Bakgrund:Spiral är en högeffektiv preventivmedelsmetod och har tidigare enbart rekommenderats till kvinnor som fött barn. Dessa riktlinjer har förändrats och spiral är ett förstahandsalternativ till unga kvinnor. Barnmorskor ger trots det varierande information kring spiral till unga kvinnor. Syfte: Att belysa barnmorskors uppfattning av spiral som preventivmedelsmetod till unga kvinnor.Metod:Fenomenografisk forskningsmetod med induktiv ansats användes i studien. Sju barnmorskor intervjuades med semistrukturerade frågor i Västra Götaland.Resultat: Resultatet presenteras i tre beskrivningskategorier och fem uppfattningar: rätt information är av betydelse; unga kvinnors sexuella erfarenhet är av betydelse; Omgivningens kunskap varierar.Konklusion:Resultatet visar att individanpassad information är av stor vikt och att unga kvinnor ska få möjlighet till ett informerat val. Barnmorskor uppfattar att spiral är en effektiv preventivmedelsmetod till unga kvinnor som har debuterat sexuellt. Till de kvinnor som inte haft penetrerande samlag, rekommenderas en annan preventivmedelsmetod. Hur information om spiral ges är viktigt för följsamheten i användningen. De unga kvinnorna bör ha en realistisk bild av spiral och det är betydelsefullt att barnmorskor informerar om både för- och nackdelar. Genom att barnmorskorna är uppdaterade och inhämtar ny forskning kan rätt kunskap kring spiral förmedlas. / Background: Intrauterine device is an effective contraceptive method and was earlier only recommended for women who have had given birth. These guidelines have changed, and intrauterine device is a first choice for young women. Still midwives give various information about intrauterine device to young women.   Purpose: To illustrate midwives’ perceptions of intrauterine device to young women.Method: Phenomenographical research with an inductive approach was used in the study. 7 midwives were interviewed with semi-structured questions in western Sweden. Result: The midwives’ perceptions of intrauterine device as a contraceptive method to young women are presented in three descriptive categories and five perceptions: Rightinformation is of meaning; Young women’s sexual experience are of relevance; The environment’s knowledge varies.Conclusion: Midwives perception is that intrauterine deviceis an effective contraceptive method for young women who have had their sexual debut. For the young women who haven’t lost their virginity other contraceptive methods are preferred. How the information about intrauterine device is given is important for adherence among young women. The young women should have a realistic imageof the intrauterine device and there for it’s important that the midwives provide both advantages and disadvantages when they give information.If Midwives are updated and stays ahead with research they can provide a better knowledge of the intrauterine device.

Introdução: A obesidade pode se constituir como fator de risco para o uso de contraceptivos hormonais, especialmente aqueles contendo estrogênios, devido a possíveis efeitos metabólicos indesejados. As alterações metabólicas decorrentes do uso do sistema intrauterino liberador de levonorgestrel (SIU-LNG) foram bem descritas em mulheres com peso normal, mas não em mulheres obesas. Objetivo: Avaliar o efeito do sistema intrauterino liberador de levonorgestrel (SIU-LNG) sobre marcadores ultrassonográficos e laboratoriais de risco metabólico e doença cardiovascular em mulheres obesas. Casuística e Métodos: Estudo clínico randomizado aberto avaliando 106 mulheres obesas (30,0 Kg/m2 e <40 Kg/m2), com idade entre 18 e 40 anos, sem outras comorbidades. As pacientes foram avaliadas antes do início da contracepção e após um ano, sendo realizada randomização simples, para uso de SIU-LNG ou método não hormonal (a paciente poderia escolher entre dispositivo intrauterino de cobre ou preservativo). Foram avaliados: evolução ponderal; circunferência da cintura; volume uterino e ovariano; insulinemia e glicemia de jejum; perfil lipídico; testosterona; sex hormone binding globulin (SHBG); hemograma; aspartato aminotransferase (AST), a alanina aminotransferase (ALT), a fosfatase alcalina e gama glutamil transferase; índice de rigidez da carótida e espessura íntima-média (EIM); dilatação mediada por fluxo da artéria braquial (DMF) e doença hepática gordurosa não alcoólica (DHGNA). Resultados: Nenhuma diferença estatística foi observada na dilatação mediada por fluxo da artéria braquial entre as mulheres em uso de SIU-LNG e métodos não hormonais em um ano de observação. Observou-se uma redução do volume ovariano (-0,5&177;2,6 vs. 0,7&177;2,6 cm3, p=0,03). A hemoglobina aumentou nas usuárias de SIU-LNG (0,4&177;0,8 vs. -0,1&177;0,8 g/dL, p=0,00) juntamente com o hematocrito (1,8&177;2,2 vs. -0,0&177;2,3 %, p=0,00). Não houve alteração do perfil lipídico, glicêmico, da função hepática e doença hepática gordurosa não alcoolica no grupo das usuárias de SIU-LNG e nem das usuárias de métodos não hormonal. Conclusão: Concluiu-se que o SIU-LNG não apresentou efeito metabólico desfavorável comparado a métodos não hormonais após um ano, em mulheres obesas grau I e II, sem outras comorbidades. / Background: Obesity may be a risk factor for the use of hormonal contraceptives, especially those containing estrogens, due to possible unwanted metabolic effects. The metabolic effects of levonorgestrel-releasing intrauterine system (LNG-IUS) have been studied in normal-weight women but not in obese women. Objective: To evaluate the effect of levonorgestrel-releasing intrauterine system on multiple ultrasonographic and laboratorial markers of metabolic and cardiovascular disease risk in obese women. Methods: A randomized clinical trial study evaluating 106 obese women ( 30.0 kg/m2 and <40 kg/m2), aged between 18 and 40 years with desire contraception, without other co-morbidities. Patients were evaluated before the start of contraception and after a year, made simple randomization to use of LNG-IUS or nonhormonal method (the patient could choose between copper intrauterine device or condom). Were evaluated: weight gain; waist circumference; uterine and ovarian volumes; insulinemia and fasting glucose; lipid profile; testosterone; sex hormone binding globulin (SHBG); hemogram; aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase and gamma glutamyl transferase; stiffness index and carotid intima-media thickness (IMT); flow-mediated brachial artery dilatation (FMD) and nonalcoholic fatty liver disease (NAFLD). Results: No statistical difference was observed in flow-mediated brachial artery among women using the LNG-IUS and non-hormonal methods in one year of observation dilation. There was a volume reduction (-0.5 &177; 2.6 vs. 0.7 &177; 2.6 cm3, p=0.03). Hemoglobin increased in users of LNG-IUS (0.4 &177; 0.8 vs. -0.1 &177; 0.8 g/dL, p=0.00) together with the hematocrit (1.8 &177; 2.2 vs. -0.0 &177; 2.3%, p=0.00). There was no change in lipid profile, glucose, liver function and nonalcoholic fatty liver disease in the group of users of the LNG-IUS or the users of non-hormonal methods. Conclusion: We conclude that the LNG-IUS showed no adverse metabolic effect compared to non-hormonal methods after one year in grade I and II obese women without other comorbidities.

