Biomarkers predicting the controller dose of omalizumab in patients with chronic spontaneous urticaria.

BACKGROUND: Clinical trials showed the efficacy of 300 mg/4 weeks of omalizumab (OMA) during 6 months in patients with severe chronic spontaneous urticaria (CSU). Nevertheless, in real life, many patients require higher doses and/or longer treatment. This study assesses the real-life performance of OMA in severe CSU and identifies factors associated with the response. METHODS: CSU patients eligible for OMA were recruited prospectively. Clinical data and a blood test were collected before OMA initiation. Urticaria Activity Score 7 (UAS7) was calculated at baseline and every 3 months during OMA treatment. CSU control was defined as UAS7 <7 points. This work was partially sponsored by OMA manufacturer. RESULTS: Eighty-nine adults (19.1% males) with severe CSU were recruited. Median duration of CSU prior to OMA initiation was 2 years, and median severity by UAS7 at baseline was 24 points (range 10-42 points). OMA controlled 94.4% of patients, but 17.9% of responders required doses >300 mg/4 weeks. A blood basophil count >20 cells/µL (OR 13.33; 95% CI 3.32-52.63; p < .001) and the absence of hypothyroidism (OR 3.65; 95% CI 0.78-16.95; p = .099) were identified as predictive factors to achieve control with 300 mg/4 weeks. Twelve patients were able to stop OMA during the study (responders in remission, RR). RR had received OMA for a median of 29 months (12-53 months). Conversely, 32 patients had been on OMA for >29 months at the end of the study (active responders, AR). AR had received OMA for a median of 45 months (30-100 months). There were no significant differences in clinical or analytical factors between RR and AR patients. CONCLUSIONS: Low blood basophil count and the presence of hypothyroidism might serve as biomarkers for the controller dose of OMA in severe CSU patients.

Metabolic pathways in immune senescence and inflammaging: Novel therapeutic strategy for chronic inflammatory lung diseases. An EAACI position paper from the Task Force for Immunopharmacology.

The accumulation of senescent cells drives inflammaging and increases morbidity of chronic inflammatory lung diseases. Immune responses are built upon dynamic changes in cell metabolism that supply energy and substrates for cell proliferation, differentiation, and activation. Metabolic changes imposed by environmental stress and inflammation on immune cells and tissue microenvironment are thus chiefly involved in the pathophysiology of allergic and other immune-driven diseases. Altered cell metabolism is also a hallmark of cell senescence, a condition characterized by loss of proliferative activity in cells that remain metabolically active. Accelerated senescence can be triggered by acute or chronic stress and inflammatory responses. In contrast, replicative senescence occurs as part of the physiological aging process and has protective roles in cancer surveillance and wound healing. Importantly, cell senescence can also change or hamper response to diverse therapeutic treatments. Understanding the metabolic pathways of senescence in immune and structural cells is therefore critical to detect, prevent, or revert detrimental aspects of senescence-related immunopathology, by developing specific diagnostics and targeted therapies. In this paper, we review the main changes and metabolic alterations occurring in senescent immune cells (macrophages, B cells, T cells). Subsequently, we present the metabolic footprints described in translational studies in patients with chronic asthma and chronic obstructive pulmonary disease (COPD), and review the ongoing preclinical studies and clinical trials of therapeutic approaches aiming at targeting metabolic pathways to antagonize pathological senescence. Because this is a recently emerging field in allergy and clinical immunology, a better understanding of the metabolic profile of the complex landscape of cell senescence is needed. The progress achieved so far is already providing opportunities for new therapies, as well as for strategies aimed at disease prevention and supporting healthy aging.

Organ-specific allergen challenges in airway allergy: Current utilities and future directions.

Atopy has been long used as the screening method for airway allergy. Nevertheless, aeroallergens can trigger respiratory symptoms not only in atopic patients (atopic respiratory allergy, ARA), but also in non-atopic subjects (local respiratory allergy, LRA). Moreover, ARA and LRA can coexist in the same patient, and this clinical scenario has been called dual respiratory allergy (DRA). When the clinical history cannot determine the relevance of sensitizations in ARA patients, nasal, conjunctival or bronchial allergen challenges (NAC, CAC, and BAC, respectively) should be conducted. Moreover, these tests are required to identify patients with LRA and DRA. The clarification of the allergic triggers of airway diseases has a profound impact on the management strategies the patients can be offered. Importantly, allergen immunotherapy (AIT) remains as the only disease-modifying intervention for ARA. Recent data indicate that AIT might have a similar effect on LRA patients. Nevertheless, AIT success relies largely on the correct phenotyping of allergic individuals, and NAC, CAC, and BAC are very helpful tools in this regard. In this review, we will summarize the main indications and methodology of CAC, NAC, and BAC. Importantly, the clinical implementation of these tests might translate into precision medicine approaches and better health outcomes for patients with airway allergy.

Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Allergen Immunotherapy for Local Respiratory Allergy.

PURPOSE OF REVIESW: Local respiratory allergy (LRA) is an eosinophilic phenotype of chronic airway disease. Three entities have been described within the LRA spectrum: local allergic rhinitis (LAR) and local allergic asthma (LAA) in non-atopic patients, and dual allergic rhinitis (DAR) in atopic patients (coexistence of LAR and allergic rhinitis). In this article, we aim to review the current evidence on the therapeutic options for LRA. RECENT FINDINGS: No controlled study has assessed the effect of standard therapy (oral antihistamines, intranasal or inhaled corticosteroids, bronchodilators) in LRA subjects. Three randomized clinical trials and one observational study demonstrated that allergen immunotherapy (AIT) is able to control nasal and ocular symptoms, decrease the need for rescue medication, and improve quality of life in LAR individuals. Nasal or inhaled steroids can be expected to improve eosinophilic inflammation in LRA patients but cannot change the natural course of the disease. Moreover, the long-term and disease-modifying effects of AIT in LRA subjects need to be investigated.

Local allergic rhinitis: Implications for management.

A significant proportion of rhinitis patients without systemic IgE-sensitisation tested by skin prick test and serum allergen-specific IgE (sIgE) display nasal reactivity upon nasal allergen provocation test (NAPT). This disease phenotype has been termed local allergic rhinitis (LAR). LAR is an underdiagnosed entity affecting children and adults from different parts of the world, with moderate-to-severe symptoms, impairment of quality of life and rapid progression to symptom worsening. LAR is a stable phenotype and not merely an initial state of AR. Allergic rhinitis and LAR share many clinical features including a positive NAPT response, markers of type 2 nasal inflammation including sIgE in nasal secretions and a significant rate of asthma development. LAR should be considered as a differential diagnosis in those subjects of any age with symptoms suggestive of AR but no evidence of systemic atopy. Although LAR pathophysiology is partially unknown, in some patients sIgE can be demonstrated directly in the nasal secretions and/or indirectly via positive responses in basophil activation test (BAT). LAR can coexist with other rhinitis phenotypes, especially AR. The diagnosis currently relies on the positivity of NAPT to a single or multiple allergens. NAPT has high sensitivity, specificity and reproducibility, and it is considered the gold standard. BAT and the measurement of nasal sIgE can also contribute to LAR diagnosis. LAR patients benefit from the same therapeutic strategies than AR individuals, including the avoidance of allergen exposure and the pharmacotherapy. Moreover, several recent studies support the effectiveness and safety of allergen immunotherapy for LAR, which opens a window of treatment opportunity in these patients.

Local allergic rhinitis is an independent rhinitis phenotype: The results of a 10-year follow-up study.

BACKGROUND: The knowledge about the natural history of local allergic rhinitis (LAR) is limited. One unmet question is to demonstrate whether LAR should be considered the first step in the development of allergic rhinitis (AR) or an independent phenotype. The aim of this study was to prospectively evaluate the natural history of a population with LAR, the potential conversion to AR with systemic atopy and the development of asthma during 10 years. METHODS: This is the second phase of a 10-year follow-up study of a cohort of 176 patients with LAR of recent onset and 115 age- and sex-matched healthy controls prospectively evaluated from 2005 to 2016. Clinical-demographic questionnaire, spirometry, skin prick test and specific IgE were evaluated yearly. Nasal allergen provocation tests (NAPT) with Dermatophagoides pteronyssinus, Alternaria alternata, Olea europaea and grass pollen were performed at baseline, and after 5 and 10 years. RESULTS: After 10-year LAR, patients experienced a significant and clinically relevant worsening of the rhinitis, with increase in emergency assistance, development of asthma, loss of allergen tolerance and impairment of the quality of life. This worsening became significant after 5 years and progressed throughout 10 years. A similar rate of development of AR with systemic atopy was detected in patients and controls (9.7% vs 7.8%, log-rank P=.623). In 5 patients, conversion to systemic atopy occurred >10 years (3%). CONCLUSIONS: LAR is a well-differentiated clinical entity with a low rate of development of systemic atopy, a natural evolution towards worsening and a risk factor for suffering asthma.

