Sirlei Morais | Universidade Estadual de Campinas (original) (raw)
Papers by Sirlei Morais
Perspectivas Médicas, 2017
Não existem conflitos de interesse RESUMO O câncer de mama é atualmente um dos grandes desafios d... more Não existem conflitos de interesse RESUMO O câncer de mama é atualmente um dos grandes desafios da saúde pública, sendo o segundo mais incidente na população feminina mundial e brasileira. O estudo descritivo e transversal objetivou identificar os fatores associados ao risco para o câncer de mama e medidas de prevenção para a doença. Foi desenvolvido com 191 mulheres de uma instituição de ensino superior de Jundiaí-SP, em 2013. As mulheres responderam a um questionário com aspectos sociodemográficos, m ó r b i d o s f a m i l i a re s , re p ro d u t i v o s e relacionados à realização de medidas preventivas. Para as ≥ 35 anos de idade foi
Revista Brasileira de Ginecologia e Obstetrícia, Dec 18, 2017
Objective To evaluate the relation between changes the body mass index (BMI) percentile, reflecte... more Objective To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes. Methods A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequate weight, overweight, and obese. The BMI was calculated at the first and at the last prenatal care visits, and these values were compared. Results An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24-0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetal macrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83). Conclusion Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn. Resumo Objetivo Avaliar a relação entre mudanças no percentual do índice de massa corporal (IMC), refletidas na curva de Atalah, e resultados perinatais. Métodos Foi realizado um estudo transversal com 1.279 mulheres. Os dados sobre o peso na gestação, características sociodemográficas e resultados perinatais foram
The European Journal of Contraception & Reproductive Health Care, Oct 26, 2022
![Research paper thumbnail of [Variation of weigth among users of the contraceptive with depot-medroxyprogesterone acetate according to body mass index in a six-year follow-up]](https://attachments.academia-assets.com/116170456/thumbnails/1.jpg)
](Revista Brasileira de Ginecologia e Obstetrícia, Aug 1, 2009
Artigo original Resumo OBJETIVO: determinar a variação de peso de mulheres com diferentes Índices... more Artigo original Resumo OBJETIVO: determinar a variação de peso de mulheres com diferentes Índices de Massa Corporal (IMC), usuárias do injetável trimestral de acetato de medroxiprogesterona de depósito (AMPD) e compará-la à de mulheres em uso de método não hormonal. MÉTODOS: Estudo retrospectivo com revisão de prontuários de 226 usuárias de AMPD e 603 controles usuárias de DIU TCu380A. As mulheres foram distribuídas conforme o IMC inicial nas categorias de peso normal (<25 kg/m 2), sobrepeso (25 a 29,9 kg/m 2) e obesas (≥30 kg/m 2) e seguidas anualmente durante seis anos com medidas de peso e IMC. Aplicou-se o teste estatístico ANOVA para medir a variação de peso entre os grupos em cada categoria de IMC a cada ano. RESULTADOS: a média de idade no início do uso do método foi maior no grupo de estudo do que no controle em todas as categorias de IMC 31,6 ± DP 7,1 X 27,4 ± DP 5,5 na categoria peso normal (p<0,0001); 37,3 ± DP 6,8 X 29,2± DP 6,0 na categoria sobrepeso (p<0,0001); e 35,3 ± DP 6,4 X 29,7 ± DP 5,8 na categoria obesas (p<0,0001). As usuárias de AMPD tiveram elevação de peso em relação às controles na categoria de sobrepeso (p=0,0082); e o aumento de peso em relação ao tempo também foi maior no grupo de usuárias de AMPD do que nas controles para as categorias de peso normal (p<0,0001) e sobrepeso (p=0,0008). No grupo de obesas não houve variação do IMC entre os grupos nem em relação ao tempo de uso do método. CONCLUSÕES: não houve variação de ganho de peso em mulheres obesas usuárias de AMPD. Estudos prospectivos deverão ser realizados com testes metabólicos para determinar os fatores desencadeadores do ganho de peso em mulheres com peso normal e sobrepeso.
International journal of gynaecology and obstetrics, Jul 7, 2015
To establish longitudinal reference intervals for pulsatility index (PI) and systolic velocity (S... more To establish longitudinal reference intervals for pulsatility index (PI) and systolic velocity (SV) of the fetal renal artery, and to evaluate their correlation with the amniotic fluid index (AFI). Methods: A prospective longitudinal study was conducted among women with low-risk pregnancies who attended outpatient clinics at the University of Campinas Medical School, Brazil, at 16-19 weeks of pregnancy between April 1, 2008, and March 31, 2010. Doppler velocimetric measurements of the fetal renal artery and assessments of the AFI were undertaken at 4-week intervals to 36 weeks, and every 2 weeks thereafter until delivery. Results: A total of 63 women were enrolled. The PI of the fetal renal artery showed little variation during pregnancy, whereas SV values increased to 36-37 weeks of pregnancy and decreased thereafter. No correlations were found between the AFI and the fetal renal artery Doppler velocimetric parameters (P N 0.05 for all). The intraclass correlation coefficients for intra-observer and inter-observer variability indicated good reproducibility of SV, but the reproducibility of PI was lower. Conclusions: The AFI did not correlate with fetal renal artery Doppler velocimetric measures among low-risk pregnancies. However, investigations are needed among high-risk pregnancies.
