Prenatal Predictors of Neurobehavioral Outcome in Children with Fetal Growth Restriction at 6 Years of Age: A Retrospective Cohort Study.

(1) Background: Fetal growth restriction (FGR) increases the risk of adverse neurodevelopmental outcomes, especially in preterm newborns. This study aims to describe the behavioral results of FGR at 6 years of age and to demonstrate the relationship of certain predictive factors with this development. (2) Methods: This retrospective cohort study included 70 children born in 2015 at the University Hospital Carlos Haya, Málaga, Spain who had been exposed to FGR during pregnancy; neonatal and infant data were recorded retrospectively. Children were assessed prospectively at 6 years of age by means of a strengths and difficulties questionnaire (SDQ) to study behavioral outcomes. (3) Results: We demonstrated that there are higher behavioral disability rates in children exposed to FGR during pregnancy and, in particular, high rates of hyperactivity or conduct problems. We also proved a negative relationship between the birth weight percentile and the total behavioral scale score, along with a positive correlation between hyperactivity and the emotional and behavioral scales. Learning difficulties were more frequent in early-onset FGR than in late-onset FGR. (4) Conclusions: Our study of behavioral development has demonstrated higher behavioral disability rates in children with FGR at 6 years of age; specifically, high rates of hyperactivity or conduct problems. At the same time, we have proved a negative relationship between the birth weight percentile and the total behavioral scale score.

Transmitted Fetal Immune Response in Cases of SARS-CoV-2 Infections during Pregnancy.

(1) Background: Little is known about the effects of SARS-CoV-2 on the placenta, and whether the maternal inflammatory response is transmitted vertically. This research aims to provide information about the effects of SARS-CoV-2 infection on maternal and fetal immunity. (2) Methods: We have studied placental changes and humoral and cellular immunity in maternal and umbilical cord blood (UCB) samples from a group of pregnant women delivering after the diagnosis of SARS-CoV-2 infection during pregnancy. IgG and IgM SARS-CoV-2 antibodies, Interleukin 1b (IL1b), Interleukin 6 (IL6), and gamma-Interferon (IFN-γ), have been studied in the UCB samples. Lymphocyte subsets were studied according to CD3, CD8, CD4, CD34, and invariant natural Killer T cells (iNKT) markers. We used in situ hybridization techniques for the detection of viral RNA in placentas. (3) Results: During the study period, 79 pregnant women and their corresponding newborns were recruited. The main gestational age at the time of delivery was 39.1 weeks (SD 1.3). We did not find traces of the SARS-CoV-2 virus RNA in any of the analyzed placental samples. Detectable concentrations of IgG anti-SARS-CoV-2 antibodies, IL1b, IL6, and IFN-γ, in UCB were found in all cases, but IgM antibodies anti-ARS-CoV-2 were systematically undetectable. We found significant correlations between fetal CD3+ mononuclear cells and UCB IgG concentrations. We also found significant correlations between UCB IgG concentrations and fetal CD3+/CD4+, as well as CD3+/CD8+ T cells subsets. We also discovered that fetal CD3+/CD8+ cell counts were significantly higher in those cases with placental infarctions. (4) Conclusion: we have not verified the placental transfer of SARS-CoV-2. However, we have discovered that a significant immune response is being transmitted to the fetus in cases of SARS-CoV-2 maternal infection.

Effects of SARS-CoV-2 Pandemic on the Mental Health of Spanish Ob-Gyn Specialists-A Nationwide Study.

It has been reported that frontline health professionals have suffered from an increased rate of mental disorders as a consequence of the SARS-CoV-2 pandemic. OBJECTIVE: This study aims to evaluate the impact of the pandemic on the mental health of Spanish specialists in the obstetrics and gynecology fields after the fifth Spanish COVID-19 wave. METHODS: Psychometric screening of the professionals was performed using a nationwide online survey designed by the Psychosocial Obstetrics and Gynecology taskforce. Post-traumatic stress disorder (PTSD), depression, and general anxiety disorder were screened. RESULTS: We found high scores for PTSD, depression, and generalized anxiety disorder. Up to 12.4% of specialists met the PTSD criteria, 12.8% showed complex PTSD, 37% showed depression, and up to 37% had a positive screening for generalized anxiety disorder. Our results showed that the pandemic has particularly affected the group of female Ob-Gyn specialists, with significant higher scores in depression and anxiety scales. CONCLUSIONS: As a lesson learned for the future in case of new health emergencies, it would be very important to provide professionals with adequate psychological support, ensuring enough human and material resources, flexible work shifts, and facilities to reconcile work and family-life, especially in the case of female specialists.

