Eating Disorders During Gestation: Implications for Mother's Health, Fetal Outcomes, and Epigenetic Changes.

Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited. Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs. Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring. Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period.

Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona.

BACKGROUND: Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. METHODS: Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. RESULTS: A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30-39, 40-44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40-44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50-2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30-5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. CONCLUSIONS: Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.

Study on the conditions of use for Caribán(R) and other antiemetics in the treatment of nausea and vomiting during pregnancy / Estudio sobre las condiciones de uso de Caribán(R) y de otros antieméticos en el tratamiento de las náuseas y vómitos en el embarazo: estudio prospectivo observacional longitudinal

Objective: We performed a prospective observational study on the conditions of use of a medication, Caribán(R), and of other antiemetics for the treatment of nausea and vomiting in pregnancy (NVP). The study was practical in design, and its main objective was to determine the frequency of use of Caribán(R) in the treatment of NVP by analyzing conditions of use in daily clinical practice. Material and methods: The study population comprised 184 pregnant women with nausea and/or vomiting during the days preceding the first study visit. The patients attended up to 4 visits, 3 of which were face-to-face, and provided clinical follow-up data and data on the treatment used by means of an app. Data on treatment and the evaluation of nausea and vomiting were obtained every 24 hours using the Pregnancy-Unique Quantification of Emesis and Nausea score (PUQE). Results: The most frequently used initial regimen was 1 capsule every 8 hours. Data were available from the baseline visit and from the daily follow-up of 158 women (ie, 4982 daily evaluations). The mean score for severity of NVP was 5.69 points (mild) (SD, 1.8; range, 3-13) and the mean cumulative dose per woman throughout the follow-up was 34.61 capsules (6-197). NVP was mild in 72.48% of evaluations, moderate in 26.57%, and severe in 0.94%. Patients did not take medication in 54% (n=1969) of the mild daily episodes and in 14% of the moderate episodes. Mean consumption per daily episode was 1.74 (0-10) capsules per episode of mild NVP and 2.14 (0-35) capsules per episode of moderate NVP. Women who had NVP took Caribán(R) according to the app on 66.7% of the days with symptoms. Conclusions: The most common initial regimen prescribed was 1 capsule every 8 hours. Most of the episodes of NVP were mild, and on 50.85% of days with mild NVP, the women did not take medication. The mean daily dose per mild episode was 1.74 capsules. The patients reported having taken medication for moderate NVP in 86% of cases. The mean dose per episode was 2.14 capsules. The patients took Caribán(R) on 66.7% of days with NVP

Objetivo: El estudio sobre las condiciones de uso de Caribán(R) y otros antieméticos en el tratamiento de las náuseas y vómitos del embarazo (NVE) es un estudio observacional prospectivo de utilización de medicamentos diseñado con criterios pragmáticos que se plantea con el objetivo principal de determinar la frecuencia de uso de Caribán(R) en el tratamiento de las náuseas y vómitos del embarazo (NVE) analizando sus condiciones de uso en la práctica clínica diaria. Material y Metodos: Han participado 184 embarazadas con náuseas y/o vómitos en los días previos a la primera visita del estudio que atendieron hasta 4 visitas, tres de ellas presenciales, y facilitaron información del seguimiento clínico y del tratamiento utilizado mediante una aplicación telefónica. Se han recogido variables de tratamiento y la valoración de náuseas y vómitos cada 24 horas mediante la escala PUQE (PregnancyUniqueQuantification of Emesis and nausea). Resultados: La pauta de inicio más frecuentemente utilizada fue una capsula cada 8 horas. Existen datos de visita basal y de seguimiento diario de 158 embarazadas que suponen 4982 valoraciones diarias. La valoración media de la gravedad de las NVE es 5,69 puntos (LEVE), (SD 1,8, rango 3-13) y la dosis acumulada media por mujer durante todo el seguimiento 34,61 cápsulas ( 6-197). En el 72,48% de todas las valoraciones las NVE fueron leves, el 26,57% moderadas y el 0,94% graves. En el 54% (n=1969) de los episodios diarios leves y en el 14% de los moderados las gestantes no tomaron medicación. El consumo medio por cada episodio diario de NVE leve fue de 1,74 (0-10) cápsulas, mientras que en cada episodio moderado se utilizaron 2,14 (0-35) cápsulas. Las mujeres que tenían NVE tomaban Caribán(R) según la aplicación en el 66,7% de los días que tenían clínica. Conclusiones: La pauta de inicio prescrita mas frecuentemente fue una capsula cada 8 horas. La mayor parte de los episodios de NVE son leves, y en el 50.85% de los días con náuseas o vómitos leves las embarazadas no tomaron medicación. La dosis media por episodio/día leve es de 1,74 cápsulas. En los episodios diarios de NVE moderados el 86% de las embarazadas señalaron tomar la medicación siendo la dosis media por episodio de 2,14. El 66,7% de los días en que las mujeres tenían NVE tomaban Caribán(R)