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problemas sist&#234;micos n&#227;o s&#227;o identificados nessa condi&#231;&#227;o e os sintomas existentes quase sempre regridem rapidamente ap&#243;s o parto&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Apesar da alta frequ&#234;ncia da doen&#231;a e de alguns grandes estudos&#44; h&#225; poucas evid&#234;ncias que sugiram uma rela&#231;&#227;o direta com quaisquer par&#226;metros cl&#237;nicos ou laboratoriais&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> Entretanto&#44; estudos anteriores com foco nesse t&#243;pico mostraram consistentemente n&#237;veis elevados de progesterona&#44; gesta&#231;&#245;es m&#250;ltiplas e imunorreatividade do receptor de progesterona em pacientes que desenvolvem PUPPP&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">13&#44;14</span></a> Considerando essa rela&#231;&#227;o hormonal e o fato de que Ghazeeri et al&#46; relataram uma incid&#234;ncia muito alta de PUPPP em gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> &#40;FIV&#41;&#44; parece que o desenvolvimento de PUPPP pode ter uma forte rela&#231;&#227;o com tratamentos hormonais durante a FIV e altera&#231;&#245;es hormonais durante a gravidez&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O objetivo deste estudo foi avaliar a frequ&#234;ncia de PUPPP em pacientes com gesta&#231;&#227;o resultante de FIV e gesta&#231;&#245;es espont&#226;neas em nosso centro&#44; e determinar quaisquer fatores associados ao desenvolvimento de PUPPP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Neste estudo&#44; 517 gesta&#231;&#245;es por FIV e 1&#46;253 gesta&#231;&#245;es espont&#226;neas seguidas entre 2014 e 2020 foram revisadas retrospectivamente para o diagn&#243;stico de PUPPP&#46; Todos os diagn&#243;sticos de PUPPP foram feitos por dermatologistas experientes&#44; de acordo com as manifesta&#231;&#245;es cl&#237;nicas t&#237;picas da doen&#231;a&#46; Ap&#243;s a an&#225;lise de todas as pacientes&#44; exclu&#237;mos gestantes com doen&#231;as cr&#244;nicas conhecidas e aquelas que haviam sido diagnosticadas com alguma doen&#231;a cut&#226;nea antes da gravidez&#46; A frequ&#234;ncia de PUPPP foi avaliada para a popula&#231;&#227;o geral em ambos os grupos&#44; e tamb&#233;m calculamos a frequ&#234;ncia entre aquelas com gravidez &#250;nica&#46; Pacientes no grupo de gravidez espont&#226;nea e no grupo de gravidez por FIV foram comparadas em termos dos seguintes par&#226;metros&#58; idade na gesta&#231;&#227;o&#44; gravidez m&#250;ltipla&#44; positividade do Rh&#44; ganho de peso da m&#227;e&#44; in&#237;cio da PUPPP na gesta&#231;&#227;o&#44; dura&#231;&#227;o da PUPPP&#44; tempo de parto&#44; taxa de parto ces&#225;reo&#44; peso do beb&#234; ao nascer e frequ&#234;ncia de rec&#233;m&#8208;nascidos do sexo masculino&#46; Tamb&#233;m comparamos gesta&#231;&#245;es por FIV com e sem PUPPP em termos de tratamentos de suporte hormonal com progesterona&#44; al&#233;m dos par&#226;metros mencionados acima&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da Maltepe University&#46; O consentimento informado foi obtido de todos os participantes individuais inclu&#237;dos no estudo&#46; O software SPSS &#40;v&#46; 22&#46;0&#41; para o sistema operacional Windows foi utilizado para a an&#225;lise estat&#237;stica dos dados&#46; As estat&#237;sticas descritivas foram relatadas como frequ&#234;ncia e porcentagem para vari&#225;veis categ&#243;ricas e como m&#233;dia&#44; desvio padr&#227;o&#44; valores m&#237;nimo&#44; m&#225;ximo e mediana para vari&#225;veis num&#233;ricas&#46; O n&#237;vel de signific&#226;ncia estat&#237;stica &#40;alfa&#41; foi aceito como p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Enquanto oito dos casos de PUPPP no grupo de gesta&#231;&#227;o espont&#226;nea eram primigestas e tr&#234;s eram mult&#237;paras&#44; todas as pacientes com PUPPP no grupo de FIV eram primigestas ou nul&#237;paras&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Em termos de compara&#231;&#245;es gerais&#44; descobrimos que PUPPP estava presente em 7&#44;4&#37; &#40;38&#47;517&#41; do grupo FIV e em 0&#44;9&#37; &#40;11&#47;1253&#41; das mulheres com gesta&#231;&#245;es espont&#226;neas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#46; Quando foram comparadas as gesta&#231;&#245;es &#250;nicas nesses grupos&#44; descobrimos que a frequ&#234;ncia de PUPPP foi de 2&#44;3&#37; &#40;10&#47;362&#41; no grupo FIV contra 0&#44;6&#37; &#40;7&#47;1206&#41; no grupo de gesta&#231;&#245;es espont&#226;neas &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A compara&#231;&#227;o dos casos de PUPPP em rela&#231;&#227;o ao tipo de gravidez produziu os seguintes resultados&#58; as taxas de gravidez m&#250;ltipla e de parto ces&#225;reo foram significativamente maiores em gesta&#231;&#245;es por FIV com PUPPP em compara&#231;&#227;o com o grupo de gesta&#231;&#245;es espont&#226;neas com PUPPP &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;022 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;038&#44; respectivamente&#41;&#46; Idade&#44; positividade do fator Rh&#44; ganho de peso materno&#44; in&#237;cio de PUPPP na gesta&#231;&#227;o&#44; dura&#231;&#227;o de PUPPP e peso do beb&#234; ao nascer e frequ&#234;ncia de rec&#233;m&#8208;nascidos do sexo masculino foram semelhantes entre os dois grupos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Em seguida&#44; comparamos gesta&#231;&#245;es por FIV com e sem PUPPP e verificamos que a frequ&#234;ncia de gravidez m&#250;ltipla e a dura&#231;&#227;o do suporte hormonal com progesterona foram significativamente maiores em pacientes com gesta&#231;&#227;o por FIV com PUPPP em compara&#231;&#227;o com pacientes com FIV sem PUPPP &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 e p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; respectivamente&#41;&#46; Idade&#44; positividade do fator Rh&#44; ganho de peso materno&#44; in&#237;cio de PUPPP na gesta&#231;&#227;o&#44; dura&#231;&#227;o de PUPPP&#44; taxa de parto ces&#225;reo&#44; peso do beb&#234; ao nascer e frequ&#234;ncia de rec&#233;m&#8208;nascidos do sexo masculino foram semelhantes entre os dois grupos &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">O principal achado deste estudo foi que a frequ&#234;ncia de PUPPP foi significativamente maior em gesta&#231;&#245;es resultantes de FIV do que em gesta&#231;&#245;es espont&#226;neas&#44; independentemente da presen&#231;a de gravidez &#250;nica ou m&#250;ltipla&#46; Que seja de nosso conhecimento&#44; este &#233; o primeiro estudo a comparar a frequ&#234;ncia de PUPPP em gesta&#231;&#245;es por FIV e gesta&#231;&#245;es espont&#226;neas&#44; levando em considera&#231;&#227;o v&#225;rias caracter&#237;sticas das pacientes&#46; H&#225; apenas um estudo anterior na literatura que relatou maior frequ&#234;ncia de PUPPP em gesta&#231;&#245;es resultantes de FIV&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> A alta frequ&#234;ncia de fetos m&#250;ltiplos em gesta&#231;&#245;es por FIV pode ser um dos fatores que contribuem para o aumento da frequ&#234;ncia de PUPPP nessas pacientes&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;5</span></a> A gesta&#231;&#227;o m&#250;ltipla que causa distens&#227;o abdominal excessiva &#233; sugerida como o fator mais comum que