Embora o dispositivo intrauterino (DIU) seja pouco usado no Brasil, ele é o método contraceptivo reversível mais usado no mundo. Trata-se de um método seguro, altamente eficaz e com resultados positivos na saúde das populações. Por meio da prevenção de gestações não planejadas, atua na redução da morbidade e mortalidade materna, mortalidade infantil e abortos inseguros. Pesquisas recentes, contudo, mostram que o acesso ao DIU nos serviços de Atenção Básica à Saúde nem sempre é facilitado, sendo permeado por barreiras organizacionais que contribuem para sua subutilização. Tais barreiras podem restringir o pleno exercício dos direitos sexuais e reprodutivos das mulheres brasileiras. Objetivo: Identificar barreiras organizacionais para disponibilização do DIU nos serviços de Atenção Básica à Saúde e elaborar, como produto desta dissertação, uma síntese destas barreiras, destinada aos gestores de saúde, com suas implicações e recomendações. Método: Estudo quantitativo, descritivo. A coleta de dados foi realizada por meio do preenchimento de um instrumento estruturado, online, pelos 79 profissionais responsáveis pela área técnica de Saúde da Mulher. O cenário do estudo foi a macrorregião Sul de Minas Gerais. A análise dos dados foi realizada por meio do software Stata, versão 14.0, e descrita por meio de número absoluto e proporções. Resultados: A maioria dos municípios possui protocolo de atenção à saúde da mulher (55,7%). Destes, 77,3% elaboraram seu próprio protocolo, mas 29,6% não treinaram a equipe de saúde para usá-lo. Dentre todos os municípios participantes, 15,2% não disponibilizam DIU, sendo que alguns também não referenciam a mulher para outros serviços (8,3%). Dentre aqueles que disponibilizam o DIU, a grande maioria não possui protocolo específico (68,7%); uma parcela não adota a gravidez como condição impossibilitante da inserção do DIU (10,5%) e, por outro lado, adotam condições menos relevantes como infecção vaginal (80,6%). Como critério para acesso ao DIU, 86,5% referiram prescrição médica, 71,6% realização de exames, 44,6% idade acima de 18 anos e 24,4% participação em grupos. Como exames necessários, foi citado o Papanicolaou (94,7%), teste de gravidez (63,2%) e exame de sangue (29,8%). Quanto ao local de disponibilização, 83,7% não o disponibilizam nas Unidades Básicas de Saúde. Como profissional que insere o DIU, 97,0% referiram médico e nenhum citou o enfermeiro. Quanto aos grupos de planejamento reprodutivo, 43,0% dos municípios não os realizam. Por fim, 86,1% dos trabalhadores reportaram não haver dificuldades para obtenção do DIU. Conclusão: Foram identificadas barreiras organizacionais que dizem respeito ao uso de protocolos, também barreiras relacionadas à disponibilização e inserção do DIU, e barreiras relativas aos grupos de planejamento reprodutivo. / Introduction: Although the intrauterine device (IUD) is little used in Brazil, it is the most used reversible contraceptive method in the world. It is about a safe method, highly effective and with positive results in the health of populations. By means of preventing unplanned pregnancies, it works to reduce maternal morbidity and mortality, infant mortality and unsafe abortions. Recent research, however, show that access to IUD in Primary Health Attention services is not always facilitated, being permeated by organizational barriers that contribute to their underutilization. Such barriers may restrict the full exercise of sexual and reproductive rights of Brazilian women. Objective: To identify organizational barriers for providing IUD in the Primary Health Attention services and elaborate, as a product of this dissertation, a summary of these barriers, which is intended for health managers, with their implications and recommendations. Method: Qualitative, descriptive study. Data collection was performed by completing, online, a structured instrument, by 79 professionals responsible for the technical field of Womens Health. The study setting was the macro-region in the southern of Minas Gerais. Data analysis was performed using Stata software, version 14.0, and described by absolute number and proportions. Results: Most municipalities have attention protocol to womens health (55.7%). Of these, 77.3% developed its own protocol, but 29.6% did not train health staff to use it. Among all participating municipalities, 15.2% do not offer IUD, and some did not refer women to other services (8.3%). Among those, which provide the IUD, the vast majority do not have specific protocol (68.7%); a portion does not adopt pregnancy as an impeditive condition of insertion of the IUD (10.5%) and, on the other hand, adopt less relevant conditions such as vaginal infection (80.6%). As a criterion for accessing the IUD, 86.5% reported prescription, 71.6% exams, 44.6% aged over 18 years old and 24.4% participation in groups. As required exams, it was quoted the Pap smear (94.7%), pregnancy test (63,2%) and blood tests (29,8%). As a place of availability, 83.7% do not provide in the Basic Health Units. As a professional to insert the IUD, 97.0% reported the doctor and none cited the nurse. Municipalities do not realize reproductive planning group at 43.0%. Finally, 86.1% of workers reported not having difficulties in obtaining the IUD. Conclusion: Organizational barriers were identified concerning the use of protocols, also barriers related to the availability and IUD insertion, and barriers related to the reproductive planning groups.

