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Héctor Gallardo-Rincón,1,2 Julieta Lomelin-Gascon,2 Luis Alberto Martinez-Juarez,2 Alejandra Montoya,2 Janinne Ortega-Montiel,2 Victoria Galicia-Hernandez,2 Diego-Abelardo Álvarez-Hernández,2 Rosangela Ávila-Domínguez,2 Enrique Reyes-Muñoz,3 Lucía Marcela Illescas-Correa,4 Daniel Alberto Diaz Martinez,5 Francisco Javier Magos Vázquez,5 Edwin Oswaldo Vargas Ávila,5 Alejandro Efraín Benitez-Herrera,6 Diana Reyes-Gómez,6 María Concepción Carmona-Ramos,6 Laura Hernández-González,6 Oscar Romero-Islas,6 Ricardo Mújica-Rosales,2 Roberto Tapia-Conyer7 1University of Guadalajara, Health Sciences University Center, Guadalajara, Jalisco, Mexico; 2Carlos Slim Foundation, Mexico City, Mexico; 3Coordination of Gynecological and Perinatal Endocrinology, National Institute of Perinatology, Mexico City, Mexico; 4Maternal and Childhood Research Center (CIMIGEN), Mexico City, Mexico; 5Ministry of Health of the State of Guanajuato, Guanajuato, Mexico; 6Ministry of Health of the State of Hidalgo, Pachuca, Hidalgo, Mexico; 7National Autonomous University of Mexico, School of Medicine, Mexico City, MexicoCorrespondence: Luis Alberto Martinez-Juarez, Carlos Slim Foundation, Lago Zurich 245, Presa Falcon Building (Floor 20), Miguel Hidalgo, Mexico City, 11529, Mexico, Tel +52 55 53 39 17 70, Fax +52 55 53 39 17 70, Email mjuarezl@fundacioncarlosslim.orgPurpose: Few pregnant women in low-resource settings are screened for gestational diabetes mellitus (GDM) using the gold standard oral glucose tolerance test (OGTT). This study compared capillary blood glucose testing with 2-h plasma glucose measurements obtained using the 75-g OGTT to screen for GDM at primary healthcare clinics in Mexico.Patients and Methods: Pregnant women who participated in a previous prospective multicenter longitudinal cohort study and who had not been previously diagnosed with diabetes were included. Participants were evaluated using the plasmatic 2-h 75-g OGTT with simultaneous capillary blood glucose measurements using a glucometer. The study endpoint was the comparability of the glucometer results to the gold standard OGTT when collected simultaneously. Sensitivity, specificity, and area under the curve of the glucose measurements obtained for capillary blood compared with venous plasma (gold standard) were calculated to determine diagnostic accuracy.Results: The study included 947 pregnant women who had simultaneous glucose measurements available (blood capillary [glucometer] and venous blood OGTT). Overall, capillary blood glucose testing was very sensitive (89.47%); the specificity was 66.58% and the area under the curve (95% confidence interval) was 0.78 (0.74– 0.81). The sensitivity, specificity and area under the curve of each capillary measurement were: 89.47%, 66.58% and 0.78 (0.74– 0.82) for the fasting measurement, 91.53%, 93.24% and 0.92 (0.88– 0.96) for the one-hour measurement, and 89.80%, 93.32%, 0.91 (0.87– 0.95) for the second-hour measurement, respectively. No adverse events were reported.Conclusion: Capillary OGTT is a valid alternative to the gold standard OGTT for screening of GDM in low-resource situations or in situations where there are other limitations to performing the OGTT as part of primary healthcare services.Keywords: capillary blood glucose, gestational diabetes mellitus, low-resource, Mexico, oral glucose tolerance test, screening

During the postmenopausal period, there are metabolic alterations that predispose individuals to metabolic syndrome (MS), oxidative stress (OS), and the risk of developing cardiovascular diseases. We aimed to compare the concentrations of OS markers in postmenopausal women with and without MS. Malondialdehyde, carbonyl groups, and total antioxidant capacity (TAC) were quantified. We conducted a cross-sectional study: Group 1 (n = 42) included women without MS, and Group 2 (n = 58) comprised women with MS. Participants' age was similar between groups. Glucose, insulin, the homeostasis model assessment of insulin resistance, triglycerides, uric acid, and body mass index were significantly lower in postmenopausal women without MS. OS markers were significantly lower in Group 1 vs. Group 2: malondialdehyde, 31.32 ± 14.93 vs. 40.27 ± 17.62 pmol MDA/mg dry weight (

