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[PMID]:29447176
[Au] Autor:Svefors P; Selling KE; Shaheen R; Khan AI; Persson LÅ; Lindholm L
[Ad] Endereço:International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
[Ti] Título:Cost-effectiveness of prenatal food and micronutrient interventions on under-five mortality and stunting: Analysis of data from the MINIMat randomized trial, Bangladesh.
[So] Source:PLoS One;13(2):e0191260, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Nutrition interventions may have favourable as well as unfavourable effects. The Maternal and Infant Nutrition Interventions in Matlab (MINIMat), with early prenatal food and micronutrient supplementation, reduced infant mortality and were reported to be very cost-effective. However, the multiple micronutrients (MMS) supplement was associated with an increased risk of stunted growth in infancy and early childhood. This unfavourable outcome was not included in the previous cost-effectiveness analysis. The aim of this study is to evaluate whether the MINIMat interventions remain cost-effective in view of both favourable (decreased under-five-years mortality) and unfavourable (increased stunting) outcomes. METHOD: Pregnant women in rural Bangladesh, where food insecurity still is prevalent, were randomized to early (E) or usual (U) invitation to be given food supplementation and daily doses of 30 mg, or 60 mg iron with 400 µg of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 µg of folic acid. E reduced stunting at 4.5 years compared with U, MMS increased stunting at 4.5 years compared with Fe60, while the combination EMMS reduced infant mortality compared with UFe60. The outcome measure used was disability adjusted life years (DALYs), a measure of overall disease burden that combines years of life lost due to premature mortality (under five-year mortality) and years lived with disability (stunting). Incremental cost effectiveness ratios were calculated using cost data from already published studies. RESULTS: By incrementing UFe60 (standard practice) to EMMS, one DALY could be averted at a cost of US$24. CONCLUSION: When both favourable and unfavourable outcomes were included in the analysis, early prenatal food and multiple micronutrient interventions remained highly cost effective and seem to be meaningful from a public health perspective.
[Mh] Termos MeSH primário: Transtornos do Crescimento/etiologia
Fenômenos Fisiológicos da Nutrição do Lactente/economia
Micronutrientes/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Bangladesh/epidemiologia
Pré-Escolar
Análise Custo-Benefício/métodos
Suplementos Nutricionais
Feminino
Ácido Fólico
Abastecimento de Alimentos
Transtornos do Crescimento/tratamento farmacológico
Transtornos do Crescimento/mortalidade
Seres Humanos
Lactente
Mortalidade Infantil
Fenômenos Fisiológicos da Nutrição do Lactente/efeitos dos fármacos
Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia
Recém-Nascido
Ferro
Masculino
Micronutrientes/administração & dosagem
Política Nutricional
Gravidez
Cuidado Pré-Natal
Fenômenos Fisiológicos da Nutrição Pré-Natal
Oligoelementos
Vitaminas
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Micronutrients); 0 (Trace Elements); 0 (Vitamins); 935E97BOY8 (Folic Acid); E1UOL152H7 (Iron)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191260


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[PMID]:28449651
[Au] Autor:Devkota R; Khan GM; Alam K; Sapkota B; Devkota D
[Ad] Endereço:Department of Drug Administration, Kathmandu, Nepal. rameshlog@hotmail.com.
[Ti] Título:Impacts of counseling on knowledge, attitude and practice of medication use during pregnancy.
[So] Source:BMC Pregnancy Childbirth;17(1):131, 2017 04 27.
