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1.
BMC Pregnancy Childbirth ; 21(1): 791, 2021 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-34823483

RESUMEN

BACKGROUND: Worldwide, hypertensive disorders of pregnancy (HDP), fetal growth restriction (FGR) and preterm birth remain the leading causes of maternal and fetal pregnancy-related mortality and (long-term) morbidity. Fetal cardiac deformation changes can be the first sign of placental dysfunction, which is associated with HDP, FGR and preterm birth. In addition, preterm birth is likely associated with changes in electrical activity across the uterine muscle. Therefore, fetal cardiac function and uterine activity can be used for the early detection of these complications in pregnancy. Fetal cardiac function and uterine activity can be assessed by two-dimensional speckle-tracking echocardiography (2D-STE), non-invasive fetal electrocardiography (NI-fECG), and electrohysterography (EHG). This study aims to generate reference values for 2D-STE, NI-fECG and EHG parameters during the second trimester of pregnancy and to investigate the diagnostic potential of these parameters in the early detection of HDP, FGR and preterm birth. METHODS: In this longitudinal prospective cohort study, eligible women will be recruited from a tertiary care hospital and a primary midwifery practice. In total, 594 initially healthy pregnant women with an uncomplicated singleton pregnancy will be included. Recordings of NI-fECG and EHG will be made weekly from 22 until 28 weeks of gestation and 2D-STE measurements will be performed 4-weekly at 16, 20, 24 and 28 weeks gestational age. Retrospectively, pregnancies complicated with pregnancy-related diseases will be excluded from the cohort. Reference values for 2D-STE, NI-fECG and EHG parameters will be assessed in uncomplicated pregnancies. After, 2D-STE, NI-fCG and EHG parameters measured during gestation in complicated pregnancies will be compared with these reference values. DISCUSSION: This will be the a large prospective study investigating new technologies that could potentially have a high impact on antepartum fetal monitoring. TRIAL REGISTRATION: Registered on 26 March 2020 in the Dutch Trial Register (NL8769) via https://www.trialregister.nl/trials and registered on 21 October 2020 to the Central Committee on Research Involving Human Subjects (NL73607.015.20) via https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm .


Asunto(s)
Ecocardiografía/métodos , Electrocardiografía/métodos , Diagnóstico Prenatal/métodos , Adulto , Femenino , Retardo del Crecimiento Fetal/diagnóstico , Frecuencia Cardíaca Fetal/fisiología , Humanos , Hipertensión Inducida en el Embarazo/diagnóstico , Estudios Longitudinales , Países Bajos , Embarazo , Segundo Trimestre del Embarazo , Nacimiento Prematuro/diagnóstico , Estudios Prospectivos , Monitoreo Uterino , Útero/fisiología
3.
BMC Pregnancy Childbirth ; 21(1): 760, 2021 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-34758757

RESUMEN

BACKGROUND: Infection with SARS-CoV-2 during pregnancy can lead to a severe condition in the patient, which is challenging for obstetricians and anaesthesiologists. Upon severe COVID-19 and a lack of improvement after multidrug therapy and mechanical ventilation, extracorporeal membrane oxygenation (ECMO) is introduced as the last option. Such treatment is critical in women with very preterm pregnancy when each additional day of the intrauterine stay is vital for the survival of the newborn. CASE PRESENTATION: We report a case of a 38-year-old woman at 27 weeks of gestation treated with multidrug therapy and ECMO. The woman was admitted to the intensive care unit (ICU) with increasing fever, cough and dyspnoea. The course of the pregnancy was uncomplicated. She was otherwise healthy. At admission, she presented with severe dyspnoea, with oxygen saturation (SpO2) of 95% on passive oxygenation, heart rate of 145/min, and blood pressure of 145/90. After confirmation of SARS-CoV-2 infection, she received steroids, remdesivir and convalescent plasma therapy. The foetus was in good condition. No signs of an intrauterine infection were visible. Due to tachypnea of 40/min and SpO2 of 90%, the woman was intubated and mechanically ventilated. Due to circulatory failure, the prothrombotic activity of the coagulation system, further saturation worsening, and poor control of sedation, she was qualified for veno-venous ECMO. An elective caesarean section was performed at 29 weeks on ECMO treatment in the ICU. A preterm female newborn was delivered with an Apgar score of 7 and a birth weight of 1440 g. The newborn had no laboratory or clinical evidence of COVID-19. The placenta showed the following pathological changes: large subchorionic haematoma, maternal vascular malperfusion, marginal cord insertion, and chorangioma. CONCLUSIONS: This case presents the successful use of ECMO in a pregnant woman with acute respiratory distress syndrome in the course of severe COVID-19. Further research is required to explain the aetiology of placental disorders (e.g., maternal vascular malperfusion lesions or thrombotic influence of COVID-19). ECMO treatment in pregnant women remains challenging; thus, it should be used with caution. Long-term assessment may help to evaluate the safety of the ECMO procedure in pregnant women.


