Are Overweight and Obesity Risk Factors for Developing Metabolic Syndrome or Hypertension after a Preeclamptic Event?

OBJECTIVE: To identify the determinants and risks associated with developing hypertension and metabolic syndrome in the first year postpartum in women who experienced preeclampsia. METHODS: A cohort study was conducted, involving women who had experienced preeclampsia (PE) recently. The control group was women with the same characteristics but a healthy pregnancy. The variables analyzed were somatometry, disease history, pre-pregnancy body mass index (Pre-BMI), and Third Adult Treatment Panel updated (ATP III) metabolic syndrome (MS) data (blood pressure, obesity, triglycerides, high-density lipoproteins, and fasting glucose). These variables were measured at 3, 6, and 12 months postpartum. RESULTS: Women with a history of PE exhibited higher systolic and diastolic blood pressure than women without PE. The risk of developing isolated diastolic arterial hypertension at 3 and 12 months of follow-up was two to eight times greater in women with a history of PE. Factors associated with having higher blood pressure levels were preeclampsia, insulin resistance, age, and BMI. Neither the pre-BMI index nor gestational weight gain (GWG) had any effect on blood pressure in any of the three assessments. Women with preeclampsia had a 5- to 8-fold increased risk of developing MS (which could be explained not only by the history of preeclampsia but also by the history of pre-pregnancy obesity). However, PE was not identified as a risk factor at the six-month evaluation and was only explained by pre-pregnancy obesity and overweight. CONCLUSIONS: Obesity and overweight, as well as preeclampsia, were strongly associated with the development of hypertension and metabolic syndrome during the first year following childbirth.

Association of Diet, Body Mass Index, and Lifestyle on the Gastrointestinal Health Risk in a Sample of Adults.

Gastrointestinal functional disorders are characterized by abnormalities in motility with visceral hypersensitivity, representing a global public health problem. We aimed to determine whether eating habits, lifestyle characteristics, and body mass index (BMI) are associated with gastrointestinal health risk. The Gastrointestinal Health (GIH) test of the World Gastroenterology Organization (WGO) and the Roma IV criteria were applied. We obtained information on food consumption habits and aerobic exercise, among other variables. Not exercising regularly, drinking water and eating vegetables less than recommended, having high body weight, and taking symptomatic medication were variables that explained 73% of the probabilities of not having good GIH (R2 = 0.734). According to Rome IV criteria, women had a 50% higher risk than men of having functional bowel disorder (RR 1.6, 95% CI: 1.04, 2.45). Among the men studied, eating few or no vegetables and drinking less than 1 L of water daily was more frequent; however, the women had significantly more intestinal symptoms. In addition, constipation was higher among women than men (p = 0.020). All of the above explains the prognostic value of eating habits and the importance of paying attention to body weight to reduce the risk of gastrointestinal disease.

Factors Associated With Weight, Length, and BMI Change in Adolescents' Offspring in Their First Year of Life.

Background: Young maternal age is associated with negative outcomes at birth and with offspring's growth. In low- and middle-income countries, adolescents' offspring growth little has been studied. Objective: To determine the association of maternal sociodemographic characteristics with weight, length, and BMI change in adolescents' offspring in their first year of life. Methods: This is a one-year follow-up study that included adolescent mothers and their offspring from 2010 to 2017. The infant anthropometric variables were performed at birth, 3, 6, and 12 months. Maternal health, pregnancy, and social variables were evaluated as well as birth outcomes. Crude, percentage, Z score, and percentile changes of weight, length, and BMI were evaluated from birth to 1-year-old. Statistical analyses were adjusted by maternal chronological age, socioeconomic status, breastfeeding duration, the timing of introduction of complementary feeding, among other variables. Results: We examined 186 dyads (mother-infant). The median maternal age was 15.5 years, and the mean pre-pregnancy BMI was 20. The mean gestational age was 39.1 weeks for infants, birth weight was 3,039 g, and length at birth was 49.5-cm. Maternal chronological age, the timing of introduction of complementary feeding, socioeconomic status, and maternal occupation were associated with offspring's weight gain at 12 months. Length gain was associated with exclusive breastfeeding. Socioeconomic status and occupation were associated with offspring's BMI change. When performing adjusted multivariable analyses, weight and length at birth were associated weight and BMI at 12 months. Conclusions: Weight at birth may negatively predict infant's weight and BMI changes at 12 months, while length at birth may positively predict the changes. Maternal chronological age, socioeconomic level, occupation, and the timing of the introduction of complementary feeding were associated with the weight change. Only exclusive breastfeeding was associated with length Z-score change in adolescents' offspring in their first 12-months of life.

