"INTERGROWTH21st vs customized fetal growth curves in the assessment of the neonatal nutritional status: a retrospective cohort study of gestational diabetes".

BACKGROUND: Gestational diabetes mellitus is associated with increased incidence of adverse perinatal outcomes including newborns large for gestational age, macrosomia, preeclampsia, polyhydramnios, stillbirth, and neonatal morbidity. Thus, fetal growth should be monitored by ultrasound to assess for fetal overnutrition, and thereby, its clinical consequence, macrosomia. However, it is not clear which reference curve to use to define the limits of normality. Our aim is to determine which method, INTERGROWTH21st or customized curves, better identifies the nutritional status of newborns of diabetic mothers. METHODS: This retrospective cohort study compared the risk of malnutrition in SGA newborns and the risk of overnutrition in LGA newborns using INTERGROWTH21st and customized birth weight references in gestational diabetes. The nutritional status of newborns was assessed using the ponderal index. Additionally, to determine the ability of both methods in the identification of neonatal malnutrition and overnutrition, we calculate sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios. RESULTS: Two hundred thirty-one pregnant women with GDM were included in the study. The rate of SGA indentified by INTERGROWTH21st was 4.7% vs 10.7% identified by the customized curves. The rate of LGA identified by INTERGROWTH21st was 25.6% vs 13.2% identified by the customized method. Newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH21st. (RR 4.24 vs 2.5). LGA newborns according to the customized method also showed a higher risk of overnutrition than those classified as LGA according to INTERGROWTH21st. (RR 5.26 vs 3.57). In addition, the positive predictive value of the customized method was superior to that of INTERGROWTH21st in the identification of malnutrition (32% vs 27.27%), severe malnutrition (22.73% vs 20%), overnutrition (51.61% vs 32.20%) and severe overnutrition (28.57% vs 14.89%). CONCLUSIONS: In pregnant women with DMG, the ability of customized fetal growth curves to identify newborns with alterations in nutritional status appears to exceed that of INTERGROWTH21st.

Neuroapoptosis in newborns with respiratory acidosis at birth.

BACKGROUND: S100B protein is one of the most accurate biomarkers for diagnosis of neuroapoptosis and brain damage. The aim was to evaluate the lactate concentration and acid-base balance (pH, pCO2, pO2, HCO3c and BEb) in umbilical cord blood to predict high risk of neuroapoptosis and analyze the relationship between the levels of these biomarkers and umbilical cord blood S100B protein concentration at birth. METHODS: Apparently healthy newborns were included. S100B protein and blood gas test (lactate and acid-base balance) were determined in umbilical cord blood at birth. Newborns were classified into two groups: with and without high risk of neuroapoptosis. Newborns with high umbilical cord blood S100B protein concentration were considered newborns at high risk of neuroapoptosis. RESULTS: Sixty-one newborns were included, 12 had high risk of neuroapoptosis and 49 did not. S100B protein concentration correlate directly with pCO2 levels (Rho: 0.286, p = .0321) and lactate concentration (Rho: 0.278, p = .0315); and indirectly with pH (Rho: -0.332, p = .01). The analysis of the ROC curves yielded significant curves for pH and pCO2 to predict high risk of neuroapoptosis, pH optimal cutoff value was 7.19 (sensitivity: 50%, specificity: 83.7%, AUC: 0.708); and pCO2 optimal cutoff value was 60 mmHg (sensitivity: 30%, specificity: 85.4%, AUC: 0.705). CONCLUSIONS: Respiratory acidosis is associated to high concentrations of S100B protein in umbilical cord blood at birth. Umbilical cord blood pH and pCO2 may be useful in differentiating newborns at high risk of neuroapoptosis. Umbilical cord blood gas test may be valuable as risk indicator for neuroapoptosis at birth.

[Overweight and obesity at risk factors for hypertensive states of pregnancy: a retrospective cohort study]. / Sobrepeso y obesidad como factores de riesgo de los estados hipertensivos del embarazo: estudio de cohortes retrospectivo.

INTRODUCTION: obesity has been associated with an increased risk of preeclampsia and gestational hypertension. OBJECTIVE: to determine if overweight and/or maternal obesity at the beginning of the pregnancy are associated with an increased risk of suffering from some hypertensive state of pregnancy in a population of southern Spain. METHODS: retrospective cohort study. We studied 4,711 cases where the IMC had been registered at the beginning of pregnancy. Two study groups were included: overweight/obesity at the beginning of the gestation. CONTROL GROUP: pregnant women with normal BMI at the beginning of gestation. Global risk of hypertensive disorders of pregnancy (HDP) and the risk of gestational hypertension, preeclampsia, chronic hypertension and preeclampsia superimposed on chronic hypertension were evaluated. RESULTS: maternal overweight was associated with an increased risk of HDP (OR 2.04, 95% CI: 1.43-2.91) and an increased risk of gestational hypertension (OR 1.68, 95% CI: 1.03-2.72) and chronic HT (OR: 3.70, 95% CI: 1.67-8.18). Maternal obesity was associated with an increase in some HDP (OR 3.54, 95% CI: 2.65-4.73), gestational hypertension (OR 2.94, 95% CI: 2-4.33), chronic HT (OR 8.31, 95% CI: 4.23-16.42) and preeclampsia (OR 2.08, 95% CI: 1.12-3.87) In the multivariate analysis (adjusted for parity and maternal age), overweight was associated with an increased risk of gestational hypertension (OR: 1.74, 95% CI: 1.06-2.85), chronic HT (OR 3.76, 95% CI: 1.69-8.35) and preeclampsia (OR 2.12, 95% CI: 1.005-4.48); obesity also increased the risk of gestational hypertension (OR 2.40, 95% CI: 1.39-4.13), chronic hypertension (OR 17.96, 95% CI: 8.78-36.76) and preeclampsia (OR 3, 69; 95% CI: 1.64-8.27). CONCLUSIONS: in conclusion, a significant and independent association was found between maternal overweight/obesity and HDP. The risk is significantly higher as the BMI increases (from overweight to obesity grade 3).

