Serotonin transporter gene methylation and emotional regulation in preschool children born preterm: A longitudinal evaluation of the role of negative emotionality in infancy.

The aim of the study was to assess the contribution of negative emotionality at 3 months (T1) and serotonin transporter gene (SLC6A4) DNA methylation at 4.5 years of age (T2) to emotion regulation in pre-schoolers born very preterm and full-term. Forty one children (n = 21 born very preterm, n = 20 born full-term) participated in the study. Fretful behavior was assessed at T1 in response to the Face-to-FaceStill-Face (FFSF) paradigm. At T2, SLC6A4 DNA methylation was analyzed and emotion regulation was assessed using an observational procedure (i.e., the Pre-schooler Regulation of Emotional Stress, PRES). The very preterm group displayed higher emotion dysregulation during the PRES Reactivity phase than the full-term group. Higher levels of fretful behavior at 3 months were associated with greater emotional distress only for very preterm children with higher methylation at T2. No significant associations emerged in the full-term group. Despite current findings cannot be generalized owing to the relatively small sample size, this work provides preliminary longitudinal evidence about the link between negative emotionality during infancy, stress-linked epigenetic status at 4.5 years and emotion dysregulation in preschoolers born preterm.

El propósito del estudio fue evaluar la contribución de la emocionalidad negativa a los 3 meses (T1) y la metilación del ADN en el gen transportador de la serotonina (SLC6A4) a los 4 años y medio de edad (T2) a la regulación de la emoción en prescolares nacidos muy antes de la gestación completa o de gestación completa. Cuarenta y un niños (n = 21 nacidos muy antes de la gestación completa, n = 20 nacidos de gestación completa) participaron en el estudio. El comportamiento irritable se evaluó a T1 como respuesta al Cara-a-Cara del paradigma de la Cara Inmóvil (FFSF). A T2, se analizó la metilación de ADN SLC6A4 y se evaluó la regulación de la emoción usando un procedimiento de observación (v.g. La Regulación del Estrés Emocional del Prescolar, PRES). El grupo nacido muy antes de la gestación completa mostró una más alta desregulación durante la fase de Reactividad PRES que el grupo nacido de gestación completa. Los niveles más altos de comportamiento irritable a los 3 meses se asociaron con una mayor angustia emocional solamente para los niños nacidos muy antes de la gestación completa con más alta metilación al T2. Ninguna asociación significativa surgió del grupo nacido de gestación completa. A pesar de que los actuales resultados no se pueden generalizar debido al tamaño relativamente pequeño del grupo muestra, este trabajo ofrece aporta evidencia longitudinal preliminar acerca de la conexión entre la emocionalidad negativa durante la infancia, el estado epigenético relacionado con el estrés a los 4 años y medio y la desregulación de la emoción en prescolares nacidos antes de la completa gestación.

Le but de cette étude était d'évaluer la contribution de l'émotivité négative à 3 mois (T1) et du gène vecteur de la sérotonine (SLC6A4) méthylation de l'ADN à l'âge de 4,5 ans (T2) à la régulation de l'émotion chez les enfants d'âge préscolaire nés très prématurés et à plein terme. Quarante et un enfant (n = 21 nés très prématurés, n = 20 nés à plein terme) ont participé à l'étude. Le comportement agité a été évalué au T1 en réponse au paradigme face-à-face visage inexpressif (abrégé FFSF en anglais). Au T2, la méthylation de l'ADN SLC6A4 a été analysée et la régulation de l'émotion a été évaluée en utilisant un protocole d'observation (à savoir, la Régulation du Stress Emotionnel de l'Enfant d'Age Préscolaire, abrégé en anglais PRES). Le groupe très prématuré a fait état d'une dysrégulation de l'émotion plus élevée durant la phase de Réactivité PRES que le groupe né à plein terme. Des niveaux plus élevés de comportement agité à 3 mois étaient liés à une détresse émotionnelle plus grande uniquement pour les enfants très prématurés avec une méthylation plus élevée au T2. Aucune association importante n'a émergé dans le groupe à plein terme. En dépit du fait que les résultats actuels ne peuvent pas être généralisés à cause de la taille relativement petite de l'échantillon, ce travail offre des preuves longitudinales préliminaires sur le lien entre l'émotivité négative durant la petite enfant, le statut épigénétique lié au stress à 4,5 ans et la dysrégulation de l'émotion chez les enfants d'âge préscolaires nés avant terme.

