Menopausal symptoms and the awareness of menopausal-related information in low-income mid-aged women from Guayaquil, Ecuador.

OBJECTIVE: To assess menopausal symptoms and determine awareness of menopausal related information in mid-aged women. METHODS: This was a cross-sectional study in which 140 women aged 40 to 60 years from Guayaquil, Ecuador were surveyed with the short 10-item Cervantes Scale (CS-10) and a questionnaire containing personal data and questions assessing awareness of menopause related information. RESULTS: The mean age of the sample was 48.0 ± 5.6 years. More than half of surveyed women had low education and non-urban residency, none were on menopausal hormone therapy, 33.6% had hypertension, 35% were postmenopausal, 78.6% had an increased body mass index (overweight/obese) and 92.9% had abdominal obesity (waist > 88 cm). The average CS-10 score was 15.3 ± 9.0 with a median of 14.0. The three most frequent menopausal symptoms were muscle-joint pain (75.0%), changes in skin texture (74.3%) and vaginal dryness (71.4%). Regarding awareness of information related to the menopause, it was found that 98.6% of women had no idea about what the menopause is and the average age of its onset. Interestingly, although 61.4% knew that during the menopause there is weight gain, 57.9% were sedentary. Married, postmenopausal, older and less educated women presented higher mean total CS-10 scores. Contrarily, those with less awareness of menopause related information present lower scores. CONCLUSION: In this low-income mid-aged female sample there was a high rate of non-awareness regarding information related to the menopause, including an unhealthy cardiometabolic profile. There is a need for educational programs aimed to increase awareness in this high-risk population in relation to the surveyed aspects in order to improve their health status and prevent chronic conditions.

Polymorphism of the THOC5 of the transcription/export multiprotein complex and its correlation with the lipid and metabolic profile in middle-aged women.

The transcription/export complex (TREX) is formed by a core called THO. These are necessary for the transcription and packaging of messenger RNA and its subsequent nuclear exportation. Studies have correlated THO-specific polymorphisms with abnormalities of HDL-C metabolism. To correlate lipid and metabolic parameters with the genetic variants of the rs8135828 polymorphism of the THOC5 gene in middle-aged women. DNA was extracted from the whole blood of 183 women aged 40-65 and tested for the rs8135828 polymorphism of the THOC5 gene using real-time PCR. HDL-C, LDL-C, triglyceride, and total cholesterol levels, as well as other metabolic parameters, were correlated with the polymorphism genotypes: GG, AG, and AA. Mean age of women was 50.6 ± 6.3 years, 54.6% were postmenopausal and 16.4% had the metabolic syndrome. GG was the most frequently determined genotype (62.3%). There were no differences in lipid levels according to genotypes; although there was a trend for lower HDL-C levels for the AA and AG + AA genotypes. Those with the AG and AG + AA genotypes displayed significantly higher glucose levels (p = .02 and p = .002, respectively); with a trend toward a higher metabolic syndrome prevalence and increased abdominal perimeters in both variants (AG and AG + AA). The AG genotype was related to higher glucose levels but not with abnormal lipid parameters. There is a need for more research in this regard.

Evaluation of depressive symptoms in mid-aged women: report of a multicenter South American study.

OBJECTIVE: To evaluate depressive symptoms and related factors among mid-aged women using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). METHODS: This was a cross-sectional multicenter study in which women aged 40 to 65 from various South American countries were surveyed with the CESD-10 and a general questionnaire containing personal and partner data. RESULTS: In all, 864 women were interviewed from Colombia (Afro-Colombian, n = 215), Ecuador (Mestizo, n = 202), Perú (Quechua at high altitude, n = 231), and Paraguay (Mestizo, n = 216). Mean age of the whole sample was 49.1 ±â€Š6.0 years. Although the rate of postmenopausal status was similar among studied sites, differences were observed in relation to age, parity, hormone therapy use, hot flush rate, sedentary lifestyle, chronic medical conditions, habits, and partner aspects. Median total CESD-10 score for all sites was 7.0, with a 36.0% (n = 311) having scores equal to 10 or more (suggestive of depressed mood). Higher scores were observed for Afro-Colombian and Quechua women, and also for postmenopausal and perimenopausal ones. Multivariate linear regression analysis found that depressed mood (higher CESD-10 total scores) was significantly associated with ethnicity (Afro-Colombian), hot flush severity, hormone therapy use, sedentary lifestyle, postmenopause, perceived unhealthy status, and lower education. Higher monthly coital frequency and having a healthy partner without premature ejaculation was related to lower scores, hence less depressed mood. CONCLUSION: In this mid-aged female South American sample, depressive symptoms correlated to menopausal status and related aspects, ethnicity, and personal and partner issues. All these features require further research.