Measuring Resilience in Women with Endometriosis.

Endometriosis is a multifactorial disease with pathophysiological factors not yet well known; it also presents a wide symptomatic range that makes us think about the need for multidisciplinary management. It is a chronic disease in which there is no definitive treatment, and is associated in a large majority of cases with psychological pathology. Connecting comorbidities and multimorbidities on a neurobiological, neuropsychological, and pathophysiological level could significantly contribute to their more successful prevention and treatment. In our study, resilience is analyzed as an adjunctive measure in the management of endometriosis. Methods: A multi-centre, cross-sectional study was performed to analyse resilience levels in a sample of Spanish women suffering from endometriosis. CDRIS-25, CDRIS-10, BDI, the STAI, and the SF-36 Health Questionnaire were used for assessments. A representative group of 202 women with endometriosis was recruited by consecutive sampling. Exploratory and confirmatory factor analyses were performed for both resilience scales. Results: Mean CDRIS-25 and CDRIS-10 scores were 69.58 (SD 15.1) and 29.37 (SD 7.2), respectively. Women with adenomyosis and without signs of deep endometriosis showed the lowest scores. The best predictive model included women's age, years of endometriosis evolution, number of pregnancies, and history of fertility problems as the best predictive factors. Conclusions: Women build resilience as the number of years of evolution of the disease increases. Symptoms such as dyspareunia and continued abdominal pain were more prevalent among less resilient women.

Correlates of Sexual Function in a Sample of Spanish Women with Endometriosis.

BACKGROUND: In the present study, we aim to report on the sexual function of women experiencing symptoms of endometriosis, analysing the clinical and psychosocial factors that may be associated. METHODS: A multicentre cross-sectional study was performed to analyse the sexual function in a sample of 196 Spanish women with endometriosis, using the Female Sexual Function Inventory. RESULTS: The Female Sexual Function Inventory (FSFI) was validated in our endometriosis study group. The mean FSFI score for the sample was 22.5 (SD 6.6), with 20.9 and 26.9 being in the 25th and 75th percentiles, respectively. Although physical sexual pain and dyspareunia were factors that influenced the sexual function of women with endometriosis, our results show that the impairment was multifactorial. CONCLUSIONS: We found impaired sexual function in women diagnosed with endometriosis. The final model included deep endometriosis, depression, age, and unemployment as strongest predictive factors for poor (deteriorated) sexual function.

Obstetricians' Attitude towards Childbirth.

(1) Background: In Spain, as in other countries, there is an increase in policies and practices focused on the humanization of perinatal care. In this regard, the quality of interpersonal interactions between women and health professionals is one of the main factors, and, apart from other factors, it is influenced by health professionals´ attitudes towards childbirth. The main objective of this study was to determine the attitudes of obstetricians towards the humanization of childbirth and the promotion of a positive childbirth experience. (2) Methods: The psychosocial task force of the Spanish Society of Obstetrics and Gynecology designed a nationwide online survey. The questionnaire on attitudes towards childbirth (CAVE, acronym for "cuestionario de actitudes sobre vivencias y experiencias en el parto") was used for the assessment. Exploratory and confirmatory factor analyses of the scale were also performed. (3) Results: A total of 384 participants completed the survey. Obstetricians showed a high-quality clinical obstetric performance, but some difficulties in identifying birth-related psychological-trauma risk factors. Some differences according to practice and gender were found in the final score and in areas regarding psychosocial risk, pain, accompaniment, and women´s expectations. (4) Conclusions: In light of the results, it is advisable to launch education initiatives aimed to improve interaction with pregnant women.

Obstetric and Perinatal Outcomes after Very Early Preterm Premature Rupture of Membranes (PPROM)-A Retrospective Analysis over the Period 2000-2020.

