Resumen Marco contextual: En tiempos de pandemia, las citas de enfermería para el seguimiento del embarazo cambiaron, sobre todo la restricción de acompañantes. Por esta razón, es importante evaluar la satisfacción de las mujeres embarazadas con los cuidados de enfermería durante este contexto pandémico. Objetivo: Evaluar la satisfacción de las mujeres embarazadas con la atención prestada por las enfermeras obstétricas en las consultas de seguimiento del embarazo durante la pandemia de COVID-19. Metodología: Estudio descriptivo transversal de carácter cuantitativo, con una muestra de 196 mujeres embarazadas. Se aplicó la Escala de Satisfacción de los Pacientes con Asistencia de Enfermería (General Practice Nurse Satisfaction Scale - GPNS), compuesta por las siguientes dimensiones: relaciones interpersonales y comunicación, confianza, credibilidad y dedicación. Resultados: Las mujeres embarazadas están, de media, más satisfechas en la dimensión relaciones interpersonales y comunicación, y menos satisfechas en la dimensión dedicación. Conclusión: Las embarazadas se mostraron satisfechas con los cuidados de enfermería y se dieron cuenta de su importancia. Esto refuerza la pertinencia de que las consultas sean realizadas por una enfermera especializada en Enfermería de Salud Materna y Obstétrica.

Resumo Enquadramento: Em tempo de pandemia, as consultas de enfermagem de vigilância da gravidez sofreram alterações, nomeadamente na restrição de acompanhantes. Por esse motivo, é importante a avaliação da satisfação das grávidas com a assistência de enfermagem durante este contexto pandémico. Objetivo: Avaliar a satisfação da grávida com a assistência das enfermeiras obstétricas nas consultas de vigilância da gravidez durante o contexto de pandemia COVID-19. Metodologia: Estudo transversal descritivo de natureza quantitativa, com uma amostra de 196 grávidas. Aplicado a Escala de Satisfação dos Pacientes com a Assistência de Enfermagem (General Practice Nurse Satisfaction Scale - GPNS), constituída pelas dimensões: relacionamento interpessoal e comunicação, confiança, credibilidade e dedicação. Resultados: As grávidas apresentam-se em média mais satisfeitas na dimensão relacionamento interpessoal e comunicação e menos satisfeitas na dimensão dedicação. Conclusão: As grávidas apresentam-se satisfeitas com a assistência de enfermagem percecionando a sua importância. Tal reforça a pertinência das consultas serem realizadas por um Enfermeiro Especialista em Enfermagem de Saúde Materna e Obstétrica.

Abstract Background: Prenatal nursing appointments underwent changes during the COVID-19 pandemic, namely in the restriction of companions. For this reason, it is important to assess pregnant women’s satisfaction with nursing care during this period. Objective: To assess pregnant women’s satisfaction with nurse midwife-led prenatal appointments during the COVID-19 pandemic. Methodology: A qualitative descriptive cross-sectional study was conducted with a sample of 196 pregnant women. The Portuguese version of the General Practice Nurse Satisfaction Scale (Escala de Satisfação dos Pacientes com a Assistência de Enfermagem) was administered to the sample. The tool consists of the following dimensions: interpersonal relationship and communication, confidence, credibility, and dedication. Results: Pregnant women are, on average, more satisfied in the interpersonal relationship and communication dimension and less satisfied in the dedication dimension. Conclusion: Pregnant women are satisfied with nursing care and acknowledge its importance. This finding reinforces the importance of nurse midwife-led consultations.

ABSTRACT Introduction: toxoplasmosis is a parasitosis that causes serious infections in immunocompromised patients and newborns. The serological status of the mother influences the possibility of transmission to the fetus if the infection is contracted during pregnancy. It is necessary to know the prevalence of this condition in pregnant women as a first step to carry out actions aimed at knowing the real burden of the disease and reducing this pathology. Objective: determine the IgG and IgM seroprevalence of toxoplasmosis in pregnant women and newborns from January 2017 to January 2021. Methodology: pregnant women in their immediate peripartum period and newborns up to one week of extrauterine life were included. IgG and IgM were measured in peripheral blood by the ECLIA method. The calculated sample size was 800 per group, for the study period. Results: 2524 newborns and 2029 pregnant women were included. The prevalence of IgG was 97.5 % and 97 % for pregnant women and newborns, respectively, and IgM: 4.7 % and 1.9% for women and newborns, respectively. The seroprevalence trends remained constant for IgG for both groups, while IgM showed a slight increasing trend. Conclusions: IgG seroprevalence was close to 100% in both populations, probably due to the transplacental transfer of IgG, however, a small percentage of IgM was noted, a probable marker of acute infection.

RESUMEN Introducción: la toxoplasmosis es una parasitosis que causa infecciones graves en inmunocomprometidos y recién nacidos. El estado serológico de la madre influye en la posibilidad de transmisión al feto si la infección es contraída durante el embarazo. Es necesario conocer la prevalencia de esta afección en gestantes como primer paso para realizar acciones tendientes a conocer la carga real de la enfermedad y disminuir esta patología. Objetivo: determinar la seroprevalencia IgG e IgM de toxoplasmosis de gestantes y recién nacidos periodo de enero 2017 a enero 2021. Metodología: se incluyeron las gestantes en su periodo periparto inmediato y recién nacidos hasta la semana de vida extrauterina. Se midió IgG e IgM en sangre periférica por método ECLIA. El tamaño muestral calculado fue de 800 por grupo, para el periodo de estudio. Muestreo no probabilístico de casos consecutivos. Resultados: fueron incluidos 2524 recién nacidos y 2029 gestantes. Las prevalencias de IgG fueron de 97,5 % y 97 % para gestantes y recién nacidos respectivamente, y la IgM: 4,7% y 1,9 % para mujeres y recién nacidos respectivamente. Las tendencias de las seroprevalencias se mantuvieron constantes para IgG para ambos grupos, mientras que la IgM presentó una leve tendencia al aumento. Conclusiones: la seroprevalencia de IgG fue cercana al 100 % en ambas poblaciones, probablemente debido a la transferencia transplacentaria de IgG, sin embargo, se nota un porcentaje pequeño de IgM, probable marcador de infección aguda.

