Diseases during pregnancy in a large unselected South American sample

OBJECTIVE

Our aim was to describe the prevalence of diseases during pregnancy and the association between fetal exposure to the most frequent maternal diseases and the risk of preterm (PTB) and/or small for gestational age (SGA) newborns in an unselected sample of women who gave birth in South American countries.

METHODS

We conducted a descriptive, cross-sectional study including 56,232 mothers of non-malformed infants born between 2002 and 2016, using data from the Latin American Collaborative Study of Congenital Malformations (ECLAMC). Diseases with higher- than-expected PTB/SGA frequencies were identified. Odds ratios of confounding variables for diseases and birth outcomes were calculated with a multivariable logistic regression.

RESULTS

Of the 14 most reported diseases, hypertension, genitourinary infection, epilepsy, hypothyroidism, diabetes, and HIV/AIDS showed higher PTB and/or SGA frequencies. Advanced and low maternal age, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with PTB, while advanced maternal age, primigravidity, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with SGA. After adjusting for the associated variables, the identified illnesses maintained their association with PTB and all, except epilepsy, with SGA.

CONCLUSION

The description of an unselected population of mothers allowed identifying the most frequent diseases occurring during gestation and their impact on pregnancy outcomes. Six diseases were associated with PTB and two with SGA newborns. To the best of our knowledge, there are no similar reports about women not intentionally selected by specific diseases during pregnancy in South American populations.

Clinical implementation of a cervical cancer screening program via co-testing at a university hospital

The Human Papillomavirus (HPV) test is a crucial technology for cervical cancer prevention because it enables programs to identify women with high-risk HPV infection who are at risk of developing cervical cancer. Current U.S. Preventive Services Task Force recommendations include cervical cancer screening every three years with cervical cytology alone or every five years with either high-risk HPV testing alone or high-risk HPV testing combined with cytology (co-testing). In Argentina, 7,548 new cervical cancer cases are diagnosed each year with 3,932 deaths attributed to this cause. Our study aims to show the clinical implementation of a cervical cancer screening program by concurrent HPV testing and cervical cytology (co-testing); and to evaluate the possible cervical cancer screening scenarios for Latin America, focusing on their performance and average cost. A cervical cancer screening five year program via co-testing algorithm (Hybrid-2-Capture/cytology) was performed on women aged 30-65 years old at a university hospital. Statistical analysis included a multinomial logistic regression, and two cancer screening classification alternatives were tested (cytology-reflex and HPV-reflex). A total of 2,273 women were included, 91.11% of the participants were double-negative, 2.55% double-positive, 5.90% positive-Hybrid-2-Capture-/negative-cytology, and 0.44% negative-Hybrid-2-Capture/positive-cytology. A thorough follow-up was performed in the positive-Hybrid-2-Capture group. Despite our efforts, 21 (10.93%) were lost, mainly because of changes on their health insurance coverage which excluded them from our screening algorithm. Of the 171 women with positive-Hybrid-2-Capture results and follow-up, 68 (39.77%) cleared the virus infection, 64 (37.43%) showed viral persistence, and 39 (22.81%) were adequately treated after detection via colposcopy/biopsy of histological HSIL (High-Grade Squamous Intraepithelial Lesion). The prevalence of high-risk HPV in this population was 192 women (8.45%), with HSIL histology detection rates of 17 per 1,000 screened women. A multinomial logistic regression analysis was performed over the women with positive-Hybrid-2-Capture considering the follow up (clearance, persistence and HSIL) as dependent variable, and the cytology test results (positive- or negative-cytology and Atypical Squamous Cells of Undetermined Significance, ASC-US) as independent variable. The model supported a direct association between cytology test results and follow up: negative-cytology/clearance, ASC-US/persistence, and positive-cytology/HSIL with the following probabilities of occurrence for these pairs 0.5, 0.647 and 0.647, respectively. Cytology could be considered a prognostic-factor in women with a positive-Hybrid-2-Capture. These findings suggest that the introduction of co-testing could diminish the burden of cervical cancer in low-and middle-income-countries, acting as a tool against inequity in healthcare.

[Evaluation of the functionality and subjective well-being of bipolar patients with the Functioning Assessment Short Test (FAST) and the World Health Organization - Five Well- Being Index (WHO-5)]

INTRODUCTION

Bipolar Disorders (BD) are a mood disorders group charactered by recurrent manic or hypomanic episodes, alternating with depressive episodes. Its prevalence is 4%, and several studies have shown that they generate disability. There are effective therapeutic options for acute episodes. However, the ultimate goal is to achieve functional recovery and adequate well-being.

