Establishment of risk factors, and mechanisms involved in preterm (premature) birth is important for society. Despite efforts to find the cause(s), a significant proportion of preterm birth is of unknown aetiology. Maternal infection has been implicated and oral infection in the form of periodontal (gum) disease has also been suggested as a risk factor for preterm birth (OPenbacher et at, 1996). The aim of this study was to examine the possible relationship between maternal periodontal disease and the delivery of preterm infants with associated low birthweight in East London. This was an unmatched case-control study with 187 cases (mothers whose infant weighed < 2500g, gestational age < 37 weeks (preterm low birthwieght (PLBW)), and 532 controls (mothers whose infant weighed z 2500g, gestational age z 37 weeks). Risk factor information for prematurity and low birthweight were collected from Maternity notes and a structured questionnaire. Maternal periodontal disease levels were measured by: Community Periodontal Index, periodontal probing pocket depths and a bleeding index. Analysis was by logistic regression. The study population was derived from a multiethnic inner city population the predominant groups being Bangladeshi (51.9%) and white Caucasian (25.9%). No differences were found between the periodontal status of the case and control mothers for any of the periodontal indices. The risk for PLBW decreased significantly (p=0.02) with increasing mean periodontal probing pocket depth (crude OR 0.83[95% CI 0.68, 1.00]). After controlling for pre-pregnancy hypertension, smoking, alcohol consumption, maternal age, ethnic group and mother's education this risk decreased further (OR 0.78[95% CI 0.63, 0.96]). No evidence was found for increased risk of PLBW with maternal periodontal disease as measured in this study population. Promotion of oral health by healthcare workers is important, but these results did not support a specific drive to improve the periodontal health of pregnant women as a means of decreasing adverse pregnancy outcomes.

Infants born prematurely are a vulnerable population with diverse nutritional needs to battle their increased risk of gastrointestinal (GI) diseases. Human milk is considered the 'gold standard' of infant nutrition. Human milk not only provides nutrition for newborn growth, but contains bioactive components which contribute to GI maturation, immune protection and neurological development. Among these bioactive components are extracellular vesicles known as exosomes. Exosomes are double-lipid membrane vesicles containing mRNA, microRNA and proteins, secreted by cells as a form of cell-to-cell communication. Human milk exosomes contain immune-related microRNA and proteins that withstand in vitro simulated human digestion, suggesting that signals are being delivered to the cells residing in the GI tract of a newborn. In premature birth, disruption of GI tract maturation predisposes the infant to increased susceptibility of GI inflammatory diseases. To prevent inflammation, immune tolerance in the GI tract of premature infants should be promoted and I hypothesized that exosomes differ between preterm and term milk, and may contribute to the anti-inflammatory effects of human milk. Human milk exosomes from mothers who gave birth to term or preterm infants were characterized based on size, surface protein markers and total protein. Preterm milk exosomes contained a more diverse protein profile. The effects of milk exosomes on intestinal epithelial cells were observed in an in vitro model using Caco-2/15 cells. Milk exosomes were able to attenuate the inflammatory response induced by heat-killed bacteria as measured by the transcription of pro-inflammatory cytokines.

O nascimento pré-termo aumenta o risco para problemas no desenvolvimento. O estudo teve por objetivos: a) examinar as associações entre condições clínicas neonatais e indicadores de cognição, atenção, temperamento e comportamento de crianças nascidas pré-termo; b) comparar esses indicadores em grupos estratificados pelo nível de prematuridade. A amostra foi composta por 50 crianças nascidas pré-termo (idade gestacional média = 31 semanas [26-35] e com peso ao nascimento médio de 1.190g [650-1.500g], de seis anos de idade, participantes de um programa de follow-up em um hospital universitário de nível terciário. As crianças foram avaliadas pela Escala de Inteligência Wechsler para Crianças (WISC-III) e Teste de Atenção por Cancelamento. As mães responderam aos Child Behavior Questionnaire (CBQ), Questionário de Capacidades e Dificuldades (SDQ) e ficha de caracterização. A história clínica foi analisada com base nos prontuários médicos. Foram processadas as análises de regressão linear múltipla e comparação entre grupos (t-Student/Qui-Quadrado); p 0,05. Os resultados mostraram que, na avaliação cognitiva pelo WISC-III, a maior parte das crianças apresentou resultados na média ou acima média nos QIs Total (70%), Verbal (76%) e de Execução (76%) e no índice fatorial de Resistência à distração (78%). No escore total de atenção, 74% das crianças situaram-se na