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SUMMARY OBJECTIVE To describe the concentration of total and specific IgG antibodies anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella spp, and anti-lipopolysaccharide of Pseudomonas spp in the umbilical cord of newborn(NB) twins and to analyze the association between neonatal infection and antibody concentration in the umbilical cord blood. METHODS A prospective cross-sectional study of a cohort of NB twins admitted during the period of 20 months. Patients with malformations and mothers with infection were excluded. Variables analyzed: gestational age(GA); birth weight(BW); antibody concentrations in umbilical cord blood; infection episodes. We used the paired Student t-test, Spearman correlation, and generalized estimation equation. RESULTS 57 pairs of twins were included, 4 excluded, making the sample of 110 newborns. GA=36±1.65weeks and BW=2304.8±460g(mean±SD). Antibody concentrations in twins(mean±SD): total IgG=835.71±190.73mg/dL, anti-StreptococcusB IgG=250.66±295.1 AU/mL, anti-lipopolysaccharide of Pseudomonas spp IgG=280.04±498.66 AU/mL and anti-lipopolysaccharide of Klebsiella spp IgG=504.75±933.93 AU/mL. There was a positive correlation between maternal antibody levels and those observed in newborns(p <0.005). The transplacental transfer of maternal total IgG and anti-LPS Pseudomonas IgG antibodies was significantly lower at NB GA <34 weeks(p <0.05). Five newborns were diagnosed with an infection. Infants with infection had significantly lower total IgG concentration(p <0.05). CONCLUSION This study showed a positive correlation between maternal and newborn antibodies levels. In infants younger than 34 weeks there is less transfer of total IgG and anti-LPS Pseudomonas IgG. The highest incidence of infection in the newborn group who had significantly lower total IgG serum antibodies reinforces the importance of anti-infectious protection afforded by passive immunity transferred from the mother.
RESUMO OBJETIVOS Descrever o título de anticorpos IgG total e específico anti-Streptococcus B, anti-lipopolissacarídeos(LPS) de Klebsiella e Pseudomonas no cordão umbilical em gêmeos e analisar a possível associação entre os títulos desses anticorpos e a ocorrência de infecção. MÉTODOS Estudo prospectivo transversal de uma coorte de recém-nascidos (RN) gemelares em 20 meses. Excluídos: malformação, infecção congênita ou materna. Variáveis estudadas: idade gestacional(IG); peso de nascimento(PN); título de anticorpos e episódios de infecção. Foram utilizados testes t-Student pareado, correlação de Spearman e equações de estimação generalizadas. RESULTADOS Elegíveis 59 pares de gêmeos, excluídos 4 e incluídos 55 pares (n=110RN). A IG foi 36±1,65semanas e o PN foi 2304,8±460g (média±DP). Concentrações de anticorpos dos RN(média±DP): IgG total=835,71±190,73 mg/dL, IgG anti-Streptococcus B=295,1±250,66 UA/mL, IgG anti-LPS Pseudomonas=280,04±498,66 UA/mL e IgG anti-LPS Klebsiella=504,75± 933,93UA/mL. Houve correlação positiva entre níveis de anticorpos maternos e aqueles observados nos RN (p<0,005). A transferência transplacentária de anticorpos maternos IgG total e IgG anti-LPS Pseudomonas foi significativamente menor em RN IG < 34semanas (p<0,05). Foram diagnosticados 5 RN com infecção. Os RN que apresentaram infecção tinham concentração de IgG total significativamente menor (p<0,05). CONCLUSÕES Na população estudada existe correlação entre os anticorpos maternos e os níveis de anticorpos no RN. Nos gêmeos menores que 34 semanas há menor transferência de IgG total e IgG anti-LPS Pseudomonas. Nos RN com infecção a concentração de IgG total é significativamente menor, o que demonstra a maior vulnerabilidade e risco de infecção dessa população e a importância da imunidade passiva transferida pela placenta.