ABSTRACT Introduction: cervical cancer represents a serious public health problem despite being highly preventable. Objective: to determine the clinical and epidemiological characteristics of the participation of women in the area of influence of a Public Hospital in the prevention of cervical cancer between the months of January to December of the years 2020 to 2021. Methodology: non-experimental cross-sectional descriptive design, with a quantitative approach. The total number of women participating in the prevention of cervical cancer in the area of influence of the Public Hospital was included. Secondary data were used that were loaded into a previously prepared form. Results: 61 % of the women were of 13 years old at risk, 83 % were not pregnant and 17 % were pregnant, 53 % had a history of PAP and 47 % did not, 86 % had a negative result for lesion, 9 % inflammatory and 4 % positive. Among the positive results, the predominant one was ASCUS with 47 %. The majority women had a negative PAP result. As a conclusion among women with positive results, there was a predominance of ASCUS diagnoses and in second place CIN I LSIL. Conclusion: the features that were found to be significantly associated with the PAP result were: being part of the age group at risk and presence of pregnancy. It is suggested to continue emphasizing prevention and follow-up, to investigate the ages at risk and to include other variables of interest in future studies.

RESUMEN Introducción: el cáncer cervical representa un grave problema de salud pública a pesar de ser altamente prevenible. Objetivo: determinar las características clínicas y epidemiológicas de la participación de las mujeres del área de influencia de un Hospital Público en la prevención del cáncer de cuello uterino entre los meses de enero a diciembre de los años 2020 al 2021. Metodología: diseño no experimental de corte transversal tipo descriptivo, con enfoque cuantitativo. Se incluyó el total de mujeres participantes de la prevención de cáncer cervical en el área de influencia del Hospital Público. Se utilizaron datos secundarios que fueron cargados en una planilla elaborada previamente. Resultados: el 61 % de las mujeres estaban en edad de riesgo, 83 % no estaban embarazadas y 17 % si, 53 % tiene antecedente de PAP y 47 %, no, 86 % tuvo resultado negativo para lesión, 9 % inflamatorio y 4 % positivo. Entre los resultados positivos el preponderante fue el de ASCUS con un 47 %. Se concluye que la mayoría de las mujeres tuvieron un resultado de PAP negativo. Entre las mujeres con resultados positivos se tuvo preponderancia de diagnósticos de ASCUS y en segundo lugar CIN I LSIL. Conclusión: las características que se encontraron significativamente asociadas al resultado de PAP fueron: formar parte del grupo de edad de riesgo y presencia de embarazo. Se sugiere seguir haciendo hincapié en la prevención y seguimiento, indagar en las edades de riesgo e incluir otras variables de interés en futuros estudios.

Abstract Introduction: Almost 800 female deaths occur daily due to preventable causes associated with complications during or after pregnancy or childbirth, equivalent to two maternal deaths per minute. Objective: To develop a nursing care process for a pregnant woman who suffered from hyperthyroidism using diagnostic taxonomies, results and nursing interventions with a focus on Orem's theory. Methodology: Case study of a pregnant woman treated in a second level care hospital, the Orem assessment guide was used, developing the stages: assessment, diagnosis, planning, execution and evaluation, individualized care plans were designed and executed. Privacy was protected by omitting identity, respecting the rights and well-being of the participant. Results: The risk conditioning factor that compromised the health of the mother-child binomial gave way to care planning aimed at the process of ineffective motherhood and ineffective self-management of health, establishing interventions such as high-risk pregnancy care and teaching the process of illness and prescribed medications, an improvement was obtained in the patient's health status, which allowed her discharge and adequate management of the high-risk pregnancy. Conclusion: The nursing care process exposed the context in which the pregnant woman with known uncontrolled pathology is admitted, which compromised maternal-fetal well-being. Nursing education is required to promote preconception maternal health for future pregnancies.

Abstrato Introdução: Quase 800 mortes femininas ocorrem diariamente por causas evitáveis associadas a complicações durante ou após a gravidez ou o parto, o equivalente a duas mortes maternas por minuto. Objetivo: Desenvolver um processo de cuidado de enfermagem a uma gestante portadora de hipertireoidismo utilizando taxonomias diagnósticas, resultados e intervenções de enfermagem com enfoque na teoria de Orem. Metodologia: Estudo de caso de uma gestante atendida em um hospital de atenção secundária, utilizou-se o guia de avaliação de Orem, desenvolvendo as etapas: avaliação, diagnóstico, planejamento, execução e avaliação, foram desenhados e executados planos de cuidados individualizados. A privacidade foi protegida pela omissão da identidade, respeitando os direitos e o bem-estar do participante. Resultados: O fator condicionante de risco que comprometia a saúde do binômio mãe-filho deu lugar ao planejamento do cuidado voltado ao processo de maternidade ineficaz e à autogestão ineficaz da saúde, estabelecendo intervenções como o cuidado à gravidez de alto risco e ensinando o processo e medicamentos prescritos, houve uma melhora no estado de saúde da paciente, o que permitiu sua alta e o gerenciamento adequado da gravidez de alto risco. Conclusão: O processo de cuidado de enfermagem expôs o contexto em que a gestante com patologia conhecida não controlada é internada, o que compromete o bem-estar materno-fetal. A educação em enfermagem é necessária para promover a saúde materna pré-concepcional em futuras gestações.

