Waist circumference in predicting gestational diabetes mellitus

Background: To evaluate waist circumference (WC) measured at 20-24 weeks of gestation as a predictor of gestational diabetes mellitus (GDM).Methods: This cross-sectional study included 240 women at 20-24 weeks of gestation. At enrollment, WC was measured, and both prepregnancy and gestational body mass index (BMI) were estimated. According to the results of 75-g oral glucose tolerance test (OGTT) performed at 24-28 weeks, subjects were allocated into two groups, non-GDM and GDM. WC sensitivity and specificity, and odds ratios (OR) and 95% confidence intervals for BMI and WC were estimated, and a receiver operating characteristics curve was generated.Results: Of the 240 pregnant women enrolled, 31 (13%) had GDM. Prepregnancy BMI (OR = 4.21), gestational BMI (OR = 3.17) and WC at 20-24 weeks (OR = 4.02) correlated with GDM risk. At 20-24 weeks, a WC of 85.5-88.5 cm was the optimal cutoff point for predicting GDM (Sens/Spec balance between 87.1/41.1% and 77.4/56.9%).Conclusion: At 20-24 weeks of gestation, WC values in the range of 86-88 cm showed to be a good performance in predicting GDM.

Three-Dimensional Sonographic Assessment of Placental Volume and Vascularization in Pregnancies Complicated by Hypertensive Disorders

Objectives-The purpose of this study was to evaluate the association between placental volumes, placental vascularity, and hypertensive disorders in pregnancy.Methods A prospective case-control study was conducted between April 2011 and July 2012. Placental volumes and vascularity were evaluated by 3-dimensional sonographic, 3-dimensional power Doppler histographic, and 2-dimensional color Doppler studies. Pregnant women were classified as normotensive or hypertensive and stratified by the nature of their hypertensive disorders. The following variables were evaluated: observed-to-expected placental volume ratio, placental volume-to-estimated fetal weight ratio, placental vascular indices, and pulsatility indices of the right and left uterine and umbilical arteries.Results Sixty-six healthy pregnant women and 62 pregnant women with hypertensive disorders were evaluated (matched by maternal age, gestational age at sonography, and parity). Placental volumes were not reduced in pregnancy in women with hypertensive disorders (P > .05). Conversely, reduced placental vascularization indices (vascularization index and vascularization-flow index) were observed in pregnancies complicated by hypertensive disorders (P < .01; P < .01), especially in patients with superimposed preeclampsia (P = .04; P = .02). A weak correlation was observed between placental volumes, placental vascular indices, and Doppler studies of the uterine and umbilical arteries.Conclusions Pregnancies complicated by hypertensive disorders are associated with reduced placental vascularity but not with reduced placental volumes. These findings are independent of changes in uterine artery Doppler studies. Future studies of the prediction of preeclampsia may focus on placental vascularity in combination with results of Doppler studies of the uterine arteries.

Estudo das alterações estruturais e da função diastólica cardíaca em mulheres portadoras de diabetes melito gestacional

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Imunologia das interações materno-fetais no diabete e na hiperglicemia gestacional leve

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Alterações da matriz extracelular causadas pelo diabetes: o impacto sobre a continência urinária

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Polymorphisms in endothelial nitric oxide synthase gene in early and late severe preeclampsia

