Association between a medical nutrition therapy program and eating behavior with gestational weight gain in women with diabetes.

Introduction: To assess the association of medical nutrition therapy (MNT) consultations and eating behavior with gestational weight gain (GWG) in Mexican women with type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM).Material and methods: Cross-sectional study conducted at (Blinded for Review) from 2013 to 2014. Fifty-seven patients with T2DM or GDM were invited to participate. The dependent variable was GWG and the main independent variables were MNT and eating behaviors. Data were obtained from medical records or interviews. Multiple linear regression models were used to assess associations.Results: Per each additional MNT consultation, GWG was reduced by 1.2 kg (ß = -1.2; 95% CI: -2, -0.3; p = .007). After adjusting for age, in women with normal pregestational weight, for each unit, increase in the EE behavior index, there was a GWG increase of 2.8 kg (ß = 2.8; 95% CI: 1.2, 4.4; p = .003).Conclusions: This study reinforces the need for additional research to determine how eating behaviors are related to GWG during pregnancy. ClinicalTrials.gov Identifier: NCT03767699.

Asociación de factores de riesgo de preeclampsia en mujeres mexiquenses / Association preeclampsia risk factors in mexiquenses women

Introducción: La preeclampsia es aún uno de los mayores problemas obstétricos en países en vías de desarrollo.Objetivo: Identificar los principales factores de riesgo para desarrollar preeclampsia en mujeres mexiquenses atendidas en el Hospital Materno Perinatal "Mónica Pretelini Sáenz".Material y métodos: Estudio de casos y controles, se incluyeron dos grupos, el grupo A casos (n=138) y el grupo B controles (n=276) con relación caso-control de 1:2.Los criterios de definición para los casos fueron: mujeres con diagnóstico inicial de preeclampsia y que cuenten con las siguientes mediciones: Tensión Arterial Sistólica (TAS)=140 ó Tensión Arterial Diastólica (TAD)=90 mmHg más una de las siguientes: concentración de proteínas en orina de 24 h =300 ó Proteinuria =++. El grupo de controles quedó conformado por mujeres que acudieron al hospital para atención del embarazo sin preeclampsia. Resultados: La media de edad fue de 27.5±8.0 para los casos (grupo A) y 25.3±6.7 para los controles (grupo B) (P<0.01). El tener 1 o más óbitos (P<0.045), las cifras iniciales y finales de TAS y TAD, el índice de masa corporal pregestacional (IMCPG), el peso al final del embarazo, y la hipertensión arterial sistémica crónica (P<0.01) así como el haber padecido preeclampsia en algún embarazo previo fueron estadísticamente significativo (P<0.01) para tener preeclampsia. Conclusiones: En nuestra población, además de los factores de riesgo tradicionales para preeclampsia se agrega el antecedente de óbitos como otro factor de riesgo para padecer preeclampsia.

Introduction: Preeclampsia is still a major obstetric problem in developing countries. Objective: To identify the main risk factors to develop preeclampsia in women from the State of Mexico attended at the Maternal Perinatal Hospital "MónicaPreteliniSáenz". Materials and methods: In this case-control study, two groups were included, group A patients (n = 138) and B controls (n = 276) with a case-control ratio of 1: 2. The criteria for defining cases were women initially diagnosed with preeclampsia and who had the following measurements: Systolic Blood Pressure (SBP) =140 or diastolic blood pressure (DBP) =90 mmHg plus one of the following: =300 protein concentration in a 24-h urine sample or proteinuria = ++. The control group was made up of women attended at the hospital who did not develop preeclampsia. Results: The mean age was 27.5 ± 8.0 years for the cases (group A) and 25.3 ± 6.7 years for controls (group B) (P <0.01). Having 1 or more stillbirth (P <0.045), initial and final measures of SBP and DBP, the pre-pregnancy body mass index (IMCPG), weight in late pregnancy, and chronic hypertension (P <0.01) as well as having had preeclampsia in a previous pregnancy were statistically significant (P <0.01) to have preeclampsia. Conclusions: In our population, in addition to the traditional risk factors for preeclampsia, history of stillbirthswas is another risk factor to develop preeclampsia.