Association of Pregestational BMI and Gestational Weight Gain with Maternal and Neonatal Outcomes in Adolescents and Adults from Mexico City.

During pregnancy, adolescents experience physiological changes different from adults because they have not concluded their physical growth. Therefore, maternal and neonatal outcomes may not be the same. This paper aimed to analyze the association between pregestational BMI (pBMI) and gestational weight gain (GWG) with maternal and neonatal outcomes in adolescent and adult pregnant women. The authors performed an observational study that included 1112 women, where 52.6% (n = 585) were adolescents. Sociodemographic information, pBMI, GWG, neonatal anthropometric measures, and maternal and neonatal outcomes were obtained. Adolescent women had a mean lower (21.4 vs. 26.2, p ≤ 0.001) pBMI than adults and a higher gestational weight gain (12.3 vs. 10.7 kg, p ≤ 0.001). According to Poisson regression models, gestational diabetes is positively associated with insufficient GWG and with pregestational obesity. Furthermore, the probability of developing pregnancy-induced hypertension increased with pBMI of obesity compared to normal weight. Preeclampsia, anemia, and preterm birth were not associated with GWG. Insufficient GWG was a risk factor, and being overweight was a protective factor for low birth weight and small for gestational age. We conclude that pBMI, GWG, and age group were associated only with gestational diabetes and low birth weight.

Prevalence and characteristics of the metabolically healthy obese phenotype in children and adolescents in a Mexican state / Prevalencia y características del fenotipo obeso metabólicamente sano en niños y adolescentes de un estado de México

OBJECTIVES: To determine the prevalence of the Metabolically Healthy Obesity (MHO), and Metabolically Obese Normal-Weight (MONW) phenotypes in a sample of children and adolescents. To evaluate which clinical and laboratory variables are related to the MONW and MHO phenotypes. METHODS: A cross-sectional study was carried out in children and adolescents aged 6-18 years old, presumably healthy. Somatometry, glucose, insulin, triglycerides, HDL-cholesterol, LDL-cholesterol, HOMA-IR, triglycerides/HDL ratio, triglycerides and glucose index, and leptin/adiponectin, were determined. RESULTS: Data from 620 children and adolescents were included (50.65% were males); the median age was 11 years. The prevalence of the MONW phenotype was 22.85% (95%CI 16.85%-29.79%), and the MHO phenotype 27.61% (95%CI 22.60%-33.06%). The variables that significantly explained the possibility of presenting the MONW and MHO phenotype were triglycerides/HDL ratio, and product of triglycerides and glucose. Insulin and HOMA-IR were significantly associated with the MHO phenotype but not with the MONW phenotype. CONCLUSIONS: Prevalence of metabolically healthy obese phenotype is lower in the Mexican population compared to European studies; thus, future studies should determine if this difference relies upon genetic profile or lifestyle. The indices to assess the action of insulin based on lipids can help identify children and adolescents with the MHO and MONW phenotypes

OBJETIVOS: Determinar la prevalencia de los fenotipos obeso metabólicamente sano (OMS) y metabólicamente obeso con peso normal (MOPN) en una muestra de niños y adolescentes. Evaluar qué variables clínicas y analíticas están relacionadas con los fenotipos OMS y MOPN. MÉTODOS: Se realizó un estudio transversal en niños y adolescentes de seis-18 años de edad presumiblemente sanos. Se determinaron las características antropométricas, la glucosa, la insulina, los triglicéridos, el colesterol HDL, el colesterol LDL, el HOMA-IR, el cociente triglicéridos/HDL, el índice triglicéridos-glucosa y la leptina/adiponectina. RESULTADOS: Se incluyeron los datos de 620 niños y adolescentes (el 50,65% varones) con una mediana de edad de 11 años. La prevalencia del fenotipo MOPN fue del 22,85% (IC al 95%, 16,85-29,79%), y la del fenotipo OMS del 27,61% (IC al 95%, 22,60-33,06%). Las variables que explicaban significativamente la posibilidad de presentar el fenotipo MOPN y el OMS eran el cociente triglicéridos/HDL y el producto de triglicéridos y glucosa. La insulina y el HOMA-IR estaban significativamente asociados con el fenotipo OMS, pero no con el fenotipo MOPN. CONCLUSIONES: La prevalencia del fenotipo obeso metabólicamente sano es menor en la población mexicana que en los estudios en Europa; así pues, hay que determinar en estudios futuros si esta diferencia se basa en el perfil genético o en la forma de vida. Los índices para valorar la acción de la insulina basados en lípidos pueden ayudar a identificar a los niños y adolescentes con los fenotipos OMS y MOPN

Prevalence and characteristics of the metabolically healthy obese phenotype in children and adolescents in a Mexican state.

