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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">As consequ&#234;ncias de curto prazo da depress&#227;o e ansiedade pr&#233;&#8208;natal sobre a sa&#250;de f&#237;sica da mulher gr&#225;vida referem&#8208;se a complica&#231;&#245;es obst&#233;tricas e sintomas f&#237;sicos&#44; ambos associados a menor crescimento fetal e neonatal e menor matura&#231;&#227;o do sistema nervoso aut&#244;nomo &#40;SNA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2</span></a> A depress&#227;o e a ansiedade compartilham uma via gen&#233;tica comum e normalmente aparecem simultaneamente&#44; tornam dif&#237;cil a avalia&#231;&#227;o de seu efeito independente&#46; Assim&#44; ao analisar o efeito da depress&#227;o e ansiedade materna&#44; pode ser importante considerar ambas simultaneamente&#44; a fim de controlar seu efeito m&#250;tuo e melhor identificar o efeito independente de cada uma&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Diferentes estudos constataram um efeito semelhante da depress&#227;o e ansiedade materna pr&#233;&#8208;natal sobre o crescimento fetal&#44; comportamento e matura&#231;&#227;o do sistema nervoso aut&#244;nomo &#40;SNA&#41;&#46; Constatou&#8208;se que os fetos de m&#227;es depressivas e ansiosas apresentam menor peso estimado e maior atividade fetal total&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;6</span></a> Al&#233;m disso&#44; estudos mencionaram que os fetos de m&#227;es depressivas e ansiosas mostraram uma maior reatividade da frequ&#234;ncia card&#237;aca em compara&#231;&#227;o com os fetos de m&#227;es sem depress&#227;o e n&#227;o ansiosas&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;7&#8211;10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Ademais&#44; os estudos tamb&#233;m constataram um efeito semelhante da depress&#227;o e ansiedade materna pr&#233;&#8208;natal sobre o crescimento neonatal&#44; comportamento e resultados de matura&#231;&#227;o&#46; Neonatos de m&#227;es depressivas e ansiosas no per&#237;odo pr&#233;&#8208;natal apresentaram maior risco de nascer prematuramente e com menor peso&#44; ambos importantes problemas de sa&#250;de infantil&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#8211;13</span></a> Constatou&#8208;se que os neonatos de m&#227;es depressivas e ansiosas apresentam padr&#245;es de sono desorganizados e frequentes mudan&#231;as de humor&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Uma menor matura&#231;&#227;o tamb&#233;m foi constatada em neonatos de m&#227;es depressivas e ansiosas no per&#237;odo pr&#233;&#8208;natal&#44; inclusive menos t&#244;nus vagal e menor maturidade neurocomportamental&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;11&#44;13&#44;14</span></a> Adicionalmente&#44; constatou&#8208;se que os neonatos de m&#227;es depressivas e ansiosas no per&#237;odo pr&#233;&#8208;natal mostram maiores n&#237;veis de cortisol e menores n&#237;veis de dopamina e serotonina&#44; em compara&#231;&#227;o com os n&#237;veis hormonais de neonatos de m&#227;es sem depress&#227;o e n&#227;o ansiosas no per&#237;odo pr&#233;&#8208;natal&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Outros estudos tamb&#233;m relataram que os neonatos de m&#227;es depressivas e ansiosas no per&#237;odo pr&#233;&#8208;natal apresentam aumento nas taxas de interna&#231;&#227;o na unidade de cuidado neonatal e retardo do crescimento durante o primeiro ano de vida&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Poucos estudos consideraram simultaneamente depress&#227;o e ansiedade materna ao analisar o efeito sobre o crescimento e comportamento fetal-neonatal&#46; Ao considerar simultaneamente depress&#227;o e ansiedade maternal&#44; os estudos apenas constataram um efeito independente da ansiedade maternal sobre o crescimento e comportamento fetal-neonatal&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#8211;20</span></a> Um estudo transversal apenas constatou o efeito da ansiedade materna sobre o crescimento e comportamento fetal &#40;os fetos de m&#227;es ansiosas apresentaram menor peso estimado e maior atividade na metade da gravidez&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> Adicionalmente&#44; dois estudos longitudinais constataram apenas o efeito da ansiedade maternal sobre as trajet&#243;rias de crescimento fetal-neonatal &#40;a maior ansiedade materna durante a gravidez foi associada a um menor aumento do peso fetal-neonatal&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;20</span></a> Contudo&#44; esses estudos inclu&#237;ram apenas uma avalia&#231;&#227;o da depress&#227;o e ansiedade materna pr&#233;&#8208;natal &#40;durante a gravidez&#41; ao analisar seu efeito sobre o crescimento fetal-neonatal&#44; n&#227;o abordou o efeito longitudinal da depress&#227;o e ansiedade materna&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Constatou&#8208;se que a depress&#227;o e ansiedade materna afetam negativamente o crescimento fetal e neonatal&#46; Apesar de esses efeitos terem sido amplamente documentados na literatura&#44; o efeito independente da depress&#227;o e ansiedade materna sobre os resultados e trajet&#243;rias de crescimento fetal-neonatal continua incerto&#46; Ademais&#44; h&#225; uma falta de