Objectives The aims of this thesis were to (1) investigate the association of gestational exposure to environmental phthalates with maternal and perinatal outcomes, and (2) explore phthalate-induced changes to maternal inflammatory responses as potential mediators of possible health effects. Methods A systematic review was performed to summarize existing evidence on the association of gestational exposure to phthalates with obstetrical outcomes, including pre-eclampsia (PE), pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), intrauterine growth restriction (IUGR), birth weight (BW), head circumference (HC), gestational age (GA), preterm birth (PB), and Apgar scores (AS). Additionally, a secondary analysis of data from the MIREC Study was conducted to evaluate the association of phthalate metabolites with clinical outcomes in the mother and infant using multiple linear and logistic regression, and with inflammatory biomarkers using multinomial logistic regression. Results The systematic review identified a total of 24 articles, and observed inconsistent evidence on BW, HC, GA, and PB, a paucity of research on IUGR, PE, GDM, and AS, and a lack of studies on PIH. However, among studies with statistically significant (p<0.05) results, most suggest an association of phthalates with decreased BW and GA, and increased HC and PB. Findings from the MIREC Study indicate a significant (p<0.01) positive association between MBP and HC among female infants; however, null results were identified for BW, GA, PB, AS, and PIH. In relation to the exposure to phthalates, general trends among suggestive associations (p<0.05) for head circumference showed consistent increases in females and decreases in males, and for gestational age displayed decreases in both stratums. Additionally, a significant positive association of MBzP and ∑DEHP was observed with high MMP-2 and low VCAM levels, respectively. Results approaching statistical significance demonstrated a positive association of ∑DEHP with low MCP1 and ICAM levels, MCPP with low GMCSF levels, MBzP with low CRP and high ICAM levels, and MEP with high MMP-7 and IL-2 levels. Conclusion From the systematic review, the effects of phthalates on maternal and perinatal health remain unclear, possibly due to sources of heterogeneity and challenges in exposure assessment. In the MIREC Study cohort, phthalate levels were associated with GA and HC in infants in a sex-specific manner. Phthalates also appear to influence the circulating inflammatory marker levels, possibly explaining the observed adverse effects. Future research is needed to validate these findings.

Objetivo: Determinar si la edad materna está asociada a un aumento o disminución de riesgo de complicaciones obstétricas y perinatales, ajustándola por diversas variables confusoras. Métodos: Estudio de cohorte retrospectiva de 67 693 gestantes en Lima, entre enero del 2000 a diciembre del 2010, usando la base de datos del Sistema informático perinatal del Hospital Nacional María Auxiliadora. Las complicaciones fueron comparadas entre gestantes adolescentes (< 20 años) y gestantes adultas (20-35 años); el grupo adolescente se clasificó en adolescentes tardías (15-19 años) y adolescentes tempranas (< 15 años). Se obtuvieron los Odds Ratio ajustados con la regresión logística simple y múltiple. Resultados: Al ajustar las diversas variables, se encontró mayor riesgo de cesárea e infección puerperal en las adolescentes menores de 15 años, así como mayor riesgo de episiotomía en el grupo total de adolescentes. Asimismo, se identificó un menor riesgo del embarazo adolescente para preeclampsia, hemorragia de la 2da mitad del embarazo, ruptura prematura de membranas, amenaza de parto pretérmino y desgarro vaginal. Conclusiones: Se encontró al embarazo adolescente como factor de riesgo para complicaciones obstétricas. Por lo tanto, se recomienda un control prenatal multidisciplinario para éste grupo etario. / Objective: To determine whether maternal age is associated with increased or decreased risk of obstetric and perinatal outcomes, adjusting by several factors. Metods: Retrospective cohort study of 67 693 pregnant women in Lima, from January 2000 to December 2010, using the perinatal database computer system from the Hospital Nacional María Auxiliadora. Outcomes were compared among pregnant adolescents (< 20 years) and adults (20-35 years); in addition, the adolescent group was divided in late adolescents (15-20 years), and early adolescents (<15 years). Adjusted odds ratios were obtained through logistic regression analysis. Results: Adjusting by several factors, an increased risk of cesarean and puerperal infection in adolescents less than 15 years was found, as well as an increased risk of episiotomy in the total group of adolescents. In addition, this study identified a lower risk of preeclampsia, 2nd half-pregnancy bleeding, premature rupture of membranes, preterm labor and vaginal tearing among adolescent mothers. Conclusion: Teenage pregnancy was found as a risk factor for adverse obstetric outcomes; hence, a multidisciplinary prenatal care for this group of adolescent is recommended. Key Word: Adolescent pregnancy, obstetric outcomes, perinatal outcomes / Tesis

