Apoyo social percibido por mujeres gestantes de Santa Marta, Colombia: un análisis comparativo / Social support perceived by pregnant women in Santa Marta, Colombia: A comparative analysis / Apoio social percebido por gestantes de Santa Marta, Colômbia: uma análise comparativa

Introducción: El apoyo social percibido durante la gestación es importante para la salud mental perinatal. Sin embargo, poco se conoce sobre estas variables en la población colombiana.Objetivo: Comparar el apoyo social percibido según variables sociodemográficas, ginecobstétricas y afecto positivo en mujeres gestantes de Santa Marta, Colombia. Materiales y métodos: Participaron 40 mujeres entre 19 y 41 años (M=26.48; DE=5.03), que se encontraban en su tercer trimestre de embarazo, beneficiarias de un programa de promoción de la lactancia materna exclusiva. Las participantes diligenciaron una ficha de información sociodemográfica y ginecobstétrica, la Escala Multidimensional de Apoyo Social Percibido (α=0.88) y una subescala de la Escala de Afectos Positivos y Negativos (α=0.82). Se aplicó la prueba U de Mann-Whitney para los análisis estadísticos comparativos y se siguieron los lineamientos éticos en investigación con humanos. Resultados: 67% de las participantes fueron de estrato socioeconómico bajo, 87.5% tenía pareja, 67.5% contaba con estudios superiores, 42.5% tenía trabajo y 47.5% eran madres primerizas. Las mujeres de estrato socioeconómico alto percibieron mayor apoyo social por parte de sus amigos (p=0.01). El apoyo social familiar fue significativamente más alto en las madres primerizas (p=0.01) y en las que reportaron mayor afecto positivo (p=0.03). Por último, el apoyo social por parte de personas significativas fue mayor cuando era el primer embarazo de la mujer (p=0.02). Conclusión: Se encontraron diferencias significativas en algunas dimensiones del apoyo social percibido según el estrato socioeconómico, ser madre primeriza y el afecto positivo. Se recomienda realizar otros estudios con mayor tamaño muestral.

Introduction: Perceived social support during gestation is important for perinatal mental health. However, little is known about these variables in the Colombian population. Objetive: To compare perceived social support with sociodemographic and gynaeco-obstetric variables and positive affect in pregnant women in Santa Marta, Colombia. Materials and Methods: Forty women between 19 and 41 years of age (M=26.48; SD=5.03), in their third trimester of pregnancy and beneficiaries of a program to promote exclusive breastfeeding, participated. The participants filled out a sociodemographic and gynaeco-obstetric form, the Multidimensional Scale of Perceived Social Support (MSPSS) (α=0.88), and a subscale of the Positive and Negative Affect Schedule (PANAS) (α=0.82). The Mann-Whitney U test was used for comparative statistical analyses. Ethical guidelines for human research were followed. Results: 67% of the participants belonged to a low socioeconomic status, 87.5% had a partner, 67.5% had a higher education, 42.5% were employed, and 47.5% were new mothers. Women of higher socioeconomic status perceived greater social support from their friends (p = 0.01). Family social support was significantly higher in first-time mothers (p=0.01) and mothers who reported higher positive affect (p = 0.03). Finally, social support from significant others was higher when it was the woman's first pregnancy (p=0.02). Conclusions: Significant differences were found in some dimensions of perceived social support according to socioeconomic status, being a first-time mother, and positive affect. Further studies with larger sample sizes are recommended.

