Artigos Originais Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(12):565-570
DOI 10.1590/SO100-720320150005488
To determine the influence of breastfeeding on the results of a postpartum oral glucose tolerance test in women recently diagnosed with gestational diabetes mellitus.
The data were obtained from the electronic medical records of the Endocrinopathy Sector during pregnancy, HCMED laboratory system ofHospital das Clínicas of São Paulo , and by telephone. According to the inclusion criteria adopted, 132 patients were eligible for the study. For statistical analysis, the patients were divided into two groups according to whether or not they breastfed. The results were analyzed by the Student t-test and by the Mann-Whitney, Chi-square and Fisher's exact tests, depending on the variable analyzed, with the level of significance set at p<0.05.
Of the 132 patients included in the study, 114 breastfed and 18 did not. Most of the patients in both groups were overweight or obese. The breastfeeding group had a lower pre-pregnancy Body Mass Index than the non-breastfeeding group (p=0.006). Insulin was introduced earlier in the group that did not breastfeed (23.21±4.33 versus 28.84±6.17; p=0.04). The group that did not breastfeed had a higher mean postpartum fasting glucose value in the oral glucose tolerance test than the group that breastfed (91.3±8.7 versus 86.5±9.3; p=0.01). Breastfeeding acted as a protective factor against the development of glucose intolerance in the postpartum oral glucose tolerance test (OR=0.27; 95%CI 0.09-0.8). By logistic regression, breastfeeding was shown to be an independent protective factor.
There was a statistically significant relationship between breastfeeding and a decreased risk of developing glucose intolerance. Breastfeeding should be encouraged because it is an effective, low cost intervention easily accessible to all patients during the postpartum period.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(12):565-570
DOI 10.1590/SO100-720320150005488
To determine the influence of breastfeeding on the results of a postpartum oral glucose tolerance test in women recently diagnosed with gestational diabetes mellitus.
The data were obtained from the electronic medical records of the Endocrinopathy Sector during pregnancy, HCMED laboratory system ofHospital das Clínicas of São Paulo , and by telephone. According to the inclusion criteria adopted, 132 patients were eligible for the study. For statistical analysis, the patients were divided into two groups according to whether or not they breastfed. The results were analyzed by the Student t-test and by the Mann-Whitney, Chi-square and Fisher's exact tests, depending on the variable analyzed, with the level of significance set at p<0.05.
Of the 132 patients included in the study, 114 breastfed and 18 did not. Most of the patients in both groups were overweight or obese. The breastfeeding group had a lower pre-pregnancy Body Mass Index than the non-breastfeeding group (p=0.006). Insulin was introduced earlier in the group that did not breastfeed (23.21±4.33 versus 28.84±6.17; p=0.04). The group that did not breastfeed had a higher mean postpartum fasting glucose value in the oral glucose tolerance test than the group that breastfed (91.3±8.7 versus 86.5±9.3; p=0.01). Breastfeeding acted as a protective factor against the development of glucose intolerance in the postpartum oral glucose tolerance test (OR=0.27; 95%CI 0.09-0.8). By logistic regression, breastfeeding was shown to be an independent protective factor.
There was a statistically significant relationship between breastfeeding and a decreased risk of developing glucose intolerance. Breastfeeding should be encouraged because it is an effective, low cost intervention easily accessible to all patients during the postpartum period.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(12):571-577
DOI 10.1590/S0100-720320150005419
To evaluate the nutritional and psychological factors associated with the occurrence of the practice of pica in pregnant women attending a public hospital in Rio de Janeiro, Brazil.
The study was based on a descriptive design with exploratory features, and conducted on 13 adult and adolescent pregnant women aged 16 to 40 years with a diagnosis of pica in the current pregnancy. Pica was diagnosed by a nutritionist in a standardized interview situation, when questions about the occurrence and frequency of pica, and types of substance ingestion were investigated. After signing the Informed Consent Form (ICF), all participants were evaluated by a nutritionist and seven of them were submitted to psychological assessment with standardized instruments to evaluate stress and anxiety, and to assess coping strategies.
The type of pica most frequently reported was pagophagia (30.8%) and the consumption of fruit with salt (30.8%). The most prevalent coping strategies were "religious practice-focused" and "seeking social support", both presented by 42% of the pregnant women. We observed the occurrence of some degree of stress and anxiety in all pregnant women, as well as comorbidities (69.2%) and gastrointestinal symptoms (84.6%).
