Moderately elevated first trimester fasting plasma total homocysteine is associated with increased probability of miscarriage. The Reus-Tarragona Birth Cohort Study.

The association between elevated early pregnancy fasting plasma total homocysteine (tHcy) and miscarriage risk was investigated prospectively in participants (n = 544) from the Reus-Tarragona Birth Cohort study. Pregnancy was confirmed before 12 gestational weeks (GW) by ultrasound scan and a fasting blood sample collected. Pregnancies with complications other than miscarriages were excluded. Miscarriages were diagnosed by ultrasound scan and gestational age at the time of miscarriage estimated by embryo size, where possible. Cases in which blood samples were collected more than a week after the miscarriage, or the miscarriage was of known cause, were excluded. Fasting plasma folate, vitamin B12, tHcy, cotinine (biomarker of smoking), red blood cell (RBC) folate, MTHFR 677C > T (rs1801133) and SLC19A1 80G>A (rs1051266) genotypes were determined. The exposed group consisted of participants with first trimester tHcy ≥ P90 (7.1 µmol/L) (n = 57) and unexposed of those with tHcy < P90 (n = 487). Adherence to folic acid supplement recommendations, plasma folate, plasma vitamin B12, RBC folate and prevalence of optimal RBC folate status (≥ 906 µmol/L) were lower in the exposed compared to unexposed group. The prevalences of the MTHFR 677 TT genotype and miscarriage were higher in the exposed group. The relative risks (95% CI) of pregnancy ending in miscarriage were 2.5 (1.1, 5.7) and 2.1 (1.0, 4.5) for participants in the high tHcy and suboptimal RBC folate groups (compared to the reference groups) respectively. Adherence to folic acid supplement recommendations was positively associated, while the MTHFR 677 TT versus CC genotype and smoking versus non-smoking were negatively associated, with RBC folate status.

Early pregnancy folate-cobalamin interactions and their effects on cobalamin status and hematologic variables throughout pregnancy.

Background: Periconception folic acid supplementation is widespread, but how it interacts with cobalamin status is rarely considered. Objective: The aim of this study was to investigate whether first-trimester folate-cobalamin interactions affect pregnancy cobalamin status, hematologic variables, and pregnancy outcomes. Design: In the longitudinal Reus-Tarragona Birth Cohort study from <12 gestational weeks throughout pregnancy, fasting plasma and red blood cell (RBC) folate, plasma cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), total homocysteine (tHcy), hemoglobin, mean cell volume (MCV), postglucose-load serum glucose, gestational hypertension, gestational age at birth, and birth weight were recorded in 563 participants. Results: The highest plasma folate concentrations occurred in the first trimester when folic acid supplement use was extensive. Supplementation beyond the first trimester interacted with time of pregnancy on plasma folate, RBC folate, and tHcy throughout pregnancy (P-interaction <0.001). Plasma folate and RBC folate were higher and tHcy was lower in continued supplement users than in nonusers. Elevated plasma folate (≥30 nmol/L) occurred in 78.9% of women who exceeded the recommended 400 µg folic acid/d. First-trimester folate-cobalamin status interactions were associated with MMA (P-interaction <0.001) throughout pregnancy. When plasma cobalamin was suboptimal (≤221 pmol/L; n = 36), participants with elevated plasma folate (n = 11) had higher MMA concentrations than did those with nonelevated plasma folate (n = 23). First-trimester folate-MMA status interactions were associated with MCV throughout pregnancy (P-interaction <0.01) and with cord plasma holoTC (P-interaction <0.05). The mean difference (95% CI) in MCV (fL) between women with elevated and nonelevated plasma folate status was -2.12 (-3.71, -0.52) for top-quartile plasma MMA (≥0.139 µmol/L) and 0.60 (-0.39, 1.60) for plasma MMA <0.139 µmol/L. Cord plasma holoTC was higher in women with elevated compared with nonelevated plasma folate status only for MMA <0.139 µmol/L. Folate-cobalamin interactions were not associated with the other investigated outcomes. Conclusion: First-trimester folate-cobalamin status interactions were associated with plasma MMA and MCV throughout pregnancy. This trial was registered at www.clinicaltrials.gov as NCT01778205.