estudos que tenham abordado simultaneamente o efeito longitudinal independente da depress&#227;o e ansiedade materna sobre as trajet&#243;rias de crescimento fetal-neonatal&#46; Este estudo visou a analisar simultaneamente o efeito da depress&#227;o e ansiedade materna pr&#233;&#8208;natal &#40;1&#41; sobre os resultados neonatais e &#40;2&#41; sobre as trajet&#243;rias do crescimento fetal-neonatal a partir do 2&#176; trimestre de gravidez at&#233; o parto&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participantes</span><p id="par0030" class="elsevierStylePara elsevierViewall">A amostra foi composta de 172 m&#227;es recrutadas no Centro Hospitalar do Porto no 1&#176; trimestre de gravidez &#40;8&#8208;14 semanas de gesta&#231;&#227;o&#41;&#46; Os crit&#233;rios de inclus&#227;o foram&#58; conseguir ler e escrever em portugu&#234;s&#59; morar em Portugal por pelo menos um ano&#59; estar com 14 semanas de gravidez&#59; e gesta&#231;&#245;es &#250;nicas sem complica&#231;&#245;es m&#233;dicas e&#47;ou obst&#233;tricas&#46; Das 172 m&#227;es que conclu&#237;ram a 1&#170; onda de avalia&#231;&#227;o&#44; 88&#44;4&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>152&#41; conclu&#237;ram todas as tr&#234;s ondas de avalia&#231;&#227;o&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedimentos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Este estudo foi conduzido de acordo com a Declara&#231;&#227;o de Helsinque e aprovado previamente pelo Comit&#234; de &#201;tica de todas as institui&#231;&#245;es envolvidas&#46; As mulheres que desejaram participar forneceram um consentimento informado por escrito&#44; depois de explicados os objetivos e procedimentos do estudo&#46; Este estudo tinha um modelo longitudinal com tr&#234;s ondas de avalia&#231;&#227;o&#58; 2&#176; trimestre de gravidez &#40;20&#8208;24 semanas de gesta&#231;&#227;o&#41;&#44; 3&#176; trimestre de gravidez &#40;30&#8208;34 semanas de gesta&#231;&#227;o&#41; e parto &#40;1&#8208;3 dias p&#243;s&#8208;natal&#41;&#46; As m&#227;es relataram repetidamente graus de depress&#227;o e ansiedade&#46; Os registros obst&#233;tricos e dados biom&#233;tricos fetais e neonatais foram coletados dos prontu&#225;rios cl&#237;nicos no 2&#176; e 3&#176; trimestre de gravidez e no parto&#46; Para evitar poss&#237;veis erros relacionados &#224; idade estimada&#44; a idade gestacional foi estimada com base no &#250;ltimo per&#237;odo menstrual das m&#227;es e confirmada com as medi&#231;&#245;es do ultrassom&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Medidas</span><p id="par0040" class="elsevierStylePara elsevierViewall">As informa&#231;&#245;es sociodemogr&#225;ficas e obst&#233;tricas foram obtidas com um question&#225;rio sociodemogr&#225;fico&#46; Para avaliar a depress&#227;o maternal&#44; foi usada a vers&#227;o em portugu&#234;s da Escala de Depress&#227;o P&#243;s&#8208;Parto de Edimburgo &#40;EPDS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#44;22</span></a> A EPDS &#233; uma escala de autorrelato composta de 10 itens em uma escala Likert de 4 pontos&#46; Um ponto de corte de 10 foi sugerido para detectar depress&#227;o em mulheres portuguesas&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> V&#225;rios estudos usaram essa escala em mulheres durante a gravidez e no per&#237;odo p&#243;s&#8208;natal&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#8211;20</span></a> A vers&#227;o em portugu&#234;s da EPDS mostrou boa consist&#234;ncia interna em mulheres durante a gravidez e no per&#237;odo p&#243;s&#8208;natal &#40;&#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;85&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;22</span></a> No presente estudo&#44; os coeficientes alfa de Cronbach variaram de 0&#44;84 a 0&#44;85&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Para avaliar a ansiedade maternal&#44; foi usada a vers&#227;o em portugu&#234;s do Invent&#225;rio de Ansiedade Tra&#231;o&#8208;Estado &#40;Idate&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23&#44;24</span></a> O Invent&#225;rio de Ansiedade Tra&#231;o&#8208;Estado &#233; composto de duas subescalas&#58; uma para avaliar a ansiedade como um estado emocional &#40;Idate&#41; e outra para avaliar o tra&#231;o de ansiedade&#44; cada uma delas com 20 itens classificados em uma escala Likert de 4 pontos&#46; Um ponto de corte de 45 foi sugerido para detectar ansiedade alta em mulheres portuguesas&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> V&#225;rios estudos usaram essa medida em mulheres durante a gravidez e no per&#237;odo p&#243;s&#8208;natal&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a> A vers&#227;o em portugu&#234;s da Idate mostrou boa consist&#234;ncia interna em mulheres durante a gravidez e no per&#237;odo p&#243;s&#8208;natal &#40;o &#945; variou de 0&#44;87 a 0&#44;93&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> No presente estudo&#44; os coeficientes alfa de Cronbach do Idate variaram de 0&#44;89 a 0&#44;93&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para avaliar o crescimento fetal&#44; o peso fetal estimado &#40;medido em gramas&#41; foi obtido dos ultrassons obst&#233;tricos no 2&#176; e 3&#176; trimestre de gravidez&#46; Essas medidas foram obtidas seguindo um protocolo