Resumen Introducción: Casi 800 muertes de mujeres en forma diaria ocurren por causas prevenibles asociadas a complicaciones durante o después del embarazo o el parto, equivaliendo dos muertes maternas por minuto. Objetivo: Desarrollar un proceso de atención de enfermería a gestante que cursó con hipertiroidismo empleando las taxonomías diagnósticas, resultados e intervenciones de enfermería con enfoque de la teoría de Orem. Metodología: Estudio de caso a mujer gestante atendida en hospital de segundo nivel de atención, se empleó la guía de valoración de Orem desarrollando las etapas: valoración, diagnóstico, planeación, ejecución y evaluación, se diseñaron y ejecutaron planes de cuidados individualizados. Se protegió la privacidad omitiendo identidad, respetando los derechos y bienestar de la participante. Resultados: El factor condicionante de riesgo que comprometía la salud del binomio madre-hijo, dio paso a la planificación del cuidado encaminado al proceso de maternidad ineficaz y autogestión ineficaz de la salud, estableciendo intervenciones como cuidados del embarazo de alto riesgo y enseñanza del proceso de enfermedad y medicamentos prescritos, se obtuvo mejora en el estado de salud de la paciente, lo que permitió su alta y un adecuado manejo del embarazo de alto riesgo. Conclusión: El proceso de atención de enfermería expuso el contexto en el que ingresa la mujer gestante con patología conocida no controlada, lo que comprometía el bienestar materno-fetal. Se requiere educación por parte de enfermería para fomentar la salud materna preconcepcional para futuros embarazos.

Resumen Los trabajadores agrícolas se exponen frecuentemente a los pesticidas, los cuales pueden afectar el sistema cardiovascular. El objetivo de la investigación fue revisar la asociación entre la exposición ocupacional a pesticidas, el desarrollo de enfermedades cardiovasculares y los biomarcadores utilizados en la vigilancia de la salud de los trabajadores. Para ello se realizó una revisión no sistemática de la literatura en tres bases de datos: Pubmed, Embase y Scopus, con ecuaciones de búsqueda elaboradas con los términos “agrochemicals”, “myocardial infarction”, “occupational exposure” y “farmers", y se incluyeron artículos publicados entre 2007 y 2022. Se encontró que los pesticidas causan elevación de las cifras de presión arterial en trabajadores expuestos y en mujeres embarazadas se relaciona con hipertensión gestacional y preeclampsia. Respecto al infarto agudo de miocardio (IAM), el contacto con los pesticidas clorpirifós, coumafós, carbofurano, pendimetalina, trifluralina y acilalanina aumentan el riesgo de IAM en mujeres, y entre los trabajadores masculinos la exposición a dibromuro de etileno, maneb/mancozeb y dimetil-ditiocarbamato de zinc se asoció con mayor mortalidad. La vigilancia epidemiológica se realiza principalmente con la medición de la actividad de la acetilcolinesterasa eritrocitaria (AChE). Se puede concluir que la exposición a pesticidas puede desencadenar enfermedades cardiovasculares agudas y crónicas, como elevación de las cifras de presión arterial, IAM fatal y no fatal. Los pesticidas dimetil ditiocarbamato de zinc, clorpirifós, coumafós, carbofurano, paratión y malatión son las sustancias que tienen mayor relación con el desarrollo de enfermedad cardiovascular.

Abstract Farmworkers are frequently exposed to pesticides, which can affect the cardiovascular system. The objective of the research was to review the association between occupational exposure to pesticides and the development of cardiovascular diseases, and the biomarkers used in monitoring the health of workers. For this, a non-systematic review of the literature was carried out in three databases: Pubmed, Embase and Scopus, with search equations prepared with the terms "agrochemicals", "myocardial infarction", "occupational exposure" and "farmers". Articles published between 2007 and 2022 were included. Pesticides were found to cause elevated blood pressure levels in exposed workers, and in pregnant women it is related to gestational hypertension and preeclampsia. Regarding acute myocardial infarction (AMI), contact the pesticides chlorpyrifos, coumaphos, carbofuran, pendimethalin, trifluralin, and acylalanine increased the risk of AMI in women, and among male workers exposure to ethylene dibromide, maneb/mancozeb, and zinc dimethyldithiocarbamate was associated with increased mortality. Epidemiological surveillance is mainly carried out by measuring erythrocyte acetylcholinesterase (AChE) activity. It can be concluded that exposure to pesticides can trigger acute and chronic cardiovascular diseases, such as elevated blood pressure, fatal and non-fatal AMI. Zinc dimethyl dithiocarbamate, chlorpyrifos, coumafos, carbofuran, parathion and malathion pesticides are the substances most closely related to the development of cardiovascular disease.

Resumen La seguridad de los psicofármacos durante el embarazo es un tema crucial en la práctica clínica. En esta revisión, se hace un breve recorrido sobre los cambios en el embarazo que impactan en la farmacodinamia de los medicamentos, además, se analizan los principales grupos farmacológicos en psiquiatría y sus efectos durante el embarazo. Se identifican tres períodos críticos durante el embarazo. El período de las primeras dos semanas se asocia con un mayor riesgo de aborto espontáneo. El período de la segunda a la décima semana es el más riesgoso, ya que pueden ocurrir alteraciones teratogénicas que afectan el desarrollo fetal. El período posterior a la décima semana se caracteriza por alteraciones en el crecimiento y desarrollo funcional del feto, pero suelen ser menos graves. Los antidepresivos, especialmente los inhibidores selectivos de la receptación de serotonina (ISRS) y los antipsicóticos de segunda generación se consideran los más seguros, pero estos últimos pueden estar asociados con síndrome metabólico, cardiopatías congénitas y trastornos del neurodesarrollo. El litio se ha asociado con efectos teratogénicos y malformaciones cardíacas, mientras que el valproato está relacionado con defectos congénitos importantes. Las benzodiacepinas pueden tener efectos tóxicos y causar síndrome de abstinencia en el recién nacido. La seguridad de los psicofármacos durante el embarazo requiere una evaluación individualizada de los beneficios y riesgos. Aunque algunos grupos de psicofármacos se consideran relativamente seguros, es necesario tener precaución y considerar las posibles complicaciones asociadas con su uso durante el embarazo.