Background and Objectives: Pre-term premature rupture of membranes (PPROM) responds for one third of preterm births, and it is associated with other complications that increase the risk of maternal or fetal poor outcome. To reduce uncertainty and provide accurate information to patients, the analysis of the large series is of great importance. In order to learn about the evolution over the time of the obstetric and perinatal outcomes in cases of PPROM at, or before, 28 weeks (very early PPROM) managed with an expectant/conservative protocol, we have designed the present study. Materials and Methods: We retrospectively studied all cases of very early PPROM attended in Malaga University Regional Hospital from 2000 to 2020. Results: Among 119,888 deliveries assisted, 592 cases of PPROM occurred in pregnancies at or before 28 weeks (0.49% of all deliveries, 3.9% of all preterm births and 12.9% of all cases of PPROM). The mean duration of the latency period between PPROM and delivery was 13.5 days (range 0 to 88 days), enlarging over the years. The mean gestational age at delivery was 27 weeks (SD 2.9; range 17-34). The proportion of cesarean deliveries was 52.5%. The overall perinatal mortality rate was 26.5%, decreasing over the period with a significant correlation Pearson's coefficient -0.128 (p < 0.05). Conclusions: In the period 2000-2020, there was an improvement in the outcomes of very early PPROM cases and perinatal mortality showed a clear trend to decrease.

Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth.

OBJECTIVES: The main objective of the present study was to evaluate what educational needs were being neglected in current perinatal educational program in the University of Malaga. METHODS: We performed a cross-sectional study using the Students' questionnaire on attitudes towards childbirth (CAVE-st) in a sample of 378 students who were finishing their undergraduate or postgraduate academic perinatal program, including medical and nursing students. RESULTS: The Cronbach's alpha reliability coefficient was 0.895. The mean score of CAVE-st in the sample was 200.34 (DT 21.0). The scores were below the median value in more than 53% of the students, especially in medical students. Female students scored systematically higher in the overall scale and its subscales, even after adjusting for study groups. On the other hand, the students with children scored significantly lower in the subscale that explored their attitudes towards unexpected results. A huge margin for improvement was recognizable in those subscales related with childbirth medicalization, respect to women decisions, and health-care prioritization. CONCLUSIONS: Students' attitude towards childbirth need to be improved as a means to improve women's childbirth experience and prevent birth-related trauma. The current undergraduate and postgraduate training in perinatal care lacks a comprehensive and biopsychosocial perspective that would improve the quality of clinical practice during childbirth.

Poor sleep quality is associated with perinatal depression. A systematic review of last decade scientific literature and meta-analysis.

Background Although pregnancy is frequently associated with mental states of happiness, hope and well-being, some physical and psychological changes can contribute to increased sleep disturbances and worsened sleep quality. Sleep quality has been linked to negative emotions, anxiety and depression. The main objective of this paper was to systematically review the impact of sleep during pregnancy on maternal mood, studying the association between objective and subjective measures of sleep quality and perinatal depression. Methods We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which included studies published between January 2008 and April 2019, and met the following criteria: (i) studies on pregnant women assessing the effects of sleep quality variables on perinatal mood disorders, (ii) studies published in English and (iii) full paper published in a peer-reviewed scientific journal with full-text format available. Results A total of 36 studies published in the last decade met the inclusion criteria for qualitative review and eight of them were suitable for meta-analysis. Both confirmed the negative effects of poor sleep on perinatal mood. However, qualitative analysis showed that unrepresentative samples and low participation rates falling below 80% biased some of the studies. The standard random-effects meta-analysis showed a pooled size effect [ln odds ratio (OR) 1.49 (95% confidence interval [CI] 1.19, 1.79)] for perinatal depression in cases of poor prenatal sleep quality, although heterogeneity was moderate to high [Q 16.05, P ≤ 0.025, H2 2.45 (95% CI 1.01, 13.70)]. Conclusion Poor sleep quality was associated with perinatal mood disturbances. The assessment of sleep quality along the pregnancy could be advisable with a view to offering preventative or therapeutic interventions when necessary.

