ana sandes | University of Lisbon (original) (raw)
Papers by ana sandes
portuguese journal of nephrology and hypertension, Jun 1, 2014
Case Reports in Perinatal Medicine, Dec 30, 2022
Objectives: Gross hematuria is rare in the neonate and requires prompt etiology evaluation and in... more Objectives: Gross hematuria is rare in the neonate and requires prompt etiology evaluation and intervention. This article aims to draw attention to adenovirus as a cause of hematuria in newborns. Case presentation: We present the case of a newborn admitted to the neonatal unit after birth with respiratory distress. Empiric treatment with ampicillin and gentamicin was initiated. He presented a favorable clinical and laboratory course with decreasing inflammatory parameters. On day 7 gross hematuria was detected and the urinalysis revealed red blood cells, trace of proteins and leukocytes. Cefotaxime was added after urine and blood cultures. Doppler ultrasound showed bladder sediment with no signs of renal venous thrombosis and the cultures were negative. There was a progressive improvement of gross hematuria with resolution on day 16. Urine adenovirus PCR was positive and the diagnosis of adenovirus hemorrhagic cystitis was made. Conclusions: Adenovirus should be considered as a potential etiology if clinical symptoms and urinalysis are suggestive of infection, but the urine culture is negative and ensuring that all other possible causes of hematuria are ruled of. As far as the authors know, this is the first case report of a newborn with adenovirus hemorrhagic cystitis.
Pediatric Transplantation
BackgroundThere is considerable variation in vaccination practices between pediatric transplant c... more BackgroundThere is considerable variation in vaccination practices between pediatric transplant centers. This study aims to evaluate active immunization attitudes and practices among ERN‐TransplantChild centers and identify potential areas of improvement that could be addressed by shared evidence‐based protocols.MethodsA cross‐sectional questionnaire of attitudes and practices toward immunization of pediatric SOT and HSCT candidates and recipients was sent to a representative member of multidisciplinary teams from 27 European centers belonging to the ERN‐TransplantChild.ResultsA total of 28/62 SOT programs and 6/12 HSCT programs across 21 European centers participated. A quarter of centers did not have an on‐site protocol for the immunizations. At the time of transplantation, pediatric candidates were fully immunized (80%–100%) in 57% and 33% of the SOT and HSCT programs. Variations in the time between vaccine administration and admission to the waiting list were reported between th...
Transplantation, 2020
Financial disclosure: The ESPN/ERA-EDTA Registry is funded by the European Society for Paediatric... more Financial disclosure: The ESPN/ERA-EDTA Registry is funded by the European Society for Paediatric Nephrology (ESPN) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). This article was written by M Bonthuis et al. on behalf of the ESPN/ERA-EDTA Registry and the ERA-EDTA Registry which is an official body of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association). Conflicts of interest: The authors declare no conflicts of interest.
Portuguese Journal of Nephrology & Hypertension
Vancomycin and aminoglycosides are potentially nephrotoxic broad-spectrum antibiotics, which can ... more Vancomycin and aminoglycosides are potentially nephrotoxic broad-spectrum antibiotics, which can be used both in the treatment of severe infections and in surgical prophylaxis, in pediatric patients. Prolonged antibiotic therapy and high trough concentrations are associated with toxicity. Additionally, several individual factors contribute to nephrotoxicity increasing the risk of acute kidney injury (AKI) and consequent chronic kidney disease in the future. We developed a retrospective and observational study in the Pediatrics Department of a tertiary hospital in Portugal, to analyze clinical practice regarding monitoring and surveillance of vancomycin and aminoglycosides. The results showed low rates of monitoring, which reinforces the importance of raising awareness about this issue, recognizing its importance, and adopting preventive measures that may mitigate the risk of toxicity and improve children’s renal prognosis in adult life.
