Magister Scientiae (Medical Bioscience) - MSc(MBS) / Pregnancy associated maternal morbidity and mortality along with adverse pregnancy outcomes have gained momentum over the past few years, particularly in Sub-Saharan Africa and Southern Asia despite the advances in medical science. Adverse pregnancy outcomes are associated with low birth weight, growth restriction, developmental and cognitive abilities in infants and children. Medical care for preterm babies is costly, requires advanced equipment and qualified trained staff. Recently, levels/concentrations of cytokines have been used to predict and determine potential risk in various medical conditions. Biomarkers have shown to be helpful in many medical conditions and could be used to reduce the number of preterm deliveries in developing countries. The aim of this study was to determine whether a highly elevated CRP serum concentration was associated with preterm delivery in a population of Rwandan mothers.

Orientador: Maria Regina Bentlin / Resumo: Introdução: A sepse tardia (ST) é um grande desafio para neonatologistas por ser frequente e grave. Objetivos: Em prematuros de muito baixo peso (PT MBP): investigar a incidência da ST, clínica e confirmada, e a distribuição dos agentes etiológicos; analisar os fatores de risco; avaliar o prognóstico da sepse em curto prazo. Métodos: Coorte retrospectiva, com coleta prospectiva de dados, aprovado pelo Comitê de Ética, realizado entre 2013-2017 na UTI Neonatal do HC FMB - UNESP. Foram selecionados todos os PT com peso de nascimento (PN) ≤ 1.500 g internados na UTI e incluídos aqueles com idade gestacional (IG) entre 23 e 33 semanas, que sobreviveram por mais de 72h e acompanhados até alta, óbito ou 120 dias de internação. Não incluídos os PT com malformações múltiplas, infecções congênitas sintomáticas. ST foi definida como sinais clínicos e laboratoriais de infecção, confirmada ou não por hemocultura (HMC). Variáveis estudadas: gestacionais, neonatais, procedimentos e agentes etiológicos. Desfechos: óbito, displasia broncopulmonar (DBP), hemorragia peri e intraventricular (HPIV) grave, leucomalácia cística e retinopatia da prematuridade (ROP) ≥ estágio 2. Comparação entre grupos: Sem ST vs ST confirmada (HMC+) vs ST clínica (HMC-). Estatística: ANOVA com comparação múltipla de Tukey ou de Wald (distribuição gama); regressão logística múltipla (stepwise e ajuste para IG). Significância: 5%. Resultados: Foram incluídos 346 PT MBP. A incidência de ST foi de 32% (21% ST confirmad... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Late onset sepsis (LOS) remains a challenge for neonatologists because it is a frequent and severe disease. Aim: In very low birth weight (VLBW) preterm infants (PT): to investigate the incidence of LOS, proven and clinical, and the distribution of etiologic agents; to analyze the risk factors evolved; to evaluate the prognosis in the short term. Methods: Retrospective analysis of cohort, with prospective data collect, approved by the Ethics Committee, performed between 2013-2017 at the Neonatal Intensive Care Unit (NICU) of the Botucatu Medical School - UNESP. All PT with birth weight (BW) ≤ 1.500 g admitted in the NICU were selected. PT with gestational age (GA) between 23 and 33 weeks, admitted for more than 72 hours and followed up until discharge, death or 120 days of NICU stay were included. Not included multiple malformations and symptomatic congenital infections. LOS was defined as clinical and laboratory signs of infection, confirmed or not by blood culture (BC). Variables: gestational, neonatal, procedures and etiological agents. Outcomes: death, bronchopulmonary dysplasia (BPD), severe peri and intraventricular hemorrhage (PIVH), cystic leukomalacia and retinopathy of prematurity (ROP) ≥ stage 2. Comparison among groups: No LOS vs Proven LOS (BC+) vs Clinical LOS (BC-). Statistical analysis: ANOVA with multiple Tukey or Wald comparison (gamma distribution); multiple regression (stepwise), with adjustment for GA. Significance: 5%. Results: 346 PT were ... (Complete abstract click electronic access below) / Mestre

