Introduction We hypothesized that nutritional deficiency would be common in a cohort of postpartum, human immunodeficiency virus (HIV)-infected women and their infants. Methods Weight and height, as well as blood concentrations of retinol, α-tocopherol, ferritin, hemoglobin, and zinc, were measured in mothers after delivery and in their infants at birth and at 6-12 weeks and six months of age. Retinol and α-tocopherol levels were quantified by high performance liquid chromatography, and zinc levels were measured by atomic absorption spectrophotometry. The maternal body mass index during pregnancy was adjusted for gestational age (adjBMI). Results Among the 97 women 19.6% were underweight. Laboratory abnormalities were most frequently observed for the hemoglobin (46.4%), zinc (41.1%), retinol (12.5%) and ferritin (6.5%) levels. Five percent of the women had mean corpuscular hemoglobin concentrations < 31g/dL. The most common deficiency in the infants was α-tocopherol (81%) at birth; however, only 18.5% of infants had deficient levels at six months of age. Large percentages of infants had zinc (36.8%) and retinol (29.5%) deficiencies at birth; however, these percentages decreased to 17.5% and 18.5%, respectively, by six months of age. No associations between infant micronutrient deficiencies and either the maternal adjBMI category or maternal micronutrient deficiencies were found. Conclusions Micronutrient deficiencies were common in HIV-infected women and their infants. Micronutrient deficiencies were less prevalent in the infants at six months of age. Neither underweight women nor their infants at birth were at increased risk for micronutrient deficiencies.

OBJECTIVES: To describe laboratory abnormalities among HIV-infected women and their infants with standard and increased lopinavir/ritonavir (LPV/r) dosing during the third trimester of pregnancy. METHODS: We evaluated data on pregnant women from NISDI cohorts (2002-2009) enrolled in Brazil, who received at least 28 days of LPV/r during the third pregnancy trimester and gave birth to singleton infants. RESULTS: 164 women received LPV/r standard dosing [(798/198 or 800/200 mg/day) (Group 1)] and 70 increased dosing [(> 800/200 mg/day) (Group 2)]. Group 1 was more likely to have advanced clinical disease and to use ARVs for treatment, and less likely to have CD4 counts > 500 cells/mm³. Mean plasma viral load was higher in Group 2. There were statistically significant, but not clinically meaningful, differences between groups in mean AST, ALT, cholesterol, and triglycerides. The proportion of women with Grade 3 or 4 adverse events was very low, with no statistically significant differences between groups in severe adverse events related to ALT, AST, total bilirubin, cholesterol, or triglycerides. There were statistically significant, but not clinically meaningful, differences between infant groups in ALT and creatinine. The proportion of infants with Grade 3 or 4 adverse events was very low, and there were no statistically significant differences in severe adverse events related to ALT, AST, BUN, or creatinine. CONCLUSION: The proportions of women and infants with severe laboratory adverse events were very low. Increased LPV/r dosing during the third trimester of pregnancy appears to be safe for HIV-infected women and their infants.

Averiguou-se a soroprevalência para HIV, sífilis, toxoplasmose, citomegalovirose e rubéola em gestantes de Sergipe, nordeste do Brasil, verificando-se a associação com idade e procedência. Selecionaram-se 9.550 gestantes (2.112 da capital e 7.438 do interior) testadas consecutivamente durante o primeiro atendimento pré-natal em 2007. Foram encontradas as seguintes frequências de soropositividade: sífilis (0,9%; IC95% 0,7%-1,6%), HIV (0,14%; IC95% 0,08%-0,2%), toxoplasmose (IgG 69,3%; IC95% 68,3%-70,2%; IgM 0,4%, IC95% 0,3%-0,6%), citomegalovirose (IgG 76,6%, IC95% 75,7%-77,5%; IgM 0,2%, IC95% 0,09%-0,3%) e rubéola (IgG 71,6%, IC95% 70,7%-72,6%; IgM 0,1%, IC95% 0,04%-0,2%). A soropositividade para toxoplasmose incrementou com a idade. A prevalência de anticorpos IgG para toxoplasmose, CMV e rubéola foi maior na capital, Aracaju, que nos demais municípios do Estado de Sergipe. Foi encontrada associação entre a idade e soropositividade para a toxoplasmose. Os achados revelam grande proporção de gestantes susceptíveis a toxoplasmose, rubéola e citomegalovirose, principalmente no interior do estado, com risco para seus filhos.