Portuguese Journal of Nephrology & Hypertension, 2022
Introduction: Cardiovascular risk factors decrease after kidney transplantation, however cardiova... more Introduction: Cardiovascular risk factors decrease after kidney transplantation, however cardiovascular disease remains one of the most common causes of death in children and young adults. The authors performed a comprehensive analysis of cardiovascular risk factors before and after kidney transplantation. Methods: Retrospective study, from 2007 to 2017, that included children and adolescents with a minimum of six months follow -up after kidney transplant. Demographic profile, chronic kidney disease characteristics and family and personal cardiovascular risk factors (hypertension, left ventricular hypertrophy, anemia, overweight/obesity, dyslipidemia, hypoalbuminemia and new onset diabetes after transplant) were assessed. Pre - and post -transplant cardiovascular risk factors were compared using the McNemar test. Results: We included 49 patients, with a mean age at the time of transplantation of 9.3 ± 4.2 years. Congenital anomalies of kidney and urinary tract (37.7%) and glomerulop...
Brazilian Journal of Nephrology, 2022
Introduction: A better understanding of hemolytic-uremic syndrome (HUS) pathophysiology significa... more Introduction: A better understanding of hemolytic-uremic syndrome (HUS) pathophysiology significantly changed its treatment and prognosis. The aim of this study is to characterize the clinical features, severity, management, and outcomes of HUS patients. Materials and Methods: Retrospective study of HUS patients admitted to a Pediatric Nephrology Unit between 1996 and 2020. Demographic and clinical data regarding etiology, severity, treatment strategies, and patient outcome were collected. Results: Twenty-nine patients with HUS were admitted to our unit, but four were excluded. Median age at diagnosis was two years (2 months - 17 years). Clinical manifestations included diarrhea, vomiting, oliguria, hypertension, and fever. During the acute phase, 14 patients (56%) required renal replacement therapy. Infectious etiology was identified in seven patients (five Escherichia coli and two Streptococcus pneumoniae). Since 2015, 2/7 patients were diagnosed with complement pathway dysregulat...
Clinical Transplantation, 2022
Acta Médica Portuguesa, Jul 2, 2007
In recent years there has been a great increase of scientific research regarding physical exercis... more In recent years there has been a great increase of scientific research regarding physical exercise during pregnancy. Nevertheless, many doubts persist leading to a decrease of its practice. We aimed to evaluate the main factors that influence the practice of physical activity during pregnancy and mothers' knowledge regarding its effects. Physical activity has decreased significantly, although it was higher in nulliparous mothers, with higher educational level, employment and between 25 and 34 years old. Mothers who practiced exercise during pregnancy breastfed longer. No correlation was found concerning birth weight, gestational age or obstetric pathology. Although most mothers understand the benefits of physical activity in pregnancy, that doesn't seem to translate in an increasing practice. We believe there should be an increased awareness of health professionals in order to promote controlled physical exercise in pregnant woman.
Acta Médica Portuguesa, Jul 2, 2007
Maternal smoking during pregnancy is related not only to perinatal adverse events but also to imp... more Maternal smoking during pregnancy is related not only to perinatal adverse events but also to important postnatal problems. Smoking is very prevalent in women with several socio-demographic factors playing an important role. To assess the frequency of smoking as well as mothers' change in behaviours during pregnancy. To identify socio-demographic factors associated to smoking and to assess women's knowledge and sources of information about adverse effects of smoking during pregnancy. We started a cohort study between March and October 2003 at the Maternity, Hospital Santa Maria. After an informed consent the mothers in the post natal ward were asked to fill in a questionnaire. Four hundred and seventy five mothers responded to the questionnaire and among them 30% were smokers before pregnancy. Thirty five percent stopped smoking during pregnancy and those who continued significantly reduced the number of cigarettes per day. Smoking was less prevalent in married women, with h...
Acta Médica Portuguesa, Jul 2, 2007
Breastfeeding is the best way of feeding the baby for the first six months of life. However, in P... more Breastfeeding is the best way of feeding the baby for the first six months of life. However, in Portugal the abandonment rate of breastfeeding is very high during the baby first's months of life. The aim of this study was to assess prevalence of breastfeeding and to identify related factors during the six months after delivery, as socio demographic variables and life styles. We conducted a cohort study at the Maternity of the Hospital Santa Maria. A standard questionnaire was applied to 475 women after delivery, at three and six months postpartum. We studied socio demographics aspects, life styles and the way of feeding during the six months after delivery. Multivariate analysis was performed. The women studied (mean age of 29.8 +/- 5,4 years), 52.2% were primiparous, 86.1% were Caucasian, 40% had a high school degree and 33% had a University degree. Four hundred and sixty (96.8%) received prenatal care. The mean gestational age was 38.8 +/- 2 weeks and the birth weight was 3198...