média ou acima desta. No temperamento, as crianças apresentaram escores moderados entre 4 a 5, nos três fatores do CBQ (afeto negativo, extroversão e controle com esforço). No comportamento, 56% das crianças obtiveram classificação normal no total, assim como 96% em comportamento pró-social e 76% em relacionamento com colegas. No entanto, houve altas porcentagens de classificações limítrofes/anormais nos sintomas emocionais (64%), problemas de conduta (56%) e hiperatividade (50%). Na comparação entre grupos, às crianças pré-termo extremo/muito pré-termo apresentaram pior desempenho apenas na atenção alternada do que as pré-termo moderado/tardio. Na análise de predição, foram encontrados os seguintes resultados nos desfechos cognitivos: menor QI-Total foi predito por menor QI-Verbal e escolaridade materna; menor QI Verbal foi predito por menos controle com esforço e atenção e menor escolaridade materna; menor QI-Execução foi predito por menos atenção, menor escolaridade materna e nível socioeconômico. Os problemas de comportamento global foram preditos por mais afeto negativo e extroversão e menor controle com esforço e atenção. A hiperatividade foi predita por mais afeto negativo e menor controle com esforço e atenção. Os problemas de conduta foram preditos por mais afeto negativo, sexo masculino e menor QI-Verbal. Os problemas de relacionamento com os colegas foi predito por mais extroversão, maior escolaridade paterna, menor escolaridade materna e menor QI-Execução. Os sintomas emocionais foram preditos por menor idade gestacional, controle com esforço e nível socioeconômico e mais afeto negativo e extroversão. Apesar da vulnerabilidade das crianças, foram verificados recursos cognitivos e de atenção. Os problemas concentraram-se mais no comportamento, que foi predito por fatores da criança (temperamento, sexo, idade gestacional) e socioeconômicos. / The preterm birth increases risk for developmental problems. The objectives of the present study were the following: a) to exam the associations between neonatal clinical conditions and cognition, attentional, temperament, and behavior indicators in preschool children born preterm; b) to compare these indicators in groups according to the prematurity level. The sample was composed of 50 children born preterm (mean gestational age = 31 weeks [26-35]), mean birth weight of 1,190g [650-1,500g]), with six years of age, who participated in a follow-up program in a tertiary teaching hospital. Preterm children were evaluated according to the Wechsler Intelligence Scale for Children (WISC-III) and the Test of Attention by Cancelling. Mothers answered to the Child Behavior Questionnaire (CBQ), Strengths and Difficulties Questionnaire (SDQ), and the Questionnaire of characteristics. Clinical history was reviewed on the medical chart. The multiple linear regression and between group comparison (t-test/Chi-square) analyses were performed; p0,05. The results showed that, in the WISC-III cognition assessment, the majority of the children presented results on average on the following intelligence quotients (QIs) scores: Total (70%), Verbal (76%), and Executive (76%), and in the Resistance to distraction Index subscale (78%). On the total attentional score 74% of the children presented mean or above mean scores. Concerning the temperament indicator, children presented moderated scores between 4 and 5 on the three CBQ factors (Negative Affectivity, Surgency, and Effortful Control). On behavior indicators, 56% of the children obtained total normal classification, as well as 96% on prosocial behavior and 76% on peer relationship. However, there were high percentages of boarder/abnormal on emotional symptoms (64%), conduct problems (56%), and hyperactivity (50%). The between groups comparison showed that children born extremely/very preterm presented lower performance only on alternating attention than moderate/late preterm children. The multiple linear regression analysis showed the following cognition outcomes: lower Total-IQ was predicted by lower Verbal IQ and maternal schoolarship; lower Verbal-IQ was predicted by lower Effortful Control and attention, and maternal schoolarship; lower Executive-IQ was predicted by lower attention, maternal scholarship, and socioeconomic status. Global behavior problems were predicted by higher Negative Affectivity, and Surgency, and lower Effortful Control, and Attention. Hyperactivity was predicted by higher Negative Affectivity and lower Effortful Control, and Attention. Conduct problems were predicted by higher Negative Affectivity, male sex, and Verbal-IQ. Peer relationship problems were predicted by higher Surgency, higher parental education, lower maternal schoolarship, and lower Executive-IQ. Emotional symptoms were predicted by gestational age, Effortful Control and socioeconomic status, and higher Negative Affectivity, and Surgency. Despite vulnerability of children there were cognitive and attentional resources. The difficulties are related to behavior, which were predicted by children factors, such as temperament, sex and gestational age, and socioeconomic factors.

