Effect of preconception multiple micronutrients vs. iron-folic acid supplementation on maternal and birth outcomes among women from developing countries: a systematic review and meta-analysis.

Background: Maternal malnutrition affects the somatic growth of the fetus and subsequent adverse events during infancy and childhood period. Though trials have been conducted on multiple micronutrient (MMN) supplements initiated during the preconception period, there is no collated evidence on this. Materials and methods: We performed a systematic review of published trials with the application of Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The searches were conducted until 30 September 2023. Meta-analysis was performed using Review Manager 5 software. The primary objective was to compare the effect of preconception MMN vs. iron-folic acid (IFA) supplementation on newborn anthropometric parameters at birth. Results: Of the 11,832 total citations retrieved, 12 studies with data from 11,391 participants [Intervention = 5,767; Control = 5,624] were included. For the primary outcome, there was no significant difference in the birth weight [MD, 35.61 (95% CI, -7.83 to 79.06), p = 0.11], birth length [MD, 0.19 (95% CI, -0.03 to 0.42), p = 0.09], and head circumference [MD, -0.25 (95% CI, -0.64 to -0.14), p = 0.22] between the MMN and control groups. For all the secondary outcomes [except for small for gestational age (SGA) and low birth weight (LBW)], the difference between the MMN and control groups was not significant. The GRADE evidence generated for all the outcomes varied from "very low to moderate certainty." Conclusion: A "very low certainty" of evidence suggests that MMN supplementation may not be better than routine IFA supplementation in improving newborn anthropometric parameters (weight, length, and head circumference). The adverse events resulting from the supplementation were not significant. We need better quality uniformly designed RCTs before any firm recommendation can be made.Systematic review registration: identifier (CRD42019144878: https://www.crd.york.ac.uk/prospero/#searchadvanced).

Antenatal reproductive screening for pregnant people including preconception: Provides the best reproductive opportunity for informed consent, quality, and safety.

INTRODUCTION: This antenatal screening review will include reproductive screening evidence and approaches for pre-conception and post-conception, using first to third trimester screening opportunities. METHODS: Focused antenatal screening peer-reviewed publications were evaluated and summarized. RESULTS: Evidenced-based reproductive antenatal screening elements should be offered and discussed, with the pregnancy planning or pregnant person, during Preconception (genetic carrier screening for reproductive partners, personal and family (including reproductive partner) history review for increased genetic and pregnancy morbidity risks); First Trimester (fetal dating with ultrasound; fetal aneuploidy screening plus consideration for expanded fetal morbidity criteria, if appropriate; pregnant person preeclampsia screening; early fetal anatomy screening; early fetal cardiac screening); Second Trimester for standard fetal anatomy screening (18-22 weeks) including cardiac; pregnant person placental and cord pathology screening; pregnant person preterm birth screening with cervical length measurement); Third Trimester (fetal growth surveillance; continued preterm birth risk surveillance). CONCLUSION: Antenatal reproductive screening has multiple elements, is complex, is time-consuming, and requires the use of pre- and post-testing counselling for most screening elements. The use of preconception and trimesters 'one to three' requires clear patient understanding and buy-in. Informed consent and knowledge transfer is a main goal for antenatal reproductive screening approaches.

Assessment of the effect of pre-conception care on preventing mother-to-child transmission of HIV in Nyeri County.

