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1.
Case Rep Obstet Gynecol ; 2023: 2124191, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37187915

RESUMEN

Introduction: Heterotopic pregnancy (HP) refers to the simultaneous presence of intrauterine pregnancy (IUP) and ectopic pregnancy, which is very rare but potentially life-threatening. The spontaneous incidence of HP in the general population is 1/30,000. With the widespread use of assisted reproductive technology (ART), the incidence rises to 1/1,000. Aims and Methods. This is a prospective case series looking at the cases of heterotopic pregnancies presenting to the early pregnancy unit (EPU) in a tertiary maternity hospital, from November 2015 to November 2016. The clinical presentation, ultrasound findings, and laparoscopy findings were all documented. The incidence of HP was calculated and compared with the quoted incidence in the literature. Outcomes. Five women with HP presented to the EPU over the course of a year. The first case describes a spontaneous HP with a previous salpingostomy. The second case describes an HP following ovulation induction. The third case describes a spontaneous HP with no known risk factors. The fourth and fifth cases describe heterotopic pregnancies following in vitro fertilisation with more than one embryo. All five cases of HP underwent laparoscopy and salpingectomy with uneventful recovery. The three women who had a viable IUP had no further complications in their pregnancies. Conclusion: Early and accurate diagnosis of HP can be challenging. An early transvaginal ultrasound plays an important role in making the diagnosis in women with risk factors and following ART. A high index of suspicion is required for timely diagnosis and appropriate intervention, especially in spontaneous HP.

2.
J Clin Oncol ; 41(19): 3545-3556, 2023 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-37098241

RESUMEN

PURPOSE: Failure to respond to induction chemotherapy portends a poor outcome in childhood acute lymphoblastic leukemia (ALL) and is more frequent in T-cell ALL (T-ALL) than B-cell ALL. We aimed to address the limited understanding of clinical and genetic factors that influence outcome in a cohort of patients with T-ALL induction failure (IF). METHODS: We studied all cases of T-ALL IF on two consecutive multinational randomized trials, UKALL2003 and UKALL2011, to define risk factors, treatment, and outcomes. We performed multiomic profiling to characterize the genomic landscape. RESULTS: IF occurred in 10.3% of cases and was significantly associated with increasing age, occurring in 20% of patients age 16 years and older. Five-year overall survival (OS) rates were 52.1% in IF and 90.2% in responsive patients (P < .001). Despite increased use of nelarabine-based chemotherapy consolidated by hematopoietic stem-cell transplant in UKALL2011, there was no improvement in outcome. Persistent end-of-consolidation molecular residual disease resulted in a significantly worse outcome (5-year OS, 14.3% v 68.5%; HR, 4.10; 95% CI, 1.35 to 12.45; P = .0071). Genomic profiling revealed a heterogeneous picture with 25 different initiating lesions converging on 10 subtype-defining genes. There was a remarkable abundance of TAL1 noncoding lesions, associated with a dismal outcome (5-year OS, 12.5%). Combining TAL1 lesions with mutations in the MYC and RAS pathways produces a genetic stratifier that identifies patients highly likely to fail conventional therapy (5-year OS, 23.1% v 86.4%; HR, 6.84; 95% CI, 2.78 to 16.78; P < .0001) and who should therefore be considered for experimental agents. CONCLUSION: The outcome of IF in T-ALL remains poor with current therapy. The lack of a unifying genetic driver suggests alternative approaches, particularly using immunotherapy, are urgently needed.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Leucemia-Linfoma Linfoblástico de Células Precursoras B , Leucemia-Linfoma Linfoblástico de Células Precursoras , Leucemia-Linfoma Linfoblástico de Células T Precursoras , Humanos , Adulto Joven , Adolescente , Leucemia-Linfoma Linfoblástico de Células T Precursoras/tratamiento farmacológico , Resultado del Tratamiento , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Linfocitos T , Pronóstico
3.
Cancers (Basel) ; 15(3)2023 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-36765607

