Saúde materno-infantil: visão crítica dos determinantes e dos programas assistenciais

Discute-se a determinação social da saúde materno-infantil nas Américas, a partir de inúmeras publicações e recomendações oficiais. Observou-se que nem todos os estudos valorizam apropriadamente as variáveis sociais e que muitos deles as consideram no mesmo nível de importância das variáveis biológicas. Como conseqüência, a compreensão final dos achados fica prejudicada e as conclusões e recomendações extraídas ficam longe de tocar a raiz dos problemas. Diferentes variáveis sociais (como escolaridade materna ou assistência médica) encontram-se freqüentemente associadas com variáveis biológicas (como peso ao nascer ou estado nutricional). Esta associação, no entanto, pode não representar uma relação causai, mas tão somente a ocorrência simultânea de características pertencentes a uma única classe social. Reitera-se a necessidade de estudos que reconheçam as classes sociais e analisem os resultados sobre saúde materno-infantil em relação às mesmas. Estes estudos provavelmente evidenciarão a importância social da saúde materno-infantil e evitarão as habituais diretrizes e recomendações restritas ao plano puramente técnico.

Tendência Genética dos Efeitos Direto e Materno sobre os Pesos à Desmama e Pós-Desmama de Bovinos da Raça Tabapuã no Brasil

Os dados são relativos aos pesos de animais da raça Tabapuã, nascidos no período de 1959 a 1996 em várias regiões brasileiras. As observações foram analisadas com o objetivo de avaliar as mudanças genéticas aditivas diretas e maternas dos pesos padronizados para 205 (P205), 365 (P365) e 550 (P550) dias de idade. As estimativas dos componentes de (co) variância utilizadas no cálculo dos valores genéticos foram obtidas pelo método de máxima verossimilhança restrita livre de derivadas (REML), usando o aplicativo MTDFREML, cujo modelo continha os efeitos aleatórios aditivo direto, materno e de ambiente permanente, além dos efeitos fixos de grupo de contemporâneos (unidade da federação, fazenda, sexo, estação e ano de nascimento do animal) e a covariável idade da vaca ao parto (efeitos linear e quadrático). As tendências genéticas dos efeitos genéticos direto e materno foram estimadas pela regressão, ponderada, das médias anuais dos valores genéticos dos animais. As tendências genéticas dos efeitos direto no período estudado foram 0,134 ; 0,207, e 0,276 kg/ano, para P205, P365 e P550, respectivamente. Ainda para os três pesos, na mesma ordem, as estimativas das tendências genéticas maternas foram 0,019; -0,011; e -0,022 kg/ano. em virtude da variação genética existente, os resultados observados estão bem aquém das mudanças possíveis.

Efeito do manejo de aleitamento nos níveis de cortisol no metabolismo e na produção de leite de vacas holandesas

Avaliou-se a influência do manejo de aleitamento nos níveis de cortisol, no metabolismo e na produção de leite de vacas leiteiras. Utilizaram-se 18 vacas holandesas e seus bezerros alocados em três tratamentos: T1: as vacas foram separadas dos bezerros 6 horas após o parto, sendo mantidas com suas crias 60 minutos por dia nos três primeiros dias; T2: as vacas foram separadas dos bezerros 6 horas após o parto; T3: as vacas foram mantidas com seus bezerros durante os três primeiros dias de lactação, exceto no momento das ordenhas. Foram coletadas amostras de sangue 168 horas antes do parto, no dia do parto (0 hora) e 24, 48, 72 e 96 horas após o parto para a determinação de glicose, triglicerídeos, proteína total e cortisol. A produção leiteira foi mensurada duas vezes ao dia e a porcentagem de leite residual foi estimada nas duas ordenhas posteriores à desmama. As concentrações de cortisol foram maiores ao parto, contudo, não houve diferença significativa entre os tratamentos. Durante o período experimental, as vacas separadas dos bezerros apresentaram maior produção de leite, porém, após este período, não houve diferença entre os tratamentos. Após a desmama, a porcentagem de leite residual foi maior em T1 e T3, demonstrando que o uso de ordenha mecânica exclusiva após um período de amamentação prejudicou a ejeção do leite, mesmo em vacas especializadas. Os níveis de glicose foram menores em T2 às 72 horas e as concentrações de triglicerídeos foram menores em T3 às 72 e 96 horas. Os manejos estudados não influenciaram os níveis de cortisol e o metabolismo das vacas e nem prejudicaram a produção leiteira após o período colostral.

