Search

[ES] Introducción: El manejo de la enfermedad de Parkinson en la mujer en edad fértil nos plantea como principal reto el manejo de la enfermedad y los fármacos durante el embarazo y lactancia. El aumento de la edad gestacional de la mujer hace más probable que la incidencia de embarazos pueda incrementarse. Objetivo: Definir las características clínicas y los factores que condicionan la vida de la mujer en edad fértil con enfermedad de Parkinson y definir una guía de actuación y manejo del embarazo en estas pacientes. Resultados: Este documento de consenso se ha realizado mediante una búsqueda bibliográfica exhaustiva y discusión de los contenidos realizados por un grupo de expertos en trastornos del movimiento de la Sociedad Española de Neurología. Conclusiones: La enfermedad de Parkinson afecta a todos los aspectos relacionados con la salud sexual y reproductiva de la mujer en edad fértil. Se debe planificar el embarazo en las mujeres con enfermedad de Parkinson para minimizar los riesgos teratogénicos sobre el feto. Se recomienda un abordaje multidisciplinar de estas pacientes para tener en cuenta todos los aspectos implicados., [EN] Introduction: The main challenge of Parkinson's disease in women of childbearing age is managing symptoms and drugs during pregnancy and breastfeeding. The increase in the age at which women are having children makes it likely that these pregnancies will become more common in future. Objectives: This study aims to define the clinical characteristics of women of childbearing age with Parkinson's disease and the factors affecting their lives, and to establish a series of guidelines for managing pregnancy in these patients. Results: This consensus document was developed through an exhaustive literature search and a discussion of the available evidence by a group of movement disorder experts from the Spanish Society of Neurology. Conclusions: Parkinson's disease affects all aspects of sexual and reproductive health in women of childbearing age. Pregnancy should be well planned to minimise teratogenic risk. A multidisciplinary approach should be adopted in the management of these patients in order to take all relevant considerations into account.

In recent years, several studies have examined the possible relationship between periodontal disease in pregnant women and preterm birth. One of the difficulties facing these studies is the heterogeneity of the clinical criteria used to define periodontitis. The aim of this cross-sectional study was to determine the degree of association between maternal periodontitis and preterm birth according to different consensus definitions of periodontal disease. In a study of 146 mothers (60 with preterm births and 86 with term deliveries) at the Sant Joan de Déu Maternal and Children's Hospital in Barcelona, a periodontal examination was carried out within 2 days of birth and the presence of periodontal disease was evaluated using the main clinical classifications published in the literature. The prevalence of periodontitis ranged from 25.4 to 52.1%, depending on the criteria used for its definition. Using the most restrictive criteria, pregnant women with periodontitis had a higher risk of preterm birth (OR: 7.49; p < 0.001) and premature rupture of membranes (OR: 2.49; p = 0.017). Premature infants born to mothers with periodontitis presented a tendency toward low weight, adjusted for gestational age (OR: 3.32; p = 0.065). Our findings suggest that the association between periodontitis and preterm birth is influenced by the definitions of periodontitis used.

Treballs Finals de Grau d'Enginyeria Informàtica, Facultat de Matemàtiques, Universitat de Barcelona, Any: 2022, Director: Karim Lekadir, [en] The main objective of this project is the development of a mobile application that serves as a social network and forum for mothers and pregnant women, especially for those with perinatal-partum depression. This application entitled "Hey, mama!" not only has a space for these users, it is also available for health professionals, psychologists, psychiatrists or doctors among others, who can publish information articles on the most common and important issues in pregnancy or perinatal depression, and can respond to queries made by users.

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Dones embarassades; Nadons Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Mujeres embarazadas; Bebés Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Pregnant women; Babies En aquest document s’estableixen les pautes a seguir en l’abordatge de l’atenció a les dones embarassades i puèrperes i dels nadons en la situació epidemiològica actual. S’estableixen els centres de referència per a l’atenció obstètrica a les dones amb infecció COVID-19 que requereixen un ingrés hospitalari durant l’embaràs, i també els centres de referència per a l’atenció al part a les dones amb infecció per COVID-19 amb simptomatologia lleu que no requereixen ingrés hospitalari. En este documento se establecen las pautas a seguir en el abordaje de la atención a las mujeres embarazadas y puérperas y de los bebés en la situación epidemiológica actual. Se establecen los centros de referencia para la atención obstétrica a las mujeres con infección COVID-19 que requieren un ingreso hospitalario durante el embarazo, así como los centros de referencia para la atención al parto a las mujeres con infección por COVID-19 con sintomatología leve que no requieren ingreso hospitalario. This document establishes the guidelines to be followed in the approach to care for pregnant and postpartum women and babies in the current epidemiological situation. Reference centers for obstetric care for women with COVID-19 infection who require hospital admission during pregnancy are established, as well as reference centers for delivery care for women with infection by COVID-19 with mild symptoms that do not require hospital admission.

Background Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. Objective This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. Methods A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire–Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. Results We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI −0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks–minutes per week vs 1386 metabolic equivalents of tasks–minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. Conclusions The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. Trial Registration ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872

Embarassades; Verola del mico; Recomanacions Embarazadas; Viruela del mono; Recomendaciones Pregnant; Monkeypox; Recommendations Aquest document conté informació sobre la verola del mico i la seva detecció i procediment en dones embarassades.

Knowing maternal satisfaction linked to interventionism is essential to improve care processes. The aim of this research is to analyze women satisfaction according to the sociodemographic variables, clinical variables related to childbirth assistance and interventionism, in order to identify those predictors. A descriptive and cross-sectional study was carried out with the participation of 301 women assisted in an obstetric unit in Girona. It was concluded that the women assisted by midwives, with a lobour at term, started spontaneously and without administration of oxytocin showed greater satisfaction, personal capacity, participation and security. Instrumental delivery, inductions of labour, and admissions at the neonatal unit were identified as barriers to maternal satisfaction, as well as low participation, low perception of safety and personal capability, manifesting that interventionism is also a barrier to maternal satisfaction Conèixer la satisfacció materna lligada a l’intervencionisme és essencial per millorar els processos assistencials. L’objectiu de la investigació és analitzar la satisfacció de les dones segons les variables sociodemogràfiques, les variables clíniques relacionades amb l’assistència i l’intervencionisme al part, i identificar els factors predictors d’aquesta satisfacció. Es va realitzar un estudi descriptiu i transversal on van participar 301 dones ateses a una unitat obstètrica de Girona. Es va concloure que les dones ateses per la llevadora, en un part a terme, d’inici espontani i sense administració d’oxitocina manifesten major satisfacció, capacitat personal, participació i seguretat. Es va identificar com a barreres de la satisfacció materna, la manca de participació, la baixa sensació de seguretat i capacitat personal, els parts distòcics, induïts i amb ingrés del nadó a la unitat de nounats, posant de manifest que l’intervencionisme també és una barrera per la satisfacció matern Programa de Doctorat en Biologia Molecular, Biomedicina i Salut

Background About 3·7 billion doses of ivermectin have been distributed in mass drug administration (MDA) campaigns globally over the past 30 years. At 10–100 times higher than current human doses, ivermectin is a known teratogen in mammals. During these campaigns with recommended doses, pregnant women might be inadvertently exposed. We therefore aimed to evaluate the existing evidence for serious and non-serious adverse events after ivermectin exposure in pregnant women. Methods For this systematic review and meta-analysis, we searched relevant databases and trial registry platforms on July 15, 2018, for randomised controlled trials (RCTs) and observational studies that reported adverse events in pregnant women. We did not use language or date restrictions. Outcomes of interest were spontaneous abortions, stillbirths, congenital anomalies, and neonatal death (serious adverse events), as well as maternal morbidity, preterm births, and low birthweight (adverse events). The risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias Tool for RCTs. We did the meta-analysis of observational studies and RCTs separately. The quality of evidence was assessed using the GRADE approach. The study protocol is registered with PROSPERO, protocol CRD42016046914. Findings We identified 147 records, of which only five observational studies and one RCT were included for quantitative analysis; these studies were published between 1990 and 2008, and were done in six African countries. 893 women with 899 pregancy outcomes were included, of whom 496 pregnant women (500 pregnancy outcomes) received ivermectin inadvertently during MDA campaigns in the observational studies and 397 pregnant women (399 pregnancy outcomes) purposely received ivermectin as part of the open-label RCT. No study reported neonatal deaths, maternal morbidity, preterm births, or low birthweight. It is unclear whether exposure to ivermectin during pregnancy increases the risk of spontaneous abortions and stillbirths (odds ratio [OR] 1·15 [95% CI 0·75–1·78] with very low certainty of evidence for the four observational studies and 0·62 [0·18–2·14] with very low certainty of evidence for the RCT) or congenital anomalies (OR 1·69 [95% CI 0·83–3·41] with very low certainty of evidence for the five observational studies and 1·10 [0·07–17·65] with very low certainty of evidence for the RCT). Interpretation There is insufficient evidence to conclude on the safety profile of ivermectin during pregnancy. Treatment campaigns should focus additional efforts on preventing inadvertent treatment of pregnant women. Funding Unitaid.