RESUMEN

T-cell lymphoblastic lymphoma (T-LBL) is a rare and aggressive lymphatic cancer, often diagnosed at a young age. Patients are treated with intensive chemotherapy, potentially followed by a hematopoietic stem cell transplantation. Although prognosis of T-LBL has improved with intensified treatment protocols, they are associated with side effects and 10-20% of patients still die from relapsed or refractory disease. Given this, the search toward less toxic anti-lymphoma therapies is ongoing. Here, we targeted the recently described DNA hypermethylated profile in T-LBL with the DNA hypomethylating agent decitabine. We evaluated the anti-lymphoma properties and downstream effects of decitabine, using patient derived xenograft (PDX) models. Decitabine treatment resulted in prolonged lymphoma-free survival in all T-LBL PDX models, which was associated with downregulation of the oncogenic MYC pathway. However, some PDX models showed more benefit of decitabine treatment compared to others. In more sensitive models, differentially methylated CpG regions resulted in more differentially expressed genes in open chromatin regions. This resulted in stronger downregulation of cell cycle genes and upregulation of immune response activating transcripts. Finally, we suggest a gene signature for high decitabine sensitivity in T-LBL. Altogether, we here delivered pre-clinical proof of the potential use of decitabine as a new therapeutic agent in T-LBL.

4.
Br J Haematol ; 194(1): 28-43, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33942287

RESUMEN

T-cell ALL (T-ALL) is an aggressive malignancy of T-cell progenitors. Although survival outcomes in T-ALL have greatly improved over the past 50 years, relapsed and refractory cases remain extremely challenging to treat and those who cannot tolerate intensive treatment continue to have poor outcomes. Furthermore, T-ALL has proven a more challenging immunotherapeutic target than B-ALL. In this review we explore our expanding knowledge of the basic biology of T-ALL and how this is paving the way for repurposing established treatments and the development of novel therapeutic approaches.


Asunto(s)
Antineoplásicos/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células T Precursoras/terapia , Antineoplásicos/administración & dosificación , Antineoplásicos Inmunológicos/uso terapéutico , Apoptosis/efectos de los fármacos , Arabinonucleósidos/uso terapéutico , Compuestos Bicíclicos Heterocíclicos con Puentes/uso terapéutico , Quinasas Ciclina-Dependientes/antagonistas & inhibidores , Heterogeneidad Genética , Humanos , Inmunoterapia , Inmunoterapia Adoptiva , Inhibidores de las Cinasas Janus/uso terapéutico , Terapia Molecular Dirigida , Proteínas de Neoplasias/antagonistas & inhibidores , Inhibidores de las Quinasa Fosfoinosítidos-3/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células T Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células T Precursoras/genética , Inhibidores de Proteínas Quinasas/uso terapéutico , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Receptor Notch1/antagonistas & inhibidores , Receptores de Interleucina-7/antagonistas & inhibidores , Terapia Recuperativa/métodos , Transducción de Señal/efectos de los fármacos , Sulfonamidas/uso terapéutico , Terapias en Investigación/métodos , Terapias en Investigación/tendencias , Resultado del Tratamiento
5.
Gynecol Oncol ; 160(2): 514-519, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33213897

RESUMEN

OBJECTIVES: To investigate whether HE4 and CA125 could identify endometrioid adenocarcinoma patients who might most benefit from full staging surgery with lymphadenectomy. METHODS: Sequential patients with a preoperative banked serum and histology of endometrioid adenocarcinoma of endometrium who had undergone surgical staging with lymph node dissection over a 5-year period between 2011 and 2016 were included from a tertiary Gynaecological Cancer Centre, Dublin, Ireland. Preoperative serum HE4 and CA125 were measured using ELISA, with the cut-offs HE4 81 pmol/L and CA125 35 U/ml. Predictive values were estimated using AUC, sensitivity, specificity and odds ratios. RESULTS: 9.5% of the cohort had lymph node metastases. A HE4 cut-off of 81 pmol/L yielded a sensitivity of 78.6% and specificity of 53.4% for predicting lymph node metastases. Sensitivity of CA125 at 35 U/ml was 57% and specificity 91.4%. The AUC was 0.66 (0.52-0.80) for HE4 and 0.74 (0.58-0.91) for CA125. Sensitivity was 92.8% and specificity 51.1% when an elevation of either HE4 or CA125 was included, AUC was 0.72 (0.61-0.83), this combination yielded the highest NPV of 98.6%. Sensitivity was 42.9% and specificity 93.8% if both markers were elevated simultaneously, AUC was 0.68 (0.51-0.86). Preoperative clinical predictors of high-grade preoperative histology and radiology had sensitivities of 21.4% and 41.7%, respectively. Patients with a HE4 above 81 pmol/L had an odds ratio of 4.2 (1.12-15.74), p < 0.05, of lymph node metastases and CA125 had an odds ratio of 14.2 (4.16-48.31), p < 0.001. CONCLUSIONS: Serum HE4 and CA125 improved on existing methods for risk stratification of endometrioid carcinomas and warrant further investigation.


