[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.

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.

Genetic determinants for gestational diabetes mellitus and related metabolic traits in Mexican women.

Epidemiological and physiological similarities among Gestational Diabetes Mellitus (GDM) and Type 2 Diabetes (T2D) suggest that both diseases, share a common genetic background. T2D risk variants have been associated to GDM susceptibility. However, the genetic architecture of GDM is not yet completely understood. We analyzed 176 SNPs for 115 loci previously associated to T2D, GDM and body mass index (BMI), as well as a set of 118 Ancestry Informative Markers (AIMs), in 750 pregnant Mexican women. Association with GDM was found for two of the most frequently replicated T2D loci: a TCF7L2 haplotype (CTTC: rs7901695, rs4506565, rs7903146, rs12243326; P=2.16 x 10(-06); OR=2.95) and a KCNQ1 haplotype (TTT: rs2237892, rs163184, rs2237897; P=1.98 x 10(-05); OR=0.55). In addition, we found two loci associated to glycemic traits: CENTD2 (60' OGTT glycemia: rs1552224, P=0.03727) and MTNR1B (HOMA B: rs1387153, P=0.05358). Remarkably, a major susceptibility SLC16A11 locus for T2D in Mexicans was not shown to play a role in GDM risk. The fact that two of the main T2D associated loci also contribute to the risk of developing GDM in Mexicans, confirm that both diseases share a common genetic background. However, lack of association with a Native American contribution T2D risk haplotype, SLC16A11, suggests that other genetic mechanisms may be in play for GDM.

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.

Atención primaria a la salud perinatal con enfoque de riesgo / Primary perinatal health care with risk strategies

Son diversos los avances en el campo de la salud de México debidos al impulso de la prevención masiva (vacunas, detección de cáncer, y control de epidemias), y se ha justificado la alta prioridad que ha tenido la medicina curativa y de rehabilitación con la creación de grandes centros médicos e institutos, sin embargo se señala la necesidad de crear, desarrollar e implantar estrategias para la prevención en el nivel primario en el área perinatal. En este trabajo se reportan los resultados obtenidos en el Centro de Investigación Materno Infantil del Grupo de Estudios al Nacimiento (CINIGen) con la aplicación de un modelo de atención perinatal, entre los que destacan: la disminución de la mortalidad perinatal a un tercio de la tasa promedio nacional; el decremento de la mortalidad materna a cero; la accesibilidad a servicios de alta calidad y humanismo a la población de recursos económicos, medios y bajos; la implementación del trabajo de las enfermeras obstétricas, como base del sistema de riesgo perinatal y de los niveles progresivos de atención (referencia oportuna); la demostración de que un sistema operativo de alta calidad y eficiencia puede ser autofinanciable; y, finalmente se señala que cuando existen intereses comunes para beneficio de la sociedad, se pueden tener grandes logros en colaboración con el trabajo del sector privado, las instituciones oficiales y los propios componentes de la comunidad