Objetivo: avaliar a associação dos níveis séricos de citocinas em gestantes assintomáticas no segundo trimestre e nascimentos pré-termo (NPT). Pacientes e métodos: Estudo caso-controle aninhado a uma coorte de conveniência prospectiva. Foram incluídas gestantes de feto único entre 20 e 25 semanas e 6 dias de idade gestacional de 2 cidades brasileiras, as quais foram submetidas a entrevista e coleta de amostras de sangue venoso e avaliadas por entrevista no momento do nascimento. Dos NPT, 197 foram consideradas como grupo de casos e o grupo controle foi selecionado por sorteio, totalizando 426 pacientes no grupo controle. Foram avaliadas 41 citocinas séricas e comparadas entre os grupos. Resultados: Na primeira análise, as citocinas GRO, PDGF-BB e sCD40L mostraram níveis séricos diminuídos no grupo dos partos pré-termo (PPT) (p<0,05). Analisando apenas os PPT espontâneos, as citocinas GRO, sCD40L e MCP-1 apresentaram níveis diminuídos no grupo de casos (p<0,05). As citocinas que apresentaram níveis séricos com valores discrepantes foram submetidas a uma transformação logarítmica para posterior comparação entre os grupos de casos e controles. No grupo de casos incluindo apenas PPT espontâneos, verificou-se níveis aumentados de IL-2 (p<0,05). Foi significativo entre os grupos caso e controle a incidência de tabagismo materno e histórico de parto pré-termo anterior, sendo então essas características consideradas como fatores de risco nas análises multivariadas das citocinas dosadas. Apenas GRO demonstrou diferença em suas concentrações séricas entre grupos caso e controle na análise multivariada. Conclusão: Níveis séricos menores de GRO no segundo trimestre estão associados a maior risco de prematuridade, podendo refletir uma deficiência na resposta inflamatória materna. / Objective: To evaluate the association between second trimester serum cytokine levels in asymptomatic pregnant women and preterm births (PTB). Patientes and methods: Cohort-nested case-control study including singleton pregnant women between 20 and 25 weeks and 6 days of gestation in two Brazilian cities. The patients were interviewed and collection of venous blood samples was performed. They were again interviewed at time of birth. Among PTB, 197 were considered as case group. The control group was selected among term births (426 patients). Fourty-one cytokines were compared between groups. Results: Cytokines GRO, PDGF-BB and sCD40L showed decreased serum levels in PTB group (p<0.05). When analyzing only spontaneous PTB, GRO, sCD40L and MCP-1 levels showed decreased levels in the case group (p <0.05). A logarithmic transformation was performed among cytokines with discrepant serum levels in an attempt of verifying the outliers influency, and it has shown increased levels of IL-2 in the group of spontaneous preterm delivery (p <0.05). In both analyzes, the incidence of maternal smoking and history of previous preterm delivery was significantly different between case and control groups. In multivariate analysis, only GRO demonstrated different serum levels between case and control groups. Conclusion: Lower second trimester serum levels of GRO in assymptomatic women are associated with increased number of preterm births. This finding may reflect a deficiency in maternal inflammatory response.

Este trabalho é um estudo de caso, cujos objetivos foram caracterizar os recém-nascidos prematuros de muito baixo peso (RNP/MBP) admitidos na Unidade de Terapia Intensiva Pediátrica e Neonatal (UTIP/N) do nascimento ao seguimento ambulatorial no primeiro ano de vida, e compreender a experiência dos pais. Sendo assim, optou-se pela realização da pesquisa em dois momentos: o primeiro, na abordagem quantitativa, com uma população de 60 RNP/MBP do Hospital Universitário da Universidade de São Paulo (HU-USP) no período compreendido entre 1999 - 2000. Os dados foram coletados dos prontuários por meio de um formulário. Os resultados mostraram que as mães eram na sua maioria primíparas (50,9%), com idade média de 27,5 anos e que 80,0% realizaram o pré-natal. Em relação aos neonatos, a média de peso ao nascer foi 1.084g e a idade gestacional de 30 semanas; 23,0% foram a óbito e a média de peso foi de 688g. Quanto ao tempo de permanência na terapia intensiva, dos 46 sobreviventes, a mediana foi 10 dias e a de internação hospitalar 49,5 dias. Foram submetidos à intubação e à ventilação mecânica (69,6%), à cateterização central (78,3%) e à nutrição parenteral (98,7%). Dos egressos do Berçário, 75,0% realizaram seguimento no Ambulatório Neonatal. O segundo momento, na abordagem qualitativa, os dados foram obtidos pela observação participante e entrevista com os pais de bebês egressos da UTIP/N do HU-USP. Adotou-se como referencial teórico-metodológico a Antropologia Cultural e a Etnografia. Da análise das narrativas, emergiram seis categorias culturais e subcategorias que evidenciaram dois temas: \"A capacidade para tornarem-se pais de um RNP/MBP: momentos de luta e crescimento\" e \"O cuidar e conviver com o filho\". Os pais vivenciaram todo o processo permeado pela ambivalência de sentimentos em que o medo e a esperança predominaram. Relataram que essa experiência foi marcante e transformadora, atribuíram à religiosidade, aos profissionais de saúde e à assistência especializada a sobrevida do filho. Sentiram-se capacitados para cuidar da criança após a alta hospitalar, embora tenham reconhecido a existência de obstáculos que emergiram do contexto sociocultural para desempenharem os papéis de pai e mãe. / This paper is a case study, it has the purpose of characterizing the preterm newborn with very low weight admitted in Neonatal and Pediatric Intensive Care Units by birth until the first year of life, as an Out Patient, and to understand the parents experience. I opted to do the research in two moments: the first one as a quantitative approach with sixty preterm newborn with very low weight, which were in the of the University Hospital at Sao Paulo University during the period 1999-2000. The data has been collected using the dossier with a specific instrument. The results showed that (50.9%) of mothers were primiparous, the average age was 27.5 years, 80.0% did prenatal. Reporting newborn, the average of birth weight was 1.084g and the pregnancy age was thirty weeks; 23.0% died, the average of birth weight was 688g. The median of permanence of the 46 survivors in ICU was 10 days and in hospital was 49.5 days. 69.6% were submitted to intubation and mechanical ventilation; 78.3% used a central catheter and 98.7% to parenteral nutrition. 75.0% of the babies from Nursery were accompanied in the Out Patient Neonatal Unit at University Hospital during the first year of life. The second moment, with a qualitative approach, the data were collected using the participant observation and the interview with ICU preterm newborn parents. We adopted Cultural Anthropology and Ethnography as theoretical reference methodologies. From this analysis emerged six cultural categories and subcategories that showed two cultural themes: \"The capacity to be parents of a very low weight preterm newborn: fighting moments and growth\" and \"Caring and living together with a child\". Parents lived all the process with fear and hope. They said this experience was very intense and transforming, attributing child\'s life to religion, health professionals and specialized care. They felt capable to take care of the child after hospital discharge, although recognized new obstacles in the social-cultural context to carry out the responsibility of being parents.

