Association between Prenatal Care and Gestational Weight Gain: Cross-Sectional Study in a Low-Income Area of Rio de Janeiro

Objetivo: Verificar a associação entre a adequação da assistência pré-natal e o ganho de peso gestacional (GPG) em puérperas brasileiras de baixa renda. Métodos: Estudo transversal no município de Mesquita-RJ, incluindo 281 mulheres no pós-parto imediato. O GPG foi classificado como adequado, insuficiente e excessivo de acordo com as recomendações do Institute of Medicine (IOM). O número de consultas do pré-natal foi categorizado (1: nenhuma consulta; 2: 1-3 consultas; 3: 4-6 consultas; 4: 7 ou mais consultas) e o início do pré-natal, segundo as semanas gestacionais (SG), foi utilizado como variável contínua. A assistência pré-natal (AP) avaliou as duas dimensões agrupadas do Índice de Kotelchuck: adequado (adequado + mais adequado) ou inadequado (intermediário e inadequado). Modelos de regressão logística multinomial foram utilizados para estimar as associações entre assistência pré-natal inadequada e GPG. Resultados: AP foi iniciada em média com 12,6 (± 6,9) SG; 8,2% das mulheres (n = 23) fizeram ≤ 4 consultas de pré-natal e 38,4% (n = 108) foram classificadas com AP inadequada. Em média, o GPG foi de 12,9 kg (± 6,2) e 36,5%, 31,0% e 32,5% das mulheres apresentaram GPG adequado, insuficiente e excessivo, respectivamente. Após o ajuste, a inadequação da AP (OR = 2,01; IC 95% = 1,03-3,90) foi associada a uma maior probabilidade de GPG abaixo das recomendações do IOM. Conclusão: Observou-se uma associação significativa entre a inadequação da assistência pré-natal e o GPG insuficiente, o que reforça a relevância da adequada AP para monitorar o adequado GPG e intervir precocemente na gestação

Association between Pre-Pregnancy BMI and Inflammatory Profile Trajectories during Pregnancy and Postpartum in Brazilian Women with Periodontitis:The IMPROVE Trial

This study aimed to explore the association between pre-pregnancy BMI and longitudinal changes in inflammatory markers from the second trimester of pregnancy to 6–8 weeks postpartum in women with periodontitis. This is a secondary exploratory analysis of 68 women who took part in a feasibility clinical trial in Rio de Janeiro, Brazil. Inflammatory markers included C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and matrix metalloproteinase-9 (MMP-9) blood concentrations at 11–22 (T0) and 30–36 gestational weeks (T1), and 6–8 weeks postpartum (T3). Longitudinal generalised linear mixed-effects models were used to identify possible associations between pre-pregnancy BMI and changes in concentrations of inflammatory markers. Pre-pregnancy excess weight (β = 4.39; 95% CI, 2.12–6.65) was significantly associated with increased CRP levels from pregnancy to postpartum. There were no significant associations between pre-pregnancy BMI and longitudinal changes in IL-6, IL-10 and MMP-9. Our findings provide evidence that a higher pre-pregnancy BMI may lead to increases in CRP levels during pregnancy in women with periodontitis, irrespective of the severity of clinical periodontal parameters. Further studies need to investigate if predictors of changes in inflammatory markers can be used as prognostic factors for gestational outcomes

Exploratory Efficacy of Calcium-Vitamin D Milk Fortification and Periodontal Therapy on Maternal Oral Health and Metabolic and Inflammatory Profile

In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6–8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions’ clinical benefits and cost-effectiveness is warranted

High protein diet promotes body weight loss among Brazilian postpartum women

There is evidence in the general population that adhering to a high protein and low carbohydrate diet may help in losing weight. However, there is little evidence among postpartum women. The aim of this study is to evaluate the effect of a high protein diet on weight loss among postpartum women. A parallel-randomized controlled trial with ninety-four postpartum women was conducted in a maternity ward in Mesquita county (recruitment from February 2009 to December 2010) and in a polyclinic in Rio de Janeiro city (recruitment from December 2010 to December 2011). Women were randomized to the intervention group (IG) or control group (CG), and both groups received an isocaloric diet (1,800 kcal). Additionally, the IG received approximately 25 g of protein obtained from 125 g per week of sardine to increase daily dietary protein content and was advised to restrict carbohydrate intake. The CG received nutritional counselling to follow the national nutrition guidelines (15% protein, 60% carbohydrates and 25% lipids). A linear mixed-effects model was used to test the effect of high protein intake and macronutrient intake on weight loss during the postpartum period. Body weight decreased in the IG compared to the CG (ß=-0.325; p=0.049) among overweight and obese postpartum women. The percentage of energy intake from lipid (ß=-0.023; p=0.050) was negatively associated with body weight, and carbohydrate intake (ß=0.020; p=0.026) was positively associated with body weight over time among all women. Protein intake and lower carbohydrate intake may be used as a dietary strategy to improve body weight loss during the postpartum period

Análise das complicações pós-operatórias de câncer colorretal / Analysis of post-operative complications of colorectal cancer

