ROSSANA PULCINELI VIEIRA FRANCISCO
Projetos de Pesquisa
Unidades Organizacionais
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
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina - Líder
15 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 15
- Association between maternal exposure to air pollution before conception and sex determination in the city of Sao Paulo(2020) CARVALHO, Mariana Azevedo; HETTFLEISCH, Karen; RODRIGUES, Agatha S.; BENACHI, Alexandra; VIEIRA, Sandra Elisabete; SALDIVA, Silvia R. D. M.; SALDIVA, Paulo Hilario N.; FRANCISCO, Rossana Pulcineli Vieira; BERNARDES, Lisandra SteinIt has been widely demonstrated that air pollution can affect human health and that some pollutant gases can have negative impacts on female fertility rates and cause adverse obstetric outcomes, such as premature birth and low birth weight. Few studies have evaluated the impact of maternal exposure to urban air pollution on the number of female births. To evaluate the association between maternal exposure to air pollution during the year before conception and sex determination. This was a prospective study using low-risk pregnant women living in Sao Paulo, Brazil. The pollutants were measured by a fixed station during a 1-year period before conception. Sex was confirmed after birth. We used multiple logistic regression models to evaluate the association between the pollutants and the sex determination and to estimate the odds ratio (OR) and the 95% confidence interval (CI) of being female based on a quantitative increase in pollutant concentration. We evaluated 371 patients. Elevated exposure to nitrogen dioxide (NO2) and particulate matter lower than 10 mu m (PM10) prior to conception were associated with increased odds of being female. Each unit increase of NO(2)exposure increased the odds of being female by 8% (OR = 1.08, 95% CI = 1.02, 1.15,p = 0.008), and each unit increase of PM(10)increased the odds of being female by 14% (OR = 1.14, 95% CI 1.02 to 1.28,p = 0.021). In Sao Paulo, maternal exposure to pollutants was significantly associated with the odds of being female.
- Maternal postpartum complications according to delivery mode in twin pregnancies(2014) STACH, Sonia Leme; LIAO, Adolfo Wenjaw; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloOBJECTIVE: We aimed to examine maternal postpartum complications of twin deliveries according to mode of delivery and investigate the associated risk factors. METHODS: This was a retrospective cohort review of twin pregnancies with delivery after 26 weeks at a tertiary teaching hospital (1993-2008). The rates of maternal postpartum complications were compared among vaginal, elective cesarean and emergency cesarean deliveries. Significant predictors of complications were investigated with stepwise regression analysis and relative risks were calculated. RESULTS: A total of 90 complications were observed in 56/817 (6.9%) deliveries: 7/131 (5.3%) vaginal, 10/251 (4.0%) elective cesarean and 39/435 (9.0%) emergency cesarean deliveries. Significant predictors included high risk pregnancy, gestational age at birth and delivery mode. The occurrence of complications was significantly increased in emergency compared to elective cesarean deliveries (RR = 2.34). CONCLUSIONS: Maternal postpartum complications in twin pregnancies are higher in emergency compared to elective cesarean deliveries and are also related to preexisting complications and earlier gestational age at delivery.
- Successful Pregnancies After Adequate Hormonal Replacement in Patients With Combined Pituitary Hormone Deficiencies(2017) CORREA, Fernanda A.; BIANCHI, Paulo H. M.; FRANCA, Marcela M.; OTTO, Aline P.; RODRIGUES, Rodrigo J. M.; EJZENBERG, Dani; SERAFINI, Paulo C.; BARACAT, Edmundo Chada; FRANCISCO, Rossana P. V.; BRITO, Vinicius N.; ARNHOLD, Ivo J. P.; MENDONCA, Berenice B.; CARVALHO, Luciani R.Context: Women with hypopituitarism have lower pregnancy rates after ovulation induction. Associated pituitary hormone deficiencies might play a role in this poorer outcome. Objective: We evaluated fertility treatment and pregnancy outcomes in five women with childhoodonset combined pituitary hormone deficiencies (CPHD). Patients and Methods: Five women with CPHD were referred for fertility treatment after adequacy of hormone replacement was determined. Patients were subjected to controlled ovarian stimulation (COS) for timed intercourse, intrauterine insemination, or in vitro fertilization, according to the presence or absence of other infertility factors (male or tubal). Results: All women became pregnant. The number of COS attempts until pregnancy was achieved varied between 1 and 5. The duration of COS resulting in at least one dominant follicle varied between 9 and 28 days, and total gonadotropin consumed varied between 1200 and 3450 IU. Two patients with severely suppressed basal gonadotropin levels since an early age had a cancelled COS cycle. All pregnancies were singleton except one (monochorionic twin gestation). The gestational ages at birth ranged from 35 weeks to 39 weeks and 4 days; three patients underwent cesarean section, and two had vaginal deliveries. Only one newborn was small for gestational age (delivered at 35 weeks). Conclusion: Adequate hormonal replacement prior to ovarian stimulation resulted in successful pregnancies in patients with childhood-onset CPHD, indicating that hormone replacement, including growth hormone, is an important step prior to fertility treatments in these patients.
