Anti-depressants are commonly used to treat major depression and post-traumatic stress disorder. 17% of women experience major depression during pregnancy, where up to 10% of pregnant women use antidepressants. 20% these women use Prozac (fluoxetine) to treat major depressive symptoms, which crosses the placental barrier and is present in breast milk. Little is known about how exposure to developmental fluoxetine affects adulthood behaviors such as agonistic and submissive behaviors, especially in females. Furthermore, the effects of developmental fluoxetine exposure on aggression and avoidance in Syrian hamsters have not been studied. Therefore, we explored how prenatal and perinatal exposure to fluoxetine affects adulthood aggression and avoidance in male and female Syrian hamsters. Dams were given fluoxetine via drinking water 7 days prior impregnation. Fluoxetine administration continue until offspring reached postnatal day (PD) 12. The offspring were weaned and group-housed at PD 25 and single-housed at PD 60. Animals were handled one week prior to behavioral testing. The following week, animals were tested for aggression in a neutral arena with a non-aggressive stimulus hamster of the same sex. Another group of hamsters were tested for avoidance behavior in a neutral arena 24 hours after social defeat. Duration of aggression and avoidance were quantified. There was no main effect of sex or drug nor was there an interaction. Therefore, we reject our hypothesis of prenatal and perinatal exposure to fluoxetine will affect aggression and avoidance in male and female Syrian hamsters. These findings may be due to a ceiling effect in Syrian hamsters, where the subtle effects of developmental fluoxetine exposure were not observable.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The importance of maintaining maternal wellbeing during the antenatal period is mandatory to the mother and the baby. Although asymptomatic maternal tachycardia could be seen as part of the physiological changes during pregnancy, it could also be a sign of a serious underlying condition. Previous studies have shown that maternal deaths could occur in women with pre-existing cardiac conditions (Naidoo, Desai & Moodley, 2002:17). The concern that many conditions associated with maternal tachycardia pass through the health care system without being noticed or investigated motivated the researcher to undertake this study. The study aimed to determine the prevalence of maternal tachycardia during late pregnancy and its association with anaemia, major cardiac diseases and/or complications and adverse maternal and perinatal outcomes. A case-control retrospective study design within a prospective study was employed with a quantitative approach. A total sample size of 204 participants, constituting 14.3% of the study population (N=1431) was purposefully selected from the Monica AN24™ recordings of the Safe Passage Study at Tygerberg Hospital to collect the data. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and a waiver of consent had been granted. A group of 16 participants, who met the inclusion criteria, constituting 7.8% of the total sample, was selected for the pilot study. Reliability and validity was ensured by the pilot study and pre-testing the data collection instrument as it was tested under the exact circumstances as the actual study experts in the field of nursing and medical research and statistics were used. The data was analyzed by the use of the STATISTICA version 9 programme. The results show a 7.1% (n=102) prevalence of maternal tachycardia in late pregnancy. There were no pre-existing cardiac conditions in any of the groups and no maternal cardiac complications during pregnancy and delivery. The case group had a higher incidence (55.0%) of haemoglobin values lower than 11.0 g/dL than the control group (47.0%), however the Mann-Whitney U test revealed no statistically significant difference of the Hb values at 28 to 38 weeks between the case and the control groups. The participants presenting with anaemia (Hb < 11.0 g/dL) were classified as mild anaemia (Hb value of 7.0 – 10.9 g/dL). There were no participants that presented with severe anaemia (Hb value of < 7.0g/dL). There was an increased prevalence (9.1%) of infection in the participants presenting with maternal tachycardia, although this difference was not significant between the two groups. The infant outcome revealed an increased mean birth weight of 194g for the case group that presented with maternal tachycardia. Several recommendations were identified that were grounded in the study findings. The findings reveal that the current antenatal care practice in terms of not recording the maternal heart rate is sufficient. / AFRIKAANSE