High First Trimester Levels of TSH as an Independent Risk Factor for Gestational Diabetes Mellitus: A Retrospective Cohort Study.

Although numerous articles have found an association between alterations in thyroid function and the risk of gestational diabetes mellitus (GDM), other studies have failed to demonstrate this association. This may be due to the different cut-off points used to define subclinical hypothyroidism. We aim to clarify the role of thyroid stimulating hormone (TSH) level in GDM within pregnant women with normal free thyroxine (fT4) levels. This retrospective cohort study was performed in 6775 pregnant women. The association between TSH and GDM was assessed by bivariate and multivariate logistic regression. Pregnant women with subclinical hypothyroidism are at significantly greater risk for GDM when compared with euthyroid pregnant women (OR = 1.85; 95% CI = 1.36-2.52). We have also observed that TSH levels increase the risk of GDM within euthyroid pregnant women, since the TSH levels between 2.5 and 4.71 showed a higher risk of GDM than those whose TSH levels are between 0.31 and 2.49 (OR = 1.54; 95% CI = 1.28-1.84). In addition, pregnant women with positive thyroid antibodies have almost 2.5 times the risk of developing GDM (OR = 2.47; 95% CI = 1.57-3.89). Our results support that in pregnant women with normal fT4 levels, higher first trimester TSH level implies a higher risk of GDM.

INTERGROWTH-21st versus a customized method for the prediction of neonatal nutritional status in hypertensive disorders of pregnancy.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) generate complications and are one of the principal causes of maternal, foetal, and neonatal mortality worldwide. It has been observed that in pregnancies with HDP, the incidence of foetuses small for their gestational age (SGA) is twice as high as that in noncomplicated pregnancies. In women with HDP, the identification of foetuses (SGA) is substantially important, as management and follow-up are determined by this information. OBJECTIVE: The objective of this study was to evaluate whether the INTERGROWTH-21st method or customized birthweight references better identify newborns with an abnormal nutritional status resulting from HDP. METHOD: A comparative analysis study was designed with two diagnostic methods for the prediction of neonatal nutritional status in pregnancies with HDP. The performance of both methods in identifying neonatal malnutrition (defined by a neonatal body mass index < 10th centile or a ponderal index < 10th centile) was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratio, Youden's index and probability ratios. RESULTS: The study included 226 pregnant women diagnosed with HDP. The customized method identified 45 foetuses as small for gestational age (19.9%), while the INTERGROWTH-21st method identified 27 newborns with SGA (11.9%). The difference between proportions was statistically significant (p < 0.01). Using body mass index (< 10th centile) as a measure of nutritional status, newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH-21st (RR: 4.87 (95% CI: 1.86-12.77) vs. 3.75 (95% CI: 1.49-9.43)) (DOR: 5.56 (95% CI: 1.82-16.98) vs. 4.84 (95% CI: 1.51-15.54)) Even when using Ponderal index (< 10th centile), newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH-21st (RR 2.37 (95% CI: 1.11-5.05) vs. 1.68 (95% CI: 0.70-4.03))(DOR 2.62 (95% CI: 1.00-6.87) vs. 1.90 (95% CI: 0.61-5.92)). CONCLUSION: In pregnant women with HDP, the predictive ability of the customized foetal growth curves to identify neonatal malnutrition appears to surpass that of INTERGROWTH-21st.

Nursing Diagnosis of Grieving in Cases of Perinatal Loss: A Preliminary Clinical Validation.

