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1.
Int. j. clin. health psychol. (Internet) ; 23(2): 1-9, abr.-jun. 2023. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-213885

RESUMO

Background/Objective: Antenatal depression (AD) is the commonest morbidity during pregnancy. There is evidence that premenstrual syndrome (PMS) and AD share common immune-inflammatory and sex hormonal pathways. This study aims to evaluate the association between the severity of depressive PMS and AD in early and late pregnancy. Method: Participants were followed from early (<=16 weeks) to late pregnancy (>=20 weeks). The Premenstrual Symptoms Screening Tool (PSST) was used to assess PMS and AD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Results: Up to 57.6% of the variance in the early EPDS score was explained by the regression on the first factor extracted from 10 depression and anxiety PSST items (dubbed the DepAnx PSST), insomnia PSST, relation dissatisfaction, and partner abuse. There were specific indirect effects of DepAnx PSST (p < 0.001), insomnia PSST (p = 0.041), relation dissatisfaction (p = 0.023) and partner abuse (p = 0.007) on the late EPDS which were mediated by the early EPDS score. Conclusion: The affective, but not psychosomatic, symptoms of PMS strongly predict AD symptoms suggesting that the pathophysiology of affective PMS symptoms overlap with those of AD. (AU)


Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Síndrome Pré-Menstrual , Depressão , Estresse Oxidativo , Tailândia , Escalas de Graduação Psiquiátrica , Inflamação
2.
Epidemiology ; 34(2): 247-258, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36722807

RESUMO

BACKGROUND: Evidence on the effects of in utero exposure to maternal diabetes on cerebral palsy (CP) in offspring is limited. We aimed to examine the effects of pregestational (PGDM) and gestational diabetes (GDM) separately on CP risk and the mediating role of increased fetal size. METHODS: In a population-based study, we included all live births in Ontario, Canada, between 2002 and 2017 followed up through 2018 (n = 2,110,177). Using administrative health data, we estimated crude and adjusted associations between PGDM or GDM and CP using Cox proportional hazards models to account for unequal follow-up in children. For the mediation analysis, we used marginal structural models to estimate the controlled direct effect of PGDM (and GDM) on the risk of CP not mediated by large-for-gestational age (LGA). RESULTS: During the study period, 5,317 children were diagnosed with CP (187 exposed to PGDM and 171 exposed to GDM). Children of mothers with PGDM showed an increased risk (hazard ratio [HR]: 1.84 [95% confidence interval (CI): 1.59, 2.14]) after adjusting for maternal sociodemographic and clinical factors. We found no associations between GDM and CP (adjusted HR: 0.91 [0.77, 1.06]). Our mediation analysis estimated that LGA explained 14% of the PDGM-CP association. CONCLUSIONS: In this population-based birth cohort study, maternal pregestational diabetes was associated with increased risk of CP, and the increased risk was not substantially mediated by the increased fetal size.


Assuntos
Paralisia Cerebral , Diabetes Gestacional , Criança , Feminino , Gravidez , Humanos , Paralisia Cerebral/epidemiologia , Paralisia Cerebral/etiologia , Estudos de Coortes , Diabetes Gestacional/epidemiologia , Coorte de Nascimento , Ontário/epidemiologia , Aumento de Peso
3.
Epidemiology ; 34(2): 265-270, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36722809

RESUMO

BACKGROUND: Prevalence statistics for pregnancy complications identified through screening such as gestational diabetes usually assume universal screening. However, rates of screening completion in pregnancy are not available in many birth registries or hospital databases. We validated screening-test completion by comparing public insurance laboratory and radiology billing records with medical records at three hospitals in British Columbia, Canada. METHODS: We abstracted a random sample of 140 delivery medical records (2014-2019), and successfully linked 127 to valid provincial insurance billings and maternal-newborn registry data. We compared billing records for gestational diabetes screening, any ultrasound before 14 weeks gestational age, and Group B streptococcus screening during each pregnancy to the gold standard of medical records by calculating sensitivity and specificity, positive predictive value, negative predictive value, and prevalence with 95% confidence intervals (CIs). RESULTS: Gestational diabetes screening (screened vs. unscreened) in billing records had a high sensitivity (98% [95% CI = 93, 100]) and specificity (>99% [95% CI = 86, 100]). The use of specific glucose screening approaches (two-step vs. one-step) were also well characterized by billing data. Other tests showed high sensitivity (ultrasound 97% [95% CI = 92, 99]; Group B streptococcus 96% [95% CI = 89, 99]) but lower negative predictive values (ultrasound 64% [95% CI = 33, 99]; Group B streptococcus 70% [95% CI = 40, 89]). Lower negative predictive values were due to the high prevalence of these screening tests in our sample. CONCLUSIONS: Laboratory and radiology insurance billing codes accurately identified those who completed routine antenatal screening tests with relatively low false-positive rates.


