Rossana Pulcineli Vieira Francisco

To compare maternal serum CRIPTO‐1 concentrations in pregnancies complicated by placenta accreta spectrum (PAS) with those complicated by placenta previa (PP). We conducted a prospective, cross‐sectional, comparative study at a tertiary center in São Paulo, Brazil (August 2022–May 2025). Singleton pregnancies with ultrasound‐confirmed PP were included and classified as either PP without accreta or PAS (accreta/increta/percreta) according to standardized imaging criteria and, when applicable, surgical/histopathological confirmation. Maternal venous blood was collected predelivery, and serum CRIPTO‐1 concentrations were measured using ELISA (Human CRIPTO SimpleStep ELISA Kit, Abcam). Primary analyses used nonparametric tests for continuous variables and Fisher′s exact test for categorical variables. The study was approved by the Research Ethics Committee of the University of São Paulo (CAAE 58202122.8.0000.0065; CAAE 55121422.3.0000.0068). Forty‐three participants were analyzed (PP = 18; PAS = 25). Median serum CRIPTO‐1 did not differ significantly between groups (PP: 0.013 pg/mL, IQR: 0.001–0.067 vs. PAS: 0.079 pg/mL, IQR: 0.005–0.360; p = 0.156). PAS was associated with greater blood loss (median 2240 vs. 568 mL; p < 0.001), higher transfusion rate (88.0% vs. 16.7%; p < 0.001), more ICU admissions (68.0% vs. 16.7%; p = 0.002), longer ICU and hospital stays (both p < 0.01), and higher hysterectomy rates (84.0% vs. 5.6%; p < 0.001). Predelivery serum CRIPTO‐1 did not discriminate PAS from PP, possibly reflecting physiological variability at delivery.

To evaluate clinical and immunological characteristics associated with adverse perinatal outcomes among pregnant people living with HIV (PPLH). This retrospective cohort study included singleton pregnancies of PPLH followed between 2006 and 2019 at a Brazilian tertiary referral center for high-risk pregnancies. Clinical and HIV-related data, including viral load (VL), CD4+ cell count, lymphopenia, and opportunistic infections (OI), were obtained from medical records. The primary endpoint was a composite adverse perinatal outcome defined as preterm birth (PTB) and/or low birth weight (LBW). Multivariable logistic regression was performed to identify factors independently associated with adverse outcomes. A total of 167 pregnancies were analyzed. The prevalence of the composite adverse perinatal outcome was 28.1%. Adverse outcomes were associated with previous opportunistic infection (p = 0.049), gestational opportunistic infection (p = 0.019), higher baseline viral load (p = 0.049), baseline lymphopenia (p = 0.002), lower body mass index (p = 0.044), lower CD4 cell count at 34 weeks (p = 0.014), and lack of viral suppression at 34 weeks (p = 0.008). In multivariable analysis, baseline VL (adjusted OR = 1.73, 95% CI = 1.10-2.99) and baseline lymphopenia (adjusted OR = 7.67, 95% CI = 1.37-42.8) remained independently associated with adverse perinatal outcomes. Adverse perinatal outcomes remain frequent among PPLH. Baseline viral load and lymphopenia were independently associated with PTB and/or LBW, highlighting the importance of early viral suppression and immune stabilization during pregnancy.