PURPOSE: To develop a preliminary clinical validation the NANDA-I nursing diagnosis "Grieving" in cases of perinatal loss. METHODS: Descriptive cross-sectional study using the Fehring model. FINDINGS: The overall clinical validity index for the diagnosis was 0.15. Only four defining characteristics and five manifestations identified in the literature were validated. CONCLUSIONS: The variability of manifestations identified in the study participants is considered to be detrimental to the overall clinical validity index. IMPLICATIONS FOR NURSING PRACTICE: The clinical validity of the diagnosis could not be substantiated by the preliminary results of this study and, therefore, additional research is necessary to determine the ability of the diagnosis to adapt to perinatal loss situations in real contexts. Some manifestations have been proposed to NANDA-I for inclusion as defining characteristics in the nursing diagnosis of grieving. OBJETIVO: Validar clínicamente de forma preliminar el diagnóstico enfermero NANDA-I duelo en caso de pérdida perinatal. MÉTODOS: Estudio descriptivo transversal usando el modelo de Fehring. RESULTADOS: El índice de validez clínica global del diagnóstico fue de 0.15. Se validaron únicamente cuatro características definitorias y cinco manifestaciones identificadas en la literatura. CONCLUSIONES: Se considera que la variabilidad de las manifestaciones presentadas por los participantes actuó en detrimento del índice de validación clínica global. IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: La validez clínica del diagnóstico no pudo ser corroborada por los resultados preliminares de este estudio y, por tanto, se necesita investigación adicional para terminar la capacidad de este diagnóstico para adaptarse a las situaciones de pérdidas perinatales en contexto reales. Se han propuesto a NANDA-I algunas manifestaciones para que sean incluidas como Características Definitorias del diagnóstico enfermero Duelo.

Design of a nursing objective structured clinical examination of a first-year clinical practice program.

OBJECTIVE: The aim of the present study was to design a content-valid nursing objective structured clinical examination attending a first-year clinical nursing practice program. METHOD: The examination was designed following a procedure based on the consensus of experts which was comprised of three phases: selection of the activities in which students should be competent according to the learning outcomes of the course, clinical case design, and integration of the clinical cases designed into the stations of the test. RESULTS: Of the 44 surveys submitted for the design of the stations, 37 were answered, of which 31 respondents met the inclusion criteria of the panel of experts. The activities on which the experts reached the highest degrees of consensus were: basic physical assessment and monitoring of vital signs, assessment of hygiene and skin status, ability to develop care plans, management of safety principles in administration of medication and administration of oral medication. Based on the selected activities, the experts developed 20 clinical cases, from which a four-station nursing objective structured clinical examination was designed. CONCLUSION: The structured methodology based on the design of experts enabled the design of a content-valid objective structured clinical examination appropriate for the evaluation of the learning outcomes achieved by the students attending a clinical practice program.

Design of a nursing objective structured clinical examination of a first-year clinical practice program / Projeto de um exame clínico estruturado objetivo de enfermagem de um programa de prática clínica do primeiro ano / Diseño de una prueba de evaluación clínica objetiva estructurada de cuidados de enfermería del primer curso de prácticas clínicas

ABSTRACT Objective: The aim of the present study was to design a content-valid nursing objective structured clinical examination attending a first-year clinical nursing practice program. Method: The examination was designed following a procedure based on the consensus of experts which was comprised of three phases: selection of the activities in which students should be competent according to the learning outcomes of the course, clinical case design, and integration of the clinical cases designed into the stations of the test. Results: Of the 44 surveys submitted for the design of the stations, 37 were answered, of which 31 respondents met the inclusion criteria of the panel of experts. The activities on which the experts reached the highest degrees of consensus were: basic physical assessment and monitoring of vital signs, assessment of hygiene and skin status, ability to develop care plans, management of safety principles in administration of medication and administration of oral medication. Based on the selected activities, the experts developed 20 clinical cases, from which a four-station nursing objective structured clinical examination was designed. Conclusion: The structured methodology based on the design of experts enabled the design of a content-valid objective structured clinical examination appropriate for the evaluation of the learning outcomes achieved by the students attending a clinical practice program.

