RESUMEN
Introdução: A comida tem um papel proeminente na obtenção do iodo e uma das melhores estratégias é a iodização do sal. No Brasil, a Anvisa reduziu as doses de iodo no sal de cozinha desde 2014. Portanto, é importante avaliar a concentração urinária de iodo (CIU) em nossa população. Com base no exposto, propõe-se avaliar a CIU das gestantes, associando-a à frequência de bócio materno, aborto e peso neonatal. Métodos: Trata-se de um estudo observacional com um corte transversal composto por 37 pacientes atendidos no Serviço de Obstetrícia da Faculdade de Medicina de Barbacena e uma clínica particular em Juiz de Fora. A CIU foi verificada em 24 horas de urina. Resultados: A média de CIU foi de 213,6 µg/l de urina, com dose mínima de 29 µg/l e máxima de 437 µg/l. A glândula tireoide foi avaliada durante o exame clínico prénatal (palpação da glândula) e em 24 pacientes (38,1%) foi considerada normal. A palpação da glândula tireoide foi associada à CIU. Houve maior iodúria em gestantes com glândula não palpável (p = 0,004; T = 14,13). Não houve associação entre a CIU e história de aborto ou peso fetal ao nascimento (p > 0,05). Conclusões: Apesar de ser uma amostra pequena da população, identificamos pacientes expostas ao déficit. No entanto, a CIU não parece estar associada ao peso do recém-nascido ou a abortos, mas à dosagem de TSH e ao tamanho da glândula tireoide. Assim, a palpação da glândula tireoide poderia ser usada como uma medida indireta do CIU. (AU)
Introduction: Food has a prominent role in providing iodine and one of the best strategies is salt iodization. The Brazilian Health Regulatory Agency has reduced iodine content in table salt since 2014. Therefore, there is a need for evaluating urinary iodine concentration in our population, especially after the modified recommendations. Based on the above, we sought to assess urinary iodine concentration in pregnant women, associating it with frequency of maternal goiter, abortion and neonatal weight. Methods: This observational, cross-sectional study included 37 patients seen at the Obstetrics Service of Barbacena Medical School and a private clinic in Juiz de Fora, both in the state of Minas Gerais, Brazil. Iodine concentration was determined in 24- hour urine through chromatography. Results: The mean 24-hour urine iodine was 213.6 µg/l, with minimum and maximum measures of 29 µg/l and 437 µg/l, respectively. The thyroid gland was assessed by prenatal clinical examination (palpation of the gland). In 24 patients (38.1%) it was considered normal. Palpation of the thyroid gland was associated with 24-hour urine iodine concentration, although a higher iodine concentration was identified in pregnant women with non-palpable gland (p = 0.004; T = 14.13). There was no association between 24-hour urine iodine concentration and history of abortion or birth weight (p > 0.05). Conclusions: This study, although based on a small sample of the population, was important to identify that even in areas where iodine is considered sufficient there may be patients exposed to iodine deficit. However, urinary iodine concentration does not appear to be associated with birth weight or abortion frequency but is associated with thyroid-stimulating hormone (TSH) level and thyroid gland size, suggesting that clinical evaluation of the thyroid gland is an important element for predicting urinary iodine concentration. Thus, palpation of the thyroid gland could be used as an indirect measure of urinary iodine concentration. (AU)
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Adulto , Complicaciones del Embarazo/epidemiología , Peso al Nacer , Aborto Espontáneo/epidemiología , Bocio/epidemiología , Yodo/deficiencia , Yodo/orina , Palpación , Complicaciones del Embarazo/orina , Atención Prenatal , Espectrofotometría , Estudios TransversalesRESUMEN
Introduction: The association of total arsenic exposure with impaired glucose tolerance and gestational diabetes has been shown; however, evidence regarding urinary inorganic arsenic in pregnant women is still limited. Our aim was to evaluate the association between urinary inorganic arsenic concentration and gestational diabetes among pregnant women living in Arica, Chile. Methods: Cross-sectional study of pregnant women receiving care at primary health centers in urban Arica. The exposure was urinary inorganic arsenic concentration, while gestational diabetes was the outcome. The association was evaluated using multiple logistic regression models adjusted by age, education level, ethnicity, and pre-pregnancy body mass index. Results: 244 pregnant women were surveyed. The median urinary inorganic arsenic was 14.95 μg/L, and the prevalence of gestational diabetes was 8.6%. After adjusting, we did not find a significant association between gestational diabetes and inorganic arsenic exposure tertiles (Odds ratio (OR) 2.98, 95% CI = 0.87â»10.18), (OR 1.07, 95% CI = 0.26â»4.33). Conclusion: This study did not provide evidence on the relationship between urinary inorganic arsenic concentration and gestational diabetes. Further research is needed to elucidate the factors underlying this association.
