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Gestational diabetes mellitus (GDM) is a major complication in pregnancy. GDM is associated with a higher risk for adverse maternal-fetal outcomes. Associations between movement behavior, including physical activity (PA) and sedentary behavior (SB), and maternal-fetal outcomes are still unclear. The objective of this study was to investigate associations between movement behavior and adverse maternal-fetal outcomes in women with GDM. A total of 68 women with GDM (20-35 weeks, 32.1 ± 5.8 years) were included in this pilot case-control study. The cases were defined by the presence of an adverse composite maternal-fetal outcome (preterm birth, newborn large for gestational age, and neonatal hypoglycemia). Controls were defined as no adverse maternal-fetal outcome. PA intensities and domains, steps/day (pedometer), and SB were analyzed. A total of 35.3% of participants showed adverse maternal-fetal outcomes (n = 24). The controls showed a higher moderate-intensity PA level than the cases (7.5, 95%CI 3.6-22.9 vs. 3.1, 95%CI 0.4-10.3 MET-h/week; p = 0.04). The moderate-intensity PA level was associated with a lower risk for adverse maternal-fetal outcomes (OR 0.21, 95%CI 0.05-0.91). No significant associations were observed for other PA and SB measures (p > 0.05). In conclusion, moderate-intensity PA during pregnancy seems to have a protective role against adverse maternal-fetal outcomes in women with GDM.

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Gestational diabetes mellitus (GDM) is a hyperglycaemic imbalance first recognized during pregnancy, and affects up to 22% of pregnancies worldwide, bringing negative maternal-fetal consequences in the short- and long-term. In order to better characterize GDM in pregnant women, 100 blood plasma samples (50 GDM and 50 healthy pregnant control group) were submitted Attenuated Total Reflection Fourier-transform infrared (ATR-FTIR) spectroscopy, using chemometric approaches, including feature selection algorithms associated with discriminant analysis, such as Linear Discriminant Analysis (LDA), Quadratic Discriminant Analysis (QDA) and Support Vector Machines (SVM), analyzed in the biofingerprint region between 1800 and 900 cm-1 followed by Savitzky-Golay smoothing, baseline correction and normalization to Amide-I band (~ 1650 cm-1). An initial exploratory analysis of the data by Principal Component Analysis (PCA) showed a separation tendency between the two groups, which were then classified by supervised algorithms. Overall, the results obtained by Genetic Algorithm Linear Discriminant Analysis (GA-LDA) were the most satisfactory, with an accuracy, sensitivity and specificity of 100%. The spectral features responsible for group differentiation were attributed mainly to the lipid/protein regions (1462-1747 cm-1). These findings demonstrate, for the first time, the potential of ATR-FTIR spectroscopy combined with multivariate analysis as a screening tool for fast and low-cost GDM detection.

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Examinar a associação entre parto a termo precoce (PTP) e hipoglicemia neonatal em mulheres com hiperglicemia na gestação (HG). 258 mulheres (30,8 ± 6,4 anos) com parto a termo e HG participaram do estudo. A hipoglicemia neonatal foi estabelecida por registro inferior a 45 mg/dl nas primeiras 24 horas de vida. A idade gestacional no parto foi estabelecida por ultrassonografia. A amostra foi dividida em dois grupos: i) mulheres com PTP (n = 163); ii) mulheres com parto a termo não precoce (n = 95). Os testes Qui-quadrado e Exato de Fisher, além da regressão logística, foram utilizados para análise de associação. O nível de significância de 5% foi adotado. Houve associação entre PTP e maior ocorrência de hipoglicemia neonatal (RC = 2,88; IC 95%: 1,19­6,96). Neonatos de mulheres com HG e PTP apresentaram maior ocorrência de hipoglicemia que seus pares nascidos a termo não precoce, o que sugere um fator de risco do parto a termo precoce em mulheres com gestação complicada por hiperglicemia.

