<p>These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed.</p><p>The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications. </p><p>The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA. </p><p>The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found.</p><p>A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia. </p>

The appropriateness of universal screening for gestational diabetes mellitus (GDM) has been strongly questioned, since it does not satisfy ethical principles for screening. The aims of these studies were to determine the prevalence of GDM, expressed in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), to evaluate different screening models using traditional anamnestic risk factors and repeated random B-glucose, to determine whether GDM increases risks for maternal complications such as preeclampsia, and to determine whether IGT during pregnancy, if left untreated, is associated with increased maternal or neonatal morbidity. Of 4,918 pregnant non-diabetic women attending maternal health care, 73.5% agreed to have a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed in 1.7%, IGT in 1.3% and DM in 0.4%. Traditional risk factor criteria were fulfilled by 15.8%. Prior GDM and a prior macrosomic infant showed the highest association with GDM. No selective or two-step universal screening model would have detected all cases of GDM. A constructed model comprising prior GDM, a prior LGA/macrosomic infant, or a cut-off random B-glucose level of 8 mmol/l as an indication for OGTT reduced the need for OGTT to 7.3% compared to the selective screening model with traditional risk factors. Such a universal two-step screening model had 100% sensitivity for DM, and 44.7% sensitivity for IGT. The Swedish Medical Birth Register was used to evaluate GDM as risk factor for preeclampsia. GDM occurred in 0.8% and preeclampsia in 2.9% of 430,852 singleton pregnancies. There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor, but cannot explain the total excess risk. In a prospective population-based case-control study 213 women with untreated IGT during pregnancy were identified. For each case, four controls were recruited from the same delivery department. The analyses confirmed that maternal and fetal morbidity were increased in the cases in terms of cesarean section rate, pre-term delivery, Erb’s palsy and admission to NICU. There was a marked, independent increase in the proportion of LGA infants (OR 7.3; 95% CI 4.1-12.7). To determine whether treatment has an effect when IGT is diagnosed during pregnancy, a randomized study is required.

These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed. The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications. The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA. The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found. A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia.

The term “gestational diabetes” first was used in 1967 by J.Pedersen [J.Pedersen, 1967]. Up till then a number of other names was used to describe this pathology in scientific literature. During the last four decades a lot of reseach was done on this pregnancy related metabolic disturbance, but it is discussed up till now if this condition is worth of attention in general and if setting the diagnose is more beneficial or more harmful. Controversy exists also concerning diagnosing methods and criteria of gestational diabetes (GD). It is still discussed about the usefullness of global screening, though the majority of authors agree that by examining only the women who have predisposing factors for GD, up till 25% of GD cases would remain undiagnosed with consequently worse pregnancy outcome compared to the diagnosed and treated cases [K.M.Adams et al., 1998; D.Baliutavičienė et al., 2005]. The major complication of GD – fetal macrosomy, appears 2-4 times more frequently compared to healthy pregnant women [O.Langer et al., 2000] and is related not only to higher probability of labour trauma to mother and newborn, but also with a higher incidence of obesity in childhood and adulthood [B.Vohr et al., 1997; D.Dabelea et al., 1999; M.W.Gillman et al., 2003]. Even though it was succeded to decreace the mortality and morbidity of newborns by normalising glucose level in blood in GD patients, the incidence of macrosomy in these risky pregnancies remains higher compared to healthy... [to full text]