[Association between neontal morbidity, gestational age and developmental delays in moderate to late preterm children]. / Asociación entre morbilidad neonatal, edad gestacional y déficit de desarrollo psicomotor en prematuros moderados y tardíos.

INTRODUCTION: There is evidence that children born moderate-to-late preterm (MLP) have a higher risk of hospitalisation, neonatal morbidity, and developmental delay (DD). OBJECTIVE: To determine the association between DD, gestational age, and neonatal morbidity in MLP children. PATIENTS AND METHOD: A case control study design nested in a cohort of MLP children born between 2006 and 2009 at a private hospital located in the Metropolitan area of Santiago. The children were assessed with the Bayley-III Scales of Infant Development at 8 or 18 months corrected age, or at 30 months of chronological age. Neonatal records were retrospectively reviewed. A multivariate analysis was performed to determine the effect of neonatal morbidity on development. RESULTS: A total of 130 MLP children, 25 cases and 105 controls, were studied. Most of them (83.8%) were hospitalised during the neonatal period. Significant differences between cases and controls regarding maternal age and symptomatic hypoglycaemia were observed (crude OR 3.5, adjusted OR 8.18). It was concluded that the variables that negatively affect the rate of development are male gender, being a twin, and gestational age. CONCLUSIONS: Symptomatic hypoglycaemia is the main risk factor for DD, while being a twin, male gender, and gestational age influenced the total development rate obtained. It is essential to develop strategies for prevention, screening, and early management of this metabolic disorder to prevent future DD.

Quality measures in neurology consult care for epileptic patients.

INTRODUCTION: Epilepsy is one of the most frequently observed diseases in neurology outpatient care. METHODS: We analysed our hospital's implementation of the 8 epilepsy quality measures proposed by the American Academy of Neurology: documented seizure types and seizure frequency, aetiology of epilepsy or the epilepsy syndrome, review of EEG, MRI, or CT results, counselling about antiepileptic drug side effects, surgical therapy referral for intractable epilepsy, and counselling about epilepsy-specific safety issues and for women of childbearing age. RESULTS: In most cases, the first four quality measures were documented correctly. In 66% of the cases, doctors had asked about any adverse drug effects during every visit. Almost all patients with intractable epilepsy had been informed about surgical options or referred to a surgical centre of reference for an evaluation at some point, although referrals usually took place more than 3 years after the initial proposal. Safety issues had been explained to 37% of the patients and less than half of women of childbearing age with epilepsy had received counselling regarding contraception and pregnancy at least once a year. CONCLUSIONS: The care we provide is appropriate according to many of the quality measures, but we must deliver more counselling and information necessary for the care of epileptic patients in different stages of life.

Acute pancreatitis during pregnancy, 7-year experience of a tertiary referral center.

INTRODUCTION: Acute pancreatitis is a common cause of acute abdomen in pregnant women. The purpose of this study was to determine the frequency at our institution and its management and outcomes. METHODS: A retrospective analysis of a database of cases presented in 7 consecutive years at a tertiary center was performed. RESULTS: Between December 2002 and August 2009, there were 19 cases of acute pancreatitis in pregnant women, 85% with a biliary etiology. The highest frequency was in the third trimester of pregnancy (62.5% cases). In cases of gallstone pancreatitis, 43.6% of pregnant women had had previous episodes before pregnancy. A total of 52.6% of the patients were readmitted for a recurrent episode of pancreatitis during their pregnancy. Overall, 26.3% of the patients received antibiotic treatment and 26.3% parenteral nutrition. Laparoscopic cholecystectomy was performed during the 2nd trimester in two patients (10.5%). There was no significant maternal morbidity. CONCLUSION: Acute pancreatitis in pregnant women usually has a benign course with proper treatment. In cases of biliary origin, it appears that a surgical approach is suitable during the second trimester of pregnancy.