[Is] ISSN:1471-2393
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Counseling has a significant role in improving knowledge, attitude and practice outcomes of pregnant women towards medication use. Proper counseling thus could be beneficial to prevent any medication related misadventure during pregnancy. The present study was aimed to assess the knowledge, attitude and practice (KAP) of pregnant women towards their medications, to provide counseling regarding their understanding of medication use during pregnancy and evaluate the impacts of such counseling. METHODS: Pre- post interventional (counseling) study was conducted at Manipal Teaching Hospital, Nepal among pregnant women who presented with complication and were prescribed at least one medication. A total of 275 pregnant women were included in the study. A structured questionnaire was used to assess the knowledge, attitude and practice of pregnant women before and after counseling. The impacts of counseling were then evaluated using suitable statistical methods. RESULTS: Of the total participants 229 completed the post counseling survey. Majority of the participants were in the age group 20-24 (43.2%), primigravida (59.4%) and in third trimester (58.6%). Housewives comprised 61.1% of participants and majority had received a University degree (33.2%). The mean and median scores assessed before counseling showed that there was no significant difference in the KAP scores with respect to age, trimester and gravidity whereas KAP scores with respect to occupation and level of education were statistically significant. There was an increase in mean and median KAP scores after counseling and the impacts of counseling was found to be statistically significant (p = <0.001). CONCLUSION: Counseling had a positive impact on knowledge, attitude and practice of pregnant women towards medication and thus it could be considered a suitable method to encourage safe medication during pregnancy.
[Mh] Termos MeSH primário: Aconselhamento/métodos
Conhecimentos, Atitudes e Prática em Saúde
Conhecimento do Paciente sobre a Medicação
Gestantes/psicologia
Cuidado Pré-Natal/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Nepal
Gravidez
Cuidado Pré-Natal/psicologia
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1186/s12884-017-1316-6


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[PMID]:29265787
[Au] Autor:Bzikowska A; Czerwonogrodzka-Senczyna A; Riahi A; Weker H
[Ad] Endereço:Warsaw Medical University, Faculty of Health Science, Department of Clinical Dietetics, Warsaw, Poland
[Ti] Título:Nutritional value of daily food rations of overweight and normal weight pregnant women
[So] Source:Rocz Panstw Zakl Hig;68(4):375-379, 2017.
[Is] ISSN:0035-7715
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:Background: Adequate nutrition and nutritional status during pregnancy are essential for mother's health and foetus development. Due to increased demands, pregnant women are vulnerable to inadequate nutritional status and paradoxically it may also affect overweight women Objective: The aim of the study was to evaluate energy and nutrients intake in the group of pregnant women in relation to nutritional standards and pre-pregnancy BMI Material and methods: The study included 90 women, during the third trimester of pregnancy, recruited from Warsaw antenatal classes. The anthropometric data gathered in the research were used to calculate BMI value before pregnancy. Pre-pregnancy BMI was categorised as: normal weight (BMI=18.5-24.9 kg/m2, n=47) and overweight (BMI ≥25.0 kg/m2, n=43). The assessment of women's nutrition was based on 3-days dietary record. Due to heterogeneous variances, differences between groups were assessed using Mann Whitney U test, p<0.05 was considered as significant Results: The mean intake of energy, protein, fat and carbohydrates in the overweight women were significantly higher than in healthy weight women (p<0.05). Most of the healthy weight women did not reach EAR standard for vitamin D (79.5%), whereas in overweight group it was 41.3% Conclusions: Despite the fact that intakes of energy and all nutrients were higher in overweight women than in normal weight ones, we observed that women in both groups had risk of insufficient supply of energy, iodine, potassium and vitamin D. For this reason, accurate nutritional assessment should be an integral part of obstetric care
[Mh] Termos MeSH primário: Dieta
Estado Nutricional
Valor Nutritivo
Terceiro Trimestre da Gravidez
Fenômenos Fisiológicos da Nutrição Pré-Natal
[Mh] Termos MeSH secundário: Índice de Massa Corporal
Registros de Dieta
Feminino
Seres Humanos
Peso Corporal Ideal
Avaliação Nutricional
Sobrepeso
Polônia
Gravidez
Cuidado Pré-Natal
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE


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[PMID]:29364329
[Au] Autor:Musskopf ML; Milanesi FC; Rocha JMD; Fiorini T; Moreira CHC; Susin C; Rösing CK; Weidlich P; Oppermann RV
[Ad] Endereço:Department of Periodontology, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
[Ti] Título:Oral health related quality of life among pregnant women: a randomized controlled trial.
[So] Source:Braz Oral Res;32:e002, 2018.