The roadmap for allergology in Europe: The subspecialty of allergology as "stop-over" on the way to a full specialty. An EAACI position statement.

The vision of European Academy of Allergy and Clinical Immunology (EAACI) and the Union of European Medical Specialists Section and Board on allergology is to promote and to establish a full specialty of allergology in all European countries. In many European countries, a full specialty does not exist. In those countries, organ-based (sub)specialists or paediatricians and internists with an expertise in allergology may deliver allergy care. There are no generally accepted requirements for the training of subspecialists available. To fill the gap between the need and availability of experienced and accredited physicians who can deliver optimal care to the allergic patients, the EAACI Specialty Committee proposes the minimal requirements for training and certification of subspecialists in allergology. This paper describes the required theoretical knowledge, skills, competences and training facilities (staff and institution). The subspecialist as described in this paper should ideally show the necessary competence in providing good quality care to patients in an environment lacking those full specialists in allergology or tertiary care paediatric subspecialists in allergy.

Review on ion mobility spectrometry. Part 1: current instrumentation.

Ion Mobility Spectrometry (IMS) is a widely used and 'well-known' technique of ion separation in the gaseous phase based on the differences in ion mobilities under an electric field. All IMS instruments operate with an electric field that provides space separation, but some IMS instruments also operate with a drift gas flow that provides also a temporal separation. In this review we will summarize the current IMS instrumentation. IMS techniques have received an increased interest as new instrumentation and have become available to be coupled with mass spectrometry (MS). For each of the eight types of IMS instruments reviewed it is mentioned whether they can be hyphenated with MS and whether they are commercially available. Finally, out of the described devices, the six most-consolidated ones are compared. The current review article is followed by a companion review article which details the IMS hyphenated techniques (mainly gas chromatography and mass spectrometry) and the factors that make the data from an IMS device change as a function of device parameters and sampling conditions. These reviews will provide the reader with an insightful view of the main characteristics and aspects of the IMS technique.

Review on ion mobility spectrometry. Part 2: hyphenated methods and effects of experimental parameters.

Ion Mobility Spectrometry (IMS) is a widely used and 'well-known' technique of ion separation in the gaseous phase based on the differences of ion mobilities under an electric field. This technique has received increased interest over the last several decades as evidenced by the pace and advances of new IMS devices available. In this review we explore the hyphenated techniques that are used with IMS, specifically mass spectrometry as an identification approach and a multi-capillary column as a pre-separation approach. Also, we will pay special attention to the key figures of merit of the ion mobility spectrum and how data sets are treated, and the influences of the experimental parameters on both conventional drift time IMS (DTIMS) and miniaturized IMS also known as high Field Asymmetric IMS (FAIMS) in the planar configuration. The present review article is preceded by a companion review article which details the current instrumentation and contains the sections that configure both conventional DTIMS and FAIMS devices. These reviews will give the reader an insightful view of the main characteristics and aspects of the IMS technique.

Sequential combined therapy with omalizumab and rituximab: a new approach to severe atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a common chronic skin disease, and a significant percentage of AD patients have severe forms. Inflammation based on type 2 helper T cells (T(H)2), autoantibodies, and CD8+ T cells could play a relevant role in this disease. When the patient requires systemic immunosuppressors for disease control, side effects are frequent. We propose a sequential therapeutic strategy with 2 monoclonal antibodies, omalizumab (anti-immunoglobulin [Ig] E) and rituximab (anti-CD20), which might induce clinical benefit with few side effects in selected individuals with AD. METHODS: We report 6 cases of severe AD refractory to conventional therapy. The patients underwent sequential switch therapy with omalizumab and rituximab. Clinical response was assessed by means of the decrease in body surface affected. Immunological parameters and side effects were also monitored. RESULTS: Four patients received omalizumab before a high-dose cycle of rituximab. In the case of recurrences, either low-dose cycles of rituximab or omalizumab were administered. A long-term clinical benefit was observed in 3 out of 4 patients. Two patients first received high-dose rituximab followed by either low-dose rituximab or omalizumab, and one of them achieved a response at 17 months. No severe side effects were recorded. Serum IgE level and B-cell counts decreased with therapy, the latter returning to baseline levels 10 to 11 months after treatment. Specific antibody responses remained protective during the study. CONCLUSIONS: With our proposed switch therapy, 4 out of 6 patients achieved a dramatic clinical improvement. This novel strategy targets different arms of the immune response and might be a good alternative for patients with severe AD.