PubMed, 2008
The study aimed to analyze the Pap smears carried out for cervical cancer screening according to ... more The study aimed to analyze the Pap smears carried out for cervical cancer screening according to Ministry of Health guidelines. All smear tests carried out within the public health system in Campinas in 2003 were analyzed. All tests that did not conform to the guidelines were considered excessive. The guidelines recommend screening once every three years for all women aged 25 to 59 after they have received two negative smears. This study showed that the majority of women initiated screening prior to 25 years of age and the periodicity was predominantly annual, followed by biannual tests. In conclusion, 63.4% of tests were excessive. The screening coverage was 14.76%, but if all the tests had been performed as recommended, the final coverage over three years could have reached 65.4%. Thus it is possible to increase the coverage with the available resources since the screening works like an organized program.
Journal of Maternal-fetal & Neonatal Medicine, Mar 17, 2015
To analyze the relationship between parity, prepregnancy Body Mass Index (BMI), and gestational w... more To analyze the relationship between parity, prepregnancy Body Mass Index (BMI), and gestational weight gain (GWG). This observational controlled study was conducted from November 2013 to April 2014, with postpartum women who started antenatal care up to 14 weeks and had full term births. Data were collected from medical records and antenatal cards. Descriptive and bivariate analyses were performed. The significance level was 5%. Data were collected from 130 primiparous and 160 multiparous women. At the beginning of prenatal care, 54.62% of the primiparous were eutrophic, while the majority of multiparous were overweight or obese (62.51%). Multiparas are two times more likely to be obese at the start of their pregnancies when compared to primiparas. The average prepregnancy weight and final pregnancy weight was significantly higher in multiparous, however the mean GWG was higher among primiparous. We found an inverse correlation between parity and the total GWG, but starting BMI was significantly higher in multiparasNevertheless, monitoring of the GWG through actions that promote a healthier lifestyle is needed, regardless of parity and nutritional status, in order to prevent excessive GWG and postpartum weight retention and consequently inadequate prepregnancy nutritional status in future pregnancies.
Brazilian Journal of Nephrology, Jan 9, 2023
Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao l... more Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao longo de suas vidas. Este estudo visou avaliar histórico sociodemográfico, clínico e obstétrico de mulheres em hemodiálise. Métodos: Realizamos estudo transversal em unidade de saúde especializada com quatro unidades de hemodiálise. Avaliou-se características sociodemográficas, histórico clínico e pessoal, resultados obstétricos e perinatais de mulheres com gestações anteriores à hemodiálise. Foram realizadas análises de prevalência, bivariadas e regressão logística. Resultados: Incluímos 208 (87,76%) mulheres. Hipertensão foi a principal causa de doença renal crônica (DRC) (128 mulheres). Taxas de desfechos perinatais adversos, incluindo prematuridade, baixo peso ao nascer, aborto espontâneo, óbito fetal e neonatal, foram de 19,3%, 14,5%, 25,5%, 12,1% e 5,3%, respectivamente. Síndromes hipertensivas durante a gestação ocorreram em 37,0% das mulheres, com 12,5% relatando préeclâmpsia e 1,4% relatando eclampsia. Até 1 ano após o parto, 45,2% das mulheres relataram hipertensão. Hemodiálise devido à hipertensão foi associada ao histórico de hipertensão na gestação (OR 2,33; IC 1,27-4,24), hipertensão gestacional (2,41; IC 3,30-4,45), e hipertensão até um ano após o parto (OR 1,98; IC 1,11-3,51). A regressão logística mostrou que hipertensão gestacional foi independentemente associada à DRC devido à hipertensão (ORa 2,76; IC 1,45-5,24). Conclusão: Mulheres submetidas à hemodiálise por hipertensão foram mais propensas a apresentar hipertensão gestacional ou hipertensão até um ano após o parto. Para retardar a doença renal em estágio terminal, deve-se identificar mulheres em risco de insuficiência renal de acordo com sua história reprodutiva. Resumo Introduction: Pregnancy-related complications may impact women's reproductive cycle and health through their lives. The objective of this study was to evaluate the sociodemographic, clinical, and obstetric history of women undergoing hemodialysis. Methods: We performed a cross-sectional study in a specialized health facility with four hemodialysis units. Sociodemographic characteristics, clinical and personal history, obstetric and perinatal results of women with pregnancies before hemodialysis were evaluated. Prevalence, bivariate, and logistic regression analyses were performed. Results: We included 208 (87.76%) women. Hypertension was the main cause of chronic kidney disease (CKD) (128 women). Rates of adverse perinatal outcomes, including prematurity, low birth weight, miscarriage, fetal death, and neonatal death, were 19.3%, 14.5%, 25.5%, 12.1%, and 5.3%, respectively. Hypertensive syndromes during pregnancy occurred in 37.0% of women, with 12.5% reporting preeclampsia and 1.4% reporting eclampsia. Up to 1 year after birth, 45.2% of women reported hypertension. Hemodialysis due to hypertension was associated with a history of hypertension during pregnancy (OR 2.33, CI 1.27-4.24), gestational hypertension (2.41, CI 3.30-4.45), and hypertension up to one year after birth (OR 1.98, CI 1.11-3.51). Logistic regression showed that gestational hypertension was independently associated with CKD due to hypertension (aOR 2.76, CI 1.45-5.24). Conclusion: Women undergoing hemodialysis due to hypertension were more likely to have gestational hypertension or hypertension up to one year after birth. To delay end-stage renal disease, it is necessary to identify women at risk of kidney failure according to their reproductive history.