The association between early term delivery (ETD) and neonatal hypoglycemia in women with diabetes in pregnancy (DP) is analyzed. 258 females (30.8 ± 6.4 years) with term delivery and diabetes in pregnancy participated in current study. Neonatal hypoglycemia was ≤ 45mg/dl in the first 24 hours of life. Gestational age at birth was established by ultrasonography. Sample was divided into (i) ETD females (n = 163) and (ii) females with non-early term delivery (n = 95). The Chi-Squared and Fisher's Exact tests and logistic regression were performed for association analysis at 5% significance level. Early term delivery and higher occurrence of neonatal hypoglycemia were associated (OR = 2.88; IC 95%: 1.19 ­ 6.96). Neonates born of females with diabetes during pregnancy and early term delivery had a higher incidence of hypoglycemia than their peers born in non-early term deliveries, which suggests a risk factor for early term delivery in females with pregnancy complicated by hyperglycemia.

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Em primeiro de agosto de 2016, considerando-se a relevância do Diabetes Mellitus Gestacional (DMG), tanto por sua prevalência como pelas consequências para o binômio materno-fetal em curto e em longo prazo, foi realizado, em São Paulo, um fórum de discussão sobre o tema, com o objetivo de definir uma proposta para o diagnóstico de DMG para o Brasil. Nesse contexto, participaram da reunião médicos especializados na assistência a mulheres com DMG: obstetras da Federação Brasileira de Ginecologia e Obstetrícia (Febrasgo), endocrinologistas da Sociedade Brasileira de Diabetes (SBD) e consultores da Organização Panamericana de Saúde (Opas/OMS Brasil) e assessores técnicos do Ministério da Saúde. Apresentamos neste documento os principais pontos debatidos visando à análise cuidadosa das possibilidades para diagnóstico de DMG, considerando-se as diferenças de acesso aos serviços de saúde existentes no Brasil.(AU)

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Objective. To evaluate the prevalence of HSV-1 and HSV-2 in pregnant and nonpregnant women, testing the correlation between DNA of the viruses with colposcopic and/or cytological changes, and evaluate association with sociodemographic characteristics and sexual activity. Methods. Included in this study were 106 pregnant and 130 nonpregnant women treated at primary health care units of Natal, Brazil, in the period 2010-2011. The patients were examined by colposcopy, and two cervical specimens were collected: one for cytology examination and another for analysis by PCR for detection of HSV-1 and HSV-2. Results. HSV-1 alone was detected in 16.0% of pregnant and 30.0% of nonpregnant women. For HSV-2, these rates were 12.3% and 15.5%, respectively. HSV-2 had a higher correlation with cytology and/or colposcopy changes than HSV-1 did. Genital HSV-1 infection was not associated with any of the variables tested, whereas HSV-2 infection was associated with ethnicity, marital status, and number of sexual partners. Conclusions. The prevalence of HSV-1 was higher than that observed for HSV-2 in both pregnant and nonpregnant women. The genital infection by HSV-2 was higher in women with changed colposcopy and/or cytology, and it was associated with ethnicity, marital status, and number of sexual partners.

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Esta revisão sistemática tem como objetivo demonstrar o valor do rastreamento e do tratamento das infecções vaginais na gravidez para prevenir o parto pré-termo. Foi realizada ampla pesquisa nas bases de dados Google Scholar, Medline-PubMed, Scielo-Lilacs e Central Cochrane. Após aplicação dos critérios de elegibilidade, foram incluídos no texto final dez estudos que descreviam nos resultados o rastreamento, o tratamento das infecções e a sua relação com o parto pré-termo. Nesta revisão não foi possível recomendar rastreamento e tratamento para Streptococcus, vaginose bacteriana e infecção por clamídia. O rastreamento e o tratamento para candidíase reduzem significativamente a ocorrência do parto pré-termo. A conduta nos casos de tricomoníase vaginal é não tratá-la durante a gravidez, pois seu tratamento representa fator de risco para prematuridade