Abstract: The safety of psychoactive drugs during pregnancy is a crucial issue in clinical practice. In this review, a brief overview of the changes in pregnancy that impact the pharmacodynamics of drugs is made; in addition, the main pharmacological groups in psychiatry and their effects during pregnancy are analyzed. Three critical periods during pregnancy are identified. The period of the first two weeks is associated with an increased risk of miscarriage. The period from the second to the tenth week is the most at risk , since teratogenic effects that affect fetal development can take place. The period after the tenth week is characterized by alterations in fetal growth and functional development , however ,less severe defects. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), and second-generation antipsychotics are considered the safest, but the latter may be associated with metabolic syndrome, congenital heart disease, and neurodevelopmental disorders. Lithium has been associated with teratogenic effects and cardiac malformations, while valproate is associated with major birth defects. Benzodiazepines can have toxic effects and cause Neonatal Withdrawal Syndrome . The safety of psychotropic drugs during pregnancy requires an individualized assesment of the benefits and risks. Although some groups of psychiatric drugs are considered relatively safe, caution is needed when considering the potential complications associated with their use during pregnancy.

Resumo As mulheres portadoras de doença renal crônica apresentam menor probabilidade de engravidar e são mais propensas a complicações gestacionais quando comparadas a pacientes com função renal normal, sendo, portanto, consideradas gestantes de alto risco materno e fetal. Ao longo dos anos, verificou-se aumento da incidência de gestações em pacientes em diálise e melhora do desfecho materno e fetal. Acredita-se que a otimização do atendimento obstétrico e neonatal, o ajuste do tratamento dialítico (em especial, o aumento do número de horas e da frequência semanal das sessões de diálise) e o uso de agentes estimuladores da eritropoiese têm proporcionado melhor controle metabólico, volêmico, pressórico, eletrolítico e da anemia. Este artigo de revisão tem o objetivo de analisar os desfechos gestacionais em pacientes com doença renal crônica em diálise e revisar a condução médica nefrológica nesse cenário. Pelo crescente interesse pelo tema, as recomendações clínicas para a prática assistencial têm ganhado em consistência tanto no manejo medicamentoso quanto no manuseio dialítico, aspectos que tratamos na presente revisão. normal sendo portanto fetal anos verificouse verificou se Acreditase Acredita neonatal especial metabólico volêmico pressórico anemia cenário tema

Abstract Women with chronic kidney disease are less likely to become pregnant and are more susceptible to pregnancy complications when compared to patients with normal kidney function. As a result, these are considered high-risk pregnancies, both maternal and fetal. Over the years, there has been an increase in the incidence of pregnancies in dialysis patients, and an improvement in maternal and fetal outcomes. It is believed that the optimization of obstetric and neonatal care, the adjustment of dialysis treatment (particularly the increase in the number of hours and weekly frequency of dialysis sessions), and the use of erythropoiesis-stimulating agents have provided better metabolic, volume, blood pressure, electrolyte, and anemia control. This review article aims to analyze pregnancy outcomes in chronic kidney disease patients undergoing dialysis and to review nephrological medical management in this scenario. Due to the growing interest in the subject, clinical recommendations for care practice have become more consistent in both drug and dialysis management, aspects that are addressed in this review. function result highrisk high risk years particularly sessions, sessions , sessions) erythropoiesisstimulating erythropoiesis stimulating metabolic volume pressure electrolyte control scenario subject

Abstract Background: Body image concerns during pregnancy can lead to a number of problems. Understanding these concerns can help health professionals improve health care for pregnant women. Objective: Translate, adapt, and validate the Body Image Concerns During Pregnancy Scale for the Portuguese population (Escala de Preocupação com a Imagem Corporal Durante a Gravidez - EPICDG). Methodology: A quantitative cross-sectional study was conducted with 231 pregnant women. The psychometric properties of the EPICDG were assessed using exploratory and confirmatory factor analysis. Results: The fit indices of the Portuguese 21-item version were identical to those of the original scale. The four-dimension model had the best fit (X 2 (176) = 446.320; p < 0.001, X 2 df = 2.536; CFI = 0.91; TLI = 0.89; GFI = 0.86; RMSEA = 0.077, p < 0.001). Conclusion: The results show that the EPICDG has adequate psychometric properties for assessing body image concerns during pregnancy in the Portuguese population.

Resumo Enquadramento: As preocupações com a imagem corporal durante a gravidez podem ter diversos problemas. A compreensão destas preocupações podem ajudar os profissionais de saúde a melhorarem os cuidados com a saúde das grávidas. Objetivo: Adaptar e validar para a população portuguesa a Body Image Concern Scale During Pregnancy, que foi traduzida Escala de Preocupação com a Imagem Corporal Durante a Gravidez (EPICDG). Metodologia: Estudo quantitativo e transversal, participaram 231 grávidas. A avaliação das propriedades métricas da EPICDG foi realizada com base na análise fatorial exploratória e confirmatória. Resultados: A versão portuguesa com 21 itens, apresentou índices de ajuste idênticos à escala original. O modelo com melhor qualidade, foi o modelo com as quatro subdimensões da escala original (X 2 (176) = 446,320; p < 0,001, X 2 df = 2,536; CFI = 0,91; TLI = 0,89; GFI = 0,86; RMSEA = 0,077, p < 0,001). Conclusão: Os resultados demonstram que a validação da escala para a língua portuguesa, tem propriedades psicométricas adequadas para a avaliação das preocupações com a imagem corporal durante a gravidez.