Introducción: la obesidad se ha asociado a un riesgo aumentado de padecer preeclampsia e hipertensión arterial gestacional.Objetivos: determinar si el sobrepeso y/o la obesidad materna al inicio de la gestación se asocian a un incremento del riesgo de padecer algún estado hipertensivo del embarazo en una población del sur de España.Métodos: estudio de cohortes retrospectivo. Se estudiaron 4.711 casos en los cuales se había registrado el IMC al inicio de la gestación. Grupos de estudio: a) sobrepeso; y b) obesidad al inicio de la gestación (desglosada por tipo de obesidad). Grupo control: IMC normal al inicio de la gestación. Se calculó el riesgo de presentar estados hipertensivos del embarazo (EHE) en general, hipertensión arterial (HTA) gestacional, preeclampsia, HTA crónica y preeclampsia sobreañadida a HTA crónica.Resultados: el sobrepeso materno se asoció a un incremento del riesgo de padecer algún EHE (OR 2,04, IC 95%: 1,43-2,91) y a un incremento del riesgo de padecer HTA gestacional (OR 1,68, IC 95%: 1,03-2,72) e HTA crónica (OR: 3,70, IC 95%: 1,67-8,18). La obesidad materna se asoció a un incremento de padecer algún EHE (OR 3,54, IC 95% 2,65-4,73), HTA gestacional (OR 2,94, IC 95% 2-4,33), HTA crónica (OR 8,31, IC 95%: 4,23-16,42) y preeclampsia (OR 2,08, IC 95%: 1,12-3,87). En el análisis multivariante (ajustado por la paridad y edad materna), el sobrepeso se asoció a un riesgo aumentado de padecer HTA gestacional (OR:1,74, IC 95%: 1,06-2,85), HTA crónica (OR 3,76, IC 95% 1,69-8,35) y preeclampsia (OR 2,12, IC 95% 1,005-4,48); la obesidad también incrementó el riesgo de HTA gestacional (OR 2,40, IC 95% 1,39-4,13), HTA crónica (OR 17,96, IC 95% 8,78-36,76) y preeclampsia (OR 3,69, IC 95% 1,64-8,27). Conclusiones: el sobrepeso y la obesidad aumentan el riesgo de padecer EHE. El riesgo es significativamente mayor conforme se incrementa el IMC (desde sobrepeso a obesidad grado 3).

Sobrepeso y obesidad como factores de riesgo de los estados hipertensivos del embarazo: estudio de cohortes retrospectivo / Overweight and obesity at risk factors for hypertensive states of pregnancy: a retrospective cohort study

Introducción: la obesidad se ha asociado a un riesgo aumentado de padecer preeclampsia e hipertensión arterial gestacional. Objetivos: determinar si el sobrepeso y/o la obesidad materna al inicio de la gestación se asocian a un incremento del riesgo de padecer algún estado hipertensivo del embarazo en una población del sur de España. Métodos: estudio de cohortes retrospectivo. Se estudiaron 4.711 casos en los cuales se había registrado el IMC al inicio de la gestación. Grupos de estudio: a) sobrepeso; y b) obesidad al inicio de la gestación (desglosada por tipo de obesidad). Grupo control: IMC normal al inicio de la gestación. Se calculó el riesgo de presentar estados hipertensivos del embarazo (EHE) en general, hipertensión arterial (HTA) gestacional, preeclampsia, HTA crónica y preeclampsia sobreañadida a HTA crónica. Resultados: el sobrepeso materno se asoció a un incremento del riesgo de padecer algún EHE (OR 2,04, IC 95%: 1,43-2,91) y a un incremento del riesgo de padecer HTA gestacional (OR 1,68, IC 95%: 1,03-2,72) e HTA crónica (OR: 3,70, IC 95%: 1,67-8,18). La obesidad materna se asoció a un incremento de padecer algún EHE (OR 3,54, IC 95% 2,65-4,73), HTA gestacional (OR 2,94, IC 95% 2-4,33), HTA crónica (OR 8,31, IC 95%: 4,23-16,42) y preeclampsia (OR 2,08, IC 95%: 1,12-3,87). En el análisis multivariante (ajustado por la paridad y edad materna), el sobrepeso se asoció a un riesgo aumentado de padecer HTA gestacional (OR:1,74, IC 95%: 1,06-2,85), HTA crónica (OR 3,76, IC 95% 1,69-8,35) y preeclampsia (OR 2,12, IC 95% 1,005-4,48); la obesidad también incrementó el riesgo de HTA gestacional (OR 2,40, IC 95% 1,39-4,13), HTA crónica (OR 17,96, IC 95% 8,78-36,76) y preeclampsia (OR 3,69, IC 95% 1,64-8,27). Conclusiones: el sobrepeso y la obesidad aumentan el riesgo de padecer EHE. El riesgo es significativamente mayor conforme se incrementa el IMC (desde sobrepeso a obesidad grado 3)