Background: Antepartum stillbirth is an important public health issue. This study aimed to identify mediation pathways from the vegetation greenness surrounding the maternal residence to antepartum stillbirth, through stillbirth risk factors. Methods: This study is part of the FetRisks project–a population-based case–control study of stillbirth and live births in 14 public hospitals in the Municipality of São Paulo, Brazil (December 2019–December 2023). We estimated vegetation greenness using the median value of the normalized difference vegetation index (NDVI) obtained from satellite images from the study period, considering buffer radii around the residences between 50 and 500 m. We used penalized logistic regressions to select maternal, placental, fetal, and neighborhood characteristics. Based on these data, we built a Bayesian network and performed counterfactual mediation analyses. Results: We analyzed 248 antepartum stillbirths (cases) and 301 live births (controls). The maternal residence of 19.4% (48/248) of cases and 30.9% (93/301) of controls had a median NDVI within a buffer radius of 150 m (NDVI-150m) greater than 0.104. Women living in residences with a median NDVI-150m greater than 0.104 had a lower risk of antepartum stillbirth (odds ratio: 0.50; 95% confidence interval [CI]: 0.33, 0.76). Fetal growth restriction and placental inflammatory signs mediated 38.5% (natural indirect effect: −0.0604; 95% CI: −0.0916, −0.0292) and 14.7% (natural indirect effect: −0.0230; 95% CI: −0.0412, −0.0047) of the effect of a median NDVI-150m greater than 0.104 on antepartum stillbirth, respectively. Conclusion: Higher residential vegetation greenness showed protective indirect effects on antepartum stillbirth partially through a lower risk of fetal growth restriction and placental inflammatory signs.

Background: The COVID-19 pandemic created a disruptive scenario with an increase in the prevalence of postpartum depression (PPD) and new associated risk factors, which deserve to be better studied, in different global contexts, which led to the present systematic review study. Methods: Observational studies published in English, Portuguese, and Spanish between 2020 and 2025 were included, and a meta-analysis was conducted using a random-effects model. Results: An initial survey of 1741 articles, of which 90 studies were selected with a total of 64,6994 women evaluated for PPD, with a range between 50 (1) and 5,134 (2) women. The overall prevalence of postpartum depression during the COVID-19 pandemic was 28.48% (25.14—31.94), with rates of 23.52% (18.961—28.40) in studies that used the Edinburgh Postnatal Depression Scale (EPDS) as a diagnostic instrument with a cutoff point ≥ 13. Studies from 31 countries were included, with higher prevalence observed in Latin America (34.08%), with lower rates in Europe (31.50%), the Middle East (29.31%), USA/Canada (24.26%), and Asia (22.32%). There was a higher prevalence of PPD in countries with a lower Human Development Index (HDI) (30.95%), with higher COVID-19 CFR (32.56%), higher maternal mortality (30.43%); and with the highest Gender Inequality Index (GII) (35.41%). PPD rates increased with postpartum time, varying between 18.31% (up to 1 month), 20.78% (up to 3 months), 34.67% (up to 6 months) and 36.55% (up to 12 months). Additionally, 11 protective factors and 53 risk factors were identified, most related to the pandemic, but also with the presence of factors already consolidated in the literature before the pandemic. Discussion: There was a global increase in the prevalence of PPD during the pandemic, with an intensification of pre-existing regional differences, causing the impact of the pandemic to be different according to the region. Conclusions: The social and health crisis of the pandemic negatively impacted postpartum mental health, with significant regional differences. Trial registration: The study was registered in PROSPERO with the code CRD42023392973.

Review the literature to provide guidance on the appropriate clinical and obstetric management of pregnant women with kidney transplants to reduce maternal and perinatal complications. The PubMed and SciELO databases, which evaluated pregnancy and kidney transplantation, were searched, focusing on clinical and obstetric management. Other variables of interest were preconception counseling, fertility, the safety of immunosuppressants, maternal complications, perinatal complications, graft worsening during pregnancy, and postpartum guidance. A total of 354 articles were identified, of which 76 were included in the analysis. Studies suggest that attempts to conceive should begin at least one year after kidney transplantation in the absence of graft rejection, with stable renal function (creatinine < 1.5 mg/dL and minimal proteinuria < 500 mg/24 h), with adjustment of the class and dose of immunosuppressants (preferably corticosteroids, azathioprine, cyclosporine, tacrolimus, and hydroxychloroquine). Preeclampsia prophylaxis with acetylsalicylic acid (81-50 mg/night) and calcium (1-1.5 g/day) should be universal in this group. Monitoring of renal function, fetal growth, and fetal vitality must be frequent. Pregnancy in kidney transplant recipients is challenging due to maternal and perinatal risks. However, the present review demonstrates that clinical and obstetric management by an experienced multidisciplinary team contributes to better maternal and perinatal outcomes in pregnancies among kidney transplant recipients.