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Humanos , Recém-Nascido , Lactente , Infecções por Pseudomonas/sangue , Infecções Estreptocócicas/sangue , Imunoglobulina G/sangue , Klebsiella , Pseudomonas , Estudos Transversais , Estudos Prospectivos , Imunidade Materno-Adquirida , InfecçõesRESUMO
Abstract Introduction: During pregnancy, levels of maternal serum triglycerides increase as a physiological adaptation mechanism to meet the needs of the developing fetus. However, although an excessive increase has been associated with preeclampsia, macrosomia and preterm delivery, the levels from which measurements should be taken in each trimester to prevent complications have not been established conclusively. Objective: To review the physiopathology, effects on mother and child, expected values in each trimester and therapeutic interventions in maternal hypertriglyceridemia. Materials and methods: A review was made based on a search of articles in the ScienceDirect, Pubmed, Scopus, LILACS, Cochrane and SciELO databases, with the terms: Pregnancy; Hypertriglyceridemia; Maternal-Fetal Exchange; Fetal Development; Pregnancy Complications in English and its equivalents in Spanish. Results: 59 articles met the search criteria and responded to the objectives. Conclusions: The limited amount and the great variability of the data indicate the need to carry out further research to establish the normal triglycerides ranges during the three trimesters of pregnancy and to determine risks and effective interventions before pregnancy in order to reduce maternal and child morbidity and mortality.
Resumen Introducción. Durante el embarazo, los niveles séricos de triglicéridos maternos aumentan como un mecanismo de adaptación fisiológica para suplir las necesidades del feto en desarrollo. Pese a que el incremento excesivo se ha asociado a preeclampsia, macrosomía y parto pretérmino, no se han establecido de manera contundente los niveles a partir de los cuales se deben tomar medidas en cada trimestre para prevenir complicaciones. Objetivo. Hacer una revisión sobre fisiopatología, efectos en madre e hijo, valores esperados en cada trimestre e intervenciones terapéuticas en hipertrigliceridemia gestacional. Materiales y métodos. Se realizó una revisión con la búsqueda de artículos en las bases de datos ScienceDirect, PubMed, Scopus, LILACS, Cochrane y SciELO con los términos: Pregnancy; Hypertriglyceridemia; Maternal-Fetal Exchange; Fetal Development; Pregnancy Complications y sus equivalentes en español. Resultados. Se encontraron 59 artículos que cumplieron los criterios de búsqueda y daban respuesta a los objetivos. Conclusiones. El número limitado y la gran variabilidad de los datos indican la necesidad de realizar más investigaciones que establezcan los rangos de normalidad de los triglicéridos durante los tres trimestres del embarazo y así determinar riesgos e intervenciones eficaces antes de la gestación y reducir la morbimortalidad materno-infantil.
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Maternal diabetes impairs fetoplacental development and programs metabolic diseases in the offspring. We have previously reported that female offspring of pregnant rats with mild diabetes develop gestational diabetes mellitus (GDM) when they become pregnant. Here, we studied the effects of supplementation with polyunsaturated fatty acids (PUFAs) in pregnant mild diabetic rats (F0) by feeding a 6% safflower-oil-enriched diet from day 1 to 14 followed by a 6% chia-oil-enriched diet from day 14 of pregnancy to term. We analyzed maternal metabolic parameters and placental signaling at term in pregnant offspring (F1). The offspring of both PUFAs-treated and untreated mild diabetic rats developed GDM. Although gestational hyperglycemia was not prevented by dietary PUFAs treatment in F0, triglyceridemia and cholesterolemia in F1 mothers were normalized by F0 PUFAs dietary treatment. In the placenta of F1 GDM rats, PPARγ levels were reduced and lipoperoxidation was increased, changes that were prevented by the maternal diets enriched in PUFAs in the F0 generation. Moreover, fetal overgrowth and placental activation of mTOR signaling pathways were reduced in F1 GDM rats whose mothers were treated with PUFAs diets. These results suggest that F0 PUFAs dietary treatment in pregnancies with mild diabetes improves maternal dyslipidemia, fetal overgrowth and placental signaling in female offspring when they become pregnant. We speculate that an increased PUFAs intake in pregnancies complicated by diabetes may prove effective to ameliorate metabolic programming in the offspring, thereby improving the health of future generations.