Introduction: obesity has been associated with an increased risk of preeclampsia and gestational hypertension. Objective: to determine if overweight and/or maternal obesity at the beginning of the pregnancy are associated with an increased risk of suffering from some hypertensive state of pregnancy in a population of southern Spain. Methods: retrospective cohort study. We studied 4,711 cases where the IMC had been registered at the beginning of pregnancy. Two study groups were included: overweight/obesity at the beginning of the gestation. Control group: pregnant women with normal BMI at the beginning of gestation. Global risk of hypertensive disorders of pregnancy (HDP) and the risk of gestational hypertension, preeclampsia, chronic hypertension and preeclampsia superimposed on chronic hypertension were evaluated. Results: maternal overweight was associated with an increased risk of HDP (OR 2.04, 95% CI: 1.43-2.91) and an increased risk of gestational hypertension (OR 1.68, 95% CI: 1.03-2.72) and chronic HT (OR: 3.70, 95% CI: 1.67-8.18). Maternal obesity was associated with an increase in some HDP (OR 3.54, 95% CI: 2.65-4.73), gestational hypertension (OR 2.94, 95% CI: 2-4.33), chronic HT (OR 8.31, 95% CI: 4.23-16.42) and preeclampsia (OR 2.08, 95% CI: 1.12-3.87) In the multivariate analysis (adjusted for parity and maternal age), overweight was associated with an increased risk of gestational hypertension (OR: 1.74, 95% CI: 1.06-2.85), chronic HT (OR 3.76, 95% CI: 1.69-8.35) and preeclampsia (OR 2.12, 95% CI: 1.005-4.48); obesity also increased the risk of gestational hypertension (OR 2.40, 95% CI: 1.39-4.13), chronic hypertension (OR 17.96, 95% CI: 8.78-36.76) and preeclampsia (OR 3, 69; 95% CI: 1.64-8.27). Conclusions: in conclusion, a signifi cant and independent association was found between maternal overweight/obesity and HDP. The risk is signifi cantly higher as the BMI increases (from overweight to obesity grade 3)

"Hypothyroidism screening during first trimester of pregnancy".

BACKGROUND: Subclinical hypothyroidism is defined as an elevated thyroid-stimulating hormone level with a normal thyroxin level without signs or symptoms of hypothyroidism. Although it is well accepted that overt hypothyroidism has a deleterious impact on pregnancy, recent studies indicate that subclinical hypothyroidism may affect maternal and fetal health. Studies suggest an association between miscarriage and preterm delivery in euthyroid women positive for anti-peroxidase antibodies and/or anti-thyroglobulin antibodies. A proposal of a new set-point to diagnose SCH was recently published. The aim of this research was to determine the optimal thyroid-stimulating hormone cut-off point to screen for subclinical hypothyroidism in the first trimester of gestation in a population of our clinical area and to determine the diagnostic value of this screening test for detecting anti-thyroid peroxidase antibodies. METHODS: This cross-sectional study determines the cutoff point for SCH screening and evaluates its usefulness to detect TPO Ab using the Receiver Operating Characteristics (ROC) curve. Prevalence of SCH was calculated using as cut-off 2.5 mIU/L, 4 mIU/L, and our TSH 97.5th percentile. The ability to detect positive anti-thyroglobulin antibodies (TG Ab) and anti-thyroid peroxidase antibodies (TPO Ab) in patients with levels of TSH >97.5th percentile was determined by ROC curves. RESULTS: The mean, range and standard deviation of TSH was 2.15 ± 1.34 mIU/L (range 0.03-8.82); FT4 was 1.18 ± 0.13 ng/dL (range 0.94-1.3); TG Ab was 89.87 ± 413.56 IU/mL (range 0.10-4000); and TPO Ab was 21.61 ± 46.27 IU/mL(range 0.10-412.4). The ROC. analysis of the ability of the TSH level to predict the presence of positive TPO Ab found an AUC of 0.563. CONCLUSION: In our population, the TSH cutoff value for gestational SCH screening is 4.7 mIU/L. Using the SEGO recommended 2.5 mIU/L TSH cut-off point, the prevalence of SCH is 37%. Applying the ATA 2017 recommended cutoff point of 4 mIU/L, the prevalence of SCH is 9.6%. Finally, when the cut-off of 4.7 mIU/L (our 97.5th centile) was used, the SCH prevalence is 5%. TSH levels in the first trimester of pregnancy are not useful to detect TPO Ab.