Considering that pica may be associated with increased perinatal risk, it is very important to investigate this disorder during prenatal care, and to dopt obstetric, psychological and nutritional preventive practices to reduce the complications for mother and fetus.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(12):571-577
DOI 10.1590/S0100-720320150005419
To evaluate the nutritional and psychological factors associated with the occurrence of the practice of pica in pregnant women attending a public hospital in Rio de Janeiro, Brazil.
The study was based on a descriptive design with exploratory features, and conducted on 13 adult and adolescent pregnant women aged 16 to 40 years with a diagnosis of pica in the current pregnancy. Pica was diagnosed by a nutritionist in a standardized interview situation, when questions about the occurrence and frequency of pica, and types of substance ingestion were investigated. After signing the Informed Consent Form (ICF), all participants were evaluated by a nutritionist and seven of them were submitted to psychological assessment with standardized instruments to evaluate stress and anxiety, and to assess coping strategies.
The type of pica most frequently reported was pagophagia (30.8%) and the consumption of fruit with salt (30.8%). The most prevalent coping strategies were "religious practice-focused" and "seeking social support", both presented by 42% of the pregnant women. We observed the occurrence of some degree of stress and anxiety in all pregnant women, as well as comorbidities (69.2%) and gastrointestinal symptoms (84.6%).
Considering that pica may be associated with increased perinatal risk, it is very important to investigate this disorder during prenatal care, and to dopt obstetric, psychological and nutritional preventive practices to reduce the complications for mother and fetus.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(12):585-592
DOI 10.1590/S0100-720320150005481
To assess attitudes about eating, weight gain and body image of pregnant adolescents.
Pregnant adolescents (n=67) were assessed using the Body Image Questionnaire, the Attitude towards Weight Gain during Pregnancy scale (AWGP) and questions about risk behaviors for eating disorders and unhealthy weight control practices. Associations between variables were analyzed by ANOVA, Kruskal-Wallis test, Pearson and Spearman tests. The influence of the independent variables regarding skipping meals, body satisfaction and binge eating was evaluated by logistic regression.
The average age of the adolescents was 15.3 years (SD=1.14) and their average gestational age was 21.9 weeks (SD=6.53). The average AWGP score was 52.6 points, indicating a positive attitude towards weight gain, and 82.1% of the pregnant girls were satisfied with their bodies. Obese girls had more body dissatisfaction (p=0.001), and overweight girls thought more about food (p=0.02) and eating (p=0.03). The frequency of reported binge eating was 41.8%, and the frequency of skipping meals was 19%. Regression analysis showed that the current Body Mass Index (p=0.03; OR=1.18) and the importance of body awareness and fitness before pregnancy (p=0.03; OR=4.63) were predictors of skipping meals. Higher socioeconomic level (p=0.04; OR=0.55) and greater concern with weight gain (p=0.03; OR=0.32) predicted binge eating.
Even though the majority of the pregnant adolescents had positive attitudes toward weight gain and body satisfaction, those heavier and more concerned with weight gain had a higher risk of unhealthy attitudes, while those of lower social class, less concerned with weight gain and less embarrassed about their bodies during pregnancy, had a lower risk of unhealthy attitudes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(12):585-592
DOI 10.1590/S0100-720320150005481
To assess attitudes about eating, weight gain and body image of pregnant adolescents.
Pregnant adolescents (n=67) were assessed using the Body Image Questionnaire, the Attitude towards Weight Gain during Pregnancy scale (AWGP) and questions about risk behaviors for eating disorders and unhealthy weight control practices. Associations between variables were analyzed by ANOVA, Kruskal-Wallis test, Pearson and Spearman tests. The influence of the independent variables regarding skipping meals, body satisfaction and binge eating was evaluated by logistic regression.
The average age of the adolescents was 15.3 years (SD=1.14) and their average gestational age was 21.9 weeks (SD=6.53). The average AWGP score was 52.6 points, indicating a positive attitude towards weight gain, and 82.1% of the pregnant girls were satisfied with their bodies. Obese girls had more body dissatisfaction (p=0.001), and overweight girls thought more about food (p=0.02) and eating (p=0.03). The frequency of reported binge eating was 41.8%, and the frequency of skipping meals was 19%. Regression analysis showed that the current Body Mass Index (p=0.03; OR=1.18) and the importance of body awareness and fitness before pregnancy (p=0.03; OR=4.63) were predictors of skipping meals. Higher socioeconomic level (p=0.04; OR=0.55) and greater concern with weight gain (p=0.03; OR=0.32) predicted binge eating.
Even though the majority of the pregnant adolescents had positive attitudes toward weight gain and body satisfaction, those heavier and more concerned with weight gain had a higher risk of unhealthy attitudes, while those of lower social class, less concerned with weight gain and less embarrassed about their bodies during pregnancy, had a lower risk of unhealthy attitudes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):498-504
DOI 10.1590/SO100-720320150005286
To evaluate the risk factors for morbidity and mortality in an obstetric intensive care unit at a university hospital.