Prenatal Diagnosis, Dec 1, 2017
Bulleted statements: Growth pattern of fetuses with gastroschisis is not fully elucidated and cau... more Bulleted statements: Growth pattern of fetuses with gastroschisis is not fully elucidated and causes controversy in time to delivery, increasing prematurity and neonatal morbidity. This study created specific curves for gastroschisis and Umbilical Artery Doppler velocimetry patterns were obtained. We concluded that these fetuses show symmetrical growth deficits for all biometric parameters, being constitutionally smaller and would be better followed-up using specific growth charts.
Maturitas, Feb 1, 2007
Objective: The objective of this study was to evaluate gynecologists' knowledge of the WHI study,... more Objective: The objective of this study was to evaluate gynecologists' knowledge of the WHI study, and its repercussions on their attitudes and practice 3 years after publication. Design: A self-administered, anonymous questionnaire containing 19 questions was sent to 6000 gynecologists, members of the São Paulo Society of Obstetrics and Gynecology. Results: The response rate was 24.2% (1453 completed questionnaires) with a sample error of 2.23% and confidence level of 95%. Although 95.9% of the respondents were aware of the WHI study, only 24.4% knew of all the other studies mentioned (HERS I, HERS II and Million Women Study). Although 84.6% stated that the results of the WHI study could not be extrapolated to other forms of HT, 23.1% and 25.2%, respectively, stopped prescribing CEE or MPA, 63.7% decreased the dose, 55.2% opted for drugs such as bisphosphonates, tibolone and SERMS, and 46.3% began to prescribe tranquilizers, isoflavone and other natural medications. Moreover, 59.2% agreed that HT should be used for only 4-5 years. Prescriptions decreased significantly for all indications (p < 0.0001). The principal reason for physicians to discontinue HT in a patient was increased risk of breast cancer (62.3%), whereas, according to the physicians, the most important factor for the patients was fear of HT (80.3%). Conclusion: A high percentage of gynecologists in this study knew of the WHI study and followed its recommendations concerning cardiovascular prevention; consequently they changed their management of the treatment of postmenopausal women by restricting indications for HT and decreasing its duration of use and dose.
Revista Brasileira de Ginecologia e Obstetrícia, Jun 27, 2019
Objective The aim of this study was to investigate the knowledge concerning gestational weight ga... more Objective The aim of this study was to investigate the knowledge concerning gestational weight gain (GWG), nutrition, and physical exercise (PE) in pregnant women, and how to put them into practice. Methods A cross-sectional study with 61 pregnant women above 26 weeks of gestation, at the Woman's Hospital, CAISM, University of Campinas. Questionnaires regarding the knowledge of healthy habits (HH) during pregnancy, sociodemographic data, and previous obstetric outcomes were applied. An educational guide with advice on HH during pregnancy and in the postpartum period was offered. Results The average age of women was 28.7 AE 6.23 years, with 85% of them being married; 32% nulliparous; the average body mass index (BMI) before pregnancy was 25.4 AE 9.8 kg/m 2 , and the mean number of years of schooling was 11.2 AE 3.8. Only 61% of the subjects had received any previous information about GWG during their antenatal care and were aware as to how many pounds they should gain during pregnancy. Among the 61 women, 85% understood that they did not need to "eat for 2" and 99% knew that PE had benefits for their body and was safe for their baby. Half of the women practiced PE prior to pregnancy; however, only 31% continued the practice of PE during the pregnancy. Conclusion Despite understanding the need for HH during pregnancy, women still need encouragement to practice PE during pregnancy, as well as more information about GWG. Resumo Objetivo O objetivo deste estudo foi investigar os conhecimentos sobre ganho de peso gestacional (GPG), nutrição, e exercício físico (EF) em gestantes e o quanto elas os colocam em prática. Métodos Estudo transversal realizado no Hospital da Mulher, CAISM, Unicamp, com 61 gestantes acima das 26 semanas gestacionais. Questionários sobre conhecimento
Journal of Obstetrics and Gynaecology, Aug 24, 2022
Clinics, 2017
OBJECTIVE: To generate a new body mass index curve of reference values and ranges for body mass i... more OBJECTIVE: To generate a new body mass index curve of reference values and ranges for body mass index and weight gain during pregnancy and to compare the new curve and weight gain ranges with the currently used references. METHODS: A prospective observational study was conducted with a total of 5,656 weight and body mass index measurements in 641 women with single pregnancy who attended their first prenatal visit before 12 weeks. All the women were over 18 years old and had no medical conditions that would influence body mass index. Data were collected using prenatal charts and medical records during hospitalization for childbirth. A linear regression method was used for standard curve smoothing in the general population and for specific curves according to the baseline body mass index classification. Curves were obtained for the 5 th , 10 th , 50 th , 85 th , 90 th and 95 th percentiles. Concordance between the classification of women using the newly generated and currently used curves was evaluated by percentages and kappa coefficients. The weight gain was compared with the reference values of the Institute of Medicine using Student's T test. The data were analyzed using SAS software version 9.2, and the significance level was set at 5%. RESULTS: A general reference curve of percentiles of body mass index by gestational age was established. Additionally, four specific curves were generated according to the four baseline body mass index categories. The new general curve offered percentile limits for women according to their initial body mass index and according to the Centers for Disease Control and Prevention limits, showing poor agreement with the currently used curve (48.3%). Women who were overweight or obese when starting prenatal care had higher weight gain than the Institute of Medicine recommendation. CONCLUSIONS: The new proposed curve for body mass index during pregnancy showed weak agreement with the currently used curve. The new curve provided more information regarding body mass index increase using percentiles for general and specific groups of body mass index. Overweight pregnant women showed an upward body mass index trend throughout pregnancy that increased more dramatically than those of other groups of pregnant women, and they also presented a major mean difference between weight gain and the Institute of Medicine recommendation.