Introdução: O apoio social percebido durante a gravidez é importante para a saúde mental perinatal. No entanto, pouco se sabe sobre essas variáveis na população colombiana. Objetivo: Comparar o apoio social percebido segundo variáveis sociodemográficas, ginecológicas e de afeto positivo em gestantes de Santa Marta, Colômbia. Materiais e Métodos: Participaram 40 mulheres entre 19 e 41 anos (M=26,48; DP=5,03), que estavam no terceiro trimestre de gestação, beneficiárias de um programa de promoção do aleitamento materno exclusivo. As participantes preencheram uma ficha sociodemográfica e ginecológica, a Escala Multidimensional de Suporte Social Percebido (α=0,88) e uma subescala da Escala de Afetos Positivos e Negativos (α=0,82). O teste U de Mann-Whitney foi aplicado para análise estatística comparativa e foram seguidas as diretrizes éticas para pesquisa em humanos. Resultados: 67% das participantes eram de baixo nível socioeconômico, 87,5% tinham companheiro, 67,5% tinham ensino superior, 42,5% trabalhavam e 47,5% eram mães de primeira viagem. As mulheres de nível socioeconômico alto perceberam maior apoio social dos amigos (p=0,01). O apoio social familiar foi significativamente maior nas novas mães (p=0,01) e naquelas que relataram maior afeto positivo (p=0,03). Por fim, o apoio social de pessoas significativas foi maior quando se tratava da primeira gravidez da mulher (p=0,02). Conclusões: Foram encontradas diferenças significativas em algumas dimensões do suporte social percebido de acordo com o nível socioeconômico, ser mãe de primeira viagem e afeto positivo. Outros estudos com tamanho amostral maior são recomendados.

Referencias locales de valores de variables biométricas fetales por trimestre de gestación / Local references of values of fetal biometric variables in each trimester of pregnancy

RESUMEN Introducción: Las tablas de crecimiento y la ecografía de rutina son el estándar de oro para valorar adecuadamente al feto. Se consideran óptimas y adecuadas las tablas de biometría fetal que se crean con datos propios de cada población con el fin de usarlas como referencia, para identificar oportunamente malformaciones, o desviaciones del crecimiento. Objetivo: Identificar desviaciones de la norma de incremento en variables biométricas: diámetro biparietal, circunferencia cefálica, circunferencia abdominal y longitud del fémur. Métodos: Se realizó una investigación con diseño analítico longitudinal retrospectivo en la provincia Villa Clara, en el período comprendido entre enero de 2013 a diciembre de 2017. La población de estudio estuvo conformada por 6050 gestantes. La selección de la muestra se realizó a través de un muestreo no probabilístico intencional por criterios y quedó constituida por 3910 gestantes. Se obtuvieron datos de libros de registros de consultas de genética de áreas de salud seleccionadas. Se utilizaron medidas de resumen para variables cuantitativas, medias y percentiles (10, 50 y 90). Resultados: En el diámetro biparietal, la circunferencia cefálica y longitud del fémur, los valores reales obtenidos fueron inferiores a Hadlock en la mayoría de las semanas; la circunferencia abdominal cambió el comportamiento que llevaban las variables, ya que en esta predominaron los valores superiores entre los reales obtenidos, sobre todo en el percentil 10. Conclusiones: Los percentiles bajos de todas las variables en las primeras semanas, presentaron valores superiores a los de la tabla de Hadlock, pero en la circunferencia abdominal fetal, la muestra local tiene valores superiores mayoritarios a través de las semanas.

ABSTRACT Introduction: growth charts and routine ultrasound are the gold standard to adequately assess the fetus. Fetal biometry tables, created with data from each population, are considered optimal and appropriate in order to use them as a reference and to timely identify malformations or growth deviations. Objective: to identify deviations from the increase norm in the following biometric variables: biparietal diameter, head circumference, abdominal circumference and femur length. Methods: a retrospective, longitudinal and analytical study was conducted in Villa Clara province between January 2013 and December 2017. The study population consisted of 6050 pregnant women. The selection of the sample was carried out through an intentional non-probabilistic sampling and was made up of 3910 pregnant women who meet the criteria established for the study. Data were obtained from genetic consultation record books from selected health areas. Summary measures were used for quantitative variables, means and percentiles (10, 50 and 90). Results: the real values obtained in the biparietal diameter, head circumference and femur length were lower than Hadlock in most weeks; abdominal circumference changed the behavior of the variables, since in this the superior values prevailed between the real ones obtained, mainly in the10th percentile. Conclusions: low percentiles of all variables in the first weeks had higher values than those of the Hadlock table, but in the fetal abdominal circumference, the local sample had higher values throughout the weeks.

