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Gurovich M, Aros S, Sepúlveda J, Rey R, Wainstein A, Sacomori C. Calidad de vida, complicaciones asociadas y satisfacción con el uso de pesarios para tratamiento conservador del prolapso de órganos pélvicos. Clínica e Investigación en Ginecología y Obstetricia 2021. [DOI: 10.1016/j.gine.2020.04.002] [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: 10/24/2022]
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Kuehn D, Aros S, Cassorla F, Avaria M, Unanue N, Henriquez C, Kleinsteuber K, Conca B, Avila A, Carter TC, Conley MR, Troendle J, Mills JL. A prospective cohort study of the prevalence of growth, facial, and central nervous system abnormalities in children with heavy prenatal alcohol exposure. Alcohol Clin Exp Res 2012; 36:1811-9. [PMID: 22823161 DOI: 10.1111/j.1530-0277.2012.01794.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 01/19/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most children who are exposed to large quantities of alcohol in utero do not develop fetal alcohol syndrome (FAS). Population-based prospective data on the risk of developing components of fetal alcohol spectrum disorders (FASD), however, are limited. METHODS This was a prospective cohort study of 9,628 women screened during their first prenatal appointment in Chile, which identified 101 who consumed at least 4 drinks/d (exposed) matched with 101 women with no reported alcohol consumption during pregnancy (unexposed). Detailed alcohol consumption data were collected during the pregnancy. Children were evaluated up to 8.5 years of age by clinicians masked to exposure status. RESULTS One or more functional central nervous system abnormalities were present in 44.0% (22/50) of the exposed children compared to 13.6% (6/44) of the unexposed (p = 0.002). Growth restriction was present in 27.2% (25/92) of the exposed and 12.5% (12/96) of the unexposed (p = 0.02). Abnormal facial features were present in 17.3% (14/81) of the exposed children compared to 1.1% (1/89) of the unexposed children (p = 0.0002) by direct examination. Of the 59 exposed children with data available to detect at least 1 abnormality, 12 (20.3%) had no abnormalities. Binge drinking from conception to recognition of pregnancy (OR = 1.48 per day, 95% CI: 1.15 to 1.91, p = 0.002) and after recognition of pregnancy (OR= 1.41 per day, 95% CI: 1.01 to 1.95, p = 0.04) and total number of drinks consumed per week from conception to recognition of pregnancy (OR = 1.02 per drink, 95% CI: 1.01 to 1.04, p = 0.0009) were significantly associated with abnormal child outcome. CONCLUSIONS After exposure to heavy alcohol consumption during pregnancy, 80% of children had 1 or more abnormalities associated with alcohol exposure. Patterns of alcohol use that posed the greatest risk of adverse outcomes were binge drinking and high total weekly intake. Functional neurologic impairment occurred most frequently and may be the only sign to alert physicians to prenatal alcohol exposure.
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Affiliation(s)
- Devon Kuehn
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Cornman-Homonoff J, Kuehn D, Aros S, Carter TC, Conley MR, Troendle J, Cassorla F, Mills JL. Heavy prenatal alcohol exposure and risk of stillbirth and preterm delivery. J Matern Fetal Neonatal Med 2011; 25:860-3. [PMID: 21728738 DOI: 10.3109/14767058.2011.587559] [Citation(s) in RCA: 19] [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] [Indexed: 12/21/2022]
Abstract
We prospectively identified 96 women consuming at least 4 drinks/day during pregnancy by screening 9628 pregnant women. In these women with heavy prenatal alcohol use, there were three stillbirths and one preterm delivery; 98 matched nondrinking women had no stillbirths and two preterm births. Preterm rates did not differ significantly. The stillbirth rate was higher in the exposed group (p = 0.06). Additional investigation showed the stillbirth rate in the exposed population (3.1%) was significantly higher (p = 0.019) than the reported Chilean population rate (0.45%). Our data suggest that heavy alcohol consumption may increase the risk for stillbirth but not preterm delivery.
