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Made available in DSpace on 2020-12-12T02:20:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-08-01 Background: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide, and this condition may be compromising female sexual function. However, there are controversial findings regarding the impact of GDM diagnosis and proposed treatments on sexual function during pregnancy. Therefore, this study seeks to elucidate the impact of GDM on sexual function in pregnant women by making a comparison between GDM and non-GDM groups using pregnancy sexual response inventory (PSRI). Materials and Methods: A case-control study involved 303 [168 women without GDM (control group) and 108 women diagnosed with GDM (case group)] Brazilian pregnant women at the Perinatal Diabetes Research Centre-Universidade Estadual Paulista, Brazil. PSRI was used to collect the data. The sexual function was scored in 10 domains as composite and specific scores by domains, categorized into quartiles (0 50). There were no significant differences in the sexual functions between the two groups before pregnancy (p > 0.0001). After GDM diagnosis and proposed treatment, the differences were significant (p

Objective To establish the Pregnancy Sexual Response Inventory (PSRI) scores for each domain before and during pregnancy, and to publish the Brazilian Portuguese version of the PSRI. Methods Pregnant women were recruited during antenatal care; the PSRI was administered to 244 women prenatally at Faculdade de Medicina de Botucatu, at Universidade do Estado de São Paulo (UNESP, in the Portuguese acronym). The PSRI scores were estimated based on the Kings Health Questionnaire (KHQ) and the Medical Outcomes Study 36-item short form survey (SF-36). The raw scale type was used to standardize the minimal value and amplitude of each domain. For each domain, the score varied from 0 to 100, and the composite score was obtained as the domain average. The composite score before and during pregnancy was determined by the sum of the scores of all specific domains for each divided by the full domain number. The categorization of the scale into quartiles was established when all PSRI-specific and composite scores were combined. Results The composite and specific scores for each domain were categorized into quartiles: 0 < 25 as “very bad;” 25 < 50 as “bad;” 50 < 75 as “good” and 75 to 100 as “excellent.” The mean scores were lower during pregnancy than before pregnancy in 8 of the 10 domains. The Brazilian Portuguese PSRI version is presented. Conclusion This study allowed the establishment of the PSRI composite and specific scores for each domain, and the categorization of scores into quartiles: very bad, bad, good and excellent. In addition, the Brazilian Portuguese version of the PSRI is presented in full for application in the Brazilian population. Resumo Objetivo Estabelecer os escores do Inventário da Resposta Sexual na Gestação (PSRI) para cada domínio antes e durante a gravidez, e publicar a versão do PSRI emportuguês brasileiro. Métodos Gestantes foram recrutadas durante o cuidado pré-natal; o PSRI foi administrado a 244 mulheres no pré-natal na Faculdade de Medicina de Botucatu da Universidade do Estado de São Paulo (UNESP). Os escores do PSRI foram estimados com base no Kings Health Questionnaire (KHQ) e Medical Outcomes Study 36-item short form survey (SF-36). O tipo de escala bruta foi utilizado para padronizar o valor mínimo e a amplitude de cada domínio. Para cada domínio, a pontuação variou de 0 a 100, e o escore composto foi obtido pelamédia do domínio. O escore composto antes e durante a gravidez foi determinado pela somatória dos escores de todos os domínios específicos para cada período dividido pelo número total do domínio. A escala de categorização em quartil foi estabelecida quando todos os escores específicos e compostos do PSRI foram reunidos. Resultados Os escores compostos e específicos para cada domínio foram categorizados em quartis: 0 < 25 como “muito ruim;” 25 < 5 0 como “ruim;” 50 < 75 como “bom” e 75 a 100 como “excelente.” As médias dos escores foram menores durante a gravidez do que antes da gravidez em 8 dos 10 domínios. Foi apresentada a versão PSRI em português brasileiro. Conclusão Este estudo permitiu o estabelecimento dos escores compostos e específicos do PSRI para cada domínio e a categorização dos escores emquartis:muito ruim, ruim, bom e excelente. Além disso, a versão em português do PSRI é apresentada integralmente para aplicação na população brasileira.