Ausgehend von einer unspezifischen bakteriellen Infektion kann es während der Schwangerschaft zu einer Infektion der Fruchthöhle kommen. Das volle Bild dieser Art von Infektionen wird Amnioninfektionssyndrom genannt. Die Infektion der Fruchthöhle bedroht Mutter und Kind und die sofortige Entbindung würde ein rasches Abklingen der Infektion des Uterus herbeiführen. Auf der anderen Seite würde häufig eine Entbindung zu einem Zeitpunkt induziert, da das Kind zusätzlich zur Infektion durch die Unreife bedroht ist. Aus der Diagnostik heraus wird die Entscheidung über konservatives oder progressives Vorgehen getroffen. Es stellen sich folgende Fragen: 1. Sind die präpartal erhobenen klinischen Zeichen eines Amnioninfektionssyndromes relevant in der Diagnostik einer konnatal erworbenen neonatalen Infektion? 2. Sind die immunkompetenten Zellen des Neugeborenen in der Lage, inflammatorische Zytokine zu produzieren? 3. Gibt es lösliche Faktoren im Nabelschnurblut, die die Diagnostik einer Infektion des Neugeborenen entscheidend verbessern und die einen Zusammenhang mit einer Infektion der Plazenta aufweisen? 4. Besteht ein Zusammenhang zwischen der präpartalen klinischen Symptomatik eines Amnioninfektionssyndromes und den infektionsabhängigen löslichen Parametern im Nabelblut? Es wurden zwei prospektive Studien zur Beantwortung der Fragestellung durchgeführt. Im Rahmen der ersten Studie wurden 511 Fälle analysiert. Es fand eine Evaluierung der präpartalen klinischen Parameter bezogen auf das Ereignis neonatale Infektion und histologisch gesicherte Infektion der Plazenta statt. Die Konzentrationen der Zytokine Interleukin-6, Interleukin-8, Tumornekrosefaktor-a, G-CSF und der laborchemischen Parameter C-reaktives Protein und Procalcitonin wurde im Nabelschnurblut direkt nach der Geburt bestimmt. Diese Konzentrationen wurden in Bezug gesetzt zu klinischen Anzeichen einer Infektion des Neugeborenen und histologischen Zeichen einer Infektion der Plazenta. Außerdem wurden sie in Bezug gesetzt zu den präpartalen Symptomen eines Amnioninfektionssyndromes. In einer zweiten Studie wurden 42 Fälle analysiert. Mittels Durchflußzytometrie wurden Zellen aus Vollblut isoliert. Isoliert wurde die T-Zellpopulation CD 4 und CD 8 der Lymphozyten untersucht Eine intrazytoplasmatische Zytokinbestimmung nach Stimulation mit Ionomycin und Phorbol-12,13-Dibutyrat unter Verwendung von Monensin wurde durchgeführt. Bestimmt wurde die intrazytoplasmatische Zytokinfreisetzung der Zytokine Interleukin-6 und Interleukin-8. Die präpartalen Symptome mütterliche Temperaturerhöhung, mütterliche CRP-Erhöhung und fetale Tachykardie haben nur eine begrenzte Aussagekraft im Hinblick auf das Ereignis Neonatale Infektion. Während für die präpartal festgestellte fetale Tachykardie und die mütterliche Temperaturerhöhung eine Sensitivität für die "Neonatale Infektion" von 28,6 % bestimmt wurde, liegt dieser Wert für die präpartale mütterliche CRP-Erhöhung bei 45,5% deutlich höher. Die aus dem Nabelblut isolierten Lymphozyten sind in der Lage, auf eine unspezifische Stimulation hin, Interleukin-8 und Interleukin-6 zu produzieren. Signifikant höher liegt die Sekretion an Interleukin-6 dann, wenn die Kinder mit dem Verdacht auf eine peripartale Infektion geboren wurden oder wenn infektionsrelevante Ereignisse vor der Geburt aufgetreten waren. Von den im Nabelschnurblut untersuchten löslichen Parametern fällt auf, daß Procalcitonin mit einer Sensitivität von 93,3% und einer Spezifität von 73,1% ein sehr zuverlässiger Parameter zur Diagnostik einer neonatalen Infektion darstellt. Mit einer Sensitivität von 58,3% und einer Spezifität von 90,4% hebt sich auch der hochsensitive Nachweis des CRP im Nabelblut noch deutlich von den herkömmlich verwendeten Parametern ab. Nur eingeschränkte Aussagekraft auf das Ereignis "Neonatale Infektion" hat die Bestimmung des Interleukin-6. Die kombinierte Betrachtung der präpartal erhobenen klinischen Parameter fetale Tachykardie, mütterliche Temperaturerhöhung und mütterliche CRP-Erhöhung verbessert die vorgeburtliche Diagnostik einer intrauterin bestehenden Infektion deutlich. Der Nachweis der intrazellulären Interleukin-6- und Interleukin-8-Produktion durch neonatale Lymphozyten zeigt die Fähigkeit der zellvermittelten Immunität des Neugeborenen schon vor der Geburt auf bakterielle Infektionen reagieren zu können. Die differenzierte Reaktionsfähigkeit zeigt sich in der gesteigerten Interleukin-6-Syntheseleistung in all den Fällen, die in die "Infektionsgruppe" eingeschlossen waren. Von den löslichen Infektparametern im Nabelblut sticht das Procalcitonin als sehr zuverlässiger Marker sowohl einer Infektion des Neugeborenen als auch der histologisch gesicherten Infektion der Plazenta hervor. Auch Interleukin-6 sollte bestimmt werden. Die nachgewiesene Möglichkeit des Neugeborenen, inflammatorische Zytokine in hohen Konzentrationen als Antwort auf eine bakterielle Invasion produzieren