Preeclampsia (PE) is characterized by hypertension and proteinuria, occurring after the 20th week of pregnancy in women who have had no previous symptoms. The disease progresses with generalized vasoconstriction and endothelial dysfunction. Clinically, it is important to diagnose the severe form of the disease (sPE), in which blood pressure and proteinuria are much higher. Recently, the gestational age (GA) of the onset of PE has led to the classification of this disease as early (GA <34 weeks) and late (GA >= 34 weeks). Several genetic polymorphisms affecting endothelial nitric oxide synthase (eNOS) levels or function were described, including G894T (Glu298Asp), VNTR b/a (variable-number 27-bp tandem repeat) and T-786C (promoter) polymorphisms. Thus, the aim of this study was to compare the distribution of G894T, VNTR b/a and T-786C polymorphisms and their haplotypes in Brazilian early and late sPE, as well as in normotensive pregnant. A total of 201 women were evaluated, 53 with early sPE, 45 with late sPE and 103 as normotensive pregnant women. The frequency of 894T allele was higher in late sPE vs normotensive pregnant, and 894TT genotype was higher in late sPE vs early sPE and normotensive pregnant. For VNTR b/a polymorphism, higher frequencies of aa genotype and a allele were observed in early sPE vs late sPE and normotensive pregnant. Besides, the frequency of haplotype T-b-C was higher in late sPE vs early sPE and normotensive pregnant. Considering the results found for eNOS polymorphisms, it is possible to suggest that the functional alterations induced by these two polymorphisms may influence the time of severe PE onset, although both alterations are putatively associated with low NO bioavailability. However, other studies are necessary to validate these findings and clarify this issue. (C) 2014 Elsevier Inc. All rights reserved.

Adequacy of antenatal care and its relationship with low birth weight in Botucatu, Sao Paulo, Brazil: a case-control study

Background: Birth weight reflects gestational conditions and development during the fetal period. Low birth weight (LBW) may be associated with antenatal care (ANC) adequacy and quality. The purpose of this study was to analyze ANC adequacy and its relationship with LBW in the Unified Health System in Brazil.Methods: A case-control study was conducted in Botucatu, Sao Paulo, Brazil, 2004 to 2008. Data were collected from secondary sources (the Live Birth Certificate), and primary sources (the official medical records of pregnant women). The study population consisted of two groups, each with 860 newborns. The case group comprised newborns weighing less than 2,500 grams, while the control group comprised live newborns weighing greater than or equal to 2,500 grams. Adequacy of ANC was evaluated according to three measurements: 1. Adequacy of the number of ANC visits adjusted to gestational age; 2. Modified Kessner Index; and 3. Adequacy of ANC laboratory studies and exams summary measure according to parameters defined by the Ministry of Health in the Program for Prenatal and Birth Care Humanization.Results: Analyses revealed that LBW was associated with the number of ANC visits adjusted to gestational age (OR = 1.78, 95% CI 1.32-2.34) and the ANC laboratory studies and exams summary measure (OR = 4.13, 95% CI 1.36-12.51). According to the modified Kessner Index, 64.4% of antenatal visits in the LBW group were adequate, with no differences between groups.Conclusions: Our data corroborate the association between inadequate number of ANC visits, laboratory studies and exams, and increased risk of LBW newborns. No association was found between the modified Kessner Index as a measure of adequacy of ANC and LBW. This finding reveals the low indices of coverage for basic actions already well regulated in the Health System in Brazil. Despite the association found in the study, we cannot conclude that LBW would be prevented only by an adequate ANC, as LBW is associated with factors of complex and multifactorial etiology. The results could be used to plan monitoring measures and evaluate programs of health care assistance during pregnancy, at delivery and to newborns, focusing on reduced LBW rates.

Le(a-b-) phenotype: potential risk factor for infection by the RH strain of Toxoplasma gondii in pregnancy