Maternal metabolic status influences pregnancy and, consequently, the perinatal outcome. Resistin is a pro-inflammatory adipokine predominantly expressed and secreted by mononuclear cells, adipose tissue, and placental trophoblastic cells during pregnancy. Recently, we reported an inverse association between maternal resistin levels and fetal low-density lipoprotein cholesterol (LDL-C). Then, in this work, we used a human placental explant model and the trophoblast cell line JEG-3 to evaluate whether resistin affects placental LDL-C uptake. Resistin exposure induced the transcription factor SREBP-2, LDLR, and PCSK9 mRNA expression, and changes at the protein level were confirmed by immunohistochemistry and Western blot. However, for LDLR, the changes were not consistent between mRNA and protein levels. Using a labeled LDL-cholesterol (BODIPY FL LDL), uptake assay demonstrated that the LDL-C was significantly decreased in placental explants exposed to a high dose of resistin and a lesser extent in JEG-3 cells. In summary, resistin induces PCSK9 expression in placental explants and JEG-3 cells, which could be related to negative regulation of the LDLR by lysosomal degradation. These findings suggest that resistin may significantly regulate the LDL-C uptake and transport from the maternal circulation to the fetus, affecting its growth and lipid profile.

Given the barriers to early detection of gestational diabetes mellitus (GDM), this study aimed to develop an artificial intelligence (AI)-based prediction model for GDM in pregnant Mexican women. Data were retrieved from 1709 pregnant women who participated in the multicenter prospective cohort study ‘Cuido mi embarazo’. A machine-learning-driven method was used to select the best predictive variables for GDM risk: age, family history of type 2 diabetes, previous diagnosis of hypertension, pregestational body mass index, gestational week, parity, birth weight of last child, and random capillary glucose. An artificial neural network approach was then used to build the model, which achieved a high level of accuracy (70.3%) and sensitivity (83.3%) for identifying women at high risk of developing GDM. This AI-based model will be applied throughout Mexico to improve the timing and quality of GDM interventions. Given the ease of obtaining the model variables, this model is expected to be clinically strategic, allowing prioritization of preventative treatment and promising a paradigm shift in prevention and primary healthcare during pregnancy. This AI model uses variables that are easily collected to identify pregnant women at risk of developing GDM with a high level of accuracy and precision.

Preterm labor accounts for more than 85% of perinatal morbidity, frequently requiring intensive care and presenting complications that can have consequences throughout the individual's life. More than half of preterm delivery cases have unknown causes and therefore no clear preventable etiology. From observation in epidemiological studies that demonstrated longer pregnancies in populations with high consumption of marine oils, attempts have been made to define the benefit of omega-3 polyunsaturated fatty acids (n-3 PUFA) prevention in premature childbirth through randomized clinical trials, as well as its preventive value. This review discusses the relationship between prenatal supplementation of n-3 long chain PUFA during pregnancy and the incidence of preterm delivery.El parto prematuro protagoniza más del 85% de la morbilidad perinatal, requiere con frecuencia cuidados intensivos y presenta complicaciones que pueden tener consecuencias a lo largo de la vida del individuo. Más de la mitad de los casos de parto pretérmino tienen causas desconocidas y por lo tanto ninguna etiología clara prevenible. Desde la observación en estudios epidemiológicos que demostraron embarazos más largos en poblaciones con alto consumo de aceites marinos se ha tratado de definir por medio de ensayos clínicos aleatorizados el beneficio de suplementos de ácidos grasos poliinsaturados omega-3 (AGPI n-3) prevenir el parto prematuro, así como su valor preventivo. Esta revisión discute la relación entre la suplementación prenatal de n-3 de cadena larga durante el embarazo y la incidencia de parto prematuro.