zu können, scheint auch die Gefahr in sich zu bergen, durch eben dieses Interleukin-6 eine cerebral schädigende Reaktion zu erfahren. Zur Abschätzung dieses Risikos ist eine Bestimmung des Interleukin-6 im Nabelschnurblut empfehlenswert. / Starting with a nonspecific bacterial infection, during the pregnancy an infection of the amnion can occur. The full expression of this kind of infections is called chorioamnionitis. The infection of the amnion endangers mother and child, and the immediate delivery would produce a quick subsidence of the uterine infection. On the other hand a delivery would frequently be induced at a time when in addition to the infection the child is endangered by prematurity. Out of the diagnostic investigation the decision on conservative or progressive procedure is made. Following questions arise: 1. Are the prepartally ascertained clinical signs of a chorioamnionitis relevant in the diagnosis of a connatally acquired neonatal infection? 2. Are the immunocompetent cells of the neonate able to produce inflammatory cytokines? 3. Are there soluble factors in the cord blood which decisively improve the diagnosis of an infection of the neonate and show a correlation with an infection of the placenta? 4. Is there a correlation between the prepartal clinical symptoms of an amniotic infection syndrome and the infection-dependent soluble parameters in cord blood? Two prospective studies were carried out in order to answer the question. Within the scope of the first study 511 cases were analyzed. An evaluation of the prepartal clinical parameters related to the occurence neonatal infection and histologically established infection of the placenta took place. The concentrations of the cytokines interleukin-6, interleukin-8, tumor necrosis factor-a, G-CSF and the lab-chemical parameters C-reactive protein and procalcitonin were measured in the cord blood directly after birth. These concentrations were related to clinical signs of an infection of the neonate and histological signs of an amniotic infection. In addition they were related to the prepartal symptoms of an amniotic infection syndrome. In a second study 42 cases were analyzed. Using flow cytometry cells were isolated from whole blood. The T cell population CD 4 and CD 8 of lymphocytes was isolatedly examined. An intracytoplasmic cytokine analysis after stimulation with Ionomycin and phorbol-12,13-dibutyrate using Monensin was performed. The intracytoplasmic cytokine release of interleukin-6 and interleukin-8 was determined. The prepartal symptoms maternal elevation of temperature, maternal CRP increase and fetal tachycardia are only poor prognostic predictors with regard to the occurence neonatal infection. While for the prepartally ascertained fetal tachycardia and the maternal rise of temperature a sensitivity for the "neonatal infection" of 28.6% was determined, for the prepartal maternal CRP increase this value is clearly higher with 45.5%. The lymphocytes isolated from cord blood are able to produce interleukin-8 and interleukin-6 on account of a nonspecific stimulation. The interleukin-6 secretion is significantly higher if the children were born with the suspicion of a peripartal infection or if infection-relevant occurences were arisen before birth. Regarding the soluble parameters examined from the cord blood, it is remarkable that with a sensitivity of 93.3% and a specificity of 73.1% procalcitonin shows to be a very reliable parameter for diagnosis of a neonatal infection. With a sensitivity of 58.3% and a specificity of 90.4% also the high sensitive detection of CRP in cord blood stands out clearly from the conventionally used parameters. The determination of interleukin-6 has only a limited meaningfulness with regard to the occurence "neonatal infection". The combined contemplation of the prepartally measured clinical parameters fetal tachycardia, maternal rise of temperature and maternal CRP elevation clearly improves the antenatal diagnosis of an intrauterine infection. The detection of intracellular interleukin-6 and interleukin-8 production through neonatal lymphocytes shows the capability of cell-mediated immunity of neonate to react to a bacterial infection before birth. The differentiated reactivity is shown in the increased interleukin-6 synthesis in all those cases which were included in the "infection group". Among the soluble infection parameters in cord blood the procalcitonin stands out as a very reliable marker of neonatal infection as well as the histologically established infection of the placenta. Interleukin-6 should also be determined. The proved possibility of the neonate to produce inflammatory cytokines in high concentrations as an answer to a bacterial invasion seems also to involve the risk to experience a cerebrally damaging reaction through exactly this interleukin-6. For estimation of this risk, an interleukin-6 analysis in cord blood is recommendable.