Prevalence of bacterial vaginosis in pregnant women attending Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria using the complete Amsel's diagnostic criteria

Background: Bacterial vaginosis (BV) in pregnant women remains a cause for clinical concern among clinicians and health care professionals. BV has been linked to prenatal, antenatal and postnatal challenges in pregnant women. Information on prevalence of BV across trimesters of pregnancy is expected to give better clinical insight into the pathophysiology of this polymicrobial disorder. This study was conducted to determine the prevalence of BV in pregnant women attending the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. Methodology: This was a cross-sectional study of 120 pregnant women (40 in each trimester of pregnancy) who had symptoms suggestive of BV, selected by systematic random sampling from among the women attending the Obstetrics and Gynaecology (O & G) clinic of NAUTH, Nnewi. Each subject participant was examined by the attending clinician, and high vaginal swab (HVS) sample was collected for diagnostic analysis of BV using with complete Amsel's clinical criteria, which consists of three of the four criteria; (i) adherent and homogenous vaginal discharge, (ii) vaginal pH > 4.5, (iii) detection of clue cells on saline wet mount, and (iv) amine odor after the addition of potassium hydroxide (positive Whiff test). Results: The mean age of the 120 selected participants was 27.25±6.09 years. The age groups 25-29 (36.7%) and 20-24 years (33.3%) constituted the largest proportion, while age groups <20 (5.0%) and 40-45 years (5.0%) constituted the least. Of the 120 participants, 26 (21.7%) were positive for BV by the Amsel's criteria. Pregnant women in age group <20 years had the highest prevalence of BV (100%, 6/6), followed by those in the age groups 20-24 (27.5%), 40-45 (16.7%), 25-29 (15.9%), 30-34 (9.1%) and 35-39 years (0%) (X 2=28.063, p=0.0001). Prevalence of BV was significantly higher in single (unmarried) pregnant women (45.5%, X 2=4.038, p=0.045), women with primary school education level (66.7%, X 2=14.530, p=0.001), unemployed women (36.1%, X 2=13.278, p=0.0013), and nulliparous women [36.4%, X 2 (for trend) = 4.805, p=0.0274), while there was no significant difference in the prevalence of BV with relation to trimester of pregnancy (X 2=2.750, p=0.253). Conclusion: This study reveals a relatively high prevalence of BV and significant association with factors such as age group, education and occupational status among pregnant women attending NAUTH Nnewi. Regular screening of women for BV prenatally may enable appropriate interventions to prevent adverse pregnancy outcomes

Somnolencia diurna excesiva identificada con la escala de Epworth en gestantes que acuden a consulta prenatal ambulatoria / Excessive daytime sleepiness identified with the Epworth scale in pregnant women attending an outpatient prenatal consultation

INTRODUCCIÓN: Durante el embarazo se reportan a menudo trastornos del sueño, pero son poco explorados en el control prenatal. El objetivo fue estimar la frecuencia e identificar los factores asociados a somnolencia diurna excesiva (SDE) en gestantes de bajo riesgo obstétrico que acudieron a consulta prenatal. MÉTODO: Estudio transversal dentro del proyecto «Salud biopsicosocial en gestantes», aprobado por el comité de ética de la Clínica Santa Cruz de Bocagrande, Cartagena, Colombia. Se estudiaron mujeres con 12 o más semanas de gestación. Se aplicó un formulario que incluía las escalas de somnolencia diurna de Epworth (ESE), de estrés percibido de 10 ítems (EPP-10) y revisada de depresión del Centro de Estudios Epidemiológicos (CESD-R10). Se realizó regresión logística ajustada y no ajustada de SDE con las otras escalas y variables cualitativas. Se buscó correlación entre variables cuantitativas y la escala de Epworth. Se consideró significativo p < 0,05. RESULTADOS: Se estudiaron 683 mujeres de 28,3 ± 6,3 años y 31,5 ± 6,9 semanas de gestación. Puntuación en la escala de Epworth: 3,82 ± 3,45. En el 4,9% se identificó SDE: 50% leve, 32,2% moderada y 17,6% importante. No se observó en el primer trimestre de gestación y la frecuencia fue similar en los otros; la SDE importante solo se observó en el tercer trimestre. Depresión: odds ratio [OR]: 3,69, intervalo de confianza del 95% [IC95%]:1,83-7,43. Anemia: OR 3,10, IC95%:1,50-6,38. Fatiga: OR 3,22, IC95%:1,23-8,44. Nerviosismo: OR 2,49, IC95%:1,22-5,12. Estrés: OR: 2,38, IC95%:1,12-5,05. Gran paridad: OR: 2,64, IC95%: 1,01-6,89. Trabajar fuera de casa: OR: 2,33, IC95%: 1,05-5,15. Todas estas variables se asociaron con SDE. En el modelo ajustado, la anemia (OR: 3,05, IC95%: 1,44-6,45) y la depresión (OR: 2,72, IC95%: 1,26-5,85) conservaron la asociación. Se observó correlación positiva, despreciable y estadísticamente significativa, de la ESE con la CESD-R10 y con la EPP-10; y ausencia de correlación con la edad materna, la edad gestacional, el número de abortos y el número de cesáreas. CONCLUSIONES: En una de cada 20 gestantes de bajo riesgo obstétrico se identificó SDE, y varias situaciones biopsicosociales se asociaron con mayor presencia.

