The influence of obesity and diet quality on fetal growth and perinatal outcome / Influencia de la obesidad y la calidad de la dieta en el crecimiento fetal y resultados perinatales

Background: maternal obesity is associated with an increase of both maternal and fetal complications as macrosomia.Aim:to assess the quality of diet in a cohort of pregnant women in terms of Mediterranean diet (MD) adherence and to examine the association between diet quality, obesity, weight gain and fetal growth and perinatal complications. Methods: Mediterranean Diet Adherence Screener (MEDAS) was applied to assess diet quality in 542 pregnant women. Fetal biometric measurements at third-trimester ultrasound were collected and perinatal outcomes were recorded. Results: only 35 % of pregnant women presented a good quality of diet, in terms of adherence to MD. Diet quality significantly increased with lower values of body mass index (BMI) and higher maternal age. Higher BMI was significantly associated with a higher abdominal circumference and estimated fetal weight at the third trimester, a higher risk of hypertension disorder, induction of labor and a higher birthweight. A statistically significant association between diet quality and ultranosographic measures or perinatal outcome was not found. However, a higher weight gain across gestation was significantly associated with a higher risk of gestational diabetes, a higher gestational age at delivery and a higher birthweight. Conclusion: most of our pregnant women did not showed a great diet quality, but there was no evidence that diet quality affected pregnancy complications. On the contrary, pre-pregnancy BMI was related to fetal and neonatal growth and obstetric outcomes, similarly to weight gain across gestation. (AU)

Introducción: la obesidad materna se asocia con un aumento de complicaciones maternas y fetales, como la macrosomía.Objetivo:evaluar la calidad de la dieta en una cohorte de mujeres embarazadas en términos de adherencia a la dieta mediterránea (DM) y examinar la asociación entre la calidad de la dieta, la obesidad, el aumento de peso y el crecimiento fetal y las complicaciones perinatales. Métodos: se aplicó el Mediterranean Diet Adherence Screener (MEDAS) para evaluar la calidad de la dieta en 542 mujeres embarazadas. Se recogieron las medidas biométricas fetales en la ecografía del tercer trimestre y se registraron los resultados perinatales. Resultados: solo el 35 % de las gestantes presentó una buena calidad de alimentación en términos de adherencia a la DM. La calidad de la dieta aumentó significativamente con valores más bajos de índice de masa corporal (IMC) y mayor edad materna. Un IMC más alto se asoció significativamente con una mayor circunferencia abdominal y peso fetal estimado en el tercer trimestre, un mayor riesgo de trastorno hipertensivo, inducción del parto y mayor peso al nacer. No se encontró una asociación estadísticamente significativa entre la calidad de la dieta y las medidas ecográficas o el resultado perinatal. Sin embargo, un mayor aumento de peso durante la gestación se asoció significativamente con un mayor riesgo de diabetes gestacional, mayor edad gestacional al momento del parto y mayor peso al nacer. Conclusiones: la mayoría de nuestras gestantes no mostró una buena calidad de la dieta, pero no hubo evidencia de que la calidad de la dieta afectara las complicaciones del embarazo. Por el contrario, el IMC pregestacional se relacionó con el crecimiento fetal y neonatal y los resultados obstétricos, de manera similar al aumento de peso durante la gestación. (AU)

The influence of obesity and diet quality on fetal growth and perinatal outcome.