Objective: To characterize current diabetes screening practices in the first trimester of pregnancy in the United States, evaluate patient characteristics and risk factors associated with early diabetes screening, and compare perinatal outcomes by early diabetes screening. Methods: This was a retrospective cohort study of US medical claims data from patients diagnosed with a viable intrauterine pregnancy who presented for care before 14 weeks of gestation without pre-existing pre-gestational diabetes from the IBM MarketScan® database for the period of January 1, 2016, to December 31, 2018. Univariate and multivariate analyses were used to evaluate clinical factors and perinatal outcomes. Results: There were 400,588 pregnancies identified as eligible for inclusion, with 18.0% of women receiving early screening for diabetes. Of those with laboratory order claims, 53.1% had hemoglobin A1c, 30.0% fasting glucose, and 16.9% oral glucose tolerance tests. Compared to women who did not have early diabetes screening, those that did were more likely to be older, obese, have a history of gestational diabetes, chronic hypertension, polycystic ovarian syndrome, hyperlipidemia, and a family history of diabetes. In adjusted logistic regression, history of gestational diabetes (aOR 3.99, 95% CI 3.73-4.26) had the strongest association with early diabetes screening. Early diabetes screening irrespective of the screening result was also associated with adverse perinatal outcomes including a higher rate of cesarean delivery, preterm delivery, gestational hypertension, pre-eclampsia, and gestational diabetes. Conclusion: First trimester early diabetes screening was mostly commonly performed by hemoglobin A1c evaluation, and women that underwent early diabetes screening regardless of the result were more likely to experience adverse perinatal outcomes.

The umbilical cord, the most important connection between fetus and placenta, which is re-sponsible for the development and maintenance of the intrauterine life, consists of a spiral structure whose blood vessels carry nutrients from mother to fetus, and catabolites from fetus to mother. Studies on number of coiling on the umbilical cord have not been relevant in the current literature. In other words, this funicular parameter is undervalued by the specialist medical community. However, some studies show an association between umbilical cord coiling and adverse perinatal outcomes. This is an analytical cross-sectional study aimed to assess the umbilical cord coiling index (UCI) during the postpartum period, and relate the UCI with perinatal outcomes in pregnant women admitted to have their births at HUSM, from June to October, 2012. A coil was defined as a complete 360 degree spiral course of the umbilical vessels around the Wharton s jelly. The UCI was defined by being the relation between the number of spirals and the length of the cord, and the values found between the 10th and 90th percentile were considered as within the limits of normality. For values under P10, the umbilical cord was hypocoiled and over P90, hypercoiled. Two hundred fifty two placentas and their cords were evaluated, but 179 births were considered for the analysis of perinatal outcomes. The average UCI was 0.17 ± 0.86 coils/cm while the hypocoiling (UCI<0.05 coils/cm) and hypercoiling (UCI> 0.28 coils/cm) represented 8.4% (n = 21) and 8.8% (n = 22) respectively. There was a significant correla-tion between the UCI and the Apgar score at 1 and 5 minute (p <0.05). Among preterm newborns, 26.3% had abnormal coiling. Among small for gestational age (SGA) 26,6% had abnormal coiling too. Only one death occurred in utero and the umbilical cord was hypercoiled (UCI = 0.42 coils/cm). There was no correlation or association between the IEC and other perinatal outcomes, such as meco-nium staining amniotic fluid, fetal distress, intrauterine growth restriction (IUGR), neonatal intensive care unit (NICU) admission and neonatal death. The results allow to conclude that the UCI can relate to adverse perinatal outcomes, although few of them in this study had statistical significance, which may be attributed to the sample size, addressing the need for further study on the subject. / O cordão umbilical, conexão mais importante entre o feto e a placenta, a qual é responsável pelo desenvolvimento e manutenção da vida intrauterina, consiste numa estrutura espiralada cujos vasos sanguíneos transportam nutrientes da mãe para o feto e catabólitos do feto para a mãe. Estudos sobre o número de espirais do cordão umbilical não têm tido relevância