espanolIntroduccion: La diabetes mellitus gestacional (DMG) afecta a entre el 5 y el 40% de mujeres embarazadas. Recientemente se han evaluado diferentes intervenciones con suplementos nutricionales para prevenir la DMG. Objetivo: Realizar una sintesis de la evidencia sobre eficacia de suplementos nutricionales (mioinositol, probioticos y vitamina D) para prevenir DMG. Metodo: Se realizo una busqueda sistematica en PubMed y la biblioteca Cochrane, se incluyeron revisiones sistematicas de estudios clinicos aleatorizados (ECAs), publicados en idioma ingles o espanol hasta mayo de 2020; se utilizaron las palabras clave: “prevencion”, “diabetes gestacional”, “hiperglicemia y embarazo”, “suplementacion”, “probioticos”, “mio-inositol” y “vitamina D”. Resultados: Se analizaron 10 revisiones sistematicas que cumplieron los criterios de inclusion. La suplementacion con mioinositol comparado con placebo disminuyo la incidencia de DMG (RR: 0.44; IC 95%: 0.27-0.87; cinco ECAs). Si bien la suplementacion con vitamina D o probioticos durante el embarazo podria disminuir la incidencia de DMG, la evidencia es limitada. Conclusiones: La suplementacion con mioinositol es efectiva para prevenir DMG en mujeres de alto riesgo. La suplementacion con vitamina D o probioticos probablemente disminuye la incidencia de DMG. EnglishIntroduction: Gestational diabetes mellitus (GDM) affects between 5 and 40% of pregnant women. Recently different interventions with nutritional supplements have been evaluated for prevention of GDM. Aim: To perform a synthesis of the evidence on the efficacy of nutritional supplements (myo-inositol, probiotics, and vitamin D) in the prevention of GDM. Methods: A systematic search in PubMed and Cochrane library was performed, including systematic reviews of randomized clinical trials (RCTs), published in English or Spanish until May 2020, using the keywords: “prevention”, “gestational diabetes”, “hyperglycemia and pregnancy”, “supplementation”, “probiotics”, “myo-inositol” and “vitamin D”. Results: 10 systematic reviews that met the inclusion criteria were analyzed. Myo-inositol supplementation compared to placebo decreased the incidence of GDM (RR: 0.44 [0.27-0.87]; five RCTs), low quality of evidence. Although the supplementation with vitamin D or probiotics during pregnancy could reduce the incidence of GDM the evidence is limited. Conclusions: Myo-inositol supplementation is effective for prevention of GDM in high-risk women. Supplementation with vitamin D or probiotics probably decreases the incidence of GDM.

espanolObjetivo: Comparar la incidencia de diabetes mellitus gestacional (DMG) en mujeres con tres o mas factores de riesgo para desarrollar DMG suplementadas con mioinositol mas probioticos versus mujeres sin suplementacion. Material y metodos: Estudio de cohorte retrospectivo, grupo 1, mujeres con suplementacion (mioinositol 2 g mas Bifidobacterium lactis y Lactobacillus rhamnosus 5x108unidades formadoras de colonias, dos veces al dia, de las 12-14 hasta las 28 semanas de gestacion); grupo 2, mujeres con control prenatal habitual sin suplementacion, pareadas por edad e indice de masa corporal (IMC). El resultado primario fue la incidencia de DMG utilizando los criterios de la Asociacion Internacional de Grupos de Estudio de Diabetes y Embarazo. Resultados: Grupo 1, n = 48, y grupo 2 n = 96. No hubo diferencias significativas en caracteristicas basales como edad, IMC, y numero de factores de riesgo entre los grupos. La incidencia de DMG en el grupo 1 fue n = 14 (29.2%) y en el grupo 2 n = 46 (47.9%); RR: 0.61 (IC 95%: 0.37-0.99; p = 0.03). Conclusiones: La suplementacion desde las 12-14 semanas de gestacion con mioinositol mas probioticos disminuye la incidencia de DMG en mujeres mexicanas. EnglishAim: To compare the incidence of gestational diabetes mellitus (GDM) in women with three or more risk factor to developing GDM supplemented with myo-inositol plus probiotics versus women care without supplementation. Methods: Retrospective cohort study, group 1, women with supplementation (myo-inositol 2g plus Bifidobacterium lactis and Lactobacillus rhamnosus 5x108 UFC, twice per day, from 12-14 to 28 weeks of gestation; group 2, women with prenatal care without supplementation, matched by age and body mass index (BMI). The primary outcome was the incidence of GDM using the International Association of Diabetes and Pregnancy Study Groups criteria. Results: Group 1 n=48, group 2 n=96. There were no significant baseline differences between groups in age, BMI and number of risk factors. The incidence of GDM in group 1 was n=14 (29.2%), and for group 2 n=46 (47.9%); RR: 0.61 (95% CI: 0.37-0.99; p = 0.03). Conclusions: Supplementation from 12-14 weeks of gestation with myo-inositol plus probiotics decrease the incidence of GDM in Mexican women.

