El tipo de parto como variable predictora del desarrollo psicológico y la inteligencia en gemelos / The type of birth as predictor of psychological development and intelligence in twins

Introducción: En los últimos años se ha producido un aumento de las gestaciones múltiples en nuestro entorno. Dada la elevada tasa de prematuridad y complicaciones perinatales que conllevan, constituyen un grupo de especial vulnerabilidad no sólo en el periodo perinatal, sino a largo plazo. Objetivos: Analizar la influencia del tipo de parto y otras variables perinatales, como el orden de nacimiento, en el desarrollo a largo plazo de niños nacidos en un parto gemelar, describiendo los modelos predictivos del mismo respecto al desarrollo psicológico y la inteligencia. Métodos: Hemos realizado un estudio observacional sobre 62 parejas de gemelos de 6 años de edad. Para ello se realizó una evaluación individual de cada uno de los niños con sus madres utilizando las baterías CUMANIN y K-BIT. Igualmente, se recogieron los datos clínicos perinatales. Realizamos un análisis estratificado y multivariante mediante regresión lineal múltiple. Resultados: El tipo de parto es la variable que mostró un mayor valor predictivo de las puntuaciones, de forma que los mejores resultados se obtuvieron en los niños nacidos por parto vaginal. Sin embargo, comparativamente, hemos observado la existencia de peores puntuaciones en los segundos gemelos nacidos por vía vaginal en las variables «estructuración espacial», «desarrollo no verbal» y «desarrollo total». Conclusiones: Las variables perinatales predicen los resultados a largo plazo en gemelos. La posible divergencia de intereses prenatales entre hermanos gemelos plantea la necesidad de individualizar cada caso y consensuar con los padres la actuación perinatal (AU)

Introduction: In recent years the incidence of multiple pregnancies has increased in our clinical settings. These mothers and their twin newborns are particularly vulnerable to neonatal mortality and morbidity due to their high rate of prematurity and perinatal complications. Long-term development outcomes have also to be considered. Objectives: To analyze the influence of the mode of delivery and other perinatal variables such as birth order, in the long-term development of twins, describing predictive models regarding psychological development and intelligence. Methods: We conducted an observational study in 62 pairs of 6-years-old twins. We assessed all children and their mothers, using CUMANIN and K-BIT batteries, and collected perinatal clinical data. We perform stratified and multivariate analysis using multiple linear regression. Results: The type of delivery was the variable that showed greater predictive value of the scores, so that the best results were obtained for children born vaginally. However, we have observed the existence of comparatively lower scores in the second twins born vaginally in some of the studied areas: spatial structuring, nonverbal development and overall development. Conclusions: Perinatal variables predict long-term outcomes in twins. Possible different prenatal interests of both co-twins make essential to provide information to parents in order to agree perinatal interventions (AU)

High levels of alcohol consumption in pregnant women from a touristic area of Southern Spain.

The prevalence of alcohol intake in women who become pregnant is similar to that found in the general population, especially in cases of unplanned pregnancies. Consequently, foetal exposure is high during the period of maximum vulnerability. The present study was carried out to determine the prenatal level of exposure to alcohol in Málaga, a Mediterranean region whose economy is based on the touristic sector (Costa del Sol). A cross-sectional, observational design was used to investigate the consumption of alcohol during pregnancy, based on a self-reporting questionnaire. A total of 451 women in the first, second or third trimesters of pregnancy were recruited. Consumption prevalences in each trimester were 40.7%, 25.5% and 17.1%. A higher educational level was associated with greater exposure to alcohol (risk ratio, 1.87 [1.30-2.69]). These results should alert the providers of obstetric care in touristic areas to the need for the adoption of adequate preventive measures.

Use of a temporary inferior vena cava filter during pregnancy in patients with thromboembolic events.

There are circumstances in the management of thromboembolic events during pregnancy when anticoagulant therapy is either contraindicated or not advisable, such as when pulmonary embolism (PE) or deep venous thrombosis is diagnosed close to term, given the risk of bleeding during delivery. In these cases, the thromboembolic risk can be controlled using temporary inferior vena cava filters (T-IVCFs). We present the case of a pregnant woman with thrombophilia who remained at rest for eight weeks due to an amniotic prolapse and for whom the placement of a T-IVCF was decided at 32 weeks' gestation after anticoagulant therapy had failed. An emergency caesarean section was performed at 33 weeks' gestation due to placental abruption following the spontaneous onset of preterm labour. The risk of bleeding during delivery when high doses of heparin are used, and the risk of PE when the heparin dose is decreased, needs to be evaluated versus the risks related to T-IVCF placement procedure and, as such, a review of the published experience in this field is warranted. We have concluded that T-IVCFs can be a safe alternative treatment for pregnant women in whom anticoagulation therapy is either contraindicated or not advisable.