background: Renal transplantation is the treatment of choice for children with end stage renal di... more background: Renal transplantation is the treatment of choice for children with end stage renal disease with positive impact on survival and quality of life. However, some complications affect morbidity and mortality. This study examines the renal transplantation complications profile in pediatric patients (< 18 y). Material and Methods: Retrospective analysis of clinical files from renal transplantation patients followed in Pediatric Nephrology Unit from September 1995 to August 2010. Collection of data regarding: demography, end stage renal disease etiology, previous renal replacement therapy, graft loss and death, complications: surgical, infectious and non-infectious (acute and chronic rejection, primary disease recurrence, metabolic and cardiovascular risk factors). Descriptive statistical analysis was performed. Results: 78 children (male: 48.7%), mean age at renal transplantation: 11.7 4.1 years. Previous peritoneal dialysis in 49 (62.6%). Five patients (6.4%) with preempti...
Acta Médica Portuguesa, 2007
spp.pt
... Professor Egas Moniz 1649-035 Lisboa 217805065 lj.silva@hsm.min-saude.pt ... Sara Martins1,... more ... Professor Egas Moniz 1649-035 Lisboa 217805065 lj.silva@hsm.min-saude.pt ... Sara Martins1, Raquel Gouveia1, Ana Rita Sandes1, Susana Correia1, Catarina Nascimento1, Joana Figueira1,Sandra Valente1, Evangelista Rocha2, Lincoln Justo da Silva1 ...
spp.pt
A cistinose nefropática é uma doença genética rara, grave, multissistémica, caracterizada pelo de... more A cistinose nefropática é uma doença genética rara, grave, multissistémica, caracterizada pelo defeito no transporte lisossomal de cistina, com acumulação nos diferentes tecidos. A doença renal terminal com evolução insidiosa pode ser uma das manifestações clínicas. Um adolescente com 15 anos foi internado para esclarecimento etiológico de quadro de deterioração grave da função renal. Apresentava atraso estaturo-ponderal, fotofobia e glicosúria, não valorizados previamente. Na investigação etiológica detectaram-se cristais de cistina na córnea, um valor elevado de cistina intraleucocitária e uma mutação em homozigotia do gene CTNS (p.Ile67_Pro-73del). Iniciou terapêutica farmacológica e foi transplantado três meses após o diagnóstico. O diagnóstico atempado permite iniciar precocemente terapêutica com cisteamina e assim prevenir ou retardar uma evolução desfavorável.
Introduction: Anaemia after renal transplantation has been associated with chronic graft dysfunct... more Introduction: Anaemia after renal transplantation has been associated with chronic graft dysfunction and increased cardiovascular mortality. There are few paediatric studies on the prevalence and on the aetiological factors involved. Objectives: To determine the prevalence of anaemia in children after renal transplantation (RT) and associated risk factors. Methods: A descriptive, analytical, retrospective study was conducted by consulting the records of patients followed in the Paediatric Nephrology Unit of tertiary care hospital in Lisbon, with more than one year of renal transplantation. The prevalence of anaemia was determined at 3 and at 12 months post -RT and the following potential risk factors were analysed: pre -renal transplantation anaemia, viral infections (CMV, EBV, PVB19), urinary tract infections, iron deficiency, graft function and occurrence of acute graft dysfunction episodes. Results: We evaluated 45 children: 82% of Caucasians, 58% female, mean age at transplant 9...
![Research paper thumbnail of [Pregnancy and physical exercise: myths, evidence and recommendations]](https://attachments.academia-assets.com/76488573/thumbnails/1.jpg)
](In recent years there has been a great increase of scientific research regarding physical exercis... more In recent years there has been a great increase of scientific research regarding physical exercise during pregnancy. Nevertheless, many doubts persist leading to a decrease of its practice. We aimed to evaluate the main factors that influence the practice of physical activity during pregnancy and mothers' knowledge regarding its effects. Physical activity has decreased significantly, although it was higher in nulliparous mothers, with higher educational level, employment and between 25 and 34 years old. Mothers who practiced exercise during pregnancy breastfed longer. No correlation was found concerning birth weight, gestational age or obstetric pathology. Although most mothers understand the benefits of physical activity in pregnancy, that doesn't seem to translate in an increasing practice. We believe there should be an increased awareness of health professionals in order to promote controlled physical exercise in pregnant woman.