Introduction: the provision of essential preconception care services for HIV-positive pregnant women is crucial to prevent HIV transmission to infants. This includes pregnancy intention screening services, adequate viral load monitoring and suppression before conception, and necessary nutritional support. In Nyeri County, the prevalence of Mother-to-Child Transmission (MTCT) of HIV is 5.3%, which is higher than the global threshold of 5%. This study aims to evaluate the impact of pre-conception care services in preventing HIV transmission to infants in Nyeri County. The study objectives are to assess the utilization of pre-conception care services among HIV-positive women, specifically focusing on pregnancy intention screening, viral load monitoring and suppression, and access to nutritional assessment services before pregnancy. Additionally, the study aims to investigate the relationship between the provision of pre-conception care services and infant HIV outcomes. Methods: this cross-sectional retrospective descriptive study employed stratified sampling to select eight level 4 and level 5 hospitals in Nyeri County. The target population consisted of HIV-infected women seeking postnatal care in these facilities, with a sample size of 252 women who had HIV-exposed infants under two years old and were receiving post-natal care at the respective hospitals. Sociodemographic characteristics, including age, marital status, and education level, were collected. Data analysis involved both descriptive and inferential statistics. Results: our findings revealed that only 34.2% of HIV-positive women seeking postnatal care had received information or services related to pregnancy intention screening, a crucial aspect of pre-conception care. Almost half (46.4%) of the women who participated in the study had undergone viral load measurements before pregnancy, which is another critical component of preconception care. Additionally, 85.6% of these women had received nutritional services during pregnancy from their healthcare providers. Interestingly, all women who received any pre-conception care services reported that their infants were alive and tested HIV-negative. Conclusion: preconception care is crucial in preventing mother-to-child transmission of HIV. Efforts should be made to ensure that all HIV-infected women planning to conceive have access to preconception care services.

Lupus nephritis: management challenges during pregnancy.

Lupus nephritis (LN), a severe complication of systemic lupus erythematosus (SLE), leads to significant kidney inflammation and damage and drastically increases mortality risk. Predominantly impacting women in their reproductive years, LN poses specific risks during pregnancy, including pre-eclampsia, growth restrictions, stillbirth, and preterm delivery, exacerbated by lupus activity, specific antibodies, and pre-existing conditions like hypertension. Effective management of LN during pregnancy is crucial and involves carefully balancing disease control with the safety of the fetus. This includes pre-conception counseling and a multidisciplinary approach among specialists to navigate the complexities LN patients face during pregnancy, such as distinguishing LN flare-ups from pregnancy-induced conditions. This review focuses on exploring the complex dynamics between pregnancy and LN, emphasizing the management difficulties and the heightened risks pregnant women with LN encounter.

Characterization of hair cortisol concentration pre-conception and during pregnancy.

BACKGROUND: The hypothalamic pituitary adrenal (HPA) axis is a system involved in stress and pregnancy regulation, and hair cortisol concentration (HCC) is a promising biomarker of its activity. Assessing factors that influence HCC in the prenatal period is critical to understand whether and how HPA axis (dys-)regulation influences maternal health and child development, particularly in high-risk populations from low- and middle-income countries (LMICs). AIMS: This study aimed at characterizing preconception and pregnancy HCC with respect to multiple sociodemographic, pregnancy-related, and hair-related factors. METHODS: In a sample of N = 2581 pregnant women in Perú, participants from two cohort studies provided a 6 cm scalp hair sample at three prenatal timepoints. Each hair sample was cut into two segments of 3 cm that represent cortisol secretion at four times: preconception, first-, second- and third trimester of pregnancy. Hair cortisol was extracted using liquid chromatography tandem mass spectrometry (LC-MS/MS). Spearman correlations, paired t-tests, and ANOVA were used to assess differences in log-transformed values of HCC (logHCC) across maternal sociodemographic, pregnancy-related, and hair-related factors. Multivariable linear regressions were used to examine independent associations of HCCs with selected correlates. RESULTS: Mean logHCC values showed an increase across the four prenatal periods. Preconception BMI was consistently associated with HCC in all three trimesters, while difficulty accessing basic foods, education, hair dyeing, and infant sex showed time-specific associations with HCCs. In sensitivity analyses, we detected no substantial segment effects in the associations of HCCs with maternal characteristics. CONCLUSION: This study is the largest to characterize HCC in pregnant women from a LMIC. Our findings provide a foundation for the use of HCC as a biomarker of prenatal HPA axis activity for future studies. This foundation may contribute to finding valid biomarkers of stress-response systems to promote maternal and child health.