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Affiliation(s)
- Joshua Cornman-Homonoff
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
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Aros S, Mills JL, Iñiguez G, Avila A, Conley MR, Troendle J, Cox C, Cassorla F. Effects of prenatal ethanol exposure on postnatal growth and the insulin-like growth factor axis. Horm Res Paediatr 2011; 75:166-73. [PMID: 20847545 PMCID: PMC3068754 DOI: 10.1159/000319706] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [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] [Received: 12/23/2009] [Accepted: 07/23/2010] [Indexed: 11/19/2022] Open
Abstract
AIMS To study the effect of in-utero alcohol exposure on the insulin-like growth factor axis (IGF) and leptin during infancy and childhood, considering that exposed children may exhibit pre- and postnatal growth retardation. METHODS We prospectively identified heavily drinking pregnant women who consumed on average 4 or more drinks of ethanol per day (≥ 48 g/day) and assessed growth in 69 of their offspring and an unexposed control group of 83 children, measuring serum IGF-I (radioimmunoassay), IGF-II (immunoradiometric assay, IRMA), insulin-like growth factor-binding protein 3 (IGFBP-3) (IRMA) and leptin (IRMA) at 1 month and 1, 2, 3, 4, and 5 years of age. RESULTS IGF-II levels increased with age in both groups, but the rate of increase was significantly higher in exposed children, and levels were significantly higher in ethanol-exposed children at 3, 4, and 5 years of age. In exposed children, IGF-I levels were higher at 3 and 4 years and leptin levels were significantly lower at 1 and 2 years. Exposed subjects showed a much lower correlation between IGF-I and growth parameters than unexposed subjects. CONCLUSION Exposure to ethanol during pregnancy increases IGF-I and IGF-II and decreases leptin during early childhood. The increase in serum IGF-II concentrations in ethanol-exposed children suggests that this hormone should be explored as a potential marker for prenatal alcohol exposure.
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Affiliation(s)
- Sofía Aros
- Department of Pediatrics, Faculty of Medicine, University of Chile, San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - James L. Mills
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Md., USA,*James L. Mills, MD, MS, 6100 Bldg. Room 7 B03. NICHD, NIH, DHHS, Bethesda, MD 20892 (USA), Tel. +1 301 496 5394, Fax +1 301 402 2084, E-Mail
| | - Germán Iñiguez
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Alejandra Avila
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Mary R. Conley
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Md., USA
| | - James Troendle
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Md., USA
| | - Christopher Cox
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Md., USA
| | - Fernando Cassorla
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
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Signore C, Aros S, Morrow JD, Troendle J, Conley MR, Flanigan EY, Cassorla F, Mills JL. Markers of oxidative stress and systemic vasoconstriction in pregnant women drinking > or =48 g of alcohol per day. Alcohol Clin Exp Res 2008; 32:1893-8. [PMID: 18715278 DOI: 10.1111/j.1530-0277.2008.00773.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The precise pathway by which alcohol causes the characteristic features of fetal alcohol spectrum disorders is unknown. Proposed mechanisms for fetal injury from maternal alcohol use include cellular damage from oxidative stress and impaired fetal oxygenation related to maternal systemic vasoconstriction. Our objective was to compare the levels of urinary markers of oxidative stress and systemic vasoconstriction between women consuming large amounts of alcohol during pregnancy and women who did not drink alcohol during pregnancy. METHODS Pregnant women consuming > or =48 g alcohol per day (n = 29) on average and pregnant women who abstained from alcohol use (n = 39) were identified using detailed interviews and home visits. Random maternal urine specimens were collected. Urinary levels of the oxidative stress marker, 8-isoprostane F2alpha, and of the vasoactive prostaglandin metabolites, 2,3-dinor-6-keto-prostaglandin F1alpha (a vasodilator) and 11-dehydro-thromboxane B2 (a vasoconstrictor), were measured using mass spectrometric methods. All analyte levels were corrected for urinary creatinine. RESULTS In crude analyses, there was no significant difference in 8-isoprostane F2alpha between pregnant drinkers and nondrinkers (2.16 vs. 2.08 ng/mg creatinine, respectively, p = 0.87). There were no significant differences between the drinking and nondrinking groups in levels of 2,3-dinor-6-keto-prostaglandin F1alpha (1.03 vs. 1.17 ng/mg creatinine, respectively, p = 0.50), 11-dehydro-thromboxane B2 (0.72 vs. 0.59 ng/mg creatinine, respectively, p = 0.21), or the ratio of vasodilatory metabolite to vasoconstrictive metabolite (1.73 vs. 2.72, respectively, p = 0.14). Adjusting for maternal age, marital status, smoking, and gestational age at sampling did not substantially alter the results. CONCLUSION Our results show no difference in levels of urinary eicosanoid markers of oxidative stress and systemic vasoconstriction between pregnant women who drink heavily and pregnant women who abstain. These findings speak against a role for maternal oxidative stress or systemic vasoconstriction in the pathogenesis of alcohol damage to the fetus.
