Auswahl der wissenschaftlichen Literatur zum Thema „Fetal malnutrition Complications“

Introduction. Antiphospholipid syndrome (AРS) is a multisystem disease characterized by elevated levels of antiphospholipid antibodies (AРA), arterial and/or venous thrombosis, thrombocytopenia, and habitual miscarriage. Various AРA types have multifactorial and indirect effects on pregnancy course from the earliest stages, leading to termination of pregnancy and putting the prerequisites for further obstetric complications. Aim: determine rate and relative risk of pregnancy complications in AРA carriers. Materials and Methods. The retrospective study, conducted between 2017 and 2019, included 268 pregnant women. All women underwent a comprehensive study consisting of clinical examination and laboratory methods. AРA of IgM and IgG classes were measured by using ELISA, lupus anticoagulant (LA) was estimated by using a coagulometer. Results. APA were detected in 213 (79.48 %) women examined; 55 (20.52 %) patients (n = 55) lacked APA. Failed in vitro fertilization attempts were 2 times more common in women with AРA (10.33 vs. 5.45 %, respectively; p < 0.001). Also, significant differences were found in this group in antenatal fetal death (4.23 vs. 1.82 %, respectively; p < 0.001) and chronic placental insufficiency without fetal malnutrition (23.47 vs. 18.18 %, respectively; p < 0.05). Of 165 women with early pregnancy loss syndrome, AРA were found in 130 (78.79 %), late pregnancy loss – in 29 (76.32 %) and antenatal fetal death – in 9 (90.0 %) women carrying serum AРA. The relative risks of unfavorable pregnancy outcomes have been identified for various AРA subtypes. Conclusion. Identifying clear-cut relative risks of adverse pregnancy outcomes for various subtypes of antiphospholipid antibodies will allow to determine risk groups and develop a special treatment algorithm for preventing pregnancy complications and perinatal losses.

A anemia falciforme (AF) é uma doença autossômica recessiva, que leva à produção de hemoglobina anormal, denominada hemoglobina S (HbS). Seus portadores sofrem com o crescimento deficiente, desde a infância, além de disfunções endócrinas, baixo consumo alimentar, alto requerimento energético, deficiência de minerais, que podem resultar em desnutrição. Durante a gestação, está associada ao aumento de complicações relacionadas à própria doença, morbimortalidade materna e perinatal mais elevada, nascimento de crianças com baixo peso e maiores taxas de complicações infecciosas puerperais. O objetivo do estudo foi buscar, através de uma revisão integrativa, esclarecer sobre o estado nutricional e as complicações clínicas de gestantes com anemia falciforme. Para tanto, realizou-se um estudo exploratório, por meio de pesquisa bibliográfica. Sendo a seleção e a localização das referências retiradas das bases de dados PubMed/LILACS, Plos One e da biblioteca eletrônica SciELO, utilizando também a Biblioteca Virtual em Saúde (BVS), a fim de identificar artigos científicos publicados no período entre 2008 e 2020, utilizando os seguintes descritores: anemia falciforme e intercorrências obstétricas; anemia falciforme e gestante; hemoglobina S e gestante e versões em inglês. Verificou-se que gestantes portadoras de anemia falciforme possuem maior propensão a complicações, como aborto espontâneo, crescimento intra-uterino restrito, aumento da mortalidade fetal intra-útero, recém-nascido de baixo peso, trabalho de parto pré-termo, somados à deficiência de macro e micronutrientes durante o período gestacional, podendo chegar à desnutrição materna e à morbimortalidade materna e neonatal. Em suma, a suscetibilidade à desnutrição materna, infecções, complicações hemolíticas e vaso-oclusivas de gestantes com anemia falciforme mostrou-se um prognóstico desfavorável, trazendo consigo complicações para a mãe e o neonato. Reforçando a importância do acompanhamento nutricional como estratégia de prevenção e orientação relativas às alterações nutricionais das gestantes portadoras da doença, como alternativa para a minimização dos resultados adversos e garantir melhoria da saúde materna e fetal. Sickle cell anemia (SCA) is an autosomal recessive disease that leads to the production of abnormal hemoglobin called hemoglobin S (HbS). Their carriers suffer from deficient growth, since childhood, in addition to endocrine dysfunction, low food consumption, high energy requirement, mineral deficiency, which can result in malnutrition. During pregnancy, it is associated with an increase in complications related to the disease itself, higher maternal and perinatal morbidity and mortality, birth of low birth weight children and higher rates of puerperal infectious complications. The aim of the study was to seek, through an integrative review, to clarify the nutritional status and clinical complications of pregnant women with sickle cell anemia. For that, an exploratory study was carried out, through bibliographical research. With the selection and location of references taken from the PubMed/LILACS, Plos One and SciELO electronic library databases, also using the Virtual Health Library (VHL), in order to identify scientific articles published in the period between 2008 and 2020, using the following descriptors: sickle cell anemia and obstetric complications; sickle cell anemia and pregnant women; hemoglobin S and pregnant women and English versions. It was found that pregnant women with sickle cell anemia are more prone to complications, such as miscarriage, restricted intrauterine growth, increased intrauterine fetal mortality, low birth weight newborn, preterm labor, in addition to disability of macro and micronutrients during the gestational period, which can lead to maternal malnutrition and maternal and neonatal morbidity and mortality. In short, the susceptibility to maternal malnutrition, infections, hemolytic and vaso-occlusive complications of pregnant women with sickle cell anemia proved to be an unfavorable prognosis, bringing with it complications for the mother and the newborn. Reinforcing the importance of nutritional monitoring as a prevention and guidance strategy regarding nutritional changes in pregnant women with the disease, as an alternative to minimizing adverse outcomes and ensuring improved maternal and fetal health.

