ABSTRACT
We hypothesized that fetal exposure to the oxidative stress induced by the combined challenge of preeclampsia (PE) and high altitude would induce a significant impairment in the development of pulmonary circulation. We conducted a prospective study in La Paz (Bolivia, mean altitude 3625 m) in which newborns from singleton pregnancies with and without PE were compared (PE group n = 69, control n = 70). We conducted an echocardiographic study in these infants at the median age of two days. The percentage of cesarean deliveries and small for gestational age (SGA) infants was significantly higher in the PE group. Heart rate, respiratory rate, and oxygen saturation did not vary significantly between groups. Estimated pulmonary arterial pressure and pulmonary vascular resistance were 30% higher in newborns exposed to PE and high altitude compared with those exposed only to high altitude. We also detected signs of right ventricular hypertrophy in infants subjected to both exposures. In conclusion, this study provides evidence that the combination of PE and pregnancy at high altitude induces subclinical alterations in the pulmonary circulation of the newborn. Follow-up of this cohort may provide us with valuable information on the potential increased susceptibility to developing pulmonary hypertension or other pulmonary and cardiovascular disorders.
ABSTRACT
Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal death in low- to middle-income countries (LMIC). The American College of Obstetricians and Gynecologists (ACOG) updated diagnostic guidelines to align signs and symptoms with those associated with maternal death. We performed an observational study to ask whether ACOG guidelines were employed and associated with adverse outcomes in La Paz-El Alto, Bolivia, an LMIC. Methods: Medical records for all HDP discharge diagnoses (n = 734) and twice as many controls (n = 1647) were reviewed for one year at the three largest delivery sites. For the 690 cases and 1548 controls meeting inclusion criteria (singleton, 18-45 maternal age, local residence), health history, blood pressures, symptoms, lab tests, HDP diagnoses (i.e., gestational hypertension [GH]; preeclampsia [PE]; haemolysis, low platelets, high liver enzymes [HELLP] syndrome, eclampsia), and adverse outcomes were recorded. Bolivian diagnoses were compared to ACOG guidelines using accuracy analysis and associated with adverse outcomes by logistic regression. Findings: Both systems agreed with respect to eclampsia, but only 27% of all Bolivian HDP diagnoses met ACOG criteria. HDP increased adverse maternal- or perinatal-outcome risks for both systems, but ACOG guidelines enabled more pre-delivery diagnoses, graded maternal-risk assessment, and targeting of HDP terminating in maternal death. Interpretation: Bolivia diagnoses agreed with ACOG guidelines concerning end-stage disease (eclampsia) but not the other HDP due mainly to ACOG's recognition of a broader range of severe features. ACOG guidelines can aid in identifying pregnancies at greatest risk in LMICs, where most maternal and perinatal deaths occur. Funding: NIH TW010797, HD088590, HL138181, UL1 TR002535.
ABSTRACT
El recién nacido experimenta varios cambios adaptativos después de nacer, uno de ellos es la regulación térmica. El objetivo de este estudio fue determinar si el contacto inmediato del recién nacido con la madre tiene influencia en la evolución de la temperatura corporal. Se estudiaron recién nacidos de término, sanos, nacidos por parto vaginal y con peso mayor de 2500 gr. Ingresaron al estudio 66 neonatos los que fueron distribuidos en dos grupos: grupo A, aquellos que tuvieron contacto inmediato con la madre y grupo B los que no tuvieron dicho contacto. Concluyeron el estudio 60: 30 en el grupo A y 30 en el grupo B, a todos ellos de les tomo la temperatura rectal a los 15 minutos, dos y cuatro horas de vida. La moda del grupo A mostró una temperatura ascendente de 36ºC; 36,2ºC y 36,7ºC en las sucesivas determinaciones y en el grupo B una temperatura descendente de 37ºC; 36,2ºC y 36ºC respectivamente. Concluimos que los neonatos con contacto inmediato piel a piel con su madre tienen mejor respuesta de adaptación térmica.
Newborn go through several adaptation changes after birth, one of them being thermal regulation. The object of this study was to determine if the newborns immediate contact with his mother influences, in any way, changes in his bodys temperature. Healthy, vaginal delivered, weighing over 2,500 g, full-term newborns were included in this study. 66 newborns were included, distributed in two groups. Group A: those who had immediate contact with their mother. Group B: those who had none. At the end of the study there where 60 newborns, 30 in each group. All of them had their temperature taken at 15 minutes, 2 and 4 hours after the birth. Group A showed ascending temperature of 36ºC, 36.2ºC and 36.7ºC, each time. Those in group B showed descending temperature of 37ºC; 36,2ºC and 36ºC respectively. We therefore conclude that immediate skin to skin contact of the newborn with his mother improves his thermal adaptation.