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2.
Rev. bioét. derecho ; (49): 141-154, jul. 2020.
Artigo em Português | IBECS | ID: ibc-192099

RESUMO

O diagnóstico seguro de malformações congênitas possibilitado pelo avanço tecnológico da propedêutica fetal possibilita o exercício da autonomia reprodutiva da gestante, embora suscite dilemas éticos e jurídicos de difícil solução, como a opção pelo aborto e a tomada de decisões em neonatos com escassas possibilidades de sobrevivência. As decisões em fim de vida e o abandono de técnicas terapêuticas fúteis que não alteram o curso natural da doença despertam conflitos éticos entre a equipe de saúde e os familiares. Nesse cenário, importa analisar o âmbito de proteção aos direitos das pessoas com deficiência no Brasil e sua aplicação aos neonatos com graves malformações congênitas, visando contribuir ao debate sobre a morte digna no período neonatal


El diagnóstico efectivo de malformaciones congénitas que resulta del avance tecnológico de la propedéutica fetal posibilita el ejercicio de la autonomía reproductiva de la mujer embarazada, aunque presente dilemas éticos y jurídicos de solución difícil, como la opción por el aborto y la toma de decisiones en casos de recién nacidos con baja posibilidad de sobrevivir. Decisiones de fin de la vida y el abandono de técnicas terapéuticas fútiles que no cambian la evolución natural de la enfermedad producen conflictos éticos entre el equipo de salud y la familia. En ese escenario, es importante analizar el ámbito de protección a los derechos de las personas con deficiencia en Brasil y su aplicación a los recién nacidos con malformaciones congénitas graves, con el objetivo de contribuir al debate sobre la muerte digna en el periodo neonatal


The diagnostic certainty of congenital malformations, made possible by the technological advances in fetal propaedeutics, enables the exercise of reproductive autonomy by the pregnant woman, although it results in ethical and legal dilemmas that are difficult to solve, such as the option for abortion, and decision-making regarding newborns with meager survival possibility. End-of-life decisions and the abandonment of futile therapeutic techniques that do not alter the natural course of the illness give rise to ethical conflicts between the health team and family members. In this setting, it is important to analyze the scope of protection of the rights of handicapped persons in Brazil, and how it applies to the newborn with severe congenital malformations, with the goal of contributing to dignified death in the neonatal period


El diagnòstic efectiu de malformacions congènites que resulta de l'avanç tecnològic de la propedèutica fetal possibilita l'exercici de l'autonomia reproductiva de la dona embarassada, encara que presenta dilemes ètics I jurídics de solució difícil, com l'opció per l'avortament I la presa de decisions en casos de nounats amb baixa possibilitat de sobreviure. Les decisions de final de la vida I l'abandonament de tècniques terapèutiques fútils que no canvien l'evolució natural de la malaltia donen lloc a conflictes ètics entre l'equip de salut I la família. En aquest escenari, és important analitzar l'àmbit de protecció dels drets de les persones amb deficiència a Brasil I la seva aplicació als nadons amb malformacions congènites greus, a fi de contribuir al debat sobre la mort digna en el període neonatal


Assuntos
Humanos , Gravidez , Recém-Nascido , Anormalidades Congênitas/genética , Temas Bioéticos , Tomada de Decisões/ética , Doenças do Recém-Nascido/genética , Futilidade Médica/ética , Viabilidade Fetal/genética , Brasil , Futilidade Médica/legislação & jurisprudência , Defesa da Criança e do Adolescente/ética , Diagnóstico Pré-Natal/ética , Troca Materno-Fetal/genética
3.
Obstet Gynecol ; 135(3): e80-e97, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32080050

RESUMO

Preterm birth occurs in approximately 10% of all births in the United States and is a major contributor to perinatal morbidity and mortality (). Prelabor rupture of membranes (PROM) that occurs preterm complicates approximately 2-3% of all pregnancies in the United States, representing a significant proportion of preterm births, whereas term PROM occurs in approximately 8% of pregnancies (). The optimal approach to assessment and treatment of women with term and preterm PROM remains challenging. Management decisions depend on gestational age and evaluation of the relative risks of delivery versus the risks (eg, infection, abruptio placentae, and umbilical cord accident) of expectant management when pregnancy is allowed to progress to a later gestational age. The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented. This Practice Bulletin is updated to include information about diagnosis of PROM, expectant management of PROM at term, and timing of delivery for patients with preterm PROM between 34 0/7 weeks of gestation and 36 6/7 weeks of gestation.