[ES] Introducción: Muchas enfermedades que cursan con trastornos del movimiento hipercinético comienzan o afectan a mujeres en edad fértil. Es importante conocer los riesgos que tienen las mujeres con estas enfermedades durante el embarazo, así como los posibles efectos de los tratamientos sobre el feto. Objetivos: Definir las características clínicas y los factores que condicionan la vida de la mujer en edad fértil con distonía, corea, síndrome de Tourette, temblor y síndrome de piernas inquietas. Definir una guía de actuación y manejo del embarazo y lactancia en las pacientes con esta enfermedad. Desarrollo: Este documento de consenso se ha realizado mediante una búsqueda bibliográfica exhaustiva y discusión de los contenidos llevadas a cabo por un Grupo de Expertos en Trastornos del Movimiento de la Sociedad Española de Neurología (SEN). Conclusiones: En todas las mujeres que padecen o comienzan con trastornos del movimiento hipercinéticos se debe valorar el riesgo-beneficio de los tratamientos, reducir al máximo la dosis eficaz o administrarlo de forma puntual en los casos en que sea posible. En aquellas enfermedades de causa hereditaria es importante un consejo genético para las familias. Es importante reconocer los trastornos del movimiento desencadenados durante el embarazo como determinadas coreas y síndrome de piernas inquietas., [EN] Introduction: Many diseases associated with hyperkinetic movement disorders manifest in women of childbearing age. It is important to understand the risks of these diseases during pregnancy, and the potential risks of treatment for the fetus. Objectives: This study aims to define the clinical characteristics and the factors affecting the lives of women of childbearing age with dystonia, chorea, Tourette syndrome, tremor, and restless legs syndrome, and to establish guidelines for management of pregnancy and breastfeeding in these patients. Results: This consensus document was developed through an exhaustive literature search and a discussion of the content by a group of movement disorder experts from the Spanish Society of Neurology. Conclusions: We must evaluate the risks and benefits of treatment in all women with hyperkinetic movement disorders, whether pre-existing or with onset during pregnancy, and aim to reduce effective doses as much as possible or to administer drugs only when necessary. In hereditary diseases, families should be offered genetic counselling. It is important to recognise movement disorders triggered during pregnancy, such as certain types of chorea and restless legs syndrome.

Background: In today's society, natural and normal situations such as the process of childbirth and pregnancy have become pathological, causing a paternalistic and hierarchical relationship in the patient-doctor relationship, where all trust is placed to health professionals leaving women in the process of childbirth as a background in terms of their dignity and autonomy. This fact leads to conduct of action or omission of the appropriation of women's reproductive bodies by health personnel, carrying out humiliations, dehumanizing and disrespectful treatment, physical abuse, procedures without consent, lack of confidentiality, omission of processes, and others. Objectives: Identify the different procedures considered as obstetric violence and therefore sexist violence during pregnancy and know the perception of women and health professionals about obstetric violence. Methods: The design of the research is a bibliographic review. The research was carried out in the Scielo, Pubmed and CINHAL databases during the months of January to March 2021. A total of 15 articles were obtained that have been included in this research after the inclusion and exclusion criteria. Results: A total of 15 articles were studied in this review. It has been divided according to the perception of women, the procedures of obstetric violence and the perception of health professionals. Conclusions: The results obtained confirm that obstetric violence is a current discrimination on the grounds of gender very prevalent around the world. It is such invisible violence because of the paternalistic doctor-patient relationship that even women accept it and blame themselves for poor care during childbirth and pregnancy. The lawsuits involve very violent and abusive acts against women, who are not aware that it is a type of violence Marc Teòric: En la societat actual s’ha patologitzat situacions tan naturals i normals com el procés del part i l’embaràs, provocant una relació paternalista i jerarquitzada en relació persona atesa-metge/ssa, on es deposita tota la confiança als professionals de la salut deixant a les dones en procés de part com a segon pla en qüestió de la seva dignitat i autonomia. Aquest fet provoca conductes d’acció o omissió de l’apropiació del cossos reproductius de les dones per parts del personal sanitari, duent a terme humiliacions, tractes deshumanitzadors i irrespectuosos, maltractaments físics, procediments sense consentiment, falta de confidencialitat, omissió de processos, entre d’altres. Objectius: Identificar els diferents procediments considerats com a violència obstètrica i per tant la violència masclista durant l’embaràs i el procés de part, conèixer la percepció de les dones i dels professionals de la salut sobre la violència obstètrica. Material i mètodes: El disseny de la investigació és una revisió bibliogràfica. La recerca s’ha realitzat en les bases de dades Scielo, Pubmed i CINHAL durant els mesos de Gener a Març del 2021. S’ha obtingut un total de 15 articles que s’han inclòs dins d’aquest investigació després de ser aplicats els criteris d’inclusió i exclusió. Resultats: S’ha estudiat un total de 15 articles en aquesta revisió. S’ha dividit segons la percepció de les dones, els procediments de violència obstètrica i la percepció dels professionals de la salut. Conclusions: Els resultats obtinguts confirmen que al violència obstètrica és una discriminació actual per raó de gènere molt prevalent arreu del món. És una violència tant invisibilitzada a causa de la relació paternalista persona atesa-metge/ssa que fins i tot les dones ho accepten i es culpen a elles mateixes d’una mala atenció durant el part i l’embaràs. Els processos comporten fets molt violents i abusius cap a les dones, els qual qui l’exerceixen tampoc són conscients de que sigui un tipus de violència

Background Cervical cancer elimination through human papillomavirus (HPV) vaccination programs requires the attainment of herd effect. Due to its uniquely high basic reproduction number, the vaccination coverage required to achieve herd effect against HPV type 16 exceeds what is attainable in most populations. We have compared how gender-neutral and girls-only vaccination strategies create herd effect against HPV16 under moderate vaccination coverage achieved in a population-based, community-randomized trial. Methods and findings In 2007–2010, the 1992–1995 birth cohorts of 33 Finnish communities were randomized to receive gender-neutral HPV vaccination (Arm A), girls-only HPV vaccination (Arm B), or no HPV vaccination (Arm C) (11 communities per trial arm). HPV16/18/31/33/35/45 seroprevalence differences between the pre-vaccination era (2005–2010) and post-vaccination era (2011–2016) were compared between all 8,022 unvaccinated women, Author summary Why was this study done? High-risk human papillomavirus (HPV) infection is a necessary cause of cervical cancer in females. HPV vaccination targeting high-risk HPV types 16 and 18 has been implemented internationally. Achieving herd protection for HPV16 may require greater than 80% girls-only vaccination coverage, a level that has not been achievable in many countries. We evaluate whether gender-neutral or girls-only HPV vaccination results in HPV16 and HPV18 herd protection when the vaccination coverage is only moderate (40%–50%). What did the researchers do and find? We implemented a community-randomized trial of gender-neutral versus girls-only versus no HPV vaccination of young adolescents in 2007–2010, with 11 communities in each arm. Vaccination coverage was implemented with moderate coverage (40%–50%) at the community level. We evaluated the herd effect created by the different vaccination strategies by measuring the cumulative incidence of vaccine-protected HPV types in 8,022 young unvaccinated pregnant females (under 23 years old), comparing the time periods 2005–2010 (pre-vaccination) and 2011–2016 (post-vaccination). An HPV16 herd effect, that is, a reduction in cumulative incidence among the unvaccinated females, was only observed in communities where gender-neutral vaccination had been implemented. What do these findings mean? Achieving a vaccination coverage of above 80%, which is required to achieve herd effect against HPV16, may be unrealistic in some populations. Implementing gender-neutral HPV vaccination provides a solution to this problem as the vaccination coverage threshold required to provide herd effect to unvaccinated females is lower. Our study finds that gender-neutral vaccination provides stronger herd effect than girls-only vaccination in the setting of moderate vaccination coverage. However, these findings are limited to this setting and are not readily generalizable to settings with high (>80%) vaccination coverage.

Islamophobia has increased in the last years, in part, due to terrorist attacks perpetrated by jihadist groups. This phenomenon might be a source of stress, being particularly problematic for pregnant (Muslim) women. We examine how stress generated by the 2017 Catalonia (Spain) attacks affected the health of newborns whose mothers are from a Muslim country (as the perpetrators). We use a difference-in-differences-in-differences model comparing newborns whose mothers come from a Muslim country and are residing in a municipality directly affected by the attacks, to other newborns, before-after the attacks. Results show that the share of low-birth-weight babies and deliveries with complications raise significantly by 23.77%, and 13.02%. We document a significant increase in Islamophobia and in emotional distress in our group of interest. We conclude that Islamophobia-related stress is possibly one of the channels affecting health at birth.

El objetivo de este artículo es analizar cómo las mujeres embarazadas y lactantes perciben la presencia de sustancias químicas en los alimentos y reflexionan acerca de los efectos en su propia salud, la del feto y la del bebé, cuando piensan sobre la acumulación, transmisión y eliminación de estas sustancias de su cuerpo. Partimos de la hipótesis de que el discurso de las mujeres sobre los efectos en salud de los Compuestos Tóxicos Persistentes (CTP) está relacionado con la proximidad o distancia social de los actores sociales reproductores de estos discursos. La recepción y aceptación de estas argumentaciones son más evidentes cuanto mayor es la confianza en los actores sociales que transmiten esa información. Este artículo analiza los discursos del personal sanitario y el entorno social próximo de estas mujeres, pues ambos juegan un papel esencial en la transmisión de dichos discursos. A pesar de que los consejos alimentarios que reciben las mujeres están fuertemente medicalizados, las informaciones facilitadas sobre sustancias químicas en los alimentos en el entorno médico son escasas y poco homogéneas, de forma que este tipo de riesgos son invisibilizados en la relación médico-paciente, y la responsabilidad sobre la gestión de los mismos suele recaer en las mujeres.

This study aims to investigate the relation between vaginal microbiota and exposition to intra-amniotic inflammation (IAI). We conducted a prospective cohort study in women with preterm labor, This project has been funded with support of the: - Project PI15/00344, that belongs to the Plan Estatal de Investigación Científica y Técnica y de Innovación 2013–2016 co-funded by Instituto de Salud Carlos III Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER), “Una manera de hacer Europa”. - Erasmus + Programme of the European Union (Framework Agreement number: 2013–0040). Universitat de Barcelona (CRAI Oficina de Difusió del Coneixement) provided funding assintance to cover Open Access Article Processing Charges.