Observational cross-sectional study with 492 pregnant/puerperal women. Patients were admitted to the obstetric intensive care unit over a period of one year, being informed about the proposals of the study and a questionnaire was applied. The analysis was performed using Microsoft Excel 2013 and GraphPad Prism 6. To evaluate risk factors, χ2 tests were used.
The main risk factors to near miss were: non-white race (OR=2.5; PR=2.3); marital status (married women) (OR=7.9; PR=7.1), schooling (primary) (OR=3.1; PR=2.8), being from the countryside (OR=4.6; PR=4.0), low income (OR=70; PR=5.5), gestational hypertensive disorders (OR=16.3; PR=13.2), receiving prenatal care (OR=5.0; PR=4.254) and C-section before labor (OR=39.2; PR=31.2).
The prevalence of near miss was associated with socioeconomic/clinical factors and care issues, revealing the importance of interventions to improve these indicators. Additionally, we suggest a better curriculum insertion of this subject in the discipline of the medical course due to the importance of avoiding the near miss using adequate medical education. The importance of correct prenatal care is emphasized in order to identify potential risks, to provide nutritional support to pregnant women, to treat potential diseases and to establish a maternal immunization program, as well as providing better care regarding the clinical features of the patients, in order to reduce obstetrical and neonatal risk.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):498-504
DOI 10.1590/SO100-720320150005286
To evaluate the risk factors for morbidity and mortality in an obstetric intensive care unit at a university hospital.
Observational cross-sectional study with 492 pregnant/puerperal women. Patients were admitted to the obstetric intensive care unit over a period of one year, being informed about the proposals of the study and a questionnaire was applied. The analysis was performed using Microsoft Excel 2013 and GraphPad Prism 6. To evaluate risk factors, χ2 tests were used.
The main risk factors to near miss were: non-white race (OR=2.5; PR=2.3); marital status (married women) (OR=7.9; PR=7.1), schooling (primary) (OR=3.1; PR=2.8), being from the countryside (OR=4.6; PR=4.0), low income (OR=70; PR=5.5), gestational hypertensive disorders (OR=16.3; PR=13.2), receiving prenatal care (OR=5.0; PR=4.254) and C-section before labor (OR=39.2; PR=31.2).
The prevalence of near miss was associated with socioeconomic/clinical factors and care issues, revealing the importance of interventions to improve these indicators. Additionally, we suggest a better curriculum insertion of this subject in the discipline of the medical course due to the importance of avoiding the near miss using adequate medical education. The importance of correct prenatal care is emphasized in order to identify potential risks, to provide nutritional support to pregnant women, to treat potential diseases and to establish a maternal immunization program, as well as providing better care regarding the clinical features of the patients, in order to reduce obstetrical and neonatal risk.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):505-511
DOI 10.1590/SO100-720320150005400
To evaluate the factors associated with anemia among pregnant women receiving public health care in a capital city in Northeastern Brazil.
This was a cross-sectional study conducted on a sample of 428 patients obtained on the basis of the estimated prevalence of anemia during pregnancy (50%), a 95% confidence interval (95%CI), an error of 5% and a sample loss of 20%. Pregnant women who lived in the city and were served by the municipal public health network were considered to be eligible for the study. Socioeconomic, lifestyle, clinical and anthropometric data and dietary iron intake were obtained, and capillary hemoglobin was determined. Anemia was identified as a hemoglobin level <11 g/dL, and its association with risk factors was tested using multivariate Poisson regression analysis, with the results expressed as the Prevalence Ratio (PR) and 95%CI.
The prevalence of anemia was 28.3% and was higher among women with more members in the household (PR=1.49; 95%CI 1.01-2.22; p=0.046) and those living with food insecurity (PR=1.43; 95%CI 1.00-2.04; p=0.047).
The prevalence of anemia among pregnant women receiving care from the public health system of the city is a moderate public health problem, requiring the planning of effective measures for its control.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):505-511
DOI 10.1590/SO100-720320150005400
To evaluate the factors associated with anemia among pregnant women receiving public health care in a capital city in Northeastern Brazil.
This was a cross-sectional study conducted on a sample of 428 patients obtained on the basis of the estimated prevalence of anemia during pregnancy (50%), a 95% confidence interval (95%CI), an error of 5% and a sample loss of 20%. Pregnant women who lived in the city and were served by the municipal public health network were considered to be eligible for the study. Socioeconomic, lifestyle, clinical and anthropometric data and dietary iron intake were obtained, and capillary hemoglobin was determined. Anemia was identified as a hemoglobin level <11 g/dL, and its association with risk factors was tested using multivariate Poisson regression analysis, with the results expressed as the Prevalence Ratio (PR) and 95%CI.
