[Maternal and perinatal morbidities associated to advanced age in pregnant women]. / Morbilidades materna y perinatal asociadas a edad avanzada en gestantes.

Background: Women in advanced maternal age (older than 35 years of age) are at higher risk of obstetric complications and adverse perinatal outcomes than younger women. Objective: To know the maternal and perinatal morbidities associated to advanced age in pregnant women. Material and methods: Analytical cross-sectional study. Women with resolution of pregnancy in the medical unit were included and distributed in two groups: group 1, advanced age, ≥ 35 years, and group 2, < 35 years. Clinical data, maternal and perinatal morbidities of the newborn (NB) were collected from the medical record. Results: We included 240 patients, 120 per group; a significant association of advanced maternal age with maternal morbidities such as diseases prior to pregnancy was demonstrated (p < 0.0001), including diabetes mellitus during pregnancy (p = 0.002), hypertensive disease of pregnancy (p = 0.0001), pregnancy resolution by cesarean section (p = 0.04), obstetric hemorrhage (p = 0.0002), prenatal control with < 5 consultations (p = 0.008), as well as those with perinatal morbidities of the NB: preterm gestational age (p = 0.001), intrauterine growth retardation (p = 0.01), low weight for gestational age (p = 0.001) and admission of the NB to the neonatal intensive care unit (p = 0.007); with multivariate analysis, an association of advanced maternal age with diabetes mellitus, hypertensive disease of pregnancy and obstetric hemorrhage was observed (R2 = 0.9884; p < 0.0001). Conclusion: The maternal and perinatal morbidities are associated with advanced age in pregnant women.

Introducción: las mujeres de edad materna avanzada (mayores de 35 años) tienen más riesgo de complicaciones obstétricas y resultados perinatales adversos que las que tienen menos de esa edad. Objetivo: conocer las morbilidades materna y perinatal asociadas a edad avanzada en gestantes. Material y métodos: estudio transversal analítico. Se incluyeron mujeres con resolución del embarazo en la unidad médica, distribuidas en: grupo 1, edad avanzada, ≥ 35 años, y grupo 2, < 35 años. Se recabaron del expediente datos clínicos, morbilidades maternas y perinatales del recién nacido (RN). Resultados: se incluyeron 240 pacientes, 120 por grupo; se observó asociación significativa de la edad materna avanzada con morbilidades maternas como enfermedades previas al embarazo (p < 0.0001), como diabetes mellitus durante el embarazo (p = 0.002), enfermedad hipertensiva del embarazo (p = 0.0001), resolución del embarazo por cesárea (p = 0.04), hemorragia obstétrica (p = 0.0002), control prenatal < 5 consultas (p = 0.008), así como aquellas con morbilidades perinatales del RN: edad gestacional pretérmino (p = 0.001), retraso en el crecimiento intrauterino (p = 0.01), peso bajo para edad gestacional (p = 0.001) e ingreso del RN a la unidad de cuidados intensivos neonatales (p = 0.007); con análisis multivariado se observó asociación de edad materna avanzada con diabetes mellitus, enfermedad hipertensiva del embarazo y hemorragia obstétrica (R2 = 0.9884; p < 0.0001). Conclusión: la morbilidad materna y perinatal se asocian a edad avanzada en gestantes.

[Prenatal diagnosis of placenta acretta by ultrasound and its histopathological association]. / Diagnóstico prenatal de acretismo placentario por ultrasonido y su asociación histopatológica.

