ROSSANA PULCINELI VIEIRA FRANCISCO

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Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 0 Citação(ões) na Scopus
    Variant rs17619600 in the gene encoding serotonin receptor 2B (HTR2B) increases the risk of gestational diabetes mellitus: a case-control study
    (2023) PENNO, Juliana Regina Chamlian Zucare; SANTOS-BEZERRA, Daniele Pereira; CAVALEIRO, Ana Mercedes; SOUSA, Ana Maria da Silva; ZACCARA, Tatiana Assuncao; COSTA, Rafaela Alkmin da; FRANCISCO, Rossana Pulcineli Vieira; CORREA-GIANNELLA, Maria Lucia
    BackgroundDuring pregnancy, the increase in maternal insulin resistance is compensated by hyperplasia and increased function of maternal pancreatic beta cells; the failure of this compensatory mechanism is associated with gestational diabetes mellitus (GDM). Serotonin participates in beta cell adaptation, acting downstream of the prolactin pathway; the blocking of serotonin receptor B (HTR2B) signaling in pregnant mice impaired beta cell expansion and caused glucose intolerance. Thus, given the importance of the serotoninergic system for the adaptation of beta cells to the increased insulin demand during pregnancy, we hypothesized that genetic variants (single nucleotide polymorphisms [SNPs]) in the gene encoding HTR2B could influence the risk of developing GDM.MethodsThis was a case-control study. Five SNPs (rs4973377, rs765458, rs10187149, rs10194776, and s17619600) in HTR2B were genotyped by real-time polymerase chain reaction in 453 women with GDM and in 443 pregnant women without GDM.ResultsOnly the minor allele C of SNP rs17619600 conferred an increased risk for GDM in the codominant model (odds ratio [OR] 2.15; 95% confidence interval [CI] 1.53-3.09; P < 0.0001) and in the rare dominant model (OR 2.32; CI 1.61-3.37; P < 0.0001). No associations were found between the SNPs and insulin use, maternal weight gain, newborn weight, or the result of postpartum oral glucose tolerance test (OGTT). In the overall population, carriers of the XC genotype (rare dominant model) presented a higher area under the curve (AUC) of plasma glucose during the OGTT, performed for diagnostic purposes, compared with carriers of the TT genotype of rs17619600.ConclusionsSNP rs17619600 in the HTR2B gene influences glucose homeostasis, probably affecting insulin release, and the presence of the minor allele C was associated with a higher risk of GDM.
  • article 0 Citação(ões) na Scopus
    Prevalence of oncogenic human papillomavirus in pregnant adolescents, association with colpocytological changes, risk factors and obstetric outcomes
    (2022) SOUZA, Henrique Diorio de; WAISSMAN, Adriana Lippi; DIORIO, Giselle Rodrigues Mota; PERES, Stela Verzinhasse; FRANCISCO, Rossana Pulcineli Vieira; GALLETTA, Marco Aurelio Knippel
    Purpose: The authors aim to carry out an investigation on the impact of cervical oncogenic Human Papillomavirus (HPV) detection in pregnant adolescents, to clarify the prevalence and risk factors, considering the importance and lack of data on this topic in Brazil. Methods: A cross-sectional study was conducted with adolescents receiving prenatal care in a tertiary hospital in Sao Paulo, Brazil, with routine Pap smear and oncogenic HPV detection test in the uterine cervix. The authors sought to associate the results of these tests with demographic and obstetric variables. Results: A total of 303 pregnant adolescents whose mean age was 15.30 +/- 1.22 years comprised the study subjects. The frequency of high-risk HPV cervical detection was 50.50%. Multivariate analysis revealed that a large number of partners in their lifetime (OR = 1.27) and having a religion (OR = 2.05) were risk factors for cervical detection of oncogenic HPV, while schooling appeared as a protective factor (OR = 0.85). There was an association between this detection and colpocytological alterations, reaching almost 30% of patients, but without association with obstetric and neonatal outcomes. Conclusion: The prevalence found is one of the highest in Brazil and worldwide. A greater number of partners during their lifetime and having religion were detected as possible factors associated with cervical HPV detection. Detection of cervical HPV-DNA did not influence obstetric and neonatal outcomes. The findings of this study reinforce the need to implement educational measures capable of modifying the incidence of sexually transmitted infections in this population and capable of promoting adherence to HPV vaccination programs.
