ABSTRACT BACKGROUND: Exclusive breastfeeding is recommended for the first six months, and mother’s age impact early weaning. Educational support and relevant information can increase breastfeeding rates. OBJECTIVE: To determine whether antenatal education enhances the maintenance, intention, and confidence in breastfeeding among adolescents. DESIGN AND SETTING: A prospective cohort study involving primiparous adolescents who gave birth at the Woman’s Hospital (CAISM), Universidade Estadual de Campinas, Brazil. METHODS: Adolescent mothers were categorized into two groups based on the location of prenatal care: those at the Woman’s Hospital (WH) who received antenatal education, and at the Primary Care (PC) who did not receive antenatal education. All adolescents received breastfeeding orientation during their postpartum hospital stay. The groups were compared using the Student’s t-test, Mann–Whitney U test, and chi-squared test. Log-binomial models were used to compare the groups at different time intervals. RESULTS: The study included 132 adolescents: 59 in the WH group and 73 in the PC group. Six months postpartum, adolescents in the WH group demonstrated higher engagement in breastfeeding (P < 0.005) and exclusive breastfeeding (P = 0.04) than PC group. PC group showed greater lack of confidence in breastfeeding (P = 0.02) and felt less prepared (P = 0.01). Notably, all WH adolescents reported a stronger desire to breastfeed after antenatal education. CONCLUSION: Antenatal education significantly improves the maintenance, intention, and confidence of breastfeeding among adolescents. This education approach can be implemented across all healthcare levels and should be made accessible to all women throughout the pregnancy and postpartum period. BACKGROUND mother s weaning rates OBJECTIVE maintenance intention SETTING Womans Woman CAISM, CAISM , (CAISM) Campinas Brazil METHODS care (WH (PC stay Students Student ttest, ttest t test t-test MannWhitney Mann Whitney chisquared chi squared Logbinomial Log binomial intervals RESULTS 13 5 7 P 0.005 0005 0 005 0.04 004 04 0.02 002 02 0.01. 001 0.01 . 01 0.01) Notably CONCLUSION period (CAISM 1 0.00 000 00 0.0 0.

Abstract Objective: To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. Methods: This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann–Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. Results: A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. Conclusion: This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women. Objective highrisk risk factors Methods crosssectional cross sectional personal perinatal hospitals s records Chisquare, Chisquare Chi square, square Chi-square Fishers Fisher exact MannWhitney Mann Whitney ROC (ROC 5 5% Results 1629 1 629 1,62 201 included 348 34 8 34.8% p 0.039, 0039 0.039 , 0 039 0.039) 0.027, 0027 0.027 027 0.027) 0.003, 0003 0.003 003 0.003) 0.001 0001 001 nonattendance. nonattendance non attendance. attendance non-attendance Conclusion cases 162 62 1,6 20 3 34.8 0.03 03 002 0.02 02 000 0.00 00 16 6 1, 2 34. 0.0 0.

Abstract Objective: To explore women's experiences with postpartum intrauterine device (PPIUD) insertion and the decision-making process in the postpartum period. Methods: A qualitative design was employed with face-to-face interviews using a semi-structured script of open questions. The sample was intentionally selected using the concept of theoretical information saturation. Results: Interviews were conducted (1) in the immediate postpartum period, and (2) in the postpartum appointment. 25 women (N = 25) over 18 years old who had a birth followed by PPIUD insertion were interviewed between October 2021 and June 2022. Three categories were constructed: (1) Choice process, (2) Relationship with the health team at the time of birth and the postpartum period, and (3) To know or not to know about contraception, that is the question. Conclusion: Professionals’ communication management, popular knowledge, advantages of the PPIUD and the moment PPIUD is offered play a fundamental role in the construction of knowledge about the IUD. Choice process did not end in the insertion. Objective womens s (PPIUD decisionmaking decision making period Methods facetoface face semistructured semi structured questions saturation Results 1 (1 2 (2 appointment N 202 2022 constructed 3 (3 contraception question Conclusion Professionals management IUD ( 20

