The Remote Approach in a Qualitative Study During the COVID-19 Pandemic: A Perspective Considering the Researcher's Life Experiences and the Trustworthiness.

The COVID-19 pandemic has raised a wide range of challenges for qualitative researchers, especially when most of the world was facing isolation during the first wave in 2020. The scientific literature rapidly raised discussion regarding data collection adaptation for remote inquiry and ethical dilemmas. However, it is still necessary to discuss the implications of running qualitative studies as a researcher immersed in a global emergency, precisely when the researchers themselves are involved in this context. To what extent, or in what way, can being fully immersed in this context influence all phases of the research? What is the role of reflexivity in this context? We proposed a new discussion based on the study we performed remotely in 2020, among infected pregnant women, using concepts of the Freudian feeling of uncanny to explore the life experience of the researcher. We also considered the concept of the discourse of the master from Jacques Lacan to debate the researchers' position during the pandemic and to bring practical implications.

Domestic violence: A cross-sectional study among pregnant and postpartum women.

AIM: To assess the prevalence of domestic violence/intimate partner violence, aggressors, types of violence and associated factors in women who attend an antenatal and postnatal care service in a public hospital in Brazil. DESIGN: Cross-sectional study. METHODS: We interviewed women attending antenatal and postpartum care services in a Brazilian public tertiary woman's hospital in Campinas, São Paulo, between July 2019 and September 2021. Data were collected through interviewer-administered questionnaires previously used in healthcare settings: Abuse Assessment Screen (AAS); Woman Abuse Screening Tool (WAST); Hurt, Insulted, Threatened with Harm and Screamed (HITS). We evaluated the relationship between the sociodemographic characteristics of women and domestic/intimate violence using bivariate and multivariable logistic regression analyses. RESULTS: Of the 600 pregnant and postpartum women interviewed, 138 (23%) had suffered any abuse. Some participants disclosed physical violence during pregnancy (2.3%) and during the last 12 months (5.3%). The partner was identified as the main aggressor in most of the cases (60%). When women had a partner, 3.5% reported domestic violence and 6.7% disclosed intimate partner violence during pregnancy or postpartum period. Women with non-white skin colour (OR = 1.53; 95% CI 1.01-2.34; p = .048), gestational age ≤ 13 weeks (OR = 3.41; 95% CI 1.03-11.25; p = .044) and in postpartum period (OR = 2.81; 95% CI 1.32-5.99; p = .008) were more likely to experience domestic violence at some time in their lives. Women interviewed before the COVID-19 pandemic were more likely to disclose that they had suffered any abuse. CONCLUSION: Experience of violence during pregnancy and postpartum period was more frequent in women with non-white skin colour, in their first gestational trimester and in the postpartum period, and was more reported before the COVID-19 pandemic. Antenatal and postpartum care services could be safe places to support violence survivors. IMPACT: Pregnant and postpartum women are a vulnerable group to experiencing domestic violence/intimate partner violence. Violence can negatively affect women's and children's health and well-being. Antenatal and postpartum care should be considered as a moment to routinely inquiry women about past and current violence experiences. Regular contact among healthcare professionals and women during this period offers a window of opportunities for implementing psychosocial interventions among women at risk of violence. Healthcare providers (i.e., physicians, psychologists, social workers, nurses and midwives) have an important role in identifying survivors, offering support and providing quality information to women.

Placental transcriptome profile of women with sickle cell disease reveals differentially expressed genes involved in migration, trophoblast differentiation and inflammation.