MATERIAL AND METHODS

There was done in Buenos Aires, Argentina a cross-sectional study comparing psychosocial functioning, with the Functioning Assessment Short Test (FAST) and subjective well-being with the Five Well-Being Index (WHO-5), among a sample of stabilized BD patients undergoing treatment at the Center of Medical Education and Clinical Research (Centro de Educación Médica e Investigaciones Clínicas) and the Bipolar Foundation (Fundación Bipolares de Argentina), with a control group.

RESULTS

A total of 102 BD patients and 52 controls where included. The FAST mean for patients and controls was 20.71 and 9.73 respectively (P=0.0000). The WHO-5 mean for patients was 59.11 and 69.76 for controls (P=0.0011). More than 70% of the patients presented functional alteration (FAST ≥12), and almost 35% presented inadequate subjective well-being (WHO-5 ≤52). Depressive symptoms conditioned worse scores on both scales. FAST scores were better among those who participated in mutual aid groups (P=0.026). While patients who underwent psychoeducation and those who received anticonvulsant drugs, presented better WHO-5 scores (P = 0.028 and P=0.048 respectively).

CONCLUSIONS

Patients with BD showed poor Functionality and poor Well-being despite being stabilized. There is direct relationship between both conditions. Depressive symptoms generated worst scores on the scales.

Preterm birth and genitourinary tract infections: assessing gene-environment interaction

BACKGROUND

Preterm birth (PTB) is the leading cause of perinatal morbimortality worldwide. Genetic and environmental factors could raise PTB risk. The aim of this study was to analyze the contribution of the statistical interaction between genes and vaginal-urinary tract infections (VI-UTI) to the risk of PTB by clinical subtype.

METHODS

Twenty-four SNPs were genotyped in 18 candidate genes from 352 fetal triads and 106 maternal triads. Statistical interactions were evaluated with conditional logistic regression models based on genotypic transmission/disequilibrium test.

RESULTS

In PTB-idiopathic subtype mothers exposed to UTI, fetal SNPs rs11686474 (FSHR), rs4458044 (CRHR1, allele G), rs883319 (KCNN3), and maternal SNP rs1882435 (COL4A3) showed a nominal significant increment in prematurity risk. In preterm premature rupture of membranes (PPROM), fetal SNP rs2277698 (TIMP2) showed a nominal significant risk increment. In mothers exposed to VI, fetal SNP rs5742612 (IGF1) in PTB-PPROM and maternal SNP rs4458044 (CRHR1, allele C) in spontaneous PTB showed nominal significant increment in prematurity risk.

CONCLUSIONS

Certain maternal and fetal genes linked to infectious/inflammatory and hormonal regulation processes increase prematurity risk according to clinical subtype when mothers are exposed to UTI or VI. These findings may help in the understanding of PTB etiology and PTB prevention.

IMPACT

Preterm birth is a major cause of perinatal morbimortality worldwide and its etiology remains unknown. This work provides evidence on the statistical interaction of six genes with gestational vaginal or urinary infections leading to the occurrence of preterm births. Statistical interactions vary according to infection type, genotype (maternal and fetal), and clinical subtype of prematurity. Certain maternal and fetal genetic variants of genes linked to infectious/inflammatory and hormonal regulation processes would increase the risk of prematurity according to clinical subtype and infection type. Our findings may help in the study of etiology of preterm birth and its prevention.

Omisión de registros de causas maternas de muerte en Argentina: estudio observacional de alcance nacional

Objetivo

Determinar la magnitud y características de la omisión del registro de causas maternas de muerte en Argentina y reestimar la razón de mortalidad materna (RMM) para el año 2014.

Métodos

Estudio de corte transversal. Revisión retrospectiva de registros médicos de mujeres en edad reproductiva que murieron por causas sospechosas de encubrir muertes maternas en instituciones del sector público, la seguridad social y privado en todas las jurisdicciones del país entre el 1 de enero y el 31 de diciembre de 2014. Se reclasificó la causa de muerte consignada en el Informe Estadístico de Defunción. Las medidas de resultado incluyeron el porcentaje de omisión del registro, la estructura de causas, el lugar, el momento de la muerte en relación con el proceso reproductivo y la edad gestacional. Se reestimó la RMM en base a los resultados.