Assuntos
Ruptura Prematura de Membranas Fetais , Feminino , Viabilidade Fetal , Humanos , Gravidez , Conduta Expectante
4.
Sex Reprod Health Matters ; 28(1): 1686201, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31892281

RESUMO

Fetal "heartbeat" bills have become the anti-abortion legislative measure of choice in the US war on sexual and reproductive health and rights (SRHR). In 2019, Georgia House Bill 481 (HB 481) passed by a narrow margin banning abortions upon detection of embryonic cardiac activity, as early as six weeks gestation. The purpose of this study was to distinguish and characterise the arguments and tactics used by legislators and community members in support of Georgia's early abortion ban. Our data included testimony and debate from House Health and Human Services and the Senate Science and Technology Committees; data were transcribed verbatim and coded in MAXQDA 18 using a constant comparison method. Major themes included: the use of the "heartbeat" as an indicator of life and therefore personhood; an attempt to create a new class of persons - fetuses in utero - entitled to legal protection; and arguments to expand state protections for fetuses as a matter of state sovereignty and rights. Arguments were furthered through appropriation by misrepresenting medical science and co-opting the legal successes of progressive movements. Our analysis provides an initial understanding of evolving early abortion ban strategy and its tactics for challenging established legal standards and precedent. As the battle over SRHR wages on, opponents of abortion bans should attempt to understand, deconstruct, and analyse anti-abortion messaging to effectively combat it. These data may inform their tactical strategies to advance sexual and reproductive health, rights, and justice both in the US context and beyond.


Assuntos
Aborto Induzido/legislação & jurisprudência , Início da Vida Humana , Regulamentação Governamental , Direitos Humanos/legislação & jurisprudência , Pessoalidade , Feminino , Viabilidade Fetal , Georgia , Humanos , Gravidez , Gestantes
5.
Theriogenology ; 142: 310-314, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31711687

RESUMO

The assessment of the behavior and physiological parameters of neonatal foals is essential in the detection of early signs of illness. Modified Apgar scoring systems from human medicine exist and have been validated in foals as a guide for assessing neonatal viability after birth. This study evaluated the viability of 44 Amiata donkey foals at birth, by assessing the Apgar score and comparing the relationship between viability and various physical parameters. A total of 44 Amiata donkey foals and 27 jennies were enrolled in this study. An expert operator examined each foal within 5 min of birth. A complete physical examination was performed, along with an existing four-parameter Apgar score. The presence of the suckling reflex was evaluated. The interval time needed to acquire sternal recumbency and quadrupedal position, as well as nurse from the mare, were recorded. In addition, heart rate (HR), respiratory rate (RR), and rectal body temperature (BT) were measured. Results were expressed as median ± standard error, minimum and maximum values. The effects of the Apgar score on time to reach sternal position and quadrupedal standing, time to nurse from the mare, RR, HR, and BT were estimated along with the differences related to Apgar scoring and gender. Differences between female and male donkey foals regarding the time to acquire sternal position and quadrupedal standing, time to nurse from the mare, RR, HR, and BT were also assessed. Differences between female and male donkey foals regarding the Apgar score was evaluated using a chi-Square test. Finally, the reference values for Amiata donkeys were also calculated. Twenty/44 (45.4%) foals were colts and 24/44 (54.5%) were fillies born from 27 jennies. None of the foals showed an Apgar score lower than 6. Twenty-nine out of 44 foals showed an Apgar score of 8/8, 10/44 a score of 7/8, while 5 foals (11.3%) showed a score of 6/8. No differences between fillies and colts in relation to the Apgar score were obtained.