RESUMO Objetivo: O objetivo do presente estudo foi elaborar um exame clínico estruturado de objetivos de enfermagem com conteúdo válido, participando de um programa de prática clínica de enfermagem do primeiro ano. Método: O exame foi elaborado seguindo um procedimento baseado no consenso de especialistas que compreendeu três fases: seleção das atividades nas quais os alunos deveriam ser competentes de acordo com os resultados de aprendizagem do curso, desenho do caso clínico e integração do quadro clínico casos projetados para as estações do teste. Resultados: Das 44 pesquisas submetidas para a concepção das estações, 37 foram respondidas, das quais 31 respondentes atenderam aos critérios de inclusão do painel de especialistas. As atividades nas quais os especialistas alcançaram maior grau de consenso foram: avaliação física básica e monitoramento dos sinais vitais, avaliação da higiene e do estado da pele, capacidade de desenvolver planos de cuidados, gestão dos princípios de segurança na administração de medicamentos e administração de medicamentos orais. Com base nas atividades selecionadas, os especialistas desenvolveram 20 casos clínicos, a partir dos quais foi elaborado um exame clínico estruturado objetivo de enfermagem em quatro estações. Conclusão: A metodologia estruturada baseada na concepção de especialistas permitiu a concepção de um exame clínico estruturado objetivo válido e de conteúdo adequado para a avaliação dos resultados de aprendizagem alcançados pelos alunos que frequentam um programa de prática clínica.

RESUMEN Objetivo: El objetivo de este estudio fue diseñar una Evaluación Clínica Objetiva Estructurada con validez de contenido para evaluar el nivel de competencias de estudiantes de primer curso de formación practico-clínica enfermera. Método: Se diseñó la prueba siguiendo un procedimiento basado en consenso de expertos con tres fases: selección de las actividades en la que los alumnos debían ser competentes en base a los resultados de aprendizaje de la asignatura, diseño de casos clínicos, e integración de los casos clínicos diseñados en las estaciones de la prueba. Resultados: Las actividades que alcanzaron mayor consenso por parte de los expertos fueron: valoración física básica y monitorización de signos vitales, valoración de la higiene y estado de la piel, capacidad para elaborar planes de cuidados, manejo de los principios de seguridad en la administración de medicación y administración de medicación oral. En base a las actividades seleccionadas, los expertos elaboraron 20 casos clínicos, a partir de los cuales se diseñó una evaluación clínica objetiva estructurada de cuidados de enfermería formada por cuatro estaciones. Conclusión: La metodología estructurada basada en el diseño de expertos permitió el diseño de una evaluación clínica objetiva estructurada adecuada para evaluar los resultados de aprendizaje alcanzados por los estudiantes de primer curso de formación práctico-clínica.

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

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

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

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

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

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

A Student Assessment Tool for Standardized Patient Simulations (SAT-SPS): Psychometric analysis.

BACKGROUND: The evaluation of the level of clinical competence acquired by the student is a complex process that must meet various requirements to ensure its quality. The psychometric analysis of the data collected by the assessment tools used is a fundamental aspect to guarantee the student's competence level. AIM: To conduct a psychometric analysis of an instrument which assesses clinical competence in nursing students at simulation stations with standardized patients in OSCE-format tests. METHOD: The construct of clinical competence was operationalized as a set of observable and measurable behaviors, measured by the newly-created Student Assessment Tool for Standardized Patient Simulations (SAT-SPS), which was comprised of 27 items. The categories assigned to the items were 'incorrect or not performed' (0), 'acceptable' (1), and 'correct' (2). PARTICIPANTS: 499 nursing students. Data were collected by two independent observers during the assessment of the students' performance at a four-station OSCE with standardized patients. Descriptive statistics were used to summarize the variables. The difficulty levels and floor and ceiling effects were determined for each item. Reliability was analyzed using internal consistency and inter-observer reliability. The validity analysis was performed considering face validity, content and construct validity (through exploratory factor analysis), and criterion validity. RESULTS: Internal reliability and inter-observer reliability were higher than 0.80. The construct validity analysis suggested a three-factor model accounting for 37.1% of the variance. These three factors were named 'Nursing process', 'Communication skills', and 'Safe practice'. A significant correlation was found between the scores obtained and the students' grades in general, as well as with the grades obtained in subjects with clinical content. CONCLUSIONS: The assessment tool has proven to be sufficiently reliable and valid for the assessment of the clinical competence of nursing students using standardized patients. This tool has three main components: the nursing process, communication skills, and safety management.