Towards a comprehensive perspective in the care of complicated pregnancies: 10 key points from a psychosocial perspective / Hacia una perspectiva integral en la atención a las gestaciones de riesgo. Aportación de un decálogo desde una perspectiva psicosocial

For a pregnant woman, the diagnosis of a high-risk pregnancy threatens the course of the pregnancy and even the woman's own life. Management of these cases requires not only that professionals have appropriate technical skills, but also that the woman is provided with the necessary tools to help her face a "complicated pregnancy" and accept the possible consequences. Therefore, it is necessary to address these problems under a compre-hensive perspective that ranges from the sociocultural features to the woman's own attitude towards pregnancy. We present 10 key points that should be taken into account by obstetricians caring for women with complicated pregnancies

El diagnóstico de riesgo durante el embarazo representa para la gestante una amenaza para el desarrollo del embarazo o incluso para su propia existencia. El manejo de estos casos precisa una adecuada formación técnica de los profesionales, pero también es necesario ofrecer a la gestante herramientas que le ayuden a afrontar la situación de "embarazo complicado" y a aceptar las posibles consecuencias. Resulta necesario abordar los problemas obstétricos bajo una perspectiva integral que incluya desde las dimensiones relacionadas con las condiciones socioculturales del entorno hasta su propia actitud ante la gestación. Presentamos en forma de decálogo los aspectos a incorporar por los equipos obstétricos encargados de la atención a las pacientes con gestaciones complejas

Exposure to tobacco, alcohol and drugs of abuse during pregnancy. A study of prevalence among pregnant women in Malaga (Spain).

The prevalence of substance abuse in women who become pregnant is similar to that of the general population, resulting in a high fetal exposure rate during the most vulnerable period regarding neurodevelopment and organogenesis. The present study was intended to assess the level of prenatal exposure to tobacco, alcohol or illicit drugs in the city of Málaga (Spain). It was designed as a cross-sectional study, and based on the anonymous self-reports of participants. A total of 451 pregnant women were recruited in the first, second or third trimester. The prevalence in each of the quarters respectively was 21.2%, 18.5% and 13.3% for smoking, 40.7%, 23.1% and 17.1% for alcohol and 4.8%, 1.9% and 1.2% for cannabis. We also found that a higher educational level was associated with a lower consumption of tobacco (RR 0.659 [0.537-0.810] p<0.0001) and greater exposure to alcohol (RR 1.87 [1.30-2.69] p<0.0007). These results, particularly in regard to alcohol intake, are sufficiently alarming to alert obstetric care providers about the need to implement preventive measures.

La prevalencia de hábitos tóxicos en la población de mujeres que quedan embarazadas es similar a la de la población general, por lo que la exposición fetal a tóxicos es elevada en el período de mayor vulnerabilidad, sobre todo en relación al neurodesarrollo y la organogénesis. El presente estudio ha sido desarrollado para conocer el nivel de exposición prenatal a tabaco, alcohol u otras drogas en la ciudad de Málaga (España). El trabajo responde a un diseño observacional de corte transversal sobre el consumo de tóxicos durante el embarazo, y se basa en la autodeclaración de las gestantes mediante la cumplimentación de un cuestionario. Se reclutaron 451 gestantes de primer, segundo y tercer trimestre. La prevalencia de consumo en cada uno de los trimestres resultó ser respectivamente del 21.2%, 18.5% y 13.3% para el tabaco, 40.7%, 23.1% y 17.1% para el alcohol y del 4.8%, 1.9% y 1.2% para cannabis. En los tres trimestres, un mayor nivel de estudios se asoció a un menor consumo de tabaco (RR 0,659 [0.537-0.810] p< 0.0001) y una mayor exposición al alcohol (RR 1.87 [1.30-2.69] p< 0.0007). Los resultados obtenidos, sobre todo en relación al consumo de alcohol, son suficientemente llamativos como para alertar a los proveedores de atención obstétrica sobre la necesidad de poner en marcha medidas preventivas.