Asunto(s)
COVID-19/terapia , Oxigenación por Membrana Extracorpórea/métodos , Placenta/patología , Complicaciones Infecciosas del Embarazo/terapia , Adulto , COVID-19/diagnóstico , Cesárea , Femenino , Humanos , Placenta/virología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Segundo Trimestre del Embarazo , Resultado del Tratamiento
5.
Int J Gynaecol Obstet ; 155(1): 19-22, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34520055

RESUMEN

Cervical cerclage is an intervention which when given to the right women can prevent preterm birth and second-trimester fetal losses. A history-indicated cerclage should be offered to women who have had three or more preterm deliveries and/or mid-trimester losses. An ultrasound-indicated cerclage should be offered to women with a cervical length <25 mm if they have had one or more spontaneous preterm birth and/or mid-trimester loss. In high-risk women who have not had a previous mid-trimester loss or preterm birth, an ultrasound-indicated cerclage does not have a clear benefit in women with a short cervix. However, for twins, the advantage seems more likely at shorter cervical lengths (<15 mm). In women who present with exposed membranes prolapsing through the cervical os, a rescue cerclage can be considered on an individual case basis, taking into account the high risk of infective morbidity to mother and baby. An abdominal cerclage can be offered in women who have had a failed cerclage (delivery before 28 weeks after a history or ultrasound-indicated [but not rescue] cerclage). If preterm birth has not occurred, removal is considered at 36-37 weeks in women anticipating a vaginal delivery.


Asunto(s)
Cerclaje Cervical , Nacimiento Prematuro , Cuello del Útero/diagnóstico por imagen , Cuello del Útero/cirugía , Femenino , Humanos , Recién Nacido , Embarazo , Segundo Trimestre del Embarazo , Nacimiento Prematuro/prevención & control
6.
BMC Infect Dis ; 21(1): 897, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34479491

RESUMEN

BACKGROUND: Maternal immunization confers passive immunity to the fetus by transplacental antibody transfer. Infants may be better protected against pertussis if the mother received a diphtheriae, tetanus and acellular pertussis (Tdap) vaccination in the second trimester of pregnancy compared to the third trimester. This study evaluates IgG antibody concentrations in term and preterm infants at birth and 2 months after birth after maternal Tdap-vaccination between 200 and 240 w of gestation vs third trimester Tdap-vaccination. Further aims are assessing the determinants that underlie acceptance of second trimester maternal Tdap-vaccination as well as the tolerability of vaccination. METHODS: This prospective cohort study consists of two parts. In the acceptance part, pregnant women complete a questionnaire on determinants that underlie acceptance of a second trimester Tdap-vaccination, which is offered subsequently between 200 and 240 w of gestation. Vaccinated women complete an additional questionnaire on vaccination tolerability. Vaccinated women may also participate in the immunogenicity part, in which blood is drawn from mother at delivery and from infant at birth and 2 months after birth. Women are also eligible for the immunogenicity part if they received a Tdap-vaccination between 200 and 240 w of gestation via the national immunization program and get hospitalized for an imminent preterm delivery. Blood sampling continues until 60 term and 60 preterm mother-infant-pairs have been included. Pertussis-specific IgG antibody concentrations are determined in serum using a fluorescent bead-based multiplex immunoassay. For term infants, non-inferiority in IgG antibody concentrations against pertussis toxin (anti-PT) will be assessed referred to a historical control group in which mothers were Tdap-vaccinated between 300 and 320 w of gestation. For preterm infants, non-inferiority of anti-PT IgG concentrations is referred to as 85% of infants having ≥ 20 international units/mL at 2 months after birth. DISCUSSION: This study investigates acceptance, tolerability and immunogenicity regarding maternal Tdap-immunization between 200 and 240 w of gestation. Its results provide insight into the effects of second trimester Tdap-vaccination on IgG antibody concentrations in term and preterm infants before primary infant vaccinations. Results on acceptance and tolerability guide antenatal care providers in communication with pregnant women and maintain the safety of second trimester Tdap-vaccination. TRIAL REGISTRATION: EU Clinical Trials Register, 2018-002976-41, retrospectively registered 24 July 2019, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2018-002976-41 .


Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular , Tos Ferina , Anticuerpos Antibacterianos , Estudios de Cohortes , Femenino , Humanos , Inmunización , Lactante , Recién Nacido , Recien Nacido Prematuro , Embarazo , Segundo Trimestre del Embarazo , Estudios Prospectivos , Vacunación , Tos Ferina/prevención & control
7.
Eur J Obstet Gynecol Reprod Biol ; 265: 90-95, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34474227

RESUMEN

OBJECTIVES: Women with a previous trachelectomy have an increased risk of premature delivery and second trimester miscarriage. In this study we aim to evaluate factors and regimes possibly affecting the risk for prematurity following fertility sparing robotic radical trachelectomy (RRT) in cervical cancer. METHODS: A retrospective study of the reproductive outcome following RRT with a cervical cerclage performed at one of four academic centers between 2007 and 2019. Factors possibly related to premature delivery, such as postoperative non-pregnant cervical length, previous vaginal deliveries, preservation of the uterine arteries, and the use of a second trimester oral metronidazole/no sexual intercourse regime, were assessed. RESULTS: 109 women remained for analyses after excluding recurrences before pregnancy (n = 8), secondary hysterectomy (n = 2), and women with less than six months follow up (n = 10). 74 pregnancies occurred in 52/71 women attempting to conceive, 56 of which developed past the first trimester. Two of 22 women (9%) who were prescribed an oral metronidazole regime (400 mg × 2 from gestational week 15 + 0 to 21 + 6 and abstaining from sexual intercourse for the duration of the pregnancy) had a premature delivery, compared with 13/31 (42%) where the regime was not applied (p = 0.009). The association remained after regression analyses including possible contributing factors as of above, none of which associated with prematurity at regression analyses (p = 0.001). CONCLUSIONS: The observed four-fold reduction in premature delivery indicates that an oral metronidazole/no sexual intercourse regime may reduce second trimester miscarriage and premature deliveries following an RRT. No association was observed for other investigated factors.


Asunto(s)
Aborto Espontáneo , Preservación de la Fertilidad , Traquelectomía , Neoplasias del Cuello Uterino , Coito , Femenino , Humanos , Metronidazol/uso terapéutico , Recurrencia Local de Neoplasia , Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Estudios Retrospectivos , Neoplasias del Cuello Uterino/cirugía
9.
Asia Pac J Clin Nutr ; 30(3): 477-486, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34587707

RESUMEN

BACKGROUND AND OBJECTIVES: The effect of fiber, especially the effect of specific fiber in different food groups, on gestational diabetes mellitus (GDM) has seldomly been investigated. This study aimed to examine the association between GDM risk and consumption of total fiber, fiber in specific food groups, and glycemic load (GL) in the second trimester in Chinese women. METHODS AND STUDY DESIGN: A total 162 GDM cases were matched to 324 controls on women's age and pre-pregnancy BMI. Dietary survey was conducted twice to evaluate dietary factors between 13-16 gestational weeks (GW) and 21-24 GW respectively. Multivariable logistic regression analysis was used to compute the odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Intake of total fiber and fruit fiber in both 13-16 GW and in 21-24 GW were significantly correlated with decreased risk of GDM, with adjusted ORs (95% CIs): 0.06 (0.03-0.13) and 0.03 (0.01-0.08) for total fiber in the highest quartile, 0.003 (0.0002-0.02) and 0.01 (0.001-0.02) for fruit fiber in the highest quartile, respectively. In contrast, consumption of cereal fiber in 21-24 GW and daily average GL in 13-16 GW were positively associated with GDM risk, with adjusted ORs (95% CIs) of the highest quartile: 3.34 (1.45-7.92) and 3.88 (1.43-10.89) respectively. CONCLUSIONS: Our findings suggested consumption of dietary fiber in various food groups in the second trimester might be associated with GDM risk. Particularly, diet rich in total fiber and fruit fiber may play a protective role.