Indications of caesarean section in overweight and obese versus normal-weight pregnant women: a retrospective cohort study.

PURPOSE: The aim of this study was to test the hypothesis that indications of c-section in overweight or obese pregnant women are different from those with normal-weight. METHODS: Retrospective cohort study at University Hospital of Puerto Real (Cádiz-Spain). We compared frequency distribution of c-section indications in overweight and obese versus normal-weight. The risk of c-section by different indications was calculated as relative risk. RESULTS: A total of 4685 births were included in the study. There are significant differences in the frequency distribution of caesarean indications among normal weight and overweight or obese women. In overweight, we found an increased risk of c-section due to previous c-section (RR: 1.73; confidence interval [CI] 95% 1.24-2.42), obstructed/non-progressive labour (RR: 1.34; CI 95% 1.03-1.75), failed induction of labour (RR: 2.38; CI 95% 1.30-4.34) and foetal distress (RR: 1.73; CI 95% 1.21-2.49). This risk was even higher in obese women: previous c-section (RR: 3.25; CI 95% 2.24-4.71), obstructed/non-progressive labour (RR: 2; CI 95% 1.45-2.77), failed induction (RR: 2.52; CI 95% 1.15-5.51) and foetal distress (RR: 2.35; CI 95% 1.51-3.65). CONCLUSIONS: The risk of caesarean section due to previous caesarean section, obstructed/non-progressive labour, failed induction of labour or foetal distress is greater in overweight and obese than in normal-weight. This increase in risk also increases progressively as maternal BMI increases.

"Hypothyroidism screening during first trimester of pregnancy".

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

Maternal underweight and perinatal outcomes: a restrospective cohort study / Infrapeso materno y resultados perinatales: estudio de cohortes retrospectivo.

Introduction: Some studies have linked maternal underweight with adverse perinatal outcomes such as spontaneous abortion, abruptio placentae, small for gestational age newborn, intrauterine growth retardation and preterm birth. Objective: To determine the influence of maternal underweight in the onset of labor, route of delivery, birth weight, Apgar score and preterm birth. Methods: Retrospective cohort study. We included pregnant women from the Hospital Universitario de Puerto Real. Period of study: 2002-2011. Study group: underweight at the beginning of gestation (BMI < 18.5 kg/m2). Control group: pregnant women with normal body mass index (BMI) at the beginning of gestation (18.5-24.9 kg/m2). The risk (OR) of induction of labor, cesarean section, small for gestational age newborn, macrosomia, 5' Apgar score < 7, and preterm birth was calculated. Results: The prevalence of underweight was 2.5% versus 58.9% of pregnant women who had a normal BMI. We found no significant differences in the rate of induction of labor, fetal macrosomia, Apgar at 5' < 7 or preterm delivery. Maternal underweight was associated with a decreased risk of caesarean section (adjusted OR 0.45, 95% CI 0.22 to 0.89) and an increased risk of small for gestational age newborn (adjusted OR 1.74; 95% CI 1.05 to 2.90). Conclusions: Maternal underweight at the start of pregnancy is associated with a lower risk of caesarean section and a greater risk of small for gestational age newborns (birth weight < P10).

