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Martín-Palumbo G, Alcorta MD, de Aguado MP, Antolín E, Bartha JL. Urinary sFlt-1 and PlGF as preeclampsia predictors: sFlt-1/creatinine ratio improves the prediction value. Eur J Obstet Gynecol Reprod Biol 2024; 298:53-60. [PMID: 38728842 DOI: 10.1016/j.ejogrb.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/28/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES To evaluate the correlation between maternal serum and urinary soluble Fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) levels and to assess their potential value in preeclampsia and fetal growth restriction. STUDY DESIGN This case-control longitudinal prospective study was performed in 49 singleton pregnant women, divided into two clinical groups, low risk pregnancy (n = 23) and pregnancy complicated by preeclampsia (n = 26). Maternal serum and urinary sFlt-1 and PlGF levels were quantified by electrochemiluminescence. Every patient underwent an ultrasound for fetal biometry. Doppler assessment was done when estimated fetal weight was under the 10th centile. ROC curves were used to evaluate the predictive capability of serum and urinary angiogenic biomarkers and their ratios on preeclampsia. Linear regression was used to compare the values of serum and urinary sFlt-1 and PlGF and their ratios. RESULTS Urine biomarkers were positively associated with their serum values, being the best associated urinary PlGF (R2 = 0.73), which also showed the highest predictive capability of preeclampsia of urine biomarkers (AUC 0.866). The predictive capability of urinary sFlt-1 was much lower (AUC 0.640), but increased when adjusting by serum creatinine, a more precise parameter (AUC 0.863). CONCLUSIONS Urinary PlGF could be a lesser invasive alternative to circulating biomarkers to monitor pregnancies complicated with preeclampsia that need repeated controls of their pregnancy complication. Urinary sFlt-1 values need adjustment by serum creatinine to be reliable.
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Affiliation(s)
- Giovanna Martín-Palumbo
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain.
| | | | - Marta Pérez de Aguado
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Eugenia Antolín
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain; Obstetrics and Gynecology of the Autonomous University of Madrid, Director of the Maternal and Fetal Research Group, Fundación para la Investigación Biomédica, La Paz University Hospital, Madrid, Spain
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Sebastián de Lucas LM, Ordás Álvarez P, de Castro Marzo L, Illescas Molina T, Herrero B, Bartha JL, Antolín E. Prenatal management and perinatal outcome in a large series of hydrops fetalis. Fetal Diagn Ther 2024:000538857. [PMID: 38643756 DOI: 10.1159/000538857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/19/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Non-immune hydrops fetalis (NIHF) is the most frequent etiology of hydrops fetalis (HF), accounting for around 95% of cases. It associates high perinatal mortality and morbidity rates. The aim of the study was firstly, to investigate etiology, prenatal management, and perinatal outcome in a large single center series of HF; secondly, to identify prenatal prognostic factors with impact on perinatal outcome. MATERIAL AND METHODS Observational retrospective study of 80 HF diagnosed or referred to a single tertiary center between 2012 and 2021. Clinical characteristics, etiology, prenatal management, and perinatal outcome were recorded. Adverse perinatal outcome was defined as intrauterine fetal death (IUFD), early neonatal death (first 7 days of life) and late neonatal death (between 7 and 28 days). RESULTS Seventy-six of the 80 cases (95%) were NIHF, main etiology being genetic disorders (28/76; 36.8%). A total of 26 women (32.5%) opted for termination of pregnancy, all of them in the NIHF group. Intrauterine fetal death (IUFD) occurred in 24 of 54 patients (44.4%) who decided to continue the pregnancy. Intrauterine treatment was performed in 29 cases (53.7%). There were 30 newborns (55.6%). Adverse perinatal outcome rate was 53.7% (29/54), significantly higher in those diagnosed < 20 weeks of gestation (82.4% <20w vs. 40.5% ≥ 20w; p=0.004). Survival rate was higher when fetal therapy was performed compared to the expectantly managed group (58.6% vs. 32%; p=0.05). Intrauterine blood transfusion and thoraco-amniotic shunt were the procedures that achieved the highest survival rates (88.9% and 100% respectively, p=0.003). CONCLUSION NIHF represented 95% of HF with genetic disorders as the main etiology. Most of them were diagnosed before 20 weeks of gestation, with worse prognosis than cases detected later in gestation. Rates of TOP, IUFD and early neonatal death were higher in NIHF. Intrauterine therapy when indicated, improved the perinatal outcome.
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Pena-Burgos EM, Sintes Álvarez-Arenas M, Quirós-González V, Bartha JL, De La Calle M. Utility of cervical pessary in the prevention of preterm birth in triplet pregnancies: A single-center observational retrospective study of 165 triplet pregnancies. Eur J Obstet Gynecol Reprod Biol 2024; 295:48-52. [PMID: 38335584 DOI: 10.1016/j.ejogrb.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Premature births are a health problem arising in triplet pregnancies, resulting in high levels of morbidity and mortality. The objective of this study is to evaluate the utility of cervical pessaries in reducing prematurity (<34 weeks) in triplet pregnancies. METHODS This is a single-center, retrospective case-control study regarding triplet pregnancies with follow-up at the La Paz University Hospital between 2000 and 2023. Maternal characteristics, obstetric and perinatal outcomes, and the use of cervical pessaries were examined. RESULTS 165 triplet pregnancies were analyzed: 87 (52.7 %) in the case group (premature triplet pregnancies) and 78 in the control group (non-premature triplet pregnancies). A cervical pessary was inserted in 15 (17.2 %) triplet pregnancies in the case group and in 12 (16.7 %) triplet pregnancies in the control group (p = 0.92; OR = 1.04 (0.46-2.35)). A pessary was later inserted in the non-premature group (p = 0.01). The risk of preterm labor and the use of tocolytics ± glucocorticoids were found to be significantly more frequent in the premature group, with p = 0.01; OR = 2.30 (1.21-4.36) and p < 0.01; OR = 2.36 (1.23-4.44), respectively. Protocol-based cesarean sections were more frequent in the non-premature group (p < 0.01), while cesarean sections due to maternal complications (p < 0.01) and premature membrane rupture (p < 0.01) were more frequent in the premature group. CONCLUSION The cervical pessary is not useful in preventing preterm births (< 34 weeks) in triplet pregnancies. It is likely that being pregnant with triplets is a powerful independent factor associated with prematurity, despite other pregnancy conditions. Women who are pregnant with triplets and at risk of preterm labor and those taking tocolytics ± glucocorticoids may benefit from pessary insertion.
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Affiliation(s)
- E M Pena-Burgos
- La Paz University Hospital, Pathology Department, Madrid, Spain.
| | | | - V Quirós-González
- 12 Octubre University Hospital, Strategic Planning Directorate, Madrid, Spain
| | - J L Bartha
- La Paz University Hospital, Obstetrics and Gynaecology Department, Madrid, Spain
| | - M De La Calle
- La Paz University Hospital, Obstetrics and Gynaecology Department, Madrid, Spain
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Villacampa A, Alfaro E, Morales C, Díaz-García E, López-Fernández C, Bartha JL, López-Sánchez F, Lorenzo Ó, Moncada S, Sánchez-Ferrer CF, García-Río F, Cubillos-Zapata C, Peiró C. Correction: SARS-CoV-2 S protein activates NLRP3 inflammasome and deregulates coagulation factors in endothelial and immune cells. Cell Commun Signal 2024; 22:64. [PMID: 38263164 PMCID: PMC10807070 DOI: 10.1186/s12964-024-01491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Alicia Villacampa
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrique Alfaro
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Biomedical Research Network- Ing Center On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina Morales
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Díaz-García
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Biomedical Research Network- Ing Center On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina López-Fernández
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Gynecology and Obstetrics Service, La Paz University Hospital, Madrid, Spain
| | | | - Óscar Lorenzo
- Laboratory of Diabetes and Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Biomedical Research Networking Centre On Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Salvador Moncada
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carlos F Sánchez-Ferrer
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Vascular Pharmacology and Metabolism (FARMA- VASM) Group, IdiPAZ, Madrid, Spain
| | - Francisco García-Río
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Biomedical Research Network- Ing Center On Respiratory Diseases (CIBERES), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carolina Cubillos-Zapata
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain.
- Biomedical Research Network- Ing Center On Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Concepción Peiró
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
- Vascular Pharmacology and Metabolism (FARMA- VASM) Group, IdiPAZ, Madrid, Spain.
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Villacampa A, Alfaro E, Morales C, Díaz-García E, López-Fernández C, Bartha JL, López-Sánchez F, Lorenzo Ó, Moncada S, Sánchez-Ferrer CF, García-Río F, Cubillos-Zapata C, Peiró C. SARS-CoV-2 S protein activates NLRP3 inflammasome and deregulates coagulation factors in endothelial and immune cells. Cell Commun Signal 2024; 22:38. [PMID: 38225643 PMCID: PMC10788971 DOI: 10.1186/s12964-023-01397-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/12/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Hyperinflammation, hypercoagulation and endothelial injury are major findings in acute and post-COVID-19. The SARS-CoV-2 S protein has been detected as an isolated element in human tissues reservoirs and is the main product of mRNA COVID-19 vaccines. We investigated whether the S protein alone triggers pro-inflammatory and pro-coagulant responses in primary cultures of two cell types deeply affected by SARS-CoV-2, such are monocytes and endothelial cells. METHODS In human umbilical vein endothelial cells (HUVEC) and monocytes, the components of NF-κB and the NLRP3 inflammasome system, as well as coagulation regulators, were assessed by qRT-PCR, Western blot, flow cytometry, or indirect immunofluorescence. RESULTS S protein activated NF-κB, promoted pro-inflammatory cytokines release, and triggered the priming and activation of the NLRP3 inflammasome system resulting in mature IL-1β formation in both cell types. This was paralleled by enhanced production of coagulation factors such as von Willebrand factor (vWF), factor VIII or tissue factor, that was mediated, at least in part, by IL-1β. Additionally, S protein failed to enhance ADAMTS-13 levels to counteract the pro-coagulant activity of vWF multimers. Monocytes and HUVEC barely expressed angiotensin-converting enzyme-2. Pharmacological approaches and gene silencing showed that TLR4 receptors mediated the effects of S protein in monocytes, but not in HUVEC. CONCLUSION S protein behaves both as a pro-inflammatory and pro-coagulant stimulus in human monocytes and endothelial cells. Interfering with the receptors or signaling pathways evoked by the S protein may help preventing immune and vascular complications driven by such an isolated viral element. Video Abstract.
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Affiliation(s)
- Alicia Villacampa
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrique Alfaro
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina Morales
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Díaz-García
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina López-Fernández
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Gynecology and Obstetrics Service, La Paz University Hospital, Madrid, Spain
| | | | - Óscar Lorenzo
- Laboratory of Diabetes and Vascular pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Biomedical Research Networking Centre on Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Salvador Moncada
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carlos F Sánchez-Ferrer
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Vascular Pharmacology and Metabolism (FARMAVASM) group, IdiPAZ, Madrid, Spain
| | - Francisco García-Río
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carolina Cubillos-Zapata
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain.
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Concepción Peiró
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
- Vascular Pharmacology and Metabolism (FARMAVASM) group, IdiPAZ, Madrid, Spain.
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Cuerva MJ, De Santiago B, Cortés M, Lopez F, Espinosa JA, Bartha JL. Vacuum-assisted birth in maternal lateral posture versus lithotomy. A simulation study. Eur J Obstet Gynecol Reprod Biol 2023; 290:88-92. [PMID: 37742455 DOI: 10.1016/j.ejogrb.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Maternal lateral postures provide advantages during childbirth. This study aims to investigate the feasibility of assisting vacuum births in maternal lateral postures in a simulation model. STUDY DESIGN In a simulation model, four obstetricians and four medical students were randomly allocated to perform vacuum-assisted births first in maternal lateral posture or lithotomy. A modification of Aldo Vacca's 5-step technique was developed to assist vacuum-assisted births in lateral posture. The lateral distance, vertical distance, and distance from the cup center to the flexion point were measured for every placement of the cup. RESULTS AND CONCLUSIONS A total of 128 vacuum-assisted births were performed. The mean distance to the flexion point was 1.15 ± 0.71 cm for the lithotomy posture and 1.31 ± 0.82 cm for the lateral posture (P = 0.127). There were no statistically significant differences in vacuum extractor cup placement accuracy based on maternal posture. Performing vacuum-assisted births in maternal lateral posture is feasible in a simulation model. The technique is easy to learn, and the differences in cup placement between the lateral and lithotomy postures are small.
