Prevalência e fatores associados ao uso de drogas ilícitas em gestantes da coorte BRISA

Intimate partner violence during pregnancy and time to return to sexual activity after childbirth: analysis of the BRISA prenatal cohort

This study aimed to analyze whether there is an association between intimate partner violence during pregnancy and time to return to sexual activity after childbirth in the BRISA cohort in São Luís, Maranhão State, Brazil, between 2010 and 2013. This is a longitudinal study conducted with 665 women. Intimate partner violence during pregnancy was measured using an instrument created and validated by the World Health Organization to measure violence against women. Time to return to sexual activity after childbirth was investigated using a structured questionnaire. Logistic regression models were used to analyze whether there is an association between intimate partner violence during pregnancy and time to return to sexual activity after childbirth. The prevalence of violence by an intimate partner during pregnancy was 24.06%. The prevalence of women who returned to sexual activity within 3 months after childbirth was 67.96%. When analyzing the association between exposure and outcome, no association was found in the crude model (OR = 0.88; 95%CI: 0.60-1.30), nor in the adjusted model (OR = 1.00; 95%CI: 0.61-1.63). The study results highlight the importance of providing comprehensive care to women, considering both physical and psychological aspects, since violence has a significant impact on several aspects of women's lives.

Psychiatric and obstetric characteristics of pregnant crack users admitted to a referral center in Southern Brazil

BACKGROUND

Psychoactive substance use among pregnant women has reached alarmingly high rates. Our aim was to characterize the psychiatric and clinical profiles of pregnant crack users in Brazil.

METHODS

This was a cross-sectional study of 24 pregnant crack users admitted to a referral hospital for psychiatric disorders in pregnant women, in Porto Alegre, Brazil, over three years. The following instruments were applied: a clinical-obstetric questionnaire; the condensed version of the Addiction Severity Index; a diagnostic interview for psychoactive substance use based on DSM-5; the Mini International Neuropsychiatric Interview for DSM-IV; and the Semi-Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II).

RESULTS

Most patients had severe crack dependence and used other substances, such as tobacco, cannabis, and alcohol. The median duration of crack use was three years, ranging between three and 12 years. Most women subsisted from illegal or informal activities; a fifth had previously been arrested and often had relationship problems. Twenty percent had HIV (n = 5), and 37.5% (n = 9) had syphilis. Borderline personality disorder was the most prevalent mental condition (62.5%), followed by suicidal tendencies (45.8%), hypomanic episodes due to substance use (37.5%), and past major depressive episodes (33.3%).

CONCLUSIONS

An alarmingly high prevalence of consumption of other drugs, psychiatric disorders, and difficult-to-treat personality disorders was observed in our study. Investigating the psychiatric profile of women who use substances is essential to minimize the impacts on the mother and child, optimize therapeutic approaches to comorbidities, and enable more effective relapse prevention.

Nível de atividade física e fatores associados entre gestantes: estudo epidemiológico de base populacional

Resumo Esta pesquisa teve como objetivo avaliar o nível de atividade física e identificar os fatores associados em gestantes assistidas na Atenção Primária à Saúde da cidade de Montes Claros - Minas Gerais (Brasil). Estudo epidemiológico, transversal, analítico, realizado com 1.279 gestantes. Utilizou-se questionário que contemplava variáveis socioeconômicas, ocupacionais, obstétricas, comportamentais, sociais, de saúde e emocionais. Também se aplicou o Questionário de Atividade Física para Gestantes. Realizou-se análise estatística descritiva e regressão logística multinominal com modelo hierarquizado. Verificou-se prevalência de inatividade física nas dimensões atividade física e lazer. O nível leve de atividade física foi associado aos fatores idade de 21 a 30 e até 20 anos, renda acima de dois salários-mínimos, trabalho assalariado e apego materno-fetal nível médio/alto. Renda de um a dois salários-mínimos e acima de dois salários, trabalho assalariado e por conta própria, sintomas de ansiedade e de estresse, apego materno-fetal médio/alto foram associados ao nível moderado/vigoroso. Aspectos multifatoriais devem ser considerados em estratégias de promoção da saúde direcionadas à prática de atividade física por gestantes.

