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Farmus L, Till C, Green R, Hornung R, Martinez-Mier EA, Ayotte P, Muckle G, Lanphear B, Flora D. Critical windows of fluoride neurotoxicity in Canadian children by Farmus and colleagues - In reply to Wood et al. (2023). ENVIRONMENTAL RESEARCH 2024; 254:115299. [PMID: 36709876 DOI: 10.1016/j.envres.2023.115299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Linda Farmus
- Department of Psychology, York University, Toronto, Canada
| | - Christine Till
- Department of Psychology, York University, Toronto, Canada
| | - Rivka Green
- Department of Psychology, York University, Toronto, Canada
| | - Richard Hornung
- Consultant to Psychology Department, York University, Toronto, ON, Canada
| | | | - Pierre Ayotte
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Gina Muckle
- Centre de Recherche Du CHU de Québec, Université Laval, Québec City, QC, Canada; School of Psychology, Université Laval, Québec, QC, Canada
| | - Bruce Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - David Flora
- Department of Psychology, York University, Toronto, Canada
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von Ash T, Alikhani A, Sharkey KM, Solano P, Morales Aquino M, Markham Risica P. Associations between Perinatal Sleepiness and Breastfeeding Intentions and Attitudes and Infant Feeding Behaviors and Beliefs. Nutrients 2023; 15:3435. [PMID: 37571371 PMCID: PMC10421484 DOI: 10.3390/nu15153435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Breastfeeding rates fall short of public health goals, but barriers are poorly understood. We examined whether excessive sleepiness during pregnancy and the postpartum period was associated with breastfeeding intentions, attitudes, initiation, and continuation in a tobacco-exposed sample participating in a randomized controlled trial to reduce smoke exposure (n = 399). We used the Epworth Sleepiness Scale (ESS) to examine associations between excessive sleepiness in early (12-16 weeks gestation) and late (32 weeks gestation) pregnancy and at 6 months postpartum, with breastfeeding attitudes using the Mitra index, intentions, initiation, and continuation, as well as other infant feeding practices using the Infant Feeding Questionnaire. Logistic regression models adjusted for age, racial/ethnic identity, parity, marital status, and maternal education showed that excessive sleepiness in late pregnancy was associated with less favorable attitudes toward breastfeeding. In addition, in unadjusted models, excessive sleepiness at 6 months postpartum was associated with less of a tendency to use feeding to calm a fussy infant. Excessive sleepiness was not associated with intent, initiation, or continuation of breastfeeding. Assessing excessive sleepiness in late pregnancy may assist in identifying individuals with negative attitudes to breastfeeding and lead to novel approaches to promoting breastfeeding in populations with lower breastfeeding rates.
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Affiliation(s)
- Tayla von Ash
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI 02903, USA;
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI 02903, USA
| | - Anna Alikhani
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI 02903, USA;
| | - Katherine M. Sharkey
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, USA;
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA
| | - Paola Solano
- Brown University, Providence, RI 02912, USA; (P.S.); (M.M.A.)
| | | | - Patricia Markham Risica
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI 02903, USA;
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI 02903, USA
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Wu M, Williams GJ, Chen G, Zhang L, Hu C, Dai X, Du W, Hua J. Prenatal second-hand smoke exposure and the risk of suspected developmental coordination disorder in preschoolers: A nationwide retrospective cohort study in China. Front Public Health 2022; 10:993471. [PMID: 36438244 PMCID: PMC9686837 DOI: 10.3389/fpubh.2022.993471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
Prenatal exposure to second-hand smoke (SHS) is associated with increased neurodevelopmental problems in children, however, its impact on the risk of developmental coordination disorder (DCD) in preschoolers have not been studied thoroughly. Herein, we probed this association based on a nationwide retrospective cohort study of 149,005 preschoolers in China. We divided the objects into the prenatal SHS-exposed group or the no prenatal smoke exposed group (NS-exposed group). Preschoolers were assessed for motor proficiency by the Chinese version of Little Developmental Coordination Disorder Questionnaire (LDCDQ). Multivariable logistic regression was used to evaluate the associations. The prevalence of prenatal SHS exposure was 23.89%. Generally, the prevalence of suspected DCD was significantly higher in prenatal SHS-exposed group (16.38% VS. 14.19%, P < 0.001). With the increase of age, the mean total scores of LDCDQ of both boys and girls increased gradually; and the prevalence of suspected DCD in girls was higher than that in boys in the same age group. After adjusting for covariates, prenatal SHS exposure had the negative association with the total score of LDCDQ and increased the risk of suspected DCD. Our results suggest a need for interventions designed to reduce maternal SHS exposure during pregnancy, early screen for DCD and increase targeted movement and coordination skill training for vulnerable children.