Sickle cell disease (SCD) is a group of disorders whose common characteristic is the presence of hemoglobin (Hb) S in erythrocytes. The main consequence of this abnormality is vaso-occlusion, which can affect almost all organs including the placenta. This study aimed to evaluate the gene expression profile in placentas of women with SCD by means of total RNA sequencing. For this, we proposed a case-control study, with three groups of pregnant women: HbSS (n = 10), HbSC (n = 14) and HbAA (n = 21). The results showed differences in expression in a number of genes such as NOS2 (fold change, FC = 4.52), HLAG (FC = 5.56), ASCL2 (FC = 3.61), CXCL10 (FC = -3.66) and IL1R2 (FC = 3.92) for the HbSC group and S100A8 (FC = -3.82), CPXM2 (FC = 4.57), CXCL10 (FC = -4.59), CXCL11 (FC = -3.72) and CAMP (FC = -4.55) for the HbSS group. Differentially expressed genes are mainly associated with migration, trophoblast differentiation and inflammation. The causes leading to altered gene expression in placentas of sickle cell patients are not fully understood, but the presence of intravascular hemolysis and vaso-occlusion, with cycles of ischemia and reperfusion, may contribute to the emergence of an environment which can be very harmful for placental physiology, altering the nutrient supply and metabolic exchange for fetal growth.

The experience of women infected by the COVID-19 during pregnancy in Brazil: a qualitative study protocol.

BACKGROUND: The Coronavirus disease (COVID-19) is highly infectious, with the recent World Health Organization decree confirming a global public health emergency. The outcomes related to maternal and fetal health among pregnant women infected with the virus are still poorly understood. The world population has been waiting for answers and remains constantly alert about the pandemic's progress. It is not yet known what impact this pandemic experience will have on the population's mental health, especially pregnant women. METHOD: We aim to understand and discuss the experiences of women who were infected by COVID-19 during pregnancy, in relation to the illness process, community relations, and social media influences. This is a qualitative study in which we will interview women who were infected by COVID-19 during pregnancy and received medical care from a tertiary university hospital specializing in women's health in Brazil. We will use the techniques of Semi-Directed Interviews of Open and In-depth Questions, socio-demographic and health data sheets, and Field Diaries. We will use purposive sampling and the criterion of theoretical saturation for its construction. The interviews will be conducted by phone or video call, with audio recorded for later transcription. The treatment of the data will be completed through Thematic Analysis and discussed in light of the Health Psychology framework, with the production of categories that answer the proposed research questions. DISCUSSION: It is expected that the results contribute to the understanding about the demands that come to the health professional of women infected by COVID-19 during pregnancy in a pandemic situation. INTRODUçãO: A doença causada pelo coronavírus (COVID-19) é altamente infecciosa, com a recente declaração da Organização Mundial de Saúde confirmando emergência global de saúde pública. Os desfechos relacionados a saúde materno-fetal entre gestantes infectadas pelo vírus ainda são pouco conhecidos. A população mundial tem aguardado respostas e se mantém constantemente em alerta sobre o progresso da pandemia. Ainda não se sabe qual será o impacto da experiência da pandemia sobre a saúde mental da população, especialmente entre mulheres grávidas. MéTODO: O objetivo deste estudo é compreender e discutir as experiências de mulheres infectadas pelo COVID-19 durante a gravidez, em relação ao processo de adoecimento, às relações comunitárias e a influência de mídias sociais. Este é um estudo qualitativo em que serão entrevistadas mulheres infectadas pelo COVID-19 durante a gestação, atendidas em um hospital universitário terciário especializado em saúde da mulher no Brasil. Serão usadas as técnicas de Entrevistas Semi-Dirigidas de Perguntas Abertas em Profundidade, ficha de dados sociodemográficos e de saúde e diários de campo. A amostra será selecionada intencionalmente, usando o critério de saturação teórica para a sua construção. As entrevistas serão conduzidas por telefone ou videoconferência, com áudio gravado para posterior transcrição. O tratamento dos dados seguirá a Análise Temática e os resultados serão discutidos sob conceitos de Psicologia da Saúde, com a produção de categorias que respondam as questões de pesquisa propostas. DISCUSSãO: Espera-se que os resultados contribuam para a compreensão de demandas emergentes entre profissionais de saúde para mulheres infectadas pelo COVID-19 durante a gestação em situação de pandemia.