Background: Anomalous adhesions of the placenta, known as placenta accreta and its variants, are the cause of obstetric hemorrhages that put the pregnant woman at risk. Accretism is strongly associated with a history of uterine surgery (cesarean section, myomectomy, curettage), as well as ultrasonographic signs, such as the presence and size of placental lacunae, loss of the placenta/bladder interface, location on the anterior face of the placenta, and presence of Doppler flow; these markers can be assessed by prenatal ultrasound. Objective: To analyze the association of prenatal diagnosis of placenta accreta by ultrasound with the histopathological result using the Tovbin index. Material and methods: Observational, cross-sectional and analytical study. 63 patients who had placenta accreta data by ultrasound measured with the Tovbin index and by means of the histopathological result obtained from the platform of the Mexican Institute for Social Security (IMSS) were included. The association between the two studies with the presence of placenta accreta was analyzed. Results: 63 patients were analyzed; the Tovbin index was positive in 89% of the patients with a diagnosis of placenta accreta confirmed by histopathology. Both the Tovbin index and the histopathology report showed a statistically significant association with a p value of 0.04 for the diagnosis of placenta accreta. Conclusion: The Tovbin index as an ultrasonographic prenatal diagnosis of placenta accreta has a statistically significant association with histopathology diagnosis.

Introducción: las adherencias anómalas de la placenta, conocidas como acretismo, y sus variantes son causa de hemorragias obstétricas que ponen en riesgo a la gestante. El acretismo se asocia firmemente con antecedentes de cirugías uterinas (cesárea, miomectomía, legrados), así como con signos ultrasonográficos como presencia y tamaño de lagunas placentarias, pérdida de la interfaz placenta/vejiga, localización en cara anterior de la placenta y presencia de flujo Doppler; estos marcadores pueden ser valorados mediante ecografía prenatal. Objetivo: analizar la asociación de diagnóstico prenatal de acretismo placentario por ultrasonido con el resultado histopatológico utilizando el Índice de Tovbin. Material y métodos: estudio observacional, transversal y analítico. Se incluyeron 63 pacientes que tenían datos de acretismo placentario por ultrasonido medido con el Índice de Tovbin y mediante el resultado histopatológico obtenido de la plataforma del Instituto Mexicano del Seguro Social. Se analizó la asociación de ambos estudios con la presencia de acretismo placentario. Resultados: se analizaron 63 pacientes; el Índice de Tovbin fue positivo en un 89% de las pacientes con diagnóstico de acretismo placentario confirmado por histopatología. Tanto el Índice de Tovbin como el reporte de histopatología mostraron una asociación estadísticamente significativa con un valor de p de 0.04 para el diagnóstico de acretismo placentario. Conclusión: el Índice de Tovbin como diagnóstico prenatal ultrasonográfico de acretismo placentario tiene asociación estadísticamente significativa con el diagnóstico de histopatología.

[Inflammatory indexes and their association with the severity of preeclampsia]. / Índices inflamatorios y su asociación con la severidad de la preeclampsia.

Background: Recent studies have confirmed the relationship between some inflammatory indexes and preeclampsia (PE); however, they have not been analyzed in PE with and without severity criteria. Objective: To know the association between inflammatory indexes and the severity of PE. Material and methods: Analytical cross-sectional prolective study. Pregnant patients were included, divided into group 1 (PE without severity criteria); group 2 (PE with severity criteria); group 3 (normotensive pregnant women). Records were reviewed and inflammatory indexes [(neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], lymphocyte-monocyte ratio [LMR] and systemic immune index [SII]) were calculated. Results: 240 patients were analyzed, 80 per group; age 28 (IQR 27-29) years. A significant difference was observed between group 1, group 2 and group 3, NLR 3.29 (IQR 2.82-3.69), 3.59 (IQR 2.83-4.2) and 3.42 (IQR 3.17-3.92), respectively, p = 0.02; PLR 121.59 (IQR 103.78-132), 108.32 (IQR 92.96-127.43) 136 (IQR 115.18-157.56), respectively, p = 0.01; LMR and SII showed no difference between the groups. LMR made possible to distinguish PE with and without severity criteria, cut-off point of ≥ 3.20, sensitivity 56%, specificity 56%, AUC 0.56, p = 0.01, and cut-off point ≥ 3.24, sensitivity 58%, specificity 58%, AUC 0.57, p = 0.04, respectively; the LMR ≥ 3.24 was associated with PE without severity criteria (OR 2.02 [95%CI 1.08-3.80], p = 0.03). Conclusions: The MLR was the only inflammatory index analyzed that was associated with the presence of PE without severity data. No inflammatory index was associated with PE with severity data.