- Dietary Pattern Influences Gestational Weight Gain: Results from the ProcriAr Cohort Study-Sao Paulo, Brazil(2022) SALDIVA, Silvia Regina Dias Medici; NETA, Adelia da Costa Pereira De Arruda; TEIXEIRA, Juliana Araujo; PERES, Stela Verzinhasse; MARCHIONI, Dirce Maria Lobo; CARVALHO, Mariana Azevedo; VIEIRA, Sandra Elisabete; FRANCISCO, Rossana Pulcineli VieiraThe maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) influence maternal and infant outcomes. This study identified patterns of habitual dietary intake in 385 pregnant women in Sao Paulo and explored their associations with excessive weight gain (EGWG). Weight at the first visit (<14 weeks) was used as a proxy for pre-pregnancy weight. Food consumption was assessed using the 24HR method, administered twice at each gestational trimester, and dietary patterns were identified by principal component analysis. Three dietary patterns were identified: ""Vegetables and Fruits,"" ""Western,"" and ""Brazilian Traditional."" Descriptive data analysis was performed using absolute and relative frequencies for each independent variable and multilevel mixed-effects logistic regression was used to analyze excessive gestational gain weight (EGWG) and dietary patterns (DP). The Brazilian Traditional dietary pattern showed a protective effect on EGWG (p = 0.04) and age > 35 years (p = 0.03), while subjects overweight at baseline had a higher probability of EGWG (p = 0.02), suggesting that the identification of dietary and weight inadequacies should be observed from the beginning of pregnancy, accompanied by nutritional intervention and weight monitoring throughout the gestational period to reduce risks to the mother and child's health.
- Association between preterm births and socioeconomic development: analysis of national data(2022) MONTEMOR, Marina Sanches; DEMARQUE, Gabriella Ferreira; RODRIGUES, Agatha Sacramento; FRANCISCO, Rossana Pulcinelli Vieira; CARVALHO, Mario Henrique Burlacchini deBackground The increasing prevalence of preterm birth, which is a global phenomenon, is attributable to the increased medical indications, artificial gestations, and some socioeconomic factors. This study was conducted to identify whether development and equality indices are associated with the incidence of preterm birth, specifically, spontaneous and elective preterm births. Methods This retrospective observational study comprised an analysis of data on live births from 2019 in Brazil and on socioeconomic indices that were derived from census information in 2017. Data were summarised using absolute and relative frequencies. Spearman's correlation was used to determine the correlation between socioeconomic factors and the preterm birth rate. Multiple beta regression analysis was performed to determine the best model of socioeconomic covariates and preterm birth rate. The significance level was set at 5%. Results In 2019 in Brazil, the preterm birth rate was 11.03%, of which 58% and 42% were spontaneous and elective deliveries, respectively. For all preterm births, Spearman's correlation varied from rho = 0.4 for the Gini Index and rho = - 0.24 for illiteracy. The best fit modelled the spontaneous preterm birth fraction as a negative function of the Human Development Index (HDI). The best-fit model considered the expected elective preterm birth fraction as a positive function of the HDI and as a negative function of the Gini Index, which was used as a precision parameter. Conclusions We observed a reduction in the fraction of spontaneous preterm births; however, the distribution was not uniform in the territory: higher rates of spontaneous preterm birth were noticed in the north, northeast, and mid-west regions. Thus, areas with lower education levels and inequal income distribution have a higher proportion of spontaneous preterm birth. The fraction of elective preterm birth was positively associated with more advantaged indices of socioeconomic status.