  • article 2 Citação(ões) na Scopus
    Pregnancy in women living with perinatally acquired HIV: Perinatal outcomes and drug resistance profile
    (2023) JR, Gilmar de Souza Osmundo; COSTA, Rafaela Alkmin da; RUOCCO, Rosa Maria Aveiro; FRANCISCO, Rossana Pulcineli Vieira
    Objectives: To analyze the perinatal outcomes of Perinatally acquired HIV Infection (PHIV) in pregnant women.Method: This retrospective cohort study included singleton pregnancies in Women Living with HIV (WLH) between 2006 and 2019. Patient charts were revised, and maternal characteristics, type of HIV infection (perinatal vs. behavioral), Antiretroviral Therapy (ART) exposure, and obstetric and neonatal outcomes were assessed. The HIV-related aspects considered were: Viral Load (VL), CD4+ cell count, opportunistic infections, and genotype testing. Laboratory analyses were performed at baseline (first appointment) and 34 weeks of gestation.Results: There were 186 WLH pregnancies, and 54 (29%) patients had PHIV. Patients with PHIV were younger (p < 0.001), had less frequently stable partnerships (p < 0.001), had more commonly serodiscordant partners (p < 0.001), had a longer time on ART (p < 0.001), and had lower rates of undetectable VL at baseline (p = 0.046) and at 34 weeks of gestation (p < 0.001). No association was observed between PHIV and adverse perinatal outcomes. Among patients with PHIV, third trimester anemia was associated with preterm birth (p = 0.039). Genotype testing was available only for 11 patients with PHIV, who presented multiple mutations related to ART resistance.Conclusions: PHIV did not seem to increase the risk of adverse perinatal outcomes. However, PHIV pregnancies have a higher risk of viral suppression failure and exposure to complex ARTs.
  • article 0 Citação(ões) na Scopus
    Adverse Perinatal Outcomes among Adolescent Pregnant Women Living with HIV: A Propensity-Score-Matched Study
    (2023) OSMUNDO JUNIOR, G. D. S.; CABAR, F. R.; PERES, S. V.; WAISSMAN, A. L.; GALLETTA, M. A. K.; FRANCISCO, R. P. V.
    HIV infection and adolescent pregnancy are known to increase the risk of adverse perinatal outcomes. However, data are limited concerning the outcomes of pregnancies among adolescent girls living with HIV. This retrospective propensity-score matched study aimed to compare adverse perinatal outcomes in adolescent pregnant women living with HIV (APW-HIV-positive) with HIV-negative adolescent pregnant women (APW-HIV-negative) and adult pregnant women with HIV (PW-HIV). APW-HIV-positive were propensity-score matched with APW-HIV-negative and PW-HIV. The primary endpoint was a composite endpoint of adverse perinatal outcomes, comprising preterm birth and low birth weight. There were 15 APW-HIV-positive and 45 women in each control group. The APW-HIV-positive were aged 16 (13–17) years and had had HIV for 15.5 (4–17) years, with 86.7% having perinatally acquired HIV. The APW-HIV-positive had higher rates of perinatally acquired HIV infection (86.7 vs. 24.4%, p < 0.001), a longer HIV infection time (p = 0.021), and longer exposure to antiretroviral therapy (p = 0.034) compared with the PW-HIV controls. The APW-HIV-positive had an almost five-fold increased risk of adverse perinatal outcomes compared with healthy controls (42.9% vs. 13.3%, p = 0.026; OR 4.9, 95% CI 1.2–19.1). The APW-HIV-positive and APW-HIV-negative groups had similar perinatal outcomes.