Lower placental growth factor and higher free ß-hCG and PAPP-A levels in the fetal circulation of near-term pregnancies complicated with severe preeclampsia.

BACKGROUND: An imbalance between anti- and angiogenic factors during early placentation is key for the development of preeclampsia. Nevertheless, the majority of studies addressing this issue relate to maternal blood and not the fetal circulation. OBJECTIVE: To measure placental growth factor (PlGF), free beta human chorionic gonadotropin (ß-hCG), and pregnancy-associated plasma protein-A (PAPP-A) levels in the fetal circulation of near-term pregnancies complicated with severe preeclampsia (n = 20), and their controls matched for parity, and maternal and gestational age. METHOD: Upon delivery, a blood sample was withdrawn from the umbilical artery and vein of each case and its control in order to measure the proposed analytes using direct fluoroimmunoassay. RESULTS: Preeclampsia cases showed significantly lower median PlGF levels in fetal circulation as compared to controls (25.2 versus 36.9 and 23.6 versus 33.9 pg/mL, artery and vein, respectively, p < 0.05). Contrarily, cases displayed higher concentrations of PAPP-A (1024.0 versus 720.9 [median] and 1027.0 ± 298.4 versus 690.3 ± 401.9 mIU/L, artery and vein, respectively, p < 0.05), and free ß-hCG (mean: 33.9 ± 4.3 versus 17.2 ± 4.0 and 30.1 ± 5.2 versus 13.7 ± 3.3 ng/mL, artery, and vein respectively, p < 0.05). CONCLUSION: Lower PlGF and higher PAPP-A and free ß-hCG levels were found in the fetal circulation of near-term severe preeclamptic pregnancies. There is a need for more research in this regard.

Polymorphisms of the methylenetetrahydrofolate reductase gene (C677T and A1298C) in the placenta of pregnancies complicated with preeclampsia.

BACKGROUND: Preeclampsia has been related to single-nucleotide polymorphisms (SNPs) of the methylenetetrahydrofolate reductase (MTHFR) gene; however, data regarding the placenta are still lacking. OBJECTIVE: To determine the frequency of C677T and A1298C SNPs of the MTHFR gene in the placenta of preeclamptic pregnancies and healthy controls. METHODS: Genotyping of C677T and A1298C polymorphisms of the MTHFR gene using RFLP-PCR was performed to the placenta of 100 gestations (n = 50 complicated with preeclampsia and n = 50 normal controls matched for parity and maternal age). RESULTS: Gestational age at birth and neonatal and placental weight were significantly lower in women with preeclampsia as compared to controls. The TT genotype of the C677T polymorphism was threefold more prevalent in preeclamptic placentas as compared to the placenta of controls (24.0% versus 8.0%, p = 0.001). Upon pooled analysis (n = 100), placental and neonatal weights were significantly lower in placentas displaying this genotype (TT, C677T) as compared with the CC genotype. CONCLUSION: This study found that the frequency of the TT mutant genotype of the C677T polymorphism was higher in the placenta of pregnancies complicated with preeclampsia. There is a need for further research in this matter.

Resultados maternos y perinatales en gestantes nulíparas con preeclampsia de aparición tardía: estudio comparativo frente a gestantes sin preeclampsia / Maternal and perinatal outcomes in nulliparous gestations with late onset preeclampsia: Comparative study with gestations without preeclampsia

OBJETIVO: Evaluar los resultados obstétricos de una muestra de gestantes nulíparas con preeclampsia, en comparación con gestantes sin preeclampsia, asistidas en el Hospital Enrique C. Sotomayor de Guayaquil, Ecuador. MÉTODO: Este fue un estudio comparativo de los resultados maternos y perinatales de gestantes con preeclampsia de aparición tardía (n = 150; edad gestacional = 36,7 ± 3,3 semanas) frente a los de embarazos normales (n = 150; edad gestacional 38,7 ± 1,7 semanas). RESULTADOS: Un 73,3% de los casos de preeclampsia fueron formas graves. En comparación con los embarazos normales, los casos de preeclampsia tuvieron índices antropométricos (perímetro del cuello y del brazo) más altos y mayores tasas de oligoamnios, cesáreas, transfusiones, niños con distrés respiratorio y resultados perinatales adversos como test de Apgar bajo al nacer y mayores tasas de nacimientos pretérmino, nacidos de bajo peso, y niños pequeños para la edad gestacional. CONCLUSIÓN: Las embarazadas con preeclampsia tuvieron resultados maternos y perinatales negativos en comparación con las gestantes sin preeclampsia