na literatura atual, ou seja, este parâmetro funicular é pouco valorizado pela comunidade médica especializada. No entanto, alguns estudos evidenciam a associação entre o espiralamento e os desfechos adversos perinatais. O objetivo deste estudo, transversal e analítico, foi o de avaliar o Índice de Espiralamento do Cordão umbilical (IEC) após o parto e relacioná-lo com desfechos perinatais nas gestantes admitidas para parto no Hospital Universitário de Santa Maria entre junho e outubro de 2012. Uma espiral foi definida como uma volta completa do cordão em torno da geleia de Warton. O IEC foi definido como a relação entre o número de espirais e o comprimento do cordão umbilical, sendo que os valores encontrados entre os percentis 10 e 90 foram considerados dentro dos limites de normalidade. Para valores abaixo do P10, o cordão umbilical era hipoespiralado e acima do P90, hiperespiralado. Foram avaliadas 252 placentas e seus cordões, sendo que, para a análise dos desfechos perinatais, 179 nascimentos foram considerados. O IEC médio foi de 0,17±0,86 espirais/cm, enquanto o hipoespiralamento (IEC<0,05 espirais/cm) e o hiperespiralamento (IEC>0,28 espirais/cm) representaram 8,4% (n=21) e 8,8% (n=22) respectivamente. Houve correlação significante entre o IEC e o índice de Apgar de primeiro e de quinto minuto (p<0,05). Dos recém-nascidos pré-termo, 26,3% tinham um IEC anormal, assim como 26,6% dos pequenos para a idade gestacional. No único óbito ocorrido in útero, o cordão era hiperespiralado (IEC=0,42 espirais/cm). Não houve correlação ou associação entre o IEC e outros desfechos perinatais, tais como presença de mecônio no líquido amniótico, sofrimento fetal agudo, crescimento intrauterino restrito, internação em UTI neonatal e óbito neonatal. Os resultados permitem concluir que o IEC pode se relacionar a desfechos perinatais adversos, embora no presente estudo poucos deles tivessem significância estatística, fato que pode ser atribuído ao tamanho da amostra estudada, o que remete para a necessidade de novos estudos a respeito.

SAMMANFATTNING Bakgrund: Ätstörningar uppträder oftast hos kvinnor i reproduktiv ålder. Orsaker till ätstörning är svåridentifierade men sociala, psykologiska och biologiska processer verkar samverka. Ätstörningar kan vara svåra att behandla då många kvinnor är hemlighetsfulla kring sin ätstörning för att de skäms över sitt störda ätbeteende. Forskning tyder på att kvinnor med någon form av ätstörning löper risk för komplikationer under graviditeten och i samband med förlossningen samt vid övergång till moderskapet. Samtidigt som kvinnor med ätstörning ska hantera oro för fostrets/barnets välbefinnande försöker de hantera sin ätstörning, vilket kan göra dem sårbara. Det är betydelsefullt för mödravården att ha kännedom om hur ätstörningar påverkar graviditetsutfall för att kunna ge dessa kvinnor adekvat behandling och stötta dem på bästa sätt. Syfte: Att beskriva vilken effekt tidigare eller pågående ätstörning har på graviditetsutfall och övergång till moderskapet. Metod: En litteraturöversikt där sökning genomförts i databaserna Cinahl, Pubmed och PsycINFO. Tjugotvå vetenskapliga artiklar utgör resultatsammanställningen, varav sexton har kvantitativ ansats och sex kvalitativ ansats. Resultat: Pågående eller tidigare ätstörning hos gravida kvinnor påverkar kvinnans graviditet och graviditetsutfall genom ökad risk för depression och ångest under graviditeten och postnatalt samt för prematur födsel. Ätstörning ökar kvinnans sårbarhet under graviditeten och vid övergång till moderskapet på grund av hennes oro över viktuppgång och att inte bli eller vara en tillräckligt bra mamma. Pågående eller tidigare ätstörning hos mamman påverkar barnet genom ökad risk för låg födelsevikt och/eller SGA-barn. Kvinnor med ätstörning visar svårigheter i det interaktiva mönstret med barnet och har ofta svårt att känna igen barnets hunger och att kunna skilja på barnets hunger och dess behov av närhet. Kvinnor med ätstörning har ett ökat behov av stöd under graviditeten och postpartum. Motstridiga resultat framkom avseende prematur födsel, missfall, kejsarsnitt och instrumentell förlossning, inducerad förlossning, födelsevikt, SGA-barn, intrauterin tillväxthämning och Apgar-poäng. Slutsats: Denna litteraturöversikt visar att kvinnor med pågående eller tidigare ätstörning har högre risk för negativa utfall under graviditeten och perinatalt samt försämrade förutsättningar vid övergången till moderskapet. Flera studier visade på motstridiga resultat. Kliniska implikationer: Det är betydelsefullt att tidigt i graviditeten identifiera kvinnor med ätstörning för att kunna hindra eller lindra negativa utfall. Eftersom kvinnor med ätstörning ofta döljer sitt störda ätbeteende, försvåras identifieringen av dem. Ett enkelt verktyg som möjliggör screening av ätstörningar skulle möjligen underlätta upptäckten av ätstörning tidigt i en graviditet.