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Affiliation(s)
- Marcos Javier Cuerva
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Spain; Hospital San Francisco de Asís, UPA (Affective Birth Unit), Madrid, Spain; School of Health Sciences, Universidad Alfonso X el Sabio, Madrid, Spain.
| | | | - Marta Cortés
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain
| | - Francisco Lopez
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain
| | - Jose Angel Espinosa
- Hospital San Francisco de Asís, UPA (Affective Birth Unit), Madrid, Spain; School of Health Sciences, Universidad Alfonso X el Sabio, Madrid, Spain
| | - José Luis Bartha
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Spain
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Bartha I, De La Fuente M, Martinez‐Sanchez N, De La Calle M, Martin Boado E, Bartha JL. The influence of air pollution on gestational age at delivery and birthweight in patients with or without respiratory allergy: A nested case-control study. Acta Obstet Gynecol Scand 2023; 102:1593-1601. [PMID: 37602745 PMCID: PMC10577623 DOI: 10.1111/aogs.14655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/15/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Air pollution is a current major health issue. The burden of airborne pollutants and aeroallergen levels varies throughout the year, as well as their interaction and consequences. Prenatal exposure during pregnancy has been associated with adverse perinatal outcomes. The aim of this study was to evaluate the impact of air pollutants on perinatal outcomes in patients with or without respiratory allergy. MATERIAL AND METHODS Nested case-control retrospective study on 3006 pregnant women. Correlations between concentrations of common pollutants in each trimester of pregnancy and on average during the whole pregnancy and both gestational age at delivery and birthweight were studied. Pearson's correlation coefficient and binary logistic regression were used. RESULTS In general, pollutants correlated more strongly with birthweight than with gestational age at delivery. Nine-month NO2 , SO2 , CO, and benzene, and second-trimester CO negatively correlated with birthweight, whereas only first-trimester NO2 showed a very mild correlation with gestational age at delivery. Negative correlations between pollutants and birthweight were much stronger in the respiratory allergy group (n = 43; 1.4%) than in the non-allergic group. After adjustments, the most significant predictive pollutant of birthweight was SO2 in both groups. The best predictive model was much stronger in the allergic group for third-trimester SO2 (R2 = 0.12, p = 0.02) than in the non-allergic group for total SO2 (R2 = 0.002, p = 0.02). For each unit that SO2 increased, birthweight reduced by 3.22% vs. 1.28% in each group, respectively. CONCLUSIONS Air pollutant concentrations, especially SO2 , negatively influenced birthweight. The impact of this association was much stronger and more relevant in the group of women with respiratory allergies.
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Affiliation(s)
- Irene Bartha
- Faculty of MedicineUniversidad Autónoma de MadridMadridSpain
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and MedicineKing's College London and Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Miguel De La Fuente
- Department of Neonatology, Faculty of Life Sciences and MedicineKing's College London and Guy's and St Thomas' NHS Foundation TrustLondonUK
| | | | - María De La Calle
- Department of Obstetrics and GynecologyUniversity Hospital La PazMadridSpain
| | - Elena Martin Boado
- Department of Obstetrics and GynecologyUniversity Hospital La PazMadridSpain
| | - José Luis Bartha
- Faculty of MedicineUniversidad Autónoma de MadridMadridSpain
- Department of Obstetrics and GynecologyUniversity Hospital La PazMadridSpain
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Barquiel B, Calvo M, Moreno-Domínguez Ó, Martínez-Sánchez N, Muner M, Bedate MF, Delgado M, López S, Hillman N, González N, De la Calle M, Bartha JL. The PREDG study: A randomised controlled trial testing whether an educational intervention can prevent gestational weight gain in women with obesity. Clin Nutr ESPEN 2023; 57:266-271. [PMID: 37739667 DOI: 10.1016/j.clnesp.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/24/2023] [Accepted: 07/07/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE The PREDG trial was designed to study the influence of an educative program on gestational weight gain in women with pregestational obesity. METHODS Randomized controlled clinical trial (https://www.isrctn.com/ISRCTN61793947) in 169 women with pregestational obesity (BMI ≥30 kg/m2). Women were randomized to participate in a group education program in nutrition and physical activity or conventional follow-up in a specialized Unit of Obesity and Pregnancy. The nutritional intervention was adjusted to prepregnancy BMI and to the physical activity intensity. Quality was based on the Mediterranean diet. Macronutrients were distributed as follows: 50% carbohydrates, 20% protein and 30% fat. Adequate gestational weight gain was defined between 5 and 9 kg (IOM 2009). Mean gestational weight gain was compared between groups by using the T Student test and frequencies of adequate gestational weight gain were compared by using ꓫ2. RESULTS Gestational weight gain was lower in the intervention group: 8 (4-11) vs 9.2 (6-13) kg, p 0.026. Gestational weight gain was below 9 kg in 24 of 39 (61.5%) women of the intervention vs 10 of 41 (24.4%) of the control group (p 0.001). Regarding obstetric complications, there were 15 (8.3%) cases of gestational diabetes with no differences between the groups. There were 14 of 85 (18.2%) cases of gestational hypertension or preeclampsia in the intervention group compared with 26 of 84 (32.5%) in the control group (p 0.040). With reference to neonatal weight, there were 7 of 82 (8.5%) large for gestational age neonates in the intervention group compared with 15 of 79 (19.2%) in the control group (p 0.050). CONCLUSIONS A group-based educative and structured intervention results in an adequate weight gain and lower rates of gestational hypertension, preeclampsia and large for gestational age neonates in pregnant women with obesity.
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Affiliation(s)
- Beatriz Barquiel
- Division of Diabetes, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain.
| | - Mercedes Calvo
- Department of Obstetrics, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Óscar Moreno-Domínguez
- Division of Diabetes, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Nuria Martínez-Sánchez
- Department of Obstetrics, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Marta Muner
- Department of Obstetrics, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - María Francisca Bedate
- Division of Diabetes, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - María Delgado
- Division of Diabetes, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Silvia López
- Division of Diabetes, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Natalia Hillman
- Division of Diabetes, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Noemí González
- Division of Diabetes, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - María De la Calle
- Department of Obstetrics, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics, Diabetes, Obesity and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
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Cuerva MJ, Carbonell M, Boria F, Gil MM, De La Calle M, Bartha JL. Influence on operative time of immediate skin-to-skin care in low-risk primary cesarean births for breech presentation: Retrospective cohort study. Birth 2023; 50:571-577. [PMID: 36265127 DOI: 10.1111/birt.12683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 05/28/2022] [Accepted: 09/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Multiple benefits for both, mother and baby have been reported from immediate skin-to-skin care (SSC). The aim of this study was to analyze the influence of SSC on operative time and blood loss in primary cesarean births for breech presentation. METHODS A SSC protocol for cesarean birth was implemented in our institution on February 25, 2019. In this single-center retrospective cohort study, we compared the outcomes of planned primary cesarean births for breech presentation at term before and after its implementation. RESULTS Data from 110 women who had a cesarean birth for breech presentation at term were analyzed, 55 in each group. Group 1 were women who had immediate SSC and Group 2 were women without immediate SSC. Maternal and surgical characteristics, and neonatal outcomes were similar in both groups. The mean operative time was 3.22 minutes shorter in the immediate SSC group compared with the not immediate SSC group (37.13 ± 12.27 vs 40.35 ± 12.23 minutes; P = 0.171). CONCLUSIONS In conclusion, immediate SSC following a low-risk cesarean birth for breech presentation neither prolongs the operative time nor increases blood loss during the procedure. Although we were unable to demonstrate a significant reduction in the operative time with the immediate SSC protocol, a decrease of 3 minutes was noted.
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Affiliation(s)
- Marcos Javier Cuerva
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
- School of Health Sciences, Universidad Alfonso X el Sabio, Madrid, Spain
| | - María Carbonell
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Félix Boria
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - María Mar Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejon de Ardoz, Spain
- School of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - María De La Calle
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
- School of medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
- School of medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Bartha I, Joumady I, Cuerva M, Bartha JL. The effect of maternal obesity and lipid profile on first-trimester serum progesterone levels. Am J Obstet Gynecol MFM 2023; 5:100959. [PMID: 37030509 DOI: 10.1016/j.ajogmf.2023.100959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Prepregnancy overweight increases the risk of adverse perinatal outcomes. Maternal lipid profile plays a key role in the production of pregnancy hormones. The influence that obesity has on the specific mechanisms that may be involved and the potential associations with abnormal conditions in pregnancy are still poorly understood. OBJECTIVE This study aimed to evaluate the effect of maternal body mass index and lipid profile on first-trimester serum progesterone levels. STUDY DESIGN This was a prospective cohort study including 734 pregnant people. First-trimester maternal serum progesterone, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were measured between 9 and 11 weeks' gestation. Free β-hCG, PAPP-A, age, body mass index, smoking status, gestational age at delivery, fetal sex, and birthweight were also recorded. Pregnant people were classified according to their body mass index into underweight (n=21), normal weight (n=395), overweight (n=221), obesity class I (n=64), and obesity class II/III (n=33) groups. RESULTS Gestational age at sampling was 10.0 4±1.12 weeks. Serum progesterone levels decreased as maternal body mass index increased (35.84±12.00 ng/mL, 33.08±11.27 ng/mL, 28.04±8.91 ng/mL, 24.37±8.56 ng/mL, and 19.87±11.00 mL for underweight, normal weight, overweight, obesity class I, and obesity class II/III groups, respectively; P<.000001). There were statistically significant negative correlations between maternal progesterone and body mass index, triglycerides, and cholesterol/high-density lipoprotein cholesterol ratio, and positive correlations with gestational age at sampling, maternal age, cholesterol, high-density lipoprotein cholesterol, crown-rump length, free β-hCG, and PAPP-A. Linear regression showed that the only independent predictor variables for progesterone levels were body mass index (P<.0001), PAPP-A (P<.0001), high-density lipoprotein cholesterol (P<.0001), and free β-hCG (P<.0001) (R2=0.33; P<.0000001). CONCLUSION First-trimester serum progesterone levels were lower in overweight pregnant people and markedly decreased in those with obesity, especially obesity class II/III. Maternal high-density lipoprotein cholesterol was independently related to progesterone levels as a protective factor. Benefits of progesterone supplementation in pregnant people with obesity need further evaluation.
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Affiliation(s)
- Irene Bartha
- Department of Obstetrics and Gynaecology, Facultad de Medicina, Universidad Autónoma de Madrid, University Hospital La Paz, Madrid, Spain.
| | - Insaf Joumady
- Department of Obstetrics and Gynaecology, Facultad de Medicina, Universidad Autónoma de Madrid, University Hospital La Paz, Madrid, Spain
| | - Marcos Cuerva
- Department of Obstetrics and Gynaecology, Facultad de Medicina, Universidad Autónoma de Madrid, University Hospital La Paz, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics and Gynaecology, Facultad de Medicina, Universidad Autónoma de Madrid, University Hospital La Paz, Madrid, Spain
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Duyos I, Ordás P, Herrero B, Rodriguez R, Cabrero MJ, Fernández-Zubillaga A, Diez Sebastian JB, De La Calle M, Bartha JL, Antolín E. Single fetal demise in monochorionic twins: How to predict cerebral injury in the survivor co-twin? Acta Obstet Gynecol Scand 2023. [PMID: 37270671 PMCID: PMC10378013 DOI: 10.1111/aogs.14604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The aims of the study were to evaluate perinatal outcome in monochorionic (MC) twins complicated with single intrauterine fetal death, spontaneously versus after fetal therapy, and to assess antenatal events that increase the risk of cerebral injury. MATERIAL AND METHODS Historical cohort study of MC pregnancies with single intrauterine fetal death diagnosed or referred to a tertiary referral hospital (2012-2020). Adverse perinatal outcome included termination of pregnancy, perinatal death, abnormal fetal or neonatal neuroimaging and abnormal neurological development. RESULTS A total of 68 MC pregnancies with single intrauterine fetal death after 14 weeks of gestation were included. Sixty-five (95.6%) occurred in complicated MC pregnancies (twin to twin transfusion syndrome: 35/68 [51.5%]; discordant malformation: 13/68 [19.1%], selective intrauterine growth restriction: 10/68 [14.7%], twin reversed arterial perfusion sequence: 5/68 [7.3%] and cord entanglement in monoamniotic twins: 2/68 [2.94%]). In 52 cases (76.5%) single intrauterine fetal demise occurred after fetal therapy and in 16 (23.5%) occurred spontaneously. Cerebral damage included 14/68 cases (20.6%): 6/68 cases (8.82%) were prenatal lesions and 8/68 cases (11.8%) were postnatal. Risk of cerebral damage tended to be higher in the spontaneous death group (6/16, 37.5%) compared to the therapy-group (8/52, 15.38%) (p = 0.07). The risk increased with gestational age at intrauterine death (OR 1.21, 95% CI: 1.04-1.41, p = 0.014) and was higher in those surviving co-twins who developed anemia (OR 9.27, 95% CI: 1.50-57.12, p = 0.016). Pregnancies complicated with selective intrauterine growth restriction tended to be at higher risk for neurological damage (OR 2.85, 95% CI: 0.68-11.85, p = 0.15). Preterm birth rate (<37 weeks of pregnancy) was 61.7% (37/60). Seven of eight postnatal cerebral lesions (87.5%) were related to extreme prematurity. Overall perinatal survival rate was 88.3% (57/68) and 7% (4/57) of children had an abnormal neurological outcome. CONCLUSIONS Risk of cerebral damage in single intrauterine fetal death is especially high when it occurs spontaneously. Gestational age at single intrauterine fetal death, selective intrauterine growth restriction and anemia of the surviving co-twin are the main predictors for prenatal lesions and might be useful in parent counseling. Abnormal postnatal neurological outcome is closely related to extreme prematurity.