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Affiliation(s)
- Meiqin Wu
- Shanghai Key Laboratory of Maternal Fetal Medicine, Department of Women's and Children's Health Care, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gareth J. Williams
- School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - Guixia Chen
- Department of Children Healthcare, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Lan Zhang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunping Hu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaotian Dai
- Shanghai Key Laboratory of Maternal Fetal Medicine, Department of Women's and Children's Health Care, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom,*Correspondence: Wenchong Du
| | - Jing Hua
- Shanghai Key Laboratory of Maternal Fetal Medicine, Department of Women's and Children's Health Care, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China,Jing Hua
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Artzi-Medvedik R, Mohamed N, Chertok IRA. Pregnant Women's Perception of Secondhand Smoke Exposure. MCN Am J Matern Child Nurs 2022; 47:353-358. [PMID: 36227075 DOI: 10.1097/nmc.0000000000000863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Birth outcomes including low birth weight, preterm birth, and delayed infant neurodevelopment are associated with secondhand smoke exposure while pregnant. The purpose of the study was to explore pregnant women's perspectives on secondhand smoke exposure to understand their experience and inform recommendations. STUDY DESIGN AND METHODS Qualitative semistructured interviews were conducted with 15 secondhand smoke-exposed pregnant women in the United States. RESULTS Four primary themes were identified: feeling powerless, trapped, and discomfort; enhancing women's self-advocacy and initiative; having conflicting feelings about secondhand smoke exposure; and desiring professional advice and education. Women expressed concern about prenatal secondhand smoke exposure, although they felt unable to request that people refrain from smoking in their presence or personal space. Women's strategies to minimize secondhand smoke exposure often involved their own social isolation. Women described sources of support, educational needs, and desire for practical advice in secondhand smoke avoidance. CLINICAL IMPLICATIONS Findings underscore the role of nurses working with pregnant women living with household members who smoke to educate women about secondhand smoke risks and strategies for avoidance and to enhance women's self-confidence in advocating for themselves to reduce their exposure.
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Yasuda S, Fukuda T, Toba N, Kamo N, Imaizumi K, Yokochi M, Okawara T, Takano S, Yoshida H, Kobayashi N, Kudo S, Miyazaki K, Hosoya M, Sato K, Takano K, Kanno A, Murata T, Kyozuka H, Yamaguchi A, Ito F, Oda S, Momoi N, Hosoya M, Fujimori K. Risk factors for discontinuation of exclusive breast feeding within 1month: a retrospective cohort study in Japan. Int Breastfeed J 2022; 17:20. [PMID: 35248098 PMCID: PMC8898407 DOI: 10.1186/s13006-022-00449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 01/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
While breastfeeding provides benefits for infants and the mother, many women either do not breastfeed or terminate breastfeeding earlier than recommended. The aim of this analysis was to identify factors associated with early discontinuation of breastfeeding in Japanese women.
Methods
This study used data from medical records of women delivering a singleton live birth between March 2017 and August 2019 in Iwase General Hospital, Fukushima Prefecture, Japan to assess cessation of breastfeeding by the 1-month postpartum appointment. Demographic (age at birth, and employment status), medical (parity, and physical and mental condition of the mother; and infant medical factors, such as sex, Apgar score, and jaundice, among other), and family factors (husband/partner, family members living at the same house, among others) in 734 women who had initiated breastfeeding during their delivery hospital stay were examined, and multiple logistic regression was used to determine significant predictors of early cessation of exclusive breastfeeding.
Results
Bivariate analysis revealed that women who were primipara, unmarried, exposed to secondhand smoke, and employed; those who smoked before pregnancy; and those who had asthma were more likely to discontinue exclusive breastfeeding than other women. Infant factors associated with discontinuation were lower birthweight, earlier gestational age, neonatal intensive care unit admission, treatment for jaundice, or lower weight gain. Multivariable analysis revealed that primiparity, passive smoking before pregnancy, maternal employment, and neonatal jaundice therapy were associated with discontinuation of breastfeeding.
Conclusions
In particular, women whose partners smoked before pregnancy may need to be targeted for additional support for breastfeeding.