Clinical application value of pre-pregnancy carrier screening in Chinese Han childbearing population.

BACKGROUND: To explore the clinical application value of pre-conception expanded carrier screening (PECS) in the Chinese Han ethnicity population of childbearing age. METHODS: The results of genetic testing of infertile parents who underwent PECS in the Reproductive Medicine Center of the Second Affiliated Hospital of Zhengzhou University, China, from September 2019 to December 2021, were retrospectively analyzed. The carrier rate of single gene disease, the detection rate of high-risk parents, and the clinical outcome of high-risk parents were statistically analyzed. RESULTS: A total of 1372 Chinese Han ethnicity patients underwent PECS, among which 458 patients underwent the extended 108-gene test, their overall carrier rate was 31.7%, and the detection rate of high-risk parents was 0.3%. The highest carrier rates were SLC22A (2.4%), ATP7B (2.4%), MMACHC (2.2%), PAH (1.8%), GALC (1.8%), MLC1 (1.3%), UNC13D (1.1%), CAPN3 (1.1%), and PKHD1 (1.1%). There were 488 women with fragile X syndrome-FMR1 gene detection, and 6 patients (1.2%) had FMR1 gene mutation. A total of 426 patients were screened for spinal muscular atrophy-SMN1, and the carrier rate was 3.5%, and the detection rate of parents' co-carrier was 0.5%. CONCLUSION: Monogenic recessive hereditary diseases had a high carrier rate in the population. Pre-pregnancy screening could provide good prenatal and postnatal care guidance for patients and preimplantation genetic testing for monogenic/single gene disorders (PGT-M) and prenatal diagnosis could provide more precise reproductive choices for high-risk parents.

Pregnancy and the Autoimmune Patient.

PURPOSE OF REVIEW: This article will review the current understanding of the immunologic changes that occur during pregnancy. It will discuss the impact of pregnancy on the disease activity of autoimmune or inflammatory rheumatic diseases (AIRD). Lastly, it will highlight the most recent data on pre-conception and pregnancy management practices that can improve pregnancy outcomes in autoimmune patients. RECENT FINDINGS: Pregnancy is an immunologically complex and dynamic state that may affect the activity of AIRDs, with more patients having active disease during pregnancy than previously thought. Uncontrolled inflammatory diseases are associated with poor pregnancy outcomes such as preeclampsia, small for gestational age infants, and prematurity. Pre-conception counseling and early pregnancy planning discussions can help ensure optimal disease control and medication management prior to attempting conception. Adequate control of AIRDs on pregnancy-compatible medications during the pre-conception, pregnancy, and postpartum periods is required for optimal pregnancy outcomes.

An audit of the maternal medicine clinic: Cancer and pregnancy.

AIMS: To explore the incidence and complexity of women presenting for maternity care who require concurrent cancer care, and to report the birth outcomes of these women. MATERIALS AND METHODS: A retrospective audit of women attending a 'high risk' maternal medicine clinic at an Australian tertiary maternity hospital between 1 October 2021 and 30 April 2023 was conducted. The inclusion criteria were a diagnosis of cancer and a concurrent pregnancy, or a diagnosis of cancer prior to the current pregnancy. Clinic lists and coding data were screened via the electronic medical record to identify potential subjects. Data were collected from the individual maternity and neonatal records. RESULTS: Forty of 705 (5.7%) women attending the maternal medicine clinic met the inclusion criteria, of which ten had a new diagnosis of cancer in pregnancy and 30 presented for maternity care after a previous diagnosis of cancer. Cancer therapy during pregnancy included surgery and chemotherapy. Most pregnancies (92.5%) resulted in term deliveries (≥37 weeks gestation). Four neonates were preterm, and one was small-for-gestational-age. Caesarean section delivery and post-partum haemorrhage were more common than expected, but the rate of other adverse pregnancy outcomes was consistent with the background population. Over half of neonates required neonatal intensive care unit / special care nursery admission but the indications for admission were common, self-limiting conditions, and the length of stay was short (mean <5.0 days). CONCLUSIONS: Approximately 6% of women attending the maternal medicine clinic had a current or previous diagnosis of cancer. Most pregnancies resulted in term deliveries and neonatal outcomes were excellent.

