Circulating sex hormones in women with severe anxiety during pregnancy / Hormonas sexuales circulantes en mujeres con ansiedad severa durante el embarazo

Abstract Introduction Anxiety, mood- and stress-related behaviors are regulated by sex hormones in pregnant and non-pregnant women. Very scarce information exists about the role of sex steroids in pregnant women displaying high levels of anxiety. Objective To determine sex hormones serum levels in pregnant women exhibiting high levels of anxiety symptoms. Method The Hamilton Anxiety Rating Scale (HARS/ HAM-A) was used to assess the intensity of anxiety symptoms in third-trimester pregnant women. Two groups were included in the study, pregnant women exhibiting severe anxiety (ANX; HARS scores ≥ 25; n = 101) and healthy control subjects (CTRL; n = 40) displaying lower scores for anxiety (HARS scores ≤ 7). Estradiol (E2), progesterone (P4), and testosterone (T) serum levels were measured using a standard chemiluminescent immunoassay. Bivariate and partial correlations were performed to detect significant associations between groups, clinical measures, biochemical data, and HARS scores. Results The anxiety group (ANX) showed an increase in E2 and T serum levels (p < .001) compared to CTRL. Conversely, significantly lower P4 levels were found in the symptomatic group (p < .001) as compared to the CTRL hormone values. The P4:E2 index was significantly reduced in pregnant women with high levels of anxiety (p < .001). Negative correlations between anxiety (HARS) scores, P4 serum levels (p = .02), and P4:E2 ratio (p = .04) were found in the symptomatic group. Conversely, T serum levels displayed a positive association (p = .001) with high levels of anxiety symptoms in the same group, after adjusting our data by clinical confounders. Discussion and conclusion Serum levels of sex-steroid hormones are altered in pregnant women exhibiting severe anxiety.

Resumen Introducción La ansiedad, el estado de ánimo y el estrés están regulados por diversos esteroides sexuales. Existe poca información sobre el papel que juegan estos esteroides en mujeres embarazadas con niveles elevados de ansiedad. Objetivo Determinar los niveles séricos de hormonas sexuales en mujeres embarazadas con altos índices de síntomas de ansiedad con respecto a mujeres gestantes sanas. Método Determinación de la intensidad de síntomas ansiosos empleando la escala de Hamilton de Ansiedad (HAM-A) en 141 mujeres embarazadas en el tercer trimestre de gestación. Cuantificación de los niveles séricos de estradiol (E2), progesterona (P4) y testosterona (T) por inmunoensayo estándar. Aplicación de las correlaciones de Pearson para detectar asociaciones entre parámetros clínicos y valores hormonales entre los grupos de estudio. Resultados Las mujeres con ansiedad severa (ANX; n = 101; HAM-A ≥ 25) mostraron niveles séricos más altos de E2 y T (p < .001), así como niveles más bajos de P4 (p < .001) en relación con el grupo control (CTRL, n = 40, HAM-A < 7). Se detectó una disminución significativa en el índice P4:E2 en el grupo de ANX (p < .001) y se observaron correlaciones negativas y positivas entre los puntajes elevados de ansiedad con los niveles circulantes de P4 (p = .02), en la taza P4:E2 (p = .04) y en los niveles séricos de T (p = .001) respectivamente, al ajustar nuestros datos con variables confusoras. Discusión y conclusión Los niveles circulantes de los esteroides sexuales se encontraron alterados en mujeres con ansiedad severa.

Diabetes and obesity during pregnancy are associated with oxidative stress genotoxicity in newborns.

Objective To compare the level of oxidative deoxyribonucleic acid (DNA) damage (genotoxicity) between the offspring of mothers with and without diabetes diagnosed during pregnancy and its association with maternal body mass index (BMI). Methods We measured 8-hydroxy-deoxyguanosine (8-OH-dG), a marker of DNA oxidative damage, in venous umbilical cord plasma from newborns of mothers with (n=34) and without (n=56) diabetes diagnoses obtained during pregnancy. Two markers of oxidative stress - namely, nitric oxide degradation products (NOx) and total glutathione (GSH) - were quantified in both mothers and newborns. The effects of BMI, glycated hemoglobin (HbA1c), age and delivery mode were also analyzed. Results Newborns of mothers with diabetes during pregnancy exhibited higher levels of 8-OH-dG than those of mothers without diabetes (P<0.001). The other markers of oxidative stress were also higher in both mothers with diabetes and their newborns, with the exception of NOx in the mothers. The association of diabetes with 8-OH-dG was independent of other analyzed factors. Conclusion The offspring of mothers with diabetes during pregnancy are born with increased genotoxicity than the offspring of mothers without diabetes. BMI and HbA1c display an independent association with 8-OH-dG, particularly in the offspring of mothers not diagnosed with diabetes.

Corrección de los múltiplos de la mediana de los biomarcadores del modelo de predicción de preeclampsia de la Fetal Medicine Foundation para población mexicana / Correction of the multiples of median of the biomarkers used in the Fetal Medicine Foundation's prediction model for preeclampsia in Mexican population

