The placental imprinted DLK1-DIO3 domain: a new link to prenatal and postnatal growth in humans.

BACKGROUND: The developmentally important DLK1-DIO3 imprinted domain on human chromosome 14 is regulated by 2 differentially methylated regions, the intergenic differentially methylated region and the MEG3 differentially methylated region. OBJECTIVE: The aim was to determine the natural variation in DNA methylation at these differentially methylated regions in human placentas, and to determine its link to gene expression levels at the domain. The second goal was to explore whether the domain's methylation and gene expression correlate with prenatal and early postnatal growth of the conceptus. STUDY DESIGN: Using pyrosequencing, we determined methylation levels at CpG dinucleotides across the 2 regulatory differentially methylated regions in placentas from 91 healthy mothers. At birth, placentas and infants were weighed (gestational age 39 ± 1 weeks; birthweight SD score 0.1 ± 0.8) and placental biopsies were collected. RNA expression was quantitated by real-time polymerase chain reaction. Infants' weights and lengths were followed up monthly during the first year. RESULTS: Methylation levels at the 2 regulatory differentially methylated regions were linked and varied considerably between placentas. MEG3 promoter differentially methylated region methylation correlated negatively with weight increase (ß = -0.406, P = .001, R2 = 0.206) and length increase (ß = -0.363, P = .002, R2 = 0.230) during the first postnatal year. The methylation level of the intergenic differentially methylated region correlated with DIO3 expression (ß = 0.313, P = .032, R2 = 0.152). Furthermore, the expression of both DIO3 and RTL1 (both imprinted genes within the DLK1-DIO3 domain) was negatively associated with birthweight (ß = -0.331, P = .002, R2 = 0.165; and ß = -0.307, P = .005, R2 = 0.159, respectively). RTL1 expression, in addition, was negatively linked to birth length (ß = -0.306, P = .007, R2 = 0.162). CONCLUSION: Our combined findings strongly suggest that placental DNA methylation at the DLK1-DIO3 domain's intergenic differentially methylated region and MEG3 promoter differentially methylated region relates to measures of early human growth, and may thus contribute to its control.

Modelo de atención al parto dirigido por matronas frente al dirigido por matronas y obstetras en el Hospital Dr. Josep Trueta de Girona / Model of care in normal childbirth, attended by midwives, compared with a medicalized care model attended by midwives and obstetricians

OBJETIVO: Analizar el modelo de atención al parto normal, dirigido por matronas, comparándolo con el modelo de atención al parto intervenido (eutócico, instrumental o por cesárea), atendido por matronas y obstetras. METODOLOGÍA: Estudio prospectivo y longitudinal realizado en el Hospital Universitario Dr. Josep Trueta de Girona entre marzo y mayo de 2010, con mujeres en proceso de parto. Se estudiaron variables sociodemográficas de las mujeres en fase de parto, su satisfacción con el proceso de parto, el estado de salud de los recién nacidos al nacer, y las complicaciones y reingresos hospitalarios de las madres o los recién nacidos durante el primer mes post-alta. El análisis estadístico se realizó con el programa SPSS 15.0 para Windows. RESULTADOS: La muestra de estudio estuvo formada por 99 mujeres en proceso de parto con una media de edad de 30,3 años. El 31,3% de ellas tuvieron un parto normal, no intervenido, y en este modelo de atención el grado de satisfacción de la mujer fue mayor. No se observaron diferencias en las variables bioquímicas ni en el estado de salud de los recién nacidos según el tipo de parto, excepto en el test de Apgar a los 5 minutos, que fue superior en los recién nacidos en un parto normal. Tampoco hubo diferencias en las complicaciones, ni maternas ni neonatales, entre los dos modelos de atención. CONCLUSIONES: No se constataron diferencias significativas entre las madres de uno y otro grupo en relación con su salud y bienestar durante el primer mes post-alta. En cuanto a los bebés, los nacidos de partos normales presentaron puntuaciones iguales o superiores en el test de Apgar a los 5 minutos

OBJECTIVE: To analyze the model of care in normal childbirth, attended by midwives, compared with a medicalized care model (attended by midwives and obstetricians) in vaginal, instrumental or caesarean delivery studying the health and wellbeing of mothers and newborns at delivery, birth plan assess, the satisfaction of users and complications and readmissions of women and newborns post-discharge in the two models. METHODS: Prospective and longitudinal study conducted at the Dr. Josep Trueta University Hospital of Girona from March to May 2010 of women going into labour. We studied the sociodemographic variables of women, satisfaction with the process of childbirth, health status of infants at birth, and complications and hospital readmissions of mothers and newborns during the first month post-discharge. Statistical analysis was performed using SPSS 15.0 for Windows. RESULTS: We studied 99 women in labour with a mean age of 30.3 years. 31.3% of pregnant women had a natural birth (non-medicalized), with a higher satisfaction score in this model. We observed no differences in biochemical variables and heath status of newborns according to the type of delivery, except that the Apgar score at 5 minutes of natural birth newborns was higher than in newborns that had medicalized deliveries. There were no differences when comparing complications between the two models of care in either the mothers or the newborn babies. CONCLUSIONS: There were no significant differences between the two models of care in the mothers with regards to health and wellness, during the first month post discharge. Newborns of normal deliveries showed a similar or higher score on the variables of wellbeing and absence of fetal distress