Pregestational Diabetes Mellitus (PDM) during pregnancy constitutes an unfavorable embryonic and fetal development environment, with a high incidence of congenital malformations (CM). Neural tube defects are the second most common type of CM in children of diabetic mothers (CDM), who also have an elevated risk of developing neurodevelopmental disorders. The mechanisms that lead to these neuronal disorders in CDM are not yet fully understood. The present study aimed to know the effect of hyperglycemia on proliferation, neuronal differentiation percentage, and expression of neuronal differentiation mRNA markers in human umbilical cord Wharton's jelly mesenchymal stem cells (hUCWJMSC) of children from normoglycemic pregnancies (NGP) and PDM. We isolated and characterized hUCWJMSC by flow cytometry, immunofluorescence, RT-PCR and were induced to differentiate into adipocytes, osteocytes, and neurons. Proliferation assays were performed to determine the doubling time, and Nestin, TUBB3, FOXO1, KCNK2, LMO3, and MAP2 mRNA gene expression was assessed by semiquantitative RT-PCR. Hyperglycemia significantly decreased proliferation and neuronal differentiation percentage in NGP and PDM cells treated with 40 mM d-glucose. Nestin mRNA expression decreased under control glycemic conditions, while FOXO1, KCNK2, LMO3, and MAP2 mRNA expression increased during neuronal differentiation in both NGP and PDM cells. On the other hand, under hyperglycemic conditions, Nestin was significantly decreased in cells from NGP but not in cells from PDM, while mRNA expression of FOXO1 and LMO3 was significantly increased in cells from NGP, but not in cells from PDM. We found evidence that maternal PDM, with hyperglycemia in culture, affects the biological properties of fetal cells. All these results could be part of fetal programming.

GDM is a heterogeneous disease. Three subtypes of GDM have been identified, insulin sensitivity defect, insulin secretion defect, and both. Insulin sensitivity defect is associated with higher risk for fetal overgrowth and GDM associated adverse outcomes. Based on the 2hr-OGTT-75g values, the phenotype of GDM-sensitivity is associated with elevated fasting glucose and GDM-secretion by elevated one and/or two hours post-load glucose values. We evaluated the 2hr-OGTT-75g values of 1713 in Mexican pregnant women without previous diagnosis of T2D from the cohort study Cuido mi Embarazo between April 20 and December 2021. We identified 251 cases of GDM (14.6%) . Based on the distribution of 2hr-OGTT-75g values related to known GDM subtypes, 132 (52.6%) had elevated fasting glucose but normal post-load glucose values (GDM-sensitivity) , 90 (35.8%) had elevated post-load glucose but normal fasting glucose values (GDM-secretion) , and 29 (11.6%) patients with elevated fasting and post-load glucose values (GDM-mixed) . Women in the GDM-sensitivity group were younger (27.3 ± 6.5 yr) , nulliparous (56.1%) and more often had a family history of T2D (50.0%) compared to the women in the GDM-secretion and GDM-mixed groups. However, there was no statistical difference between the principal groups regarding pregestational BMI (GDM-sensitivity: 27.7 ± 5.5; GDM-secretion: 27.4 ± 4.4; GDM-mixed: 28.4 ± 6.2 kg/m2, p=0.90) ; although this last group showed the higher prevalence of obesity (29.4% - 23.3% - 38.0% respectively for each group) . To our knowledge, this is the first analysis of GDM subtypes in Mexican pregnant women. The high proportion of GDM diagnoses with normal fasting glucose supports the importance of unavoidably offering a complete OGTT. This strategic approach by classifying GDM subtypes according to OGTT values takes clinical importance in the offering of personalized and timely management care to minimize perinatal and newborn adverse outcomes. Disclosure H.Gallardo-rincón: None. N.Garcia-gonzalez: None. A.H.Perez-hernandez: None. B.Perez-romero: None. C.G.Granillo-ramirez: None. R.Tapia-conyer: None. J.Ortega-montiel: None. L.Martinez-juarez: None. J.Lomelin-gascon: None. A.Montoya: None. E.Reyes-muñoz: None. V.Galicia-hernandez: None. R.Avila-dominguez: None. L.V.Perez-torres: None. Funding Eli Lilly and Company