INTRODUCTION: Sleep disturbances are constantly reported during pregnancy, although they are not often taken care of in prenatal care. The aim was to estimate the regularity and identify factors associated with excessive daytime sleepiness (EDS) in pregnant women at low obstetric risk who attended prenatal consultation. METHOD: Cross-sectional study belonging to the project “Biopsychosocial health in pregnant women”, approved by the ethics committee of the Santa Cruz de Bocagrande Clinic, Cartagena, Colombia. Pregnant women with 12 or more weeks of gestation were studied. A form including: Epworth Daytime Sleepiness Scale, 10-item Perceived Stress and the Revised Depression Scale of the Centre for Epidemiological Studies was applied. Adjusted and unadjusted logistic regression was performed between EDS with the other scales and qualitative variables. In addition, correlation between quantitative variables and the Epworth scale. P<0.05 was significant. RESULTS: 683 pregnant women were studied, maternal age 28.3 ± 6.3 years and gestational age 31.5±6.9 weeks. Epworth Scale score: 3.82 ± 3.45. EDS was identified in 4.9%, 50% mild, 32.2% moderate and 17.6% severe. It was not observed in the first gestational trimester and the frequency was similar in the others, severe EDS only in the third trimester. Depression OR: 3.69 [95% CI: 1.83-7.43], anemia OR: 3.10 [95% CI: 1.50-6.38], fatigue OR: 3.22 [95% CI: 1.23-8.44], nervousness OR: 2.49 [95% CI: 1.22-5.12, stress OR: 2.38 [95% CI: 1.12-5.05], high parity OR: 2.64 [95% CI: 1.01-6.89] and working outside the home OR: 2.33 [95% CI: 1.05-5.15, were associated with EDS. In the adjusted model, anemia OR: 3.05 [95% CI: 1.44-6.45] and depression OR: 2.72 [95% CI: 1.26-5.85] retained the association. CONCLUSIONS: In one out of every twenty low obstetric risk pregnant women EDS was identified and several biopsychosocial situations were associated with more presence.

Validez de contenido de lineamientos de ejercicio físico para mujeres embarazadas / Content validity of guidelines for physical exercise for pregnant

Objetivo: determinar la validez de contenido del procedimiento ejercicio físico para mujeres embarazadas 2018. La prescripción del ejercicio físico en mujeres embarazadas es una de las actividades que mayores beneficios fisiológicos y psicosociales trae a la mujer y al niño. Materiales y métodos: estudio descriptivo. Valoración de contenido con la técnica de juicio de expertos. Resultados: se obtuvo un valor promedio de coeficientes kappa para la dimensión de examen de 0,64 y para la dimensión de intervención de 0,75. El índice kappa para el instrumento fue de 0,69 (acuerdo sustancial).Adicionalmente, para la dimensión de examen fisioterapéutico se obtuvieron valores de proporción de acuerdo medio (̅P a) que superan el umbral de concordancia sustancial, excepto la propiedad de claridad. En la dimensión de intervención los valores de (̅Pa) indican que todas las propiedades de la intervención fisioterapéutica superan el umbral de concordancia sustancial. Conclusiones: el ejercicio físico es una práctica fundamental durante el embarazo, su aplicación requiere de un examen riguroso que conlleve a una intervención individualizada donde se reconozcan los antecedentes de la mujer para así determinar la intensidad adecuada de la prescripción. A partir del procedimiento "lineamientos de ejercicio físico en mujeres embarazadas" los profesionales contarán con una herramienta basada en evidencia científica que incluye una fase de examen y una fase de intervención..Au