Resultados

Se analizaron 969 registros médicos (82,4%) de una muestra de 1 176 casos. Se identificaron 60 casos donde se omitió la causa materna de muerte (48 muertes maternas, 12 muertes maternas tardías). El porcentaje de omisión fue del 14,2% para las muertes maternas y del 33,3% para las muertes maternas tardías. La nueva RMM estimada para el año 2014 osciló entre 43,3 y 47,2 muertes por cada 100 000 nacidos vivos.

Conclusiones

La omisión de registro de causas maternas de muerte en Argentina podría ser menor a la reportada por agencias internacionales. Existen diferencias de omisión entre las regiones. Se necesitan esfuerzos que enfaticen la importancia del llenado correcto de los certificados de defunción.

Dermoscopic Evaluation Improves Clinical Diagnosis of Oral Melanotic Macules: A Study in 50 Patients with Oral Pigmented Lesions

BACKGROUND: Dermoscopy is a non-invasive in vivo method rarely used for the diagnosis of oral pigmented lesions. OBJECTIVE: To analyze clinical, dermoscopic, and histologic features of Oral Melanotic Macules (OMMs), and to evaluate the usefulness of dermoscopy in the diagnosis of OMMs. METHODS: Fifty patients presenting solitary or multiple circumscribed pigmented lesions in the oral mucosa were included. RESULTS: OMMs were diagnosed in 19 patients (84% women and 16 % men); 52 % of patients had multiple lesions, 48% had one lesion. Lesion sites in decreasing order of frequency were the labial mucosa (63 %), gingiva (31.57 %), cheek mucosa (26.31%), labial semimucosa (21%), palate (10.52 %), alveolar ridge (5.26 %) and tongue (5.26 %). The dermoscopic pattern of OMMs was linear in 89 % of cases (47% parallel line, 35% fish scale-like, and 17% hyphal patterns). Histological analysis showed increased melanin in the basal cell layer in all cases with a linear dermoscopic pattern, slight acanthosis in 14 cases, and a slight increase in number of basal melanocytes in 13 cases. Globules were seen in 21% of cases corresponding histologically with increased melanin or melanophages in the lamina propria. The dermoscopic observation of symmetrical lines further enhances the diagnostic ability of dermoscopy in OMMs, with 73.68% sensitivity, 87.1% specificity, 77.78% positive predictive value, 84.38 % negative predictive value, 5.71 positive likelihood ratio, and 0.30 negative likelihood ratio. CONCLUSIONS: Dermoscopy may play a role in improving noninvasive diagnosis of oral pigmented lesions occurring on several areas of non-keratinized mucosa.

[Patient's suicide: Emotional impact on healthcare professionals and changes in their behavior]

The objective of the study was to assess the emotional impact on healthcare professionals and changes in their behavior as a result of patients' suicide in Argentina. An anonymous survey was e-mailed to healthcare professionals registered in CEMIC University Institute Department of Psychiatry database. A total of 250 responses were obtained. Among respondents, 50.6% had provided treatment to patients that committed suicide. The rate rose to 62.5% among psychiatrists. The professionals that gave an affirmative response were assessed with Horowitz Impact of Event Scale to determine the severity of trauma. The mean score for the sample was 19.6 (mild severity), with a higher mean observed in women (21.2). A difference was found in the group of younger professionals (20-29 years), who revealed a higher impact of event, with moderate severity (29.0). This difference was numerical and failed to be statistically significant (chi2 (4)=8.2110 p=0.084). Only 11.5% of respondents referred to the need to undergo treatment as a result of a patient's suicide-related death. However, 41.5% experienced a negative impact on their physical or mental health. About 60% of professionals made changes in their clinical practice after a patient's suicide. About 80% of respondents admitted they had not received enough training about suicide. Acknowledging these difficulties and providing support to healthcare professionals is crucial to face these challenges.

Odon device for instrumental vaginal deliveries: results of a medical device pilot clinical study

Background

A prolonged and complicated second stage of labour is associated with serious perinatal complications. The Odon device is an innovation intended to perform instrumental vaginal delivery presently under development. We present an evaluation of the feasibility and safety of delivery with early prototypes of this device from an early terminated clinical study.