Asunto(s)
Biomarcadores de Tumor/sangre , Antígeno Ca-125/sangre , Carcinoma Endometrioide/diagnóstico , Neoplasias Endometriales/diagnóstico , Metástasis Linfática/diagnóstico , Proteínas de la Membrana/sangre , Proteína 2 de Dominio del Núcleo de Cuatro Disulfuros WAP/análisis , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Endometrioide/sangre , Carcinoma Endometrioide/patología , Carcinoma Endometrioide/cirugía , Neoplasias Endometriales/sangre , Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Endometrio/patología , Endometrio/cirugía , Femenino , Humanos , Histerectomía , Escisión del Ganglio Linfático/estadística & datos numéricos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Metástasis Linfática/patología , Persona de Mediana Edad , Clasificación del Tumor/estadística & datos numéricos , Estadificación de Neoplasias/estadística & datos numéricos , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Curva ROC , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo/métodos , Salpingooforectomía
7.
Cancer Discov ; 10(7): 998-1017, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32349972

RESUMEN

Loss-of-function mutations of EZH2, the enzymatic component of PRC2, have been associated with poor outcome and chemotherapy resistance in T-cell acute lymphoblastic leukemia (T-ALL). Using isogenic T-ALL cells, with and without CRISPR/Cas9-induced EZH2-inactivating mutations, we performed a cell-based synthetic lethal drug screen. EZH2-deficient cells exhibited increased sensitivity to structurally diverse inhibitors of CHK1, an interaction that could be validated genetically. Furthermore, small-molecule inhibition of CHK1 had efficacy in delaying tumor progression in isogenic EZH2-deficient, but not EZH2 wild-type, T-ALL cells in vivo, as well as in a primary cell model of PRC2-mutant ALL. Mechanistically, EZH2 deficiency resulted in a gene-expression signature of immature T-ALL cells, marked transcriptional upregulation of MYCN, increased replication stress, and enhanced dependency on CHK1 for cell survival. Finally, we demonstrate this phenotype is mediated through derepression of a distal PRC2-regulated MYCN enhancer. In conclusion, we highlight a novel and clinically exploitable pathway in high-risk EZH2-mutated T-ALL. SIGNIFICANCE: Loss-of-function mutations of PRC2 genes are associated with chemotherapy resistance in T-ALL, yet no specific therapy for this aggressive subtype is currently clinically available. Our work demonstrates that loss of EZH2 activity leads to MYCN-driven replication stress, resulting in increased sensitivity to CHK1 inhibition, a finding with immediate clinical relevance.This article is highlighted in the In This Issue feature, p. 890.


Asunto(s)
Quinasa 1 Reguladora del Ciclo Celular (Checkpoint 1)/metabolismo , Proteína Potenciadora del Homólogo Zeste 2/metabolismo , Proliferación Celular , Humanos , Mutación , Leucemia-Linfoma Linfoblástico de Células T Precursoras/genética
8.
Ir J Med Sci ; 189(3): 1135-1141, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32056159