padr&#227;o de medi&#231;&#227;o cl&#237;nica&#44; por um obstetra da equipe de pesquisa&#46; O peso fetal estimado foi calculado com a f&#243;rmula de Hadlock&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Para avaliar os resultados de crescimento neonatal&#44; o peso neonatal&#44; o comprimento &#40;medido em cent&#237;metros&#41;&#44; o &#237;ndice ponderal &#40;100 x &#91;peso&#47;comprimento&#93;<span class="elsevierStyleSup">3</span>&#41; e a idade gestacional no nascimento foram coletados dos prontu&#225;rios m&#233;dicos&#46; Essas medidas foram sugeridas por uma pesquisa anterior como importantes marcadores de crescimento e resultados fetal-neonatal&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#8211;20</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Estrat&#233;gia de an&#225;lise de dados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Para analisar simultaneamente o efeito da depress&#227;o e da ansiedade materna no per&#237;odo pr&#233;&#8208;natal sobre os resultados neonatais&#44; foi feita uma An&#225;lise Multivariada de Covari&#226;ncia &#40;Mancova&#41; Bidirecional&#46; No modelo&#44; a depress&#227;o e a ansiedade materna no per&#237;odo pr&#233;&#8208;natal &#40;m&#233;dia dos escores no 2&#176; e 3&#176; trimestre de gravidez&#59; codificada como 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>EPDS<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10 e 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>EPDS &#8805; 10 para depress&#227;o&#59; 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Idate<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45 e 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Idate &#8805; 45 para ansiedade&#41; foram inclu&#237;das como vari&#225;veis independentes e os resultados de crescimento neonatal &#40;peso&#44; comprimento&#44; &#237;ndice ponderal e idades gestacional no nascimento&#41; como vari&#225;veis dependentes&#46; O peso da m&#227;e antes da gravidez e o consumo de tabaco e caf&#233; durante a gravidez foram inclu&#237;dos como covari&#225;veis&#46; A Mancova Bidirecional foi feita com o SPSS &#40;IBM Corp&#59; SPSS Estat&#237;stica para Windows&#44; vers&#227;o 23&#46;0&#46; NY&#44; EUA&#41;&#46; A medida de tamanho do efeito do eta quadrado parcial &#40;&#951;p<span class="elsevierStyleSup">2</span>&#41; foi apresentada para os resultados da Mancova Bidirecional&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Para analisar simultaneamente o efeito da depress&#227;o e ansiedade materna sobre o crescimento e as trajet&#243;rias fetal-neonatal&#44; os modelos de curva de crescimento &#40;MCC&#41; foram estimados com a modelagem multin&#237;vel&#46; O tempo 0 foi definido como a data da primeira avalia&#231;&#227;o no 2&#176; trimestre de gravidez &#40;base&#41; e o tempo vari&#225;vel foi classificado em semanas desde a base at&#233; o parto&#46; Os escores da escala de peso fetal-neonatal&#44; depress&#227;o materna &#40;escores EPDS&#41; e sintomas de ansiedade &#40;escores Idate&#41; foram examinados em cada onda de avalia&#231;&#227;o&#46; Os efeitos fixos para os sintomas de depress&#227;o e ansiedade materna &#40;efeitos vari&#225;veis no tempo centrados em suas grandes m&#233;dias&#41; foram inclu&#237;dos no modelo&#46; Foram feitos dois modelos &#40;incondicional e com preditores&#41;&#46; O peso da m&#227;e antes da gravidez e o consumo de tabaco e caf&#233; durante a gravidez foram inclu&#237;dos como covari&#225;veis&#46; As intera&#231;&#245;es significativas foram interpretadas e grafadas com um desvio padr&#227;o acima e abaixo da grande m&#233;dia das vari&#225;veis preditoras como valores altos e baixos&#46; Foi feito um teste de diferen&#231;a de desvio entre o modelo incondicional e o modelo com preditores para examinar as melhorias de ajuste nos modelos&#46; Os MCC foram feitos em um conjunto de dados pares&#8208;pessoa&#8208;per&#237;odo com a vers&#227;o 23&#46;0 do SPSS &#40;SPSS Inc&#46;&#44; EUA&#41;&#46; Os dados resultantes consistiram em 516 poss&#237;veis observa&#231;&#245;es &#40;172 participantes por 3 pontos temporais&#41;&#46; O tamanho do efeito <span class="elsevierStyleItalic">r</span> foi estimado para todos os efeitos significativos&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">Quase todas as m&#227;es eram portuguesas &#40;92&#44;1&#37;&#41;&#44; brancas &#40;94&#44;8&#37;&#41;&#44; casadas ou em coabita&#231;&#227;o &#40;86&#44;8&#37;&#41; e moravam com o parceiro &#40;86&#44;2&#37;&#41;&#46; Mais da metade tinha entre 18 e 29 anos &#40;M<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#44;69&#44; DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;82&#41;&#44; pertencia a um n&#237;vel socioecon&#244;mico m&#233;dio&#8208;baixo ou baixo &#40;62&#44;0&#37;&#41;&#44; tinha empregado &#40;67&#44;1&#37;&#41; e entre nove e 12 anos de escolaridade &#40;54&#44;5&#37;&#41;&#46; Al&#233;m disso&#44; mais da metade das m&#227;es era prim&#237;para &#40;52&#44;1&#37;&#41;&#44; teve parto eut&#243;cico &#40;com ou sem epidural&#59; 56&#44;3&#37;&#41;&#46; A maioria relatou que n&#227;o fumou durante a gravidez &#40;83&#44;8&#37;&#41;&#44; mais da metade relatou n&#227;o ter consumido caf&#233; &#40;70&#44;7&#37;&#41; e todas relataram n&#227;o