Background Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under different intensities of malaria transmission. Methods P. falciparum at delivery was assessed by microscopy, quantitative PCR (qPCR) and placental histology in 946 HIV-uninfected and 768 HIV-infected pregnant women from Benin, Gabon, Kenya and Mozambique. Resistance was defined by the proportion of submicroscopic infections and the levels of anti-parasite antibodies quantified by Luminex, and tolerance by the relationship of pregnancy outcomes with parasite densities at delivery. Results P. falciparum prevalence by qPCR in peripheral and/or placental blood of HIV-uninfected Mozambican, Gabonese and Beninese women at delivery was 6% (21/340), 11% (28/257) and 41% (143/349), respectively. The proportion of peripheral submicroscopic infections was higher in Benin (83%) than in Mozambique (60%) and Gabon (55%; P = 0.033). Past or chronic placental P. falciparum infection was associated with an increased risk of preterm birth in Mozambican newborns (OR = 7.05, 95% CI 1.79 to 27.82). Microscopic infections were associated with reductions in haemoglobin levels at delivery among Mozambican women (–1.17 g/dL, 95% CI –2.09 to –0.24) as well as with larger drops in haemoglobin levels from recruitment to delivery in Mozambican (–1.66 g/dL, 95% CI –2.68 to –0.64) and Gabonese (–0.91 g/dL, 95% CI –1.79 to –0.02) women. Doubling qPCR-peripheral parasite densities in Mozambican women were associated with decreases in haemoglobin levels at delivery (–0.16 g/dL, 95% CI –0.29 to –0.02) and increases in the drop of haemoglobin levels (–0.29 g/dL, 95% CI –0.44 to –0.14). Beninese women had higher anti-parasite IgGs than Mozambican women (P

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Dones embarassades; Nadons Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Mujeres embarazadas; Bebés Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Pregnant women; Babies En aquest document s’estableixen les pautes a seguir en l’abordatge de l’atenció a les dones embarassades i puèrperes i dels nadons en la situació epidemiològica actual. S’estableixen els centres de referència per a l’atenció obstètrica a les dones amb infecció COVID-19 que requereixen un ingrés hospitalari durant l’embaràs, i també els centres de referència per a l’atenció al part a les dones amb infecció per COVID-19 amb simptomatologia lleu que no requereixen ingrés hospitalari.

Background: The healthcare and socio-economic burden resulting from influenza A (H1N1) pdm09 in Spain was considerable. Our aim was to estimate and compare the management (resource utilization) and economic healthcare impact in an at-risk group of unvaccinated pregnant women with an unvaccinated group of non-pregnant woman of childbearing age (15-44 yr old). Methods: We addressed this question with a longitudinal, observational, multicentre study. Inputs were the requirements in managing both groups of women. Outcome measures were healthcare costs. Direct healthcare (including medical utilisation, prescriptions of antivirals, medication, diagnostic tests, and hospitalisation) costs and indirect (productivity loss) costs were considered. Unit of cost was attributed to the frequency of health service resources utilisation. The mean cost per patient was calculated in this group of women. Results: We found that the influenza clinical pattern was worse in non-pregnant women as they had a high medical risk of 20.4% versus 6.1% of pregnant women. Non-pregnant required more antipyretics and antibiotics, and needed more health service resource utilisation (338 medical visits in non-pregnant women vs. 42 in pregnant women). The total cost of non-pregnant women was higher (€4,689.4/non-pregnant and €2,945.07/pregnant). Conclusions: Cost per (H1N1) pdm09 was lower for pregnant women, probably due to more preventive measures adopted for their protection in Spain. The highest costs were incurred by hospitalisations/day and work absenteeism for non-pregnant than for pregnant women. These data will allow better future pandemic influenza planning

BACKGROUND. Preterm premature rupture of membranes defined as rupture of membranes before the onset of labour is a complication of pregnancy whose main consequences are prematurity of the infant and infection of the amniotic fluid. The management in most of the cases is aimed to prolong the gestation to reduce the mortality and morbidity related to prematurity, as well as to reduce the incidence of chorioamnionitis which increases as the gestation is prolonged. This is why antibiotics are an important tool to prevent chorioamnionitis and to treat subclinical intraamniotic infections. Nevertheless, the antibiotic therapy of choice is not well stablished. Moreover, even if genital mycoplasma is the main microorganism identified as an agent implicated in the etiology of this pathology, most of the management protocols do not include specific tests to determine its presence, therefore, the possibility of a specific targeted therapy is not possible. OBJECTIVES. The aim of this study is to compare the differences in latency period with targeted antibiotic with azithromycin and empiric antibiotic treatment in the management of singleton pregnancies with preterm premature rupture of membrane between 23 and 34 weeks of gestation with positive PCR in amniotic fluid for genital mycoplasma. STUDY DESING AND POPULATION. A randomized, open label and controlled clinical trial will be done. It will be a multi-centric study involving the four provincial hospitals of Catalonia between June 2020 and May 2022. The sample size will be of 192 pregnant women who meet inclusion but not the exclusion criteria. METHODS. Patients included in this study will be randomly assign to one group of intervention. 96 patients will receive empiric antibiotic (therapy A) and 96 patients will receive intravenous azithromycin (therapy B). The main outcome will be latency period (defined as time between the rupture of membranes and labour). The following covariates will be considered: age, body mass index, ethnicity, parity, time between onset of the symptoms and antibiotic initiation, socioeconomic status and sexual risk behaviour

[cat] INTRODUCCIÓ: L’interès per l’alimentació a les societats industrialitzades es centra en conèixer si l’alimentació escollida resulta fiable en termes de qualitat, innocuïtat i seguretat. En els últims anys, s’han produït canvis soci-econòmics relacionats amb la industrialització, urbanització i desenvolupament tecnològic que han provocat noves formes de producció, processament i distribució d’aliments. Els consumidors tenen dubtes i es mostren cada cop més preocupats per la seva salut i desconfien del procés d’elaboració dels aliments i de les substàncies que s’usen en aquest procés. Aquesta preocupació ha generat desconfiança cap als productes preparats en els que es desconeix la procedència de la matèria prima així com els productes que se l’hi afegeixen. Aquestes substàncies afegides suposen una ingesta sistemàtica i prolongada de substàncies químiques de les quals se’n desconeixen les conseqüències. La major part d’aquestes substàncies són compostos tòxics persistents (CTPs). Aquests contaminants s’ingereixen a través de productes com els peixos, les carns, les verdures i les fruites. A més a més, tenen la peculiaritat d’entrar en la cadena alimentària, acumular-se en els teixits greixosos dels animals, i finalment arribar a l’organisme humà mitjançant la seva ingesta. Els CTPs són de difícil degradació i resten durant llargs períodes de temps en l’ambient i en els organismes vius. Els CTPs provoquen a llarg termini, conseqüències nocives per a la salut. JUSTIFICACIÓ: Les gestants i lactants poden estar més amoïnades per la percepció de risc alimentari per la pròpia salut i la del seu nadó. OBJECTIU: Conèixer la percepció social del risc alimentari que tenen les dones embarassades i lactants respecte els contaminants tòxics persistents i substàncies químiques sintètiques. DISSENY: Estudi qualitatiu de tipus etnogràfic i multicèntric a dues regions de Catalunya (Barcelona i Tarragona) i una d’Andalusia. El subjecte d’estudi varen ser dones que assistiren a grups de suport a la lactància i a les classes de preparació al part i al post-part dels municipis on es va fer l'etnografia. METODOLOGIA: La mostra s’escollí de forma no probabilística i oportunista. Les tècniques etnogràfiques utilitzades varen ser el treball de camp, les entrevistes semi-estructurades, els diaris d'alimentació i l'observació participant. Tots aquests mètodes són complementaris entre sí i es van utilitzar per tal de treure el màxim d'informació possible. Les dades es varen analitzar amb el programa Atlas-ti. RESULTATS: El número total de participants va ser de 33 dones. Dotze a la província d’Almeria, 11 a la de Barcelona i 10 a Tarragona. Vint-i-tres estaven embarassades i 10 eren lactants. Els investigadors van detectar, així, diferències en les informacions rebudes segons el rol que havien adoptat. La informació obtinguda de les narratives i observacions de les etnografies pel que fa a les substàncies presents en els aliments, es poden dividir en quatre categories segons: A) les característiques organolèptiques que aquestes substàncies aporten als aliments; B) el nivell d’afectació sobre la salut que les informants creuen que tenen aquestes substàncies; C) la manipulació dels productes en la cadena alimentària o en l’elaboració domèstica; D) la interacció d’aquestes substàncies en el cos (eliminació, transmissió al fetus durant la gestació o al nadó durant la lactància, o acumulació). DISCUSSIÓ: La presentació dels etnògrafs influïa en la resposta de les dones. Quan l’investigador informava voluntàriament sobre el seu rol, desconeixia el sentit que tenia pels informants cada opció. Les substàncies que es troben en els aliments consumits per les dones, la manipulació d'aquests i la interacció entre ells poden afectar la salut del fetus o del nadó. CONCLUSIONS: El rol dels etnògrafs genera diferents tipus de respostes. La informació alimentària rebuda durant l'embaràs i la gestació, per part dels professionals és la més ben valorada; tot i que les dones manifesten haver-ne rebut poca. Els professionals sanitaris no coneixen els contaminants tòxics persistents, per la qual cosa no poden informar a les dones., [eng] BACKGROUND: The interest in food in industrialized societies focuses on whether the food chosen is reliable in terms of quality, safety and security. In recent years, there have been socioeconomic changes related to industrialization, urbanization, and technological development that have led to new forms of food production, processing, and distribution. Consumers have doubts and are they increasingly concerned about their health and distrust the process of making food and the substances used in this process.This concern has led to distrustof prepared products in which the origin of the raw material and the products added to it are unknown.These added substances involve a systematic and prolonged intake of chemicals, the consequences of which are unknown. Most of these substances are persistent organic pollutants (POPs). These contaminants are ingested through products such as fish, meat, vegetables and fruits.In addition, these components have the particularity of entering the food chain, accumulating in the fatty tissues of animals and, finally, reaching the human body through ingestion. POPs are difficult to degrade and are kept in the environment and living organisms for long periods of time. POPs cause long-term, harmful health consequences. JUSTIFICATION: It is believed that pregnant and lactating women may be more concerned about the perception of food risk to their own health and that of their baby. AIM: to know the social perception of the food risk that pregnant and lactating women have with respect to persistent toxic contaminants and synthetic chemicals. DESIGN: Qualitative study of ethnographic and multicenter type, intwo regions of Catalonia (Barcelona and Tarragona) and one in Andalusia.The subjects studied were women who attended breastfeeding support groups and childbirth and postpartum preparation classes in the municipalities where the ethnographies were performed. Methodology:The sample was chosen non-probabilistically and accidentally. Ethnographic techniques: Fieldwork, semi-structured interviews, food diaryand observation of the practices. To analyze the content, the computer program Atlas.ti was used. RESULTS: A total of 33 women were monitored. Twelve in the province of Almeria, 11 in Barcelona and 10 in Tarragona. Twenty-three were pregnant and 10 were breastfeeding women. The researchers detected differences in the information received according to the role they had taken. The information given by professionals is very important for informants. The information obtained from the narratives and observations of ethnographies regarding the substances present in food, can be divided into four categories according to: A) the organoleptic characteristics that these substances contribute to food; B) the level of health impact that the informants believe these substances have; C) the handling of products in the food chain or in domestic processing; and D) the interaction of these substances in the body (elimination, transmission to the fetus during pregnancy or to the baby during lactation, or accumulation). DISCUSSION: The ethnographers ’presentation influenced women’s response. When the researcher voluntarily reported his role, he was unaware of the meaning of each option for the informants. Substances found in foods consumed by women, their handling and interaction between them can affect the health of the fetus or baby. CONCLUSIONS: The role of ethnographers generates different types of responses. Food information received during pregnancy and pregnancy by professionals is the most valued; although women say they have received little. Healthcare professionals are unaware of persistent toxic contaminants, so they cannot report women.