Polycystic ovary syndrome (PCOS) is an endocrine disease associated with infertility and metabolic disorders in reproductive-aged women. In this study, we evaluated the expression of eight genes related to endometrial function and their DNA methylation levels in the endometrium of PCOS patients and women without the disease (control group). In addition, eight of the PCOS patients underwent intervention with metformin (1500 mg/day) and a carbohydrate-controlled diet (type and quantity) for three months. Clinical and metabolic parameters were determined, and RT-qPCR and MeDIP-qPCR were used to evaluate gene expression and DNA methylation levels, respectively. Decreased expression levels of HOXA10, GAB1, and SLC2A4 genes and increased DNA methylation levels of the HOXA10 promoter were found in the endometrium of PCOS patients compared to controls. After metformin and nutritional intervention, some metabolic and clinical variables improved in PCOS patients. This intervention was associated with increased expression of HOXA10, ESR1, GAB1, and SLC2A4 genes and reduced DNA methylation levels of the HOXA10 promoter in the endometrium of PCOS women. Our preliminary findings suggest that metformin and a carbohydrate-controlled diet improve endometrial function in PCOS patients, partly by modulating DNA methylation of the HOXA10 gene promoter and the expression of genes implicated in endometrial receptivity and insulin signaling.

Breast cancer associated with pregnancy is defined as a malignant neoplasm of the breast that is diagnosed during pregnancy, breastfeeding or one year after delivery.To analyze perinatal outcomes in a series of young patients with breast cancer and pregnancy in a tertiary care hospital.Retrospective, analytical study of 26 women younger than 40 years of age with breast cancer who resolved their pregnancy at the National Institute of Perinatology between 2013 and 2018. Clinical-pathological characteristics, perinatal outcomes and family planning methods were studied. Percentages and central tendency measures were obtained, and comparisons were made with the chi-square test or Fisher's exact test.Association of breast cancer with pregnancy was observed in 0.26% of all births; mean age of presentation was 34 years, 38.4% of cases had cancer at advanced clinical stages and 57.1% of the women were treated with modified radical mastectomy; no trend towards higher perinatal complications was observed.Breast cancer associated with pregnancy implies an oncological challenge and does not appear to be a risk factor for adverse perinatal outcomes.El cáncer de mama asociado a embarazo se define como la neoplasia maligna de mama que se diagnostica durante el embarazo, la lactancia o un año después del parto.Analizar los resultados perinatales en una serie de pacientes jóvenes con cáncer de mama y embarazo en un hospital de tercer nivel.Estudio analítico retrospectivo de 26 mujeres menores de 40 años con cáncer de mama que resolvieron su embarazo en el Instituto Nacional de Perinatología entre 2013 y 2018. Se estudiaron las características clínico-patológicas, resultados perinatales y métodos de planificación familiar. Se obtuvieron porcentajes y medidas de tendencia central y se realizaron comparaciones con pruebas de chi cuadrada o exacta de Fisher.La asociación de cáncer de mama y embarazo se observó en 0.26 % de todos los nacimientos, la edad media de presentación fue de 34 años, 38.4 % de los casos cursaba con cáncer en estadio clínico avanzado y 57.1 % de las mujeres fueron tratadas con mastectomía radical modificada; no se apreció tendencia a mayores complicaciones perinatales.El cáncer de mama asociado a embarazo implica un reto oncológico y no parece ser un factor de riesgo para desenlaces perinatales adversos.

This study aims to understand the factors that can hinder Italian midwifery students' educational process, what messages are given to students during their clinical practice, and how students interact with tutors and other professionals. Seven hundred and eighty Italian students of midwifery were asked to answer an Internet-based questionnaire regarding their own opinions concerning their theoretical–practical formative path. For male Italian students, satisfaction is lower than female students as well as for students from Southern than Northern Italy. Students are dissatisfied with the quality of their academic and practical training, particularly regarding recognising their professional role and their relationship with tutors. Based on these data, it is essential to design a formative path for midwives that considers students' opinions and the positive experiences of other countries.Impact StatementWhat is already known on this subject? Several studies underscore the poor preparation of students for learning in clinical settings. The current reality of the Italian academic path in most universities disregards midwifery students' expectations and formative needs. What do the results of this study add? For male Italian students, satisfaction is lower than for female students and students from Southern than Northern Italy. Students are dissatisfied with the quality of their academic and practical training, particularly regarding recognising their professional role and their relationship with tutors. What are the implications of these findings for clinical practice and/or further research? It is essential to design a formative path for midwives that considers students' opinions and other countries' positive experiences.