The aim of this systematic review is to demonstrate the role of screening and treatment of vaginal infections to avoid preterm delivery. A broad research has been done in Google Scholar, Medline-PubMed, Scielo-Lilacs and Central Cochrane databases. Ten studies that described the role of screening and treatment of vaginal infections to prevent preterm birth met the inclusion criteria. In this review it was not possible to recommend the screening and treatment programs for Streptococcus, Vaginosis and Chlamydia in pregnant women may reduce preterm birth. The screening and treatment for Candidiasis significantly reduce the preterm birth. It is not recommended to treat trichomonas vaginalis during pregnancy, since its treatment represents a risk factor for prematurity

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Aproximadamente metade dos nascimentos prematuros espontâneos está associada a um processo infeccioso, que se ocorrer em ambiente intra-uterino desencadeia a cascata inflamatória materna e fetal, induzindo as contrações. Um número significativo de parto pré-termo, especialmente aqueles que ocorrem antes de 32 semanas de gestação, parece associar-se a vaginose bacteriana e a outras infecções do trato genital, mesmo que estas se apresentem de forma assintomática. Os genes possivelmente envolvidos na fisiopatologia desta doença codificam mediadores do processo inflamatório, tais como: o fator de necrose tumoral (TNF), fibronectina fetal, defensinas e interleucinas (IL-1, IL-6 e IL-10). Os autores revisam o tema, enfatizando a importância destes mediadores, uma vez que a facilidade no diagnóstico e a discriminação de marcadores preditivos dos processos inflamatórios intra-uterinos permitirão tratar precocemente o trabalho de parto pré-termo de causa infecciosa.

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A macrossomia fetal tem crescente incidência, sendo relacionada ao sobrepeso materno, ganho de peso excessivo na gravidez e diabetes mellitus gestacional (DMG). A morbimortalidade materna e fetal elevada envolve fatores como hiperglicemia, hiperinsulinemia, presença de co-morbidades e complicações agudas e crônicas próprias do diabetes mellitus. A macrossomia tem repercussões fetais importantes, como o aumento do risco de óbito fetal e complicações como tocotraumatismo, distócias, hipoglicemia neonatal, miocardiopatia hipertrófica, malformações e trombose vascular. As conseqüências maternas observadas são: elevada taxa de cesárea, laceração perineal extensa, hemorragia pós-parto e tempo prolongado de hospitalização. Controle metabólico durante o pré-natal, dieta, exercícios físicos, uso de insulina e interrupção da gravidez com 38 semanas são estratégias utilizadas com o intuito de prevenir esta morbidade. O conhecimento dos fatores de risco possibilita o rastreio e diagnóstico precoce do diabetes gestacional para que, estabelecida uma terapêutica eficaz e individualizada, a grávida seja mantida em euglicemia, prevenindo assim, a ocorrência da macrossomia e suas implicações

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This study evaluated the effectiveness of Papanicolaou staining for the initial diagnosis of Chlamydial infection in pregnant women. A hundred thirteen patients were examined with a Papanicolaou test, independent of gestational age, parity or maternal age. Three endocervical samples were collected; the first two were collected with a brush (Cytobrush plus, Mediscand, Sweden) and the third with Ayre's spatula. The first specimen was used for McCoy cell culture and the other two were examined cytologically. Chlamydial infection was detected in 9 (7.9 percent) patients. Only one (0.8 percent) was diagnosed by cytological exam. The sensitivity and specificity of the cytological examination were 10 and 98 percent, respectively. The estimated positive predictive value was 33.3 percent and the negative predictive value was 92.7 percent. When Papanicolaou stain diagnosis suggests Chlamydia, a more specific complementary exam should be added to confirm infection; subsequently adequate treatment can be implemented, thereby preventing the frequent complications of untreated subclinical infections.