Asunto(s)
Diabetes Gestacional , Carga Glucémica , Estudios de Casos y Controles , Diabetes Gestacional/epidemiología , Dieta , Fibras de la Dieta , Ingestión de Alimentos , Femenino , Humanos , Embarazo , Segundo Trimestre del Embarazo , Estudios Prospectivos , Factores de Riesgo
10.
Zhonghua Fu Chan Ke Za Zhi ; 56(8): 545-553, 2021 Aug 25.
Artículo en Chino | MEDLINE | ID: mdl-34420286

RESUMEN

Objective: To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester. Methods: A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared. Results: Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta (P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95%CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness (OR=0.033, 95%CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions: (1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.


Asunto(s)
Placenta Accreta , Embolización de la Arteria Uterina , Cicatriz , Femenino , Humanos , Placenta Accreta/diagnóstico por imagen , Placenta Accreta/epidemiología , Embarazo , Segundo Trimestre del Embarazo , Estudios Retrospectivos
11.
JAMA ; 326(6): 539-562, 2021 08 10.
Artículo en Inglés | MEDLINE | ID: mdl-34374717

RESUMEN

Importance: Gestational diabetes is associated with several poor health outcomes. Objective: To update the 2012 review on screening for gestational diabetes to inform the US Preventive Services Task Force. Data Sources: MEDLINE, EMBASE, and CINAHL (2010 to May 2020), ClinicalTrials.gov, reference lists; surveillance through June 2021. Study Selection: English-language intervention studies for screening and treatment; observational studies on screening; prospective studies on screening test accuracy. Data Extraction and Synthesis: Dual review of titles/abstracts, full-text articles, and study quality. Single-reviewer data abstraction with verification. Random-effects meta-analysis or bivariate analysis (accuracy). Main Outcomes and Measures: Pregnancy, fetal/neonatal, and long-term health outcomes; harms of screening; accuracy. Results: A total of 76 studies were included (18 randomized clinical trials [RCTs] [n = 31 241], 2 nonrandomized intervention studies [n = 190], 56 observational studies [n = 261 678]). Direct evidence on benefits of screening vs no screening was limited to 4 observational studies with inconsistent findings and methodological limitations. Screening was not significantly associated with serious or long-term harm. In 5 RCTs (n = 25 772), 1-step (International Association of Diabetes and Pregnancy Study Group) vs 2-step (Carpenter and Coustan) screening was significantly associated with increased likelihood of gestational diabetes (11.5% vs 4.9%) but no improved health outcomes. At or after 24 weeks of gestation, oral glucose challenge tests with 140- and 135-mg/dL cutoffs had sensitivities of 82% and 93%, respectively, and specificities of 82% and 79%, respectively, against Carpenter and Coustan criteria, and a test with a 140-mg/dL cutoff had sensitivity of 85% and specificity of 81% against the National Diabetes Group Data criteria. Fasting plasma glucose tests with cutoffs of 85 and 90 mg/dL had sensitivities of 88% and 81% and specificities of 73% and 82%, respectively, against Carpenter and Coustan criteria. Based on 8 RCTs and 1 nonrandomized study (n = 3982), treatment was significantly associated with decreased risk of primary cesarean deliveries (relative risk [RR], 0.70 [95% CI, 0.54-0.91]; absolute risk difference [ARD], 5.3%), shoulder dystocia (RR, 0.42 [95% CI, 0.23-0.77]; ARD, 1.3%), macrosomia (RR, 0.53 [95% CI, 0.41-0.68]; ARD, 8.9%), large for gestational age (RR, 0.56 [95% CI, 0.47-0.66]; ARD, 8.4%), birth injuries (odds ratio, 0.33 [95% CI, 0.11-0.99]; ARD, 0.2%), and neonatal intensive care unit admissions (RR, 0.73 [95% CI, 0.53-0.99]; ARD, 2.0%). The association with reduction in preterm deliveries was not significant (RR, 0.75 [95% CI, 0.56-1.01]). Conclusions and Relevance: Direct evidence on screening vs no screening remains limited. One- vs 2-step screening was not significantly associated with improved health outcomes. At or after 24 weeks of gestation, treatment of gestational diabetes was significantly associated with improved health outcomes.