RESUMEN

BACKGROUND: Ireland has changed over the past sixty years, and the dynamic practice of obstetrics and gynaecology has changed with it. STUDY DESIGN AND METHODS: To describe these changes, a review was performed of clinical reports of a tertiary referral teaching hospital over six decades. RESULTS: Since the 1960s, the hospital's total births per annum has risen (3050 to 8362 births). Teenage pregnancy is less common (4.7 to 2.0%, p < 0.001), with more women over age 40 at booking (2.6 to 6.4%, p < 0.001). There are more multiple pregnancies now (1.8 to 4.1%, p < 0.001) and less grand-multiparous woman (10.1 to 1.3%, p < 0.001). Eclampsia is less common (0.18 to 0.02%, p = 0.003), with a slight decrease in rate of preeclampsia (3.8 to 3.0%, p = 0.03). Induction of labour increased considerably (8.8 to 32.1%, p < 0.001). While the instrumental delivery rate remained stable, the instrument of choice has changed from forceps (11.3 to 5.4%, p = 0.001) to ventouse delivery (0.6 to 9.1%, p = 0.001). The caesarean section rate rose (5.9 to 29.7%, p < 0.001). Vaginal birth after caesarean section rate dropped (90.4 to 28.2%, p < 0.001) without significant change in rate of uterine rupture (0.4 to 0.7%, p = 0.1). The perinatal mortality rate improved (48.5 to 5.4 per 1000 births, p < 0.001). Preterm birth rate rose (4.9 to 6.6%, p = 0.001). Foetal macrosomia decreased in this time (2.5 to 1.7%, p = 0.007), despite a rise in the incidence of gestational diabetes mellitus. CONCLUSION: This study provides an intriguing glimpse into the changes in the practice of obstetrics and demonstrates how it adapts to the population it serves.


Asunto(s)
Parto/fisiología , Adulto , Femenino , Humanos , Recién Nacido , Irlanda , Embarazo , Factores de Tiempo
10.
J Obstet Gynaecol ; 37(5): 591-594, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28366035

RESUMEN

Maternal obesity is an emerging challenge in contemporary obstetrics. To date there has been no study analysing the relationship between specific maternal body composition measurements and foetal soft-tissue measurements. The aim of this study was to determine whether measurement of maternal body composition at booking predicts foetal soft-tissue trajectories in the third trimester. We analysed the relationship between foetal thigh in the third trimester and both maternal BMI and body composition using the Tanita digital scales in the first trimester. Foetal subcutaneous thigh tissue measurements were obtained at intervals of 28, 32 and 36 weeks of gestation. A total of 160 women were identified. There was a direct correlation between MTST at 36 weeks and BMI (p = .002). There was a positive correlation between MTST at 36 weeks and leg fat mass (p = .13) and leg fat free mass (p = .013). There was a positive correlation between arm fat free mass and MTST at 36 weeks. We showed there is an association between maternal fat distribution and foetal subcutaneous thigh tissue measurements. MTST may be more useful in determining if a child is at risk of macrosomia. Impact statement Previous studies have suggested that maternal obesity programmes intrauterine foetal adiposity and growth. The aim of this study was to examine the relationship in a high-risk obstetric population between measurements of maternal body composition in early pregnancy and the assessment of foetal adiposity in the third trimester using serial ultrasound measurements of mid-thigh soft-tissue thickness. BMI is only a surrogate measurement of fat and does not measure fat distribution. Our study shows the distribution of both maternal fat and fat-free mass in early pregnancy may be positively associated with foetal soft-tissue measurements in the third trimester. Maternal arthropometric measurements other than BMI may help predict babies at risk of macrosomia and neonatal adiposity.


Asunto(s)
Adiposidad , Desarrollo Fetal , Adulto , Índice de Masa Corporal , Impedancia Eléctrica , Femenino , Humanos , Embarazo , Tercer Trimestre del Embarazo
11.
Blood ; 129(24): 3221-3226, 2017 06 15.
Artículo en Inglés | MEDLINE | ID: mdl-28270453