Physical activity level and associated factors among pregnant women: a population-based epidemiological study

Abstract This research aimed to assess the level of physical activity and identify the associated factors in pregnant women assisted in primary health care in the city of Montes Claros, Minas Gerais (Brazil). This was an epidemiological, cross-sectional, analytical study, carried out with 1,279 pregnant women. Socioeconomic, occupational, obstetric, behavioral, social, health, and emotional variables were assessed using a questionnaire. The Physical Activity Questionnaire for Pregnant Women was also applied. Descriptive statistical analysis and multinominal logistic regression with a hierarchical model were performed. The prevalence of physical inactivity in the physical activity and leisure time dimensions was verified. A mild level of physical activity was associated with the variables such as age from 21 to 30 years and up to 20 years old, income above two minimum wages, salaried work, and maternal-fetal attachment at a medium/high level. Income from one to two minimum wages and above two wages, paid work and self-employment, anxiety and stress symptoms, and medium/high maternal-fetal attachment were associated with the moderate/vigorous level. Multifactorial aspects must be considered in health promotion strategies directed to the practice of physical activity by pregnant women.

Factors associated with neonatal-near miss: birth cohorts in three Brazilian cities - Ribeirão Preto, Pelotas and São Luís, Brazil

The aim of this study was to investigate the association of sociodemographic factors, lifestyle, maternal reproductive profile and prenatal and childbirth care with neonatal near miss (NNM) morbidity in four birth cohorts. This study involved four population-based birth cohorts: Ribeirão Preto (RP) and São Luís (SL) (2010), Pelotas 2004 (PEL04) and 2015 (PEL15). NNM was defined when one or more of the following conditions were present: birthweight <1,500 g, 5-minute Apgar score <7, gestational age <32 weeks, and report of congenital malformations. The covariates were obtained with questionnaires applied to the puerperal women. Some particularities between cohorts were identified. In the RP and SL cohorts, factors of the more distal levels (sociodemographic, lifestyle, and reproductive profile) were associated with NNM. On the other hand, proximal factors related to healthcare were more significant for the occurrence of NNM in PEL. Only the absence of prenatal care was associated with NNM in all cohorts: RP (OR=4.27, 95%CI 2.16-8.45), SL (OR=2.32, 95%CI 1.09-4.94), PEL04 (OR=4.79, 95%CI 1.59-14.46), and PEL15 (OR=5.10, 95%CI 2.60-9.97).

"Whose baby is this?": challenges for homeless women's right to motherhood

The experiences of homeless pregnant women create tensions in the public debate between individual guarantees and limits on State interventions. This article analyzes the scientific research on this issue, focusing on the biomedical, legal, and social arguments backing the positions in this debate. Based on an integrative review of Brazilian and international databases, the authors analyzed 21 studies and identified four propositions: Health risks for the woman and the fetus/child; Discourses on prenatal care; Rights of women and fetuses/children; and Meanings of motherhood. The article concludes that the experience of motherhood for these women is extremely complex, not only because of their homelessness, but due to the entire context, marked by unequal class, race, and gender relations. The Brazilian and international scenario features a discourse of protection and care for the fetus/infant that overrides care for the mother. The criminalization of homeless women's motherhood has been a global trend in which the expansion of "fetal/infant" rights translates as a cutback in the women's rights. Such an approach fails to encourage homeless women to seek social and health services, rather discouraging them from doing so. An ethical and humanitarian imperative is to conceive different approaches to care, grounded in a human rights perspective so that care for the fetus/child does not translate as violence against the mother.

Content validation of the nursing diagnosis Risk for disturbed maternal-fetal dyad

OBJECTIVE

To validate the content of the diagnosis Risk for disturbed maternal-fetal dyad in high-risk pregnant women.

METHOD

Nursing diagnosis content analysis study in which 48 nurses evaluated agreement regarding title, definition, class, and domain of the studied nursing diagnosis, as well as the relevance of its antecedents. The items were considered relevant when the Confidence Interval of the Content Validity Index was 0.8 or higher. When lower, the item was modified or excluded according to the experts' suggestions.