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Arsénico/efectos adversos , Arsénico/orina , Arsenicales/efectos adversos , Arsenicales/orina , Diabetes Gestacional/epidemiología , Exposición a Riesgos Ambientales/estadística & datos numéricos , Complicaciones del Embarazo/epidemiología , Contaminación Química del Agua/estadística & datos numéricos , Adulto , Chile/epidemiología , Estudios Transversales , Diabetes Gestacional/inducido químicamente , Diabetes Gestacional/orina , Relación Dosis-Respuesta a Droga , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Humanos , Modelos Logísticos , Oportunidad Relativa , Embarazo , Complicaciones del Embarazo/inducido químicamente , Complicaciones del Embarazo/orina , Prevalencia , Contaminación Química del Agua/efectos adversosRESUMEN
BACKGROUND: Selenium is an essential element, but its metabolism in humans is not well characterized. A few small studies indicate that the trimethylselenonium ion (TMSe) is a common selenium metabolite in humans. OBJECTIVE: This study aimed to elucidate the human metabolism of selenium to TMSe. DESIGN: Study individuals constituted subsamples of 2 cohorts: 1) pregnant women (n = 228) and their 5-y-old children (n = 205) in rural Bangladesh with poor selenium status [median urinary selenium (U-Se): 6.4 µg/L in mothers, 14 µg/L in children] and 2) women in the Argentinian Andes (n = 83) with adequate selenium status (median U-Se: 24 µg/L). Total U-Se and blood selenium were measured by inductively coupled plasma mass spectrometry (ICPMS), and urinary concentrations of TMSe were measured by high-performance liquid chromatography/vapor generation/ICPMS. A genomewide association study (GWAS) was performed for 1,629,299 (after filtration) single nucleotide polymorphisms (SNPs) in the Bangladeshi women (n = 72) by using Illumina Omni5M, and results were validated by using real-time polymerase chain reaction. RESULTS: TMSe "producers" were prevalent (approximately one-third) among the Bangladeshi women and their children, in whom TMSe constituted â¼10-70% of U-Se, whereas "nonproducers" had, on average, 0.59% TMSe. The TMSe-producing women had, on average, 2-µg U-Se/L higher concentrations than did the nonproducers. In contrast, only 3 of the 83 Andean women were TMSe producers (6-15% TMSe in the urine); the average percentage among the nonproducers was 0.35%. Comparison of the percentage of urinary TMSe in mothers and children indicated a strong genetic influence. The GWAS identified 3 SNPs in the indolethylamine N-methyltransferase gene (INMT) that were strongly associated with percentage of TMSe (P < 0.001, false-discovery rate corrected) in both cohorts. CONCLUSIONS: There are remarkable population and individual variations in the formation of TMSe, which could largely be explained by SNPs in INMT. The TMSe-producing women had higher U-Se concentrations than did nonproducers, but further elucidation of the metabolic pathways of selenium is essential for the understanding of its role in human health. The MINIMat trial was registered at isrctn.org as ISRCTN16581394.