Submitted by MARIANA PINTO SIRIMARCO null (mpsirimarco@yahoo.com.br) on 2016-04-08T03:04:00Z No. of bitstreams: 1 VERSÃO FINAL 2 08-04.pdf: 1774461 bytes, checksum: 13e24ee503bed7a9ca8d50a2f58cd2aa (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-04-08T16:39:33Z (GMT) No. of bitstreams: 1 sirimarco_mp_me_bot.pdf: 1774461 bytes, checksum: 13e24ee503bed7a9ca8d50a2f58cd2aa (MD5) / Made available in DSpace on 2016-04-08T16:39:33Z (GMT). No. of bitstreams: 1 sirimarco_mp_me_bot.pdf: 1774461 bytes, checksum: 13e24ee503bed7a9ca8d50a2f58cd2aa (MD5) Previous issue date: 2016-02-29 / JUSTIFICATIVA – desde agosto de 2011 o Serviço Especializado de Diabetes e Gravidez da Faculdade de Medicina de Botucatu/Unesp (SEDG-FMB/Unesp) adotou o novo protocolo diagnóstico para o DMG recomendado pela ADA/IADPSG. Entretanto, o Perfil Glicêmico (PG) continuou associado ao TOTG 75g, para diagnosticar a Hiperglicemia Gestacional Leve (HGL), reconhecida e tratada em nosso Serviço como se fosse DMG. A controvérsia sobre o custo-benefício do novo protocolo da ADA/IADPSG e a dúvida sobre a necessidade de manutenção do PG no protocolo do Serviço justificam o presente estudo. OBJETIVOS – avaliar o impacto do novo protocolo da ADA/IADPSG na prevalência de HGL e de DMG, na ocorrência de resultados perinatais adversos (RPNA) e na associação TOTG 75g e PG para diagnóstico de HGL no SEDG-FMB/Unesp. MÉTODO – estudo de corte transversal, incluindo gestantes, e seus recém-nascidos (RN), submetidas aos protocolos diagnósticos e que realizaram pré-natal e parto no Serviço, antes (janeiro de 2008 a 14 de agosto de 2011) e após (15 de agosto de 2011 a dezembro de 2014) à mudança do protocolo, definindo uma amostra por conveniência. Considerando os dois períodos, foram comparadas a prevalência de DMG e de HGL e a ocorrência de RN-GIG, macrossomia, primeira cesárea e tempo de internação dos RN. Na análise estatística foram utilizados análise de Poison e teste t-Student, teste do Qui-quadrado ou Exato de Fischer e cálculo de risco (RR e IC 95%) para os desfechos avaliados. O limite de significância estatística foi de 95% (p < 0,05). RESULTADOS – o NOVO protocolo resultou em aumento no número de mulheres com DMG e deixou de identificar 17,3% do total de gestantes, que mantiveram o diagnóstico de HGL, apesar do TOTG 75g normal. O novo protocolo ADA/IADPSG não influenciou o desfecho perinatal. CONCLUSÕES – esses resultados reforçam a validade da manutenção do PG no protocolo diagnóstico do SEDG-FMB/Unesp. Para concluir sobre o custo-benefício do NOVO protocolo, são necessários grandes estudos, multicêntricos e com tamanho amostral adequado. / BACKGROUND - since August 2011 the Specialized Center of Diabetes and Pregnancy of the Botucatu Medical School / Unesp (SEDG-FMB / Unesp) has adopted a new diagnostic protocol for Gestational Diabetes Mellitus (GDM) recommended by the ADA / IADPSG guidelines. However, the glycemic profile (GP) remained associated with the 75g OGTT to diagnose Mild Gestational Hyperglycemia Lite (MGH), recognized and treated in our department as if it were GDM. The controversy over the cost-effectiveness of the new ADA / IADPSG guideline and doubt about the need for GP maintenance in the service protocol justify this study. OBJECTIVES - To assess the impact of the new ADA / IADPSG guideline in the prevalence of MGH and GDM, in the incidence of adverse perinatal outcomes (APNO) and in the association 75g OGTT and PG for diagnosis of MGH at the SEDG-FMB / Unesp. METHOD - cross-sectional study, including pregnant women and their newborns (NB) that underwent diagnostic protocols and had their prenatal care and delivery at the service before (January 2008 to August 14, 2011) and after (15 August 2011 to December 2014) the protocol modification, defining