Mechanisms underlying the effects of caloric restriction on hypertension.

Hypertension is a major risk factor for cardiovascular disease (CVD) as well as a major contributor to all-cause mortality and disability worldwide. The pathophysiology of hypertension is highly attributed to a dysfunctional endothelium and vascular remodeling. Despite the wide use of pharmacological therapies that modulate these pathways, a large percentage of patients continue to have uncontrolled hypertension, and the use of non-pharmacological interventions is increasingly investigated. Among these, caloric restriction (CR) appears to be a promising nutritional intervention for the management of hypertension. However, the mechanisms behind this effect are not yet fully understood, although an evolving view supports a significant impact of CR on vascular structure and function, specifically at the level of vascular endothelial cells, vascular smooth muscle cells along with their extracellular matrix (ECM). Accumulating evidence suggests that CR promotes endothelium-dependent vasodilation through activating eNOS and increasing nitric oxide (NO) levels through multiple cascades involving modulation of oxidative stress, autophagy, and inflammation. Indeed, CR diminishes phenotypic shift, and suppresses proliferation and migration of VSMCs via pathways involving NO and mTOR. By regulating transforming growth factor-ß and matrix metalloproteinases, CR appears to reduce ECM and collagen deposition in vascular walls. Here, we offer a detailed discussion of how these mechanisms contribute to CR's influence on reducing blood pressure. Such mechanisms could then provide a valuable foundation on which to base new therapeutic interventions for hypertension.

Analysis of the influence of PTPN22 gene polymorphisms in systemic sclerosis.

OBJECTIVE: Two functional single nucleotide polymorphisms (SNP) in the PTPN22 gene (rs24746601 and rs33996649) have been associated with autoimmunity. The aim of this study was to investigate the role of the R263Q SNP for the first time and to re-evaluate the role of the R620W SNP in the genetic predisposition to systemic sclerosis (SSc) susceptibility and clinical phenotypes. METHODS: 3422 SSc patients (2020 with limited cutaneous SSc and 1208 with diffuse cutaneous SSc) and 3638 healthy controls of Caucasian ancestry from an initial case--control set of Spain and seven additional independent replication cohorts were included in our study. Both rs33996649 and rs2476601 PTPN22 polymorphisms were genotyped by TaqMan allelic discrimination assay. A meta-analysis was performed to test the overall effect of these PTPN22 polymorphisms in SSc. RESULTS: The meta-analysis revealed evidence of association of the rs2476601 T allele with SSc susceptibility (p(FDRcorrected)=0.03 pooled, OR 1.15, 95% CI 1.03 to 1.28). In addition, the rs2476601 T allele was significantly associated with anticentromere-positive status (p(FDRcorrected)=0.02 pooled, OR 1.22, 95% CI 1.05 to 1.42). Although the rs33996649 A allele was significantly associated with SSc in the Spanish population (p(FDRcorrected)=0.04, OR 0.58, 95% CI 0.36 to 0.92), this association was not confirmed in the meta-analysis (p=0.36 pooled, OR 0.89, 95% CI 0.72 to 1.1). CONCLUSION: The study suggests that the PTPN22 R620W polymorphism influences SSc genetic susceptibility but the novel R263Q genetic variant does not. These data strengthen evidence that the R620W mutation is a common risk factor in autoimmune diseases.

Dataset of working mPEG-alkyne with scCO2.

This article contains data related to the research article entitled "Carbon dioxide sorption and melting behavior of mPEG-alkyne". The presented data gives information on the thermodynamics properties of the solvent and the polymer. The time saturation of mPEG-alkyne in supercritical carbon dioxide (scCO2) was evaluated in a high-pressure variable volume cell in different period of time at different pressure at the same temperature. The effects of pressure and temperature on the density of CO2 when it is above supercritical conditions are determined with Sanchez Lacombe and Bender Equation and compared with the NIST database and values of equation of Bender. The characteristic parameters of CO2 were determined with the equations proposed by Chengyong Wang et al. [1] and the sum of squared error was calculated for each parameter. Furthermore in this work the solubility data of scCO2/polymer mixture were correlated with Sanchez Lacombe Equation of State (SL EOS) and Heuristic model proposed by Irene Pasquali et al. [2]. This work describes the methodology for solving the SL EOS between the polymer and scCO2 and the procedure of determining the solubility parameter with the group contribution method necessary to apply the heuristic model is described.

