Vitamin D status is assessed with circulating 25-hydroxyvitamin D [25(OH)D]. As some evidence suggests that low vitamin D status adversely affects neonatal health, this project aimed to determine the association between cord blood 25(OH)D levels and preterm birth (PTB; <37 weeks gestation), low birthweight (LBW; <2500 grams) and small for gestational age (SGA; <10th percentile) and to examine the relationship between maternal 25(OH)D levels during the first trimester of pregnancy and fetal 25(OH)D levels at birth in a Canadian population. This nested case-control study used serums, questionnaires and chart reviews collected in Quebec City. Compared to 25(OH)D concentrations ≥75 nmol/L, concentrations 37.5-<75, 50-<75, and <75 nmol/L were associated with lower odds of LBW, PTB and an adverse neonatal composite outcome, and PTB as well as LBW, respectively. Maternal and neonatal 25(OH)D were correlated (r=0.23, p<0.01; adjusted r=0.46, p<0.01). This study contributes to evidence for identifying further policy and research directions.

Background: Physiological studies have shown that many preterm infants and infants with chronic lung disease may suffer chronic hypoxaemia, which possibly leads to poor growth and development. Anecdotal reports indicate that there is a drive to increase the oxygen saturation target range to a higher level in these infants due primarily to perceived benefits derived from clinical experience and from uncontrolled observational studies of babies discharged on home oxygen. Objective The BOOST (Benefits Of Oxygen Saturation Targeting) trial is the first randomised trial to assess the long-term benefits and harms of two different oxygen saturation target ranges. Methods: BOOST was a multicentre, double blinded, randomised controlled trial that enrolled 358 infants born at less than 30 weeks� gestation who remained oxygen-dependent at 32 weeks postmenstrual age. They were randomly assigned to target either a functional oxygen saturation range of 91-94% (standard or control group) or 95-98% (higher or treatment group). The primary outcomes were growth and neurodevelopmental measures at 12 months corrected age. Secondary outcomes included length of hospital stay, retinopathy of prematurity, health service utilisation, parental stress, and infant temperament. Results: Prognostic baseline characteristics did not differ between the two groups. Mean birth weight and gestational age of enrolled infants was 917g and 26.5 weeks respectively. The rate of antenatal corticosteroid use was 83%.

Submitted by CAROLINE DE PAULA VENEZIAN RICCETTO (carol_venezian@hotmail.com) on 2017-08-30T02:23:37Z No. of bitstreams: 1 Dissertação Mestrado Final Reservatório - Caroline de Paula Venezian Riccetto.pdf: 1192284 bytes, checksum: 70d4763a62fcf9cfaa5cf750dc451f3c (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-08-30T17:33:13Z (GMT) No. of bitstreams: 1 riccetto_cpv_me_bot.pdf: 1192284 bytes, checksum: 70d4763a62fcf9cfaa5cf750dc451f3c (MD5) / Made available in DSpace on 2017-08-30T17:33:13Z (GMT). No. of bitstreams: 1 riccetto_cpv_me_bot.pdf: 1192284 bytes, checksum: 70d4763a62fcf9cfaa5cf750dc451f3c (MD5) Previous issue date: 2017-08-21 / Objetivo: Determinar o efeito do uso da sonda de Foley para o preparo de colo uterino, em gestantes tratadas em regime ambulatorial versus internação. Sujeitos e métodos: Foi realizado um estudo prospectivo, randomizado e do tipo ensaio clínico. Trinta e sete mulheres com gestação de baixo risco foram randomizadas para o preparo de colo uterino, com sonda de Foley, em dois grupos: ambulatorial (n=17) e internação (n=20). Os principais desfechos avaliados foram: índice de Bishop final, número de gestantes que modificaram o índice de Bishop de desfavorável para favorável, tipo de parto, uso de ocitocina, tempo de internação, morbidade materna e neonatal grave, óbito neonatal, taquissistolia com alteração da frequência cardíaca fetal e Apgar de quinto minuto ≤ 7. Para a análise estatística foram utilizados o teste de qui-quadrado para comparar proporções e o teste t de Student para a comparação de médias. O nível de significância estabelecido foi de 5% ( = 0,05). Resultados: Não houve diferença estatística significativa entre os dois grupos quanto ao índice de Bishop final, tipo de parto, necessidade de uso de ocitocina, morbidade materna e neonatal grave, óbito