OPSOMMING: Die belangrikheid van die handhawing van moederlike welsyn gedurende die voorgeboorte tydperk is noodsaaklik vir die moeder en die baba. Alhoewel asimptomatiese moederlike tagikardie gesien kan word as deel van die fisiologiese veranderinge tydens swangerskap, kan dit ook 'n teken wees van 'n ernstige onderliggende toestand. Vorige studies het aangetoon dat moederlike sterftes kan voorkom in vroue met voorafgaande harttoestande (Naidoo, Desai & Moodley, 2002:17). Die kommer dat verskeie toestande wat verband hou met moederlike tagikardie, deur die gesondheidsorg stelsel kan deurglip sonder om opgemerk te word, het die navorser gemotiveer om hierdie studie te onderneem. Die studie is daarop gemik om die voorkoms van moederlike tagikardie tydens laat swangerskap en sy verbintenis met anemie, ernstige hartsiektes en/of komplikasies en ongunstige moederlike en perinatale uitkoms te bepaal. 'n Gevalkontrole retrospektiewe studie-ontwerp binne 'n voornemende studie is gebruik met 'n kwantitatiewe benadering. 'n Totale steekproefgrootte van 204 deelnemers, wat 14.3% van die populasie (N=1431) uitmaak is op ‘n doelgerigte manier uitgekies uit die Monica AN24™ opnames van die Veilige Geboorte Studie by Tygerberg Hospitaal om die data in te samel. Etiese goedkeuring is verkry van die Mensnavorsing Etiese komitee komitee van Fakulteit van Geneeskunde en Gesondheidswetenskappe van die Universiteit Stellenbosch en 'n kwytskelding van toestemming is verleen. 'n Groep van 16 deelnemers, wat voldoen aan die insluitingskriteria, wat 7,8% van die totale steekproef bestaan, is geselekteer vir die loodsstudie. Betroubaarheid en geldigheid is verseker deur die loodsstudie en die voorafgaande toets van die data-insamelingsinstrument onder presies dieselfde omstandighede as die werklike studie sowel as die gebruik van kenners in die gebied van verpleging en mediese navorsing en statistiek. Die data is ontleed deur die gebruik van die Statistica weergawe 9 program. Die resultate toon 'n 7,1% (n=102) voorkoms van moederlike tagikardie in laat swangerskap. Daar was geen onderliggende harttoestande in enige van die groepe en geen moederlike hartkomplikasies tydens swangerskap en geboorte nie. Die gevalgroep het 'n hoër voorkoms (55,0%) van Hb waardes laer as 11.0 g/dl as die kontrole groep (47.0%) gehad, maar die Mann-Whitney U-toets toon geen statisties beduidende verskil in die Hb waardes by 28-38 weke tussen die geval en die kontrolegroepe nie. Die deelnemers met anemie (Hb < 11.0 g/dl) is geklassifiseer met ligte bloedarmoede (Hb waarde van 7.0-10.9 g/dl). Daar was geen deelnemers wat erge bloedarmoede (Hb waarde van < 7.0g/dL) getoon het nie. Daar was verhoogde voorkoms (9,1%) van infeksie in die deelnemers met moederlike tagikardie, hoewel die verskil nie beduidend tussen die twee groepe was nie. Die baba uitkoms toon 'n toename in gemiddelde geboortegewig van 194g vir die gevalgroep wat met moederlike tagikardie gediagnoseer is. Verskeie aanbevelings is geïdentifiseer wat in die studie se bevindinge gegrond is. Die bevindinge dui daarop dat die huidige voorgeboortelike sorgpraktyk in terme van nie rekordering van die moederlike hartspoed voldoende is.

Objetivo: Determinar las características perinatales de los recién nacidos de madres adolescentes atendidos en el Servicio de Neonatología del Hospital Nacional Dos de Mayo durante el periodo Octubre – Diciembre del 2014. Materiales y Métodos: Se realizó un estudio retrospectivo, observacional de corte transversal, en el cual se revisó el Libro de Registro de Ingresos del Servicio de Neonatología recolectando datos de la madre y del neonato. Resultados: La prevalencia de madres adolescentes en nuestro estudio fue de 17.5%. La edad promedio fue 17.7 años. 71% de ellas presentaron control prenatal (CPN) adecuado, y el 56% culminó la gestación por cesárea. Se encontró 93% neonatos a término, y 6% pretérmino. 88 % de los neonatos presentaron peso normal, 5% bajo peso y 2% muy bajo peso. 80% de neonatos fueron adecuados para la edad gestacional y 9% pequeños para la edad gestacional. Adolescentes con CPN adecuados tuvieron 75% menos riesgo de culminar el embarazo por cesárea (p =0.015, OR: 0.25 (0.085-0.0768)), sin embargo adolescentes con CPN inadecuados tienen 5 veces más el riesgo de tener un neonato no a término (p = 0.038, OR: 5.7 (1.104 – 29.9)). Conclusiones: En el presente estudio, se encontró que las repercusiones desfavorables en neonatos de madres adolescentes (neonato pretérmino, neonatos con bajo-muy bajo peso y pequeño para la edad gestacional) resultaron poco frecuentes. Sin embargo se observó que adolescentes con CPN inadecuados tienen mayor riesgo de culminar la gestación por cesárea, y presentar un neonato no a término.