Influence of breakfast and meal frequency in calcium intake among pregnant adolescents.

Calcium is an essential micronutrient that plays a role in growing and pregnancy, and its necessity is increased during pregnancy in adolescence. Thus, the aim of the study is to describe the daily calcium intake and its associations with dietetic habits, sociodemographic data and perinatal outcomes among pregnant adolescents. A prospective cohort study was conducted among primiparous adolescents who started prenatal care before 20 weeks of gestation. Sociodemographic data, weight and height, 24-h dietary recall (24hRec) and perinatal outcomes were collected over four meetings (three during pregnancy and one in puerperium). All 24hRecs were analysed by the Nutrition Data System for Research (NDSR)® programme, and descriptive analysis and univariate and multivariate logistic regression were done. A total of 150 pregnant adolescents were included, with a mean of daily calcium intake of 659.9 mg (50% of recommended intake). Adolescents who ate more than three meals per day (89.3%), and ate breakfast every day (69.3%), were shown to have higher daily calcium intake, odds ratio (OR CI 95%) of 3.4 (1.0, 11.0) and 16.8 (1.0, 302.1), respectively. No correlation was observed between calcium daily intake and sociodemographic data or perinatal outcomes. Dairy products were the foods that mostly contributed to achieving recommended daily calcium intake. In our cohort, pregnant adolescents had a low daily calcium intake. They should be advised to eat more than three meals per day, eat breakfast in particular, increase the consumption of calcium rich-foods, such as dairy products and green leafy vegetables, and consider calcium supplementation.

How to classify BMI among pregnant adolescents? A prospective cohort.

OBJECTIVE: Pregnancy in adolescence is a global health issue, especially in developing countries. Additionally, the recommended gestational weight gain (GWG) is usually based on pre-pregnancy BMI and that might be complex for pregnant teens. The study objective was to compare three different methods of BMI classification and suggest the best way of determining pre-pregnancy BMI and monitoring GWG among pregnant adolescents. DESIGN: Pre-pregnancy weight, weight at first prenatal visit, height, sociodemographic, reproductive and perinatal data were collected. Weighted kappa and McNemar statistics were used to assess agreement between the classification methods. SETTING: Prof. Dr Jose Aristodemo Pinotti Women's Hospital, University of Campinas, Brazil.ParticipantsPrimiparas younger than 19 years of age and with less than 20 weeks of gestational age (n 150). RESULTS: BMI of the primiparas was determined according to the WHO recommendation for adult women, the Child Growth Standards (CGS) and their gynaecological age (GA). The WHO and GA measurements presented a strong agreement with each other (κ w=0·99; 95 % CI 0·97, 1·00), but did not agree with the CGS classification (κ w=0·62; 95 % CI 0·50, 0·74 by WHO; κ w=0·62; 95 % CI 0·51, 0·74 by GA). Also, inadequate GWG was observed in 72·2 % of cases and was correlated with a higher rate of caesarean birth. CONCLUSIONS: BMI classification according to the CGS differed from WHO and GA. However, CGS and WHO agreed on perinatal outcomes. We recommend using BMI classification by WHO to assess pregnant adolescents, since it is easily applied and better known among health professionals.

Fetal growth standards in gastroschisis: Reference values for ultrasound measurements.

OBJECTIVES: The objectives of this study were to create growth curves based on ultrasonography biometric parameters of fetuses with gastroschisis, comparing them with normal growth standards, and to analyze umbilical artery (UA) Doppler velocimetry patterns. METHODS: A cohort study of 72 fetuses with gastroschisis, at gestational ages between 14 and 39 weeks was designed. Mean and standard deviation were calculated, with the 5th, 10th, 50th, 90th, and 95th centiles being established for biometric parameters according to gestational age. Curves were obtained, comparing with normal reference via the Mann-Whitney test. UA Doppler velocimetry patterns were obtained. RESULTS: A total of 434 examinations were performed, and centiles were established for biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight. A significant difference was observed between the gastroschisis measurements when compared to control, with all curves shifted downwards. Abdominal circumference was the parameter presenting the largest difference. Estimated fetal weight was also lower, with mean difference of 256.3 ± 166.8 g for the 50th centile (P < .0001). UA Doppler velocimetry was normal in 97.5%. CONCLUSIONS: Fetuses with gastroschisis show symmetrical growth deficits in the second and third trimesters, with normal UA Doppler velocimetry. These results reinforce the hypothesis that they are constitutionally smaller, yet not restricted because of placental insufficiency.