neonatal, taquissistolia com alteração da frequência cardíaca fetal e Apgar de quinto minuto ≤ 7. Como esperado, as gestantes do grupo internação tiveram mais horas dentro do ambiente hospitalar do que as do grupo ambulatorial (77,7 horas no grupo ambulatorial versus 93,1 horas no grupo internação), entretanto não houve diferença estatística. Conclusão: Gestantes do grupo ambulatorial apresentaram os mesmos desfechos que gestantes do grupo internação, com diminuição do tempo de internação e, consequentemente, redução do custo de tratamento, além da possibilidade de permanecer maior tempo no conforto do lar e na convivência familiar. / Objective: To determine the effect of the use of the Foley catheter for the cervical ripening, in pregnant women treated on an outpatient basis versus hospitalization. Subjects and methods: A prospective, randomized clinical trial was conducted. Thirty-seven women with low-risk pregnancies were randomized to the cervical ripening with a Foley catheter in two groups: outpatient (n = 17) and hospitalization (n = 20). The main outcome measures were: Bishop's final index, number of pregnant women who modified Bishop's ratio from unfavorable to favorable, type of delivery, oxytocin use, hospitalization time, severe maternal and neonatal morbidity, neonatal death, tachysystole with alteration of Fetal heart rate and fifth-minute Apgar ≤ 7. For the statistical analysis the chi-square test was used to compare proportions and Student's t-test for comparison of means. The level of significance was set at 5% ( = 0.05). Results: There was no statistically significant difference between the two groups regarding the final Bishop index, type of delivery, need for oxytocin use, severe maternal and neonatal morbidity, neonatal death, tachysystole with altered fetal heart rate, and fifth-minute Apgar ≤ 7. As expected, the pregnant women in the hospitalization group had more hours within the hospital setting than the outpatient group (77.7 hours in the outpatient group versus 93.1 hours in the hospitalization group), however there were no statistical differences. Conclusion: Pregnant women in the outpatient group presented the same outcomes as pregnant women in the hospitalization group, with a reduction in the length of hospital stay and, consequently, a reduction in the cost of treatment, as well as the possibility of remaining longer in the comfort of the home and in the family support.

Orientador: Vera Therezinha Medeiros Borges / Resumo: Objetivo: Determinar o efeito do uso da sonda de Foley para o preparo de colo uterino, em gestantes tratadas em regime ambulatorial versus internação. Sujeitos e métodos: Foi realizado um estudo prospectivo, randomizado e do tipo ensaio clínico. Trinta e sete mulheres com gestação de baixo risco foram randomizadas para o preparo de colo uterino, com sonda de Foley, em dois grupos: ambulatorial (n=17) e internação (n=20). Os principais desfechos avaliados foram: índice de Bishop final, número de gestantes que modificaram o índice de Bishop de desfavorável para favorável, tipo de parto, uso de ocitocina, tempo de internação, morbidade materna e neonatal grave, óbito neonatal, taquissistolia com alteração da frequência cardíaca fetal e Apgar de quinto minuto ≤ 7. Para a análise estatística foram utilizados o teste de qui-quadrado para comparar proporções e o teste t de Student para a comparação de médias. O nível de significância estabelecido foi de 5% ( = 0,05). Resultados: Não houve diferença estatística significativa entre os dois grupos quanto ao índice de Bishop final, tipo de parto, necessidade de uso de ocitocina, morbidade materna e neonatal grave, óbito neonatal, taquissistolia com alteração da frequência cardíaca fetal e Apgar de quinto minuto ≤ 7. Como esperado, as gestantes do grupo internação tiveram mais horas dentro do ambiente hospitalar do que as do grupo ambulatorial (77,7 horas no grupo ambulatorial versus 93,1 horas no grupo internação), entretanto não hou... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: To determine the effect of the use of the Foley catheter for the cervical ripening, in pregnant women treated on an outpatient basis versus hospitalization. Subjects and methods: A prospective, randomized clinical trial was conducted. Thirty-seven women with low-risk pregnancies were randomized to the cervical ripening with a Foley catheter in two groups: outpatient (n = 17) and hospitalization (n = 20). The main outcome measures were: Bishop's final index, number of pregnant women who modified Bishop's ratio from unfavorable to favorable, type of delivery, oxytocin use, hospitalization time, severe maternal and neonatal morbidity, neonatal death, tachysystole with alteration of Fetal heart rate and fifth-minute Apgar ≤ 7. For the statistical analysis the chi-square test was used to compare proportions and Student's t-test for comparison of means. The level of significance was set at 5% ( = 0.05). Results: There was no statistically significant difference between the two groups regarding the final Bishop index, type of delivery, need for oxytocin use, severe maternal and neonatal morbidity, neonatal death, tachysystole with altered fetal heart rate, and fifth-minute Apgar ≤ 7. As expected, the pregnant women in the hospitalization group had more hours within the hospital setting than the outpatient group (77.7 hours in the outpatient group versus 93.1 hours in the hospitalization group), however there were no statistical differences. Conclusion: Pregnant women ... (Complete abstract click electronic access below) / Mestre

Women using addictive substances during pregnancy: the effects of substance abuse on the prenatal and postnatal development of child Blanka Nechanská Abstract Background: Substance abuse among pregnant women represents a public health issue internationally, associated with high costs to the society and at the personal level for the women and children involved. Aims: The aim of the study was to determine the basic socioeconomic characteristics of women with substance use disorder during pregnancy and selected characteristics neonatal outcomes their children. Another goal was to study the morbidity in children prenatally exposed to addictive substances by studying hospitalizations up to three years of age. Material and methods: Series of analysis within database-linkage study combining data on pregnancy and neonatal outcomes with data from in-patient treatment in CR in 2000-2014 was performed. The sample consisted of pregnant women diagnosed with substance use disorder during pregnancy and women from general population, and their children. Neonatal outcomes were gestational age, birth weight and length, preterm birth, and intrauterine growth restriction (Small-for-Gestational-Age, SGA). Information on the number of hospita- lizations, treatment time and diagnostic groups according to ICD-10 were outcomes of...

Limited clinical evidence exists regarding whether the single private room Neonatal Intensive Care Unit (NICU) environment of care delivery has a positive, negative, or neutral impact on health outcomes for the high risk neonate and on maternal stress as compared to the open room design. The study purpose was to examine whether a difference exists in health outcomes in the open room versus single private room NICU environment. The factors considered were weight gain, ventilator days, hospital length of stay, incidence and grade of intraventricular hemorrhage (IVH), the number of parental visits, and perceptions of maternal stress. Infants hospitalized in an open room environment (n=52) were matched by gestational age to infants in a single private room NICU (n=52). Mothers of the infants from the open room (n=26) and the single private room (n=20) groups completed the Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU) survey instrument. The t-test for independent groups demonstrated a difference for the number of parent visits (t=6.672, df=60.13, p<.001) with a significant increase in visitation frequency for infants in the single private room NICU. Maternal perceptions of stress were not different (t=.154, df=44, p=.878), and high stress scores were reported for both groups regardless of the infant's environment of hospitalization. This study demonstrates that the single private room environment promotes increased parental access to their infants. The finding of high levels of maternal perception of stress in both the open room and single private room NICU's demonstrates that the environment did not impact the perception of maternal stress. This finding supports the implication that mothers of hospitalized infants need nursing support regardless of the type of NICU environment.