OBJECTIVE: To assess obstetrical outcomes in a sample of nulliparous gestations with preeclampsia, as compared to gestations without preeclampsia, attended in the Enrique C. Sotomayor Hospital of Guayaquil, Ecuador. METHOD: This was a comparative study of maternal and perinatal outcome data of gestations with late onset preeclampsia (n = 150; gestational age = 36.7 ± 3.3 weeks) with that of normal gestations (n = 150; gestational age 38.7 ± 1.7 weeks). RESULTS: Almost three-quarters (73.3%) of preeclampsia cases were defined as severe. Compared to normal gestations, preeclampsia cases had higher anthropometric indices (neck and mid-arm circumference) and had more oligohydramnios, cesarean sections, transfusions, distressed fetuses, and adverse perinatal outcomes such as, lower Apgar scores at birth, and more preterm births, lower birth weight and small for gestational age infants. CONCLUSIÓN: Gestations with preeclampsia had a negative impact on maternal and perinatal outcomes compared to gestations without preeclampsia

[Maternal and perinatal outcomes in nulliparous gestations with late onset preeclampsia: Comparative study with gestations without preeclampsia]. / Resultados maternos y perinatales en gestantes nulíparas con preeclampsia de aparición tardía: estudio comparativo frente a gestantes sin preeclampsia.

OBJECTIVE: To assess obstetrical outcomes in a sample of nulliparous gestations with preeclampsia, as compared to gestations without preeclampsia, attended in the Enrique C. Sotomayor Hospital of Guayaquil, Ecuador. METHOD: This was a comparative study of maternal and perinatal outcome data of gestations with late onset preeclampsia (n=150; gestational age=36.7±3.3 weeks) with that of normal gestations (n=150; gestational age 38.7±1.7 weeks). RESULTS: Almost three-quarters (73.3%) of preeclampsia cases were defined as severe. Compared to normal gestations, preeclampsia cases had higher anthropometric indices (neck and mid-arm circumference) and had more oligohydramnios, cesarean sections, transfusions, distressed fetuses, and adverse perinatal outcomes such as, lower Apgar scores at birth, and more preterm births, lower birth weight and small for gestational age infants. CONCLUSION: Gestations with preeclampsia had a negative impact on maternal and perinatal outcomes compared to gestations without preeclampsia.

Polymorphisms of the methylenetetrahydrofolate reductase gene (C677T and A1298C) in nulliparous women complicated with preeclampsia.

OBJECTIVE: To determine the prevalence of C677T and A1298C Single-nucleotide polymorphisms (SNPs) of the MTHFR gene in nulliparous women complicated with preeclampsia (PE). METHODS: One hundred fifty gestations complicated with PE and their corresponding controls without the disease were recruited for the genotyping of C677T and A1298C polymorphisms of the MTHFR gene using restriction fragment length polymorphism polymerase chain reaction. Secondarily, homocysteine (HCy) plasma levels were measured in preeclamptic women displaying the CC genotype of the A1298C polymorphism (homozygous) and compared to HCy levels determined among controls with the normal AA genotype for the A1298C variant. RESULTS: Only the mutant CC genotype of the A1298C polymorphism was associated to higher risk of presenting PE, as frequency of this genotype was significantly higher among cases than controls (15.3% versus 0.7%, p < 0.05). All PE women with a neck circumference ≥32 cm presented the mutant CC A1298C polymorphism as compared to none among preeclamptics with a lower neck circumference (p = 0.0001). Women with the mutant CC A1298C SNP displayed higher plasma HCy levels as compared to controls with normal AA A1298C genotype (8.4 ± 2.6 versus 7.5 ± 2.7 mmoL/L p = 0.04). CONCLUSION: Prevalence of the CC mutant genotype of the A1298C polymorphism was higher among PE women. This mutation among PE women was related to increased neck circumference and higher HCy levels. Future research should aim at linking these gestational findings with obesity and cardiovascular risk.

Intimate partner violence and psychoemotional disturbance among pregnant women admitted to hospital with prenatal complications.