Evolucao materno-infantil da contaminacao por mercurio: Estudo em duas populacoes indigenas brasileiras

Considering the severity of Hg intoxication to human health and the frequent use of the metal in gold prespection on Brazilian Amazonia, an extensive project in being developed in order to quantify such conditions in two indigenous Kayapo populations, inhabitants of South of Para State, Gorotire and Djudjetikitire. This paper reports evolution of this contamination on mothers and babies. During puerperium, it was registered both an important decline on dosimetric values observed before in pregnancy and the occurrence of expressive levels in the babies. Such data are discussed based on contemporary medical-biologic conceptions, since it raises conceptual review of the matter.

Bupivacaína, Ropivacaína e Levobupivacaína em Analgesia e Anestesia de Parto. Repercussões Materno-Fetais

Background and Objectives - Bupivacaine has been a very useful local anesthetic in Obstetrics in spite of its potential cardiotoxicity. In obstetric analgesia, ropivacaine is preferred to bupivacaine, and levobupivacaine is less cardiotoxic than the racemic mixture. The aim of this study was to compare the maternal-fetal effects of bupivacaine, ropivacaine and levobupivacaine in obstetric analgesia and anesthesia. Methods - Participated in this study 33 term pregnant women, physical status ASA I and II submitted to epidural anesthesia who received 18.75 mg (in 15 ml completed with 9% saline) of: GI - bupivacaine, GII - ropivacaine, and GIII - levobupivacaine. Pain intensity, sensory block level, onset time, quality of analgesia, motor block intensity, analgesia duration and time for labor resolution were evaluated. For vaginal delivery, 40 mg (in 8 ml of saline) of the same local anesthetic were used; for cesarean delivery, the dose has been mg in 20 ml solution. Newborns of these mothers were evaluated through the Apgar score in minutes 1, 5 and 10, and through the Amiel-Tison method (neurologic and adaptative capacity score - NACS) at 30 min, 2 h, and 24 h. Results - There were no significant statistical differences among groups as to sensory block level, onset time, quality of analgesia, labor analgesia duration, time for labor resolution, and Apgar scores at minute 1. Ast to motor block, GIII > GII and GI was intermediary. In relation to pain intensity, there was a trend for GI > GIII. For Apgar scores in minute 5, GII > (GI = GIII), and in minute 10 (GI = GII) < GIII. NACS at 2 h showed, GII > GI > GIII, and at 24 h, GII > GIII > GI. Conclusions - Ropivacaine has relieved maternal pain with less motor block. Newborns of GII mothers (ropivacaine) showed the best Apgar and NACS scores.

Determinação precoce do sexo fetal pela análise do DNA no plasma materno

Purpose: to verify the viability of early diagnosis of fetal gender in maternal plasma by the real-time polymerase chain reaction (real-time PCR) starting at the 5th week of pregnancy. Methods: peripheral blood was collected from pregnant women with single fetus starting at the 5th week of gestation. After centrifugation, 0.4 mL plasma was separated for fetal DNA extraction. The DNA was analyzed in duplicate by real-time PCR for two genomic regions, one of the Y chromosome and the other common to both sexes, through the TaqMan® method, which uses a pair of primers and a fluorescent probe. Patients who aborted were excluded. Results: a total of 79 determinations of fetal DNA in maternal plasma were performed in 52 pregnant women. The results of the determinations were compared to fetal gender after delivery. Accuracy according to gestational age was 92.6% (25 of 27 cases) at 5 weeks with 87% sensitivity, and 95.6% (22 of 23 cases) at 6 weeks with 92% sensitivity. Starting at the 7th week of pregnancy, accuracy was 100% (29 of 29 cases). Specificity was 100% regardless of gestational age. Conclusion: real-time PCR for the detection of fetal gender in maternal plasma starting at the 5th week of gestation has good sensitivity and excellent specificity. There was agreement of the results in 100% of the cases in which male gender was diagnosed, regardless of gestational age, and from the 7th week of gestation for female gender diagnosis.

