Analysis of the NANDA-I taxonomy “maternal-fetal dyad” concept in high-risk pregnancy: integrative review

Gomes, Ryanne Carolynne Marques; Lopes, Marcos Venícios de Oliveira; Perrelli, Jaqueline Galdino Albuquerque; Pontes, Cleide Maria; Linhares, Francisca Márcia Pereira; Mangueira, Suzana de Oliveira

doi:10.1590/0034-7167-2019-0649

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 73 (suppl 4) • 2020 • https://doi.org/10.1590/0034-7167-2019-0649 copy

Analysis of the NANDA-I taxonomy “maternal-fetal dyad” concept in high-risk pregnancy: integrative review

Análisis del concepto “binomio madre-feto” de la taxonomía nanda-i en mujeres embarazadas de alto riesgo: revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the NANDA-I taxonomy “maternal-fetal dyad” concept in high-risk pregnancy.

Method:

an integrative literature review based on the Conceptual Analysis model proposed by Walker and Avant. It was conducted at PUBMED, CINAHL, SCOPUS, LILACS and SciELO, with the descriptors: Complications of pregnancy, Risk Factors, and Pregnancy, High-Risk (from 2008-2020).

Result:

the sample consisted of 44 articles, which identified two attributes and 21 antecedents of the concept.

Conclusion:

concept analysis allowed to identify the attributes and antecedents of the “maternal-fetal dyad” concept in high-risk pregnancy, in addition to raising and clarifying ideas. It was possible to identify 12 antecedents that are not included in NANDA-I as well as the need to review the definition of the diagnosis proposed by the taxonomy.