The Lewis histo-blood group system is characterized by the expression of the Lea and Le(b) antigens in the gastrointestinal tract, whose synthesis results in interactions between alpha 2-L-fucosyltransferase (FUTII) and alpha 3/4-L-fucosyltransferase (FUTIII) enzymes coded by the FUT2 (19q. 13.3) and FUT3 (19p13.3) genes. FUTII and FUTIII fucosylate the type 1 oligosaccharide precursor (Gal beta 1 -> 3NAcGlc beta 1 -> 3-R) at distinct positions to form H type 1 (Fuc alpha 1. 2Gal beta 1. 3NAcGlc beta 1 -> 3-R) and Le(a) (Gal beta 1 -> 3[Fuc alpha 1 -> 4] NAcGlc beta 1 -> 3-R) antigens, respectively. The fucosylation of H type 1 antigens by FUTIII results in the Leb antigen (Fuc alpha 1. 2Gal beta 1. 3[Fuca1. 4] NAcGlc beta 1. 3-R). Thus, the presence of the FUTII and FUTIII enzymes leads to the expression of the Le(a+b+) phenotype, while the presence of only FUTIII allows the expression of the Le(a+b-) phenotype. The absence of the FUTIII enzyme leads to the expression of the Le(a-b-) phenotype, independent of the presence or absence of FUTII. Point mutations in FUT2 and FUT3 genes change the activity of these enzymes, impair the synthesis of Le(a) and Le(b) antigens, and contribute to the variability of Lewis phenotypes in the gastrointestinal tract. Toxoplasma gondii, an apicomplexan parasite that infects a large proportion of the world's population, utilizes the gastrointestinal tract as an infection route and seems to adhere to glycosylated molecules to invade human cells. These apparently independent events may be related. The aim of this study was to test the hypothesis that there is an association between the Lewis histo-blood group system and infection by T. gondii. Two hundred and nine serum samples collected from pregnant women were submitted to screening tests to detect anti-T. gondii antibodies, employing the indirect hemagglutination method. ELISA was utilized to identify IgG class anti-T. gondii antibodies specific for the RH strain. A hundred and ninety-five samples with concordant results for both methods were selected to form two groups: seropositive (G1) and seronegative (G2). The G428A mutation of the FUT2 gene, and T202C and C314T of the FUT3 gene, which allow inference of the gastrointestinal tract Lewis phenotypes, were identified using PCR-RFLP and PCR-SSP methods, respectively. Among the 195 samples selected, 116 (59.5%) were seropositive and 79 (40.5%) were seronegative. In G1, 68 (58.6%) were classified as Le(a+b+), 30 (25.9%) as Le(a+b-), and 18 (15.5%) as Le(a-b-), and in G2, 67 (84.8%) were classified as Le(a+b+), 12 (15.2%) as Le(a+b-), and 0 (0%) as Le(a-b-) (P < 0.0001). The Le(a-b-) phenotype is associated with a high risk of RH strain T. gondii infection when compared with the Le(a+b+) [P = 0.0001; OR = 36,460; 95%CI = 2.152-617,680] and Le(a+b-) phenotypes [P = 0.0118; OR = 15,165; 95%CI = 0.8463-271,710]. The Le(a+b-) phenotype showed a higher risk compared to the Le(a+b+) phenotype [P = 0.0206; OR = 2463; 95%CI = 2463-5214]. The results suggest that the Le(a-b-) phenotype is strongly associated with a greater risk of infection by the RH strain of T. gondii compared to the other phenotypes. It is possible that the absence of fucosylation of the type 1 oligosaccharide precursor as well as the variations in the structures of the Le(a) and Le(b) antigens influence susceptibility to infection by this parasite.

Perfil materno e dos recém-nascidos nascidos vivos na primeira década do século XXI em município do interior paulista com ênfase na prematuridade