In this article, we analyze how pregnant and breastfeeding women perceive the inside of their bodies as well as their thoughts regarding the accumulation and elimination of chemical compounds present in food, and how these are then transmitted to the fetus. We explore different social perceptions of risk regarding the circulation of chemical compounds inside the body using qualitative research based on the technique of body mapping, comprised of women&rsquo, s figures of their bodies in combination with comments on the figures, food diaries and narratives from in-depth interviews. We examine how these 41 women (21 pregnant and 20 breastfeeding) perceive the body&rsquo, s internal mechanisms during the stages of pregnancy and breastfeeding, as well as the circulation of chemical contaminants within it. The body mapping technique allowed us to analyze participants&rsquo, knowledge of internal pollution, a little-understood process in society. Thanks to these pregnant and breastfeeding women, who made an effort to represent and reflect on these new risks, this study shows that scientists and obstetricians need to collaborate with women in order to better understand and publicize the risks of internal pollution.

We report a case of spontaneous abortion associated with Zika virus infection in a pregnant woman who traveled from Spain to the Dominican Republic and developed a rash. Maternal Zika viremia persisted at least 31 days after onset of symptoms and 21 days after uterine evacuation.

BACKGROUND: In spite of the last decade increase in availability of contraception, around half of the annual 21 million pregnancies notified in low- and middle-income countries in individuals aged 15-19 years are unintended. We sought to explore the contribution of the underuse of modern of contraception methods (MMC) to the annual incidence of unintended pregnancies among adolescent women. METHODS: We used Demographic and Health Survey (DHS) data from 12 low- and middle-income countries. The pooled analysis exploring the risk of unintended pregnancy included 1,717 adolescent women with a current unintended pregnancy and 29,304 currently not pregnant 15- to 19-year-old sexually active women who did not desire pregnancy. For each country and the pooled analysis, the odds ratio of unintended pregnancy was calculated in relation to the type of contraception (MMC, Traditional Methods, and No Contraception). Expected unintended pregnancies and population attributable fraction (PAF) of unintended pregnancies attributable to not using MMC were calculated for each country. FINDINGS: The use of traditional methods was associated with a 3·4 (95% CI 2·0-4·9) time increased odds of having an undesired pregnancy compared with the use of MMC of contraception while not using any method of contraception was associated with a 4.9 (95% CI 2·9-6·8) times increased odds. The population attributable fraction (PAF) of not using MMC accounted for 86·6% of the estimated unintended pregnancies (9,464,654 in total in the 12 countries) in the pooled analysis. PAF ranged from 62·7% (974,760) for Bangladesh to 95·1% (540,176) for Niger and the estimated number of unintended pregnancies because of the use of traditional methods or non-use of contraception ranged from 18,638 in Namibia to 4,234,916 in India. INTERPRETATION: Eight million out of 9·5 million unintended pregnancies occurring annually in twelve countries could have been prevented with the optimal use of MMC of contraception. MMC need to be further supported in order to further prevent unintended pregnancies globally. FUNDING STATEMENT: None. DECLARATION OF INTERESTS: The authors declare no competing interests. ETHICS APPROVAL STATEMENT: This analysis did not require additional ethical approval. The analysis relied upon publicly available dataset with no identifying data to guarantee participant anonymity. Ethics approval for the survey was obtained by the institutional review board of ORC Macro (Calverton, MD, USA) and country health authorities.

Maternal factors and exposure to pathogens have an impact on infant health. For instance, HIV exposed but uninfected infants have higher morbidity and mortality than HIV unexposed infants. Innate responses are the first line of defense and orchestrate the subsequent adaptive immune response and are especially relevant in newborns. To determine the association of maternal HIV infection with maternal and newborn innate immunity we analyzed the cytokine responses upon pattern recognition receptor (PRR) stimulations in the triad of maternal peripheral and placental blood as well as in cord blood in a cohort of mother-infant pairs from southern Mozambique. A total of 48 women (35 HIV-uninfected and 13 HIV-infected) were included. Women and infant innate responses positively correlated with each other. Age, gravidity and sex of the fetus had some associations with spontaneous production of cytokines in the maternal peripheral blood. HIV-infected women not receiving antiretroviral therapy (ART) before pregnancy showed decreased IL-8 and IL-6 PRR responses in peripheral blood compared to those HIV-uninfected, and PRR hyporesponsiveness for IL-8 was also found in the corresponding infant's cord blood. HIV infection had a greater impact on placental blood responses, with significantly increased pro-inflammatory, T H 1 and T H 17 PRR responses in HIV-infected women not receiving ART before pregnancy compared to HIV-uninfected women. In conclusion, innate response of the mother and her newborn was altered by HIV infection in the women who did not receive ART before pregnancy. As these responses could be related to birth outcomes, targeted innate immune modulation could improve maternal and newborn health.

Background: WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. Methods: We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). Results: A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02–7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48–0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75–1.34). Conclusions: Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications.

The immune status of women changes during and after pregnancy, differs between blood compartments at delivery and is affected by environmental factors particularly in tropical areas endemic for multiple infections. We quantified the plasma concentration of a set of thirty-one TH1, TH2, TH17 and regulatory cytokines, pro-inflammatory and anti-inflammatory cytokines and chemokines, and growth factors (altogether biomarkers), in a cohort of 540 pregnant women from five malaria-endemic tropical countries. Samples were collected at recruitment (first antenatal visit), delivery (periphery, cord and placenta) and postpartum, allowing a longitudinal analysis. We found the lowest concentration of biomarkers at recruitment and the highest at postpartum, with few exceptions. Among them, IL-6, HGF and TGF-β had the highest levels at delivery, and even higher concentrations in the placenta compared to peripheral blood. Placental concentrations were generally higher than peripheral, except for eotaxin that was lower. We also compared plasma biomarker concentrations between the tropical cohort and a control group from Spain at delivery, presenting overall higher biomarker levels the tropical cohort, particularly pro-inflammatory cytokines and growth factors. Only IL-6 presented lower levels in the tropical group. Moreover, a principal component analysis of biomarker concentrations at delivery showed that women from Spain grouped more homogenously, and that IL-6 and IL-8 clustered together in the tropical cohort but not in the Spanish one. Plasma cytokine concentrations correlated with Plasmodium antibody levels at postpartum but not during pregnancy. This basal profiling of immune mediators over gestation and in different compartments at delivery is important to subsequently understand response to infections and clinical outcomes in mothers and infants in tropical areas.

Inorganic arsenic (i-As) is a non-threshold human carcinogen that has been associated with several adverse health outcomes. Exposure to i-As is of particular concern among pregnant women, infants and children, as they are specifically vulnerable to the adverse health effects of i-As, and in utero and early-life exposure, even low to moderate levels of i-As, may have a marked effect throughout the lifespan. Ion chromatography-mass spectrometry detection (IC-ICP-MS) was used to analyse urinary arsenic speciation, as an exposure biomarker, in samples of 4-year-old children with relatively low-level arsenic exposure living in different regions in Spain including Asturias, Gipuzkoa, Sabadell and Valencia. The profile of arsenic metabolites in urine was also determined in samples taken during pregnancy (1st trimester) and in the children from Valencia of 7 years old. The median of the main arsenic species found in the 4-year-old children was 9.71 mug/l (arsenobetaine-AsB), 3.97 mug/l (dimethylarsinic acid-DMA), 0.44 mug/l (monomethylarsonic acid-MMA) and 0.35 mug/l (i-As). Statistically significant differences were found in urinary AsB, MMA and i-As according to the study regions in the 4-year-old, and also in DMA among pregnant women and their children. Spearman's correlation coefficient among urinary arsenic metabolites was calculated, and, in general, a strong methylation capacity to methylate i-As to MMA was observed.