  • article 0 Citação(ões) na Scopus
    Three-dimensional Ultrasound Evaluation of Lung Volume in Fetuses with Abdominal Wall Defect
    (2023) NISHIE, Estela Naomi; OSMUNDO-JUNIOR, Gilmar de Souza; MOHAMED, Samirah Hosney Mahmoud; TANNURI, Ana Cristina Aoun; GIBELLI, Maria Augusta Bento Cicaroni; CARVALHO, Werther Brunow de; PERES, Stela Verzinhasse; FRANCISCO, Rossana Pulcineli Vieira; BRIZOT, Maria de Lourdes
    Introduction: Abdominal wall defects (AWD) interfere with postnatal respiratory parameters. We aimed to evaluate lung volume (LV) in fetuses with AWD using three-dimensional (3D) ultrasound (US) and to correlate AWD with the type (omphalocele and gastroschisis) and size of the defect and neonatal morbidity and mortality.Methods: This prospective study included 72 pregnant women with fetuses with AWD and a gestational age <25 weeks. Abdominal volume, 3D US LV, and herniated volume were acquired every 4 weeks up to 33 weeks. LV was compared with normal reference curves and correlated with abdominal and herniated volumes.Results: Omphalocele (p<0.001) and gastroschisis (p<0.001) fetuses had smaller LV than did normal fetuses. LV was positively correlated with abdominal volume (omphalocele, r=0.86; gastroschisis, r=0.88), whereas LV was negatively correlated with omphalocele-herniated volume/abdominal volume (p<0.001, r= -0.51). LV was smaller in omphalocele fetuses that died (p=0.002), were intubated (p=0.02), or had secondary closure (p<0.001). In gastroschisis, a smaller LV was observed in fetuses discharged using oxygen (p=0.002).Discussion/Conclusion: Fetuses with AWD had smaller 3D LV than normal fetuses. Fetal abdominal volume was inversely correlated with LV. In omphalocele fetuses, a smaller LV was associated with neonatal mortality and morbidity.
  • article 0 Citação(ões) na Scopus
    Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic
    (2024) RITTO, Ana Paula; ARAUJO, Adriana Ladeira de; CARVALHO, Carlos Roberto Ribeiro de; SOUZA, Heraldo Possolo De; FAVARETTO, Patricia Manga e Silva; SABOYA, Vivian Renata Boldrim; GARCIA, Michelle Louvaes; KULIKOWSKI, Leslie Domenici; KALLAS, Esper Georges; PEREIRA, Antonio Jose Rodrigues; COBELLO JUNIOR, Vilson; SILVA, Katia Regina; ABDALLA, Eidi Raquel Franco; SEGURADO, Aluisio Augusto Cotrim; SABINO, Ester Cerdeira; RIBEIRO JUNIOR, Ulysses; FRANCISCO, Rossana Pulcineli Vieira; MIETHKE-MORAIS, Anna; LEVIN, Anna Sara Shafferman; SAWAMURA, Marcio Valente Yamada; FERREIRA, Juliana Carvalho; SILVA, Clovis Artur; MAUAD, Thais; GOUVEIA, Nelson da Cruz; LETAIF, Leila Suemi Harima; BEGO, Marco Antonio; BATTISTELLA, Linamara Rizzo; DUARTE, Alberto Jose da Silva; SEELAENDER, Marilia Cerqueira Leite; MARCHINI, Julio; FORLENZA, Orestes Vicente; ROCHA, Vanderson Geraldo; MENDES-CORREA, Maria Cassia; COSTA, Silvia Figueiredo; CERRI, Giovanni Guido; BONFA, Eloisa Silva Dutra de Oliveira; CHAMMAS, Roger; BARROS FILHO, Tarcisio Eloy Pessoa de; BUSATTO FILHO, Geraldo
    Introduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
  • article 2 Citação(ões) na Scopus
    Demographic and epidemiological characteristics of pregnant and postpartum women who died from severe acute respiratory syndrome in Brazil: A retrospective cohort study comparing COVID-19 and nonspecific etiologic causes
    (2022) FRANCO, Veridiana Freire; RODRIGUES, Agatha Sacramento; ROSA JUNIOR, Elias Ribeiro; GODOI, Luciana Graziela de; MONROY, Nataly Adriana Jimenez; COSTA, Rafaela Alkmin da; FRANCISCO, Rossana Pulcineli Vieira