pode desencadear PUPPP&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> Isso ocorre porque a erup&#231;&#227;o das les&#245;es foi associada a danos ao tecido conjuntivo nas estrias em at&#233; 90&#37; das pacientes com PUPPP&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> Curiosamente&#44; em nosso estudo&#44; as circunfer&#234;ncias abdominais foram semelhantes entre gesta&#231;&#245;es por FIV e gesta&#231;&#245;es espont&#226;neas&#46; Al&#233;m disso&#44; em gesta&#231;&#245;es por FIV de feto &#250;nico&#44; o risco de PUPPP foi significativamente maior do que em gesta&#231;&#245;es espont&#226;neas&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Embora a PUPPP tenha sido descrita h&#225; mais de quatro d&#233;cadas e seja uma das dermatoses mais comuns que se desenvolvem durante a gravidez&#44; pouco se sabe sobre sua etiologia&#46; Uma alta porcentagem de mulheres com PUPPP &#233; primigesta&#46; Em uma revis&#227;o anterior avaliando esse t&#243;pico&#44; foi relatado que 42&#37; das pacientes eram primigestas e 68&#37; eram nul&#237;paras&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> enquanto outros estudos apresentam frequ&#234;ncias um pouco mais altas&#44; em torno de 70&#37; a 75&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;7</span></a> Em nosso estudo&#44; todas as pacientes com PUPPP no grupo de FIV eram primigestas ou nul&#237;paras&#44; pois estavam recebendo tratamento por causa da infertilidade&#46; Um estudo prospectivo que analisou mulheres com diversas dermatoses da gravidez determinou preval&#234;ncia elevada em mulheres gestando fetos masculinos em compara&#231;&#227;o com fetos femininos&#44; com uma propor&#231;&#227;o de 2&#58;1&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> De maneira similar&#44; tamb&#233;m observamos um aumento geral entre aquelas com fetos masculinos&#44; mas n&#227;o foi observada signific&#226;ncia estat&#237;stica &#8211; uma situa&#231;&#227;o comum em grande parcela da literatura&#46; Al&#233;m disso&#44; em nosso estudo&#44; as taxas de parto ces&#225;reo foram maiores&#44; semelhantes &#224;s da literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;10&#44;15</span></a> No entanto&#44; &#233; bem poss&#237;vel atribuir essa associa&#231;&#227;o ao fato de o parto ces&#225;reo ser utilizado com muito mais frequ&#234;ncia em mulheres com gesta&#231;&#227;o m&#250;ltipla &#40;tamb&#233;m frequente na FIV&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Neste estudo&#44; encontramos aumento da incid&#234;ncia de PUPPP em gesta&#231;&#245;es por FIV&#46; Para explicar a causa desse aumento&#44; foram avaliados os par&#226;metros cl&#237;nicos mostrados na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; Como esperado&#44; encontramos uma associa&#231;&#227;o positiva entre a frequ&#234;ncia de PUPPP e o aumento das taxas de gravidez m&#250;ltipla em gesta&#231;&#245;es resultantes de FIV&#46; Talvez o mais interessante seja que a dura&#231;&#227;o do suporte hormonal com progesterona tamb&#233;m tenha sido mais longa em gesta&#231;&#245;es por FIV com PUPPP quando comparada a gesta&#231;&#245;es por FIV sem PUPPP&#46; Na FIV&#44; o suporte hormonal com progesterona &#233; aplicado de maneira padronizada e doses semelhantes s&#227;o administradas na maioria das pacientes&#46; Este resultado sugere que o aumento da dosagem cumulativa de progesterona em pacientes com gesta&#231;&#245;es resultantes de FIV com PUPPP pode ser respons&#225;vel por um risco aumentado de desenvolvimento de PUPPP&#46; Que seja de nosso conhecimento&#44; esta &#233; a primeira vez que o tratamento prolongado com progesterona em gesta&#231;&#245;es resultantes de FIV foi associado a PUPPP&#46; Estudos anteriores que discutiram uma poss&#237;vel associa&#231;&#227;o entre n&#237;veis elevados de progesterona e PUPP&#44; eram mais comumente focados em pacientes que tinham n&#237;veis mais elevados de progesterona em associa&#231;&#227;o com gesta&#231;&#245;es m&#250;ltiplas espont&#226;neas&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> Em termos de resultados cl&#237;nicos e sugest&#245;es&#44; nossos achados mostram que m&#233;dicos e pacientes devem estar cientes do risco aumentado de PUPPP em gesta&#231;&#245;es resultantes de FIV&#44; especialmente na presen&#231;a de uma necessidade de suporte prolongado de progesterona&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Semelhante ao relato anterior de Ghazeeri et al&#46;&#44; nosso estudo tamb&#233;m revelou uma porcentagem mais alta de fator Rh positivo em pacientes com PUPPP&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> Exceto por este estudo&#44; n&#227;o h&#225; relatos que apoiem esse resultado na literatura&#46; A fim de esclarecer a etiopatogenia de PUPPP&#44; consideramos que seria &#250;til examinar o fator Rh positivo em mais detalhes&#46; Ganho de peso materno excessivo &#40;&#62; 15<span class="elsevierStyleHsp" style=""></span>kg por defini&#231;&#227;o&#41; tamb&#233;m foi detectado em nossas pacientes com PUPPP&#44; o que est&#225; de acordo com a literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;9</span></a> O ganho de peso excessivo aumenta a frequ&#234;ncia de PUPPP ao aumentar a distens&#227;o cut&#226;nea abdominal&#46; Cohen et al&#46; descobriram que o ganho de peso e a frequ&#234;ncia de gesta&#231;&#245;es gemelares foram mais altos em gestantes com PUPPP&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a> Foi sugerido que uma poss&#237;vel raz&#227;o para essa rela&#231;&#227;o positiva entre ganho de peso e PUPPP pode ser pelo fato de que os ant&#237;genos de col&#225;geno resultantes da distens&#227;o abdominal desencadeiam a rea&#231;&#227;o inflamat&#243;ria observada em casos de PUPPP&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> Essa hip&#243;tese tamb&#233;m &#233; apoiada por estudos que relatam que PUPPP &#233; observada mais cedo em gesta&#231;&#245;es m&#250;ltiplas&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">17&#44;18</span></a> Ap&#243;s uma forte sugest&#227;o do diagn&#243;stico de PUPPP&#44; o grau de desconforto relacionado ao prurido deve ser avaliado caso a caso&#44; uma vez que o tratamento &#233; principalmente sintom&#225;tico&#46; Todas as pacientes deste estudo foram tratadas sintomaticamente com cremes hidratantes e corticosteroides t&#243;picos&#46; Banhos frios e calmantes&#44; aplica&#231;&#227;o de emolientes e uso de roupas leves de algod&#227;o tamb&#233;m foram sugeridos &#224;s pacientes e foi relatado al&#237;vio sintom&#225;tico adicional&#44; semelhante &#224; literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;9</span></a> Muito embora a PUPPP regrida ap&#243;s o parto&#44; definitivamente n&#227;o &#233; uma indica&#231;&#227;o para parto antecipado&#44; uma vez que a PUPPP &#233; quase sempre autolimitada e benigna&#46; Portanto&#44; nenhuma das pacientes neste estudo teve parto prematuro em raz&#227;o da presen&#231;a de PUPPP&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">19&#44;20</span></a> &#201; consenso geral que a PUPPP representa um risco insignificante para a m&#227;e ou o feto&#59; entretanto&#44; alguns graus de rea&#231;&#245;es adversas foram relatados em alguns casos&#46; Por exemplo&#44; um relato de caso mostrou uma rela&#231;&#227;o com hipertens&#227;o e