Introduction: .Background: maternal obesity is associated with an increase of both maternal and fetal complications as macrosomia. Aim: to assess the quality of diet in a cohort of pregnant women in terms of Mediterranean diet (MD) adherence and to examine the association between diet quality, obesity, weight gain and fetal growth and perinatal complications. Methods: Mediterranean Diet Adherence Screener (MEDAS) was applied to assess diet quality in 542 pregnant women. Fetal biometric measurements at third-trimester ultrasound were collected and perinatal outcomes were recorded. Results: only 35 % of pregnant women presented a good quality of diet, in terms of adherence to MD. Diet quality significantly increased with lower values of body mass index (BMI) and higher maternal age. Higher BMI was significantly associated with a higher abdominal circumference and estimated fetal weight at the third trimester, a higher risk of hypertension disorder, induction of labor and a higher birthweight. A statistically significant association between diet quality and ultranosographic measures or perinatal outcome was not found. However, a higher weight gain across gestation was significantly associated with a higher risk of gestational diabetes, a higher gestational age at delivery and a higher birthweight. Conclusion: most of our pregnant women did not showed a great diet quality, but there was no evidence that diet quality affected pregnancy complications. On the contrary, pre-pregnancy BMI was related to fetal and neonatal growth and obstetric outcomes, similarly to weight gain across gestation.

Introducción: Introducción: la obesidad materna se asocia con un aumento de complicaciones maternas y fetales, como la macrosomía. Objetivo: evaluar la calidad de la dieta en una cohorte de mujeres embarazadas en términos de adherencia a la dieta mediterránea (DM) y examinar la asociación entre la calidad de la dieta, la obesidad, el aumento de peso y el crecimiento fetal y las complicaciones perinatales. Métodos: se aplicó el Mediterranean Diet Adherence Screener (MEDAS) para evaluar la calidad de la dieta en 542 mujeres embarazadas. Se recogieron las medidas biométricas fetales en la ecografía del tercer trimestre y se registraron los resultados perinatales. Resultados: solo el 35 % de las gestantes presentó una buena calidad de alimentación en términos de adherencia a la DM. La calidad de la dieta aumentó significativamente con valores más bajos de índice de masa corporal (IMC) y mayor edad materna. Un IMC más alto se asoció significativamente con una mayor circunferencia abdominal y peso fetal estimado en el tercer trimestre, un mayor riesgo de trastorno hipertensivo, inducción del parto y mayor peso al nacer. No se encontró una asociación estadísticamente significativa entre la calidad de la dieta y las medidas ecográficas o el resultado perinatal. Sin embargo, un mayor aumento de peso durante la gestación se asoció significativamente con un mayor riesgo de diabetes gestacional, mayor edad gestacional al momento del parto y mayor peso al nacer. Conclusiones: la mayoría de nuestras gestantes no mostró una buena calidad de la dieta, pero no hubo evidencia de que la calidad de la dieta afectara las complicaciones del embarazo. Por el contrario, el IMC pregestacional se relacionó con el crecimiento fetal y neonatal y los resultados obstétricos, de manera similar al aumento de peso durante la gestación.

Assessment of an intervention to optimise antenatal management of women admitted with preterm labour and intact membranes using amniocentesis-based predictive risk models: study protocol for a randomised controlled trial (OPTIM-PTL Study).

INTRODUCTION: The majority of women admitted with threatened preterm labour (PTL) do not delivery prematurely. While those with microbial invasion of the amniotic cavity (MIAC) represent the highest risk group, this is a condition that is not routinely ruled out since it requires amniocentesis. Identification of low-risk or high-risk cases might allow individualisation of care, that is, reducing overtreatment with corticosteroids and shorten hospital stay in low-risk women, while allowing early antibiotic therapy in those with MIAC. Benefits versus risks of amniocentesis-based predictor models of spontaneous delivery within 7 days and/or MIAC have not been evaluated. METHODS AND ANALYSIS: This will be a Spanish randomised, multicentre clinical trial in singleton pregnancies (23.0-34.6 weeks) with PTL, conducted in 13 tertiary centres. The intervention arm will consist in the use of amniocentesis-based predictor models: if low risk, hospital discharge within 24 hours of results with no further medication will be recommended. If high risk, antibiotics will be added to standard management. The control group will be managed according to standard institutional protocols, without performing amniocentesis for this indication. The primary outcome will be total antenatal doses of corticosteroids, and secondary outcomes will be days of maternal stay and the occurrence of clinical chorioamnionitis. A cost analysis will be undertaken. To observe a reduction from 90% to 70% in corticosteroid doses, a reduction in 1 day of hospital stay (SD of 2) and a reduction from 24% to 12% of clinical chorioamnionitis, a total of 340 eligible patients randomised 1 to 1 to each study arm is required (power of 80%, with type I error α=0.05 and two-sided test, considering a dropout rate of 20%). Randomisation will be stratified by gestational age and centre. ETHICS AND DISSEMINATION: Prior to receiving approval from the Ethics Committee (HCB/2020/1356) and the Spanish Agency of Medicines and Medical Devices (AEMPS) (identification number: 2020-005-202-26), the trial was registered in the European Union Drug Regulating Authorities Clinical Trials database (2020-005202-26). AEMPS approved the trial as a low-intervention trial. All participants will be required to provide written informed consent. Findings will be disseminated through workshops, peer-reviewed publications and national/international conferences. PROTOCOL VERSION: V.4 10 May 2021. TRIAL REGISTRATION NUMBERS: NCT04831086 and Eudract number 2020-005202-26.