Brazilian Journal of Nephrology, Jan 9, 2023
Gestational hypertension as a factor associated with chronic kidney disease: the importance of ob... more Gestational hypertension as a factor associated with chronic kidney disease: the importance of obstetric history of women undergoing hemodialysis Hipertensão gestacional como fator associado à doença renal crônica: a importância do histórico obstétrico de mulheres submetidas à hemodiálise Introdução: Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao longo de suas vidas. Este estudo visou avaliar histórico sociodemográfico, clínico e obstétrico de mulheres em hemodiálise. Métodos: Realizamos estudo transversal em unidade de saúde especializada com quatro unidades de hemodiálise. Avaliou-se características sociodemográficas, histórico clínico e pessoal, resultados obstétricos e perinatais de mulheres com gestações anteriores à hemodiálise. Foram realizadas análises de prevalência, bivariadas e regressão logística. Resultados: Incluímos 208 (87,76%) mulheres. Hipertensão foi a principal causa de doença renal crônica (DRC) (128 mulheres). Taxas de desfechos perinatais adversos, incluindo prematuridade, baixo peso ao nascer, aborto espontâneo, óbito fetal e neonatal, foram de 19,3%, 14,5%, 25,5%, 12,1% e 5,3%, respectivamente. Síndromes hipertensivas durante a gestação ocorreram em 37,0% das mulheres, com 12,5% relatando pré-eclâmpsia e 1,4% relatando eclampsia. Até 1 ano após o parto, 45,2% das mulheres relataram hipertensão. Hemodiálise devido à hipertensão foi associada ao histórico de hipertensão na gestação (OR 2,33; IC 1,27-4,24), hipertensão gestacional (2,41; IC 3,30-4,45), e hipertensão até um ano após o parto (OR 1,98; IC 1,11-3,51). A regressão logística mostrou que hipertensão gestacional foi independentemente associada à DRC devido à hipertensão (ORa 2,76; IC 1,45-5,24). Conclusão: Mulheres submetidas à hemodiálise por hipertensão foram mais propensas a apresentar hipertensão gestacional ou hipertensão até um ano após o parto. Para retardar a doença renal em estágio terminal, deve-se identificar mulheres em risco de insuficiência renal de acordo com sua história reprodutiva.
Revista Brasileira de Ginecologia e Obstetrícia, 2013
OBJETIVO: Avaliar a correlação entre o International Consultation on Incontinence Questionnaire-U... more OBJETIVO: Avaliar a correlação entre o International Consultation on Incontinence Questionnaire-Urinary Incontinence/Short Form (ICIQ-UI/SF) e a Avaliação Urodinâmica (AU) em mulheres com incontinência urinária (IU). MÉTODOS: Foram analisados retrospectivamente dados clínicos, AU e escore do ICIQ-UI/SF de 358 mulheres com IU atendidas em clínica privada. O teste de correlação entre ICIQ-UI/SF e os parâmetros urodinâmicos foi o teste de Spearman. Foi utilizada a curva ROC, com os valores de sensibilidade e especificidade dos escores do ICIQ-UI/SF apresentados pelas pacientes, para identificar o valor do questionário que determinasse a presença da alteração urodinâmica estudada. Para o cálculo do valor p foi utilizado o teste do χ 2 ou exato de Fisher. O nível de significância foi de 5% e o software utilizado para análise foi o SAS versão 9.2. RESULTADOS: As pacientes com IU aos Esforços segundo a AU-IUE urodinâmica-representaram 67,3% do total; aquelas com IUE na AU e Hiperatividade Detrusora (HD)-IUM urodinâmica-16,2%, e as pacientes com HD isolada-HD-7,3% do total. As pacientes com AU normal representaram 9,2% do total da amostra. Houve associação significativa entre escore ≥14 no ICIQ-UI/SF e as pacientes com IUE urodinâmica e IUM urodinâmica. Pacientes com Pressão de Perda ao Esforço (PPE) ≤90 cmH2O apresentaram escore ao ICIQ-UI/SF≥15. O teste de Spearman mostrou correlação inversa fraca entre o escore e a PPE, porém não mostrou correlação entre esse escore e a Capacidade Cistométrica Máxima (CCM) ou com o volume vesical no primeiro desejo miccional. CONCLUSÃO: Houve associação entre o escore do ICIQ-UI/SF e IUE urodinâmica (isolada ou associada à HD); porém não houve associação com a HD isolada. Quanto menor o valor da PPE, maior o escore total do ICIQ-UI/SF. O ICIQ-UI/SF não foi capaz de discriminar o tipo de IU na população estudada.
2 � ABSTRACT: Patients' reaction to chemotherapy is directly related to the state of their ho... more 2 � ABSTRACT: Patients' reaction to chemotherapy is directly related to the state of their hormonal receptors. In most cases, studies on the chemoprevention of breast cancer use women with a not necessarily hormone-sensitive high risk of breast cancer (using the Gail Model). This study compared the capabilities of a new hybrid model and the Gail model in selecting women to chemoprevention. The objective was to determine the better method to select women who should be benefited with breast cancer chemoprevention. The new hybrid model was constructed using fuzzy sets classification of risk factors and crispy rules (constructed by translating physicians' perceptions of hormone-sensitive breast cancer's risk). This model considered age, age at menarche, number of previous biopsies, number of relatives affected by breast cancer, and age at first live birth. Since the new model had been developed, we calculated and compared the risks by Gail Model and by fuzzy hybrid model. Th...