Introducción: algunos estudios han asociado el infrapeso materno con resultados perinatales adversos tales como aborto espontáneo, desprendimiento placentario, feto pequeño para edad gestacional, crecimiento intrauterino retardado y parto pretérmino. Objetivos: determinar si el infrapeso materno al inicio de la gestación influye sobre la forma de inicio y vía del parto, peso al nacer, índice de Apgar al minuto 5 y edad gestacional en el momento del parto. Métodos: estudio de cohortes retrospectivo en gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Grupo de estudio: infrapeso al inicio de la gestación (índice de masa corporal [IMC] < 18,5); grupo control: IMC normal al inicio de la gestación (18,5-24,9). Analizamos el riesgo (OR) de inducción de parto, cesárea, bajo peso al nacer, macrosomía, Apgar a los 5' < 7 y parto pretérmino. Resultados: la prevalencia de infrapeso fue del 2,5% frente al 58,9% de gestantes que presentaron un IMC normal. No encontramos diferencias significativas en la tasa de inducción de parto, macrosomía fetal, Apgar a los 5' < 7 ni parto pretérmino. El infrapeso materno se asoció a una disminución en el riesgo de cesárea (OR ajustada 0,45; IC 95% 0,22-0,89) y a un riesgo aumentado de presentar recién nacido pequeño para su edad gestacional (OR ajustada 1,74; IC 95% 1,05-2,90). Conclusiones: el infrapeso materno al inicio de la gestación se asocia a una menor probabilidad de que el parto finalice mediante la realización de una cesárea y a un mayor riesgo de que el recién nacido presente un peso al nacer por debajo del percentil 10.

Infrapeso materno y resultados perinatales: estudio de cohortes retrospectivo / Maternal underweight and perinatal outcomes: a restrospective cohort study

Introducción: algunos estudios han asociado el infrapeso materno con resultados perinatales adversos tales como aborto espontáneo, desprendimiento placentario, feto pequeño para edad gestacional, crecimiento intrauterino retardado y parto pretérmino. Objetivos: determinar si el infrapeso materno al inicio de la gestación influye sobre la forma de inicio y vía del parto, peso al nacer, índice de Apgar al minuto 5 y edad gestacional en el momento del parto. Métodos: estudio de cohortes retrospectivo en gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Grupo de estudio: infrapeso al inicio de la gestación (índice de masa corporal [IMC] < 18,5); grupo control: IMC normal al inicio de la gestación (18,5-24,9). Analizamos el riesgo (OR) de inducción de parto, cesárea, bajo peso al nacer, macrosomía, Apgar a los 5’ < 7 y parto pretérmino. Resultados: la prevalencia de infrapeso fue del 2,5% frente al 58,9% de gestantes que presentaron un IMC normal. No encontramos diferencias significativas en la tasa de inducción de parto, macrosomía fetal, Apgar a los 5’ < 7 ni parto pretérmino. El infrapeso materno se asoció a una disminución en el riesgo de cesárea (OR ajustada 0,45; IC 95% 0,22-0,89) y a un riesgo aumentado de presentar recién nacido pequeño para su edad gestacional (OR ajustada 1,74; IC 95% 1,05-2,90). Conclusiones: el infrapeso materno al inicio de la gestación se asocia a una menor probabilidad de que el parto finalice mediante la realización de una cesárea y a un mayor riesgo de que el recién nacido presente un peso al nacer por debajo del percentil 10 (AU)

Introduction: Some studies have linked maternal underweight with adverse perinatal outcomes such as spontaneous abortion, abruptio placentae, small for gestational age newborn, intrauterine growth retardation and preterm birth. Objective: To determine the influence of maternal underweight in the onset of labor, route of delivery, birth weight, Apgar score and preterm birth. Methods: Retrospective cohort study. We included pregnant women from the Hospital Universitario de Puerto Real. Period of study: 2002-2011. Study group: underweight at the beginning of gestation (BMI < 18.5 kg/m2). Control group: pregnant women with normal body mass index (BMI) at the beginning of gestation (18.5-24.9 kg/m2). The risk (OR) of induction of labor, cesarean section, small for gestational age newborn, macrosomia, 5’ Apgar score < 7, and preterm birth was calculated. Results: The prevalence of underweight was 2.5% versus 58.9% of pregnant women who had a normal BMI. We found no significant differences in the rate of induction of labor, fetal macrosomia, Apgar at 5’ < 7 or preterm delivery. Maternal underweight was associated with a decreased risk of caesarean section (adjusted OR 0.45, 95% CI 0.22 to 0.89) and an increased risk of small for gestational age newborn (adjusted OR 1.74; 95% CI 1.05 to 2.90). Conclusions: Maternal underweight at the start of pregnancy is associated with a lower risk of caesarean section and a greater risk of small for gestational age newborns (birth weight < P10) (AU)

Development and Psychometric Evaluation of a Questionnaire Based on the Nursing Outcomes Classification to Determine the Knowledge of Parents on Breast-Feeding: Research Protocol.