Autism spectrum disorder (ASD) has been attributed to genetic and non-genetic risk factors. Of the non-genetic factors, prenatal and perinatal complications have been extensively investigated, though few associations have been replicated consistently. We selected 2,562 families with at least one individual with ASD and one unaffected sibling. We investigated the relationships between 29 prenatal and perinatal complications and ASD, while considering the influences of confounding factors, comorbid conditions, and different ASD definitions. Although many complications were associated with ASD in the pairwise comparisons, only haematological disorders of the newborn and lower Apgar scores remained significant after adjusting for the effects of the confounders. After removing individuals with congenital anomalies, only 5-minute Apgar scores were associated with ASD. In conclusion, after considering confounding effects and four ASD definitions, several perinatal complications were associated with ASD with moderate effect sizes. Furthermore, comorbid conditions with ASD appear to be intertwined in these relationships. / October 2016

La esferoterapia es utilizada por diferentes especialistas, conociéndose los beneficios de su uso, permitiendo a la gestante variar las rutinas de movimiento y las posibilidades de sostén de su cuerpo en el espacio, sintiéndose más liviana y ágil cuando realiza los ejercicios. Objetivo: Precisar si la incorporación de la técnica de la esferoterapia de Pilates en la Psicoprofilaxis Obstétrica permite obtener beneficios en el periodo expulsivo en nulíparas. Metodología: Cuasi-experimental, comparativo, prospectivo y longitudinal. La muestra seleccionada estuvo comprendida por 100 pacientes que cumplieron con los criterios de inclusión y exclusión para el estudio. Resultados: El promedio del tiempo del expulsivo, los desgarros y episiotomías del grupo de estudio fue menor al grupo control, siendo esta diferencia estadísticamente significativa. El apgar al minuto y a los cinco minutos fueron similares en ambos grupos. Conclusiones: Se concluye de la investigación que la técnica utilizada para el grupo de estudio si brinda beneficios maternos en el periodo expulsivo de nulíparas en estos campos: Un menor tiempo de expulsivo, disminución de las episiotomías y desgarros. En cuanto a los beneficios perinatales encontramos que el uso de la esferoterapia de Pilates en la Psicoprofilaxis Obstétrica no presenta significación estadística por los datos obtenidos.

OBJETIVO: Determinar la asociación entre el estrés prenatal y las complicaciones obstétricas en gestantes adolescentes atendidas en el Instituto Nacional Materno Perinatal en enero del 2016. METODOLOGÍA: Estudio de tipo observacional, con diseño analítico de casos y controles, prospectivo, que tuvo una muestra conformada por dos grupos: 53 gestantes adolescentes que presentaron alguna complicación obstétrica (grupo caso) y 53 gestantes sin complicaciones (grupo control). Para las variables cualitativas se utilizó en el análisis descriptivo, frecuencias absolutas y relativas y para las variables cuantitativas se utilizó el promedio y la desviación estándar. Se estimó el Chi - cuadrado de Pearson, para establecer la asociación entre las variables, siendo significativo cuando tenía un valor de p<0.05, asimismo se utilizó la prueba Odd Ratio. RESULTADOS: Las adolescentes presentaron como principales complicaciones obstétricas a la anemia materna (17.2%), la infección del tracto urinario (17.2%), la ruptura prematura de membranas (10.3%), la amenaza de parto pre término (6.9%) y la hipertensión inducida por el embarazo (3.4%). Se encontró que no existe relación entre el estrés interno y las complicaciones obstétricas (p=0.30) (OR=3.12). Por otro lado hubo relación significativa entre la presencia de estrés externo y las complicaciones obstétricas (p=0.000) (OR=144.46). A nivel general, se evidenció que existe relación significativa entre la presencia de estrés global y las complicaciones obstétricas (p=0.000) (OR=31.52). CONCLUSIÓN: Existe asociación significativa entre el estrés prenatal y las complicaciones obstétricas en gestantes adolescentes atendidas en el Instituto Nacional Materno Perinatal (p=0.000) (OR=31.52). PALABRAS CLAVES: Estrés prenatal, complicaciones obstétricas, gestación, adolescencia. / --- OBJECTIVE: To determine the association between prenatal stress and obstetric complications in pregnant adolescents attended at the National Maternal and Perinatal Institute in January of 2016. METHODOLOGY: Observational study with analytical design of case-control, prospective, which had a sample consisted of two groups: 52 pregnant teenagers who presented some obstetric