Objectives: The purpose of the present study was to examine background and modifiable pregnancy health behavior factors predicting infant birthweight in an economically and educationally disadvantaged sample with low medical risk. Methods: Participants were recruited from a family practice center in rural Appalachia. Participants: Over 220, predominantly Caucasian and lower SES women with low risk pregnancies were included in the sample. Data were collected through systematic chart review. Half of the women smoked during pregnancy and over 10% gave birth to low birth weight (LBW; < 2500 g) babies. Results: Compared with those who gave birth to normal weight newborns, women with LBW babies had more miscarriages, but did not differ significantly on other background factors. Women who delivered LBW babies gained less weight during pregnancy and were more likely to smoke than remaining women. After control for background factors, modifiable pregnancy health behavior factors (weight gain, prenatal care, smoking, alcohol and substance use) accounted for over 11% of birth weight variance, with nearly 7% attributable solely to smoking. Conclusions: Pregnancy smoking was the strongest behavioral predictor of LBW in this economically and educationally disadvantaged rural sample, suggesting that efforts to reduce LBW in similar populations should include targeting pregnancy smoking.

The benefits of prenatal care (PNC) are extensively documented; however, controversy surrounds the extent to which benefits are experienced among different racial groups. Determining whether PNC influences positive birth outcomes and if advantages differ by race is pertinent to attaining positive health outcomes. The purpose of this study was to examine the relationship between gestational weight gain (GWG), low birthweight (LBW), and PNC while weighing racial differences. The theoretical foundation was the motivation-facilitation theory of PNC access. Research questions were designed to (a) determine if there was a significant association between GWG and LBW, (b) determine if PNC had a mediating role if GWG was found to be associated with LBW, and (c) determine if PNC was a mediator and if that role differed between races. A quantitative, deductive correlational analysis was carried out using a retrospective observational approach. Spearman correlation showed that the relationship between GWG and LBW was significant (rs = 0.14, p < .001). Binary logistic regression was used for analysis and showed that the overall model was significant, Ï?2(12) = 50.29, p < .001, and that maternal age, race, marital status, GWG, education, body mass index (BMI), cigarette use, and gestational diabetes significantly affected the chances of LBW. Baron and Kenny's mediation analysis supported partial mediation for American Indian or Alaskan Native and Asian or Pacific Islander races and showed that PNC was significantly associated with birthweight. Based on these findings, providers can aim to implement motivational factors to increase the facilitation and use of PNC to decrease adverse birth outcomes and increase population health.

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Background: Opioid maintenance therapy has been advocated by American College of Obstetrics and Gynecology (ACOG) along with American Society of Addiction Medicine (ASAM) for opioid use disorder in pregnancy. Marijuana use has been increasing with legalization of marijuana in many states along with reported benefit of antiemetic effect in pregnancy. Both have been independently implicated in adverse neonatal outcome but they haven't been studied for concurrent use in pregnancy. Objective: Objective of the study was to look in to the use of opioid and marijuana in pregnancy related with neonatal outcomes; birth weight, Apgar scores,low birth weight, preterm birth along with social determinant of opioid and marijuana use in pregnancy. Design/Methods: A retrospective chart review from July 2011 to June 2016 of all births from 6 delivery hospitals in South-Central Appalachia was conducted to determine pregnancy and neonatal outcomes of pregnancies exposed to any form of opioid and positive urine drug screen (UDS) for marijuana(THC) at the time of delivery. Inclusion criteria were UDS positive for THC at delivery and exposure to opioid during pregnancy.18730 births were identified during the study period, 2638 pregnancy were opioid exposed, and 2375 pregnancies met the inclusion criteria were included for analysis with 108 pregnancies positive for THC in UDS at the time of delivery. Maternal characteristics, delivery and perinatal outcome were studied. Student t-test and Chi-Square test were used for group comparison for presence and absence of marijuana. Logistic regression was done for significant confounding variables like parity, maternal status, tobacco, and benzodiazepine to find aOR for marijuana exposure for NAS diagnosis, premature birth, and low birth weight (LBW). Results: Among opioid using women, marijuana positive women were more likely to be unmarried, nulliparous, and use tobacco and benzodiazepines. Infants born to the marijuana users were likely to be of earlier gestational age (3 days), lower birth weight, and preterm; with preterm birth and low birth weight (mean difference = 265 gms) increased two fold even after controlling for parity, marital status, tobacco and benzodiazepine use with aOR of 2.35 (1.30-4.23) and 2.02 (1.18-3.47) respectively. Conclusion(s): In view of ACOG and ASAM guidelines for continuing opioid for opioid use disorder during pregnancy, finding of increased prematurity along with LBW carries significance of advocating counseling against use of marijuana in pregnancy exposed to opioids.

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