pr&#233;&#8208;ecl&#226;mpsia discreta e indu&#231;&#227;o do parto prematuro em associa&#231;&#227;o com o desenvolvimento de hipertens&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> Embora esses problemas sejam relativamente raros&#44; ainda assim devem ser levados em considera&#231;&#227;o em pacientes com PUPPP&#46; No estudo atual&#44; tivemos tr&#234;s pacientes com diabetes gestacional no grupo de gravidez por FIV&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A limita&#231;&#227;o mais importante deste estudo pode ser considerada a pequena porcentagem de pacientes com PUPPP em rela&#231;&#227;o ao tamanho muito grande de ambos os grupos de estudo&#46; Entretanto&#44; o n&#250;mero de pacientes com PUPPP deste estudo foi consideravelmente maior em compara&#231;&#227;o com a maioria dos estudos da literatura&#46; Al&#233;m disso&#44; esta &#233; uma an&#225;lise retrospectiva de pacientes&#44; o que limitaria a caracteriza&#231;&#227;o objetiva das pacientes e poderia induzir vieses na avalia&#231;&#227;o das mesmas&#46; Finalmente&#44; este &#233; um estudo de centro &#250;nico&#44; mas seu ponto forte est&#225; na an&#225;lise detalhada de registros m&#233;dicos mantidos de maneira meticulosa&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0075" class="elsevierStylePara elsevierViewall">Neste estudo&#44; a PUPPP foi estatisticamente mais frequente em gesta&#231;&#245;es resultantes de FIV do que em gesta&#231;&#245;es espont&#226;neas&#46; Descobrimos ainda que a dura&#231;&#227;o do tratamento com progesterona est&#225; associada &#224; PUPPP&#46; Esses resultados indicam que a dosagem cumulativa de progesterona ou tratamentos prolongados podem desempenhar um papel na patog&#234;nese da PUPPP&#46; Mais estudos com um n&#250;mero maior de pacientes representando diferentes comunidades devem ser realizados para confirmar nossos achados e determinar as varia&#231;&#245;es dentro&#47;entre diferentes popula&#231;&#245;es&#46; O papel da progesterona no desenvolvimento da PUPPP tamb&#233;m deve ser identificado por meio de estudos <span class="elsevierStyleItalic">in vitro</span> e <span class="elsevierStyleItalic">in vivo</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0085" class="elsevierStylePara elsevierViewall">Nur Dokuzeylul Gungor&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Tugba Gurbuz&#58; An&#225;lise estat&#237;stica&#59; Revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Tugba Ture&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; concep&#231;&#227;o e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O desenvolvimento de p&#225;pulas e placas urticariformes pruriginosas da gravidez pode ter uma forte rela&#231;&#227;o com tratamentos hormonais durante a fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> e altera&#231;&#245;es hormonais durante a gravidez&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar e comparar a frequ&#234;ncia de p&#225;pulas e placas da gravidez e fatores relacionados em gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> e gesta&#231;&#245;es espont&#226;neas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Neste estudo&#44; 517 gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> e 1&#46;253 gesta&#231;&#245;es espont&#226;neas foram revisadas retrospectivamente em rela&#231;&#227;o &#224; frequ&#234;ncia de p&#225;pulas e placas da gravidez&#46; O diagn&#243;stico de p&#225;pulas e placas da gravidez foi realizado por meio de encaminhamento ao Departamento de Dermatologia e de acordo com as manifesta&#231;&#245;es cl&#237;nicas t&#237;picas da doen&#231;a&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As p&#225;pulas e placas da gravidez foram mais comuns em todas as gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> &#40;incluindo gesta&#231;&#245;es &#250;nicas&#41; do que em gesta&#231;&#245;es espont&#226;neas&#46; Idade&#44; positividade do fator Rh&#44; ganho de peso materno&#44; in&#237;cio da doen&#231;a na gesta&#231;&#227;o&#44; dura&#231;&#227;o da doen&#231;a&#44; peso ao nascer e frequ&#234;ncia de fetos masculinos foram semelhantes entre os dois grupos &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; A taxa de gravidez m&#250;ltipla foi maior em gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> com p&#225;pulas e placas da gravidez do que em gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> sem p&#225;pulas e placas da gravidez &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A dura&#231;&#227;o do tratamento com progesterona tamb&#233;m foi significativamente maior em gesta&#231;&#245;es com fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> e com p&#225;pulas e placas da gravidez em compara&#231;&#227;o com gesta&#231;&#245;es com fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> sem p&#225;pulas e placas da gravidez &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Desenho retrospectivo e de centro &#250;nico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os resultados deste estudo indicam que o aumento da dosagem de progesterona ou o tratamento prolongado podem desempenhar um papel na patog&#234;nese das p&#225;pulas e placas da gravidez&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamentos"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Limita&#231;&#245;es do estudo"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Gungor ND&#44; Gurbuz T&#44; Ture T&#46; Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through <span class="elsevierStyleItalic">in vitro</span> fertilization&#46; An Bras Dermatol&#46; 2021&#59;96&#58;171&#8211;5&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado na Bahcesehir Universitesi Goztepe Medical Park Hospital&#44; Istambul&#44; Turquia&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 estatisticamente significativo&#59; os valores de <span class="elsevierStyleItalic">p</span> significativos s&#227;o apresentados em negrito&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">FIV</span>&#44; fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span>&#59; <span class="elsevierStyleItalic">PUPPP</span>&#44; p&#225;pulas e placas urticariformes pruriginosas da gravidez &#40;<span class="elsevierStyleItalic">pruritic urticarial papules and plaques of pregnancy</span>&#41;&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequ&#234;ncia de PUPPP em todas as gesta&#231;&#245;es&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gesta&#231;&#245;es por FIV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>517&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gesta&#231;&#245;es espont&#226;neas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1253&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;4 &#40;38 de 517&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9 &#40;11 de 1253&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frequ&#234;ncia de PUPPP em gesta&#231;&#245;es &#250;nicas&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Gesta&#231;&#245;es por FIV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>362&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Gesta&#231;&#245;es espont&#226;neas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1206&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;3 &#40;10 de 362&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6 &#40;7 de 1206&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o da frequ&#234;ncia de PUPPP em todas as gesta&#231;&#245;es e gesta&#231;&#245;es &#250;nicas em rela&#231;&#227;o ao tipo de concep&#231;&#227;o</p>"