PURPOSE: To develop and psychometrically evaluate a questionnaire based on the outcome "Knowledge: Breast-feeding" of the Nursing Outcomes Classification (NOC) to determine the knowledge of parents on breast-feeding. BACKGROUND: The NOC outcome "Knowledge: Breast-feeding" allows for nurses/midwives to assess the efficacy of interventions aimed to improve the knowledge on breast-feeding in parents thought the clinical interview/observation. However, the use of self-administered questionnaires by patients could facilitate its evaluation. METHODS: Two-phased study: (1) Development of the questionnaire based on experts' opinions; (2) Methodological design to assess its psychometric properties. IMPLICATIONS FOR NURSING PRACTICE: The availability of tools that enable the determination of the knowledge of patients would facilitate nurses/midwives to set objectives, individualize interventions, and measure their effectiveness.

Birthweight in pregnant women with protein S deficiency treated with low-molecular-weight heparin: a retrospective cohort study.

OBJECTIVE: To determine the risk of small-for-gestational-age (SGA) and intrauterine growth retardation (IUGR) in pregnant women with protein S (PS) deficiency who received low-molecular-weight heparin (LMWH). METHODS: Retrospective cohort study of pregnant women seen from January 2002 to December 2011. The study cohort comprised a total of 328 patients with PS deficiency, who received prophylactic enoxaparin during pregnancy. The control cohort included 11 884 pregnant women without significant past medical history. The risk of SGA and IUGR was calculated as odds ratio. Multivariate regression analysis over the entire reference population was performed determining the risk of both SGA and IUGR by adjusting for maternal age, first delivery, maternal underweight status, pre-eclampsia, other treated thrombophilias or history of recurrent abortion. RESULTS: The SGA rates in the PS deficiency and control cohorts were 10.7% and 8.5%, respectively (p > 0.05). There was no increased risk of SGA (unadjusted OR = 1.28, 95% confidence interval [CI] 0.9-1.83; adjusted OR = 1.35, 95% CI 0.91-2.01). The IUGR rate was 2.7% in pregnant women with PS deficiency versus 4.1% in the control group (p > 0.05). Also, we did not find a significant risk of IUGR (OR = 0.66; 95% CI 0.34-1.28; adjusted OR = 0.843; 95% CI 0.42-1.70). CONCLUSIONS: In women with PS deficiency treated with LMWH, the risk of SGA and IUGR is similar to the one found in healthy pregnant women.

Sobrepeso y obesidad maternos como factores de riesgo independientes para que el parto finalice en cesárea.