Introducción: estudios recientes han confirmado la relación que existe entre algunos índices inflamatorios y la preeclampsia (PE); sin embargo, no se han analizado en la PE con y sin criterios de severidad. Objetivo: conocer la asociación entre los índices inflamatorios y la severidad de la PE. Material y métodos: estudio transversal analítico prolectivo. Se incluyeron pacientes embarazadas, distribuidas en PE sin criterios de severidad (grupo 1), PE con criterios de severidad (grupo 2) y normotensión (grupo 3). Se revisaron expedientes y se calcularon los índices inflamatorios (índice neutrófilos linfocitos [INL], plaquetas linfocitos [IPL], linfocito monocito [ILM] e inmunosistémico [IIS]). Resultados: se analizaron 240 pacientes, 80 por grupo; edad de 28 años (RIC 27-29). Se observó diferencia significativa entre grupo 1, grupo 2 y grupo 3, INL 3.29 (RIC 2.82-3.69), 3.59 (RIC 2.83-4.2) y 3.42 (RIC 3.17-3.92), respectivamente, p = 0.02; IPL 121.59 (RIC 103.78-132), 108.32 (RIC 92.96-127.43) 136 (RIC 115.18-157.56), respectivamente, p = 0.01; ILM y ISS no mostraron diferencia entre los grupos. ILM permitió distinguir PE con y sin criterios de severidad, punto de corte ≥ 3.20, sensibilidad 56%, especificidad 56%, AUC 0.56, p = 0.01, y, punto de corte ≥ 3.24, sensibilidad 58%, especificidad 58%, AUC 0.57, p = 0.04, respectivamente; el ILM ≥ 3.24 se asoció con PE sin criterios de severidad (RM 2.02 [IC 95% 1.08-3.80], p = 0.03). Conclusiones: el ILM fue el único índice inflamatorio analizado que se asoció con la presencia de PE sin criterios de severidad. Ningún índice inflamatorio se asoció con la PE con datos de severidad.

[Comparison of unfavorable perinatal outcomes in primiparous adolescents and adults]. / Comparación de resultados perinatales desfavorables en primigestas adolescentes y adultas.

Background: Adolescent pregnancy may be associated with medical complications related to the biological immaturity of the mother, and adult primiparous mothers may present perinatal outcomes associated with pre-existing age-related chronic changes. Objective: To compare unfavorable perinatal outcomes in adolescent and adult primiparous women. Material and methods: Observational, cross-sectional, retrospective and analytical study. Records of adolescent women from 12-19 years and adult women from 20-40 years in their first pregnancy, with a gestation of more than 20 weeks, who entered the Obstetrics Area of a third level hospital for pregnancy resolution were included. Perinatal outcomes were compared using chi-squared, Fisher's exact test, or Mann-Whitney U test. Results: 220 records of primiparous women, 110 adolescents aged 18 (16-19) and 110 adults aged 24 (21-25) were included. Adolescent mothers presented as unfavorable perinatal outcomes newborns (NB) small-for-gestational-age (SGA): odds ratio (OR) 2.95 (95%CI 1.10-7.85), p = 0.04. Adult pregnant women presented more comorbidities (gestational hypertension [11.82 vs. 3.64%] and preeclampsia [10.91 vs. 4.55%], gestational diabetes [6.36 vs. 0.91%], [p = 0.006]) that were associated with prematurity (p = 0.018) and with hospitalization in the NB (p = 0.008). Conclusions: Adolescent mothers presented twice more SGA NB. Prematurity and hospitalization of the NB was associated with the presence of comorbidities in adult mothers.