Análisis comparativo de dos protocolos de misoprostol en abortos de segundo trimestre de la gestación / Comparative analysis of two misoprostol protocols in second-trimester pregnancy termination

Objetivo. Comparar el tiempo medio de expulsión de dos protocolos de misoprostol vaginal en abortos de segundo trimestre. Material y métodos. Estudio retrospectivo de 281 casos entre enero de 2000 y diciembre de 2005 (protocolo A: 800mg/24h) y junio de 2007 y diciembre de 2008 (protocolo B: 400mg/4h). Se recogió como variable principal el tiempo de expulsión. Resultados. El tiempo medio de expulsión fue similar para los dos protocolos (19,7h para el A y 17,7h para el B). Tampoco encontramos diferencias significativas en cuanto a las tasas de expulsión a las 12, 24 y 48h. El efecto adverso observado con mayor frecuencia fue la fiebre, siendo más frecuente en el protocolo B. No hubo efectos adversos mayores como rotura uterina o hemorragia severa. Conclusiones. No existen diferencias significativas entre los dos protocolos en cuánto a tiempo medio de expulsión fetal, aunque sí mayor porcentaje de fiebre en el protocolo B (AU)

Objective. To compare the mean induction-expulsion times in two regimens of vaginal misoprostol for second-trimester pregnancy termination. Material and methods. We performed a retrospective study of 281 pregnancies between January 2000 and December 2005 (regimen A: 800mg /24h) and between June 2007 and December 2008 (regimen B: 400mg /4h). Induction-expulsion time was taken as the main outcome. Results. The mean expulsion time was similar in both regimens (19.7h for A and 17.7h for B). No significant differences were found in the expulsion rate at 12, 24 and 48h. The most commonly observed adverse effect was fever, which was more frequent in regimen B. No major adverse effects such as uterine rupture or severe hemorrhage were observed. Conclusions. No significant differences were found between regimens A and B in the mean fetal expulsion time, although fever was more common in regimen B (AU)

Donovanosis genital / Genital donovanosis

Presentamos un caso de donovanosis genital en una gestante cuyo diagnóstico fue dificultoso dada la baja incidencia de esta enfermedad en nuestro país. La donovanosis o granuloma inguinal es una infección de transmisión sexual, causa de úlcera genital crónica no dolorosa. Es una enfermedad endémica en países tropicales y subtropicales. Debido al aumento de la inmigración procedente de estas zonas y al turismo sexual a países endémicos, estamos asistiendo a un aumento de esta patología infecciosa poco prevalente hasta ahora en nuestro medio (AU)

We report a case of genital donovanosis in a pregnant woman, whose diagnosis was difficult because of the low incidence of this disease in our country. Donovanosis or granuloma inguinale is a sexually transmitted infection that causes chronic genital painless ulceration. It is an endemic disease in tropical and subtropical countries. Due to the increase of immigration coming from these countries and sexual tourism in endemic countries, we are witnessing an increase in this infectious disease not very prevalent in our country until now (AU)