Asistencia a la gestante con diabetes. Guía de práctica clínica actualizada en 2014 / Care of pregnancies complicated by diabetes. Clinical practice guidelines: 2014 update

La diabetes es una de las complicaciones metabólicas más frecuentes de la gestación y se asocia a un incremento del riesgo de morbimortalidad maternal y fetal, que pueden evitarse y/o reducirse con un adecuado control. En la diabetes pregestacional, la preparación específica previa a la gestación es indispensable para intentar conseguir un control glucémico lo más próximo a la normalidad, evaluar complicaciones y revisar las pautas de tratamientos farmacológicos. En el caso de la diabetes gestacional, el tratamiento de esta entidad ha demostrado disminuir la tasa de complicaciones maternas y perinatales, por lo que su diagnóstico está justificado. En relación con la estrategia diagnóstica, ante la falta de consenso y la controversia desatada tras la aparición de los nuevos criterios IADPSG, el grupo ha decidido mantener la misma estrategia diagnóstica en 2 pasos y con los mismos puntos de corte hasta disponer de datos sólidos que avalen la introducción de nuevos criterios

Diabetes is one of the most common metabolic complications of pregnancy, and is associated with an increased risk of maternal and foetal morbidity and mortality that can be prevented and/or reduced with adequate glycaemic control. In pre-gestational diabetes, specific preparation prior to the pregnancy is essential in order to achieve glycaemic control near to normal as possible and to evaluate complications and review pharmacologic treatment prescription. The treatment of gestational diabetes has been shown to decrease the rate of maternal and perinatal complications, thus its diagnosis is justified. As regards the diagnostic strategy and due to the lack of consensus and the controversy arising after the publication of the new International Association of the Diabetes and Pregnancy Study Groups (IADPSG), the group has decided to keep the same diagnostic strategy in two stages, and with the same cut-off points, until there are solid data available that support the introduction of new criteria

Low folate status enhances pregnancy changes in plasma betaine and dimethylglycine concentrations and the association between betaine and homocysteine.

BACKGROUND: Folate, choline, and betaine participate in homocysteine metabolism. It is not known whether they interact during pregnancy. OBJECTIVE: The objective was to investigate how folate status affects choline, betaine, and dimethylglycine during pregnancy. DESIGN: Fasting plasma folate, cobalamin, free choline, betaine, dimethylglycine, and total homocysteine (tHcy) were measured longitudinally at <12, 15, 24-27, and 34 gestational weeks (GW); at labor (nonfasting); and in the cord in participants (n = 522) from the Reus-Tarragona Birth Cohort (NUTrició i Creixement Intrauterí Retardat phase). Timing, dose, and duration of folic acid supplement use were recorded. Folate status was classified as below (low) or above (high) median plasma folate at baseline (27.6 nmol/L) and at 24-27 GW (11.4 nmol/L). Associations between folate or betaine with tHcy were investigated by using multiple linear regression analysis. RESULTS: Plasma betaine decreased by 34.8% (1.0%) throughout pregnancy, and dimethylglycine increased by 39.7% (2.7%) between 24-27 GW and labor (all P < 0.001). Compared with high folate status, low status was associated with a higher dimethylglycine/betaine ratio from 15 GW and with lower plasma betaine and higher dimethylglycine from 24 to 27 GW, for the rest of pregnancy. Regression analysis showed that by 24-27 GW, both plasma folate and betaine were inversely associated with tHcy when folate status was low and that the association between betaine and tHcy depended on folate status at 24-27 and 34 GW (interaction terms: P < 0.001 and P < 0.01). Betaine was inversely associated with tHcy at labor regardless of folate status. CONCLUSION: Low folate status enhances the reduction in betaine and the increase in dimethylglycine during pregnancy and strengthens the association between betaine and tHcy. This trial was registered at clinicaltrials.gov as NCT01778205.

Aproximaciones complementarias y alternativas al cuidado de la salud en niños con cáncer: estudio con grupos focales / Alternative and complimentary approaches for health care in children with cancer: focus croup study

Objetivos: Este estudio busca conocer cuáles son los tipos de aproximaciones complementarias y alternativas al cuidado de la salud que utilizan los padres o los cuidadores de niños con cáncer que son atendidos en el Instituto Nacional de Cancerología de Bogotá, así como los mecanismos de acción que se adjudican a tales intervenciones. Métodos: Se realizó un estudio con una metodología cualitativa de grupos focales, para explorar los tipos de intervenciones usados, así como los mecanismos de acción propuestos. Resultados: Se armaron 5 grupos focales, que contaron con un total de 45 participantes (padres o cuidadores de niños con diagnóstico de cáncer). Los tipos de intervenciones referidos se relacionan, más que todo, con el grupo de terapias biológicas. Dentro de esta categoría se destaca, como mecanismo de acción, el refuerzo del sistema inmune. Conclusiones: Parece haber un perfil de utilización de estas aproximaciones al cuidado de la salud que es diferente en niños y adultos. Algunos de estos métodos no aparecen reportados en la literatura. Hay diversos mecanismos de acción sugeridos para las terapias biológicas, varios de los cuales han sido reportados en estudios efectuados en otras culturas. Es necesario cuantificar la frecuencia de utilización de estas intervenciones en la población pediátrica.