Asunto(s)
Metiltransferasas/genética , Polimorfismo de Nucleótido Simple , Compuestos de Selenio/metabolismo , Selenio/metabolismo , Adulto , Argentina , Bangladesh , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Estudios de Cohortes , Enfermedades Carenciales/sangre , Enfermedades Carenciales/genética , Enfermedades Carenciales/metabolismo , Enfermedades Carenciales/orina , Femenino , Estudio de Asociación del Genoma Completo , Humanos , Isoenzimas/genética , Isoenzimas/metabolismo , Masculino , Fenómenos Fisiologicos Nutricionales Maternos , Metiltransferasas/metabolismo , Estado Nutricional , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/genética , Complicaciones del Embarazo/metabolismo , Complicaciones del Embarazo/orina , Eliminación Renal , Salud Rural , Selenio/sangre , Selenio/deficiencia , Selenio/orina , Compuestos de Selenio/sangre , Compuestos de Selenio/orinaRESUMEN
OBJECTIVE: To evaluate the performance of a commercial urinary test to screen for abnormal first trimester pregnancies in women presenting to an emergency room. STUDY DESIGN: In this prospective observational cohort, women with a confirmed first trimester pregnancy (gestational age <12 weeks) provided a urine sample for diagnosing the viability of their gestation. Pregnancy viability and location testing were confirmed by ultrasound and/or laparoscopy. RESULTS: From 815 eligible patients for the study, 12 were excluded for not having a confirmed pregnancy (n = 6) or were lost to follow-up (n = 6). A total of 803 patients underwent testing and completed follow-up. The pretest probability of an abnormal pregnancy was 44% (9% for ectopic pregnancy and 35% for miscarriage). The test had the following parameters to identify an abnormal first-trimester pregnancy (sensitivity, 13%; 95% confidence interval [CI], 10-17; specificity, 82%; 95% CI, 78-86; positive predictive value, 36; 95% CI, 28-46; negative predictive value, 54; 95% CI, 50-58; accuracy, 47%; positive likelihood ratio, 0.74; 95% CI, 0.53-1.03; negative likelihood ratio, 1.06; 95% CI, 1-1.12). The reproducibility of the test in our study was high (kappa index between readers, 0.89; 95% CI, 0.77-1). CONCLUSION: In our emergency setting, we were not able to confirm that the commercial test is adequate to detect or exclude an abnormal first-trimester pregnancy.
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Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/orina , Pruebas de Embarazo , Primer Trimestre del Embarazo/orina , Adolescente , Adulto , Urgencias Médicas , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Estudios Prospectivos , Sensibilidad y Especificidad , Adulto JovenAsunto(s)
Prueba de Papanicolaou , Atención Prenatal/historia , Urinálisis/historia , Frotis Vaginal/historia , Amenaza de Aborto/diagnóstico , Amenaza de Aborto/prevención & control , Cuello del Útero/citología , Células Epiteliales/citología , Femenino , Muerte Fetal/diagnóstico , Madurez de los Órganos Fetales , Edad Gestacional , Historia del Siglo XX , Humanos , Trabajo de Parto Prematuro/diagnóstico , Trabajo de Parto Prematuro/prevención & control , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/patología , Complicaciones del Embarazo/orina , Pruebas de Embarazo , Atención Prenatal/métodos , Vagina/citologíaRESUMEN
INTRODUCTION: Iodine is considered to be an essential micronutrient in pregnant women. Iodine placental transport to the embryo-fetus is essential for hormone synthesis and is crucial for nervous system development. However, the relationship between iodine intake and placental weight and its potential implications for the newborn have not been studied. MATERIAL AND METHODS: Iodine intake was analyzed in 77 pregnant women based on urinary iodine excretion (UIE) levels, measured using Pinós modified method (normal value, ≥ 150 µg/L). Placental weight was measured (PW: normal, ≥500 g). In the newborn, weight, height, and head perimeter (HP) were also measured. Placental index (PI: placental weight/newborn weight) was calculated, and was considered normal if ≥0.15. RESULTS: UIE was normal in 50 pregnant women (mean ± SD, 279 µg/L ± 70.22 µg/L) and decreased in 27 (94 µg/L ± 31.49 µg/L). Newborns of mothers with low UIE had a similar weight (3357 g ± 416.30 g; n: 27) to those of mothers with normal UIE (3489 g ± 560.59 g; n: 50). Forty-four percent of mothers with low UIE had PW <500 g, and statistically lower HPs were found in newborns of mothers with low PW (PW(3)500 g: 36.05 cm ± 0.55 cm, n: 54; PW <500 g: 33.93 cm ± 15 cm, n:23, p<0.019). Similar results were found with PI, but they did not reach statistical significance (0,17 ± 0,04; p=0.066). No differences were seen in all other parameters. CONCLUSION: The study suggests the existence of a relationship between PW and HP. This finding may be related to iodine intake during pregnancy.