Resumen Marco contextual: La preocupación por la imagen corporal durante el embarazo puede causar diversos problemas. Comprender estas preocupaciones puede ayudar a los profesionales sanitarios a mejorar los cuidados a las mujeres embarazadas. Objetivo: Adaptar y validar para la población portuguesa la Body Image Concerns During Pregnancy Scale, que fue traducida en la Escala de Preocupação com a Imagem Corporal Durante a Gravidez (EPICDG). Metodología: Estudio cuantitativo transversal en el que participaron 231 mujeres embarazadas. Las propiedades métricas de la EPICDG se evaluaron mediante análisis factorial exploratorio y confirmatorio. Resultados: La versión portuguesa con 21 ítems mostró índices de ajuste idénticos a los de la escala original. El modelo con mejor calidad fue el que tenía las cuatro subdimensiones de la escala original (X 2 (176) = 446,320; p < 0,001, X 2 df = 2,536; CFI = 0,91; TLI = 0,89; GFI = 0,86; RMSEA = 0,077, p < 0,001). Conclusión: Los resultados muestran que la validación de la escala para el idioma portugués tiene propiedades psicométricas adecuadas para evaluar las preocupaciones sobre la imagen corporal durante el embarazo.

SUMMARY OBJECTIVE: The aim of this study was to investigate the role of systemic immune-inflammation index, neutrophil–lymphocyte ratio, lymphocyte–monocyte ratio, and platelet–lymphocyte ratios calculated in the first trimester as inflammatory markers in predicting gestational diabetes mellitus diagnosis. METHODS: This study was conducted retrospectively at a tertiary center between January 2020 and June 2023. A total of 111 pregnant women with gestational diabetes and 378 pregnant women in the control group were included in the study. Systemic immune-inflammation index, neutrophil–lymphocyte ratio, lymphocyte–monocyte ratio, and platelet–lymphocyte ratios values were compared between the gestational diabetes mellitus group patients and the healthy group. Receiver operating characteristic analysis curve was used for predicting gestational diabetes mellitus using systemic immune-inflammation index and lymphocyte–monocyte ratio. RESULTS: In pregnant women in the first trimester, systemic immune-inflammation index and lymphocyte–monocyte ratio values based on routine complete blood count parameters were found to be statistically significantly higher in gestational diabetes mellitus patients compared to healthy patients, while neutrophil–lymphocyte ratio and platelet–lymphocyte ratios values were found to be similar (p=0.033, p=0.005, p=0.211, and p=0.989). For predicting gestational diabetes mellitus, a cut-off value of 655.75 for systemic immune-inflammation index resulted in 80.2% sensitivity and 34.4% specificity, and a cut-off value of 3.62 for lymphocyte–monocyte ratio resulted in 56.8% sensitivity and 63.2% specificity, indicating good discriminatory ability. CONCLUSION: We believe that systemic immune-inflammation index and lymphocyte–monocyte ratio values measured in the first-trimester complete blood count parameters are effective in predicting gestational diabetes mellitus but are not effective in determining insulin requirement. OBJECTIVE immuneinflammation immune inflammation neutrophillymphocyte neutrophil lymphocyte lymphocytemonocyte monocyte plateletlymphocyte platelet diagnosis METHODS 202 2023 11 37 RESULTS p=0.033, p0033 p 0 033 (p=0.033 p0005 005 p=0.005 p0211 211 p=0.211 p=0.989. p0989 p=0.989 . 989 p=0.989) cutoff cut off 65575 655 75 655.7 802 80 2 80.2 344 34 4 34.4 specificity 362 3 62 3.6 568 56 8 56.8 632 63 63.2 ability CONCLUSION firsttrimester requirement 20 1 p=0.033 p003 03 (p=0.03 p000 00 p=0.00 p021 21 p=0.21 p098 p=0.98 98 6557 65 7 655. 80. 34. 36 6 3. 5 56. 63. p=0.03 p00 (p=0.0 p=0.0 p02 p=0.2 p09 p=0.9 9 p0 (p=0. p=0. (p=0 p=0 (p= p= (p

SUMMARY OBJECTIVE: The objective of this study was to investigate serum Metrnl levels in pregnant women with gestational diabetes mellitus and compare them with pregnant women without gestational diabetes mellitus. METHODS: The gestational diabetes mellitus group consisted of 87 pregnant women diagnosed with gestational diabetes mellitus, and the control group consisted of 93 healthy pregnant women without gestational diabetes mellitus. Serum Metrnl levels were determined by the enzyme-linked immunosorbent assay method. RESULTS: The two groups were similar in terms of demographic features. The median serum Metrnl level was found to be 1.16 ng/mL in the gestational diabetes mellitus group, while it was determined as 2.2 ng/mL in the control group (p=0.001). The two groups were divided into two subgroups based on participants’ body mass index, normal weight and overweight. The lowest median Metrnl level was detected in the normal weight gestational diabetes mellitus group, followed by the overweight gestational diabetes mellitus group, normal weight control group, and overweight control group (1.1, 1.2, 2, and 2.4 ng/mL, respectively). Receiver operating curve analysis was performed to determine the value of the serum Metrnl level in terms of predicting gestational diabetes mellitus. The area under the curve analysis of serum Metrnl for gestational diabetes mellitus estimation was 0.768 (p=0.000, 95%CI 0.698–0.839). The optimal cutoff value for serum Metrnl level was determined as 1.53 ng/mL with 69% sensitivity and 70% specificity. CONCLUSION: Serum Metrnl levels in pregnant women with gestational diabetes mellitus were found to be significantly lower than in pregnant women without gestational diabetes mellitus. The mechanisms underlying the decrease in serum Metrnl levels in gestational diabetes mellitus remain unclear for now, and future studies will reveal the role of Metrnl in the pathophysiology of gestational diabetes mellitus. OBJECTIVE METHODS 8 9 enzymelinked enzyme linked method RESULTS features 116 1 16 1.1 ngmL ng mL 22 2 2. p=0.001. p0001 p p=0.001 . 0 001 (p=0.001) participants index 1.1, 11 (1.1 12 1.2 24 4 respectively. respectively respectively) 0768 768 0.76 p=0.000, p0000 000 (p=0.000 95CI CI 95 0.698–0.839. 06980839 0.698–0.839 698 839 0.698–0.839) 153 53 1.5 69 70 specificity CONCLUSION now 1. p000 p=0.00 00 (p=0.001 (1. 076 76 0.7 p=0.000 (p=0.00 0698083 0.698–0.83 83 15 5 6 7 p00 p=0.0 (1 07 0. (p=0.0 069808 0.698–0.8 p0 p=0. ( (p=0. 06980 0.698–0. p=0 (p=0 0698 0.698–0 p= (p= 069 0.698– (p 06 0.698 0.69 0.6