complications (case group) and 52 pregnant women without complications (control group). For qualitative variables in the descriptive analysis was used absolute and relative frequencies and in quantitative variables was used the mean and standard deviation. The estimated Chi - square Pearson to establish the association between the variables, being significant when it had a value of p <0.05. Also the test Odd ratio was used. RESULTS: pregnant teenagers reported as major obstetric maternal complications: anemia (17.2%), urinary tract infection (17.2%), premature rupture of membranes (10.3%), threat of preterm delivery (6.9%) and induced hypertension pregnancy (3.4%). It was not found that the correlation between the internal stress and obstetric complications (p=0.30) (OR=3.12). There were also significant relationship between the presence of external stress and obstetric complications (p=0.000) (OR=144.46). Overall, it was evident that there is significant relationship between stress and overall presence of obstetric complications (p=0.000) (OR=31.52). CONCLUSIONS: There is significant association between prenatal stress and obstetric complications in pregnant adolescents attended at the National Maternal and Perinatal Institute (p=0.000) (OR=31.52). KEYWORDS: Prenatal stress, obstetric complications, pregnancy, adolescence.

Introducción: La atención prenatal es una de las principales estrategias para garantizar una gestación monitorizada que permita que el parto y el nacimiento ocurran en óptimas condiciones. El carnet de control prenatal (CPN) es una herramienta donde el profesional médico registra información indispensable para la toma de decisiones y el manejo clínico individual de la mujer embarazada y del neonato. La información de CPN debe ser clara, concisa y ordenada que permita un análisis eficiente y refleje en gran medida la calidad de atención a la mujer embarazada. Objetivo: Determinar el nivel de calidad de información registrada en el carnet de control prenatal en puérperas hospitalizadas en el servicio de Gineco- Obstetricia del Hospital Vitarte Agosto – Octubre 2015. Material y Método: Se realizó un estudio de tipo descriptivo, retrospectivo y de corte transversal. Se aplicó una ficha de recolección de datos en 187 carnets de CPN, seleccionados según criterios de inclusión y exclusión. Ficha donde se consideraron las principales variables: datos sociodemográficos y biológico; antecedentes patológicos personales, familiares y Gineco-obstetricia; embarazo actual. Se elaboró una base de datos en SPSS v22 en la cual se basó la información reunida por una ficha. La evaluación fue por percentiles según puntaje obtenido: Nivel de calidad MALO, REGULAR y BUENO. Resultados: Del total de carnets evaluados el 83.4.% fueron registrado un nivel de calidad “BUENO”, el 16.6 % un nivel de calidad “REGULAR” . En relación a la profesión del Responsable del control prenatal se obtuvo el siguiente resultado: 46 % de los Médicos llenaron el carnet con un nivel de calidad “BUENO”, y con el mismo nivel de calidad 35.3 % por el profesional Obstetra Conclusiones: Tuvo La finalidad de evaluar la calidad del registro de información realizado por el médico el cual fue BUENO con el mismo nivel de calidad los Obstetras. El nivel de calidad de información registrada en los carnet de control prenatal de las puérperas hospitalizadas que ingresan al Hospital Vitarte presentan un registro de información eficiente que nos facilita la identificación y prevención de posible complicaciones del problema estudiado

Prenatal health programs and public health promotion provide strategies to mitigate modifiable risks to pregnancy. Women marginalized by race/ethnicity, disability, sexual identity, socioeconomic status, immigration, Francophone and Indigenous status experience barriers to prenatal service access. Multijurisdictional program evaluations were conducted to review prenatal health promotion, design, implementation and evaluation strategies for Canadian government-hosted websites, prenatal e-classes and international prenatal guidance documents. Gaps were noted in prenatal content targeted to non-Anglophone, immigrant, Indigenous and disabled women and LGBTQ communities. I recommend that prenatal program best practices consist of evidence-based, theoretical foundations which recognize the diverse interacting determinants of health across the lifespan. Intersectoral collaborations and integration of public health into primary care facilitates delivery of accessible, inclusive, woman-centred services. These best practices are anticipated to help harmonize prenatal programs across communities, which optimize maternal-child health and children’s long-term health outcomes.