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Diabetes Gestacional/metabolismo , Ácidos Graxos Insaturados/farmacologia , PPAR gama/metabolismo , Placenta/efeitos dos fármacos , Serina-Treonina Quinases TOR/metabolismo , Animais , Diabetes Mellitus Experimental/dietoterapia , Diabetes Mellitus Experimental/metabolismo , Diabetes Gestacional/dietoterapia , Diabetes Gestacional/etiologia , Suplementos Nutricionais , Feminino , Masculino , Placenta/metabolismo , Gravidez , Ratos WistarRESUMO
Objetivo: Se estudia la infección por Trypanosoma cruzi en mujeres embarazadas en Moniquirá y Miraflores, en Boyacá, Colombia, y la transmisión transplacentaria. Materiales y métodos: Se programó el tamizaje de 826 maternas (600 a 950) en los 2 municipios, se logró un total de 702 participantes de las cuales se procesaron 659 muestras (358 de Moniquirá y 301 de Miraflores), mediante técnicas de ELISA en papel de filtro y se confirmaron las positivas con ELISA en suero, inmunofluorescencia indirecta, hemocultivo y reacción en cadena de la polimerasa. Resultados: La prevalencia actual de enfermedad de Chagas en maternas es de 3,34% (22/659), 3,99% (12/301) en Miraflores y 2,79% (10/358) en Moniquirá. De 22 maternas en seguimiento, se logró obtener datos de 18 de los recién nacidos (RN), de los cuales 6 fueron positivos para las pruebas de hemocultivo. Se consideró el hemocultivo como la técnica confirmatoria de parasitemia en RN antes de 8 meses, por lo tanto, la incidencia transplacentaria global sería de 27,27% RN positivos/año (6/22). Luego del seguimiento del entorno hogar y peridomicilio, búsqueda de triatomíneos y fumigación de la vivienda, se inició tratamiento de RN con benzonidazole a razón de 5-8 mg/kg/día durante 60 días. Conclusiones: La prevalencia en maternas obtenida es superior a los reportes en Chile y Brasil; pero inferiores a Bolivia, Argentina y Uruguay. La incidencia transplacentaria encontrada en un año de seguimiento es similar a la reportada en Chile (16 al 28%), superior a la de Brasil (1%), Uruguay (0,5 a 3%) y Bolivia y Paraguay (7%).
AbstractObjective:To study Trypanosoma cruzi infection in pregnant women and its transplacental transmission in Moniquira and Miraflores, Boyaca, Colombia.Materials and methods: Screening of 862 pregnant women in both municipalities was planned; 689 participants were screened by Elisa technique on blood samples drawn on filter paper from whom 659 samples were processed (358 from Moniquira and 301 from Miraflores). Elisa and IFAT in serum, blood cultures and PCR were carried out in positive pregnant women and their children.Results: The total prevalence of Chagas disease in pregnant women was 3.3% (22/659), 3.9% (12/301) in Miraflores and 2.7% (10/358) in Moniquira. Of the 22 pregnant women who were followed, data was obtained from 18 of their newborns, 6 of whom had positive blood cul-ture tests. Blood cultures were considered as the confirmatory technique for parasitemia in newborns before 8 months of age. Therefore, the overall rate of transmission of congenital infection was 33.3% (6/18). After following-up at the homes and peridomiciles, searching for triatomine bugs and spraying the homes, we began treatment for the infected newborns with benznidazole at a dose of 5-8 mg/kg/day for 60 days.Conclusions: The prevalence found in pregnant women was similar to that reported for Casanare. The rate of transmission of congenital infection was similar to that reported in Chile (16%-28%) and higher than those in Brazil (1%), Argentina (1.5%-4.5%), Uruguay (0.5%-3%), Bolivia (7%) and Paraguay (7%)
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Humanos , Feminino , Gravidez , Recém-Nascido , Doença de Chagas , Doença de Chagas/diagnóstico , Parasitos , Trypanosoma cruzi , Programas de Rastreamento , ColômbiaRESUMO
OBJETIVO: Descrever a cobertura vacinal de gestantes para influenza e fatores associados à recusa ou à aceitação da vacina. MÉTODOS: Estudo descritivo, prospectivo, que incluiu 300 puérperas atendidas no Hospital e Maternidade Santa Joana (SP). Os dados foram coletados em outubro de 2010, por meio de questionário pré-testado, aplicado por profissional treinado. RESULTADOS: A média de idade das mães foi 30,5 anos; 231 (77%) eram casadas; 164 (54,7%) primigestas; 192 (64%) tinham nível superior de escolaridade; e 240 (80%) estavam empregadas. Durante o pré-natal, 234 (78%) receberam informação sobre a vacina contra influenza e 287 (95,7%) foram imunizadas; 210 (73,2%) mulheres tinham conhecimento sobre a proteção neonatal pela vacinação materna. Fatores associados à aceitação foram: campanha do governo (133; 44,3%) e recomendação médica durante o pré-natal (163; 54,3%). Entre as 13 grávidas que recusaram a vacinação, as razões foram: negligência (4), falta de tempo (4), falta de indicação médica (3) ou contraindicação pelo médico (2), mas 69,2% teriam sido vacinadas se tivessem sido informadas sobre a proteção neonatal. CONCLUSÃO: O receio da pandemia e a campanha pública tiveram importante impacto na elevada cobertura vacinal para influenza em gestantes. Recomendação médica e campanha do governo foram os principais motivos de aceitação da vacina.