The article provides a comparative characteristic the main clinical parameters of pregnancy and delivery in adolescents and women of average reproductive age. The results of this study generally confirm the literature data on the greater frequency of complications of pregnancy and childbirth in juvenile women than in women of average reproductive age. Thus, significantly more frequently in pregnant adolescents dated anemia, preeclampsia, fetal malnutrition, during delivery more frequently dated premature rupture of membranes, perineotomy and newborn injury. At the same time, significant differences in the incidence of weakness of labor activity, hemorrhage, neonatal asphyxia and maternal injury was not observed according to our data, which is not consistent with the known literature data.

Intrauterine growth restriction (IUGR) is the failure of the fetus to achieve his/her intrinsic growth potential, due to anatomical and/or functional disorders and diseases in the feto–placental–maternal unit. IUGR results in significant perinatal and long-term complications, including the development of insulin resistance/metabolic syndrome in adulthood.The thrifty phenotype hypothesis holds that intrauterine malnutrition leads to an adaptive response that alters the fetal metabolic and hormonal milieu designed for intrauterine survival. This fetal programming predisposes to an increased susceptibility for chronic diseases. Although the mechanisms controlling intrauterine growth are poorly understood, adipose tissue may play an important role in linking poor fetal growth to the subsequent development of adult diseases. Adipose tissue secretes a number of hormones, called adipocytokines, important in modulating metabolism and recently involved in intrauterine growth.This review aims to summarize reported findings concerning the role of adipocytokines (leptin, adiponectin, ghrelin, tumor necrosis factor (TNF), interleukin-6 (IL6), visfatin, resistin, apelin) in early life, while attempting to speculate mechanisms through which differential regulation of adipocytokines in IUGR may influence the risk for development of chronic diseases in later life.

Background: Teenage adolescent pregnancy is an important community health issue globally. Research shows that mothers in teenage period are at a higher risk of maternal death and complications related with pregnancy in comparison to the mothers who are adult. Therefore, this research was directed to examine the sociodemographic profile and fetal and maternal outcomes related with teenage pregnancy and their comparison with mothers of 20-30 years of age. Study Design: A comparative cross-sectional study. Place and Duration: In the obstetrics and Gynecology department of Sheikh Zaid Women Hospital Larkana for one-year duration from March 2021 to February 2022. Methods: A total of 60 teenage mothers ≤19 and 60 mothers who were 20-30 years of age respectively, were nominated as controls and cases. Data on the obstetric complications, fetal outcomes and sociodemographic profile were collected through face-to-face interviews using a pre-tested, pre-designed, partially structured questionnaire. The statistics were analyzed by entering data in the excel sheet of Microsoft. Results: In this study, 18.1 years was the mean age in teenage pregnant females and 24.3 years in the control group. 17.8 years was the mean age at which teenage mothers were married and for adults it was 20.1 years. 66.7% of teenage mothers and 61.7% of the control group are of high-low socioeconomic status. 80% of teenage pregnant females and 75% of control group were from rural areas. The mainstream of teenage mothers (70%) and control mothers (58.3%) are housewives by profession. The consanguineous marriages were observed in 33.3% of adolescent pregnant females and 41.7% in the control group. In this study, 38.3% and 46.7% of the mothers in adolescent and control group respectively had ante-natal checks during their pregnancy. Stillbirth / miscarriage were reported in 13.3% of adolescent mothers and 25% in the control group. 63.3% of teenage mothers had mild anemia and 53.3% in controls. The incidence of malnutrition (40% vs 15%, p <0.05), PPH (25% vs 6.7%, p <0.05), PROM (20% vs 3.3%, p <0.05) was significant in teenage mothers in comparison to mothers who were adults. The incidence of PIH was lower significantly in mothers during adolescence in comparison to adult mothers (13.3% vs. 31.7%, p <0.05). Conclusions: Complications such as PROM, maternal malnutrition, premature delivery, PPH and low birth weight occurred more frequently in adolescent mothers than in mothers who were adults. The adult mother’s higher proportion of PIH than in teenage mothers. Keywords: Adult pregnancy, teenage pregnancy, sociodemographic factors, adverse fetal and maternal outcomes.

Background: Teenage adolescent pregnancy is an important community health issue globally. Research shows that mothers in teenage period are at a higher risk of maternal death and complications related with pregnancy in comparison to the mothers who are adult. Therefore, this research was directed to examine the sociodemographic profile and fetal and maternal outcomes related with teenage pregnancy and their comparison with mothers of 20-30 years of age. Study Design: A comparative cross-sectional study. Place and Duration: In the obstetrics and Gynecology department of Sheikh Zaid Women Hospital Larkana for one-year duration from March 2021 to February 2022. Methods: A total of 60 teenage mothers ≤19 and 60 mothers who were 20-30 years of age respectively, were nominated as controls and cases. Data on the obstetric complications, fetal outcomes and sociodemographic profile were collected through face-to-face interviews using a pre-tested, pre-designed, partially structured questionnaire. The statistics were analyzed by entering data in the excel sheet of Microsoft. Results: In this study, 18.1 years was the mean age in teenage pregnant females and 24.3 years in the control group. 17.8 years was the mean age at which teenage mothers were married and for adults it was 20.1 years. 66.7% of teenage mothers and 61.7% of the control group are of high-low socioeconomic status. 80% of teenage pregnant females and 75% of control group were from rural areas. The mainstream of teenage mothers (70%) and control mothers (58.3%) are housewives by profession. The consanguineous marriages were observed in 33.3% of adolescent pregnant females and 41.7% in the control group. In this study, 38.3% and 46.7% of the mothers in adolescent and control group respectively had ante-natal checks during their pregnancy. Stillbirth / miscarriage were reported in 13.3% of adolescent mothers and 25% in the control group. 63.3% of teenage mothers had mild anemia and 53.3% in controls. The incidence of malnutrition (40% vs 15%, p <0.05), PPH (25% vs 6.7%, p <0.05), PROM (20% vs 3.3%, p <0.05) was significant in teenage mothers in comparison to mothers who were adults. The incidence of PIH was lower significantly in mothers during adolescence in comparison to adult mothers (13.3% vs. 31.7%, p <0.05). Conclusions: Complications such as PROM, maternal malnutrition, premature delivery, PPH and low birth weight occurred more frequently in adolescent mothers than in mothers who were adults. The adult mother’s higher proportion of PIH than in teenage mothers. Keywords: Adult pregnancy, teenage pregnancy, sociodemographic factors, adverse fetal and maternal outcomes.

One of the main markers of socially unfavorable pregnancy is anthropometric indicators of newborns. They reflect not only the narrow medical problems of complicated gestation but also social problems in general, the quality and access to the medical care. The objective: to determine the risk factors for fetal macrosomia in pregnancy with high levels of psychosocial stress. Materials and methods. The course of pregnancy and childbirth, demographic and medical risk factors for a fetal macrosomia were analyzed in 140 pregnant women with different levels of psychosocial stress. They were divided into 2 groups: 1 group (main) – 56 women-forced migrants from Luhansk and Donetsk regions, 2 group – 84 women with low and moderate level stress according to the questionnaires and psychological tests (L. Reeder, Spielberg–Khanin scale). Results. Gestational diabetes was the main reason for the birth of heavy children in both groups. Women–forced migrants had late manifestation of impaired tolerance to carbohydrates and a higher frequency of pathological weight gain. Male neonates are at risk for macrosomia. Childbirth in women with macrosomia is accompanied by a high frequency of complications and abnormal births. Conclusions. The frequency of births of macrosomic children in women - forced migrants is higher than in women at low risk of psychosocial stress. Risk factors in this group of pregnants include: the level of stress and behavioral responses to stress, impaired carbohydrate tolerance due to gestational diabetes, abnormal weight gain due to malnutrition and male sex of the fetus. Keywords: macrosomia, pregnancy, childbirth, women–forced migrants psychosocial stress, gestational diabetes, weight gain.

The new coronavirus infection (COVID-19) is a life-threatening condition. The features of the treatment of COVID-19 in pregnant women are not sufficiently studied and contradictory, therefore, research in this area is relevant.Objective. Assess the presence of liver disease in pregnant women with COVID-19 infection during pregnancy and after childbirth, taking into account the treatment.Methods. A retrospective analysis of medical records of 43 pregnant women aged 19 to 39 years (mean age 29.1 ± 5.4 years) who were hospitalized with laboratory-confirmed COVID-19 infection was performed. The selection was carried out by the method of continuous sampling.Results. 17 women (39.5%) had an acute respiratory viral disease, 26 people (60.5%) were diagnosed with bilateral polysegmental pneumonia with pulmonary tissue damage from 5 to 25%. In the structure of extragenital pathology, 46.5% of women had anemia and 23.3% of diseases of the hepatobiliary system, including chronic non-calculous cholecystitis (4.7%), biliary dysfunction (7%), chronic viral hepatitis B (2.3%) and chronic viral hepatitis C (9.3%). 6.9% were diagnosed with cholestatic hepatosis of pregnant women before admission to the hospital. An increase in the level of transaminases above the upper normal values was noted in 69.8% of cases, alkaline phosphatase – in 76.7%. In the structure of pregnancy complications in women with COVID-19 infection, fetal hypoxia prevailed in 15 women (34.9%). In second place is premature rupture of amniotic fluid (16.3%) and fetal malnutrition (16.3%).Conclusions. Pregnant women with diseases of the hepatobiliary system and anemia are most susceptible to new coronavirus infection. They have an increase in the level of transaminases and alkaline phosphatase, which can be caused by liver damage due to the increased tropism of the virus to cholangiocytes and hepatocytes, as well as hepatotoxic drugs. The most common complications of pregnancy in women with a new infection are premature birth, fetal hypoxia, and antenatal death.

Introduction: Eclampsia is a multisystem disorder with potential life-threatening complications that can result in significant maternal and fetal morbidity and mortality. The case fatality rate of eclampsia is 1.8% in developed countries, 17.7% in India and 13% in Nepal. The incidence of pre-eclampsia and eclampsia is high in developing countries due to hypoproteinemia, malnutrition and poor obstetric facilities. Objective: To assess the maternal and perinatal outcome in patients of eclampsia Methodology: This was a hospital based cross-sectional study where all the patients presenting with eclampsia from June 2019 to November 2020 in the department of Obstetrics & Gynecology, Birat Medical College and Teaching Hospital were enrolled for the study. Data analyzed included various maternal parameters and fetal parameters along with the mode of delivery, outcome of baby, postpartum maternal condition and maternal mortality were noted. Results: Among 6631 deliveries, 50 patients had eclampsia with the incidence of 7.54/1000 deliveries. Thirty four (68%) patients were of 20-30 years of age, 37 (74%) were primigravidas, 36 (72%) from rural areas, 34 (68%) were illiterate, 49 (98%) were low to middle socioeconomic status, 41 (82%) were unbooked and 33 (66%) patients had antepartum eclampsia. Eleven (22%) women developed eclampsia related complications. There were 02 (4%) maternal deaths and the common causes were HELLP Syndrome and pulmonary oedema. Neonatal outcome consisted of live births in 39 (78%) newborns, 03 (6%) were still births, 08 (16%) were birth asphyxia and 15 (30%) were low birth weight. Conclusion: Majority of the patients were young, illiterate, unbooked primi gravidas with poor to average socioeconomic status from rural areas. Majority of the eclamptic women nearly 39 (78%) cases delivered via caesarean section for better neonatal outcome. Two (4%) eclamptic women died as a result of eclamptic complications and three (6%) newborns had neonatal deaths because of low birth weight and prematurity. Adequate antenatal screening, early detection of hypertension, timely referral, and early initiation of treatment and termination of eclamptic patients can help to improve the maternal and perinatal outcomes.

The endpoint of the negative impact of adverse processes in the mother’s body with influenza is the formation of placental insufficiency, the basis of which is a violation of the uteroplacental blood flow. The objective: to study the features of the course of pregnancy, the state of the fetus and the newborn after the influenza in the first trimester of pregnancy. Materials and methods. 120 women who had the influenza in the first trimester of pregnancy were examined. In 68 (56.7%) pregnant women signs of feto-placental dysfunction were observed, 2 groups were distinguished: the main group - 68 patients with feto-placental dysfunction, the comparison group – 52 pregnant women without signs of feto-placental insufficiency. Results. 3 times more often than women without manifestations of placental insufficiency (42.6% versus 15.4%; p<0.05) a severe course of influenza was observed, it accompanied by a high frequency of clinical manifestations, including in almost all patients (95.6% versus 67.3%; p<0.05), body temperature rose to 38 °C and higher, and in 61.7% of women it stayed for 4–6 days (versus 11.5%; p<0.05). Among the complications of influenza: bronchitis (25.0% versus 9.3%; p<0.05), pneumonia (17.6% versus 5.7%; p<0.05), sinusitis (17.6% versus 7.7%; p<0.05). The threat of abortion was noted in 57.4% of cases, the threat of preterm birth was observed in 39.7% of women. Most often, placental dysfunction was associated with fetal distress (76.5% versus 13.5%; p<0.05) and growth retardation (54.4% versus 3.8%; p<0.05). 32.4% versus 13.5% of women had preeclampsia (p<0.05). The frequency of both polyhydramnios (17.6%) and low water (10.3%) is significantly higher. By cesarean section, 35.3% women were delivered (versus 15.4%, (p<0.05). Delivery was preterm in 17.6% of women versus 7.7% (p<0.05). Premature discharge of amniotic fluid (17.6%) and pathological blood loss during childbirth (16.2%), fetal distress during childbirth (48.5% versus 9.6%; p<0.05) were noted. Maternal placental dysfunction, fetal distress, prematurity (17.6%) and malnutrition (22.1%) led to a high incidence of birth asphyxia (46.5% versus 19.2%, p <0.05). Half (51.5%) of children had disadaptation syndromes, most often neurological disorders (32.4% versus 11.5%; p<0.05) and respiratory disorders (27.9% versus 7.7%; p<0.05). Conclusion. Influenza in early pregnancy with a severe course and a high frequency of complications is associated with a high frequency of feto-placental dysfunction and other obstetric and perinatal complications, which requires a more detailed study to determine risk factors and develop tactics for managing this category of pregnant women. Keywords: pregnancy, influenza, feto-placental dysfunction, obstetric and perinatal complications, newborn.

Includes bibliographical references (leaves 228-257). Aims to determine the impact of maternal undernutrition during late gestation and during the periconceptional and gestational periods on fetal growth, fetal blood pressure and the fetal hypothalamo-pituitary adrenal axis in the sheep.

Orientador: Vanda Maria Gimenes Gonçalves
Tese (doutorado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas
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Resumo: A desnutrição intra-uterina tem sido associada a morbidade neurológica em longo prazo. Tendo em vista que os lactentes nascidos pequenos para a idade gestacional (PIG) representam um modelo de estudo para essa situação e que a maioria dos trabalhos focaliza a idade escolar, o presente estudo teve como objetivo comparar o desempenho motor de lactentes nascidos a termo PIG com lactentes nascidos a termo adequados para a idade gestacional (AIG) no 1°, 2°, 3° e 6° meses. Tratou-se de um estudo prospectivo e seccional. Os neonatos foram selecionados na maternidade do Centro de Atenção Integral a Saúde da Mulher da Universidade Estadual de Campinas, no período de maio de 2000 a julho de 2003, obedecendo aos seguintes critérios de inclusão: recém-nascidos (RN) residentes na região de Campinas, que permaneceram no alojamento conjunto, resultantes de gestação de feto único, com idade gestacional entre 37 e 41 semanas, com peso ao nascimento classificado entre o percentil 10 e 90 da curva de crescimento fetal para o grupo AIG e, abaixo do percentil 10 para o grupo PIG. Foram excluídos: RN com síndromes genéticas, malformações e infecções congênitas. Para avaliação foi utilizada a Escala Motora das Bayley Scales of Infant Development-II. A partir da pontuação do Index Score (IS), com media 100 e desvio padrão de 15, os lactentes foram classificados com performance acelerada (IS=115), performance dentro dos limites normais (IS=85-114), performance levemente atrasada (IS=70-84) ou performance significantemente atrasada (IS=69). Para analise dos dados foi considerado o valor do IS obtido no 1°, 2°, 3° e 6° meses. Quando houve diferença significativa de IS entre os grupos PIG e AIG, as provas daquela idade e as características familiares que poderiam contribuir para as diferenças foram investigadas. A amostra compreendeu 63 lactentes (18 PIG; 45 AIG) no 1° mês, 68 lactentes (25 PIG; 43 AIG) no 2° mês, 68 lactentes (22 PIG; 46 AIG) no 3° mês e 66 lactentes (24 PIG; 42 AIG) no 6° mês. O grupo PIG apresentou media de IS significativamente menor que o grupo AIG no 2° e 6° meses. Nesses períodos, houve menor proporção de lactentes do grupo PIG que realizaram com sucesso as seguintes provas: "faz movimentos alternantes para arrastar em prono", "troca de decúbito lateral para dorsal", "equilibra a cabeça", "senta sozinho momentaneamente por 2 segundos" e "senta sozinho por 30 segundos". Considerando as características familiares, os grupos diferiram quanto a ocupação materna, escolaridade materna e renda per capita, de modo que no grupo PIG houve maior freqüência de mães que não trabalhavam fora do lar, que apresentavam menos de 8 anos de estudo e com baixa renda familiar. Os resultados obtidos sugerem que os lactentes nascidos a termo PIG estão sob maior risco para apresentar alterações no desenvolvimento motor
Abstract: Intrauterine malnutrition has been associated with long-term neurological morbidity. Considering that infants born small for gestational age represent a study model for this condition and that most studies focus on school age children, the present study aimed to compare the motor performance of infants born small for gestational age (SGA) with those appropriate for gestational age (AGA) at 1, 2, 3, and 6 months. This was a cross-sectional and prospective study. The neonates were selected at the Neonatology Service of the Center for Integral Attention to Women's Health-University of Campinas, between May 2000 and July 2003, according to the following criteria: healthy newborns resident in the region of Campinas, resulting of single fetus pregnancies, with gestational age between 37 and 41 weeks, with birthweight between the 10th and 90th percentiles of fetal growth curves for the AGA group and under the 10th percentile for the SGA group. Newborns with genetic syndromes, congenital malformations and infections were excluded. The Motor Scale of Bayley Scales of Infant Development-II was used for evaluation. Using the index score (IS), with a mean of 100 and standard deviation of 15, the infants were classified as presenting accelerated performance (IS=115), within normal performance limits (IS=85- 114), mildly delayed performance (IS=70-84) or significantly delayed performance (IS=69). The IS during the 1st, 2nd, 3rd and 6th months of life were considered in the analysis of the results obtained. When a significant difference in IS occurred between the SGA and AGA groups, the items at that age and the family characteristics that could contribute to these differences were investigated. The sample comprised 63 infants (18 SGA; 45 AGA) aged 1 month, 68 infants (25 SGA; 43 AGA) aged 2 months, 68 infants (22 SGA; 46 AGA) aged 3 months and 66 infants (24 SGA; 42 AGA) aged 6 months. The SGA group presented a mean motor IS lower than the AGA group at 2 and 6 months. For these periods, the SGA group presented a lower proportion of infants who successfully performed the following skills: "makes crawling movements", "turns from side to back", "balances head", "sits alone momentarily" and "sits alone for 30 seconds". Considering the family characteristics, the groups differed with respect to maternal occupation, maternal education and family income; therefore, the SGA group showed a large number of mothers who did not work outside the home, had less than 8 years of study and low family incomes. The results obtained suggest that the infants who are SGA present a greater risk for adverse motor outcomes
Doutorado
Ciencias Biomedicas
Doutor em Ciências Médicas