ABSTRACT OBJECTIVE To assess maternal mortality (MM) in Brazilian Black, Pardo, and White women. METHODS We evaluated the maternal mortality rate (MMR) using data from the Brazilian Ministry of Health public databases from 2017 to 2022. We compared MMR among Black, Pardo, and White women according to the region of the country, age, and cause. For statistical analysis, the Q2 test prevalence ratio (PR) and confidence interval (CI) were calculated. RESULTS From 2017 to 2022, the general MMR was 68.0/100,000 live births (LB). The MMR was almost twice as high among Black women compared to White (125.81 vs 64.15, PR = 1.96, 95%CI:1.84–2.08) and Pardo women (125.8 vs 64.0, PR = 1.96, 95%CI: 1.85–2.09). MMR was higher among Black women in all geographical regions, and the Southeast region reached the highest difference among Black and White women (115.5 versus 60.8, PR = 2.48, 95%CI: 2.03–3.03). During the covid-19 pandemic, MMR increased in all groups of women (Black 144.1, Pardo 74.8 and White 80.5/100.000 LB), and the differences between Black and White (PR = 1.79, 95%CI: 1.64–1.95) and Black and Pardo (PR = 1.92, 95%CI: 1.77–2.09) remained. MMR was significantly higher among Black women than among White or Pardo women in all age ranges and for all causes. CONCLUSION Black women presented higher MMR in all years, in all geographic regions, age groups, and causes. In Brazil, Black skin color is a key MM determinant. Reducing MM requires reducing racial disparities. (MM (MMR 201 2022 country cause analysis Q CI (CI calculated 680100000 68 0 100 000 68.0/100,00 LB. LB . (LB) 125.81 12581 125 81 6415 64 15 64.15 196 1 96 1.96 95%CI1.84–2.08 95CI184208 95%CI 1.84–2.08 95 84 2 08 95%CI:1.84–2.08 125.8 1258 8 (125. 640 64.0 95CI 1.85–2.09. 185209 1.85–2.09 85 09 1.85–2.09) regions 115.5 1155 115 5 (115. 608 60 60.8 248 48 2.48 2.03–3.03. 203303 2.03–3.03 03 3 2.03–3.03) covid19 covid 19 covid-1 pandemic 1441 144 144.1 748 74 74. 805100000 80 80.5/100.00 LB, , LB) 179 79 1.79 1.64–1.95 164195 192 92 1.92 1.77–2.09 177209 77 remained causes years Brazil determinant disparities 20 202 68010000 6 10 00 68.0/100,0 (LB 12 641 64.1 9 1.9 CI1 95%CI1.84–2.0 95CI18420 184208 1.84–2.0 95%CI:1.84–2.0 125. (125 64. 18520 1.85–2.0 115. 11 (115 60. 24 4 2.4 20330 2.03–3.0 covid1 covid- 14 144. 7 80510000 80.5/100.0 17 1.7 1.64–1.9 16419 1.77–2.0 17720 6801000 68.0/100, 1. 95%CI1.84–2. 95CI1842 18420 1.84–2. 95%CI:1.84–2. (12 1852 1.85–2. (11 2. 2033 2.03–3. 8051000 80.5/100. 1.64–1. 1641 1.77–2. 1772 680100 68.0/100 95%CI1.84–2 95CI184 1842 1.84–2 95%CI:1.84–2 (1 185 1.85–2 203 2.03–3 805100 80.5/100 1.64–1 164 1.77–2 177 68010 68.0/10 95%CI1.84– 95CI18 184 1.84– 95%CI:1.84– ( 18 1.85– 2.03– 80510 80.5/10 1.64– 16 1.77– 6801 68.0/1 95%CI1.84 95CI1 1.84 95%CI:1.84 1.85 2.03 8051 80.5/1 1.64 1.77 680 68.0/ 95%CI1.8 1.8 95%CI:1.8 2.0 805 80.5/ 1.6 68.0 95%CI1. 95%CI:1. 80.5 68. 95%CI1 95%CI:1 80.

ABSTRACT OBJECTIVE To assess maternal mortality (MM) in Brazilian Black, Pardo, and White women. METHODS We evaluated the maternal mortality rate (MMR) using data from the Brazilian Ministry of Health public databases from 2017 to 2022. We compared MMR among Black, Pardo, and White women according to the region of the country, age, and cause. For statistical analysis, the Q2 test prevalence ratio (PR) and confidence interval (CI) were calculated. RESULTS From 2017 to 2022, the general MMR was 68.0/100,000 live births (LB). The MMR was almost twice as high among Black women compared to White (125.81 vs 64.15, PR = 1.96, 95%CI:1.84–2.08) and Pardo women (125.8 vs 64.0, PR = 1.96, 95%CI: 1.85–2.09). MMR was higher among Black women in all geographical regions, and the Southeast region reached the highest difference among Black and White women (115.5 versus 60.8, PR = 2.48, 95%CI: 2.03–3.03). During the covid-19 pandemic, MMR increased in all groups of women (Black 144.1, Pardo 74.8 and White 80.5/100.000 LB), and the differences between Black and White (PR = 1.79, 95%CI: 1.64–1.95) and Black and Pardo (PR = 1.92, 95%CI: 1.77–2.09) remained. MMR was significantly higher among Black women than among White or Pardo women in all age ranges and for all causes. CONCLUSION Black women presented higher MMR in all years, in all geographic regions, age groups, and causes. In Brazil, Black skin color is a key MM determinant. Reducing MM requires reducing racial disparities.

