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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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De la Calle M, Bartha JL, García L, Cuerva MJ, Ramiro-Cortijo D. Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes. Int J Environ Res Public Health 2021; 18:ijerph182413117. [PMID: 34948726 PMCID: PMC8701912 DOI: 10.3390/ijerph182413117] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022]
Abstract
Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.
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Affiliation(s)
- María De la Calle
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (J.L.B.); (M.J.C.)
| | - Jose L. Bartha
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (J.L.B.); (M.J.C.)
| | - Laura García
- Department of Pediatrics, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Marcos J. Cuerva
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (J.L.B.); (M.J.C.)
| | - David Ramiro-Cortijo
- Department of Physiology, Faculty of Medicine, Universidad Autonoma de Madrid, 28029 Madrid, Spain
- Correspondence:
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Pena Burgos EM, Regojo Zapata RM, Turiel Miranda M, Antolín Alvarado E, De la Calle M. Spontaneous twin anemia-polycythemia sequence from two donors to one recipient in a monochorionic triamniotic pregnancy: Case report and review of the literature. J Obstet Gynaecol Res 2021; 47:4450-4455. [PMID: 34647391 DOI: 10.1111/jog.15042] [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: 01/01/2021] [Revised: 08/30/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022]
Abstract
Monochorionic triamniotic (MCTA) pregnancies present a high number of complications, mainly due to the presence of unbalanced vascular anastomoses, such as twin anemia-polycythemia sequence (TAPS). Previous reported cases related to TAPS are in twin pregnancies or only affect the monochorionic component of dichorionic triamniotic (DCTA) pregnancies. We report an exceptional case, the only one reported as far as we know, of a MCTA pregnancy that developed a TAPS in which the three triplets are implicated, from two donors to one recipient. The pregnancy had been previously sonographically diagnosed as DCTA pregnancy and this could not explain the clinical results. The pathological study of the placenta showed the presence of three monochorionic dividing membranes, a congested area in the recipient parenchyma and two non-congested areas in the donor's parenchyma that confirmed the clinical findings. Pathological study of multiple placentas should always be done because it provides understanding of pregnancy complications.
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Affiliation(s)
| | | | | | | | - María De la Calle
- Department of Gynaecology-Obstetrics, La Paz University Hospital, Madrid, Spain
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Soriano-Arandes A, Frick MA, García López-Hortelano M, Sulleiro E, Rodó C, Sánchez-Seco MP, Cabrera-Lafuente M, Suy A, De la Calle M, Santos M, Antolin E, Viñuela MDC, Espiau M, Salazar A, Guarch-Ibáñez B, Vázquez A, Navarro-Morón J, Ramos-Amador JT, Martin-Nalda A, Dueñas E, Blázquez-Gamero D, Reques-Cosme R, Olabarrieta I, Prieto L, De Ory F, Thorne C, Byrne T, Ades AE, Ruiz-Burga E, Giaquinto C, Mellado-Peña MJ, García-Alix A, Carreras E, Soler-Palacín P. Clinical Outcomes of a Zika Virus Mother-Child Pair Cohort in Spain. Pathogens 2020; 9:pathogens9050352. [PMID: 32392815 PMCID: PMC7281364 DOI: 10.3390/pathogens9050352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. Methods: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. Results: ZIKV infection was diagnosed in 163 PW; 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up; three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4–6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4–39.6%). Conclusions: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations.
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Affiliation(s)
- Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
- Correspondence: ; Tel.: +34-93-4893-140
| | - Marie Antoinette Frick
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | | | - Elena Sulleiro
- Departament of Microbiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carlota Rodó
- Unit of Fetal Medicine, Department of Obstetrics, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.R.); (A.S.); (E.C.)
| | | | | | - Anna Suy
- Unit of Fetal Medicine, Department of Obstetrics, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.R.); (A.S.); (E.C.)
| | - María De la Calle
- Department of Obstetrics, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (E.A.)
| | - Mar Santos
- Department of Paediatrics, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (M.S.); (E.D.)
| | - Eugenia Antolin
- Department of Obstetrics, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (E.A.)
| | | | - María Espiau
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | - Ainara Salazar
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | - Borja Guarch-Ibáñez
- Department of Paediatrics, Hospital Universitari Josep Trueta, 17007 Girona, Spain;
| | - Ana Vázquez
- Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.P.S.-S.); (A.V.); (F.D.O.)
| | | | | | - Andrea Martin-Nalda
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | - Eva Dueñas
- Department of Paediatrics, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (M.S.); (E.D.)
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense, 28041 Madrid, Spain; (D.B.-G.); (L.P.)
| | | | | | - Luis Prieto
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense, 28041 Madrid, Spain; (D.B.-G.); (L.P.)
| | - Fernando De Ory
- Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.P.S.-S.); (A.V.); (F.D.O.)
| | - Claire Thorne
- University College London Great Ormond Street Institute of Child Health, GOSH NIHR BRC, London WC1N 1EH, UK; (C.T.); (T.B.); (E.R.-B.)
| | - Thomas Byrne
- University College London Great Ormond Street Institute of Child Health, GOSH NIHR BRC, London WC1N 1EH, UK; (C.T.); (T.B.); (E.R.-B.)
| | | | - Elisa Ruiz-Burga
- University College London Great Ormond Street Institute of Child Health, GOSH NIHR BRC, London WC1N 1EH, UK; (C.T.); (T.B.); (E.R.-B.)
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35122 Padova, Italy;
| | - María José Mellado-Peña
- Department of Paediatrics, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.G.L.-H.); (M.J.M.-P.)
| | | | - Elena Carreras
- Unit of Fetal Medicine, Department of Obstetrics, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.R.); (A.S.); (E.C.)
| | - Pere Soler-Palacín
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
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Abascal-Saiz A, De la Calle M, Herrero B, Rodríguez R, Antolín E, Bertha JL. [Giant sacrococcygeal teratoma in twin pregnancy]. Ginecol Obstet Mex 2014; 82:843-850. [PMID: 25826969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Sacrococcygeal teratoma tumors are more frequent in infants alive. It is characterized by its benign histology in the majority of the cases diagnosed prenatally; it is necessary to follow narrow to prevent neonatal complications that can lead to urinary tract complications and fecal, high-output heart failure, hydrops and, in extreme cases, the death of the fetus. CASE REPORT Primigravidae 30 years old, with gestation twins, bicorial, biamniotic in the first trimester of pregnancy to one of the twins is diagnosed sacrococcygeus teratoma giant, with favorable monitoring in the maternal-fetal Medicine Unit of the University Hospital of La Paz in Madrid, and with postnatal resection surgery successful. We review the diagnostic procedures and treatment of this tumor in unique and twin gestations.
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