The information currently available about girls and women who are trafficked worldwide for the purpose of sexual exploitation only shows us one part of the picture. In the Puigvert (2012–2014) TRATA: Life trajectories that move away or bring closer to the trafficking processes of sexual exploitation, through 25 qualitative techniques conducted with social service providers with a communicative orientation, we have identified a group of Moroccan adolescent girls between 12 and 18 years old who are particularly vulnerable to sex trafficking: the petites bonnes or young housemaids. Sexual exploitation, as well as sexual abuse that sometimes leads to pregnancy, can result in the flight or expulsion of these girls from their homes. These results unveil two recruitment elements that are used by trafficking networks: the irregular situation in which girls have arrived in a city and the circumstances of inequality in which they find themselves, including having low education levels and poor work experience. Furthermore, these elements make these girls invisible to the authorities and other professionals who could assist them. Based on these results, we conclude that tackling these challenges requires primary prevention measures that will increase the financial viability of the social groups at risk, establish programs that ensure successful educational trajectories for girls in their places of origin, and raise the awareness of people about this reality in their environments.

Relating pregnancy and violence may seem contradictory, since, in the collective imagination, giving birth and pregnancy are usually associated with satisfaction and personal fulfillment. However, some studies indicate that up to 20% of women can suffer violence, infringed by their partners, during pregnancy. While approaching gender violence during pregnancy is a sensitive issue, it becomes even more so when the health system is the perpetrator of the violence, of what is known as «obstetric violence». This term is used to denounce the excessive medicalization in health care during the physiological process of childbirth, referring to the dehumanized treatment given to women during care. The articles presented in this issue derive from the papers presented in the «Third International Conference on Gender, Ethics and Care: Giving Visibility to Violence against Women during Pregnancy», held in Barcelona in May 2018. Throughout 2019, both in this issue and following, the journal MUSAS will publish some of the most outstanding papers and communications of the conference., Relacionar embarazo y violencia puede parecer contradictorio, puesto que en el imaginario colectivo se suele asociar el nacimiento de los hijos y el embarazo con plenitud y realización personal. Sin embargo, algunos estudios nos indican que hasta un 20% de las mujeres pueden sufrir violencia, por parte de la pareja, durante el embarazo. Si el abordaje de la violencia de género durante el embarazo es un tema sensible, ello aún se manifiesta con mayor fuerza cuando es el propio sistema sanitario el generador de la violencia, un fenómeno que se conoce como «violencia obstétrica» y que denuncia el exceso de medicalización en la atención sanitaria al proceso fisiológico del parto y al trato deshumanizado dado a las mujeres durante dicha atención. Los trabajos presentados en este número derivan de las aportaciones al «III Congreso Internacional Género, Ética y Cuidado: Visibilizando la violencia hacia las mujeres en el embarazo», realizado en Barcelona en mayo de 2018. A lo largo de este año 2019, tanto en este número como en el siguiente, la revista MUSAS publicará algunas de las ponencias y comunicaciones más destacadas del congreso.

Vegetarian and vegan diets have increased worldwide in the last decades, according to the knowledge that they might prevent coronary heart disease, cancer, and type 2 diabetes. Althought plant-based diets are at risk of nutritional deficiencies such as proteins, iron, vitamin D, calcium, iodine, omega-3, and vitamin B12, the available evidence shows that well planned vegetarian and vegan diets may be considered safe during pregnancy and lactation, but they require a strong awareness for a balanced intake of key nutrients. A review of the scientific literature in this field was performed, focusing specifically on observational studies in humans, in order to investigate protective effects elicited by maternal diets enriched in plant-derived foods and possible unfavorable outcomes related to micronutrients deficiencies and their impact on fetal development. A design of pregestational nutrition intervention is required in order to avoid maternal undernutrition and consequent impaired fetal growth.

Dear editor: A recent editorial in Travel Medicine and Infectious Diseases highlighted the lack of studies about Zika virus (ZIKV) in pregnancy and its implications in many countries [1]. Zika virus infection can induce congenital defects in the newborn such as microcephaly and miscarriage when mothers are infected during pregnancy [2]. However, relevant questions remain to be completely understood, such as the risk of infection for pregnant women and of subsequent congenital defects, and the ratio between symptomatic and asymptomatic ZIKV infections in the general population and in pregnant women. Here, we describe the results of a ZIKV screening of pregnant women in Catalonia, northeastern Spain. Testing for ZIKV was recommended for all pregnant women with history of travel to ZIKV endemic areas during pregnancy or in the 8 weeks before conception [3]. Symptomatic patients were screened by serological methods from day four after the onset of symptoms and by molecular methods within the first week (serum) and two weeks (urine) after illness. Asymptomatic patients were tested by serological methods. Seroneutralization assay for ZIKV was perfomed in samples positive for antibodies. Commercial diagnostic assays were used (RT-PCR, Altona Diagnostics and IIFT, Euroimmun). Neutralization titers ≥1/32 were considered indicative of the presence of ZIKV neutralizing antibodies. Follow up at two designated reference obstetrical departments for early detection of microcephaly or other malformations was offered to pregnant women with laboratory evidence of ZIKV infection. When available, amniotic fluid and placental tissue samples were tested for ZIKV by RT-PCR in cases of microcephaly or miscarriage, respectively.

Background: Liberia is a West African country that needs substantial investment to strengthen its National Malaria Control Programme (NMCP), which was disrupted during the 2014–2016 Ebola epidemic. As elsewhere, Liberian pregnant women are especially vulnerable to malaria. Understanding prevention and treatment-seeking behaviours among the population is crucial to strategize context-specifc and women-centred actions, including locally-led malaria research, to improve women’s demand, access and use of NMCP strategies against malaria in pregnancy. Methods: In 2016, after the Ebola crisis, a qualitative inquiry was conducted in Monrovia to explore populations’ insights on the aetiology, prevention and therapeutics of malaria, as well as the community and health workers’ perceptions on the utility of malaria research for pregnant women. In-depth interviews and focus group discussions were conducted among pregnant women, traditional community representatives and hospital staf (n=38), using a feminist interpretation of grounded theory. Results: The narratives indicate that some Liberians believed in elements other than mosquito bites as causes of malaria; many had a low malaria risk perception and disliked current efective prevention methods, such as insecticide-treated nets; and some would resort to traditional medicine and spiritual care to cure malaria. Access to clinic-based malaria care for pregnant women was reportedly hindered by lack of fnancial means, by unofcial user fees requested by healthcare workers, and by male partners’ preference for traditional medicine. The participants suggested that malaria research in Liberia could help to design evidence-based education to change current malaria prevention, diagnostic and treatment-seeking attitudes, and to develop more acceptable prevention technologies. Conclusion: Poverty, insufcient education on malaria, corruption, and poor trust in healthcare establishment are structural factors that may play a greater role than local traditional beliefs in deterring Liberians from seeking, access‑ ing and using government-endorsed malaria control strategies. To increase access to and uptake of preventive and biomedical care by pregnant women, future malaria research must be informed by people’s expressed needs and constructed meanings and values on health, ill health and healthcare.

Sex hormone-binding globulin (SHBG) negatively associates with pre-gestational body mass index (BMI) and gestational weight gain. The link with other cardio-metabolic risk factors in pregnant women is poorly understood. Our aim was to study the association of SHBG levels with common cardio-metabolic risk parameters in pregnant woman. Serum SHBG was quantified in 291 Caucasian pregnant women (142 with normal weight, 42 with pregestational obesity, 50 with gestational obesity and 57 with pregestational plus gestational obesity) with uncomplicated pregnancies and parturition. Cardio-metabolic [C-reactive protein (CRP), blood pressure (BP), glycosylated hemoglobin (HbAc1), glucose, C-peptide, insulin, triglycerides and high molecular weight (HMW) adiponectin], and endocrine [testosterone and estradiol] parameters were also assessed. SHBG was negatively correlated with BMI, but also with CRP, BP, HbAc1, pre and post-load glucose, C-peptide, HOMA-IR, triglycerides; and positively with HMW adiponectin (all p