OBJECTIVES: To determine the prevalence of the Metabolically Healthy Obesity (MHO), and Metabolically Obese Normal-Weight (MONW) phenotypes in a sample of children and adolescents. To evaluate which clinical and laboratory variables are related to the MONW and MHO phenotypes. METHODS: A cross-sectional study was carried out in children and adolescents aged 6-18 years old, presumably healthy. Somatometry, glucose, insulin, triglycerides, HDL-cholesterol, LDL-cholesterol, HOMA-IR, triglycerides/HDL ratio, triglycerides and glucose index, and leptin/adiponectin, were determined. RESULTS: Data from 620 children and adolescents were included (50.65% were males); the median age was 11 years. The prevalence of the MONW phenotype was 22.85% (95%CI 16.85%-29.79%), and the MHO phenotype 27.61% (95%CI 22.60%-33.06%). The variables that significantly explained the possibility of presenting the MONW and MHO phenotype were triglycerides/HDL ratio, and product of triglycerides and glucose. Insulin and HOMA-IR were significantly associated with the MHO phenotype but not with the MONW phenotype. CONCLUSIONS: Prevalence of metabolically healthy obese phenotype is lower in the Mexican population compared to European studies; thus, future studies should determine if this difference relies upon genetic profile or lifestyle. The indices to assess the action of insulin based on lipids can help identify children and adolescents with the MHO and MONW phenotypes.

Neonatal adiposity may increase plasmatic cytokines.

Maternal health and nutritional status before and during gestation may affect neonates' immune system and energy balance as they develop. The objective of this study was to associate certain clinical markers of maternal adiposity (body mass index and gestational weight gain) and neonatal adiposity (birth weight, abdominal circumference, and waist/height index) with the levels of pro- and anti-inflammatory cytokines in umbilical cord blood at birth: IL-1ß, IL-1Rα, IL-4, IL-6, IL-10, IFN-γ, and TNF-α. An exploratory cross-sectional study was conducted with a convenience sample of women from one hospital recruited shortly before giving birth through scheduled cesarean section. Of 31 the pregnant women who agreed to participate and met the inclusion criteria, twenty-nine newborns from these women were analyzed. Three cases of tobacco smoking during pregnancy were identified as an unexpected maternal risk factor and were included in the analysis. Typical of the population treated at this hospital, ten of our participants had diabetes during pregnancy, and nine of them had a pre-pregnancy BMI> 25. Non-parametric statistical analyses and a generalized linear model with gamma scale response with a log link were performed. Results: Correlation analyses, differences in medians, and a prediction model all showed positive and significant results between cytokine levels in cord blood and neonatal abdominal circumference, birth weight, and waist-height index. For maternal variables, smoking during pregnancy showed significant associations with cytokine levels in cord blood. Conclusion: This study found a variety of associations suggesting that increased neonatal adiposity increases pro-inflammatory cytokine levels at birth.

Dietary Knowledge and Myths Vary by Age and Years of Schooling in Pregnant Mexico City Residents.