- Prediction of perinatal mortality in triplet pregnancies(2016) MAIA, Carolina B.; LIAO, Adolfo W.; BRIZOT, Maria L.; FRANCISCO, Rossana P. V.; ZUGAIB, MarceloPurpose To investigate predictors of perinatal mortality in triplet pregnancies. Methods Retrospective cohort managed in a tertiary teaching hospital (1998-2012) including all pregnancies with tree live fetuses at the first ultrasound examination, performed after 11 weeks of gestation. Primary end-point was defined as the number of children alive at hospital discharge. Ordinal stepwise regression analysis examined the association with maternal age, parity, pregnancy chorionicity, gestational age at our first ultrasound evaluation, presence of maternal clinical, obstetrical and fetal complications and gestational age at delivery. Results Sixty-seven triplet pregnancies were first seen at 18.5 +/- 6.8 weeks, 33 (49.3 %) were trichorionic, obstetric complications occurred in 34 (50.7 %) and fetal complications were diagnosed in 17 (25.4 %). Perinatal mortality rate was 249 % (95 % CI 189-317) and 138 (73 %) children were discharged alive from hospital (11 pregnancies with no survivors; single and double survival in ten cases each; all children alive in 36). Regression analysis showed that presence of fetal complications (OR 0.10, 95 % CI 0.03-0.36) and gestational age at delivery (OR 1.55, 95 % CI 1.31-1.85) are significant predictors of outcome (p < 0.001). Conclusions Perinatal mortality in non-selected triplet pregnancies is high and is related to the presence of fetal complications and gestational age at delivery.
- Diet Quality Indices and Physical Activity Levels Associated with Adequacy of Gestational Weight Gain in Pregnant Women with Gestational Diabetes Mellitus(2021) ALMEIDA, Vanessa Averof Honorato de; COSTA, Rafaela Alkmin da; PAGANOTI, Cristiane de Freitas; MIKAMI, Fernanda Cristina; SOUSA, Ana Maria da Silva; PERES, Stela Verzinhasse; LOPES, Marco Antonio Borges; FRANCISCO, Rossana Pulcineli VieiraThe aim of this study was to evaluate the Diet Quality Index (DQI) and the Physical Activity (PA) levels associated with adequacy of gestational weight gain in pregnant women with gestational diabetes mellitus (GDM). A total of 172 pregnant women with a single fetus and a diagnosis of GDM participated. Food intake was self-reported on the food frequency questionnaire and DQI was quantified using the index validated and revised for Brazil (DQI-R). To assess PA, the Pregnancy Physical Activity Questionnaire was administered. Gestational weight gain was classified, following the criteria of the Institute of Medicine, into adequate (AWG), insufficient (IWG), or excessive (EWG) weight gain. A multinomial logistic regression analysis was performed, with level of significance <0.05. The participants were divided into 3 groups: AWG (33.1%), IWG (27.3%), and EWG (39.5%). The analysis indicated that if the pregnant women PA fell into tertile 1 or 2, then they had a greater chance of having IWG, whereas those with the lowest scores on the DQI-R, whose PA fell into tertile 2, and pregestational obesity women had the greatest chance of having EWG. This study has shown that low PA levels may contribute towards IWG. On the other hand, a low final DQI-R score, representing inadequate food habits, low PA levels, and pregestational obesity may increase the chance of EWG in patients with GDM.