OBJECTIVES: To describe the immunization coverage of the influenza vaccine for pregnant women, and factors associated to vaccination compliance. METHODS: This is a prospective, descriptive study including 300 women who had just given birth at Hospital and Maternity Santa Joana in Sao Paulo, Brazil. Data were collected through a pre-tested questionnaire applied by a trained evaluator during October 2010. RESULTS: The mean age of mothers was 30.5 years; 231 (77%) were married; 164 (54.7%) were primigravidas; 192 (64%) had higher education; and 240 (80%) were employed. During the prenatal period, 234 (78%) received information about the influenza vaccine and 287 (95.7%) were immunized; 210 (73.2%) women knew about neonatal protection achieved through maternal vaccination. The factors associated with maternal acceptance of the vaccine were government campaign (133; 44.3%), and medical recommendation during prenatal visits (163; 54.3%). A total of 13 pregnant women refused vaccination for the following reasons: neglect (4), lack of time (4), lack of recommendation from their physician (3) or contraindication by physician (2), but 69.2% of them would have accepted immunization had they been informed about neonatal protection. CONCLUSIONS: The fear of a pandemic and the public vaccination campaign had an important impact on the high immunization coverage for influenza on pregnant women. Medical recommendation and the government campaign were the main reasons for vaccine compliance.
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Programas de Imunização , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Troca Materno-Fetal , Complicações Infecciosas na GravidezRESUMO
This review analyses the changes in immunological tolerance, and the systemic and local hemodynamic changes observed along human pregnancy. To underscore the conceptual importance of tolerance and adaptation the background isprovided by the two main advocates ofthese ideas: Gandhi and Darwin. The cognate factors that determine immunological tolerance (IT), systemic (SA) and local adaptation (LA) are múltiple; IT = desensitisation to paternal antigens, absence of HLA-A, roles of HLA-G, natural killer cells and their receptors; SA = decreased vascular resistance, plasma volume expansión, increased cardiac output and plasma renin activity; LA = prostacyclin, nitric oxide, kallikrein-kinin system, vasodilator arm of the renin angiotensin system, vascular endothelial growth factor (VEGF). A possible role of vasodilators in the crucial process of trophoblast invasión and uterine artery transformation is supported. The relevance ofan adequate adaptation to pregnancy is highlighted not only by the intragestational complications derivedfrom a defective process, such as intrauterine growth restriction, preterm birth, and preeclampsia -its foremost expression- but also by the long term cardiovascular complications ofthe mother and her offspring.
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Feminino , Humanos , Adaptação Fisiológica/fisiologia , Hemodinâmica/fisiologia , Tolerância Imunológica/fisiologia , Gravidez/fisiologia , Endotélio Vascular/fisiologiaRESUMO
Justificativa e objetivos: o objetivo desta revisão é proporcionar ao leitor informações úteis para a condução adequada da anestesia obstétrica. Conteúdo: inicialmente, discorre-se sobre a fisiologia e as funções da placenta e os principais determinantes do fluxo útero-placentário. Os mecanismos de passagem transplacentária de fármacos são elucidados com destaque para a difusão simples, que se fundamenta na lei de Fick.A correlação de técnicas e drogas anestésicas com a segurança materna, circulação útero-placentária e o bem-estar fetal é pormenorizada nos seguimentos da anestesia regional, relacionada ao uso de anestésicos locais e opioides e da anestesia geral, com o uso de anestésicos venosos, inalatórios e bloqueadores neuromusculares. Conclusão: o progresso e novos conhecimentos sobre as técnicas anestésicas em obstetrícia são de suma importância para a segurança materno-fetal.
Background and objectives: The objective of this review is to provide the reader with useful information for the proper conduct of obstetric anesthesia. Contents: Initially, the authors discuss about the physiology and functions of the placenta and the major determinants of utero-placental flow. The mechanisms of transplacental transfer of drugs are elucidated with emphasis on simple diffusion, which is based in the Fick's law. The correlation of anesthetic drugs and techniques with maternal safety, uteroplacental circulation and fetal well-being is detailed in regional anesthesia, related to the use oflocal anesthetics and opioids, and in general anesthesia, related to the use of inhaled and intravenous anesthetics, and also neuromuscular blockers. Conclusion: Progress and new knowledge about anesthetic techniques in obstetrics are important to provide a good level of security to the mother and fetus.