Descriptors:
Nursing Diagnosis; Risk Factors; Fetus; High Risk Pregnancy; Review

Title	Year	Attributes	Antecedents
Pre-pregnancy counselling for women with chronic kidney disease: a retrospective analysis of nine years' experience⁽⁹9 Wiles KS, Kate B, Alina V, Kate RH, Paramit C, Cath JT, Catherine N-P. Pre-pregnancy counselling for women with chronic kidney disease: a retrospective e analysis of nine years' experience. BMC Nephrol. 2015;16(1):16-28. doi: 10.1186/s12882-015-0024-6 https://doi.org/10.1186/s12882-015-0024-... ⁾	2015	-	Related conditions: complications of pregnancy; compromised oxygen transfer; medication regimen.
Preeclampsia in high risk women is characterized by risk group-specific abnormalities in serum biomarkers⁽¹⁰10 Metz TD, Allshouse AA, Euser AG, Kent DH. Preeclampsia in high risk women is characterized by risk group specific abnormalities in serum biomarkers. Am J Obstet Gynecol. 2014;211(5):512-6. doi: 10.1016/j.ajog.2014.04.027 https://doi.org/10.1016/j.ajog.2014.04.0... ⁾	2014	-	Related conditions: complications of pregnancy; compromised oxygen transfer; maternal illnesses.
Complications of pregnancy and Cardiovascular Disease Death: Fifty-Year Follow-Up of the Child Health and Development Studies Pregnancy Cohort⁽¹¹11 Cirillo PM, Cohn BA. Pregnancy complications and cardiovascular disease death: fifty year follow up of the child health and development studies pregnancy cohort. Circul AHA. 2015;1(1):1-24. doi: 10.1161/CIRCULATIONAHA.113.003901 https://doi.org/10.1161/CIRCULATIONAHA.1... ⁾	2015	-	Risk factors: overweight and tobacco. Population at risk: preeclampsia in previous pregnancy. Related conditions: complications of pregnancy; compromised oxygen transfer; maternal illnesses.
Understanding the association of biomedical, psychosocial and behavioral risks with adverse pregnancy⁽¹²12 Kiely M, Ayman A, Gantz MG, Chowdhury D, Thornberry JS, El-Khorazaty MN. Understanding the association of biomedical, psychosocial and behavioral risks with adverse pregnancy outcomes among African-Americans in Washington, DC. Matern Child Health J. 2011;15(1):85-95. doi: 10.1007/s10995-011-0856-z https://doi.org/10.1007/s10995-011-0856-... ⁾	2011	-	Risk factors: overweight; tobacco; violence; drugs; alcohol. Related conditions: compromised oxygen transfer and maternal illnesses.
Effect of older maternal age on the risk of spontaneous preterm labor: a population-based study⁽¹³13 Mcintyre SH, Newburn-Cook CV, O'Brien B, Demianczuk NN. Effect of older maternal age on the risk of spontaneous preterm labor: a population based study. Health Care Women Int. 2009;30(8):670-689. doi: 10.1080/07399330802596473 https://doi.org/10.1080/0739933080259647... ⁾	2009	-	Risk factors: tobacco; drugs; alcohol; low gestational weight gain. Population at risk: increased maternal age. Related conditions: complications of pregnancy; compromised oxygen transfer; maternal illnesses.
Maternal obesity in early pregnancy and risk of adverse outcomes⁽¹⁴14 Keely A, Gunning M, Denison F. Maternal obesity in pregnancy: women's understanding of risks. Braz J Microbiol. 2011;19(6):364-69. doi: 10.12968/bjom.2011.19.6.364 https://doi.org/10.12968/bjom.2011.19.6.... ⁾	2013	-	Risk factors: obesity.
Pregnancy characteristics and women's future cardiovascular health: an underused opportunity to improve women's health?⁽¹⁵15 Rich-Edwards JW, Fraser A, Lawlor DA, Catov JM. Pregnancy characteristics and women's future cardiovascular health: an underused opportunity to improve women's health? Epidemiol Rev. 2013;36(1):57-70. doi: 10.1093/epirev/mxt006 https://doi.org/10.1093/epirev/mxt006... ⁾	2013	-	Risk factors: tobacco and obesity. Population at risk: increased maternal age. Related conditions: complications of pregnancy; compromised oxygen transfer; maternal illnesses; maternal conditions.
Maternal risk during pregnancy: a concept analysis⁽¹⁶16 Otterloo LRV, Connelly CD. Maternal risk during pregnancy: a concept analysis. J Clin Nurs. 2016;25(18):2393-401. doi: 10.1111/jocn.13294 https://doi.org/10.1111/jocn.13294... ⁾	2016	-	Risk factors: drugs.