ABSTRACT Introduction: Pregnancy-related complications may impact women’s reproductive cycle and health through their lives. The objective of this study was to evaluate the sociodemographic, clinical, and obstetric history of women undergoing hemodialysis. Methods: We performed a cross-sectional study in a specialized health facility with four hemodialysis units. Sociodemographic characteristics, clinical and personal history, obstetric and perinatal results of women with pregnancies before hemodialysis were evaluated. Prevalence, bivariate, and logistic regression analyses were performed. Results: We included 208 (87.76%) women. Hypertension was the main cause of chronic kidney disease (CKD) (128 women). Rates of adverse perinatal outcomes, including prematurity, low birth weight, miscarriage, fetal death, and neonatal death, were 19.3%, 14.5%, 25.5%, 12.1%, and 5.3%, respectively. Hypertensive syndromes during pregnancy occurred in 37.0% of women, with 12.5% reporting preeclampsia and 1.4% reporting eclampsia. Up to 1 year after birth, 45.2% of women reported hypertension. Hemodialysis due to hypertension was associated with a history of hypertension during pregnancy (OR 2.33, CI 1.27 – 4.24), gestational hypertension (2.41, CI 3.30 – 4.45), and hypertension up to one year after birth (OR 1.98, CI 1.11 – 3.51). Logistic regression showed that gestational hypertension was independently associated with CKD due to hypertension (aOR 2.76, CI 1.45 – 5.24). Conclusion: Women undergoing hemodialysis due to hypertension were more likely to have gestational hypertension or hypertension up to one year after birth. To delay end-stage renal disease, it is necessary to identify women at risk of kidney failure according to their reproductive history. Introduction Pregnancyrelated Pregnancy related womens s lives sociodemographic Methods crosssectional cross sectional units characteristics evaluated Prevalence bivariate Results 20 87.76% 8776 87 76 (87.76% (CKD 128 (12 . women) outcomes prematurity weight miscarriage death 193 19 3 19.3% 145 14 5 14.5% 255 25 25.5% 121 12 12.1% 53 5.3% respectively 370 37 0 37.0 125 12.5 4 1.4 eclampsia 452 45 2 45.2 OR 233 33 2.33 127 27 1.2 4.24, 424 4.24 , 24 4.24) 2.41, 241 41 (2.41 330 30 3.3 4.45, 445 4.45 4.45) 198 98 1.98 111 11 1.1 3.51. 351 3.51 51 3.51) aOR 276 2.76 5.24. 524 5.24 5.24) Conclusion endstage end stage 87.76 877 8 7 (87.76 (1 19.3 14.5 25.5 12.1 5.3 37. 12. 1. 45. 23 2.3 42 4.2 2.41 (2.4 3. 44 4.4 9 1.9 35 3.5 2.7 52 5.2 87.7 (87.7 ( 19. 14. 25. 5. 2. 4. 2.4 (2. 87. (87. (2 (87 (8