Asunto(s)
Diabetes Gestacional/diagnóstico , Tamizaje Masivo , Diabetes Gestacional/terapia , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Recién Nacido , Tamizaje Masivo/efectos adversos , Tamizaje Masivo/métodos , Guías de Práctica Clínica como Asunto , Embarazo , Resultado del Embarazo , Segundo Trimestre del Embarazo , Medición de Riesgo
12.
J Transl Med ; 19(1): 366, 2021 08 26.
Artículo en Inglés | MEDLINE | ID: mdl-34446048

RESUMEN

BACKGROUND: The causes of gestational diabetes mellitus (GDM) are still unclear. Recent studies have found that the imbalance of the gut microbiome could lead to disorders of human metabolism and immune system, resulting in GDM. This study aims to reveal the different gut compositions between GDM and normoglycemic pregnant women and find the relationship between gut microbiota and GDM. METHODS: Fecal microbiota profiles from women with GDM (n = 21) and normoglycemic women (n = 32) were assessed by 16S rRNA gene sequencing. Fasting metabolic hormone concentrations were measured using multiplex ELISA. RESULTS: Metabolic hormone levels, microbiome profiles, and inferred functional characteristics differed between women with GDM and healthy women. Additionally, four phyla and seven genera levels have different correlations with plasma glucose and insulin levels. Corynebacteriales (order), Nocardiaceae (family), Desulfovibrionaceae (family), Rhodococcus (genus), and Bacteroidetes (phylum) may be the taxonomic biomarkers of GDM. Microbial gene functions related to amino sugar and nucleotide sugar metabolism were found to be enriched in patients with GDM. CONCLUSION: Our study indicated that dysbiosis of the gut microbiome exists in patients with GDM in the second trimester of pregnancy, and gut microbiota might be a potential diagnostic biomarker for the diagnosis, prevention, and treatment of GDM.


Asunto(s)
Diabetes Gestacional , Microbioma Gastrointestinal , Glucemia , China , Femenino , Humanos , Embarazo , Segundo Trimestre del Embarazo , ARN Ribosómico 16S/genética
13.
Pan Afr Med J ; 39: 75, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34422198

RESUMEN

Hyperreactio luteinalis (HL) is a rare entity in which both ovaries are multicystic and enlarged under the action of human chorionic gonadotropin (hCG), mostly seen in the third trimester of pregnancy. This benign condition is usually asymptomatic and doesn't need any specific treatment, as the ovaries spontaneously reduce in size after birth. This is a case report of a 33-year-old woman diagnosed with hyperreactio luteinalis during the second trimester of her induced pregnancy. An ultrasound scan at 22 weeks of gestation revealed bilateral multicystic enlarged ovaries along with multiple fetal malformations and hydropsfetalis. Usually, HL is most commonly seen in situations in which there are high levels of hCG, but our patient had normal levels of hCG during all her pregnancy, which makes our case even rarer. In conclusion, the most important challenge when faced with HL is to differentiate between it and other differential diagnosis especially malignant tumors, because unlike them, this benign condition doesn't need surgical treatment.


Asunto(s)
Gonadotropina Coriónica/sangre , Quistes Ováricos/diagnóstico por imagen , Complicaciones del Embarazo/diagnóstico por imagen , Anomalías Múltiples/diagnóstico por imagen , Adulto , Femenino , Humanos , Hallazgos Incidentales , Embarazo , Segundo Trimestre del Embarazo , Ultrasonografía Prenatal
16.
Matern Child Nutr ; 17(4): e13239, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34350703