Methods

Hospital-based, multi-phased, open-label, pilot clinical study with no control group in tertiary hospitals in Argentina and South Africa. Multiparous and nulliparous women, with uncomplicated singleton pregnancies, were enrolled during the third trimester of pregnancy. Delivery with Odon device was attempted under non-emergency conditions during the second stage of labour. The feasibility outcome was delivery with the Odon device defined as successful expulsion of the fetal head after one-time application of the device.

Results

Of the 49 women enrolled, the Odon device was inserted successfully in 46 (93%), and successful Odon device delivery as defined above was achieved in 35 (71%) women. Vaginal, first and second degree perineal tears occurred in 29 (59%) women. Four women had cervical tears. No third or fourth degree perineal tears were observed. All neonates were born alive and vigorous. No adverse maternal or infant outcomes were observed at 6-weeks follow-up for all dyads, and at 1 year for the first 30 dyads.

Conclusions

Delivery using the Odon device is feasible. Observed genital tears could be due to the device or the process of delivery and assessment bias. Evaluating the effectiveness and safety of the further developed prototype of the BD Odon Device™ will require a randomized-controlled trial.

Trial registration

ANZCTR ACTRN12613000141741 Registered 06 February 2013. Retrospectively registered.

[QUICK INVENTORY OF DEPRESSIVE SYMPTOMATOLOGY SELF-REPORT IN THE CLINICAL PRACTICE OF DEPRESSIVE PATIENTS]

INTRODUCTION

To determine the intensity of depressive disorder is helpful to make treatment decisions. The purpose of this study is to establish the correlation between the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16) and Montgomery Asberg Depression Rating Scale (MADRS), in order to measure the depression intensity in outpatients from two urban areas in Argentina.

METHOD

Over an 18-month period, 67 outpatients from the current clinical practice were included in the study. They first presented with a diagnosis of nonpsychotic major depressive disorder, according to the DSM-IV-TR criteria. Both the QIDS-SR16 and MADRS were administered.

RESULTS

The internal consistency of the QIDS-SR16 was acceptable, with the Cronbach's alpha being 0.74. Criterion validity was estimated through the correlation between both scales and was 0.84 (p<0.0001), while gamma statistics for the ordinal comparison of categories was 0.95, thus showing a high correlation.

CONCLUSION

The study findings show that the correlation between the two analyzed questionnaires allows determining depression intensity in patients from our setting. These findings further allow analyzing the usefulness of the scale for several depressive subtypes. As far as training and administration, the QIDS-SR16 is less time-consuming.

[Clinical-pathological features and gene profile in colorectal cancer]

Colorectal cancer is the third most frequent cancer in men and the second most frequent in women, with a worldwide incidence of approximately 1.2 million new cases per year. Our primary objective was to study the relationship between clinical and histological features of individuals with colorectal cancer and the mutational status of codons 12 and 13 of the KRAS gene (7 validated mutations), in order to find a histopathological marker to mutated tumors. The secondary objective was to determine how many patients had additional mutations in codons 15 and 61 of the KRAS gene, and codon 600 of the BRAF gene, which could modify the tumor phenotype. Sixty individuals with colorectal cancer (30 wild-type subjects and 30 with validated mutations in codons 12 and 13 of the KRAS gene) were selected. Exons 2 and 3 of the KRAS gene, and exon 15 of the BRAF gene were amplified and sequenced. The data collected were reviewed by a descriptive, univariate and/or multivariate analysis, as appropriate. In conclusion, no relation was found between clinical and histological features of individuals with colorectal cancer and their mutational status for codons 12 and 13 of the KRAS gene. This suggests that those easily available data do not allow predicting the response to anti-EGFR therapy. In patients with advanced colorectal adenocarcinomas and KRAS wild-type status, further study of codon 600 of the BRAF gene could be required.

Immunohistochemical characterization of neoplastic cells of breast origin

Background

After skin cancer, breast cancer is the most common malignancy in women. Tumors of unknown origin account for 5-15% of malignant neoplasms, with 1.5% being breast cancer. An immunohistochemical panel with conventional and newer markers, such as mammaglobin, was selected for the detection of neoplastic cells of breast origin. The specific objectives are: 1) to determine the sensitivity and specificity of the panel, with a special emphasis on the inclusion of the mammaglobin marker, and 2) to compare immunohistochemistry performed on whole tissue sections and on Tissue Micro-Array.