a convenience sample. Considering the two periods, the prevalence of GDM and MGH and the occurrence of LGA-NB, macrosomia, first cesarean delivery and NB hospital stay were compared. For statistical analysis, Poison analysis and Student's t test, chi-square or Fisher's exact test were used and risk estimate (RR and 95% CI) for the assessed outcomes. The statistical significance threshold was 95% (p <0.05). RESULTS - The new protocol resulted in a increase in the number of women with GDM, but failed to identify 17.3% of pregnant women who maintained the diagnosis of MGH, despite normal 75g OGTT. The new ADA / IADPSG guideline did not influence the perinatal outcome. CONCLUSIONS - These results reinforce the validity of maintaining the GP in the diagnosis protocol at the SEDG-FMB / Unesp. To conclude on the cost-effective of the new protocol, large multicenter studies with adequate sample size are required

Submitted by ANDRESSA TRECENTI DAMACENA null (dretrecenti@hotmail.com) on 2016-05-04T11:16:43Z No. of bitstreams: 1 Dissertacao Andressa - Repositório.pdf: 2946507 bytes, checksum: 9abbfaa6ae7910659e2f50cdfcba9757 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-05-04T20:44:45Z (GMT) No. of bitstreams: 1 damacena_at_me_bot.pdf: 2946507 bytes, checksum: 9abbfaa6ae7910659e2f50cdfcba9757 (MD5) / Made available in DSpace on 2016-05-04T20:44:45Z (GMT). No. of bitstreams: 1 damacena_at_me_bot.pdf: 2946507 bytes, checksum: 9abbfaa6ae7910659e2f50cdfcba9757 (MD5) Previous issue date: 2016-02-23 / Introdução: Pré-eclâmpsia é uma síndrome sistêmica específica da gestação com etiopatogenia ainda não esclarecida, porém acredita -se ser decorrente de alterações no processo de invasão trofoblástica, com consequente inadequado suprimento sanguíneo uterino e estresse oxidativo do tecido placentário. O aumento da concentração de ácido úrico sérico materno (AU) em mulheres com pré-eclâmpsia tem sido associado com a gravidade da hipertensão, proteinúria e prognóstico materno e perinatal na gestação. Objetivos: Identificar a associação entre a concentração sérica de ácido úrico e resultados maternos e perinatais adversos e correlacionar a concentração sérica do ácido úrico materno com recémnascidos pequenos para idade gestacional e proteinúria materna. Sujeitos e Métodos: Foi realizado estudo retrospectivo, em gestantes com pré-eclâmpsia, as quais foram estratificadas de acordo com a dosagem de ácido úrico sérico em dois grupos: I (inferior a 6 mg/dL) e II (igual ou superior a 6 mg/dL) e avaliados resultados adversos maternos e perinatais. Resultados: No grupo II houve maior frequência de crise hipertensiva(25%), eclampsia(6,9%), síndrome HELPP parcial (7,8%) e síndrome HELLP(6,9%), maior número de recém-nascidos pequenos para idade gestacional(47%), menor peso do recém-nascido, maior porcentagem de óbito fetal(1,8%), de prematuridade(68%) e de índice de Apgar no 1º minuto(38%). Conclusões: Os resultados demonstram que as paciente com ácido úrico elevado apresentam piores resultados adversos tanto maternos quanto perinatais, sendo assim a dosagem de ácido úrico sérico materna associadas a outros exames clínicos e laboratoriais, pode auxiliar nos processos de decisão na prática obstétrica. / Introduction: Preeclampsia is a specific systemic disease of pregnancy with unknown etiology, but it is believed to be due to changes in the process of trophoblastic invasion, leading to an inadequate uterine blood supply and oxidative stress of the placental tissue. Increasing of maternal uric acid serum concentration (UA) in women with pre-eclampsia has been associated with the severity of hypertension, proteinuria and maternal and perinatal outcome on pregnancy. Objectives: Identify the association between serum uric acid and adverse maternal