[Evaluation of a breakfast as screening test for the detection of gestational diabetes]. / Evaluación de un desayuno como prueba de tamiz para la detección de diabetes gestacional.

A standard breakfast was evaluated as a screening test (BT) for gestational diabetes in a case-control study. The breakfast had a high carbohydrate content and was designed based on women's preferences in a similar sample. Women were selected with a standard 50 g, 1 hour glucose screening test (GT). Fifteen women had a positive GT and 15 had a negative test. A glucose tolerance test (GTT) and a standard breakfast (719 kcal) were performed to all women. Age, weight, height, tricipital and subscapular skinfold thicknesses were obtained by previously standardized personnel and glucose levels were determined by an automatic technique (oxidase glucose). Ten women had gestational diabetes. Sensitivity and specificity were calculated for the GT and several values of the BT, in order to identify the threshold and optimum time. Concordance of both screening tests with GTT was calculated through Kappa test. For the BT, a sensitivity of 0.90 and specificity of 1.00 with a glucose level > or = 140 mg/L (7.2 mmol/L) at 60 and 90 minutes were found. The 60 minutes timing were preferred due to a shorter waiting time to performed the test. Concordance of GTT with GT and BT was 0.53 and 0.92 respectively, both statistically significant. GT had high frequency of false negative values (6/15) that explain the low kappa value. Standard breakfast can be used as an alternative method for assessing carbohydrate tolerance in pregnancy with a better physiological response in these women.

[Assessment of a preconception preventive program in a community]. / Evaluación de un programa preventivo pregestacional en una comunidad.

Primary Health Care (PHC) is the basic health support that includes health promotion and disease prevention, considering social and developmental factors. It is the main axis to pregestational health programs with the basic elements for the women's self-care. This study evaluated the impact on health behavior and adherence to a community based pregestational preventive program in 224 women of reproductive age from Mexico City. The women were exposed to a health education intervention for twelve months, with free clinical examination every six months in a mobile screening unit close to their homes. Food and hygiene one to one orientation was offered, together with anthropometric, blood pressure and biochemical evaluations. Program adherence was 55%. Most of the women were less than 25 years of age, education above nine years, non-single, housework occupation as housewives, from an extended family, with social security and two or less live children and desire for more. No differences were found in the evaluated factors between those who continued and those who left the program. When comparing initial and final data, a significant larger proportion did breast self-examination, while this was not the case for the Pap smear test, no differences were found in prevalence of anemia or overweight. Drop-out was mainly due to a lack of interest, school or work problems and change of address. While breast self examination showed a positive effect, the negative or no effect on the other factors requires the intervention of other health professionals and implies more effort from the women. If one of the objectives of the PHC is health promotion, nurse intervention is a prominent role in the community.

Facial anthropometric measurements in offspring of epileptic mothers.

BACKGROUND: Minor facial anomalies in 14-33% of exposed fetuses have been associated with the teratogenic effect of antiepileptic drugs (AED) since 1968. The purpose of this article is to describe the facial characteristics of offspring of epileptic mothers with and without exposure to AED by means of 22 anthropometric measurements, for the purpose of comparison with the measurements of offspring of non-epileptic women previously described in the literature, and to correlate the facial anomalies with the specific drug. METHODS: An interval was defined where 95% of the central values were considered as "common values" and the remaining 5% as "uncommon values" (UV) or as being in the "alert zone"; the odds ratio with Wolf modification was used and then Fisher's test for comparison with healthy newborns. Full-term eutrophic newborns of epileptic mothers who received attention at the epilepsy clinic of a gyneco-obstetric center were included. RESULTS: During the study period, 72 eutrophic, full-term newborns were included; in 70 cases at least one measurement was found in the alert zone, with a predominance of the mid-line area. No differences were found between neonates who received monotherapy vs. polytherapy. The groups exposed to phenobarbital, clonazepam and multiple AED showed more uncommon values (p < 0.05), identified as minor dysmorphisms by other authors. It seems to be a particular susceptibility of the mid-line of the face to show the effects of AED and, additionally, of environmental agents. CONCLUSIONS: No differences were found in the facial values among the different AED used in monotherapy form. It is suggested that the choice of drug used during pregnancy must be decided on according to the clinical diagnosis of each mother's epilepsy, and not on the basis of potential teratogenic risk.

[Nutritional status of Mexican women]. / Condiciones de nutrición de la mujer mexicana.