    The objective of this study is to compare the demographic characteristics and symptoms in pregnant and postpartum women who died from Severe Acute Respiratory Syndrome (SARS) caused by COVID-19 or by nonspecific cause in different states of Brazil. This is a retrospective cohort study and the analysis was conducted on SARS death records between 02/16/2020 and 04/17/2021, obtained from the Information System for the Epidemiological Surveillance of Influenza (Sistema de Informacao da Vigilancia Epidemiologica da Gripe, SIVEP-Gripe). Pregnant and postpartum women, aged between 10 and 55 years, who died from SARS, were included and classified into two groups: SARS due to confirmed COVID-19 or SARS due to nonspecific cause. The cases were analyzed according to the women's demographic and epidemiological characteristics, clinical symptoms, risk factors and disease evolution. As results, 19,333 pregnant and postpartum women were identified. From these, 1,279 died (1,026 deaths from COVID-19 and 253 deaths from SARS with nonspecific cause). The groups showed significant differences in age, education, race, and occurrence of obesity and chronic lung disease. The group of women who died from confirmed COVID-19 presented a significantly higher frequency of symptoms of fever, cough, fatigue, loss of taste, and loss of smell, as well as a higher rate of admission to the intensive care unit (ICU). Data analysis draws attention to the high number of cases of SARS without a causal diagnosis, the low access to ICU and orotracheal intubation (OTI), which might be explained by the demographic and regional inequalities in the access to healthcare.
  • article 4 Citação(ões) na Scopus
    COVID-19: Impact of Original, Gamma, Delta, and Omicron Variants of SARS-CoV-2 in Vaccinated and Unvaccinated Pregnant and Postpartum Women
    (2022) SERRA, Fabiano Elisei; ROSA JUNIOR, Elias Ribeiro; ROSSI, Patricia de; FRANCISCO, Rossana Pulcineli Vieira; RODRIGUES, Agatha Sacramento
    This study compares the clinical characteristics and disease progression among vaccinated and unvaccinated pregnant and postpartum women who tested positive for different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using the Brazilian epidemiological data. Data of pregnant or postpartum patients testing positive for SARS-CoV-2 and presenting with coronavirus disease 2019 (COVID-19) from February 2020 to July 2022 were extracted from Brazilian national database. The patients were grouped based on vaccination status and viral variant (original, Gamma, Delta, and Omicron variants), and their demographics, clinical characteristics, comorbidities, symptoms, and outcomes were compared retrospectively. Data of 10,003 pregnant and 2361 postpartum women were extracted from the database. For unvaccinated postpartum women, intensive care unit (ICU) admission was more likely; invasive ventilation need was more probable if they tested positive for the original, Gamma, and Omicron variants; and chances of death were higher when infected with the original and Gamma variants than when infected with other variants. Vaccinated patients had reduced adverse outcome probability, including ICU admission, invasive ventilation requirement, and death. Postpartum women showed worse outcomes, particularly when unvaccinated, than pregnant women. Hence, vaccination of pregnant and postpartum women should be given top priority.