International Journal of Gynecologic Cancer, 2004
Perspectivas Médicas, 2017
Não existem conflitos de interesse RESUMO O câncer de mama é atualmente um dos grandes desafios d... more Não existem conflitos de interesse RESUMO O câncer de mama é atualmente um dos grandes desafios da saúde pública, sendo o segundo mais incidente na população feminina mundial e brasileira. O estudo descritivo e transversal objetivou identificar os fatores associados ao risco para o câncer de mama e medidas de prevenção para a doença. Foi desenvolvido com 191 mulheres de uma instituição de ensino superior de Jundiaí-SP, em 2013. As mulheres responderam a um questionário com aspectos sociodemográficos, m ó r b i d o s f a m i l i a re s , re p ro d u t i v o s e relacionados à realização de medidas preventivas. Para as ≥ 35 anos de idade foi
Revista Brasileira de Ginecologia e Obstetrícia, Dec 18, 2017
Objective To evaluate the relation between changes the body mass index (BMI) percentile, reflecte... more Objective To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes. Methods A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequate weight, overweight, and obese. The BMI was calculated at the first and at the last prenatal care visits, and these values were compared. Results An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24-0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetal macrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83). Conclusion Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn. Resumo Objetivo Avaliar a relação entre mudanças no percentual do índice de massa corporal (IMC), refletidas na curva de Atalah, e resultados perinatais. Métodos Foi realizado um estudo transversal com 1.279 mulheres. Os dados sobre o peso na gestação, características sociodemográficas e resultados perinatais foram
The European Journal of Contraception & Reproductive Health Care, Oct 26, 2022
Revista Brasileira de Ginecologia e Obstetrícia, Aug 1, 2009
Artigo original Resumo OBJETIVO: determinar a variação de peso de mulheres com diferentes Índices... more Artigo original Resumo OBJETIVO: determinar a variação de peso de mulheres com diferentes Índices de Massa Corporal (IMC), usuárias do injetável trimestral de acetato de medroxiprogesterona de depósito (AMPD) e compará-la à de mulheres em uso de método não hormonal. MÉTODOS: Estudo retrospectivo com revisão de prontuários de 226 usuárias de AMPD e 603 controles usuárias de DIU TCu380A. As mulheres foram distribuídas conforme o IMC inicial nas categorias de peso normal (<25 kg/m 2), sobrepeso (25 a 29,9 kg/m 2) e obesas (≥30 kg/m 2) e seguidas anualmente durante seis anos com medidas de peso e IMC. Aplicou-se o teste estatístico ANOVA para medir a variação de peso entre os grupos em cada categoria de IMC a cada ano. RESULTADOS: a média de idade no início do uso do método foi maior no grupo de estudo do que no controle em todas as categorias de IMC 31,6 ± DP 7,1 X 27,4 ± DP 5,5 na categoria peso normal (p<0,0001); 37,3 ± DP 6,8 X 29,2± DP 6,0 na categoria sobrepeso (p<0,0001); e 35,3 ± DP 6,4 X 29,7 ± DP 5,8 na categoria obesas (p<0,0001). As usuárias de AMPD tiveram elevação de peso em relação às controles na categoria de sobrepeso (p=0,0082); e o aumento de peso em relação ao tempo também foi maior no grupo de usuárias de AMPD do que nas controles para as categorias de peso normal (p<0,0001) e sobrepeso (p=0,0008). No grupo de obesas não houve variação do IMC entre os grupos nem em relação ao tempo de uso do método. CONCLUSÕES: não houve variação de ganho de peso em mulheres obesas usuárias de AMPD. Estudos prospectivos deverão ser realizados com testes metabólicos para determinar os fatores desencadeadores do ganho de peso em mulheres com peso normal e sobrepeso.
International journal of gynaecology and obstetrics, Jul 7, 2015
To establish longitudinal reference intervals for pulsatility index (PI) and systolic velocity (S... more To establish longitudinal reference intervals for pulsatility index (PI) and systolic velocity (SV) of the fetal renal artery, and to evaluate their correlation with the amniotic fluid index (AFI). Methods: A prospective longitudinal study was conducted among women with low-risk pregnancies who attended outpatient clinics at the University of Campinas Medical School, Brazil, at 16-19 weeks of pregnancy between April 1, 2008, and March 31, 2010. Doppler velocimetric measurements of the fetal renal artery and assessments of the AFI were undertaken at 4-week intervals to 36 weeks, and every 2 weeks thereafter until delivery. Results: A total of 63 women were enrolled. The PI of the fetal renal artery showed little variation during pregnancy, whereas SV values increased to 36-37 weeks of pregnancy and decreased thereafter. No correlations were found between the AFI and the fetal renal artery Doppler velocimetric parameters (P N 0.05 for all). The intraclass correlation coefficients for intra-observer and inter-observer variability indicated good reproducibility of SV, but the reproducibility of PI was lower. Conclusions: The AFI did not correlate with fetal renal artery Doppler velocimetric measures among low-risk pregnancies. However, investigations are needed among high-risk pregnancies.