Insulinoterapia, controle glicêmico materno e prognóstico perinatal - Diferença entre o diabetes gestacional e o clínico

PURPOSE: to evaluate the insulin therapy protocol and its maternal and perinatal outcome in patients with clinical or gestational diabetes in a high risk reference service. METHODS: descriptive and prospective study including 103 pregnant women with gestational or clinical diabetes treated with insulin and attended by the reference service from October 2003 to December 2005. Gemellarity, miscarriages, unfinished prenatal care and deliveries not attended by the service were excluded. The gestational age at the beginning of the treatment, dosage, doses/day, increment of insulin (UI/kg), glycemic index (GI) and perinatal outcomes were compared. ANOVA, Fisher's exact test and Goodman's test considering p<0.05 were used. RESULTS: multiparity (92 versus 67.9%), pre-gestational body mass index (BMI) >25 kg/m 2 (88 versus 58.5%), weight gain (WG) <8 kg (36 versus 17%) and a high increment of insulin characterized the gestational diabetes. For the patients with clinical diabetes, despite the highest GI (120 mg/dL (39.2 versus 24%)) at the end of the gestational period, insulin therapy started earlier (47.2 versus 4%), lasted longer (56.6 versus 6%) and higher doses of insulin (92 versus 43 UI/day) were administered up to three times a day (54.7 versus 16%). Macrosomia was higher among newborns from the cohort of patients with gestational diabetes (16 versus 3.8%), being the only significant neonatal outcome. There were no neonatal deaths, except for one fetal death in the cohort of patients with clinical diabetes. There were no differences in the other neonatal complications in both cohorts, and most of the newborns were discharged from hospital up to seven days after delivery (46% versus 55.8%). CONCLUSIONS: the analysis of these two cohorts has shown differences in the insulin therapy protocol in quantity (UI/day), dosage (UI/kg weight) and number of doses/day, higher for the clinical diabetes cohort, and in the increment of insulin, higher for the gestational diabetes cohort. Indirectly, the quality of maternal glycemic control and the satisfactory perinatal outcome have proven that the treatment protocol was adequate and did not depend on the type of diabetes.

The materno-fetal interface in llama (Lama guanicoe glama)

Samples from 9 llamas (28 through 36 weeks of gestation) were collected and fixed in 4% buffered paraformaldehyde (light microscopy) and in 2.5% buffered glutaraldehyde (transmission and scanning electron microscopy). The material was processed in paraplast and slides (5μm) were stained with HE, PAS, Masson-Trichrome, acid phosphatase and Perl's. The uteroferrin was immunolocalized. The results show that llama placenta is chorioallantoic, diffuse, folded and epitheliochorial, and the fetus is covered with an epidermal membrane. The trophoblast cells have variable morphology: cubic, rounded and triangular cells, with cytoplasm containing PAS-positive granules. Binucleated cells with large cytoplasm and rounded nuclei, as well as giant trophoblastic cells with multiple nuclei were also observed. Numerous blood vessels were observed beneath the cells of the uterine epithelium and around the chorionic subdivided branches. Glandular activity was shown by PAS, Perl's, and acid phosphatase positive reactions in the cytoplasm and glandular lumen, and by immunolocalization of the uteroferrin in the glandular epithelium. The uterine glands open in spaces formed by the areoles, which are filled by PAS-positive material. The llama fetus was covered by the epidermal membrane, composed of stratified epithelium, with up to seven layers of mono-, bi- or trinucleated cells. The high level of maternal and fetal vascularization surfaces indicates an intense exchange of substances across both surfaces. The metabolic activity shown in the uterine glands suggests an adaptation of the gestation to the high altitudes of the natural habitat of this species.

Quantificação do interferon-tau durante o reconhecimento materno da gestação em fêmeas bovinas Bos taurus indicus

During the critical period of the maternal recognition, which occurs between days 15 and 19 of pregnancy, the conceptus must competently synthesize molecules capable of blocking the synthesis of prostaglandin F2α (PGF2α) and luteolysis. In cattle, the major macromolecule involved in suck blockage is the protein interferontau (IFN-τ). During the critical period, failures in the recognition of pregnancy determine embryonic mortality on up to 40% of inseminated cows. Data about IFN-τ in Bos taurus indicus are still scarce. Objective of this study was to quantitatively evaluate the presence of IFN-τ during the critical period for maternal recognition of pregnancy in uterine flushings obtained in vivo by Foley catheter (Days 14, 16 and 18 post estrus) or post-mortem (Day 18 post estrus). Multiparous, cyclic or pregnant zebu cows (Bos taurus indicus) on days 14, 16 and 18 post estrus were used for in vivo or post mortem uterine flushing collection. In both cases, a Ringer solution was used to wash the uterus of cows. Uterine flushings were concentrated by ultrafiltration and lyophilized. Proteins were separated by one-dimensional electrophoresis (SDS-PAGE) in a 15% polyacrilamide gel. Interferontau quantification in uterine flushings was performed by western blotting and densitometry. Non-specific protein bands were observed in both in vivo and post mortem uterine flushings. Interferon-tau was detected only in uterine flushings obtained from pregnant cows post-mortem (P<0.05). Optical density of protein bands was not affected by the day of the critical period, state (cyclic or pregnant) or interaction day x state. There was no effect of the conceptus weight or progesterone concentration on the day of uterine flushing collection in the optical density of the IFN-τ protein band. It was concluded that the detection and quantification of IFN-τ in the uterine environment of zebu cows, in these experimental?conditions, is only possible in uterine flushings obtained post-mortem.