Situational analysis of facilitators and barriers to availability and utilization of magnesium sulfate for eclampsia and severe preeclampsia in the public health system in Brazil.

BACKGROUND: Eclampsia is the main cause of maternal death in Brazil. Magnesium sulfate is the drug of choice for seizure prevention and control in the management of severe preeclampsia and eclampsia. Despite scientific evidence demonstrating its effectiveness and safety, there have been delays in managing hypertensive disorders, including timely access to magnesium sulfate. To conduct a general situational analysis on availability and use of magnesium sulfate for severe preeclampsia and eclampsia in the public health system. METHOD: A situational analysis was conducted with two components: a documental analysis on information available at the official websites on the policy, regulation and availability of the medication, plus a cross sectional study with field analysis and interviews with local managers of public obstetric health services in Campinas, in the southeast of Brazil. We used the fishbone cause and effect diagram to organize study components. Interviews with managers were held during field observations using specific questionnaires. RESULTS: There was no access to magnesium sulfate in primary care facilities, obstetric care was excluded from urgency services and clinical protocols for professional guidance on the adequate use of magnesium sulfate were lacking in the emergency mobile care service. Magnesium sulfate is currently only administered in referral maternity hospitals. CONCLUSION: The lack of processes that promote the integration between urgency/emergency care and specialized obstetric care possibly favors the untimely use of magnesium sulfate and contributes to the high maternal morbidity/mortality rates.

Severe maternal morbidity and maternal near miss in the extremes of reproductive age: results from a national cross- sectional multicenter study.

BACKGROUND: The aim of this study was to assess severe maternal morbidity (SMM) and near miss (NM) cases among adolescent girls and women over 35 years of age in the Brazilian Network for Surveillance of Severe Maternal Morbidity, using a set of standard criteria, compared to pregnant women aged 20 to 34 years. METHODS: A cross-sectional multicenter study conducted in 27 referral obstetric units in Brazil. All pregnant women admitted to these centers during a one-year period of prospective surveillance were screened to identify cases of maternal death (MD), NM and other SMM. Indicators of maternal morbidity and mortality were evaluated for the three age groups. Sociodemographic, clinical and obstetric characteristics, gestational and perinatal outcomes, main causes of morbidity and delays in care were also compared. Two multiple analysis models were performed, to estimate the adjusted prevalence ratio for identified factors that were independently associated with the occurrence of severe maternal outcome (SMO = MNM + MD). RESULTS: Among SMM and MD cases identified, the proportion of adolescent girls and older women were 17% each. The risk of MNM or death was 25% higher among older women. Maternal near miss ratio and maternal mortality ratios increased with age, but these ratios were also higher among adolescents aged 10 to 14, although the absolute numbers were low. On multivariate analysis, younger age was not identified as an independent risk factor for SMO, while this was true for older age (PR 1.25; 1.07-1.45). CONCLUSIONS: SMO was high among women below 14 years of age and increased with age in Brazilian pregnant women.

Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study.

BACKGROUND: Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders. METHODS: This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed. RESULTS: Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care. CONCLUSIONS: In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.

Factors associated with the absence of postpartum consultations in a high-risk population.

Objective: To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. Methods: This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann-Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. Results: A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. Conclusion: This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.

Pregnancy and postpartum experiences of women undergoing hemodialysis: a qualitative study.

