Daniele Marano

Objective: We aimed to evaluate the association between pre-pregnancy excess weight and the adequacy of the ω-6/ω-3 ratio using a directed acyclic graph (DAG) to guide the selection of potential confounders. Methods: We conducted a cross-sectional study with 89 lactating women visiting a breast milk bank in Rio de Janeiro, Brazil. Pre-pregnancy excess weight was assessed using the body mass index according to World Health Organization criteria. ω-6 and ω-3 levels were determined by gas chromatography, and their ratios were calculated and categorized, with a ratio of greater than 10 being considered inadequate in accordance with dietary intake recommendations for these fatty acids. A DAG was constructed to identify a minimally sufficient set of confounders, including maternal age, socioeconomic status, parity, interbirth interval and food consumption patterns. Prevalence ratios were estimated using Poisson regression with robust variance. Results: The mean ω-6/ω-3 ratio was 10.8. Prevalence of inadequate ω-6/ω-3 ratio was higher in women with pre-pregnancy excess weight compared to women with normal pre-pregnancy weight. After adjusting for the confounders identified by the DAG, prevalence of inadequate ω-6/ω-3 ratio was higher among women with pre-pregnancy excess weight (PR = 1.35; 95% CI: 1.02–1.78). Conclusions: Pre-pregnancy excess weight is associated with an unfavorable breast milk lipid profile characterized by an imbalance in the ω-3 to ω-6 essential fatty acid ratio. The use of a DAG-based approach enables parsimonious and theoretically grounded adjustment for potential confounders, contributing to greater robustness of the findings. Our results underscore the importance of nutritional care strategies during the preconception period to promote maternal and child health.

The scope of this thematic issue is to address strategic issues and innovations related to the health of women, children and adolescents, while engaging with other populations in situations of vulnerability and sundry at-risk groups. It reflects part of what the Graduate Program in Child and Women’s Health (PPGSCM-IFF/Fiocruz) has been building over the years: knowledge produced in collaboration with national and international institutions and research groups, grounded in the experiences, struggles, and challenges encountered in day-to-day health care practice and service delivery¹.

This article aims to analyze the factors associated with neonatal near miss (NMN) in public and private hospitals in the Southeast region of Brazil. A prospective cohort study with 7,552 live births from singleton pregnancies from the “Born in Brazil II” study (2021-2023). NMN was defined according to the criteria of Pileggi-Castro et al. (2014), and the independent variables were organized in a hierarchical model: distal level (sociodemographic characteristics), intermediate level (maternal conditions and prenatal care), and proximal level (obstetric complications, type of delivery, and sex of the newborn). Neonatal mortality (NMN) occurred in 12.5% of live births. After adjustment, the following were associated with the outcome: urban residence (OR=1.75), absence of a partner (OR=1.36), hypertensive syndromes of pregnancy, pre-gestational diabetes (OR=2.76), syphilis (OR=5.44), less than 50% of prenatal visits (OR=2.14), alcoholism (OR=1.50), severe maternal morbidity (OR=1.96), forceps/vacuum delivery (OR=2.39), and male sex (OR=1.23). NMN was associated with clinical, sociodemographic, and care determinants, highlighting persistent inequalities in prenatal and intrapartum care and the need to strengthen integrated maternal and neonatal care policies.

Resumo O objetivo deste artigo é analisar os fatores associados ao near miss neonatal (NMN) em hospitais públicos e privados da região Sudeste do Brasil. Estudo de coorte prospectiva com 7.552 nascidos vivos de gestações únicas do estudo Nascer no Brasil II (2021-2025). O NMN foi definido pelos critérios de Pileggi-Castro et al. (2014) e as variáveis independentes foram organizadas em modelo hierárquico: nível distal (características sociodemográficas), intermediário (condições maternas e assistência pré-natal) e proximal (complicações obstétricas, tipo de parto e sexo do recém-nascido). O NMN ocorreu em 12,5% dos nascidos vivos. Após ajuste, associaram-se ao desfecho: residência urbana (OR=1,75), ausência de companheiro (OR=1,36), síndromes hipertensivas da gestação, diabetes pré-gestacional (OR=2,76), sífilis (OR=5,44), realização de menos de 50% das consultas pré-natais (OR=2,14), etilismo (OR=1,50), morbidade materna grave (OR=1,96), parto por fórceps/vácuo (OR=2,39) e sexo masculino (OR=1,23). O NMN associou-se a determinantes clínicos, sociodemográficos e assistenciais, evidenciando desigualdades persistentes na atenção pré-natal e intraparto e a necessidade de fortalecer políticas integradas de cuidado materno e neonatal.