The available epidemiological information of nutrition status of Mexican women at reproductive age is presented. The consulted sources were The National Nutrition Survey and The National Survey of Chronic Diseases and three local surveys performed in open populations (Urban Nutrition Survey), one performed in San Luis Potosí, one in Merída, Yucatán and one performed in a specific zone in Mexico City (delegación Alvaro Obregón). All surveys included the evaluation of women at reproductive age and registered in a direct form weight and height to calculate the body mass index (BMI), however, they did not use the same criteria to define low weight, overweight and obesity. Even with these limitations, the different studies showed that while to some populations stratums, problems related to insufficient feeding persist (close to 29% with a BMI < 20.1), according to The National Nutrition Survey), for most of the women in reproductive age overweight and obesity are a serious health problem (40.7% of women between 20 to 49 years old have a BMI > or = 27.3), according to The National Survey of Chronic Diseases. Information of the risk increment to present hypertension and Diabetes Mellitus in overweight and obese women is shown.

Overweight and hypertension: data from the 1992-1993 Mexican survey.

Data of the 1992-1993 Mexican Survey of Chronic Diseases in the Urban Adult Population were analyzed to investigate the effects of age and sex on the association between overweight and hypertension. Blood pressure, body weight, and height were measured in a group of 13,945 Mexicans aged 20 to 69 years living in towns and cities larger than 15,000 people. Hypertension was defined following the recommendations of the Joint National Committee for Detection, Evaluation, and Treatment of High Blood Pressure-V. Overweight was defined following the recommendations of the National Institutes of Health Consensus on Health and Obesity. The prevalence of types of hypertension was higher in men than in women, particularly in the groups of 20 to 39 years of age. Cross-classification of subjects according to the presence of hypertension and overweight confirmed the association between both variables. The odds ratio and 95% confidence intervals indicated that overweight was associated with systolic and diastolic hypertension and with isolated diastolic hypertension in women and, to a lesser extent, in men. This association was not found in the 60- to 69-year group in both sexes. Overweight did not show significant association with isolated systolic hypertension in both sexes. Results of a multiple logistic regression analysis of overweight on hypertension, controlling for age and sex, were consistent with these findings. It is suggested that other factors, independent of overweight, explain the observed gender-specific differences in the prevalence of hypertension in younger age groups. The hormonal environment of young women is one of the mentioned factors modifying the prevalence of hypertension in this group of the Mexican urban adult population.

[Prevalence of dental caries, gingivitis and periodontal disease in pregnant diabetic women]. / Prevalencia de caries dental, gingivitis y enfermedad periodontal en la paciente gestante diabética.

OBJECTIVE: To determine the difference in the prevalence of dental caries, gingivitis, and periodontal disease among non-diabetic, type-II diabetic and pregnant diabetic women. MATERIAL AND METHODS: In the period from June 1993 to January 1994, a cross-sectional study was carried out at the Instituto Nacional de Perinatología among 160 pregnant women; eighty non-diabetic women were included in the control group, while 40 type-II diabetic and 40 gestational diabetic women conformed the study group. In each patient the following variables were recorded: age, week of pregnancy, the Simplified Oral Hygiene Index, the Decayed, Missing and Filled Teeth Index, the Gingival Index, and the Extent and Severity Index. Statistical analysis was carried out using Analysis of Variance and the Multiple Range Test, with a 95% confidence internal. RESULTS: All of the groups had similar prevalences of dental caries (100%). Type-II diabetic women showed a higher prevalence of gingivitis (42.5%) than non-diabetic (36.25%) and gestational diabetic (10%) women, but the differences were not statistically significant between the non-diabetic and type-II diabetic women. Type-II diabetic women had a statistically significant higher prevalence of periodontal disease (12.5%) than the women in the other groups. CONCLUSIONS: It is very important to establish proper metabolic control and a fitting oral hygiene in pregnant diabetic women, since type-II diabetes was shown to be associated with a higher prevalence of periodontal disease. Besides, gestational diabetes is likely to pose a high risk of periodontal disease in the absence of preventive measures.