Assuntos
Animais Recém-Nascidos , Índice de Apgar , Parto/fisiologia , Exame Físico/veterinária , Animais , Equidae , Feminino , Viabilidade Fetal/fisiologia , Gravidez , Reflexo/fisiologia , Projetos de Pesquisa , Comportamento de Sucção/fisiologia , Medicina Veterinária/métodos
6.
Am J Perinatol ; 37(2): 184-195, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31437859

RESUMO

OBJECTIVE: To describe periviability counseling practices and decision making. STUDY DESIGN: This is a retrospective review of mothers and newborns delivering between 22 and 24 completed weeks from 2011 to 2015 at six U.S. centers. Maternal and fetal/neonatal clinical and maternal sociodemographic data from medical records and geocoded sociodemographic information were collected. Separate analyses examined characteristics surrounding receiving neonatology consultation; planning neonatal resuscitation; and centers' planned resuscitation rates. RESULTS: Neonatology consultations were documented for 40, 63, and 72% of 498 mothers delivering at 22, 23, and 24 weeks, respectively. Consult versus no-consult mothers had longer median admission-to-delivery intervals (58.7 vs. 8.7 h, p < 0.001). Consultations were seen more frequently when parental decision making was evident. In total, 76% of mothers had neonatal resuscitation planned. Resuscitation versus no-resuscitation newborns had higher mean gestational ages (24.0 vs. 22.9 weeks, p < 0.001) and birthweights (618 vs. 469 g, p < 0.001). Planned resuscitation rates differed at higher (HR) versus lower (LR) rate centers at 22 (43 vs. 7%, p < 0.001) and 23 (85 vs. 58%, p < 0.001) weeks. HR versus LR centers' populations had more socioeconomic hardship markers but fewer social work consultations (odds ratio: 0.31; confidence interval: 0.15-0.59, p < 0.001). CONCLUSION: Areas requiring improvement included delivery/content of neonatology consultations, social work support, consideration of centers' patient populations, and opportunities for shared decisions.


Assuntos
Aconselhamento , Tomada de Decisões , Viabilidade Fetal , Lactente Extremamente Prematuro , Cuidado Pré-Natal , Ordens quanto à Conduta (Ética Médica) , Peso ao Nascer , Grupos de Populações Continentais , Feminino , Humanos , Recém-Nascido , Mães , Neonatologia , Equipe de Assistência ao Paciente , Gravidez , Nascimento Prematuro , Estudos Retrospectivos
7.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570361

RESUMO

A 28-year-old woman suffered a traffic accident resulting in severe head injuries with deleterious prognosis. Diagnostics further revealed a hitherto unknown pregnancy, at suspected week 9. Based on the patient's wish to donate organs, brain death protocol confirmed irreversible loss of brain function. Yet, vital pregnancy rendered organ transplantation impossible. Multiple ethical and legal issues arose, from invalidation of established legal care after brain death to the delivery of a healthy child after trauma and long-term critical care. After medicolegal and ethical counselling, pregnancy was sustained, and the goal of organ donation postponed. Critical care focused on foetal homeostasis. At 30+4 weeks, a viable girl was born via assisted vaginal delivery. Postpartal organ donation resulted in heart, kidney and pancreas transplantation. The case emphasises the medical, legal and ethical challenges to combine two apparently diametrical goals: the successful full-term pregnancy and the fulfilment of a patient's wish to donate organs.


Assuntos
Morte Encefálica , Viabilidade Fetal/fisiologia , Cuidados para Prolongar a Vida/ética , Doadores Vivos/ética , Mães , Defesa do Paciente/ética , Cuidado Pré-Natal/ética , Obtenção de Tecidos e Órgãos/ética , Adulto , Diretivas Antecipadas , Aconselhamento , Cuidados Críticos , Feminino , Humanos , Cuidados para Prolongar a Vida/métodos , Direitos do Paciente/ética , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/métodos
10.
Clin Perinatol ; 46(4): 801-816, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31653309

RESUMO

Advances in imaging and technique have pushed the boundaries of the types of surgical interventions available to fetuses with congenital and developmental abnormalities. This review focuses on fundamental aspects of fetal anesthesia, including the physiologic changes of pregnancy, uteroplacental perfusion, and fetal physiology. We discuss the types of fetal surgeries and procedures currently being performed and discuss the specific anesthetic approaches to different categories of fetal surgeries. We also discuss ethical aspects of fetal surgery and anesthesia.