[Impact on mental healthcare after collaboration between primary healthcare and mental health services]. / Impacto en la asistencia en salud mental tras la colaboración entre atención primaria y salud mental.

INTRODUCTION: The primary care physician is the professional with whom the psychiatric patient has contact first and most frequently. For this reason, a good coordination between the Primary Healthcare (PHC) and Mental Health (MH) services is essential to provide the best care to patients and at the same time optimise the limited resources of this service. The aim of this work is to determine whether the collaboration between PHC and MH results in a more efficient use of the limited resources in MH. METHODOLOGY: An observational, retrospective, mirror study was carried out with a total sample of 135 patients over 16 years old referred for the first time from PHC to Psychiatry. The results during the first 6 months of the collaboration between PHC and MH (POST Group) are compared with those of the 6 months prior to the intervention (PRE Group). RESULTS: After collaboration meetings, the percentage of patients who are discharged by the psychiatrist after the first visit decreases (32.2% vs. 16%) and the percentage of follow-up by psychiatry and psychology increases. Furthermore, the percentage of patients who do not attend the first visit decreases (23.3% vs. 13.7%). CONCLUSIONS: The data suggest that the collaboration between PHC and MH improves the effectiveness and functioning of MH services.

[Nurse's report for patient discharge. The end of caretaking episode?]. / Informe de enfermería al alta. Fin del episodio de cuidados?

Should a nurse's report for patient discharge from clinical care be the end of the caretaking episode? The authors started by posing this question and then elaborated a poster which they submitted and won First Prize at the IV National Conference for Nurses of Internal Medicine. As an answer to the question posed, the authors conclude that the aforementioned patient discharge report ensures continuing care, thereby preventing possible complications and the need to readmit patients into hospital care.

Resultados perinatales tras la suplementación de una cohorte de gestantes con vitamina D / Perinatal results after vitamin D supplementation in a pregnant women cohort

INTRODUCCIÓN Y OBJETIVOS: La deficiencia de vitamina D es muy prevalente durante la gestación, siendo cada vez más numerosos los estudios que relacionan esta condición con peores resultados perinatales. El objetivo del presente trabajo es describir los resultados perinatales y el curso del embarazo de una cohorte de gestantes deficitarias en vitamina D durante el primer trimestre del embarazo, suplementándolas con colecalciferol, así como establecer una comparación entre los resultados perinatales de aquellas pacientes con déficit o insuficiencia que lograron niveles normales de vitamina D en el tercer trimestre frente a aquellas que no lo lograron. Como objetivo secundario se describe el curso del embarazo de una cohorte de pacientes que durante el mismo periodo de tiempo del estudio presentaban normovitaminosis al inicio de la gestación. MÉTODOS: La cohorte de 190 pacientes analizada procede de casos consecutivos en la primera consulta de embarazo. Se determinaron los niveles de 25-hidroxivitamina D (25-OH-D) en la analítica del primer trimestre de 190 gestantes diferenciando entre valores normales (>30ng/mL), insuficiencia (30-15 ng/mL) y deficiencia (<15 ng/mL). Las pacientes con insuficiencia se suplementaron con 1000 UI/día de colecalciferol y las pacientes con deficiencia con 2000 UI/día. En el tercer trimestre se determinaron de nuevo los niveles de 25-OH-D en las pacientes suplementadas, suspendiendo la prescripción en caso de haberse normalizado los valores. Se comparan estadísticamente los resultados perinatales entre aquellas pacientes que mejoraron con la suplementación frente a aquellas que no lo hicieron. RESULTADOS: De las 190 pacientes analizadas, un 45% presentaban insuficiencia; un 27,5% deficiencia; y un 27,5% valores normales. De forma global, un 61% de las pacientes suplementadas habían normalizado sus niveles de vitamina D en la analítica del tercer trimestre, suspendiéndose la prescripción. De ese 61% normalizado, un 63% pertenecían al grupo de insuficiencia y un 37% al de deficiencia. Dentro del grupo suplementado con colecalciferol, un 1,4% de las pacientes desarrollaron hipertensión arterial, mientras que un 33% desarrollaron diabetes en el embarazo, de las cuales un 87% la controlaron exclusivamente con dieta y un 13% precisaron insulina. Un 3,6% de las gestaciones cursaron con retraso del crecimiento y la tasa de prematuridad fue igualmente del 3,6%. La tasa de cesáreas fue del 23%, de las cuales un 77% fueron indicadas intraparto y un 23% cesáreas programadas. El peso medio al nacimiento fue 3205g. Dentro del grupo con valores normales de 25-OH-D en el primer trimestre de la gestación, ninguna paciente desarrolló hipertensión arterial, mientras que un 15% presentaron diabetes gestacional controlada con dieta. Un 3,8% de dichas gestaciones cursaron con retrasos del crecimiento y la tasa de prematuridad fue del 1,9%. La tasa de cesáreas fue del 23%, de las cuales un 50% fueron indicadas intraparto y el 50% restante programadas. El peso medio al nacimiento fue de 3280g. En el análisis comparativo de los resultados perinatales entre el grupo de pacientes suplementadas que normalizaron sus cifras de vitamina D y aquellas que no lo hicieron, no se hallan diferencias estadísticamente significativas para ninguno de los parámetros analizados. CONCLUSIONES: La elevada tasa de hipovitaminosis D en la muestra analizada apoya la extensión del cribado y suplementación a todas las embarazadas y no solamente a aquellas con factores de riesgo. Dado que no se observaron diferencias estadísticamente significativas entre los niveles de vitamina D en el tercer trimestre y las variables perinatales estudiadas, podemos concluir que en nuestro estudio la suplementación con vitamina D no se ha comportado como factor protector de eventos obstétricos adversos.