SUMMARY OBJECTIVE: The aim of this study was to assess obstetric and perinatal outcomes in women with hyperprolactinemia according to the type of treatment indicated, with cabergoline or bromocriptine. METHODS: A retrospective cohort study with 464 women diagnosed with hyperprolactinemia was undertaken at the endocrine gynecology outpatient clinic of a tertiary hospital from May 2002 to February 2022. All women diagnosed with hyperprolactinemia who were being treated with dopamine agonists (cabergoline or bromocriptine) and who became pregnant during the follow-up were included. Women whose medical records did not provide data related to pregnancy and delivery were excluded. The women were divided into two groups according to the type of treatment: bromocriptine or cabergoline. Clinical and laboratory characteristics and obstetric and perinatal outcomes, such as complications during pregnancy, type of delivery, and intrapartum complications, were evaluated in both groups. RESULTS: Of the 464 women evaluated, 72 became pregnant during the follow-up, 66 of them were using dopamine agonists, while 6 were not using medication. The mean age of the women was 28.3±6.8 years. Among the causes of hyperprolactinemia, 48.6% were idiopathic, 45.7% were tumoral, and 3.7% had other causes. Most women with idiopathic hyperprolactinemia used bromocriptine, while those with tumoral hyperprolactinemia used cabergoline (p=0.04). There was no difference in obstetric outcomes according to the type of treatment used. The majority of women did not have any complications during pregnancy (76.3%) or intrapartum (86.8%). CONCLUSION: Regardless of the type of previous drug treatment with dopamine agonists, hyperprolactinemia does not alter obstetric outcomes. OBJECTIVE indicated METHODS 46 200 2022 followup follow up included excluded RESULTS 7 followup, up, medication 28368 28 3 8 28.3±6. years 486 48 48.6 457 45 45.7 37 3.7 p=0.04. p004 p p=0.04 . 0 04 (p=0.04) 76.3% 763 76 (76.3% 86.8%. 868 86.8% 86 (86.8%) CONCLUSION 4 20 202 2836 2 28.3±6 48. 45. 3. p00 p=0.0 (p=0.04 76.3 (76.3 86.8 (86.8% 283 28.3± p0 p=0. (p=0.0 76. (76. 86. (86.8 28.3 p=0 (p=0. (76 (86. 28. p= (p=0 (7 (86 (p= ( (8 (p

Abstract Introduction: Pre-eclampsia complicates 2-4% of pregnancies. Metformin is a promising therapeutic candidate as would reduce the secretion of soluble fms-like tyrosine kinase 1 and soluble endoglin from endothelial cells and primary villous trophoblasts. Objective: The objective of the study was to determine the effects and safety of metformin for preventing pre-eclampsia. Materials and methods: A systematic review was carried out with Cochrane methodology, performing an electronic search for randomized clinical trials in pregnant women, which compared the use of metformin with placebo or no intervention, and reported incidence of pre-eclampsia within their results. Review manager software was used for the statistical analysis. Results: Five studies were included with results for 1977 participants. A 56% reduction in the risk of pre-eclampsia in pregnant women who received metformin was found, compared to placebo or no intervention (RR 0.44; 95% confidence interval 0.21-0.90; random effects analysis; I2 = 71%; Tau2 = 0.46; low-quality evidence). No significant differences were found for the secondary outcomes. Conclusions: The use of metformin in overweight or obese pregnant women, beginning before 20 weeks of gestation, could reduce the risk of pre-eclampsia by 56%; however, the beneficial effect could be non-significant, due to heterogeneity and low quality of current evidence.

Resumen Introducción: La preeclampsia complica del 2 al 4% de los embarazos. La metformina es un candidato terapéutico prometedor, al reducir la secreción de tirosina-quinasa-1 soluble similar a fms (sFlt-1) y endoglina soluble (sEng) de las células endoteliales y los trofoblastos vellosos primarios. Objetivo: Se propone determinar los efectos y la seguridad de la metformina para prevenir la preeclampsia a través de una revisión sistemática con metodología Cochrane. Materiales y métodos: Se realizó búsqueda electrónica de ensayos clínicos aleatorizados en mujeres embarazadas, que compararon el uso de metformina con placebo o ninguna intervención, y reportaron dentro de sus resultados incidencia de preeclampsia. Resultados: Se incluyeron cinco estudios con resultados de 1977 participantes. Se encontró una reducción del 56% en el riesgo de preeclampsia en embarazadas que recibieron metformina, en comparación con placebo o ninguna intervención (RR 0,44; IC 95% 0,21-0,90; I2 = 71%; baja calidad evidencia). No hubo diferencias significativas para los resultados secundarios. Conclusiones: El uso de metformina en mujeres embarazadas con sobrepeso u obesidad, iniciado antes de las 20 semanas de gestación, podría reducir el riesgo de preeclampsia en un 56%. Sin embargo, el efecto beneficioso podría no ser significativo, dada la heterogeneidad y baja calidad de la evidencia actual.