The concern with infant mortality has been a priority in public policies, especially for Brazil to achieve the Millennium Development Goal number four: reducing child mortality by 75% by the year 2015. It is known that prematurity has an intimate relationship with mortality of children under one year and therefore it is necessary an effective intervention in risk factors linked to premature births. To evaluate the profile of mothers and newborn babies living in Botucatu-SP, in the period 2001 to 2009, focusing on prematurity. A quantitative study, retrospective, descriptive, epidemiological, from the Information System Newborn Alive. The prevalence of preterm births was 15.1%, and low birth weight 14.7%. Among infants, the Apgar score below 7 at 1 and at 5 minutes was 13.1% and 2.4% respectively. Considering the total of pregnant women studied, 20.3% were adolescents and 10.3% were aged 35 years or more and most (63.2%) had eight or more years of school approval. The profile of mothers of premature infants shows that 23.6% were teenagers, 14.1% had at least 35 years and 60.4% had at least primary education. With regard to premature deliveries, caesarean sections and 58.4% were between the total newborns, this type of delivery was achieved in 46.6% of cases. Prematurity was associated with an Apgar score below seven in the first and fifth minutes of life, presence of malformation and multiple pregnancy. Among maternal variables, prematurity was associated with extremes of maternal age, maternal education, history of stillbirth, primiparas, white and presence of the mother's partner. With regard to delivery was associated with cesarean section and outside the hospital. This study assessed maternal characteristics associated with prematurity and point out how relevant the pregnancies at the extremes of age and those that occur in women with low education level, indicating the interference... (Complete abstract click electronic access below)

Avaliação dos custos da assistência de recém-nascidos de mães hipertensas no Hospital das Clínicas - UNESP - Botucatu

The Hypertension Arterial Gestationis is a of largest complications to the pregnant women, a time that is associated with to high risk of morbimortalidade fetal and maternal ;the term If referred the levels pressure equal or above of 140mmhg to the pressure systolic and of 90mmhg to the pressure diastolic (1).Hypertension in pregnancy can be classified into gestational hypertension, chronic hypertension, preeclampsia and eclampsia(3). This study aimed to calculate and analyze the cost of care of newborns of hypertensive mothers hospitalized in rooming, nursery and the neonatal intensive care unit (Neonatal UTI). It’s a study of exploratory, descriptive and quantitative data analysis, in newborns of mothers with hypertension, who underwent prenatal care in HCFMB, from January 1 to 31 in December 2010. The data analysis showed that the cost of care for newborn in rooming was R$ 38.62 for the control group and groups of hypertensive mothers were R$ 19.93 to R$ 37.38. The costs of care to the newborn in the nursery were R$ 1,781.81 for the control group and groups of hypertensive mothers were R$ 680.03 to 7544.10. The costs for the newborn who Neonatal UTI were R$ 7,468.60 for the control group and groups of hypertensive mothers were R$ 5,228.02 to R $ 18,372.75. The total costs of care for newborn in rooming, nursery and Neonatal UTI were R$ 916.15 for the control group, R$ 1,385.98 for the HAC group, R$ 327.23 for the group HAS, R$ 3,896.57 for the group of preeclampsia and R$ 6,326.54 for the group of eclampsia. Considerations It can be concluded that the costs of mothers with preeclampsia and eclampsia were higher, being conditions with increased risk of maternal-fetal morbidity / mortality, requiring care in intensive care unit and longer stay in hospital

Determinação de adenosina deaminase, fator de necrose tumoral-alfa e interleucina-1 em gestantes portadoras de pré-eclâmpsia

Preeclampsia is a specific disorder of pregnancy, characterized by arterial hypertension and proteinuria detected after 20 weeks of gestation. This pathology is associated with hyperuricemia, higher levels of pro-inflammatory cytokines, enhanced leukocyte activation and oxidative stress. Adenosine deaminase (ADA) is an enzyme present in all human tissues and, it is involved with the maturation of the immune system. Although its function is not fully understood, ADA is considered an indicator of cellular inflammation and, its increased serum concentration is observed in inflammatory diseases, such as tuberculosis and rheumatoid arthritis. This study aimed to assess serum ADA levels in preeclamptic patients (PE) compared with normotensive pregnant (NT) and non-pregnant women (NP), and to correlate these values with TNF-α and IL-1β production. Ninety pregnant women were included: 60 were pre-eclamptic and 30 were normotensive matched for gestational age. As control group 20 healthy non-pregnant women matched with pregnant for age were included. Peripheral blood mononuclear cells (PMMC) obtained from the three groups studied were cultured with or without lipopolysaccharide (LPS) for 18h at 37oC, and TNF-α and IL-1β production was assessed in the supernatant of cultures by enzyme immunoassay (ELISA). ADA plasmatic concentration was determined by colorimetric method. The results show that ADA plasma levels were significantly higher in PE group compared with NT and NP groups. A positive correlation between ADA and uric acid levels was detected in preeclamptic women. There was no significant difference in relation to ADA levels when PE patients were classified in early and late-onset PE. The endogenous production of IL-1β and TNF-α by PBMC was significantly higher in PE group than in NT and NP women, showing the activation state of these cells in PE. LPS induced...(Complete abstract click electronic access below)

