Objective:To develop and test an instrument in Brazilian Portuguese to evaluate KAP regarding GDM. Methods:We developed an instrument with 22 items (10 items for practice, 4 for knowledge and 8 for attitude), which was tested in a population of pregnant women (24 - 28 weeks) with GDM. We performed an Exploratory Factor Analysis to evaluate the items included in the instrument, the covariance among the domains evaluated by the instrument, and the robustness of the instrument. Results:One hundred seventy-five participants were included in this study (mean gestational age: 25.4±7.1 weeks). The majority of them did not present adequate KAP regarding diabetes. The average knowledge score was 0.84±1.02 points; the attitude score was 32.46±2.94; and the practice score was 4.65±1.65. The model with the best robustness to evaluate KAP was composed of 3 items for knowledge, 6 for attitude, and 5 for practice. Conclusion:The levels of KAP regarding diabetes among Brazilian pregnant women are low. The moderate association between knowledge and practice underscores the need for targeted educational interventions within prenatal care. Implementing a specific Brazilian Portuguese instrument to evaluate KAP among this population can bring evidence regarding the dimension of the problem in the country.

BACKGROUND:It has been proposed that the school origin of items for cross-institutional Progress Tests (PTs) may introduce a bias in favour of students from the same school, posing a potential threat to the validity and reliability of PT results and cross-institutional comparisons. The aim of this study was to examine whether origin bias is present in a Brazilian cross-institutional PT examination. METHODS:This study conducted a cross-sectional analysis of seven schools affiliated with the oldest PT consortium in Brazil, utilising a pooled analysis of differences in students' performance concerning self and non-self items. A proportional meta-analysis of the items' rate differences and confidence intervals with random effects was performed, providing an odds ratio (OR) for self and non-self items. Differences between the two groups of items were assessed by scrutinising whether the OR and 95% confidence intervals overlapped. RESULTS:The findings indicated no discernible differences in psychometric indices based on the school responsible for item creation. Three schools consistently demonstrate superior performance on items authored by their faculty, however, these they also excelled on non-self items. Furthermore, an overlap in the 95% confidence intervals for both self and non-self items was observed across all seven schools. CONCLUSIONS:In contrast to prior reports, this study revealed the absence of origin bias, suggesting that adoption of best practices in blueprinting, item writing, and editing may have played a role in mitigating such bias.

OBJECTIVES:This study compares the expulsion rate of the postplacental copper intrauterine device (IUD) based on the insertion technique: manual versus ring forceps. Pain, perforation, infection, and increased bleeding were assessed as secondary outcomes. METHOD:The study consisted of a randomized clinical trial involving 210 women (with 105 in each group) admitted for vaginal delivery at a teaching hospital who wanted to use an IUD and had no contraindications to use an IUD. Patient recruitment occurred between December 2021 and June 2024. Pain was evaluated using the visual analog scale immediately after insertion. Descriptive statistics and bivariate analysis were performed. The Cochran-Armitage test was used to assess the temporal trend of expulsion. Participants were followed up between 6 and 12 weeks postpartum. RESULTS:The complete IUD expulsion rate was 20.5%, with no significant difference between forceps and manual insertion (25% vs. 16.7%, P = 0.168). Expulsions were easily perceived by the women and occurred early. Notably, in this teaching hospital setting, the turnover of new medical residents (P = 0.057) performing insertions did not affect the expulsion rates throughout the year. Manual insertion was associated with greater discomfort compared to forceps (P = 0.001), even with epidural anesthesia (P = 0.002). There were no cases of uterine perforation or infection. CONCLUSION:The postplacental IUD expulsion rate was lower with manual insertion, although not statistically significant. Insertion discomfort was lower in the forceps group, regardless of analgesia. Postplacental IUD insertion was well tolerated, safe, and easily reproducible by junior doctors. TRIAL REGISTRATION:This study was approved by the Ethics and Research Commission of the University of Campinas (UNICAMP) and the Brazilian Registry of Clinical Trials (REBEC): https://ensaiosclinicos.gov.br/rg/RBR-4j62jv6, (number RBR-4j62jv6).

