Background: The coronavirus disease 2019 (COVID-19) pandemic may have an effect on maternal anxiety and influence postpartum experience. Objective: To study the prevalence of maternal anxiety in late pregnancy in the context of the COVID-19 outbreak in Brazil and to analyze its association with maternal knowledge and concerns about the pandemic. Methods: This was a national multicenter cross-sectional study performed in 10 different public university hospitals, between 1 June and 31 August 2020, in Brazil. The inclusion criteria were: maternal age more than 18 years; gestational age more than 36 weeks at childbirth; single alive newborn without malformations; and absence of mental disorders. We applied a structured questionnaire to explore the knowledge and concerns about COVID-19. Maternal anxiety was assessed using the Beck Anxiety Inventory (BAI). Results: Of the 1662 women interviewed, the BAI score in late pregnancy indicated that 13.9% presented moderate and 9.6% severe maternal anxiety. Moderate or severe maternal anxiety was independently associated with the fear of being unaccompanied at childbirth (aOR1.12, 95% CI 1.10–1.35), and independent protective factors were confidence in knowing how to protect oneself from COVID-19 (aOR0.89, 95% CI 0.82–0.97) and how to safely breastfeed (aOR0.89, 95% CI 0.83–0.95). Conclusion: The COVID-19 pandemic has a significant impact on maternal anxiety.

Depression with postpartum onset: a prospective cohort study in women undergoing elective cesarean section in Brasilia, Brazil Abstract PURPOSE: It was to determine the prevalence of depressive symptoms in a sample of puerperal women from Brasília, Brazil, distinguishing cases with onset after delivery from those already present during pregnancy. METHODS: A prospective cohort study with convenience sampling of patients submitted to elective cesarean section at two private hospitals. As an instrument for assessing depressive symptoms, the Edinburgh Postnatal Depression Scale with cutoff ≥13 was applied shortly before delivery and four to eight weeks after childbirth. RESULTS: Among the 107 women who completed the study, 11 (10.3%) had significant depressive symptoms during pregnancy and 12 (11.2%) during the postpartum period. Among the 12 patients with postpartum symptoms, 6 had symptoms during pregnancy, so that 5.6% of the sample had postpartum onset of depression. The higher overall frequency of depression was significantly among single women than among married women (p=0.04), a fact mainly due to a higher frequency of single women experiencing persistent depressive symptoms both before and after delivery (p=0.002). The risk of depression was not influenced by age, parity or educational level. CONCLUSION: Women with depression identified during the postpartum period comprise a heterogeneous group, in which symptoms may have started before pregnancy, during pregnancy or after childbirth. In this sample, half of the postpartum depression cases already presented symptoms during late pregnancy. Since depression can arise before and after childbirth, it may have different etiologies and, therefore, a different response to treatment, a possibility that should be considered by clinicians and researchers. ResumoOBJETIVO: Foi determinar a prevalência de sintomas depressivos em uma amostra de puérperas da cidade de Brasília, Brasil, discriminando os casos com surgimento após o parto daqueles já presentes durante a gestação. MÉTODOS: Estudo de corte prospectivo. Amostragem por conveniência de pacientes que seriam submetidas à cesariana eletiva em dois hospitais privados. Como instrumento para avaliar os sintomas depressivos, foi utilizada a Escala de Depressão Pós-natal de Edimburgo, com ponto de corte ≥13, aplicada momentos antes do parto e quatro a oito semanas após o nascimento da criança. RESULTADOS: Das 107 mulheres que completaram o estudo, 11 (10,3%) apresentaram sintomas depressivos significativos na gestação e 12 (11,2%) no período pós-parto. Das 12 pacientes com sintomas no pós-parto, 6 já tinham os sintomas durante a gestação, de modo que 5,6% da amostra teve depressão com início após o parto. A frequência global de depressão foi significativamente maior entre as mulheres solteiras em comparação com mulheres casadas (p=0,04) por causa principalmente da maior frequência de mulheres solteiras apresentando sintomas depressivos persistentes, antes e depois do parto (p=0,002). O risco de depressão não foi influenc...

CRH concentration in the CSF was higher in pregnant women than in nonpregnant women. However, in this sample, CSF CRH in late pregnancy was not associated with new-onset depressive symptoms in the early postpartum period.