Orientador: Renato Passini Júnior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-27T13:00:34Z (GMT). No. of bitstreams: 1 Gouveia_HelgaGeremias_D.pdf: 931546 bytes, checksum: 649c57d45b2bb56f7b161a505e6ccfcc (MD5) Previous issue date: 2010 / Resumo: Introdução: A prematuridade é definida como o nascimento que ocorre antes da 37º semana de gestação, sendo responsável por 75% da morbidade e mortalidade no período neonatal. Situações de risco para o desfecho da gestação influenciam de modo negativo a percepção de uma mulher sobre a qualidade de vida. Objetivo: Avaliar a qualidade de vida durante a gestação associada ao risco para parto prematuro. Método: revisão de literatura, seguida de estudo de corte transversal e comparativo, com três grupos de 54 gestantes (Grupo 1: sem risco atual para parto prematuro; Grupo 2: com fatores de risco para parto prematuro; Grupo 3: com trabalho de parto prematuro), totalizando 162 mulheres, realizado entre abril de 2008 a agosto de 2009 em maternidade de alto risco e unidade básica de saúde da cidade de Campinas (SP). Após assinatura de Termo de Consentimento Livre e Esclarecido foram verificadas informações sociodemográficas e obstétricas das mulheres e para avaliação da qualidade de vida foi aplicado o instrumento MOS-SF 36. Os dados foram analisados utilizando frequências, média e desvio-padrão. A homogeneidade entre os grupos foi avaliada pelos testes qui-quadrado de Pearson e exato de Fisher, para as variáveis categóricas e Kruskall-Wallis, seguido de Mann-Whitney para as variáveis contínuas. Ajustou-se um modelo de análise de variância (Anova) para comparar os domínios do SF-36 entre os grupos, contendo as variáveis: idade, renda familiar, número de gestações e número de abortos, seguido pelo teste de Bonferroni. O nível de significância adotado foi 5% e o software SAS, versão 9.1.3, foi utilizado na análise estatística. Resultados: há poucos estudos abordando a qualidade de vida durante a gestação. No estudo de corte os grupos apresentaram diferenças significativas em relação à idade e renda familiar (1X2 e 2X3); entre as gestantes dos Grupos 2 e 3, o principal antecedente obstétrico foi o trabalho de parto prematuro e a prematuridade foi a principal causa de filhos mortos; no Grupo 2 a insuficiência istmo-cervical foi a condição mórbida mais frequentemente encontrada. As características obstétricas que apresentaram diferença significativa entre os grupos (1X2 e 2x3) foram idade gestacional, número de gestações e aborto. Nos aspectos da Qualidade de Vida, verificamos, no total das gestantes analisadas, que o Estado Geral de Saúde foi o domínio de maior escore (71,9 pontos) enquanto que o item Aspectos Físicos foi o de menor escore (30,1). Na comparação entre grupos houve diminuição progressiva dos valores dos escores dos domínios do SF - 36, do Grupo 1 em relação ao 2 e deste em relação ao 3, com exceção da Capacidade Funcional, que foi menor no Grupo 2. Diferenças estatisticamente significativas foram observadas entre os Grupos 1 e 2 nos domínios Capacidade Funcional, Dor e Aspectos Sociais e entre os Grupos 1 e 3 nos domínios Capacidade Funcional, Aspectos Físicos, Dor, Aspectos Sociais, Aspectos Emocionais e Saúde Mental. Entre os Grupos 2 e 3 não houve diferenças entre os domínios. Conclusão: Gestantes de baixo risco (Grupo 1) apresentam melhor qualidade de vida quando comparadas com as de risco de parto prematuro (Grupos 2 e 3); a qualidade de vida entre as gestantes em trabalho de parto prematuro não foi diferente daquelas com fatores de risco de parto prematuro / Abstract: Introduction: Preterm birth occurs before 37 weeks' gestation, and accounts for 75% of neonatal morbidity and mortality. Situations of risk for the outcome of pregnancy would adversely affect a woman's perception on the quality of life. Objective: To evaluate the quality of life during pregnancy associated with risk for preterm delivery. Methods: literature review, followed by was a cross-sectional and comparative study, with three groups of 54 patients (group 1: no current risk for preterm delivery, group 2: with risk factors for preterm delivery and group 3, with preterm labor), totalizing 162 women, conducted from April 2008 to August 2009 in a high-risk maternity and in a primary care unit in Campinas (SP). After signing the consent form, demographic and obstetric information were collected, and the instrument MOS SF-36 was applied to evaluate quality of life. Data were analyzed using frequencies, mean and standard deviation. Homogeneity between groups was assessed using the Pearson chi-square test and Fisher exact test for categorical variables and Kruskall-Wallis followed by Mann-Whitney test for continuous variables. A model of analysis of variance (ANOVA) was set up to compare the domains of the SF-36 between groups, containing the variables: age, family income, number of pregnancies and abortions, followed by Bonferroni test. The level of significance was 5% and SAS software, version 9.1.3, was used for statistical analysis. Results: there are few studies addressing quality of life during pregnancy. In cross-sectional study groups showed significant differences on the subject of age and family income (1 versus 2 and 2 versus 3); among groups 2 and 3, main obstetric history was preterm labor and preterm birth was the main cause of child deaths; in group 2 cervical insufficiency was the most frequent morbid condition; obstetric characteristics that showed significant differences between groups (1 versus 2 and 2 versus 