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Cabeza/embriología , Recién Nacido , Yodo/deficiencia , Placenta/patología , Placentación , Complicaciones del Embarazo/fisiopatología , Adolescente , Adulto , Argentina , Peso al Nacer , Estatura , Cefalometría , Dieta , Desarrollo Embrionario , Femenino , Cabeza/anatomía & histología , Humanos , Yodo/farmacocinética , Yodo/orina , Intercambio Materno-Fetal , Necesidades Nutricionales , Tamaño de los Órganos , Embarazo , Complicaciones del Embarazo/orina , Adulto JovenRESUMEN
Leaños Miranda and collaborators published that the measurement of protein/creatinine ratio in a single random urine sample is a reliable indicator of significant proteinuria and may be reasonably used as alternative to the 24-hours urine collection method as a diagnostic criteria for urinary protein, and it is also a criterion for identifying the disease severity. This leads us to present this successful result of the investigation as a position statement in the care of pregnant women with hypertension.
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Creatinina , Hipertensión , Complicaciones del Embarazo , Proteinuria , Femenino , Humanos , Embarazo , Creatinina/orina , Hipertensión/orina , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/orina , Proteinuria/diagnóstico , Proteinuria/orina , Distribución Aleatoria , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: Iodine nutrition during pregnancy has become an important public health concern because of the deleterious impact of iodine deficiency on brain development during fetal and early postnatal life. Iodine nutrition status can be assessed in a population by the median urinary iodine concentration (UIC). World Health Organization, the United Nations Children's Fund, and the International Council for Iodine Deficiency Disorders have established that a median of UIC between 150 and 249 µg/L in pregnant women indicates an adequate iodine intake. The aim of this study was to assess iodine nutrition status in Mexican pregnant women. METHODS: Two hundred ninety-four pregnant women receiving prenatal care in the Public Medical Units of the State Ministry of Health for each pregnancy trimester (first, n=60; second, n=103; and third, n=131) in Queretaro, Mexico, were enrolled to assess UIC by the Sandell-Kholtoff method. RESULTS: The median of UIC was 273, 285, and 231 µg/L in the first, second, and third trimesters of gestation, respectively. Globally, the median (range) of UIC was 260 (5-1320) µg/L, and the percentage of samples with UIC below 150 µg/L was 28%. There was no significant difference between the UIC of women using iodine-containing multivitamins compared with those who reported the consumption of noniodized multivitamins (p>0.05). In addition, we found no difference between the UIC of women using iodized table salt compared with those who employed noniodized table salt, with those who did not know whether their table salt was iodized (p>0.05). CONCLUSIONS: Based on the median UIC, iodine intake in Queretaro, Mexico, is slightly above requirements during the first two trimesters, and adequate in the third trimester. The wide Mexican universal iodized salt program seems to supply adequate dietary iodine to pregnant women without health insurance in this region. However, regular monitoring of iodine status is recommended during pregnancy throughout Mexico.