Pregnancy is a stage in a woman's life when she is more open to receiving health advice, especially related to diet. However, women are often caught between receiving scientifically unfounded myths and concrete empirical knowledge. Culturally perpetuated myths may be acted upon more than knowledge, but research on these concepts, especially in the Americas, is scarce. This cross-sectional study aimed to describe the frequency of diet and nutrition myths and knowledge and describe the associated factors in pregnant mothers receiving care in Mexico City. A total of 695 pregnant adults and 322 pregnant adolescents participated in this study, in which they responded to a questionnaire on nutrition and diet myths, knowledge, and practice during pregnancy and breastfeeding. The myths were examined individually, but for the purposes of statistical analysis, a score was obtained. We compared means of variables that could be associated to myth and knowledge scores, then calculated linear and logistical regressions. Forty-six percent of participants had below the mean myth scores. Ninety-two percent of participants had a knowledge score below the mean. Age (ß = 0.025, SE 0.007, 95% CI 0.011-0.040, p = 0.001) and years of education (ß = 0.166, SE 0.024, 95% CI 0.119-0.213, p = 0.001) explained the myth's score, while age explained the knowledge score (ß = 0.011, SE 0.020, 95% CI -0.032--0.008, p = 0.002). We found that although most women reported not believing in the myths, they acted on them. The probability of practicing such myths as "You must eat for two during pregnancy" was associated with being an adolescent (OR 1.76, p = 0.001) and being married (OR 1.47, p = 0.007), "Not satisfying cravings leave a mark on the infant's body" with being adolescent (OR 1.59, p = 0.003) and low socioeconomic level (OR 1.41, p = 0.038), "A frightened or angry mother should not nurse her baby" with being adult (OR 2.61, p = 0.004), and "Drinking atole or beer enhances breast milk production" with being single (OR 2.07, p = 0.001). The probability of not acting on some knowledge was associated with being an adolescent (p ≤ 0.003) and having a high school education or below (p ≤ 0.046). Almost all of our participants held at least one myth about nutrition and diet during pregnancy and breastfeeding; younger participants showed a higher frequency of holding myths. Years of schooling and age were associated with acting on myths and not acting on correct knowledge.

Associations between prenatal serum levels of leptin, IGF-I, and estradiol and adolescent mothers' height gain during and after pregnancy.

Mexico is within the top three Latin American countries with the highest proportion of adolescent pregnancies while being in the lowest ten Latin American countries in terms of height. It is still unclear how much growth in adolescence is affected by pregnancy; therefore, this study was designed to study the association between prenatal serum concentrations of leptin, IGF-I, and estradiol and the increase in the height of a group of pregnant adolescents between the 28th week of gestation to one year postpartum. We conducted a cohort study from 2009 to 2017 in pregnant adolescents in their third trimester of pregnancy receiving prenatal care at Mexico's National Institute of Perinatology. Data on hormones, other covariates, and confounding variables were analyzed through bivariate analysis and then a linear univariate analysis. Our patients were an average of 15.5±1 years and gained an average of 9.5 mm during the study period. A Pearson's correlation showed a positive and significant height increase between height and leptin and IGF-I, and negative between height and estradiol. The general linear model (adjusted by age, bone age, gynecological age, parent's stature, breastfeeding, body fat, energy intake, and BMI) found that leptin and estradiol serum concentrations explained 39.6% of height increase; IGF-I did not have any predictive effect. Leptin and estradiol concentrations in the third trimester of pregnancy are associated with increased height in our group of teenage mothers. No effect association was observed between height and IGF-I concentrations.

Characterization of the Gut Microbiota of Individuals at Different T2D Stages Reveals a Complex Relationship with the Host.

In this work, we studied 217 Mexican subjects divided into six groups with different stages of glucose intolerance: 76 Controls (CO), 54 prediabetes (PRE), 14 T2D no medication (T2D-No-M), 14 T2D with Metformin (T2D-M), 22 T2D with polypharmacy (T2D-P), and 37 T2D with polypharmacy and insulin (T2D-P+I). We aimed to determine differences in the gut microbiota diversity for each condition. At the phylum level, we found that Firmicutes and Bacteroidetes outline major changes in the gut microbiota. The gut bacterial richness and diversity of individuals in the T2D-No-M group were lesser than other groups. Interestingly, we found a significant difference in the beta diversity of the gut microbiota among all groups. Higher abundance was found for Comamonadaceae in PRE, and Sutterella spp. in T2D-No-M. In addition, we found associations of specific microbial taxa with clinical parameters. Finally, we report predicted metabolic pathways of gut microbiota linked to T2D-M and PRE conditions. Collectively, these results indicate that each group has specific predicted metabolic characteristics and gut bacteria populations for each phenotype. The results of this study could be used to define strategies to modulate gut microbiota through noninvasive treatments, such as dietary intervention, probiotics or prebiotics, and to improve glucose tolerance of individuals with prediabetes or T2D.

Oxidative stress biomarkers and their relationship with cytokine concentrations in overweight/obese pregnant women and their neonates.