Deficiência de vitamina D na gravidez e o seu impacto sobre o feto, o recém-nascido e na infância ⁽ ¹⁷17 Pereira MU, Solé D. Deficiência de vitamina D na gravidez e o seu impacto sobre o feto, o recém-nascido e na infância. Rev Paul Pediatr. 2015;33(1):104-113. doi: 10.1016/j.rpped.2014.05.004. https://doi.org/10.1016/j.rpped.2014.05.... ⁾	2015	Maternal-fetal bond; symbiotic maternal-fetal relationship.	Related conditions: complications of pregnancy; compromised oxygen transfer; maternal illnesses; maternal conditions.
Effect of maternal moderate to severe asthma on perinatal outcomes⁽¹⁸18 Firoozi F, Lemière C, Ducharme FM, Beauchesne MF, Perreault S, Bérard A, et al. Effect of maternal moderate to severe asthma on perinatal outcomes. Respirat Medic. 2010;104(9):1278-87. doi: 10.1016/j.rmed.2010.03.010 https://doi.org/10.1016/j.rmed.2010.03.0... ⁾	2010	-	Related conditions: compromised oxygen transfer.
Gestational weight gain and risks for adverse perinatal outcomes: A retrospective cohort study based on the 2009 Institute of Medicine guidelines⁽¹⁹19 Hung TH, Chen SF, Hsu JJ. Gestational weight gain and risks for adverse perinatal outcomes: A retrospective cohort study based on the 2009 Institute of Medicine guidelines. Taiw J Obst and Gyn. 2015;54(4):421-25. doi: 10.1016/j.tjog.2015.06.010 https://doi.org/10.1016/j.tjog.2015.06.0... ⁾	2015	-	Related conditions: compromised oxygen transfer.
Obstetrical complications in women with epilepsy⁽²⁰20 Borthen I. Obstetrical complications in women with epilepsy. Seizure (Lond.). 2015;28(1):32-34. doi: 10.1016/j.seizure.2015.02.018 https://doi.org/10.1016/j.seizure.2015.0... ⁾	2015	-	Risk factors: overweight and obesity. Related conditions: complications of pregnancy; maternal illnesses; maternal conditions.
Intrauterine growth retardation in foetuses of women with epilepsy⁽²¹21 Farmen AH, Grundt J, Tomson T, Nakken KO, Nakling J, Mowinchel P, et al. Intrauterine growth retardation in foetuses of women with epilepsy. Seizure (Lond.). 2015;28:76-80. doi: 10.1016/j.seizure.2015.02.026 https://doi.org/10.1016/j.seizure.2015.0... ⁾	2015	-	Related conditions: compromised oxygen transfer and medication regimen.
Risk factors for congenital anomalies in high risk pregnant women: A large study from South India⁽²²22 Sunitha T, Prasoona KR, Kumari TM, Srinadh B, Deepika, MLN, Aruna, R, et al. Risk factors for congenital anomalies in high risk pregnant women: a large study from South India. Egypt J Medic Human Gen. 2017;18(1):79-85. doi: 10.1016/j.ejmhg.2016.04.001 https://doi.org/10.1016/j.ejmhg.2016.04.... ⁾	2017	-	Risk factors: tobacco. Related conditions: complications of pregnancy; compromised oxygen transfer; medication regimen.
Maternal overweight and obesity and risk of pre-eclampsia in women with type 1 diabetes or type 2 diabetes⁽²³23 Persson M, Cnattingius S, Wikström AK, Johansson S. Maternal overweight and obesity and risk of pre-eclampsia in women with type1 diabetes or type 2 diabetes. Diabetolog. 2015;59(10):2099-105. doi: 10.1007/s00125-016-4035-z https://doi.org/10.1007/s00125-016-4035-... ⁾	2016	-	Risk factors: absent/inadequate prenatal care. Related conditions: complications of pregnancy.
Body mass index, gestational weight gain, and obstetric complications in Moroccan population⁽²⁴24 Mochhoury L, Razine R, Kasouati JKM, Barkat A. Body mass index, gestational weight gain, and obstetric complications in Moroccan population. J Pregn. 2016;2013(1):1-6. doi: 10.1155/2013/379461. https://doi.org/10.1155/2013/379461... ⁾	2013	-	Risk factors: overweight and obesity. Related conditions: compromised oxygen transfer and maternal illnesses.
Early gestational weight gain rate and adverse pregnancy outcomes in Korean women⁽²⁵25 Cho EH, Hur J, Lee KJ. Early gestational weight gain rate and adverse pregnancy outcomes in Korean women. PloS One. 2015;10(10):e0140376. doi: 10.1371/journal.pone.0140376. https://doi.org/10.1371/journal.pone.014... ⁾	2015	Symbiotic maternal-fetal relationship.	Risk factors: obesity. Population at risk: increased maternal age.
Pregnancy at very increased maternal age: a UK population based cohort study⁽²⁶26 Fitzpatrick KE, Tuffnell D, Kurinczuk JJ, Knight M. Pregnancy at very advanced maternal age: a UK population based cohort study. Int J Obstet Gy. 2016;124(7):1097-106. doi: 10.1111/1471-0528.14269 https://doi.org/10.1111/1471-0528.14269... ⁾	2017	-	Related conditions: maternal illnesses.