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This study evaluated the effectiveness of Papanicolaou staining for the initial diagnosis of Chlamydial infection in pregnant women. A hundred thirteen patients were examined with a Papanicolaou test, independent of gestational age, parity or maternal age. Three endocervical samples were collected; the first two were collected with a brush (Cytobrush plus, Mediscand, Sweden) and the third with Ayre's spatula. The first specimen was used for McCoy cell culture and the other two were examined cytologically. Chlamydial infection was detected in 9 (7.9%) patients. Only one (0.8%) was diagnosed by cytological exam. The sensitivity and specificity of the cytological examination were 10 and 98%, respectively. The estimated positive predictive value was 33.3% and the negative predictive value was 92.7%. When Papanicolaou stain diagnosis suggests Chlamydia, a more specific complementary exam should be added to confirm infection; subsequently adequate treatment can be implemented, thereby preventing the frequent complications of untreated subclinical infections.

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Nos últimos anos, após a epidemia de aids (síndrome da imunodeficiência adquirida), o estudo dos mecanismos de defesa vaginal têm se revestido de especial importância para a compreensão da fisiopatogênese das infecções genitais femininas. A resposta imune celular é talvez um dos principais mecanismos de proteção da mucosa vaginal mediante desenvolvimento de resposta imune local. Na placa basal do epitélio vaginal existem células de defesa (macrófagos, linfócitos, plasmócitos, células de Langerhans, eosinófilos e mastócitos) prontas para atuar. Os linfócitos são as principais células de defesa que migram pelos canais intercelulares, precedidos pelas células de Langerhans e pelos macrófagos para erradicar o microorganismo invasor. As células de defesa controlam o crescimento bacteriano e fúngico, mediante ativação de mecanismos de fagocitose. Havendo falha da imunidade celular, com a exposição da mucosa vaginal aos antígenos, pode ocorrer o desenvolvimento de infecções vaginais. Os autores revisam o tema enfatizando a importância da resposta imune adequada na manutenção do equilíbrio vaginal.

After the aids (acquired immunodeficiency syndrome) epidemic, the mechanisms of vaginal defense have been coated with special importance in the study of the genital feminine infections. The cellular immune response is perhaps one of the main protection mechanisms of the vaginal mucosa by means development of local immune response. There are many different defense cells (macrophages, lymphocytes, Langerhans cells, eosinophils and mastocytes) in the vaginal epithelium ready to be elicited. The lymphocytes are the main defense cells; they come from the basal plaque crossing the intercellular canals, preceded only by Langerhans cells and macrophages, in order to eradicate the invasive microorganisms. The defense cells control the bacterial and fungi growth, by means of phagocytosis activation. If the cellular immune response fails, vaginal infections can occur. The authors revise the theme emphasizing the importance of the adequate immune response in the vaginal equilibrium.

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O crescimento fetal excessivo ou macrossomia tem etiologia multifatorial e pode ser o responsável por várias intercorrências no decurso da gestação, como: asfixia e hipoglicemia neonatal, abortamento e distocia de ombro. Estas são muito nocivas tanto para mãe como para o feto, além de aumentarem o risco para o recém nascido desenvolver obesidade e diabetes tipo 2 na adolescência. Uma das principais causas de macrossomia é a resistência periférica à insulina, devido ao diabetes gestacional. Os fetos macrossômicos que nascem de gravidez com diabetes, freqüentemente apresentam assimetria; entretanto, ainda são avaliados apenas em termos de peso ao nascer e não por características antropométricas que possam sugerir desproporção. O reconhecimento desta intercorrência clínica na gravidez tem especial importância na prevenção de complicações maternas e fetais. Os autores discutem a sensibilidade e a reprodutibilidade dos principais exames utilizados no diagnóstico precoce desta entidade.