Assuntos
Diabetes Gestacional , Seguro , Gravidez , Recém-Nascido , Feminino , Humanos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Diagnóstico Pré-Natal , Colúmbia Britânica , Bases de Dados Factuais
4.
Epidemiology ; 34(2): 293-301, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36722812

RESUMO

BACKGROUND: Existing evidence on the link between smoking and appendicitis is scarce and ambiguous. We therefore conducted a population-based cohort study in Denmark to investigate whether smoking during pregnancy is associated with an increased risk of appendicitis in offspring. METHODS: We used the Danish Birth Registry to include all singletons born during 1991-2017 and to identify maternal smoking status during pregnancy. We followed the children from birth until date of appendicitis, emigration, death, or administrative end of study (31 December 2018), whichever came first. We calculated crude and adjusted hazard ratios (HRs) of appendicitis with 95% confidence intervals (CIs) comparing children of mothers who smoked during pregnancy to children of nonsmokers. Further, we conducted a bias analysis and sibling analysis. RESULTS: We included 1,659,526 singletons of whom 19% were born to mothers who smoked during pregnancy. After maximum 28 years of follow-up, hazard rates for children of smokers were slightly higher than for children of nonsmokers [adjusted HR: 1.07 (95% CI = 1.04, 1.10)]. Stratification by sex revealed no association for males [adjusted HR: 1.02 (95% CI = 0.99, 1.06)], but a higher HR for females [adjusted HR: 1.13 (95% CI = 1.09, 1.18)]. This association increased with increasing length of follow-up, indicating that the association may be mediated by later-life exposures. The bias analysis indicated that misclassification of maternal smoking could attenuate a true association, while the sibling analysis showed no association. CONCLUSIONS: Maternal smoking during pregnancy and appendicitis in the offspring may be associated.


Assuntos
Apendicite , Criança , Feminino , Masculino , Gravidez , Humanos , Apendicite/epidemiologia , Apendicite/etiologia , Estudos de Coortes , Fumar/efeitos adversos , Fumar/epidemiologia , Fumantes , Irmãos
5.
Environ Health Perspect ; 131(2): 27002, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36723383

RESUMO

BACKGROUND: Perfluoroalkyl acids (PFAA) have been measured in ovarian follicular fluid from women using in vitro fertilization (IVF), although associations between follicular fluid PFAA and IVF outcomes have been inconsistent. OBJECTIVES: We investigated the association between follicular fluid PFAA and embryo quality in women undergoing IVF. METHODS: We prospectively enrolled 729 women undergoing IVF treatment in Guangxi province, China, from July 2018 to December 2018. We measured 32 PFAA, including branched isomers, in follicular fluid using ultra-performance liquid chromatography coupled to tandem mass spectrometry. We applied restricted cubic splines, linear regression, and log-binominal regression models to investigate associations between follicular fluid PFAA and embryo quality, adjusting for confounding variables and investigated oocyte maturity as an intervening variable using causal mediation analysis. We further estimated the overall effect of the PFAA mixture on outcomes using Bayesian kernel machine regression (BKMR). RESULTS: We detected 8 of 32 measured PFAA in >85% of follicular fluid samples. Higher PFAA concentrations were associated with fewer high-quality embryos from IVF. The high-quality embryo rates at the 50th percentile of linear perfluoro-1-octanesulfonate acid (n-PFOS), all branched PFOS isomers (Br-PFOS) and linear perfluoro-n-octanoic acid (n-PFOA) were -6.34% [95% confidence interval (CI): -9.45, -3.32%], -16.78% (95% CI: -21.98, -11.58%) and -8.66% (95% CI: -11.88, -5.43%) lower, respectively, than the high quality embryo rates at the reference 10th percentile of PFAA. Oocyte maturity mediated 11.76% (95% CI: 3.18, 31.80%) and 14.28% (95% CI: 2.95, 31.27%) of the n-PFOS and n-PFOA associations, respectively. The results of the BKMR models showed a negative association between the PFAA mixture and the probability of high-quality embryos, with branched PFOS isomers having posterior inclusion probabilities of 1 and accounting for the majority of the association. DISCUSSION: Exposure to higher PFAA concentrations in follicular fluid was associated with poorer embryo quality during IVF. Branched PFOS isomers may have a stronger effect than linear PFOS isomers. More studies are needed to confirm these findings and to directly estimate the effects on pregnancy and live-birth outcomes. https://doi.org/10.1289/EHP10857.