[Implications of arginine-vasopressin and copeptin in normal gestation and in pre-eclampsia]. / Implicaciones de la arginina-vasopresina y de la copeptina en la gestación normal y en la preeclampsia.

Preeclampsia represents a specific complication of pregnancy hypertension, which appears de novo after the 20th week of gestation, accompanied by proteinuria and/or maternal or utero-placental organ dysfunction. Despite an uncertain etiopathogenesis, impaired vascular remodeling of the spiral artery and placental ischemia is the most widespread hypothesis. The finding of elevated levels of copeptin in women with preeclampsia compared to normal pregnant women has valued the involvement of arginine vasopressin in the etiopathogenesis of this complication. In this paper, its usefulness as a marker of preeclampsia is considered through the review of the main studies carried out with this molecule.

[Effect of gestational weight gain in a cohort of pregnancy women with obesity operated and not operated for bariatric surgery]. / Efecto de la ganancia ponderal gestacional en una cohorte de gestantes con obesidad operadas y no operadas de cirugía bariátrica.

Introduction: Objective: to determine the effect of gestational weight gain and perinatal outcomes in obese women who underwent and did not undergo bariatric surgery. Material and methods: a retrospective observational cohort study was conducted. The gestational weight gain was classified as insufficient, adequate or excessive according to the guidelines of the United States Institute of Medicine: 4.99-9.07 kg for body mass index (BMI) > 30 kg/m2. Weight gain was calculated as the difference between the weight at the first visit of the 1st trimester and the weight at the visit of the 3rd trimester. Outcomes examined included antepartum variables (gestational diabetes, gestational hypertension, preeclampsia, premature rupture of membranes, placenta previa, placental abruption, intrauterine growth retardation, chorioammionitis, spontaneous abortion), intrapartum variables (induced delivery, vaginal delivery, vacuum, forceps delivery, cesarean section, shoulder dystocia), postpartum variables (postpartum hemorrhage, need for postpartum transfusion, postpartum anemia, need for emergency care, maternal death, postpartum tear, postpartum thrombosis) and neonatal variables (preterm delivery, weight percentile > 90, weight percentile < 10, Apgar score < 7, malformations). Using the statistical package SPSS 22.0, a statistical analysis of the data was performed. Results: two hundred and fifty-six women were recruited; 38 (14.58 %) were pregnant after bariatric surgery and 218 (85.15 %) were pregnant women with obesity who had not been operated on. Of the pregnant women with obesity who had not been operated on, 119 (46.68 %) had grade 1 obesity (BMI 30-34.9), and 99 (38.67 %) had grade 2 and 3 obesity (BMI > 35). A global and subgroup analysis was performed. In the overall analysis, 78 (30.46 %) had insufficient gain, 117 (45.70 %) had adequate gain, and 61 (23.82 %) excessive gain. Overall, insufficient weight gain was associated with a lower probability of gestational hypertension (p < 0.015) and forceps delivery (p < 0.000) and large for gestational age newborn (p < 0.000). On the other hand, insufficient weight gain was associated with a higher probability of intrauterine growth retardation (p 0.044), peripartum infection (0.022), preterm delivery (0.006), and delivery < 35 weeks (p 0.016). Excessive weight gain was associated with a higher probability of gestational hypertension (p 0.025), induced labor (p 0.009), forceps delivery (p 0.011) and large for gestational age newborn (p 0.006). Pregnancies after bariatric surgery had fewer overall complications compared to the other groups. Conclusions: insufficient and excessive weight gain worsens perinatal outcomes. Adequate weight gain does not increase complications and produces some benefits.