Predictors of hyperlipidemia during the first half of pregnancy in Mexican women / Predictores de hiperlipidemia durante la primera mitad del embarazo en mujeres mexicanas

Objective: To determine the predictors of hypercholesterolemia and of hypertriglyceridemia during the first half of pregnancy in Mexican women. Methods: Cross-sectional comparative study of pregnant women with less than 21 weeks of gestational age. Measurements: Demographic information, obstetric history, prepregnancy body mass index, cholesterol and triglycerides. Cross tabulations and multiple logistic regression were used for statistical analysis. Results: 230 participants; 61 women with normal prepregnancybody mass index, 108 with overweight, and 61 with obesity. Dyslipidemia was defined as elevated cholesterol (>180 mg/dL) or triglycerides (>170 mg/dL). After adjusting by potential confounders, independent predictors of hypercholesterolemia included being overweight (OR=2.8, 95% CI 1.4-5.9), being obese (OR=3.7 95% CI 1.6-8.4) or being on the second trimester of pregnancy. The same predictors were found for hypertriglyceridemia, respectively OR=2.8, 95% CI 1.4-5.6, OR=2.9, 95% CI 1.3-6.5, OR=2.6, 95% CI 1.4-4.7. Conclusion: Mexican women with prepregnancy overweight or obesity have greater risk of suffering hypercholesterolemia and hypertriglyceridemia during pregnancy. Women in the second trimester had higher levels of both lipids as compared to the first one. This is the first Mexican study that confirms the increase of lipids as gestational age progresses (AU)

Objetivo: Determinar los predictores de hipercolesterolemia y de hipertrigliceridemia durante la primera mitad del embarazo en mujeres Mexicanas. Métodos: Estudio transversal comparativo de mujeres embarazadas con menos de 21 semanas de edad gestacional. Mediciones: información demográfica, historia obstétrica, índice de masa corporal pregestacional, niveles sanguíneos de colesterol y triglicéridos. Se usaron tabulaciones cruzadas y regresión logística múltiple en el análisis estadístico. Resultados: 230 participantes; 61 mujeres con índice de masa corporal pregestacional normal, 108 con sobrepeso, y 61 con obesidad. Dislipidemia se definió como elevación de colesterol (>180 mg/dL) ó triglicéridos (>170 mg/dL). Después de ajustar con potenciales variables de confusión, los predictores independientes de hipercolesterolemia incluyeron sobrepeso (OR=2.8, 95% CI 1.4-5.9), obesidad (OR=3.7 95% CI 1.6-8.4) o estar en el segundo trimestre del embarazo. Los mismos predictores se encontraron para hipertrigliceridemia, respectivamente: OR=2.8, 95% CI 1.4-5.6, OR=2.9, 95% CI 1.3-6.5, OR=2.6, 95% CI 1.4-4.7. Conclusión: Mujeres Mexicanas con sobrepeso u obesidad pregestacional tienen mayor riesgo de presentar hipercolesterolemia e hipertrigliceridemia durante el embarazo. Mujeres en el segundo trimestre tuvieron niveles más altos de ambos lípidos comparando con el primer trimestre. Este es el primer estudio Mexicano que confirma el incremento de lípidos conforme la edad gestacional progresa (AU)

Predictors of hyperlipidemia during the first half of pregnancy in Mexican women.

OBJECTIVE: To determine the predictors of hypercholesterolemia and of hypertriglyceridemia during the first half of pregnancy in Mexican women. METHODS: Cross-sectional comparative study of pregnant women with less than 21 weeks of gestational age. MEASUREMENTS: Demographic information, obstetric history, prepregnancy body mass index, cholesterol and triglycerides. Cross tabulations and multiple logistic regression were used for statistical analysis. RESULTS: 230 participants; 61 women with normal prepregnancy body mass index, 108 with overweight, and 61 with obesity. Dyslipidemia was defined as elevated cholesterol (>180 mg/dL) or triglycerides (>170 mg/dL). After adjusting by potential confounders, independent predictors of hypercholesterolemia included being overweight (OR=2.8, 95% CI 1.4-5.9), being obese (OR=3.7 95% CI 1.6-8.4) or being on the second trimester of pregnancy. The same predictors were found for hypertriglyceridemia, respectively OR=2.8, 95% CI 1.4-5.6, OR=2.9, 95% CI 1.3-6.5, OR=2.6, 95% CI 1.4-4.7. CONCLUSION: Mexican women with prepregnancy overweight or obesity have greater risk of suffering hypercholesterolemia and hypertriglyceridemia during pregnancy. Women in the second trimester had higher levels of both lipids as compared to the first one. This is the first Mexican study that confirms the increase of lipids as gestational age progresses.