Relações materno-filiais e sua influência no peso pré-desmama de animais Nelore da Bahia

The aim of this study was to investigate the maternal-offspring relationships in the bovine breeds Nellore PO (Pure Breed) and Nellore CL (Cara Limpa) in Bahia State. The genetic composition of breeds did not affect LP (latency time to stand); this variable showed mean values of 71 min and 52 min, respectively, for Nellore PO and Nellore CL. The variable LPTM (latency time to begin suckling after standing) was significantly higher for Nellore PO (mean values of 39 min) tham for Nellore CL (18 min). The variable TCC (time in contact with the calf) was classified as class 4 (60 to 80% of the time was spent with the calves). The P120 (weight at 120 days) had mean values of 122.3 kg and 122.7 kg respectively, for Nellore PO and Nellore CL. In conclusion, the maternal-offspring behaviour had little influence of the genetic composition of the breeds. These results suggest that more studies are necessary to define technological parameters for cattle raising in Bahia State.

Efeito materno sobre a curva de crescimento de ovinos Santa Inês por meio de modelos de regressão aleatória

Data set of 17.767 weight records of 4.210 Santa Inês lambs were used aiming to evaluate the importance of the inclusion of the maternal effect in the model to estimate components of (Co) variance and resulting genetic parameters for the growth curve through random regression models. The fixed and random regressions were fitted using Legendre Polynomials of order three, being fit four models that differed in relation to the inclusion of the additive genetic and permanent environmental maternal effects. Considerable increase was observed in Log L and decrease in the criteria AIC and BIC when the maternal effect was included (genetic or permanent environmental), evidencing its importance. The maternal genetic effect explained larger proportion of the phenotypic variance than the maternal permanent environmental along the growth curve. The direct additive genetic variance was inflated by maternal effect, when this last one was not considered in the analysis model, reflecting the same behavior in the heritabilities. The maternal permanent environmental effect contributed to maternal variance, as well as, it inflated maternal genetic variance, when it was not considered in the model. Similar behavior was verified with maternal heritability. The correlation estimated for the four models hardly differed in function of maternal effect. The maternal effect should be considered in the genetic studies of the growth curve of Santa Inês sheep.

Qualidade de vida de crianças e adolescentes asmáticos: Sua relação com estratégias de enfrentamento materno

Objective: To evaluate the quality of life of asthmatic children and adolescents, its relation with sociodemographic and clinical variables, and maternal coping strategies. Methods: Cross-sectional study in which children and adolescents with asthma answered a quality of life questionnaire, and their mothers did the same with a coping scale. Results: Out of the 42 children and adolescents investigated, 74% were classified as having mild/severe persistent asthma; 19%, mild persistent asthma; and 7%, intermittent asthma. A total of 69% of the participants showed impaired quality of life with mean scores ranging between 4.7 and 3.5, with greater harm in the domain of symptoms (score=3.6). There was a significant association between maternal schooling and the general index of quality of life, whereas maternal coping strategies were not associated with the severity of asthma. A large number of strategies used by mothers to cope with their children's crises were related to the management of stressors or to religious practices, and the latter presented negative correlation with the children's quality of life general index, showing that mothers whose children had worse quality of life used more religious coping. Conclusions: Asthmatic children, particularly those with moderate/severe persistent asthma, showed significant alterations as to quality of life. The high percentage of mothers using religious strategies, particularly in face of more severe clinical conditions, seem to indicate that they feel powerless to act, thus requiring concrete and useful orientation to low income families.

Morfologia da placenta e interação materno-fetal em jumentas (Equus asinus) da raça Pêga

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Efeitos cardiovasculares da exposição pré-natal à permetrina, isoladamente ou em associação à desnutrição intra-uterina, em ratos adultos e o comportamento materno nessas condições

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influência do controle metabólico materno nos resultados da cardiotocografia anteparto e sua relação com o prognóstico perinatal, nas gestações complicadas pelo diabete

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB