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Background and aims To analyze the prevalence of hyperferritinemia in pregnant women with preeclampsia and its association with adverse perinatal outcomes. Methods A cross-sectional study carried out in 2017 with a convenience sample of pregnant women with preeclampsia attended at a high-risk maternity hospital in Alagoas, Brazil. Socioeconomic, lifestyle, clinical and biochemical data were collected through a structured questionnaire. Type of delivery, gestational age, weight and length at birth, and Apgar score were analyzed as outcome variables. Women were dichotomized according to the serum ferritin level (150 ng/mL). Poisson regression models were used to analyze the effect of hyperferritinemia on the outcome variables. Estimates were presented as prevalence ratio with 95% confidence intervals (PR [95% CI]). Results Based on the Fisher’s exact statistical teste and in the proportions of the neonatal outcome (birth weight), with a statistical significance of 5%, the statistical power of the sample studied was 83%. Two hundred six pregnant women with preeclampsia were recruited, which 8.74% presented hyperferritinemia. Except for ferritin level, there were no differences in C-reactive protein (CRP), hemoglobin, Glutamate Oxaloacetate Transaminase (GOT) and Pyruvic Glutamic Transaminase (PGT) levels between women with or without hyperferritinemia. After adjusting for potential confounders, hyperferritinemia was associated with low birth weight (2.19 [2.13–3.89 95%CI]), low birth length (7.76 [2.52–23.8 95% CI]) and being born small for gestational age (3.14 [1.36–7.28 95% CI]). Conclusion In the presence of hyperferritinemia, preeclampsia patients were associated with a higher rate of unfavorable neonatal outcomes.

Objectives: to compare the adverse perinatal outcomes in pregnancies of adolescents and elderly women of public health network. Methods: a cross-sectional study carried out with pregnant women at the extremes of reproductive age according to the classification of the Brazilian Ministry of Health (adolescents those aged ≤19 years and those who were older than 35 years) and their newborns. Socioeconomic data (income, schooling, occupation and marital status), as well as clinical (diseases), anthropometric (maternal BMI) and perinatal (gender, weight, length, Apgar and gestational age) data were collected, and Poisson regression in hierarchical model was performed, with the results in Ratio of Prevalence (PR) and its respective Confidence Interval at 95% (95% CI). Results: when comparing adolescent and elderly women, 38.7% vs 54.6% (PR=0.71, CI=0.54-0.94, p=0.002) were observed, respectively, cesarean deliveries; 37.8% vs 25.2% (PR=0.83, CI=0.58-1.19, p=0.332) preterm births; 16.6% vs 20.5% (RP=1.07, CI=0.78-1.46, p=0.666) births of small infants for gestational age (SGA); 18.0% vs 15.3% (RP=1.01, CI=0.69-1.47, p=0.948) births of large-for-gestational-age newborns (LGA); 32.2% vs 34.7% (RP=1.08, CI=0.82-1.42, p=0.578), low birth weight infants and 28.5% vs 42.9% (RP=1.18, CI=0.91-1.54, p=0.201) with high birth length. Conclusions: When compared with adolescent women, pregnant women of advanced age presented a higher frequency of cesarean deliveries. Resumo Objetivos: comparar os resultados perinatais adversos em gestações de adolescentes e mulheres em idade avançada de rede pública de saúde. Métodos: estudo transversal realizado com gestantes nos extremos de idade reprodutiva segundo classificação do Ministério da Saúde do Brasil (adolescentes aquelas com idade ≤19 anos e em idade avançada aquelas com idade ≥35 anos) e seus recém-nascidos. Foram coletados dados socioeconômicos (renda, escolaridade, ocupação e situação conjugal), clínicos (presença de doenças), antropométricos (IMC materno) e perinatais (sexo, peso, comprimento, Apgar e idade gestacional), e realizada regressão de Poisson em modelo hie-rarquizado, com resultados em Razão de Prevalência (RP) e respectivo Intervalo de Confiança a 95% (IC95%). Resultados: quando comparadas gestantes adolescentes e aquelas em idade avançada, foram observados, respectivamente: 38,7% vs 54,6% (RP=0,71; IC=0,54-0,94; p=0,002) partos cesarianos; 37,8% vs 25,2% (RP=0,83; IC=0,58-1,19; p=0,332) nascimentos de pré-termos; 16,6% vs 20,5% (RP=1,07; IC=0,78-1,46; p=0,666) nascimentos de recém-nascidos pequenos para idade gestacional; 18,0% vs 15,3% (RP=1,01; IC=0,69-1,47; p=0,948) nascimentos de recém-nascidos grandes para a idade gestacional; 32,2% vs 34,7% (RP=1,08; IC=0,82-1,42; p=0,578)recém-nascidos com baixo peso ao nascer e28,5% vs 42,9% (RP=1,18; IC=0,91-1,54; p=0,201) com comprimento elevado ao nascer. Conclusões: as gestantes em idade avançada quando comparadas com as adolescentes apresentaram maior frequência de partos cesarianos.

N-acetylcysteine (NAC) is a medicine widely used to treat paracetamol overdose and as a mucolytic compound. It has a well-established safety profile, and its toxicity is uncommon and dependent on the route of administration and high dosages. Its remarkable antioxidant and anti-inflammatory capacity is the biochemical basis used to treat several diseases related to oxidative stress and inflammation. The primary role of NAC as an antioxidant stems from its ability to increase the intracellular concentration of glutathione (GSH), which is the most crucial biothiol responsible for cellular redox imbalance. As an anti-inflammatory compound, NAC can reduce levels of tumor necrosis factor-alpha (TNF-α) and interleukins (IL-6 and IL-1β) by suppressing the activity of nuclear factor kappa B (NF-κB). Despite NAC’s relevant therapeutic potential, in several experimental studies, its effectiveness in clinical trials, addressing different pathological conditions, is still limited. Thus, the purpose of this chapter is to provide an overview of the medicinal effects and applications of NAC to human health based on current therapeutic evidence.

Objective To compare redox and inflammatory markers between normal and PE-derived placentas and to evaluate the relationship between placental redox imbalance markers and perinatal outcomes in pregnancies with PE. Methods This was a cross-sectional study conducted at the maternity hospital of a university hospital in Maceio-Alagoas, Brazil, in 2017, including women diagnosed with PE and healthy pregnant women and their conceptuses. After screening, standardized questionnaires containing socioeconomic, clinical, obstetric and anthropometric data were applied. After delivery, placental samples were collected for quantification of biomarkers of redox imbalance (catalase – CAT; malondialdehyde – MDA; hydrogen peroxide – H2O2; superoxide dismutase – SOD; reduced glutathione – GSH; oxidized glutathione – GSSG; and their ratio – GSH/GSSG) and inflammation (myeloperoxidase – MPO; interleukin (IL)-6; IL-8; IL-10; and tumor necrosis factor-alpha – TNF-α). All biomarkers were evaluated via linear regression with adjustments of variables with measures of weight, length, head circumference (HC), chest circumference (CC) and gestational age of newborns at birth, considering p Results A total of 100 pregnant women with PE and 50 healthy pregnant women were studied. Higher placental levels of catalase (p = 0.018), SOD (p = 0.031), the GSH/GSSG ratio (p = 0.019) and IL-6 (p = 0.010) and lower GSSG (p = 0.001) were observed in pregnant women with PE than in the control group. Positive associations between placental GSH levels and body weight, HC, CC and gestational age at birth (p Conclusion PE-derived placentas had high concentrations of some antioxidants (enzymes and thiols), which might be a compensation mechanism against oxidative stress. Placental GSH levels were the only biomarker, among the studied ones, related positively with beneficial perinatal outcomes, suggesting that this endogenous antioxidant plays an important role in maintaining the health of the conceptus and women with PE.