Persistent organic pollutants (POPs) present in the living environment are thought to have detrimental health effects on the population, with pregnant women and the developing foetus being at highest risk. We report on the levels of selected POPs in maternal blood of 155 delivering women residing in seven regions within the São Paulo State, Brazil.The following selected POPs were measured in the maternal whole blood: 12 polychlorinated biphenyls (PCBs) congeners (IUPAC Nos. 99, 101, 118, 138, 153, 156, 163, 170, 180, 183, 187, 194); dichlordiphenyltrichloroethane p,p′-DDT, diphenyldichloroethylene p,p′-DDE and other pesticides such as hexachlorocyclohexanes (α-HCH, β-HCH, γ-HCH), hexachlorobenzene (HCB), chlordane derivatives cis-chlordane, trans-chlordane, oxy-chlordane, cis-nonachlor and trans-nonachlor.Statistical comparisons between regions were performed only on compounds having concentrations above LOD in 70% of the samples. PCB118 congener was found to be highest in the industrial site (mean 4.97 ng/g lipids); PCB138 congener concentration was highest in the Urban 3 site (mean 4.27 ng/g lipids) and congener PCB153 was highest in the industrial and Urban 3 sites with mean concentration of 7.2 ng/g lipids and 5.89 ng/g lipids respectively. Large differences in levels of p,p′-DDE between regions were observed with the Urban 3 and industrial sites having the highest concentrations of 645 ng/g lipids and 417 ng/g lipids, respectively; β-HCH was found to be highest in the Rural 1 site; the γ-HCH in Rural 1 and industrial; the HCB in the Rural 1 and industrial sites and oxy-chlordane and t-NC in the Rural 2 sites. An association between levels of some contaminants and maternal age and parity was also found. Keywords: Pesticides exposure, Delivering women, Human blood, São Paulo State, Brazil

CONTEXT AND OBJECTIVE There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. DESIGN AND SETTING Cross-sectional study, conducted in a public university. METHODS 220 women who had undergone elective cesarean section or vaginal childbirth two years earlier were selected. Their urinary incontinence symptoms were investigated, and their pelvic floor muscle dysfunction was assessed using digital palpation and a perineometer. RESULTS The two-year urinary incontinence prevalences following vaginal childbirth and cesarean section were 17% and 18.9%, respectively. The only risk factor for pelvic floor muscle dysfunction was weight gain during pregnancy. Body mass index less than 25 kg/m 2 and normal pelvic floor muscle function protected against urinary incontinence. Gestational urinary incontinence increased the risk of two-year postpartum urinary incontinence. CONCLUSION Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence. CONTEXTO E OBJETIVO É ainda controversa na literatura a teoria de que eventos obstétricos e traumas no assoalho pélvico representariam menor risco para mulheres submetidas ao parto cesárea do que para aquelas submetidas a parto vaginal, no tocante a subsequente incontinência urinária. O objetivo do estudo foi avaliar a prevalência de incontinência urinária e disfunção muscular do assoalho pélvico dois anos após o parto e os fatores responsáveis por elas. TIPO DE ESTUDO E LOCAL Estudo transversal conduzido em universidade pública. MÉTODOS Foram selecionadas 220 mulheres dois anos após parto cesáreo eletivo ou parto vaginal. Foram avaliados sintomas de incontinência urinária e disfunção muscular do assoalho pélvico por palpação digital e perineômetro. RESULTADOS A prevalência de incontinência urinária dois anos após parto vaginal e cesárea foi de 17% e 18,9% respectivamente. O único fator de risco para disfunção muscular do assoalho pélvico foi o ganho de peso durante a gestação. Índice de massa corporal inferior a 25 kg/m 2 e disfunção muscular do assoalho pélvico normal foram fatores de proteção contra incontinência urinária. Incontinência urinária na gestação aumentou o risco de incontinência urinária dois anos pós-parto. CONCLUSÃO Incontinência urinária gestacional foi um precursor crucial de incontinência urinária pós-parto. O ganho de peso durante a gestação aumentou o risco posterior de disfunção muscular do assoalho pélvico e o parto cesárea eletivo não foi uma ação de prevenção para a incontinência urinária.

Made available in DSpace on 2013-08-28T14:08:24Z (GMT). No. of bitstreams: 1 WOS000208608000034.pdf: 309172 bytes, checksum: 05a2caa24fe4029a19f4b003e0be7007 (MD5) Made available in DSpace on 2013-09-30T18:20:32Z (GMT). No. of bitstreams: 2 WOS000208608000034.pdf: 309172 bytes, checksum: 05a2caa24fe4029a19f4b003e0be7007 (MD5) WOS000208608000034.pdf.txt: 31117 bytes, checksum: 4d1552d48a1bf06516c319117d65a326 (MD5) Previous issue date: 2011-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:33Z No. of bitstreams: 2 WOS000208608000034.pdf: 309172 bytes, checksum: 05a2caa24fe4029a19f4b003e0be7007 (MD5) WOS000208608000034.pdf.txt: 31117 bytes, checksum: 4d1552d48a1bf06516c319117d65a326 (MD5) Made available in DSpace on 2014-05-20T13:35:33Z (GMT). No. of bitstreams: 2 WOS000208608000034.pdf: 309172 bytes, checksum: 05a2caa24fe4029a19f4b003e0be7007 (MD5) WOS000208608000034.pdf.txt: 31117 bytes, checksum: 4d1552d48a1bf06516c319117d65a326 (MD5) Previous issue date: 2011-01-01 Kellogg Foundation São Paulo State Health Secretary Background: In 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015.Objective: To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.Methods: Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05.Results: Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.Conclusions: This safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections. São Paulo State Univ UNESP, Botucatu Med Sch, Dept Gynecol & Obstet, São Paulo, Brazil São Paulo State Univ UNESP, Botucatu Med Sch, Dept Gynecol & Obstet, São Paulo, Brazil