Pre-pregnancy high-risk factors at first antenatal visit: how predictive are these of pregnancy outcomes?⁽²⁷27 Tandu-Umba B, Mbangama MA, Kamongola KMB, Tchawou AGK, Kivuidi MP, Munene SK, et al. Pre-pregnancy high-risk factors at first antenatal visit: how predictive are these of pregnancy outcomes?. Int J Womens Health. 2014;6(1):1011-18. doi: 10.2147/IJWH.S69230 https://doi.org/10.2147/IJWH.S69230... ⁾	2014	-	Risk factors: overweight; tobacco; obesity; absent/inadequate prenatal care. Population at risk: increased maternal age. Related conditions: complications of pregnancy; compromised oxygen transfer; maternal illnesses.
Maternal obesity in early pregnancy and risk of adverse outcome⁽²⁸28 Castaño IB, Sanchez PH, Perez NA, Salvador JJG, Quesada AG, Hernández JAG, et al. Maternal obesity in early pregnancy and risk of adverse outcomes. PLoS One. 2013;8(11):e80410. doi: 10.1371/journal.pone.0080410 https://doi.org/10.1371/journal.pone.008... ⁾	2013	-	Risk factors: overweight; drugs; alcohol; obesity. Related conditions: complications of pregnancy and maternal illnesses.
Obstetrical complications in women with endometriosis: a cohort study in Japan⁽²⁹29 Harada T, Taniguchi F, Onishi K, Kurozawa Y, Hayashi K, Harada T. Obstetrical complications in women with endometriosis: a cohort study in Japan. PLoS One. 2016;11(12):e0168476. doi: 10.1371/journal.pone.0168476 https://doi.org/10.1371/journal.pone.016... ⁾	2016	-	Related conditions: complications of pregnancy; compromised oxygen transfer; maternal illnesses; maternal conditions.
Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: a systematic review and meta-analysis⁽³⁰30 Zhang Y, Wang H, Pan X, Teng W, Shan Z. Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: a systematic review and meta-analysis. PloS One. 2017;12(4):e0175708. doi: 10.1371/journal.pone.0175708 https://doi.org/10.1371/journal.pone.017... ⁾	2017	-	Related conditions: maternal illnesses.
Risk factors and birth outcomes of anaemia in early pregnancy in a nulliparous cohort⁽³¹31 Masukume G, Khashan AS, Kenny LC, Baker PN, Nelson G, Scope Consortium. Risk factors and birth outcomes of anaemia in early pregnancy in a nulliparous cohort. PloS One. 2015;10(4):e0122729. doi: 10.1371/journal.pone.0122729 https://doi.org/10.1371/journal.pone.012... ⁾	2015	-	Related conditions: complications of pregnancy and compromised oxygen transfer.
Weight change across the start of three consecutive pregnancies and the risk of maternal morbidity and SGA birth at the second and third pregnancy⁽³²32 Wallace JM, Bhattacharya S, Horgan GW. Weight change across the start of three consecutive pregnancies and the risk of maternal morbidity and SGA birth at the second and third pregnancy. PloS One. 2017;12(6):e0179589. doi: 10.1371/journal.pone.0179589 https://doi.org/10.1371/journal.pone.017... ⁾	2017	-	Risk factors: overweight and obesity. Related conditions: maternal illnesses.
Morbidade materna grave em um hospital universitário de referência municipal em Campinas, Estado de São Paulo ⁽ ³³33 Luz AG, Tiago DB, Silva JCGD, Amaral E. Morbidade materna grave em um hospital universitário de referência municipal em Campinas, Estado de São Paulo. Rev Bras Ginecol Obstet. 2008;30(6):281-6. doi: 10.1590/S0100-72032008000600003 https://doi.org/10.1590/S0100-7203200800... ⁾	2008	-	Related conditions: complications of pregnancy.
Estudo retrospectivo das implicações maternas, fetais e perinatais em mulheres portadoras de diabetes, em 20 anos de acompanhamento no Hospital Escola da Universidade Federal do Triângulo Mineiro ⁽ ³⁴34 Chaves EGS, Franciscon PDM, Nascentes GAN, Paschoini MC, Silva APD, Borges MDF. Estudo retrospectivo das implicações maternas, fetais e perinatais em mulheres portadoras de diabetes, em 20 anos de acompanhamento no Hospital Escola da Universidade Federal do Triângulo Mineiro. Arq Bras Endocrinol Metabol. 2010;54(7):620-629. doi: 10.1590/S0004-27302010000700006 https://doi.org/10.1590/S0004-2730201000... ⁾	2010	Maternal-fetal bond.	Risk factors: tobacco. Related conditions: maternal illnesses.
Aspectos sociodemográficos y obstétricos de la morbilidad materna grave ⁽ ³⁵35 Loureiro C, Cataño CR, Torricelli L, Monteiro JCS, Gomes-Sponholz FA. Aspectos sociodemográficos y obstétricos de la morbilidad materna grave. Cienc y Enferm. 2017;23(2):21-32. doi: 10.4067/S0717-95532017000200021 https://doi.org/10.4067/S0717-9553201700... ⁾	2017	-	Related conditions: complications of pregnancy and compromised oxygen transfer.