        ]
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      1 => array:8 [
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        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Os valores de <span class="elsevierStyleItalic">p</span> significativos s&#227;o mostrados em negrito&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">DMG</span>&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> gestacional&#59; <span class="elsevierStyleItalic">DP</span>&#44; desvio padr&#227;o&#59; <span class="elsevierStyleItalic">FIV</span>&#44; fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span>&#59; <span class="elsevierStyleItalic">NS</span>&#44; n&#227;o significativo&#46; <span class="elsevierStyleItalic">PUPPP</span>&#44; p&#225;pulas e placas urticariformes pruriginosas da gravidez &#40;<span class="elsevierStyleItalic">pruritic urticarial papules and plaques of pregnancy</span>&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PUPPP em gesta&#231;&#245;es por FIV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#44; fetos n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PUPPP em gesta&#231;&#245;es espont&#226;neas&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#44; fetos n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Idade na gesta&#231;&#227;o &#40;anos&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP &#40;varia&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;4 &#40;20&#8208;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;8 &#40;20&#8208;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;588&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taxa de gravidez m&#250;ltipla &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;7 &#40;28&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;4 &#40;4&#47;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fator Rh positivo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#44;4 &#40;59&#47;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;7 &#40;13&#47;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;762&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ganho de peso materno &#40;kg&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;847&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frequ&#234;ncia de DMG &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;9 &#40;3&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#47;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;336&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In&#237;cio do PUPPP na gesta&#231;&#227;o &#40;semanas&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dura&#231;&#227;o de PUPPP &#40;dias&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;688&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade gestacional no parto &#40;semanas&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parto ces&#225;reo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;32&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;6&#47;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peso do beb&#234; ao nascer &#40;gramas&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3063<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>448&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3051<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>608&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;927&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rec&#233;m&#8208;nascido do sexo masculino &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;2 &#40;45&#47;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#40;12&#47;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;366&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o de casos de PUPPP em gesta&#231;&#245;es por FIV e gesta&#231;&#245;es espont&#226;neas</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Os valores de p significativos s&#227;o mostrados em negrito&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">DMG</span>&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> gestacional&#59; <span class="elsevierStyleItalic">DP</span>&#44; desvio padr&#227;o&#59; <span class="elsevierStyleItalic">FIV</span>&#44; fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span>&#59; <span class="elsevierStyleItalic">NS</span>&#44; n&#227;o significativo&#59; <span class="elsevierStyleItalic">PUPPP</span>&#44; p&#225;pulas e placas urticariformes pruriginosas da gravidez &#40;<span class="elsevierStyleItalic">pruritic urticarial papules and plaques of pregnancy</span>&#41;&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gesta&#231;&#245;es resultantes de FIV com PUPPP &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gesta&#231;&#245;es resultantes de FIV sem PUPPP &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>479&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Idade na gesta&#231;&#227;o &#40;anos&#41; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;740&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taxa de gravidez m&#250;ltipla &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;7 &#40;28&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;5 &#40;127&#47;479&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fator Rh positivo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#44;4 &#40;59&#47;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#44;6 &#40;537&#47;606&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;849&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ganho de peso materno &#40;kg&#41; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;723&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frequ&#234;ncia de DMG&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8 &#40;3&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;8 &#40;28&#47;479&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;490&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In&#237;cio de PUPPP na gesta&#231;&#227;o &#40;semanas&#41; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;419&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Dura&#231;&#227;o de PUPPP &#40;dias&#41; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;097&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;425&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68&#44;2 &#40;45&#47;66&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61&#44;2 &#40;371&#47;606&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Dura&#231;&#227;o do suporte hormonal com progesterona &#40;dias&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP &#40;intervalo&#41;&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o de gesta&#231;&#245;es resultantes de FIV com e sem PUPPP em rela&#231;&#227;o aos poss&#237;veis par&#226;metros cl&#237;nicos</p>"
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A manutenção prolongada da fase lútea com progesterona pode aumentar a frequência de pápulas e placas urticariformes pruriginosas da gravidez em gestações resultantes de fertilização in vitro
Nur Dokuzeylul Gungora,
Autor para correspondência
nurkaganece@gmail.com

Autor para correspondência.