The aim of this study was to examine the efficacy of intensive medical nutrition therapy (MNT) plus metformin in preventing gestational diabetes mellitus (GDM) among high-risk Mexican women. An open-label randomized clinical trial was conducted. Inclusion criteria were pregnant women with three or more GDM risk factors: Latino ethnic group, maternal age >35 years, body mass index >25 kg/m2, insulin resistance, and a history of previous GDM, prediabetes, a macrosomic neonate, polycystic ovarian syndrome, or a first-degree relative with type 2 diabetes. Women before 15 weeks of gestation were assigned to group 1 (n = 45): intensive MNT-plus metformin (850 mg twice/day) or group 2 (n = 45): intensive MNT without metformin. Intensive MNT included individual dietary counseling, with ≤50% of total energy from high carbohydrates. The primary outcome was the GDM incidence according to the International Association of Diabetes Pregnancy Study Groups criteria. There were no significant differences in baseline characteristics and adverse perinatal outcomes between the groups. The GDM incidence was n = 11 (24.4%) in the MNT plus metformin group versus n = 7 (15.5%) in the MNT without metformin group: p = 0.42 (RR: 1.57 [95% CI: 0.67–3.68]). There is no benefit in adding metformin to intensive MNT to prevent GDM among high-risk Mexican women. Clinical trials registration: NCT01675310.

An altered mitochondrial DNA copy number (mtDNAcn) at birth can be a marker of increased disease susceptibility later in life. Gestational exposure to acute stress, such as that derived from the earthquake experienced on 19 September 2017 in Mexico City, could be associated with changes in mtDNAcn at birth. Our study used data from the OBESO (Biochemical and Epigenetic Origins of Overweight and Obesity) perinatal cohort in Mexico City. We compared the mtDNAcn in the umbilical cord blood of 22 infants born before the earthquake, 24 infants whose mothers were pregnant at the time of the earthquake (exposed), and 37 who were conceived after the earthquake (post-earthquake). We quantified mtDNAcn by quantitative real-time polymerase chain reaction normalized with a nuclear gene. We used a linear model adjusted by maternal age, body mass index, socioeconomic status, perceived stress, and pregnancy comorbidities. Compared to non-exposed newborns (mean ± SD mtDNAcn: 0.740 ± 0.161), exposed and post-earthquake newborns (mtDNAcn: 0.899 ± 0.156 and 0.995 ± 0.169, respectively) had increased mtDNAcn, p = 0.001. The findings of this study point at mtDNAcn as a potential biological marker of acute stress and suggest that experiencing an earthquake during pregnancy or before gestation can have programing effects in the unborn child. Long-term follow-up of newborns to women who experience stress prenatally, particularly that derived from a natural disaster, is warranted.

Introduction and Objective: The weight gained during pregnancy could determine the immediate and future health of the mother-child dyad. Excessive gestational weight gain (EGWG) due to abnormal adipose tissue (AT) accumulation is strongly associated with adverse perinatal outcomes as gestational diabetes, macrosomia, obesity, and hypertension further in life. Dysregulation of adipokine, AT dysfunction, and an imbalance in the prooxidant-antioxidant systems are critical features in altered AT accumulation. This study was aimed to investigate the association between adipokines and oxidative stress markers in pregnant women and the influence of the GWG on this association. Methods: Maternal blood samples were obtained in the third trimester of pregnancy (n = 74) and serum adipokines (adiponectin, leptin, and resistin), oxidative damage markers: 8-oxo-2′-deoxyguanosine (8-oxodG), lipohydroperoxides (LOOH), malondialdehyde (MDA), and carbonylated proteins (CP), and glucose a metabolic marker were measured. Results: Women with EGWG had low adiponectin levels than women with adequate weight gain (AWG) or insufficient weight gain (IWG). Multiple linear regression models revealed a positive association between adiponectin and 8-oxodG in women with AWG (B = 1.09, 95% CI: 164–222, p = 0.027) and IWG (B = 0.860, 95% CI: 0.199–1.52, p = 0.013) but not in women with EGWG. In women with EGWG, leptin was positively associated with LOOH (p = 0.018), MDA (p = 0.005), and CP (p = 0.010) oxidative markers. Conclusion: Our findings suggest that concurrent mechanisms regulate adipokine production and oxidative stress in pregnant women and that this regulation is influenced by GWG, probably due to an excessive AT accumulation.