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Affiliation(s)
- Inmaculada Duyos
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Polán Ordás
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Beatriz Herrero
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Roberto Rodriguez
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Miguel Jesús Cabrero
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | | | | | - María De La Calle
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Eugenia Antolín
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
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Cuerva MJ, Rodriguez E, Perez De Aguado M, Gil MDM, Rolle V, Lopez F, Bartha JL. Intrapartum ultrasound in maternal lateral versus semi-recumbent posture. A repeated measures study. Eur J Obstet Gynecol Reprod Biol 2023; 285:46-49. [PMID: 37044018 DOI: 10.1016/j.ejogrb.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/05/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE This study aimed to assess whether intrapartum ultrasound (ITU) measurements in maternal lateral posture are superimposable to ITU measurements in semi-recumbent position. STUDY DESIGN A single-center, repeated measures design was used. Women in the second stage of labor were randomized to ITU first in semi-recumbent followed by ITU in side-lying posture without and with contraction, or inversely. The angle of progression (AOP) and the head-perineum distance (HPD) between contractions (AOP1 and HPD1) and with contraction (AOP2 and HPD2) were measured in each maternal posture. The differences between AOP1 and AOP2 (dAOP), and between HPD1 and HPD2 (dHPD) were calculated. RESULTS AND CONCLUSIONS Forty-two women participated in the study. A generalized estimating equation model showed that AOP1 (-3.00°; 95 % CI -5.77 to -0.23; p = 0.03) and AOP2 (-4.14°; 95 % CI -7.20 to -1.08; p = 0.008) were lower in semi-recumbent compared to maternal lateral posture. HPD1 (+1.43 mm; 95 % CI 0.05-2.81; p = 0.042) and HPD2 (+1.53 mm; 95 % CI 0.17-2.89; p = 0.03) were higher in semi-recumbent position. Differences in the ITU measurements in maternal lateral posture compared to semi-recumbent position are small. Monitoring the second stage of labor with ITU in lateral maternal posture is possible.
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Affiliation(s)
- Marcos Javier Cuerva
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain; School of medicine. Universidad Autónoma de Madrid, Spain.
| | - Elena Rodriguez
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain
| | | | - Maria Del Mar Gil
- Hospital Universitario de Torrejón, Department of Obstetrics and Gynecology, Spain; School of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Valeria Rolle
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain
| | - Francisco Lopez
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain
| | - José Luis Bartha
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain; School of medicine. Universidad Autónoma de Madrid, Spain
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Rodo C, de la Calle M, Maroto A, Maiz N, Arévalo S, Garcia-Manau P, Mendoza M, Bartha JL, Carreras E. Gestational age-based reference ranges for cervical length and preterm birth prediction in triplet pregnancies: an observational retrospective study. BMC Pregnancy Childbirth 2022; 22:669. [PMID: 36042432 PMCID: PMC9426284 DOI: 10.1186/s12884-022-04997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To develop gestational age-based reference ranges for cervical length in triplet pregnancies. The secondary objective was to assess the performance of cervical length measured between 18 and 20 + 6 days for the prediction of preterm delivery before 28 and 32 weeks, respectively. METHODS Observational retrospective study of triplet pregnancies in three Spanish tertiary-care hospitals between 2001 and 2019. Cervical length measurements were consecutively obtained between 15 and 34 weeks of gestation. Pregnancies undergoing multifetal reduction or fetal surgery were excluded. RESULTS Two hundred and six triplet pregnancies were included in the final analysis. There was a quadratic decrease in cervical length with gestational age. The median and fifth centiles for cervical length at 20 weeks were 35 and 13 mm. In the prediction of preterm birth < 28 weeks, for a false positive rate of 5%, and 10%, the detection rates were 40.9%, and 40.9%, respectively, and the prediction of preterm birth < 32 weeks, 22.0% and 26.0%, respectively. CONCLUSIONS In triplet pregnancies, cervical length decreases with gestational age. The performance of cervical length at 18-20 + 6 in screening for preterm birth before 28 and 32 weeks is poor.
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Affiliation(s)
- Carlota Rodo
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - María de la Calle
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - Anna Maroto
- Maternal-Fetal Medicine, Department of Obstetrics, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Nerea Maiz
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Silvia Arévalo
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Pablo Garcia-Manau
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Manel Mendoza
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - José Luis Bartha
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - Elena Carreras
- Maternal-Fetal Medicine Research Group, Department of Obstetrics, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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Cuerva MJ, Rodriguez E, Lopez F, Bartha JL. Intrapartum Ultrasound in Maternal Lateral Position. A Prospective Observational Study. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4909197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Yuste Gómez A, Ramos Álvarez MDP, Bartha JL. Influence of Diet and Lifestyle on the Development of Gestational Diabetes Mellitus and on Perinatal Results. Nutrients 2022; 14:nu14142954. [PMID: 35889912 PMCID: PMC9319526 DOI: 10.3390/nu14142954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/12/2022] [Accepted: 07/17/2022] [Indexed: 12/10/2022] Open
Abstract
GDM is a multifactorial disease, so there is controversy regarding the mechanisms involved in its pathogenesis. We speculate whether lifestyle and eating habits influenced the appearance and pathogenesis of GDM. To explore this issue, the aim of the present study was to analyze maternal diet and lifestyle characteristics in early pregnancy and their influence on the development of GDM. The study included 103 pregnant women who completed a questionnaire on nutritional knowledge, lifestyle and eating habits. Perinatal and biochemical outcomes as well as pregestational lifestyle and eating habits were compared between normoglycemic women and those who developed GDM. The results obtained showed that women who developed GDM had erroneous knowledge regarding nutrition. Consumption of white bread (p = 0.018), added sugars (p = 0.037), legumes (p = 0.025), fish (p = 0.014), butter (p = 0.010) and the performance of less physical activity (p = 0.024) correlated with glucose intolerance in pregnant women. In conclusion, we found a relationship between dietary and lifestyle habits at the beginning of pregnancy and the later diagnosis of GDM.
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Affiliation(s)
- Alba Yuste Gómez
- Department of Chemistry and Biochemistry, Faculty of Pharmacy, CEU San Pablo University, 28925 Madrid, Spain;
- Director of the Maternal and Fetal Reseach Group, IdiPaz, Department of Maternal Fetal Medicine, Hospital Universitario La Paz, 28046 Madrid, Spain;
- Correspondence:
| | | | - José Luis Bartha
- Director of the Maternal and Fetal Reseach Group, IdiPaz, Department of Maternal Fetal Medicine, Hospital Universitario La Paz, 28046 Madrid, Spain;
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Ordás P, Rodríguez R, Herrero B, Deiros L, Gómez E, Llurba E, Bartha JL, Antolín E. Longitudinal changes in fetal head biometry and fetoplacental circulation in fetuses with congenital heart defects. Acta Obstet Gynecol Scand 2022; 101:987-995. [PMID: 35726340 DOI: 10.1111/aogs.14401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/12/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Objectives were to analyze changes in fetal cephalic biometry and fetoplacental circulation throughout pregnancy in fetuses with congenital heart defects. MATERIAL AND METHODS Prospective study conducted on three university tertiary referral hospitals. Fetuses with the diagnosis of isolated congenital heart defects attending between 2014 and 2018 were included. Congenital heart defects were divided into two groups according to the oxygen supply to the central nervous system: group I (expected low placental blood content and low oxygen delivery to the brain) and group II (expected intermediate and high placental blood content). Fetal biometry and Doppler parameters were collected between 25-30 weeks of gestation and 34-40 weeks of gestation and transformed into Z scores. The results were compared with healthy controls. Finally, general linear modeling was performed to analyze repeated measurements. RESULTS In all, 71 fetuses met the inclusion criteria. Fetuses with congenital heart defects had significantly smaller head (biparietal diameter [p < 0.001], head circumference [p = 0.001]) and abdominal circumference (p < 0.001), and lower estimated fetal weight (p < 0.001) than controls. When analyzing according to congenital heart defects type, head size was significantly smaller in group I compared with group II (p = 0.04). Regarding Doppler parameters, fetuses with congenital heart defects showed higher umbilical artery pulsatility index (p < 0.001) and lower cerebroplacental ratio (p = 0.044) than controls. In group I, umbilical artery pulsatility index was above the 95th centile in 15.4% of fetuses compared with 6.7% in group II and 1.9% in controls (p < 0.001); moreover, middle cerebral artery pulsatility index was below the 5th centile in 5.4% of group I fetuses compared with 0% in group II and 1.2% in controls (p = 0.011). General linear model for two measurements showed significant longitudinal changes in biometric parameters. Growth rate of fetal head through pregnancy (head circumference Z score) was lower in fetuses with congenital heart defects compared with controls (p = 0.043). In group I, the head circumference Z score longitudinal decrease was significantly higher than in group II (p < 0.001). CONCLUSIONS Fetuses with congenital heart defects are at risk of smaller head size and Doppler changes. Growth rate of fetal head throughout pregnancy is also affected. These findings are mainly associated with cardiac defects with expected low oxygen supply to the central nervous system.
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Affiliation(s)
- Polán Ordás
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University Hospital La Paz, Madrid, Spain
| | - Roberto Rodríguez
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University Hospital La Paz, Madrid, Spain
| | - Beatriz Herrero
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University Hospital La Paz, Madrid, Spain
| | - Lucía Deiros
- Division of Pediatric Cardiology, University Hospital La Paz, Madrid, Spain
| | - Enery Gómez
- Division of Maternal and Fetal Medicine, Department Obstetrics and Gynecology, University Hospital 12 Octubre, Madrid, Spain
| | - Elisa Llurba
- Division of Maternal and Fetal Medicine, Department Obstetrics and Gynecology, St Creu and St Pau Hospital, Barcelona, Spain.,RETICS "Maternal and Child Health and Development Network" (SAMID Network), ISCIII, Madrid, Spain
| | - José Luis Bartha
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University Hospital La Paz, Madrid, Spain.,RETICS "Maternal and Child Health and Development Network" (SAMID Network), ISCIII, Madrid, Spain
| | - Eugenia Antolín
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University Hospital La Paz, Madrid, Spain.,RETICS "Maternal and Child Health and Development Network" (SAMID Network), ISCIII, Madrid, Spain
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Iniesta S, Esteban S, Armijo Ó, Lobo S, Manzano S, Espinosa I, Cárdenas N, Bartha JL, Jiménez E. Ligilactobacillus salivarius PS11610 exerts an effect on the microbial and immunological profile of couples suffering unknown infertility. Am J Reprod Immunol 2022; 88:e13552. [PMID: 35506742 DOI: 10.1111/aji.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022] Open
Abstract
PROBLEM Unknown or idiopathic infertility has been associated with urogenital tract dysbiosis, reducing pregnancy and delivery ratios during assisted reproductive treatments (ART). The Ligilactobacillus salivarius PS11610 strain has shown extraordinary antimicrobial activity in vitro against urogenital pathogens as well as other probiotic characteristics. Therefore, an intervention study was performed to evaluate the effect of L. salivarius PS11610 on the microbial composition of urogenital tract in infertile couples with bacterial dysbiosis. METHOD OF STUDY Seventeen couples undergoing ART diagnosed with unknown infertility were selected. After confirming urogenital dysbiosis, they started a 6-month treatment with L. salivarius PS11610 (1 dose/12 h for female and 1 dose/24 h for male). Vaginal, seminal, glans, uterine and plasma samples were collected for determination of the microbiome and immune profile at the beginning and the end of the treatment. RESULTS Supplementation with L. salivarius PS11610 significantly modified the urogenital microbiome composition in male and female samples, solving dysbiosis of 67% of the couples. Pathogens disappeared from the vaginal samples whereas Lactobacilli percentage increased after 3 and 6 months of treatment. Moreover, L. salivarius PS11610 changed the uterine microbiome that could be associated with a change of the uterine immune profile. Additionally, the probiotic intake could be associated with the observed change in the systemic immunological profile of couples. Finally, the pregnant and delivery ratio were improved. CONCLUSIONS Probiotic supplementation with L. salivarius PS11610 improved the male and female urogenital tract microbiome, modulating the immune system and increasing pregnancy success in couples undergoing ART.