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Affiliation(s)
- Caroline Signore
- Epidemiology Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA
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Aros S, Cassorla F. [Possible perinatal determinants of morbidity in adult age]. Rev Med Chil 2001; 129:307-15. [PMID: 11372300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Recently, several groups have studied the influence of possible noxious elements present in the intrauterine environment which may favor the development of several diseases in the adult. There is evidence of an increased prevalence of some disorders in special risk groups of fetuses. In the small for gestational age patient, a form of "programming" may occur which produce metabolic changes in the fetus in response to malnutrition. There are several other associations described, but in most of them the precise pathogenic mechanisms involved have not been elucidated. In this article we present evidence of several disorders which develop in the adult and their relationship with conditions during fetal life. Finally, we offer some recommendations to diminish these risks.
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Affiliation(s)
- S Aros
- Departamento de Pediatría Campus Centro e Instituto de Investigaciones Materno Infantil (IDIMI), Facultad de Medicina, Universidad de Chile, Santiago de Chile
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Barrera F, Rebollo MJ, Aros S, Moraga F, Vera P, Escobar S, Rebolledo MJ. [Total gastrectomy in newborn infant]. Rev Chil Pediatr 1991; 62:256-9. [PMID: 1844527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Total gastrectomy is rarely indicated in childhood and when necessary it involves multiple ulterior therapeutic problems, mainly nutritional, which need a meticulous physiological approach to avoid further complications, as illustrated by the following patient who, at age 15 months, was submitted to total gastric resection, Y en Roux esophagojejunal anastomosis and splenectomy, because of peritonitis secondary to dehiscence of a recent esophagogastric anastomosis for partial gastric resection due to gastric volvulus and necrosis, which in turn were associated to diaphragmatic relaxation. The patient was admitted to our hospital one month later with signs of acute calorie-protein malnutrition (W/A 60% and W/H 68%, NCHS standards) requiring combined parenteral and enteral nutritional support (via central venous catheter and jejunostomy tube for 15 and 35 days respectively) together with intramuscular vitamin B 12, oral iron and oral vitamin supplements before it became possible to fed him only by mouth. Prophylaxis against Streptococcus pneumonia infections with monthly benzatin penicillin was also instituted. Mean daily weight increases of 16 g, W/A 68% and W/H 74% were thus achieved before hospital discharge, without evidence of dumping syndrome nor alkaline reflux.
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Affiliation(s)
- F Barrera
- Servicio de Pediatría, Hospital Clínico San Borja, Afriarán
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Pumarino H, Contreras P, Michelsen H, Youlton R, Campino C, Aros S, Basaure J. [Idiopathic hypoparathyroidism, a syndrome with various clinical expressions: analysis of 10 cases]. Rev Med Chil 1989; 117:647-52. [PMID: 2519414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report 10 patients with primary hypoparathyroidism. Age at onset varied from 7 months to 52 years (mean 28); 7 were female. Diagnosis was established at a mean of 4.1 years after the appearance of clinical manifestations. Unexplained hypocalcemia (mean 5.3 mg/dl) and hyperphosphatemia (mean 6.4 mg/dl) were present in all patients. Prevalent symptoms included tetany (9 patients), seizures (5) and hypocalcemic cataracts (4). Clinical manifestations may be grouped into 5 types 1) tetany; 2) seizures; 3) other neurologic disorders (basal ganglia calcification, pseudotumor of the brain, ataxia, nystagmus, hypertonus, paresis); 4) disorders of the lens including fully developed cataracts and 5) skin alterations like psoriasis and others. Some of these run on acute course (seizures, tetany), others a subacute one (skin alterations) while others are rather chronic (cataract and other neurologic disorders). Seizures and electroencephalographic disorders predominate in younger patients while tetany is more prevalent in older subjects.
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