Background/Objectives: Preterm birth (PTB) is a leading cause of neonatal mortality, particularly in women with a short cervix. Vaginal dysbiosis has been associated with increased PTB risk. Progesterone (PR) and Arabin pessary (PE) are commonly used for PTB prevention, but their impact on vaginal microbiome composition is unclear. This study aimed to compare the effects of these interventions on the vaginal microbiome in women at risk of PTB. Methods: In a secondary analysis of a randomized trial at Hospital das Clínicas, Universidade de São Paulo, 203 women with singleton pregnancies and cervical length ≤ 25 mm at the second trimester were assigned to daily vaginal PR (200 mg) or PE. Vaginal swabs from 44 participants (n = 22 per group) were collected at baseline and 4 weeks post-treatment and analyzed via 16S rRNA gene sequencing. Results: From 88 samples analyzed, 80 showed a low-diversity, Lactobacillus-dominated microbiota, 42 classified into Lactobacillus iners-dominated community state type (CST-III), and 38 presented other Lactobacillus species dominance (termed CST-I/II/V). The remaining eight samples presented non-Lactobacillus dominance (CST-IV). Comparing the two groups, no significant changes in CST were observed between sampling timepoints (PE group, p = 0.368; PR group, p = 0.223). Similarly, Shannon alpha diversity did not change (PE group, p = 0.62; PR group, p = 0.30), and Bray–Curtis dissimilarity also did not change after treatment (p = 0.96, before; p = 0.87, after treatment). Conclusions: Arabin pessary and vaginal progesterone maintain vaginal microbiome stability in women at high PTB risk, supporting the microbiological safety of both interventions.

The high fertility rate (FR) in adolescents is a global public health problem, with the Americas region having the second highest FR in the world. This study aims to carry out a temporal and spatial analysis of the FR in adolescents in Brazil in the period 2012−2021 and evaluate the effects of primary care population (PCP) coverage on the FR in adolescents in different contexts of human development, measured by the Municipal Human Development Index (HDI-M). This is an ecological study developed in three stages: 1) time trend analysis of the FR in girls aged 10–14 years and 15–19 years; 2) spatial analysis of the FR in girls aged 10–14 years and 15–19 years; and 3) analysis of the effect of PCP coverage on the FR in girls aged 10–19 years in different contexts of HDI-M, before and during the COVID-19 pandemic. In the period from 2012 to 2021, FR for girls aged 10–14 and 15–19 years had a statistically significant decrease, going from 3.4 to 2.4 and from 61.9 to 45.3 per 1,000, respectively. In the year 2021, the downward trend attenuated for girls aged 15–19 years and stopped for girls aged 10–14 years. Clusters with high FR were observed in the North and Midwest regions of the country. Higher FR were observed in municipalities with lower HDI-M and lower PCP coverage, with the increase in PCP coverage having a more intense effect on reducing the FR in municipalities with lower HDI-M. There was an attenuation of the effect of the increase in PCP coverage in the FR during the pandemic period, reinforcing the importance of guaranteeing access to sexual and reproductive health services even in contexts of health crisis.