Assuntos
Ácidos Alcanossulfônicos , Fluorcarbonetos , Gravidez , Feminino , Humanos , Líquido Folicular , Estudos Prospectivos , Teorema de Bayes , China , Fertilização In Vitro
6.
NCHS Data Brief ; (458): 1-8, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36723453

RESUMO

Smoking during pregnancy is an established risk factor for adverse pregnancy outcomes and health issues for newborns later in life (1-3). National birth certificate data on cigarette smoking and the number of cigarettes smoked before and during pregnancy first became available in 2016. These data allow for the analysis of maternal cigarette use during pregnancy by numerous maternal and infant characteristics. This report describes changes in the number and percentage of mothers who smoked cigarettes at any time during pregnancy in the United States from 2016 to 2021 and changes between 2016 and 2021 in the percentage of mothers who smoked during pregnancy by maternal age, race and Hispanic origin, and state of residence.


Assuntos
Fumar Cigarros , Gravidez , Feminino , Recém-Nascido , Estados Unidos/epidemiologia , Humanos , Fumar Cigarros/epidemiologia , Idade Materna , Resultado da Gravidez , Mães , Fatores de Risco
7.
Natl Vital Stat Rep ; 72(1): 1-53, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36723449

RESUMO

Objectives-This report presents 2021 data on U.S. births according to a variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.


Assuntos
Gravidez na Adolescência , Gravidez , Feminino , Adolescente , Humanos , Estados Unidos/epidemiologia , Idade Materna , Coeficiente de Natalidade , Declaração de Nascimento , Parto
8.
Rev Med Suisse ; 19(812): 212-216, 2023 Feb 01.
Artigo em Francês | MEDLINE | ID: mdl-36723650

RESUMO

Thyroid problems are frequent in pregnant women; recent data allow observation only in women with positive antithyroperoxidase antibodies (anti-TPO) but normal thyroïd function. New minimally invasive techniques are being developed for the management of thyroid nodules; radiofrequency ablation is effective for benign nodules. The management of Cushing's syndrome is oriented towards a more personalized approach; new treatments are available, with increased efficacy and a very good safety profile.


Les problématiques thyroïdiennes sont fréquentes chez la femme enceinte, des données récentes permettent cependant une attitude de surveillance chez les femmes avec des anticorps antithyroperoxydase (anti-TPO) positifs mais en euthyroïdie. De nouvelles techniques minimalement invasives pour la prise en charge des nodules thyroïdiens sont développées et la thermoablation par radiofréquence est efficace pour les nodules bénins. La prise en charge du syndrome de Cushing s'oriente vers une approche personnalisée. Des nouveaux traitements sont proposés, avec une efficacité accrue et un très bon profil de sécurité.


Assuntos
Ablação por Cateter , Ablação por Radiofrequência , Nódulo da Glândula Tireoide , Gravidez , Humanos , Feminino , Nódulo da Glândula Tireoide/cirurgia , Resultado do Tratamento , Ablação por Cateter/métodos
9.
Rev Med Suisse ; 19(812): 221-224, 2023 Feb 01.
Artigo em Francês | MEDLINE | ID: mdl-36723652

RESUMO

Our article summarizing the most important studies of the past year emphasizes the difficulty of controlling blood pressure (BP) in hypertensive patients. In addition, it discusses factors such as temperature and sodium that may influence BP, proposes new targets in pregnant hypertensive patients, and challenges the usefulness of taking an antihypertensive drug nightly. Finally, a strategy targeting endothelin blockade in resistant hypertension is presented.