Gestational diabetes is one of the most prevalent diseases in pregnancy, with an incidence of 5 to 18

Objective:In this systematic review, we aim to compare the GWG in pregnant women with diabetes treated with metformin and other interventions. Methods:Data Sources: The searched baselines included PubMed, Scopus, Web of Science, Embase, and Virtual Health Library (BVS). Study selection: We selected articles that compared the GWG in women with diabetes treated with metformin or insulin. We have included clinical trials (randomized or not), observational studies (cohort, case control, and cross-sectional). Reviews (systematic or not), posters, event abstracts, and letters were excluded. Data Collection: We pooled odds ratios (OR) and mean difference (MD) and used a random effect model using R Studio software to compare the weight gain, fetal birthweight and preeclampsia according to treatment. Results:On research conducted in January 2024, with no data limit of the search, 433 trials were identified, of which 175 remained after duplicate removal. 50 studies were analyzed in the full text analyses and 9 were selected for the systematic review. 8 studies demonstrated that gestational weight gain during metformin treatment is lower when compared to other treatments, especially insulin, although it was not different from other outcomes. Meta-analyses demonstrated that oral medication GWG is lower than insulin with a standard mean difference (SMD) -1,05 [-1,87, - 0,23]. Conclusion:Oral medication has a lower gestational weight gain in patients with gestational diabetes when compared to insulin. International Prospective register of Systematic Reviews PROSPERO:CRD 42024492158.

Objective: This study aimed to evaluate the prevalence of hypertensive disorders during pregnancy among Brazilian women with preterm births and to compare the epidemiological characteristics and perinatal outcomes among preterm births of women with and without hypertension. Methods: This was a secondary cross-sectional analysis of the Brazilian Multicenter Study on Preterm Birth. During the study period, all women with preterm births were included and further split into two groups according to the occurrence of any hypertensive disorder during pregnancy. Prevalence ratios were calculated for each variable. Maternal characteristics, prenatal care, and gestational and perinatal outcomes were compared between the two groups using chi 2 and t -tests. Results: A total of 4,150 women with preterm births were included, and 1,169 (28.2%) were identified as having hypertensive disorders. Advanced maternal age (prevalence ratio (PR) 2.49) and obesity (PR= 2.64) were more common in the hypertensive group. The gestational outcomes were worse in women with hypertension. Early preterm births were also more frequent in women with hypertension. Conclusion: Hypertensive disorders of pregnancy were frequent among women with preterm births, and providerinitiated preterm births were the leading causes of premature births in this group. The factors significantly associated with hypertensive disorders among women with preterm births were obesity, excessive weight gain, and higher maternal age.

AIM:Compare nutritional intake, weight gain, frequency of superimposed pre-eclampsia (SPE) and adequate use/knowledge on preventive interventions for PE, before and during the COVID-19 pandemic among pregnant women with chronic hypertension (CH) METHODS: Prospective cohort of pregnant women with CH. Inclusion between 13 and 25 weeks, with sociodemographic characterization, food frequency questionnaire and 24-hour recall (R24h). Indirect adherence test MEDTAKE was employed to investigate adequate use/understanding of calcium and aspirin. Frequency of SPE, weight gain, food intake, maternal and perinatal outcomes were compared between periods. RESULTS:58 women were included and 116 R24h considered. Over 80 % used aspirin and calcium for PE prophylaxis. However, less than half understood the meaning of such interventions. There were no differences in sociodemographic characteristics, majority white, 20 to 34 years-old, and multiparous. There were 31 women included before and 27 during the pandemic. Frequency of SPE was respectively 40 % and 44.4 % before and during the pandemic (p = 0.746) and weight gain 8.7Kg before and 7.4Kg during the pandemic. There was no difference in macronutrient intake, average calcium consumption was 444.8 mg before and 402.6 mg during the pandemic; with inadequate use/understanding of preventive interventions for PE. CONCLUSION:The pandemic period did not significantly increase the risk of SPE, without significant increase in weight gain or worsening food quality intake and knowledge on preventive interventions.