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PIP: At present probably about 1/2 million people have AIDS in the world. About 10 million may be infected with HIV without showing symptoms. By 2000 at least 5 million new cases of AIDS are expected. In Latin America AIDS was first concentrated among urban male homosexuals. Lately AIDS has increased rapidly among heterosexuals especially among bisexuals. In Sao Paulo and Rio de Janeiro 28% of bisexuals were infected with HIV in 1987. In Rio about 1/2 of male or female prostitutes were infected. The number of partners, the frequency of coitus, simultaneous infection with genital ulcers, and anal sex increases the chances of heterosexual transmission. 25-50% of the children of infected pregnant women are born infected with HIV. By the end of 1992 at least 1 million babies will be born to infected mothers of whom 250,000 will be HIV positive. Vertical transmission from the mother to the fetus by decidual leukocytes (especially trophoblasts) via transplacental passage was verified by identifying HIV in aborted fetuses in the 2nd and 3rd trimester. HIV infection can also occur during delivery. The virus can also be transmitted via mother's milk: there have been reports of HIV in milk since 1985. The US Centers for Disease Control advised against breast feeding by HIV infected mothers. Up to 15 months of age it is difficult to assess whether HIV antibodies are derived from the mother's infection or from the infant itself. A polymerase chain reaction test could resolve this problem by amplifying the genetic chain in the blood and detecting HIV in the DNA of the child. Recent studies have indicated that there is no additional risk posed by breast feeding for those infants who have been exposed to HIV during pregnancy or delivery. Mothers infected with HIV in developing countries may breast feed their infants because it is crucial in reducing infant mortality.^ieng
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Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Homossexualidade , Troca Materno-Fetal , Leite Humano , Fatores de Risco , América , Comportamento , Biologia , Brasil , Países em Desenvolvimento , Doença , Lactação , América Latina , Fisiologia , Gravidez , Reprodução , Comportamento Sexual , América do Sul , VirosesRESUMO
PIP: Lead exposure even at low levels has adverse effects for the central nervous system (CNS), but pregnant women, neonates, lactating infants, and preschool and school age children are most susceptible to it. In rats anatomical alterations included swelling in the mitochondria of renal duct cells (at 26 mcg/dl); biochemical effects involved marked reduction of cytochrome content in the cerebral cortex (36 mcg/dl); and physiological effects were induced at the level of 30-50 mcg/dl. Central nervous system effects entailed persistent decrease of visual acuity (65 mcg/dl at birth and 7 mcg/dl 90 days later), the increase of the latency of primary and secondary components of evoked visual responses during the prenatal and adult period (65 mcg/dl and 7 mcg/dl on days 21 and 90 after birth, respectively). 30 and even 20 mcg/dl of lead in the blood produced nerve conductivity deficits. A study of 425 children with lead poisoning showed a 39% rate of mental retardation and convulsions impervious to treatment. Lead levels within a range of 10-25 mcg/dl reduced the score on the mental development inventory by 4-8 points. The population of the Valley of Mexico numbers 15-20 million with 50% of Mexico's industry. A who investigation indicated blood levels of an average of 22.5 mcg/dl in a group of school teachers, the highest in 10 major population centers in the world. Blood levels in 405 pregnant women in Mexico City averaged 20.3 mcg/dl, and the sample from the umbilical cord of fetuses showed 13.6 mcg/dl. Another study disclosed blood levels of 16 mcg/dl in mothers and 13 mcg/dl in their offspring. The most probable sources of lead are: leaded gasoline, secondary recapture of lead for making batteries, use of paints, ceramics used for storing and cooking food, lead seal of milk containers, and consumption of food contaminated with lead.^ieng
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Animais de Laboratório , Sistema Nervoso Central , Desenvolvimento Infantil , Poluição Ambiental , Indústrias , Chumbo , Troca Materno-Fetal , Transtornos Mentais , América , Biologia , Fenômenos Químicos , Química , Países em Desenvolvimento , Doença , Economia , Meio Ambiente , Compostos Inorgânicos , América Latina , Metais , México , América do Norte , Fisiologia , Gravidez , Reprodução , PesquisaRESUMO
PIP: Although not as common as for males, 4-7% of AIDS reports are in females, therefore allowing the possibility of perinatal transmission. Some routes of transmission are suspected: 1) intrauterine transmission, 2) during delivery, 3) breastfeeding, 4) direct contact between parents and infant. Some studies suggest that pregnancy increases the likelihood for disease development. The HTLV-III virus has been identified in breast milk, therefore breastfeeding is not recommended to mothers with AIDS. The HIV test is recommended to pregnant women with evidence of infections or that have been using IV drugs, women from high incidence areas, prostitutes, and those with high risk group partners.^ieng
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Síndrome da Imunodeficiência Adquirida , Biologia , Aleitamento Materno , Doença , Infecções por HIV , Incidência , Fenômenos Fisiológicos da Nutrição do Lactente , Troca Materno-Fetal , Fenômenos Fisiológicos da Nutrição , Gravidez , Reprodução , Projetos de Pesquisa , Viroses , Saúde , PesquisaRESUMO
The acquired immunodeficiency syndrome has been observed with increasing frequency in children with associated hemophilia, high-risk environmental backgrounds, and blood transfusions. AIDS should be considered in the differential diagnosis of childhood immunodeficiency, and it must be distinguished from congenital disorders. We emphasize the importance of epidemiologic, clinical, and laboratory data in diagnosis and aggressive management of infectious complications. The relationship between human retrovirus infection and AIDS remains to be precisely defined, especially with regard to cofactors that may play a role in the development of severe immunodeficiency following exposure to the agent.