PubMed, 2008
The study aimed to analyze the Pap smears carried out for cervical cancer screening according to ... more The study aimed to analyze the Pap smears carried out for cervical cancer screening according to Ministry of Health guidelines. All smear tests carried out within the public health system in Campinas in 2003 were analyzed. All tests that did not conform to the guidelines were considered excessive. The guidelines recommend screening once every three years for all women aged 25 to 59 after they have received two negative smears. This study showed that the majority of women initiated screening prior to 25 years of age and the periodicity was predominantly annual, followed by biannual tests. In conclusion, 63.4% of tests were excessive. The screening coverage was 14.76%, but if all the tests had been performed as recommended, the final coverage over three years could have reached 65.4%. Thus it is possible to increase the coverage with the available resources since the screening works like an organized program.
Journal of Maternal-fetal & Neonatal Medicine, Mar 17, 2015
To analyze the relationship between parity, prepregnancy Body Mass Index (BMI), and gestational w... more To analyze the relationship between parity, prepregnancy Body Mass Index (BMI), and gestational weight gain (GWG). This observational controlled study was conducted from November 2013 to April 2014, with postpartum women who started antenatal care up to 14 weeks and had full term births. Data were collected from medical records and antenatal cards. Descriptive and bivariate analyses were performed. The significance level was 5%. Data were collected from 130 primiparous and 160 multiparous women. At the beginning of prenatal care, 54.62% of the primiparous were eutrophic, while the majority of multiparous were overweight or obese (62.51%). Multiparas are two times more likely to be obese at the start of their pregnancies when compared to primiparas. The average prepregnancy weight and final pregnancy weight was significantly higher in multiparous, however the mean GWG was higher among primiparous. We found an inverse correlation between parity and the total GWG, but starting BMI was significantly higher in multiparasNevertheless, monitoring of the GWG through actions that promote a healthier lifestyle is needed, regardless of parity and nutritional status, in order to prevent excessive GWG and postpartum weight retention and consequently inadequate prepregnancy nutritional status in future pregnancies.
Brazilian Journal of Nephrology, Jan 9, 2023
Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao l... more Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao longo de suas vidas. Este estudo visou avaliar histórico sociodemográfico, clínico e obstétrico de mulheres em hemodiálise. Métodos: Realizamos estudo transversal em unidade de saúde especializada com quatro unidades de hemodiálise. Avaliou-se características sociodemográficas, histórico clínico e pessoal, resultados obstétricos e perinatais de mulheres com gestações anteriores à hemodiálise. Foram realizadas análises de prevalência, bivariadas e regressão logística. Resultados: Incluímos 208 (87,76%) mulheres. Hipertensão foi a principal causa de doença renal crônica (DRC) (128 mulheres). Taxas de desfechos perinatais adversos, incluindo prematuridade, baixo peso ao nascer, aborto espontâneo, óbito fetal e neonatal, foram de 19,3%, 14,5%, 25,5%, 12,1% e 5,3%, respectivamente. Síndromes hipertensivas durante a gestação ocorreram em 37,0% das mulheres, com 12,5% relatando préeclâmpsia e 1,4% relatando eclampsia. Até 1 ano após o parto, 45,2% das mulheres relataram hipertensão. Hemodiálise devido à hipertensão foi associada ao histórico de hipertensão na gestação (OR 2,33; IC 1,27-4,24), hipertensão gestacional (2,41; IC 3,30-4,45), e hipertensão até um ano após o parto (OR 1,98; IC 1,11-3,51). A regressão logística mostrou que hipertensão gestacional foi independentemente associada à DRC devido à hipertensão (ORa 2,76; IC 1,45-5,24). Conclusão: Mulheres submetidas à hemodiálise por hipertensão foram mais propensas a apresentar hipertensão gestacional ou hipertensão até um ano após o parto. Para retardar a doença renal em estágio terminal, deve-se identificar mulheres em risco de insuficiência renal de acordo com sua história reprodutiva. Resumo Introduction: Pregnancy-related complications may impact women's reproductive cycle and health through their lives. The objective of this study was to evaluate the sociodemographic, clinical, and obstetric history of women undergoing hemodialysis. Methods: We performed a cross-sectional study in a specialized health facility with four hemodialysis units. Sociodemographic characteristics, clinical and personal history, obstetric and perinatal results of women with pregnancies before hemodialysis were evaluated. Prevalence, bivariate, and logistic regression analyses were performed. Results: We included 208 (87.76%) women. Hypertension was the main cause of chronic kidney disease (CKD) (128 women). Rates of adverse perinatal outcomes, including prematurity, low birth weight, miscarriage, fetal death, and neonatal death, were 19.3%, 14.5%, 25.5%, 12.1%, and 5.3%, respectively. Hypertensive syndromes during pregnancy occurred in 37.0% of women, with 12.5% reporting preeclampsia and 1.4% reporting eclampsia. Up to 1 year after birth, 45.2% of women reported hypertension. Hemodialysis due to hypertension was associated with a history of hypertension during pregnancy (OR 2.33, CI 1.27-4.24), gestational hypertension (2.41, CI 3.30-4.45), and hypertension up to one year after birth (OR 1.98, CI 1.11-3.51). Logistic regression showed that gestational hypertension was independently associated with CKD due to hypertension (aOR 2.76, CI 1.45-5.24). Conclusion: Women undergoing hemodialysis due to hypertension were more likely to have gestational hypertension or hypertension up to one year after birth. To delay end-stage renal disease, it is necessary to identify women at risk of kidney failure according to their reproductive history.
Prenatal Diagnosis, Dec 1, 2017
Bulleted statements: Growth pattern of fetuses with gastroschisis is not fully elucidated and cau... more Bulleted statements: Growth pattern of fetuses with gastroschisis is not fully elucidated and causes controversy in time to delivery, increasing prematurity and neonatal morbidity. This study created specific curves for gastroschisis and Umbilical Artery Doppler velocimetry patterns were obtained. We concluded that these fetuses show symmetrical growth deficits for all biometric parameters, being constitutionally smaller and would be better followed-up using specific growth charts.