Nayeli Martínez-Cruz,1 Agnese Maria Chiara Rapisarda,2 Karla Patricia Soriano-Ortega,3 Lidia Arce-Sánchez,1 Antonio Cianci,2 Carlos Ortega-Gonzalez,1 Ursula Torres-Herrera,1 Salvador Espino-Y-Sosa,3 Guadalupe Estrada-Gutierrez,4 Araceli Montoya-Estrada,5 José Romo-Yañez,5 Enrique Reyes-Muñoz5 1Department of Endocrinology, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México; 2Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy; 3Division of Clinical Research, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México; 4Direction of Research, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México; 5Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, MéxicoCorrespondence: Enrique Reyes-MuñozDepartment of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800 Lomas Virreyes, Miguel, Hidalgo 11000, Mexico CityMexicoTel +52 5555209900 Ext 307Email dr.enriquereyes@gmail.comPurpose: To compare the risk of adverse perinatal outcomes (APO) between pregnant women with mild gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, on no specific treatment, versus pregnant women without GDM.Patients and Methods: A retrospective cohort study of pregnant women referred to the Instituto Nacional de Perinatología, in Mexico City, for prenatal care and delivery. Eligibility criteria were singleton pregnancy, age >18 years, gestational age 20–28 weeks, and no history of pre-gestational diabetes. The study population was divided into two groups: Group 1, comprising women with mild GDM defined by one abnormal glucose value at the oral glucose tolerance test (OGTT) according to IADPSG criteria [fasting: 5.1–5.2 mmol/L (92–94 mg/dL) or 2h 8.5–8.56 mmol/L (153–154 mg/dL)], who did not receive specific treatment for GDM, and Group 2, comprising women without GDM, matched for maternal age and pre-gestational body mass index (BMI). Women with two or more abnormal OGTT values, pre-gestational diabetes, any chronic disease, or multiple pregnancies were excluded.Results: As many as 282 women were included in each group. There were no significant differences in basal characteristics between groups. APO analysis showed that newborn weight was significantly higher in Group 1 (3042.4±499g) vs Group 2 (2910±565g) p=0.003; conversely, the incidence of large for gestational age (LGA) and macrosomic neonates was similar in both groups (6 vs 5.7% and 2.1 vs 2.2%, respectively). There were no differences in rates of preeclampsia and gestational hypertension, cesarean and preterm delivery, or premature rupture of membranes. A sub-analysis by maternal pre-gestational BMI showed that LGA incidence was significantly higher among babies born to women with pre-gestational BMI ≥30 kg/m2 in both groups.Conclusion: The risk of APO was similar among Mexican women with mild untreated GDM diagnosed by IADPSG criteria, compared to pregnant women without GDM. Pre-gestational BMI was an independent risk factor for LGA.Keywords: gestational diabetes, large for gestational age, IADPSG, hyperglycemia, pregnancy &nbsp

Polycystic ovary syndrome (PCOS) is the leading endocrine and metabolic disorder in premenopausal women characterized by hyperandrogenism and abnormal development of ovarian follicles. To date, the PCOS etiology remains unclear and has been related to insulin resistance, obesity, type 2 diabetes mellitus, cardiovascular disease and infertility, among other morbidities. Substantial evidence illustrates the impact of genetic, intrauterine and environmental factors on the PCOS etiology. Lately, epigenetic factors have garnered considerable attention in the pathogenesis of PCOS considering that changes in the content of DNA methylation, histone acetylation and noncoding RNAs have been reported in various tissues of women with this disease. DNA methylation is changed in the peripheral and umbilical cord blood, as well as in ovarian and adipose tissue of women with PCOS, suggesting the involvement of this epigenetic modification in the pathogenesis of the disease. Perhaps, these defects in DNA methylation promote the deregulation of genes involved in inflammation, hormone synthesis and signaling and glucose and lipid metabolism. Research on the role of DNA methylation in the pathogenesis of PCOS is just beginning, and several issues await investigation. This review aims to provide an overview of current research focused on DNA methylation and PCOS, as well as discuss the perspectives regarding this topic.

Background: Vitamin E has antioxidant properties, which help in scavenging free radicals, thereby reducing oxidation of lipids and proteins. This study aims to evaluate the efficacy of oral vitamin E supplementation in preventing retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants with respiratory distress syndrome (RDS) and decreasing oxidative stress 15 and 28 days post-intervention. Methods: Ninety VLBW infants were randomly assigned to two groups: 1. Treatment (treatment group (T), n = 48) or 2. Placebo (control group (C), n = 42). Each group received 25 IU of vitamin E (T) or placebo (C). Results: The incidence of ROP in groups T and C was 12.5% (n=6) and 31% (n = 13), respectively (RR: 0.40; 95% CI: 0.10–0.96). There were no differences in mortality between groups. As expected, the vitamin E concentration was significantly increased 28 days post-intervention in group T. Conclusion: Oral supplementation with vitamin E may effectively prevent ROP development in VLBW infants with RDS. Oxidative damage markers were significantly lower, whereas total antioxidant capacity was increased in group T. However, levels of other antioxidants as vitamin A and C were not measured in two groups.