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Dieta , Suplementos Dietéticos , Alimentos Fortificados , Yodo/administración & dosificación , Estado Nutricional , Complicaciones del Embarazo/prevención & control , Fenómenos Fisiologicos de la Nutrición Prenatal , Cloruro de Sodio Dietético/administración & dosificación , Adolescente , Adulto , Biomarcadores/orina , Femenino , Humanos , Yodo/deficiencia , Yodo/orina , Modelos Logísticos , México , Política Nutricional , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/orina , Trimestres del Embarazo/orina , Adulto JovenRESUMEN
The clays consumed by geophagous individuals contain large quantities of aluminum, a known neurological and hematological toxin. This is the first study to evaluate the risk of aluminum poisoning in geophagous individuals. Blind determinations of plasma and urinary aluminum concentrations were carried out in 98 anemic geophagous pregnant women and 85 non-anemic non-geophagous pregnant women. Aluminum concentrations were significantly higher (P < 0.0001) in the geophagous anemic women than in the controls, with odds ratios of 6.83 (95% confidence interval [CI] = 2.72-19.31) for plasma concentrations (13.92 ± 14.09 µg/L versus 4.95 ± 7.11 µg/L) and 5.44 (95% CI = 2.17-14.8) for urinary concentrations (92.83 ± 251.21 µg/L versus 12.11 ± 23 µg/L). The ingested clay is the most likely source of this overexposure to aluminum. If confirmed, the clinical consequences of this absorption for pregnant women and their offspring should be explored.
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Silicatos de Aluminio/toxicidad , Aluminio/envenenamiento , Anemia/etiología , Pica/complicaciones , Complicaciones del Embarazo , Adulto , Aluminio/sangre , Aluminio/orina , Silicatos de Aluminio/química , Anemia/sangre , Anemia/orina , Estudios de Casos y Controles , Arcilla , Femenino , Guyana Francesa , Humanos , Pica/sangre , Pica/orina , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/orina , Adulto JovenRESUMEN
Chronic exposure to inorganic arsenic (In-As) from drinking water is associated with different health effects, including skin, lung, bladder, and kidney cancer as well as vascular and possibly reproductive effects. In-As is metabolized through the process of methylation, resulting in the production and excretion of methylated species, mainly monomethylarsenate (MMA) and dimethylarsenate (DMA). Because a large percentage of the dose is excreted in urine, the distribution of urinary In-As, MMA, and DMA is considered a useful indicator of methylation patterns in human populations. Several factors affect these patterns, including sex and exposure level. In this study, we investigated the profile of urinary In-As, MMA, and DMA of pregnant women. Periodic urine samples were collected from early to late pregnancy among 29 pregnant women living in Antofagasta, Chile, who drank tap water containing 40 micro g/L In-As. The total urinary arsenic across four sampling periods increased with increasing weeks of gestation, from an initial mean value of 36.1 to a final value of 54.3 micro g/L. This increase was mainly due to an increase in DMA, resulting in lower percentages of In-As and MMA and a higher percentage of DMA. Our findings indicate that among women exposed to moderate arsenic from drinking water during pregnancy, changes occur in the pattern of urinary arsenic excretion and metabolite distribution. The toxicologic significance of this is not clear, given recent evidence suggesting that intermediate methylated species may be highly toxic. Nevertheless, this study suggests that arsenic metabolism changes throughout the course of pregnancy, which in turn may have toxicologic effects on the developing fetus. Key words: arsenic, arsenic metabolism, arsenic methylation, Chile, pregnancy, urinary arsenic.