Assuntos
Anestesia por Condução/métodos , Anestesia Geral/métodos , Anestésicos/uso terapêutico , Doenças Fetais/cirurgia , Terapias Fetais/métodos , Feto/cirurgia , Analgésicos Opioides/uso terapêutico , Cesárea/métodos , Feminino , Terapias Fetais/ética , Viabilidade Fetal , Fetoscopia/métodos , Idade Gestacional , Humanos , Injeções Intramusculares , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Agulhas , Bloqueadores Neuromusculares/uso terapêutico , Circulação Placentária/fisiologia , Gravidez/fisiologia , Cirurgia Assistida por Computador
11.
Anim Reprod Sci ; 209: 106139, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31514939

RESUMO

Intrauterine position and sex of adjacent fetuses in litter bearing species have been implicated in physiological and behavioral differences of offspring. The effects of uterine position and sex status of flanking fetuses with crowded uterine conditions on fetal and placental growth rate was tested. Gilts were unilaterally hysterectomized-ovariectomized at 160 d of age and mated at approximately 280 d of age, with fetal harvest at 45, 65, 85, or 105 d of gestation. Uterine position relative to the cervix, fetal status (alive, dead, sex), fetal weight, and placental weight were recorded at harvest. Each fetus was coded as adjacent to 0, 1, or 2 opposite sex fetuses and analyzed using an ANOVA fitting contemporary group, line, and flanking fetal sex code as fixed effects with sire as a random effect. The fraction of live fetuses in each classification (0, 1, 2) was 26.4%, 50.1%, and 23.4%, respectively, indicating no effect on fetal survival. Fetal weight was affected by flanking sex status between 65 d (P < 0.05) and 105 d (P < 0.001), with means at 105 d of 800.0 ± 20.3, 748.5 ± 17.8, and 672.7 ± 25.2 g, respectively for flanking sex status codes 0, 1, 2. Placental weight was similarly affected (P < 0.01) by flanking sex code, but only at 105 d. It is concluded that fetal growth and placental development in pigs is influenced by sex status of adjacent fetuses. This could be a potential source of variation in behavioral and reproductive differences later in life.


Assuntos
Desenvolvimento Fetal/fisiologia , Viabilidade Fetal/fisiologia , Tamanho da Ninhada de Vivíparos/fisiologia , Placentação , Prenhez , Suínos , Animais , Animais Recém-Nascidos , Feminino , Masculino , Placenta/fisiologia , Gravidez , Característica Quantitativa Herdável , Seleção Artificial , Caracteres Sexuais , Suínos/embriologia , Suínos/fisiologia
15.
Theriogenology ; 138: 121-126, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31326658

RESUMO

Variable gestation length in the mare poses a challenge for determination of fetal readiness for birth. The objectives of this study were to describe sonographic characteristics of the fetal GI tract in the late gestation mare and identify changes that occur with progressing fetal maturity. Based on these characteristics, a grading scale modeled after the existing human and canine scoring system was developed. Weekly sonographic examination of the fetus by one observer beginning 2-3 weeks prior to a calculated due date of 330 days was performed. Fetal assessment included; presence of stomach rugae, bowel segment definition (uniform echogenic, some defined, clearly defined), bowel segment dilation (none, segmental dilation), intestinal contents (none, mixed echogenicity) and peristalsis (none, occasional, every 3 s, continuous). Based on these characteristics a phase was assigned to the GI tract (1-5). Phase 1 was defined as a uniform echogenic grey area caudal to the diaphragm. The differentiation of Phase 2-5 was based primarily on the frequency of peristalsis, with Phase 2 exhibiting no peristalsis, Phase 3 exhibiting occasional peristalsis, Phase 4 exhibiting peristalsis every 3 s and Phase 5 exhibiting continuous peristalsis. Only data from mares with a normal parturition and healthy foals were included in the statistics (N = 10). Associations amongst sonographic fetal GI characteristics and days prepartum were validated using a simulation-based bootstrap approach with 1000 replicates using Stata 14. Stomach rugae, peristalsis, intestinal contents, tail head relaxation and udder development were all highly correlated with days prepartum. Using a multiple linear regression model, tail head relaxation and peristalsis predicted days prepartum with a 95% CI ±â€¯6 days. The same model predicted days prepartum with a 95% CI ±â€¯4 days when day of gestation, tail head relaxation and peristalsis were included as variables. Based on these findings, characterization of the fetal GI tract could provide valuable information concerning the maturity of the equine fetus. Further studies are needed comparing high risk mares to normal mares before this information could be used with confidence in the clinical setting.