The seroprevalence of antibodies for HIV, syphilis, toxoplasmosis, cytomegalovirosis and rubella and its association with age and origin was investigated among pregnant women in Sergipe, northeastern Brazil. A total of 9,550 pregnant women (2,112 from the state capital and 7,438 from other municipalities) were enrolled in the study and consecutively tested during their first antenatal care visit in 2007. The following serum prevalences were found: syphilis (0.9%; 95% CI 0.7%-1.6%), HIV (0.14%; 95% CI 0.08%-0.2%), toxoplasmosis (IgG 69.3%; 95% CI 68.3%-70.2%; IgM 0.4%, 95% CI 0.3%-0.6%), cytomegalovirosis (IgG 76.6%, 95% CI 75.7%-77.5%; IgM 0.2%, 95% CI 0.09%-0.3%) and rubella (IgG 71.6%, 95% CI 70.7%-72.6%; IgM 0.1%, 95% CI 0.04%-0.2%). Toxoplasmosis seropositivity increased with age. The prevalences of IgG antibodies for toxoplasmosis, cytomegalovirus and rubella were higher in Aracaju (state capital) than in other municipalities in the State of Sergipe. The results showed that a large proportion of the pregnant women, particularly in municipalities other than the state capital, were susceptible to toxoplasmosis, rubella and cytomegalovirus, with a risk for their infants.

OBJETIVOS: avaliar o uso de corticosteróide antenatal (CA) nas mães e as suas repercussões nas condições de nascimento das crianças nascidas pré-termo nas oito unidades neonatais universitárias da Rede Brasileira de Pesquisas Neonatais. MÉTODOS: estudo observacional do tipo coorte prospectivo. Foram avaliadas 463 gestantes com idade gestacional (IG) entre 23 e 34 semanas e seus 514 recém-nascidos no período de 1 de agosto a 31 de dezembro de 2001. Os dados foram obtidos por entrevista materna, análise de prontuário e acompanhamento dos recém-nascidos, e analisados pelos testes do chi2, Mann-Whitney, ANOVA e regressão logística múltipla, com nível de significância de 0,05. RESULTADOS: 60,1% (282/463) das gestantes (variação de 12,5 a 87,3% entre as unidades) receberam ao menos uma dose de CA. A freqüência do uso de CA foi diretamente associada ao número de consultas de pré-natal, hipertensão materna e uso antenatal de tocolíticos. Quando as gestantes foram tratadas, os RN apresentaram maior peso de nascimento (1379±421 vs 1244±543 g), idade gestacional mais avançada (30,9±2,0 vs 29,5±3,5 semanas), melhores valores do escore de Apgar no 1º e 5º minuto e menor freqüência de intervenção na sala de parto. O uso de CA, a IG e o fato de ser pequeno para a IG melhoraram, de forma independente, as condições de nascimento. CONCLUSÕES: o uso de CA, na maioria dos centros, foi feito em freqüência abaixo da desejada e em metade das vezes de forma inadequada. O tratamento foi mais aplicado a mães com melhor acompanhamento durante o pré-natal e foi associado com melhores condições de nascimento.

PURPOSE: to assess the use of antenatal corticosteroid (AC) by mothers and its repercussion on the birth conditions of preterm babies at the eight university neonatal units belonging to the Brazilian Network of Neonatal Research. METHODS: an observational prospective cohort study. All 463 pregnant women with a gestational age (GA) of 23 to 34 weeks and their 514 newborn babies were evaluated during the period from August 1 to December 31, 2001. The data were obtained by maternal interview, by the analysis of the medical records and by the follow-up of the newborn infants, and analyzed statistically using chi2, Mann-Whitney and ANOVA tests and multiple logistic regression, with the level of significance set at 0.05. RESULTS: 60.1% (282/463) of the pregnant women (a variation from 12.5 to 87.3% among units) received at least one AC dose. The AC use was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented higher birth weight (1,379±421 vs 1,244±543 g), longer gestational age (30.9±2.0 vs 29.5±3.5 weeks), better Apgar scores at the 1st and 5th minute, and a reduced need for intervention in the delivery room. The use of AC, the GA and a baby small for GA independently improved the birth conditions. CONCLUSIONS: at most centers, AC was administered at frequencies below the desired ones, and in 50% of cases in an inadequate manner. Treatment was applied more to mothers who received appropriate prenatal care and was associated with better birth conditions.