terem consumido &#225;lcool e drogas durante a gravidez&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Mais da metade dos neonatos era menino &#40;56&#44;3&#37;&#41; e nasceu com comprimento de &#8805; 50<span class="elsevierStyleHsp" style=""></span>cm &#40;63&#44;5&#37;&#41;&#46; A maioria n&#227;o foi reanimada no nascimento &#40;94&#44;0&#37;&#41;&#44; nasceu com peso entre 2&#46;500 e 4&#46;199<span class="elsevierStyleHsp" style=""></span>g &#40;91&#44;0&#37;&#41;&#44; &#237;ndice ponderal &#8805; 2&#44;50 &#40;81&#44;2&#37;&#41;&#44; idade gestacional ao nascer &#8805; 37 semanas &#40;95&#44;8&#37;&#41; e apresentou &#237;ndice de Apgar entre 7 e 10 no 1&#176; &#40;92&#44;6&#37;&#41; e 5&#176; minutos &#40;98&#44;8&#37;&#41;&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Nenhuma associa&#231;&#227;o e diferen&#231;a foi encontrada entre as m&#227;es que conclu&#237;ram e aquelas que n&#227;o conclu&#237;ram as tr&#234;s ondas de avalia&#231;&#227;o&#44; com rela&#231;&#227;o &#224;s vari&#225;veis das m&#227;es e dos neonatos&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Adicionalmente&#44; nenhuma associa&#231;&#227;o e diferen&#231;a foi encontrada entre as m&#227;es que conclu&#237;ram e aquelas que n&#227;o conclu&#237;ram as tr&#234;s ondas de avalia&#231;&#227;o em todas as vari&#225;veis do estudo em cada onda de avalia&#231;&#227;o&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Foram feitas as estat&#237;sticas descritivas de todas as vari&#225;veis do estudo em cada avalia&#231;&#227;o &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Foram encontradas associa&#231;&#245;es significativas entre as vari&#225;veis do estudo no in&#237;cio &#40;varia&#231;&#227;o de <span class="elsevierStyleItalic">r</span> de &#8722;0&#44;289&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; a 0&#44;652&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; N&#227;o foi encontrada associa&#231;&#227;o entre o peso fetal e os sintomas depressivos maternos no in&#237;cio&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Efeito da depress&#227;o e ansiedade materna pr&#233;&#8208;natal sobre os resultados de crescimento neonatal</span><p id="par0095" class="elsevierStylePara elsevierViewall">A Mancova Bidirecional revelou efeitos multivariados significativos de ansiedade materna pr&#233;&#8208;natal sobre os resultados de crescimento neonatal&#44; <span class="elsevierStyleItalic">Wilk&#39;s Lambda</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;91&#44; <span class="elsevierStyleItalic">F</span> &#40;4&#44;142&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;29&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#44; &#951;p<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;09&#46; Os resultados revelaram efeitos univariados da ansiedade maternal pr&#233;&#8208;natal sobre o peso neonatal&#44; o comprimento neonatal e o &#237;ndice ponderal neonatal&#46; Os neonatos de m&#227;es ansiosas no per&#237;odo pr&#233;&#8208;natal mostraram menor peso&#44; comprimento e &#237;ndice ponderal no nascimento do que os neonatos de m&#227;es n&#227;o ansiosas no per&#237;odo pr&#233;&#8208;natal&#46; N&#227;o foi encontrado efeito univariado significativo da ansiedade materna pr&#233;&#8208;natal sobre a idade gestacional neonatal ao nascer &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">N&#227;o foi encontrado efeito multivariado significativo da depress&#227;o materna pr&#233;&#8208;natal sobre os resultados de crescimento neonatal&#44; <span class="elsevierStyleItalic">Wilk&#39;s Lambda</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;95&#44; <span class="elsevierStyleItalic">F</span> &#40;4&#44;142&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;92&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;110&#44; &#951;p<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Efeito da depress&#227;o e ansiedade materna sobre as trajet&#243;rias de crescimento fetal-neonatal a partir do 2&#176; trimestre de gravidez at&#233; o nascimento</span><p id="par0105" class="elsevierStylePara elsevierViewall">Importantes efeitos com rela&#231;&#227;o ao tempo foram encontrados sobre o peso fetal-neonatal&#44; <span class="elsevierStyleItalic">b</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>96&#44;71&#44; <span class="elsevierStyleItalic">SE</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;71&#44; IC de <span class="elsevierStyleItalic">95&#37;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#91;93&#44;33&#44;100&#44;08&#93;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; tamanho do efeito <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;95&#46; Do 2&#176; trimestre de gravidez at&#233; o nascimento&#44; houve aumento no peso fetal-neonatal&#44; em m&#233;dia&#44; 97 gramas por semana&#46; Al&#233;m disso&#44; foram encontrados efeitos de intera&#231;&#227;o dos sintomas de ansiedade e tempo&#44; <span class="elsevierStyleItalic">b</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;65&#44; <span class="elsevierStyleItalic">SE</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;10&#44; IC de <span class="elsevierStyleItalic">95&#37;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#91;2&#44;45&#44; 