3) were gestational age, number of pregnancies and abortion. Regarding quality of life, among all women tested, General State of Health was the area of highest score (71.9 points) while Physical Aspects had the lowest scores (30.1). In the comparison between groups, there was a progressive decrease in scores in the domains of the SF - 36, group 1 compared to 2 and this in relation to 3, with the exception of Functional Capacity, that was lower in group 2. Statistically significant differences were observed between groups 1 and 2 in the domains Functional Capacity, Pain and Social Aspects and between groups 1 and 3 in the domains Functional Capacity, Physical Aspects, Pain, Social Aspects, Emotional Aspects and Mental Health. Between groups 2 and 3 there was no statistically significant difference in any of the domains. Conclusion: low risk pregnant women (group 1) had better quality of life compared to women who had risk factors or who were in preterm labor (group 2 and 3); quality of life among women in preterm labor was not different from those with risk factors for preterm birth / Doutorado / Saúde Materna e Perinatal / Doutor em Ciências da Saúde

Literature review abstract Background: Domain-general processes, such as working memory (WM), short-term memory (STM), and attention, have been found to be related to mathematical performance in children. The relationship between these abilities, however, is not well understood. Objective: This systematic review aimed to evaluate the literature investigating the relationship between mathematical performance and WM, STM, and attention in typically developing primary school aged children. Methods: Three databases were searched for studies published between January 1974 and February 2015 reporting associations between mathematics performance and at least one measure of WM, STM, and attention. Study selection was undertaken by applying inclusion and exclusion criteria and 43 studies were selected for inclusion. The methodological quality of the included studies was assessed using a validated checklist. Results: WM, STM, and attention were all significantly related to mathematics performance. Visuospatial STM and WM were strongly related to mathematics performance in younger children, while verbal STM and WM were more strongly related in older children; although some studies found the opposite pattern. The relationship between attention and mathematics performance increased in strength with age. Conclusions: There are many factors relevant to the relationship between mathematical performance and WM, STM, and attention which can affect the strength of the association, including the types of tasks used to measure the constructs, the confounding variables considered, and the age of the participants. Future research needs to focus on the construction of an integrated model of mathematical development.   Empirical paper abstract Background: Moderate to late preterm children (MLPT; born between 32 weeks and 36 weeks and 6 days) are at increased risk of developing cognitive difficulties compared to term children (born between 37 weeks and 41 weeks and 6 days). Mathematical attainment is an important area of academic development. Domain-general cognitive abilities, which constrain all learning, and domain-specific mathematical precursors are both important for mathematical development. Objectives: The current study had two aims: 1) to investigate the relationship between gestational age (GA), mathematical attainment, working memory (WM), short-term memory (STM), and attentional control; and 2) to investigate WM, STM, and attentional control as domain-general predictors of mathematical attainment. It was hypothesised that WM would predict additional variance in mathematical attainment after attentional control, STM, and demographic variables (intellectual ability (IQ) and socioeconomic status) were accounted for. Methods: A cross-sectional and correlational design was used to investigate the study aims. Participants were 34 MLPT children and 25 term children who were between 72 and 107 months at the time of the study. Children who weighed less than 1500 grams at birth, had cerebral palsy, epilepsy, severe hearing or vision loss, or had a diagnosed learning disability were excluded. Each participant completed a cognitive assessment which measured their mathematical attainment and components of WM, STM, and attentional control. Results: GA was only significantly correlated with IQ. In the model of mathematical attainment, GA also significantly moderated the relationship between attentional switching and mathematical attainment. The hypothesis regarding the role of WM in predicting mathematical attainment was partially supported as only verbal WM predicted significant additional variance in mathematical attainment. Attention behaviour and IQ also predicted significant additional variance in mathematical attainment. Conclusion: These findings suggest that birth weight greater than 1500g, higher socioeconomic status, and lower levels of co-morbid medical conditions may serve as protective factors against the potential negative consequences of MLPT birth. Findings regarding the domain-general predictors of mathematical attainment supported some previous findings and highlighted the need for a variety of tasks to be used to measure each domain-general ability. Longitudinal studies in MLPT children would be helpful for further understanding the role of GA and domain-general abilities in the development of mathematical attainment.