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Arsénico/análisis , Arsénico/orina , Monitoreo del Ambiente/métodos , Embarazo/orina , Contaminantes Químicos del Agua/análisis , Abastecimiento de Agua/análisis , Adulto , Chile , Creatinina/orina , Femenino , Edad Gestacional , Humanos , Metilación , Embarazo/metabolismo , Complicaciones del Embarazo/orina , Trimestres del Embarazo/orina , Fumar/orinaRESUMEN
To test the hypothesis that normal volume expansion during pregnancy is impaired during chronic renal failure, we evaluated the effects of 5/6 nephrectomy (Nx) in Sprague-Dawley rats. Partial Nx was produced by ligation of 2/3 renal arteries and contralateral Nx. Control rats had a sham operation. Four weeks later, rats were assigned to nonpregnant (n=6/each) or pregnant groups (n=11 to 12/each). At day 21, blood pressure, plasma volume, renal function, hormonal levels, and reproductive outcome were determined. Statistical analysis was performed by ANOVA, and values were expressed as mean+/-SEM. Rats with 5/6 Nx had proteinuria and lower creatinine clearance; pregnancy did not affect these parameters. Blood pressure increased in 5/6 Nx rats and was reduced by pregnancy. Both pregnant groups had lower hematocrit and higher plasma volume values (nonpregnant control, 13.4+/-0.2; nonpregnant 5/6 Nx, 14.4+/-0.2; pregnant control, 19.1+/-0.7, pregnant 5/6 Nx, 19+/-0.9 mL, P<0.001). Pregnancy increased plasma renin activity only in control rats (nonpregnant control, 2.0+/-0.7; nonpregnant 5/6 Nx, 1.6+/-1.1; pregnant control, 36.1+/-7.9, pregnant 5/6 Nx, 6.1+/-1.8 ng AI/mL per hour, P<0.001). Serum aldosterone levels were unaffected by 5/6 Nx and were higher in pregnant than in nonpregnant rats. Urinary kallikrein activity was reduced by 5/6 Nx and not changed by pregnancy (nonpregnant control, 1499+/-237; nonpregnant 5/6 Nx, 346+/-90; pregnant control, 1595+/-180, pregnant 5/6 Nx, 374+/-95 nmol/16 hours, P<0.001). No significant differences in fetal and placental weights were observed between control and 5/6 Nx rats. Present data indicate that 5/6 Nx pregnant rats were able to normally expand plasma volume despite lower renin and kallikrein levels.
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Calicreínas/orina , Fallo Renal Crónico/fisiopatología , Volumen Plasmático , Complicaciones del Embarazo/fisiopatología , Renina/sangre , Animales , Presión Sanguínea , Femenino , Riñón/fisiopatología , Fallo Renal Crónico/sangre , Fallo Renal Crónico/orina , Nefrectomía , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/orina , Ratas , Ratas Sprague-DawleyRESUMEN
OBJECTIVE: To validate urinary iodine (I) excretion and the simplified classification of goiter by palpation, comparing them with ultrasound of the thyroid gland as the gold standard, to identify endemic goiter in pregnant women. POPULATION AND SETTING: 300 pregnant women identified in referral hospitals, in three geographic regions. METHODS: Two endocrinologists, previously trained, evaluated thyroid size by palpation and by ultrasound. Urinary iodine excretion in a sample of urine was determined. Thyroid size below the 90th centile by ultrasound was considered normal. RESULTS: Mean age of study women was 23 years old. The prevalence of low weight for gestational age was 39% and of anaemia 47%. Our sample distribution showed that 120 microg I/L was the best cut off for low urinary iodine excretion to identify endemic goiter in pregnant women (sensitivity 57% and specificity 70%, likelihood ratio of 1.4). The prevalence of goiter was 10% using ultrasound. Palpation had a sensitivity of identification goiter of 94% (95% CI 89-99%), a specificity of 80% (95% CI 75-85%), a likelihood ratio of 4.7, positive post-test probability of 36.5% and negative post-test probability of 99%. CONCLUSIONS: Low urinary iodine excretion identified up to 46% of women with goiter. This test by itself is not useful as a screening tool to identify pregnant women at risk of goiter. Identification of thyroid size by palpation was a better screening test. However, when both tests were combined in parallel, up to 100% of women with goiter were correctly identified. Our results suggest that the commonly used cut off point of 100 microg I/L to identify low urinary iodine excretion may under-estimate the prevalence of iodine deficiency disorders when used during pregnancy.