Notre article résumant les études marquantes de l'année écoulée met l'accent sur la difficulté à contrôler la pression artérielle (PA) chez les hypertendus. De plus, il aborde certains facteurs comme la température et le sodium pouvant influencer la PA, les cibles chez les patientes hypertendues enceintes et l'utilité d'une prise vespérale d'un antihypertenseur. Finalement, une stratégie visant le blocage de l'endothéline est présentée dans l'hypertension résistante.


Assuntos
Hipertensão , Gravidez , Feminino , Humanos , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Anti-Hipertensivos/farmacologia , Pressão Sanguínea , Sódio
10.
FASEB J ; 37(3): e22779, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36723798

RESUMO

Preeclampsia is a gestational disease characterized by two major pathological changes-shallow trophoblast invasion and impaired spiral artery remodeling. Atrial natriuretic peptide (ANP) is a kind of peptide hormone that regulates blood pressure, while the lack of active ANP participates in preeclampsia pathogenesis. However, the underlying mechanism of how ANP modulates trophoblasts function remains unclarified. Here, we performed isobaric tags for relative and absolute quantification (iTRAQ) in ANP-treated HTR-8/SVneo cells and identified Protein Kinase 3 (PKN3) as the downstream factor of ANP, which was downregulated in preeclamptic placenta. Chromatin immunoprecipitation analysis and luciferase assays showed that NFYA was one of the transcription factors for the PKN3 promoter, which was also regulated by ANP treatment in HTR-8/SVneo cells. Transmission electron microscopy and Western Blotting in HTR-8/SVneo cells indicated that ANP inhibited autophagy via AMPK-mTORC1 signaling, while excess autophagy was observed in preeclamptic placenta. The increased expression of PKN3 and enhanced cell invasion ability in HTR-8/SVneo cells induced by ANP could be abolished by autophagy activation or transfection with PKN3 shRNA or NFYA shRNA or NPR-A shRNA via regulating the invasion-related genes and the epithelial mesenchymal transition molecules. Our results demonstrated that ANP could enhance trophoblast invasion by upregulating PKN3 via NFYA promotion through autophagy inhibition in an AMPK/mTORC1 signaling-dependent manner.


Assuntos
Pré-Eclâmpsia , Gravidez , Feminino , Humanos , Pré-Eclâmpsia/metabolismo , Proteínas Quinases Ativadas por AMP/metabolismo , Linhagem Celular , Placenta/metabolismo , Trofoblastos/metabolismo , RNA Interferente Pequeno/metabolismo , Autofagia , Alvo Mecanístico do Complexo 1 de Rapamicina/metabolismo , Movimento Celular
11.
JAMA Netw Open ; 6(2): e2254151, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36723941

RESUMO

Importance: Acoustic cry characteristics have been associated with severe medical problems in newborns. However, little is known about the utility of neonatal acoustic cry characteristics in the prediction of long-term outcomes of very preterm infants. Objectives: To evaluate whether acoustic characteristics of infant cry at neonatal intensive care unit (NICU) discharge are associated with behavioral and developmental outcomes at age 2 years in infants born very preterm. Design, Setting, and Participants: Infants born less than 30 weeks postmenstrual age (PMA) were enrolled from April 2014 through June 2016 as part of a multicenter (9 US university affiliated NICUs) cohort study and followed to adjusted age 2 years. Reported analyses began on September 2021. Data were analyzed from September 2021 to September 2022. Exposures: The primary exposure was premature birth (<30 weeks PMA). Main Outcomes and Measures: Cries were recorded during a neurobehavioral examination administered during the week of NICU discharge. Cry episodes were analyzed using a previously published computerized system to characterize cry acoustics. Year-2 outcomes included the Bayley-III Composite scores, Child Behavior Checklist (CBCL) and the Modified Checklist for Autism in Toddlers (M-CHAT R/F), dichotomized using clinically significant cutoffs (<85 on Bayley Language, Cognitive and/or Motor Composite scores, T-score >63 on the CBCL Internalizing, Externalizing and/or Total Problem Scales and total M-CHAT R/F score >2). Results: Analyzed infants (363 participants) were primarily male (202 participants [55.65%]) and had a mean [SD] gestational age of 27.08 [1.95] weeks). Cross-validated random forest models revealed that cry acoustics were associated with 2-year outcomes. Tests of diagnostic odds ratios (DOR) revealed that infants who exhibited total problem behavior CBCL scores greater than 63 at age 2 years were 3.3 times more likely (95% CI, 1.44-7.49) to be identified as so by random forest model estimates relative to other infants (scores ≤63); this association was robust to adjustment for family-wise type-I error rates and covariate measures. Similar associations were observed for internalizing (DOR, 2.39; 95% CI, 1.04-5.47) and externalizing (DOR, 2.25; 95% CI, 1.12-4.54) scores on the CBCL, clinically significant language (DOR, 1.71; 95% CI, 1.10-2.67) and cognitive (DOR, 1.70; 95% CI, 1.00-2.88) scores on the Bayley-III, and a positive autism screen on the M-CHAT (DOR, 1.91; 95% CI, 1.05-3.44). Conclusions and Relevance: In this cohort study of preterm infants, findings pointed to the potential use of acoustic cry characteristics in the early identification of risk for long-term developmental and behavioral deficits.