RESUMO Introdução: Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao longo de suas vidas. Este estudo visou avaliar histórico sociodemográfico, clínico e obstétrico de mulheres em hemodiálise. Métodos: Realizamos estudo transversal em unidade de saúde especializada com quatro unidades de hemodiálise. Avaliou-se características sociodemográficas, histórico clínico e pessoal, resultados obstétricos e perinatais de mulheres com gestações anteriores à hemodiálise. Foram realizadas análises de prevalência, bivariadas e regressão logística. Resultados: Incluímos 208 (87,76%) mulheres. Hipertensão foi a principal causa de doença renal crônica (DRC) (128 mulheres). Taxas de desfechos perinatais adversos, incluindo prematuridade, baixo peso ao nascer, aborto espontâneo, óbito fetal e neonatal, foram de 19,3%, 14,5%, 25,5%, 12,1% e 5,3%, respectivamente. Síndromes hipertensivas durante a gestação ocorreram em 37,0% das mulheres, com 12,5% relatando pré-eclâmpsia e 1,4% relatando eclampsia. Até 1 ano após o parto, 45,2% das mulheres relataram hipertensão. Hemodiálise devido à hipertensão foi associada ao histórico de hipertensão na gestação (OR 2,33; IC 1,27 - 4,24), hipertensão gestacional (2,41; IC 3,30 - 4,45), e hipertensão até um ano após o parto (OR 1,98; IC 1,11 - 3,51). A regressão logística mostrou que hipertensão gestacional foi independentemente associada à DRC devido à hipertensão (ORa 2,76; IC 1,45 - 5,24). Conclusão: Mulheres submetidas à hemodiálise por hipertensão foram mais propensas a apresentar hipertensão gestacional ou hipertensão até um ano após o parto. Para retardar a doença renal em estágio terminal, deve-se identificar mulheres em risco de insuficiência renal de acordo com sua história reprodutiva. Introdução vidas sociodemográfico Métodos Avaliouse Avaliou se sociodemográficas pessoal prevalência Resultados 20 87,76% 8776 87 76 (87,76% (DRC 128 (12 . mulheres) adversos prematuridade nascer espontâneo neonatal 193 19 3 19,3% 145 14 5 14,5% 255 25 25,5% 121 12 12,1 53 5,3% respectivamente 370 37 0 37,0 125 12,5 préeclâmpsia pré eclâmpsia 4 1,4 eclampsia 452 45 2 45,2 OR 2,33 233 33 127 27 1,2 4,24, 424 4,24 , 24 4,24) 2,41 241 41 (2,41 330 30 3,3 4,45, 445 4,45 4,45) 1,98 198 98 111 11 1,1 3,51. 351 3,51 51 3,51) ORa 2,76 276 5,24. 524 5,24 5,24) Conclusão terminal devese deve reprodutiva 87,76 877 8 7 (87,76 (1 19,3 14,5 25,5 12, 5,3 37, 1, 45, 2,3 23 42 4,2 2,4 (2,4 3, 44 4,4 1,9 9 35 3,5 2,7 52 5,2 87,7 (87,7 ( 19, 14, 25, 5, 2, 4, (2, 87, (87, (2 (87 (8

ABSTRACT Introduction: There are particularities of chronic kidney disease (CKD) in women and their treatment. The biology of women exposes them to greater risk factors for CKD and both pregnancy and the postpartum period place an additional burden on renal health. Pregnancy complications may cause or worsen CKD. Objective: To explore the experiences of women with CKD undergoing hemodialysis in relation to their reproductive history. Methods: This study consisted of clinical-qualitative design with semi-structured individual interviews and open-ended questions. The sample selection was intentional and according to the theoretical saturation criterion. The data analysis was carried out based on the seven steps of the clinical-qualitative content analysis and validated by Nvivo11. This study was conducted in a public hemodialysis clinic of the Brazilian National Health System. Results: Twelve women undergoing hemodialysis were interviewed. The results from the analysis revealed three categories: 1) Association of pregnancy with CKD; 2) Nebulosity in relation to diagnosis and reproductive history 3) Being a woman undergoing hemodialysis. Conclusion: Our study showed the importance of considering the specificities of CKD in women, suggesting that these issues are important for diagnosis and treatment adherence. Consideration of reproductive life history allows the health of women undergoing hemodialysis to be promoted holistically, including aspects of mental health. Introduction (CKD Objective Methods clinicalqualitative clinical qualitative semistructured semi structured openended open ended questions criterion Nvivo11 Nvivo System Results interviewed categories 1 2 3 Conclusion adherence holistically Nvivo1

Resumo Introdução: Existem particularidades da doença renal crônica (DRC) em mulheres e seu tratamento. A biologia das mulheres as expõe a fatores de risco mais elevados para DRC e tanto a gravidez quanto o puerpério implicam um ônus adicional à saúde renal. Complicações na gestação podem causar ou piorar a DRC. Objetivo: Explorar as experiências de mulheres com DRC submetidas à hemodiálise em relação ao seu histórico reprodutivo. Métodos: Este estudo consistiu em desenho clínico-qualitativo com entrevistas individuais semiestruturadas e questões abertas. A seleção da amostra foi intencional e de acordo com o critério de saturação teórica. A análise de dados foi realizada com base nos sete passos da análise clínico-qualitativa de conteúdo e validada pelo Nvivo11. Este estudo foi realizado em uma clínica pública de hemodiálise do Sistema Único de Saúde brasileiro. Resultados: Foram entrevistadas 12 mulheres em hemodiálise. Os resultados da análise revelaram três categorias: 1) Associação da gravidez com DRC; 2) Nebulosidade em relação ao diagnóstico e à história reprodutiva; 3) Ser mulher e fazer hemodiálise. Conclusões: Nosso estudo mostrou a importância de considerar as especificidades da DRC em mulheres, sugerindo que estas questões são importantes para o diagnóstico e a adesão ao tratamento. A consideração do histórico de vida reprodutiva permite promover de forma holística a saúde das mulheres submetidas à hemodiálise, incluindo aspectos de saúde mental. Introdução (DRC tratamento Objetivo reprodutivo Métodos clínicoqualitativo clínico qualitativo abertas teórica clínicoqualitativa qualitativa Nvivo11 Nvivo brasileiro Resultados 1 categorias 2 3 Conclusões mental Nvivo1