Objective Pregnancy after bariatric surgery is a reality of the 21 st century and therefore is essential that all obstetricians know how to manage it. The most prevalent nutritional deficiency is iron deficiency and, consequently, anemia. Although bariatric surgery and pregnancy are already risk factors for anemia, we evaluated in our study if there were any other risk factors and actions to improve hemoglobin levels in this population.Methods We performed a retrospective cohort study, and performed frequency measurements and analyzes of odds ratio, X 2 and Fisher exact test to evaluate the risk factors.Results We evaluated 44 pregnancies after bariatric surgery, with an incidence of anemia of 62%, and the only identifiable risk factor for anemia was being black. As for the treatment, the iron salt used for oral supplementation did not associate with anemia risk, and in 27% of the patients, the adjustment of the oral dosage was enough for improvement in hemoglobin levels, but in 36% supplementation with intravenous iron was necessary.Conclusion Being black is a risk factor for anemia. The type of iron salt does not correlate with the incidence of anemia, and for the treatment and improvement of iron dosages, it seems an effective increase in iron intake.

Objective: The objective was to compare the maternal and perinatal characteristics and outcomes between women with and without diabetes in a Brazilian cohort of women with preterm births. Methods: This was an ancillary analysis of the Brazilian Multicenter Study on Preterm Birth, which included 4,150 preterm births. This analysis divided preterm births into two groups according to the presence of diabetes; pregestational and gestational diabetes were clustered in the same Diabetes Group. Differences between both groups were assessed using chi 2 or Student's t tests. Results: Preterm births of 133 and 4,017 women with and without diabetes, respectively, were included. The prevalence of diabetes was 3.2%. Pregnant women aged >= 35 years were more common in the Diabetes Group (31.6% versus 14.0% non-diabetic women, respectively). The rate of cesarean section among patients with diabetes was 68.2% versus 52.3% in non-diabetic cases), with a gestational age at birth between 34 and 36 weeks in 78.9% of the cases and 62.1% of the controls. Large-for-gestational-age babies were 7 times more common in the Diabetes Group. Conclusion: Preterm birth among Brazilian women with diabetes was more than twice as prevalent; these women were older and had regular late preterm deliveries, usually by cesarean section. They also had a greater frequency of fetal morbidities, such as malformations and polyhydramnios, and a higher proportion of large-for-gestational-age and macrosomic neonates.

OBJECTIVE:Evaluate the different perspectives that involve the choice of long-acting reversible contraceptives (LARCs), the issues related to this process and the consequences of deciding one method in the women's in the primary health care (PHC) center in Sousas, a district in Campinas, SP (Brazil). METHODS:This is an analytical cross-sectional study, it was performed at the PHC in Sousas. Data were collected through the analysis of medical records and interviews with women who live in Sousas and had the insertion of the copper intrauterine device (IUD) (D) from April 2021 to April 2022 or the etonogestrel implant (I) from May to December 2022. The study was approved by the Research Ethics Committee of the Medical Science School at the State University of Campinas (UNICAMP). RESULTS:Reason for choosing this LARC: medical (D: 52%; I: 100%), easy adhesion (D: 71%; I: 67%), effectiveness (D: 55%; I: 100%). Indication by health professionals (D: 65%; I: 100%). And improvement of clinical characteristics: mood (D: 77%; I: 67%), body mass index (BMI; D: 52%; I: 33%), and libido (D: 84%; I: 67%). CONCLUSION:It is suggested that women tend to decide between LARCs when guided by their doctor or PHC health professionals, and they select LARCs because of the ease of use and low failure rates. Therefore, this study highlights how LARCs can positively interfere in the aspects that pervade contraception, such as BMI, libido, and mood.

Background Ensuring effective and long-term contraception in the immediate postpartum period is an effective strategy for reducing unplanned pregnancies. In the meantime, the intrauterine device (IUD) is an excellent option. The aim of our study was to evaluate the best way to insert post-placental IUDs in the immediate postpartum period. Discomfort during insertion, expulsion rate, uterine perforation rate, and proper positioning 40–60 days postpartum will be analyzed. Methods Randomized, controlled, open clinical trial. The study group will be composed of women between 18 and 43 years old who are admitted for vaginal birth at the Women’s Hospital of the State University of Campinas and who wish to use the IUD as a contraceptive method. The sample will be randomized into two insertion groups: manual and forceps. To calculate the sample size, the method of comparing the proportion between 2 groups was used, setting the level of significance alpha at 5% (alpha=0.05) and the power of the sample at 80% (beta=0.20). Based on the results, it was estimated that a sample of n =186 women ( n =93 with manual insertion and n =93 with forceps) would be representative for comparison of expulsion between the 2 groups. All participants will undergo a postpartum consultation 40–60 days after birth with transvaginal ultrasound to assess the proper placement of the IUD. Discussion Insertion of an IUD in the immediate postpartum period has been considered a good option to increase coverage and access to contraception, and its benefit outweighs the inconvenience of a higher expulsion rate. Trial registration This study was approved by the Ethics and Research Commission of UNICAMP (CAAE: 50497321.4.0000.5404) and the Brazilian Registry of Clinical Trials (REBEC) (number RBR-4j62jv6). This is the first version of the study protocol approved on 11/12/2021 prior to the start of participant recruitment.