[Is] ISSN:1807-3107
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:The aim of the present study was to compare negative impacts of oral conditions in Oral Heath Related Quality of Life (OHRQoL) assessed by the Oral Health Impact Profile-14 (OHIP-14) scores in pregnant women receiving or not comprehensive periodontal treatment. This randomized controlled clinical trial included pregnant women aged between 18 and 35 years old. Participants were randomized in a test group with 96 and a control group with 114 women. Patients in the test group received comprehensive periodontal treatment, supra and subgingival scaling and root-planning and periodontal maintenance appointments. The OHIP-14 was applied before and after treatment. The primary outcome was changes in OHIP-14 scores after follow-up period. The impact of having received or not comprehensive periodontal treatment on the change of the OHIP-14 scores was also investigated. Both groups showed significant reduction in OHIP-14 scores and effect size for the test group was 0.60 and 0.36 for the control group. Multinomial logistic regression analysis showed that participants of the control group had 5.9-fold odds (CI 95% 1.88-18.52) of worsening in OHIP-14 scores and their perception of oral conditions in relation to test group. Comprehensive periodontal treatment during pregnancy can reduce the negative impacts in OHRQoL.
[Mh] Termos MeSH primário: Saúde Bucal/estatística & dados numéricos
Doenças Periodontais/terapia
Complicações na Gravidez/terapia
Qualidade de Vida
[Mh] Termos MeSH secundário: Adulto
Índice de Placa Dentária
Feminino
Nível de Saúde
Seres Humanos
Modelos Logísticos
Índice Periodontal
Gravidez
Cuidado Pré-Natal
Perfil de Impacto da Doença
Fatores Socioeconômicos
Inquéritos e Questionários
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:D; IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE


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[PMID]:29236362
[Au] Autor:Rogers AJ; Akama E; Weke E; Blackburn J; Owino G; Bukusi EA; Oyaro P; Kwena ZA; Cohen CR; Turan JM
[Ad] Endereço:Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
[Ti] Título:Implementation of repeat HIV testing during pregnancy in southwestern Kenya: progress and missed opportunities.
[So] Source:J Int AIDS Soc;20(4), 2017 Dec.
[Is] ISSN:1758-2652
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Repeat HIV testing during the late antenatal period is crucial to identify and initiate treatment for pregnant women with incident HIV infection to prevent perinatal HIV transmission and keep mothers alive. In 2012, the Kenya Ministry of Health adopted international guidelines suggesting that pregnant women be offered retesting three months after an initial negative HIV test. Our objectives were to determine the current rate of antenatal repeat HIV testing; identify successes, missed opportunities and factors associated with retesting; and estimate the incidence of HIV during pregnancy. METHODS: Retrospective analysis of longitudinal data was conducted for a cohort of 2145 women attending antenatal care clinic at a large district hospital in southwestern Kenya. Data were abstracted from registers for all women who attended the clinic from the years 2011 to 2014. RESULTS: Although 90.2% of women first came to clinic prior to their third trimester and 27.5% had at least four clinic visits, 58.0% of all women went to delivery without a retest. Missed opportunities for retesting included not returning to clinic at all, not returning when eligible, or late gestational age (>28 weeks) at first clinic visit making them ineligible for retesting (accounting for 14.2%, 26.8% and 9.6% of all clinic attendees respectively); and failure to be retested even when eligible at one or more visits (accounting for 73.2% of eligible returnees). Being unmarried and aged 20 or younger was associated with an increase in mean gestational age of first visit by 2.52 weeks (95% CI: 1.56, 3.48) and a 2.59 increased odds (95% CI: 1.90, 3.54) of failing to return to clinic, compared to those who were married and over 20 years of age. On retest, two women tested HIV positive, suggesting an incidence rate of 4.4 per 100 person-years. After adjusting for potential confounders, only later year of last menstrual period (2013 vs. 2012 and 2011) was associated with retesting. CONCLUSIONS: Adoption of retesting guidelines in 2012 appears to have successfully increased retesting rates, but missed opportunities to identify incident HIV infection during pregnancy may contribute to continuing high rates of perinatal HIV transmission in southwestern Kenya.