A malária é uma doença parasitária grave e quando ocorre durante a gravidez é uma das principais causas de mortalidade materno-infantil, podendo apresentar como consequências anemia materna, aborto, nascimento prematuro, restrição do crescimento intrauterino e baixo peso ao nascer (BPN). A infecção por Plasmodium (P.) falciparum é reconhecida como um determinante importante de consequências sérias durante a gravidez e efeitos adversos semelhantes também foram relatados em infecções por P. vivax. A despeito de sua alta prevalência e a sua possível associação com importantes complicações durante a gravidez, os efeitos da malária para gestantes e seus conceptos ainda não estão totalmente compreendidos. Este trabalho propõe estudar as consequências da malária gestacional e sua associação com a restrição do crescimento intrauterino e baixo peso ao nascer em uma área endêmica no extremo oeste da Amazônia brasileira. Foi realizado um estudo retrospectivo e prospectivo composto por gestantes da região do Vale do Alto Juruá (Acre, Brasil), no qual foram avaliadas as consequências e a extensão do efeito da malária sobre o recém-nascido através da coleta de dados epidemiológicos e material biológico. Neste estudo, foi observado um aumento no número de partos prematuros e BPN entre os recém-nascidos das gestantes infectadas por P. vivax quando comparadas com o grupo não infectado. Em relação à infecção por P. falciparum durante a gravidez, observamos que a doença representou um fator de risco para o nascimento de neonatos com perímetro cefálico reduzido, assim como uma maior probabilidade de ocorrência de casos de microcefalia e nascimentos prematuros. Além disso, todos esses efeitos adversos estavam ligados à malária placentária, caracterizada principalmente por um aumento de agregados nucleares sinciciais e infiltrados inflamatórios, bem como um forte desequilíbrio dos fatores angiogênicos e diminuição dos níveis de leptina. Muitos estudos, realizados principalmente na África, destacam os efeitos deletérios da malária por P. falciparum no contexto materno-fetal, mas pouco se sabe sobre a malária gestacional nas áreas endêmicas da América, onde predominam as infecções por P. vivax. Nossos resultados sugerem que infecções por esta espécie estão longe de serem benignas em razão da alta incidência de lesões placentárias, baixo peso ao nascer, abortos e partos prematuro em nossa casuística. Além disso, este estudo também mostrou que a malária gestacional por P. falciparum aumentou a probabilidade de partos prematuros e a ocorrência da redução do perímetro cefálico nos recém-nascidos, o que está associado à malária placentária. Assim, o conhecimento do impacto da infecção sobre a placenta e no desenvolvimento fetal poderá trazer uma importante contribuição para o entendimento da malária gestacional, além de possibilitar o desenvolvimento de ações específicas na rotina de cuidado pré-natal. / Malaria is a severe parasitic disease that, when occurs during pregnancy, it is one of the main cause of maternal-fetal mortality leading also to maternal anemia, abortion, preterm birth, intrauterine growth restriction and low birth weight. Infections by Plasmodium (P.) falciparum are known to be detrimentally involved in poor pregnancy outcomes, effects that were also described during P. vivax infections. Despite its significant prevalence and possible association to severe complications during pregnancy, the impact of malaria in pregnant women and their children are not clearly understood. Current study aims to evaluate the consequences of malaria in pregnancy and correspondent association with intrauterine growth restriction and low birth weight in an endemic area located in the furthest west region of the Brazilian Amazon. A retrospective and prospective study was performed, accounting with pregnant women living in the region of Vale do Alto Juruá (Acre, Brazil) in which the consequences and extension of malaria effects on the newborns was evaluated through the analysis of epidemiological data and biological material. In this study, we observed an increase in the number of preterm deliveries and low birth weight among children born from pregnant women infected with P. vivax when compared to non-infected pregnant women. Regarding P. falciparum infection during pregnancy, we have noticed that this is a risk factor for newborns with reduced head circumference, also increasing the probability of occurring cases of microcephaly and preterm birth. Besides, every deleterious effect was associated with placental malaria, which is mainly characterized by an increase in the syncytial nuclear aggregates and inflammatory infiltrates, as well as by an imbalance in placental angiogenic factors and a reduction in leptin levels. Several studies mainly developed in Africa, highlight the negative effects of P. falciparum malaria in the maternal-fetal context yet, little is known about malaria in pregnancy that occurs in the endemic areas of the America where infections caused by P. vivax are predominate. Our results suggest that infections promoted by this parasite species are far from being benign as it was depicted in our cohort, which has shown high incidence of placental lesions, low birth weight, abortion and preterm delivery. Moreover, the present study has shown that malaria in pregnancy caused by P. falciparum increased the probability of preterm delivery and reduction of head circumference in newborns, which is associated to placental malaria. Therefore, knowing the impact of infection in the placenta and fetal development may bring an important contribution to the understanding of malaria in pregnancy, allowing the development of specific action that can be implemented in the routine of antenatal cares.