and perinatal outcomes. More specifically, the correlation of maternal UA serum concentration with newborn size for gestational age and maternal proteinuria. Subjects and Methods: Cross observational study in pregnant women with preeclampsia, which were stratified according to dose of serum uric acid into two groups, as follow: I (below 6 mg/dL) and II (greater or equal to 6 mg/dL). Maternal and perinatal adverse outcomes were examined. Results were analyzed by T - Student and chi-square tests and correlations were evaluated by Pearson test. The level of significance used was 5%. Results: In group II there were a greater frequency of hypertensive crisis, eclampsia, partial HELPP syndrome and HELLP syndrome. Also it were observed an increased number of small newborns for gestational age, lower weight of the newborn, the higher percentage of fetal death, prematurity and index Apgar at 1 minute. Conclusions: The results suggest that patients with higher uric acid have worse adverse outcomes both for maternal and perinatal. In conclusion, the dosage of maternal serum uric acid associated with other clinical and laboratory tests can help in the decision on obstetrical practice.

Orientador: Iracema de Mattos Paranhos Calderon / Resumo: JUSTIFICATIVA – desde agosto de 2011 o Serviço Especializado de Diabetes e Gravidez da Faculdade de Medicina de Botucatu/Unesp (SEDG-FMB/Unesp) adotou o novo protocolo diagnóstico para o DMG recomendado pela ADA/IADPSG. Entretanto, o Perfil Glicêmico (PG) continuou associado ao TOTG 75g, para diagnosticar a Hiperglicemia Gestacional Leve (HGL), reconhecida e tratada em nosso Serviço como se fosse DMG. A controvérsia sobre o custo-benefício do novo protocolo da ADA/IADPSG e a dúvida sobre a necessidade de manutenção do PG no protocolo do Serviço justificam o presente estudo. OBJETIVOS – avaliar o impacto do novo protocolo da ADA/IADPSG na prevalência de HGL e de DMG, na ocorrência de resultados perinatais adversos (RPNA) e na associação TOTG 75g e PG para diagnóstico de HGL no SEDG-FMB/Unesp. MÉTODO – estudo de corte transversal, incluindo gestantes, e seus recém-nascidos (RN), submetidas aos protocolos diagnósticos e que realizaram pré-natal e parto no Serviço, antes (janeiro de 2008 a 14 de agosto de 2011) e após (15 de agosto de 2011 a dezembro de 2014) à mudança do protocolo, definindo uma amostra por conveniência. Considerando os dois períodos, foram comparadas a prevalência de DMG e de HGL e a ocorrência de RN-GIG, macrossomia, primeira cesárea e tempo de internação dos RN. Na análise estatística foram utilizados análise de Poison e teste t-Student, teste do Qui-quadrado ou Exato de Fischer e cálculo de risco (RR e IC 95%) para os desfechos avaliados. O limite de signifi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: BACKGROUND - since August 2011 the Specialized Center of Diabetes and Pregnancy of the Botucatu Medical School / Unesp (SEDG-FMB / Unesp) has adopted a new diagnostic protocol for Gestational Diabetes Mellitus (GDM) recommended by the ADA / IADPSG guidelines. However, the glycemic profile (GP) remained associated with the 75g OGTT to diagnose Mild Gestational Hyperglycemia Lite (MGH), recognized and treated in our department as if it were GDM. The controversy over the cost-effectiveness of the new ADA / IADPSG guideline and doubt about the need for GP maintenance in the service protocol justify this study. OBJECTIVES - To assess the impact of the new ADA / IADPSG guideline in the prevalence of MGH and GDM, in the incidence of adverse perinatal outcomes (APNO) and in the association 75g OGTT and PG for diagnosis of MGH at the SEDG-FMB / Unesp. METHOD - cross-sectional study, including pregnant women and their newborns (NB) that underwent diagnostic protocols and had their