Antibiotic use during pregnancy in Sweden: A nationwide utilization study covering 2007-2019.

INTRODUCTION: Antibiotics are often prescribed during pregnancy. Assessing the current state of prenatal antibiotic use is therefore imperative for optimizing prescribing and identifying emerging research priorities. The study aimed to describe recent trends and patterns in antibiotic use during pregnancy among women who gave birth in Sweden, including user characteristics. MATERIAL AND METHODS: Population-based descriptive study using linked nationwide registers. All pregnancies delivered in Sweden from 2007 to 2019 were included. Prevalence of use was defined as the percentage of pregnancies during which at least one prescription forantibiotics was filled. Temporal trends in the prevalence of antibiotic use by calendar year, trimester and weeks of gestation were assessed from time series graphs. RESULTS: Prescriptions for systemic antibiotics were filled in 20.7% of 1 434 431 pregnancies overall, decreasing from 24.7% in 2007 to 18.0% in 2019. Phenoxymethylpenicillin (8.5%), pivmecillinam (6.5%), nitrofurantoin (4.7%), amoxicillin (1.6%) and cefadroxil (1.5%) use were the most prevalent. Their use decreased over the 13-year period, except for pivmecillinam, which increased from 4.0% to 7.4%. Prevalence of use was highest in the second trimester (9.5%), with weekly trends peaking at 13 and 34 weeks of gestation. Compared with non-users, antibiotic users more often belonged to the youngest and oldest age strata, carried multipleton pregnancies, had delivered before, had attained a lower education level and smoked in early pregnancy. A higher body mass index, asthma, chronic renal disease and diabetes mellitus were more prevalent among antibiotic users than among non-users. CONCLUSIONS: Although outpatient antibiotic use during pregnancy in Sweden has been declining, one in five pregnancies was exposed to systemic antibiotics.

Cardiogenic shock in pregnancy.

Cardiac disease complicates 1%-4% of pregnancies globally, with a predominance in low and middle-income countries (LMICs). Increasing maternal age, rates of obesity, cardiovascular comorbidities, pre-eclampsia and gestational diabetes all contribute to acquired cardiovascular disease in pregnancy. Additionally, improved survival in congenital heart disease (CHD) has led to increasing numbers of women with CHD undergoing pregnancy. Implementation of individualised care plans formulated through pre-conception counselling and based on national and international guidance have contributed to improved clinical outcomes. However, there remains a significant proportion of women of reproductive age with no apparent comorbidities or risk factors that develop heart disease during pregnancy, with no indication for pre-conception counselling. The most extreme manifestation of cardiac disease is cardiogenic shock (CS), where the primary cardiac pathology results in inadequate cardiac output and hypoperfusion, and is associated with significant mortality and morbidity. Key to management is early recognition, intervention to treat any potentially reversible underlying pathology and supportive measures, up to and including mechanical circulatory support (MCS). In this narrative review we discuss recent developments in the classification of CS, and how these may be adapted to improve outcomes of pregnant women with, or at risk of developing, this potentially lethal condition.

Analysis of antioxidant activity on cocktail honey products as female pre-conception supplements

Objective: Cocktail honey is derived from a mixture of honey (trigona sp.), bee bread, and homogeneous royal jelly. The material has a phenolic content rich in antioxidants that are beneficial for women's reproductive health, especially for pre-conception, because it can suppress the content of free radicals in the body. Antioxidants are useful to overcome oxidative damage due to free radicals in the body that prevent various diseases from increasing fertility during pre-conception. Method: This study used the DPPH (2,2-diphenyl-1-picrylhydrazyl) test method using UV–vis spectrophotometry to express the value of free radical reduction activity as IC50 (inhibitory concentration) values. Results: The DPPH test on cocktail honey products obtained an average yield of 4577.7 μg/mL, which was included in the product category was very weak in the antioxidant activity content. Conclusion: The content contained in the honey cocktail contains weak bioactive content by assessing the antioxidant content using DPPH. The difference in the results of antioxidant activity tests using DPPH is caused by the test method and the conditions used in processing, homogeneous ingredients, solvent volume, extraction time, temperature, and pressure in product management. (AU)