Introducción: el embarazo en la adolescencia puede estar asociado a complicaciones médicas relacionadas con la inmadurez biológica de la madre y las madres primigestas adultas pueden presentar resultados perinatales asociados a alteraciones crónicas preexistentes relacionadas con la edad. Objetivo: comparar los resultados perinatales desfavorables en primigestas adolescentes y adultas. Material y métodos: estudio observacional, transversal, retrospectivo y analítico. Se incluyeron expedientes de mujeres adolescentes de 12-19 años de edad y mujeres adultas de 20-40 años primigestas, con gestación mayor de 20 semanas, que ingresaron al área de Obstetricia de un hospital de tercer nivel para resolución del embarazo. Los resultados perinatales se compararon con chi cuadrada, prueba exacta de Fisher o U de Mann-Whitney. Resultados: se incluyeron 220 expedientes de mujeres primigestas, 110 adolescentes de 18 (16-19) años y 110 adultas de 24 (21-25) años. Las madres adolescentes presentaron como resultados perinatales desfavorables a recién nacidos (RN) con peso bajo para edad gestacional (PBEG): razón de momios (RM) 2.95 (IC 95% 1.10-7.85), p = 0.04. Las embarazadas adultas presentaron más comorbilidades (hipertensión gestacional [11.82 frente a 3.64%] y preeclampsia [10.91 frente a 4.55%], diabetes gestacional [6.36 frente a 0.91%], [p = 0.006]) que se asociaron con prematurez (p = 0.018) y con la hospitalización en el RN (p = 0.008). Conclusiones: las madres adolescentes presentaron dos veces más RN con PBEG. La prematurez y la hospitalizacion del RN se asoció a la presencia de comorbilidades de las madres adultas.

Nutritional status and food intake in women with humanpapillomavirus

Introduction: Human papilloma virus (HPV) is the mainlycause of cervical cancer. Nutritional management considerationswith antioxidant rich diet, an adequate BMI range are protectivefactors that can modify the disease natural progression. Objective: To evaluate the nutritional status and foodintake in women with HPV. Methods: A cross-sectional study in 75 women of 18 to 35years old, selected by simple availability. A frequency foodintake was applied and analyzed with adequacy percentage.Nutritional status and risk factors as tobacco smoke wereassessed. Results: A 66% of women were obese or overweight.Tobacco was positive in 36%. The energy intake was covered in73%, 84% for lipid, 52% for protein and 66% for carbohydrates.Micronutrient intake was according recommendations.MaritalStatus, Smoking, Firs sexual intercourse age <18, obesity oroverweight, Waist circumference >80cm were risk factorsassociated between group 18 to 28 years vs 29 to 35 years old.Frecuency food intake were low for foods rich in acid folic,carotenoids, vitamin C mainly. Conclusions: This evidence showed the poor nutrimentsintake in the participants related with antioxidant function,that is important for treatment in premalignant lesion forHPV. These results highlight the importance of nutritionalmanagement considerations in prevention for resolution ofhuman papillomavirus premalignant lesions. (AU)

Food insecurity in homes of mothers of premature newborns with anthropometric alterations at birth

INTRODUCTION: Preterm newborns are physiologically immature and have special nutritional needs for growing and developing adequately. There are not enough studies that show a relationship between food insecurity in households with premature infants. OBJECTIVE: To analyze food insecurity in the homes of preterm infants and identify its association with variables like family status and newborn anthropometry (weight, length, and head circumference). METHODS: A Cross sectional study was conducte in 45 mothers who were applied the Latin American and Caribbean Household Food Security Scale, with preterm newborns from 30 to 37 weeks of gestation (WG) in a public hospital. RESULTS: A 49% households had food security while 51% had food insecutiry (28.8%, 8.8%, 13.3% had mild, moderate, and severe food insecurity respectively). There were differences between the groups more than 1 day of hospital stay (72% households with food security vs 95% households with food insecurity, p = 0.044). The anthropomethric variables showed significant differences for the weight (p = 0.015), length (p = 0.027) and head circumference (p = 0.002) for the newborns with and without food security. CONCLUSIONS: It is not only important to control nutrition during pregnancy, but also food security, especially severe food insecurity that the anthropometric variables of preterm newborns can have an impact