Introducción: el sobrepeso y la obesidad se asocian a una mayor probabilidad de que el parto finalice en cesárea. Dado que dicho incremento del riesgo podría estar sesgado por variables de confusión como la diabetes o la hipertensión, en el presente trabajo pretendemos determinar si este riesgo persiste tras ser ajustado por numerosas variables de control.Objetivo: determinar si el sobrepeso y/o la obesidad son factores de riesgo independientes para que el parto finalice en cesárea.Métodos: estudio de cohortes retrospectivo. Se han incluido gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Se incluyeron dos grupos de estudio: sobrepeso al inicio de la gestación (IMC entre 25 y 29,9) y obesidad al inicio de la gestación (IMC ≥ 30). Grupo ontrol: IMC al inicio de la gestación normal (entre 18,5 y 24,9). El riesgo de cesárea fue analizado mediante un estudio de regresión logística múltiple incluyendo como covariables: edad materna, parto inducido, diabetes gestacional, diabetes pregestacional, macrosomía, hipertensión arterial, nuliparidad, cesárea anterior, parto pretérmino y parto postérmino.Resultados: de los 18.243 partos registrados, el IMC al inicio de la gestación constaba en 4.711 casos (25,8%). El 26,1% presentaban sobrepeso, el 12,4% obesidad y el 58,9% IMC normal. Sin ajustar por variables control, se asociaron a un incremento del riesgo de cesárea: sobrepeso (OR 1,48; IC95% 1,27-1,73); obesidad grado 1 (OR 2,09; IC95% 1,66-2,64); obesidad grado 2 (OR 3,23; IC95% 2,31-4,53); obesidad grado 3 (OR 2,57; IC95% 1,56-4,22). El riesgo aumentado se mantuvo significativo en el análisis multivariante: sobrepeso (OR 1,51; IC95% 1,24-1,84); obesidad (OR 2,15; IC95% 1,67-2,76).Conclusiones: encontramos una asociación significativa e independiente entre el sobrepeso/obesidad maternos y la finalización del parto mediante cesárea incluso ajustando por numerosas variables de control como: edad materna, nuliparidad, cesárea anterior, hipertensión, diabetes, peso al nacer y edad gestacional al parto.

Sobrepeso y obesidad maternos como factores de riesgo independientes para que el parto finalice en cesárea / Maternal overweight and obesity as independent risk factors for cesarean delivery

Introducción: el sobrepeso y la obesidad se asocian a una mayor probabilidad de que el parto finalice en cesárea. Dado que dicho incremento del riesgo podría estar sesgado por variables de confusión como la diabetes o la hipertensión, en el presente trabajo pretendemos determinar si este riesgo persiste tras ser ajustado por numerosas variables de control. Objetivo: determinar si el sobrepeso y/o la obesidad son factores de riesgo independientes para que el parto finalice en cesárea. Métodos: estudio de cohortes retrospectivo. Se han incluido gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Se incluyeron dos grupos de estudio: sobrepeso al inicio de la gestación (IMC entre 25 y 29,9) y obesidad al inicio de la gestación (IMC ≥ 30). Grupo control: IMC al inicio de la gestación normal (entre 18,5 y 24,9). El riesgo de cesárea fue analizado mediante un estudio de regresión logística múltiple incluyendo como covariables: edad materna, parto inducido, diabetes gestacional, diabetes pregestacional, macrosomía, hipertensión arterial, nuliparidad, cesárea anterior, parto pretérmino y parto postérmino. Resultados: de los 18.243 partos registrados, el IMC al inicio de la gestación constaba en 4.711 casos (25,8%). El 26,1% presentaban sobrepeso, el 12,4% obesidad y el 58,9% IMC normal. Sin ajustar por variables control, se asociaron a un incremento del riesgo de cesárea: sobrepeso (OR 1,48; IC95% 1,27-1,73); obesidad grado 1 (OR 2,09; IC95% 1,66-2,64); obesidad grado 2 (OR 3,23; IC95% 2,31-4,53); obesidad grado 3 (OR 2,57; IC95% 1,56-4,22). El riesgo aumentado se mantuvo significativo en el análisis multivariante: sobrepeso (OR 1,51; IC95% 1,24-1,84); obesidad (OR 2,15; IC95% 1,67-2,76). Conclusiones: encontramos una asociación significativa e independiente entre el sobrepeso/obesidad maternos y la finalización del parto mediante cesárea incluso ajustando por numerosas variables de control como: edad materna, nuliparidad, cesárea anterior, hipertensión, diabetes, peso al nacer y edad gestacional al parto (AU)