, Tugba Gurbuzb, Tugba Turec
a Departamento de Medicina Reprodutiva e Fertilização in vitro, Goztepe Medical Park Hospital, Istambul, Turquia
b Departamento de Obstetrícia e Ginecologia, Nisantasi University e Private Medistate Hospital, Istambul, Turquia
c Departamento de Dermatologia, Clínica Particular, Istambul, Turquia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A condi&#231;&#227;o definida como p&#225;pulas urticariformes pruriginosas e placas da gravidez &#40;PUPPP&#44; do ingl&#234;s <span class="elsevierStyleItalic">pruritic urticarial papules and plaques of pregnancy</span>&#41;&#44; tamb&#233;m conhecida como erup&#231;&#227;o polimorfa da gravidez&#44; &#233; uma doen&#231;a cut&#226;nea benigna e autolimitada associada &#224; gravidez&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a> Foi descrita pela primeira vez por Lawley em 1979&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> A incid&#234;ncia relatada da PUPPP &#233; de 0&#44;5&#37; em gesta&#231;&#245;es &#250;nicas&#44; 2&#44;9&#37; a 16&#37; em gesta&#231;&#245;es gemelares e 14&#37; a 17&#37; em gesta&#231;&#245;es de trig&#234;meos&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;5</span></a> &#201; mais prevalente em mulheres prim&#237;paras&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> Embora a etiopatog&#234;nese da PUPPP ainda n&#227;o seja claramente compreendida&#44; considera&#8208;se que v&#225;rios fatores desempenhem um papel combinado&#44; incluindo gravidez m&#250;ltipla&#44; ganho de peso materno excessivo&#44; feto masculino&#44; presen&#231;a&#47;aus&#234;ncia do fator Rh&#44; aumento da imunorreatividade do receptor de progesterona e altos n&#237;veis de progesterona&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7&#8211;10</span></a> Pacientes com PUPPP geralmente apresentam o desenvolvimento de p&#225;pulas e placas na parte inferior do abd&#244;men e nas regi&#245;es superiores das extremidades inferiores durante o terceiro trimestre de gesta&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> Embora o prurido seja comum e inc&#244;modo&#44; problemas sist&#234;micos n&#227;o s&#227;o identificados nessa condi&#231;&#227;o e os sintomas existentes quase sempre regridem rapidamente ap&#243;s o parto&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Apesar da alta frequ&#234;ncia da doen&#231;a e de alguns grandes estudos&#44; h&#225; poucas evid&#234;ncias que sugiram uma rela&#231;&#227;o direta com quaisquer par&#226;metros cl&#237;nicos ou laboratoriais&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> Entretanto&#44; estudos anteriores com foco nesse t&#243;pico mostraram consistentemente n&#237;veis elevados de progesterona&#44; gesta&#231;&#245;es m&#250;ltiplas e imunorreatividade do receptor de progesterona em pacientes que desenvolvem PUPPP&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">13&#44;14</span></a> Considerando essa rela&#231;&#227;o hormonal e o fato de que Ghazeeri et al&#46; relataram uma incid&#234;ncia muito alta de PUPPP em gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> &#40;FIV&#41;&#44; parece que o desenvolvimento de PUPPP pode ter uma forte rela&#231;&#227;o com tratamentos hormonais durante a FIV e altera&#231;&#245;es hormonais durante a gravidez&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O objetivo deste estudo foi avaliar a frequ&#234;ncia de PUPPP em pacientes com gesta&#231;&#227;o resultante de FIV e gesta&#231;&#245;es espont&#226;neas em nosso centro&#44; e determinar quaisquer fatores associados ao desenvolvimento de PUPPP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Neste estudo&#44; 517 gesta&#231;&#245;es por FIV e 1&#46;253 gesta&#231;&#245;es espont&#226;neas seguidas entre 2014 e 2020 foram revisadas retrospectivamente para o diagn&#243;stico de PUPPP&#46; Todos os diagn&#243;sticos de PUPPP foram feitos por dermatologistas experientes&#44; de acordo com as manifesta&#231;&#245;es cl&#237;nicas t&#237;picas da doen&#231;a&#46; Ap&#243;s a an&#225;lise de todas as pacientes&#44; exclu&#237;mos gestantes com doen&#231;as cr&#244;nicas conhecidas e aquelas que haviam sido diagnosticadas com alguma doen&#231;a cut&#226;nea antes da gravidez&#46; A frequ&#234;ncia de PUPPP foi avaliada para a popula&#231;&#227;o geral em ambos os grupos&#44; e tamb&#233;m calculamos a frequ&#234;ncia entre aquelas com gravidez &#250;nica&#46; Pacientes no grupo de gravidez espont&#226;nea e no grupo de gravidez por FIV foram comparadas em termos dos seguintes par&#226;metros&#58; idade na gesta&#231;&#227;o&#44; gravidez m&#250;ltipla&#44; positividade do Rh&#44; ganho de peso da m&#227;e&#44; in&#237;cio da PUPPP na gesta&#231;&#227;o&#44; dura&#231;&#227;o da PUPPP&#44; tempo de parto&#44; taxa de parto ces&#225;reo&#44; peso do beb&#234; ao nascer e frequ&#234;ncia de rec&#233;m&#8208;nascidos do sexo masculino&#46; Tamb&#233;m comparamos gesta&#231;&#245;es por FIV com e sem PUPPP em termos de tratamentos de suporte hormonal com progesterona&#44; al&#233;m dos par&#226;metros mencionados acima&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da Maltepe University&#46; O consentimento informado foi obtido de todos os participantes individuais inclu&#237;dos no estudo&#46; O software SPSS &#40;v&#46; 22&#46;0&#41; para o sistema operacional Windows foi utilizado para a an&#225;lise estat&#237;stica dos dados&#46; As estat&#237;sticas descritivas foram relatadas como frequ&#234;ncia e porcentagem para vari&#225;veis categ&#243;ricas e como m&#233;dia&#44; desvio padr&#227;o&#44; valores m&#237;nimo&#44; m&#225;ximo e mediana para vari&#225;veis num&#233;ricas&#46; O n&#237;vel de signific&#226;ncia estat&#237;stica &#40;alfa&#41; foi aceito como p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Enquanto oito dos casos de PUPPP no grupo de gesta&#231;&#227;o espont&#226;nea eram primigestas e tr&#234;s eram mult&#237;paras&#44; todas as pacientes com PUPPP no grupo de FIV eram primigestas ou nul&#237;paras&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Em termos de compara&#231;&#245;es gerais&#44; descobrimos que PUPPP estava presente em 7&#44;4&#37; &#40;38&#47;517&#41; do grupo FIV e em 0&#44;9&#37; &#40;11&#47;1253&#41; das mulheres com gesta&#231;&#245;es espont&#226;neas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#46; Quando foram comparadas as gesta&#231;&#245;es &#250;nicas nesses grupos&#44; descobrimos que a frequ&#234;ncia de PUPPP foi de 2&#44;3&#37; &#40;10&#47;362&#41; no grupo FIV contra 0&#44;6&#37; &#40;7&#47;1206&#41; no grupo de gesta&#231;&#245;es espont&#226;neas &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A compara&#231;&#227;o dos casos de PUPPP em rela&#231;&#227;o ao tipo de gravidez produziu os seguintes resultados&#58; as taxas de gravidez m&#250;ltipla e de parto ces&#225;reo foram significativamente maiores em gesta&#231;&#245;es por FIV com PUPPP em compara&#231;&#227;o com o grupo de gesta&#231;&#245;es espont&#226;neas com PUPPP &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;022 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;038&#44; respectivamente&#41;&#46; Idade&#44; positividade do fator Rh&#44; ganho de peso materno&#44; in&#237;cio de PUPPP na gesta&#231;&#227;o&#44; dura&#231;&#227;o de PUPPP e peso do beb&#234; ao nascer e frequ&#234;ncia de rec&#233;m&#8208;nascidos do sexo masculino foram semelhantes entre os dois grupos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Em seguida&#44; comparamos gesta&#231;&#245;es por FIV com e sem PUPPP e verificamos que a frequ&#234;ncia de gravidez m&#250;ltipla e a dura&#231;&#227;o do suporte hormonal com progesterona foram significativamente maiores em pacientes com gesta&#231;&#227;o por FIV com PUPPP em compara&#231;&#227;o