No disponible

Experiencias en torno a la falta de acceso al agua en hogares del Estado de Guanajuato, México / Experiences around the lack of access to water in homes in the State of Guanajuato, Mexico

Fundamentos: Se analiza la experiencia en hogares del Estado de Guanajuato, México, que padecen limitaciones en torno al acceso al agua en calidad y cantidad. Métodos: Se aplicó una encuesta de 17 ítems a 352 hogares (jefas de familia) para medir las experiencias en torno al acceso al agua, además de la seguridad alimentaria, escolaridad y aspectos sociodemográficos. Resultados: Un 33,4% de los hogares reportaron preocupación de no tener acceso al agua y el 74,8% no tuvo acceso. El 70,8% tuvo que comprar agua para beber y el 5,7% se enfermó y lo relacionó con el consumo de agua. Un 65,6% de los hogares presentó inseguridad alimentaria. La correlación fue significativa para nivel de escolaridad de las jefas de familia, el número de hogares con niños de 1 y 12 años con el uso de agua de la llave para beber, preparar leche en polvo para los niños, y para los alimentos en casa y agua fresca. Conclusiones: Estas experiencias de los hogares en torno al acceso al agua contribuyen a la discusión y al desarrollo de escalas sobre inseguridad al agua, considerando la seguridad alimentaria

Background: We analyze the experience in households in the State of Guanajuato, Mexico that suffer from limitations regarding access to water in quality and quantity. Methods: A survey of 17 items was applied to 352 households (female heads of household) to measure experiences regarding access to water, in addition to food security, schooling and sociodemographic aspects. Results: Where 33,4% of households reported concern about not having access to water and 74,8% did not have access. 70,8% had to buy water to drink and 5,7% got sick and related it to water consumption. 65,6% of households showed food insecurity. The correlation was significant for the level of education of female heads of household, households with children under 1 and 12 years old with the use of tap water, preparing powdered milk for children, and for food at home and water. Conclusions: These experiences of households around access to water contribute to the discussion and development of scales that insecurity to water, considering food security

Riesgo cardiometabólico en adolescentes con y sin obesidad: Variables metabólicas, nutricionales y consumo de refresco / Cardiometabolic risk in adolescents with and without obesity: Metabolic, nutritional and soft drink consumption variables

Resumen El consumo alto de azúcares añadidos (AZA) se asocia a mayor sobrepeso y obesidad; sin embargo, la posesión de un peso corporal adecuado puede no descartar dicho consumo. El objetivo del presente estudio fue investigar la asociación de los principales factores de riesgo cardiometabólico con el estado nutricio, el consumo de refresco (CNR) y de otras bebidas con AZA. Participaron 89 adolescentes de 10-15 años de edad (53 con obesidad [OG] y 36 sin obesidad [WOG]). Las medidas recabadas fueron: porcentaje de grasa corporal, índice de masa corporal, presión arterial, ácido úrico y glucosa sanguínea; además de un recordatorio de alimentación (24 hrs) y un cuestionario de frecuencia de consumo de alimentos. Del OG, 31% presentó hipertensión, 71% acantosis nigricans, 13% hiperuricemia y 17% valores altos de glucosa. No obstante, el WOG registró mayor consumo de refresco, así como valores limítrofes en los demás factores de riesgo. Aunque no hubo diferencia entre los grupos en el consumo de carbohidratos, si en la frecuencia y cantidad del consumo de azúcar simple y de bebidas con AZA, entre ellas el refresco. Destaca la importancia de integrar a los factores de riesgo ya conocidos, el análisis pormenorizado del CNR y otras bebidas con AZA.