Introducción: Objetivo: determinar el efecto de la ganancia de peso gestacional y los resultados perinatales en mujeres con obesidad operadas y no operadas de cirugía bariátrica. Material y métodos: se realizó un estudio retrospectivo observacional de cohortes. La ganancia ponderal gestacional fue clasificada como insuficiente, adecuada o excesiva según las guías del Instituto de Medicina de Estados Unidos: 4,99-9,07 kg para índice de masa corporal (IMC) > 30 kg/m2. La ganancia ponderal se calculó con la diferencia entre el peso de la primera visita del primer trimestre y el peso en la visita del tercer trimestre. Los resultados examinados incluyeron variables anteparto (diabetes gestacional, hipertensión gestacional, preeclampsia, ruptura prematura de membranas, placenta previa, desprendimiento prematuro de placenta, retraso de crecimiento intrauterino, corioamnionitis, aborto espontáneo), intraparto (parto inducido, parto vaginal, ventosa, fórceps, cesárea, distocia de hombros), posparto (hemorragia posparto, necesidad de trasfusión posparto, anemia posparto, necesidad de asistencia a Urgencias, muerte materna, desgarro posparto, trombosis posparto) y neonatales (parto pretérmino, percentil peso > 90, percentil peso < 10, puntuación Apgar < 7, malformaciones). Mediante el paquete estadístico SPSS 22.0 se realizó un análisis estadístico de los datos. Resultados: se reclutaron 256 mujeres; 38 (14,58 %) eran gestantes poscirugía bariátrica y las 218 (85,15 %) restantes eran gestantes con obesidad no operadas. De las gestantes con obesidad no operadas, 119 (46,68 %) tenían obesidad grado 1 (IMC 30-34,9) y 99 (38,67 %) tenían obesidad grados 2 y 3 (IMC > 35). Se realizó un análisis global y por subgrupos. En el análisis global tuvieron ganancia insuficiente 78 (30,46 %), ganancia adecuada 117 (45,70 %) y excesiva 61 (23,82 %). En conjunto, la ganancia ponderal insuficiente se asoció con menor probabilidad de hipertensión arterial (HTA) gestacional (p 0,015) y parto con fórceps (p 0,000) y grande para edad gestacional (p 0,000). Por otro lado, la ganancia ponderal insuficiente se asoció a mayor probabilidad de retraso de crecimiento intrauterino (p 0,044), infección periparto (0,022), parto pretérmino (0,006) y parto < 35 semanas (p 0,016). La ganancia ponderal excesiva se asoció a mayor probabilidad de HTA gestacional (p 0,025), parto inducido (p 0,009), parto por fórceps (p 0,011) y grande para edad gestacional (p 0,006). Las gestaciones poscirugía bariátrica tuvieron menos complicaciones globales respecto al resto de grupos. Conclusiones: la ganancia ponderal insuficiente y excesiva empeora los resultados perinatales. La ganancia ponderal adecuada no aumenta las complicaciones y produce algunos beneficios.

[Reference levels of thyroid hormones in pregnant woman from Guadalajara]. / Valores de referencia de hormonas tiroideas en la población de gestantes de Guadalajara.

INTRODUCTION: Thyroid dysfunction during gestation impacts on maternal-fetal health and may influence the neurocognitive development of the child. Thyroid physiology changes during pregnancy and requires the establishment of specific reference levels per trimester and for each population and method. The objectives of our study were to analyse thyroid function throughout pregnancy and to establish reference levels for TSH and T4L in each trimester for our population and methodology. MATERIAL AND METHODS: Prospective analytical study of 598 pregnant women from March 2018 to October 2020. TSH, T4L, T3L, ATPO and ATG were determined in all of them. A total of 151 pregnant women were excluded due to positive thyroid immunity, previous thyroid disease in treatment with levothyroxine, twin pregnancy, diagnosis of hypothyroidism and hyperthyroidism in the request or absence of some of the parameters studied, with a reference population of 447 pregnant women. RESULTS: The reference levels for TSH were 0.07-3.14mIU/L for the first, 0.66-3.21mIU/L for the second and 0.52-2.97mIU/L for the third trimester. Reference levels for T4L were 0.81-1.19ng/dL for the first, 0.71-1.07ng/dL for the second and 0.69-1.06ng/dL for the third trimester. CONCLUSIONS: The reference levels for TSH and T4L obtained in this study differ from those used for the general population, which may have led to misclassification errors and unnecessary treatment in pregnant women.

Female ophthalmologists' perception of occupational hazards during pregnancy.