RESULTS

Out of 21 antecedents, 14 were considered relevant. The labels of five elements considered irrelevant were changed, and one item was excluded. The experts did not choose the title and definition proposed by NANDA-I, preferring instead the ones suggested in this study. The experts agreed with the class and domain proposed by the taxonomy.

CONCLUSION

Ten risk factors, four populations at risk, and six associated conditions for this nursing diagnosis were maintained; these may provide a basis for nursing practice. The phase of clinical validation is suggested to be conducted to corroborate this study's results.

Prevalence of Illicit Drug Use During Pregnancy: A Global Perspective

The World Drug Report 2019 presented an alarming figure to the world: more than 5% of the world's population has been using some type of illicit drug, and that number is growing every year. While its use increases, its abuse during pregnancy has become a global public health problem, resulting in medical and social challenges related to maternal and child health. In this context, the objective of this review was to determine the prevalence of illicit drug use during gestation across the globe, alongside with a critical review of the evaluated studies. Research was performed by simultaneously searching terms ("pregnant woman OR pregnant" OR "gestation" OR "pregnancy" AND "illicit drugs" OR "street drugs") in the databases of the Scientific Electronic Library Online, PubMed, and Web of Science. Comparisons between studies were performed in software Statistica 10.0. The data presented worrying results in relation to the variation in prevalence of illicit drug use during pregnancy, when comparing studies based on interviews or questionnaires (self-reported) (1.65%) and studies based on toxicological analysis (12.28%). In addition, we emphasize the high prevalence (5.16%) of illicit drug use among adolescent pregnant women and the low number of studies on this population. This study reveals worrying data about pregnant drug-user population, mainly the underestimation of prevalence in studies that use only questionnaires or similar methods in comparison to studies that use toxicological analysis of biological matrices. This scenario reveals necessity for health systems in different countries to establish specific public health policies for this population.

Motivos associados à interrupção do aleitamento materno exclusivo até seis meses de idade em lactentes acompanhados em Estratégias de Saúde da Família da cidade de Registro, São Paulo

Objetivo: Identificar os motivos associados à interrupção do aleitamento materno exclusivo entre nutrizes durante os primeiros seis meses de vida do lactente. Métodos: Estudo exploratório, descritivo, transversal, com abordagem quantitativa, conduzido com 911 mães/responsáveis de crianças de zero a 23 meses. Foram coletadas informações sociodemográficas e relato dos motivos que levaram a interrupção do aleitamento materno exclusivo antes dos seis meses de idade do lactente. Resultados: As participantes do estudo eram predominantemente brancas, com companheiro, com ensino médio, sem vínculo empregatício, com dois a quatro filhos, com renda familiar ≤ 1 salário mínimo, com moradia própria, na faixa etária ≥ 20 anos. Em sua maioria, as mães/responsáveis relataram ter recebido orientações sobre a alimentação de seu filho com maior frequência realizada pelo enfermeiro e 28,5% afirmaram ter interrompido o aleitamento materno exclusivo antes dos seis meses de vida do lactente. Possuir moradia própria, usar de tabaco e álcool foram associados à interrupção do aleitamento materno exclusivo. Os motivos que predominaram na interrupção do aleitamento materno exclusivo estiveram ligados principalmente ao relato de leite materno insuficiente, retorno ao trabalho/escola e recusa inexplicada. Conclusão: Os motivos para abandono do aleitamento materno exclusivo identificado neste estudo foram desde o relato de choro da criança à alegação de leite materno insuficiente. A identificação dos motivos que levam ao desmame precoce pode auxiliar no planejamento de estratégias para evitar a interrupção do aleitamento materno.

