Elvira Maria Mafaldo Soares

Efeito da Idade Materna sobre os Resultados Perinatais

Purpose: to investigate the interactions between maternal age and adverse perinatal outcomes in the State of Rio Grande do Norte. Methods: we analyzed official records of 57,088 infants in the State of Rio Grande do Norte, from January 1997 to December 1997. Data were obtained from the Information System of the Health Ministry, Brazil. The sample was divided into three Groups I, II and III according to maternal age range: 10 to 19 years, 20 to 34, and 35 or more, respectively. The main outcome variables were: length of pregnancy, birth weight and mode of delivery. Statistical analysis was performed using c2 test. Results: preterm deliveries were 4.3% in the adolescent group vs 3.7% in Group II (p = 0.0028). The incidence of cesarean section was higher in Group II than in the other Groups (p<0.001). Low birth weight was significantly higher in Groups I (8.4%) and III (8.3%) when compared with Group II (6.5%) (p<0.0001). Conclusions: we found a higher incidence of lower birth weight and preterm delivery in the adolescent group. In women ³35 years old there was a high incidence of low birth weight and macrosomia. Results suggest that cesarean sections are more common in women aged 20-34 years than in adolescent and older mothers.

Índices de obesidade central e fatores de risco cardiovascular na síndrome dos ovários policísticos

FUNDAMENTO: A obesidade abdominal apresenta elevada prevalencia em mulheres com sindrome dos ovarios policisticos (SOP) e esta associada a um aumento do risco cardiovascular. OBJETIVO: Verificar a acuracia da circunferencia da cintura (CC), da relacao cintura-quadril (RCQ), da relacao cintura-estatura (RCEST) e do indice de conicidade (indice C), no que se refere a deteccao de fatores de risco cardiovascular (FRCV) em mulheres com SOP. METODOS: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 ± 5 anos) com diagnostico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicerideos (TG), o LDL-colesterol (LDL-C), o HDL-colesterol (HDL-C), a glicemia de jejum, a glicemia apos teste oral de tolerância a glicose (TOTG) e a pressao arterial (PA) foram avaliados em todas as pacientes, alem das variaveis antropometricas. RESULTADOS: A relacao cintura-estatura foi o marcador que apresentou correlacoes positivas significativas com o maior numero de FRCV (PA, TG e glicemia apos TOTG), destacando-se ainda a correlacao negativa com HDL-C. Todos os marcadores antropometricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correlacao positiva tambem com TG. No tocante a acuracia para deteccao de FRCV, os indicadores antropometricos considerados apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEST, que apresentou sensibilidade superior a 70%. CONCLUSAO: A RCEST demonstrou ser o indicador antropometrico com a melhor acuracia para a predicao de FRCV. Nesse sentido, propoe-se a inclusao desse parâmetro de facil mensuracao na avaliacao clinica para o rastreamento de mulheres com SOP e FRCV.BACKGROUND Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. OBJECTIVE To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. METHODS The present transversal study allocated 102 women (26.5 +/- 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. RESULTS The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. CONCLUSION The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF.

Evaluation of cardiovascular risk by the LAP index in non-obese patients with polycystic ovary syndrome

OBJECTIVE To analyze the cardiovascular risk of non-obese women with polycystic ovary syndrome (PCOS) by the LAP index (lipid accumulation product). SUBJECTS AND METHODS 283 patients (18-34 years) assigned at the University Hospital of the Federal University of Rio Grande do Norte, Natal-RN, were divided into four groups: 1) lean PCOS (n = 35); 2) healthy lean (n = 162); 3) overweight PCOS (n = 28); 4) healthy overweight (n = 58). RESULTS Patients with PCOS showed higher values of the LAP index than healthy controls: lean (22.26 vs. 15.87 cm.mmol/L; p = 0.007); overweight (40.83 vs. 26.32 cm.mmol/L; p = 0.001). The percentage of women above the 75th percentile of the LAP index was also higher in the subgroups with PCOS: lean (17.1 vs. 6.8%; p = 0.04); overweight (37.5 vs. 13.8%; p = 0.01). CONCLUSIONS In our sample, patients with PCOS showed higher cardiovascular risk assessed by the LAP index in relation to healthy women, even in the absence of obesity.

