Biomarcador de síndrome metabólica está associado a maior gravidade do câncer mamário

A obesidade, que está relacionada a diversas comorbidades incluindo a síndrome metabólica (SM), também tem sido associada ao desenvolvimento e progressão do câncer mamário, que é o tipo de câncer mais frequente entre as mulheres. A SM tem sido associada ao risco, tanto para o desenvolvimento como para o pior prognóstico desse tipo de câncer. Dentre as diversas adipocinas secretadas pelo tecido adiposo encontra-se a proteína transportadora de ácidos graxos de adipócitos (A-FABP), que na obesidade está presente em concentrações mais elevadas e tem sido considerada um marcador de SM. Mais recentemente esta adipocina tem sido associada à carcinogênese e a piores prognósticos de vários tumores, incluindo os de mama. Com o objetivo de avaliar a associação da A-FABP com a SM e as características clinicopatológicas do câncer de mama, 152 pacientes atendidas no CAISM/UNICAMP foram classificadas em três grupos: não obesas (NO), sobrepeso/obesidade (SP/O) e sobrepeso/obesidade com síndrome metabólica (SP/O-SM); e tiveram as concentrações séricas de A-FABP determinadas pela técnica de ELISA. Concentrações mais elevadas de A-FABP foram detectadas no grupo SP/O-SM, sugerindo o papel da A-FABP como um biomarcador da SM, também em pacientes com câncer mamário. Além disso, esta adipocina mostrou associações com fatores de pior prognóstico tanto no grupo SP/O-SM, como no grupo NO. Como essas associações foram mantidas após ajustes das variáveis: índice de massa corpórea, circunferência abdominal e idade/estado menopausal, os resultados sugerem relação da A-FABP com maior gravidade do câncer mamário, independentemente de obesidade e incentivam o estudo mais aprofundado dessas relações.</jats:p

Can pre-eclampsia explain higher cesarean rates in the different groups of Robson's classification?

To evaluate the impact of pre-eclampsia on cesarean delivery by using the Robson classification. A retrospective cross-sectional study including all women who delivered in a referral maternity hospital in southeast Brazil from January 2017 to February 2018. Women were classified into 1 of 10 Robson groups and then further subdivided into pre-eclampsia (PE) and non-PE (NPE) groups. Frequency of cesarean was determined for each group and compared by using χ2 and prevalence ratio.Overall, 3102 women were included, of whom 1578 (50.9%) delivered by cesarean. Classification in Robson group 5 was the most frequent among all women (n=727, 23.4%). In the PE group (n=258, 8.3%), group 10 was the most frequent classification (n=120, 46.5%); in NPE, Robson group 5 was the most frequency (n=682, 24.0%). Pre-eclampsia was associated with a higher occurrence of cesarean (77.5% vs 48.4%; prevalence ratio, 2.29; 95% confidence interval, 1.82–2.82), owing to higher rates in Robson groups 1, 5, and 10.Pre-eclampsia was associated with a higher occurrence of cesarean delivery in some Robson groups. Robson classification may be used to evaluate the impact of specific conditions at a facility level to help plan future interventions to optimize the use of cesarean152333934

Diabetes among women with preterm births: outcomes of a Brazilian multicenter study

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