Morbidade materna grave na microrregião de Barbacena/MG ⁽ ³⁶36 Vidal CEL, Carvaho MAB, Grimaldi IR, Reis MC, Baêta MCN, Garcia RB, et al. Morbidade materna grave na microrregião de Barbacema/MG. Cad Saúde Colet. 2016;24(2): 131-6. doi: 10.1590/1414-462X201600020181 https://doi.org/10.1590/1414-462X2016000... ⁾	2016	-	Risk factors: absent/inadequate prenatal care. Population at risk: increased maternal age. Related conditions: complications of pregnancy; compromised oxygen transfer; maternal illnesses.
Gestações complicadas por sífilis materna e óbito fetal ⁽ ³⁷37 Nascimento MID, Cunha ADA, Guimarães EV, Alvarez FS, Oliveira SRDSM, Bôas V, et al. Gestações complicadas por sífilis materna e óbito fetal. Rev Bras Ginecol Obstet. 2011;34(2):56-62. doi: 10.1590/S0100-72032012000200003 https://doi.org/10.1590/S0100-7203201200... ⁾	2011	-	Related conditions: complications of pregnancy; maternal illnesses; maternal conditions.
Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco ⁽ ³⁸38 Nomura RMY, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34(3): 107-112. doi: 10.1590/S0100-72032012000300003 https://doi.org/10.1590/S0100-7203201200... ⁾	2017	Maternal-fetal bond.	Risk factors: obesity. Related conditions: compromised oxygen transfer and maternal illnesses.
Muerte fetal: caracterización epidemiológica ⁽ ³⁹39 Tinedo MJ, Santander F, Alonso J, Herrera A, Colombo C, Díaz M. Muerte fetal: caracterización epidemiológica. Salus [Internet]. 2016 [cited 2018 Jun 28];20(2):37-43. Available from: http://www.scielo.org.ve/pdf/s/v20n2/art08.pdf http://www.scielo.org.ve/pdf/s/v20n2/art... ⁾	2016	Maternal-fetal bond.	Risk factors: overweight; tobacco; obesity. Related conditions: complications of pregnancy; compromised oxygen transfer; maternal illnesses.
Estrés psicosocial laboral como factor de riesgo para las complicaciones de la gestación y el bajo peso al nacer ⁽ ⁴⁰40 Santos MDLM, Hernández JJR, Avich NS. Estrés psicosocial laboral como factor de riesgo para las complicaciones de la gestación y el bajo peso al nacer. Rev Cuba Salud Pública [Internet]. 2013 [cited 2018 Jun 28];39(1):864-880. Available from: http://scielo.sld.cu/pdf/rcsp/v39s1/spu06513.pdf http://scielo.sld.cu/pdf/rcsp/v39s1/spu0... ⁾	2013	Maternal-fetal bond.	Related conditions: complications of pregnancy and compromised oxygen transfer.
Depressive symptoms in pregnancy and associated factors: longitudinal study⁽⁴¹41 Lima MDOP, Tsunechiro MA, Bonadio IC, Murata M. Depressive symptoms in pregnancy and associated factors: longitudinal study. Acta Paul Enferm. 2017;30(1):39-46. doi: 10.1590/1982-0194201700007 https://doi.org/10.1590/1982-01942017000... ⁾	2017	Maternal-fetal bond.	Risk factors: absent/inadequate partner support and absent/inadequate social support. Population at risk: unintended pregnancy; low education level; economically disadvantaged. Related conditions: compromised oxygen transfer.
Influencia de la obesidad pregestacional en el riesgo de preeclampsia/eclampsia ⁽ ⁴²42 González JAS, Guerrero RP, Machado MG, Delgado MRC, Tápanes YM, González VC. Influencia de la obesidade pregestacional em el riesgo de preeclampsia/eclampsia. Rev Cubana Obstet Ginecol [Internet]. 2013 [cited 2018 Jun 28];39(1):3-11. Available from: http://scielo.sld.cu/pdf/gin/v39n1/gin02113.pdf http://scielo.sld.cu/pdf/gin/v39n1/gin02... ⁾	2013	-	Risk factors: obesity. Related conditions: compromised oxygen transfer.
Mortalidad Perinatal de la Población afiliada a una EPS de Pasto. Departamento de Nariño ⁽ ⁴³43 Bravo AID, Maya JVL, Paredes FCM. Mortalidad Perinatal de la Población afiliada a una EPS de Pasto. Departamento de Nariño. 2007. Hacia Promoc Salud [Internet]. 2015 [cited 2018 Jun 28];15(1):92-109. Available from: http://www.scielo.org.co/pdf/hpsal/v15n1/v15n1a07.pdf http://www.scielo.org.co/pdf/hpsal/v15n1... ⁾	2015	-	Risk factors: tobacco; alcohol; absent/inadequate prenatal care. Related conditions: complications of pregnancy; compromised oxygen transfer; maternal illnesses.
Complicações maternas em gestantes com idade avançada ⁽ ⁴⁴44 Gonçalves ZR, Monteiro DLM. Complicações maternas em gestantes com idade avançada. Feminina [Internet]. 2012 [cited 2018 Jun 28];40(5):275-9. Available from: http://files.bvs.br/upload/S/0100-7254/2012/v40n5/a3418.pdf http://files.bvs.br/upload/S/0100-7254/2... ⁾	2012	-	Risk factors: tobacco and absent/inadequate prenatal care. Related conditions: complications of pregnancy; impaired glucose metabolism; compromised oxygen transfer; maternal illnesses.