2&#44;86&#93;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; tamanho do efeito <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;86&#46; Os fetos&#8208;neonatos de m&#227;es muito ansiosas mostraram um menor aumento de peso a partir do 2&#176; trimestre de gravidez at&#233; o nascimento que os fetos&#8208;neonatos de m&#227;es pouco ansiosas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; N&#227;o foram encontrados efeitos importantes dos sintomas da ansiedade materna sobre o peso fetal-neonatal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">N&#227;o foram encontrados efeitos importantes dos sintomas de depress&#227;o materna sobre o peso fetal-neonatal&#46; Da mesma forma&#44; n&#227;o foram encontrados efeitos da intera&#231;&#227;o entre os sintomas de depress&#227;o das m&#227;es e tempo e efeitos da intera&#231;&#227;o entre os sintomas de depress&#227;o materna&#44; os sintomas de ansiedade materna e tempo&#46; Os efeitos de intercep&#231;&#227;o e aleat&#243;rios &#40;intercepto<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>tempo&#59; residuais&#41; foram estatisticamente significativos &#40;todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; O teste de diferen&#231;a de desvio mostrou que o modelo com preditores &#40;sintomas de depress&#227;o e ansiedade materna&#41; forneceu melhor adequa&#231;&#227;o aos dados&#44; &#967;<span class="elsevierStyleSup">2</span>&#40;5&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>138&#44;87&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discuss&#227;o</span><p id="par0115" class="elsevierStylePara elsevierViewall">Considerando simultaneamente o efeito da depress&#227;o e ansiedade materna no per&#237;odo pr&#233;&#8208;natal&#44; foi encontrado um efeito independente significativo da ansiedade materna pr&#233;&#8208;natal sobre os principais marcadores de resultados de crescimento neonatal&#46; Os neonatos de m&#227;es ansiosas no per&#237;odo pr&#233;&#8208;natal mostraram menor peso&#44; comprimento e &#237;ndice ponderal no nascimento do que os neonatos de m&#227;es n&#227;o ansiosas no per&#237;odo pr&#233;&#8208;natal&#46; Esses resultados s&#227;o compat&#237;veis com uma pesquisa anterior que relata que os neonatos de m&#227;es ansiosas nasceram com menor peso&#44; comprimento e &#237;ndice ponderal&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Adicionalmente&#44; considerando simultaneamente a depress&#227;o e ansiedade materna&#44; foi encontrado um efeito de intera&#231;&#227;o significativo dos sintomas de ansiedade materna e tempo sobre um principal marcador de crescimento fetal-neonatal&#46; Esse resultado sugere o efeito dos sintomas de ansiedade materna sobre as trajet&#243;rias de crescimento fetal-neonatal a partir do 2&#176; trimestre de gravidez at&#233; o nascimento&#46; Os fetos&#8208;neonatos de m&#227;es ansiosas mostraram um menor aumento de peso&#44; a partir do 2&#176; trimestre de gravidez at&#233; o nascimento&#44; do que os fetos&#8208;neonatos de m&#227;es n&#227;o ansiosas&#46; Esses achados sugeriram que a ansiedade materna afeta negativamente esse importante marcador de trajet&#243;rias normativas de crescimento fetal-neonatal a partir do per&#237;odo pr&#233;&#8208;natal at&#233; o nascimento&#44; mesmo ao considerar simultaneamente o efeito da depress&#227;o materna&#46; Esse resultado &#233; compat&#237;vel com uma pesquisa anterior que constatou um menor aumento de peso em fetos&#8208;neonatos de m&#227;es ansiosas que os fetos&#8208;neonatos de m&#227;es n&#227;o ansiosas da gravidez at&#233; o nascimento&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">V&#225;rios mecanismos subjacentes foram sugeridos para explicar o efeito da ansiedade maternal sobre o crescimento fetal-neonatal&#46; Mecanismos epigen&#233;ticos foram propostos como poss&#237;veis mediadores do efeito da ansiedade pr&#233;&#8208;natal sobre o crescimento fetal-neonatal&#46; Estudos sugeriram que a ansiedade pr&#233;&#8208;natal pode alterar a fisiologia fetal permanentemente&#44; a saber uma hiperativa&#231;&#227;o do eixo Hipot&#225;lamo Pituit&#225;ria Adrenal &#40;HPA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26&#44;27</span></a> A literatura tamb&#233;m sugeriu a hiperativa&#231;&#227;o do HPA das m&#227;es como um mediador do efeito da ansiedade materna pr&#233;&#8208;natal sobre o crescimento fetal-neonatal&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> A ansiedade pr&#233;&#8208;natal pode ser um fator de estresse para mulheres gr&#225;vidas&#44; estimular o eixo HPA a produzir maiores n&#237;veis de glicocorticoides&#46; Os glicocorticoides maternos podem ser transduzidos para o feto pelo transporte transplacent&#225;rio e pela libera&#231;&#227;o induzida pelo estresse de horm&#244;nios placent&#225;rios na circula&#231;&#227;o fetal&#46; O aumento no cortisol fetal contribui para a matura&#231;&#227;o dos sistemas dos &#243;rg&#227;os&#44; necess&#225;ria para a sobrevida extrauterina&#46; Contudo&#44; os n&#237;veis excessivos de glicocorticoide feto&#8208;placent&#225;rio podem resultar em restri&#231;&#227;o do crescimento intrauterino&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Al&#233;m disso&#44; a ansiedade materna pr&#233;&#8208;natal tem sido associada a uma