BACKGROUND: Oxidative damage present in obese/overweight mothers may lead to further oxidative stress conditions or inflammation in maternal and cord blood samples. Thirty-four pregnant women/newborn pairs were included in this study to assess the presence of oxidative stress biomarkers and their relationship with serum cytokine concentrations. Oxidative stress biomarkers and antioxidant enzymes were compared between the mother/offspring pairs. The presence of 27 cytokines was measured in maternal and cord blood samples. Analyses were initially performed between all mothers and newborns and later between normal weight and mothers with overweight and obesity, and diabetic/non-diabetic women. RESULTS: Significant differences were found in biomarker concentrations between mothers and newborns. Additionally, superoxide-dismutase activity was higher in pre-pregnancy overweight mothers compared to those with normal weight. Activity for this enzyme was higher in neonates born from mothers with normal pregestational weight compared with their mothers. Nitrites in overweight/obese mothers were statistically lower than in their offspring. Maternal free fatty acids, nitrites, carbonylated proteins, malondialdehyde and superoxide dismutase predicted maternal serum concentrations of IL-4, IL-13, IP-10 and MIP-1ß. Arginase activity in maternal plasma was related to decreased concentrations of IL-4 and IL-1ß in cord arterial blood. Increased maternal malondialdehyde plasma was associated with higher levels of IL-6 and IL-7 in the offspring. CONCLUSIONS: Oxidative stress biomarkers differ between mothers and offspring and can predict maternal and newborn cytokine concentrations, indicating a potential role for oxidative stress in foetal metabolic and immunologic programming. Moreover, maternal obesity and diabetes may affect maternal microenvironments, and oxidative stress related to these can have an impact on the placenta and foetal growth.

Relationship between Irisin Concentration and Serum Cytokines in Mother and Newborn.

INTRODUCTION: Irisin is considered to be a myokine and adipokine that may also participate in reproductive functions, as it increases significantly throughout pregnancy. However, the regulation of circulating irisin and its relationship with other cytokines has not been assessed thus far in pregnant women and their offspring. OBJECTIVE: The aim of this study was to evaluate differences in irisin and cytokine concentrations between women at the end of pregnancy and their offspring, as well as the relationship between maternal and newborn irisin and maternal and newborn biomarkers. METHODS: Twenty-eight mother/newborn pairs were included in this study. The following biomarkers were evaluated in maternal venous and arterial umbilical cord blood samples: irisin, 27 cytokine panel, total antioxidant capacity (TAC), total plasma protein, and free fatty acid concentration. RESULTS: The newborns had significantly lower irisin concentrations compared to their mothers (p = 0.03), but this difference was present only in babies born from mothers without labor prior to cesarean section delivery (p = 0.01). No significant differences in maternal and newborn irisin concentrations were found between diabetic and non-diabetic mothers or between overweight/obese and normal weight mothers. A significant positive correlation was found between TAC level and irisin concentration in newborns. Maternal and newborn interleukin (IL)-1ß, IL-1RA, IL-5, IL-7, and interferon gamma-induced protein (IP)-10 levels were significantly positively correlated with irisin concentrations in both study groups. In addition, maternal IL1ß, IL-5, IL-7, and IP-10 levels positively predicted maternal irisin concentrations. Furthermore, arterial cord blood TAC and IL-1ß and IL1-RA levels positively predicted newborn irisin concentrations. Multiple regression analyses showed that maternal IL-13 negatively predicted offspring irisin levels (p = 0.03) and that maternal IL-1ß positively predicted newborn irisin concentrations (p = 0.046). CONCLUSION: No evidence was found that serum irisin concentrations in mothers at pregnancy termination or those of their newborns correlated with maternal body mass index, the presence of diabetes mellitus, or free fatty acid levels. However, the results of this study indicated that cytokines might predict irisin concentration in mothers and their offspring, although interactions between irisin levels during pregnancy and the newborn have not yet been fully elucidated.

Reporting detection of Chlamydia trachomatis DNA in tissues of neonatal death cases.