Objective: to determine the content validity of the procedure guidelines for physical exercise for pregnant women 2018. Prescribing physical exercise in pregnant women is one of the recommendations that brings the greatest physiological and psychosocial benefits to women and children. Materials and methods: descriptive study. Content validity with expert judgment technique. Results: an average value of kappa coefficients was obtained for the examination dimension of 0.64 and for the intervention dimension of 0.75. The Kappa index for the instrument was 0.69 (substantial agreement). Additionally, for the physiotherapeutic examination dimension, mean agreement ratio (̅P a) values were obtained that exceed the threshold of substantial agreement except the property of clarity. In the intervention dimension, the values of (̅Pa) indicate that all the properties of the physiotherapeutic intervention exceed the threshold of substantial agreement. Conclusions: physical exercise is a fundamental practice during pregnancy, its application requires a rigorous examination that leads to an individualized intervention where the woman's history is recognized in order to determine the appropriate intensity of the prescription. Starting with the procedure "Guidelines for physical exercise in pregnant women", professionals will have a tool based on scientific evidence that includes an examination phase and an intervention phase..Au

Effects of gestational weight gain at different stages on pregnancy complications / 中华围产医学杂志

Objective:To investigate the effects of gestational weight gain (GWG) at different stages on pregnancy complications such as preeclampsia, gestational hypertension, gestational diabetes mellitus(GDM), small for gestational age (SGA), and large for gestational age (LGA).Methods:This was a prospective longitudinal cohort study. Singleton pregnancies at 11-13 +6 weeks of gestation in the Affiliated Drum Tower Hospital, Medical School of Nanjing University from January 2017 to November 2019 were recruited. The maternal height, weight, blood pressure, and fetal ultrasonic parameters were measured at 19-23 +6, 29-34 +6, and 35-40 +6 weeks of gestation by face-to-face interview and the pregnancy outcomes were followed up. All participants were grouped by body mass index (BMI) in the first trimester, with <18.50 kg/m 2 as underweight group, 18.50-23.99 kg/m 2 as normal group, ≥24.00 kg/m 2 as overweight/obesity group. Chi-square test and rank-sum test were adopted for comparison among groups. Weekly weight gain was converted into Z scores, and insufficient, appropriate, and excessive weight gain were respectively defined when Z<-1, -1≤ Z≤1, and Z>1. The effect of weekly weight gain at different gestational trimesters on pregnancy complications was analyzed by binary logistic regression. Results:Totally, 4 143 pregnant women entered the cohort. After excluding 327 cases, 3 816 were finally included in the analysis, with 394 in underweight group, 2 668 in normal group, and 754 in overweight/obesity group. Excessive weekly weight gain in the early second trimester was a risk factor for LGA( aOR=1.78, 95% CI:1.31-2.42, P<0.001), and in the later second trimester it was associated with preterm preeclampsia ( aOR=3.00, 95% CI: 1.26-7.10, P=0.013), gestational hypertension ( aOR=2.38, 95% CI: 1.44-3.94, P=0.001), and LGA ( aOR=1.59, 95% CI: 1.15-2.22, P=0.005). In the third trimester, excessive weekly weight gain was associated with higher risks of term preeclampsia ( aOR=2.70, 95% CI: 1.61-4.54, P<0.001) and gestational hypertension ( aOR=1.84, 95% CI: 1.05-3.21, P=0.033); while insufficient weekly weight gain was a risk factor for SGA ( aOR=1.58, 95% CI: 1.01-2.48, P=0.045), but a protective factor for term preeclampsia ( aOR=0.37, 95% CI: 0.14-0.97, P=0.041). Insufficient and excessive weekly weight gain in the early second trimester were not related to GDM (both P>0.05). Conclusions:GWG at different stages has different effects on pregnancy complications. A more relaxed control of GWG in the early second trimester combined with strict control in both the later second trimester and the third trimester may be a reasonable strategy to reduce the risk of preeclampsia without increasing the risk of SGA.