redu&#231;&#227;o geral no consumo aliment&#237;cio e menor ingest&#227;o de vitaminas essenciais e &#225;cidos graxos &#40;p&#46; ex&#46;&#44; &#225;cido f&#243;lico&#44; vitamina B12&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">As principais preocupa&#231;&#245;es com rela&#231;&#227;o ao baixo peso ao nascer&#44; comprimento e &#237;ndice ponderal surgiram devido a seu efeito negativo sobre a sa&#250;de infantil&#44; associada &#224; maior mortalidade perinatal&#58; ventila&#231;&#227;o mec&#226;nica&#44; apoio mec&#226;nico de oxig&#234;nio&#44; alimenta&#231;&#227;o oral posterior&#44; retinopatia&#44; displasia broncopulmonar&#44; pneumot&#243;rax&#44; hemorragia intraventricular e outras complica&#231;&#245;es pedi&#225;tricas&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> Adicionalmente&#44; mais problemas de desenvolvimento foram identificados em neonatos com baixo peso ao nascer&#44; inclusive problemas de aten&#231;&#227;o&#44; cogni&#231;&#227;o e funcionamento neuromotor&#44; aumento do risco de morbidez na primeira inf&#226;ncia&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Algumas limita&#231;&#245;es podem ser destacadas&#46; A natureza volunt&#225;ria da participa&#231;&#227;o no estudo pode levar a um vi&#233;s de sele&#231;&#227;o&#46; As m&#227;es que concordaram em participar e concluir todas as ondas de avalia&#231;&#227;o podem ser aquelas que se sentem mais satisfeitas e envolvidas com a experi&#234;ncia da gravidez&#46; Apesar disso&#44; n&#227;o foi encontrada diferen&#231;a entre as participantes que conclu&#237;ram e aquelas que n&#227;o conclu&#237;ram todas as ondas de avalia&#231;&#227;o&#46; Um maior tamanho da amostra pode aumentar o poder estat&#237;stico da an&#225;lise&#46; Uma entrevista cl&#237;nica padronizada para avaliar depress&#227;o e ansiedade pode aumentar a validade dos resultados&#46; Contudo&#44; ambas as medidas mostraram boa consist&#234;ncia interna&#46; Os fatores de confus&#227;o n&#227;o avaliados podem ter influenciado os efeitos descritos&#46; Contudo&#44; alguns desses fatores &#40;peso<span class="elsevierStyleHsp" style=""></span>da m&#227;e antes da gravidez&#44; fumo e consumo de caf&#233; durante a gravidez&#41; foram controlados na an&#225;lise&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Este estudo demonstra o efeito longitudinal independente da ansiedade materna sobre os principais marcadores de resultados e trajet&#243;rias de crescimento fetal-neonatal&#44; considerando simultaneamente o efeito da depress&#227;o e ansiedade materna&#46; Isso destacou um aumento na necessidade de uma avalia&#231;&#227;o sistem&#225;tica de ansiedade durante a gravidez&#46; Esses achados tamb&#233;m sugeriram que os fetos de m&#227;es ansiosas s&#227;o aqueles que podem ser beneficiados pelo cuidado individualizado em unidades de cuidado neonatal&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Podem ser feitas sugest&#245;es de pesquisa&#46; Estudos futuros podem explorar simultaneamente o efeito independente da depress&#227;o e ansiedade materna sobre outros marcadores de crescimento&#44; comportamento e matura&#231;&#227;o fetal-neonatal&#46; Uma pesquisa futura pode explorar ainda o papel mediador dos mecanismos epigen&#233;ticos e endofenot&#237;picos no efeito da ansiedade materna pr&#233;&#8208;natal sobre os resultados e trajet&#243;rias de crescimento fetal-neonatal&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflitos de interesse</span><p id="par0145" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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              "titulo" => "Efeito da depress&#227;o e ansiedade materna sobre as trajet&#243;rias de crescimento fetal-neonatal a partir do 2&#176; trimestre de gravidez at&#233; o nascimento"
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            0 => "Maternal depression"
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            0 => "Depress&#227;o maternal"
            1 => "Ansiedade maternal"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Maternal depression and anxiety have been found to negatively affect fetal and neonatal growth&#46; However&#44; the independent effects of maternal depression and anxiety on fetal-neonatal growth outcomes and trajectories remain unclear&#46; This study aimed to analyze simultaneously the effects of maternal prenatal depression and anxiety on &#40;1&#41; neonatal growth outcomes&#44; and &#40;2&#41;&#44; on fetal-neonatal growth trajectories&#44; from the 2nd trimester of pregnancy to childbirth&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A sample of 172 women was recruited and completed self&#8208;reported measures of depression and anxiety during the 2nd and 3rd trimesters of pregnancy&#44; and at childbirth&#46; Fetal and neonatal biometrical data were collected from clinical reports at the same assessment moments&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Neonates of prenatally anxious mothers showed lower weight &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#44; length &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;025&#41;&#44; and ponderal index &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41; at birth than neonates of prenatally non&#8208;anxious