Orientadores: Maria Valeriana Leme de Moura-Ribeiro, Vanda Maria Gimenes Gonçalves
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A desnutrição intra-uterina tem sido associada à morbidade neurológica em longo prazo, sendo o lactente nascido pequeno para a idade gestacional um modelo de estudo para essa situação. O presente estudo teve por objetivo avaliar e comparar os indicadores do neurodesenvolvimento segundo as Escalas Bayley do Desenvolvimento Infantil, no primeiro ano de vida, entre lactentes nascidos a termo pequenos para a idade gestacional e lactentes nascidos com peso adequado. Foram selecionados 125 neonatos no Centro de Atenção Integral à Saúde da Mulher da UNICAMP, obedecendo aos critérios de inclusão: neonatos cujos pais ou responsáveis legais que assinaram o Termo de Consentimento Informado; que não necessitaram de cuidados especiais; com idade gestacional entre 37 e 41 semanas; com avaliação no 1º, 2º, 3º e 6º, 9º e 12º meses. Foram excluídos neonatos com infecção congênita, malformações diagnosticadas no período neonatal e aqueles resultantes de gestação múltipla. A casuística, composta por 95 lactentes que compareceram para pelo menos uma avaliação programada no 1º ano de vida, foi dividida em dois grupos de acordo com a adequação peso/idade gestacional: grupo PIG, constituído por 33 lactentes com peso ao nascimento abaixo do percentil 10 e grupo AIG por 62 lactentes com peso entre o percentil 10 e 90 da curva de crescimento fetal de Battaglia e Lubchenco (1967). Foram utilizadas as Escalas Bayley de Desenvolvimento Infantil II (1993), aplicadas no 1º, 2º, 3º, 6º, 9º e 12º meses de vida, no Laboratório de Estudos do Desenvolvimento Infantil I. Para a análise de resultados, a casuística do grupo PIG foi reagrupada de acordo com a proporcionalidade corporal ao nascimento em: PIG com crescimento intra-uterino simétrico (PIG-S) e PIG com crescimento intra-uterino assimétrico (PIG-A). Os grupos não apresentaram diferenças na performance nas escalas mental e motora quando classificados em inadequados (Index Score < 85) (IS) e adequados (IS = 85). O grupo PIG apresentou pontuações menores de IS na escala mental nas avaliações do primeiro semestre, sendo que esses resultados foram influenciados pelo grupo PIG-S. No entanto, não houve diferenças estatisticamente significativas em nenhum dos meses analisados. Na escala motora, o grupo PIG apresentou médias menores no 2º e no 12º meses (p = 0,008 e 0,046 Teste Mann-Whitney, respectivamente); e o grupo PIG-S no 2º mês (p = 0,016 Teste Kruskal Wallis). Considerando-se a Escala de Classificação do Comportamento (ECC), observou-se risco de associação à performance inadequada 5,19 vezes maior no grupo PIG (IC95%: 1,03-29,12) no 2º mês de vida. Quando classificados pela proporcionalidade corporal ao nascimento, observou-se risco de associação à performance inadequada 8,39 vezes maior no grupo PIG-S (IC95%: 1,53-57,40) no 2º mês e risco 22,0 vezes maior no grupo PIG-A no 3º mês na ECC. Considerando o perímetro craniano ao nascimento, o lactente nascido com microcefalia apresentou maior proporção com performance inadequada no 1º mês de vida (p = 0,011 Teste Exato de Fisher). Não foram observadas associações na análise univariada considerando-se a associação entre as variáveis biológicas e as relacionadas às condições sócio-demográficas com as performances mental e motora nos meses analisados. No estudo evolutivo comparando-se os resultados obtidos no primeiro semestre e no 9º mês com os resultados do 12º mês observou-se que, em grande proporção, os lactentes que apresentaram performance inadequada nas primeiras três avaliações apresentaram recuperação no 12º mês; os lactentes com performance inadequada no 6º e no 9º mês mantiveram-se inadequados no 12º mês