OBJETIVOS: estudar o efeito das drogas anti-retrovirais sobre o metabolismo glicêmico em gestantes portadoras do HIV-1 e a ação dessas medicações sobre o prognóstico perinatal. MÉTODOS: estudo prospectivo realizado em 57 gestantes divididas em três grupos: grupo AZT, utilizando zidovudina (n=20); grupo TT, utilizando zidovudina+lamivudina+nelfinavir (n=25), e grupo controle, gestantes normais (n=12). Obteve-se a área sob a curva (ASC) das glicemias após teste oral de tolerância à glicose com 75 g de glicose em quatro oportunidades durante a gravidez (1º=14-20 semanas, 2º=21-26 semanas, 3º=27-32 semanas e 4º=33-38 semanas). O prognóstico perinatal levou em consideração as taxas de prematuridade, restrição de crescimento intra-útero (RCIU), baixo peso ao nascer, mortalidade perinatal e transmissão vertical do HIV-1. Os dados foram analisados utilizando-se os testes não paramétricos do c², de Friedman e de Kruskal-Wallis. RESULTADOS: os valores da mediana da ASC foi de 11.685 mg/dL-2h para o grupo controle, 13.477 mg/dL-2h para o grupo AZT e 13.650 mg/dL-2h para o grupo TT (p=0,049). Não se observou efeito deletério dos anti-retrovirais sobre as taxas de prematuridade, baixo peso ao nascer, RCIU e índices de Apgar. Não houve nenhum caso de transmissão vertical do HIV-1. CONCLUSÕES: verificou-se o desenvolvimento de intolerância glicêmica em gestantes que utilizaram tratamento tríplice, não sendo observado naquelas que utilizaram apenas AZT. Não houve efeitos deletérios dos anti-retrovirais sobre o prognóstico perinatal.

PURPOSE: to investigate the effect of antiretroviral drugs on carbohydrate metabolism in HIV-infected pregnant women and on fetal and neonatal prognosis. METHODS: a prospective study was conducted on 57 pregnant women. The women were divided into three groups: ZDV group, taking zidovudine (n=20), TT group, taking zidovudine + lamivudine + nelfinavir (n=25), and control group (n=12). Blood samples were obtained for the determination of the area under the curve (AUC) after a 75-g oral glucose test at four periods during pregnancy (1st=14-20 weeks, 2nd= 21-26 weeks, 3rd=27-32 weeks and 4th=33-38 weeks). Perinatal prognosis was based on prematurity rates, intrauterine growth restriction (IUGR), low birth weight, perinatal mortality, and vertical HIV-1 transmission. Data were analyzed statistically using the nonparametric c² test, Friedman test and Kruskal-Wallis test. RESULTS: the median values of the AUC were 11.685 mg/dL for the control group, 13.477 mg/dL for the ZDV Group, and 13.650 mg/dL for the TT group (p=0.049). The antiretroviral agents had no deleterious effects on prematurity, low birth weight, IUGR rates or on Apgar score. There was no case of vertical transmission of HIV-1. CONCLUSIONS: an association was detected between the use of triple therapy and the development of carbohydrate intolerance during pregnancy. This association was not shown with ZDV alone. The antiretroviral agents had no deleterious effects on perinatal prognosis.

OBJETIVO: avaliar os efeitos de drogas anti-retrovirais isoladas e em associação sobre as taxas de fertilidade em ratas prenhes expostas a estes fármacos, bem como o efeito perinatal nas crias. MÉTODOS: foram utilizadas ratas fêmeas prenhes adultas da raça Wistar, pesando inicialmente entre 200 e 230 g. Foram testadas a azidotimidina (AZT), lamivudina (3TC) e nelfinavir (NFV), cujas dosagens foram padronizadas em 10 vezes a dose normalmente utilizada em gestantes, proporcionalmente ao peso dos animais. No total foram avaliados sete grupos, incluindo o controle. O início da experimentação foi o dia zero da prenhez e as cesarianas foram realizadas com 21 dias de prenhez. Para o cálculo das taxas de fertilidade, avaliaram-se o número de fetos vivos e mortos, sítios de implantação e número de corpos lúteos. Utilizaram-se o teste t de Student e Mann-Whitney para a análise estatística. RESULTADOS: não houve alterações significativas nas taxas de perdas pré-implantação e da eficiência de implantação de ratas tratadas com anti-retrovirais isolados e em associação. No entanto, houve aumento significativo nas taxas de perdas pós-implantação (grupo controle: 7,6%; grupos medicamentos: de 20,2 a 26,7%), redução significativa nas taxas de viabilidade fetal (grupo controle: 92,4%; grupos medicamentos: de 73,3 a 79,8%) e redução significativa no número de fetos por ninhada (grupo controle: 14,7, grupos medicamentos: de 11,1 a 12,7). Observou-se também que houve redução do peso materno e dos fetos nos grupos tratados com 3TC, AZT + 3TC e AZT + 3TC + NFV. CONCLUSÃO: com a utilização de doses elevadas de medicamentos anti-retrovirais na presente casuística, efeitos importantes sobre a fertilidade foram encontrados, o que sinaliza para a necessidade de se pesquisarem outros fármacos anti-retrovirais com menor potencial histotóxico e que possam, com segurança, ser utilizados por gestantes portadoras da infecção pelo vírus da imunodeficiência humana.