PIP: To date, the acquired immunodeficiency syndrome (AIDS) has been identified in over 50 children in the US, including those with associated hemophilia, high-risk environmental factors (Haitian background, parental intravenous drug abuse, or prostitution), and blood transfusions. The evaluation of an infant or young child in whom AIDS is suspected requires exclusion of congenital disorders of immune function. A specific test is not currently available, but inclusion criteria for childhood AIDS have been developed. The diseases accepted as indicative of underlying cellular immunodeficiency children are the same as those used in defining AIDS in adults, with the exclusion of congenital infections such as toxoplasmosis or herpes simplex virus infection in the 1st month of life or cytomegalovirus infection in the 1st 6 months of life. Specific conditions that must be excluded in children are primary immunodeficiency diseases (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome, ataxia-telangiectasia, neutrophil function abnormality) and secondary immuno-deficiency associated with immunosuppressive therapy, lymphoreticular malignancy, or starvation. Almost all young children with AIDS have hepatosplenomegaly, interstitial pneumonitis, and poor growth. The average age of 36 US child AIDS victims studied in detail was 5 months at presentation with findings suggestive of severe immunodeficiency. Mucocutaneous candidiasis was present in 75% of these 36 children, and Pneumocystis carinii and cytomegalovirus were each isolated from 30% of cases. Normal T4:T8 ratios occur in about 15% of pediatric AIDS cases. Laboratory evidence of polyclonal hypergammaglobulinemia generally supports the AIDS diagnosis. Recurrent infection and malnutrition are major problems in the clinical management of child AIDS patients.
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Síndrome da Imunodeficiência Adquirida , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/fisiopatologia , Síndrome da Imunodeficiência Adquirida/terapia , Síndrome da Imunodeficiência Adquirida/transmissão , Formação de Anticorpos , Linfócitos B/imunologia , Criança , Deltaretrovirus/imunologia , Hemofilia A/imunologia , Humanos , Imunidade Celular , Monócitos/imunologia , Fenômenos Fisiológicos da Nutrição , Recidiva , Infecções por Retroviridae/imunologia , Risco , Linfócitos T/imunologia , Reação TransfusionalRESUMO
PIP: A study was conducted on the frequency of smoking during pregnancy in women residents of Ribeirao Preto, Sao Paulo, from May 1978 to May 1979. The study consisted of 6,306 pregnant women, of which 29.0% smoked; 284 (15.9%) stopped smoking during pregnancy and only 0.4% started smoking during the pregnancy period. The following variables were analyzed regarding the pregnant women: age, income, level of education, length of pregnancy, number of abortions and prior pregnancies. Regarding newborn babies of both sexes, the following variables were studied: weight at birth and neonatal mortality rate; the study sought to compare the relationship between the number of cigarettes smoked by the mother on a daily basis and possible health hazards. It was noted that regarding the age variable younger mothers tended to smoke more. Illiterate mothers or those with a low level of education tended to smoke more. The lowest income and greatest number of abortions was also found among pregnant women who stated that they smoked more than 10 cigarettes per day. The highest percentage of newborns with the lowest weight was among those whose mothers smoked more than 5 cigarettes/day. As for neonatal mortality rates, for both sexes the highest ratio was found among those whose mothers smoked more than 10 cigarettes per day. In sum, there is evidence of a correlation between the number of cigarettes smoked per day during pregnancy and low weight of the baby at birth, as well as that the highest neonatal mortality rate and abortions in prior pregnancies was found among women who smoked more than 10 cigarettes per day.^ieng