SAMMANFATTNING Bakgrund Kvinnlig könsstympning (Female Genital Mutilation, FGM) är en uråldrig tradition med starka band till kulturell och etnisk identitet. Mer än 200 miljoner kvinnor och flickor beräknas vara könsstympade och årligen riskerar cirka 3,9 miljoner ytterligare flickor att utsättas. Andelen kvinnor från länder där FGM är vanligt förekommande och som föder barn i Sverige har ökat i och med ökad invandring från dessa länder. FGM är internationellt betraktat som en kränkning av de mänskliga rättigheterna samt ett brott mot kvinnor och barns rättigheter. Syfte Att jämföra förekomsten och risken för perinatala komplikationer hos kvinnor med en diagnos av FGM med kvinnor utan denna diagnos som fött barn i Sverige mellan åren 2007 - 2017. Metod En populationsbaserad kohortstudie. Resultat Det huvudsakliga resultatet i denna studie är att barn födda av kvinnor med en FGM diagnos har en signifikant ökad risk för låg Apgar, födas lätta för tiden (SGA), drabbas av kramper, perinatal död inklusive intrauterin fosterdöd samt att födas överburna. Slutsats FGM är förknippat med ett flertal allvarliga perinatala komplikationer. Störst risk kunde ses mellan FGM och att födas lätt för tiden, födas överburen och intrauterin fosterdöd. Dessa samband var robusta oavsett vilket land kvinnan är född. Det går att dra slutsatsen att kvinnor med en FGM-diagnos och deras nyfödda barn tillhör en riskgrupp. Det är av stor vikt att arbeta preventivt för att skydda dessa kvinnor och barns hälsa. / ABSTRACT Background Female Genital Mutilation (FGM) is an ancient tradition with strong ties to cultural and ethnic identity. More than 200 million women and girls are estimated to be exposed, and about 3.9 million more girls are at risk each year. The proportion of women from countries where female genital mutilation is common, and which gives birth to children in Sweden has increased with an increased immigration. Female genital mutilation is internationally considered as a violation of human rights and a violation of women's and children's rights. Aim To compare the incidence and risk of perinatal complications among women with a diagnosis of FGM with women without this diagnosis who has given birth to a child in Sweden during the years 2007 - 2017. Method A population-based cohort study. Results The main result of this study is that children born of women with an FGM-diagnosis have a significantly increased risk of low apgar scores, being born Small for Gestational Age, convulsions, perinatal death and prolonged pregnancy could be observed. Conclusion FGM is associated with a number of serious perinatal complications. The greatest risk was seen between female genital mutilation and being born Small for Gestational Age, prolonged pregnancy and intrauterine fetal death. These relationships were robust regardless of which country the woman was born. It can be concluded that women with an FGM diagnosis and their newborn children belong to a risk group. It is very important to work preventively to protect these women and children's health.

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome exhibited by infants born to mothers with opioid use disorder (OUD). The American College of Obstetricians and Gynecologists and other professional societies endorse opioid agonist pharmacotherapy (MATs) as the optimal treatment for OUD during pregnancy. This study focuses on impact of weaning of MAT drugs on the incidence of NAS and neonatal birth outcomes among babies born to women with opioid exposure. The study population included eighty-six pregnant women with OUD, divided in to weaning and non-weaning groups based on their choice to wean the MATs during pregnancy. Univariate analysis was performed between the clinical and demographic variables of both groups. Multivariate analysis was performed to find the association between outcome variables and predictor variables. All analyses were conducted using SAS version 9.4. The study identified a significant negative correlation (p-value: 0.0099) between weaning from MATs and NAS incidence. The study showed significant correlations of weaning with shorter LOS (p-value: 0.0036) and higher birth weights (p-value: 0.0408). Weaning emerged as a significant predictor for decreasing the incidence of NAS and improving the neonatal outcomes. Logistic regression confirmed weaning as a protective factor (odds ratio: 4.881 CI: 1.3, 18.1). The intricacies of weaning of MATs in the context of OUD during pregnancy present profound health and ethical considerations for both mothers and infants. The investigation into NAS incidence among infants born to women with OUD revealed a significant association with weaning from MATs during pregnancy. The study highlights the potential benefits of weaning, offering insights into optimized neonatal care and efficient healthcare resource utilization.