com pacientes com FIV sem PUPPP &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 e p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; respectivamente&#41;&#46; Idade&#44; positividade do fator Rh&#44; ganho de peso materno&#44; in&#237;cio de PUPPP na gesta&#231;&#227;o&#44; dura&#231;&#227;o de PUPPP&#44; taxa de parto ces&#225;reo&#44; peso do beb&#234; ao nascer e frequ&#234;ncia de rec&#233;m&#8208;nascidos do sexo masculino foram semelhantes entre os dois grupos &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">O principal achado deste estudo foi que a frequ&#234;ncia de PUPPP foi significativamente maior em gesta&#231;&#245;es resultantes de FIV do que em gesta&#231;&#245;es espont&#226;neas&#44; independentemente da presen&#231;a de gravidez &#250;nica ou m&#250;ltipla&#46; Que seja de nosso conhecimento&#44; este &#233; o primeiro estudo a comparar a frequ&#234;ncia de PUPPP em gesta&#231;&#245;es por FIV e gesta&#231;&#245;es espont&#226;neas&#44; levando em considera&#231;&#227;o v&#225;rias caracter&#237;sticas das pacientes&#46; H&#225; apenas um estudo anterior na literatura que relatou maior frequ&#234;ncia de PUPPP em gesta&#231;&#245;es resultantes de FIV&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> A alta frequ&#234;ncia de fetos m&#250;ltiplos em gesta&#231;&#245;es por FIV pode ser um dos fatores que contribuem para o aumento da frequ&#234;ncia de PUPPP nessas pacientes&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;5</span></a> A gesta&#231;&#227;o m&#250;ltipla que causa distens&#227;o abdominal excessiva &#233; sugerida como o fator mais comum que pode desencadear PUPPP&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> Isso ocorre porque a erup&#231;&#227;o das les&#245;es foi associada a danos ao tecido conjuntivo nas estrias em at&#233; 90&#37; das pacientes com PUPPP&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> Curiosamente&#44; em nosso estudo&#44; as circunfer&#234;ncias abdominais foram semelhantes entre gesta&#231;&#245;es por FIV e gesta&#231;&#245;es espont&#226;neas&#46; Al&#233;m disso&#44; em gesta&#231;&#245;es por FIV de feto &#250;nico&#44; o risco de PUPPP foi significativamente maior do que em gesta&#231;&#245;es espont&#226;neas&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Embora a PUPPP tenha sido descrita h&#225; mais de quatro d&#233;cadas e seja uma das dermatoses mais comuns que se desenvolvem durante a gravidez&#44; pouco se sabe sobre sua etiologia&#46; Uma alta porcentagem de mulheres com PUPPP &#233; primigesta&#46; Em uma revis&#227;o anterior avaliando esse t&#243;pico&#44; foi relatado que 42&#37; das pacientes eram primigestas e 68&#37; eram nul&#237;paras&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> enquanto outros estudos apresentam frequ&#234;ncias um pouco mais altas&#44; em torno de 70&#37; a 75&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;7</span></a> Em nosso estudo&#44; todas as pacientes com PUPPP no grupo de FIV eram primigestas ou nul&#237;paras&#44; pois estavam recebendo tratamento por causa da infertilidade&#46; Um estudo prospectivo que analisou mulheres com diversas dermatoses da gravidez determinou preval&#234;ncia elevada em mulheres gestando fetos masculinos em compara&#231;&#227;o com fetos femininos&#44; com uma propor&#231;&#227;o de 2&#58;1&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> De maneira similar&#44; tamb&#233;m observamos um aumento geral entre aquelas com fetos masculinos&#44; mas n&#227;o foi observada signific&#226;ncia estat&#237;stica &#8211; uma situa&#231;&#227;o comum em grande parcela da literatura&#46; Al&#233;m disso&#44; em nosso estudo&#44; as taxas de parto ces&#225;reo foram maiores&#44; semelhantes &#224;s da literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;10&#44;15</span></a> No entanto&#44; &#233; bem poss&#237;vel atribuir essa associa&#231;&#227;o ao fato de o parto ces&#225;reo ser utilizado com muito mais frequ&#234;ncia em mulheres com gesta&#231;&#227;o m&#250;ltipla &#40;tamb&#233;m frequente na FIV&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Neste estudo&#44; encontramos aumento da incid&#234;ncia de PUPPP em gesta&#231;&#245;es por FIV&#46; Para explicar a causa desse aumento&#44; foram avaliados os par&#226;metros cl&#237;nicos mostrados na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; Como esperado&#44; encontramos uma associa&#231;&#227;o positiva entre a frequ&#234;ncia de PUPPP e o aumento das taxas de gravidez m&#250;ltipla em gesta&#231;&#245;es resultantes de FIV&#46; Talvez o mais interessante seja que a dura&#231;&#227;o do suporte hormonal com progesterona tamb&#233;m tenha sido mais longa em gesta&#231;&#245;es por FIV com PUPPP quando comparada a gesta&#231;&#245;es por FIV sem PUPPP&#46; Na FIV&#44; o suporte hormonal com progesterona &#233; aplicado de maneira padronizada e doses semelhantes s&#227;o administradas na maioria das pacientes&#46; Este resultado sugere que o aumento da dosagem cumulativa de progesterona em pacientes com gesta&#231;&#245;es resultantes de FIV com PUPPP pode ser respons&#225;vel por um risco aumentado de desenvolvimento de PUPPP&#46; Que seja de nosso conhecimento&#44; esta &#233; a primeira vez que o tratamento prolongado com progesterona em gesta&#231;&#245;es resultantes de FIV foi associado a PUPPP&#46; Estudos anteriores que discutiram uma poss&#237;vel associa&#231;&#227;o entre n&#237;veis elevados de progesterona e PUPP&#44; eram mais comumente focados em pacientes que tinham n&#237;veis mais elevados de progesterona em associa&#231;&#227;o com gesta&#231;&#245;es m&#250;ltiplas espont&#226;neas&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> Em termos de resultados cl&#237;nicos e sugest&#245;es&#44; nossos achados mostram que m&#233;dicos e pacientes devem estar cientes do risco aumentado de PUPPP em gesta&#231;&#245;es resultantes de FIV&#44; especialmente na presen&#231;a de uma necessidade de suporte prolongado de progesterona&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Semelhante ao relato anterior de Ghazeeri et al&#46;&#44; nosso estudo tamb&#233;m revelou uma porcentagem mais alta de fator Rh positivo em pacientes com PUPPP&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> Exceto por este estudo&#44; n&#227;o h&#225; relatos que apoiem esse resultado na literatura&#46; A fim de esclarecer a etiopatogenia de PUPPP&#44; consideramos que seria &#250;til examinar o fator Rh positivo em mais detalhes&#46; Ganho de peso materno excessivo &#40;&#62; 15<span class="elsevierStyleHsp" style=""></span>kg por defini&#231;&#227;o&#41; tamb&#233;m foi detectado em nossas pacientes com PUPPP&#44; o que est&#225; de acordo com a literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;9</span></a> O ganho de peso excessivo aumenta a frequ&#234;ncia de PUPPP ao aumentar a distens&#227;o cut&#226;nea abdominal&#46; Cohen et al&#46; descobriram que o ganho de peso e a frequ&#234;ncia de gesta&#231;&#245;es gemelares foram mais altos em gestantes com PUPPP&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a> Foi sugerido que uma poss&#237;vel raz&#227;o para essa rela&#231;&#227;o positiva entre ganho de peso e PUPPP pode ser pelo fato de que os ant&#237;genos de col&#225;geno resultantes da distens&#227;o abdominal desencadeiam a rea&#231;&#227;o inflamat&#243;ria observada em casos de PUPPP&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> Essa hip&#243;tese tamb&#233;m &#233; apoiada por estudos que relatam que PUPPP &#233; observada mais cedo em gesta&#231;&#245;es m&#250;ltiplas&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">17&#44;18</span></a> Ap&#243;s uma forte sugest&#227;o do diagn&#243;stico de PUPPP&#44; o grau de desconforto relacionado ao