OBJECTIVE: Woman ophthalmologists of childbearing age are exposed to different types of occupational risks which can be harmful to pregnancy and to the development of the fetus. The objective of this paper is to analyze the perception of these risks during pregnancy. METHODS: We designed a survey which was answered by 42 ophthalmologists who had been working during pregnancy. We report the perception of global and specific risk according to the type of agent. RESULTS: 38.1% of the ophthalmologists perceive that the overall risk of working during pregnancy is high, and 35.7% consider it moderate. Regarding specific risk, the most relevant agents are the ergonomic and psychosocial ones. Physical agents are considered the least important. CONCLUSIONS: Although most of the surveyed ophthalmologists perceived the occupational risk as high or moderate, only 19% of them took time off work due to this reason. The most important agents were ergonomic and psychosocial.

Epilepsy and pregnancy. Factors associated with epileptic seizures during pregnancy.

INTRODUCTION: The management of epilepsy during pregnancy requires optimal seizure control, avoiding the potential teratogenic effects of antiepileptic drugs. OBJECTIVES: This study aims to describe the clinical characteristics and perinatal outcomes of pregnant patients with epilepsy; to analyse the factors associated with seizures during pregnancy; to describe the most commonly used antiseizure drugs in these patients; and to analyse changes in treatment regimens in 2 periods, 2000-2010 and 2011-2018. METHODS: We conducted a prospective observational study of patients with epilepsy who reported their pregnancy between 2000 and 2018. Patients were evaluated in the first and second trimesters of pregnancy, after delivery, and at one year. Data were collected on demographic variables, epilepsy, and perinatal and obstetric variables. RESULTS: A total of 101 pregnancies were included. Patients' mean age was 32.6 years; 55.4% had focal epilepsy, 38.6% had generalised epilepsy, and 5.9% had undetermined epilepsy. We recorded 90 live births, 9 miscarriages, and 5 cases of congenital malformations, 4 of which were born to women who received valproate monotherapy. Forty patients (39.6%) presented seizures, with 16 (40%) presenting generalised tonic-clonic seizures. The variables associated with seizures during pregnancy were poor seizure control in the year prior to pregnancy (66.7% vs 15.1%; P < .001), treatment with 2 or more antiseizure drugs (30% vs 14.8%; P < .001), and untreated epilepsy (25% vs 0%; P < .001). Antiseizure medications most widely used in monotherapy were lamotrigine (n = 19; 27.1%), valproate (n = 17; 24.2%), and levetiracetam (n = 12; 17.1%). In the most recent period (2011-2018), we observed a greater proportion of patients receiving monotherapy (81.5%, vs 55.3%), as well as a decrease in the use of carbamazepine (2.3%, vs 23.1%) and valproate (20.5%, vs 30.8%); and a marked increase in the use of levetiracetam (27.3%, vs 0%). CONCLUSIONS: The factors associated with the presence of seizures during pregnancy were previous poor seizure control, treatment with 2 or more antiseizure drugs, and lack of treatment during pregnancy. The most commonly used drugs were lamotrigine, valproate, and levetiracetam, with an increase in levetiracetam use and a decrease in valproate use being observed in the later period (2011-2018).

Spontaneous subcapsular hepatic hematoma in pregnant patients.

Spontaneous subcapsular hepatic hematoma (SSHH) with or without previous history of preeclampsia and/or HELLP syndrome represents a very rare pathological condition in pregnancy and postpartum, (1/45,000-1/225,000 pregnancies). Its importance for the anesthesiologist lays in its association with high morbidity and mortality for the mother (60-86%, 39%) and newborn (42%). After a high clinical suspicion, the certainty clinical diagnosis is settled by different imaging techniques. However, in most cases the diagnosis of SSHH is a casual intraoperative finding associated to a maternal or foetal compromise. Nowadays the obstetric and anaesthetic management of a SSHH is not standardized and depends on its integrity, hemodynamic stability and the gestational period when diagnosed. The possibility of an acute critic haemorrhage with necessity of massive transfusion, makes advisable to provide updated protocols for the treatment of obstetric hemorrhage, adapting them to the clinical peculiarities of these patients. After the acute phase, close attention should be kept on thromboembolic complications.

