Maternal distress and the development of hypertensive disorders of pregnancy.

Despite the implementation of programmes to improve maternal health, maternal and foetal mortality rates still remain high. The presence of maternal distress and its association with the development of pregnancy hypertensive disorders is not well established. The aim of this study was to evaluate the association between maternal distress and the development of hypertensive disorders in pregnancy in a prospective cohort of 321 Mexican women. Symptoms of maternal distressing were evaluated at week 20th of gestation using the General Health Questionnaire. The presence of acute somatic symptoms, social dysfunction, anxiety and insomnia increased the odds of developing a pregnancy hypertensive disorder by 5.1-26.4 times in study population (p values < .05). Our results support the participation of maternal distress in the development of hypertensive disorders of pregnancy. The implementation of effective programmes prioritising risk factors during pregnancy including the presence of maternal distressing factors is recommended. Impact statement What is already known on this subject: Changes in the nervous, endocrine, and immune systems have been observed in pregnant women with distress conditions leading to gestational disorders. What do the results of this study add: The presence of acute somatic symptoms, social dysfunction, anxiety and insomnia increased the developing of hypertensive disorders in Mexican population. What are the implications of these findings for clinical practice and/or further research: These findings may contribute to a better understanding of the role of the maternal stress in the development of hypertensive disorders of pregnancy, and in the implementation of effective programmes for clinical practice prioritising risk factors during pregnancy, including the presence of maternal distressing factors.

Spontaneous abortion is preceded by an altered serum concentration of matrix metalloproteinases.

Objective: To evaluate the usefulness of the serum concentration of nine matrix metalloproteinases (MMPs) as biomarkers of spontaneous abortion.Methods: A retrospective nested cohort case-control study was carried out in Zacatecas, Mexico. MMP-1-3, MMP-7-10, and MMP-12-13 were analyzed in serum from women who had spontaneous abortion of unknown causes (n = 7), who suffered abortions attributed to urinary tract infection (n = 7) and from those with healthy pregnancies without complications (controls; n = 20). Protein profiles were determined between 11 and 13 weeks of gestation (GW) using the Bio-Plex Pro Human MMP Panel. Differences in serum MMP concentrations between the study groups and their correlation with clinical findings were evaluated statistically.Results: There were differences in serum concentrations of MMP-9 between groups of spontaneous abortion of unknown cause (13.2 ± 7.5 ng/µL), abortion attributed to urinary tract infection (11.6 ± 5.8 ng/µL) and the controls (11.8 ± 16.5 ng/µL) (p = .022). Compared with controls, higher serum concentrations of MMP-8, MMP-9, and MMP-10 were observed in the group of spontaneous abortions of unknown causes (p value < .05). A negative correlation between MMP-8 and MMP-9 and urine density was also identified (r = -0.949, p value = .0167; and r = -0.947, p = .0167).Conclusions: Elevated serum concentrations of MMP-8, MMP-9, and MMP-10 were associated and preceded by the appearance of spontaneous interruption of pregnancy of unknown causes. Our results support the hypothesis that altered MMP modulation may be related with the pathogenesis of spontaneous abortion.

Screening of nutritional risk: assessment of predictive variables of nutritional risk in hospitalized patients in a second-level care center in Mexico.

INTRODUCTION: Introduction: worldwide, hospital malnutrition constitutes an important issue of morbidity and mortality. Although the prevalence of malnutrition has been calculated as between 7% and 27% in hospitalized patients, its real prevalence remains unknown or underestimated because of the different criteria for its identification and diagnosis. The aim of this study was to determine the prevalence of nutritional risk in a cohort of hospitalized patients and to identify the significance of the predictors associated with nutritional risk. Methods: the evaluation of the presence of nutritional risk was carried out in 247 individuals hospitalized at the second-level care institution Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE) Zacatecas, Hospital General Nº 26, in Mexico. Nutritional screening was evaluated during the first 24 hours of stay with the NRS 2002. The weighing of associated variables with nutritional risk was calculated statistically using the software Sigma Plot v11. Results: forty-two percent of patients were at risk of malnutrition. Significant associations between nutritional risk and a reduction in food ingestion (during the last week), the illness severity of the patient, as well as age and sex (p < 0.05), were observed. A reduction in food ingestion during the previous week increased the likelihood of having nutritional risk 6.67 times more (95% CI: 3.4-13.2; p < 0.001) in the studied population. Conclusion: the risk of malnutrition in hospitalized patients at ISSSTE-Zacatecas, Hospital General Nº 26 is frequent (42%). Therefore, early detection of nutritional risk is important to offer for proper nutritional intervention with the objective of decreasing the associated morbidity and mortality.

INTRODUCCIÓN: Introducción: la desnutrición hospitalaria constituye un problema de morbimortalidad en todo el mundo. Aunque la prevalencia de malnutrición se ha calculado entre el 7% y el 27% en pacientes hospitalizados, su prevalencia real sigue siendo desconocida o subestimada debido a los diferentes criterios para su identificación y diagnóstico. El objetivo de este estudio fue determinar la prevalencia del riesgo nutricional mediante la herramienta Nutritional Risk Screening 2002 (NRS-2002) en pacientes hospitalizados y ponderar los factores predictivos asociados con el riesgo nutricional. Métodos: la evaluación de la presencia de riesgo nutricional se realizó en 247 hospitalizados en el hospital general de segundo nivel Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE) Zacatecas, Hospital General Nº 26, en México. La evaluación nutricional se realizó durante las primeras 24 horas de estadía mediante la herramienta NRS 2002. El análisis de datos se llevó a cabo mediante el software Sigma Plot v11. Resultados: el 42% de los pacientes presentaron riesgo de desnutrición. Después de la corrección por covariables, se encontraron asociaciones significativas entre el riesgo nutricional y una reducción de la ingesta de alimentos (durante la última semana), la gravedad de la enfermedad del paciente, la edad y el sexo (p < 0,05). Entre la población estudiada, la reducción de la ingesta durante la última semana aumentó 6,67 veces la probabilidad de presentar riesgo nutricional (IC 95%: 3,4-13,2; p < 0,001). Conclusión: el riesgo de desnutrición en pacientes hospitalizados en el Hospital General Nº 26 Zacatecas-ISSSTE es frecuente (42%), por lo que es importante realizar una detección temprana para ofrecer una intervención nutricional adecuada y, con ello, disminuir la morbimortalidad asociada.