portuguese journal of nephrology and hypertension, Jun 1, 2014
Case Reports in Perinatal Medicine, Dec 30, 2022
Objectives: Gross hematuria is rare in the neonate and requires prompt etiology evaluation and in... more Objectives: Gross hematuria is rare in the neonate and requires prompt etiology evaluation and intervention. This article aims to draw attention to adenovirus as a cause of hematuria in newborns. Case presentation: We present the case of a newborn admitted to the neonatal unit after birth with respiratory distress. Empiric treatment with ampicillin and gentamicin was initiated. He presented a favorable clinical and laboratory course with decreasing inflammatory parameters. On day 7 gross hematuria was detected and the urinalysis revealed red blood cells, trace of proteins and leukocytes. Cefotaxime was added after urine and blood cultures. Doppler ultrasound showed bladder sediment with no signs of renal venous thrombosis and the cultures were negative. There was a progressive improvement of gross hematuria with resolution on day 16. Urine adenovirus PCR was positive and the diagnosis of adenovirus hemorrhagic cystitis was made. Conclusions: Adenovirus should be considered as a potential etiology if clinical symptoms and urinalysis are suggestive of infection, but the urine culture is negative and ensuring that all other possible causes of hematuria are ruled of. As far as the authors know, this is the first case report of a newborn with adenovirus hemorrhagic cystitis.
Pediatric Transplantation
BackgroundThere is considerable variation in vaccination practices between pediatric transplant c... more BackgroundThere is considerable variation in vaccination practices between pediatric transplant centers. This study aims to evaluate active immunization attitudes and practices among ERN‐TransplantChild centers and identify potential areas of improvement that could be addressed by shared evidence‐based protocols.MethodsA cross‐sectional questionnaire of attitudes and practices toward immunization of pediatric SOT and HSCT candidates and recipients was sent to a representative member of multidisciplinary teams from 27 European centers belonging to the ERN‐TransplantChild.ResultsA total of 28/62 SOT programs and 6/12 HSCT programs across 21 European centers participated. A quarter of centers did not have an on‐site protocol for the immunizations. At the time of transplantation, pediatric candidates were fully immunized (80%–100%) in 57% and 33% of the SOT and HSCT programs. Variations in the time between vaccine administration and admission to the waiting list were reported between th...
Transplantation, 2020
Financial disclosure: The ESPN/ERA-EDTA Registry is funded by the European Society for Paediatric... more Financial disclosure: The ESPN/ERA-EDTA Registry is funded by the European Society for Paediatric Nephrology (ESPN) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). This article was written by M Bonthuis et al. on behalf of the ESPN/ERA-EDTA Registry and the ERA-EDTA Registry which is an official body of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association). Conflicts of interest: The authors declare no conflicts of interest.
Portuguese Journal of Nephrology & Hypertension
Vancomycin and aminoglycosides are potentially nephrotoxic broad-spectrum antibiotics, which can ... more Vancomycin and aminoglycosides are potentially nephrotoxic broad-spectrum antibiotics, which can be used both in the treatment of severe infections and in surgical prophylaxis, in pediatric patients. Prolonged antibiotic therapy and high trough concentrations are associated with toxicity. Additionally, several individual factors contribute to nephrotoxicity increasing the risk of acute kidney injury (AKI) and consequent chronic kidney disease in the future. We developed a retrospective and observational study in the Pediatrics Department of a tertiary hospital in Portugal, to analyze clinical practice regarding monitoring and surveillance of vancomycin and aminoglycosides. The results showed low rates of monitoring, which reinforces the importance of raising awareness about this issue, recognizing its importance, and adopting preventive measures that may mitigate the risk of toxicity and improve children’s renal prognosis in adult life.