Methods

Twenty-nine metastatic breast tumors were included and assumed as tumors of unknown origin. Other 48 biopsies of diverse tissues were selected and assumed as negative controls. Tissue Micro-Array was performed. Immunohistochemistry for mammaglobin, gross cystic disease fluid protein-15, estrogen receptor, progesterone receptor and cytokeratin 7 was done.

Results

Mammaglobin positive staining was observed in 10/29 cases, in 13/29 cases for gross cystic disease fluid protein-15, in 20/29 cases for estrogen receptor, in 9/29 cases for progesterone receptor, and in 25/29 cases for cytokeratin 7. Among the negative controls, mammaglobin was positive in 2/48, and gross cystic disease fluid protein-15 in 4/48.

Conclusions

The inclusion of MAG antibody in the immunohistochemical panel for the detection of tumors of unknown origin contributed to the detection of metastasis of breast cancer. The diagnostic strategy with the highest positive predictive value (88%) included hormone receptors and mammaglobin in serial manner.

Virtual slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1366310812718988

Role of cognitive reserve in progression from mild cognitive impairment to dementia

Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies.

Prenatal sonographic detection of birth defects in 18 hospitals from South America

OBJECTIVE

The purpose of this study was to assess the accuracy of prenatal sonographic diagnosis of birth defects and the gestational age at detection according to the health insurance schemes of mothers in 450 malformed neonates from 18 South American hospitals on the basis of prenatal sonographic records.

METHODS

Between July 2000 and December 2003, 18 hospitals included in the Latin American Collaborative Study of Congenital Malformations (13 from Argentina [8 public and 5 nonpublic], 3 from Brazil [2 public and 1 nonpublic], 1 from Chile [nonpublic], and 1 from Venezuela [public]) voluntarily participated in this prospective observational study, recording fetuses with sonographically detected malformations. Prenatal sonographic descriptions of anomalies were compared with those recorded at birth.

RESULTS

Of 812 anomalies detected at birth, 457 had been prenatally detected (detection rate, 56.3%; 95% confidence interval, 52.8%-59.8%). Before 24 gestational weeks, anencephaly had the highest detection rate. Cleft lip and clubfoot were more easily detected when associated with other anomalies. The detection rates for central nervous system and renourinary malformations were greater than 80%. Detection rates between both health insurance schemes (public and nonpublic) did not show significant differences, but anencephaly, spina bifida, renourinary defects, and cleft lip with or without cleft palate were detected earlier in patients from nonpublic rather than in public hospitals.

CONCLUSIONS

For specific anomalies, South America shows similar levels of prenatal sonographic detection as developed countries. Detection rates during pregnancy were similar for public and nonpublic hospitals, whereas cases were diagnosed earlier in patients from nonpublic hospitals.

Mild behavioral impairment and risk of dementia: a prospective cohort study of 358 patients

BACKGROUND

Mild cognitive impairment (MCI) is a transitional state between normal aging and dementia, at least for some patients. Behavioral symptoms in MCI are associated with a higher risk of dementia, but their association with dementia risk in patients without MCI is unknown. Mild behavioral impairment (MBI) refers to a late-life syndrome with prominent psychiatric and related behavioral symptoms in the absence of prominent cognitive symptoms that may also be a dementia prodrome. This study sought to compare MCI and MBI patients and to estimate the risk of dementia development in these 2 groups.

METHOD

Between January 2001 and January 2006, a consecutive series of 358 elderly (>or= 65 years old) patients (239 with MCI and 119 with MBI) presenting to an outpatient general hospital specialty clinic were followed for up to 5 years until conversion to dementia or censoring.

RESULTS

Thirty-four percent of MCI patients and over 70% of patients with MBI developed dementia (log-rank p = .011). MBI patients without cognitive symptoms were more likely to develop dementia (log-rank p < .001). MBI patients were more likely to develop frontotemporal dementia (FTD) than dementia of the Alzheimer's type (DAT).

CONCLUSION

MBI appears to be a transitional state between normal aging and dementia. MBI (specifically in those without cognitive symptoms) may confer a higher risk for dementia than MCI, and it is very likely an FTD prodrome in many cases. These findings have implications for the early detection, prevention, and treatment of patients with dementia in late life, by focusing the attention of researchers on the emergence of new behavioral symptoms.

Sensitivity of direct immunofluorescence in oral diseases. Study of 125 cases

Direct immunofluorescence (DIF) is widely used for the diagnosis of bullous diseases and other autoimmune pathologies such as oral lichen planus. There is no evidence in the literature on how the following variants influence the detection rate of DIF: intraoral site chosen for the biopsy, perilesional locus or distant site from the clinical lesion, number of biopsies and instrument used.