RESUMEN

Gestational diabetes mellitus (GDM) is a common medical disorder that begins during pregnancy. The present work aimed to investigate the relationship of maternal or foetal circulatory zinc levels with GDM. Related studies were retrieved against the PubMed/Medline, Web of Science, Scopus databases till July 2020. The overall effects were expressed as standard mean difference (SMD). Furthermore, the random effects model was used to assess the summarised risk ratios (SRRs) to determine the relationship between zinc and the risk of GDM. A total of 15 articles involving were retrieved for meta-analysis; in the meantime, 4955 subjects including 1549 GDM cases were enrolled for quantitative analysis. Compared with normal control, GDM cases had decreased circulating zinc level on the whole, but the difference was not statistically significant (SMD = -0.40, 95%CI: -0.80 to -0.00, P = 0.05). Interestingly, upon subgroup analysis stratified by serum zinc content but not plasma zinc concentration, there was significant difference in zinc content between GDM cases and normal controls (SMD = -0.56; 95%CI: -1.07 to -0.04, P = 0.03). Meanwhile, subgroup analysis also revealed similar tendency among the Asians and during the 2nd trimester, but not among the Caucasians or during the 1st or 3rd trimester. Data extracted from four studies that compared pregnant women with GDM in the high level of zinc and GDM in the low level of zinc yielded an SRR of 0.929 (95%CI: 0.905-0.954). According to existing evidence, the serum zinc content decreases among GDM cases compared with subjects with no abnormality in glucose tolerance, in particular among the Asians and during the second trimester. Nonetheless, more well designed prospective study should be carried out for understanding the dynamic relationship of zinc level with the incidence of GDM.


Asunto(s)
Diabetes Gestacional , Femenino , Humanos , Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Estudios Prospectivos , Zinc
17.
Obstet Gynecol ; 138(3): 443-448, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34352829

RESUMEN

OBJECTIVE: To evaluate whether a 12-mL paracervical block is noninferior to a 20-mL block in reducing pain with osmotic dilator insertion. METHODS: In this single-blinded noninferiority trial, we randomized individuals undergoing insertion of osmotic dilators before second-trimester abortion to receive either a 12-mL or 20-mL 1% lidocaine paracervical block. The primary outcome was pain immediately after insertion of osmotic dilators. Prespecified secondary outcomes included pain with paracervical block administration, overall pain, and side effects, with 88 participants being required for a noninferiority margin of 15 mm on a 100-mm visual analog scale assuming an SD of 28. We analyzed data using Wilcoxon rank sum, χ2, and t tests and performed analysis of variance to account for repeated measures. Secondary analysis included multivariable regression to explore potential confounders. RESULTS: From January 2018 to October 2020, of 232 eligible individuals, 174 were approached and 96 randomized (48 participants to each group); 91 were available for analysis (45: 12 mL, 46: 20 mL). Group demographics were similar, with a mean gestation of 21 weeks and four osmotic dilators placed. The 12-mL paracervical block was noninferior to the 20-mL paracervical block for pain with osmotic dilator insertion with a difference in means of -1.36 (95% CI -12.56 to 9.85) favoring 12 mL. Median pain scores after dilator placement were 47 mm (interquartile range 22-68) and 50 mm (interquartile range 27-67) in 12-mL compared with 20-mL paracervical block, respectively (P=.81). No difference was seen in median pain at baseline, with paracervical block administration, postprocedure or with overall pain or experience. At least one lidocaine-related side effect occurred in 4% of participants in the 12-mL group compared with 13% for those receiving 20 mL (P=.15), with metallic taste, ringing in ears, and lightheadedness being most common. CONCLUSION: A 12-mL paracervical block is noninferior to a 20-mL block for pain reduction with osmotic dilator insertion. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03356145.


Asunto(s)
Aborto Inducido , Anestésicos Locales/administración & dosificación , Lidocaína/administración & dosificación , Dolor/prevención & control , Atención Prenatal , Adulto , Cuello del Útero , Femenino , Humanos , Dimensión del Dolor , Embarazo , Segundo Trimestre del Embarazo , Método Simple Ciego , Resultado del Tratamiento
18.
Obstet Gynecol ; 138(3): 482-486, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34352832

RESUMEN

BACKGROUND: Cervical varices complicating pregnancy are rare but can cause significant maternal and perinatal morbidity. There is limited evidence regarding the optimal management of bleeding caused by cervical varices during pregnancy. CASE: A 38-year-old woman was admitted to the hospital at 16 weeks of gestation due to vaginal hemorrhage in the setting of cervical varices accompanied by placenta previa. A cervical pessary was placed at 21 weeks of gestation without further bleeding. Magnetic resonance imaging demonstrated variceal reduction after pessary placement, and a cesarean delivery was performed at 36 weeks of gestation without complications. CONCLUSION: Cervical pessary should be considered as conservative option to control the bleeding associated with cervical varices during pregnancy.