Risk factors for women attending pre-pregnancy screening in selected clinics in Selangor

Background: The Ministry of Health is committed to achieve Millenium Development Goal (MDG) MDG 4 and 5 by 2015 and include pre-pregnancy care as a strategy. This study evaluates the risk factors detected during the pre-pregnancy screening at selected public primary care clinics in Selangor. Objectives: The objectives of this study were to determine the proportion of women with risk factors receiving pre-pregnancy care in selected clinics in Selangor, their socio demographic features, the types of risk factors detected and their significance. Methods: A retrospective review using secondary data was carried out from the month of March until June 2013 in four public primary care clinics in Klang and Petaling districts of Selangor. Data were obtained through non-probability sampling, using the pre-pregnancy screening form utilised in 2012, which is a standard questionnaire to determine the presence of risk factors. Women with at least one defined risk factor were considered as being at risk of an adverse obstetric outcome. Data were analysed using SPSS version 16. Results: A total of 840 pre-pregnancy screening forms were collected. However only 614 (73.1%) were analysed and studied. The proportion of women with at least one risk factor was 68.8% (95% CI: 65.1, 72.5). The majority was Malays who had tertiary education and earned more than RM 1000. Most were in the reproductive age group of 18–35 years old (350, 82.9%). The mean age was 28.68 + 5.78 years. Most of the women were parous (259, 65.1%) and did not practice any form of contraception (308, 80.8%) despite having risks. The percentage of those not receiving any form of immunisation was small i.e. 9.8% but it was of importance and needed to be addressed prior to the conception. This study did not reveal any person with mental disorder or those who endured domestic abuse. Additionally, 3% (12) of them had unhealthy lifestyle habits, which include smoking, alcohol and substance abuse. Approximately one-third (212, 35.2%) of the women screened were overweight and obese, putting them at risk of developing gestational diabetes mellitus, pregnancy induced hypertension or deep vein thrombosis. The mean body mass index (BMI) for those at risk was 25.36 + 5.94 compared to 21.06 ± 1.46 for those with no risk. This study also found a small percentage of women with raised blood pressure (3.9%), abnormal physical examination (1.5%) and anaemia (14.4%), which need to be investigated and treated prior to conception. Conclusion: More than half of the women who attended the pre-pregnancy screening were found to have at least one risk factor.

Pesquisa de los riesgos preconcepcional y prenatal / Screening of the pre-conception and prenatal risks

La evaluación del riesgo reproductivo a nivel comunitario incluye el diagnóstico de las condiciones que significan un peligro potencial para el desarrollo saludable de la gestación y el niño. En el presente trabajo se muestran los resultados de la pesquisa de los riesgos preconcepcional y prenatal en mujeres en edad fértil y gestantes, respectivamente, residentes en la provincia de Las Tunas. Se revisaron los registros y reportes estadísticos del Centro Provincial de Genética Médica correspondientes a los años 2007 y 2008 para tomar el universo de mujeres a evaluar y las estudiadas, con lo que se calculó la cobertura de ambos programas. Se determinaron las frecuencias relacionadas con los riesgos por cada condición de riesgo: cromosomopatías, hemoglobinopatías, malformaciones congénitas, teratogenicidad y otras afecciones hereditarias. El 55,0 por ciento de las mujeres evaluadas durante el último año y el 79,3 por ciento en el 2007 fue clasificada con algún riesgo preconcepcional, con un predominio de las cromosomopatías como criterio más frecuente de riesgo. El 40,7 por ciento de las 5 746 gestantes atendidas en el 2008 fue considerada con riesgos prenatales, por debajo del 49,2 por ciento en el año precedente. El riesgo por cromosomopatía fue el predominante en la evaluación prenatal, presente en 62,1 por ciento y 71,3 por ciento de las gestantes en el 2007 y el 2008, respectivamente, a expensas del embarazo en la adolescencia. Se requiere de criterios uniformes para la evaluación del riesgo genético en las mujeres, a las que se les ofrece un seguimiento especializado por los servicios comunitarios de Genética e interconsultas con otras especialidades