OBJECTIVE: to determine whether C. trachomatis was present in neonates with infection, but without an isolated pathogen, who died during the first week of life. METHODS: early neonatal death cases whose causes of death had been previously adjudicated by the institutional mortality committee were randomly selected. End-point and real-time polymerase chain reaction of the C. trachomatis omp1 gene was used to blindly identify the presence of chlamydial DNA in the paraffinized samples of five organs (from authorized autopsies) of each of the dead neonates. Additionally, differential diagnoses were conducted by amplifying a fragment of the 16S rRNA of Mycoplasma spp. RESULTS: in five cases (35.7%), C. trachomatis DNA was found in one or more organs. Severe neonatal infection was present in three cases; one of them corresponded to genotype D of C. trachomatis. Interestingly, another case fulfilled the same criteria but had a positive polymerase chain reaction for Mycoplasma hominis, a pathogen known to produce sepsis in newborns. CONCLUSION: the use of molecular biology techniques in these cases of early infant mortality demonstrated that C. trachomatis could play a role in the development of severe infection and in early neonatal death, similarly to that observed with Mycoplasma hominis. Further study is required to determine the pathogenesis of this perinatal infection.

[Anti-C. trachomatis IgG antibodies levels in serum to identify infertility caused by tubal damage]. / Evaluación de los niveles séricos de anticuerpos IgG anti-Chlamydia trachomatis para el diagnóstico de infertilidad por factor tubario.

OBJECTIVE: To identify the serologic titers of anti-Chlamydia trachomatis IgG (Ab) antibodies that could be used to differentiate tubal damage infertility from other causes of subfertility in a group of Mexican women. MATERIAL AND METHODS: This was a prospective, longitudinal and analytical study of 147 women selected in a non-random way. The women were classified into three sub-groups: 1) infertile women with tubal occlusion detected by laparoscopy (n = 58); 2) infertile women with alternative causes of subfertility (n = 50), and 3) fertile women for the control group (n = 39). An assay of indirect immunofluorescence was performed on all infertile women (n = 108). The results obtained were compared with the laparoscopic and hormonal analyses carried out on the 108 infertile women. The statistical analysis included a model in ROC Curve and Logistical Regression. RESULTS: The results showed that the titer 1:256 is able to differentiate fertile women from infertile women. Moreover, in the adjusted analysis, the titer 1:512 was able to identify infertile women with tubal occlusion (OR 2.6, CI 95% 1.24, 5.4), with a sensibility of 40% and a specificity of 90%. Positive and negative predictive values were 85% and 50%, respectively and the positive and negative likelihood ratios were 3.85 and 0.67, respectively. The pattern of the ROC curve confirmed a court value of 1:512, with an area under the curve of 62.2% (CI 95%: 53.4-72%). CONCLUSION: A titer greater or equal to 1:512 of anti-C. trachomatis IgG antibodies is useful in the identification of tubal factor infertility.

[High prevalence of group B Streptococcus colonization in Mexican pregnant women]. / Elevada prevalencia de colonización por Streptococcus del grupo B en mujeres mexicanas embarazadas.

OBJECTIVE: To determine the prevalence of group B Streptococcus (GBS) colonization in two anatomical sites in Mexican women of childbearing age, as well as the associated risk factors. PATIENTS AND METHOD: A retrospective cohort analysis was made with two groups of women between 14 and 44 years old. We formed two groups of 72 women; one had a recent positive group B Streptococcus culture and the other, paired by age and culture date, had a negative culture of the same bacterium. All of them answered a validated questionnaire and two rectal swabs were obtained and cultured for isolation of group B Streptococcus. RESULTS: Prevalence of GBS colonization was 18% for two anatomical sites (heavy colonization), and 37% for one anatomical site; the overall prevalence was 54.9%. Three or more sexual partners increased by 4-fold the risk of heavy GBS colonization (p < 0.01). In this study 49 (34%) women were pregnant, 26 (53%) of them were colonized by GBS and 7 (14.3%) were heavy colonized. CONCLUSIONS: Prevalence of GBS during pregnancy in Mexican women was higher than the reported previously, even in developed countries. Risk of colonization increased by 4-fold with a history of three or more sexual partners.

[Maternal and congenital syphilis in two Mexican hospitals: evaluation of a rapid diagnostic test]. / Sífilis matema y congénita en dos hospitales mexicanos: evaluación de una prueba diagnóstica rápida.