Objectives: This study seeks to identify what kinds of complimentary approaches and health care alternatives are used by parents or caregivers of children with cancer treated at the National Cancer Institute in Bogotá, as well as the mechanisms of action which allow them to be achieved. Methods: The study was based on qualitative methodology with focus groups in which types of intervention and proposed mechanisms of action were explored. Results: Five focus groups were formed, with a total of 45 participants (parents or caregivers of children with cancer). The most widely discussed intervention topics were those related to biological therapy; with immune system reinforcement appearing as the primary mechanism of action. Conclusions: A distinction appears to exist in the use of health care approaches - some of which are not reported on in the literature - between children and adults. Diverse mechanisms of action for biological therapy have been suggested, mostly in reports from studies carried out in other cultures. It is necessary that the frequency with which these interventions are used be quantified among the pediatric population.

Concepto de calidad de vida en mujeres con cáncer / The concept of quality of life in women suffering from cancer

Objetivo Analizar el concepto de calidad de vida en mujeres con cáncer y evaluar la estructura del concepto según grupos de edad. Material y métodos Se efectuó esta pregunta abierta a 114 mujeres con cáncer de seno: ¿En su opinión, qué es calidad de vida? Se realizó análisis lexicográfico de las respuestas mediante métodos factoriales para variables categóricas. Resultados Las formas gráficas y los segmentos repetidos más frecuentes se relacionaron con conceptos asociados a bienestar y salud. El análisis de formas características corrobora la importancia de conceptos relacionados con salud, bienestar y tranquilidad. Según los grupos de edad hay conceptos predominantes: En el de mujeres más jóvenes destaca la preocupación por el derecho de tener buen tratamiento. En el de 41-50 años el poder manejar su enfermedad y ver respuesta al tratamiento. En el de 51-60 años es importante la capacidad funcional y de disfrute, a pesar de padecer enfermedad. En el de mayores de 60 años resalta el bienestar espiritual. Se detectaron tres dimensiones: Salud como capacidad de disfrutar funciones nutricias y afectivas, capacidad de autonomía o de sana dependencia, y armonía familiar y social. Los grupos de edad se representan de manera diferencial en cada una de estas tres dimensiones. Conclusiones La espiritualidad y la disponibilidad de sistemas de salud que garanticen el tratamiento surgen como dominios importantes en pacientes con cáncer. La calidad de vida es un concepto que se modifica dependiendo de la edad de los pacientes, lo cual apoya la concepción subjetiva del constructo.

Objective Analyzing a group of females suffering from cancers concept of the quality of life and evaluating how they perceived such concept, depending on patients age-group. Methods The following open-ended question was put to a sample of 114 women suffering from breast cancer, "In your opinion, what is quality of life?" Their replies were analyzed using factorial methods for categorical variables. Results The most used graphical forms and repeated segments were associated with notions linked to well-being and health; analyzing characteristic forms supported these concepts importance. Some concepts appeared to be more relevant according to patient age-group. The young female group emphasized the right and opportunity to have adequate treatment whilst overcoming disease and response to its treatment were relevant to the 41-50 year-old group. Functioning and enjoyment were significant for the 51-60 year-old group whilst patients aged over 60 emphasized spiritual well-being. Binary correspondence analysis identified three domains: health (not just being the absence of disease or infirmity), autonomy or adequate dependence, and family/social well-being. Age-groups had differential representation regarding each domain. Conclusions Besides traditional domains, spirituality and a particular system guaranteeing access to quality health-care emerged as being important domains in female cancer patients perception of the quality of life. Quality of life is a multidimensional and dynamic concept that changes according to age; this suggested that quality of life is supported by subjective conceptualization; the use of scales for measuring quality of life could thus be questionable because of their subjectivity and dynamic nature.

[The concept of quality of life in women suffering from cancer]. / Concepto de calidad de vida en mujeres con cáncer.

OBJECTIVE: Analyzing a group of females suffering from cancers concept of the quality of life and evaluating how they perceived such concept, depending on patients age-group. METHODS: The following open-ended question was put to a sample of 114 women suffering from breast cancer, "In your opinion, what is quality of life?" Their replies were analyzed using factorial methods for categorical variables. RESULTS: The most used graphical forms and repeated segments were associated with notions linked to well-being and health; analyzing characteristic forms supported these concepts importance. Some concepts appeared to be more relevant according to patient age-group. The young female group emphasized the right and opportunity to have adequate treatment whilst overcoming disease and response to its treatment were relevant to the 41-50 year-old group. Functioning and enjoyment were significant for the 51-60 year-old group whilst patients aged over 60 emphasized spiritual well-being. Binary correspondence analysis identified three domains: health (not just being the absence of disease or infirmity), autonomy or adequate dependence, and family/social well-being. Age-groups had differential representation regarding each domain. CONCLUSIONS: Besides traditional domains, spirituality and a particular system guaranteeing access to quality health-care emerged as being important domains in female cancer patients perception of the quality of life. Quality of life is a multidimensional and dynamic concept that changes according to age; this suggested that quality of life is supported by subjective conceptualization; the use of scales for measuring quality of life could thus be questionable because of their subjectivity and dynamic nature.