Portuguese Journal of Nephrology & Hypertension, 2022
Introduction: Cardiovascular risk factors decrease after kidney transplantation, however cardiova... more Introduction: Cardiovascular risk factors decrease after kidney transplantation, however cardiovascular disease remains one of the most common causes of death in children and young adults. The authors performed a comprehensive analysis of cardiovascular risk factors before and after kidney transplantation. Methods: Retrospective study, from 2007 to 2017, that included children and adolescents with a minimum of six months follow -up after kidney transplant. Demographic profile, chronic kidney disease characteristics and family and personal cardiovascular risk factors (hypertension, left ventricular hypertrophy, anemia, overweight/obesity, dyslipidemia, hypoalbuminemia and new onset diabetes after transplant) were assessed. Pre - and post -transplant cardiovascular risk factors were compared using the McNemar test. Results: We included 49 patients, with a mean age at the time of transplantation of 9.3 ± 4.2 years. Congenital anomalies of kidney and urinary tract (37.7%) and glomerulop...
Brazilian Journal of Nephrology, 2022
Introduction: A better understanding of hemolytic-uremic syndrome (HUS) pathophysiology significa... more Introduction: A better understanding of hemolytic-uremic syndrome (HUS) pathophysiology significantly changed its treatment and prognosis. The aim of this study is to characterize the clinical features, severity, management, and outcomes of HUS patients. Materials and Methods: Retrospective study of HUS patients admitted to a Pediatric Nephrology Unit between 1996 and 2020. Demographic and clinical data regarding etiology, severity, treatment strategies, and patient outcome were collected. Results: Twenty-nine patients with HUS were admitted to our unit, but four were excluded. Median age at diagnosis was two years (2 months - 17 years). Clinical manifestations included diarrhea, vomiting, oliguria, hypertension, and fever. During the acute phase, 14 patients (56%) required renal replacement therapy. Infectious etiology was identified in seven patients (five Escherichia coli and two Streptococcus pneumoniae). Since 2015, 2/7 patients were diagnosed with complement pathway dysregulat...
Clinical Transplantation, 2022
Acta Médica Portuguesa, Jul 2, 2007
In recent years there has been a great increase of scientific research regarding physical exercis... more In recent years there has been a great increase of scientific research regarding physical exercise during pregnancy. Nevertheless, many doubts persist leading to a decrease of its practice. We aimed to evaluate the main factors that influence the practice of physical activity during pregnancy and mothers' knowledge regarding its effects. Physical activity has decreased significantly, although it was higher in nulliparous mothers, with higher educational level, employment and between 25 and 34 years old. Mothers who practiced exercise during pregnancy breastfed longer. No correlation was found concerning birth weight, gestational age or obstetric pathology. Although most mothers understand the benefits of physical activity in pregnancy, that doesn't seem to translate in an increasing practice. We believe there should be an increased awareness of health professionals in order to promote controlled physical exercise in pregnant woman.
Acta Médica Portuguesa, Jul 2, 2007
Maternal smoking during pregnancy is related not only to perinatal adverse events but also to imp... more Maternal smoking during pregnancy is related not only to perinatal adverse events but also to important postnatal problems. Smoking is very prevalent in women with several socio-demographic factors playing an important role. To assess the frequency of smoking as well as mothers' change in behaviours during pregnancy. To identify socio-demographic factors associated to smoking and to assess women's knowledge and sources of information about adverse effects of smoking during pregnancy. We started a cohort study between March and October 2003 at the Maternity, Hospital Santa Maria. After an informed consent the mothers in the post natal ward were asked to fill in a questionnaire. Four hundred and seventy five mothers responded to the questionnaire and among them 30% were smokers before pregnancy. Thirty five percent stopped smoking during pregnancy and those who continued significantly reduced the number of cigarettes per day. Smoking was less prevalent in married women, with h...
Acta Médica Portuguesa, Jul 2, 2007
Breastfeeding is the best way of feeding the baby for the first six months of life. However, in P... more Breastfeeding is the best way of feeding the baby for the first six months of life. However, in Portugal the abandonment rate of breastfeeding is very high during the baby first's months of life. The aim of this study was to assess prevalence of breastfeeding and to identify related factors during the six months after delivery, as socio demographic variables and life styles. We conducted a cohort study at the Maternity of the Hospital Santa Maria. A standard questionnaire was applied to 475 women after delivery, at three and six months postpartum. We studied socio demographics aspects, life styles and the way of feeding during the six months after delivery. Multivariate analysis was performed. The women studied (mean age of 29.8 +/- 5,4 years), 52.2% were primiparous, 86.1% were Caucasian, 40% had a high school degree and 33% had a University degree. Four hundred and sixty (96.8%) received prenatal care. The mean gestational age was 38.8 +/- 2 weeks and the birth weight was 3198...