Abstract A high added sugars (AS) intake is associated with greater overweight and obesity; however, having normal weight does not mean low intake of AS. The objective of this study was to associate the main cardiometabolic risk factors with nutritional status, soft drink intake (SDI) and other beverages with AS. Participants were 89 adolescents 1015 years old (53 with obesity [OG] and 36 without obesity [WOG]). The measures were: body fat percentage, body mass index, blood pressure, uric acid and blood glucose; besides a food reminder of 24 hours and a food intake frequency questionnaire. From the OG, 31% had hypertension, 71% acanthosis nigricans, 13% hyperuricemia and 17% high values of glucose. However, the WOG increased the consumption of soft drinks, as well as the limit values in other risk factors. Although there were no differences between the groups in the consumption of carbohydrates, there were in the frequency and amount of simple sugar and drinks with AS, for instance soft drinks. It is highlighted the importance to include the already known risk factors and a detailed analysis of SDI and other soft drinks with AS.

Breastfeeding and metabolic indicators in Mexican premature newborns.

BACKGROUND: Morbidity and mortality rates are higher among preterm infants due to physiological immaturity and greater growth demands. Nutritional intervention contributes to proper weight gain, which translates into better growth and neurological development, and prevents the onset of metabolic complications. The effect of breastfeeding duration was studied in the analytic profile at the end of the first six months of life. OBJECTIVE: To describe the nutritional and metabolic markers effect in preterm infants at the end of the first semester of life. MATERIAL AND METHODS: We performed an analytical, transversal and comparative study in 100 preterm infants, 30 to 36 weeks gestational age. Measures for weight, length and head circumference at birth were taken from the subjects' clinical files. A follow-up conducted at 6 to 9 months of age evaluated the same nutritional indicators (weight, length, head circumference) and compared them with values at birth and recommendations. Metabolic indicators (glucose, hemoglobin, cholesterol, triglycerides, insulin, urea, creatinine, gamma-glutamyl-transferase and alkaline phosphatase) were compared with the recommendations. Follow-up study in 100 preterm infants (30 to 36 weeks gestational age). Weight, length and head circumference were measured at birth and 6 to 9 months later. We measured analytic parameters related to metabolic syndrome (glucose, hemoglobin, cholesterol, triglycerides, insulin, urea, creatinine, gamma-glutamyl transferase and alkaline phosphatase). Confusing factors like income level and access to public services were also studied. RESULTS: The mean age at follow-up was 7.3 +/- 1.4 months. Levels of hemoglobin, creatinine and urea showed significant differences with regard to reference values (Wilcoxon ranks test, < 0.05). The average duration of breastfeeding was 4.3 months. The mean age at follow-up was 7.3 +/- 1.4 months. Risk factors for hypercholesterolemia, as well as levels of hemoglobin, creatinine and urea showed significant differences with regard to reference values (Wilcoxon ranks test, < 0.05). CONCLUSIONS: Premature infants showed deficiencies in weight gain. Biochemical parameters could reflect metabolic risk, therefore we recommend prolonging breastfeeding as well as extending the follow-up of these infants for monitoring their growth and development once out of the hospital.

[Comparison between five growth curves used in a public hospital]. / Comparación de cinco curvas de crecimiento de uso habitual para prematuros en un hospital público.

OBJECTIVE: To compare five curves routinely used for growth evaluation in preterm newborns in a public hospital in Leon, Guanajuato, and to identify those with similar diagnosis according to the reference curve (Williams) in order to determine their usefulness in the clinical practice. METHODS: Analytical, prospective, comparative and cross sectional study in 100 preterm infants, of both sexes, 30 to 36 weeks of gestation without congenital malformations. We obtained the weight and length for their interpretation and to compare the nutritional diagnosis, between five curves routinely used for growth evaluation in preterm newborns: Babson-Benda, Fenton, Jurado-Garcia, Battaglia-Lubchenco and Williams, subsequently, four of the curves were compared against the reference curve (Williams). To analyse the proportions, the chi2 statistic was used. RESULTS: The average age of the preterm infants was 34 +/- 2 gestation weeks, with birth weight 1932 +/- 699 g. When the combination between them were, it was noted that Babson and Benda-Fenton showed similar distribution for the diagnosis of small for gestional age by 50%. Small for gestational age was diagnosed with the Jurado-Garcia, Williams, Battaglia-Lubchenco curves in 43, 38 and 29% respectively. The comparison showed that the curves of Jurado-Garcia and Battaglia-Lubchenco rendered a similar diagnosis, respect to the curve of Williams. CONCLUSIONS: According to this study, the curves of Jurado-Garcia and Battaglia- Lubchenco are recommended for evaluating the extra uterine and intrauterine growth of preterm infants.