Maturitas, Feb 1, 2007
Objective: The objective of this study was to evaluate gynecologists' knowledge of the WHI study,... more Objective: The objective of this study was to evaluate gynecologists' knowledge of the WHI study, and its repercussions on their attitudes and practice 3 years after publication. Design: A self-administered, anonymous questionnaire containing 19 questions was sent to 6000 gynecologists, members of the São Paulo Society of Obstetrics and Gynecology. Results: The response rate was 24.2% (1453 completed questionnaires) with a sample error of 2.23% and confidence level of 95%. Although 95.9% of the respondents were aware of the WHI study, only 24.4% knew of all the other studies mentioned (HERS I, HERS II and Million Women Study). Although 84.6% stated that the results of the WHI study could not be extrapolated to other forms of HT, 23.1% and 25.2%, respectively, stopped prescribing CEE or MPA, 63.7% decreased the dose, 55.2% opted for drugs such as bisphosphonates, tibolone and SERMS, and 46.3% began to prescribe tranquilizers, isoflavone and other natural medications. Moreover, 59.2% agreed that HT should be used for only 4-5 years. Prescriptions decreased significantly for all indications (p < 0.0001). The principal reason for physicians to discontinue HT in a patient was increased risk of breast cancer (62.3%), whereas, according to the physicians, the most important factor for the patients was fear of HT (80.3%). Conclusion: A high percentage of gynecologists in this study knew of the WHI study and followed its recommendations concerning cardiovascular prevention; consequently they changed their management of the treatment of postmenopausal women by restricting indications for HT and decreasing its duration of use and dose.
Revista Brasileira de Ginecologia e Obstetrícia, Jun 27, 2019
Objective The aim of this study was to investigate the knowledge concerning gestational weight ga... more Objective The aim of this study was to investigate the knowledge concerning gestational weight gain (GWG), nutrition, and physical exercise (PE) in pregnant women, and how to put them into practice. Methods A cross-sectional study with 61 pregnant women above 26 weeks of gestation, at the Woman's Hospital, CAISM, University of Campinas. Questionnaires regarding the knowledge of healthy habits (HH) during pregnancy, sociodemographic data, and previous obstetric outcomes were applied. An educational guide with advice on HH during pregnancy and in the postpartum period was offered. Results The average age of women was 28.7 AE 6.23 years, with 85% of them being married; 32% nulliparous; the average body mass index (BMI) before pregnancy was 25.4 AE 9.8 kg/m 2 , and the mean number of years of schooling was 11.2 AE 3.8. Only 61% of the subjects had received any previous information about GWG during their antenatal care and were aware as to how many pounds they should gain during pregnancy. Among the 61 women, 85% understood that they did not need to "eat for 2" and 99% knew that PE had benefits for their body and was safe for their baby. Half of the women practiced PE prior to pregnancy; however, only 31% continued the practice of PE during the pregnancy. Conclusion Despite understanding the need for HH during pregnancy, women still need encouragement to practice PE during pregnancy, as well as more information about GWG. Resumo Objetivo O objetivo deste estudo foi investigar os conhecimentos sobre ganho de peso gestacional (GPG), nutrição, e exercício físico (EF) em gestantes e o quanto elas os colocam em prática. Métodos Estudo transversal realizado no Hospital da Mulher, CAISM, Unicamp, com 61 gestantes acima das 26 semanas gestacionais. Questionários sobre conhecimento
Journal of Obstetrics and Gynaecology, Aug 24, 2022
Clinics, 2017
OBJECTIVE: To generate a new body mass index curve of reference values and ranges for body mass i... more OBJECTIVE: To generate a new body mass index curve of reference values and ranges for body mass index and weight gain during pregnancy and to compare the new curve and weight gain ranges with the currently used references. METHODS: A prospective observational study was conducted with a total of 5,656 weight and body mass index measurements in 641 women with single pregnancy who attended their first prenatal visit before 12 weeks. All the women were over 18 years old and had no medical conditions that would influence body mass index. Data were collected using prenatal charts and medical records during hospitalization for childbirth. A linear regression method was used for standard curve smoothing in the general population and for specific curves according to the baseline body mass index classification. Curves were obtained for the 5 th , 10 th , 50 th , 85 th , 90 th and 95 th percentiles. Concordance between the classification of women using the newly generated and currently used curves was evaluated by percentages and kappa coefficients. The weight gain was compared with the reference values of the Institute of Medicine using Student's T test. The data were analyzed using SAS software version 9.2, and the significance level was set at 5%. RESULTS: A general reference curve of percentiles of body mass index by gestational age was established. Additionally, four specific curves were generated according to the four baseline body mass index categories. The new general curve offered percentile limits for women according to their initial body mass index and according to the Centers for Disease Control and Prevention limits, showing poor agreement with the currently used curve (48.3%). Women who were overweight or obese when starting prenatal care had higher weight gain than the Institute of Medicine recommendation. CONCLUSIONS: The new proposed curve for body mass index during pregnancy showed weak agreement with the currently used curve. The new curve provided more information regarding body mass index increase using percentiles for general and specific groups of body mass index. Overweight pregnant women showed an upward body mass index trend throughout pregnancy that increased more dramatically than those of other groups of pregnant women, and they also presented a major mean difference between weight gain and the Institute of Medicine recommendation.