Introdução: Evidências sugerem que alterações no ambiente intrauterino afetam o persistentemente o desenvolvimento de diferentes órgãos e sistemas de modo a programar o risco para doenças crônicas ao longo da vida. A restrição de crescimento intrauterino (RCIU) é associada com o aumento da preferência pelos alimentos palatáveis e risco para doenças metabólicas na vida adulta. Níveis alterados de insulina no ambiente fetal encontrados em indivíduos que sofreram RCIU podem modificar a formação das vias associadas ao prazer e recompensa (sistemas opioide e dopaminérgico), modificando o comportamento alimentar. O objetivo deste estudo foi avaliar possíveis alterações na resposta frente ao alimento palatável em animais submetidos à RCIU. Metodologia: No dia 10 de gestação ratas Sprague-Dawley receberam dieta à vontade (AdLib), ou dieta restrição de 50% (FR). No nascimento, houve adoção cruzada dos filhotes, gerando os grupos (gestação/lactação): AdLib/AdLib (Controles) e FR/AdLib (Restrição de Crescimento Fetal - FR). No estudo 1, foi avaliada a resposta hedônica dos animais em 2 momentos (nas primeiras 24h de vida e aos 90 dias de vida). Em ambas as idades os ratos receberam solução de sacarose ou água destilada e as respostas hedônicas faciais exibidas em 60 segundos foram analisadas. No estudo 2, na idade adulta (ratos machos ao redor dos 80 dias de vida) foi avaliado o consumo de dieta hiperpalatável e o nível de organização do comportamento alimentar usando o BioDAQ®, assim como a liberação de dopamina frente à ração padrão ou alimento palatável foi mensurada pela cronoamperometria no núcleo accumbens (NAcc), com ou sem o uso prévio de insulina sistêmica (5UI/kg) Resultados: Estudo 1; nos filhotes a resposta hedônica foi maior nos animais FR expostos a sacarose em comparação a água, sem diferenças nos filhotes do grupo controle. Houve diminuição na fosforilação do receptor mu opioide nos filhotes FR comparados aos controles. Na vida adulta, a resposta hedônica e a fosforilação mu opioide não foram diferentes entre os grupos, sugerindo que as alterações da resposta hedônica e a fosforilação mu opioide observadas no primeiro dia de vida não persistem. No estudo 2, existiu uma interação entre grupo e período do dia em relação ao consumo de ração hiperpalatável, os animais FR comeram mais ração hiperpalatável do que os controles no período ativo (ciclo escuro), e o padrão alimentar apresentou uma maior entropia (consumo imprevisível e fragmentado) no grupo FR neste ciclo. Existiu um atraso na liberação de dopamina no grupo FR em resposta ao Froot Loops® (tempo para a dopamina alcançar o pico máximo), mas não em resposta a ração padrão. O tratamento com insulina reverteu a diferença observada entre os grupos na resposta ao Froot Loops®. Western Blotting mostrou que SOCS3 diminui na área tegmentar ventral (VTA) dos FR; pTH/TH aumentou no NAcc de FR, como previamente demonstrado, mas similarmente aos achados da cronoamperometria, estas diferenças foram revertidas pela insulina Conclusão: Há alteração da resposta hedônica no primeiro dia de vida em animais RCIU, juntamente de modificações na fosforilação de receptores opioides, e estas diferenças não persistem na vida adulta. A RCIU altera a sensibilidade à insulina no VTA e consequentemente leva à modulação diferencial do sistema dopaminérgico, o que se reflete no padrão e preferência alimentar em machos adultos. A RCIU induz a alterações nos níveis de insulina possivelmente modificando a funcionalidade das vias hedônicas opioide e dopaminérgica. A RCIU programa alterações neurocomportamentais, afetando o comportamento alimentar, persistentes ao longo da vida que podem colaborar com o desenvolvimento da síndrome metabólica a longo prazo. / Introduction: Evidence suggests that alteration in the intrauterine environment persistently affects the development of different organs and systems and programs the risk for chronic diseases throughout the life. Intrauterine growth restriction (IUGR) is associated with increased preference for palatable foods and risk to metabolic disease in adulthood. Altered insulin levels in fetal environment in individuals who suffer IUGR can modify the development of the pathways associated with pleasure and reward (opioid and dopaminergic system), modifying eating behavior. The aim of this study was to evaluate possible changes in the brain response to palatable food in animals submitted to IUGR. Methods: At gestation day 10, Sprague-Dawley dams are assigned to receive ad libitum diet (AdLib) or 50% restricted diet (FR). At birth, pups were cross-fostered generating two groups (pregnancy/lactation): AdLib/AdLib (Controls) and FR/Adlib (Intrauterine growth restriction - FR). In the Study 1 the hedonic response of the animals was evaluated in 2 moments (24 hours after birth and at 90 days of life). In both ages, rats received sucrose solution or water and the hedonic facial responses exhibited within 60 sec were analyzed. The Study 2, in adulthood (male rats around 80 days of life) the palatable food consumption was evaluated and feeding behavior entropy was assessed using the BioDAQ®. The dopamine release facing standard chow and palatable food was measured by chronoamperometry recordings in nucleus accumbens (NAcc), with or without previous systemic insulin treatment (5UI/kg) Results: In the Study 1, pups’ hedonic responses were higher in FR pups exposed to sucrose as compared to water, without differences in Control pups. There was decreased phosphorylation of the mu opioid receptor in FR pups compared to Controls. In adult life, hedonic responses and mu opioid phosphorylation were not different between groups, suggesting that the alterations in hedonic response and in mu opioid phosphorylation observed in early life do not persist. In the Study 2, there was an interaction between group and time of the day on the palatable food consumption, FR rats eat more palatable foods than the Control group in the active period (dark cycle), and the eating pattern has a higher entropy (unpredictable and fragmented consumption) in the FR group in this cycle. There was a delayed dopamine release in the FR group in response to Froot Loops® (time to reach the peak dopamine release), but not in response to standard chow. Insulin treatment reverted the difference observed between groups in the dopamine (DA) response to Froot Loops®. Western blot showed that SOCS3 was decreased in the ventral tegmental area (VTA) of FR; pTH/TH was increased in the NAcc of FR, as we have previously shown, but similarly to the chronoamperometry findings, these differences was reverted by insulin Conclusion: There is an alteration in the hedonic response to sucrose in the first day of life in IUGR animals, together with modifications in opioid receptor phosphorylation, and these differences do not persist in adult life. IUGR alters insulin sensitivity in VTA and consequently leads to a differential dopaminergic modulation by insulin, which is reflected in the pattern and food preference in adult males. IUGR induces alterations in insulin levels possibly modifying the functionality of the opioid and dopaminergic hedonic pathways. IUGR programs neurobehavioral changes, affecting eating behavior, persistently throughout life that may contribute to the development of metabolic syndrome in the long term.