Abstract Introduction. Postpartum anxiety after childbirth is a common condition among pregnant women due to reasons such as the uncertainty of experiencing pregnancy and childbirth for the first time, or previous negative experiences. Fear of childbirth can affect the mother’s baby care process. Objective. This study was conducted analytically with a single-subject design to determine the effects of maternal concerns about childbirth and the postpartum period on obsessive and compulsive behaviors related to baby care. Materials and methods. The study was conducted with 260 mothers. Data were collected using a descriptive information form, and the scales ‘Fear of Childbirth and Postpartum Period’, and ‘Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care’. The data were analyzed using the SPSS™ software to calculate percentages, mean values, t tests, ANOVA, Pearson’s correlation, and simple linear regression analysis. Results. A statistically significant and positive correlation was found between participant scores of the ‘Fear of Childbirth and Postpartum Period’ and the ‘Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care’ scales (p < 0.01). The regression model showed that 18.0% of the total variance in the obsessive and compulsive behaviors of mothers in the postpartum was explained by the fear of childbirth and the postpartum period (corrected R2 = 0.180). Conclusions. Fear of childbirth and the postpartum period were moderate. However, as the fear of women regarding childbirth and the postpartum period increased, their postpartum obsessive and compulsive behaviors about baby care also increased.

Resumen Introducción. La ansiedad del parto y el posparto es una condición común entre las mujeres embarazadas por la incertidumbre de vivir el embarazo y el parto por primera vez o por previas experiencias negativas. El miedo al parto puede afectar el proceso del cuidado del bebé de la madre. Objetivo. Determinar el efecto de las preocupaciones maternas sobre el parto y el puerperio y su efecto sobre las conductas obsesivas y compulsivas relacionadas con el cuidado del bebé. Materiales y métodos. El estudio se realizó con 260 madres. Los datos fueron recolectados en el formulario de información descriptiva y se usaron la “Escala de miedo al parto y al período posparto” y la de “Comportamientos obsesivos y compulsivos de las madres en el período posparto relacionados con el cuidado del bebé”. Los datos fueron evaluados mediante el software SPSS™ mediante el cálculo de porcentajes, promedio, prueba t, ANOVA, correlación de Pearson y análisis de regresión múltiple. Resultados. Se encontró una correlación positiva y estadísticamente significativa entre la “Escala de miedo al parto y del período posparto” y la de “Comportamientos obsesivos y compulsivos de las madres en el período posparto relacionadas con el cuidado del bebé” (p < 0.01). En el modelo creado por análisis de regresión se observó que el 18,0% del cambio en la escala de comportamientos obsesivos-compulsivos estaba explicado por el miedo al parto y al puerperio (R2corregido = 0,180). Conclusiones. En el estudio se determinó que el miedo al parto y al puerperio era moderado. Sin embargo, a medida que aumentaba el puntaje de miedo al parto y al período posparto, también aumentaban los comportamientos obsesivos y compulsivos de las madres en el puerperio relacionados con el cuidado del bebé.

Abstract Parvovirus B19 congenital infection is vertically transmitted after maternal infection. Fetal disease may be serious with anemia, hydrops or death. An IUT may be indicated. It has been described a great increase in number and severity in Europe and USA in 2023-2024. In our Centre we have also noticed this situation which correlates with a much higher number of IUT performed. So, it’s from the uttermost importance to alert health professionals to identify and counsel high risk pregnant women in order to promote primary prevention and early detection of the maternal/fetal infection allowing a quick referral to specialized centres.

Resumo A infeção congénita por PB19 ocorre por transmissão vertical após infeção materna. O efeito fetal pode ser grave com anemia, hidrópsia ou morte e indicada a transfusão intrauterina (TIU). Tem sido descrito um grande aumento da sua incidência e gravidade na Europa e EUA em 2023-2024. Também constatámos essa alteração que se traduziu num aumento do número de TIU realizadas em 2024 no nosso Centro. Pretendemos continuar a sensibilizar profissionais de saúde recomendando medidas que identifiquem grávidas em risco, promovendo a prevenção primária, a deteção precoce da infeção materna e fetal e uma rápida referenciação aos centros especializados.

A gravidez na adolescência é um problema significativo de saúde pública no Brasil, contribuindo para altas taxas de morbimortalidade entre mulheres jovens. Durante a gestação, muitas adolescentes abandonam a escola e o trabalho, o que resulta em menor qualificação e maior vulnerabilidade ao mercado de trabalho informal. Além disso, as adolescentes grávidas enfrentam riscos elevados de complicações gestacionais e desafios emocionais, como ansiedade e depressão. A pandemia exacerbou essas vulnerabilidades, especialmente em relação ao abuso doméstico, devido ao isolamento social. Este estudo justifica-se pela necessidade de compreender o perfil demográfico e as características das parturientes adolescentes no Ceará entre 2020 e 2022, oferecendo subsídios para políticas públicas que visem melhorar a qualidade de vida dessas jovens e de seus filhos. Todos os dados foram analisados utilizando R. Durante o período analisado, foram registrados 331.924 nascimentos vivos no Ceará, dos quais 21.667 (6,53%) eram de mães com idade igual ou inferior a 17 anos. A idade média das mães adolescentes foi de 15,93 ± 1,11 anos, enquanto a média para as mães adultas foi de 28,00 ± 6,21 anos, evidenciando uma diferença estatisticamente significativa (Teste-t de Student, P &lt; 0,05). A análise também revelou uma diferença significativa entre a idade dos pais de crianças nascidas de mães adolescentes (22,25 ± 5,72 anos) em comparação à idade dos pais de crianças nascidas de mães adultas (32,45 ± 7,81 anos) (Figura 3, Teste-T, P &lt; 0,05). No que se refere à etnia, adolescentes indígenas representaram 9,95% dos casos de gravidez, seguidas pelas adolescentes pardas (7,26%) e pretas (5,9%). A menor proporção foi observada entre adolescentes brancas (4,43%). Não houve diferença estatisticamente significativa entre os grupos indígenas, pardas, pretas e a população amarela. Quanto ao estado civil, 71% das adolescentes se declararam solteiras. A análise educacional demonstrou uma tendência significativa de gravidez entre adolescentes com Ensino Fundamental II incompleto, completo, ou Ensino Médio incompleto, indicando que essas jovens ainda estavam em fase de conclusão desses ciclos escolares. Não foi observada uma relação significativa entre a redução da idade materna e a diminuição do escore APGAR em recém-nascidos (APGAR = 0,014 × “IDADE DA MÃE” + 8,5; P &lt; 0,05, R² = 0,0004). Além disso, não houve diferença significativa na proporção de anomalias congênitas entre os nascimentos de mães adolescentes e adultas.