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Cherubini KA, Schmidt MI, Vigo Á, Drehmer M. Breastfeeding rates and related factors at one year postpartum in women with gestational diabetes initially recruited for a diabetes prevention program. Can J Diabetes 2022; 46:441-448. [DOI: 10.1016/j.jcjd.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/02/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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Kulkarni SV, Xangsayarath P, Douangvichith D, Siengsounthone L, Phandouangsy K, Tran LTH, Le PH, Bui TC. Secondhand Smoke Exposure in Lao People's Democratic Republic: Results From the 2015 National Adult Tobacco Survey. Int J Public Health 2021; 66:1604436. [PMID: 35035350 PMCID: PMC8758564 DOI: 10.3389/ijph.2021.1604436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives: Second-hand smoke (SHS) exposure causes >600,000 deaths annually worldwide, however, information regarding SHS exposure in Lao People's Democratic Republic (Lao PRD) is limited; we report SHS exposure prevalence at home, inside workplaces, and indoor public spaces in Lao PDR. Methods: Data were from the 2015 Lao National Adult Tobacco Survey, a nationally representative sample of 7,562 participants aged ≥15 years recruited through a stratified 2-stage cluster sampling approach. Results: 88.3% (83.9% of non-smokers) reported SHS exposure at home and 63.0% (54.0% of non-smokers) at workplaces. Among non-smokers, women had greater exposure at home than men (86.6 vs. 77.0%). Lower education levels were associated with exposure at home or the workplace. 99.2% reported SHS exposure at any public place; specifically for restaurants/food stores 57.7%, government offices 56.2%, public transport 31.6%, and health care facilities 11.7%. Conclusion: SHS exposure at home and workplace in Lao PDR is among the highest in South-East Asia. Comprehensive smoke-free policies at government-owned workplaces and facilities, stricter enforcement of these smoke-free policies, and strategies to encourage smoke-free environments at homes and in public places are urgently needed.
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Affiliation(s)
- Shweta Vishwas Kulkarni
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | | | | | - Latsamy Siengsounthone
- Lao Tropical and Public Health Institute, Ministry of Health of Lao PDR, Vientiane, Laos
| | - Khatthanaphone Phandouangsy
- Secretary of the National Tobacco Control Taskforce, Department of Hygiene and Health Promotion, Ministry of Health of Lao PDR, Vientiane, Laos
| | | | - Phuc Hong Le
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, United States
| | - Thanh Cong Bui
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Sobh E, Mohammed AM, Adawy Z, Nassef AH, Hasheesh A. The impact of secondhand smoke exposure on the pregnancy outcome: a prospective cohort study among Egyptian community. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-021-00097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Secondhand smoke (SHS) exposure gained lesser interest than active smoking. There is evidence from previous studies that SHS exposure had negative effects on fetal growth. This study aimed to examine the effect of smoke exposure on pregnancy outcome and to evaluate the level of nicotine urinary end-product cotinine in pregnant women in the late trimester. We included 36 women with a history of SHS exposure and 48 women without a history of exposure; all were in last trimester of pregnancy. We measured cotinine level in urine and followed the two groups until delivery and recorded fetal outcomes. Fetal biophysical parameters and blood flow waveforms were measured using B-mode and Doppler ultrasonography, respectively.
Results
The total range of the urinary cotinine creatinine ratio (CCR) concentration in the SHS exposed pregnant women was 0.01–0.2, IQR = 0.18 ng/mg.cr, versus 0.01–0.1, and IQR = 0.03 ng/mg.cr in the non-exposed group. The mean value as well as the mean rank of CCR was significantly higher (0.1 ± 0.08 ng/mg.cr., 40.3 respectively) in the exposed pregnant women as compared to the non-exposed pregnant women ((0.04 ± 0.02), 29.3 respectively, p value < 0.05). Newborn of the exposed women had significantly low birth weight which negatively correlated with cotinine level and had a dose-response relationship.
Conclusions
SHS exposure had negative effects on fetal outcomes. Efforts should be utilized to increase awareness of the consequences of secondhand smoke on the fetus and strict follow-up of exposed women for early detection.
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Sharma T, Khapre M. Exposure of second hand smoke in women and children: A narrative review. J Family Med Prim Care 2021; 10:1804-1807. [PMID: 34195106 PMCID: PMC8208198 DOI: 10.4103/jfmpc.jfmpc_1397_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/17/2020] [Accepted: 01/21/2021] [Indexed: 11/04/2022] Open
Abstract
Second-hand smoke is a neglected public health issue. Every year 1.2 million people die due to this exposure. Second-hand smoke is also related to various other diseases like cardiovascular diseases, lung diseases, low birth weight, maternal depression, etc. The purpose of this review is to look over various studies and to gain an understanding of existing research about second-hand smoke and its adverse effects. In addition, we tried to identify the barriers behind creating a smoke-free environment at home and successful strategies employed and suggestion given in various studies. A comprehensive search of the recent literature related to Second-hand smoke was undertaken using electronic databases like MEDLINE, PUBMED, Google Scholar, and Research gate. Keyword searches were conducted for publications published since 2004 or later on Second-hand smoke exposure in pregnant women. Prevalence of SHS among pregnant women ranged from 24% 92%. Lack of knowledge, absence of comprehensive smoking ban, low status of women was among the main contributing factors. Community awareness and counseling by primary health-care physician was found to be successful strategies. There are various cultural and social barriers behind a smoke-free home for pregnant women. Interventional approaches like focused counseling by primary care physicians can help to overcome this issue. There is a need for behavioral interventions and community awareness to be done in this aspect.