The prevalence of anemia was 28.3% and was higher among women with more members in the household (PR=1.49; 95%CI 1.01-2.22; p=0.046) and those living with food insecurity (PR=1.43; 95%CI 1.00-2.04; p=0.047).
The prevalence of anemia among pregnant women receiving care from the public health system of the city is a moderate public health problem, requiring the planning of effective measures for its control.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):512-515
DOI 10.1590/SO100-720320150005434
To assess the chemotactic activity and phagocytic response of neutrophilic polymorphonuclear leukocytes among women in the first five days postpartum.
A prospective, cross-sectional clinical-laboratory study was conducted. Data of 31 postpartum women during the first five days after vaginal delivery were compared with those of 24 healthy non-pregnant non-postpartum women matched for age. The inclusion criteria were postpartum, clinically and obstetrically healthy women; vaginal delivery, singleton pregnancy carried to term; non-hypertensive, hyperglycemic, allergic, malnourished or with autoimmune or neoplastic diseases; not having received vaccines or blood products in the last three months. The Control Group was chosen according to the same inclusion criteria but involving non-pregnant non-postpartum women. The chemotactic activity of neutrophilic polymorphonuclear leukocytes was assessed by determining the distance from directed migration to bacterial lipopolysaccharide, in three Boyden chamber assays. The phagocytic response was identified by assessing the Zymosan particles' ingestion in three assays carried out in Leighton tubes. The Student's t- test was used in the statistical analysis, adopting a 5% level of significance.
The chemotactic activity of neutrophilic polymorphonuclear leukocytes from postpartum women in the presence of homologous (73.2±6.9) and autologous (78.6±13.9) sera showed a significant increase compared to the values observed in the Control Group (64.1±4.1 and 66.6±5.4). Both chemotactic response and phagocytosis ingestion phase of neutrophilic polymorphonuclear leukocytes were significantly increased (p<0.05) in postpartum women compared to healthy non-pregnant and non-postpartum women.
There was an increase in the chemotactic activity and phagocytic response of neutrophilic polymorphonuclear leukocytes during the first five days after vaginal delivery in women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):512-515
DOI 10.1590/SO100-720320150005434
To assess the chemotactic activity and phagocytic response of neutrophilic polymorphonuclear leukocytes among women in the first five days postpartum.
A prospective, cross-sectional clinical-laboratory study was conducted. Data of 31 postpartum women during the first five days after vaginal delivery were compared with those of 24 healthy non-pregnant non-postpartum women matched for age. The inclusion criteria were postpartum, clinically and obstetrically healthy women; vaginal delivery, singleton pregnancy carried to term; non-hypertensive, hyperglycemic, allergic, malnourished or with autoimmune or neoplastic diseases; not having received vaccines or blood products in the last three months. The Control Group was chosen according to the same inclusion criteria but involving non-pregnant non-postpartum women. The chemotactic activity of neutrophilic polymorphonuclear leukocytes was assessed by determining the distance from directed migration to bacterial lipopolysaccharide, in three Boyden chamber assays. The phagocytic response was identified by assessing the Zymosan particles' ingestion in three assays carried out in Leighton tubes. The Student's t- test was used in the statistical analysis, adopting a 5% level of significance.
The chemotactic activity of neutrophilic polymorphonuclear leukocytes from postpartum women in the presence of homologous (73.2±6.9) and autologous (78.6±13.9) sera showed a significant increase compared to the values observed in the Control Group (64.1±4.1 and 66.6±5.4). Both chemotactic response and phagocytosis ingestion phase of neutrophilic polymorphonuclear leukocytes were significantly increased (p<0.05) in postpartum women compared to healthy non-pregnant and non-postpartum women.
There was an increase in the chemotactic activity and phagocytic response of neutrophilic polymorphonuclear leukocytes during the first five days after vaginal delivery in women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):516-519
DOI 10.1590/SO100-720320150005454
To investigate the frequencies of polymorphic allele and genotypes for the LT-α gene, position +252 (rs909253), in Brazilian women with preeclampsia.
This is a case-control study, in which 30 women with preeclampsia, classified according to the criteria of the National High Blood Pressure Education Program, and 115 women in the control group, with at least two healthy pregnancies, were selected. Peripheral blood was collected, and DNA was extracted, followed by genotyping, using specific primers and restriction analysis. The genotypes obtained were AA, AG and GG. Statistical analysis was performed using the χ2 association test. The Hardy-Weinberg Equilibrium was tested using the Haploview Program.