Hyperinsulinaemia and normal glucose tolerance tests in pregnancy

Hyperinsulinaemia is a condition present during late pregnancy, returning to normal after delivery. Since some pregnant women are not able to adapt themselves to this high insulin secretion they could become gestational diabetics. We attempt here to describe the insulin metabolism during late pregnancy according to the women's levels of fasting insulin at six months postpartum. Sixty-seven pregnant women underwent a glucose tolerance test at weeks 20, 30 and 36 of pregnancy and at 6 months postpartum. Glucose and insulin values were measured. The women were classified as follows: group one, women who at 6 months postpartum had fasting insulin levels above the mean (13.5/dl) and group two, who fasting levels were below the mean. The significant difference between the groups was found at all points of the insulin curve at six months postpartum, but not for the glucose curve. During pregnancy, a difference in insulin was also found for weeks 20;30 and 36 but not for the glucose. Group one, whose insulin level were higher since week 20, presented with hyperinsulinaemia, while group two behaved as described in the literature, i.e., secreting more insulin as the pregnancy advanced. Women of group one are at major risk to develop diabetes mellitus, type II later in life (AU)

Evaluation of a screening test for gestational diabetes mellitus

A screening breakfast test was designed and evaluated with good results in non-pregnant women. It was also considered whether to use this screening breakfast test in pregnant women. Forty pregnant women were evaluated between weeks 28 and 32 of gestation; they were diagnosed according to the values of international committees for gestational diabetes. Fourteen of the women were diagnosed as diabetic and 26 were negative. Each woman underwent a tolerance breakfast curve at 0;60;90;120;150 and 180 mins, in order to explore all possible absorption times. Results were analyzed by stratified prognostic test, the optimum time of 60 mins, and postload value of the breakfast test was used to discriminate subjects with and without gestational diabetes. The cut-off point was glucose > 140 mg/dl, with a significance level of p<0.01. A comparison was done of the diagnosis of gestational diabetes, in relation to the screening breakfast test and the glucose test. It was found that the breakfast test had a sensitivity of 92.8 percent; specificity of 96.1 percent and negative prognostic value of 92.8 percent and 96.1 percent, respective; whereas for the glucose test, the results were 100 percent; 76.9 percent; 70.0 percent and 100.0 percent, respectively. The breakfast test can be used as a screening test with similar results to the glucose test (AU)

Parity and the prevalence of overweight.

OBJECTIVE: To assess the association between previous term pregnancies and the prevalence of overweight in a group of urban women, controlling for the influence of age. METHODS: One thousand twelve women, living in middle and low socioeconomic areas of Mexico City, were interviewed at home and their reproductive histories studied. Height and weight were measured in a clinical setting using controlled procedures. Overweight (BMI > 25) was the dependent variable used to calculate odds ratios and to perform a multiple logistic regression analysis. RESULTS: Age and parity were significantly associated with the prevalence of overweight. Controlling for age, two or more previous pregnancies significantly increased the magnitude of the association. CONCLUSION: During the reproductive years parity seems to increase the risk of overweight in low and middle socioeconomic level urban women.

Vitamin C status, cervico-vaginal infection and premature rupture of amniotic membranes.

A prospective study to evaluate the role of vitamin C and cervico-vaginal infection in the premature rupture of amniotic membranes (PROM) was designed. The leukocyte vitamin C levels of 44 pregnant women that did not consume vitamin supplements was evaluated at weeks 20, 28 and 32 of pregnancy. On each evaluation the presence of cervico-vaginal infection was diagnosed and treated. The leukocyte vitamin C level throughout gestation showed a decrease towards week 28 and then it recovered at the end of pregnancy. Six of every ten women had normal flora in their vaginal secretion cultures. Eleven cases had PROM (0.24), no association was found between cervico-vaginal infection and PROM. The leukocyte vitamin C levels on week 20 of gestation showed an association with PROM. (chi 2 = 6.34, p < 0.05, odds ratio 6.75 [CI 1.26-26.03]).

[Notification of family history of diabetes]. / El antecedente familiar de diabetes como dato referido.

In clinical practice the presence of a positive family history of diabetes mellitus is one of the criteria to perform a glucose screening test. However it has been shown not to be always reliable. The aim of this study is to verify the concordance between the data referred by a group of daughters about the existence of diabetes mellitus in both parents, the data given by their parents, and a corroboration by blood glucose testing of the parents. A total of 82 triads (father, mother and daughter) were studied. The daughters were healthy and belonged to a cohort of perinatal studies of the Instituto Nacional de Perinatologia in Mexico City; they were not pregnant and had both patients alive, who agreed to participate in the study. Each daughter was asked about her parents history of diabetes having three options as an answer: yes, no, do not know. The same information about themselves was asked to the parents separately, not giving a chance to the members of the triad to communicate among themselves. The necessary glucose tests were performed to integrate a diagnosis by accepted international criteria. A chi-square test was used to compare the data referred by parents and daughters; agreement percentage (kappa values) were calculated. A prespecified order test was performed to the answers given and evaluated by occurrence rates (Bartholomew's test). In the latter analysis there were significant differences (p < 0.001) between the answer given by the parents, daughter and the confirmed blood glucose values. No differences were found between what the parents said, nor in what they said and what the daughters answered.