Assuntos
Recém-Nascido Prematuro , Nascimento Prematuro , Lactente , Feminino , Gravidez , Recém-Nascido , Humanos , Masculino , Pré-Escolar , Estudos de Coortes , Idade Gestacional , Recém-Nascido de muito Baixo Peso
12.
JAMA Netw Open ; 6(2): e2254287, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36723945

RESUMO

This cross-sectional study assesses changes in pregnancy-associated mortality from drug overdose, homicide, suicide, and other causes in the US from 2018 through 2020.


Assuntos
COVID-19 , Suicídio , Feminino , Gravidez , Humanos , Pandemias , Homicídio
13.
PLoS One ; 18(2): e0280273, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36724156

RESUMO

The number of homeless people has been constantly increasing in Europe over recent years, as well as the proportion of women among the homeless population. Pregnancy can increase the risk of becoming homeless and, on the other hand, homelessness has been widely connected to adverse perinatal outcomes. The objective of this study was to describe the overall perceived impact of homelessness on health during pregnancy and the postpartum period, using a qualitative research approach to prioritize women's perspective. One-time semi structured interviews were conducted with 10 pregnant women and 10 women in the postpartum period experiencing homelessness in the metropolitan area of Nantes, as well as with six people from their social surroundings. A thematic analysis was performed to identify major themes and sub-themes. Homelessness was perceived as having an overall negative impact on all aspects of health (physical health, mental health, and social well-being) during pregnancy and the postpartum period. Stress and anxiety, food insecurity, social isolation, physical suffering, deterioration of chronic diseases, and pregnancy complications, were the main perceived consequences of homelessness on health. On the other hand, social support, and the "welcomeness" of healthcare professionals during pregnancy and the postpartum period were identified as capable of palliating those consequences. Finally, basic needs, such as having access to suitable housing, being independent, and being in good health, were identified by participants in the study as their main priorities. The results of this study, as well as those found by previous research, allowed us to identify possible axes in tackling homelessness and its complex consequences on health during pregnancy and the postpartum period. Housing and income assistance interventions, promoting social support and employment, outreach services enhancing collaborative networks among healthcare service providers, and integrating coordinated multidisciplinary approaches in primary care have shown to provide promising solutions to this issue.


Assuntos
Problemas Sociais , Humanos , Feminino , Gravidez , Pesquisa Qualitativa , Gestantes/psicologia , Período Pós-Parto
14.
BMC Med ; 21(1): 35, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36721200