The results showed no association between genotypes and preeclampsia development (χ2=2.0; p=0.4). When the AG and GG genotypes were grouped according to allele G presence or absence (genotype AA), the data showed that the presence of allele G was not significantly different between cases (women with preeclampsia) and controls (χ2=0.0; p=1.0). The LT-α gene polymorphism, position +252 (rs909253), seems not to be an important candidate for the development of preeclampsia. Other inflammatory genes should be researched, and studies involving gene-environment interactions should be performed, in order to reach a better understanding of the etiology of the preeclampsia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):516-519
DOI 10.1590/SO100-720320150005454
To investigate the frequencies of polymorphic allele and genotypes for the LT-α gene, position +252 (rs909253), in Brazilian women with preeclampsia.
This is a case-control study, in which 30 women with preeclampsia, classified according to the criteria of the National High Blood Pressure Education Program, and 115 women in the control group, with at least two healthy pregnancies, were selected. Peripheral blood was collected, and DNA was extracted, followed by genotyping, using specific primers and restriction analysis. The genotypes obtained were AA, AG and GG. Statistical analysis was performed using the χ2 association test. The Hardy-Weinberg Equilibrium was tested using the Haploview Program.
The results showed no association between genotypes and preeclampsia development (χ2=2.0; p=0.4). When the AG and GG genotypes were grouped according to allele G presence or absence (genotype AA), the data showed that the presence of allele G was not significantly different between cases (women with preeclampsia) and controls (χ2=0.0; p=1.0). The LT-α gene polymorphism, position +252 (rs909253), seems not to be an important candidate for the development of preeclampsia. Other inflammatory genes should be researched, and studies involving gene-environment interactions should be performed, in order to reach a better understanding of the etiology of the preeclampsia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):520-525
DOI 10.1590/SO100-720320150005438
To translate, to adapt and to validate the Utian Quality of Life (UQOL) for the Brazilian population.
Women in the climacteric phase, residents in the city of Natal, Rio Grande do Norte, located in the Brazilian Northeast, were randomly selected. UQOL and SF-36 questionnaires were used, and the translation from English to Portuguese was made by three teachers, while the adaptation stage of the translated version was made by applying the questionnaire to 35 women, which could mark the answer choice "I did not understand the question"; reproducibility measurements (test-retest) and construct validity were used to validate, following international methodological standards.
The Brazilian version was fully recognized by the target population, which was comprised of 151 women, as no question showed a percentage of "non-understanding" equal to or greater than 20%. The results for intra and interobserver reproducibility demonstrated significant agreement on all the questionnaire items. This version showed consistency above the required criteria (>70), demonstrating its accuracy, while the construct validity was obtained by statistically significant correlations between the domains occupation, health and emotional of UQOL and the SF-36 domains. The Cronbach's alpha coefficient for the whole instrument was 0.82, representing good accuracy. Item-total correlation analysis showed the scale homogeneity
From the steps taken, the UQOL questionnaire was translated and adapted for its use in Brazil, with high reproducibility and validity. Thus, it can be included and used in Brazilian studies that aim at evaluating the quality of life of women during the peri- and postmenopausal.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):520-525
DOI 10.1590/SO100-720320150005438
To translate, to adapt and to validate the Utian Quality of Life (UQOL) for the Brazilian population.
Women in the climacteric phase, residents in the city of Natal, Rio Grande do Norte, located in the Brazilian Northeast, were randomly selected. UQOL and SF-36 questionnaires were used, and the translation from English to Portuguese was made by three teachers, while the adaptation stage of the translated version was made by applying the questionnaire to 35 women, which could mark the answer choice "I did not understand the question"; reproducibility measurements (test-retest) and construct validity were used to validate, following international methodological standards.
The Brazilian version was fully recognized by the target population, which was comprised of 151 women, as no question showed a percentage of "non-understanding" equal to or greater than 20%. The results for intra and interobserver reproducibility demonstrated significant agreement on all the questionnaire items. This version showed consistency above the required criteria (>70), demonstrating its accuracy, while the construct validity was obtained by statistically significant correlations between the domains occupation, health and emotional of UQOL and the SF-36 domains. The Cronbach's alpha coefficient for the whole instrument was 0.82, representing good accuracy. Item-total correlation analysis showed the scale homogeneity
From the steps taken, the UQOL questionnaire was translated and adapted for its use in Brazil, with high reproducibility and validity. Thus, it can be included and used in Brazilian studies that aim at evaluating the quality of life of women during the peri- and postmenopausal.