & purificação , Coeficiente de Natalidade , Infecções por Coronavirus , Trabalho de Parto Prematuro/epidemiologia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Adulto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Estudos Transversais , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Idade Materna , New York/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Cuidado Pré-Natal/métodos , Fatores de Tempo
19.
Neurology ; 95(9): e1163-e1173, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32727836

RESUMO

OBJECTIVE: To examine the relationship between neonatal inflammatory cytokines and perinatal stroke using a systems biology approach analyzing serum and blood-spot cytokines from 47 patients. METHODS: This was a population-based, controlled cohort study with prospective and retrospective case ascertainment. Participants were recruited through the Alberta Perinatal Stroke Project. Stroke was classified as neonatal arterial ischemic stroke (NAIS), arterial presumed perinatal ischemic stroke (APPIS), or periventricular venous infarction (PVI). Biosamples were stored blood spots (retrospective) and acute serum (prospective). Controls had comparable gestational and maternal ages. Sixty-five cytokines were measured (Luminex). Hierarchical clustering analysis was performed to create heat maps. The Fisher linear discriminant analysis was used to create projection models to determine discriminatory boundaries between stroke types and controls. RESULTS: A total of 197 participants were analyzed (27 with NAIS, 8 with APPIS, 12 with PVI, 150 controls). Cytokines were quantifiable with quality control measures satisfied (standards testing, decay analysis). Linear discriminant analysis had high accuracy in using cytokine profiles to separate groups. Profiles in participants with PVI and controls were similar. NAIS separation was accurate (sensitivity 77%, specificity 97%). APPIS mapping was also distinguishable from NAIS (sensitivity 86%, specificity 99%). Classification tree analysis generated similar diagnostic accuracy. CONCLUSIONS: Unique inflammatory biomarker signatures are associated with specific perinatal stroke diseases. Findings support an acquired pathophysiology and suggest the possibility that at-risk pregnancies might be identified to develop prevention strategies. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that differences in acute neonatal serum cytokine profiles can discriminate between patients with specific perinatal stroke diseases and controls.


Assuntos
Isquemia Encefálica/imunologia , Citocinas/imunologia , Inflamação/imunologia , Acidente Vascular Cerebral/imunologia , Adulto , Idade de Início , Infarto Encefálico/classificação , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/imunologia , Infarto Encefálico/fisiopatologia , Isquemia Encefálica/classificação , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Análise por Conglomerados , Análise Discriminante , Teste em Amostras de Sangue Seco , Feminino , Humanos , Recém-Nascido , Infarto da Artéria Cerebral Média/classificação , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/imunologia , Infarto da Artéria Cerebral Média/fisiopatologia , Doenças Arteriais Intracranianas/classificação , Doenças Arteriais Intracranianas/diagnóstico por imagem , Doenças Arteriais Intracranianas/imunologia , Doenças Arteriais Intracranianas/fisiopatologia , Modelos Lineares , Imagem por Ressonância Magnética , Masculino , Idade Materna , Paresia/fisiopatologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Convulsões/fisiopatologia , Fumar/epidemiologia , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Substância Branca/diagnóstico por imagem , Adulto Jovem
20.
Natl Vital Stat Rep ; 69(7): 1-18, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32730740

RESUMO

Objectives-This report presents 2018 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined. Methods-Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2018 period linked birth/infant death file; the linked birth/infant death file is based on birth and death certificates registered in all states and the District of Columbia. Results-A total of 21,498 infant deaths were reported in the United States in 2018. The U.S. infant mortality rate was 5.67 infant deaths per 1,000 live births, lower than the rate of 5.79 in 2017 and an historic low in the country. The neonatal and post neonatal mortality rates for 2018 (3.78 and 1.89, respectively) demonstrated a nonsignificant decline compared with 2017 (3.85 and 1.94, respectively). The 2018 mortality rate declined for infants of Hispanic women compared with the 2017 rate; changes in rates for other race and Hispanic-origin groups were not statistically significant. The 2018 infant mortality rate for infants of non-Hispanic black women (10.75) was more than twice as high as that for infants of non-Hispanic white (4.63), non-Hispanic Asian (3.63), and Hispanic women (4.86). Infants born very preterm (less than 28 weeks of gestation) had the highest mortality rate (382.20), 186 times as high as that for infants born at term (37-41 weeks of gestation) (2.05). The five leading causes of infant death in 2018 were the same as in 2017; cause-of-death rankings and mortality rates varied by maternal race and Hispanic origin. Infant mortality rates by state for 2018 ranged from a low of 3.50 in New Hampshire to a high of 8.41 in Mississippi.


Assuntos
Mortalidade Infantil/tendências , Adolescente , Adulto , Distribuição por Idade , Causas de Morte/tendências , Grupos Étnicos/estatística & dados numéricos , Feminino , Idade Gestacional , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Recém-Nascido , Masculino , Idade Materna , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Gravidez , Características de Residência/estatística & dados numéricos , Estados Unidos/epidemiologia , Estatísticas Vitais , Adulto Jovem
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