[Influence of an individualized diet to control gestational diabetes mellitus]. / Influencia de una dieta individualizada en el control de la diabetes mellitus gestacional.

BACKGROUND: Dietetic control is part of an integral therapy to gestational diabetes mellitus. OBJECTIVE: To evaluate the effect of an individualized diet with 52% of complex carbohydrates of low and moderate glycemic index to control gestational diabetes mellitus. MATERIAL AND METHODS: Analytic and longitudinal study in 31 patients with gestational diabetes mellitus in a third level hospital in Leon, Guanajuato, from August 2005 to December 2006. During 4 months, starting on 24 to 26 weeks of pregnancy, patients followed a 1,700 to 2,000 kcal/day diet, with 52% of complex carbohydrates of low and moderate glycemic index, 30% of fat and 18% of proteins. Total diet intake, weight gain, percentage of weight for gestational age, and glucose were measured monthly; glycosylated hemoglobin was measured at the beginning and at the end of the study. The weight of the newborn was registered. RESULTS: Overall, 76% of patients were obese and 24% had overweight. Final weight gain at the end of third trimester was 3 kg. There were significant differences in month-to-month and final comparisons of glucose (146 +/- 37 vs 90 +/- 5 mg/dL), caloric intake (2,800 +/- 1,030 vs 1,740 +/- 109 kcal/day) and macronutrients, as well as in glycosylated hemoglobin (7.1 +/- 1.2 vs 5.3 +/- 0.5%). At the end of the study diet of 65% of patients was recommendable, in comparison with 14% at the beginning. Adherence to diet plan improved in final months. Average newborn weight was 3,347 +/- 385 g. CONCLUSION: An individualized diet here prescribed leads to control of gestational diabetes and to the birth of normal size babies. There were significant differences in the month-to-month comparisons of glucose, weight, caloric intake and macronutrients, as well as in the initial and final glycosylated hemoglobin (7.1 +/- 1.2 and 5.0 +/- 0.7%). Our results suggest that an individual diet of 52% of complex carbohydrates allowed a satisfactory control of gestational diabetes mellitus, with normal levels of glucose, glycosylated hemoglobin, and weight gain.

[Risk factors associated to ovarian cancer]. / Factores de riesgo asociados con cáncer de ovario.

OBJECTIVE: To determine the risk factors associated to ovarian cancer. PATIENTS AND METHODS: A case-control study was carried out including 31 women with ovarian cancer and 69 patients with benign ovarian tumors corroborated with a histopathological study. We analyzed 26 independent variables, which classification was clinic, sociodemographic and ultrasonographic. The dependent variable was ovarian cancer, and it was assigned a value of 1 if it was present and 0 if it was absent. The statistical analysis was done using a logistic regression analysis, with an alpha value of 0.05. RESULTS: The malignant tumor of epithelial cells was the most common histological variety and was seen in 22 cases (71%). There were 24 cases (77.4%) in clinical stage I at the time of the diagnosis. Out of the 26 studied variables late menarche (p = 0.02), multiparity (p = 0.02), loss of weight (p = 0.04), solid tumor (p = 0.02), mixed tumor (p = 0.02) and irregularities of the tumor (p = 0.03) were significant in the applied model. CONCLUSIONS: The sociodemographic variables associated to ovarian cancer were: late menarche and multiparity; the clinical significant variable was loss of weight; and the ultrasonographic variables were solid tumor, mixed tumor and irregularities of the tumor. A population screening program is recommended in women who are in reproductive age, and it should include a gynecological ultrasonographic scanning in order to make an opportune diagnosis of this pathology.