Abstract Objective To evaluate the impact of the race (Black versus non-Black) on maternal and perinatal outcomes of pregnant women with COVID-19 in Brazil. Methods This is a subanalysis of REBRACO, a Brazilian multicenter cohort study designed to evaluate the impact of COVID-19 on pregnant women. From February2020 until February 2021, 15 maternity hospitals in Brazil collected data on women with respiratory symptoms. We selected all women with a positive test for COVID-19; then, we divided them into two groups: Black and non-Black women. Finally, we compared, between groups, sociodemographic, maternal, and perinatal outcomes. We obtained the frequency of events in each group and compared them using X2 test; p-values < 0.05 were considered significant. We also estimated the odds ratio (OR) and confidence intervals (CI). Results 729 symptomatic women were included in the study; of those, 285 were positive for COVID-19, 120 (42.1%) were Black, and 165 (57.9%) were non-Black. Black women had worse education (p = 0.037). The timing of access to the health system was similar between both groups, with 26.3% being included with seven or more days of symptoms. Severe acute respiratory syndrome (OR 2.22 CI 1.17–4.21), intensive care unit admission (OR 2.00 CI 1.07–3.74), and desaturation at admission (OR 3.72 CI 1.41–9.84) were more likely to occur among Black women. Maternal death was higher among Black women (7.8% vs. 2.6%, p = 0.048). Perinatal outcomes were similar between both groups. Conclusion Brazilian Black women were more likely to die due to the consequences of COVID-19. nonBlack non COVID19 COVID 19 COVID-1 REBRACO February202 2021 1 symptoms then groups Finally sociodemographic X pvalues values 005 0 05 0.0 significant OR CI. . (CI) 72 those 28 COVID19, 19, 12 42.1% 421 42 (42.1% 16 57.9% 579 57 9 (57.9% nonBlack. Black. 0.037. 0037 0.037 037 0.037) 263 26 3 26.3 222 2 22 2.2 1.17–4.21, 117421 1.17–4.21 , 17 4 21 1.17–4.21) 200 00 2.0 1.07–3.74, 107374 1.07–3.74 07 74 1.07–3.74) 372 3.7 1.41–9.84 141984 41 84 7.8% 78 7 8 (7.8 vs 6 2.6% 0.048. 0048 0.048 048 0.048) COVID19. 19. COVID1 COVID- February20 202 0. (CI 42.1 (42.1 57.9 5 (57.9 003 0.03 03 26. 2. 11742 1.17–4.2 20 10737 1.07–3.7 37 3. 1.41–9.8 14198 7.8 (7. 2.6 004 0.04 04 February2 42. (42. 57. (57. 1174 1.17–4. 1073 1.07–3. 1.41–9. 1419 7. (7 (42 (57 117 1.17–4 107 1.07–3 1.41–9 141 ( (4 (5 11 1.17– 10 1.07– 1.41– 14 1.17 1.07 1.41 1.1 1.0 1.4 1.