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Bocio Endémico/patología , Yodo/orina , Complicaciones del Embarazo/patología , Glándula Tiroides/patología , Adulto , Femenino , Bocio Endémico/diagnóstico por imagen , Bocio Endémico/orina , Humanos , Tamizaje Masivo , Palpación/métodos , Embarazo , Complicaciones del Embarazo/diagnóstico por imagen , Complicaciones del Embarazo/orina , Factores de Riesgo , Sensibilidad y Especificidad , Glándula Tiroides/diagnóstico por imagen , Ultrasonografía Prenatal/métodosRESUMEN
The aim of the present research was to compare the uric acid, sodium and potassium excretions among patients with mild preeclampsia and normotensive pregnancy and to determine their behavior towards an acute physiologic state of hyperglycemia-hyperinsulinemia. It was carried out a cuasi-experimental study with parallel group in 25 patients with mild preeclampsia and in 25 patients with normotensive pregnancy all of them in the third trimester of gestation. The intervention consisted in administering an oral load of 50 grams of glucose in order to achieve a physiologic state of hyperglycemia-hyperinsulinemia. The seric levels of glucose, insulin, creatine, uric acid, sodium and potassium were measured, as well as the last four in urine before the oral load (with at least 6 hours fasting) and 60 minutes after the load, besides that, the urinary excretions of solutes were calculated with standard formulas. The urinary excretions of uric acid, sodium and potassium in fasting, and so after the oral glucose load were lower in the group of preeclampsia patients than in the normotensive gestation group. Upon analyzing the influence of a physiologic state of hyperglycemia-hyperinsulinemia, after the oral glucose load on determined solutes and their urinary excretion, we found that there was a significant decrease in the seric potassium level, without modifying its urinary excretion, as much as in the preeclampsia group as in the normotensive group. The seric uric acid and sodium levels diminished in the preeclampsia group and in normotensive group respectively, without modifying their urinary excretion. In conclusion, in the current study the urinary excretion of sodium, potassium and uric acid were lower in the preeclampsia patients than the women with normotensive pregnancy and a physiologic state of hyperglycemia-hyperinsulinemia didn't modify these excretions.
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Hiperglucemia/complicaciones , Hiperglucemia/orina , Hiperinsulinismo/orina , Potasio/orina , Preeclampsia/complicaciones , Preeclampsia/orina , Complicaciones del Embarazo/orina , Sodio/orina , Ácido Úrico/orina , Enfermedad Aguda , Adulto , Femenino , Humanos , EmbarazoRESUMEN
Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialytic treatment, and the most adequate dialysis therapy in the management of these pregnant patients has not been established. During the period 1988-1995, we studied the outcome of 17 pregnancies in dialyzed females, with an average age of 28.2 +/- 5.9 years (range: 18-38 years). Seven women had adequate urine volume (>800 ml/24 h). Five patients started dialysis after conception and the remaining 12 pregnancies were diagnosed after 6-72 months on dialysis. Fourteen women were maintained on hemodialysis (HD) and 3 on continuous ambulatory peritoneal dialysis (CAPD). The HD schedule was increased to 3 h 5-6 times weekly, and CAPD was increased to six 2-liter exchanges/day. Mean serum urea was 78.6 +/- 27.4 mg/dl (range 45-110); serum creatinine was 6.5 +/- 3.7 mg/dl (3.3-9.8 mg/dl); and hematocrit was 28.9 +/- 3.3 vol% (22-35 vol%). Anemia was partially controlled with rHuEpo in 8 patients. Significant problems were polyhydramnios in 7 cases (5 HD/2 CAPD), oligohydramnios in 1 (HD), gestational diabetes in 2 (CAPD), premature labor with spontaneous abortion at the 19th, 22nd and 28th weeks of gestation (2 HD/1 CAPD), hypertension in 8 (7 HD/1 CAPD), and sterile eosinophilic peritonitis in 1 case (CAPD). Mean gestational age at delivery in 14 successful pregnancies (12 HD/2 CAPD) was 32.3 +/- 2.6 weeks (27-36 weeks) and mean baby weight was 1,400.7 +/- 579.1 g (range 720-2,650 g). No congenital fetal abnormality was observed. Respiratory distress was observed in 6 infants, with 2 deaths (1 HD/1 CAPD) in the first week after delivery. In this study, successful pregnancies were reported in 70.6% of dialyzed women with uremia, with hemodialysis having a rate of fetal survival of 78.6% and CAPD with 33.3%.