Background A growing body of evidence suggests that SARS-COV-2 infection during pregnancy may affect maternal-fetal outcomes and possibly result in implications for the long-term development of SARS-CoV-2–exposed children. Objective The PROUDEST (Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study) is a multicenter, prospective cohort study designed to elucidate the repercussions of COVID-19 for the global health of mothers and their children. Methods The PROUDEST trial comprises 2 prospective, sequential substudies. The PREGNANT substudy will clinically assess the effects of SARS-CoV-2 infection on pregnancy, childbirth, and puerperium from a mechanistic standpoint to elucidate the pregnancy-related inflammatory and immunological phenomena underlying COVID-19. Pregnant women aged 18-40 years who have been exposed (proven with laboratory tests) to SARS-CoV-2 (group A; n=300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B; n=300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study that will assess the offspring of women who enrolled in the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children’s growth, neurodevelopment, and metabolism from birth up to 5 years of age. It includes two comparison groups; group A (exposed; n=300) comprises children born from SARS-CoV-2–exposed pregnancies, and group B (controls; n=300) comprises children born from nonexposed mothers. Results Recruitment began in July 2020, and as of January 2021, 260 pregnant women who were infected with SARS-CoV-2 during pregnancy and 160 newborns have been included in the study. Data analysis is scheduled to start after all data are collected. Conclusions Upon completion of the study, we expect to have comprehensive data that will provide a better understanding of the effects of SARS-CoV-2 infection and related inflammatory and immunological processes on pregnancy, puerperium, and infancy. Our findings will inform clinical decisions regarding the care of SARS-CoV-2–exposed mothers and children and support the development of evidence-based public health policies. Trial Registration Brazilian Register of Clinical Trials RBR65QXS2; https://ensaiosclinicos.gov.br/rg/RBR-65qxs2 International Registered Report Identifier (IRRID) DERR1-10.2196/26477

Case report of a 39-year-old intended mother of a surrogate pregnancy who underwent induction of lactation by sequential exposure to galactagogue drugs (metoclopramide and domperidone), nipple mechanical stimulation with an electric pump, and suction by the newborn. The study aimed to analyze the effect of each step of the protocol on serum prolactin levels, milk secretion and mother satisfaction, in the set of surrogacy. Serum prolactin levels and milk production had no significant changes. Nevertheless, the mother was able to breastfeed for four weeks, and expressed great satisfaction with the experience. As a conclusion, within the context of a surrogate pregnancy, breastfeeding seems to bring emotional benefits not necessarily related to an increase in milk production. Palavras-chave ResumoRelato de caso de mãe por útero de substituição, de 39 anos de idade, submetida a indução da lactação por exposição sequencial a drogas galactogogas (metoclopramida e domperidona), estimulação mamilar mecânica com bomba elétrica, e sucção pelo recém-nascido. O estudo teve como objetivo analisar os efeitos de cada etapa do protocolo na concentração sérica de prolactina, no volume de secreção láctea e na satisfação materna. A concentração sérica de prolactina e a produção láctea não apresentaram mudanças significativas. Entretanto, a mãe foi capaz de amamentar a criança por quatro semanas, e manifestou grande satisfação com a experiência. Como conclusão, no contexto de maternidade por útero de substituição, o aleitamento materno parece promover benefícios emocionais, não necessariamente relacionados ao aumento do volume de leite.

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Objective The moment of admission for delivery may be inappropriate for offering an intrauterine device (IUD) to women without prenatal contraception counseling. However, in countries with high cesarean rates and deficient prenatal contraception counseling, this strategy may reduce unexpected pregnancies and repeated cesarean sections. Methods This was a prospective cohort study involving 100 women without prenatal contraception counseling. Postplacental IUD was offered after admission for delivery and placed during cesarean. The rates of IUD continuation, uterine perforation, and endometritis were assessed at 6 weeks and 6 months, and the proportion of women continuing with IUD at 6 months was assessed with respect to the number of previous cesareans. Results Ninety-seven women completed the follow-up. The rate of IUD continuation was 91% at 6 weeks and 83.5% at 6 months. The expulsion/removal rate in the first 6 weeks was not different from that between 6 weeks and 6 months (9 vs 9.1%, respectively). There were 2 cases of endometritis (2.1%), and no case of uterine perforation. Among 81 women continuing with intrauterine device after 6-months, 31% had undergone only the cesarean section in which the IUD was inserted, 44% had undergone 2 and 25% had undergone 3 or more cesarean sections. Conclusion Two thirds of the women who continued with IUD at 6 months had undergone 2 or more cesarean sections. Since offering trial of labor is unusual after 2 or more previous cesareans, we believe that offering IUD after admission for delivery may reduce the risk of repeated cesarean sections and its inherent risks.

The physiological changes of pregnancy that interfere with the production, release and availability of the active form of hormones interfere with the diagnosis and management of hyperthyroidism during pregnancy.• Gestational thyrotoxicosis or transient hyperthyroidism, the most common cause of hyperthyroidism in pregnancy, is related to the increased production of human chorionic gonadotropin (hCG) and may persist until week 18. • Untreated hyperthyroidism can have fetal, neonatal, and maternal effects.• The obstetrician must be aware of the fetal, neonatal and/or maternal risks caused by the drug treatment of hyperthyroidism during pregnancy. • Graves' disease (GD) is the main pathology etiologically associated with hyperthyroidism in pregnancy.• The diagnosis of hyperthyroidism in pregnancy is preferably made by measuring free thyroxine (FT4) and thyroid-stimulating hormone (TSH). • The measurement of anti-TSH receptor antibody (TRAb) allows the diagnosis of GD, which is an important cause of hyperthyroidism. • Propylthiouracil (PTU) is the first-choice drug for the treatment of hyperthyroidism in pregnancy in the first trimester, while methimazole (MMZ) is used in the second and third trimesters and puerperal period. • The use of antithyroid drugs (ATD) is allowed during breastfeeding.• Radioactive iodine ( 131 I) should not be used during pregnancy or breastfeeding.