This article aims to evaluate the association between mode of delivery, obstetric practices, and reason for cesarean section with depressive symptoms in postpartum women up to one year postpartum. Cross-sectional study using data from the 2019 National Health Survey, including women aged >15 years and up to 12 months postpartum. Variables: mode of delivery, obstetric interventions, reasons for cesarean section, and postpartum depressive symptoms. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9>4 symptoms of mild depression and ≥9 as severe). STATA 15.0 was used for the analyses, with Directed Acyclic Graphs supporting confounding variables. A total of 986 postpartum women were analyzed. The prevalence of severe depressive symptoms was 13.1%. Of the total, 54.8% underwent cesarean section, 65.3% without appropriate indication. There was no association between type of delivery and depression, nor between obstetric practices during vaginal delivery and depression. The odds of mild depression symptoms (PHQ-9>4) were higher when cesarean section was the physician’s choice during prenatal care compared with cesarean sections indicated due to complications. Unnecessary cesarean sections may increase maternal psychological vulnerability. The importance of prenatal care focused on preparing women to make their decisions is emphasized.

Resumo O objetivo deste artigo é avaliar associação entre via de parto, práticas obstétricas e motivo de cesariana com sintomas depressivos em puérperas até um ano pós-parto. Estudo transversal, com dados da Pesquisa Nacional de Saúde 2019, incluindo mulheres >15 anos, até 12 meses pós-parto. Variáveis: tipo de parto, intervenções obstétricas, motivos de cesariana e sintomas depressivos pós-parto. Sintomas depressivos foram avaliados pelo Patient Health Questionnaire-9 (PHQ-9>4 sintomas de depressão leve e ≥9 como grave). Para as análises, utilizou-se STATA 15.0, com apoio de Gráficos Acíclicos Direcionados para variáveis confundidoras. Foram analisadas 986 puérperas. A prevalência de sintomas depressivos moderados/graves foi 13,1%. Do total, 54,8% realizaram cesariana, sendo 65,3% sem indicação adequada. Não houve associação entre tipo de parto e depressão, nem entre práticas obstétricas no parto normal e depressão. A chance de sintomas de depressão leves (PHQ-9>4) foi maior quando a cesariana foi escolha do médico no pré-natal comparadas às cesarianas indicadas por complicações. Cesarianas desnecessárias podem aumentar a vulnerabilidade psicológica materna. Ressalta-se a importância do pré-natal voltado ao preparo da mulher, com respeito às suas decisões.

Este número temático tuvo como objetivo abordar cuestiones estratégicas e innovaciones relacionadas con la salud de niños, mujeres y adolescentes, en diálogo con otros grupos vulnerables y otros titulares de derechos. Expresa parte de lo que el Programa de Posgrado en Salud Infantil y de la Mujer (PPGSCM-IFF/Fiocruz) ha venido construyendo a lo largo de los años: una producción realizada en colaboración con diferentes instituciones y grupos de investigación nacionales e internacionales, comprometidos con las experiencias, las luchas y los desafíos que se presentan en la práctica diaria de la atención y los servicios de salud¹.

Resumen El objetivo es comparar el porcentaje de anticuerpos neutralizantes frente a las variantes Wuhan y Omicron en la leche y la sangre de lactantes inmunizados contra el SRAS-CoV-2 en función del número de dosis y las tecnologías vacunales utilizadas. Estudio transversal realizado en 2022 con 214 mujeres lactantes inmunizadas contra COVID-19 con vacunas de ARNm, vector viral no replicante o virus completo inactivado. Datos recolectados mediante cuestionario estandarizado y muestras de leche materna y sangre. Anticuerpos detectados por el método ELISA. Se consideró un nivel de significación del 5%. El porcentaje de anticuerpos fue mayor en sangre que en leche para las variantes Wuhan (sangre-91-3%/leche-23-1%) y Omicron (sangre-83-7%/leche-15-2%). Entre las mujeres que recibieron tres o más dosis, la sangre mostró porcentajes más elevados para las variantes Wuhan y Omicron. En la leche, aunque no se encontró disparidad en el porcentaje de anticuerpos, la probabilidad de que hubiera anticuerpos fue mayor que en la sangre para ambas variantes. Las tecnologías de vacunas dieron lugar a diferencias significativas en la presencia de anticuerpos en la leche, pero no en la sangre a lo largo del tiempo para la variante Omicron. No se observaron diferencias en el caso de la variante Wuhan. La protección conferida por los anticuerpos presentes en la leche duró más que en la sangre.

The aim is to compare the percentage of antibodies with neutralizing potential to Wuhan and Omicron variants in the milk and blood of lactating women immunized for SARS-CoV-2 based on the number of doses, vaccine technologies used. Cross-sectional study conducted in 2022 with 214 lactating women vaccinated for COVID-19 with mRNA, non-replicating viral vector or inactivated whole virus vaccines. Data gathered via standardized questionnaire, and samples of breast milk and blood. Antibodies detected by the ELISA method. A significance level of 5% was considered. Blood had higher neutralizing antibodies percentage than milk for Wuhan (blood-91·3%/milk-23·1%) and Omicron (blood-83·7%/milk-15·2%) variants. Women receiving three or more doses had higher blood antibody percentages for Wuhan and Omicron variants. In milk, no disparity in the percentage of antibodies was found, but the probability of antibodies’ presence was higher than in blood for both variants. Vaccine technologies led to significant differences in the presence of antibodies in milk but not in blood over time for Omicron variant. No difference was observed for Wuhan variant. Protection conferred by antibodies present in milk lasted longer than in blood.