Vacunació; Embaràs; Fetus Vacunación; Embarazo; Feto Vaccination; Pregnancy; Fetus La vacunació de la dona embarassada té l’objectiu d’evitar els riscos que es puguin produir per infeccions prevenibles amb vacunes sobre la mare, el fetus en desenvolupament i el nadó. És molt important no acotar la vacunació al període de l’embaràs, ja que és fonamental assegurar la immunització de la gestant contra malalties com la rubèola, la varicel·la o el xarampió, contra les que no es pot vacunar durant l’embaràs. Històricament, l’ús de vacunació en l’embaràs ha estat restringit sota una premissa de prudència respecte a possibles efectes indesitjables, així com una possible mala resposta a les vacunes. Per garantir la seguretat davant aquesta hipotètica possibilitat, les vacunes atenuades (triple vírica, antivaricel·losa, vacuna BCG, antitifoidal oral, contra la febre groga i de la grip intranasal) estan contraindicades durant la gestació i es recomana que s’eviti l’embaràs durant el mes posterior a la seva administració. Les vacunes inactivades es consideren segures durant la gestació. En cada embaràs es recomana de manera sistemàtica la vacunació contra la tos ferina entre les setmanes 27 i 36 de la gestació i contra la grip, si l’embaràs coincideix amb la campanya de vacunació antigripal. També és necessari vacunar contra el tètanus si l’embarassada no està vacunada. En cas de presentar factors de risc, també es pot realitzar vacunació selectiva amb les vacunes inactivades que estiguin indicades. La vacunació de l’embarassada constitueix una part molt important de l’atenció prenatal. La vacunación de la mujer embarazada tiene el objetivo de evitar los riesgos que se puedan producir por infecciones prevenibles con vacunas sobre la madre, el feto en desarrollo y el bebé. Es muy importante no acotar la vacunación al período del embarazo, ya que es fundamental asegurar la inmunización de la gestante contra enfermedades como la rubéola, la varicela o el sarampión, contra las que no se puede vacunar durante el embarazo. Históricamente, el uso de vacunación en el embarazo ha sido restringido bajo una premisa de prudencia respecto a posibles efectos indeseables, así como una posible mala respuesta a las vacunas. Para garantizar la seguridad ante esta hipotética posibilidad, las vacunas atenuadas (triple vírica, antivaricel·losa, vacuna BCG, antitifoidal oral, contra la fiebre amarilla y de la gripe intranasal) están contraindicadas durante la gestación y se recomienda que se evite el embarazo durante el mes posterior a su administración. Las vacunas inactivadas se consideran seguras durante la gestación. En cada embarazo se recomienda de manera sistemática la vacunación contra la tos ferina entre las semanas 27 y 36 de la gestación y contra la gripe, si el embarazo coincide con la campaña de vacunación antigripal. También es necesario vacunar contra el tétanos si la embarazada no está vacunada. En caso de presentar factores de riesgo, también se puede realizar vacunación selectiva con las vacunas inactivadas que estén indicadas. La vacunación de la embarazada constituye una parte muy importante de la atención prenatal. Vaccination of the pregnant woman aims to avoid the risks that can be produced by preventable infections with vaccines on the mother, the developing fetus and the baby. It is very important not to limit the vaccination to the period of pregnancy, since it is essential to ensure the immunization of the pregnant woman against diseases such as rubella, varicella or measles, against which you can not vaccinate during pregnancy. Historically, the use of vaccination in pregnancy has been restricted under a premise of prudence regarding possible undesirable effects, as well as a possible poor response to vaccines. To guarantee safety in the face of this hypothetical possibility, attenuated vaccines (triple viral, antivaricellosis, BCG vaccine, antitifoidal oral, against yellow fever and intranasal flu) are contraindicated during pregnancy and it is recommended that pregnancy be avoided during the month after administration. Inactivated vaccines are considered safe during pregnancy. In each pregnancy, vaccination against whooping cough is systematically recommended between weeks 27 and 36 of pregnancy and against influenza, if the pregnancy coincides with the influenza vaccination campaign. It is also necessary to vaccinate against tetanus if the pregnant woman is not vaccinated. In case of presenting risk factors, selective vaccination can also be carried out with the inactivated vaccines that are indicated. Vaccination of the pregnant woman is a very important part of prenatal care.

The consumption of alcohol and drugs of abuse among pregnant women has experienced a significant increase in the last decades. Suitable maternal nutritional status is crucial to maintain the optimal environment for fetal development but if consumption of alcohol or drugs of abuse disrupt the intake of nutrients, the potential teratogenic effects of these substances increase. Despite evidence of the importance of nutrition in addicted pregnant women, there is a lack of information on the effects of alcohol and drugs of abuse on maternal nutritional status; so, the focus of this review was to provide an overview on the nutritional status of addicted mothers and fetuses. Alcohol and drugs consumption can interfere with the absorption of nutrients, impairing the quality and quantity of proper nutrient and energy intake, resulting in malnutrition especially of micronutrients (vitamins, omega⁻3, folic acid, zinc, choline, iron, copper, selenium). When maternal nutritional status is compromised by alcohol and drugs of abuse the supply of essential nutrients are not available for the fetus; this can result in fetal abnormalities like Intrauterine Growth Restriction (IUGR) or Fetal Alcohol Spectrum Disorder (FASD). It is critical to find a strategy to reduce fetal physical and neurological impairment as a result of prenatal alcohol and drugs of abuse exposure combined with poor maternal nutrition. Prenatal nutrition interventions and target therapy are required that may reverse the development of such abnormalities. KEYWORDS: Fetal Alcohol Spectrum Disorder (FASD); Intrauterine Growth Restriction (IUGR); alcohol; drugs of abuse; fetal nutrition; maternal nutrition; pregnancy

The enzyme FASN (fatty acid synthase) is potentially related with hypertension and metabolic dysfunction. FASN is highly expressed in the human placenta. We aimed to investigate the relationship circulating FASN has with blood pressure, maternal metabolism and newborn parameters in healthy pregnant women. Circulating FASN was assessed in 115 asymptomatic pregnant women in the second trimester of gestation along with C-peptide, fasting glucose and insulin, post-load glucose lipids, HMW-adiponectin and blood pressure (the latter was assessed in each trimester of gestation). At birth, newborns and placentas were weighed. FASN expression was also able to be assessed in 80 placentas. Higher circulating FASN was associated with lower systolic blood pressure (SBP), with a more favourable metabolic phenotype (lower fasting glucose and insulin, post load glucose, HbAc1, HOMA-IR and C-peptide), and with lower placental and birth weight (all p FASN expression related positively to circulating FASN (p

BACKGROUND: The role of tobacco smoke exposure in the development and persistence of asthma and rhinoconjunctivitis through childhood into adolescence is unclear. OBJECTIVES: We assessed the associations of parental smoking from fetal life through adolescence with asthma and rhinoconjunctivitis during childhood and adolescence. METHODS: We analyzed data for 10,860 participants of five European birth cohort studies from the Mechanisms of the Development of Allergy (MeDALL) consortium. Parental smoking habits and health outcomes (early transient, persistent, and adolescent-onset asthma and rhinoconjunctivitis) were based on questionnaires covering the period from pregnancy to 14-16 y of age. Data were combined and analyzed using a one-stage and two-stage individual participant data meta-analysis. RESULTS: Overall, any maternal smoking during pregnancy tended to be associated with an increased odds of prevalent asthma [adjusted odds ratio (aOR)=1.19 (95% CI: 0.98, 1.43)], but not prevalent rhinoconjunctivitis [aOR=1.05 (95% CI: 0.90, 1.22)], during childhood and adolescence. In analyses with phenotypes related to age of onset and persistence of disease, any maternal smoking during pregnancy was associated with early transient asthma [aOR=1.79 (95% CI: 1.14, 2.83)]. Maternal smoking of >/=10 cigarettes/day during pregnancy was associated with persistent asthma [aOR=1.66 (95% CI: 1.29, 2.15)] and persistent rhinoconjunctivitis [aOR=1.55 (95% CI, 1.09, 2.20)]. Tobacco smoke exposure during fetal life, infancy, childhood, and adolescence was not associated with adolescent-onset asthma or rhinoconjunctivitis. CONCLUSIONS: Findings from this combined analysis of five European birth cohorts strengthen evidence linking early exposure to tobacco smoke with asthma during childhood and adolescence. Children with high early-life exposure were more likely than unexposed children to have early transient and persistent asthma and persistent rhinoconjunctivitis. https://doi.org/10.1289/EHP2738.

BACKGROUND: Adoption of prevention and therapeutic innovations to ensure that National Malaria Control Programmes meet their incidence reduction targets is highly dependent on the conduct of rigorous clinical trials. In Liberia, malaria control virtually halted during the recent Ebola epidemic, and could enormously benefit from innovations to protect its most vulnerable populations, including pregnant women, against malaria. Health policy-planners could feel more inclined to adopt novel interventions with demonstrated safety and efficacy when trialled among their women population. However, pregnant women are especially vulnerable when targeted as research participants. Whilst some studies in the region attempted to understand the ethical issues around the conduct of clinical research, there is need of such information from Liberia to inform future malaria research. METHODS: This is a grounded theory study that aims to understand the barriers and opportunities for pregnant women to consent to participate in malaria research in Liberia. The study was conducted between November 2016 and May 2017 at the St Joseph's Catholic Hospital, Monrovia. In-depth interviews and focus group discussions were held with hospital staff, traditional community representatives, and pregnant women. RESULTS: According to the participants, useful strategies to motivate pregnant women to consent to participate in malaria research could be providing evidence-based education on malaria and research to the general population and encouraging engagement of traditional leaders in research design and community mobilization. Fears and suspicions towards research and researchers, which were amplified during the conduct of Ebola vaccine and drug clinical trials, may influence women's acceptance and willingness to engage in malaria research. Population's mistrust in the public healthcare system might hinder their acceptance of research, undermining the probability of their benefiting from any improved malaria control intervention. CONCLUSION: Benchmarking for acceptable practices from previous public health interventions; building community discussion and dissemination platforms; and mapping communication and information errors from how previous research interventions were explained to the Liberian population, are strategies that might help ensure a safe and fully informed participation of pregnant women in malaria research. Inequity issues impeding access and use of biomedical care for women must be tackled urgently.

PURPOSE: Group B streptococcus (GBS) is an important cause of neonatal sepsis worldwide. Data on the prevalence of maternal GBS colonization, risk factors for carriage, antibiotic susceptibility and circulating serotypes are necessary to tailor adequate locally relevant public health policies. METHODOLOGY: A prospective study including pregnant women and their newborns was conducted between March and July 2013 in Morocco. We collected clinical data and vagino-rectal and urine samples from the recruited pregnant women, together with the clinical characteristics of, and body surface samples from, their newborns. Additionally, the first three newborns admitted every day with suspected invasive infection were recruited for a thorough screening for neonatal sepsis. Serotypes were characterized by molecular testing. RESULTS: A total of 350 pregnant women and 139 of their newborns were recruited. The prevalence of pregnant women colonized by GBS was 24 %. In 5/160 additional sick newborns recruited with suspected sepsis, the blood cultures were positive for GBS. Gestational hypertension and vaginal pruritus were significantly associated with a vagino-rectal GBS colonization in univariate analyses. All of the strains were susceptible to penicillin, while 7 % were resistant to clindamycin and 12 % were resistant to erythromycin. The most common GBS serotypes detected included V, II and III. CONCLUSION: In Morocco, maternal GBS colonization is high. Penicillin can continue to be the cornerstone of intrapartum antibiotic prophylaxis. A pentavalent GBS vaccine (Ia, Ib, II, III and V) would have been effective against the majority of the colonizing cases in this setting, but a trivalent one (Ia, Ib and III) would only prevent 28 % of the cases.