Embarazo de alto riesgo ⁽ ⁴⁵45 Donoso B, Oyarzún E. Embarazo de alto riesgo. Medwave. 2012;12(5):e5429. doi: 10.5867/medwave.2012.05.5429 https://doi.org/10.5867/medwave.2012.05.... ⁾	2012	-	Risk factors: drugs; alcohol; obesity. Population at risk: low education level and economically disadvantaged. Related conditions: compromised oxygen transfer and maternal illnesses.
Prevalence and profile of adverse drug reactions in high-risk pregnancy: a cohort study⁽⁴⁶46 Silva KDL, Fernandes FEM, Pessoa TL, Lima SIVC, Oliveira AG, Martins RR. Prevalence and profile of adverse drug reactions in high-risk pregnancy: a cohort study. BMC Pregnancy and Childbirth. 2019;19(1):199-205. doi:10.1186/s12884-019-2321-8 https://doi.org/10.1186/s12884-019-2321-... ⁾	2019	-	Related conditions: impaired glucose metabolism; maternal illnesses; medication regimen.
Maternal near miss determinants at a maternity hospital for high-risk pregnancy in northeastern Brazil: a prospective study⁽⁴⁷47 Lima THB, Katz L, Kassar SB, Amorim MM. Neonatal near miss determinants at a maternity hospital for high-risk pregnancy in Northeastern Brazil: a prospective study. BMC Pregnancy Childbirth. 2018;18(1):401-10. doi:10.1186/s12884-019-2381-9 https://doi.org/10.1186/s12884-019-2381-... ⁾	2018	-	Risk factors: absent/inadequate prenatal care. Population at risk: low education level and increased maternal age. Related conditions: compromised oxygen transfer; maternal illnesses; complications of pregnancy.
High risk pregnancy associated perinatal morbidity and mortality: a second birth population-based survey in Huai'an in 2015⁽⁴⁸48 Zhu X, Niu H, Wang H, Li X, Qi T, Ding W, et al. High risk pregnancy associated perinatal morbidity and mortality: a second birth population-based survey in Huai'an in 2015. BMC Pregnancy Childbirth. 2019;19(1):224-8. doi: 10.1186/s12884-019-2323-6 https://doi.org/10.1186/s12884-019-2323-... ⁾	2019	Symbiotic maternal-fetal relationship.	Population at risk: low education level and increased maternal age. Related conditions: maternal illnesses and complications of pregnancy.
Complications and pre-existing diseases in pregnant women with Diabetes mellitus⁽⁴⁹49 Queiroz IS, Bertolin DC, Werneck AL. Complications and pre-existing diseases in pregnant women with diabetes mellitus. Rev Enferm UFPE. 2019;13(5):1202-8. doi: 10.5205/1981-8963-v13i05a238773p1202-1207-2019 https://doi.org/10.5205/1981-8963-v13i05... ⁾	2019	-	Risk factors: obesity and tobacco. Population at risk: increased maternal age and preeclampsia in previous pregnancy. Related conditions: impaired glucose metabolism and maternal illnesses.
Gestational diabetes and pre-natal assistance at high risk⁽⁵⁰50 Guerra JVV, Alves VH, Valete COS, Rodrigues DP, Branco MBLR, Santos MV. Gestational diabetes and pre-natal assistance at high risk. Rev Enferm UFPE. 2019;13(2):449-54. doi: 10.5205/1981-8963-v13i02a235033p449-454-2019 https://doi.org/10.5205/1981-8963-v13i02... ⁾	2019	-	Risk factors: overweight; obesity; absent/inadequate prenatal care. Population at risk: increased maternal age. Related conditions: impaired glucose metabolism and maternal illnesses.
Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta-analysis of observational studies⁽⁵¹51 Veloso FCS, Kassar LDML, Oliveira MJC, Lima THB, Bueno NB, Gurgel RQ, et al. Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta-analysis of observational studies. J Pediatr. 2019;95(5):519-30. doi: 10.1016/j.jped.2018.12.014 https://doi.org/10.1016/j.jped.2018.12.0... ⁾	2019	Maternal-fetal bond.	Risk factors: absent/inadequate prenatal care. Population at risk: low education level and increased maternal age. Related conditions: complications of pregnancy.
Influence of maternal age in perinatal conditions In live births of São Luís, Maranhão⁽⁵²52 Nunes FBB, Silva PC, Barbosa TLSM, Lopes MLH, Silva EL. Influence of maternal age in perinatal conditions in live births of São Luís, Maranhão. Rev Pesqui: Cuid Fundam. 2020;12(1):281-7. doi: 10.9789/2175-5361.rpcfo.v12.8618 https://doi.org/10.9789/2175-5361.rpcfo.... ⁾	2020	-	Risk factors: absent/inadequate prenatal care. Population at risk: low education level and increased maternal age.