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Antropometria , Comportamento , Biologia , Peso ao Nascer , Peso Corporal , Desenvolvimento Infantil , Demografia , Doença , Crescimento , Mortalidade Infantil , Troca Materno-Fetal , Mortalidade , Fisiologia , Dinâmica Populacional , População , Complicações na Gravidez , Gravidez , Reprodução , Pesquisa , Fumar , Comportamento Social , América , Brasil , Países Desenvolvidos , Países em Desenvolvimento , Economia , Escolaridade , Renda , América Latina , Características da População , Projetos de Pesquisa , Classe Social , Fatores Socioeconômicos , América do Sul , TecnologiaRESUMO
Fourteen infants with clinical and laboratory features of an acquired immunodeficiency syndrome were identified in a single metropolitan area from November 1980 to July 1983. Patients were predominantly of Haitian parentage, although two cases occurred in offspring of non-Haitian intravenous drug abusers. Only one patient had received a blood transfusion before the development of clinical findings. The predominant clinical findings included failure to thrive, persistent infection of the oral mucosa by Candida albicans, chronic pulmonary infiltrates, hepatosplenomegaly, lymphadenopathy, and diarrhea. Immunologic studies showed most of the infants to have inverted ratios of T-cell subsets, greatly increased immunoglobulin levels, and circulating immune complexes. Lymphopenia was not common, as it is in adult patients. Infectious agents responsible for opportunistic infections in this series included Pneumocystis carinii, herpesviruses, particularly cytomegalovirus, and C. albicans. Bacterial infections were common, and gram-negative sepsis was the major cause of death in the seven infants who have died. At autopsy, two infants had disseminated lymphadenopathic Kaposi's sarcoma. These observations suggest the likelihood of transplacental, perinatal, or postnatal transmission of an as yet unidentified infectious agent that causes this disease.
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Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/microbiologia , Complexo Antígeno-Anticorpo/análise , Insuficiência de Crescimento/complicações , Feminino , Florida , Haiti/etnologia , Humanos , Imunoglobulinas/análise , Lactente , Recém-Nascido , Infecções/complicações , Ativação Linfocitária , Masculino , Linfócitos T/imunologiaRESUMO
PIP: The statement that breast milk can provide infants with better resistence against infections stems from 3 main lines of investigation: 1) biochemical, immunologic, and bacteriologic analyses of breast milk and of the feces of breast fed infants; 2) epidemiological studies on infant morbidity and mortality of children fed with breast milk or with cow milk; and, 3) the study of dozens of clinical cases. This long article examines data from all kinds of studies, especially regarding immunization against infant diarrhea, and suggests a few possible lines of investigation on the advantages of breast milk.^ieng
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Leite Humano/imunologia , Anticorpos Antibacterianos/análise , Infecções Bacterianas/imunologia , Aleitamento Materno , Feminino , Humanos , Imunoglobulinas/análise , Recém-NascidoRESUMO
Anthropometric measurements were made on 4,952 mothers and their neonates from a Peruvian urban population. Based on age-specific percentiles, the mothers were separated into categories of short and tall stature, high and low fat, and high and low muscle. The study indicates that: (1) tall and short mothers characterized by similar subcutaneous fat and upper arm muscle area (whether high or low) had newborns with similar birth weight and recumbent length; (2) mothers characterized by high subcutaneous fat had heavier and fatter, but not longer, newborns than mothers with low subcutaneous fat; (3) mothers characterized by high upper arm muscle area had heavier, leaner and longer newborns than mothers with low upper arm muscle area; (4) mothers characterized by high muscle and high fat had heavier and longer newborns than mothers with high muscle and low fat; but (5) mothers characterized by high muscle and low fat had heavier and longer newborns than mothers with low muscle and high fat. Considering that subcutaneous fat and arm muscle area reflect calorie and protein reserves respectively, it is concluded that an increase in maternal calorie reserves results in increased infant fatness, but a lesser increase in linear growth. In contrast, an increase in maternal protein reserves does enhance both birth weight and prenatal linear growth.