Asunto(s)
Cuello del Útero/irrigación sanguínea , Complicaciones Hematológicas del Embarazo/diagnóstico , Diagnóstico Prenatal , Hemorragia Uterina/diagnóstico , Várices/diagnóstico , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Pesarios , Embarazo , Complicaciones Hematológicas del Embarazo/terapia , Segundo Trimestre del Embarazo , Hemorragia Uterina/terapia , Várices/terapia
19.
Nutrients ; 13(7)2021 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-34371944

RESUMEN

Animal studies have shown that exposure to excess sugar during the prenatal and postnatal periods may alter early brain structure in rat pups. However, evidence in humans is lacking. The aim of this study was to determine associations of maternal total and added sugar intake in pregnancy with early brain tissue organization in infants. Adolescent mothers (n = 41) were recruited during pregnancy and completed 24 h dietary recalls during the second trimester. Diffusion tensor imaging was performed on infants using a 3.0 Tesla Magnetic Resonance Imaging Scanner at 3 weeks. Maps of fractional anisotropy (FA) and mean diffusivity (MD) were constructed. A multiple linear regression was used to examine voxel-wise associations across the brain. Adjusting for postmenstrual age, sex, birth weight, and total energy intake revealed that maternal total and added sugar consumption were associated inversely and diffusely with infant MD values, not FA values. Inverse associations were distributed throughout all of the cortical mantle, including the posterior periphery (Bs = -6.78 to -0.57, Ps < 0.001) and frontal lobe (Bs = -4.72 to -0.77, Ps ≤ 0.002). Our findings suggest that maternal total and added sugar intake during the second trimester are significantly associated with features of brain tissue organization in infants, the foundation for future functional outcomes.


Asunto(s)
Encéfalo/anatomía & histología , Encéfalo/diagnóstico por imagen , Azúcares de la Dieta , Efectos Tardíos de la Exposición Prenatal , Fenómenos Fisiologicos de la Nutrición Prenatal , Adolescente , Anisotropía , Imagen de Difusión Tensora , Femenino , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Madres , Embarazo , Segundo Trimestre del Embarazo , Estudios Prospectivos , Adulto Joven
20.
JAMA ; 326(6): 531-538, 2021 08 10.
Artículo en Inglés | MEDLINE | ID: mdl-34374716

RESUMEN

Importance: Gestational diabetes is diabetes that develops during pregnancy. Prevalence of gestational diabetes in the US has been estimated at 5.8% to 9.2%, based on traditional diagnostic criteria, although it may be higher if more inclusive criteria are used. Pregnant persons with gestational diabetes are at increased risk for maternal and fetal complications, including preeclampsia, fetal macrosomia (which can cause shoulder dystocia and birth injury), and neonatal hypoglycemia. Gestational diabetes has also been associated with an increased risk of several long-term health outcomes in pregnant persons and intermediate outcomes in their offspring. Objective: The USPSTF commissioned a systematic review to evaluate the accuracy, benefits, and harms of screening for gestational diabetes and the benefits and harms of treatment for the pregnant person and infant. Population: Pregnant persons who have not been previously diagnosed with type 1 or type 2 diabetes. Evidence Assessment: The USPSTF concludes with moderate certainty that there is a moderate net benefit to screening for gestational diabetes at 24 weeks of gestation or after to improve maternal and fetal outcomes. The USPSTF concludes that the evidence on screening for gestational diabetes before 24 weeks of gestation is insufficient, and the balance of benefits and harms of screening cannot be determined. Recommendation: The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes in asymptomatic pregnant persons before 24 weeks of gestation. (I statement).


Asunto(s)
Diabetes Gestacional/diagnóstico , Tamizaje Masivo/normas , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Tamizaje Masivo/efectos adversos , Tamizaje Masivo/métodos , Embarazo , Segundo Trimestre del Embarazo , Trimestres del Embarazo , Medición de Riesgo , Factores de Riesgo
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