Resumo Objetivo Avaliar o impacto da raça (negra versus não negra) nos desfechos maternos e perinatais de gestantes com COVID-19 no Brasil. Métodos Esta é uma subanálise da REBRACO, um estudo de coorte multicêntrico brasileiro desenhado para avaliar o impacto da COVID-19 em mulheres grávidas. De fevereiro de 2020 a fevereiro de 2021, 15 maternidades do Brasil coletaram dados de mulheres com sintomas respiratórios. Selecionamos todas as mulheres com teste positivo para COVID-19; em seguida, as dividimos em dois grupos: mulheres negras e não negras. Finalmente, comparamos, entre os grupos, os resultados sociodemográficos, maternos e perinatais. Obtivemos a frequência dos eventos em cada grupo e comparamos usando o teste X2; Valores de p <0,05 foram considerados significativos. Também estimamos o odds ratio (OR) e os intervalos de confiança (IC). Resultados 729 mulheres sintomáticas foram incluídas no estudo; desses, 285 foram positivos para COVID-19, 120 (42,1%) eram negros e 165 (57,9%) não eram negros. As mulheres negras apresentaram pior escolaridade (p = 0,037). O tempo de acesso ao sistema de saúde foi semelhante entre os dois grupos, com 26,3% incluídos com sete ou mais dias de sintomas. Síndrome respiratória aguda grave (OR 2,22 CI 1,17–4,21), admissão em unidade de terapia intensiva (OR 2,00 CI 1,07–3,74) e dessaturação na admissão (OR 3,72 CI 1,41–9,84) foram mais prováveis de ocorrer entre mulheres negras. A mortalidade materna foi maior entre as negras (7,8% vs. 2,6%, p = 0,048). Os resultados perinatais foram semelhantes entre os dois grupos. Conclusão Mulheres negras brasileiras tiveram maior probabilidade de morrer devido às consequências da COVID-19. negra COVID19 COVID 19 COVID-1 REBRACO grávidas 202 2021 1 respiratórios seguida grupos Finalmente sociodemográficos X2 X 005 0 05 <0,0 significativos OR IC. IC . (IC) 72 desses 28 COVID19, 19, 12 42,1% 421 42 (42,1% 16 57,9% 579 57 9 (57,9% 0,037. 0037 0,037 037 0,037) 263 26 3 26,3 222 2 22 2,2 1,17–4,21, 117421 1,17–4,21 , 17 4 21 1,17–4,21) 200 00 2,0 1,07–3,74 107374 07 74 372 3,7 1,41–9,84 141984 41 84 7,8% 78 7 8 (7,8 vs 6 2,6% 0,048. 0048 0,048 048 0,048) COVID19. 19. COVID1 COVID- 20 <0, (IC 42,1 (42,1 57,9 5 (57,9 003 0,03 03 26, 2, 11742 1,17–4,2 1,07–3,7 10737 37 3, 1,41–9,8 14198 7,8 (7, 2,6 004 0,04 04 <0 42, (42, 57, (57, 0,0 1174 1,17–4, 1,07–3, 1073 1,41–9, 1419 7, (7 < (42 (57 0, 117 1,17–4 1,07–3 107 1,41–9 141 ( (4 (5 11 1,17– 1,07– 10 1,41– 14 1,17 1,07 1,41 1,1 1,0 1,4 1,

RESUMO Introdução: Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao longo de suas vidas. Este estudo visou avaliar histórico sociodemográfico, clínico e obstétrico de mulheres em hemodiálise. Métodos: Realizamos estudo transversal em unidade de saúde especializada com quatro unidades de hemodiálise. Avaliou-se características sociodemográficas, histórico clínico e pessoal, resultados obstétricos e perinatais de mulheres com gestações anteriores à hemodiálise. Foram realizadas análises de prevalência, bivariadas e regressão logística. Resultados: Incluímos 208 (87,76%) mulheres. Hipertensão foi a principal causa de doença renal crônica (DRC) (128 mulheres). Taxas de desfechos perinatais adversos, incluindo prematuridade, baixo peso ao nascer, aborto espontâneo, óbito fetal e neonatal, foram de 19,3%, 14,5%, 25,5%, 12,1% e 5,3%, respectivamente. Síndromes hipertensivas durante a gestação ocorreram em 37,0% das mulheres, com 12,5% relatando pré-eclâmpsia e 1,4% relatando eclampsia. Até 1 ano após o parto, 45,2% das mulheres relataram hipertensão. Hemodiálise devido à hipertensão foi associada ao histórico de hipertensão na gestação (OR 2,33; IC 1,27 - 4,24), hipertensão gestacional (2,41; IC 3,30 - 4,45), e hipertensão até um ano após o parto (OR 1,98; IC 1,11 - 3,51). A regressão logística mostrou que hipertensão gestacional foi independentemente associada à DRC devido à hipertensão (ORa 2,76; IC 1,45 - 5,24). Conclusão: Mulheres submetidas à hemodiálise por hipertensão foram mais propensas a apresentar hipertensão gestacional ou hipertensão até um ano após o parto. Para retardar a doença renal em estágio terminal, deve-se identificar mulheres em risco de insuficiência renal de acordo com sua história reprodutiva.