BACKGROUND: Few data on HIV resistance in pregnancy are available from Mozambique, one of the countries with the highest HIV toll worldwide. Understanding the patterns of HIV drug resistance in pregnant women might help in tailoring optimal regimens for prevention of mother to child transmission of HIV (pMTCT) and antenatal care. OBJECTIVES: To describe the frequency and characteristics of HIV drug resistance mutations (HIVDRM) in pregnant women with virological failure at delivery, despite pMTCT or antiretroviral therapy (ART). METHODS: Samples from HIV-infected pregnant women from a rural area in southern Mozambique were analysed. Only women with HIV-1 RNA >400c/mL at delivery were included in the analysis. HIVDRM were determined using MiSeq(R) (detection threshold 1%) at the first antenatal care (ANC) visit and at the time of delivery. RESULTS: Ninety and 60 samples were available at the first ANC visit and delivery, respectively. At first ANC, 97% of the women had HIV-1 RNA>400c/mL, 39% had CD4+ counts

Background: In the Netherlands organophosphate (OP) pesticides are frequently used for pest control in agricultural settings. Despite concerns about the potential health impacts of low-level OP pesticides exposure, particularly in vulnerable populations, the primary sources of exposure remain unclear. The present study was designed to investigate the levels of DAP metabolites concentrations across pregnancy and to examine various determinants of DAP metabolite concentrations among an urban population of women in the Netherlands. Method: Urinary concentrations of six dialkyl phosphate (DAP) metabolites, the main urinary metabolites of OP pesticides, were determined at 25 weeks of pregnancy in 784 pregnant women participating in the Generation R Study (between 2004 and 2006), a large population-based birth cohort in Rotterdam, the Netherlands. Questionnaires administered prenatally assessed demographic and lifestyle characteristics and maternal diet. Linear mixed models, with adjustment for relevant covariates, were used to estimate associations between the potential exposure determinants and DAP metabolite concentrations expressed as molar concentrations divided by creatinine levels. Results: The median DAP metabolite concentration was 311 nmol/g creatinine for the first trimester, 317 nmol/g creatinine for the second trimester, and 310 nmol/g creatinine for the third trimester. Higher maternal age, married/living with a partner, underweight or normal weight (BMI of

Treballs Finals de Grau d'Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Curs: 2016-2017, Tutor: Glòria Seguranyes Guillot, Objectiu general. Avaluar l’efectivitat de la utilització de la immersió a l’aigua en les dones gestants de baix risc obstètric durant el procés de part en relació a les que tenen un part convencional pel que fa a la satisfacció materna i als resultats materns i neonatals. Àmbit d’estudi. La seu de la Maternitat de l’Hospital Clínic de Barcelona. Disseny. Disseny quasi experimental amb 3 grups d’estudi. Un grup control, on les dones donaran a llum mitjançant un part convencional, i 2 grups experimentals que es diferenciaran en que, en un, les dones passaran només el període de dilatació dins l’aigua i, en l’altre, hi passaran tant el període de dilatació com el d’expulsió. Subjectes d’estudi. S’estudiaran a 150 gestants de baix risc obstètric, 50 per a cada grup, que s’inclouran als diferents grups segons la seva preferència de tipus de part. La tècnica de mostreig serà no probabilística consecutiva. Instruments. S’utilitzarà l’Escala Visual Numèrica del dolor, l’Escala Mackey per la satisfacció materna, el Test d’Apgar i una graella de recollida de dades. Anàlisis de dades. Es realitzarà un anàlisis estadístic descriptiu i inferencial mitjançant les proves de contrast d’hipòtesi de chi al quadrat, t de Student i ANOVA. El nivell de significació serà

Curs 2016-2017, Actualment més de 200 milions de dones i nenes al món han estat exposades a patir Mutilació Genital Femenina (MGF) (OMS, 2008). Aquesta provoca greus conseqüències per a la salut física i psicològica de les dones que la pateixen. Cal preparar els professionals sanitaris per proporcionar l’atenció sanitària necessària, però en l’actualitat no apareixen gaires estudis en referència al procés d’embaràs. Objectius: (1) Conèixer quines són les possibles complicacions físiques, psíquiques i socials, que poden patir les dones amb MGF, de tipus II o III, durant el seu procés d’embaràs, part i postpart. (2) Observar l’abordatge dels professionals sanitaris, durant el procés d’embaràs, part i postpart, en dones amb MGF. Metodologia: es planteja fer ús d’un mètode qualitatiu interpretatiu i de disseny narratiu, on són les pròpies pacients les que expliquen la seva vivència personal. La obtenció de dades s’ha realitzat mitjançant l’observació semiparticipant i les entrevistes semiestructurades en profunditat. Els resultats han sigut recollits amb l’ajuda de guions i gravacions i han sigut analitzats amb el programa informàtic ATLAS.ti. Limitacions: (1) Dificultat en l’obtenció de la mostra per a l’estudi, (2) diferències culturals importants i (3) falta d’acceptació de l’estudi per part dels familiars., Actually more than 200 millions of women and girls in the world have been exposed to suffer FGM (OMS, 2008). This cause seriously consequence for the physical and psychological health of women who suffer. It’s necessary prepare heath professionals to provide needed health care, but actually aren’t many studies about the process of pregnancy. Objectives: (1) Know what the possible complication physical, mental and social, can suffer the women whit FGM, type II or III, during the process of pregnancy, childbirth and postpartum. (2) Observe the approach of health professionals during pregnancy, childbirth and postpartum process, in women with FGM. Methodology: We use a qualitative method of interpretation and narrative design where patients describe their personal experience. The data collection was performed though observation and semi-structured interviews. The results have been recollected with the help of scripts and recording, and have been analysed with the software ATLAS.ti. Limitations: (1) Difficulty in obtaining the sample for the study, (2) Significant cultural differences and (3) lack of acceptance of the study by relatives.

A vaccine to eliminate malaria would need a multi-stage and multi-species composition to achieve robust protection, but the lack of knowledge about antigen targets and mechanisms of protection precludes the development of fully efficacious malaria vaccines, especially for Plasmodium vivax (Pv). Pregnant women constitute a risk population who would greatly benefit from a vaccine preventing the adverse events of Plasmodium infection during gestation. We hypothesized that functional immune responses against putative targets of naturally acquired immunity to malaria and vaccine candidates will be associated with protection against malaria infection and/or poor outcomes during pregnancy. We measured (i) IgG responses to a large panel of Pv and Plasmodium falciparum (Pf) antigens, (ii) the capacity of anti-Pv ligand Duffy binding protein (PvDBP) antibodies to inhibit binding to Duffy antigen, and (iii) cellular immune responses to two Pv antigens, in a subset of 1,056 pregnant women from Brazil, Colombia, Guatemala, India, and Papua New Guinea (PNG). There were significant intraspecies and interspecies correlations for most antibody responses (e.g., PfMSP119 versus PfAMA1, Spearman's rho = 0.81). Women from PNG and Colombia had the highest levels of IgG overall. Submicroscopic infections seemed sufficient to boost antibody responses in Guatemala but not antigen-specific cellular responses in PNG. Brazil had the highest percentage of Duffy binding inhibition (p-values versus Colombia: 0.040; Guatemala: 0.047; India: 0.003, and PNG: 0.153) despite having low anti-PvDBP IgG levels. Almost all antibodies had a positive association with present infection, and coinfection with the other species increased this association. Anti-PvDBP, anti-PfMSP1, and anti-PfAMA1 IgG levels at recruitment were positively associated with infection at delivery (p-values: 0.010, 0.003, and 0.023, respectively), suggesting that they are markers of malaria exposure. Peripheral blood mononuclear cells from Pv-infected women presented fewer CD8+IFN-gamma+ T cells and secreted more G-CSF and IL-4 independently of the stimulus used in vitro. Functional anti-PvDBP levels at recruitment had a positive association with birth weight (difference per doubling antibody levels: 45 g, p-value: 0.046). Thus, naturally acquired binding-inhibitory antibodies to PvDBP might confer protection against poor outcomes of Pv malaria in pregnancy.

Background Pregnant women exposed to Plasmodium falciparum generate antibodies against VAR2CSA, the parasite protein that mediates adhesion of infected erythrocytes to the placenta. There is a need of high-throughput tools to determine the fine specificity of these antibodies that can be used to identify immune correlates of protection and exposure. Here we aimed at developing a multiplex-immunoassay to detect antibodies against VAR2CSA antigens. Methods and findings We constructed two multiplex-bead arrays, one composed of 3 VAR2CSA recombinant-domains (DBL3X, DBL5Ɛ and DBL6Ɛ) and another composed of 46 new peptides covering VAR2CSA conserved and semi-conserved regions. IgG reactivity was similar in multiplexed and singleplexed determinations (Pearson correlation, protein array: R2 = 0.99 and peptide array: R2 = 0.87). IgG recognition of 25 out of 46 peptides and all recombinant-domains was higher in pregnant Mozambican women (n = 106) than in Mozambican men (n = 102) and Spanish individuals (n = 101; p