prenatal care and delivery at the service before (January 2008 to August 14, 2011) and after (15 August 2011 to December 2014) the protocol modification, defining a convenience sample. Considering the two periods, the prevalence of GDM and MGH and the occurrence of LGA-NB, macrosomia, first cesarean delivery and NB hospital stay were compared. For statistical analysis, Poison analysis and Student's t test, chi-square or Fisher's exact test were used and risk estimate (RR and 95% CI) for the assessed outcomes.... (Complete abstract click electronic access below) / Mestre

Orientador: Vera Terezinha Medeiros Borges / Resumo: Introdução: Pré-eclâmpsia é uma síndrome sistêmica específica da gestação com etiopatogenia ainda não esclarecida, porém acredita -se ser decorrente de alterações no processo de invasão trofoblástica, com consequente inadequado suprimento sanguíneo uterino e estresse oxidativo do tecido placentário. O aumento da concentração de ácido úrico sérico materno (AU) em mulheres com pré-eclâmpsia tem sido associado com a gravidade da hipertensão, proteinúria e prognóstico materno e perinatal na gestação. Objetivos: Identificar a associação entre a concentração sérica de ácido úrico e resultados maternos e perinatais adversos e correlacionar a concentração sérica do ácido úrico materno com recémnascidos pequenos para idade gestacional e proteinúria materna. Sujeitos e Métodos: Foi realizado estudo retrospectivo, em gestantes com pré-eclâmpsia, as quais foram estratificadas de acordo com a dosagem de ácido úrico sérico em dois grupos: I (inferior a 6 mg/dL) e II (igual ou superior a 6 mg/dL) e avaliados resultados adversos maternos e perinatais. Resultados: No grupo II houve maior frequência de crise hipertensiva(25%), eclampsia(6,9%), síndrome HELPP parcial (7,8%) e síndrome HELLP(6,9%), maior número de recém-nascidos pequenos para idade gestacional(47%), menor peso do recém-nascido, maior porcentagem de óbito fetal(1,8%), de prematuridade(68%) e de índice de Apgar no 1º minuto(38%). Conclusões: Os resultados demonstram que as paciente com ácido úrico elevado apresentam piores resulta... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Preeclampsia is a specific systemic disease of pregnancy with unknown etiology, but it is believed to be due to changes in the process of trophoblastic invasion, leading to an inadequate uterine blood supply and oxidative stress of the placental tissue. Increasing of maternal uric acid serum concentration (UA) in women with pre-eclampsia has been associated with the severity of hypertension, proteinuria and maternal and perinatal outcome on pregnancy. Objectives: Identify the association between serum uric acid and adverse maternal and perinatal outcomes. More specifically, the correlation of maternal UA serum concentration with newborn size for gestational age and maternal proteinuria. Subjects and Methods: Cross observational study in pregnant women with preeclampsia, which were stratified according to dose of serum uric acid into two groups, as follow: I (below 6 mg/dL) and II (greater or equal to 6 mg/dL). Maternal and perinatal adverse outcomes were examined. Results were analyzed by T - Student and chi-square tests and correlations were evaluated by Pearson test. The level of significance used was 5%. Results: In group II there were a greater frequency of hypertensive crisis, eclampsia, partial HELPP syndrome and HELLP syndrome. Also it were observed an increased number of small newborns for gestational age, lower weight of the newborn, the higher percentage of fetal death, prematurity and index Apgar at 1 minute. Conclusions: The results suggest that pati... (Complete abstract click electronic access below) / Mestre

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.