INTRODUCTION: There are particularities of chronic kidney disease (CKD) in women and their treatment. The biology of women exposes them to greater risk factors for CKD and both pregnancy and the postpartum period place an additional burden on renal health. Pregnancy complications may cause or worsen CKD. OBJECTIVE: To explore the experiences of women with CKD undergoing hemodialysis in relation to their reproductive history. METHODS: This study consisted of clinical-qualitative design with semi-structured individual interviews and open-ended questions. The sample selection was intentional and according to the theoretical saturation criterion. The data analysis was carried out based on the seven steps of the clinical-qualitative content analysis and validated by Nvivo11. This study was conducted in a public hemodialysis clinic of the Brazilian National Health System. RESULTS: Twelve women undergoing hemodialysis were interviewed. The results from the analysis revealed three categories: 1) Association of pregnancy with CKD; 2) Nebulosity in relation to diagnosis and reproductive history 3) Being a woman undergoing hemodialysis. CONCLUSION: Our study showed the importance of considering the specificities of CKD in women, suggesting that these issues are important for diagnosis and treatment adherence. Consideration of reproductive life history allows the health of women undergoing hemodialysis to be promoted holistically, including aspects of mental health.

Improving breastfeeding among adolescent mothers: a prospective cohort.

BACKGROUND: Exclusive breastfeeding is recommended for the first six months, and mother's age impact early weaning. Educational support and relevant information can increase breastfeeding rates. OBJECTIVE: To determine whether antenatal education enhances the maintenance, intention, and confidence in breastfeeding among adolescents. DESIGN AND SETTING: A prospective cohort study involving primiparous adolescents who gave birth at the Woman's Hospital (CAISM), Universidade Estadual de Campinas, Brazil. METHODS: Adolescent mothers were categorized into two groups based on the location of prenatal care: those at the Woman's Hospital (WH) who received antenatal education, and at the Primary Care (PC) who did not receive antenatal education. All adolescents received breastfeeding orientation during their postpartum hospital stay. The groups were compared using the Student's t-test, Mann-Whitney U test, and chi-squared test. Log-binomial models were used to compare the groups at different time intervals. RESULTS: The study included 132 adolescents: 59 in the WH group and 73 in the PC group. Six months postpartum, adolescents in the WH group demonstrated higher engagement in breastfeeding (P < 0.005) and exclusive breastfeeding (P = 0.04) than PC group. PC group showed greater lack of confidence in breastfeeding (P = 0.02) and felt less prepared (P = 0.01). Notably, all WH adolescents reported a stronger desire to breastfeed after antenatal education. CONCLUSION: Antenatal education significantly improves the maintenance, intention, and confidence of breastfeeding among adolescents. This education approach can be implemented across all healthcare levels and should be made accessible to all women throughout the pregnancy and postpartum period.

Gestational hypertension as a factor associated with chronic kidney disease: the importance of obstetric history of women undergoing hemodialysis.

INTRODUCTION: Pregnancy-related complications may impact women's reproductive cycle and health through their lives. The objective of this study was to evaluate the sociodemographic, clinical, and obstetric history of women undergoing hemodialysis. METHODS: We performed a cross-sectional study in a specialized health facility with four hemodialysis units. Sociodemographic characteristics, clinical and personal history, obstetric and perinatal results of women with pregnancies before hemodialysis were evaluated. Prevalence, bivariate, and logistic regression analyses were performed. RESULTS: We included 208 (87.76%) women. Hypertension was the main cause of chronic kidney disease (CKD) (128 women). Rates of adverse perinatal outcomes, including prematurity, low birth weight, miscarriage, fetal death, and neonatal death, were 19.3%, 14.5%, 25.5%, 12.1%, and 5.3%, respectively. Hypertensive syndromes during pregnancy occurred in 37.0% of women, with 12.5% reporting preeclampsia and 1.4% reporting eclampsia. Up to 1 year after birth, 45.2% of women reported hypertension. Hemodialysis due to hypertension was associated with a history of hypertension during pregnancy (OR 2.33, CI 1.27 - 4.24), gestational hypertension (2.41, CI 3.30 - 4.45), and hypertension up to one year after birth (OR 1.98, CI 1.11 - 3.51). Logistic regression showed that gestational hypertension was independently associated with CKD due to hypertension (aOR 2.76, CI 1.45 - 5.24). CONCLUSION: Women undergoing hemodialysis due to hypertension were more likely to have gestational hypertension or hypertension up to one year after birth. To delay end-stage renal disease, it is necessary to identify women at risk of kidney failure according to their reproductive history.