OBJECTIVES

to determine if the following variants influenced the sensitivity (detection rate): intraoral site chosen for the biopsy, perilesional or distant site from the clinical lesion, number of biopsies and instrument used (punch or scalpel).

MATERIAL AND METHODS

A retrospective study was done at the Cátedra de Patología y Clínica Bucodental II at the Facultad de Odontología, Universidad de Buenos Aires; 136 clinical medical histories were revised for the period March 2000 - March 2005 corresponding to patients with clinical diagnosis of OLP and bullous diseases (vulgar pemphigus, bullous pemphigoid and cicatricial pemphigoid).

RESULTS

DIF detection rate was 65.8% in patients with OLP, 66.7% in cicatricial pemphigoid patients, in bullous pemphigoid 55.6%, in pemphigus vulgaris 100%, and in those cases in which certain diagnosis could not be obtained, the DIF positivity rate was 45.5% (Pearson chi(2) (4)= 21.5398 Pr= 0.000). There was no statistically significant difference between the different sites of biopsy (Fisher exact test: 0.825). DIF detection rate in perilesional biopsies was 66.1% and in those distant from the site of clinical lesion was 64.7% (Pearson chi(2) v1)= 0.0073 Pr= 0.932. When the number of biopsies were incremented, DIF detection rate also incremented (Pearson chi(2) = 8.7247 Pr= 0.003). The biopsies taken with punch had a higher detection rate than those taken with scalpel (39.1% versus 71.7%) (Pearson chi(2) = 49.0522 Pr= 0.000).

CONCLUSION

While not statistically significant, the tendency outlined in this study indicates there are intraoral regions in which the detection rate of the DIF technique is higher than others: mouth floor, hard palate, superior labial mucosa, ventral face of tongue. This finding could allow a choice of accessible locations and easy operator manipulation, even in distant places from the clinical lesion. Perilesional biopsies have a detection rate similar to those taken distant from the clinical lesion, and those taken with punch have a higher sensitivity rate than those taken with scalpel (both differences were statistically significant).

Awareness and attitude toward prenatal diagnosis of chromosomal abnormalities in patients with no access to legal termination of pregnancy

OBJECTIVE

To analyze variables affecting couples' decision making about prenatal cytogenetic diagnosis in patients with no access to legal termination of pregnancy (TOP).

METHODS

Patients undergoing invasive prenatal diagnosis were anonymously surveyed after counseling and before the procedure. The questionnaire enquired about sociodemographic features, medical history, knowledge of and attitudes toward genetic testing and TOP.

RESULTS

Two genetic units distributed 372 questionnaires. Mean maternal age was 36 +/- 4 years. Access to prenatal genetic counseling was mainly patient's own initiative, or 'self-referral'. Most self-referred patients (87%) considered that 'receiving accurate information' was the main issue. Eighty-one per cent of all couples knew that TOP because of fetal anomalies was not legal. In case of a serious anomaly, 68.2% of patients would contemplate TOP, in spite of the risk of being exposed to an unsafe abortion.

CONCLUSIONS

In many countries, prenatal genetic testing is offered, but TOP is not available. In the present study, although most of the couples who decided to undergo prenatal genetic testing were aware of this, they still chose to perform prenatal diagnosis. The main reason given was to obtain reliable information about fetal condition. Finally, if a fetal chromosomal abnormality were detected, most of them would consider TOP.

Blood glucose monitoring in gestational diabetes mellitus: 1- versus 2-h blood glucose determinations

Gestational diabetes mellitus is a common disorder of pregnancy affecting 3-5% of pregnant women. Although significant controversy exists regarding its diagnosis and treatment, macrosomia has been consistently associated with maternal hyperglycemia. Numerous studies have addressed different approaches to monitoring blood glucose levels, but data on the ideal timing for postprandial determinations are scarce. This article reviews current recommendations and recent findings on the implications of 1- versus 2-h blood glucose determinations in pregnant women with gestational diabetes mellitus. Preliminary studies have shown a statistically significant reduction in macrosomia and decreased need for emergency Cesarean section among women monitored 1 h after meals. Until larger studies confirm these benefits, compliance is of the utmost importance for successful treatment. Therefore, patient preferences should be considered in planning a monitoring strategy.