OBJECTIVE: To estimate the prevalence of maternal and neonatal syphilis, to assess the usefulness of a rapid treponemic diagnostic test, and to evaluate the frequency of screening for syphilis during prenatal care in Mexican women. MATERIAL AND METHODS: This was a cross-sectional study that included 1,322 women interviewed in two hospitals (Hospital General in Cuernavaca, Morelos, and Hospital de la Mujer in Mexico City). Women answered a questionnaire on reproductive background, exposure to sexually transmitted infections and prenatal care. In order to diagnose syphilis, a rapid Determine TP test and a latex-VDRL test were used among all participating women. Positive cases were confirmed using FTA-ABS test. RESULTS: Prevalence of serologically active syphilis was 0.3% (4/1322). Using as comparison standard a combination of VDRL and FTA-ABS tests, the Determine TP test had a sensitivity and specificity of 100%. Two newborns with positive FTA-ABS IgM, one negative with FTA-ABS IgM and one first-trimester abortion were found from seropositive women. Prenatal serum screening for syphilis was conducted in only 6.9% of women included in the study. CONCLUSIONS: Although the prevalence of maternal syphilis is relatively low, results show that if the situation found in the hospitals studied is shared by other hospitals in Mexico, a systematic screening for maternal syphilis would help to diagnose more cases of this infection than the number reported in official figures. Screening of syphilis in pregnant women using rapid tests may help in the prevention of congenital syphilis.

Sífilis materna y congénita en dos hospitales mexicanos: evaluación de una prueba diagnóstica rápida / Maternal and congenital syphilis in two Mexican hospitals: Evaluation of a rapid diagnostic test

Objective. To estimate the prevalence of maternal and neonatal syphilis, to assess the usefulness of a rapid treponemic diagnostic test, and to evaluate the frequency of screening for syphilis during prenatal care in Mexican women. Material and methods. This was a cross-sectional study that included 1,322 women interviewed in two hospitals (Hospital General in Cuernavaca, Morelos, and Hospital de la Mujer in Mexico City). Women answered a questionnaire on reproductive background, exposure to sexually transmitted infections and prenatal care. In order to diagnose syphilis, a rapid Determine TP test and a latex-VDRL test were used among all participating women. Positive cases were confirmed using FTA-ABS test. Results. Prevalence of serologically active syphilis was 0.3% (4/1322). Using as comparison standard a combination of VDRL and FTA-ABS tests, the Determine TP test had a sensitivity and specificity of 100%. Two newborns with positive FTA-ABS IgM, one negative with FTA-ABS IgM and one first-trimester abortion were found from seropositive women. Prenatal serum screening for syphilis was conducted in only 6.9% of women included in the study. Conclusions. Although the prevalence of maternal syphilis is relatively low, results show that if the situation found in the hospitals studied is shared by other hospitals in Mexico, a systematic screening for maternal syphilis would help to diagnose more cases of this infection than the number reported in official figures. Screening of syphilis in pregnant women using rapid tests may help in the prevention of congenital syphilis.

Objetivos. Estimar la seroprevalencia de sífilis materna y neonatal, analizar la utilidad de una prueba diagnóstica treponémica rápida y estudiar la frecuencia de escrutinio serológico de sífilis durante el embarazo. Material y métodos. Se realizó un estudio transversal que incluyó a 1,322 mujeres entrevistadas en dos hospitales (Hospital General de Cuernavaca y Hospital de la Mujer de la ciudad de México). Las mujeres contestaron un cuestionario sobre antecedentes ginecoobstétricos, de exposición a infecciones de transmisión sexual y de atención prenatal. Para el diagnóstico de sífilis se empleó en primera instancia la prueba rápida Determine TP a todas las participantes, posteriormente se aplicó de la misma manera la prueba de VDRL-látex. Los casos positivos se confirmaron con la prueba FTA-ABS. Resultados. La prevalencia de sífilis materna serológicamente activa fue de 0.3% (4/1322). Utilizando como pruebas de referencia la combinación de VDRL y FTA-ABS, Determine TP mostró una sensibilidad y una especificidad de 100%. De las mujeres seropositivas nacieron dos neonatos con FTA-ABS IgM positiva, en otra con FTA-ABS IgM negativa y la restante tuvo un aborto en el primer trimestre. En el transcurso del control prenatal la realización de la prueba de anticuerpos reagínicos por VDRL fue de 6.9% en la muestra de mujeres analizadas. Conclusiones. Si bien la frecuencia observada de sífilis materna es relativamente baja, los resultados encontrados en este estudio sugieren que la prevalencia de sífilis es mayor a la informada de manera global por la Dirección General de Epidemiología. El escrutinio sistemático de sífilis con pruebas rápidas en embarazadas, coadyuvaría a la prevención de la sífilis congénita.