Physical Exercise Pattern for Undergraduate Students and Its Importance in the Quality of Life, Well-Being, and Future Patient Orientation.

Background: This study evaluated physical activity (PA), physical exercise (PE), quality of life (QoL), PE barriers and benefits, contents learned about PA, and related factors of PE practice among undergraduate medical and nursing students. Methods: This cross-sectional study conducted an online survey. We collected sociodemographic data and previous knowledge regarding PA/PE. We applied the International Physical Activity Questionnaire (IPAQ), Well-being and Quality of Life Index (WHO-5), and scale of benefits and barriers for PE. We performed bivariate, univariate, and multivariate logistic regression analyses. Results: Participants who exercised were identified as "active" and "very active" by the IPAQ, had better health self-perception, higher general total metabolic equivalent, and higher WHO-5 scores, perceived more PE benefits than barriers, and desired more information about PA/PE. Conclusion: Undergraduate students should be encouraged to participate in PE. Adequate knowledge could be a resource they value and disseminate to their future patients.

Nutricional intake, maternal outcomes and knowledge on preeclampsia prevention: Was there impact during the COVID-19 pandemic among women with hypertension?

AIM: Compare nutritional intake, weight gain, frequency of superimposed pre-eclampsia (SPE) and adequate use/knowledge on preventive interventions for PE, before and during the COVID-19 pandemic among pregnant women with chronic hypertension (CH) METHODS: Prospective cohort of pregnant women with CH. Inclusion between 13 and 25 weeks, with sociodemographic characterization, food frequency questionnaire and 24-hour recall (R24h). Indirect adherence test MEDTAKE was employed to investigate adequate use/understanding of calcium and aspirin. Frequency of SPE, weight gain, food intake, maternal and perinatal outcomes were compared between periods. RESULTS: 58 women were included and 116 R24h considered. Over 80 % used aspirin and calcium for PE prophylaxis. However, less than half understood the meaning of such interventions. There were no differences in sociodemographic characteristics, majority white, 20 to 34 years-old, and multiparous. There were 31 women included before and 27 during the pandemic. Frequency of SPE was respectively 40 % and 44.4 % before and during the pandemic (p = 0.746) and weight gain 8.7Kg before and 7.4Kg during the pandemic. There was no difference in macronutrient intake, average calcium consumption was 444.8 mg before and 402.6 mg during the pandemic; with inadequate use/understanding of preventive interventions for PE. CONCLUSION: The pandemic period did not significantly increase the risk of SPE, without significant increase in weight gain or worsening food quality intake and knowledge on preventive interventions.

Brazilian Black Women are at Higher Risk for COVID-19 Complications: An Analysis of REBRACO, a National Cohort.