Secondary analysis of Brazilian Multicenter Study on Preterm Birth (EMIP). Cross sectional study on preterm births, with sample of term births to evaluate risk factors and comparisons. Current analysis compared prevalence of anemia in term and preterm births and among their types (spontaneous preterm birth (sPTB), preterm premature rupture of membranes (pPROM), or provider initiated preterm birth (piPTB)) and between women with anemia in both groups, correlating maternal and neonatal findings. Multivariate analysis to identify conditions that independently associated to anemia in term and preterm groups was performed.

Objective To evaluate the obstetric and sociodemographic characteristics of gestational diabetic women who maintained hyperglycemia in the postpartum period (6-12 weeks postpartum). Methods This is a longitudinal cohort study with women who have had gestational diabetes and/or macrosomic children between March 1st, 2016 and March 1st, 2017. Between 6 and 12 weeks after birth, women who had gestational diabetes collected fasting glycemia, glucose tolerance test, and glycated hemoglobin results. The data were collected from medical records and during an interview in the first postpartum consultation. A statistical analysis was performed using frequency, percentage, Chi-Squared test, Fisher exact test, Mann-Whitney test, and multivariate Poisson regression. The significance level adopted for the statistical tests was 5%. Results One hundred and twenty-two women were included. Most of the women were younger than 35 years old (70.5%), white, multiparous, and with no history of gestational diabetes. Thirteen percent of the participants developed persistent hyperglycemia. A univariate analysis showed that maternal age above 35 years, being overweight, having grade 1 obesity and weight gain under 5 kg was related to the persistence of hyperglycemia in the postpartum period. Conclusion Maternal age above 35 years, obesity and overweight, and the diagnosis of gestational diabetes in the first trimester of pregnancy are associated with hyperglycemia during the postpartum period.

Spontaneous preterm birth (sPTB) is a major pregnancy complication involving biological, social, behavioural and environmental mechanisms. Workload, shift and intensity may play a role in the occurrence of sPTB. This analysis is aimed addressing the effect of occupational activities on the risk for sPTB and the related outcomes. We conducted a secondary analysis of the EMIP study, a Brazilian multicentre cross-sectional study. For this analysis, we included 1,280 singleton sPTB and 1,136 singleton term birth cases. Independent variables included sociodemographic characteristics, clinical complications, work characteristics, and physical effort devoted to household chores. A backward multiple logistic regression analysis was applied for a model using work characteristics, controlled by cluster sampling design. On bivariate analysis, discontinuing work during pregnancy and working until the 7 th month of pregnancy were risks for premature birth while working during the 8 th - 9 th month of pregnancy, prolonged standing during work and doing household chores appeared to be protective against sPTB during pregnancy. Previous preterm birth, polyhydramnios, vaginal bleeding, stopping work during pregnancy, or working until the 7 th month of pregnancy were risk factors in the multivariate analysis. The protective effect of variables compatible with exertion during paid work may represent a reverse causality. Nevertheless, a reduced risk associated with household duties, and working until the 8 th -9 th month of pregnancy support the hypothesis that some sort of physical exertion may provide actual protection against sPTB.

