A Novel Predictive Machine Learning Model Integrating Cytokines in Cervical-Vaginal Mucus Increases the Prediction Rate for Preterm Birth.

Preterm birth (PB) is a leading cause of perinatal morbidity and mortality. PB prediction is performed by measuring cervical length, with a detection rate of around 70%. Although it is known that a cytokine-mediated inflammatory process is involved in the pathophysiology of PB, none screening method implemented in clinical practice includes cytokine levels as a predictor variable. Here, we quantified cytokines in cervical-vaginal mucus of pregnant women (18-23.6 weeks of gestation) with high or low risk for PB determined by cervical length, also collecting relevant obstetric information. IL-2, IL-6, IFN-γ, IL-4, and IL-10 were significantly higher in the high-risk group, while IL-1ra was lower. Two different models for PB prediction were created using the Random Forest machine-learning algorithm: a full model with 12 clinical variables and cytokine values and the adjusted model, including the most relevant variables-maternal age, IL-2, and cervical length- (detection rate 66 vs. 87%, false positive rate 12 vs. 3.33%, false negative rate 28 vs. 6.66%, and area under the curve 0.722 vs. 0.875, respectively). The adjusted model that incorporate cytokines showed a detection rate eight points higher than the gold standard calculator, which may allow us to identify the risk PB risk more accurately and implement strategies for preventive interventions.

A comparison of heart rate variability in women at the third trimester of pregnancy and during low-risk labour.

Heart rate variability (HRV) has been recognised as a non-invasive method for assessing cardiac autonomic regulation. Aiming to characterize HRV changes at labour in women, we studied 10 minute ECG recordings from young mothers (n=30) at the third trimester of pregnancy (P) or during augmentation of labour (L) (n=30). Data of the L group were collected when no-contractions (L-NC) or the contractile activity (L-C) was manifested. Accordingly, the inter-beat interval (IBI) time series were processed to estimate relevant parameters of HRV such as the mean IBI (IBI¯), the mean heart rate HR¯, the root mean square of successive differences (RMSSD) in IBIs, the natural logarithm of high-frequency component (LnHF), the short-term scaling parameters from detrended fluctuation and magnitude and sign analyses such as (α1, α1(MAG), α1(SIGN)), and the sample entropy (SampEn). We found statistical differences (p<0.05) for RMSSD among P and L-NC/L-C groups (25 ± 13 vs. 36 ± 14/34 ± 16 ms) and for LnHF between P and L-NC (5.37 ± 1.15 vs. 6.05 ± 0.86 ms(2)). Likewise, we identified statistical differences (p<0.05) for α1(SIGN) among P and L-NC/L-C groups (0.19 ± 0.20 vs. 0.32 ± 0.17/0.39 ± 0.13). By contrast, L-NC and L-C groups showed statistical differences (p<0.05) in α1(MAG) (0.67 ± 0.12 vs. 0.79 ± 0.12), and SampEn (1.62 ± 0.26 vs. 1.20 ± 0.44). These results suggest that during labour, despite preserving a concomitant non-linear influence, the maternal short-term cardiac autonomic regulation becomes weakly anticorrelated (as indicated by α1(SIGN)); furthermore, an increased vagally mediated activity is observed (as indicated by RMSSD and LnHF), which may reflect a cholinergic pathway activation owing to the use of oxytocin or the anti-inflammatory cholinergic response triggered during labour.

[Hemoglobin values for pregnant women residing at middle altitude]. / Valores de hemoglobina en mujeres embarazadas residentes en zonas de altitud media.

OBJECTIVE: To determine maternal hemoglobin behavior during pregnancy for middle altitude residents and to compare it with that reported in other populations with or without iron supplementation. MATERIALS AND METHODS: Hematological values from 227 pregnant women residing at 2 240 m altitude (Mexico City), with low obstetric and perinatal risk, and receiving supplementary iron, were compared with reference values obtained from other populations of pregnant women residing at different altitudes, after correcting for altitude. RESULTS: While the hemoglobin values for the first and second trimester of pregnancy in our studied population were similar to those reported for iron-supplemented populations (p>0.05), the third trimester values were similar to those reported for a population without this supplement (p>0.05). CONCLUSIONS: Despite receiving supplementary iron, hemoglobin values during pregnancy from women residing at middle altitude show similar behavior to that reported for pregnant women without iron supplementation.

Valores de hemoglobina en mujeres embarazadas residentes en zonas de altitud media / Hemoglobin values for pregnant women residing at middle altitude

Objetivo. Determinar el comportamiento de la concentración de hemoglobina materna durante el embarazo en mujeres que residen en zonas de altitud media y compararlo con el reportado para poblaciones con y sin suplemento de hierro. Material y métodos. Valores hematológicos de 227 mujeres embarazadas, residentes a 2 240 metros de altitud (Ciudad de México), sin complicaciones obstétricas ni perinatales y recibiendo suplemento de hierro, fueron comparados con valores de referencia para mujeres embarazadas de otras altitudes. Resultados. Durante el primer y segundo trimestre, los valores de hemoglobina en nuestra población fueron similares a los observados en poblaciones con y sin suplemento de hierro (p>0.05). Durante el tercer trimestre, los valores fueron similares únicamente a los de poblaciones sin suplemento de hierro (p>0.05). Conclusiones. No obstante recibir hierro suplementario, el comportamiento de la concentración de hemoglobina durante el embarazo en mujeres residentes de la altitud media es similar al reportado para poblaciones sin hierro suplementario.

Objective. To determine maternal hemoglobin behavior during pregnancy for middle altitude residents and to compare it with that reported in other populations with or without iron supplementation. Materials and methods. Hematological values from 227 pregnant women residing at 2 240 m altitude (Mexico City), with low obstetric and perinatal risk, and receiving supplementary iron, were compared with reference values obtained from other populations of pregnant women residing at different altitudes, after correcting for altitude. Results. While the hemoglobin values for the first and second trimester of pregnancy in our studied population were similar to those reported for iron-supplemented populations (p>0.05), the third trimester values were similar to those reported for a population without this supplement (p>0.05). Conclusions. Despite receiving supplementary iron, hemoglobin values during pregnancy from women residing at middle altitude show similar behavior to that reported for pregnant women without iron supplementation.