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Affiliation(s)
- Silvia Iniesta
- Department of Gynecology and Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Sergio Esteban
- Probisearch, SLU. c/Santiago Grisolía, 2, Tres Cantos, Madrid, Spain
| | - Ónica Armijo
- Department of Gynecology and Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Sonia Lobo
- Department of Gynecology and Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Susana Manzano
- Probisearch, SLU. c/Santiago Grisolía, 2, Tres Cantos, Madrid, Spain
| | - Irene Espinosa
- Probisearch, SLU. c/Santiago Grisolía, 2, Tres Cantos, Madrid, Spain
| | - Nivia Cárdenas
- Probisearch, SLU. c/Santiago Grisolía, 2, Tres Cantos, Madrid, Spain
| | - José Luis Bartha
- Department of Gynecology and Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Esther Jiménez
- Probisearch, SLU. c/Santiago Grisolía, 2, Tres Cantos, Madrid, Spain
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18
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Martín-Palumbo G, Duque Alcorta M, Atanasova VB, Rego Tejeda MT, Antolín Alvarado E, Bartha JL. Prenatal prediction of very late onset small-for-gestational age newborns in low-risk pregnancies. J Matern Fetal Neonatal Med 2022; 35:9816-9820. [PMID: 35341457 DOI: 10.1080/14767058.2022.2054322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To find a multivariate model for predicting small-for-gestational age newborns at 36 weeks' gestation by using clinical, biochemical and ultrasound measurements. MATERIALS AND METHODS We evaluated 564 low-risk pregnant women and recorded maternal age, maternal body mass index, maternal mean blood pressure, soluble fms-like tyrosine kinase-1 (multiples of the median), placental growth factor (multiples of the median), soluble fms-like tyrosine kinase-1/placental growth factor ratio, estimated fetal weight centile and mean uterine artery pulsatility index at 36 weeks. Binary logistic regression was used. Statistical significance was set at 95% level (p < 0.05). RESULTS We found three multivariate models showing relatively small differences in predictive capability. Model 1 only included estimated fetal weight centiles (area under the curve [AUC] 0.86; R2 = 0.42; p < 0.0001), Model 2 estimated fetal weight centiles and placental growth factor (multiples of the median) (AUC 0.87; R2 = 0.44; p < 0.0001) and Model 3 estimated fetal weight centiles, placental growth factor (multiples of the median) and mean uterine artery pulsatility index (AUC 0.88; R2 = 0.45; p < 0.0001). CONCLUSION Small-for-gestational age at delivery may be predicted by using a multivariate formula. The inclusion of parameters other than estimated fetal weight centile at 36 weeks' gestation modestly improves the predictive capability of the model. Clinical decisions should consider whether or not these slight differences deserve a change in current strategies.
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Affiliation(s)
- Giovanna Martín-Palumbo
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | | | - Vangeliya Blagoeva Atanasova
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - María Teresa Rego Tejeda
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Eugenia Antolín Alvarado
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
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19
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Martínez-Sánchez N, De la Calle Fernández-Miranda M, Bartha JL. Safety profile of treatments administered in COVID 19 infection in pregnant women. Clin Invest Ginecol Obstet 2021; 48:100663. [PMID: 33654337 PMCID: PMC7906532 DOI: 10.1016/j.gine.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/10/2021] [Indexed: 12/27/2022]
Abstract
SARS-CoV-2 infection has unexpectedly arrived in our society. In pregnant women, the situation has been similar to general population. Some drugs have been used empirically, and obstetricians have to consider whether the same treatments used in the general population were valid for pregnant women with severe disease, according to their safety profile for both the mother and the fetus. There has been a wide experience with the use of hydroxychloroquine and lopinavir/ritonavir in pregnant women. Tocilizumab and interferon beta could be used if benefits exceed risks. There is no experience using remdesivir in pregnancy.
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Affiliation(s)
- N Martínez-Sánchez
- Obstetrics and Gynecology Department, University Hospital La Paz, Madrid, Spain
| | | | - J L Bartha
- Obstetrics and Gynecology Department, University Hospital La Paz, Madrid, Spain
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20
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Döbert M, Varouxaki AN, Mu AC, Syngelaki A, Ciobanu A, Akolekar R, De Paco Matallana C, Cicero S, Greco E, Singh M, Janga D, Del Mar Gil M, Jani JC, Bartha JL, Maclagan K, Wright D, Nicolaides KH. Pravastatin Versus Placebo in Pregnancies at High Risk of Term Preeclampsia. Circulation 2021; 144:670-679. [PMID: 34162218 DOI: 10.1161/circulationaha.121.053963] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Effective screening for term preeclampsia is provided by a combination of maternal factors with measurements of mean arterial pressure, serum placental growth factor, and serum soluble fms-like tyrosine kinase-1 at 35 to 37 weeks of gestation, with a detection rate of ≈75% at a screen-positive rate of 10%. However, there is no known intervention to reduce the incidence of the disease. METHODS In this multicenter, double-blind, placebo-controlled trial, we randomly assigned 1120 women with singleton pregnancies at high risk of term preeclampsia to receive pravastatin at a dose of 20 mg/d or placebo from 35 to 37 weeks of gestation until delivery or 41 weeks. The primary outcome was delivery with preeclampsia at any time after randomization. The analysis was performed according to intention to treat. RESULTS A total of 29 women withdrew consent during the trial. Preeclampsia occurred in 14.6% (80 of 548) of participants in the pravastatin group and in 13.6% (74 of 543) in the placebo group. Allowing for the effect of risk at the time of screening and participating center, the mixed-effects Cox regression showed no evidence of an effect of pravastatin (hazard ratio for statin/placebo, 1.08 [95% CI, 0.78-1.49]; P=0.65). There was no evidence of interaction between the effect of pravastatin, estimated risk of preeclampsia, pregnancy history, adherence, and aspirin treatment. There was no significant between-group difference in the incidence of any secondary outcomes, including gestational hypertension, stillbirth, abruption, delivery of small for gestational age neonates, neonatal death, or neonatal morbidity. There was no significant between-group difference in the treatment effects on serum placental growth factor and soluble fms-like tyrosine kinase-1 concentrations 1 and 3 weeks after randomization. Adherence was good, with reported intake of ≥80% of the required number of tablets in 89% of participants. There were no significant between-group differences in neonatal adverse outcomes or other adverse events. CONCLUSIONS Pravastatin in women at high risk of term preeclampsia did not reduce the incidence of delivery with preeclampsia. Registration: URL: https://www.isrctn.com; Unique identifier ISRCTN16123934.
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Affiliation(s)
- Moritz Döbert
- Fetal Medicine Research Institute, King's College Hospital, London, UK (M.D., A.N.V., A.C.M., A.S., A.C., K.H.N.)
| | - Anna Nektaria Varouxaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK (M.D., A.N.V., A.C.M., A.S., A.C., K.H.N.)
| | - An Chi Mu
- Fetal Medicine Research Institute, King's College Hospital, London, UK (M.D., A.N.V., A.C.M., A.S., A.C., K.H.N.)
| | - Argyro Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK (M.D., A.N.V., A.C.M., A.S., A.C., K.H.N.)
| | - Anca Ciobanu
- Fetal Medicine Research Institute, King's College Hospital, London, UK (M.D., A.N.V., A.C.M., A.S., A.C., K.H.N.)
| | | | - Catalina De Paco Matallana
- Hospital Clínico Universitario Virgen de la Arrixaca and Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Spain (C.D.P.M.)
| | | | | | - Mandeep Singh
- Southend University Hospital, Westcliff-on-Sea, UK (M.S.)
| | - Deepa Janga
- North Middlesex University Hospital, London, UK (D.J.)
| | - Maria Del Mar Gil
- School of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain (M.d.M.G.).,Hospital Universitario de Torrejón, Madrid, Spain (M.d.M.G.)
| | - Jacques C Jani
- University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (J.C.J.)
| | | | | | | | - Kypros H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK (M.D., A.N.V., A.C.M., A.S., A.C., K.H.N.)
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21
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Martín-Palumbo G, Atanasova VB, Rego Tejeda MT, Antolín Alvarado E, Bartha JL. Third trimester ultrasound estimated fetal weight for increasing prenatal prediction of small-for-gestational age newborns in low-risk pregnant women. J Matern Fetal Neonatal Med 2021; 35:6721-6726. [PMID: 34024243 DOI: 10.1080/14767058.2021.1920915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM The early detection of small-for-gestational age (SGA) fetuses and newborns is pivotal in the prevention of perinatal mortality. OBJECTIVES To compare the predictive capability of performing ultrasound-based estimated fetal weight (EFW) at 32 versus 36 weeks' gestation on the detection rate of SGA fetuses and SGA newborns at delivery, and to find a better cutoff level to consider a fetus at risk of being born small. MATERIAL AND METHODS Nine hundred fifteen low-risk pregnant women were assessed at both 32 and 36 weeks' gestation. EFW centile was calculated in both occasions. The rate of SGA fetuses was compared. SGA fetuses were considered when both abdominal circumference (AC) and EFW were below the 10th centile from a total of 488 delivered at our Hospital. Paired comparisons between ultrasound at 32 and 36 weeks' gestation were done to predict SGA at delivery. Percentages of SGA fetuses were compared by chi-squared test. ANOVA test was used for comparing centiles among groups. Receiver operating characteristic (ROC) curve was used to find the best cutoff ultrasound centile to predict SGA at delivery. Statistical significance was previously set at 95% level (p < .05). RESULTS Ultrasound-based EFW at 32 weeks showed 23 cases of SGA (2.5%) while at 36 weeks this rate increased up to 4% (37/915) (p < .000001). When comparing both outcomes, 2.8% of those catalogued as adequate-for-gestational age (AGA) at 32 weeks were cases of SGA at 36 weeks. In addition, 47.8% of those diagnosed as SGA were not confirmed at 36 weeks. Only 12.3% of SGA neonates were identified at 32 weeks' gestation ultrasound, while using the 36 weeks' gestation approach this rate increased up to 30.9%. So, only a low proportion of SGA neonates were SGA fetuses at any of these two gestational ages. However, the area under the curve (AUC) at 36 weeks was as high as 0.86. Being a matter of cutoff rather than a matter of choosing the correct variable, ROC analysis showed that the best cutoff for prediction having the best sensitivity (0.80) with the best specificity (0.77) was 28th centile of EFW. This represents 24.9% of the studied women (228/915). CONCLUSIONS In general, ultrasound at 36 weeks has better performance detecting SGA fetuses than ultrasound at 32 weeks and we suggest to definitively change from 32 to 36 weeks in order to increase the detection rate of SGA fetuses. Moreover, in order to detect those fetuses who will grow below the lower level of the normal range in the last month of pregnancy, we suggest that those with EFW below the 28th centile at 36 weeks should be rescanned later in pregnancy to identify prenatally as many cases as we can of SGA newborns.
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Affiliation(s)
- Giovanna Martín-Palumbo
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University Hospital La Paz, Madrid, Spain
| | - Vangeliya Blagoeva Atanasova
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University Hospital La Paz, Madrid, Spain
| | - María Teresa Rego Tejeda
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University Hospital La Paz, Madrid, Spain
| | - Eugenia Antolín Alvarado
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University Hospital La Paz, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University Hospital La Paz, Madrid, Spain
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Martínez-Sánchez N, Robles Marhuenda A, De la Calle Fernández-Miranda M, Bartha JL. First trimester combined screening test for aneuploidies in anti-Ro carriers pregnant women. Clin Rheumatol 2021; 40:2699-2705. [PMID: 33559011 DOI: 10.1007/s10067-021-05616-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Anti-Ro/SSA and anti-La/SSB antibodies are associated with neonatal lupus and congenital heart block. Controversial results regarding perinatal outcomes are found and less is known about aneuploidy screening. The hypothesis is that the presence of anti-Ro and/or anti-La antibodies influences the levels of PAPP-A and ß-HCG, thus interfering in the calculation of risk of aneuploidies. MATERIAL AND METHODS Fifty-five anti-Ro/SSA positive pregnant women were included. The demographic characteristics and laboratory variables were studied. Data concerning chromosomopaties screening were also recorded. RESULTS PAPP-A and β-HCG levels were calculated (as well as NT and CRL) and compared with a healthy cohort of 12971 pregnant women. PAPP-A levels in mg/mL were lower significatively. In anti-La/SS-B cohort, significant differences were found in PAPP-A in mg/mL and in MoM. Combined risks for Down syndrome (DS) in both groups were higher but the differences were due to age. CONCLUSIONS Serum levels of PAPP-A were significative lower but not confirmed when adjusted to MoM. This will have to be confirmed in studies with a larger number of patients and to check whether there is an impact in the calculation of DS risk or not. They could represent a group of pregnant women with significantly a higher risk of adverse perinatal outcome. Key Points • Pregnant patients with anti-Ro/SS-A ant/or anti-La/SS-B antibodies have low PAPP-A levels compared with pregnant women without antibodies. • PAPP-A levels are used in obstetrics for aneuploidies screening in the first trimester, so in these patients, there could be more false positive screening. • In these findings are verified in trials with a larger number of patients, a correction variable would have to be applied for the aneuploidies screening calculation. • Also, low PAPP-A levels are correlated with poor placentation, that is to say, more risk of miscarriages, small fetus for gestational age, and preeclampsia. This is another topic to take into consideration in this population.