mothers&#46; Moreover&#44; fetuses&#8208;neonates of high&#8208;anxiety mothers showed a lower increase of weight from the 2nd trimester of pregnancy to childbirth than fetuses&#8208;neonates of low&#8208;anxiety mothers &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Considering maternal depression and anxiety simultaneously&#44; only the effect of maternal anxiety was found on these markers of fetal-neonatal growth outcomes and trajectories&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This study demonstrates the independent longitudinal effect of maternal anxiety on major markers of fetal-neonatal growth outcomes and trajectories&#44; simultaneously considering the effect of maternal depression and anxiety&#46;</p></span>"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Foi constatado que a depress&#227;o e ansiedade materna afetam negativamente o crescimento fetal e neonatal&#46; Contudo&#44; o efeito independente da depress&#227;o e ansiedade materna sobre os resultados e as trajet&#243;rias de crescimento fetal e neonatal continua incerto&#46; Este estudo visou a analisar simultaneamente o efeito da depress&#227;o e ansiedade materna pr&#233;&#8208;natal &#40;1&#41; sobre os resultados de crescimento neonatal e &#40;2&#41; sobre as trajet&#243;rias do crescimento fetal-neonatal a partir do 2&#176; trimestre de gravidez at&#233; o parto&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Uma amostra de 172 mulheres foi recrutada e elas relataram graus de depress&#227;o e ansiedade no 2&#176; e 3&#176; trimestre de gravidez e parto&#46; Os dados biom&#233;tricos fetais e neonatais foram coletados dos prontu&#225;rios cl&#237;nicos nas mesmas ondas de avalia&#231;&#227;o&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os neonatos de m&#227;es ansiosas no per&#237;odo pr&#233;&#8208;natal mostraram menor peso &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#44; comprimento &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41; e &#237;ndice ponderal &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41; no nascimento do que os neonatos de m&#227;es n&#227;o ansiosas no per&#237;odo pr&#233;&#8208;natal&#46; Al&#233;m disso&#44; os neonatos de m&#227;es muito ansiosas mostraram um menor aumento de peso do 2&#176; trimestre de gravidez at&#233; o parto que os fetos&#8208;neonatos de m&#227;es pouco ansiosas &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Considerando simultaneamente a depress&#227;o e a ansiedade maternal&#44; apenas o efeito da ansiedade materna foi constatado nesses marcadores de resultados e trajet&#243;rias de crescimento fetal-neonatal&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este estudo demonstra o efeito longitudinal independente da ansiedade materna sobre os principais marcadores de resultados e trajet&#243;rias de crescimento fetal-neonatal&#44; considerando simultaneamente o efeito da depress&#227;o e ansiedade materna&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Como citar este artigo&#58; Pinto TM&#44; Caldas F&#44; Nogueira&#8208;Silva C&#44; Figueiredo B&#46; Maternal depression and anxiety and fetal-neonatal growth&#46; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;452&#8211;9&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1311
            "Ancho" => 2258
            "Tamanyo" => 123727
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Trajet&#243;rias do peso estimado para fetos&#8208;neonatos de m&#227;es muito ansiosas e pouco ansiosas&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
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        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:2 [
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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="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">M&#227;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>172 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Idade &#40;anos&#41;</td><td class="td" title="table-entry  " align="left" valign="top">15&#8208;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18&#8208;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">30&#8208;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">N&#237;vel socioecon&#244;mico</td><td class="td" title="table-entry  " align="left" valign="top">Alto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#233;dio alto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#233;dio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#233;dio baixo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baixo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Situa&#231;&#227;o profissional</td><td class="td" title="table-entry  " align="left" valign="top">Empregada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Desempregada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dona de casa&#47;estudante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Escolaridade &#40;em anos&#41;</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#8208;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#62; 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Paridade</td><td class="td" title="table-entry  " align="left" valign="top">Prim&#237;paras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mult&#237;paras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Tipo de parto</td><td class="td" title="table-entry  " align="left" valign="top">Eut&#243;pico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dist&#243;cico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Consumo de tabaco</td><td class="td" title="table-entry  " align="left" valign="top">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Consumo de caf&#233;</td><td class="td" title="table-entry  " align="left" valign="top">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#44;7&nbsp;\t\t\t\t\t\t\n