Nutritional status during pregnancy and the effects of nutritional deficiencies on pregnancy outcomes following bariatric surgery is an important issue that warrants further study. Objective: To investigate pregnancy outcomes and nutritional indices following restrictive and malabsorptive procedures. Setting: University Hospital, Greece. Methods: We investigated pregnancy outcomes of 113 women who gave birth to 150 children following biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between June 1994 and December 2011. Biochemical indices and pregnancy outcomes were compared among the different types of surgery and to overall 20-year hospital data, as well as to 56 pre-surgery pregnancies in 36 women of the same group. Results: Anemia was observed in 24.2% and 15.6% of pregnancies following BPD and RYGB, respectively. Vitamin B12 levels decreased postoperatively in all groups, with no further decrease during pregnancy; however, low levels were observed not only after BPD (11.7%) and RYGB (15.6%), but also after SG (13.3%). Folic acid levels increased. Serum albumin levels decreased in all groups during pregnancy, but hypoproteinemia was seen only after BPD. Neonates after BPD had significantly lower average birth weight without a higher frequency of low birth weight defined as less than 2500gr. A comparison of neonatal data between babies born before surgery (BS) and siblings born after surgery (AS) showed that AS newborns had lower average birth weight with no significant differences in body length or head circumference and no cases of macrosomia. Conclusions: Our study showed reasonably good pregnancy outcomes in this sample population following all types of bariatric surgery provided nutritional supplement guidelines are followed. Closer monitoring is required in pregnancies following malabsorptive procedures especially regarding protein nutrition. / Η θρεπτική κατάσταση κατά τη διάρκεια της εγκυμοσύνης και οι συνέπειες διατροφικών ανεπαρκειών στην έκβαση της, που ακολουθεί μια χειρουργική επέμβαση για κλινική σοβαρή παχυσαρκία αποτελεί θέμα που χρήζει περαιτέρω έρευνας. Σκοπός της συγκεκριμένης μελέτης ήταν η διερεύνηση της θρεπτικής κατάστασης και της έκβασης της εγκυμοσύνης, τόσο στις μητέρες όσο και στα νεογνά, σε γυναίκες που είχαν υποβληθεί στο παρελθόν σε περιοριστικές και δυσαπορροφητικές επεμβάσεις για κλινικά σοβαρή παχυσαρκία. Μελετήθηκαν 113 γυναίκες που γέννησαν 150 παιδιά μετά από χολοπαγκρεατική εκτροπή (BPD), Roux-en-Y γαστρική παράκαμψη (RYGB) και επιμήκη γαστρεκτομή μεταξύ Ιουνίου 1994 και Δεκεμβρίου 2011. Συγκρίθηκαν τα αποτελέσματα των θρεπτικών δεικτών και της έκβασης της εγκυμοσύνης μεταξύ των επεμβάσεων καθώς και με τα 20ετή στοιχεία γεννήσεων του νοσοκομείου μας και τα αποτελέσματα από 56 προεγχειρητικές εγκυμοσύνες σε 36 από τις ίδιες γυναίκες. Αναιμία παρατηρήθηκε σε 24.2% και 15.6% των κυήσεων μετά από BPD και RYGB, αντίστοιχα. Τα επίπεδα της βιταμίνης B12 μειώθηκαν μετεγχειρητικά σε όλες τις ομάδες, χωρίς περαιτέρω μείωση κατά τη διάρκεια της εγκυμοσύνης• όμως, χαμηλά επίπεδα παρατηρήθηκαν σε κάποιες γυναίκες όχι μόνο μετά από BPD (11.7%) και RYGB (15.6%), αλλά και μετά από SG (13.3%). Τα επίπεδα του φυλλικού οξέος αυξήθηκαν μετεγχειρητικά και κατά τη διάρκεια της εγκυμοσύνης. Η τιμή της αλβουμίνης μειώθηκε σε όλες τις ομάδες κατά τη διάρκεια της εγκυμοσύνης, αλλά υποπρωτεϊναιμία παρατηρήθηκε μόνο μετά από BPD. Τα νεογνά μετά από BPD είχαν χαμηλότερο μέσο όρο βάρους γέννησης (p<0.05), χωρίς να υπάρχει μεγαλύτερη συχνότητα χαμηλού βάρους γέννησης (<2500gr). Η σύγκριση μεταξύ των νεογνών που γεννήθηκαν πριν και μετά το χειρουργείο έδειξε ότι τα νεογνά που γεννήθηκαν μετά είχαν χαμηλότερο βάρος (p<0.001) χωρίς σημαντικές διαφορές στη διάρκεια κύησης, στο μήκος ή στην περίμετρο της κεφαλής και καθόλου μακροσωμία. Συμπερασματικά, η δική μας μελέτη έδειξε σχετικά καλή θρεπτική κατάσταση και έκβαση στη εγκυμοσύνη μετά από όλους τους τύπους επεμβάσεων στη συγκεκριμένη πληθυσμιακή ομάδα εφόσον υπάρχει συστηματική παρακολούθηση και ακολουθούνται οι διατροφικές οδηγίες. Πιο στενή παρακολούθηση χρειάζεται μετά από δυσαπορροφητικές επεμβάσεις ιδιαίτερα ως προς το θέμα της πρωτεϊνικής θρέψης