Introdução: Alterações no ambiente fetal conferem um risco aumentado para doenças crônicas como obesidade, doença cardiovascular, hipertensão arterial e diabetes tipo 2. As evidências sugerem que a restrição de crescimento intrauterino (RCIU) pode programar de forma persistente as preferências alimentares, e acredita-se que esse tipo de alteração comportamental, pode explicar, pelo menos em parte, o aumento do risco para essas doenças em indivíduos que sofreram RCIU. Portanto, torna-se importante entender os fatores associados e mecanismos envolvidos nesse comportamento. O objetivo deste trabalho foi investigar o efeito da RCIU no comportamento alimentar em animais e humanos, assim como os possíveis mecanismos envolvidos na sua programação. Métodos: Ratas Sprague Dawley prenhes foram randomizadas para o grupo controle (Adlib), que recebeu dieta padrão ad libitum ou grupo restrição 50% (FR), que recebeu 50% do consumo habitual de genitoras alimentadas ad libitum. As dietas foram oferecidas a partir do dia 10 de gestação até o dia 21 de lactação. Em até 24h após o nascimento, foi realizada a adoção cruzada formando os grupos: Adlib_Adlib, FR_Adlib, FR_FR, Adlib_FR. O consumo de ração padrão foi comparado entre todos os grupos. A preferência alimentar, a preferência condicionada por lugar induzida por alimento palatável, assim como a fosforilação da enzima tirosina hidroxilase e os níveis de receptores D2 no núcleo acumbens foram comparados entre os grupos de interesse (Adlib_Adlib e FR_Adlib). Nos humanos, 75 jovens, classificados quanto à RCIU, participaram de avaliação antropométrica, bioquímica e de comportamento alimentar (teste de escolha alimentar, no qual todos recebiam um valor monetário para compra de um lanche, e Dutch Eating Behaviour Questionnaire, DEBQ). Dados de neuroimagem funcional em repouso entre regiões relacionadas à recompensa de 28 indivíduos foram processados e analisados, de um total de 43 exames realizados. Resultados: No estudo experimental, viu-se que o consumo de ração padrão não foi diferente entre os grupos. Ratos restritos apresentaram preferência pela dieta palatável, mas menor condicionamento de preferência ao lugar associado ao alimento palatável. A fosforilação da tirosina hidroxilase no núcleo acumbens foi maior nestes animais no estado basal, mas após exposição ao doce essa diferença entre os grupos permaneceu apenas nos machos. A RCIU também se associou a menores níveis de receptores D2 no núcleo acumbens. No estudo clínico, encontrou-se que a menor razão de crescimento fetal (indicativo de maior RCIU) e alto índice de massa corporal predizem um estilo alimentar restritivo visto pelo DEBQ. Pessoas nascidas com RCIU também usaram menor quantidade do um recurso financeiro oferecido no teste de escolha alimentar após um período de jejum. Os dados de neuroimagem funcional sugerem que os indivíduos restritos apresentam um padrão de conectividade em repouso alterado entre o córtex orbito-frontal, o estriado ventral/dorsal e a amígdala. Conclusão: A RCIU esteve associada com preferência por alimentos palatáveis e alterações no sistema dopaminérgico no estudo experimental e alterações da conectividade em repouso entre áreas do sistema mesocorticolímbico no estudo clínico. As alterações observadas no sistema dopaminérgico dos animais restritos indicam que esse sistema estaria envolvido na programação da preferência alimentar nesses indivíduos. Além disso, o padrão de conectividade em repouso observado nos indivíduos restritos sugere que alterações em determinadas regiões do sistema de recompensa poderiam estar associadas com mudanças no comportamento alimentar. As alterações neurocomportamentais observadas confirmam a existência de programação fetal do comportamento alimentar pela RCIU, apontando modificações persistentes no sistema de recompensa do cérebro, o que pode ser visto como um fator de risco para o desenvolvimento de obesidade e suas comorbidades. / Introduction: Fetal environment changes can lead to adaptations that are associated with increased risk for obesity, cardiovascular disease, hypertension and diabetes in adult life. Evidence suggests that intrauterine growth restriction (IUGR) can persistently program the subject’s preference for palatable foods. It is believed that feeding behavior alterations can explain, at least in part, the increased risk for chronic diseases in IUGR individuals. Therefore, it becomes important to understand the factors and mechanisms involved in this behavior. The aim of this study was to explore how IUGR affects feeding behavior of animals and humans, as well as to verify the potential mechanisms related to this behavioral programming. Methods: Time-mated pregnant Sprague-Dawley rats were randomly allocated to Control (receiving standard chow ad libitum) or 50% food restricted (FR), receiving 50% of the ad libitum-fed dam’s habitual intake. These diets were provided from day 10 of pregnancy throughout day 21 of lactation. Within 24 hours after birth, pups were crossfostered, forming four groups: Adlib_Adlib, FR_Adlib, FR_FR, Adlib_FR. Standard chow consumption was compared between all groups. Food preference, conditioned place preference to a palatable diet, and the nucleus accumbens tyrosine hydroxylase phosphorylation and D2 receptor levels were analyzed focusing on two groups of interest (Adlib_Adlib and FR_Adlib). In humans, 75 youths were classified regarding IUGR and had anthropometric data, biochemical data, and feeding behavior (food choice task, in which everyone received a monetary value to