Objectives: to analyze the factors associated with the birth of small for gestational age (SGA)infants, in a Northeastern Brazilian capital. Methods: a cross-sectional study was carried out with 331 pregnant women and their newborns attending the public health network in the city of Maceió, in 2014. Maternal antenatal data were collected (socioeconomic, lifestyle, clinical and nutritional) as well as data of the newborns (gestational age, mode of delivery, sex, birth weight and length), after delivery. Birth weight was classified according to the INTERGROWTH-21st curves, being considered SGA those below the 10th percentile according to gestational age and gender. The results were analyzed by Poisson regression using a hierarchical model and were expressed as prevalence ratios (PR) and their respective 95% confidence intervals (CI95%). Results: it was verified that 5.1% of the newborns were SGA. Regarding the associated factors, after adjustment of the hierarchical model, the variable working outside the home was associated with the endpoint studied [PR = 0.14; (CI95% = 0.02-0.75); p=0.022]. Conclusions: it was verified a low frequency of SGA infants in the evaluated population. The fact that the mother works outside the home proved to be a protective factor for this condition. Resumo Objetivos: analisar os fatores associados ao nascimento de recém-nascidos pequenos para a idade gestacional (PIG), em uma capital do Nordeste brasileiro. Métodos: estudo transversal realizado com 331 gestantes e seus recém-nascidos atendidos na rede pública de saúde do município de Maceió, em 2014. Foi realizada a coleta de dados maternos antes do parto (socioeconômicos, de estilo de vida, clínicos e nutricionais) e após o parto os dados dos recém-nascidos (idade gestacional no momento do parto, via de parto, sexo, peso e comprimento ao nascer). O peso ao nascer foi classificado segundo as curvas do INTERGROWTH-21st, sendo considerados PIG aqueles abaixo do percentil 10 de acordo com a idade gestacional e o sexo. Os resultados foram analisados por regressão de Poisson, com emprego de modelo hierarquizado, sendo expressos como razões de prevalência [RP] e seus respectivos intervalos de confiança de 95% (IC95%). Resultados: foi constatado que 5,1% dos recém-nascidos eram PIG. Quanto aos fatores associados, após ajuste do modelo hierarquizado, permaneceu-se associada ao desfecho estudado a variável trabalhar fora do lar [RP=0,14; (IC95%=0,02-0,75); p=0,022]. Conclusões: foi verificada baixa frequência de recém-nascidos PIG na população avaliada. O fato da mãe trabalhar fora do lar mostrou-se como fator protetor para esta condição.

To assess whether there is a risk of kidney disease during the postpartum period of women who had preeclampsia (PE).Observational trials were searched in the PubMed, Science Direct, Clinical trials, Cochrane, LILACS and Web of Science databases. The data extracted from the studies were systematized, and the risk of bias was evaluated for each of them. Meta-analyses were performed with studies that evaluated chronic kidney disease (CKD) and end-stage renal disease (ESRD), pooling the natural logarithms of the adjusted risk measures and the confidence intervals of each study in a random effects model.Of the 4149 studies evaluated, 35 articles were included in the review, of which 3 of the CKD and 6 of the ESRD presented the necessary outcomes to compose the meta-analysis. A formal registration protocol was included in the PROSPERO database (number: CRD42019111821). There was a statistically significant difference between the development of CKD (hazard ratio (HR): 1.82, confidence interval to 95% (95% CI): 1.27-2.62, P 0.01) and ESRD (HR: 3.01, confidence interval to 95% (95% CI): 1.92-4.70, P 0.01) in postpartum women affected by PE.PE was considered a risk factor for the onset of CKD and ESRD in the postpartum period. Thus, more research is needed to clarify the underlying mechanisms of this association, and to assist in determining the most appropriate and effective clinical conduct to prevent and/or treat such complications.