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Affiliation(s)
- N Martínez-Sánchez
- Obstetrics and Gynecology Department, University Hospital La Paz, Madrid, Spain.
| | | | | | - J L Bartha
- Obstetrics and Gynecology Department, University Hospital La Paz, Madrid, Spain
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Antolín E, Herrero B, Rodríguez R, Illescas T, Duyos I, Gimeno A, Sotillo L, Abascal A, Orensanz I, Hernández A, Bartha JL. [How to organize a Fetal Medicine Unit in the context of COVID-19 pandemic. Safe measures for obstetric scans and equipment cleaning]. Clin Invest Ginecol Obstet 2021; 48:3-13. [PMID: 32836610 PMCID: PMC7328539 DOI: 10.1016/j.gine.2020.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 11/05/2022]
Abstract
During a pandemic, the three basic principles are. to prioritize medical resources, ensure patients' lockdown in order to avoid community transmission and prevent healthcare collapse, and keep the number of visits to an absolute minimum to avoid patient exposure and safeguard healthcare workers. Antenatal care must be maintained during a health crisis, regardless of the COVID-19 state of alert. Routine and specialist obstetric ultrasound scans are essential for clinical decision-making during pregnancy, as it has a direct impact on the management of mothers and fetuses and on the perinatal outcome. In an attempt to minimize in-person visits, these will be organized according to the established ultrasound schedule. Based on scientific evidence, and on existing main national and international guidelines, this document has been prepared, in which proposals and options are provided for managing pregnant women in the context of the SARS-CoV-2 pandemic. It includes how a Fetal Medicine Unit facing this health crisis should be restructured, what safety measures should be followed in the performance of obstetric scans and invasive procedures, and how ultrasound rooms, equipment and transducers should be cleaned and disinfected. These recommendations should be adapted to different units based on their resources and infrastructure.
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Affiliation(s)
- E Antolín
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
- Red de Salud Materno Infantil y del Desarrollo (SAMID), España
| | - B Herrero
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - R Rodríguez
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - T Illescas
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - I Duyos
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - A Gimeno
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - L Sotillo
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - A Abascal
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - I Orensanz
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - A Hernández
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - J L Bartha
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
- Red de Salud Materno Infantil y del Desarrollo (SAMID), España
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Alonso-Espías M, Martínez-Sánchez N, Robles-Marhuenda A, Martín-Boado ME, Regojo-Zapata RM, Bartha JL. Diagnosis of amyopathic dermatomyositis after two intrauterine fetal deaths. Obstet Med 2020; 14:109-112. [PMID: 34394721 DOI: 10.1177/1753495x20929507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/29/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic histiocytic intervillositis (CHIV) is an uncommon condition, characterized by an infiltrate of mononuclear cells of maternal origin in the intervillous space that has been related to placenta insufficiency and poor perinatal outcomes. The aetiology is unclear, although maternal immunological aggression toward fetal tissues has been proposed. Dermatomyositis (DM) is a multisystem autoimmune inflammatory myopathy. Different autoantibodies have been associated with particular clinical phenotypes; presence of anti-melanoma differentiation-associated gen 5 (MDA5) antibody has been associated with rapidly progressive interstitial lung disease and severe skin lesions, none of which the woman had. Described here is a case of a woman diagnosed with amyopathic DM with positive anti-MDA5 antibodies after two intrauterine fetal deaths. Pathological examination of the placenta in both pregnancies showed CHIV. The presence of a potential relationship between both processes is discussed.
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Affiliation(s)
- M Alonso-Espías
- Department of Obstetrics & Gynaecology, Hospital Universitario La Paz, Madrid, Spain
| | - N Martínez-Sánchez
- Department of Obstetrics & Gynaecology, Hospital Universitario La Paz, Madrid, Spain
| | - A Robles-Marhuenda
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - M E Martín-Boado
- Department of Obstetrics & Gynaecology, Hospital Universitario La Paz, Madrid, Spain
| | - R M Regojo-Zapata
- Department of Pathology, Hospital Universitario La Paz, Madrid, Spain
| | - J L Bartha
- Department of Obstetrics & Gynaecology, Hospital Universitario La Paz, Madrid, Spain
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25
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De la Calle M, Baquero-Artigao F, Rodríguez-Molino P, Cabanes M, Cabrera M, Antolin E, Mellado MJ, Bartha JL. Combined treatment with immunoglobulin and valaciclovir in pregnant women with cytomegalovirus infection and high risk of symptomatic fetal disease. J Matern Fetal Neonatal Med 2020; 35:3196-3200. [PMID: 32933353 DOI: 10.1080/14767058.2020.1815188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Congenital cytomegalovirus (CMV) infection is one of the most common during pregnancy. The infection, particularly in the first trimester, is associated with important sequelae in up to half of the children. Valaciclovir and immunoglobulin have been tested separately for the treatment of fetal CMV infection with relative success. Nevertheless, there is no experience with the simultaneous use of both therapies. METHODS combination therapy (oral valaciclovir 2 g/6h until the end of pregnancy and intravenous hyperimmune gamma globulin 200 UI/kg) was offered to pregnant women with CMV infection acquired during pregnancy and viral load (VL) in amniotic fluid above 105 copies/ml and/or brain injuries in the ultrasonography. Additional immunoglobulin monthly doses were used in case of ultrasonography or MRI evidence of persistent fetal involvement. Neurological and hearing evaluations of infants were performed at birth and every 3 months during follow-up. RESULTS 15 pregnant women were enrolled: primary infection, 14, non-primary infection, 1; first trimester, 11, second trimester, 4. Mean gestational age at the start of combination treatment were 23.2 weeks and 29.3 weeks, depending on the infection being diagnosed in the first or the second trimester, respectively. Median VL of CMV-DNA in amniotic fluid was 62.5 × 105 copies/ml. Intrauterine progression of fetal brain lesions was only observed in two cases in which the dose of CMV-HIG was repeated, slowing their progression. Although the treatment has failed to reverse ultrasound fetal lesions, only 3 children were born with hearing impairment and their psychomotor development was consistent with chronological age in all patients but one. Combination therapy was not associated with adverse effects in either the mothers or the fetuses. CONCLUSION Combination therapy with immunoglobulin and valaciclovir may be a useful alternative in CMV fetal infection, particularly if changes in cerebral echography or high VL in the amniotic fluid are present.
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Affiliation(s)
- Maria De la Calle
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
| | | | | | - Maria Cabanes
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
| | - Marta Cabrera
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Eugenia Antolin
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
| | - Maria José Mellado
- Department of Pediatric Infectology, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
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Cuerva MJ, Carbonell M, Martín Palumbo G, Lopez Magallon S, De La Calle M, Bartha JL. Personal Protective Equipment during the COVID-19 pandemic and operative time in cesarean section: retrospective cohort study. J Matern Fetal Neonatal Med 2020; 35:2976-2979. [PMID: 32662314 DOI: 10.1080/14767058.2020.1793324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The covid-19 pandemic has meant a change in working protocols, as well as in Personal Protective Equipment (PPE). Obstetricians have had to adapt quickly to these changes without knowing how they affected their clinical practice. The aim of the present study was to evaluate how COVID-19 pandemic and PPE can affect operative time, operating room time, transfer into the operating room to delivery time and skin incision to delivery time in cesarean section. METHODS This is a single-center retrospective cohort study. Women with confirmed or suspected SARS-CoV-2 infection having a cesarean section after March 7th, 2020 during the COVID-19 pandemic were included in the study. For each woman with confirmed or suspected SARS-CoV-2 infection, a woman who had a cesarean section for the same indication during the COVID-19 pandemic and with similar clinical history but not affected by SARS-CoV-2 was included. RESULTS 42 cesarean sections were studied. The operating room time was longer in the COVID-19 confirmed or suspected women: 90 (73.0 to 110.0) versus 61 (48.0 to 70.5) minutes; p < .001. The transfer into the operating room to delivery time was longer, but not statistically significant, in urgent cesarean sections in COVID-19 confirmed or suspected women: 25.5 (17.5 to 31.75) versus 18.0 (10.0 to 26.25) minutes; p = .113. CONCLUSIONS There were no significant differences in the operative time, transfer into the operating room to delivery time and skin incision to delivery time when wearing PPE in cesarean section. The COVID-19 pandemic and the use of PPE resulted in a significant increase in operating room time.
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Affiliation(s)
| | - María Carbonell
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - María De La Calle
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
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27
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Illescas T, Mansilla E, Herrero B, Rodríguez R, López F, Aza-Carmona M, Regojo RM, Santos-Simarro F, Heath KE, Bartha JL, Antolín E. Prenatal diagnosis of fetal skeletal dysplasias in a tertiary Hospital in Spain. Eur J Obstet Gynecol Reprod Biol 2020; 250:209-215. [PMID: 32470698 DOI: 10.1016/j.ejogrb.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of prenatal ultrasound for detecting fetal skeletal dysplasias and to describe its role in orienting genetic studies. STUDY DESIGN Observational study of pregnant women surveyed in our hospital, between 2011 and 2018, with fetal long bones below the 3rd centile (shortened long bones), either as an isolated finding or associated to other skeletal anomalies. We used a systematic protocol for the ultrasound evaluation and selection of those fetuses suspected of having a skeletal dysplasia. We report the demographics of these patients along with the sonographic follow-up of their fetuses, the genetic results and the outcome of the pregnancies and the newborn in the entire group and also compare data between the two sub-groups (isolated shortened long bones vs shortened long bones associated to other anomalies). RESULTS A total of 81 pregnancies with a suspected fetal skeletal dysplasia were included, with a complete follow-up available in 75 cases, 22 with isolated shortened long bones and 53 cases that presented shortened long bones with other skeletal anomalies. In the shortened long bones sub-group, a total of five (23 %) were born healthy neonates, 10 (45 %) were small for gestational age or intrauterine growth restricted (one of them of genetic origin) and seven (32 %) had a skeletal dysplasia (6 of them with genetic diagnosis). Whilst among the 53 cases that presented with shortened long bones + other skeletal anomalies, three (6%) were healthy neonates, five (9%) were small for gestational age/intrauterine growth restricted (two of genetic origin) and 45 (85 %) had a skeletal dysplasia (19 genetically confirmed and 26 with a clinical diagnosis). These differences in frequencies between the two sub-groups were determined to be statistically significant (χ2: p = 0.02). CONCLUSION Around one third of fetuses with isolated shortened long bones will have a skeletal dysplasia. If abnormal skeletal ultrasound findings are associated with shortened long bones, the risk for skeletal dysplasia is significantly increased (85 %). Prenatal systematic approach in a multidisciplinary unit is useful in the orientation of genetic studies.