prurido deve ser avaliado caso a caso&#44; uma vez que o tratamento &#233; principalmente sintom&#225;tico&#46; Todas as pacientes deste estudo foram tratadas sintomaticamente com cremes hidratantes e corticosteroides t&#243;picos&#46; Banhos frios e calmantes&#44; aplica&#231;&#227;o de emolientes e uso de roupas leves de algod&#227;o tamb&#233;m foram sugeridos &#224;s pacientes e foi relatado al&#237;vio sintom&#225;tico adicional&#44; semelhante &#224; literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;9</span></a> Muito embora a PUPPP regrida ap&#243;s o parto&#44; definitivamente n&#227;o &#233; uma indica&#231;&#227;o para parto antecipado&#44; uma vez que a PUPPP &#233; quase sempre autolimitada e benigna&#46; Portanto&#44; nenhuma das pacientes neste estudo teve parto prematuro em raz&#227;o da presen&#231;a de PUPPP&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">19&#44;20</span></a> &#201; consenso geral que a PUPPP representa um risco insignificante para a m&#227;e ou o feto&#59; entretanto&#44; alguns graus de rea&#231;&#245;es adversas foram relatados em alguns casos&#46; Por exemplo&#44; um relato de caso mostrou uma rela&#231;&#227;o com hipertens&#227;o e pr&#233;&#8208;ecl&#226;mpsia discreta e indu&#231;&#227;o do parto prematuro em associa&#231;&#227;o com o desenvolvimento de hipertens&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> Embora esses problemas sejam relativamente raros&#44; ainda assim devem ser levados em considera&#231;&#227;o em pacientes com PUPPP&#46; No estudo atual&#44; tivemos tr&#234;s pacientes com diabetes gestacional no grupo de gravidez por FIV&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A limita&#231;&#227;o mais importante deste estudo pode ser considerada a pequena porcentagem de pacientes com PUPPP em rela&#231;&#227;o ao tamanho muito grande de ambos os grupos de estudo&#46; Entretanto&#44; o n&#250;mero de pacientes com PUPPP deste estudo foi consideravelmente maior em compara&#231;&#227;o com a maioria dos estudos da literatura&#46; Al&#233;m disso&#44; esta &#233; uma an&#225;lise retrospectiva de pacientes&#44; o que limitaria a caracteriza&#231;&#227;o objetiva das pacientes e poderia induzir vieses na avalia&#231;&#227;o das mesmas&#46; Finalmente&#44; este &#233; um estudo de centro &#250;nico&#44; mas seu ponto forte est&#225; na an&#225;lise detalhada de registros m&#233;dicos mantidos de maneira meticulosa&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0075" class="elsevierStylePara elsevierViewall">Neste estudo&#44; a PUPPP foi estatisticamente mais frequente em gesta&#231;&#245;es resultantes de FIV do que em gesta&#231;&#245;es espont&#226;neas&#46; Descobrimos ainda que a dura&#231;&#227;o do tratamento com progesterona est&#225; associada &#224; PUPPP&#46; Esses resultados indicam que a dosagem cumulativa de progesterona ou tratamentos prolongados podem desempenhar um papel na patog&#234;nese da PUPPP&#46; Mais estudos com um n&#250;mero maior de pacientes representando diferentes comunidades devem ser realizados para confirmar nossos achados e determinar as varia&#231;&#245;es dentro&#47;entre diferentes popula&#231;&#245;es&#46; O papel da progesterona no desenvolvimento da PUPPP tamb&#233;m deve ser identificado por meio de estudos <span class="elsevierStyleItalic">in vitro</span> e <span class="elsevierStyleItalic">in vivo</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0085" class="elsevierStylePara elsevierViewall">Nur Dokuzeylul Gungor&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Tugba Gurbuz&#58; An&#225;lise estat&#237;stica&#59; Revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Tugba Ture&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; concep&#231;&#227;o e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O desenvolvimento de p&#225;pulas e placas urticariformes pruriginosas da gravidez pode ter uma forte rela&#231;&#227;o com tratamentos hormonais durante a fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> e altera&#231;&#245;es hormonais durante a gravidez&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar e comparar a frequ&#234;ncia de p&#225;pulas e placas da gravidez e fatores relacionados em gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> e gesta&#231;&#245;es espont&#226;neas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Neste estudo&#44; 517 gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> e 1&#46;253 gesta&#231;&#245;es espont&#226;neas foram revisadas retrospectivamente em rela&#231;&#227;o &#224; frequ&#234;ncia de p&#225;pulas e placas da gravidez&#46; O diagn&#243;stico de p&#225;pulas e placas da gravidez foi realizado por meio de encaminhamento ao Departamento de Dermatologia e de acordo com as manifesta&#231;&#245;es cl&#237;nicas t&#237;picas da doen&#231;a&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As p&#225;pulas e placas da gravidez foram mais comuns em todas as gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> &#40;incluindo gesta&#231;&#245;es &#250;nicas&#41; do que em gesta&#231;&#245;es espont&#226;neas&#46; Idade&#44; positividade do fator Rh&#44; ganho de peso materno&#44; in&#237;cio da doen&#231;a na gesta&#231;&#227;o&#44; dura&#231;&#227;o da doen&#231;a&#44; peso ao nascer e frequ&#234;ncia de fetos masculinos foram semelhantes entre os dois grupos &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; A taxa de gravidez m&#250;ltipla foi maior em gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> com p&#225;pulas e placas da gravidez do que em gesta&#231;&#245;es resultantes de fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> sem p&#225;pulas e placas da gravidez &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A dura&#231;&#227;o do tratamento com progesterona tamb&#233;m foi significativamente maior em gesta&#231;&#245;es com fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> e com p&#225;pulas e placas da gravidez em compara&#231;&#227;o com gesta&#231;&#245;es com fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span> sem p&#225;pulas e placas da gravidez &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Desenho retrospectivo e de centro &#250;nico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os resultados deste estudo indicam que o aumento da dosagem de progesterona ou o tratamento prolongado podem desempenhar um papel na patog&#234;nese das p&#225;pulas e placas da gravidez&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Gungor ND&#44; Gurbuz T&#44; Ture T&#46; Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through <span class="elsevierStyleItalic">in vitro</span> fertilization&#46; An Bras Dermatol&#46; 2021&#59;96&#58;171&#8211;5&#46;</p>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 estatisticamente significativo&#59; os valores de <span class="elsevierStyleItalic">p</span> significativos s&#227;o apresentados em negrito&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">FIV</span>&#44; fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span>&#59; <span class="elsevierStyleItalic">PUPPP</span>&#44; p&#225;pulas e placas urticariformes pruriginosas da gravidez &#40;<span class="elsevierStyleItalic">pruritic urticarial papules and plaques of pregnancy</span>&#41;&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequ&#234;ncia de PUPPP em todas as gesta&#231;&#245;es&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gesta&#231;&#245;es espont&#226;neas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1253&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;4 &#40;38 de 517&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frequ&#234;ncia de PUPPP em gesta&#231;&#245;es &#250;nicas&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gesta&#231;&#245;es