Made available in DSpace on 2015-07-22T20:49:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-09-29 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Objetivo: determinar se polimorfismos relacionados aos genes codificadores de Adiponectina (+45 e -11377), IL-10 (-1082), IL-6 (-174) e TNFA (-308) estão associados à ocorrência de diabetes gestacional (DG), diabetes mellitus tipo 1 (DM1) e diabetes mellitus tipo 2 (DM2). Além disso, pretendemos avaliar nestes pacientes a expressão destes fatores inflamatórios durante o terceiro trimestre gestacional, considerando o índice de massa corpórea (IMC) pré-gestacional. Métodos: Este estudo teve caráter tipo caso-controle e incluiu 79 pacientes com DG, 26 com DM1, 19 com DM2 e 169 mulheres sem patologia sistêmica ou obstétrica (C), e com história de duas ou mais gestações sem intercorrências como controles. O DNA genômico foi extraído de sangue periférico por método de DTAB/CTAB, e as genotipagens foram realizadas por técnica de PCR-RFLP. Para a análise dos resultados foram aplicados os testes qui-quadrado (χ2), exato de Fischer e Mann-Whitney, tendo sido adotado o nível de significância de p<0,05. Resultados: Não houve associação entre DG, DM1 e DM2 e qualquer um dos polimorfismos analisados. Os níveis séricos de adiponectina foram maiores no grupo controle do que em DG (p=0,0004) e DM2 (p=0,005). As concentrações de adiponectina de gestantes com DM1 também foram maiores do que em DG (p=0,0009) e DM2 (p=0,01). Tais diferenças persistiram considerando-se o IMC pré-gestacional, inclusive quando confrontados gestantes eutróficas ou obesas, entre si. Os níveis de IL-10, IL-6 e TNFA em sobrenadantes de cultura não diferiram entre os grupos C, DG, DM1 e DM2. Conclusões: Não houve associação entre nenhum dos polimorfismos analisados e DG, DM1 e DM2. Os grupos de estudo apresentaram diferenças entre si quanto aos níveis séricos de adiponectina, mas não quanto à produção de IL-10, IL-6 e TNFA. / Background: Adiponectin is involved in glycemic regulation and in the physiopathology of obesity. Adiponectin gene polymorphisms may influence the expression of this molecule. The aims of this study were to assess adiponectin +45 (rs2241766) and -11377 (rs266729) gene polymorphisms and adiponectin serum levels in Brazilian women with gestational diabetes (GD) according to the patients´ prepregnancy body mass index (BMI). Methods: This case-control study involved 79 GD patients and 169 healthy pregnant controls (C) grouped according to BMI (normal < 25 and obese ≥ 25). Genomic DNA was extracted from peripheral blood, and polymorphisms genotyping were obtained by digesting PCR products with the following restriction endonucleases: SmaI (+45) and HhaI (-11377). Adiponectin serum levels were determined by ELISA. Data were analyzed by Mann-Whitney, chi-square or Fisher tests; p<0.05 was considered significant. Results: When both groups were analyzed, adiponectin serum levels were higher in C than in GD women (p=0.0004). Adiponectin serum levels were higher in normal weight versus obese women, both in the C (p=0.01) and in GD (p=0.03) groups, as well as in normal weight C versus normal weight GD (p=0.03) and in obese C compared to obese GD women (p=0.01). Conclusions: Our data suggest that there were no associations between GD and the analyzed gene polymorphisms. There was a significant association between adiponectin -11377 gene polymorphism and adiponectin levels in healthy pregnant women. GD women have decreased adiponectin levels independently of BMI. / FAPESP: 08/55888-8 / TEDE / BV UNIFESP: Teses e dissertações

O estudo das funções extra-esqueléticas da vitamina D vem ampliando-se nos últimos anos. Na gestação, a preocupação com os níveis de vitamina D maternos ocorre pela necessidade desta vitamina para a formação do esqueleto fetal e pela associação da hipovitaminose D com desfechos adversos materno-fetais. Para o recém-nascido (RN), as complicações incluem o baixo peso ao nascer, o comprometimento do crescimento longitudinal e as infecções respiratórias. Para a gestante, a deficiência de vitamina D vem sendo associada à alteração na homeostase glicêmica e ao aumento da incidência de diabetes gestacional (DG) , à pré-eclâmpsia e à vaginose bacteriana. Entretanto, a evidência científica atual ainda é controversa e não há definição estabelecida sobre o real benefício da suplementação da vitamina D na gestação. O diabetes gestacional, por sua vez, também está associado a desfechos adversos para a gestante e para a prole. Para o feto, há aumento da incidência de prematuridade, macrossomia, distócia de ombro e hipoglicemia neonatal; enquanto para a mãe, há associação com aumento da taxa de cesariana, pré-eclâmpsia e diabetes pós-gestacional. Desta forma, os desfechos adversos da hipovitaminose D e do DG presentes de forma simultânea na gestação podem ser aditivos. Este artigo propõe-se à revisão das repercussões da deficiência da vitamina D e do DG na gestação, para a