Anthropometric indices of central obesity how discriminators of metabolic syndrome in Brazilian women with polycystic ovary syndrome

Background: Central obesity is highly prevalent in women with polycystic ovary syndrome (PCOS) and is strongly associated with metabolic syndrome (MetS). Objectives: To define cut-off points of waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and conicity index (C-Index) to discriminate metabolic syndrome (MetS) in Brazilian women with PCOS. Methods: In a cross-sectional study, anthropometric, biochemical and clinical parameters were measured in 113 Brazilian PCOS women (27.2 ± 4.5 years). Receiver operating characteristic (ROC) analysis was used to find out the cut-off points of anthropometric indices to predict MetS according with National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria. Results: Considering the ROC curve analysis the WC and WHtR had a similar performance in predicting MetS and these parameters were better than WHR and C-Index. The optimal cut-off values of the anthropometric indices for discriminate MetS were: WC = 95 cm; WHtR = 0.59; WHR = 0.88; and C-Index = 1.25. By using these cut-off points the sensitivity and specificity rates of WC and WHtR were higher than those observed for WHR and C-Index.Conclusion: Our results indicated that WC and WHtR are more accurate than WHR and C-Index to predict MetS in Brazilian PCOS women.

Correlação entre as queixas de incontinência urinária de esforço e o pad test de uma hora em mulheres na pós-menopausa

OBJECTIVE: to correlate complaints of stress urinary incontinence and the results of a one-hour pad test in pre- and postmenopausal women. METHODS: cross-sectional study conducted on 60 postmenopausal volunteers divided into two groups: one consisting of 34 women with involuntary loss of urine due to stress incontinence and the other consisting of 26 women without involuntary loss of urine. A control group of 15 premenopausal women with normal menstrual cycles and no urinary complaints was also used. All women underwent clinical and laboratory analysis as well as the one-hour pad test. Patients were considered to be incontinent when sanitary pad weight post-test was more than 1 g. Data were submitted to descriptive statistics, parametric ANOVA, post-hoc Tukey test and Pearsons correlation. RESULTS: all postmenopausal women presented with stress urinary incontinence during the pad test, both those with urinary loss (4 g) and with no previous loss (3.5 g). A strong correlation was observed between urinary loss and time since menopause (r=0.8; p<0.01) and body mass index (r=0.7; p=0.01). Premenopausal women were continent during the pad test (0.4 g). CONCLUSIONS: the results of the one-hour pad test showed that all postmenopausal women exhibited stress urinary incontinence, including those without urine loss on effort. Urine loss was correlated with time since menopause and body mass index.

Aerobic exercise improves cardiac autonomic modulation in women with polycystic ovary syndrome

BACKGROUND This study aimed to evaluate the effects of aerobic exercise on cardiac autonomic modulation in women with polycystic ovary syndrome (PCOS). METHODS Thirty women with PCOS (25.8±4.8 years old; body mass index, BMI≥25 kg/m2) were divided into two groups; exercise group (n=15) and control group (n=15). R-R interval was recorded during 15-min at rest in the supine position. Heart rate variability (HRV) was analyzed by linear (rMSSD, SDNN, LF, HF, LFnu, HFnu, and LF/HF) and nonlinear methods (Shannon entropy, SE; symbolic analyses, 0 V%, 1 V%, 2LV%, and 2UV%) at baseline and after 16 weeks. The multivariate analysis of covariance was used to analyze the effects of exercise on HRV indexes, adjusted for changes in BMI, fasting insulin, and testosterone level. RESULTS The exercise group increased parasympathetic modulation (rMSSD, HF, HFnu, 2UV%; (p<0.05)) and decreased sympathetic modulation (LF, LFnu, 0 V%; (p<0.05)) independently of changes in BMI, fasting insulin, and testosterone level. Moreover, the exercise group decreased resting HR and systolic blood pressure (p<0.05). All parameters remained unchanged in the control group. CONCLUSIONS Aerobic exercise increased vagal modulation and decreased sympathetic modulation in women with PCOS. This finding reinforces the recommendations for exercise during the clinical management of these patients.

Is there a difference in the electromyographic activity of the pelvic floor muscles across the phases of the menstrual cycle

[Purpose] To evaluate the electrical activity of the pelvic floor muscle in women during the follicular, ovulatory, and luteal phases of the menstrual cycle and its correlation with estradiol and total testosterone levels. [Subjects and Methods] This cross-sectional study involved 30 women with ovulatory menstrual cycles. Total testosterone and estradiol levels were measured and the muscle tone and maximum voluntary contraction of the pelvic floor muscles were evaluated using surface electromyography. [Results] Muscle tone was significantly lower during the follicular (21.1±3.3 μV) and ovulatory (27.1±5.9 μV) phases than the luteal phase (30.4±4.1 μV). The maximum voluntary contraction was not different across phases. The estradiol level on the 7th day of the menstrual cycle showed a strong positive correlation with muscle tone and maximum voluntary contraction, and the testosterone level was positively correlated with muscle tone on the 21st day. [Conclusion] Women have better muscle tone during the luteal phase. The muscle tone and maximum voluntary contraction were strongly correlated with the estradiol level on the 7th day, and the muscle tone was correlated with the testosterone level on the 21st day of the menstrual cycle. These findings suggest that hormonal fluctuations during the menstrual cycle alter pelvic floor muscle activity.