por FIV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>362&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gesta&#231;&#245;es espont&#226;neas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1206&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;3 &#40;10 de 362&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6 &#40;7 de 1206&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o da frequ&#234;ncia de PUPPP em todas as gesta&#231;&#245;es e gesta&#231;&#245;es &#250;nicas em rela&#231;&#227;o ao tipo de concep&#231;&#227;o</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Os valores de <span class="elsevierStyleItalic">p</span> significativos s&#227;o mostrados em negrito&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">DMG</span>&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> gestacional&#59; <span class="elsevierStyleItalic">DP</span>&#44; desvio padr&#227;o&#59; <span class="elsevierStyleItalic">FIV</span>&#44; fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span>&#59; <span class="elsevierStyleItalic">NS</span>&#44; n&#227;o significativo&#46; <span class="elsevierStyleItalic">PUPPP</span>&#44; p&#225;pulas e placas urticariformes pruriginosas da gravidez &#40;<span class="elsevierStyleItalic">pruritic urticarial papules and plaques of pregnancy</span>&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PUPPP em gesta&#231;&#245;es por FIV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#44; fetos n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PUPPP em gesta&#231;&#245;es espont&#226;neas&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#44; fetos n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade na gesta&#231;&#227;o &#40;anos&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP &#40;varia&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;4 &#40;20&#8208;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;8 &#40;20&#8208;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;588&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taxa de gravidez m&#250;ltipla &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;7 &#40;28&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;4 &#40;4&#47;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fator Rh positivo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#44;4 &#40;59&#47;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;7 &#40;13&#47;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;762&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ganho de peso materno &#40;kg&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;847&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frequ&#234;ncia de DMG &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;9 &#40;3&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#47;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;336&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In&#237;cio do PUPPP na gesta&#231;&#227;o &#40;semanas&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dura&#231;&#227;o de PUPPP &#40;dias&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;688&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade gestacional no parto &#40;semanas&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parto ces&#225;reo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;32&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;6&#47;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peso do beb&#234; ao nascer &#40;gramas&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3063<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>448&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3051<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>608&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;927&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rec&#233;m&#8208;nascido do sexo masculino &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o de casos de PUPPP em gesta&#231;&#245;es por FIV e gesta&#231;&#245;es espont&#226;neas</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Os valores de p significativos s&#227;o mostrados em negrito&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">DMG</span>&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> gestacional&#59; <span class="elsevierStyleItalic">DP</span>&#44; desvio padr&#227;o&#59; <span class="elsevierStyleItalic">FIV</span>&#44; fertiliza&#231;&#227;o <span class="elsevierStyleItalic">in vitro</span>&#59; <span class="elsevierStyleItalic">NS</span>&#44; n&#227;o significativo&#59; <span class="elsevierStyleItalic">PUPPP</span>&#44; p&#225;pulas e placas urticariformes pruriginosas da gravidez &#40;<span class="elsevierStyleItalic">pruritic urticarial papules and plaques of pregnancy</span>&#41;&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gesta&#231;&#245;es resultantes de FIV com PUPPP &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gesta&#231;&#245;es resultantes de FIV sem PUPPP &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>479&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">29&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;740&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Taxa de gravidez m&#250;ltipla &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#44;7 &#40;28&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26&#44;5 &#40;127&#47;479&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fator Rh positivo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">89&#44;4 &#40;59&#47;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">88&#44;6 &#40;537&#47;606&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;849&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">17&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;723&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Frequ&#234;ncia de DMG&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7&#44;8 &#40;3&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;8 &#40;28&#47;479&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;490&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In&#237;cio de PUPPP na gesta&#231;&#227;o &#40;semanas&#41; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;419&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Dura&#231;&#227;o de PUPPP &#40;dias&#41; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;097&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Idade gestacional no parto &#40;semanas&#41; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;425&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parto ces&#225;reo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">84 &#40;32&#47;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;380&#47;479&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;472&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Peso do beb&#234; ao nascer &#40;gramas&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3063<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>448&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2980<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>428&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;321&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rec&#233;m&#8208;nascido do sexo masculino &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;2 &#40;45&#47;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#44;2 &#40;371&#47;606&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Dura&#231;&#227;o do suporte hormonal com progesterona &#40;dias&#41;&#44; m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP &#40;intervalo&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">101<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
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