Background: According to the World Health Organization’s infant and young child feeding guidelines, infants should be exclusively breastfed for the first 6 months of life. Despite public health campaigns to increase exclusive breastfeeding (EBF) rates, socioeconomic inequities persist among low-income breastfeeding mothers, especially in countries with large wealth and health gaps, such as Brazil. Social transfer programs are initiatives that provide financial support to individuals or households to improve their well-being and reduce financial burdens. These may be conditional, requiring recipients to meet specific criteria to receive the transfer, or unconditional, in which recipients receive the transfer without prerequisites. Evidence suggests that conditional and unconditional social transfers may help increase EBF rates while addressing the economic challenges breastfeeding mothers face. A randomized controlled trial (RCT) conducted in Vientiane, Lao People’s Democratic Republic, found that a social transfer program significantly improved both EBF rates at 6 months and EBF duration. Building on this study, we aim to evaluate the impact of this intervention in a different socioeconomic and cultural context. Objective: This protocol aims to implement an RCT to assess whether conditional and unconditional social transfers improve EBF rates at 6 months postpartum for mothers in low-income communities in São Paulo, Brazil. Methods: A prospective RCT will be conducted among 400 mothers who gave birth in the last 72 hours and plan to exclusively breastfeed. Participants will be recruited in São Paulo at the University Hospital of São Paulo and Amparo Maternal. Participants will be randomly assigned to one of the following groups: (1) control group—no social transfer; (2) intervention group 1—an unconditional social transfer at 6 months postpartum; and (3) intervention group 2—a social transfer at 6 months postpartum, conditional upon mothers’ EBF. All groups will receive educational materials supporting EBF. The study will have visits at birth, 1 month, 6 months, 1 year, and 2 years and will include a questionnaire and biological collections of breast milk samples, infant fecal samples, and blood samples (finger pricks) from both the mother and infant. The main study outcomes are the prevalence of EBF at 6 months and the duration of EBF across the 3 groups, where we hypothesize higher rates of EBF among mothers in the conditional group. Results: Recruitment began on March 6, 2024. As of September 2025, we enrolled 204 participants. Our goal is to recruit 400 mother-infant dyads by October 2025, with study visits expected to be completed by October 2027. Conclusions: We hypothesize that the Social Transfers for Exclusive Breastfeeding in Brazil (STEBB) intervention will positively impact breastfeeding mothers in São Paulo. If successful, the program may inform national policy to enhance Brazil’s existing social transfer program for new mothers. Trial Registration: ClinicalTrials.gov NCT06157697; https://clinicaltrials.gov/study/NCT06157697 International Registered Report Identifier (IRRID): DERR1-10.2196/75796

BACKGROUND Healthy eating during pregnancy is fundamental to fetal development and offspring health. However, promoting adequate eating habits faces challenges, such as limited access to and adherence to nutritional recommendations. Mobile health (mHealth) technology, through smartphone applications, has emerged as a promising tool to complement nutritional monitoring in pregnant women. Nevertheless, the quality of information provided by these apps, which often lacks a scientific basis, remains a concern. OBJECTIVE This review aimed to map the effectiveness and practical use of mobile applications in promoting changes in pregnant women's eating habits, with a focus on improving their diet during this critical period. METHODS This scoping review followed the recommendations proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The following databases were searched: PubMed, Web of Science, Scopus, Embase, Cochrane, and BVS (Biblioteca Virtual em Saúde), as well as grey literature (Google Scholar and studies referenced in other articles). The eligibility criteria included all articles published in Portuguese or English up to March 2025 that focused on the use of mHealth applications for nutritional guidance during prenatal care. The descriptors used were maternal health, pregnancy, mHealth, mobile applications, healthy diet, and nutritional education. RESULTS Sixteen articles published between 2018 and 2023 were included after full-text screening. The intervention periods ranged from two weeks to eighteen months. The most frequent gestational age for inclusion in the studies was ≤20 weeks (62.5%). The primary objectives of these applications are managing gestational weight gain, controlling or preventing gestational diabetes mellitus, and providing reliable information on prenatal nutrition and health. Fourteen studies (87.5%) reported beneficial outcomes for pregnant individuals, and all interventions were supplementary to prenatal care without replacing regular consultations. CONCLUSIONS mHealth interventions in prenatal care can contribute to the improvement of health behaviors in pregnant women and serve as complementary tools. Further research involving collaboration among healthcare professionals, technology experts, and policymakers is required to ensure the effectiveness and accessibility of such applications.