Objetivo: Determinar los predictores de hipercolesterolemia y de hipertrigliceridemia durante la primera mitad del embarazo en mujeres Mexicanas. Métodos: Estudio transversal comparativo de mujeres embarazadas con menos de 21 semanas de edad gestacional. Mediciones: información demográfica, historia obstétrica, índice de masa corporal pregestacional, niveles sanguíneos de colesterol y triglicéridos. Se usaron tabulaciones cruzadas y regresión logística múltiple en el análisis estadístico. Resultados: 230 participantes; 61 mujeres con índice de masa corporal pregestacional normal, 108 con sobrepeso, y 61 con obesidad. Dislipidemia se definió como elevación de colesterol (>180 mg/dL) ó triglicéridos (>170 mg/dL). Después de ajustar con potenciales variables de confusión, los predictores independientes de hipercolesterolemia incluyeron sobrepeso (OR=2.8, 95% CI 1.4-5.9), obesidad (OR=3.7 95% CI 1.6-8.4) o estar en el segundo trimestre del embarazo. Los mismos predictores se encontraron para hipertrigliceridemia, respectivamente: OR=2.8, 95% CI 1.4-5.6, OR=2.9, 95% CI 1.3-6.5, OR=2.6, 95% CI 1.4-4.7. Conclusión: Mujeres Mexicanas con sobrepeso u obesidad pregestacional tienen mayor riesgo de presentar hipercolesterolemia e hipertrigliceridemia durante el embarazo. Mujeres en el segundo trimestre tuvieron niveles más altos de ambos lípidos comparando con el primer trimestre. Este es el primer estudio Mexicano que confirma el incremento de lípidos conforme la edad gestacional progresa.

[Micronutrients supplementation in women with hypertensive states in pregnancy]. / Suplementación de micronutrimentos en mujeres con estados hipertensivos del embarazo (EHE).

Pregnancy presents a large number of metabolic adaptations and requirements of micro and macronutrients could be increased, which are not always covered by the diet making necessary to supplement some of them. The micronutrients are an important part of metabolic reactions and both; their deficiency as their excess could participate in damage to organs and tissues of the mother and the fetus. Actually the hypertension pregnant states (HPS) participate in the leading causes of death during pregnancy, making necessary the search for interventions to prevent or reduce the consequences.The oxidative stress levels are linked with the risk to develop HPS, which has created assumptions about the use of micronutrients with antioxidant power and its possible role as protectors in these pathologies, however, the information is still uncertain and the metabolic action of the use of micronutrients supplementation is not precisely known because some micronutrients have shown a protective effect on the development of HPS. It is necessary to evaluate the nutritional status before and during pregnancy, as well to realize more studies about it and strengthen public policies about the use of micronutrients during the pregnancy.

Índice aterogénico como factor de riesgo para el síndrome de preeclampsia / Atherogenic index as a risk factor for preeclampsia syndrome