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

RESUMO O objetivo desta revisão de literatura é trazer alguns resultados de gestação em mulheres transplantadas, propostas de avaliação pré-concepcional, pré-natal e do puerpério, incluindo a contracepção pós-parto e orientação terapêutica na concomitância da gestação e lactação. Com base nos resultados encontrados em pesquisa no PubMed sem limitação de data ou língua, discutimos a importância do planejamento reprodutivo para mulheres com transplante de órgãos sólidos e que deve ser feito desde antes da realização do transplante. Existem contraindicações formais de gestação, entretanto quando planejada, dentro de critérios clínicos, laboratoriais e uso de imunossupressão adequada e em seguimento de pré-natal especializado essa gestação é possível e com bons resultados perinatais. Salientamos também a importância do acompanhamento psicológico entre gestantes com transplantes de órgãos sólidos. transplantadas préconcepcional, préconcepcional pré concepcional, concepcional pré-concepcional prénatal natal puerpério pósparto pós parto lactação língua planejada clínicos perinatais

ABSTRACT The objective of this literature review is to provide some pregnancy results in transplanted women, proposals for preconception, prenatal and postpartum evaluation, including postpartum contraception, and therapeutic guidance during pregnancy and lactation. Based on the results found in research on PubMed without date or language limitations, we discuss the importance of reproductive planning for women with solid organ transplants and what should be done before the transplant. There are formal contraindications to pregnancy; however, when planned, within clinical and laboratory criteria, and with adequate immunosuppression and specialized prenatal care, pregnancy is possible with good perinatal results. We also highlight the importance of psychological support among pregnant women with solid organ transplants. preconception evaluation contraception lactation limitations transplant however planned criteria care

RESUMO O aumento na sobrevida após o transplante e o crescimento da população feminina receptora de órgãos destacam a importância de considerar cuidadosamente a saúde reprodutiva e ginecológica dessas mulheres. Uma das principais preocupações é o risco aumentado de câncer após o transplante, atribuído em parte ao uso de terapia imunossupressora. Cânceres ginecológicos com alta associação com infecções virais, como câncer de colo uterino, devem receber cuidados e rastreios específicos, em especial entre mulheres mais jovens. Além disto, o caráter imunoprevinível do câncer de colo uterino torna a vacinação mandatória antes da realização do transplante. O câncer de mama, outro câncer ginecológico de especial interesse por sua alta prevalência, deve ser rastreado na população transplantada, seguindo as diretrizes da população geral. A fertilidade e o planejamento familiar também são considerações importantes, pois a maioria das mulheres apresenta o retorno da ovulação e da menstruação após o transplante. Estratégias de contracepção, como métodos de longa ação reversíveis, são recomendadas devido à sua eficácia e baixa taxa de falhas. O uso de contraceptivos hormonais e imunossupressores também devem ser avaliados, enfatizando a necessidade de observar cuidadosamente as possíveis interações medicamentosas. A abordagem integrada à saúde ginecológica das mulheres após um transplante de órgão sólido possibilita melhores resultados, tanto para a saúde do enxerto quanto para a saúde ginecológica daquela mulher, revertendo em melhores desfechos para a paciente. O acompanhamento e a vigilância cuidadosa, a prevenção do câncer e a gestão eficaz da fertilidade e contracepção são cruciais para garantir sua qualidade de vida e bem-estar. imunossupressora virais específicos jovens disto mama prevalência transplantada geral importantes reversíveis falhas avaliados medicamentosas resultados mulher paciente cuidadosa bemestar. bemestar bem estar. estar bem-estar

ABSTRACT The increase in survival after transplantation and the growth of the female organ recipient population underscore the importance of carefully considering the reproductive and gynecological health of these women. One of the main concerns is the increased risk of cancer after transplantation, partly attributed to the use of immunosuppressive therapy. Gynecological cancers with a high association with viral infections, such as cervical cancer, should receive specific care and screening, especially among younger women. Additionally, the preventable nature of cervical cancer makes vaccination mandatory before undergoing transplantation. Breast cancer, another gynecological cancer of special interest due to its high prevalence, should be screened in the transplant population following guidelines for the general population. Fertility and family planning are also important considerations, as most women experience the return of ovulation and menstruation after transplantation. Contraception strategies, such as reversible long-acting methods, are recommended due to their effectiveness and low failure rate. The use of hormonal contraceptives and immunosuppressants should also be evaluated, emphasizing the need to carefully monitor potential drug interactions. An integrated approach to the gynecological health of women after solid organ transplantation enables better outcomes for both graft health and the gynecological health of the woman, resulting in improved outcomes for the patient. Ongoing follow-up, careful surveillance, cancer prevention, and effective management of fertility and contraception are crucial to ensure their quality of life and well-being. therapy infections screening Additionally prevalence considerations strategies longacting long acting methods rate evaluated interactions woman patient followup, followup follow up, up follow-up surveillance prevention wellbeing. wellbeing well being. being well-being