Model case

R.D., 31 years old, primigravida, starts prenatal consultations at eight weeks of gestation with the purpose of maintaining an efficient monitoring and quality assistance for the maternal-fetal dyad. Although she perceives herself to be healthy, she worries about pregnancy risk factors, as she is aware of the symbiotic maternal-fetal relationship. In prenatal consultations, R.D. increases the knowledge about the well-being of the dyad, as she starts to realize how essential the bond between her and her child is to maintain the physiological exchange and the good quality of affective-emotional interactions during the gestational period.⁽¹⁶16 Otterloo LRV, Connelly CD. Maternal risk during pregnancy: a concept analysis. J Clin Nurs. 2016;25(18):2393-401. doi: 10.1111/jocn.13294
https://doi.org/10.1111/jocn.13294... ⁾.

Contrary case

M.V. is a 36-year-old primigravida and starts labor at 28 weeks of gestation due to complications of pregnancy. She reports not having had prenatal care, complains of headache, epigastric pain and is concerned about the well-being of the child. The nurse performs fetal monitoring, obtains the vital signs of M.V and checks the presence of protein in the urine, to observe the presence or absence of maternal and fetal complications. Blood pressure is 170/98 mmHg and proteinuria is observed in the Labstix test (2+). The nurse identifies the potential for pre-eclampsia and subsequent fetal hypoxia, which can lead to compromised maternal and fetal health. M.V. claims that she had headaches throughout her pregnancy. The nurse, as well as the doctor, discusses this situation with M.V., providing information about her condition that contributes to the risk for disturbed maternal-fetal dyad and the potential adverse effects on her health and that of her child⁽¹⁶16 Otterloo LRV, Connelly CD. Maternal risk during pregnancy: a concept analysis. J Clin Nurs. 2016;25(18):2393-401. doi: 10.1111/jocn.13294
https://doi.org/10.1111/jocn.13294... ⁾.

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[1] Corresponding author: Ryanne Carolynne Marques Gomes. E-mail: ryannecarolynne@gmail.com