Efeito da silibinina sobre o fator de transcrição nuclear-kB e produção de citocinas inflamatórias por células mononucleares de gestantes portadoras de pré-eclâmpsia

Pre-eclampsia (PE) is a complication of human pregnancy characterized by hypertension and proteinuria after 20 weeks of gestation. Its incidence varies from 5% to 7% of pregnancies and is a major cause of morbidity and maternal and fetal mortality. This is a multisystemic disease, with focus on vascular dysfunction and is closely related to the exacerbated activation of the immune system. In addition to increased activation of monocytes and granulocytes, there is an elevated production of proinflammatory cytokines in pregnant women with PE. The nuclear transcription factor-kB (NF-kB) is present in the cells of the immune system and is responsible for transcription of genes related to inflammation. Whereas the PE is associated with intense inflammatory response, the use of substances modulating the activity of NF-kB factor could be useful in alleviating the inflammation present in these patients. Silibinin is the main component of silymarin, a polyphenolic extract obtained from fruits and seeds of Sylibum marianum with potent hepatoprotective, anti-inflammatory and anti-fibrotic activities. The silibinin mechanism of action includes the ability to inhibit NF-kB activation and, consequently, its migration to the nucleus. The objective of this study was to assess whether silibinin modulates the activity of NF-kB and the production of inflammatory cytokines in mononuclear cells of patients with PE. We evaluated 34 pregnant women with PE, 20 normotensive pregnant women (GN) and 15 non-pregnant women (NG). Peripheral blood mononuclear cells (PBMC) were obtained from those groups of women and cultured in the presence or absence of silibinin (5 uM or 50 uM) and stimulated or not with lipopolysaccharide (LPS) for 18 h to obtain supernatant for determination of tumor necrosis factor-alpha (TNF-α) and interleukin-1 (IL-1β) by enzyme immunoassay (ELISA). The cells were...(Complete abstract click electronic access below)

Polimorfismo do gene IL6 candidato à predisposição à rotura prematura de membranas pré-termo e ao trabalho de parto pré-termo

Introduction: Preterm Labor (PTL) and Preterm Premature Rupture of Membranes (PPROM) cause severe complications for both mother and fetus. Among the risk factors associated with preterm labor and PPROM, genetic predisposition has been gaining importance. However, the association between polymorphic genes and the pathogenesis of PTL and PPROM remains elusive. A better understanding of the genetic mechanisms underlying these adverse pregnancy outcomes may enable the identification of high risk patients and allow new approaches to minimize the deleterious effects of prematurity. Aim: To determine the association between maternal IL-6 polymorphism gene and the occurrence of PTL and PPROM. Patients and Methods: The study included 109 patients with prior history of PL and/or PPROM that delivered prematurely at the Obstetrical Unit Care of Botucatu Medical School, UNESP between 2003 and 2012. The control group consisted of 68 patients that delivered at term, matched to the case group by age, ethnicity, and sex of the newborn. Oral swabs (Cath-AllTM – Epicentre Biotechnologies) were collected for analysis of genetic polymorphisms by PCR. Statistical tests were performed to compare genotype, clinical and socio-demographic data from the groups. A p-value of <0.05 was considered significant. Results: The sociodemographic characteristics in both groups were homogeneously distributed. The frequency of the polymorphic allele C, associated with less production of IL-6, and therefore thought to be protective against PTL and PPROM, was 32,5% in the study group and 30,9% in the control group, without statistically significant differences. Conclusion: Considering the sample size included in this study, the frequency of the mutated allele is similar in pregnant women who delivered at term and gestational complications as PTL and PPROM