INTRODUCTION AND OBJECTIVES: Vitamin D deficiency is highly prevalent during pregnancy, with an increasing number of studies linking this condition with worse perinatal outcomes. The objective of this present work is to describe the perinatal results and the course of pregnancy in a cohort of pregnant women deficient in vitamin D during the first trimester of pregnancy, supplementing them with cholecalciferol, as well as to establish a comparison between perinatal results of those patients with deficiencnieve or insufficiency who achieved normal levels of vitamin D in the third trimester compared to those who did not. As a secondary objective, the course of pregnancy is described in a cohort of patients who presented normal levels at the beginning of gestation during the same period of time of the study. METHODS: The cohort of 190 patients analyzed comes from consecutive cases in the first pregnancy visit. The levels of 25-hydroxyvitamin D (25-OH-D) were determined in the analysis of the first trimester of 190 pregnant women, differentiating between normal values (> 30ng / mL), insufficiency (30-15 ng / mL) and deficiency (<15 ng / mL). Patients with insufficiency were supplemented with 1000 IU/day of cholecalciferol and patients with deficiency with 2000 IU/day. In the third trimester, the 25-OH-D levels were determined again in the supplemented patients, suspending the prescription if the values had normalized. Perinatal outcomes are statistically compared between those patients who improved with supplementation versus those who did not. RESULTS: Of the 190 patients analyzed, 45% had insufficiency; 27.5% deficiency; and 27.5% normal values. Overall, 61% of the supplemented patients had normalized their vitamin D levels in the third trimester analysis, suspending the prescription. Within that 61% normalized, 63% belonged to the insufficiency group and 37% to the deficiency group. In the group supplemented with cholecalciferol, 1.4% of the patients developed arterial hypertension, while 33% developed diabetes in pregnancy, of which 87% controlled it exclusively with diet and 13% required insulin. 3.6% of pregnancies had intrauterine growth restriction and the prematurity rate was also 3.6%. The caesarean section rate was 23%, of which 77% were indicated intrapartum and 23% scheduled caesarean sections. The mean weight at birth was 3205g. Within the group with normal 25-OH-D values in the first trimester of pregnancy, no patient developed hypertension, while 15% had diet-controlled gestational diabetes. 3.8% of these pregnancies had intrauterine growth restriction and the prematurity rate was 1.9%. The cesarean section rate was 23%, of which 50% were indicated intrapartum and the remaining 50% scheduled. The mean weight at birth was 3280g. In the comparative analysis of the perinatal results between the group of supplemented patients who normalized their vitamin D levels and those who did not, no statistically significant differences were found for any of the parameters analyzed. CONCLUSIONS: The high rate of hypovitaminosis D in the analyzed sample supports the extension of screening and supplementation to all pregnant women and not only to those with risk factors. Since no statistically significant differences were observed between vitamin D levels in the third trimester and the perinatal outcomes studied, we can conclude that in our study vitamin D supplementation has not behaved as a protective factor against adverse obstetric events.