RESUMEN

Somatic mutations within noncoding genomic regions that aberrantly activate oncogenes have remained poorly characterized. Here we describe recurrent activating intronic mutations of LMO2, a prominent oncogene in T-cell acute lymphoblastic leukemia (T-ALL). Heterozygous mutations were identified in PF-382 and DU.528 T-ALL cell lines in addition to 3.7% of pediatric (6 of 160) and 5.5% of adult (9 of 163) T-ALL patient samples. The majority of indels harbor putative de novo MYB, ETS1, or RUNX1 consensus binding sites. Analysis of 5'-capped RNA transcripts in mutant cell lines identified the usage of an intermediate promoter site, with consequential monoallelic LMO2 overexpression. CRISPR/Cas9-mediated disruption of the mutant allele in PF-382 cells markedly downregulated LMO2 expression, establishing clear causality between the mutation and oncogene dysregulation. Furthermore, the spectrum of CRISPR/Cas9-derived mutations provides important insights into the interconnected contributions of functional transcription factor binding. Finally, these mutations occur in the same intron as retroviral integration sites in gene therapy-induced T-ALL, suggesting that such events occur at preferential sites in the noncoding genome.


Asunto(s)
Proteínas Adaptadoras Transductoras de Señales/genética , Proteínas Adaptadoras Transductoras de Señales/metabolismo , Proteínas con Dominio LIM/genética , Proteínas con Dominio LIM/metabolismo , Mutación , Leucemia-Linfoma Linfoblástico de Células T Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células T Precursoras/metabolismo , Proteínas Proto-Oncogénicas/genética , Proteínas Proto-Oncogénicas/metabolismo , Elementos de Respuesta , Adolescente , Adulto , Niño , Preescolar , Femenino , Regulación Leucémica de la Expresión Génica , Humanos , Células Jurkat , Masculino , Leucemia-Linfoma Linfoblástico de Células T Precursoras/patología
12.
Am J Perinatol ; 30(2): 199-204, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24915555

RESUMEN

OBJECTIVE: This longitudinal study compared changes in maternal weight and body mass index (BMI) in early pregnancy in the time interval between when a woman first attended for antenatal care with her first child and when she next attended for antenatal care. STUDY DESIGN: We studied women with a singleton pregnancy who delivered their first baby weighing ≥ 500 g in 2009 and who attended again for antenatal care with an ongoing pregnancy before January 1, 2012. Maternal weight and height were measured before 18 weeks' gestation in both pregnancies and BMI was calculated. RESULTS: Of the 3,284 primigravidas, the mean weight at the first visit in 2009 was 66.4 kg (standard deviation [SD] 12.7). The mean BMI was 24.5 kg/m(2) (SD 4.6), and 11.3% (n = 370) were obese. Of the 3,284 women, 1,220 (37.1%) re-attended for antenatal care before 2012 after sonographic confirmation of an ongoing pregnancy. Of the 1,220 women who re-attended, 788 (64.6%) had gained weight (mean 4.6 kg [SD 3.9]), 402 (33%) had lost weight (mean 3 kg [SD 2.9]), and 30 (2.4%) had maintained their weight. CONCLUSION: The birth of a first baby was associated with an increase in maternal weight in two-thirds of women when they next attended for antenatal care.


Asunto(s)
Intervalo entre Nacimientos , Obesidad/epidemiología , Complicaciones del Embarazo/epidemiología , Aumento de Peso , Adulto , Índice de Masa Corporal , Femenino , Humanos , Irlanda/epidemiología , Estudios Longitudinales , Sobrepeso/epidemiología , Embarazo , Atención Prenatal , Pérdida de Peso , Adulto Joven
14.
Acta Obstet Gynecol Scand ; 92(12): 1414-8, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24116732

RESUMEN

OBJECTIVE: To review induction of labor analyzed by body mass index (BMI) category in primigravidas and multigravidas. DESIGN: Prospective observational study. POPULATION: Women enrolled after sonographic confirmation of singleton pregnancy in the first trimester. SETTING: Large university teaching hospital. METHODS: Maternal height and weight were measured accurately before BMI calculation. Clinical details were recorded after review of individual obstetric records. MAIN OUTCOME MEASURES: Emergency cesarean section and obstetric interventions. RESULTS: Of 2000 women enrolled, 50.4% (n = 1008) were primigravidas and 17.3% (n = 346) were obese. The induction rate was 25.6% and the overall cesarean section rate 22.0%. Primigravidas were more likely to have labor induced than multigravidas (38.1% vs. 23.4%, p < 0.001). Compared with women with a normal BMI, obese primigravidas but not obese multigravidas were more likely to have labor induced. In primigravidas who had labor induced, the cesarean section rate was 20.6% (91/442) compared with 8.3% (17/206) in multigravidas who had labor induced (p < 0.001). In obese primigravidas, induction of labor was also more likely to be associated with other interventions such as epidural analgesia, fetal blood sampling and emergency cesarean section. In contrast, induction of labor in obese multigravidas was not only less common but also not associated with an increase in other interventions compared with multigravidas with a normal BMI. CONCLUSIONS: Due to the short-term and long-term implications of an unsuccessful induction in an obese primigravida, we recommend that induction of labor should only be undertaken for strict obstetric indications after careful consideration by an experienced clinician.