The assessment of reproductive risk at community level includes the diagnosis of conditions that are a potential risk for the healthy development of pregnancy and the baby. In the present paper the results of a screening of the pre-conception and prenatal risks in women of fertile age and pregnants, respectively, resident of the Las Tunas provinceare shown. The authors analyzed the registries and statistical reports from the Provincial Central of Medical Genetic corresponding to years 2007 and 2008 in order to include both the universe of women assessed and studied, estimating the coverage of both programs. The frequencies related to each risk condition, e.g. chromosomal diseases, hemoglobinopathies, birth defects, theratogenicity and other hereditary affections were al determined. 55.0 percent of women assessed during the last year and 79.3 percent in 2007 were classified with some pre-conception risk with a predominance of chromosomal diseases as the most frequent criterion of risk. The 40,7 percent of the 5 746 pregnants seen in 2008 was considered in prenatal risks, a figure under the 49,2 percent in the previous year. The risk of chromosomal disease was predominant in the prenatal assessment, present in the 62,1 percent and the 71,3 percent of pregnants in 2007 and 2008, respectively, at the expense of the pregnant during adolescence. It is necessary the presence of uniform criteria to assess the genetic risk in women who receive a specialized follow-up by Genetics community services and inter-consultation with other specialties

Pesquisa de los riesgos preconcepcional y prenatal / Screening of the pre-conception and prenatal risks

La evaluación del riesgo reproductivo a nivel comunitario incluye el diagnóstico de las condiciones que significan un peligro potencial para el desarrollo saludable de la gestación y el niño. En el presente trabajo se muestran los resultados de la pesquisa de los riesgos preconcepcional y prenatal en mujeres en edad fértil y gestantes, respectivamente, residentes en la provincia de Las Tunas. Se revisaron los registros y reportes estadísticos del Centro Provincial de Genética Médica correspondientes a los años 2007 y 2008 para tomar el universo de mujeres a evaluar y las estudiadas, con lo que se calculó la cobertura de ambos programas. Se determinaron las frecuencias relacionadas con los riesgos por cada condición de riesgo: cromosomopatías, hemoglobinopatías, malformaciones congénitas, teratogenicidad y otras afecciones hereditarias. El 55,0 por ciento de las mujeres evaluadas durante el último año y el 79,3 por ciento en el 2007 fue clasificada con algún riesgo preconcepcional, con un predominio de las cromosomopatías como criterio más frecuente de riesgo. El 40,7 por ciento de las 5 746 gestantes atendidas en el 2008 fue considerada con riesgos prenatales, por debajo del 49,2 por ciento en el año precedente. El riesgo por cromosomopatía fue el predominante en la evaluación prenatal, presente en 62,1 por ciento y 71,3 por ciento de las gestantes en el 2007 y el 2008, respectivamente, a expensas del embarazo en la adolescencia. Se requiere de criterios uniformes para la evaluación del riesgo genético en las mujeres, a las que se les ofrece un seguimiento especializado por los servicios comunitarios de Genética e interconsultas con otras especialidades (AU)