Introdução: O parto prematuro espontâneo é doença multifatorial e sua etiologia permanece desconhecida em até 40% das vezes. Neste estudo, investigamos a existência de trombofilias maternas adquiridas e hereditárias em gestantes de risco para o parto prematuro espontâneo e as relacionamos com a incidência de prematuridade na gestação. Métodos: Neste estudo prospectivo, realizado entre julho de 2004 e setembro de 2006, foram pesquisadas 66 gestantes com antecedente de parto prematuro espontâneo e 66 gestantes sem antecedente de complicações, com pelo menos um parto a termo anterior. Até 25 semanas de gestação, foi realizada coleta única dos seguintes testes laboratoriais: anticardiolipina IgG, anticardiolipina IgM, anticoagulante lúpico, fator V Leiden, mutação da protrombina e homocisteína. Foram excluídas três gestantes por abortamento, duas por incompetência cervical, duas por malformação fetal, e uma por coleta inadequada. Dessa maneira, foram avaliadas 64 gestantes de risco e 60 sem complicações (grupo controle). Resultados: A incidência de prematuridade espontânea foi significantemente maior no grupo de risco (RR=7,97; IC95%=1,92-33,04, p<0,05). Não houve diferenças quanto ao tipo de parto nem quanto às médias dos pesos dos recém-nascidos entre os grupos. Entre as pacientes com antecedente de prematuridade, a presença de trombofilias adquiridas e hereditárias foi mais freqüente (OR=3,2; IC95%=1,4-7,5, p<0,05). As trombofilias adquiridas, quando analisadas em separado, foram mais freqüentes no grupo de risco (OR=3,0; IC95%=1,1-7,7, p<0,05), assim como, observou-se maior freqüência da anticardiolpina IgG em títulos baixos (OR=2,8; IC95%=1,0-7,5, p<0,05) e IgM em títulos intermediários ou altos (OR=3,9; IC95%=1,0-15,1, p<0,05). O anticoagulante lúpico e as trombofilias hereditárias, quando analisados em separado, não diferiram entre os grupos. Entre os casos com prematuridade espontânea na gestação atual, 79% apresentaram algum teste de trombofilia alterado. Na análise univariada, a presença de trombofilias aumentou o risco de prematuridade espontânea (OR=4,5; IC95%=1,4-14,4, p<0,05). Na análise multivariada, no entanto, o parto prematuro prévio esteve 11 vezes mais associado à prematuridade espontânea. Conclusões: Concluímos que as trombofilias adquiridas e hereditárias foram mais freqüentes no grupo de risco, sendo prevalentes as adquiridas, das quais a anticardiolpina IgG e IgM foram as mais freqüentemente encontradas. Houve aumento do risco de prematuridade espontânea nas portadoras de trombofilias adquiridas e hereditárias, mas o antecedente de parto prematuro permaneceu como o maior fator de risco associado à prematuridade espontânea. / Introduction: The spontaneous preterm birth is a multifactorial disease and its etiology remains unknown in 40% of the time. In this study, we investigated the acquired and inherited thrombophilias in high risk pregnant patients to the spontaneous preterm birth and related to the incidence of prematurity in the current pregnancy. Methods: In this prospective study realized from July of 2004 to September of 2006 was evaluated 66 pregnant women with previous spontaneous preterm birth and 66 pregnant women without complications, with at least one previous term birth. Until 25 weeks of pregnancy, was realized single collection of the following laboratorial tests: IgG/IgM anticardiolipin, lupus anticoagulant, factor V Leiden, prothrombin mutation and homocystein. It was excluded three pregnant women due to miscarriage, two for cervical incompetence, two for fetal malformation, and one for inadequated collection of exams. In this way, we evaluated 64 high risk pregnant women and 60 with no complications (control group). Results: The frequency of spontaneous preterm birth was significantly higher in the high risk group (RR=7,97; IC95%=1,92-33,04, p<0,05). There was neither differences in the birth type nor in the average weight in newborn infants between the groups. Among to the patients with risk of preterm birth in the current pregnancy, the acquired and inherited thrombophilias were more frequent (OR=3,2; IC95%=1,4-7,5, p<0,05). The acquired thrombophilias, when analysed in separately, were more frequents in the risk group (OR=3,0; IC95%=1,1-7,7, p<0,05), like it was observed more frequency of IgG anticardiolipin in low titles (OR=2,8; IC95%=1,0-7,5, p<0,05) and IgM anticardiolipin in intermediary or high titles (OR=3,9; IC95%=1,0-15,1, p<0,05). The lupus anticoagulant and the inherited thrombophilias when analysed separately were not different among groups. In spontaneous preterm birth cases in the current pregnancy, 79% had some altered thrombophilia test. In univariated analysis, the existence of thrombophilias increased the risk for spontaneous preterm birth (OR=4,5; IC95%=1,4-14,4, p<0,05). In multivariated analysis, however, the previous spontaneous preterm birth was 11 times more associated with current spontaneous preterm birth. Conclusions: We conclude that the acquired and inherited thrombophilias were more frequent in high risk group, being more prevalent the acquired ones, of which IgG anticardiolipin and IgM anticardiolipin were more frequently founded. There was increased risk for spontaneous preterm birth in women with acquired and inherited thrombophilias but the previous preterm birth remained the major risk factor related to the spontaneous preterm birth.