Asunto(s)
Cesárea/estadística & datos numéricos , Trabajo de Parto Inducido/estadística & datos numéricos , Trabajo de Parto/fisiología , Obesidad/fisiopatología , Paridad , Complicaciones del Embarazo/fisiopatología , Adulto , Índice de Masa Corporal , Femenino , Humanos , Irlanda , Embarazo , Estudios Prospectivos
15.
Prenat Diagn ; 33(10): 945-51, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23716034

RESUMEN

OBJECTIVE: The aim of this study was to profile longitudinal changes in thigh muscle and fat with gestation and to determine whether thigh measurements can improve the prediction of birth weight (BW). METHODS: A prospective longitudinal study of subcutaneous soft tissue measurements was conducted in 328 singleton fetuses at 28 and 37 weeks gestation. Estimated fetal weight (EFW) was calculated using abdominal circumference, femur length, biparietal diameter, and head circumference. RESULTS: The fetal abdominal subcutaneous tissue (FAST) and thigh muscle and fat show an increase with gestation. At 28 weeks gestation, the abdominal circumference, thigh fat, FAST, and EFW percentile were found to be significant predictors of BW. A combination of EFW percentile and thigh fat were found to be the optimal multivariate model at 28 weeks for predicting BW. At 37 weeks, BW prediction using EFW percentile, FAST, and thigh fat was the most accurate. The results revealed acceptable reproducibility for fetal thigh muscle and fat. CONCLUSION: This study provides reference ranges for thigh fat and muscle at 28 and 37 weeks gestation. The inclusion of fetal thigh fat in the algorithm improves the predictive power for birth weight. This information is important to explore the role of fetal thigh in the detection of aberrant growth.


Asunto(s)
Peso al Nacer/fisiología , Feto , Muslo/diagnóstico por imagen , Ultrasonografía Prenatal/métodos , Abdomen/diagnóstico por imagen , Adulto , Femenino , Fémur/diagnóstico por imagen , Peso Fetal , Cabeza/diagnóstico por imagen , Humanos , Recién Nacido , Estudios Longitudinales , Embarazo , Pronóstico , Grasa Subcutánea/diagnóstico por imagen
16.
Obes Facts ; 6(2): 211-5, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23615621

RESUMEN

OBJECTIVE: The purpose of this nested cohort study was to compare the rate of pre-pregnancy supplementation in obese women with that of women with a normal BMI. METHODS: Pregnant women were enrolled at their convenience in a large university hospital. Weight and height were measured in the first trimester and BMI categorised. RESULTS: Of the 288 women, 35.1% were in the normal, 29.5% in the overweight and 35.4% in the obese BMI categories. Only 45.1% (n = 46) of the obese women took pre-pregnancy folic acid compared with 60.4% (n = 61) of women with a normal BMI (p < 0.03). The lower incidence of folic acid supplementation in obese women was associated with an unplanned pregnancy in 36.3% of women compared with 22.8% in the normal BMI category (p < 0.04). CONCLUSIONS: Obese women should take folate supplements whether they are planning to conceive or not.