Brazilian Journal of Nephrology, Jan 9, 2023
Gestational hypertension as a factor associated with chronic kidney disease: the importance of ob... more Gestational hypertension as a factor associated with chronic kidney disease: the importance of obstetric history of women undergoing hemodialysis Hipertensão gestacional como fator associado à doença renal crônica: a importância do histórico obstétrico de mulheres submetidas à hemodiálise Introdução: Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao longo de suas vidas. Este estudo visou avaliar histórico sociodemográfico, clínico e obstétrico de mulheres em hemodiálise. Métodos: Realizamos estudo transversal em unidade de saúde especializada com quatro unidades de hemodiálise. Avaliou-se características sociodemográficas, histórico clínico e pessoal, resultados obstétricos e perinatais de mulheres com gestações anteriores à hemodiálise. Foram realizadas análises de prevalência, bivariadas e regressão logística. Resultados: Incluímos 208 (87,76%) mulheres. Hipertensão foi a principal causa de doença renal crônica (DRC) (128 mulheres). Taxas de desfechos perinatais adversos, incluindo prematuridade, baixo peso ao nascer, aborto espontâneo, óbito fetal e neonatal, foram de 19,3%, 14,5%, 25,5%, 12,1% e 5,3%, respectivamente. Síndromes hipertensivas durante a gestação ocorreram em 37,0% das mulheres, com 12,5% relatando pré-eclâmpsia e 1,4% relatando eclampsia. Até 1 ano após o parto, 45,2% das mulheres relataram hipertensão. Hemodiálise devido à hipertensão foi associada ao histórico de hipertensão na gestação (OR 2,33; IC 1,27-4,24), hipertensão gestacional (2,41; IC 3,30-4,45), e hipertensão até um ano após o parto (OR 1,98; IC 1,11-3,51). A regressão logística mostrou que hipertensão gestacional foi independentemente associada à DRC devido à hipertensão (ORa 2,76; IC 1,45-5,24). Conclusão: Mulheres submetidas à hemodiálise por hipertensão foram mais propensas a apresentar hipertensão gestacional ou hipertensão até um ano após o parto. Para retardar a doença renal em estágio terminal, deve-se identificar mulheres em risco de insuficiência renal de acordo com sua história reprodutiva.
Revista Brasileira de Ginecologia e Obstetrícia, 2013
OBJETIVO: Avaliar a correlação entre o International Consultation on Incontinence Questionnaire-U... more OBJETIVO: Avaliar a correlação entre o International Consultation on Incontinence Questionnaire-Urinary Incontinence/Short Form (ICIQ-UI/SF) e a Avaliação Urodinâmica (AU) em mulheres com incontinência urinária (IU). MÉTODOS: Foram analisados retrospectivamente dados clínicos, AU e escore do ICIQ-UI/SF de 358 mulheres com IU atendidas em clínica privada. O teste de correlação entre ICIQ-UI/SF e os parâmetros urodinâmicos foi o teste de Spearman. Foi utilizada a curva ROC, com os valores de sensibilidade e especificidade dos escores do ICIQ-UI/SF apresentados pelas pacientes, para identificar o valor do questionário que determinasse a presença da alteração urodinâmica estudada. Para o cálculo do valor p foi utilizado o teste do χ 2 ou exato de Fisher. O nível de significância foi de 5% e o software utilizado para análise foi o SAS versão 9.2. RESULTADOS: As pacientes com IU aos Esforços segundo a AU-IUE urodinâmica-representaram 67,3% do total; aquelas com IUE na AU e Hiperatividade Detrusora (HD)-IUM urodinâmica-16,2%, e as pacientes com HD isolada-HD-7,3% do total. As pacientes com AU normal representaram 9,2% do total da amostra. Houve associação significativa entre escore ≥14 no ICIQ-UI/SF e as pacientes com IUE urodinâmica e IUM urodinâmica. Pacientes com Pressão de Perda ao Esforço (PPE) ≤90 cmH2O apresentaram escore ao ICIQ-UI/SF≥15. O teste de Spearman mostrou correlação inversa fraca entre o escore e a PPE, porém não mostrou correlação entre esse escore e a Capacidade Cistométrica Máxima (CCM) ou com o volume vesical no primeiro desejo miccional. CONCLUSÃO: Houve associação entre o escore do ICIQ-UI/SF e IUE urodinâmica (isolada ou associada à HD); porém não houve associação com a HD isolada. Quanto menor o valor da PPE, maior o escore total do ICIQ-UI/SF. O ICIQ-UI/SF não foi capaz de discriminar o tipo de IU na população estudada.
2 � ABSTRACT: Patients' reaction to chemotherapy is directly related to the state of their ho... more 2 � ABSTRACT: Patients' reaction to chemotherapy is directly related to the state of their hormonal receptors. In most cases, studies on the chemoprevention of breast cancer use women with a not necessarily hormone-sensitive high risk of breast cancer (using the Gail Model). This study compared the capabilities of a new hybrid model and the Gail model in selecting women to chemoprevention. The objective was to determine the better method to select women who should be benefited with breast cancer chemoprevention. The new hybrid model was constructed using fuzzy sets classification of risk factors and crispy rules (constructed by translating physicians' perceptions of hormone-sensitive breast cancer's risk). This model considered age, age at menarche, number of previous biopsies, number of relatives affected by breast cancer, and age at first live birth. Since the new model had been developed, we calculated and compared the risks by Gail Model and by fuzzy hybrid model. Th...
International Journal of Gynecologic Cancer, 2004