Submitted by Maria Aparecida (cidazen@gmail.com) on 2017-04-24T13:10:02Z No. of bitstreams: 1 Marianne de Carvalho Rodrigues.pdf: 783432 bytes, checksum: 47b0cab16ad64cf53837adef47c49034 (MD5) / Made available in DSpace on 2017-04-24T13:10:02Z (GMT). No. of bitstreams: 1 Marianne de Carvalho Rodrigues.pdf: 783432 bytes, checksum: 47b0cab16ad64cf53837adef47c49034 (MD5) Previous issue date: 2017-02-10 / FAPEMA / Breast milk (LM) is the best food for the child, especially in the first six months of life, because it contains fats, vitamins, minerals, immunoglobulins and other nutrients necessary for the maintenance, growth and development of the children. For preterm newborns (PTNBs), breastfeeding has also been the main food indication, both in the hospital setting and after discharge. Breastmilk supplementation has been highly recommended for the nutrition of PTNB and of very low birth weight, since it has been shown to be effective in providing calories and nutrients that may be below the needs of these children in their mothers' milk, for proper growth of the neonate. However, there is no consensus as to how best to feed these children after discharge. Given the conditions to which PTNBs are exposed and that breastmilk has components that can provide a better growth for the baby, this study intends to compare the growth among PTNBs and very low birth weight infants from the Neonatal Intensive Care Unit exclusively breastfed up to 6 Months of age with those not exclusively breastfed during this same period. Cohort study, conducted at the University Hospital of the Federal University of Maranhão, Unidade Materno Infantil, using data from the children followed up at the Follow-up service of Neonatology. For data collection, a form was constructed with the variables of interest, socio-demographic variables and growth variables of the children. The sample consisted of 174 individuals compared to the type of feeding and anthropometric measures of growth at six months of corrected gestational age. / O leite materno (LM) é o melhor alimento para a criança, principalmente nos seis primeiros meses de vida, por ter, em sua composição, gorduras, vitaminas, minerais, imunoglobulinas e demais nutrientes necessários à manutenção, crescimento e desenvolvimento desta. Para os recém-nascidos pré-termo (RNPT), o aleitamento materno também tem sido a principal indicação alimentar, tanto em ambiente hospitalar quanto após a alta. A suplementação do leite materno tem sido bastante recomendada para a nutrição dos RNPT e de muito baixo peso, pois tem se mostrado eficaz em prover calorias e nutrientes que podem estar aquém das necessidades destas crianças no leite de suas mães, contribuindo, desta forma, para o crescimento adequado do neonato. Porém, não se tem um consenso de qual a melhor forma de alimentar essas crianças após a alta hospitalar. Dadas as condições às quais os RNPT estão expostos e que o leite materno possui componentes que podem propiciar melhor crescimento ao bebê, este estudo pretende comparar o crescimento entre RNPT e de muito baixo peso egressos de Unidade de Terapia Intensiva Neonatal, amamentados exclusivamente até os seis meses de idade com aqueles não amamentados de forma exclusiva neste mesmo período. Estudo de coorte, realizado no Hospital Universitário da Universidade Federal do Maranhão, Unidade Materno Infantil, utilizando dados das crianças acompanhadas no Follow-up do Serviço de Neonatologia. Para coleta de dados foi construído um formulário com as variáveis de interesse, sócio demográficas e variáveis de crescimento das crianças. A amostra foi composta por 174 indivíduos comparados quanto ao tipo de alimentação e medidas antropométricas de crescimento aos seis meses de idade gestacional corrigida.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-15T17:07:42Z No. of bitstreams: 1 AnnaVieira.pdf: 2823027 bytes, checksum: fce49db1d19b8bbf99ab34a0e9eaef9a (MD5) / Made available in DSpace on 2017-05-15T17:07:42Z (GMT). No. of bitstreams: 1 AnnaVieira.pdf: 2823027 bytes, checksum: fce49db1d19b8bbf99ab34a0e9eaef9a (MD5) Previous issue date: 2016-11-30 / Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA) / Untreated oral disease may compromise the health of the pregnant woman and her baby. Thus, studies aimed at understanding all the factors that influence the prevalence of tooth decay in pregnant women, as well as the reflection of the disease in pregnancy, are essential for planning strategies of health promotion and prevention in oral health. This Thesis studied aspects related to dental caries in women in the immediate postpartum period, based on data from the Multicenter Geravida Project, giving rise to two original articles. The first item is listed in Chapter I of this work and it is entitled: "Hyperglycemia and factors associated with dental caries during pregnancy." The objective of this work was to study, retrospectively, in women in the immediate postpartum period, the factors associated with dental caries in pregnancy, and verify if mothers with hyperglycemia have more tooth decay than those with normal blood glucose. The sample included 297 women. Caries was recorded as present when a lesion of fossa, fissure or smooth surface had an obvious cavity, undermined enamel, or a detectable softening of the floor or walls. The restored teeth that had one or more areas with carious lesions were considered decayed. It was recorded also the restored teeth without decay and lost by decay. The oral biofilm was assessed by visible