Asunto(s)
Índice de Masa Corporal , Suplementos Dietéticos , Ácido Fólico/administración & dosificación , Obesidad/complicaciones , Complicaciones del Embarazo/epidemiología , Atención Prenatal , Complejo Vitamínico B/administración & dosificación , Estudios de Cohortes , Suplementos Dietéticos/estadística & datos numéricos , Femenino , Humanos , Obesidad/epidemiología , Sobrepeso/complicaciones , Sobrepeso/epidemiología , Embarazo , Embarazo no Planeado , Atención Prenatal/estadística & datos numéricos , Prevalencia , Valores de Referencia
17.
Obstet Gynecol ; 121(1): 46-50, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23232753

RESUMEN

OBJECTIVE: To estimate which maternal body composition parameters measured using multifrequency segmental bioelectric impedance analysis in the first trimester of pregnancy are predictors of increased birth weight. METHODS: Nondiabetic women were recruited after ultrasonographic confirmation of an ongoing singleton pregnancy in the first trimester. Maternal body composition was measured using bioelectric impedance analysis. Multivariable linear regression analysis was performed to identify the strongest predictors of birth weight, with multiple logistic regression analysis performed to assess predictors of birth weight greater than 4 kg. RESULTS: Data were analyzed for 2,618 women, of whom 49.6% (n=1,075) were primigravid and 16.5% (n=432) were obese based on a body mass index (BMI) of 30 or higher. In univariable analysis, maternal age, BMI, parity, gestational age at delivery, smoking, fat mass, and fat-free mass all correlated significantly with birth weight. In multivariable regression analysis, fat-free mass remained a significant predictor of birth weight (model R=0.254, standardized ß=0.237; P<.001), but no relationship was found between maternal fat mass and birth weight. After adjustment for confounding variables, women in the highest fat-free mass quartile had an adjusted odds ratio of 3.64 (95% confidence interval 2.34-5.68) for a birth weight more than 4 kg compared with those in the lowest quartile. CONCLUSIONS: Based on direct measurements of body composition, birth weight correlated positively with maternal fat-free mass and not adiposity. These findings suggest that, in nondiabetic women, interventions intended to reduce fat mass during pregnancy may not prevent large-for-gestational-age neonates and revised guidelines for gestational weight gain in obese women may not prevent large-for-gestational-age neonates. LEVEL OF EVIDENCE: : III.


Asunto(s)
Peso al Nacer , Composición Corporal , Adolescente , Adulto , Índice de Masa Corporal , Impedancia Eléctrica , Femenino , Edad Gestacional , Humanos , Recién Nacido , Modelos Logísticos , Edad Materna , Obesidad/complicaciones , Embarazo , Ultrasonografía Prenatal , Adulto Joven
18.
Obes Facts ; 5(3): 393-8, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22797366

RESUMEN

OBJECTIVE: To compare the incidence of spontaneous miscarriage in women with moderate to severe obesity to that in women with a normal BMI after sonographic confirmation of the foetal heart rate in the first trimester. METHODS: Women were enrolled in a prospective observational study at their convenience in the first trimester after an ultrasound confirmed an ongoing singleton pregnancy with foetal heart activity present. Maternal height and weight were measured digitally and BMI was calculated. RESULTS: In the 3,000 women enrolled, the miscarriage rate overall was 3.9% (n = 117). The mean gestational age at enrolment was 11.1 weeks. In the class 2-3 (BMI > 34.9 kg/m(2)) obese primigravidas the miscarriage rate was 11.3% (n = 8) compared with 2.7% (n = 24) in the normal BMI category (p = 0.003), and 3.7% (n = 5) in the class 1 obese category (not significant). In multigravidas, there was no increased rate of miscarriage among class 2-3 obese women compared with multigravidas in the normal BMI category. The mean body composition values showed that primigravidas who miscarried had both increased fat and fat-free masses compared with those who did not, but multigravidas who miscarried had a similar fat mass and fat-free mass with those who did not. CONCLUSIONS: In women with sonographic evidence of foetal heart activity in the first trimester, the rate of spontaneous miscarriage is low. It was increased in moderate to severely obese primigravidas, but was not increased in other obese women compared to women in the normal BMI category.