Obesity management in women of reproductive age.

With the increasing prevalence of obesity among women of reproductive age, the detrimental effects on maternal and neonatal health are increasing. The objective of this review is to summarise the evidence that comprehensive management of weight control in women of reproductive age has on maternal-fetal outcomes. First, the impact that obesity has on fertility and pregnancy is described and then the specific aspects of continued weight management in each of the stages (preconception, pregnancy and postpartum) during these years are outlined, not only to benefit women affected by obesity before pregnancy, but also to avoid and reverse weight gain during pregnancy that complicates future pregnancies. Finally, the special planning and follow-up needs of women with a history of bariatric surgery are discussed in order to avoid nutritional deficiencies and/or surgical complications that endanger the mother or affect fetal development.

Executive summary of the SEEN (Sociedad Española de Endocrinología y Nutrición[Spanish Society of Endocrinology and Nutrition])-SEGO (Sociedad Española deGinecología y Obstetricia [Spanish Society of Gynaecology and Obstetrics]) consensusdocument on the management of thyroid dysfunction during pregnancy.

During pregnancy, thyroid function disorders are associated with multiple complications, both maternal and foetal. In recent years, numerous Clinical Practice Guidelines have been developed to facilitate the identification and correct management of thyroid disease in pregnant women. However, this proliferation of guidelines has led to confusion by proposing different cut-off points for reference values and different recommendations for similar situations. For this reason, the Sociedad Española de Endocrinología y Nutrición and the Sociedad Española de Ginecología y Obstetricia have prepared this Consensus Document, with the aim of creating a framework for joint action to unify criteria for the diagnosis and treatment of thyroid dysfunction in these patients. The document is structured to answer the most frequently asked questions in clinical practice, grouped into five sections: 1/Reference values for thyroid function tests and screening during pregnancy 2/Iodine nutrition 3/Hypothyroidism and pregnancy 4/Hyperthyroidism and pregnancy 5/ Thyroid autoimmunity.

Safety and effectiveness of bDMARDs during pregnancy in patients with rheumatic diseases: Real-world data from the BIOBADASER registry.

INTRODUCTION: Inflammatory rheumatic diseases usually affect women of childbearing age treated with biologic drugs. However, there is a lack of literature on the efficacy and toxicity of biologic disease-modifying drugs during pregnancy. The aim of this study was to determine the presence of pregnant patients treated with bDMARDs in a real-world dataset and to examine the impact of pregnancy and lactation on the evolution of rheumatic disease in a registry of Spanish patients. METHOD: This was a multicentre prospective study with a real-world setting. Information was obtained from BIOBADASER registry. Patients included are women who got pregnant until November 2020 from 19 rheumatology units. We conducted proportions, means, and standard deviations (SD) to describe the study population and the use of treatments. T-test and Chi-square test were applied to assess differences between groups. RESULT: Ninety cases of pregnancy were registered (n=68 full-term pregnancies; n=22 spontaneous miscarriages). Most of the cases discontinued bDMARDs during pregnancy (78.9%) but 13 cases continued treatment during pregnancy, mainly using certolizumab pegol. These cases were obtaining better management of rheumatic disease, although the differences were not statistically significant [DAS28-CRP, 2.9 (SD: 1.6) vs. 2.0 (1.2), p=.255; DAS28-ESR, 2.2 (1.0) vs. 1.7 (.5), p=.266]. No serious adverse events were reported during pregnancy and lactation. CONCLUSION: Being pregnant is still an uncommon condition in patients with rheumatic diseases and using bDMARDs. Our results show that rheumatic disease tended to progress better during pregnancy in patients who continued to take bDMARDs.

[Anaemia prevalence in pregnant population]. / Prevalencia de anemia en población gestante.