This study was designed to evaluate the degree of environmental contamination and possible exposure of pregnant women to toxic elements in seven selected areas of Sao Paulo State, Brazil. The overall median concentration of Mo in maternal blood was 0.53 μg L−1, highly significant differences found between sites (p < 0.0001). Cd was found to be low overall − 0.09 μg L−1 (0.01–0.58 μg L−1) – with mothers from the Coastal and Rural 1 sites having the highest levels (p < 0.016). Median Hg concentration was 0.60 μg L−1 (0.06 μg L−1–4.35 μg L−1); median Pb level was 16.2 μg L−1 (3.5–57.7 μg L−1) and no differences between sites were observed for both metals. Median Mn level was 16.7 μg L−1 (7.0–39.7 μg L−1), being highest in Urban 2 site (p

Environmental toxicants such as metals may be detrimental to foetus and infant development and health because of their physiological immaturity, opportunistic and differential exposures, and a longer lifetime over which disease, initiated during pregnancy and in early life, can develop. The placental mechanisms responsible for regulation of absorption and excretion of elements during pregnancy are not fully understood. The aim of this paper is to assess the correlation for selected toxic and essential elements in paired whole blood samples of delivering women and cord blood, as well as to evaluate the placental permeability for selected elements. Regression analyses used to assess this correlation in 62-paired samples of maternal and cord whole blood of delivering women show that the concentrations of mercury, lead, cobalt, arsenic and selenium in maternal and cord blood differed statistically. Lead, cobalt, arsenic and selenium appear to pass the placental barrier by a diffusion mechanism. It was also found that the mercury levels in cord blood were almost double those of the mother, suggesting that the foetus may act as a filter for the maternal mercury levels during pregnancy. Transplacental transfer for arsenic and cobalt was 80% and 45%, respectively, suggesting that the placenta modulates the rate of transfer for these elements. Cadmium, manganese, copper and zinc levels did not show statistically significant correlations between two compartments (maternal versus cord whole blood). The study confirms that most of the toxic metals measured have an ability to cross the placental barrier.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:23:57Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:46:29Z : No. of bitstreams: 1 2-s2.0-69049092787.pdf: 200304 bytes, checksum: 5a7a9e7dcafa2445dc988d949390c7c8 (MD5) Made available in DSpace on 2014-05-27T11:23:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-08-27 Background. A review of validated methods for assessing female sexual dysfunction and a review of male and female sexual dysfunction did not refer to any specific questionnaire for evaluating sexuality during pregnancy. A study was performed at the Obstetrics and Gynecology Department of Botucatu Medical School, São Paulo State University, Brazil to design and validate a pregnancy sexuality questionnaire, the Pregnancy Sexual Response Inventory (PSRI). Methods. Women with a singleton pregnancy between 10 and 35 weeks of gestation were randomly recruited. There were five phases in the development of the PSRI: (1) item selection; (2) item development; (3) determination of internal consistency, reliability and convergence; (4) content validity; and (5) determination of inter-interviewer reliability. Internal consistency and reliability were evaluated using Cronbach's alpha. Inter-interviewer reliability was assessed by evaluating the responses of 18 academics at various institutions, using Kappa Index and Student t test. Results. Good internal consistency and reliability were obtained (Cronbach's alpha coefficient = 0.79). Among the 18 academics, 13 totally agreed (K = 1.0), three partially agreed (K = 0.67) and two disagreed (K = 0.33) with the proposed questions. Comparisons of the mean PSRI domain scores made between the primary investigators and the other interviewers showed no significant differences in all domains (p > 0.05). Conclusion. PSRI is a new validated instrument for evaluating sexuality and sexual activity and related health concerns during pregnancy. © 2009 Rudge et al; licensee BioMed Central Ltd. Institute of Community Medicine, Tromso Department of Obstetrics and Gynecology Botucatu Medical School São Paulo State University (UNESP) Research Group Council Botucatu Medical School (UNESP) Department of Sexology Mater Dei Hospital, Belo Horizonte, MG Institute of Community Medicine University of Tromsø Department of Obstetrics and Gynecology Botucatu Medical School São Paulo State University (UNESP) Research Group Council Botucatu Medical School (UNESP)