Objective To compare maternal and perinatal outcomes between twin and single preterm births (PTB) and associated factors. Methods A cross-sectional multicenter study was conducted in Brazil with 4046 PTBs from April 2011 to July 2012. Causes of PTB, use of tocolytics, corticosteroids, and antibiotics in twin and single pregnancies, and factors possibly associated with twinning were evaluated using chi(2) tests. Maternal and perinatal outcomes were assessed with prevalence ratios (PR). Results The main cause of PTB in twin pregnancy was spontaneous onset of preterm labor. Tocolytics were more frequently used in twins (26.9% vs 20.2%). Factors associated with PTB in twins were: maternal age >25 years (62.3% vs 53.4%); interpregnancy interval >3 years (39.0% vs 33.4%); no history of PTB (87.4% vs 79.6%); no previous maternal conditions (78.0% vs 73.3%); no alcohol abuse (88.5% vs 84.3%); no drug addiction (97.5% vs 94.5%); and >6 prenatal visits (46.5% vs 37.6%). Twin pregnancies run a 46% higher risk of cesarean delivery, while first and second twins face a 20% higher risk of low birth weight. Twin pregnancies run increased risks for admission to the NICU, cerebral hemorrhage, necrotizing enterocolitis, and any adverse perinatal outcome. Conclusion Preterm twin birth is associated with low birth weight and worse neonatal outcomes.

OBJECTIVES: Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB. METHODS: This was a secondary analysis of a multicenter cross-sectional study with a nested case-control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated. RESULTS: The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03-1.59]), other variables did not show any significant difference between groups. CONCLUSION: Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes.

A hiperglicemia na gestação é classificada em diabetes mellitus gestacional (DMG), diabetes mellitus tipo 1 (DM1) e diabetes mellitus tipo 2 (DM2) durante o ciclo gravídico. A passagem transplacentária de glicose leva a uma série de morbidades para o feto (alterações placentárias, hipóxia, óbito). No pré natal de alto risco (PNAR) das gestantes diabéticas, para diminuir ou evitar tais comorbidades, são utilizados os seguintes métodos para avialação da vitalidade fetal (AVF): registro de movimentos fetais (CMF), cardiotocografia (CTG), perfil biofísico fetal (PBF) e a doplervelocimetria. O objetivo desse estudo foi comparar os métodos de monitorização fetal em gestantes diabéticas com o índice Apgar para avaliar qual método de AVF que melhor prediz hipoxemia. Foram analisadas 77 gestantes que tiveram seus partos realizados no Centro de Atenção Integral a Saúde da Mulher (CAISM) da UNICAMP. O estudo demonstrou que não houve diferença significativa entre os métodos quando comparados com o Apgar de primeiro e quinto minuto.

Trata-se de um estudo transversal com 190 mulheres com diagnóstico de diabetes mellitus gestacional (DMG) que evoluíram para parto no Hospital da Mulher CAISM/UNICAMP no período de janeiro de 2017 a janeiro de 2018. O objetivo do trabalho foi avaliar a idade gestacional no momento do diagnóstico do DMG e correlacionar com resultados gestacionais e perinatais maternos e fatores associados.

The association of body mass index (BMI) and gestational weight gain (GWG) with preterm birth (PTB) remains controversial in the literature. To evaluate different maternal BMI and GWG categories, according to the initial BMI, in relation to different PTB subtypes and perinatal outcomes, we conducted a secondary analysis of a multicentre cross-sectional study, along with a nested case-control study including PTB from 20 centers in Brazil. Pre-pregnancy underweight was associated with a lower risk of provider-initiated PTB, while overweight and obesity were associated with a higher risk of provider-initiated PTB and a lower risk of spontaneous preterm birth. Insufficient gestational weight gain was associated with a higher prevalence of spontaneous PTB and preterm premature rupture of membranes. Excessive GWG correlated with a higher prevalence of provider-initiated PTB or preterm premature rupture of membranes. Irrespective of the initial BMI, the greater the rate of GWG, the higher the predicted probability of all PTB subtypes, except for spontaneous PTB in underweight women and those with normal BMI. On multivariate analysis, the initial BMI was shown to be the only factor associated with pi-PTB. Briefly, further studies evaluating the risk for PTB should consider that GWG may have a different role depending on the initial BMI and PTB subtype.

Análise de complicações maternas e neonatais em pacientes com diagnóstico de Diabetes Mellitus na gestação,comparando em relação ao critério diagnóstico utilizado e à presença do diagnóstico previamente à gestação.