BACKGROUND: Exposure to perfluoroalkyl substances (PFASs) may increase risk for metabolic diseases; however, epidemiologic evidence is lacking at the present time. Pregnancy is a period of enhanced tissue plasticity for the fetus and the mother and may be a critical window of PFAS exposure susceptibility. OBJECTIVE: We evaluated the associations between PFAS exposures and metabolic outcomes in pregnant women. METHODS: We analyzed 1,240 pregnant women from the Spanish INMA [Environment and Childhood Project (INfancia y Medio Ambiente)] birth cohort study (recruitment period: 2003-2008) with measured first pregnancy trimester plasma concentrations of four PFASs (in nanograms/milliliter). We used logistic regression models to estimate associations of PFASs (log10-transformed and categorized into quartiles) with impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM), and we used linear regression models to estimate associations with first-trimester serum levels of triglycerides, total cholesterol, and C-reactive protein (CRP). RESULTS: Perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS) were positively associated with IGT (137 cases) [OR per log10-unit increase=1.99 (95% CI: 1.06, 3.78) and OR=1.65 ( 95% CI: 0.99, 2.76), respectively]. PFOS and PFHxS associations with GDM (53 cases) were in a similar direction, but less precise. PFOS and perfluorononanoate (PFNA) were negatively associated with triglyceride levels [percent median change per log10-unit increase=-5.86% (95% CI: -9.91%, -1.63%) and percent median change per log10-unit increase=-4.75% (95% CI: -8.16%, -0.61%, respectively], whereas perfluorooctanoate (PFOA) was positively associated with total cholesterol [percent median change per log10-unit increase=1.26% (95% CI: 0.01%, 2.54%)]. PFASs were not associated with CRP in the subset of the population with available data (n=640). CONCLUSIONS: Although further confirmation is required, the findings from this study suggest that PFAS exposures during pregnancy may influence lipid metabolism and glucose tolerance and thus may impact the health of the mother and her child. https://doi.org/10.1289/EHP1062. This study was funded in part by grants from the European Union (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), the Instituto de Salud Carlos III, the Spanish Ministry of Health (Red INMA G03/176; CB06/02/0041; FIS-PI12/01890, FIS-PI041436, FIS- PI081151, FIS-PI06/0867, FIS-PS09/00090; FIS-FEDER: 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, 11/01007, 11/02591, 11/02038, 13/1944, 13/2032, 14/00891, and 14/01687; Miguel Servet-FEDER CP11/0178, MS13/00054, and CPII16/00051; and PFIS-FI14/00099), Generalitat Valenciana (FISABIO: UGP 15-230, UGP-15-244, and UGP-15-249), the Department of Health of the Basque Government (2005111093 and 2009111069), the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), the Generalitat de Catalunya-CIRIT (1999SGR 00241), and the National Institutes of Health/National Institute of Environmental Health Sciences (grant number ES021477). This study has been reviewed and approved by the accredited committees of the following institutions: The Municipal Institute of Sanitary Assistance of Barcelona, La Fe University Hospital of Valencia, and The Donostia Hospital.

BACKGROUND: The huge proportion of child marriage contributes to high rates of pregnancies among adolescent girls in Bangladesh. Despite substantial progress in reducing maternal mortality in the last two decades, the rate of adolescent pregnancy remains high. The use of skilled maternal health services is still low in Bangladesh. Several quantitative studies described the use of skilled maternal health services among adolescent girls. So far, very little qualitative evidence exists about attitudes and practices related to maternal health. To fill this gap, we aimed at exploring maternal health care-seeking behavior of adolescent girls and their experiences related to pregnancy and delivery in Bangladesh. METHODS AND FINDINGS: A prospective qualitative study was conducted among thirty married adolescent girls from three Upazilas (sub-districts) of Rangpur district. They were interviewed in two subsequent phases (2014 and 2015). To triangulate and validate the data collected from these married adolescent girls, key informant interviews (KIIs) and focus group discussions (FGDs) were conducted with different stakeholders. Data analysis was guided by the Social-Ecological Model (SEM) including four levels of factors (individual, interpersonal and family, community and social, and organizational and health systems level) which influenced the maternal health care-seeking behavior of adolescent girls. While adolescent girls showed little decision making-autonomy, interpersonal and family level factors played an important role in their use of skilled maternal health services. In addition, community and social factors and as well as organizational and health systems factors shaped adolescent girls' maternal health care-seeking behavior. CONCLUSIONS: In order to improve the maternal health of adolescent girls, all four levels of factors of SEM should be taken into account while developing health interventions targeting adolescent girls.

ObjetivoComparar el grado de ansiedad de un grupo de mujeres con un feto con retraso de crecimiento intrauterino (RCIU) visitadas exclusivamente por especialistas en medicina maternofetal en relación a otras mujeres que, además, también fueron visitadas por una matrona formada en técnicas de relajación y detectar los sentimientos prevalentes cuando se informa del diagnóstico.Material y métodoEstudio multimétodo: cuantitativo (diseño cuasi-experimental) y cualitativo (fenomenológico). Las participantes fueron gestantes con feto con RCIU, mayores de edad, sin trastornos psiquiátricos ni dificultad idiomática. En el grupo control, se incluyeron mujeres que siguieron el control de la gestación de alto riesgo. Las mujeres del grupo experimental además del control estándar, tuvieron tres visitas con la matrona en la que se explicaron técnicas de control de la ansiedad. Ambos grupos realizaron el mismo test para evaluar la ansiedad (test STAI), al inicio y al final de su participación. Finalmente, se realizaron entrevistas semiestructuradas a las mujeres del grupo experimental.Resultados y conclusionesLas mujeres que tuvieron contacto con la matrona, además de los cuidados técnicos, obtuvieron puntuaciones más bajas en la escala STAI (menor grado de ansiedad) que aquellas que sólo recibieron cuidados por especialistas en Medicina Maternofetal. Las entrevistas pusieron de manifiesto sentimientos: las categorías que emergieron del análisis fueron: a) sentimientos en relación a ellas mismas, b) sentimientos en relación al personal o al hospital y c) sentimientos de afrontamiento. En suma, ofrecer técnicas de relajación a aquellas madres con un embarazo de riesgo (feto RCIU) mejora su grado de ansiedad., Objective To compare the degree of anxiety in two groups of women carrying fetuses diagnosed with intrauterine growth retardation (IUGR): one group attended exclusively by specialists in maternal-fetal medicine, and the other also attended by a midwife trained in relaxation techniques; and to identify the most prevalent feelings in women on being informed of the diagnosis. Material and Method Multi-method study: quantitative (quasi-experimental design) and qualitative (phenomenological). Participants were pregnant adult women carrying a fetus diagnosed with IUGR, without psychiatric disorders or language difficulties. The control group included women who followed the gestation control protocol in place at the high-risk unit. Women in the experimental group, in addition to standard controls, had three visits with the midwife, during which the midwife explained anxiety control techniques to them in detail. Both groups performed the same test to evaluate anxiety (STAI), at the beginning and at the end of their participation. In addition, semi-structured interviews were conducted with the women in the experimental group. Results Women who had contact with the midwife in addition to the standard care had lower scores on the STAI scale (indicating lower anxiety levels) than women who received care only from maternal-fetal medicine specialists. The interviews revealed the most prevalent feelings to be: a) feelings regarding themselves, b) feelings regarding the staff and hospital, and c) feelings regarding coping. Conclusions Offering relaxation techniques to pregnant mothers at risk (with IUGR) reduces their level of anxiety.

Objetivo: evaluar la efectividad del tratamiento con acupuntura y moxibustión en un entorno hospitalario, en mujeres embarazadas de 33 a 38 semanas de gestación con presentación no cefálica del feto. Método: estudio experimental de intervención, unicéntrico, en un centro hospitalario de tercer nivel, sobre una muestra de 250 mujeres embarazadas de 33 a 38 semanas de gestación con presentación no cefálica fetal. Como variable principal se consideró la versión o no a presentación cefálica posintervención y como variables secundarias las semanas de gestación en el inicio del tratamiento, la paridad, cómo finalizó el parto, el peso del recién nacido al nacer y la edad de la madre. Resultados: la prevalencia posintervención de reversión del feto a una presentación cefálica fue del 53,5% de todas las embarazadas que hicieron tratamiento con acupuntura y moxibustión y se obtuvieron diferencias significativas (p < 0,0001 en el test de la χ2) con un intervalo de confianza del 95%. El 75% finalizo en parto vaginal, mientras que en el grupo que permaneció en presentación no cefálica el 97,9% de los partos finalizó en cesárea. Durante el tratamiento no mostraron efectos adversos y hubo una gran aceptación y adherencia al tratamiento. Conclusiones: el tratamiento con acupuntura y moxibustión resulto ser efectivo y seguro practicado entre las semanas 33 a 38 de gestación en una presentación no cefálica y disminuyó el número de cesáreas. Se considera recomendable la realización de un ensayo clínico aleatorizado que pueda aportar mayor evidencia científica.

Podeu consultar dades primàries associades a l'article a: http://hdl.handle.net/2445/101775, P. vivax infection during pregnancy has been associated with poor outcomes such as anemia, low birth weight and congenital malaria, thus representing an important global health problem. However, no vaccine is currently available for its prevention. Vir genes were the first putative virulent factors associated with P. vivax infections, yet very few studies have examined their potential role as targets of immunity. We investigated the immunogenic properties of five VIR proteins and two long synthetic peptides containing conserved VIR sequences (PvLP1 and PvLP2) in the context of the PregVax cohort study including women from five malaria endemic countries: Brazil, Colombia, Guatemala, India and Papua New Guinea (PNG) at different timepoints during and after pregnancy. Antibody responses against all antigens were detected in all populations, with PNG women presenting the highest levels overall. P. vivax infection at sample collection time was positively associated with antibody levels against PvLP1 (fold-increase: 1.60 at recruitment -first antenatal visit-) and PvLP2 (fold-increase: 1.63 at delivery), and P. falciparum co-infection was found to increase those responses (for PvLP1 at recruitment, fold-increase: 2.25). Levels of IgG against two VIR proteins at delivery were associated with higher birth weight (27 g increase per duplicating antibody levels, p

Vaginal Escherichia coli colonization is related to obstetric infections and the consequent development of infections in newborns. Ampicillin resistance among E. coli strains is increasing, which is the main choice for treating empirically many obstetric and neonatal infections. Vaginal E. coli strains are very similar to extraintestinal pathogenic E. coli with regards to the virulence factors and the belonging to phylogroup B2. We studied the antimicrobial resistance and the genetic virulence profile of 82 E. coli isolates from 638 vaginal samples and 63 isolated from endometrial aspirate, placental and amniotic fluid samples from pregnant women with obstetric infections. The prevalence of E. coli in the vaginal samples was 13%, which was significant among women with associated risk factors during pregnancy, especially premature preterm rupture of membranes (p