Objetivo: Esse estudo, através de uma revisão narrativa, objetiva determinar as possíveis complicações pós-operatórias do Câncer Colorretal (CCR), um dos 3 tumores mais prevalentes no mundo, baseado na abordagem escolhida. A cirurgia é a base do tratamento com potencial terapêutico, podendo variar desde ressecções endoscópicas até cirurgias abertas, a depender do estadiamento no momento do diagnóstico e do tipo de câncer. Métodos: Foram utilizados como base, estudos publicados nos bancos de dados eletrônicos PuBmed, LILACS, Science Direct e SciELO, entre 2015 e 2020. Resultados: Apesar de todos os procedimentos cirúrgicos para tratamento de CCR conferirem riscos de complicações, intervenções de urgência e cirurgias abertas apresentam maiores taxas quando comparados a cirurgias minimamente invasivas. A colectomia laparoscópica destaca-se dentre as outras opções pela menor taxa de complicações, seguida da ileocolectomia direita e prótese endoluminal. Conclusão: A cirurgia de escolha dependerá de diversos fatores incluindo eficiência e eficácia do método para cada estágio da doença, experiência do cirurgião e fatores de risco do paciente, sempre visando a menor probabilidade de complicações

Calcium and vitamin D supplementation and/or periodontal therapy in the treatment of periodontitis among Brazilian pregnant women: protocol of a feasibility randomised controlled trial (the IMPROVE trial)

Background: Periodontitis is a common oral inflammation, which is a risk factor for adverse pregnancy outcomes. Intakes of vitamin D and calcium are inversely associated with occurrence and progression of periodontitis. This study aims to assess the feasibility of a multi-component intervention, including provision of milk powder supplemented with calcium and vitamin D and periodontal therapy (PT), for improving maternal periodontal health and metabolic and inflammatory profiles of low-income Brazilian pregnant women with periodontitis. Methods: The IMPROVE trial is a feasibility randomised controlled trial (RCT) with a 2 × 2 factorial design with a parallel process evaluation. Pregnant women with periodontitis, aged 18–40 years and with < 20 gestational weeks (n = 120) were recruited and randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus PT during pregnancy, (2) placebo sachet and powdered milk plus PT during pregnancy, (3) fortified sachet (vitamin D and calcium) and powdered milk plus PT after delivery and (4) placebo sachet and powdered milk plus PT after delivery. Dentists and participants are blinded to fortification. Acceptability of study design, recruitment strategy, random allocation, data collection procedures, recruitment rate, adherence and attrition rate will be evaluated. Data on serum levels of vitamin D, calcium and inflammatory biomarkers; clinical periodontal measurements; anthropometric measurements; and socio-demographic questionnaires are collected at baseline, third trimester and 6–8 weeks postpartum. Qualitative data are collected using focus group, for analysis of favourable factors and barriers related to study adherence. Discussion: Oral health and mineral/vitamin supplementation are much overlooked in the public prenatal assistance in Brazil and of scarcity of clinical trials addressing these issues in low and middle-income countries,. To fill this gap the present study was designed to assess the feasibility of a RCT on acceptability of a multi-component intervention combining conventional periodontal treatment and consumption of milk fortified with calcium-vitamin D for improving periodontal conditions and maternal metabolic and inflammation status, among Brazilian low-income pregnant women with periodontitis. Thus, we hope that this relatively low-cost and safe multicomponent intervention can help reduce inflammation, improve maternal periodontal health and metabolic profile and consequently prevent negative gestational outcomes

PAPEL DAS CITOCINAS CUTÂNEAS DA PSORÍASE E GRAVIDEZ: UMA PERSPECTIVA IMUNOLÓGICA

Introduction: The relationship between pregnancy and psoriasis is observed, as several studies and research indicate a direct relationship, in which immunological variations generated by pregnancy end up affecting and influencing the aforementioned disease. Those responsible for the skin's immunological reactions are Cytokines. Objective: Understand how Cytokine proteins act in relation to psoriasis in pregnant women. Methodology: A systematic literature review was carried out covering the years from January 2003 to December 2023. The study was based and guided by the question mentioned throughout the article. Results: Starting from the point that pregnant women present several immunological changes so that they can generate sustainability for the growth of the fetus, an increase in the number of so-called anti-inflammatory cytokines is noted, for example beta (TGF), which can reduce the psoriasis inflammation process. On the other hand, there are other types of Cytokine proteins that end up triggering and aggravating peeling and inflammatory lesions. Conclusion: Pregnant women end up having limitations to psoriasis treatments, since in most cases a personalized care strategy plan is needed according to the individual's clinical status and insurance so that it is possible that no type of complication occurs.Introdução: Observa-se a relação da gravidez com psoríase, já que diversos estudos e pesquisas apontam uma relação direta, na qual as variações imunológicas geradas pela gestação acaba afetando e influenciando na doença citada. As responsáveis pelas reações imunológicas da pele são as Citocinas. Objetivo: Compreender como as proteínas de Citocinas atuam em relação a psoríase em gestantes. Metodologia: Foi realizada uma revisão sistemática de literatura abrangendo os anos de janeiro de 2003 a dezembro de 2023. O estudo teve como base e norteamento a pergunta citada no decorrer do artigo. Resultados: Partindo do ponto que a mulher grávida apresenta diversas mudanças imunológicas para que consiga gerar sustentabilidade ao crescimento do feto, nota-se uma elevação do número das chamadas citocinas anti-inflamatórias, por exemplo da beta (TGF), a qual pode reduzir o processo de inflamação da psoríase. Por outro lado, existem outros tipos de proteínas de Citocinas que acabam desencadeando e agravando lesões descamadas e inflamatórias. Conclusão: As mulheres gestantes acabam possuindo limitações aos tratamentos da psoríase, uma vez que na maioria dos casos é preciso um plano de estratégia de cuidado personalizado de acordo com estado clínico do indivíduo e seguro para que seja possível que não ocorra nenhum tipo de intercorrência