OBJECTIVE: To evaluate the impact of the race (Black versus non-Black) on maternal and perinatal outcomes of pregnant women with COVID-19 in Brazil. METHODS: This is a subanalysis of REBRACO, a Brazilian multicenter cohort study designed to evaluate the impact of COVID-19 on pregnant women. From February 2020 until February 2021, 15 maternity hospitals in Brazil collected data on women with respiratory symptoms. We selected all women with a positive test for COVID-19; then, we divided them into two groups: Black and non-Black women. Finally, we compared, between groups, sociodemographic, maternal, and perinatal outcomes. We obtained the frequency of events in each group and compared them using X2 test; p-values < 0.05 were considered significant. We also estimated the odds ratio (OR) and confidence intervals (CI). RESULTS: 729 symptomatic women were included in the study; of those, 285 were positive for COVID-19, 120 (42.1%) were Black, and 165 (57.9%) were non-Black. Black women had worse education (p = 0.037). The timing of access to the health system was similar between both groups, with 26.3% being included with seven or more days of symptoms. Severe acute respiratory syndrome (OR 2.22 CI 1.17-4.21), intensive care unit admission (OR 2.00 CI 1.07-3.74), and desaturation at admission (OR 3.72 CI 1.41-9.84) were more likely to occur among Black women. Maternal death was higher among Black women (7.8% vs. 2.6%, p = 0.048). Perinatal outcomes were similar between both groups. CONCLUSION: Brazilian Black women were more likely to die due to the consequences of COVID-19.

OBJETIVO: Avaliar o impacto da raça (negra versus não negra) nos desfechos maternos e perinatais de gestantes com COVID-19 no Brasil. MéTODOS: Esta é uma subanálise da REBRACO, um estudo de coorte multicêntrico brasileiro desenhado para avaliar o impacto da COVID-19 em mulheres grávidas. De fevereiro de 2020 a fevereiro de 2021, 15 maternidades do Brasil coletaram dados de mulheres com sintomas respiratórios. Selecionamos todas as mulheres com teste positivo para COVID-19; em seguida, as dividimos em dois grupos: mulheres negras e não negras. Finalmente, comparamos, entre os grupos, os resultados sociodemográficos, maternos e perinatais. Obtivemos a frequência dos eventos em cada grupo e comparamos usando o teste X2; Valores de p < 0,05 foram considerados significativos. Também estimamos o odds ratio (OR) e os intervalos de confiança (IC). RESULTADOS: 729 mulheres sintomáticas foram incluídas no estudo; desses, 285 foram positivos para COVID-19, 120 (42,1%) eram negros e 165 (57,9%) não eram negros. As mulheres negras apresentaram pior escolaridade (p = 0,037). O tempo de acesso ao sistema de saúde foi semelhante entre os dois grupos, com 26,3% incluídos com sete ou mais dias de sintomas. Síndrome respiratória aguda grave (OR 2,22 CI 1,17­4,21), admissão em unidade de terapia intensiva (OR 2,00 CI 1,07­3,74) e dessaturação na admissão (OR 3,72 CI 1,41­9,84) foram mais prováveis de ocorrer entre mulheres negras. A mortalidade materna foi maior entre as negras (7,8% vs. 2,6%, p = 0,048). Os resultados perinatais foram semelhantes entre os dois grupos. CONCLUSãO: Mulheres negras brasileiras tiveram maior probabilidade de morrer devido às consequências da COVID-19.

Exercise and physical activity in the prevention of pre-eclampsia: systematic review.

Exercise and physical activity have been studied and suggested as a way to reduce or minimize the effects of pre-eclampsia. Our aim was to evaluate the association between exercise and/or physical activity and occurrence of pre-eclampsia. We conducted electronic searches without year of publication and language limitations. This was a systematic review designed according to PRISMA. Different databases accessed were as follows: PubMed®; Latin-American and Caribbean Literature in Health Sciences (LILACS); Scientific Electronic Library On-line (SciELO); Physiotherapy Evidence Database (PEDro); and ISI web of Knowledge(SM) . The Medical Subject Headings (MeSH) were as follows: ("exercise" OR "motor activity" OR "physical activity") AND ("pre-eclampsia" OR "eclampsia" OR "hypertension, pregnancy-induced"). Inclusion criteria were studies conducted in adults who were engaged in some physical activity. The selection and methodological evaluation were carried out by two independent reviewers. Risk assessment was made by the odds ratio (OR) and incidence of pre-eclampsia in the population who performed physical activity/exercise. A total of 231 articles were found, 214 of which were excluded based on title and full-text, so that 17 remained. Comparison of six case-control studies showed that physical activity had a protective effect on the development of pre-eclampsia [OR 0.77, 95% confidence interval (CI) 0.64-0.91, p < 0.01]. The 10 prospective cohort studies showed no significant difference (OR 0.99, 95% CI 0.93-1.05, p= 0.81). The only randomized clinical trial showed a protective effect on the development of pre-eclampsia in the stretching group (OR 6.34, 95% CI 0.72-55.37, p= 0.09). This systematic review indicates a trend toward a protective effect of physical activity in the prevention of pre-eclampsia.