Abstract: Intrauterine malnutrition has been associated to long-term neurological morbidity and the small for gestational age infant is considered as a model for study this propose. The objective of this study was to evaluate the neurodevelopmental indicators according to Bayley Scales of Infant Development of full-term small-for-gestational age (SGA) infants compared with those born appropriate for gestational age (AGA), in the first year of life. The research design was a prospective study of two cohorts, one of full-term SGA group and other of control AGA group; with cross-sectional data analysis. A hundred and twenty five full-term neonates were selected at Neonatology Service in the Center of Integral Attention to the Woman's Health (CAISM) of the University of Campinas (UNICAMP), São Paulo, Brazil. Ethical permission was obtained from the Research Ethics Committee of the Medical Faculty of UNICAMP and the parents also gave the fully informed consent. They were selected on the following criteria: subjects living in the metropolitan area of Campinas; neonates considered in good health for going home within 2 days after birth; gestational age categorized as full-term (37-41 weeks) by Capurro postnatal method; expected birth weight for determined gestational age by Battaglia and Lubchenco method; birth weight less than the 10th percentile for the SGA group and between the 10th and the 90th percentile for the AGA group. Genetic syndromes, multiple congenital malformations and verified congenital infections (syphilis, toxoplasmosis, rubella, citomegalovirus, herpes) were excluded. The SGA group infants were classified according to body proportionality as symmetric SGA (S-SGA) and asymmetric SGA (A-SGA) for data analysis. All children were scheduled for developmental evaluation by the Bayley Scales of Infant Development II (Bayley, 1993) and two professionals who were unaware of the classification of the neonate's group performed the assessments of the infants, in the presence of their mothers, at 1, 2, 3, 6, 9 and 12 months of age. The infant's score for each item was registered in the Mental and Motor Scale Record Form. A total of 95 infants were performed. No differences were observed in Mental and Motor Scales performance, when classified as adequate (IS = 85) or inadequate (IS < 85). In the Mental Scale, means comparison between the groups showed no statistical differences. Considering the Motor Scale the SGA group showed lower IS means in the 2nd and in the 12th months (p = 0,008 and 0,046, respectively, Mann-Whitney test) and the S-SGA group in the 2hd month of age (p = 0,016 Kruskal Wallis test). Considering the Behavior Rating Scale, the inadequate performance were associated in the 2nd month of life, 5,19 times in higher proportion to SGA group (IC95%: 1,03-29,12) and 8,89 times to S-SGA group (IC95%: 1,53-57,40). In the 3rd month of age, was 22,0 times in higher proportion to A-SGA infants. Considering the occipitofrontal circumference at birth, the microcephalic born infants demonstrated association with inadequate performance in higher proportion in the 1st month of life (p = 0,011 Exact Fisher test) in the Mental Scale. Analyzing the relationship between biologic and socio-demographic variables using the univariate analysis, there was no association with theses variables and mental and motor performances in any month of the first year of life
Doutorado
Neurologia
Doutor em Ciências Médicas

Includes bibliographical references (leaves 228-257).
xxii, 257 leaves : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Aims to determine the impact of maternal undernutrition during late gestation and during the periconceptional and gestational periods on fetal growth, fetal blood pressure and the fetal hypothalamo-pituitary adrenal axis in the sheep.
Thesis (Ph.D.)--University of Adelaide, Dept. of Physiology, 2001

Includes bibliographical references (leaves 228-257).
xxii, 257 leaves : ill. ; 30 cm.
Aims to determine the impact of maternal undernutrition during late gestation and during the periconceptional and gestational periods on fetal growth, fetal blood pressure and the fetal hypothalamo-pituitary adrenal axis in the sheep.
Thesis (Ph.D.)--University of Adelaide, Dept. of Physiology, 2001