The assessment of reproductive risk at community level includes the diagnosis of conditions that are a potential risk for the healthy development of pregnancy and the baby. In the present paper the results of a screening of the pre-conception and prenatal risks in women of fertile age and pregnants, respectively, resident of the Las Tunas provinceare shown. The authors analyzed the registries and statistical reports from the Provincial Central of Medical Genetic corresponding to years 2007 and 2008 in order to include both the universe of women assessed and studied, estimating the coverage of both programs. The frequencies related to each risk condition, e.g. chromosomal diseases, hemoglobinopathies, birth defects, theratogenicity and other hereditary affections were al determined. 55.0 percent of women assessed during the last year and 79.3 percent in 2007 were classified with some pre-conception risk with a predominance of chromosomal diseases as the most frequent criterion of risk. The 40.7 percent of the 5 746 pregnants seen in 2008 was considered in prenatal risks, a figure under the 49.2 percent in the previous year. The risk of chromosomal disease was predominant in the prenatal assessment, present in the 62.1 percent and the 71.3 percent of pregnants in 2007 and 2008, respectively, at the expense of the pregnant during adolescence. It is necessary the presence of uniform criteria to assess the genetic risk in women who receive a specialized follow-up by Genetics community services and inter-consultation with other specialties (AU)

Pesquisa de los riesgos preconcepcional y prenatal / Screening of the pre-conception and prenatal risks

La evaluación del riesgo reproductivo a nivel comunitario incluye el diagnóstico de las condiciones que significan un peligro potencial para el desarrollo saludable de la gestación y el niño. En el presente trabajo se muestran los resultados de la pesquisa de los riesgos preconcepcional y prenatal en mujeres en edad fértil y gestantes, respectivamente, residentes en la provincia de Las Tunas. Se revisaron los registros y reportes estadísticos del Centro Provincial de Genética Médica correspondientes a los años 2007 y 2008 para tomar el universo de mujeres a evaluar y las estudiadas, con lo que se calculó la cobertura de ambos programas. Se determinaron las frecuencias relacionadas con los riesgos por cada condición de riesgo: cromosomopatías, hemoglobinopatías, malformaciones congénitas, teratogenicidad y otras afecciones hereditarias. El 55,0 por ciento de las mujeres evaluadas durante el último año y el 79,3 por ciento en el 2007 fue clasificada con algún riesgo preconcepcional, con un predominio de las cromosomopatías como criterio más frecuente de riesgo. El 40,7 por ciento de las 5 746 gestantes atendidas en el 2008 fue considerada con riesgos prenatales, por debajo del 49,2 por ciento en el año precedente. El riesgo por cromosomopatía fue el predominante en la evaluación prenatal, presente en 62,1 por ciento y 71,3 por ciento de las gestantes en el 2007 y el 2008, respectivamente, a expensas del embarazo en la adolescencia. Se requiere de criterios uniformes para la evaluación del riesgo genético en las mujeres, a las que se les ofrece un seguimiento especializado por los servicios comunitarios de Genética e interconsultas con otras especialidades (AU)

The assessment of reproductive risk at community level includes the diagnosis of conditions that are a potential risk for the healthy development of pregnancy and the baby. In the present paper the results of a screening of the pre-conception and prenatal risks in women of fertile age and pregnants, respectively, resident of the Las Tunas provinceare shown. The authors analyzed the registries and statistical reports from the Provincial Central of Medical Genetic corresponding to years 2007 and 2008 in order to include both the universe of women assessed and studied, estimating the coverage of both programs. The frequencies related to each risk condition, e.g. chromosomal diseases, hemoglobinopathies, birth defects, theratogenicity and other hereditary affections were al determined. 55.0 percent of women assessed during the last year and 79.3 percent in 2007 were classified with some pre-conception risk with a predominance of chromosomal diseases as the most frequent criterion of risk. The 40,7 percent of the 5 746 pregnants seen in 2008 was considered in prenatal risks, a figure under the 49,2 percent in the previous year. The risk of chromosomal disease was predominant in the prenatal assessment, present in the 62,1 percent and the 71,3 percent of pregnants in 2007 and 2008, respectively, at the expense of the pregnant during adolescence. It is necessary the presence of uniform criteria to assess the genetic risk in women who receive a specialized follow-up by Genetics community services and inter-consultation with other specialties (AU)