- Vertical transmission of SARS-CoV2 during pregnancy: A high-risk cohort(2021) MAEDA, Mariane de Fatima Yukie; BRIZOT, Maria de Lourdes; GIBELLI, Maria Augusta Bento Cicaroni; IBIDI, Silvia Maria; CARVALHO, Werther Brunow de; HOSHIDA, Mara Sandra; MACHADO, Clarisse Martins; SABINO, Ester Cerdeira; SILVA, Lea Campos de Oliveira da; JAENISCH, Thomas; MENDES-CORREA, Maria Cassia Jacintho; MAYAUD, Philippe; FRANCISCO, Rossana Pulcinelli VieiraObjective Identify the potential for and risk factors of SARS-CoV-2 vertical transmission. Methods Symptomatic pregnant women with COVID-19 diagnosis in whom PCR for SARS-CoV-2 was performed at delivery using maternal serum and at least one of the biological samples: cord blood (CB), amniotic fluid (AF), colostrum and/or oropharyngeal swab (OPS) of the neonate. The association of parameters with maternal, AF and/or CB positivity and the influence of SARS-CoV-2 positivity in AF and/or CB on neonatal outcomes were investigated. Results Overall 73.4% (80/109) were admitted in hospital due to COVID-19, 22.9% needed intensive care and there were four maternal deaths. Positive RT-PCR for SARS-CoV-2 was observed in 14.7% of maternal blood, 13.9% of AF, 6.7% of CB, 2.1% of colostrum and 3.7% of OPS samples. The interval between COVID-19 symptoms and delivery was inversely associated with SARS-CoV-2 positivity in the maternal blood (p = 0.002) and in the AF and/or CB (p = 0.049). Maternal viremia was associated with positivity for SARS-CoV-2 in AF and/or CB (p = 0.001). SARS-CoV-2 positivity in the compartments was not associated with neonatal outcomes. Conclusion Vertical transmission is possible in pregnant women with COVID-19 and a shorter interval between maternal symptoms and delivery is an influencing factor.
- The Effect of Being Pregnant during Respiratory Pandemics: A Comparison between 2009/10 Flu and 2020/21 COVID-19 Pandemic in Brazil(2022) ZANON, Ana Beatrice Bonganha; ROSA JUNIOR, Elias Ribeiro; MONROY, Nataly Adriana Jimenez; GODOI, Luciana Graziela de; MATTOS, Bruna Rodrigues de; PAGANOTI, Cristiane de Freitas; FRANCISCO, Rossana Pulcineli Vieira; RODRIGUES, Agatha Sacramento; COSTA, Rafaela Alkmin daPregnant women undergo physiological changes that make them a challenging group of patients during pandemic respiratory diseases, as previously found during H1N1 2009 pandemic and recently ratified in COVID-19 pandemic. We conducted a retrospective cohort analysis on 5888 hospitalized women for H1N1 flu pandemic (2190 pregnant and 3698 non-pregnant) and 64,515 hospitalized women for COVID-19 pandemic (5151 pregnant and 59,364 non-pregnant), from the Brazilian national database, to compare demographic profile, clinical aspects, and mortality in childbearing aged women during both pandemics. Additionally, the effect of being pregnant was compared between both pandemics. In both pandemics, pregnant women were younger than non-pregnant women. Overall, pregnant women had lower frequencies of comorbidities and were less symptomatic. Among hospitalized women, pregnant women presented lower mortality rates than non-pregnant women (9.7% vs. 12.6%, p = 0.002 in the H1N1 pandemic and 9.7% vs. 17.4%, p < 0.001 in the COVID-19 pandemic) and this difference was statistically more pronounced in the COVID-19 pandemic, even after balancing pregnant and non-pregnant groups regarding age and chronic diseases.
- Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital(2021) MARQUES, Heloisa Helena de Sousa; PEREIRA, Maria Fernanda Badue; SANTOS, Angelica Carreira dos; FINK, Thais Toledo; PAULA, Camila Sanson Yoshino de; LITVINOV, Nadia; SCHVARTSMAN, Claudio; DELGADO, Artur Figueiredo; GIBELLI, Maria Augusta Bento Cicaroni; CARVALHOL, Werther Brunow de; ODONE FILHO, Vicente; TANNURI, Uenis; CARNEIRO-SAMPAIO, Magda; GRISI, Sandra; DUARTE, Alberto Jose da Silva; ANTONANGELO, Leila; FRANCISCO, Rossana Pucineli Vieira; OKAY, Thelma Suely; BATISTTELLA, Linamara Rizzo; CARVALHO, Carlos Roberto Ribeiro de; BRENTANI, Alexandra Valeria Maria; SILVA, Clovis ArturOBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p < 0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p <0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.