[Maxillofacial anthropometry tables in healthy newborns]. / Tablas de antropometría maxilofacial en recién nacidos sanos.

With the purpose of having parameters which can be useful to evaluate the maxillofacial anthropometric characteristics at birth, we present the results of maxillofacial anthropometric measurements of 22 items in 373 healthy eutrophic newborns of both sexes delivered at the National Institute of Perinatology in Mexico City. Minor alterations of facial structures may indicate the presence of a dysmorphological syndrome such as: wide nasal bridge and wide intercantal distance. This study did not show big increments in the different anthropometric measurements from one week of gestation to the next, except for the bizygomatic and intercommissural measurements.

El efecto diabetogénico del embarazo, ¿afecta a todas las gestantes? / The diabetogenic effect in pregnancy, Does it effect all pregnancy women?

Es el objetivo de este trabajo el comportamiento de los valores de glucosa durante la segunda mitad del embarazo en un grupo de gestantes sin patología evidente, que no desarrollaran diabetes gestacional y que se dividen para su análisis de acuerdo a indicadores de riesgo. Se evaluaron 29 mujeres en 4 ocasiones, 3 durante la gestación (semana 23, 30 y 36 + - 7 días) y 1 en el post-parto (50 + - 14 días). Se dividió a la población en: alto riesgo (AR) a mujeres que presentaron antecedentes familiares de diabetes mellitus en padre y/o madre positivos, y/o porcentaje de peso para la talla pregestacional (%P/T pregest.) igual o mayor a 127; mientras que se asignó bajo riesgo (BR) a las mujeres con ausencia de los indicadores antes mencionados y cuya edad fuera menor a los 31 años y el número de gestaciones menos abortos menor a 4. Se determinó glucosa en suero mediante glucosa oxidasa tanto al ayuno como en el post-prandio de 2 hrs., después de la ingesta de una carga de 100 g de glucosa. La compración entre ambos grupos de riesgo se evaluó con estadística paramétrica. El comportamiento del ayuno en ambos grupos no presenta diferentes de BR se observa a las 2 hrs., un comportamiento igualmente uniforme con una mínima variabilidad hasta el post-parto. Situación que no se presenta con las mujeres de AR cuyos valores de glucosa son significativamente mayores que los del BR y además se incrementan conforme la gestación avanza hasta en un 34%, obteniéndose una diferencia significativa entre las semanas 30 a 36 (p menor a 0.05). De los indicadores de riesgo, el % P/T pregest y la edad, fueron los indicadores con mayor grado de asociación con altos valores de glucosa.

[Factors associated with breast feeding. II Study of women with no prenatal control]. / Factores asociados a la practica de lactancia II. Estudio de mujeres sin control prenatal.

PIP: This prospective study on breastfeeding practices sought to identify if factors that intervene or determine breastfeeding practices are those influenced by women themselves, promoted by institutions such as hospitals or is a combination of both factors. The methodology included 582 women who did not attend prenatal consultations and only attended the 3 hospitals included in the study to deliver their babies. Hospital A studied 252 women, supported breastfeeding practices and gave patients milk samples; hospital B studied 80 women, did not support breastfeeding and gave milk samples; and hospital C interviewed 250 women, did not support breastfeeding and did not give women milk samples. Invitations to attend the study explained that 12 hours postpartum a questionnaire would be given and 15 days postpartum a session would be held to verify if they were breastfeeding. The independent variables were: place of birth, residence of the new mothers and that their own mothers age, educational level, status of relationship with the father of the baby, number of pregnancies, number of live children, background and number of previous stillbirths, were they living with the father of the baby and was he supporting her, was the pregnancy planned, previous problems with breastfeeding, was previous baby breastfed number of previous babies breastfed, reasons for not breastfeeding, and prior to the study what were other sources of information on breastfeeding. Results demonstrated that the sociocultural and demographic differences between each of the 3 populations attending the 3 hospitals were found to have stronger effects on breastfeeding practices than hospital policies.^ieng

[Analysis of the relationship of social indicators and reproductive loss]. / Analisis de la relacion de indicatores sociales con perdidas reproductivas.