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Affiliation(s)
- Tamara Illescas
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain.
| | - Elena Mansilla
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - Beatriz Herrero
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Roberto Rodríguez
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Francisco López
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Miriam Aza-Carmona
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - Rita María Regojo
- Department of Pathology, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Santos-Simarro
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - Karen E Heath
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - José Luis Bartha
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Eugenia Antolín
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
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García-Patterson A, Balsells M, Bartha JL, Solà I, Corcoy R. Current evidence about better perinatal outcomes associated to one step approach in the diagnosis of gestational diabetes mellitus is not of high quality. J Matern Fetal Neonatal Med 2020; 35:1580-1582. [PMID: 32345088 DOI: 10.1080/14767058.2020.1759532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - José Luis Bartha
- División de Medicina Materno Fetal. Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Madrid, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Center CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Rosa Corcoy
- Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER Bioingeniería, Biomateriales y Nanomedicina (CIBERBBN), Madrid, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Espinosa JA, Cuerva MJ, Nieto L, Garcia-Casarrubios P, Leal MÁ, Bartha JL. Length of uterine cavity after second phase of postpartum period in women requesting long-acting reversible contraception. J OBSTET GYNAECOL 2020; 41:162-163. [PMID: 32027192 DOI: 10.1080/01443615.2019.1702935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- José Angel Espinosa
- Affective Childbirth Department, Hospital San Francisco de Asis, Madrid, Spain
| | - Marcos Javier Cuerva
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Nieto
- Department of Obstetrics and Gynecology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - María Ángeles Leal
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
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Barquiel B, Herranz L, Martínez-Sánchez N, Montes C, Hillman N, Bartha JL. Increased risk of neonatal complications or death among neonates born small for gestational age to mothers with gestational diabetes. Diabetes Res Clin Pract 2020; 159:107971. [PMID: 31805352 DOI: 10.1016/j.diabres.2019.107971] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/09/2019] [Accepted: 11/29/2019] [Indexed: 01/18/2023]
Abstract
AIMS To evaluate if neonatal complications or death were poorer for neonates born small for gestational age (SGA) than for those born with adequate weight or large for gestation age (LGA) to women with gestational diabetes mellitus (GDM). METHODS Retrospective analysis of the clinical outcomes of neonates born to 3413 women with GDM. The prevalence of neonatal hypoglycaemia, hypocalcaemia, hyperbilirubinemia, polycythaemia, and death was compared among three birthweight groups: SGA, adequate, and LGA. A two-sided chi-squared or Fisher's exact test was used for between-group comparisons. A forward multiple logistic regression was performed to determine the odds ratio (OR) associated with SGA. RESULTS Neonatal complications were more frequent in the SGA group (20.1%) than in the adequate (9.9%) or LGA (15.2%) groups. There were four deaths (1.6%) in the SGA group compared to one in the LGA (0.4%) and six in the adequate (0.2%) groups (P = 0.002). SGA was a risk factor for neonatal complications or death (OR. 2.122; 95% confidence interval, 1.552-2.899), independent of maternal age, weight gain, fasting glucose, glycaemic control, gestational hypertension, pre-eclampsia, smoking, or neonatal prematurity. CONCLUSION SGA birthweight is an important risk factor for neonatal complications or death among neonates born to mothers with GDM.
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Affiliation(s)
- Beatriz Barquiel
- Division of Diabetes, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain.
| | - Lucrecia Herranz
- Division of Diabetes, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Nuria Martínez-Sánchez
- Department of Obstetrics, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Cristina Montes
- Division of Diabetes, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Natalia Hillman
- Division of Diabetes, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
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Delgado P, Robles Á, Martínez López JA, Sáez-Comet L, Rodríguez Almaraz E, Martínez-Sánchez N, Ugarte A, Vela-Casasempere P, Marco B, Espinosa G, Galindo M, Casellas M, Ruiz-Irastorza G, Martínez-Taboada V, Bartha JL. Pregnancy control in Patients with Systemic Lupus Erythematosus/Antiphospholipid Syndrome. Part 3: Childbirth. Puerperium. Breastfeeding Contraception. Newborn. ACTA ACUST UNITED AC 2019; 17:183-186. [PMID: 31831386 DOI: 10.1016/j.reuma.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/23/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In order to agree on the fundamental aspects related to the management of pregnancy in patients with systemic lupus erythematosus and antiphospholipid syndrome, the Spanish Societies of Gynaecology and Obstetrics, Internal Medicine and Rheumatology have set up a working group for the preparation of three consensus documents. METHODS Each of the Scientific Societies involved proposed five representatives based on their experience in the field of pregnancy control in patients with autoimmune diseases. The recommendations were developed following the Delphi methodology. RESULTS This third document contains the recommendations regarding the management of delivery, puerperium and lactation, including medication use during these periods and the care of the newborn. In addition, a section on contraception is included. CONCLUSIONS These multidisciplinary recommendations are considered decision-making tools for clinicians involved in the care of patients with systemic lupus erythematosus/antiphospholipid syndrome during pregnancy.
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Affiliation(s)
- Paloma Delgado
- Servicio de Obstetricia y Ginecología, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, España
| | - Ángel Robles
- Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
| | | | - Luis Sáez-Comet
- Unidad de Enfermedades Autoinmunes Sistémicas (UEAS), Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - Amaia Ugarte
- Unidad de Enfermedades Autoinmunes, Servicio de Medicina Interna, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Barakaldo, Bizkaia, España
| | - Paloma Vela-Casasempere
- Sección de Reumatología, Hospital Universitario de Alicante, Instituto de investigaci ón sanitaria y biomédica ISABIAL - FISABIO, Departamento de Medicina Clínica, Universidad Miguel Hernandez, Alicante, España
| | - Beatriz Marco
- Servicio de Ginecología y Obstetricia, HUP La Fe, Valencia, España
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Biological aggresion and response mechanisms, IDIBAPS, Barcelona, Universitat de Barcelona, España
| | - María Galindo
- Servicio de Reumatología, Hospital 12 de Octubre, Madrid, España
| | - Manel Casellas
- Unitat Alt Risc Obstetric, Vall d' Hebron Hospital Campus, Barcelona, España
| | - Guillermo Ruiz-Irastorza
- Unidad de Enfermedades Autoinmunes, Servicio de Medicina Interna, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Barakaldo, Bizkaia, España.
| | - Victor Martínez-Taboada
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Facultad de Medicina, Universidad de Cantabria, Santander, España
| | - José Luis Bartha
- Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Madrid, España
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Sukhwani M, Antolín E, Herrero B, Rodríguez R, de la Calle M, López F, Bartha JL. Management and perinatal outcome of selective intrauterine growth restriction in monochorionic pregnancies. J Matern Fetal Neonatal Med 2019; 34:3838-3843. [PMID: 31766901 DOI: 10.1080/14767058.2019.1698030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Selective intrauterine growth restriction (sIUGR) is a complication observed in about 10-15% of all monochorionic (MC) pregnancies, causing a significant increase in perinatal mortality and morbidity.Objective: To evaluate clinical management options and perinatal outcomes of sIUGR in MC pregnancies monitored in a single tertiary center.Methods: A retrospective study was performed on 55-MC pregnancies with sIUGR between January 2012 and May 2018 at the Fetal Medicine Unit of La Paz Hospital. Cases were classified according to the umbilical artery (UA) Doppler pattern as type I (positive end-diastolic flow; n = 25), type II [persistently absent or reversed end-diastolic flow (AREDF); n = 5] and type III [intermittently absent or reversed end-diastolic flow (iAREDF); n = 25]. Types II and III were then merged together as severe sIUGR cases. Subsequently, two possible approaches were considered: expectant management (EM) with elective preterm delivery in case of fetal deterioration, or in-utero therapy via fetoscopic laser photocoagulation (FLP) of intertwin anastomosis or selective umbilical cord occlusion (CO) of the growth-restricted fetus.Results: Gestational age (GA) at diagnosis was progressively lower with each type. Severe sIUGR cases delivered significantly earlier than type I, showing lower birth weights and higher intertwin biometric discordance. Unintended fetal demise occurred in 14% (6/25) of severe sIUGR pregnancies as opposed to 0% (0/19) in type I, p = .028. A significantly higher proportion of twins was admitted in NICU in severe cases when compared to type I [87% (33/38) versus 47% (18/38), p < .001]. In addition, brain damage at birth was also found to be more prevalent in this group [21% (8/38) versus 11% (4/38), p = .346], especially in the larger twin, when comparing any short-term neurological sequel [30% (7/23) versus 0% (0/19), p = .011] or specifically periventricular leukomalacia [PVL; 22% (5/23) versus 0% (0/19), p = .053]. Although the overall mortality rate was significantly higher in severe sIUGR that underwent CO instead of EM [58% (7/12) versus 11% (4/36), p = .002], NICU admissions were higher in the latter [94% (17/18) versus 40% (2/5), p = .021]. Neurological sequels at birth were similar in both groups [39% (7/18) versus 40% (2/5), p = 1.000], similarly when considering only the larger twin for any brain lesion [28% (5/18) versus 40% (2/5), p = .621] or just PVL [22% (4/18) versus 20% (1/5), p = 1.000].Conclusion: Given the good prognosis of type I sIUGR, expectant management is the first approach to consider. However, due to the poorer clinical evolution of types II and III sIUGR, the decision-making is challenging and needs to be individualized depending on the UA Doppler pattern, GA at diagnosis, severity of growth restriction and biometric discordance, technical issues and parents' preferences.
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Affiliation(s)
- Meghna Sukhwani
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, La Paz Hospital, La Paz Hospital, Medical Faculty of Autónoma University, Madrid, Spain
| | - Eugenia Antolín
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, La Paz Hospital, La Paz Hospital, Medical Faculty of Autónoma University, Madrid, Spain
| | - Beatriz Herrero
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, La Paz Hospital, La Paz Hospital, Medical Faculty of Autónoma University, Madrid, Spain
| | - Roberto Rodríguez
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, La Paz Hospital, La Paz Hospital, Medical Faculty of Autónoma University, Madrid, Spain
| | - María de la Calle
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, La Paz Hospital, La Paz Hospital, Medical Faculty of Autónoma University, Madrid, Spain
| | - Francisco López
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, La Paz Hospital, La Paz Hospital, Medical Faculty of Autónoma University, Madrid, Spain
| | - José Luis Bartha
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, La Paz Hospital, La Paz Hospital, Medical Faculty of Autónoma University, Madrid, Spain
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Romero A, San Hipólito‐Luengo Á, Villalobos LA, Vallejo S, Valencia I, Michalska P, Pajuelo‐Lozano N, Sánchez‐Pérez I, León R, Bartha JL, Sanz MJ, Erusalimsky JD, Sánchez‐Ferrer CF, Romacho T, Peiró C. The angiotensin-(1-7)/Mas receptor axis protects from endothelial cell senescence via klotho and Nrf2 activation. Aging Cell 2019; 18:e12913. [PMID: 30773786 PMCID: PMC6516147 DOI: 10.1111/acel.12913] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 12/03/2018] [Accepted: 01/06/2019] [Indexed: 12/25/2022] Open
Abstract
Endothelial cell senescence is a hallmark of vascular aging that predisposes to vascular disease. We aimed to explore the capacity of the renin–angiotensin system (RAS) heptapeptide angiotensin (Ang)‐(1‐7) to counteract human endothelial cell senescence and to identify intracellular pathways mediating its potential protective action. In human umbilical vein endothelial cell (HUVEC) cultures, Ang II promoted cell senescence, as revealed by the enhancement in senescence‐associated galactosidase (SA‐β‐gal+) positive staining, total and telomeric DNA damage, adhesion molecule expression, and human mononuclear adhesion to HUVEC monolayers. By activating the G protein‐coupled receptor Mas, Ang‐(1‐7) inhibited the pro‐senescence action of Ang II, but also of a non‐RAS stressor such as the cytokine IL‐1β. Moreover, Ang‐(1‐7) enhanced endothelial klotho levels, while klotho silencing resulted in the loss of the anti‐senescence action of the heptapeptide. Indeed, both Ang‐(1‐7) and recombinant klotho activated the cytoprotective Nrf2/heme oxygenase‐1 (HO‐1) pathway. The HO‐1 inhibitor tin protoporphyrin IX prevented the anti‐senescence action evoked by Ang‐(1‐7) or recombinant klotho. Overall, the present study identifies Ang‐(1‐7) as an anti‐senescence peptide displaying its protective action beyond the RAS by consecutively activating klotho and Nrf2/HO‐1. Ang‐(1‐7) mimetic drugs may thus prove useful to prevent endothelial cell senescence and its related vascular complications.