background: Renal transplantation is the treatment of choice for children with end stage renal di... more background: Renal transplantation is the treatment of choice for children with end stage renal disease with positive impact on survival and quality of life. However, some complications affect morbidity and mortality. This study examines the renal transplantation complications profile in pediatric patients (< 18 y). Material and Methods: Retrospective analysis of clinical files from renal transplantation patients followed in Pediatric Nephrology Unit from September 1995 to August 2010. Collection of data regarding: demography, end stage renal disease etiology, previous renal replacement therapy, graft loss and death, complications: surgical, infectious and non-infectious (acute and chronic rejection, primary disease recurrence, metabolic and cardiovascular risk factors). Descriptive statistical analysis was performed. Results: 78 children (male: 48.7%), mean age at renal transplantation: 11.7 4.1 years. Previous peritoneal dialysis in 49 (62.6%). Five patients (6.4%) with preempti...
Acta Médica Portuguesa, 2007
spp.pt
... Professor Egas Moniz 1649-035 Lisboa 217805065 lj.silva@hsm.min-saude.pt ... Sara Martins1,... more ... Professor Egas Moniz 1649-035 Lisboa 217805065 lj.silva@hsm.min-saude.pt ... Sara Martins1, Raquel Gouveia1, Ana Rita Sandes1, Susana Correia1, Catarina Nascimento1, Joana Figueira1,Sandra Valente1, Evangelista Rocha2, Lincoln Justo da Silva1 ...
spp.pt
A cistinose nefropática é uma doença genética rara, grave, multissistémica, caracterizada pelo de... more A cistinose nefropática é uma doença genética rara, grave, multissistémica, caracterizada pelo defeito no transporte lisossomal de cistina, com acumulação nos diferentes tecidos. A doença renal terminal com evolução insidiosa pode ser uma das manifestações clínicas. Um adolescente com 15 anos foi internado para esclarecimento etiológico de quadro de deterioração grave da função renal. Apresentava atraso estaturo-ponderal, fotofobia e glicosúria, não valorizados previamente. Na investigação etiológica detectaram-se cristais de cistina na córnea, um valor elevado de cistina intraleucocitária e uma mutação em homozigotia do gene CTNS (p.Ile67_Pro-73del). Iniciou terapêutica farmacológica e foi transplantado três meses após o diagnóstico. O diagnóstico atempado permite iniciar precocemente terapêutica com cisteamina e assim prevenir ou retardar uma evolução desfavorável.
Introduction: Anaemia after renal transplantation has been associated with chronic graft dysfunct... more Introduction: Anaemia after renal transplantation has been associated with chronic graft dysfunction and increased cardiovascular mortality. There are few paediatric studies on the prevalence and on the aetiological factors involved. Objectives: To determine the prevalence of anaemia in children after renal transplantation (RT) and associated risk factors. Methods: A descriptive, analytical, retrospective study was conducted by consulting the records of patients followed in the Paediatric Nephrology Unit of tertiary care hospital in Lisbon, with more than one year of renal transplantation. The prevalence of anaemia was determined at 3 and at 12 months post -RT and the following potential risk factors were analysed: pre -renal transplantation anaemia, viral infections (CMV, EBV, PVB19), urinary tract infections, iron deficiency, graft function and occurrence of acute graft dysfunction episodes. Results: We evaluated 45 children: 82% of Caucasians, 58% female, mean age at transplant 9...
In recent years there has been a great increase of scientific research regarding physical exercis... more In recent years there has been a great increase of scientific research regarding physical exercise during pregnancy. Nevertheless, many doubts persist leading to a decrease of its practice. We aimed to evaluate the main factors that influence the practice of physical activity during pregnancy and mothers' knowledge regarding its effects. Physical activity has decreased significantly, although it was higher in nulliparous mothers, with higher educational level, employment and between 25 and 34 years old. Mothers who practiced exercise during pregnancy breastfed longer. No correlation was found concerning birth weight, gestational age or obstetric pathology. Although most mothers understand the benefits of physical activity in pregnancy, that doesn't seem to translate in an increasing practice. We believe there should be an increased awareness of health professionals in order to promote controlled physical exercise in pregnant woman.