Exposición a tabaco, alcohol y drogas de abuso en gestantes. Estudio de prevalencia en gestantes de Málaga (España) / Exposure to tobacco, alcohol and drugs of abuse during pregnancy. A study of prevalence among pregnant women in Malaga (Spain)

La prevalencia de hábitos tóxicos en la población de mujeres que quedan embarazadas es similar a la de la población general, por lo que la exposición fetal a tóxicos es elevada en el período de mayor vulnerabilidad, sobre todo en relación al neurodesarrollo y la organogénesis. El presente estudio ha sido desarrollado para conocer el nivel de exposición prenatal a tabaco, alcohol u otras drogas en la ciudad de Málaga (España). El trabajo responde a un diseño observacional de corte transversal sobre el consumo de tóxicos durante el embarazo, y se basa en la autodeclaración de las gestantes mediante la cumplimentación de un cuestionario. Se reclutaron 451 gestantes de primer, segundo y tercer trimestre. La prevalencia de consumo en cada uno de los trimestres resultó ser respectivamente del 21.2%, 18.5% y 13.3% para el tabaco, 40.7%, 23.1% y 17.1% para el alcohol y del 4.8%, 1.9% y 1.2% para cannabis. En los tres trimestres, un mayor nivel de estudios se asoció a un menor consumo de tabaco (RR 0,659 [0.537-0.810] p< 0.0001) y una mayor exposición al alcohol (RR 1.87 [1.30-2.69] p< 0.0007). Los resultados obtenidos, sobre todo en relación al consumo de alcohol, son suficientemente llamativos como para alertar a los proveedores de atención obstétrica sobre la necesidad de poner en marcha medidas preventivas

The prevalence of substance abuse in women who become pregnant is similar to that of the general population, resulting in a high fetal exposure rate during the most vulnerable period regarding neurodevelopment and organogenesis. The present study was intended to assess the level of prenatal exposure to tobacco, alcohol or illicit drugs in the city of Málaga (Spain). It was designed as a cross-sectional study, and based on the anonymous self-reports of participants. A total of 451 pregnant women were recruited in the first, second or third trimester. The prevalence in each of the quarters respectively was 21.2%, 18.5% and 13.3% for smoking, 40.7%, 23.1% and 17.1% for alcohol and 4.8%, 1.9% and 1.2% for cannabis. We also found that a higher educational level was associated with a lower consumption of tobacco (RR 0.659 [0.537-0.810] p<0.0001) and greater exposure to alcohol (RR 1.87 [1.30-2.69] p<0.0007). These results, particularly in regard to alcohol intake, are sufficiently alarming to alert obstetric care providers about the need to implement preventive measures

Effects of oxytocin used during delivery on development: a retrospective cohort study.

OBJECTIVE: The objective was to evaluate the potential influence of oxytocin administered during delivery on children's development at the age of 5. METHOD: This study was designed as a retrospective cohort study where children from patients given synthetic oxytocin during delivery were considered as the exposed cohort and children from patients not given oxytocin as the nonexposed cohort. From a total of 7465 births attended at our maternity ward in 2006, an initial sample of 400 was randomly selected. A total of 148 children were evaluated using the Battelle Developmental Inventory. Potential confounding and adjustment factors were analyzed using stratified analysis and multivariate analysis (logistic regression). RESULTS: Oxytocin use did not significantly affect the overall risk of developmental delay in the study sample (relative risk, RR, 1.46; 95% confidence interval, CI [0.79-2.71]). The best fit regression model included twin delivery, type of delivery, and maternal age. In the group of vaginal noninstrumental deliveries, oxytocin administration increased the risk of poor Battelle Developmental Inventory outcome, particularly when maternal age was under 28 or over 35 years of age (odds ratio, OR, 67.14; 95% CI [5.46-824.86]). When delivery was instrumental or through cesarean section in mothers aged 28-35 years, oxytocin administration decreased the risk of developmental disorders (OR 0.16; 95% CI [0.04-0.66]). CONCLUSION: Although oxytocin administration during delivery did not affect the overall risk of low Battelle Developmental Inventory scores in the study sample, some effects were seen according to maternal age and type of birth.