INTRODUCTION: Gestational anaemia, which has specific haemoglobin (Hb) reference values in each trimester of gestation, increases the risk of maternal mortality and complications both in pregnancy and in the first months of the newborn's life. The objective of this study is to evaluate haemoglobin levels in pregnant women in our population, to determine the prevalence of gestational anaemia and to propose reference values specific to them. MATERIAL AND METHODS: Retrospective study of all blood counts requested in pregnancy and postpartum controls during 2019. RESULTS: 9995 gestation haemograms corresponding to 5507 pregnant women were reviewed. Of these, 1134 patients underwent complete follow-up in 2019. The prevalence data for anaemia were 1.8%, 11.8% and 13.2% in each trimester respectively, and the global prevalence in pregnancy was 22.6%. Regarding postpartum anaemia, its prevalence with respect to all pregnant women was 2.99%, increasing to 38.2% in those patients with complications during delivery. CONCLUSIONS: The prevalence of gestational anaemia in our population is somewhat higher than in countries like ours. Therefore, there is room for improvement in our current clinical protocols. It is important to assess updating analytical controls with other more adequate parameters to determine iron reserves, as this is the main cause of anaemia.

Type 1 diabetes and pregnancy: An update on glucose monitoring and insulin treatment.

The relevance of type 1 diabetes during pregnancy stems from its impact on the health of mother and offspring and its increasing prevalence. Glycemic control during pregnancy is one of the main risk factors for adverse events. Besides, treatment becomes a major challenge not only due to the modifications in insulin requirements due to changes in hormones and cytokines but also to the stricter control targets. Given the recent appearance of new ultra-rapid and basal insulin analogues and the constant evolution of technology to treat people with diabetes, we review these aspects in relation to the treatment of women with type 1 diabetes during pregnancy.

[Twin gestation with complete hydatidiform mole and a coexisting live fetus: A case report and review of the literature]. / Embarazo gemelar con mola hidatiforme completa y feto vivo asociado: reporte de un caso y revisión bibliográfica.

Twin pregnancies with complete hydatidiform mole and coexisting live fetus are very rare, with only about 300 reported cases. This type of pregnancy is considered a high obstetric risk due to the possibility of severe maternal-fetal complications. Although the clinical and ultrasound findings can be highly suggestive of this type of pregnancy, the definitive diagnosis is usually reached by histopathological examination. The differential diagnosis usually includes partial hydatidiform mole and hydropic pregnancies, which can present similar findings in specimens from the first trimester of pregnancy and thus it is important to interpret correctly the differentiating features. The use of immunohistochemistry for p57 can prove very useful, although some cases show an aberrant expression. We present a case of a twin pregnancy with complete hydatidiform mole associated with a live fetus, with magnetic resonance imaging and ultrasound for radiopathological correlation. We discuss the differential diagnosis and the utility of p57 immunohistochemistry.

Congenital cytomegalovirus infection in newborns born to HIV-infected mothers.

INTRODUCTION: Congenital citomegalovirus (CMVc) infection is more common in children exposed to HIV during pregnancy, with reported rates in pre-ART era from 2 to 7%. The use of combined antiretroviral treatment (ARTc) could be a determining factor in reducing this risk of CMV transmission. The aim of this study was to describe the epidemiology of CMVc infection in newborns of HIV-infected mothers at Hospital Universitario 12 de Octubre, Madrid, Spain, from 2000 to 2017. MATERIAL AND METHODS: An observational and retrospective study was carried out. Epidemiological and clinical variables were collected. Statistical analysis was performed with the SPSS 24.0 computer program. RESULTS: 288 mother-infant pairs were included in the study. We observed a CMVc rate of 2.1% (95% CI 0.9-4.9). CONCLUSIONS: The rate of CMVc in HIV-exposed children observed was lower than that reported in pre-ARTc era but seems higher than those described in general population.

[Has sexuality changed in pregnancy? Baby boom generation versus millennial generation]. / ¿Ha variado la sexualidad en el embarazo? Generación baby boom versus generación millennial.