PIP: Anthropometic measurements were made on 4952 mothers and their neonates from a Peruvian urban population in an effort to determine the effects of maternal nutritional status during pregnancy on prenatal growth. Measurements of height, pre-partum weight, upper arm circumference and triceps skinfolds were obtained using standard procedures as were measurements of birth weight, recumbent length, head circumference, thorax circumference, upper arm circumference and triceps skinfold thickness. On the basis of age-specific percentiles, the mothers were separated into categories of short and tall stature, high and low fat, and high and low muscle. The following were included among the findings: 1) tall and short mothers had newborns with similar birth weight and recumbent length; 2) mothers characterized by high subcutaneous fat had heavier and fatter, but not longer, newborns than mothers with low subcutaneous fat; 3) mothers characterized by high upper arm muscle area had heavier, leaner and longer newborns tha mothers with low upper arm muscle area; 4) mothers characterized by high muscle and high fat had heavier and longer newborns than mothers with high muscle and low fat; and 5) mothers characterized by high muscle and low fat had heavier and longer newborns than mothers with low muscle and high fat. On the basis that subcutaneous fat and arm muscle area reflect calorie and protein reserves respectively, it is concluded that an increase in maternal calorie reserves results in increased infant fatness but a lesser increase in linear growth. Increase in maternal protein reserves enhances both birth weight and prenatal linear growth.
Assuntos
Peso ao Nascer , Troca Materno-Fetal , Fenômenos Fisiológicos da Nutrição , Antropometria , Braço , Estatura , Feminino , Humanos , Recém-Nascido , Masculino , Músculos , Peru , Gravidez , Dobras Cutâneas , População UrbanaRESUMO
PIP: Dr. Holger Hansen comments on an article by Buist and Jhavarie on maternal hyperphenylalaninemia. The noted that the condition causes prenatal brain damage and recommended a low-phenylalanine diet during pregnancy for women with blood phyenylalanine levels greater than 10 to 15 mg per 100 ml. In the same Journal of Pediatrics issue in which their article appeared, there was a report of a mother with hyperphenylalaninemia who had 2 normal children. In 8 women out of 20 with maternal hyperphenylalaninemia, phenylalanine levels were greater than 10 mg per 100 ml. 12 normal children were born and 10 mentally retarded children were born. Dr. Hansen suggests that that termination of pregnancy in hyperphenylalaninemic mothers should not continue to be the treatment of choice. Buist and Jhaveri respond that Dr. Hansen does not provide all the data and that there are reports in which all the children of affected mothers were severely brain damaged. They contend that the controlled use of some form of phenylalanine-restricted diet during pregnancy should be the treatment of choice.^ieng
Assuntos
Dano Encefálico Crônico/etiologia , Doenças Fetais/etiologia , Fenilcetonúrias/prevenção & controle , Complicações na Gravidez , Dano Encefálico Crônico/prevenção & controle , Dietoterapia , Feminino , Doenças Fetais/prevenção & controle , Humanos , Recém-Nascido , Deficiência Intelectual/etiologia , Deficiência Intelectual/prevenção & controle , Fenilalanina , Fenilcetonúrias/complicações , GravidezRESUMO
PIP: The article reviews the relationship between smoking habits of the mother and pregnancy, delivery, and the newborn. Nicotinic acid affects the central nervous system, and produces several cardiovascular, gastrointestinal and respiratory effects on people who inhale the smoke. 2095 pregnant patients were controlled in Caracas, Venezuela, 38.4% were smokers. Although the habit of smoking did not seem to modify fetal movements, it did modify fetal cardiac frequency. Length of gestation was similar for smoking or nonsmoking mothers; incidence of spontaneous abortion was 3 times higher for smoking mothers, who also had a higher incidence of premature rupture of membranes. The incidence of preeclampsia and hemorrhage was lower for smoking mothers, whose deliveries did not significantly differ from those of nonsmoking mothers. Mothers who were smokers had a higher risk of premature deliveries and, consequently, a higher risk of low birth weight babies. This last very important factor did not change in primiparous or multiparous mothers, or with age, or with the family's socioeconomic status, or with smoking habits of the father. It did change, however, with the number of cigarettes smoked every day by the mother. The relationship between sex of the newborn and smoking is not clear; what is clear is that there is a relationship between smoking and fetal or neonatal mortality, which is consistently higher for babies born to smoking mothers. Incidence of congenital malformations was found similar for babies of both groups of mothers, while, apparently, twins were born more often to mothers who smoked. Finally, nicotinic acid did definitely inhibit or reduce lactation.^ieng