Banca de QUALIFICAÇÃO: NAYARA GOMES GRACILIANO

BIOANALYSIS OF COLOSTRUM OF NURSING WOMEN AFFECTED BY COVID-19 DURING PREGNANCY AND SOCIOECONOMIC DETERMINANTS OF MATERNAL MORTALITY RELATED TO THE DISEASE IN THE BRAZILIAN SEMI-ARID

Coronavirusdisease 2019, causedby SARS-CoV-2, hasbecome a global threatto global publichealth. As thepandemicevolved, infections, hospitalizationsand deaths variedbetweenandwithin countries andregionsaroundthe world, raisingquestionsaboutriskandprotectivefactors for thedisease. The protectivepowerofbreastmilkagainstinfectiousdiseaseshasbeenknown for more than 20 years. Basedontheabsenceofvaccinesagainst COVID-19 for infantsunder 6 monthsof age, passive immunityconferredbythe placenta andbreastfeeding are theonlywaysto, respectively, provideimmunologicaldefensetothefetusandneonate.In thissense, thefirstobjectiveofthisthesiswastoanalyzethe profile ofbioactivecompounds in thecolostrumofnursingmothersaffectedby SARS-CoV-2 duringpregnancy, whodidanddidnotpresentsymptoms. Using a case-controlstudy design, wecollectedcolostrumfrom 14 nursingmotherswith a confirmeddiagnosisof COVID-19 duringpregnancyand 12 without a diagnosis, betweenSeptember 2020 and May 2021. Samples wereanalyzed for IgA and IgG immunoglobulins for theprotein S of SARS-CoV-2, oxidative stress markers, cytokinesandchemokines. Immunophenotypingwasperformedtoevaluatethefrequencyofdifferentcelltypes in colostrum. Colostrumfromthesymptomatic COVID-19 pregnancygroupcontainedreducedlevelsof H2O2, IFN-α2, and GM-CSF. Thisgroupalsohadhigherlevelsof GSH, and a higherproportionofboth NK cellsubtypes (CD56dimand CD56bright).Theseresultsreinforcetheprotective role ofcolostrumeven in cases ofmild SARS-Cov-2 infection, in additiontodemonstratinghowadaptivethecompositionofcolostrumisafterinfections. Consideringthatmortalityandlethality rates from COVID-19 are heterogeneousbetweenregionsofBrazilandthatpopulations in thepoorestregionsofBrazil are more vulnerabletotheimpactsof SARS-CoV-2 infection, thesecondobjectiveofthisthesiswastoinvestigatetheassociationof maternal deaths andmortality rates dueto COVID-19 amongpregnantwomen, postpartumwomenandinfantsandtheirassociationwiththe social determinantsofhealth in theBrazilianSemiarid region.Throughanecologicalstudythatemployedpanel data regression models, usingvariablesextractedfromnationaldatabases, it wasdiscoveredthat social determinantsofhealthrelatedto local healthinfrastructure, educationand healthcare expendituresexerted a statisticallysignificantinfluenceonoutcomesanalyzed. Municipalities in theSemiaridregionsuffered more fromtheeffectsofthepandemic in relationtotheseverityofthedisease, presentingworsemortality rates dueto COVID-19. Thesefindingscontributeto a betterunderstandingoftheimpactsofsocioeconomicfactorsonmortalityandlethalityoutcomesdueto COVID-19 for the maternal andchildpopulation, highlightingthedisparitiesthatexistbetweenthemunicipalitiesofthestatesthat make upthesemi-aridregionofBrazil. Together, theseresultsrevealthecomplexityofprotectiveandriskfactors for COVID-19, which still represents a publichealthconcerntoday, particularly for infantsunder 1 yearof age, whichreinforcestheimportanceofadvancingvaccinationcoverage for thisdisease. public, as well as theimportanceofbreastfeeding, especially for childrenunder 6 monthsof age who do nothavevaccinesagainst COVID-19.