Resumen OBJETIVO: Calcular y ajustar los múltiplos de la mediana para el índice de pulsatilidad medio de las arterias uterinas, presión arterial media materna, factor de crecimiento placentario y proteína plasmática A asociada al embarazo, a fin de valorar el desempeño diagnóstico del modelo corregido de preeclampsia de la Fetal Medicine Foundation en población mexicana. MATERIALES Y MÉTODOS: Estudio de casos y controles anidado en una cohorte prospectiva efectuado en el Centro de Salud Dr. Galo Soberón y Parra entre el 1 de octubre de 2015 y el 30 de junio de 2016. Criterio de inclusión: pacientes con embarazo de 11-13.6 semanas. Criterio de exclusión: pacientes de riesgo no seleccionado, con embarazo único, entre 11 y 13.6 semanas calculadas por ecografía mediante longitud cráneo cauda. Criterio de eliminación: pacientes que abandonaron el estudio. Se evaluaron el índice de pulsatilidad medio de las arterias uterinas, la presión arterial media, los valores séricos del factor de crecimiento placentario y la proteína plasmática A asociada al embarazo. Se comparó la diferencia en la distribución de los biomarcadores entre la observada en población mexicana y la esperada según la formula original de la Fetal Medicine Foundation. Cuando la diferencia fue mayor a 0.2 múltiplos de la mediana, se utilizó la mediana del observado como coeficiente de ajuste a la fórmula original del esperado. RESULTADOS: De las 300 pacientes reclutadas, 292 concluyeron el estudio. La media de semanas de embarazo al momento del tamizaje fue de 12.4 (desviación estándar 0.72). La prevalencia de preeclampsia fue de 4.5% (13 de 292). Se encontraron diferencias importantes en la distribución de múltiplos de la mediana para el índice de pulsatilidad medio de las arterias uterinas, factor de crecimiento placentario y proteína plasmática A asociada al embarazo. Posterior a la corrección de los biomarcadores, la sensibilidad, falsos positivos y área bajo la curva del modelo ajustado para detectar cualquier preeclampsia fue de 92% (12 de 13), 5.7% (16 de 279) y 93.3%, respectivamente. CONCLUSIONES: La distribución de los múltiplos de la mediana en población mexicana es distinta para los biomarcadores: factor de crecimiento placentario, proteína plasmática A asociada al embarazo e índice de pulsatilidad medio de las arterias uterinas. El ajuste de estos biomarcadores para población mexicana resulta en un buen desempeño diagnóstico del modelo de preeclampsia.

Abstract OBJECTIVE: Calculate and adjust the multiples of the median (MoMs) for the mean pulsatility index of uterine arteries (IPm Aut), mean arterial pressure (PAM), placental growth factor (PlGF) and plasma protein associated with pregnancy (PAPP-A), in order to assess the diagnostic performance of the corrected preeclampsia model of the fetal medicine foundation in the Mexican population. MATERIALS AND METHODS: Case-control study nested in a prospective cohort conducted at the "Dr. Galo Soberón y Parra "from October 1, 2015 - June 30, 2016. Patients with pregnancy of 11-13.6 weeks were included, multiple pregnancies or older than 14 weeks were excluded and patients with medication intake prior to pregnancy; Patients who decided to leave the study were eliminated. Autm IPm, PAM, PlGF and PAPP-A serum values were evaluated. The difference in the distribution of biomarkers between that observed in the Mexican population and that expected was compared according to the original formula of the Fetal Medicine Foundation. When the difference was greater than 0.2 MoMs, the median observed was used as an adjustment coefficient to the original expected formula. RESULTS: Of the 300 patients recruited, 292 concluded the study. The average gestational age at the time of screening was 12.4 weeks (standard deviation [SD] 0.72). The prevalence of preeclampsia was 4.5% (13/292). Important differences were found in the distribution of multiples of the median (MoMs) for IPm Aut, PlGF and PAPP-A. After correction of the biomarkers, the sensitivity, false positives and area under the curve (AUC) of the model adjusted to detect any preeclampsia was 92% (12/13), 5.7% (16/279) and 93.3%, respectively . CONCLUSIONS: The distribution of MoMs in the Mexican population is different for the PlGF, PAPP-A and IPm Aut biomarkers. The adjustment of these biomarkers to the Mexican population results in a good diagnostic performance of the preeclampsia model.

[Laparoscopic cholecystectomy in pregnant patient: experience in hospital General de Mexico in a period of 5 years (2008-2012)]. / Colecistectomía laparoscópica en pacientes embarazadas: experiencia del Hospital General de México 2008-2012.

BACKGROUND: Cholecystitis is the second cause of abdominal pain during pregnancy. 1-8 of 10,000 requiring surgery, being performed in the first and second quarter laparoscopically. 100% of patients with cholecystitis, about 12% are associated with pancreatitis with high rates of maternal and fetal morbidity and mortality. OBJECTIVE: To evaluate advantages--disadvantages of maternal-fetal pregnancy laparoscopic cholecystectomy and its preventive character avoiding cases of pancreatitis. We analyze the results obtained in Perinatology Service in General Hospital of Mexico (2008 to 2012) comparing them with the current literature. MATERIAL AND METHODS: A retrospective, cross sectional, descriptive. Analyzing the following variables: maternal age, gestational age, number of gestations, surgical technique, and postoperative complications trans, maternal and perinatal morbidity, gallbladder colic episodes prior, liver ultrasound report--bile ducts, tocolytic management. RESULTS: 20 laparoscopic cholecystectomies were performed in pregnant patients. Maternal age 21-38 years, mostly multigesta. 5 patients was performed at weeks 9, 14, 20 and 25 between the SDG and 1 at 27.5 SDG.Vesicular colicky eight previous USG mostly with gallstones.Two cases of mild acute pancreatitis satisfactorily resolved. No trans or postoperative complications. Open technique for performing pneumoperitoneum (Hasson). Tocolytic management indomethacin in 100% of cases. CONCLUSIONS: The results obtained are consistent with the current literature, confirming that laparoscopic cholecystectomy is the best treatment option with minimal fetal maternal morbidity, reducing the incidence of pancreatitis and maternal- fetal consequences.