Assuntos
Cavalos , Intestinos/diagnóstico por imagem , Intestinos/embriologia , Ultrassonografia Pré-Natal/veterinária , Animais , Feminino , Desenvolvimento Fetal , Monitorização Fetal/veterinária , Maturidade dos Órgãos Fetais/fisiologia , Viabilidade Fetal , Feto/diagnóstico por imagem , Idade Gestacional , Cavalos/anatomia & histologia , Cavalos/embriologia , Intestinos/anatomia & histologia , Parto , Gravidez , Prognóstico
16.
BMC Pediatr ; 19(1): 204, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221128

RESUMO

BACKGROUND: We aimed to explore the shared decision-making context at the limit of viability (weeks 22-25 of gestation) through analyzing neonatologist's communication strategies with parents and their possible impact on survival and neurodevelopmental impairment (NDI) outcomes. METHODS: A mixed methods approach was applied where a systematic literature search and in-depth semi-structured interviews with five heads of neonatology departments and one clinical ethicist from the Austrian context were integrated into a literature review. The aim was to identify decision practice models and the choice context specific to Austria. RESULTS: Professional biases, parental understanding, and the process of information giving were identified as aspects possibly influencing survival and NDI outcomes. Institutions create self-fulfilling prophecies by recommending intensive/palliative care based upon their institutional statistics, yet those vary considerably among high-income countries. Labelling an extremely preterm (EP) infant by the gestational week was shown to skew the estimates for survival while the process of information giving was shown to be subject to framing effect and other cognitive biases. CONCLUSION: Communication strategies of choice options to parents may have an impact on the way parents decide and hence also on the outcomes of EP infants.


Assuntos
Comunicação , Tomada de Decisão Compartilhada , Viabilidade Fetal , Idade Gestacional , Neonatologistas , Pais , Áustria , Viés , Causas de Morte , Comportamento de Escolha , Tomada de Decisão Clínica , Cuidados Críticos , Eticistas , Comissão de Ética , Feminino , Humanos , Lactente Extremamente Prematuro , Internacionalidade , Entrevistas como Assunto/métodos , Transtornos do Neurodesenvolvimento/etiologia , Cultura Organizacional , Cuidados Paliativos , Gravidez , Pesquisa Qualitativa , Normas Sociais , Avaliação da Tecnologia Biomédica
17.
Midwifery ; 76: 110-117, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31195219

RESUMO

OBJECTIVES: The research team aimed to understand women's lived experiences during pregnancies with poor prognosis following prenatal detection of Fetal Growth Restriction at the limits of viability (FGRLV). METHODS: Qualitative interviews with six women who had attended a specialist service following a prenatal diagnosis of FGRLV were conducted. The interview data were analysed using interpretative phenomenological analysis. FINDINGS: Three superordinate themes alongside thirteen subthemes were identified. Theme 1 described 'a fine line between supportive and unhelpful' care experiences. A second theme of 'understanding the situation and decisions to be made' described how women faced many uncertainties. The final theme of 'parental responsibility' reflected how women imagined their futures to have been, exploring their embodied parental role and connection to their unborn or young child. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Women highlighted the importance of maternal healthcare teams providing clear information and reassurance to them. They also reported that prior experiences were important to them in influencing their perception of that pregnancy. Furthermore, women reflected on their desperation for a positive outcome. Understanding these factors can enable maternal healthcare teams to facilitate informed decision-making and provide individualised emotional support for women. Our findings will enable maternal care teams to better support women in similar clinical situations.


Assuntos
Retardo do Crescimento Fetal/psicologia , Viabilidade Fetal , Gestantes/psicologia , Adulto , Feminino , Humanos , Entrevistas como Assunto/métodos , Acontecimentos que Mudam a Vida , Gravidez , Pesquisa Qualitativa , Medicina Estatal , Reino Unido
18.
J Perinatol ; 39(12): 1595-1601, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31209275

RESUMO

PURPOSE: To assess the relationship between decision quality and mental health outcomes for women and their important others (IO) 3 months following periviable birth. METHOD: Mental health outcomes were assessed prior to delivery and at 3 months postpartum using depression (PHQ-9), anxiety (GAD-7), and post-traumatic stress disorder (PTSD) (IES-22) scales. Decision quality was measured in terms of Decisional Conflict, Control, Regret, and Satisfaction with Decision. Descriptive analyses and linear regression modeling were conducted using SAS version 9.4. RESULT: We recruited 30 eligible women and 16 IOs. Participants had mild anxiety and depression, and symptoms of PTSD were among bereaved parents. Participants with lower decision control had higher levels of depression (women: p = 0.014; IOs: p = 0.059) and anxiety (women: p = 0.053; IOs: p = 0.032). Depression was also associated with higher decisional regret (women: p = 0.073; IOs: p = 0.023). CONCLUSION: Our findings suggest that decision quality is associated with mental health outcomes for families who experience periviable delivery.