PIP: The objective of this study is to describe the socio-demographic indicators of populations and to determine the social variables that are related to reproductive loss. A program was organized to follow-up on the prevention and detection of perinatal risk in women of reproductive ages not using contraception. 573 Mexican women were selected for the study. The study lasted from 1979-81. Conclusions of the study indicated that the population studied was characterized by young women ranging in age from 14-29, with low educational levels, lack of skills, and a large percentage of reproductive loss, specifically intrauterine deaths. There was a correlation between the collective use of water and bathing facilities and reproductive loss. When collective water and bath usage was extended to include whole families, the percentage of intrauterine deaths increased. These statistically significant and unexpected relationships suggest greater risks for intrauterine deaths. Future studies on causes relating to neonatal deaths will require additional inclusion of biological and macrosocial indicators.^ieng

[Bases for formulating a program to promote breast-feeding: methodological aspects].

Based on the relevance of breastfeeding for maternal-infant health, it is necessary that the prospective and longitudinal studies carried out in Mexico be analyzed as a whole in order to create an analytic model and to develop an institutional intervention program concerning the mother's risk of not starting or of abandoning lactation. To create this program all the factors which can be modified must be taken into account in order to make sure the mother has the elements to make a decision. The National Institute of Perinatology has developed a research program about lactation that consists of 3 studies that have been carried out since 1983. The general aim of these studies is to understand the breastfeeding phenomenon in an integral way considering the role of the institution as an educational instrument and a means of providing health support. These studies were based on different perspectives, approaches and times but had similar objectives. For this reason it is desirable to analyze them as a whole in order to obtain new considerations and temporal projections. In order to integrate the 3 studies a database will be created and then an analytical model (from a multivariate analysis) will be generated from the 1st study (by temporal order) which will be tested in the 2nd study making the pertinent modifications and finally it will be applied in the 3rd study. At the same time it will be necessary to group the variables into 2 classification systems: The first according to the temporal proximity with regard to lactation and the second according to the organization level to which they belong.

[Breast feeding: impact of early mother-child post-partum contact]. / La lactancia: impacto del encuentro temprano madre-hijo

PIP: The objective of this study is to evaluate the impact of early contact between mother and her newborn (during the 1st hour after birth) and the establishment and duration of breastfeeding, within the context of a rooming-in service which provides continuous 24 hour contact during postpartum hospitalization. 60 healthy pares were studied, 30 of which were provided with early contact and rooming-in, while the other 30 experienced regular rooming-in. Milk production was measured during the 1st 3 days postpartum. The early contact group had significantly greater milk production on the 1st day than the group with only rooming-in. However, by the 2nd and 3rd days, this difference was no longer present. These results suggest that the continued contact and demand feeding which rooming-in provides compensates for the initial advantage of the mothers early contact group. With respect to duration of lactation, 50% of the mothers were still breastfeeding at 6 months regardless of the group to which they belonged. It is concluded that the early contact has a positive effect on the establishment of milk production in the 1st day. However, it had no additional impact on the duration of breastfeeding given the continued contact of the rooming-in experience. Mothers for this study all lived in the Federal District in Mexico and delivered full-term, healthybabies. They had no significant differences in age, parity, socioeconomic status, education, or prenatal care/instruction. (author's modified)^ieng

[Bases for a program designed to promote breast-feeding. I. Identification of variables in the immediate post-partum period]. / Bases para la formulacion de un programa de promocion a la lactancia. I. Identificacion de variables en el posparto inmediato

PIP: The variables involved in the duration of breastfeeding were analyzed in a group of 60 mothers in Mexico who were followed from delivery until 6 months postpartum. 2 groups were formed: women without any previous breastfeeding experience (primipara) and women with previous experience (multipara). The analysis was performed by step wise regression, grouping the variables in 2 classification systems. The 1st, which was according to temporal proximity to breastfeeding practice, divided the variables into predisposing prenatal, early, and late neonatal factors. The 2nd, according to the level of organization, used the following categories: social, biological, and behavioral motivation. The results show that both groups of mothers base their breastfeeding on the confidence that they have in their own breastfeeding capacity. For the primiparal, this confidence is expressed by age, the advantages they found in nonhuman milk, their milk production, the difficulty they had in establishing breastfeeding during the 1st days, and their anticipation of future breastfeeding problems. The multiparal base their confidence on their prior experience in addition to the previously mentioned factors. The multivariate regression for the primipara explained 98.41% of the variance. Of the 3 significant variables, early postpartum contact accounted for 74.43%. In the case of multiparal, 66.70% of the variance was explained by variables. Of these, the starting age of supplementation was negatively related and explained 47.14% of the variance.^ieng