mãe e para o RN, e discute a potencial repercussão da associação de ambas situações já que a hipovitaminose D pode estar relacionada com aumento da ocorrência de DG. / Extra-skeletal functions of vitamin D have been studied in the last years. During pregnancy, the concern with vitamin D levels is justified by its importance for the fetal skeleton development and by the association of hypovitaminosis D with adverse maternal and fetal outcomes. For the newborn, adverse outcomes include low birth weight, impaired longitudinal growth and respiratory infections. For the women, vitamin D deficiency has been associated with glucose homeostasis impairment and increased incidence of gestational diabetes (GD), preeclampsia and bacterial vaginosis. However, the available scientific data is still controversial and the real benefit of vitamin D supplementation during pregnancy is not defined. Hyperglycemia during pregnancy is also associated with increased rates of perinatal adverse outcomes. For the fetus and the newborn, GD is associated with an increased incidence of prematurity, macrosomia, shoulder dystocia and neonatal hypoglycemia; for the mother, there are increased rates of cesarean delivery, preeclampsia and type 2 diabetes. Therefore, adverse outcomes of hypovitaminosis D and GD present simultaneously during pregnancy could be additive. This manuscript aims to review the impact of vitamin D deficiency and of GD for the women and the newborn, and to discuss the potential association between these two clinical situations since hypovitaminosis D may increase the risk for GD.

Introdução: Devido à fatores hormonais e mecânicos, a gestação e o parto provocam alterações que podem gerar disfunções do assoalho pélvico (DAP). Os estudos sobre as DAP no puerpério a curto prazo são escassos e fazem uso assistemático de métodos avaliativos. Objetivo: Identificar e avaliar as DAP no pós-parto imediato, um mês e três meses após o parto, comparando parto vaginal (PV), cesárea eletiva (CE) e cesárea intraparto (CI). Métodos: Estudo observacional longitudinal que avaliou mulheres até 48 horas (fase 1); um mês (fase 2) e três meses após o parto (fase 3). Utilizou-se o International Consultation on Incontinence Questionnaire (ICIQ-SF); o Índice de Incontinência Anal (IA) de Jorge-Wexner; a Escala Análoga Visual (EVA) para dor pélvica; o Pelvic Organ Prolapse Quantification system (POP-Q) e a perineometria dos Músculos do Assoalho Pélvico (MAP), além de questionário estruturado. Resultados: Foram avaliadas 227 pacientes na fase 1 (141 realizaram PV; 28 realizaram CI e 58 realizaram CE); 79 na fase 2 e 41 na fase 3. O escore do ICIQ-SF, índice de IA, EVA e perineometria não apresentaram diferenças significativas em relação ao tipo de parto. O ponto distal do colo uterino apresentou-se mais prolapsado no grupo PV. Conclusão: O tipo de parto não foi um fator significante para o desenvolvimento das DAP no pós-parto a curto prazo. Foi identificado que ocorreu recuperação fisiológica na funcionalidade dos MAP e piora na sustentação da parede vaginal anterior e no impacto da incontinência urinária na qualidade de vida ao longo dos três meses. / Introduction: Due to mechanical and hormonal factors, pregnancy and childbirth triggers changes that can lead to pelvic floor dysfunction (PFD). PFD studies in the immediate postpartum period are scarce and do unsystematic use of evaluation methods. Objective: To identify and evaluate the immediate, one month and three months postpartum PFD, comparing vaginal delivery (VD), elective cesarean (ECS) and cesarean indicating (ICS) during labor. Methods: This was a longitudinal observational study that assessed postpartum women after up to 48 hours (phase 1); one month (phase 2) and three months (phase 3). The study used the International Consultation on Incontinence Questionnaire (ICIQ-SF); Jorge-Wexner's Anal Incontinence (AI) score; the Visual Analogue Scale (VAS) for pelvic pain; the Pelvic Organ Prolapse Quantification System (POP-Q); and a Pelvic Floor Muscles (PFM) perineometer, as well as a structured questionnaire. Results: A total of 227 patients were assessed in phase 1 (141 had VD, 28 ICS and 58 ECS); 79 in phase 2 and 41 in phase 3. The ICIQ-SF, AI, VAS and perineometer index did not present significant differences in relation to the type of delivery. The distal point of the cervix presented more prolapse in VD. Conclusion: The type of delivery was not a significant factor for the development of postpartum PFD in the short term. The study found that there was physiological recovery of the functionality of PFM and worsening prolapse of the anterior vaginal wall and urinary incontinence over the three months.