Polycystic Ovary Syndrome: Aggressive or Protective Factor for the Retina? Evaluation of Macular Thickness and Retinal Nerve Fiber Layers Using High-Definition Optical Coherence Tomography

Objective. To compare macular thickness (MT) and retinal nerve fiber layers (RNFL) between women with polycystic ovary syndrome (PCOS) and healthy women. Materials and Methods. The study included 45 women with PCOS and 47 ovulatory women undergoing clinical-gynecological and ophthalmic evaluations, including measurement of MT, RNFL, and optic disc parameters using optical coherence tomography. Results. The superior RNFL around the optic nerve was significantly thicker in PCOS than in healthy volunteers (P = 0.036). After stratification according to insulin resistance, the temporal inner macula (TIM), the inferior inner macula (IIM), the nasal inner macula (NIM), and the nasal outer macula (NOM) were significantly thicker in PCOS group than in control group (P < 0.05). Both the presence of obesity associated with insulin resistance (P = 0.037) and glucose intolerance (P = 0.001) were associated with significant increase in the PC1 mean score, relative to MT. A significant increase in the PC2 mean score occurred when considering the presence of metabolic syndrome (P < 0.0001). There was a significant interaction between obesity and inflammation in a decreasing mean PC2 score relative to macular RNFL thickness (P = 0.034). Conclusion. Decreased macular RNFL thickness and increased total MT are associated with metabolic abnormalities, while increased RNFL thickness around the optic nerve is associated with hormonal changes inherent in PCOS.

Central obesity index and cardiovascular risk factors in polycystic ovary syndrome

FUNDAMENTO: A obesidade abdominal apresenta elevada prevalencia em mulheres com sindrome dos ovarios policisticos (SOP) e esta associada a um aumento do risco cardiovascular. OBJETIVO: Verificar a acuracia da circunferencia da cintura (CC), da relacao cintura-quadril (RCQ), da relacao cintura-estatura (RCEST) e do indice de conicidade (indice C), no que se refere a deteccao de fatores de risco cardiovascular (FRCV) em mulheres com SOP. METODOS: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 ± 5 anos) com diagnostico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicerideos (TG), o LDL-colesterol (LDL-C), o HDL-colesterol (HDL-C), a glicemia de jejum, a glicemia apos teste oral de tolerância a glicose (TOTG) e a pressao arterial (PA) foram avaliados em todas as pacientes, alem das variaveis antropometricas. RESULTADOS: A relacao cintura-estatura foi o marcador que apresentou correlacoes positivas significativas com o maior numero de FRCV (PA, TG e glicemia apos TOTG), destacando-se ainda a correlacao negativa com HDL-C. Todos os marcadores antropometricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correlacao positiva tambem com TG. No tocante a acuracia para deteccao de FRCV, os indicadores antropometricos considerados apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEST, que apresentou sensibilidade superior a 70%. CONCLUSAO: A RCEST demonstrou ser o indicador antropometrico com a melhor acuracia para a predicao de FRCV. Nesse sentido, propoe-se a inclusao desse parâmetro de facil mensuracao na avaliacao clinica para o rastreamento de mulheres com SOP e FRCV.BACKGROUND Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. OBJECTIVE To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. METHODS The present transversal study allocated 102 women (26.5 +/- 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. RESULTS The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. CONCLUSION The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF.

Evaluation of the relationship between the pelvic floor muscles and insulin resistance.

Purpose The aim of this study was to evaluate the pelvic floor muscles (PFMs) in women with insulin resistance (IR) using surface electromyography and to associate the results with insulin levels. Patients and methods Through an analytical, cross-sectional study, 86 women were evaluated and divided into two groups: a control group (n=35) and an IR group (n=51). Data were collected through detailed history-taking, physical examination, and biochemical analysis. Fasting insulin levels were used for diagnosing IR. Electromyography of the PFMs was used for analyzing the tone and maximal voluntary contraction (MVC). The measures of central tendency and linear regression models were used. Results The average age was 25.3±4.5 years in the IR group and 27.2±4.4 years in the control group. The mean weight was 75.6±17.6 kg and 51.8±4.9 kg in the IR and control groups, respectively. Fasting insulin levels were 19.7±6.6 µIU/mL in the IR group and 5.4±1.8 µIU/mL in the control group (P<0.010). There were significant differences between the groups with regard to PFM tone (IR: 13.4±3.4 µV; control: 25.1±3.3 µV; P<0.001) and MVC (IR: 47.6±4.5 µV; control: 64.3±5.0 µV; P<0.001). Multiple linear regression analysis using the insulin levels as dependent variable showed a significant association for MVC (P=0.047), weight (P=0.017), and waist circumference (P=0.000). Conclusion Compared with the control group, the IR group showed lower electromyographic activity of the PFMs, and there was an association between insulin levels and electromyographic activity.