PURPOSE: to evaluate experimentally the effects of antiretroviral drugs used alone and in association upon the fertility of pregnant Wistar rats and the perinatal effects on the offspring. METHODS: adult female pregnant Wistar rats weighing 200-230 g were used. The antiretroviral drugs zidovudine (AZT), lamivudine (3TC) and nelfinavir (NFV) were used alone and in association at daily doses of ten times the dose normally used in pregnant women, proportionally to the animal's body weight. Seven groups were studied, including the control one. The experiment started on day 0 and the pregnant animals were sacrificed on day 21. The alive and dead fetuses, the total implantation sites and the total numbers of corporea lutea were used to calculate the fertility values. The statistical analysis was performed by Student's t test and by the Mann-Whitney test. RESULTS: there were no significant statistical differences regarding preimplantation loss and implantation efficiency values of the rats treated with isolated and associated antiretroviral drugs. There was a significant increase in the postimplantation loss values (control group: 7.6%; drug groups variation: 20.2-26.7%), a decrease in the fetal viability values (control group: 92.4%, drug groups variation: 73.3-79.8%), and a decreasing number of fetuses per animal (control group: 14.7; drug groups variation: 11.1-12.7). There was a significant weight reduction of the female rats and of the offspring of animals treated with 3TC, AZT + 3TC and AZT + 3TC + NFV. CONCLUSION: with the administration of high antiretroviral doses, important fertility effects could be observed, which showed that less histotoxic antiretroviral drugs must be studied in order to warrant the safety of using these medicines in pregnant HIV-1 - infected women.

Visando aferir a tasa de reatividade sérica do HBsAg e de outros marcadores da infecção pelo VHB em parturientes, além de avaliar quais os fatores de risco, estudaram-se 7992 mulheres que tiveram suas gestações resolvidas no Hospital das Clínicas da Universidade de São Paulo. A reatividade sérica do HBsAg foi aferida por o teste ELISA em duas etapas: a primeira com período de incubação de 2 h (triagem) e a segunda de 18 horas (confirmatória) realizada nas amostras positivas ao triagem. Os marcadores anti-HBsAg, HBeAg, anti-HBeAg, e anti-HBcAg foram testados nas amostras confirmadamente positivas. No triagem, foram positivas para o HBsAg 1,05% (IC95%; 0,84-1,30) das amostras. Apenas 0,95% (IC95%; 0,75-1,19) foram confirmadamente positivas, sendo significativamente superior nas pacientes cujas gestações terminaram em aborto (1,84%) do que as 0,84% que terminaram em parto (chi2 correção de Yates = 7,76; P < 0,005). A anamnese possibilitou identificar fatores de risco para a infecção pelo VHB em apenas 27,6% das pacientes avaliadas. Dessas amostras, 21,3% (IC95%; 1,04-30,56) apresentavam HBeAg positivo, de elevado risco para transmissão vertical desse vírus. Esses resultados reforçam a necessidade de pesquisa sorológica específica no final da gestação, possibilitando o máximo benefício da imunoprofilaxia neonatal.

The work reported here points up the real benefits provided by neonatal immunoprophylaxis of newborns delivered by mothers who are seropositive for the hepatitis B virus surface antigen HBsAg and underscores the need to properly identify such mothers in Brazil so that immunoprophylaxis can be undertaken. To help determine levels of hepatitis B virus (HBV) infection and seropositivity for various HBV markers among pregnant women in Southeast Brazil, investigators studied 7992 pregnant women delivering at the Clinical Hospital of the University of São Paulo's Ribeirão Preto School of Medicine in Ribeirão Preto, Brazil. Seroreactivity for HBsAg was determined first by serologic screening with an enzyme-linked immunosorbent assay (ELISA) procedure in which the sera were incubated for 2 hours and then by confirmation with another ELISA in which the sera were incubated for 18 hours. Subsequently, tests for anti-HBsAg, HBeAg, anti-HBeAg, and anti-HBcAg markers were conducted using confirmed positive samples. Initial screening found 84 of the 7992 samples (1.05%, 95% CI: 0.84-1.30) to be positive for HBsAg; however, this HBsAg positivity was confirmed in only 76 (0.95%, 95% CI: 0.75-1.19). The positivity rate was significantly higher among subjects whose pregnancies terminated in miscarriage (1.84%) than among those with live births (0.83%) (chi2, Yates correction = 7.6; P = 0.005). Anamnesis was able to identify HBV risk factors in only 27.6% of the confirmed HBsAg-positive subjects or close household contacts. However, 21.3% (95% CI: 1.04-30.56) of the confirmed HBsAg-positive subjects were found positive for HBeAg, indicating a high risk of vertical transmission of the virus. These results demonstrate a need to conduct specific serologic research at term, in order to provide effective neonatal immunoprophylactic benefits.