Quality of Life of Pregnant Women with Systemic Lupus Erythematosus.

OBJECTIVE: To assess the quality of life (QoL) of pregnant women with systemic lupus erythematosus (SLE) treated at a high-risk prenatal outpatient clinic during the third trimester of gestation. METHODS: An observational descriptive study was performed in a high-risk prenatal outpatient clinic. Women in the third trimester of pregnancy and undergoing antenatal care between July 2017 and July 2019 answered the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions divided into 4 domains (physical, psychological, social and environmental). RESULTS: We interviewed 50 pregnant women with a mean gestational age of 30 weeks (standard deviation [SD]: 10 weeks) who were diagnosed with SLE. The average age of the participants was 30 years (SD: 14.85), and the average time since the diagnosis of SLE was of 9.06 years (SD: 6.8 years). Most participants had a partner, did not plan their pregnancy (76%), and did not use contraception prior to pregnancy (80%). The score of each domain ranges from 0 (the worst score) to 100 (the best score). The means ± SDs of the scores of the participants on each domain were: physical - 52.21 ± 18.44); psychological - 64.17 ± 18.56); social - 66.33 ± 27.09); and environmental - 64.56 (18.53). The means ± SDs of the general QoL, and health-related QoL items were of 70.50 ± 24.06 and 70.00 ± 30.72 respectively. CONCLUSION: The physical domain presented the lowest scores compared with the other three domains. Pregnant women with SLE had high overall QoL scores, and their health-related QoL scores were also relatively high.

OBJETIVO: Investigar a qualidade de vida (QV) de gestantes com lúpus eritematoso sistêmico (LES), em acompanhamento ambulatorial pré-natal de alto risco, durante o terceiro trimestre de gestação. MéTODOS: Foi realizado um estudo observacional descritivo em ambulatório de pré-natal de alto risco. As mulheres em acompanhamento pré-natal no terceiro trimestre de gravidez entre julho de 2017 e julho de 2019 responderam ao questionário abreviado de Qualidade de Vida da Organização Mundial de Saúde (abbreviated World Health Organization Quality of Life, WHOQOL-BREF, em inglês), composto por 26 questões divididas em 4 domínios (físico, psicológico, social e ambiental). RESULTADOS: Foram entrevistadas 50 gestantes com diagnóstico de LES e média de 30 semanas de idade gestacional (desvio padrão [DP]: 10 semanas). A idade média das participantes foi de 30 anos (DP: 14,85), e o tempo médio desde o diagnóstico de lúpus foi de 9,06 anos (DP = 15,55 anos). A maioria das participantes tinha companheiro, não havia planejado a gravidez (76%), e não fazia uso de anticoncepcional antes da gravidez (80%). A pontuação em cada domínios varia de 0 (pior pontuação) a 100 (melhor pontuação). As médias ± DPs das pontuações das participantes em cada domínios foram: físico ­ 52,21 ± 18,44; psicológico ­ 64,17 ± 18,56; social ­ 66,33 ± 27,09; e ambiental ­64,56 ± 18,53). As médias ± DPs dos itens relativos à QV geral e à QV relacionada à saude foram de 70,50 ± 24,06) e 70,00 ± 30,72, respectivamente. CONCLUSãO: O domínio físico apresentou as menores pontuações em comparação com os outros três domínios. Mulheres grávidas com LES tiveram pontuação alta no item de QV geral, e a pontuação no item de QV relacionada à saúde também foi relativamente alta.