Introduction: Overweight and obesity both are associated with an increased risk of cesarean section. Since this increased risk could be biased by confounding variables such as diabetes or hypertension, in this study we aim to determine whether this risk persists after adjusting for numerous control variables. Objective: To determine if maternal overweight and/or obesity are independent risk factors to cesarean section. Methods: Retrospective cohort study. We included pregnant women from the University Hospital of Puerto Real. Period of study: 2002-2011. Two study groups were included: overweight at the beginning of the gestation (BMI between 25 and 29.9 kg/m2) and obesity at the beginning of the gestation (BMI ≥ 30 kg/m2). Control group: pregnant women with normal BMI at the beginning of the gestation (Between 18.5 and 24.9 kg/m2). Multiple logistic regression analysis was conducted in order to evaluate the risk of caesarean. The variables included in the model were maternal age, induced labor, diabetes (gestational and pregestational), macrosomia, arterial hypertension, nulliparous, previous caesarean section, preterm birth and post-term childbirth. Results: Initial BMI was registered in 4,711 cases (25.8%) of a total of 18,243 births. Of these, 26.1% were overweight; 12.4% obesity and 58.9% normal BMI. Without adjusting by control variables, both overweight and obesity are associated to an increase in the risk of caesarean section: overweight (OR 1.48; CI95% 1.27-1.73); type 1 obesity (OR 2.09; CI95% 1.66-2.64); type 2 obesity (OR 3.23; CI95% 2.31-4.53); type 3 obesity (OR 2.57; IC95% 1.56-4.22). The risk remained significantly increased in the multivariate analysis: overweight (OR 1.51; CI95% 1.24-1.84); obesity (OR 2.15; IC95% 1.67-2.76). Conclusions: In conclusion, a significant and independent association was found between maternal overweight/obesity and cesarean section, even including numerous control variables such as age, nulliparous, previous cesarean section, hypertension, diabetes, birth weight and gestational age at birth (AU)

Customized versus Population-Based Birth Weight References for Predicting Fetal and Neonatal Undernutrition.

OBJECTIVES: The aim of our study was to construct a model of customized birth weight curves based on a Spanish population and to compare the ability of this customized model to our population-based chart to predict a neonatal ponderal index (PI) <10th percentile. METHODS: We developed a model that can predict the 10th percentile for a fetus according to gestational age and gender as well as maternal weight, height, and age. We compared the ability of this customized model to that of our own population-based model to predict a neonatal PI <10th percentile. Data from a large database were used (32,854 live newborns, from 1993 through 2012). Only singleton pregnancies with a gestational age at delivery of 32-42 weeks were included. RESULTS: In the entire pregnant population, the customized method was superior to the population-based method for detecting newborns with a PI <10th percentile (sensitivity: 55 vs. 40.96%; specificity: 99.6 vs. 91.23%; positive predictive value: 11.49 vs. 9.55%, and negative predictive value: 98.84 vs. 98.55%, respectively). In pregnant women with a BMI >90th percentile, the sensitivity was 75%, compared to 50% in the population-based method. In pregnant women with a height >90th percentile, the sensitivity was almost as high as in the population-based method (61.53 vs. 33.33%). CONCLUSION: The customized birth weight curve is superior to the population-based method for the detection of newborns with a PI <10th percentile. This is especially the case in women in the higher scales of height and weight as well as in preterm babies.

Nursing diagnosis of grieving: content validity in perinatal loss situations.

PURPOSE: To validate the content of the NANDA-I nursing diagnosis of grieving in situations of perinatal loss. METHODS: Using the Fehring's model, 208 Spanish experts were asked to assess the adequacy of the defining characteristics and other manifestations identified in the literature for cases of perinatal loss. FINDINGS: The content validity index was 0.867. Twelve of the 18 defining characteristics were validated, seven as major and five as minor. From the manifestations proposed, "empty inside" was considered as major. CONCLUSION: The nursing diagnosis of grieving fits in content to the cases of perinatal loss according to experts. IMPLICATIONS FOR NURSING PRACTICE: The results have provided evidence to support the use of the diagnosis in care plans for said clinical situation.