Neuroprotección antenatal en recién nacidos pretérmino. Propuesta de un centro terciario / Prenatal neuroprotection in preterm neonates. A proposal made by a tertiary hospital

Diversos trabajos publicados en últimos años apoyan que el uso del sulfato de magnesio como neuroprotector antenatal administrado ante la inminencia de un parto pretérmino reduce el riesgo de padecer severas secuelas neurológicas en los recién nacidos. Guías clínicas de actuación de diversos países apoyan la instauración de estos tratamientos neuroprotectores. En nuestro trabajo haremos una revisión del problema, de la bibliografía al respecto y realizaremos una propuesta metódica de un protocolo de neuroprotección dirigido a intentar reducir la morbilidad neurológica de los nacidos pretérmino con una terapia que ya ha demostrado su efectividad. Al mismo tiempo, invitamos a diferentes hospitales a sumarse a nuestra propuesta aportando elementos de mejora y participando en estudios multicéntricos que nos permitan evaluar en un tiempo razonable los resultados de esta actuación cotejándolos con los publicados hasta ahora en la literatura (AU)

Several recent studies provide evidence that the use of magnesium sulfate as a prenatal neuroprotector administered in imminent preterm delivery reduces the risk of severe neurologic sequelae in newborns. Clinical guidelines from various countries support the implementation of these neuroprotective therapies. The present study provides a review of the problem and of the pertinent literature and describes a protocol for neuroprotection that attempts to reduce neurological morbidity in preterm newborns by using a treatment with proven effectiveness. At the same time we invite other hospitals to join our proposal, contribute improvements, and participate in multicenter studies that would allow us to evaluate in a timely manner the results of this protocol by comparing them with data published in the literature (AU)

Quiste folicular gigante luteinizado del puerperio / Giant luteinised follicular cyst during the puerperium

Son extremadamente infrecuentes los tumores no neoplásicos que aparece durante el embarazo o el puerperio y originan complicaciones obstétricas, la mayor parte de las veces debido al tamaño que pueden llegar a alcanzar.El hallazgo de una masa anexial es, en general, casual ya que las no complicadas producen escasa sintomatología. El uso generalizado de la ecografía durante el embarazo y el puerperio permite su diagnóstico.El manejo de un tumor anexial durante la gestación o el puerperio debe ser individualizado, dependiendo de los síntomas de la paciente, la edad gestacional y el tamaño y las características de la tumoración.El quiste folicular gigante solitario luteinizado del puerperio es una lesión poco frecuente del ovario que puede surgir en el embarazo y aumentar de tamaño durante el puerperio hasta que es detectado.Presentamos el caso de un quiste folicular gigante luteinizado del puerperio diagnosticado en una paciente en la 6.ª semana del puerperio. Realizamos asimismo una revisión de las masas ováricas no neoplásicas más frecuentes (AU)

Non neoplasic masses that appear during pregnancy or postpartum together with obstetric complications are extremely rare, most times because of the size they can reach.The finding of an adnexal mass is usually casual as not-complicated ones provoque very few symptoms. The extended use of the ecography during pregnancy and postpartum will bring out a casual finding of this pathology.The management of adnexal masses during pregnancy or postpartum must be individualiced and depends on the symptoms, gestacional age, size and features of the mass.Massive luteinized follicular cyst in postpartum is an infrequent lesion in ovary that may appear during pregnancy and increases its size during postpartum untill it is detected. depenWepresent a case of a massive luteinized follicular cyst in a patient in her 6th week alter a vaginal delivery. We also perform an overview of the literature about most frequent non-oncologic ovarian masses (AU)

Estrés, ansiedad y depresión en gestantes controladas en la Unidad de Ginecología Psicosomática del Hospital Materno-Infantil de Málaga / Stress, anxiety and depression among pregnant women managed in the Gynecological Psychosomatic Unit of the Maternity Hospital of Malaga (Spain)