Resumo O objetivo deste artigo é avaliar a prevalência e os fatores associados à ausência de aleitamento materno na alta hospitalar em uma maternidade pública de Maceió, Alagoas, Brasil. Estudo transversal realizado com puérperas sob alta hospitalar assistidas na maternidade do hospital universitário da capital. Foram calculadas razões de prevalência (RP) e respectivos intervalos de confiança de 95% (IC95%) por regressão de Poisson com emprego de modelo hierarquizado. Aproximadamente 20% das puérperas não estavam amamentando. Hábito tabagista na gravidez [RP = 5,20; (IC95% = 1,75-15,33); p = 0,003]; intercorrências na gestação [RP = 3,50; (IC95% = 1,04-11,77); p = 0,042] e falta de informações sobre aleitamento materno no pré-natal [RP = 5,44; (IC95% = 1,78-16,67); p = 0,003] foram fatores desfavoráveis à amamentação. A prática de aleitamento materno dentro da maternidade está aquém do ideal. Evidencia-se a importância do pré-natal, visando fornecer orientações quanto à prevenção do tabagismo na gestação e aconselhamento sobre aleitamento materno, com atenção especial àquelas puérperas que tiveram intercorrências na gestação. Abstract This article sets out to evaluate the prevalence and associated factors with the lack of breastfeeding upon discharge from hospital in a public maternity facility in Maceio, Alagoas, Brazil. It involved a cross-sectional study performed with women who had recently given birth at the moment of discharge from the maternity ward of a university hospital in the capital. Prevalence ratios (PR) and confidence intervals of 95% (CI95%) were calculated by Poisson regression with the use of a hierarchical model. Approximately 20% of mothers did not breastfeed. Smoking during pregnancy [PR = 5.20; (CI95% =1.75 to 15.33), p = 0.003]; complications during pregnancy [PR =3.50; (CI95% =1.04 to 11.77), p = 0.042] and insufficient information about breastfeeding during prenatal care [PR = 5.44; (CI95% 1.78 to 16.67); p = 0.003] were the major negative factors associated with the lack of breastfeeding. Breastfeeding in the maternity ward was lower than ideal. Guidelines on smoking prevention and encouragement of breastfeeding must be highlighted during prenatal care, especially for women with complications during pregnancy.

Objectives: to compare the assessment of the adequacy of birth weight for gestational age according to different intrauterine growth curves. Methods: across-sectional study, which analyzed gestational and neonatal information from 344 mother-newborn binomials. Birth weight data were analyzed using the International Fetal and New Born Growth Consortium for the 21st Century (INTERGROWTH-21st) and compared with the growth curves proposed by Alexander et al. and Fenton & Kim. Newborns were classified as small for gestational age (SGA), suitablefor gestational age (SUGA) or large for gestational age (LGA). Results: among the newborns, 51.2% were male, and 93.0% were born at term. Higher prevalence of SUGA and LGA and lower SGA was found by the INTERGROWTH-21st curves when compared to the references of Fenton & Kim and Alexander et al. Moderate agreement was observed in detecting birth weight by different growth curves. Conclusions: there was a lower detection of SGA infants and a higher screening, especially of LGA infants, in the INTERGROWTH-21st evaluation, when compared to the growth curves of Fenton & Kim and Alexander et al. Resumo Objetivos: comparar a avaliação da adequação do peso ao nascer para idade gestacional segundo diferentes curvas de crescimento intrauterino. Métodos: estudo transversal, onde foram analisadas informações gestacionais e neonatais de 344 binômios mães-recém-nascidos. Os dados de peso ao nascer foram analisados utilizando-se a International Fetal and New Born Growth Consortium for the 21st Century (INTERGROWTH-21st) e comparados com as curvas de crescimento propostas por Alexander et al. e Fenton & Kim. Os recém-nascidos foram classificados em pequenos para idade gestacional (PIG), adequados para idade gestacional (AIG) ou grandes para idade gestacional (GIG). Resultados: dentre os recém-nascidos, 51,2% eram do sexo masculino, sendo que 93,0% nasceram a termo. Maior prevalência de AIG e GIG e menor de PIG foi constatada pelas curvas INTERGROWTH-21st, quando comparadas às referências de Fenton & Kim e Alexander et al. Foi observada concordância moderada na detecção do peso ao nascer pelas diferentes curvas de crescimento. Conclusões: verificou-se menor detecção de recém-nascidos PIG e maior rastreio, principalmente, de recém-nascidos GIG na avaliação pela INTERGROWTH-21st, quando comparada às curvas de crescimento de Fenton & Kim e Alexander et al.