Assuntos
Ansiedade , Tomada de Decisões , Depressão , Saúde Mental , Mães/psicologia , Transtornos de Estresse Pós-Traumáticos , Adolescente , Adulto , Feminino , Viabilidade Fetal , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pais/psicologia , Morte Perinatal , Gravidez , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto Jovem
19.
Am J Physiol Endocrinol Metab ; 317(2): E261-E268, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31084500

RESUMO

Elucidating the mechanism underlying the transmission of metabolic disease to subsequent generations requires robust preclinical mouse breeding strategies. Western diets rich in fat and carbohydrates are contributing factors in the rise of diabetes and obesity rates worldwide. Therefore, determining the impact of Western diets consumed by parents on offspring and future generations is critical for understanding the perpetuation of these diseases. Specifically, epigenetic regulation and transgenerational inheritance of metabolic disease is an emerging field of study requiring robust murine models. However, a major challenge to transgenerational studies is offspring mortality, exacerbated by maternal stress during pregnancy. Here, we describe a challenge experienced in our metabolic research in Western diet-fed female mice leading to the loss of litters via pup mortality and cannibalism by the mother. Furthermore, our study evaluates various breeding schemes with pregnancy efficiency and refined husbandry techniques to overcome pup mortality and infanticide, to characterize dams' and pups' metabolic characteristics, and to determine the impact on physiology of dams under detailed breeding schemes.


Assuntos
Pesquisa Biomédica/tendências , Cruzamento/métodos , Viabilidade Fetal/fisiologia , Tamanho da Ninhada de Vivíparos/fisiologia , Doenças Metabólicas , Efeitos Tardios da Exposição Pré-Natal , Estresse Fisiológico/fisiologia , Criação de Animais Domésticos/métodos , Criação de Animais Domésticos/tendências , Animais , Pesquisa Biomédica/métodos , Dieta Ocidental , Metabolismo Energético/fisiologia , Epigênese Genética/fisiologia , Feminino , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Doenças Metabólicas/genética , Doenças Metabólicas/mortalidade , Doenças Metabólicas/prevenção & controle , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/etiologia , Obesidade/genética , Obesidade/metabolismo , Gravidez , Complicações na Gravidez/genética , Complicações na Gravidez/metabolismo , Complicações na Gravidez/mortalidade , Efeitos Tardios da Exposição Pré-Natal/genética , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Efeitos Tardios da Exposição Pré-Natal/mortalidade
20.
J Perinatol ; 39(9): 1190-1195, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31089258

RESUMO

OBJECTIVE: To quantify racial differences in contribution of previable live births (<20 weeks gestational age (GA)) to United States (US) Infant Mortality Rates (IMR). METHODS: Population-based retrospective cohort of US live births (2007-14) using CDC WONDER database stratified by maternal race/ethnicity. We compared the contribution of previable births to IMR and calculated modified IMRs (≥20 weeks GA) excluding previable live births in each group. Contingency tables and chi-square calculations were performed to detect differences between groups. RESULTS: Previable deaths represented 4.1%, 7.7%, and 5.0% of total deaths for nonHispanic white, nonHispanic black, and Hispanic, respectively. Previable contribution to total IMR are 0.21, 0.89, and 0.26 per 1000 live births (P < 0.0001). Modified IMRs are 4.98, 10.85, and 4.69 deaths per 1000 live births. CONCLUSION: IMR standardization with a minimum GA may obscure the disproportionate contribution of previable births to IMRs among the black population, which has the largest proportion of previable births.


Assuntos
Viabilidade Fetal , Disparidades nos Níveis de Saúde , Mortalidade Infantil/etnologia , Lactente Extremamente Prematuro , Adulto , Afro-Americanos , Feminino , Mortalidade Fetal/etnologia , Humanos , Lactente , Recém-Nascido , Nascimento Vivo , Masculino , Idade Materna , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
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