Objective To evaluate data from patients with normal oral glucose tolerance test (OGTT) results and a normal or impaired glycemic profile (GP) to determine whether lower cutoff values for the OGTT and GP (alone or combined) could identify pregnant women at risk for excessive fetal growth. Methods We classified 701 pregnant women with positive screening for gestational diabetes mellitus (GDM) into 2 categories-(i) normal 100-g OGTT and normal GP and (2) normal 100-g OGTT and impaired GP—to evaluate the influence of lower cutoff points in a 100-g OGTT and GP (alone or in combination) for identification of pregnant women at excessive fetal growth risk. The OGTT is considered impaired if 2 or more values are above the normal range, and the GP is impaired if the fasting glucose level or at least 1 postprandial glucose value is above the normal range. To establish the criteria for the OGTT (for fasting and 1,2, and 3 hours after an oral glucose load, respectively), we considered the mean (75 mg/dL, 120 mg/dL, 113 mg/dL, and 97 mg/dL), mean plus 1 SD (85 mg/dL, 151 mg/dL, 133 mg/dL, and 118 mg/dL), and mean plus 2 SD (95 mg/dL, 182 mg/dL, 153 mg/dL, and 139 mg/dL); and for the GP, we considered the mean and mean plus 1 SD (78 mg/dL and 92 mg/dL for fasting glucose levels and 90 mg/dL and 130 mg/dL for 1- or 2- hour postprandial glucose levels, respectively). Results Subsequently, the women were reclassified according to the new cutoff points for both tests (OGTT and GP). Consideration of values, in isolation or combination, yielded 6 new diagnostic criteria. Excessive fetal growth was the response variable for analysis of the new cutoff points. Odds ratios and their respective confidence intervals were estimated, as were the sensitivity and specificity related to diagnosis of excessive fetal growth for each criterion. The new cutoff points for the tests, when used independently rather than collectively, did not help to predict excessive fetal growth in the presence of mild hyperglycemia. Conclusion Decreasing the cutoff point for the 100g OGTT (for fasting and 1, 2, and 3 hours) to the mean (75 mg/dL, 120 mg/dL, 113 mg/dL, and 97 mg/dL) in association with the GP (mean or mean plus 1 SD—78 mg/dL and 92 mg/dL for the fasting state and 90 mg/dL and 130 mg/dL for 1- or 2-hour postprandial values—increased the sensitivity and specificity, and both criteria had statistically significant predictive power for detection of excessive fetal growth. (Endocr Pract. 2008;14:678-685)

This pilot study uses concentrations of metals in maternal and cord blood at delivery, in seven selected geographical areas of South Africa, to determine prenatal environmental exposure to toxic metals. Samples of maternal and cord whole blood were analysed for levels of cadmium, mercury, lead, manganese, cobalt, copper, zinc, arsenic and selenium. Levels of some measured metals differed by site, indicating different environmental pollution levels in the regions selected for the study. Mercury levels were elevated in two coastal populations studied (Atlantic and Indian Ocean sites) with mothers from the Atlantic site having the highest median concentration of 1.78 µg/L ranging from 0.44 to 8.82 µg/L, which was found to be highly significant (p < 0.001) when compared to other sites, except the Indian Ocean site. The highest concentration of cadmium was measured in maternal blood from the Atlantic site with a median value of 0.25 µg/L (range 0.05–0.89 µg/L), and statistical significance of p < 0.032, when compared to all other sites studied, and p < 0.001 and p < 0.004 when compared to rural and industrial sites respectively, confounding factor for elevated cadmium levels was found to be cigarette smoking. Levels of lead were highest in the urban site, with a median value of 32.9 µg/L (range 16–81.5 µg/L), and statistically significant when compared with other sites (p < 0.003). Levels of selenium were highest in the Atlantic site reaching statistical significance (p < 0.001). All analysed metals were detected in umbilical cord blood samples and differed between sites, with mercury being highest in the Atlantic site (p < 0.001), lead being highest in the urban site (p < 0.004) and selenium in the Atlantic site (p < 0.001). To the best of our knowledge this pilot investigation is the first study performed in South Africa that measured multiple metals in delivering mothers and umbilical cord blood samples. These results will inform the selection of the geographical sites requiring further investigation in the main study.