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Affiliation(s)
- Alejandra Romero
- Department of Pharmacology Faculty of Medicine Universidad Autónoma de Madrid Madrid Spain
| | | | - Laura A. Villalobos
- Department of Pharmacology Faculty of Medicine Universidad Autónoma de Madrid Madrid Spain
| | - Susana Vallejo
- Department of Pharmacology Faculty of Medicine Universidad Autónoma de Madrid Madrid Spain
- Instituto de Investigaciones Sanitarias IdiPAZ Madrid Spain
| | - Inés Valencia
- Department of Pharmacology Faculty of Medicine Universidad Autónoma de Madrid Madrid Spain
| | - Patrycja Michalska
- Department of Pharmacology Faculty of Medicine Universidad Autónoma de Madrid Madrid Spain
- Instituto Teófilo Hernando Universidad Autónoma de Madrid Madrid Spain
| | - Natalia Pajuelo‐Lozano
- Department of BiochemistryFaculty of MedicineUniversidad Autónoma de Madrid Madrid Spain
- Instituto de Investigaciones BiomédicasUAM-CSIC Madrid Spain
| | - Isabel Sánchez‐Pérez
- Department of BiochemistryFaculty of MedicineUniversidad Autónoma de Madrid Madrid Spain
- Instituto de Investigaciones BiomédicasUAM-CSIC Madrid Spain
- CIBER for Rare Diseases Valencia Spain
| | - Rafael León
- Instituto Teófilo Hernando Universidad Autónoma de Madrid Madrid Spain
- Servicio de Farmacología ClínicaInstituto de Investigación SanitariaHospital Universitario de la Princesa Madrid Spain
| | - José Luis Bartha
- Instituto de Investigaciones Sanitarias IdiPAZ Madrid Spain
- Department of Obstetrics and GynecologyFaculty of MedicineUniversidad Autónoma de Madrid Madrid Spain
| | - María Jesús Sanz
- Department of PharmacologyUniversidad de Valencia Valencia Spain
- Institute of Health Research INCLIVAUniversity Clinic Hospital of Valencia Valencia Spain
| | | | - Carlos F. Sánchez‐Ferrer
- Department of Pharmacology Faculty of Medicine Universidad Autónoma de Madrid Madrid Spain
- Instituto de Investigaciones Sanitarias IdiPAZ Madrid Spain
| | - Tania Romacho
- Department of Pharmacology Faculty of Medicine Universidad Autónoma de Madrid Madrid Spain
| | - Concepción Peiró
- Department of Pharmacology Faculty of Medicine Universidad Autónoma de Madrid Madrid Spain
- Instituto de Investigaciones Sanitarias IdiPAZ Madrid Spain
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Di Renzo GC, Bartha JL, Bilardo CM. Expanding the indications for cell-free DNA in the maternal circulation: clinical considerations and implications. Am J Obstet Gynecol 2019; 220:537-542. [PMID: 30639383 DOI: 10.1016/j.ajog.2019.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/30/2018] [Accepted: 01/04/2019] [Indexed: 12/26/2022]
Abstract
Noninvasive prenatal testing for fetal aneuploidy using cell-free DNA has been widely integrated into routine obstetrical care. The scope of cell-free DNA testing has expanded from trisomies 21, 18, and 13 to include sex chromosome conditions, panels of specific microdeletions, and more recently genome-wide copy number variants and rare autosomal trisomies. Because the technical ability to test for a condition does not necessarily correspond with a clinical benefit to a population or to individual pregnant women, the benefits and harms of screening programs must be carefully weighed before implementation. Application of the World Health Organization criteria to cell-free DNA screening is informative when considering implementation of expanded cell-free DNA test menus. Most microdeletions and duplications are rare to the point that the prevalence has not even been defined and their natural history cannot be reliably predicted in the prenatal period. At the current time, scientific evidence regarding clinical performance of expanded cell-free DNA panels is lacking. Expanded cell-free DNA menus therefore create a dilemma for diagnosis, treatment, and counseling of patients. The clinical utility of expanding cell-free DNA testing to include panels of microdeletions and genome-wide assessment of large chromosomal imbalances has yet to be demonstrated; as such, the clinical implementation of this testing is premature.
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Rostom A, De la Calle M, Bartha JL, Ruiz CJ. Heart failure in a post-partum patient with patent ductus arteriosus. J OBSTET GYNAECOL 2019; 39:707-708. [PMID: 30983448 DOI: 10.1080/01443615.2019.1568972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A Rostom
- a Department of Obstetrics and Gynaecology , Maternal-Fetal Medicine Unit, University La Paz Hospital , Madrid , Spain
| | - M De la Calle
- a Department of Obstetrics and Gynaecology , Maternal-Fetal Medicine Unit, University La Paz Hospital , Madrid , Spain
| | - J L Bartha
- a Department of Obstetrics and Gynaecology , Maternal-Fetal Medicine Unit, University La Paz Hospital , Madrid , Spain
| | - Contador J Ruiz
- b Department of Cardiology , University La Paz Hospital , Madrid , Spain
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Jiménez Navarro M, Galian-Gay L, Avanzas P, Ballesteros S, González García A, González Mesa E, Martínez Bendayán I, Pijuan Domenech A, Prieto R, Subirana MT, Bartha JL, Caro J, Delgado JL, Manso B, Rosillo S, Ignacio Zabala J, Alfonso F, Ibáñez B, Arribas F, Berga Congost G, Bueno H, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de la Isla L, Sambola A, Vázquez R, Viana-Tejedor A. Comentarios a la guía ESC 2018 sobre el tratamiento de las enfermedades cardiovasculares durante el embarazo. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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López Sánchez F, Delgado Sánchez E, Duyos Mateo I, González Álvarez MDLC, Antolín Alvarado E, Bartha JL. Evaluation of Fetal Lung Maturity by Quantitative Analysis (quantusFLM) in Women with Gestational Diabetes Mellitus. Fetal Diagn Ther 2018; 45:345-352. [PMID: 30179865 DOI: 10.1159/000488939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/30/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate fetal lung maturity using the noninvasive method of quantitative ultrasound analysis of fetal lung texture (quantusFLM) in women with gestational diabetes mellitus (GDM). METHODS A total of 96 women at 36-38 weeks of gestation were enrolled. They were classified as follows: 33 GDM cases treated with diet, 30 GDM cases treated with diet plus insulin, and 33 normoglycemic women (control group). A quantitative analysis of lung texture was performed. RESULTS There were significant differences in the lung maturity results among groups (p = 0.004). These differences were established between the insulin-treated group of patients and both the control (p = 0.006) and diet-only (p = 0.003) groups. While none of the women in the control group or in the diet group had a high risk of immaturity, 16.7% of those treated with insulin (5/30) did (p = 0.003). There was no statistically significant correlation between HbA1c and the result of the test. CONCLUSIONS Quantitative ultrasound study of fetal lung texture suggests that a significant percentage of pregnant women with GDM treated with insulin had fetal lung immaturity in the late preterm to early term.
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Barquiel B, Herranz L, Meneses D, Moreno Ó, Hillman N, Burgos MÁ, Bartha JL. Optimal Gestational Weight Gain for Women with Gestational Diabetes and Morbid Obesity. Matern Child Health J 2018; 22:1297-1305. [PMID: 29497985 DOI: 10.1007/s10995-018-2510-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Our aim was to investigate the greatest gestational weight gain (GWG) without adverse pregnancy complications in women with gestational diabetes mellitus (GDM) and morbid obesity. METHODS An observational retrospective study including 3284 patients with single pregnancies and GDM was completed. Of the patients, 131 (4.0%) were classified as having pre-pregnancy morbid obesity (BMI ≥ 35 kg/m2). Perinatal complications were compared among BMI groups. In the group with morbid obesity, GWG threshold values to predict outcomes were examined based on sensitivity and specificity values under the receiver operating characteristic curve. RESULTS GWG was higher in mothers with morbid obesity and macrosomic neonates: 11.3 (4.4-15.7) versus 4.8 (1.5-8.2) kg (p = 0.033). The GWG and neonatal ponderal index were positively correlated (r = 0.305, p = 0.001). The GWG was 7.0 (2.9-11.6) kg in women with hypertensive disorder versus 4.5 (1.0-7.5) kg in normotensive women (p = 0.017). A GWG above 5 kg was a risk factor for macrosomia (87.8% sensitivity, 54.7% specificity) and hypertensive disorder (70.0% sensitivity, 48.4% specificity). GWG associations were maintained after controlling for glycemic control, maternal and gestational age, parity, smoking and neonatal sex. CONCLUSIONS FOR PRACTICE A GWG below 5 kg is recommended for women with GDM and morbid obesity. In these women, adequate GWG may prevent macrosomia, fetal overgrowth and hypertensive disorder.
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Affiliation(s)
- Beatriz Barquiel
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain.
| | - Lucrecia Herranz
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Diego Meneses
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Óscar Moreno
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Natalia Hillman
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Mª Ángeles Burgos
- Diabetes and Pregnancy Unit, Department of Obstetrics, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Diabetes and Pregnancy Unit, Department of Obstetrics, La Paz University Hospital, Madrid, Spain
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Rostom A, de la Calle M, Bartha JL, Castro A, Lecumberri B. Primary hyperparathyroidism diagnosed and treated surgically during pregnancy. ACTA ACUST UNITED AC 2018; 65:239-241. [PMID: 29429952 DOI: 10.1016/j.endinu.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/16/2017] [Accepted: 12/25/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Asma Rostom
- Servicio de Obstetricia, Hospital Universitario La Paz, Madrid, España.
| | - María de la Calle
- Servicio de Obstetricia, Hospital Universitario La Paz, Madrid, España
| | - José Luis Bartha
- Servicio de Obstetricia, Hospital Universitario La Paz, Madrid, España
| | - Alejandro Castro
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España
| | - Beatriz Lecumberri
- Servicio de Endocrinología y Nutrición, Hospital Universitario La Paz, Madrid, España
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Palacio M, Bonet-Carne E, Cobo T, Perez-Moreno A, Sabrià J, Richter J, Kacerovsky M, Jacobsson B, García-Posada RA, Bugatto F, Santisteve R, Vives À, Parra-Cordero M, Hernandez-Andrade E, Bartha JL, Carretero-Lucena P, Tan KL, Cruz-Martínez R, Burke M, Vavilala S, Iruretagoyena I, Delgado JL, Schenone M, Vilanova J, Botet F, Yeo GS, Hyett J, Deprest J, Romero R, Gratacos E, Palacio M, Cobo T, López M, Castro D, Piraquive JP, Ramírez JC, Migliorelli F, Martínez-Terrón M, Botet F, Gratacós E, Sabrià J, Martínez SF, Gómez Roig D, Bonet-Carné E, Pérez À, Domínguez M, Coronado D, Deprest J, Richter J, DeKoninck P, Kacerovsky M, Musilova I, Bestvina T, Maly J, Kokstein Z, Jacobsson B, Cedergren L, Johansson P, Tsiartas P, Sävman K, Hallingström M, García Posadas R, González FB, Fajardo MA, Quintero Prado R, Melero Jiménez V, Benavente Fernández I, Prat RS, de la Barrera Correa B, Valencia EG, Martínez Rodríguez R, Roma Mas E, Vives Argilagós À, Rodríguez Veret A, García Cancela E, Salinas PA, Parra-Cordero M, Sepúlveda-Martínez Á, Hernández-Andrade E, Romero R, Ahn H, Bartha JL, Antolín E, Carretero Lucena P, Molina García F, Jiménez Garrido N, Tallón CC, Antón BM, Yeo G, Tan KL, Cruz-Martínez R, Martínez-Rodríguez M, Hyatt J, Burke M, Mogra R, Vavilala S, Iruretagoyena JI, Delgado JL, Schenone M, Vilanova J, Bons N. Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study. Am J Obstet Gynecol 2017; 217:196.e1-196.e14. [PMID: 28342715 DOI: 10.1016/j.ajog.2017.03.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/23/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure restricts the use of fetal lung maturity assessment. OBJECTIVE The objective of the study was to evaluate the performance of quantitative ultrasound texture analysis of the fetal lung (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries. STUDY DESIGN This was a prospective multicenter study conducted in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks of gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated. RESULTS A total of 883 images were collected, but 17.3% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101 of 730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, positive and negative predictive values of 74.3% (75 of 101), 88.6% (557 of 629), 51.0% (75 of 147), and 95.5% (557 of 583), respectively. Accuracy was 86.5% (632 of 730) and positive and negative likelihood ratios were 6.5 and 0.3, respectively. CONCLUSION The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a noninvasive technique.
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De la Calle M, Baquero F, Rodriguez R, González M, Fernández A, Omeñaca F, Bartha JL. Successful treatment of intrauterine cytomegalovirus infection with an intraventricular cyst in a dichorionic diamniotic twin gestation using cytomegalovirus immunoglobulin. J Matern Fetal Neonatal Med 2017; 31:2226-2229. [PMID: 28573940 DOI: 10.1080/14767058.2017.1338259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Congenital cytomegalovirus (CMV) infection is the leading cause of severe congenital abnormalities. CMV immunoglobulin (CMVIG) may lower risk for symptomatic disease in congenital CMV infection. In a twin pregnancy, only one fetus shows CMV infection, raising a dilemma about intervention since the uninfected fetus would be exposed to treatment unnecessarily. CMVIG (2 × 200 U/kg) was given due to high viral load and development of an intraventricular cyst. The cyst growth plateaued, no other brain damage developed, and at 8 months, the infant was symptom-free. CMVIG appears appropriate to treat intrauterine CMV infection in this setting.