  • article 3 Citação(ões) na Scopus
    Post-Viral Fatigue Following SARS-CoV-2 Infection during Pregnancy: A Longitudinal Comparative Study
    (2022) OLIVEIRA, Ana Maria da Silva Sousa; CARVALHO, Mariana Azevedo; NACUL, Luis; CABAR, Fabio Roberto; FABRI, Amanda Wictky; PERES, Stela Verzinhasse; ZACCARA, Tatiana Assuncao; O'BOYLE, Shennae; ALEXANDER, Neal; TAKIUTI, Nilton Hideto; MAYAUD, Philippe; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli Vieira
    Studies reported post-COVID-19 fatigue in the general population, but not among pregnant women. Our objectives were to determine prevalence, duration, and risk factors of post-viral fatigue among pregnant women with SARS-CoV-2. This study involved 588 pregnant women with SARS-CoV-2 during pregnancy or delivery in Brazil. Three groups were investigated: G1 (n = 259, symptomatic infection during pregnancy); G2 (n = 131, positive serology at delivery); G3 (n = 198, negative serology at delivery). We applied questionnaires investigating fatigue at determined timepoints after infection for G1, and after delivery for all groups; fatigue prevalence was then determined. Cox regression was used to estimate hazard ratio (HR) and 95% CI of the risk of remaining with fatigue in G1. Overall fatigue prevalence in G1 at six weeks, three months and six months were 40.6%, 33.6%, and 27.8%, respectively. Cumulative risk of remaining with fatigue increased over time, with HR of 1.69 (95% CI: 0.89-3.20) and 2.43 (95% CI: 1.49-3.95) for women with moderate and severe symptoms, respectively. Multivariate analysis showed cough and myalgia as independent risk factors in G1. Fatigue prevalence was significantly higher in G1 compared to G2 and G3. Post-viral fatigue prevalence is higher in women infected during pregnancy; fatigue's risk and duration increased with the severity of infection.
  • article 1 Citação(ões) na Scopus
    Lung ultrasound versus chest computed tomography for pregnant inpatients with COVID-19
    (2023) BIANCOLIN, Sckarlet Ernandes; FERNANDES, Hermann dos Santos; SAWAMURA, Marcio Valente Yamada; QUEIROZ, Joelma; CENTOFANTI, Sandra Frankfurt; LIAO, Adolfo Wenjaw; LEITE, Claudia da Costa; FRANCISCO, Rossana Pulcineli Vieira; BRIZOT, Maria de Lourdes; BASSI, Aline Scalisse; FABRI, Amanda Wictky; SOUZA, Ana Claudia Rodrigues Lopes Amaral de; FARCHE, Ana Claudia Silva; IGAI, Ana Maria Kondo; OLIVEIRA, Ana Maria da Silva Sousa; WAISSMAN, Adriana Lippi; MARTINS, Carlos Eduardo do Nascimento; PAGANOTI, Cristiane de Freitas; DOMINGUES, Danielle Rodrigues; MIKAMI, Fernanda Cristina Ferreira; BAPTISTA, Fernanda Spadotto; CIPPICIANI, Jacqueline Kobayashi; ALBERTINI, Jessica Gorrao Lopes; NIIGAKI, Juliana Ikeda; GALLETTA, Marco Aurelio Knippel; MIYADAHIRA, Mariana Yumi; BARBOSA, Mariana Vieira; MAEDA, Mariane de Fatima Yukie; BARROS, Monica Fairbanks de; TAKIUTI, Nilton Hideto; MARTINELLI, Silvio; ARRYM, Tiago Pedromonico; GOMEZ, Ursula Trovato; FRANCO, Veridiana Freire
    Purpose To compare lung ultrasound (US) and computed tomography (CT) in the assessment of pregnant women with COVID-19. Methods Prospective study comprising 39 pregnant inpatients with COVID-19 who underwent pulmonary assessment with CT and US with a maximum span of 48 h between the exams. The thorax was divided into 12 regions and assessed in terms of the following: the presence of B-lines (>2), coalescent B-lines, consolidation on US; presence of interlobular thickening, ground glass, consolidation on CT. The two methods were scored by adding up the scores from each thoracic region. Results A significant correlation was found between the scores obtained by the two methods (rICC = 0.946; p < 0.001). They were moderately in agreement concerning the frequency of altered pulmonary regions (weighted kappa = 0.551). In US, a score over 15, coalescent B-lines, and consolidation were predictors of the need for oxygen, whereas the predictors in CT were a lung score over 16 and consolidation. The two methods, US (p < 0.001; AUC = 0.915) and CT (p < 0.001; AUC = 0.938), were fairly accurate in predicting the need for oxygen. Conclusion In pregnant women, lung US and chest CT are of similar accuracy in assessing lungs affected by COVID-19 and can predict the need for oxygen.