Litíase urinária e gestação / Urolithiasis and pregnancy

A litíase urinária é frequentemente diagnosticada durante a gestação. O diagnóstico de nefrolitíase assintomática durante a gestação não requer medidas adicionais, apenas o seguimento do pré-natal normal. Contudo, quando ocorre cólica renal ou complicações decorrentes da litíase urinária, medidas adicionais tornam-se necessárias. Nestes eventos, mais comuns nos últimos meses de gestação, há particularidades relacionadas ao quadro clínico, diagnóstico e tratamento específicos para esta população de pacientes. O presente artigo tem como objetivo revisar estes aspectos de litíase urinária na gestação à luz do conhecimento atual e da experiência pessoal dos autores.

The diagnosis of urolithiasis during pregnancy is common, even though no additional measures are required in asymptomatic cases. Renal colic or complications of urinary lithiasis occur more frequently during the last months of pregnancy, and there are several particularities for the diagnosis and treatment of this subset of women. The present manuscript aim to review the current knowledge concerning this subject and present authors personal experience.

Relationship between fasting plasma glucose in middle and last trimester and gestational diabetes mellitus:analysis of 18 851 cases / 中华围产医学杂志

Objective To explore the feasibility of excluding oral 75 g glucose tolerance test (OGTT)in pregnant women with fasting plasma glucose (FPG) ＜4.4 mmol/L in middle and late trimester.Methods From February 1,2012 to August 31,2013,18 851 pregnant women without pre-gestational diabetes mellitus who received 75 g OGTT in Maternal and Child Health Hospital of Hubei Province,China,at 24-28 weeks of gestation were enrolled.The criteria for gestational diabetes mellitus (GDM) were FPG ＞5.1 mmol/L and/or 1 h plasma glucose ＞10.0 mmol/L and/or 2 h plasma glucose ＞8.5 mmol/L in OGTT.The values of FPG in predicting GDM were analyzed with receiver operating characteristic (ROC) curve.The differences of detection rates for GDM among women of different ages,women with different FPG levels,and those with or without risk factors of GDM were compared by x2 test and Fisher's exact test.Results The overall detection rate of GDM was 9.11％(1 718/18 851).The detection rate of GDM was lower in women aged ＜ 25 years than women aged 25-,30-and ≥ 35 years [4.77％ (137/2 875) vs 7.76％ (803/10 350),12.43％ (552/4 440)and 19.06％ (226/1 186),respectively,x2=30.53,120.24 and 210.66,all P＜0.01].The sensitivity and specificity were 55％ and 68％,respectively,when the cutoff value of FPG was 4.4 mmol/L,and the Youden index was 0.23 and the area under the ROC curve was 0.61 (95％CI:0.59-0.63,P＜0.01).The sensitivity and specificity were 40％ and 80％,respectively,when the cutoff value was 4.5 mmol/L,and the Youden index was 0.20 and the area under the ROC curve was 0.61 (95％CI:0.59-0.63,P＜0.01).The missed diagnosis rate was lower when the cutoff point of FPG was defined as 4.4 mmol/L.The detection rate for GDM was 3.45％ (384/11 121) in women with FPG ＜4.4 mmol/L,significantly lower than in those with FPG ≥ 4.4 but ＜5.1 mmol/L and ≥ 5.1 mmol/L [8.06％ (561/6 957) and 100.00％ (773/773),x2=183.66 and 7 672.08,all P＜0.01].When FPG was ＜4.4 mmol/L or ≥ 4.4 but ＜5.1 mmol/L,the detection rate for GDM was significantly higher in women with GDM risk factors than in those without [5.09％ (118/2 318) and 10.75％ (184/1 712) vs 3.02％ (266/8 803) and 7.19％ (377/5 245),x2=23.56 and 22.06,P＜0.01].Conclusion OGTT may not be included in GDM screening in the pregnant women with FPG＜4.4 mmol/L and without GDM risk factors in the areas lack of medical resources.