Estudos sobre os impactos da assistência pré-natal sobre o desenvolvimento da criança têm apresentado resultados controversos. O desenvolvimento infantil é um processo que se inicia desde a vida intrauterina e envolve múltiplas aquisições, tais como o crescimento físico, a maturação neurológica e a construção de habilidades relacionadas ao comportamento, à cognição, às relações sociais e afetivas da criança. O presente estudo teve como objetivo avaliar a relação entre a assistência ao pré-natal e o desenvolvimento neuropsicomotor em um município do Sul de Minas Gerais. Trata-se de um estudo epidemiológico, descritivo, longitudinal, com abordagem quantitativa. O estudo foi realizado no município do sul de Minas Gerais. A população de estudo foi constituída pelas puérperas, que tiveram assistência nos dois hospitais de atendimento do SUS, através de um estudo retrospectivo de registro das salas de parto nos hospitais, com um grupo válido foi de 135 puérperas. Para a coleta dos dados foram utilizados instrumentos válidos disponíveis, para avaliação do pré-natal, dados do nascimento e o critério socioeconômico. A pesquisa foi encaminhada ao Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo e aprovado. Quanto às variáveis sociodemográficas verificou-se quanto à idade das puérperas que 7 (5,2%) tinham entre 18 e 19 anos, 78 (57,8%) 20 e 29 anos, 47 (34,7%) 30 a 39 anos e, 3 (2,2%) mais de 40 anos. Quanto ao risco gestacional, observou-se que 72 (53,3%) eram de baixo, 16 (11,9%) de médio e 47 (34,8%) de alto risco gestacional. Quanto às intercorrências clínicas obstétricas 86 (63,7%) eram de baixo risco, 12 (8,9%) de médio e 37(26,9%) alto risco. O pré-natal foi considerado adequado em 01 (0,7%) e parcial para 134 (99,7%) das gestantes. Em relação ao número de consultas, para 89 gestantes (65,9%) foi considerado adequado, para 15 (11,1%) parcial e para 31 (23%) inadequado. Observou-se que 68 (50,4%) dos RN eram do sexo masculino e 67 (49,6%) do sexo feminino, e quanto ao peso nove (6,6%) apresentaram peso abaixo de 2.500g. Houve predomínio de RNs com peso entre 2.501g e 4.000g, 121 (89,6%). Os resultados apontam que a maioria dos RN e lactentes apresentaram um desenvolvimento neuropsicomotor normal para a idade de acordo com o TTDD II, contudo, 30,4% no primeiro mês e 21,5% no sexto mês eram classificados como suspeitos em relação a área de domínio linguagem. Os principais fatores responsáveis pela classificação das gestantes como de alto risco, neste estudo, foram: características individuais e intercorrências clínicas obstétricas sendo que um dos principais fatores foi o consumo de drogas. As principais intercorrências clínicas e obstétricas foram hemorragias na gestação (12,6%), idade gestacional superior a 41 semanas (11,1%) e episódios de infecção urinária (10,4%). Verificou-se que 47,4 % das gestantes foram classificadas como de alto risco gestacional na classificação geral, enquanto na classificação das características individuais 77% foram de baixo risco, na história reprodutiva 86,7 % de baixo risco e nas intercorrências clínicas obstétricas 63,7%. Em 99,3% a assistência ao pré-natal foi classificada como parcial. Nenhum dos aspectos da assistência pré-natal mostrou associação significativa com o desenvolvimento neuropsicomotor do RN e/ou lactente. A contribuição do presente estudo refere-se à descrição da qualidade da assistência pré-natal no contexto em que foi desenvolvido. Sugere a não relação entre essa assistência e o desenvolvimento neuropsicomotor da criança nos primeiros seis meses de vida / Studies about the prenatal assistance impacts on child development has shown controversial results. Child development begins in intrauterine life and encompass multiple attainments such as physical growth, neurological maturing and building of skills related to behavior, cognition, child\'s social and affective relations. This paper aimed assess the relation between prenatal assistance and neuropsychomotor development at a South of Minas Gerais\' city. It is a longitudinal descriptive epidemiologic study with a quantitative approach. The study has been carried at the