[Mh] Termos MeSH primário: Infecções por HIV/diagnóstico
Complicações Infecciosas na Gravidez/diagnóstico
[Mh] Termos MeSH secundário: Feminino
Infecções por HIV/prevenção & controle
Infecções por HIV/transmissão
Seres Humanos
Incidência
Transmissão Vertical de Doença Infecciosa/prevenção & controle
Quênia
Programas de Rastreamento
Gravidez
Complicações Infecciosas na Gravidez/epidemiologia
Cuidado Pré-Natal
Diagnóstico Pré-Natal
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE
[do] DOI:10.1002/jia2.25036


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[PMID]:28453821
[Au] Autor:Do M; Wang W; Hembling J; Ametepi P
[Ad] Endereço:Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA.
[Ti] Título:Quality of antenatal care and client satisfaction in Kenya and Namibia.
[So] Source:Int J Qual Health Care;29(2):183-193, 2017 Apr 01.
[Is] ISSN:1464-3677
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: Despite much progress in maternal health service coverage, the quality of care has not seen parallel improvement. This study assessed the quality of antenatal care (ANC), an entry point to the health system for many women. Design: The study used data from recent Service Provision Assessment (SPA) surveys of nationally representative health facilities in Kenya and Namibia. Setting: Kenya and Namibia represent the situation in much of sub-Saharan Africa, where ANC is relatively common but maternal mortality remains high. Participants: The SPA comprised an inventory of health facilities that provided ANC, interviews with ANC providers and clients, and observations of service delivery. Interventions: Not applicable. Main Outcome Measures: Quality was measured in terms of structure and process of service provision, and client satisfaction as the outcome of service provision. Results: Wide variations in structural and process attributes of quality of care existed in both Kenya and Namibia; however, better structural quality did not translate to better service delivery process or greater client satisfaction. Long waiting time was a common problem and was generally more serious in hospitals and health centers than in clinics and smaller facilities; it was consistently associated with lower client satisfaction. The study also indicates that the provider's technical preparedness may not be sufficient to provide good-quality services and to ensure client satisfaction. Conclusions: Findings highlight important program implications, including improving ANC services and promoting their use at health clinics and lower-level facilities, and ensuring that available supplies and equipment are used for service provision.
[Mh] Termos MeSH primário: Satisfação do Paciente/estatística & dados numéricos
Cuidado Pré-Natal/organização & administração
Qualidade da Assistência à Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Feminino
Instalações de Saúde/recursos humanos
Instalações de Saúde/normas
Seres Humanos
Quênia
Serviços de Saúde Materna/organização & administração
Serviços de Saúde Materna/estatística & dados numéricos
Namíbia
Gravidez
Cuidado Pré-Natal/recursos humanos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/intqhc/mzx001


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[PMID]:29325263
[Au] Autor:Yu L; Tang M; Fan XH; Du HM; Tang H; Chen P; Xing SL; Su CH; Chen DJ
[Ad] Endereço:Department of Obstetrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China.
[Ti] Título:[Analysis of 2 204 stillbirths in 11 hospitals of Guangdong province].
[So] Source:Zhonghua Fu Chan Ke Za Zhi;52(12):805-810, 2017 Dec 25.