plaque index, and blood glucose by HbA1c through test. Socioeconomic characteristics of harmful habits and oral health were obtained through structured questionnaires. Women also records the information was collected.The results showed that more than half of mothers (66%) had caries and that is not associated with hyperglycemia in pregnancy (p = 0.386). The model of hierarchical logistic regression showed that the variables maternal education ≤ 8 years of schooling (adjusted OR = 2.40 [CI 1.19 to 4.82]), have previous children (adjusted OR = 1.81 [CI 1, 08-3.03), flossing (adjusted OR = 048 [CI 0.27 to 0.86]) and visible plaque index ≥ 30% (adjusted OR = 1.83 [CI 1.05 to 3, 20]) are associated with the presence of caries in pregnancy. The second work is listed in Chapter II and is entitled, "Maternal dental caries: there is an association with prematurity?" and it aimed to investigate the relationship between dental caries and prematurity. The sample consisted of 279 women in the postpartum, and 91 had premature births and 188 births at term, respecting the proportionality of 1 case 2 controls. Data were collected through questionnaires, information from medical records and intra-oral clinical examination, which covered the dental caries record according to the WHO criteria and visible plaque indexThe results of this study showed that tooth decay is not associated with prematurity (OR = 1.08, p = 0.90). The presence of caries was identified in 62.3% of women with a positive outcome and 62.5% of women with a negative outcome. In addition, this study examined other factors associated with preterm birth, finding that prematurity is associated with maternal education (OR = 2.56, p = 0.010), low birth weight (OR = 12.18 p ˂ 0.001) and hypertension (OR = 2.32, p = 0.019). The results of this Thesis call attention to the high prevalence of tooth decay in pregnant women and the need to understand the factors that influence the mechanisms responsible for this phenomenon. / Doenças bucais não tratadas podem comprometer a saúde da gestante e do seu bebê. Neste sentido, estudos voltados para a compreensão de todos os fatores que influenciam a prevalência da cárie dentária em gestantes, bem como os reflexos da doença na gestação são imprescindíveis para o planejamento de estratégias de promoção e prevenção em saúde bucal. Esta Tese estudou aspectos relacionados à cárie dentária em mulheres no pós-parto imediato, a partir dos dados provenientes do Projeto Multicêntrico Geravida, dando origem a dois artigos originais. O primeiro artigo consta no Capítulo I deste trabalho e tem por título: “Hiperglicemia e fatores associados à carie dentária na gestação”. O objetivo deste trabalho foi estudar, retrospectivamente, em mulheres no pós-parto imediato, os fatores associados à cárie dentária na gestação, e verificar se as puérperas com hiperglicemia apresentam mais cáries dentárias que as com glicemia normal. A amostra totalizou 297 mulheres. A cárie foi registrada como presente quando uma lesão de fóssula, fissura ou de superfície lisa tinha uma cavidade evidente, esmalte socavado, ou um amolecimento detectável do assoalho ou das paredes. Os dentes restaurados que tinham uma ou mais áreas com lesão de cárie foram considerados cariados. Registrou-se também os dentes restaurados e sem cárie e os perdidos por cárie. O biofilme oral foi avaliado por meio do índice de placa visível e a glicose no sangue, através do teste Hb A1c. Características socioeconômicas, de hábitos nocivos e de saúde bucal foram obtidas através de questionários estruturados. Também foram coletadas informações dos prontuários das mulheres. A análise dos resultados mostrou que mais da metade das puérperas (66%) apresentaram lesões de cárie e que esta não está associada à hiperglicemia na gravidez (p = 0,386). O modelo de regressão logística hierarquizado mostrou que as variáveis escolaridade materna ≤ 8 anos de estudo (OR ajustado = 2,40 [IC 1,19 – 4,82]), ter filhos anteriores (OR ajustado = 1,81 [IC 1,08 – 3,03]), uso do fio dental (OR ajustado = 048 [IC 0,27 – 0,86]) e índice de placa visível ≥ 30% (OR ajustado = 1,83 [IC 1,05 – 3,20]) estão associados à presença de cárie na gestação. O segundo trabalho consta no Capítulo II e tem por título: “Cárie dentária materna: existe associação com a prematuridade?” cujo objetivo foi averiguar a relação entre cárie dentária e prematuridade. A amostra foi composta por 279 puérperas, sendo que 91 tiveram partos prematuros e 188 partos a termo, respeitando a proporcionalidade de 1 caso para 2 controles. Os dados foram coletados por meio de questionários, informações dos prontuários e exame clínico intra-bucal, que abrangeu o registro de cárie dentária de acordo com os critérios da OMS e índice de placa visível. Os resultados deste estudo mostraram que a cárie dentária não está associada à prematuridade (OR = 1,08, p = 0,90). A presença de cárie foi identificada em 62,3% das mulheres com desfecho positivo e em 62,5% das mulheres com desfecho negativo. Além da cárie da dentária, este trabalho analisou outros fatores associados com o nascimento prematuro, encontrando associação da prematuridade com a escolaridade materna (OR = 2,56, p = 0,010), o baixo peso ao nascer (OR = 12,18 p ˂ 0,001), e a hipertensão arterial (OR = 2,32, p = 0,019). Os resultados deste trabalho de Tese chamam a atenção para a elevada prevalência de cárie dentária em grávidas e para a necessidade de compreensão dos fatores que influenciam os mecanismos responsáveis por este fenômeno.