South of Minas Gerais\' city. The study\'s population is composed by women who have recently given birth that had assisted at two public system hospitals through retrospective analysis of the delivery rooms registries, with a valid groupd of 135 women. Available valid instruments were used in data collection to assess prenatal, birth data and socio-economic criteria. The research was sent to and approved by the Universidade de São Paul\'s Nursing School Ethic Committee in Research at Ribeirão Preto. In socio-demographic variables there were 7 (5,2%) women aging between 18 and 19 years, 78 (57,8%) with 20 to 29 years, 47 (34,7%) with 30 to 39 years and 3 (2,2%) with more than 40 years old. As for the gestational risk 72 (53,3%) were at low, 16 (11,9%) at medium and 47 (34,8%) at high gestational risk. For obstetric clinical complications there were 86 (63,7%) with low risk, 12 (8,9%) with medium and 37 (26,9%) with high risk. Appropriate prenatal was found in 1 (0,7%) and partial in 134 (99,7%) women. There were 89 (65,9%)women with adequate, 15 (11,1%) with partial and 31 (23%) with inadequate number of consults. Among the newborn, 68 (50,4%) were male and 67 (49,6%) female and 9 children (6,6%) weighed bellow 2.500g. There was a predominance of newborn weighing between 2.501g and 4.000g, 121 (89,6%). Results point out that most of the newborn and infant shown normal neuropsychomotor development for the age, according to the TTDD II, although 30,4% on the first month and 21,5% on the sixth month were classified as suspects regarding language domain. The main factors for the women classification with high risk in this study were: individual characteristics and obstetric clinical complications and drug consumption were a key factor. The major obstetric clinical complications were gestation bleeding (12,6%), gestation age above 41 weeks (11,1%) and urinary infection episodes (10,4%). 47,4% of the woman were classified as gestational high risk on general classification while on individual characteristics classification 77% were low risk. On reproductive history 86,7% were low risk and on obstetric clinical complications 63,7%. In 99,3% the prenatal assistance were classified as partial. None of the prenatal assistance aspects shown meaningful relation with newborn and/or infant neuropsychomotor development. The present study contribution lies in the quality description of the prenatal assistance on the context it was developed. It proposes no relation between this assistance and child neuropsychomotor development in its first six months old

Determina si existe asociación entre el vínculo prenatal y las prácticas de autocuidado en gestantes atendidas en el Centro de Salud San Juan de Miraflores durante el periodo agosto - octubre 2018, mediante un estudio observacional, analítico y de corte transversal, donde la muestra estuvo conformada por 70 embarazadas, con una edad gestacional mayor a 20 semanas. Se utilizó como ficha de recolección de datos el instrumento adaptado de la Maternal Antenatal Attachment Scale (MAAS) y el instrumento de Prácticas de Autocuidado en el embarazo. La validación estadística de ambos se realizó de acuerdo al alfa de Cronbach. El análisis inferencial se evaluó mediante la prueba Chi Cuadrado de Pearson, considerando un nivel de confianza del 95% y se asumió que existe asociación ya que el valor de p es menor de 0.05. Los resultados arrojan una asociación entre el vínculo prenatal y las prácticas de autocuidado en el embarazo con una evidencia estadísticamente significativa de (p=0.025). En la dimensión de calidad de vínculo prenatal y las prácticas de autocuidado de igual manera existió una asociación estadísticamente significativa (p=0.049). No ocurriendo lo mismo en el caso de intensidad de preocupación del vínculo prenatal y las prácticas de autocuidado, donde no se halló evidencia estadísticamente significativa (p=0.064). En conclusión, existe relación significativa entre vínculo prenatal y prácticas de autocuidado en el embarazo en las gestantes que acuden al Centro de Salud de San Juan de Miraflores en el periodo agosto-octubre del 2018. / Tesis