Sexuality is a complex and multidimensional phenomenon that constitutes a fundamental component in human relationships. Pregnancy is a crucial period in women's life and the physiological changes that happen in this period affect their sexuality. OBJECTIVE: Knowing how pregnancy impacts on sexual behaviors in millenial generation compared to baby boom generation. MATERIAL AND METHODS: Descriptive and cross-sectional study, by means of a self-completed, population-based survey, to a sample of pregnant women in the third trimester of gestation who attended Primary Care. A descriptive study of the frequency distribution of all the variables was carried out. RESULTS: In baby boom generation and millennial generation, it is observed that during pregnancy couple's attraction decreases slightly. According to variables desire and frequency of intercourse, results obtained show that as the pregnancy progresses there is a marked decrease in desire and intercourse frequency. Women state that they do not have enough information about sexuality in their current state, despite years having passed. CONCLUSIONS: During last 35 years, sexual behaviors have not changed in pregnant women. In both generations, changes in desire and intercourse domains were particularly significant, being in third trimester of pregnancy when frequency of intercourse decline. Pregnant women continue to hold erroneous beliefs about sexuality and request more sexual education.

Gestational weight gain influences neonatal outcomes in women with obesity and gestational diabetes.

INTRODUCTION: Obesity and gestational diabetes mellitus (GDM) are associated with an increased risk of perinatal complications and obesity in the offspring. However, the impact of gestational weight gain (GWG) on maternal and foetal outcomes is controversial. PATIENTS AND METHODS: Retrospective study of 220 women with GDM and pre-pregnancy body mass index (BMI)>30kg/m2. Pregnant women were classified according to the Institute of Medicine (IOM) recommendations regarding their prior BMI and GWG. We evaluated the impact of GWG on perinatal and obstetric outcomes. RESULTS: Mean maternal age was 34.7±5.3 years. Pre-pregnancy obesity was classified as class I in 55.3% of the cases, class II in 32.0% and class III in 12.7%. GWG was adequate (5-9kg) in 24.2%, insufficient (<5kg) in 41.8% and excessive (>9kg) in 34.2%. Birth weight was within normal range in 81.9%, 3.6% were small for gestational age (microsomia) and 14.4% were large for gestational age (macrosomia). Insufficient GWG was associated with a higher rate of microsomal offspring, excessive GWG was associated to macrosomia and adequate GWG with normal birth weight. CONCLUSION: GWG in women with pre-pregnancy obesity and GDM impacts neonatal birthweight. Insufficient GWG is associated with microsomia and excessive GWG is associated with macrosomia. Women with adequate GWG according to the IOM guidelines obtained better perinatal outcomes.

Neonatal TSH as a marker of iodine nutrition status. Effect of maternal ioduria and thyroid function on neonatal TSH.

INTRODUCTION: Neonatal thyroid stimulating hormone (nTSH) is a marker of iodine nutrition status in the population. The WHO considers a prevalence of less than 3% of nTSH levels greater than 5 mIU/L in samples obtained within 72h from birth indicative of iodine sufficiency. The aim of this study was to determine the prevalence of nTSH levels greater than 5 mIU/L in an iodine-sufficient population and its association with maternal, neonatal and obstetric factors. MATERIALS AND METHODS: A total of 243 pregnant women were recruited between May and June 2017 in our health area. A questionnaire of iodine intake was administered, in addition to determination of ioduria, thyroid function and autoimmunity in the first trimester of gestation. We analysed nTSH levels in samples collected between 48 and 72h post birth and other obstetric and neonatal factors. RESULTS: The mean nTSH level (standard deviation) was 2.43 (1.68 mIU/L), with 7.8% of neonates having levels greater than 5 mIU/L. The highest nTSH levels corresponded to neonates of mothers with insufficient ioduria (P = 0.021) or TSH levels greater than 2.5 mIU/L, in both the case of negative (P = 0.049) and positive (P = 0.006) thyroid autoimmunity results. Maternal ioduria less than 150 µg/L was a risk factor for nTSH levels greater than 5 mIU/L (3.70 [1.06-14.60]; P = 0.046), while a neonatal weight of 2500 g or greater was a protective factor (0.14 [0.02-1.00]; P = 0.038). CONCLUSIONS: The prevalence of nTSH levels greater than 5 mIU/L in our health area was high based on the WHO recommendations. Maternal iodine deficiency was associated with a higher risk of nTSH levels greater than 5 mIU/L. Given that nTSH is currently measured before 72h post birth, we need new cut-off points to keep on using nTSH as a marker of iodine nutritional status.