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Affiliation(s)
- M De la Calle
- a Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit , La Paz University Hospital , Madrid , Spain
| | - F Baquero
- b Department of Pediatric Infectology , La Paz University Hospital , Madrid , Spain
| | - R Rodriguez
- a Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit , La Paz University Hospital , Madrid , Spain
| | - M González
- a Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit , La Paz University Hospital , Madrid , Spain
| | - A Fernández
- c Department of Radiology , La Paz University Hospital , Madrid , Spain
| | - F Omeñaca
- d Department of Neonatology , La Paz University Hospital , Madrid , Spain
| | - J L Bartha
- a Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit , La Paz University Hospital , Madrid , Spain
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Sánchez-Galán A, Encinas JL, Antolín E, Vilanova A, Dore M, Triana P, Bartha JL, López-Santamaría M. [Intestinal complications in twin-to-twin transfusion syndrome (TTTS) treated by laser coagulation (LC)]. Cir Pediatr 2017; 30:33-38. [PMID: 28585788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM OF THE STUDY The hemodynamic imbalance due to placental vascular anastomoses in TTTS but also vascular changes generated after intrauterine treatment may lead to hypoxic-ischemic complications. Different intestinal complications in TTTS are reviewed in this paper. METHODS Retrospective review of TTTS cases treated by laser coagulation (LC) from 2012-2015. Demographic data, fetal therapy, prenatal diagnosis (US, MRI) and perinatal outcome were recorded. We describe cases with intestinal complications and their postnatal management. Results are expressed by median and range. RESULTS 29 monochorionic pregnancies with TTTS were treated (23 LC, 4 cord occlusions and 2 cord occlusions after LC). The diagnosis was made at 19 (16-26) weeks and 86% presented stage of Quintero ≥ II. In 70% of mothers survived at least one fetus with a median of 31 (24-37) weeks at birth. Four patients had intestinal complications (1 jejunal atresia, 2 ileal atresia, 1 perforated necrotizing enterocolitis), half of them had prenatal diagnosis. Postnatal resections of the affected segments and ostomies were performed. Intestinal transit was restored and there were no severe digestive sequelae after 21 (8-38) months of follow up. CONCLUSIONS Different types of intestinal complications were associated with TTTS and LC. US and MRI enable prenatal diagnosis of these complications and this allows prompt decisions after birth.
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Affiliation(s)
- A Sánchez-Galán
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - J L Encinas
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - E Antolín
- Servicio de Obstetricia y Ginecología. Hospital Universitario La Paz. Madrid
| | - A Vilanova
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - M Dore
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - P Triana
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - J L Bartha
- Servicio de Obstetricia y Ginecología. Hospital Universitario La Paz. Madrid
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Bedoya C, Bartha JL, Rodriguez I, Fontan I, Bedoya JM, Sanchez-Ramos J. A trial of labor after cesarean section in patients with or without a prior vaginal delivery. Int J Gynaecol Obstet 2017; 39:285-9. [PMID: 1361461 DOI: 10.1016/0020-7292(92)90259-l] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the outcome of labor in women with a previous cesarean section, with or without prior vaginal delivery. METHOD Records were reviewed for 1065 women with a previous cesarean section at 'Virgen Macarena' Hospital who were attended for a subsequent labor. RESULTS Chi-squared tests demonstrated that women with previous vaginal delivery (n = 346) had a significantly higher rate of vaginal delivery after a trial of labor (95.24%) than those without previous vaginal delivery (n = 719) (82.95%). All the ruptures of uterine scar (n = 4) were found in women without previous vaginal delivery. CONCLUSION It appears that a cesarean section in a multiparous woman is not a determinant fact in her reproductive history and the risk of rupture of uterine scar did not appear to be present.
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Affiliation(s)
- C Bedoya
- Department of Obstetrics and Gynecology, Clinical Hospital Virgen Macarena, University of Seville, Spain
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De la Calle M, Vidaurrázaga C, Martinez N, González-Beato M, Antolín E, Bartha JL. Successful treatment of a severe early onset case of pemphigoid gestationis with intravenous immunoglobulin in a twin pregnancy conceived with in vitro fertilisation in a primigravida. J OBSTET GYNAECOL 2016; 37:246-247. [PMID: 27922278 DOI: 10.1080/01443615.2016.1244809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M De la Calle
- a Department of Obstetrics and Gynaecology. Maternal-Fetal Medicine Unit , Universitary La Paz Hospital , Madrid , Spain
| | - C Vidaurrázaga
- b Department of Dermatology , Universitary La Paz Hospital , Madrid , Spain
| | - N Martinez
- a Department of Obstetrics and Gynaecology. Maternal-Fetal Medicine Unit , Universitary La Paz Hospital , Madrid , Spain
| | - M González-Beato
- c Department of Pathology , Universitary La Paz Hospital , Madrid , Spain
| | - E Antolín
- a Department of Obstetrics and Gynaecology. Maternal-Fetal Medicine Unit , Universitary La Paz Hospital , Madrid , Spain
| | - J L Bartha
- a Department of Obstetrics and Gynaecology. Maternal-Fetal Medicine Unit , Universitary La Paz Hospital , Madrid , Spain
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Barquiel B, Herranz L, Hillman N, Burgos MÁ, Grande C, Tukia KM, Bartha JL, Pallardo LF. HbA1c and Gestational Weight Gain Are Factors that Influence Neonatal Outcome in Mothers with Gestational Diabetes. J Womens Health (Larchmt) 2016; 25:579-85. [DOI: 10.1089/jwh.2015.5432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Beatriz Barquiel
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| | - Lucrecia Herranz
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| | - Natalia Hillman
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| | - M Ángeles Burgos
- Diabetes and Pregnancy Unit, Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Cristina Grande
- Diabetes and Pregnancy Unit, Department of Biochemistry, Hospital Universitario La Paz, Madrid, Spain
| | - Keleni M. Tukia
- Division of Hematology/Oncology, Department of Medicine, University of Miami School of Medicine, Miami, Florida
| | - José Luis Bartha
- Diabetes and Pregnancy Unit, Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Luis Felipe Pallardo
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
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Oepkes D, Bartha JL, Schmid M, Yaron Y. Benefits of contingent screening vs primary screening by cell-free DNA testing: think again. Ultrasound Obstet Gynecol 2016; 47:542-545. [PMID: 26415101 DOI: 10.1002/uog.15758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Affiliation(s)
- D Oepkes
- Leiden University Medical Centre, Department of Obstetrics, Leiden, The Netherlands
| | - J L Bartha
- University Hospital La Paz, Madrid, Spain
| | - M Schmid
- Medical University of Vienna, Vienna, Austria
| | - Y Yaron
- Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Palacio M, Cobo T, Antolín E, Ramirez M, Cabrera F, Mozo de Rosales F, Bartha JL, Juan M, Martí A, Oros D, Rodríguez À, Scazzocchio E, Olivares JM, Varea S, Ríos J, Gratacós E. Vaginal progesterone as maintenance treatment after an episode of preterm labour (PROMISE) study: a multicentre, double-blind, randomised, placebo-controlled trial. BJOG 2016; 123:1990-1999. [DOI: 10.1111/1471-0528.13956] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M Palacio
- BCNatal; Hospital Clínic of Barcelona and Hospital Sant Joan de Déu; Fetal i+D Fetal Medicine Research Centre; IDIBAPS; University of Barcelona; Barcelona Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER); Barcelona Spain
| | - T Cobo
- BCNatal; Hospital Clínic of Barcelona and Hospital Sant Joan de Déu; Fetal i+D Fetal Medicine Research Centre; IDIBAPS; University of Barcelona; Barcelona Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER); Barcelona Spain
| | - E Antolín
- Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - M Ramirez
- Hospital Universitario Virgen Macarena; Sevilla Spain
| | - F Cabrera
- Complejo Hospitalario Universitario lnsular Materno Infantil; Las Palmas de Gran Canaria Spain
| | | | - JL Bartha
- Hospital Puerta del Mar; Cádiz Spain
| | - M Juan
- Hospital de Son Llàtzer; Mallorca Spain
| | - A Martí
- Althaia Xarxa Assistencial Universitària de Manresa; Hospital de Sant Joan de Déu; Manresa Spain
| | - D Oros
- Hospital Clínico Universitario Lozano Blesa; Instituto de Investigación Sanitaria de Aragón; Red SAMID, RETICS; Zaragoza Spain
| | - À Rodríguez
- Hospital de Sabadell, Corporació Sanitària Parc Taulí; Sabadell Spain
- Institut Universitari Parc Taulí - UAB. Universitat Autónoma de Barcelona; Barcelona Spain
| | - E Scazzocchio
- Hospital Universitario Quirón-Dexeus; Barcelona Spain
| | - JM Olivares
- Consorci Sanitari de Terrassa; Terrassa Spain
| | - S Varea
- Hospital Clínic of Barcelona; Clinical Trials Unit/Clinical Pharmacology Department; Hospital Clinic Barcelona; Barcelona Spain
| | - J Ríos
- Biostatistics and Data Management Core Facility; IDIBAPS; Hospital Clinic Barcelona; Barcelona Spain
- Biostatistics Unit; School of Medicine; Universitat Autònoma de Barcelona; Barcelona Spain
| | - E Gratacós
- BCNatal; Hospital Clínic of Barcelona and Hospital Sant Joan de Déu; Fetal i+D Fetal Medicine Research Centre; IDIBAPS; University of Barcelona; Barcelona Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER); Barcelona Spain
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De la Calle M, Rodriguez R, Deirós L, Bartha JL. Fetal cardiac biometry and function in HIV-infected pregnant women exposed to HAART therapy. Prenat Diagn 2016; 35:453-5. [PMID: 25512023 DOI: 10.1002/pd.4549] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/30/2014] [Accepted: 12/10/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Previous studies have suggested that antiretroviral therapy in human immunodeficiency virus (HIV)-infected pregnant women can cause alterations in cardiac structure and function in fetuses or children, although the results are not very clear. The aim of this study is to assess whether or not these alterations are present in the heart of fetuses of HIV-infected pregnant women, undergoing treatment with highly active antiretroviral therapy (HAART). STUDY DESIGN We performed a prospective study on 29 consecutive HIV-positive pregnant women treated with HAART and 70 consecutive HIV-negative pregnant women as controls. Fetal cardiac biometry and function was evaluated by echocardiography at 30-32 weeks of gestation. Fetal biometry, estimated fetal weight and umbilical artery Doppler were also measured. RESULTS We found E/A tricuspid ratio values slightly increased (0.84 vs 0.80, p = 0.03) and diastolic length shortened (49.7 vs 51.7%, p = 0.03) in the HIV-infected group. The rest of the biometric and functional cardiac parameters were not different between both groups. There were no cases of vertical transmission of HIV infection. CONCLUSION In HIV-infected pregnant women treated with HAART, no significant changes are showed in fetal cardiac parameters.
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Affiliation(s)
- M De la Calle
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University Hospital La Paz, Madrid, Spain
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González-González NL, González-Dávila E, Cabrera F, Vega B, Padron E, Bartha JL, Armas-Gonzalez M, García-Hernández JA. Application of Customized Birth Weight Curves in the Assessment of Perinatal Outcomes in Infants of Diabetic Mothers. Fetal Diagn Ther 2014; 37:117-22. [DOI: 10.1159/000365444] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/11/2014] [Indexed: 11/19/2022]
Abstract
Objective: To determine whether the use of customized curves (CC) allows better detection of large- (LGA) or small-for-gestational age (SGA) infants at risk of adverse perinatal morbidity than non-CC in women with diabetes mellitus (DM). Material and Methods: A model of CC was applied to all infants of diabetic mothers (IDM) who attended the Hospital Universitario Materno Infantil de Canarias between 2008 and 2011. We compared perinatal outcomes of IDM classified as LGA or SGA by non-CC versus CC. Results: One of 4 LGA was appropriate for gestational age (AGA) by CC (false-positive rate: 25%) and 30% of SGA by CC were not identified by non-CC (false-negative rate). False-positive LGA and SGA showed similar perinatal outcomes to AGA infants. The rates of cesarean section, cephalopelvic disproportion, total fetal distress and shoulder dystocia were significantly higher in false-negative LGA than in AGA by CC (p < 0.004, p < 0.02, p < 0.04 and p < 0.04, respectively). Fetal distress was higher in false-negative SGA than in AGA by CC (p < 0.03). Discussion: In pregnancies complicated by DM, the use of CC allowed more accurate identification of LGA and SGA infants at high risk of perinatal morbidity than non-CC.
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