Effects of Methcathinone Exposure during Prenatal and Lactational Periods on the Development and the Learning and Memory Abilities of Rat Offspring

This study aimed to investigate the effects of prenatal and lactational methcathinone exposure on the development and the learning and memory abilities of rat offspring using a Sprague-Dawley rat model. Pregnant and lactating rats were administered a consecutive daily dose of methcathinone (0.37 mg/kg) or an equivalent volume of saline by injection on gestational days 7-20 and postnatal days 2-15, respectively. The physical development and neurobehavioral test results of rat pups were recorded throughout the lactation period. Morris water maze (MWM) and novel object recognition (NOR) tests were performed from postnatal day 35 to day 42 to assess the learning and memory abilities of rat offspring in adolescence. The occurrence of hair growth and developments in neurological reflexes, such as improvements in limb grasp, righting reflex, and gait, were delayed in pups after perinatal methcathinone exposure compared with that in the control. Results from MWM and NOR tests indicate that perinatal methcathinone exposure induced deficits in spatial memory, learning ability, and novel object exploration in the adolescent offspring compared with that in the control. The impairment of spatial learning and memory was greater in the prenatal exposure group, while the impairment of novel object exploration was greater in the lactational exposure group. These data show that the prenatal and lactational methcathinone exposure induced the delay of physical and neurological reflex development and impaired learning and memory in rat offspring.

Fetal Alcohol Spectrum Disorders: Health Needs Assessment in Brazil

BACKGROUND

Fetal alcohol syndrome (FAS) is a disorder caused by alterations in embryo-fetal development due to prenatal alcohol exposure. It is estimated that between 0.5 and 2 per 1,000 individuals are born with FAS every year. In Brazil, there are few studies addressing the extent of the problem of FAS/fetal alcohol spectrum disorders (FASD); these studies are confined to limited geographic areas. Therefore, we decided to perform a health needs assessment for FAS/FASD in Brazil.

METHODS

To estimate the prevalence of FAS and FASD in Brazil, we used information from the literature, which estimates between 0.5 and 2/1,000 births per year for FAS and 10 to 50/1,000 for FASD.

RESULTS

We estimated that approximately 1,500 to 6,000 children are born with FAS every year. Considering the whole population, the prevalence would be 95,377 to 380,000 affected people. However, when we consider FASD as a whole, we estimate that between 1,900,000 and 9,500,000 Brazilians might suffer the more severe consequences of alcohol exposure during pregnancy and be living with FASD.

CONCLUSION

The results of the current study indicate that FAS and FASD are prevalent disorders in Brazil, and more policies targeting alcohol intake during pregnancy must be developed.

Malformation and death X Alcoholism: perspective of Nursing the Theory of Transitions for alcoholic pregnant women

OBJECTIVE

To analyze the knowledge of women who are being treated in Psychosocial Care Centers for Alcohol and Drugs about the harm caused by alcohol consumption during pregnancy, especially regarding fetal malformation.

METHOD

Qualitative, descriptive and exploratory study using the Life Narrative approach. Data was collected between February and May 2016, in the city of Rio de Janeiro, with an open interview with the guiding question: "Tell me about your life in relation to alcohol consumption during pregnancy and the guidance received in prenatal care".

RESULTS

The narratives revealed lack of information and fear of malformation (physical) and fetal death due to alcohol consumption during pregnancy.

DISCUSSION

Malformation or fetal death may trigger a transitional process in women.

FINAL CONSIDERATIONS

Women have incipient knowledge about the effects of alcohol on the fetus. They consider that alcohol can only cause physical defects in the children.

[Prevalence and factors associated with alcohol use during pregnancy in a maternity hospital in Goiás, Central Brazil]

The scope of this article is to estimate the prevalence and factors associated with alcohol use during pregnancy. It involved a cross-sectional study in a sample of 361 pregnant women in a reference service for gynecological and prenatal care. The data related to socio-demographic characteristics, alcohol use and potential associated factors were collected through face-to-face interviews. Poisson regression with robust variance was used to identify factors associated with the outcome analyzed. The consumption of alcohol in the sample was 17.7% (95% CI: 95% CI: 14.1% to 22.0%). A history of pre-gestational or gestational diabetes, suicidal ideation and tobacco use in the last 30 days was associated with alcohol use during pregnancy (p < 0.05). The study showed a high prevalence of alcohol use during the current pregnancy and its association with important factors. Actions such as screening for alcohol and advice on problems associated with the use of this substance, especially during the prenatal period, can contribute to effective reduction of alcohol use in pregnant women and related maternal and fetal injuries.