purchase a snack, and Dutch Eating Behaviour Questionnaire) assessed. Forty three neuroimaging exams were performed and resting state functional connectivity between brain regions related to reward of 28 individuals were processed and analyzed. Results: In the experimental study, standard chow consumption was not different between groups. IUGR adult rats had increased preference for palatable food, but showed less conditioned place preference to a palatable diet compared to controls. At baseline, the accumbal tyrosine hydroxylase phosphorylation was increased in IUGR rats compared to controls. After sweet food exposure, the difference between groups remained only in males. Accumbal D2 receptors levels were decreased in IUGR rats. In the clinical study, it was found that low birth weight ratio (indicative of higher IUGR) and high body mass index predict a restrained eating style as seen by the DEBQ. IUGR individuals used a smaller quantity of a financial resource offered in the food choice task after a fasting period. Resting state functional connectivity data suggest that IUGR individuals had an altered pattern of connectivity between the orbitofrontal cortex, the ventral/dorsal striatum and the amygdala. Conclusion: IUGR was associated with a preference for palatable foods and alterations in the dopaminergic system in the experimental study, as well as changes in the resting state functional connectivity between regions of the mesocorticolimbic pathway in the clinical study. Alterations in the mesolimbic dopaminergic system observed in IUGR rats indicate an important role in the programming of food preferences. Moreover, the IUGR pattern of brain connectivity observed suggests that alterations in certain regions involved in reward processing and evaluation could be associated with changes in eating behavior. Neurobehavioral changes observed confirmed the existence of a fetal programming of feeding behavior associated with IUGR, pointing out to persistent modifications in the brain reward system, which can be seen as a risk factor for the development of obesity and its comorbidities.

<p>This secondary analysis aimed to develop dietary scores to assess the dietary intake of pregnant women in the West Coast/ Winelands region and determine the association with LBW. Further to determine the association between the dietary scores and maternal socioeconomic and socio-demographic characteristics and maternal smoking and/or alcohol consumption during pregnancy.</p>

In an unselected series of mentally retarded children in the county of Västerbotten, Sweden, the annual incidence of children with severe mental retardation (SMR) (IQ &lt; 50) and alive at the age of one year decreased from 5.3 per 1,000 in 1959 - 1963 to 3.1 per 1,000 in 1967 -1970. This was mainly due to a decrease in the incidence of Down's syndrome. In parallel the proportion of mothers 35 years of age or more at the birth of the child decreased significantly. The prevalence of children with SMR in 1976 was 3.5 per 1,000. The main cause of the SMR was prenatal in 70 percent, perinatal in 8 percent and postnatal in 1 percent. The cause of the SMR was untraceable in 20 percent of the cases. Associated CNS-handicaps occurred in 52 percent of the cases. The annual incidence of mildly mentally retarded children (IQ 50 - 69) registered at the Bureau for Provision and Services for Mentally Retarded was 4.2 per 1,000 and the prevalence in 1979 was 3.8 per 1,000. The cause of the mild mental retardation (MMR) was untraceable in 43 percent. Prenatal causes were identified in as many as 43 percent. Perinatal causes were found in 7 percent and postnatal causes in 5 percent of the cases. Associated CNS-handicaps occurred in 30 percent of the cases.A syndrome of mental retardation with X-linked inheritance not recognized previously in Sweden was characterized clinically (mainly in boys, machro-orchidism, verbal disabilities) and cytogenetically (a fragile site on the X-chromosomes seen after cui turing in special folic acid deficient media) and found to have a prevalence of 6 percent in the population of severely mentally retarded boys. This makes this syndrome the next most common cause of SMR in boys after Down's syndrome. The chromosomal fragility was also identified in female carriers, which has implications for genetic counselling.Through identification of an untreated Phenylketonurie mother giving birth to five severely mentally retarded children, attention was focused on the risks for the fetus of the growing number of Phenylketonurie women identified neonatally and treated di etarily but untreated after the age of 10 - 15 years.Great improvement in intellectual and social ability was seen in a boy with phenylketonuria although the dietary treatment was not introduced until the age of eight years.Heavy irradiation of a fetus late in gestation caused mental retardation, microcephaly, stunted growth, and eye and teeth abnormalities, although such abnormalities are thought not to result from irradiation after 20 weeks of pregnancy. / <p>Endast s.1-71: sammanfattningen (kappan) i fulltexten.</p><p>Ej med i fulltexten s.72-145: 7 delar.</p> / digitalisering@umu

<p>This secondary analysis aimed to develop dietary scores to assess the dietary intake of pregnant women in the West Coast/ Winelands region and determine the association with LBW. Further to determine the association between the dietary scores and maternal socioeconomic and socio-demographic characteristics and maternal smoking and/or alcohol consumption during pregnancy.</p>