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OBJECTIVE: To determine and to compare the levels of secretory immunoglobulin A in samples of colostrum and milk of mothers of term and preterm neonates. MATERIAL AND METHODS: The levels of secretory immunoglobulin A of 10 mothers of term neonates and 10 mothers of preterm neonates were determined from 5mL of colostrum or milk collected on the 1st, 4th, 10th and 15th days of the puerperal period, using the radial immunodifusion technique. We employed anamnesis, as well as physical and gynecological exams in women in the puerperal period. All the patients were attended at the Januário Cicco Maternity College. RESULTS: The secretory immunoglobulin A levels were significantly higher in the colostrum and milk of mothers of preterm neonates when compared with the levels found in colostrum and milk of mothers of term neonates (Mann-Whitney test, p<0.0001). There was a significant decline in the secretory immunoglobulin A levels of the colostrum and milk of the mothers of term and preterm neonates during the four periods (Kruskal-Wallis test, p<00001). CONCLUSIONS: The secretory immunoglobulin A levels in colostrum and milk of mothers of preterm neonates were significantly higher than in the mothers of term neonates, demonstrating immunological adaptation in preterm neonate breast-feeding.

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OBJECTIVE: To determine and to compare the levels of secretory immunoglobulin A in samples of colostrum and milk of mothers of term and preterm neonates. MATERIAL AND METHODS: The levels of secretory immunoglobulin A of 10 mothers of term neonates and 10 mothers of preterm neonates were determined from 5 mL of colostrum or milk collected on the 1st, 4th, 10th and 15th days of the puerperal period, using the radial immunodiffusion technique. We employed anamnesis, as well as physical and gynecological exams in women in the puerperal period. All the patients were attended at the Januário Cicco Maternity College. RESULTS: The secretory immunoglobulin A levels were significantly higher in the colostrum and milk of mothers of preterm neonates when compared with the levels found in colostrum and milk of mothers of term neonates (Mann-Whitney test, p<0.0001). There was a significant decline in the secretory immunoglobulin A levels of the colostrum and milk of the mothers of term and preterm neonates during the four periods (Kruskal-Wallis test, p<00001). CONCLUSIONS: The secretory immunoglobulin A levels in colostrum and milk of mothers of preterm neonates were significantly higher than in the mothers of term neonates, demonstrating immunological adaptation in preterm neonate breast-feeding.

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Introdução: Diabetes Mellitus Gestacional (DMG) é definido como qualquer grau de intolerância à glicose, com início ou primeiro reconhecimento durante a gestação. Este conceito independe da necessidade de se usar insulina no tratamento e ou da persistência do quadro metabólico após o parto (ADA, 2002). Em recente publicação, a American Diabetes Association (2002) fez estimativa de incidência de 7 por cento de gestações complicadas por diabetes, o que resulta em mais de 200.000 casos por ano, contudo, dependendo da população estudada e do critério diagnóstico utilizado, esta freqüência oscila entre 1 e 14 por cento de todas as gestações. Entre os prejuízos do período neonatal determinados pela nefasta associação de diabetes com gravidez, a macrossomia tem sido considerada ponto clinicamente relevante por ser, particularmente, fator predisponente para toco-traumatismos (distócia de ombro, hemorragia subdural, lesão de plexo braquial, fratura de clavícula e outros (Sacks, 1995; Tyrala, 1996). A alteração do peso fetal inclui aumento de adiposidade, de massa muscular e de órgãos como fígado, placenta e coração, tendo sido encontrada em 50 por cento das gestações complicadas por diabetes e em 40 por cento nas grávidas diabéticas do tipo insulino-dependentes. Estes índices são 10 (dez) vezes superiores aos encontrados nas gestantes normais (Landon & Gabbe, 1994). No "Fourth International Workshop Conference on Gestational Diabetes Mellitus", registrou-se que os critérios originais de O'Sullivan & Mahan foram validados pelo seu valor preditivo para um futuro diabetes na mulher, contudo recebeu críticas por n ão ter sido desenvolvido especificamente para detectar riscos ao concepto no decorrer da gravidez. Objetivo: Foi propósito desta pesquisa determinar a sensibilidade, a especificidade, os valores preditivos positivo e negativo e o ponto de corte mais adequado da glicemia de 2 horas...(au)

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