Opinião : sobre a desconstrução de serviços públicos que funcionam

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Exploring the Gantt chart as a tool to highlight double report in case series published during the first wave of the COVID-19 pandemic

Background: During the COVID-19 pandemic, some studies describing diferent aspects of the infection included very similar participants, rising suspicion about double reporting. We aimed to evaluate the Gantt chart as a tool to highlight possible double reporting. The chart is routinely used in business applications to depict tasks of a project, by plotting horizontal bars against time, showing their time span and overlaps. Methods: All case reports and case series of pregnant women with COVID-19, published by July 15, 2020, were included. Initial and final dates of participants’ enrollment, country, city, hospital, and number of pregnancies were plotted in the Gantt chart. Bars stand for enrollment dates of each study, according to hospital and city, thus allowing comparisons. Results: We included 116 articles in the present analysis. The Gantt chart highlighted papers in which some participants were likely the same, thus allowing easier identifcation of double reporting of cases. Combining all information and pregnancy characteristics and outcomes helped to recognize duplications when the authors did not acknowledged the previous publication. Conclusions: Unintended double reporting may occur, especially in exceptional times. The Gantt chart may help researchers to visually identify potential duplications, thus avoiding biased estimates in systematic reviews or meta-analysis

Low gestational weight gain in obese women and pregnancy outcomes

Obesity during pregnancy and excessive weight gain during this period are associated with several maternal–fetal and neonatal complications. Moreover, a significant percentage of women have weight retention in the postpartum period, especially those with excessive weight gain during pregnancy. The recommendations of the 2009 Institute of Medicine were based on observational studies that have consistently shown that women with weight gain within the recommended range had better outcomes during pregnancy. In patients with obesity, however, there is no recommendation for weight gain, according to the class of obesity. This review, therefore, aims to evaluate the evidence on key maternal and fetal complications related to low weight gain during pregnancy in obese and overweight patients

Birth weight classification in gestational diabetes: is there an ideal chart?

Introduction: Gestational diabetes mellitus (GDM) is associated to increased rates of large for gestational age newborns and macrosomia. Several charts are used to classify birth weight. Is there an ideal chart to classify newborns of GDM mothers?Methods: We evaluated adequacy of birth weight of 332 neonates born to GDM mothers at Hospital de Clínicas de Porto Alegre, Brazil. Newborns were classified according to gestational age as small (SGA), adequate or large (LGA) based on four charts: Alexander, Pedreira, INTERGROWTH 21st Project and SINASC-2012. The latter was built using data from a large national registry of 2012, the Born Alive National Surveillance System (Sistema de Informações de Nascidos Vivos – SINASC), which included 2.905,789 birth certificates. Frequencies of SGA and LGA and Kappa agreement were calculated.Results: In non-gender adjusted curves, SGA rates (95% confidence interval) varied from 8% (5-11) to 9% (6-13); LGA rates, from 11% (8-15) to 17% (13-21). For males, SGA rates varied from 3% (1-6%) to 6% (3-11%), and LGA rates, from 18% (13-24%) to 31% (24-38%); for female, SGA rates were from 3% (1-7%) to 10% (6-16%) and LGA rates, from 11% (6-16%) to 19% (13-26%). Kappa results were: ALEXANDER vs. SINASC-2012: 0.80 (0.73-0.88); INTERGROWTH 21st vs. SINASC-2012 (adjusted by sex): 0.62 (0.53-0.71); INTERGROWTH 21st vs. PEDREIRA: 0.71 (0.62-0.79); SINASC-2012 (by sex) vs. PEDREIRA: 0.86 (0.79-0.93).Conclusions: Misclassification has to be taken into account when evaluating newborns of GDM mothers, as LGA rates can almost double depending on the chart used to classify birth weight

Vitamin D deficiency increases the risk of adverse neonatal otcomes in gestational diabetes

Background: Gestational diabetes mellitus (GDM) and vitamin D deficiency have been associated with increased risk of adverse perinatal outcomes but the consequences of both conditions simultaneously present in pregnancy have not yet been evaluated. Our objective was to study the influence of vitamin D deficiency in neonatal outcomes of pregnancies with GDM. Methods: 184 pregnant women with GDM referred to specialized prenatal monitoring were included in this cohort and had blood sampled for 25-hydroxyvitamin D measurement. Vitamin D was measured by chemiluminescence and deficiency was defined as < 20 ng/mL. Participants were followed until puerperium and adverse neonatal outcomes were evaluated. Results: Newborns of women with vitamin D deficiency had higher incidences of hospitalization in intensive care units (ICU) (32 vs 19%, P = 0.048), of hypoglycemia (any, 17.3 vs 7.1%, P = 0.039 requiring ICU, 15.3 vs 3.6%, P = 0.008), and were more frequently small for gestational age (SGA) (17.3 vs 5.9%, P = 0.017). After adjustment, relative risk (RR) for hypoglycemia requiring ICU was 3.63 (95%CI 1.09±12.11) and for SGA was 4.32 (95%CI 1.75± 10.66). The incidence of prematurity, jaundice and shoulder dystocia was no statistically different between groups. Conclusions: In this cohort of pregnant women with GDM, vitamin D deficiency was associated with a major increase in the incidence of adverse neonatal outcomes such as SGA newborns and neonatal hypoglycemia