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Affiliation(s)
- Twinkle Sharma
- Department of Community and Family Medicine, AIIMS Rishikesh, Uttarakhand, India
| | - Meenakshi Khapre
- Department of Community and Family Medicine, AIIMS Rishikesh, Uttarakhand, India
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Shetty SS, Jayaraj R, Shetty NJ. Study Methods. J Am Dent Assoc 2021; 151:885-886. [PMID: 33228878 DOI: 10.1016/j.adaj.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sameep S Shetty
- Fellowship Oral Oncology, Reader, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, India; Manipal Academy of Higher Education, a Constituent of MAHE
| | - Rama Jayaraj
- Department of Artificial Intelligence, Nanjing University of Information Science and Technology, Jiangsu, China; Northern Territory Institute of Research and Training, Darwin, Northern Territory, Australia
| | - Neetha J Shetty
- Professor and Head, Department of Periodontology, Manipal College of Dental Sciences, Mangalore, India; Manipal Academy of Higher Education, a Constituent of MAHE
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Gould GS, Havard A, Lim LL, Kumar R. Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2034. [PMID: 32204415 PMCID: PMC7142582 DOI: 10.3390/ijerph17062034] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 12/15/2022]
Abstract
The aim of this review of reviews was to collate the latest evidence from systematic reviews about the maternal and child health outcomes of being exposed to tobacco and nicotine during pregnancy; the effectiveness of interventions designed to reduce these exposures, and barriers to and facilitators of smoking cessation during pregnancy. Two databases were searched to obtain systematic reviews published from 2010 to 2019. Pertinent data from 76 articles were summarized using a narrative synthesis (PROSPERO reference: CRD42018085896). Exposure to smoke or tobacco in other forms during pregnancy is associated with an increased risk of obstetric complications and adverse health outcomes for children exposed in-utero. Counselling interventions are modestly effective, while incentive-based interventions appear to substantially increase smoking cessation. Nicotine replacement therapy is effective during pregnancy but the evidence is not conclusive. Predictors and barriers to smoking cessation in pregnancy are also discussed. Smoking during pregnancy poses substantial risk to mother's and child's health. Psychosocial interventions and nicotine replacement therapy (NRT) appear to be effective in helping pregnant women quit smoking. Barriers to smoking cessation must be identified and steps taken to eradicate them in order to reduce smoking among pregnant women. More research is needed on smoking cessation medications and e-cigarettes.
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Affiliation(s)
- Gillian S. Gould
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia; (L.L.L.); (R.K.)
| | - Alys Havard
- Centre for Big Data Research in Health, UNSW Sydney, Sydney NSW 2052, Australia;
| | - Ling Li Lim
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia; (L.L.L.); (R.K.)
| | | | - Ratika Kumar
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia; (L.L.L.); (R.K.)
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Lechosa Muñiz C, Paz-Zulueta M, Cornejo del Río E, Mateo Sota S, Sáez de Adana M, Madrazo Pérez M, Cabero Pérez MJ. Impact of Maternal Smoking on the Onset of Breastfeeding versus Formula Feeding: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4888. [PMID: 31817170 PMCID: PMC6950614 DOI: 10.3390/ijerph16244888] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
This study sought to estimate the prevalence of maternal smoking and its association with exclusive breastfeeding vs. formula feeding. A cross-sectional study was performed on postpartum women at a public hospital in Spain, between January and August 2018. The main variables studied were their age, level of study, smoking habits, and chosen mode of infant feeding. In total, 948 postpartum women were included. Of these, 12.45% were smokers who smoked a mean of 7.23 cigarettes/day. Among the group of smokers, the probability of feeding the newborns with formula milk was multiplied by 2.32 ([95%CI 1.50-3.58] p < 0.001). When stratifying tobacco use into mild, moderate and severe, we found a statistically significant dose-response pattern. These associations and their statistical significance were maintained when adjusting by age and level of study. In conclusion, in the group of postpartum mothers who smoked, the probability of feeding the newborns with formula milk doubled. Our data highlight the need to improve health education programs in women of childbearing age, especially during pregnancy.
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Affiliation(s)
| | - María Paz-Zulueta
- Faculty of Nursing, Universidad de Cantabria, IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, 39008 Santander, Spain
| | - Elsa Cornejo del Río
- Obstetrics Service, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain; (E.C.d.R.); (S.M.S.)
| | - Sonia Mateo Sota
- Obstetrics Service, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain; (E.C.d.R.); (S.M.S.)
| | - María Sáez de Adana
- Gynecology Service, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
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