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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="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Neonatos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>168 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Sexo</td><td class="td" title="table-entry  " align="left" valign="top">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Reanima&#231;&#227;o</td><td class="td" title="table-entry  " align="left" valign="top">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Peso &#40;g&#41;</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 2500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2500&#8208;4199&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8805; 4200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Comprimento &#40;cm&#41;</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8805; 50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#205;ndice ponderal</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 2&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8805; 2&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Idade gestacional ao nascer &#40;semanas&#41;</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8805; 37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#44;8&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">Caracter&#237;sticas obst&#233;tricas e sociodemogr&#225;ficas das m&#227;es e dados biom&#233;tricos dos neonatos</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
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            "identificador" => "at2"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DP&#44; desvio padr&#227;o&#59; EPDS&#44; Escala de Depress&#227;o P&#243;s&#8208;parto de Edimburgo&#59; Idate&#44; invent&#225;rio de ansiedade tra&#231;o&#8208;estado&#59; M&#44; m&#233;dia&#46;</p>"
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                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="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Gravidez</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2&#176; trimestre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3&#176; trimestre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Depress&#227;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>172 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>160 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o depressiva &#40;EPDS<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Depressiva &#40;EPDS &#8805; 10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Ansiedade</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>170 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>164 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>160 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o ansiosa &#40;Idate<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ansiosa &#40;Idate &#8805; 45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            1 => array:2 [
              "tabla" => array:1 [
                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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peso fetal-neonatal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1722&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">397&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3177&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">479&#44;97&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;84&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;32&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="spar0055" class="elsevierStyleSimplePara elsevierViewall">Estat&#237;sticas descritiva das vari&#225;veis do estudo com o tempo</p>"
        ]
      ]
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        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at3"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">DP&#44; desvio padr&#227;o&#59; M&#44; m&#233;dia&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Observa&#231;&#227;o&#58; O peso da m&#227;e antes da gravidez e o consumo de tabaco e caf&#233; durante a gravidez foram inclu&#237;dos como covari&#225;veis&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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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="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>114&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>122&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resultados de crescimento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">df&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
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