The COVID-19 lockdown represents a new challenge for mental health researchers and clinical practitioners. This cross-sectional study aimed to investigate the prevalence of depression, anxiety, and perceived stress in postpartum Mexican women. The study included 293, 4–12-week postpartum women over the age of 18. The Edinburgh Postpartum Depression Scale (EPDS), Trait-State Trait Anxiety Inventory (T-STAI), and Ten Perceived Stress Scale (PSS-10), which are all questionnaires validated for the Mexican population, were applied using a web-based online survey. Prevalence and 95% confidence intervals (CIs) were calculated. The mean ± standard deviation (SD) of the maternal age was 29.9 ± 6.3 years, the EPDS score: 11 ± 6, T-STAI score: 41.7 ± 12.3, and PSS-10 score: 17.1 ± 7. The prevalence (95% CI) of the postpartum depression symptoms was 39.2% (34–45%), trait anxiety symptoms were found among 46.1% (32–43%) of the participants, and moderate and high perceived stress were in 58% (52–64) and 10.9% (7.8–15) of the participants, respectively. The prevalence of depressive symptoms, generalized anxiety, and perceived stress was higher among postpartum Mexican women during the COVID-19 outbreak than before the lockdown. Our findings highlight the importance of monitoring perinatal mental health during pandemics and the need to design effective psychologic interventions for these patients.

The primary aim of this study was to compare the prevalence of subclinical hypothyroidism (SCH) using two different cut-off levels for TSH values (≥2.5 mIU/L versus ≥4.1 mIU/L). The secondary objective was to analyze the clinical-biochemical characteristics in women with and without SCH. This was a retrospective cross-sectional study. In total, 1496 Mexican women with infertility were included: Group 1, women with TSH levels ranging between 0.3 and 2.49 mIU/L, n = 886, Group 2, women with TSH between 2.5 and 4.09 mIU/L, n = 390, and Group 3, women with TSH ≥4.1 mIU/L n = 220. SCH prevalence was 40.7% (CI 95%: 38.3–43.3%) with TSH cut-off ≥ 2.5 mIU/L, and 14.7% (CI 95%: 12.7–16.5%) with TSH cut-off ≥ 4.1 mIU/L, (p = 0.0001). The prevalence of overweight was higher in Group 2 than in Groups 1 and 3. Thyroid autoimmunity, obesity and insulin resistance were higher in Group 3 than in Group 1 (p &lt, 0.05). No other differences were observed between groups. Conclusions: The prevalence of SCH in our selected patients increased almost three times using a TSH cut-off ≥ 2.5 mIU/L compared with a TSH cut-off ≥ 4.1 mIU/L. Women with TSH ≥4.1 mIU/L compared with TSH cut-off ≤ 2.5 mIU/L more often presented with obesity, thyroid autoimmunity and insulin resistance.

Background and objectives: Thyroid autoimmunity (TAI) has been associated with a significantly increased risk of miscarriage in women with recurrent pregnancy loss (RPL). The aim of this study was to determine the prevalence of TAI in women with RPL and compare the clinical characteristics of positive and negative TAI women. Materials and Methods: This is a retrospective cross-sectional study, 203 women with RPL were included. Thyroid profile, anti-thyroid peroxidase (TPO-Ab), and anti-thyroglobulin (TG-Ab) antibodies were measured in all participants. Clinical characteristics and causes of RPL were compared between positive and negative TAI. Results: Prevalence of TAI was 14.8%, prevalence of positive TPO-Ab and TG-Ab was 12.3% and 4.9%, respectively. Women with TAI had significantly higher concentrations of thyrotropin (TSH) compared to women without TAI (4.8 &plusmn, 3.8 versus 3.1 &plusmn, 1.1, p = 0.001). There was no significant difference in age, the number of gestations, miscarriages, state of antiphospholipid antibodies (aPL), or causes of RPL between women that were TAI-positive versus TAI-negative. Prevalence of positive TAI by cause of RPL was: endocrine 7/25 (28%), genetic 1/5 (20%), autoimmune 1/5 (20%), anatomic 8/55 (14.5%), and unexplained cause 13/112 (11.6%). Conclusions: The prevalence of TAI in women with RPL is 14.8%. Women with an endocrine cause have the highest prevalence of TAI.