Perfil epidemiológico de parturientes submetidas à cesariana na maternidade de um hospital escola de Botucatu-SP

During the pregnancy process, the maternal organism commonly undergoes changes. Such changes follow the normal course of pregnancy; however, some maternal or fetal factors can interfere with pregnancy and adversely affect its outcomes, thus triggering what is referred to as high-risk pregnancy, which is responsible for increasing maternal, fetal or newborns’ morbimortality rates1,2. One of the obstetric alternatives for a safe resolution of this pregnancy type is the caesarean section. Nevertheless, an expressive increase in the number of caesarean sections has been observed worldwide, and they are, many times, unnecessarily indicated8. The world Health Organization (WHO) recommends that the total number of caesarean sections in relation to the total number of deliveries performed at health service should be a maximum of 15% 11, a limit that is easily surpassed in various services. To outline the epidemiological profile of pregnant women submitted to caesarean sections at a reference health care service in the city of Botucatu-SP. This is a cross-sectional, retrospective, exploratory, descriptive, quantitative study. The target population consisted of one hundred pregnant women assisted in this institution, who had been submitted to caesarean sections in 2010 and were randomly selected to compose the sample. In the analyzed period, there were 1,189 deliveries, of which 601 (50.5%) were natural deliveries, 588 (49.4%) were caesarean sections. As regards maternal age, 76% were in the age range of 19 to 36 years. A high percentage of patients (27%) had not completed elementary education and did not have a paid job; 67% were homemakers. Most of the participants were married (56%); 34% of the women were primiparas, but 19% were in their fourth or more pregnancies. Concerning prenatal care, little was found, since many of them had consultations out of the institution which were not recorded... (Complete abstract click electronic access below)

Associação entre expressão de receptores TLR2 e TLR4 e produção de TNF-alpha e IL-10 por monócitos de gestantes portadoras de pré-eclâmpsia

Preeclampsia (PE) is a pregnancy specific syndrome characterized by a systemic inflammatory response, with higher intensity than that observed in normal pregnancy. Cells of the immune system, such as monocytes and granulocytes are endogenously activated and secrete high levels of free radicals and inflammatory cytokines. The objective of this study was to assess the activation state of monocytes from pregnant women with preeclampsia by endogenous expression of TLR2 e TLR4 receptors and to correlate the expression of TLR2 and TLR4 on monocytes surface of pregnant women with PE with the production of tumor necrosis factor-alpha (TNF- and interleukin-10 (IL-10) by these cells stimulated or not with peptidoglycan (PG) and lipopolysaccharide (LPS), as agonists agents of TLR2 and TLR4, respectively. We evaluated 15 pregnant women with PE, 15 normotensive pregnant women (NT) and 15 non-pregnant (NP). Peripheral blood monocytes were incubates in the presence or absence of LPS or PG. The supernatant obtained after 18h of culture was aspirated and used for TNF- and IL-10 determination by enzyme immunoassay (ELISA). The endogenous expression of TLR2 and TLR4 receptors was evaluated by flow cytometry. Our results showed significant highly concentrations of TNF- and TLR4 expression in monocytes of preeclamptic women when compared with NT and NP. Normal pregnant women presented higher levels of IL-10 in comparison with PE and NP groups. TLR2 expression was similar in the three groups studied. Therefore, our study highlights the important role of TLR4 in PE and the consequent high production of TNF- by monocytes of these patients, as well as the potential mechanism involving low levels of IL-10 in the pathophysiology of the disease. These observations demonstrate the strong link between the pathology of PE and the immune system of these patients