O diabetes gestacional (DG) é uma condição definida como intolerância a carboidratos e hiperglicemia, com início no segundo trimestre da gravidez. Trabalhos desenvolvidos por nosso grupo mostraram que a progesterona (PG) é capaz de causar a morte de células pancreáticas, por um mecanismo dependente da geração de radicais livres, o que poderia contribuir para o desenvolvimento do DG. O objetivo desse trabalho foi estudar o efeito da PG, na presença ou não de antioxidantes, na expressão de genes relacionados ao estresse oxidativo e na defesa oxidante em células pancreáticas da linhagem RINm5F. As células foram incubadas com PG 0,1, 1,0 e 100 &#181M por 6 ou 24 h, na presença ou não dos antioxidantes vitamina E e C. Após a incubação, foram realizados ensaios de viabilidade celular e fragmentação do DNA. A PG, não causou perda da integridade da membrana das células RINm5F, porém, ela promoveu fragmentação do DNA em, aproximadamente, 40% das células RINm5F e MCF-7 (controle positivo), enquanto que os antioxidantes vitamina E e C reduziram tal fragmentação. A partir da extração do RNA e síntese de cDNA foi investigada a expressão de 84 genes envolvidos no estresse oxidativo e defesa antioxidante. Dos 84 genes, cinco deles tiveram sua expressão aumentada em no mínimo, duas vezes em, pelo menos, duas concentrações diferentes, independentemente do tempo de incubação, ou nas mesmas concentrações em tempos diferentes, como os que codificam para a proteína de choque térmico a1a (Hspa1a), glutationa peroxidase 6 (Gpx6), dual oxidase 1 (Duox1), heme oxigenase 1(Hmox1) e estearoil-CoA desaturase 1 (Scd1). Esses genes, juntamente com a peroxirredoxina 4 (Prdx4), desempenham importante papel na fisiologia da célula pancreática e/ou DG. A expressão desses genes também foi estudada na pré-incubação das células RINm5F com as vitaminas E e C. Tais antioxidantes, de forma geral, foram capazes de aumentar a expressão de Hmox1 e Prdx4, genes com funções antioxidantes, e de diminuir de Scd1, um gene com função pró- oxidante. Ao nível citoplasmático, verificou-se que as quantidades das proteínas Hmox1 e Prdx4 também foram moduladas pela da PG e/ou vitamina E e C. Os resultados sugerem que esses antioxidantes apresentam importante papel na proteção da células RINm5F contra o dano oxidativo induzido pela PG. Desta forma, os resultados obtidos nesse projeto, em conjunto, devem colaborar para melhor compreensão da patogênese do DG, abrindo novas perspectivas não só para elucidação do mecanismo molecular envolvido na ação da PG sobre células pancreáticas e sua relação com o DG, mas para o desenvolvimento de estratégias de prevenção e tratamento dessa doença baseadas na terapia com antioxidantes / Gestational diabetes (GD) is a condition defined as carbohydrate intolerance and hyperglycemia, beginning in the second trimester of pregnancy. Studies developed by our group have shown that progesterone (PG) is able to cause pancreatic cells death, by a mechanism dependent on the generation of free radicals, which could contribute to the development of GD. The aim of this work was to study the effect of PG, in the presence or absence of antioxidants, on the expression of genes related to oxidative stress and oxidant defense in pancreatic cells of the RINm5F lineage. Cells were incubated with 0.1, 1.0 and 100 µM PG for 6 or 24 h, in the presence or absence of vitamin E and C antioxidants. PG did not cause loss of membrane integrity of RINm5F cells, however, it promoted DNA fragmentation in approximately 40% of the RINm5F and MCF-7 cells (positive control), whereas vitamin E and C antioxidants reduced such fragmentation. From the RNA extraction and cDNA synthesis was investigated the expression of 84 genes involved in oxidative stress and antioxidant defense. Among of 84 investigated genes, five of them had their expression increased, in the minimum 2-fold in, at least, two different concentrations independent of incubation time (6 or 24 h), or at the same concentrations at different times, such as those that encoding for heat shock protein a1a (Hspa1a), glutathione peroxidase 6 (Gpx6), dual oxidase 1 (Duox1), heme oxygenase 1 (Hmox1) and stearoyl-CoA denaturase 1 (Scd1). These genes, together with the peroxiredoxin 4 (Prdx4), play an important role in pancreatic cell physiology and/or DG. The gene expression was also studied in the preincubation of RINm5F cells with vitamin E and C. These antioxidants were generally able to increase the Hmox1 and Prdx4 expression, genes with antioxidant functions, and decrease the Scd1 expression, a gene with pro-oxidant function. At the cytoplasmic level, it was found that the amounts of Hmox1 and Prdx4 proteins were also modulated by PG and / or vitamin E and C. The results suggest that these antioxidants play an important role in the RINm5F protection cells against the oxidative damage induced by PG. Thus, the results obtained in this project, together, should contribute to a better understanding of the pathogenesis of DG, opening new perspectives not only to elucidate the molecular mechanism involved in the action of PG on pancreatic cells and its relationship with DG, but for the development of strategies for the prevention and treatment of this disease based on antioxidant therapy

Made available in DSpace on 2014-12-17T14:03:42Z (GMT). No. of bitstreams: 1 FernandaBSR_DISSERT.pdf: 1261202 bytes, checksum: 37b0751e1ff652078acf0329a1653ef1 (MD5) Previous issue date: 2013-06-27 / Universidade Federal do Rio Grande do Norte / Micronutrient deficiencies affect individuals mainly in developing countries, where vitamin A deficiency is a public health problem worldwide more worrying, especially in groups with increased physiological needs such as children and women of reproductive age. Vitamin A is supplied to the body through diet and has an important role in the visual process, cell differentiation, maintenance of epithelial tissue, reproductive and resistance to infection. The literature has demonstrated the relationship between vitamin A and diabetes, including gestational, leading to a risk to both mother and child. Gestational diabetes is any decrease in glucose tolerance of variable magnitude diagnosed each the first time during pregnancy, and may or may not persist after delivery. Insulin resistance during pregnancy is associated with placental hormones, as well as excess fat. Studies have shown that retinol transport protein produced in adipose tissue in high concentrations, this would be associated with resistance by interfering with insulin signaling. Therefore, this study aimed to evaluate the concentration of retinol in serum and colostrum from healthy and diabetic mothers in the immediate postpartum period. One hundred and nine parturient women were recruited, representing seventy-three healthy and thirty-six diabetic. Retinol was extracted and subsequently analyzed by High Performance Liquid Chromatography. Among the results highlights the mothers with gestational diabetes were older than mothers healthy, had more children and a higher prevalence of cases of cesarean section. Fetal macrosomia was present in 1.4% of healthy parturient women and in 22.2% of diabetic mothers. The maternal serum retinol showed an average of 39.7 ? 12.5 mg/dL for healthy parturients 35.12 ? 15 mg/dL for diabetic and showed no statistical difference. It was observed that in the group of diabetic had 17% vitamin A deficiency, whereas in the healthy group, only 4% of the women were deficentes. Colostrum, the concentration of retinol in healthy was 131.3 ? 56.2 mg/dL and 125.3 ? 41.9 mg/dL in diabetic did not differ statistically. This concentration of retinol found in colostrum provides approximately 656.5 mg/day for infants born to healthy mothers and 626.5 mg/day for infants of diabetic mothers, based on a daily consumption of 500 mL of breast milk and need Vitamin A 400 mg/day, thus reaching the requirement of the infant. The diabetic mothers showed significant risk factors and complications related to gestational diabetes. Although no 11 difference was found in serum retinol concentration and colostrum among women with and without gestational diabetes, the individual analysis shows that parturients women with diabetes are 4.9 times more likely to develop vitamin A deficiency than healthy parturients. However, the supply of vitamin A to the newborn was not committed in the presence of gestational diabetes / As car?ncias de micronutrientes afetam indiv?duos principalmente nos pa?ses em desenvolvimento, em que a hipovitaminose A ? um dos problemas de sa?de p?blica mais preocupante mundialmente, principalmente nos grupos com necessidades fisiol?gicas aumentadas como crian?as e mulheres em idade reprodutiva. A vitamina A ? fornecida ao organismo por meio da dieta e possui papel essencial no processo visual, diferencia??o celular, manuten??o do tecido epitelial, reprodu??o e resist?ncia ?s infec??es. A literatura tem demonstrado rela??o entre a vitamina A e diabetes, inclusive a gestacional, levando a um risco para bin?mio m?e-filho. A diabetes gestacional ? qualquer diminui??o da toler?ncia ? glicose de magnitude vari?vel diagnosticada pela primeira vez na gesta??o, podendo ou n?o persistir ap?s o parto. A resist?ncia ? insulina na gesta??o est? associada aos horm?nios placent?rios, bem como ao excesso de tecido adiposo. Estudos t?m demonstrado que a prote?na transportadora de retinol produzida no tecido adiposo, em altas concentra??es, estaria associada a esta resist?ncia por interferir na sinaliza??o da insulina. Com isso, este trabalho objetivou avaliar a concentra??o de retinol no soro e colostro de parturientes diab?ticas e saud?veis no p?s-parto imediato. Cento e nove parturientes foram recrutadas, correspondendo a setenta e tr?s saud?veis e trinta e seis diab?ticas. O retinol foi extra?do e posteriormente analisado por Cromatografia L?quida de Alta Efici?ncia. Dentre os resultados destaca-se que as parturientes com diabetes gestacional tinham idade superior a das parturientes saud?veis, possu?am mais filhos e maior preval?ncia de casos de cesarianas. A macrossomia estava presente em 1,4% das parturientes saud?veis e em 22,2% das parturientes diab?ticas. O retinol do soro materno apresentou uma m?dia de 39,7 ? 12,5 &#956;g/dL para parturientes saud?veis e 35,12 ? 15 &#956;g/dL para diab?ticas e n?o apresentaram diferen?a estat?stica. Foi observado que no grupo de diab?ticas 17% tinham hipovitaminose A, enquanto que no grupo saud?vel, apenas 4% das mulheres estavam deficientes. No colostro, a concentra??o de retinol nas saud?veis foi de 131,3 ? 56,2 &#956;g/dL e nas diab?ticas 125,3 ? 41,9 &#956;g/dL, n?o diferindo estatisticamente. Esta concentra??o de retinol encontrada no colostro fornece aproximadamente 656,5&#956;g/dia para os rec?m-nascidos de m?es saud?veis e 626,5 &#956;g/dia para os rec?m-nascidos de diab?ticas, com base em um consumo di?rio de 500 mL de leite materno e necessidade nutricional de vitamina A de 400 &#956;g/dia, 9 atingindo assim, o requerimento do lactente. As parturientes diab?ticas apresentaram importantes fatores de risco e complica??es relacionadas ? diabetes gestacional. Apesar de n?o ter sido encontrada diferen?a na concentra??o de retinol s?rico e do colostro entre as mulheres com e sem diabetes gestacional, a an?lise individual demonstra que as parturientes diab?ticas est?o 4,9 vezes mais prop?cias a desenvolver hipovitaminose A do que as parturientes saud?veis. Contudo, o fornecimento de vitamina A para o rec?m-nascido n?o foi comprometido na presen?a da diabetes gestacional

Introdução: Devido à fatores hormonais e mecânicos, a gestação e o parto provocam alterações que podem gerar disfunções do assoalho pélvico (DAP). Os estudos sobre as DAP no puerpério a curto prazo são escassos e fazem uso assistemático de métodos avaliativos. Objetivo: Identificar e avaliar as DAP no pós-parto imediato, um mês e três meses após o parto, comparando parto vaginal (PV), cesárea eletiva (CE) e cesárea intraparto (CI). Métodos: Estudo observacional longitudinal que avaliou mulheres até 48 horas (fase 1); um mês (fase 2) e três meses após o parto (fase 3). Utilizou-se o International Consultation on Incontinence Questionnaire (ICIQ-SF); o Índice de Incontinência Anal (IA) de Jorge-Wexner; a Escala Análoga Visual (EVA) para dor pélvica; o Pelvic Organ Prolapse Quantification system (POP-Q) e a perineometria dos Músculos do Assoalho Pélvico (MAP), além de questionário estruturado. Resultados: Foram avaliadas 227 pacientes na fase 1 (141 realizaram PV; 28 realizaram CI e 58 realizaram CE); 79 na fase 2 e 41 na fase 3. O escore do ICIQ-SF, índice de IA, EVA e perineometria não apresentaram diferenças significativas em relação ao tipo de parto. O ponto distal do colo uterino apresentou-se mais prolapsado no grupo PV. Conclusão: O tipo de parto não foi um fator significante para o desenvolvimento das DAP no pós-parto a curto prazo. Foi identificado que ocorreu recuperação fisiológica na funcionalidade dos MAP e piora na sustentação da parede vaginal anterior e no impacto da incontinência urinária na qualidade de vida ao longo dos três meses. / Introduction: Due to mechanical and hormonal factors, pregnancy and childbirth triggers changes that can lead to pelvic floor dysfunction (PFD). PFD studies in the immediate postpartum period are scarce and do unsystematic use of evaluation methods. Objective: To identify and evaluate the immediate, one month and three months postpartum PFD, comparing vaginal delivery (VD), elective cesarean (ECS) and cesarean indicating (ICS) during labor. Methods: This was a longitudinal observational study that assessed postpartum women after up to 48 hours (phase 1); one month (phase 2) and three months (phase 3). The study used the International Consultation on Incontinence Questionnaire (ICIQ-SF); Jorge-Wexner's Anal Incontinence (AI) score; the Visual Analogue Scale (VAS) for pelvic pain; the Pelvic Organ Prolapse Quantification System (POP-Q); and a Pelvic Floor Muscles (PFM) perineometer, as well as a structured questionnaire. Results: A total of 227 patients were assessed in phase 1 (141 had VD, 28 ICS and 58 ECS); 79 in phase 2 and 41 in phase 3. The ICIQ-SF, AI, VAS and perineometer index did not present significant differences in relation to the type of delivery. The distal point of the cervix presented more prolapse in VD. Conclusion: The type of delivery was not a significant factor for the development of postpartum PFD in the short term. The study found that there was physiological recovery of the functionality of PFM and worsening prolapse of the anterior vaginal wall and urinary incontinence over the three months.