[Is] ISSN:0529-567X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To analyze the incidence and causes of stillbirth in 11 hospitals of Guangdong province, and to explore the appropriate interventions. Clinical data of stillbirth in 11 hospitals of Guangdong province were collected from January 2014 to December 2016. The gestational weeks, causes, maternal conditions and other factors were analyzed. (1) From 2014 to 2016, 103 472 newborns were delivered in the 11 hospitals, and the number of stillbirth was 2 204, with the incidence of 2.13%. Among them, 0.71%(738/103 472) was therapeutic induction, 1.42%(1 066/103 472) was natural stillbirth. At different gestational age (<28 weeks, 28-<37 weeks and ≥37 weeks), the incidence of stillbirth was 55.63% (1 226/2 204), 28.45% (627/2 204) and 15.92% (351/2 204), respectively, with statistically significant difference ( 0.01). (2) For stillbirth<28 weeks, the first reason was therapeutic induction, accounting for 53.34% (654/1 226). For stillbirth during 28-37 weeks, pre-eclampsia was the major cause, accounting for 40.67% (255/627). And for full-term stillbirth, the causes were umbilical cord factors (19.37%, 68/351), abnormal labor (17.09%, 60/351). (3) In all the stillbirth cases, the incidence of fetal growth restriction (FGR) 28 weeks was significantly higher than that during 28-37 weeks [23.49% (288/1 226) vs 18.02% (113/627) , 0.01]. (4) The stillbirth rate during labor was significantly higher in women ≥35 years old than in younger women [63.88% (191/299) vs 36.12% (108/299) ; χ(2)=9.346, 0.000]. For the causes of stillbirth during labor, the incidence of severe maternal obstetrical complications [61.11% (33/54) vs 38.89% (21/54) ; χ(2)=3.323, 0.002], abnormal labor [65.82% (52/79) vs 34.18% (27/79) ; χ(2)=4.067, 0.001] and abnormal fetal position [66.63% (26/39) vs 33.37% (13/39) ; χ(2)=3.002, 0.013] were higher in women ≥35 years old than in younger women. (5) Cesarean section during labor accounted for 33.77% (101/299) of stillbirth, including 76 cases of emergency cesarean section or converted to cesarean section during labor. (1) The incidence of stillbirth in the 11 hospitals is high, and the causes are different at different gestational ages, therefore, different interventions are needed to reduce the incidence in different gestational weeks. Supervision of therapeutic induction should be strengthened <28 gestational weeks; standard management of pregnancy might decrease the occurrence of natural death ≥28 weeks. (2) Attention should be paid to fetal body weight during pregnancy, especially FGR. (3) The stillbirth rate is high in elderly pregnant women, so it is important to strengthen the management of the elderly pregnant women.
[Mh] Termos MeSH primário: Distocia/epidemiologia
Retardo do Crescimento Fetal/epidemiologia
Pré-Eclâmpsia/epidemiologia
Natimorto/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Cesárea
China/epidemiologia
Feminino
Retardo do Crescimento Fetal/etiologia
Idade Gestacional
Hospitais
Seres Humanos
Incidência
Recém-Nascido
Trabalho de Parto
Gravidez
Cuidado Pré-Natal
Natimorto/etnologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-567x.2017.12.003


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[PMID]:29325266
[Au] Autor:Hu MN; Zhang Y; Zhao W
[Ad] Endereço:Department of Health Care, Haidian Maternal and Child Health Hospital, Beijing 100080, China.
[Ti] Título:[Analysis of 649 cases of stillbirth in third trimester].
[So] Source:Zhonghua Fu Chan Ke Za Zhi;52(12):822-827, 2017 Dec 25.
[Is] ISSN:0529-567X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To analyze the risk factors of stillbirth in third trimester. Clinical data of 649 cases of stillbirth in third trimester were analyzed retrospectively in 22 hospitals of Haidian district from October 2011 to September 2016, including the incidence, the maternal profile, the perinatal care during pregnancy and the causes of stillbirth. (1) The incidence of stillbirth in third trimester in Haidian district from October 2011 to September 2016 was 0.293%(649/221 845). While the incidence in floating pregnant women (0.349%, 342/97 939) was higher than that in the residence (0.248%, 307/123 906), with statistically significant difference (χ(2)=19.178, <0.01). The incidence of stillbirth in multiple pregnancy(0.201%, 89/4 264) was higher than that in singleton pregnancy (0.257%, 560/217 581), with statistically significant difference(χ(2)=4.690, <0.01). There was no statistically significant difference in the incidence of stillbirth between male (0.300%, 347/115 632) and female fetuses (0.284%, 302/106 205; χ(2)=0.467, >0.05).(2)Among the 649 cases, the floating population accounted for the majority of those who never had prenatal visit (84.0%, 21/25), or less than 5 visits (80.7%, 125/155), or the first visit was beyond 13 gestational weeks(66.0%, 165/649). The causes of stillbirth in order were fetal factors (30.7%, 199/649), maternal factors(28.0%, 182/649), umbilical cord factors (20.0%, 130/649), unexplained factors (17.6%, 114/649) and placental factors (3.7%, 24/649). Birth defects, pregnancy hypertensive disorders, umbilical cord entanglement or torsion were the most important factors, accounting for 22.8%(148/649), 17.4%(113/649), 17.3%(112/649), respectively. The floating pregnant women are key population of stillbirth in third trimester. Maternal care and education should be strengthened in this population. The prevention of birth defect, better prenatal care in women with complications, and close monitor during labor are the key measures to reduce the incidence of stillbirth in third trimester.