El embarazo en la adolescencia es un problema significativo de salud pública en Brasil, que contribuye a altas tasas de morbimortalidad entre las mujeres jóvenes. Durante el embarazo, muchas adolescentes abandonan la escuela y el trabajo, lo que resulta en menor calificación y mayor vulnerabilidad en el mercado laboral informal. Además, las adolescentes embarazadas enfrentan mayores riesgos de complicaciones gestacionales y desafíos emocionales, como ansiedad y depresión. La pandemia exacerbó estas vulnerabilidades, especialmente en relación con el abuso doméstico, debido al aislamiento social. Este estudio se justifica por la necesidad de comprender el perfil demográfico y las características de las madres adolescentes en Ceará entre 2020 y 2022, ofreciendo apoyo para políticas públicas que busquen mejorar la calidad de vida de estas jóvenes y sus hijos. Todos los datos fueron analizados utilizando R. Durante el período analizado, se registraron 331.924 nacimientos vivos en Ceará, de los cuales 21.667 (6,53%) eran de madres de 17 años o menos. La edad promedio de las madres adolescentes fue de 15,93 ± 1,11 años, mientras que la media para las madres adultas fue de 28,00 ± 6,21 años, evidenciando una diferencia estadísticamente significativa (Prueba t de Student, P &lt; 0,05). El análisis también reveló una diferencia significativa entre la edad de los padres de niños nacidos de madres adolescentes (22,25 ± 5,72 años) en comparación con la edad de los padres de niños nacidos de madres adultas (32,45 ± 7,81 años) (Prueba de Wilcoxon, P &lt; 0,05). En cuanto a la etnia, las adolescentes indígenas representaron el 9,95% de los casos de embarazo, seguidas por las adolescentes mestizas (7,26%) y negras (5,9%). La menor proporción se observó entre las adolescentes blancas (4,43%). No hubo diferencia estadísticamente significativa entre los grupos indígenas, mestizas, negras y la población amarilla. En cuanto al estado civil, el 71% de las adolescentes se declararon solteras. El análisis educativo demostró una tendencia significativa de embarazo entre adolescentes con secundaria incompleta o completa, o educación media incompleta, lo que indica que estas jóvenes aún estaban en proceso de completar estos niveles educativos. No se observó una relación significativa entre la disminución de la edad materna y la reducción de la puntuación APGAR en los recién nacidos (APGAR = 0,014 × "EDAD DE LA MADRE" + 8,5; P &lt; 0,05, R² = 0,0004). Además, no hubo diferencia significativa en la proporción de anomalías congénitas entre los nacimientos de madres adolescentes y adultas.

Adolescent pregnancy is a significant public health issue in Brazil, contributing to high morbidity and mortality rates among young women. During pregnancy, many adolescents drop out of school and work, leading to lower qualifications and increased vulnerability to the informal labor market. Moreover, pregnant adolescents face higher risks of gestational complications and emotional challenges, such as anxiety and depression. The pandemic exacerbated these vulnerabilities, particularly concerning domestic abuse, due to social isolation. This study is justified by the need to understand the demographic profile and characteristics of adolescent mothers in Ceará between 2020 and 2022, providing support for public policies aimed at improving the quality of life for these young women and their children. All data were analyzed using R. During the analyzed period, 331,924 live births were recorded in Ceará, of which 21,667 (6.53%) were from mothers aged 17 years or younger. The average age of adolescent mothers was 15.93 ± 1.11 years, while the average for adult mothers was 28.00 ± 6.21 years, showing a statistically significant difference (Student's t-test, P &lt; 0.05). The analysis also revealed a significant difference between the age of fathers of children born to adolescent mothers (22.25 ± 5.72 years) compared to the age of fathers of children born to adult mothers (32.45 ± 7.81 years) (Wicoxon test, P &lt; 0.05). Regarding ethnicity, indigenous adolescents accounted for 9.95% of pregnancy cases, followed by brown (7.26%) and black (5.9%) adolescents. The lowest proportion was observed among white adolescents (4.43%). There was no statistically significant difference among indigenous, mixed-race, black, and yellow populations. Concerning marital status, 71% of adolescents declared themselves single. Educational analysis showed a significant trend of pregnancy among adolescents with incomplete or complete middle school or incomplete high school education, indicating that these young women were still in the process of completing these educational levels. There was no significant relationship between decreasing maternal age and a reduction in newborns' APGAR scores (APGAR = 0.014 × "MOTHER'S AGE" + 8.5; P &lt; 0.05, R² = 0.0004). Additionally, there was no significant difference in the proportion of congenital anomalies between births of adolescent and adult mothers.