Abstract Objective To assess maternal and neonatal outcomes in women with chronic kidney disease (CKD) at a referral center for high-risk pregnancy. Methods A retrospective cohort of pregnant women with CKD was followed at the Women's Hospital of Universidade Estadual de Campinas, Brazil, between 2012 and 2020. Variables related to disease etiology, treatment duration, sociodemographic variables, lifestyle, other associated diseases, obstetric history, and perinatal outcomes were assessed. The causes of CKD were grouped into 10 subgroups. Subsequently, we divided the sample according to gestational age at childbirth, as preterm and term births, comparing maternal and neonatal outcomes, and baseline characteristics as well as outcomes among such groups. Results A total of 84 pregnancies were included, in 67 women with CKD. Among them, six pregnancies evolved to fetal death, five to miscarriage, and one was a twin pregnancy. We further analyzed 72 single pregnancies with live births; the mean gestational age at birth was 35 weeks and 3 days, with a mean birth weight of 2,444 g. Around half of the sample (51.39%) presented previous hypertension, and 27.7% developed preeclampsia. Among the preterm births, we observed a higher frequency of hypertensive syndromes, longer maternal intensive care unit (ICU) stay in the postpartum period, higher incidence of admission to the neonatal ICU, higher neonatal death, lower 5-minute Apgar score, and lower birth weight. Conclusion This study demonstrates increased adverse outcomes among pregnancies complicated by CKD and expands the knowledge on obstetric care among such women in an attempt to reduce maternal risks and identify factors related to prematurity in this population. (CKD highrisk high risk pregnancy Womens Women s Campinas Brazil 201 2020 etiology duration variables lifestyle diseases history assessed 1 subgroups Subsequently childbirth births groups 8 included 6 them death miscarriage 7 days 2444 2 444 2,44 g 51.39% 5139 51 39 (51.39% hypertension 277 27 27.7 preeclampsia syndromes ICU (ICU period 5minute minute 5 score population 20 202 244 44 2,4 51.39 513 (51.39 27. 24 4 2, 51.3 (51.3 51. (51. (51 (5 (

Resumo Objetivo Avaliar os desfechos maternos e neonatais em mulheres com doença renal crônica (DRC) em um centro de referência para gestação de alto risco. Métodos Coorte retrospectiva de gestantes com DRC acompanhadas no Hospital da Mulher da Universidade Estadual de Campinas, Brasil, entre 2012 e 2020. Variáveis relacionadas à etiologia da doença, duração do tratamento, variáveis sociodemográficas, estilo de vida, outras doenças associadas, história obstétrica, número de consultas de pré-natal e os resultados perinatais foram avaliados. As causas da DRC foram agrupadas em 10 subgrupos. Posteriormente, dividimos a amostra de acordo com a idade gestacional no parto, pois os nascimentos pré-termo e a termo comparam os desfechos maternos e neonatais bem como as características basais e desfechos entre esses grupos. Resultados Um total de 84 gestações foram incluídas em 67 mulheres com DRC. Dentre elas, seis gestações evoluíram para óbito fetal, cinco para aborto espontâneo, e uma era gestação gemelar. Foram analisadas ainda 72 gestações únicas, com nascidos vivos; a idade gestacional média ao nascer foi de 35 semanas e 3 dias, e o peso médio ao nascer foi 2.444 g. Cerca de metade da amostra (51,39%) apresentava hipertensão prévia e 27,7% desenvolveram pré-eclâmpsia. Entre os casos de prematuridade (34 casos), observamos maior frequência de síndromes hipertensivas, mais dias de internação materna na UTI no pós-parto, maior incidência de internação na UTI neonatal, óbito neonatal, menor índice de Apgar de 5 minutos e menor peso ao nascimento. Conclusão Este estudo demonstra o aumento de desfechos adversos em gestações complicadas por DRC e amplia o conhecimento sobre cuidados obstétricos entre essas mulheres na tentativa de reduzir os riscos maternos e identificar fatores relacionados à prematuridade nessa população. (DRC risco Campinas Brasil 201 2020 tratamento sociodemográficas vida associadas obstétrica prénatal pré natal avaliados 1 subgrupos Posteriormente parto prétermo grupos 8 6 elas fetal espontâneo gemelar 7 únicas vivos 2444 2 444 2.44 g 51,39% 5139 51 39 (51,39% 277 27 27,7 préeclâmpsia. préeclâmpsia eclâmpsia. eclâmpsia pré-eclâmpsia 34 (3 casos, , casos) hipertensivas pósparto, pósparto pós pós-parto neonatal nascimento população 20 202 244 44 2.4 51,39 513 (51,39 27, ( 24 4 2. 51,3 (51,3 51, (51, (51 (5