OBJECTIVE: To assess intimate partner violence (IPV) and psychoemotional disturbance among pregnant women in a low-income setting. METHODS: In total, 283 pregnant women with high-risk prenatal complications were surveyed via the 20-item Self-Reporting Questionnaire (SRQ-20) and the Violence against Women screening tool. A total SRQ-20 score of at least 7 was defined as indicating psychoemotional disturbance. RESULTS: Median age of participants was 24 years, 65 (23.0%) came from marginal areas, 6 (2.1%) had no education, and 75 (26.5%) had fewer than 5 prenatal visits. Median gestational age at survey was 33 weeks, with 224 (79.2%) admitted for treatment of threatened preterm labor. Median age of partner was 27 years, and 72 (25.5%) consumed alcohol on a daily basis. Ninety-eight (34.6%) pregnant women experienced at least 1 type of physical abuse or violence during the current pregnancy. Median total SRQ-20 score was 7. Overall, 145 (51.2%) had scores of 7 or higher. Total SRQ-20 scores positively correlated with the presence of IPV (number of positive items) and parity, and inversely correlated with maternal education level and gestational age at survey. CONCLUSION: IPV was highly prevalent and significantly correlated with female psychoemotional disturbance.

Inhaled intrapartum analgesia using a 50-50 % mixture of nitrous oxide-oxygen in a low-income hospital setting.

AIM: To analyze the benefits of an inhaled analgesia procedure over intrapartum pain and the degree of satisfaction of using this method. METHODS: This was a pilot study carried out at a low-income hospital setting in which women with singleton pregnancies, cephalic presentation and active phase of labor were requested to inhale ad libitum a 50-50 % mixture of nitrous oxide and oxygen (N(2)O-O(2)) (Oxicalm(®), Indura S.A-Indura Ecuador) using a face mask with an auto-demand valve. Effect over labor pain and dynamics and side effects were recorded. RESULTS: A total of 126 gravids participated with a mean age of 21.6 ± 6.7 years, 50.8 % of which were adolescents. As assessed by the Visual Analog Scale 1 h after initiating the procedure pain significantly decreased 56.2 % on average (8.9-4.9 points, p = 0.001), while increasing cervical dilation and effacement by 28.4 and 21.7 %, respectively. Overall vaginal delivery was achieved in 96.9 % of cases, with an average procedure initiation to delivery time interval of 2 ± 1 h and mixture consumption of 0.93 kg. Vaginal delivery rates were 36.5, 78.6 and 89.7 % for the first, second and third hour, respectively. During that time maternal hemodynamic parameters remained unaltered. Mean duration of the second stage of delivery was 6.2 min. Obstetrical and neonatal outcome was otherwise favorable. Main adverse effect of using the mixture was dizziness (43.7 %) referred by gravids as mild and tolerable. A 96 % of users answered that they would recommend the method and graded it in 92.9 % as good/excellent. CONCLUSION: Inhaled intrapartum analgesia using a N(2)O-O(2) 50-50 % mixture provided rapid pain alleviation. It is an appealing, effective and safe method for the management of pain during labor, most useful at institutions with infrastructure and personnel limitations.

Depressive Symptoms and Resilience among Pregnant Adolescents: A Case-Control Study.

Background. Data regarding depression and resilience among adolescents is still lacking. Objective. To assess depressive symptoms and resilience among pregnant adolescents. Method. Depressive symptoms and resilience were assessed using two validated inventories, the 10-item Center for Epidemiologic Studies Short Depression Scale (CESD-10) and the 14-item Wagnild and Young Resilience Scale (RS), respectively. A case-control approach was used to compare differences between adolescents and adults. Results. A total of 302 pregnant women were enrolled in the study, 151 assigned to each group. Overall, 56.6% of gravids presented total CESD-10 scores 10 or more indicating depressed mood. Despite this, total CESD-10 scores and depressed mood rate did not differ among studied groups. Adolescents did however display lower resilience reflected by lower total RS scores and a higher rate of scores below the calculated median (P < .05). Logistic regression analysis could not establish any risk factor for depressed mood among studied subjects; however, having an adolescent partner (OR, 2.0 CI 95% 1.06-4.0, P = .03) and a preterm delivery (OR, 3.0 CI 95% 1.43-6.55, P = .004) related to a higher risk for lower resilience. Conclusion. In light of the findings of the present study, programs oriented at giving adolescents support before, during, and after pregnancy should be encouraged.