Introducción y objetivos: La hipertensión inducida por el embarazo o preeclampsia presenta características fisiopatológicas similares a las de la aterosclerosis y las enfermedades cardiovasculares. El propósito del estudio fue identificar los factores de riesgo aterogénico y su relación en la preeclampsia. Método: Se realizó una investigación descriptiva de tipo transversal, con 50 pacientes en el tercer trimestre del embarazo. Mediante la entrevista se establecieron el peso y la talla, para calcular el índice de masa corporal. La tensión arterial > 140/90 mmHg acompañada de edema y proteinuria en el embarazo, se clasificó como hipertensión arterial. Se tomaron muestras de sangre para determinar los valores de colesterol sérico, triglicéridos y HDL. Las variables se expresaron en porcentajes. Resultados: En cada paciente se analizó el número de factores de riesgo y sus asociaciones. Los resultados más relevantes consistieron en que el 76 por ciento presentó sobrepeso u obesidad. En cuanto al síndrome de preeclampsia, se mostró en el 30 por ciento con un riesgo relativo de 3 veces más que las normolipídicas, y 30 por ciento tuvo un índice aterogénico elevado. Conclusiones: La dislipidemia es un factor de riesgo aterogénico de importancia, y en conjunto constituyen un factor de riesgo para la preeclampsia. El incremento del índice aterogénico aumenta la susceptibilidad a la aterogénesis en la preeclampsia. La dislipidemia aparenta ser el punto de inicio de esta cadena de sucesos. El estudio del papel de la dislipidemia podría contribuir a la comprensión de los mecanismos de disfunción endotelial en la preeclampsia(AU)

Gasto cardíaco materno como predictor del síndrome de preeclampsia-eclampsia / Maternal cardiac output as a predictor of preeclampsia-eclampsia syndrome

Introducción y objetivos: La hipertensión es la complicación médica más común del embarazo, y puede dejar secuelas permanentes como: alteraciones neurológicas, hepáticas, hematológicas o renales. Cada tres minutos muere una mujer debido a la preeclampsia. Durante el embarazo el gasto cardíaco sufre un incremento de hasta 40 por ciento. Este incremento es secundario al aumento de aproximadamente 30 por ciento del volumen sistólico. El objetivo de la investigación fue predecir la aparición del síndrome de preeclampsia-eclampsia mediante la identificación de alteraciones del gasto cardíaco. Método: Se realizó un estudio observacional, descriptivo, longitudinal y analítico, de cohorte prospectiva, donde se determinó, por ecocardiografía, el gasto cardíaco en 31 embarazadas, entre las semanas 11 y 13,6 de gestación como único valor; y mediante seguimiento prenatal, se observó la aparición o no del síndrome de Preeclampsia-Eclampsia. Resultados: Se logró el seguimiento de 31 embarazadas a las que se le midió el gasto cardíaco, y se encontró una prevalecía de la enfermedad de 12,9 por ciento con un 64,5 por ciento de pacientes correctamente diagnosticados, con una sensibilidad de 75 por ciento, con valor predictivo positivo de 23 por ciento, especificidad de 62 por ciento y valor predictivo negativo de 94 por ciento, con un riesgo relativo de 4,1 (intervalo de confianza 95 por ciento, 0,48-35,6). Conclusiones: Es posible establecer la medición de gasto cardíaco como estudio de escrutinio para predecir la aparición del síndrome de Preeclampsia desde el control prenatal, y contribuir así a la disminución de la muerte materna(AU)

[Evaluation of efficacy of ketoconazole 800 mg-clindamycin 100 mg tablets vaginal against ketoconazole 800 mg- clindamycin 100 mg vaginal capsules in candida vaginitis and vaginosis]. / Evaluación de la eficacia de ketoconazol 800 mg-clindamicina 100 mg tabletas vaginales, contra ketoconazol 800 mg-100 mg de clindamicina cápsulas vaginales en vaginitis candidiásica y vaginosis.

BACKGROUND: pharmaceutical forms (presentations) influence treatment compliance and therefore the effectiveness. Here we present the results in the relief of vaginitis and vaginosis with two different dosage forms. OBJECTIVE: To compare the efficacy and safety of a combination of ketoconazole 800 mg + clindamycin in soft vaginal gel capsules 100 mg (vaginal capsules) against ketoconazole 800 mg + 100 mg clindamycin vaginal tablets (TV) in the management of vaginitis by C. albicans and/or vaginosis. MATERIAL AND METHOD: In a randomized, multicenter, comparative open label study, patients between 18 and 60 years with a diagnosis of vaginitis by C. albicans and/or vaginosis were included. Patients were evaluated clinically and direct exam of genital discharge and culture were performed. Patients were randomized to one of two treatments vaginal tablets or vaginal capsules, for 3 days. RESULTS: one hundred an sitxty nine patients were included, 85 in TV Group and 84 in vaginal capsules group. We found significant statistical difference in clinical response for tablet group at day three for burning p = 0.032 and itching p = 0.043. Microbiological cure was observed in patients with vaginitis by C. albicans, 92.5% in Group TV vs. 90.47% vaginal capsules group, all patients with G. vaginalis at baseline were negative for the organism at the end of the study, cure in patients with mixed infections were 78.94% for TV group vs. 78.26% vaginal capsules; group no adverse events were reported during treatment. CONCLUSIONS: Treatment of vaginitis/vaginosis with vaginal tablets is clinically better than vaginal soft gelatin capsules both treatments were well tolerated.