[Mh] Termos MeSH primário: Complicações na Gravidez/epidemiologia
Terceiro Trimestre da Gravidez
Natimorto/epidemiologia
[Mh] Termos MeSH secundário: Adulto
China/epidemiologia
Feminino
Feto
Seres Humanos
Placenta
Gravidez
Cuidado Pré-Natal
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-567x.2017.12.006


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[PMID]:29480850
[Au] Autor:Cho HY; Cho Y; Shin YJ; Park J; Shim S; Jung Y; Shim S; Cha D
[Ad] Endereço:Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam.
[Ti] Título:Functional analysis of cell-free RNA using mid-trimester amniotic fluid supernatant in pregnancy with the fetal growth restriction.
[So] Source:Medicine (Baltimore);97(2):e9572, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The prediction and monitoring of fetal growth restriction (FGR) fetuses has become with the use of ultrasound. However, these tools lack the fundamental evidence for the growth of fetus with FGR excluding pathogenic factors.Amniotic fluid samples were obtained from pregnant women for fetal karyotyping and genetic diagnosis at 16 to 19 weeks of gestation. For this study, 15 FGR and 9 control samples were selected, and cell-free fetal RNA was isolated from each supernatant of the amniotic fluid for microarray analysis.In this study, 411 genes were differentially expressed between the FGR and control group. Of these genes, 316 genes were up-regulated, while 95 genes were down-regulated. In terms of gene ontology, the up-regulated genes were highly related to metabolic process as well as protein synthesis, while the down-regulated genes were related to receptor activity and biological adhesion. In terms of tissue-specific expression, the up-regulated genes were involved in various organs while down-regulated genes were involved only in the brain. In terms of organ-specific expression, many genes were enriched for B-cell lymphoma, pancreas, eye, placenta, epithelium, skin, and muscle. In the functional significance of gene, low-density lipoprotein receptor-related protein 10 (LRP10) was significantly increased (6-fold) and insulin-like growth factor (IGF-2) was dramatically increased (17-fold) in the FGR cases.The results show that the important brain-related genes are predominantly down-regulated in the intrauterine growth restriction fetuses during the second trimester of pregnancy. This study also suggested possible genes related to fetal development such as B-cell lymphoma, LRP10, and IGF-2. To monitor the fetal development, further study may be needed to elucidate the role of the genes identified.
[Mh] Termos MeSH primário: Líquido Amniótico/química
Retardo do Crescimento Fetal/diagnóstico
RNA/análise
[Mh] Termos MeSH secundário: Adulto
Líquido Amniótico/metabolismo
Feminino
Retardo do Crescimento Fetal/metabolismo
Seres Humanos
Masculino
Análise em Microsséries
Gravidez
Segundo Trimestre da Gravidez
Cuidado Pré-Natal
Estudos Prospectivos
RNA/metabolismo
Reação em Cadeia da Polimerase em Tempo Real
Transcriptoma
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
63231-63-0 (RNA)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009572


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[PMID]:29450525
[Au] Autor:Daw JR; Sommers BD
[Ad] Endereço:Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Association of the Affordable Care Act Dependent Coverage Provision With Prenatal Care Use and Birth Outcomes.