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Enfermedades Renales/terapia , Complicaciones del Embarazo , Diálisis Renal , Adolescente , Adulto , Femenino , Humanos , Enfermedades Renales/sangre , Enfermedades Renales/orina , Masculino , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/orina , Resultado del EmbarazoRESUMEN
Las infecciones del tracto urinario representan las complicaciones más frecuentes en el embarazo; de tal forma se señala una prevalecencia promedio de 4 a 7 por ciento de bacteriuria asintomática durante esta etapa. El propósito de esta investigación es estudiar la asociación entre la bacteriuria asintomática recurrente (BAR) durante el embarazo y el bajo peso del recién nacido. Se efectuo un estudio de cohortes en derechohabientes adscritas a la unidad de Medicina Familiar No.10 en Jalapa, Veracruz, en el periodo de enero a diciembre de 1996. Para determinar esta asociación en una población de 846 embarazadas se estudio una muestra de 118 casos, formándose dos grupos: 59 con BAR (grupo experimental) y 59 sin BAR (grupo control). Las gestantes fueron estudiadas cuando acudieron a control prenatal realizándoles un urocultivo cuantitativo, el cual de resultar positivo requirió corroboración con otro. La prevalencia de BAR observada fue de 6.97 por ciento. Las diferencias encontradas al estudiar la asociación entre bacteriuria asintomática recurrente durante el embarazo y bajo peso del recién nacido no fueron estadísticamente significativas
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Complicaciones del Embarazo/microbiología , Complicaciones del Embarazo/orina , Tercer Trimestre del Embarazo/orina , Infecciones Urinarias/etiología , Infecciones Urinarias/epidemiología , Recién Nacido de Bajo PesoRESUMEN
Sixty pregnant women with symptoms of UTI, who assisted to the Emergency Room of the INPer, were submitted to urine culture and rapid urine tests for the detection of nitrites and leukocytes with the "Multistix 10 SG" (R) stripes. A control group was integrated of 20 pregnant women without symptoms of UTI submitted to the same methodology. In the first group, 34 urine cultures were reported as negative, 9 were as contaminated and 17 were positive. The sensitivity and specificity of the nitrite test was 94%. For the leukocyte test, the sensitivity was 64% and the specificity was 100%. In the control group, 13 urine cultures were negative, two were contaminated and five were positive. In this group, the sensitivity of the nitrite test was 100% and the specificity was 92%; while the sensitivity of the leukocyte test was 40% and the specificity was 100%.
Asunto(s)
Complicaciones del Embarazo/diagnóstico , Infecciones Urinarias/diagnóstico , Adulto , Femenino , Humanos , Recuento de Leucocitos , Nitratos/orina , Embarazo , Complicaciones del Embarazo/orina , Infecciones Urinarias/etiologíaRESUMEN
We conducted a prospective cohort study of 323 consecutively born very low birth weight infants (< or = 1499 gm) to determine any association between prenatal cocaine exposure and (1) intracranial ultrasonographic abnormalities and (2) other adverse perinatal outcomes. The infants were assigned to either a cocaine-exposed group (n = 86) or a cocaine-nonexposed group (n = 146) on the basis of combined detection methods for prenatal maternal cocaine abuse including maternal history, maternal and infant urine immunoassay (Emit), and meconium analysis (high-performance liquid chromatography and gas chromatography-mass spectrometry). Ninety-one infants were not assigned because of early death before complete testing (n = 80) or missed tests (n = 11). The detected incidence of cocaine exposure in the assigned population was 37% (86/232). Meconium testing with high-performance liquid chromatography and gas chromatography-mass spectrometry was the sole means of detection in 30% (26/86) of cases. The cocaine-nonexposed infants did not differ from the cocaine-exposed infants in the incidence of intraventricular hemorrhage (36% vs 35%), grades III and IV intraventricular hemorrhage (14% vs 14%), or periventricular leukomalacia (4% vs 2%). Adverse outcomes increased by cocaine exposure were abruptio placentae (8% vs 18%; p = 0.046), surgical ligation of a patent ductus arteriosus (1% vs 7%; p = 0.02), and seizures (5% vs 17%; p = 0.004). We conclude that prenatal cocaine exposure does not increase the incidence or severity of intracranial hemorrhage or periventricular leukomalacia but does increase the risk of abruptio placentae, surgical ligation of a patent ductus arteriosus and seizures in very low birth weight infants.