[New therapeutics alternative in severe preeclampsia]. / Nueva alternativa terapéutica en preeclampsia severa.

INTRODUCTION: Vasoconstriction is a major pathophysiologic finding in preeclampsia due to hyperactivity of the sympathetic nervous system and a consequent increase in concentration of plasmatic catecholamine. Thus, vasodilatation produced by secondary sympathetic block to lumbar epidural blockade favors control of high blood pressure in patients with severe preeclampsia. OBJECTIVE: Our objective was to evaluate whether lumbar epidural blockade with bupivacaine 0.25% decreases high blood pressure of patients with severe preeclampsia within a lapse of 6 h in comparison with customary antihypertensive treatment. MATERIAL AND METHODS: An open, randomized, controlled trial was carried out in 24 pregnant patients with 30 weeks of gestational age or more and diagnosis of severe preeclampsia who entered the Intensive Care Uni of the IMEIM Hospital of Gynecology and Obstetrics for hemodynamic stabilization and resolution of pregnancy. Group 1 (n = 12) was managed with customary antihypertensive treatment and group 2 (n = 12), with lumbar epidural blockade and bupivacaine 0.25%: 10 mg in bolus and 5 mg/h continuous epidural infusion. Patients were monitored non-invasively and with continuous clinical monitoring with MAP, SAP, and DAP during 6 h. Statistical analysis employed consisted of ANOVA measurement repeats. RESULTS: In MAP and SAP, there were no significant differences between the two groups; DAP in first and second h of treatment had significant differences between the two groups (p value of < or = 0.05). CONCLUSIONS: Lumbar epidural blockade with bupivacaine 0.25% can be used as a therapeutic alternative in high blood pressure control in patients with severe preeclampsia during the the first 6 h of hemodynamic stabilization.

[Presence of equinocyte in the preeclampsia-eclampsia syndrome. Is this a subclinical manifestation of the syndrome?]. / Presencia del equinocito en el síndrome de preeclampsia-eclampsia ¿Manifestación subclínica del síndrome?

OBJECTIVE: To determine the relationship between erythrocyte deformations and preeclampsia-eclampsia syndrome before presentation of the triad high blood pressure-edema-proteinuria. MATERIAL AND METHODS: Aleatory study. A total of 308 patients were studied without evidence of preeclampsia, with negative erythrocyte deformation smear, between 12 and 18 weeks of pregnancy. Monthly laboratory samples were performed including arterial blood pressure monitorization, weight, and periphery blood smear considered as positive with presence of 50% of morphologic changes of erythrocyte (equinocyte) deem in 10 fields, with light microscopic and oil immersion at 100X. Statistical studies were performed to determine relative risk (RR), sensitivity (S), and specificity (E), and positive and negative predictive values. RESULTS: A total of 308 patients were studied; 36 patients (100%) had a positive smear, nine (25%) had preeclampsia. Erythrocyte deformation was seen at between 22 and 26 weeks of pregnancy in all patients before onset of high blood pressure, edema, and proteinuria; of 27 patients with positive smear who did not present preeclampsia (75%), five had thrombocytopenia, of five had edema and increased weight, and 17 were normal with normal vaginal delivery. A total of 267 patients who had negative smear until the end of pregnancy (98%), five (2%) had preeclampsia (sensitivity = 64%, specificity = 90%, VP+ = 25%, VP- = 98%, RR = 13.6%). CONCLUSIONS: There is a close relationship between erythrocyte deformations with onset of preeclampsia-eclampsia syndrome prior to presentation of the triad high blood pressure-edema-proteinuria.