[So] Source:JAMA;319(6):579-587, 2018 02 13.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The effect of the Affordable Care Act (ACA) dependent coverage provision on pregnancy-related health care and health outcomes is unknown. Objective: To determine whether the dependent coverage provision was associated with changes in payment for birth, prenatal care, and birth outcomes. Design, Setting, and Participants: Retrospective cohort study, using a differences-in-differences analysis of individual-level birth certificate data comparing live births among US women aged 24 to 25 years (exposure group) and women aged 27 to 28 years (control group) before (2009) and after (2011-2013) enactment of the dependent coverage provision. Results were stratified by marital status. Main Exposures: The dependent coverage provision of the ACA, which allowed young adults to stay on their parent's health insurance until age 26 years. Main Outcomes and Measures: Primary outcomes were payment source for birth, early prenatal care (first visit in first trimester), and adequate prenatal care (a first trimester visit and 80% of expected visits). Secondary outcomes were cesarean delivery, premature birth, low birth weight, and infant neonatal intensive care unit (NICU) admission. Results: The study population included 1 379 005 births among women aged 24-25 years (exposure group; 299 024 in 2009; 1 079 981 in 2011-2013), and 1 551 192 births among women aged 27-28 years (control group; 325 564 in 2009; 1 225 628 in 2011-2013). From 2011-2013, compared with 2009, private insurance payment for births increased in the exposure group (36.9% to 35.9% [difference, -1.0%]) compared with the control group (52.4% to 51.1% [difference, -1.3%]), adjusted difference-in-differences, 1.9 percentage points (95% CI, 1.6 to 2.1). Medicaid payment decreased in the exposure group (51.6% to 53.6% [difference, 2.0%]) compared with the control group (37.4% to 39.4% [difference, 1.9%]), adjusted difference-in-differences, -1.4 percentage points (95% CI, -1.7 to -1.2). Self-payment for births decreased in the exposure group (5.2% to 4.3% [difference, -0.9%]) compared with the control group (4.9% to 4.3% [difference, -0.5%]), adjusted difference-in-differences, -0.3 percentage points (95% CI, -0.4 to -0.1). Early prenatal care increased from 70% to 71.6% (difference, 1.6%) in the exposure group and from 75.7% to 76.8% (difference, 0.6%) in the control group (adjusted difference-in-differences, 0.6 percentage points [95% CI, 0.3 to 0.8]). Adequate prenatal care increased from 73.5% to 74.8% (difference, 1.3%) in the exposure group and from 77.5% to 78.8% (difference, 1.3%) in the control group (adjusted difference-in-differences, 0.4 percentage points [95% CI, 0.2 to 0.6]). Preterm birth decreased from 9.4% to 9.1% in the exposure group (difference, -0.3%) and from 9.1% to 8.9% in the control group (difference, -0.2%) (adjusted difference-in-differences, -0.2 percentage points (95% CI, -0.3 to -0.03). Overall, there were no significant changes in low birth weight, NICU admission, or cesarean delivery. In stratified analyses, changes in payment for birth, prenatal care, and preterm birth were concentrated among unmarried women. Conclusions and Relevance: In this study of nearly 3 million births among women aged 24 to 25 years vs those aged 27 to 28 years, the Affordable Care Act dependent coverage provision was associated with increased private insurance payment for birth, increased use of prenatal care, and modest reduction in preterm births, but was not associated with changes in cesarean delivery rates, low birth weight, or NICU admission.
[Mh] Termos MeSH primário: Cobertura do Seguro
Reembolso de Seguro de Saúde/estatística & dados numéricos
Patient Protection and Affordable Care Act
Resultado da Gravidez
Cuidado Pré-Natal/utilização
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Cesárea/estatística & dados numéricos
Feminino
Seres Humanos
Recém-Nascido de Baixo Peso
Cobertura do Seguro/estatística & dados numéricos
Seguro Saúde
Unidades de Terapia Intensiva Neonatal
Modelos Lineares
Medicaid/estatística & dados numéricos
Gravidez
Nascimento Prematuro/epidemiologia
Cuidado Pré-Natal/economia
Estudos Retrospectivos
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180217
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2018.0030



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