RESUMO

BACKGROUND: Congenital heart diseases (CHDs) remain a significant cause of infant morbidity and mortality. Epidemiological studies have explored maternal risk factors for offspring CHDs, but few have used genetic epidemiology methods to improve causal inference. METHODS: Three birth cohorts, including 65,510 mother/offspring pairs (N = 562 CHD cases) were included. We used Mendelian randomisation (MR) analyses to explore the effects of genetically predicted maternal body mass index (BMI), smoking and alcohol on offspring CHDs. We generated genetic risk scores (GRS) using summary data from large-scale genome-wide association studies (GWAS) and validated the strength and relevance of the genetic instrument for exposure levels during pregnancy. Logistic regression was used to estimate the odds ratio (OR) of CHD per 1 standard deviation (SD) higher GRS. Results for the three cohorts were combined using random-effects meta-analyses. We performed several sensitivity analyses including multivariable MR to check the robustness of our findings. RESULTS: The GRSs associated with the exposures during pregnancy in all three cohorts. The associations of the GRS for maternal BMI with offspring CHD (pooled OR (95% confidence interval) per 1SD higher GRS: 0.95 (0.88, 1.03)), lifetime smoking (pooled OR: 1.01 (0.93, 1.09)) and alcoholic drinks per week (pooled OR: 1.06 (0.98, 1.15)) were close to the null. Sensitivity analyses yielded similar results. CONCLUSIONS: Our results do not provide robust evidence of an effect of maternal BMI, smoking or alcohol on offspring CHDs. However, results were imprecise. Our findings need to be replicated, and highlight the need for more and larger studies with maternal and offspring genotype and offspring CHD data.


Assuntos
Estudo de Associação Genômica Ampla , Cardiopatias Congênitas , Fumar , Feminino , Humanos , Lactente , Gravidez , Índice de Massa Corporal , Etanol , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/genética , Fumar/efeitos adversos , Fumar/epidemiologia , Análise da Randomização Mendeliana
15.
J Int Assoc Provid AIDS Care ; 22: 23259582231151844, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36721359

RESUMO

Introduction: Intimate partner violence (IPV) is the most common form of violence against women. Pregnant women are also not exempted from the menace of IPV which has dire consequences for both the mother and child. There is an established link between HIV and IPV and both have a synergistic effect. This study is aimed at comparing the prevalence, pattern, and determinants of IPV among pregnant women living with HIV and HIV-negative pregnant women attending antenatal clinics in Oyo state. Methodology: This is a descriptive cross-sectional study carried out among women attending antenatal clinics in Oyo state using a multistage sampling technique. The study spanned through March and September 2019. The data collection was conducted using a semi-structured questionnaire and the analysis was done using Statistical Package for Social Sciences version 22. The pattern and prevalence of IPV were measured using the Composite Abuse Scale, a 30-item validated interviewer-administered research instrument. It measured 4 dimensions of abuse: physical, emotional, severe, combined, and sexual harassment. A preliminary cut-off score of 7 was used to divide respondents into the presence or absence of IPV. A Chi-square test was used to test for an association between IPV and socio-demographic characteristics and a logistic regression was used at the multivariate level to identify the determinants of IPV. The P-value was set at <.05. Results: Out of the 240 booked pregnant women, 44.2% of HIV-negative respondents and 47.5% of women living with HIV reported being abused in the index pregnancy. Severe combined abuse was the most common type of abuse, 110 (75.1%), followed by emotional abuse, 70 (40.2%), physical abuse, 68 (39.3%), and sexual harassment, 67 (38.1%). Respondents living with HIV reported suffering more physical abuse than their HIV-negative counterparts. Occupation of respondents and duration of marriage determinants of IPV among HIV-positive participants are statistically significant while the duration of marriage was not statistically significant for IPV among HIV-negative respondents. Conclusion: This study recorded a high prevalence of IPV among pregnant women living with HIV and HIV-negative pregnant women with a slight increase in the group living with HIV. It is therefore recommended that IPV screening programs and intervention strategies should be developed for every pregnant woman, irrespective of their HIV status.


Assuntos
Infecções por HIV , Violência por Parceiro Íntimo , Gravidez , Feminino , Humanos , Criança , Gestantes , Nigéria/epidemiologia , Estudos Transversais , Infecções por HIV/epidemiologia
16.
J Nutr Sci ; 12: e1, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36721726