Objetivos: Comprender la depresión perinatal,buscar factores de riesgo de depresión durante elembarazo, reconocer la depresión durante el embarazo, describir posibles relaciones entre depresión y embarazo, descubrir si esta enfermedad puede repercutir sobre el recién nacido, embarazo o parto, así como estudiar y entender los tratamientos de la depresión durante el embarazo.Material y métodos: Estudio prospectivo de 118 gestantes vistas en el Servicio de Obstetricia y Ginecología Psicosomática del Hospital Materno-Infantil de Málaga por ansiedad, depresión o tratamientos psicofarmacológicos. Análisis estadístico observacional descriptivo y prospectivo.Resultados: Respecto a los antecedentes psicológicos, el 30% había tenido depresión y el 9% crisis de ansiedad. Entre las pacientes tratadas hubo 63 casos de depresión, 106 de ansiedad (56 con depresión) y 9 de estrés (5 con ansiedad y 4 con ansiedad y depresión). Respecto a la paridad: el 60% tenía un parto anterior y el 40% tuvo uno o más abortos (el 32% eran interrupción voluntaria del embarazo [IVE]) La forma de finalización fue la siguiente: partos eutócicos, un 66%; cesáreas, un 28%; abortos espontáneos, un 4%; IVE, un 2%; partos pretérmino, un 16% (mayor que en población normal, lo que corrobora la bibliografía al respecto). El 5% fue eutócico y el 11% por cesárea. Respecto al tratamiento antidepresivo: el 63% tomó antidepresivos, de los cuales el 51% recibió tratamiento con paroxetina, el 9% con fluoxetina y el 3% con sertralina. Respecto al tratamiento de la ansiedad, el 91% consumió algún ansiolítico durante el embarazo. Sólo el 11% presentó rechazo hacia su recién nacido, de los cuales: el 31% sedebió a la prematuridad del recién nacido; otro31% se debió a la depresión materna; el 15% sedebió a cardiopatías graves; un 7,5% se debió amuerte del marido; un 7,5% se debió a muerte delsegundo gemelo, y un 7,5% se debió a problemasimportantes de pareja.Conclusiones: Si pudiéramos definir un perfil deembarazada que tendría más posibilidades depresentar cuadros de ansiedad o depresión, seríauna mujer de más de 30 años, más frecuentemente segundípara y con algún aborto previo, con antecedentes psicológicos depresivos, dificultades en la relación de pareja y que trabaja como ama de casa o en hostelería preferentemente, y que sehaya visto sometida durante el embarazo a técnicasinvasivas y haya sido ingresada por hiperemesis.En relación con la valoración riesgo-beneficio, esmás perjudicial para el feto que la madre seencuentre ansiosa o depresiva que el posibleefecto que sobre él puede ejercer el psicofármaco

Objectives: To understand perinatal depression,identify risk factors for depression duringpregnancy, recognize depression during pregnancy,describe the possible links between depression andpregnancy, discover whether this disease affects thenewborn, pregnancy or childbirth, and analyzetreatment for depression during pregnancy.Material and methods: We performed an observational, descriptive, prospective study of 118 pregnant women followed-up in the Obstetrics and Gynecology Psychosomatic Unit of the Maternity Hospital of Malaga for anxiety, depression or psychopharmacological treatment.Results: A history of depression was found in 30%of the patients and a history of anxiety disorder in9%. Among the patients treated, 63 had depression,106 had anxiety (56 with depression), and ninehad stress (five with anxiety and four with anxietyand depression). Sixty percent had one previousdelivery and 40% had had one or more abortions(32% were voluntary). Pregnancy terminated invaginal delivery in 66%, cesarean section in 28%,miscarriage in 4%, abortion in 2%, and pretermdelivery in 16% (a frequency higher than in thegeneral population, corroborating the literature onthe subject). Of preterm deliveries, 5% werevaginal deliveries and 11% were cesarean sections.Treatment for depression consisted ofantidepressant drugs in 63% (51% with paroxetine,9% with fluoxetine and 3% with sertraline). Amongpatients treated for anxiety, 91% received ananxiolytic agent during the pregnancy. Only 11%rejected their newborns: 31% due to pretermdelivery, 31% due to maternal depression, 15% dueto severe cardiac defects, 7.5% due to the death ofthe husband, 7.5% due to death of the secondtwin, and 7.5% due to major problems with the partner.Conclusions: The factors associated with a greaterrisk of anxiety or depression in pregnancy were asfollows: age more than 30 years old, being asecundipara and having a prior abortion, a historyof depression, difficulties in the relationship withthe partner, being a housewife or working in thecatering trade or hotel industry, undergoing aninvasive technique during pregnancy, and hospitalstay due to hyperemesis. The effects of anxiety anddepression are more negative for the fetus thanthose of drug treatment for these disorders (AU)