Asunto(s)
Aborto Espontáneo/etiología , Composición Corporal , Índice de Masa Corporal , Número de Embarazos , Frecuencia Cardíaca Fetal , Obesidad/complicaciones , Complicaciones del Embarazo , Aborto Espontáneo/diagnóstico por imagen , Aborto Espontáneo/epidemiología , Tejido Adiposo/metabolismo , Adulto , Compartimentos de Líquidos Corporales/metabolismo , Femenino , Humanos , Obesidad/diagnóstico por imagen , Obesidad Mórbida/complicaciones , Obesidad Mórbida/diagnóstico por imagen , Embarazo , Complicaciones del Embarazo/diagnóstico por imagen , Primer Trimestre del Embarazo , Prevalencia , Estudios Prospectivos , Valores de Referencia , Índice de Severidad de la Enfermedad , Ultrasonografía , Adulto Joven
19.
Cytokine ; 60(1): 96-9, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22726456

RESUMEN

Outside pregnancy, both obesity and diabetes mellitus are associated with changes in inflammatory cytokines. Obesity in pregnancy may be complicated by gestational diabetes mellitus (GDM) and/or fetal macrosomia. The objective of this study was to determine the correlation between maternal cytokines and fetomaternal adiposity in the third trimester in women where the important confounding variable GDM had been excluded. Healthy women with a singleton pregnancy and a normal glucose tolerance test at 28 weeks gestation were enrolled at their convenience. Maternal cytokines were measured at 28 and 37 weeks gestation. Maternal adiposity was assessed indirectly by calculating the Body Mass Index (BMI), and directly by bioelectrical impedance analysis. Fetal adiposity was assessed by ultrasound measurement of fetal soft tissue markers and by birthweight at delivery. Of the 71 women studied, the mean maternal age and BMI were 29.1 years and 29.2 kg/m(2) respectively. Of the women studied 32 (45%) were obese. Of the cytokines, only maternal IL-6 and IL-8 correlated with maternal adiposity. Maternal TNF-α, IL-ß, IL-6 and IL-8 levels did not correlate with either fetal body adiposity or birthweight. In this well characterised cohort of pregnant non-diabetic women in the third trimester of pregnancy we found that circulating maternal cytokines are associated with maternal adiposity but not with fetal adiposity.


Asunto(s)
Adiposidad , Biomarcadores/sangre , Citocinas/sangre , Mediadores de Inflamación/sangre , Adulto , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Peso Fetal , Edad Gestacional , Humanos , Interleucina-6/sangre , Interleucina-8/sangre , Edad Materna , Embarazo , Tercer Trimestre del Embarazo , Ultrasonografía Prenatal , Adulto Joven
20.
Prenat Diagn ; 32(7): 620-6, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22544542

RESUMEN

OBJECTIVE: The aims of the study were to establish reference ranges for placental length and thickness in a low-risk obstetric population and to assess the likelihood of a small for gestational age (SGA) neonate on the basis of placental length at 18-24 weeks' gestation. METHODS: Placental length and thickness were measured by two sonographers in 520 singleton pregnancies. Uterine artery Doppler studies and a placental morphological assessment were also performed. Placental size was correlated with the birthweight centiles at delivery. RESULTS: A placental length <10th centile between the gestational age of 18 and 24 weeks is a significant factor associated with SGA neonate [odds ratio (OR) = 2.8, 95% CL, 1.1-6.9]. An abnormal uterine artery Doppler is a significant factor for SGA neonate (OR = 3.4, 95% CL, 1.6-7.4). There was a weak relationship between cord insertion <2 cm from the placental margin and an SGA neonate (OR = 1.8, 95% CL, 0.4-8.2). CONCLUSION: We have provided reference ranges for placental length and thickness from 18 to 24 weeks' gestation. A single measurement of placental length incorporated into the anatomy scan may assist in the early detection of a group at risk of delivering an SGA neonate.


Asunto(s)
Edad Gestacional , Recién Nacido de Bajo Peso , Recién Nacido Pequeño para la Edad Gestacional , Placenta/anatomía & histología , Ultrasonografía Prenatal/métodos , Cordón Umbilical/anatomía & histología , Adulto , Biometría , Peso al Nacer , Femenino , Humanos , Recién Nacido , Estudios Longitudinales , Tamaño de los Órganos , Placenta/diagnóstico por imagen , Embarazo , Segundo Trimestre del Embarazo , Estudios Prospectivos , Cordón Umbilical/diagnóstico por imagen , Arteria Uterina/anatomía & histología , Arteria Uterina/diagnóstico por imagen
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