RESUMO

It is currently debated whether vitamin D requirements during pregnancy differ from those during non-gravid states. In current analyses, we aimed to determine the best model for the association between PTH and serum 25-hydroxyvitamin D (25(OH)D) and the threshold for circulating 25(OH)D at which serum parathyroid hormone (PTH) is suppressed. This multicenter prospective cross-sectional study was conducted on 227 Iranian pregnant women aged 15-45 years in their third trimester of pregnancy. The locally weighted smoothing scatter plot (LOWESS) was used to determine the curvilinear shape of the 25(OH)D/PTH relationship. Linear and non-linear methods were employed to determine the best fit and cut-point for serum 25(OH)D concentration. The median serum 25(OH)D and corresponding serum PTH concentration were 17⋅26 (13⋅44-23⋅08) ng/ml and 19⋅46 (15⋅08-25⋅04) pg/ml in our study population, respectively. The LOWESS curve suggested a non-linear and monotonic with a negative slope relation between PTH (pg/ml) and serum 25(OH)D (ng/ml). The optimal model for the association between PTH and serum 25(OH)D was a one-term fractional polynomial (FP1) (AIC = 1640⋅463). The FP1 analysis identified the 25(OH)D threshold of 12⋅48 ng/ml at which serum PTH rapidly rose. The expected degree of PTH stimulation seems to have a linear trend as 25(OH)D falls below 40 ng/ml. 25(OH)D (ng/ml) and PTH (pg/ml) had a non-linear and monotonic relationship with a negative slope. Our data suggest that a 25(OH)D threshold of 12⋅48 ng/ml is sufficient for parathyroid hormone suppression, which could be used to screen for deficient individuals.


Assuntos
Calcifediol , Hormônio Paratireóideo , Feminino , Humanos , Gravidez , Estudos Transversais , Irã (Geográfico) , Estudos Prospectivos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade
17.
J Genet ; 1022023.
Artigo em Inglês | MEDLINE | ID: mdl-36722223

RESUMO

The objective of the study was to perform the prenatal diagnosis of two foetuses with 22q11.2 duplication for 2.5 Mb after noninvasive prenatal testing (NIPT), and to explore the prenatal diagnosis and genetic characteristics of these foetuses. After amniocentesis, each foetus was diagnosed through karyotype analysis and single-nucleotide polymorphism array (SNP-array), and copy number variation using shotgun sequencing (CNV-seq) was carried out on each mother's peripheral blood for comparative analysis. Both pregnant woman 1 and pregnant woman 2 had foetal amniotic fluid chromosomal karyotypes of 46, XN. The SNP-array result for foetus 1 was arr[hg19] 22q11.21(18,648,856-21,800,471) x3; namely, 22q11.2 had a 3.1 Mb repeat, and the SNP-array result of foetus 2 was arr[hg19]22q11.2(18,648,855-21,464,764) x3; there was a 2.4 Mb repeat of 22q11.2. The CNV-Seq result of the peripheral blood of pregnant woman 1 was seq[hg19]22q11.2(18,953,139-21,449,967) x3; namely, in this mother's 22q11.2 region, there was ~2.5 Mb of duplicate fragment that was pathogenic to CNV. We confirmed that case 1 was inherited from the mother by CNV-seq. In both cases, however, there were key region deletions, including 41 OMIM genes such as CLTCL1, HIRA and TBX1. Both SNP-array and CNV-seq can effectively diagnose 22q11.2 duplication syndrome and clarify its fracture site and involved genes, which may facilitate understanding of the genotype and phenotype correlations.


Assuntos
Variações do Número de Cópias de DNA , Síndrome de DiGeorge , Feminino , Humanos , Gravidez , Síndrome de DiGeorge/diagnóstico , Síndrome de DiGeorge/genética , Genótipo , Diagnóstico Pré-Natal
18.
Artigo em Inglês | MEDLINE | ID: mdl-36722670

RESUMO

Amniotic fluid DNA samples were genotyped by multilocus-nested-PCR-RFLP, but only three of 11 markers amplified 113 of 122 (92.6%) samples, resulting in 12 untyped and 101 partial non-archetypal genotypes. The 101 typed samples were subdivided into four groups: G1 with 73 samples (5'and 3' SAG2 allele I + SAG3 allele III + GRA6 allele III), 53 had parasite load ≤ 102 parasites/mL (43 asymptomatic, 10 mild infections), 17 had load > 102 and ≤ 103 (one mild, 13 moderate and three severe), and three had load > 103 parasites/mL (three severe); G2 with 22 samples (5'and 3' SAG2 allele I + SAG3 allele III), all parasite load levels ≤ 102 parasites/mL (18 asymptomatic and four mild); G3 with five samples (5' and 3' SAG2 allele I + SAG3 allele II), parasite load ≤ 102 parasites/mL (three asymptomatic and two mild); G4 with one sample (5' and 3' SAG2 allele II + SAG3 allele II + GRA6 allele I), a parasite load < 102 parasites/mL in an asymptomatic infant. After DNA sequencing, restriction sites confirmed SAG2, SAG3 and GRA6 alleles in 98.7%, 100% and 100% of the cases, respectively, while single nucleotide polymorphisms confirmed 90% of 5'-SAG2 allele I; 98.7% of 3'-SAG2 allele I; 98% of SAG-3 allele III, but only 40% of GRA6 allele III results. For the moment, partial non-archetypal genotypes of parasites did not show any relationship with either parasite load in amniotic fluid samples or clinical outcome of infants at the age of 12 months.


Assuntos
Doenças Fetais , Toxoplasma , Toxoplasmose , Feminino , Humanos , Lactente , Alelos , Líquido Amniótico/parasitologia , Infecções Assintomáticas , Doenças Fetais/parasitologia , Carga Parasitária , Polimorfismo de Nucleotídeo Único , Proteínas de Protozoários/genética , Toxoplasma/genética , Toxoplasmose/parasitologia , Gravidez
19.
Epidemiology ; 34(2): 230-237, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36722805

RESUMO

BACKGROUND: Fecundability (conception rate per menstrual cycle) varies among non-contracepting couples. Time-to-pregnancy studies can identify exposures contributing to that variability, using three designs: incident cohort, prevalent cohort, and retrospective. Typically, researchers then apply semi-parametric, generalized linear time-to-pregnancy models to data, with either a log or a logit "link," to estimate either a fecundability ratio (FR) or a fecundability odds ratio (FOR). The ongoing-attempt study design can also be informative. METHODS: We consider a different generalized linear model, based on an inverse link. It models the heterogeneity as beta distributed and enables estimation of both the FR and FOR, defined based on population mean fecundabilities, without requiring constancy across attempt time. Under an ongoing-attempt design, the parameter associated with a dichotomous exposure has no clear meaning with a log or a logit link, but under the proposed approach estimates the ratio of the two average times to pregnancy. Basing simulations on conception rates from a large study, we compare the three analytic approaches for confidence interval coverage and power. We also assess the performance of a commonly used method for verifying the constancy of FOR or FR across time. RESULTS: The inverse-link approach had slightly less power than the others, but its estimates maintained nominal confidence interval coverage under nonconstancy. A popular method for testing constancy across time for the FR and FOR had poor power. CONCLUSIONS: The inverse-link analysis offers a useful alternative to the usual methods, with estimation performance that generalizes to the ongoing-attempt design and does not require hard-to-verify constancy assumptions.


Assuntos
Ciclo Menstrual , Tempo para Engravidar , Feminino , Gravidez , Humanos , Estudos Retrospectivos , Modelos Lineares , Razão de Chances
20.
Epidemiology ; 34(2): 238-246, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36722806

RESUMO

BACKGROUND: Observational studies are often the only option to estimate effects of interventions during pregnancy. Causal inference from observational data can be conceptualized as an attempt to emulate a hypothetical pragmatic randomized trial: the target trial. OBJECTIVE: To provide a step-by-step description of how to use healthcare databases to estimate the effects of interventions initiated during pregnancy. As an example, we describe how to specify and emulate a target trial of COVID-19 vaccination during pregnancy, but the framework can be generally applied to point and sustained strategies involving both pharmacologic and non-pharmacologic interventions. METHODS: First, we specify the protocol of a target trial to evaluate the safety and effectiveness of vaccination during pregnancy. Second, we describe how to use observational data to emulate each component of the protocol of the target trial. We propose different target trials for different gestational periods because the outcomes of interest vary by gestational age at exposure. We identify challenges that affect (i) the target trial and thus its observational emulation (censoring and competing events), and (ii) mostly the observational emulation (confounding, immortal time, and measurement biases). CONCLUSION: Some biases may be unavoidable in observational emulations, but others are avoidable. For instance, immortal time bias can be avoided by aligning the start of follow-up with the gestational age at the time of the intervention, as we would do in the target trial. Explicitly emulating target trials at different gestational ages can help reduce bias and improve the interpretability of effect estimates for interventions during pregnancy.


Assuntos
COVID-19 , Feminino , Humanos , Gravidez , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Bases de Dados Factuais , Idade Gestacional , Vacinação , Ensaios Clínicos Pragmáticos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
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