Interacción social: Experiencias de mujeres positivas a COVID-19 con riesgo perinatal / Social Interaction: The experiences of COVID-19 positive women with perinatal risk

Resumen La pandemia COVID-19 provocó cambios en la dinámica de la vida de las mujeres en etapa perinatal quienes, ante la crisis sanitaria reconfiguraron prácticas de cuidado y convivencia social. El objetivo fue conocer a través de la interacción social algunas experiencias de mujeres con embarazo de alto riesgo positivas a COVID-19. El trabajo se realizó en un hospital de tercer nivel de atención perinatal. Se empleó metodología cualitativa, se aplicaron cuestionarios y entrevistas a 14 mujeres positivas a COVID-19 en etapa perinatal vía zoom. Se realizó análisis crítico-interpretativo del discurso con base al concepto interacción social y el pensamiento complejo. Para los resultados se desarrollaron tres tipos de interacción social: a) Interacción social primaria: Experiencias ante la notificación de la positividad al COVID-19; b) Interacción social aprendida: Experiencias del cuidado ante el COVID-19; y c) Interacción social resiliente: Experiencias necesarias ante el COVID-19. El vínculo de las experiencias desemboca en nuevas formas de interacciones sociales que van desde la notificación pasando por el cuidado y la resiliencia. Concluimos que las experiencias por el COVID-19 vividas por mujeres en etapa perinatal reinventaron sus modos de convivencia y cuidado dentro de lo institucional, familiar y personal.

Abstract The COVID-19 pandemic induced changes in the dynamics of the life of women in the perinatal phase who, due to the health crisis, restructured social care and coexistence practices. The scope of this paper was to assess the experiences of high-risk perinatal pregnancy risk among COVID-19 positive women through social interaction. The work was conducted in a hospital of tertiary perinatal care. Qualitative methodology was used, whereby questionnaires and interviews were conducted via zoom with 14 COVID-19 positive women in the perinatal phase. Critical-interpretative discourse analysis was applied based on the concept of social interaction and complex thinking. Three types of social interaction were developed to assess the results: a) Initial social interaction: experiences when becoming aware of being COVID-19 positive; b) Acquired social interaction: experiences of care prior to COVID-19; c) Enduring social interaction: experience required in the face of COVID-19. The result of experience leads to new forms of social interaction after notification ranging from care to resilience. The conclusion drawn is that the experience of COVID-19 of women in the perinatal period remodeled their ways of coexistence and care within the institutional, family, and personal spheres.

Factores de riesgo perinatal asociados al trastorno del espectro autista y al síndrome de Rett / Perinatal risk factors associated with autistic spectrum disorder and the Rett syndrome

Resumen El propósito de este proyecto fue identificar los factores de riesgo perinatal asociados al trastorno del espectro autista (TEA) y al síndrome de Rett y compararlos entre sí, estando enmarcado dentro de un estudio de tipo descriptivo. Para esta investigación se utilizó una unidad de análisis conformada por 421 historias clínicas, de las que 377 fueron de TEA y 44 de Rett, a las cuales se les aplicó un instrumento especializado en identificar factores de riesgo perinatales llamado Cuestionario Materno de Riesgo Perinatal (CMRP), con el que se encontró una gran prevalencia de niños nacidos por cesárea y que las ocupaciones de sus padres estaban relacionadas con los cuidados requeridos por el trastorno. Esta identificación de factores servirá para la toma de precauciones a nivel clínico médico y a nivel de prevención de los riesgos asociados al trastorno del espectro autista y el síndrome de Rett.

Abstract The purpose of this project was to identify the perinatal risk factors associated with Autism Spectrum Disorder (ASD) and Rett Syndrome and compare them to each other, being framed within a descriptive study; For this research, an analysis unit consisting of 421 medical records was used, of which 377 were from ASD and 44 from Rett, to which a specialized instrument was applied to identify perinatal risk factors called the Maternal Perinatal Risk Questionnaire (MPRQ ), which found a high prevalence of children born by caesarean section and that their parents' occupations were related to the care required by the disorder. This identification of factors will serve to take precautions at the medical clinical level and at the level of prevention of the risks associated with Autism Spectrum Disorder and Rett Syndrome.

Revisión de los riesgos maternos y perinatales en tiempos de COVID-19: desafíos para el rol de la Matronería / Review of maternal and perinatal risks in times of COVID-19: challenges for the role of Midwifery

INTRODUCCIÓN Y OBJETIVO Una enfermedad nueva, COVID-19, está afectando dramáticamente al mundo. Conocer los riesgos para la salud reproductiva es un imperativo para la práctica obstétrica y ginecológica. Esta investigación analiza los riesgos maternos y perinatales asociados a COVID-19, con el objetivo de identificar desafíos que la enfermedad plantea a la práctica de la matronería. MÉTODOS Revisión narrativa. Se consultaron artículos científicos de fuentes primarias indexados en las bases Scielo, Pubmed, Scope, WOS, mediante los siguientes términos de búsqueda: "embarazo" "transmisión vertical" "salud materna y perinatal", "riesgos maternos y perinatales" "lactancia materna", COVID-19", "Coronavirus". Se realizaron 3 fases de selección. Los tópicos de análisis fueron: Transmisión vertical, Riesgo materno y perinatal, Lactancia materna. RESULTADOS. En mujeres embarazadas las formas severas de COVID-19 se presentan en presencia de enfermedades crónicas. A nivel perinatal el riesgo mayor es el parto prematuro, generalmente por indicación médica y por cesárea. Aunque no hay evidencias de transmisión vertical, tampoco puede descartarse. Los riesgos neonatales se relacionan con el contagio por proximidad y con medidas restrictivas que pueden afectar la lactancia materna y la interacción madre-hija(o). CONCLUSIONES. La COVID-19 aporta varios desafíos para la práctica de la matronería: implementación de métodos de prevención del contagio a la gestante y a su entorno cercano; adecuación de la preparación al parto en caso de positividad; prevención del estrés y desgaste emocional materno desde el inicio de la gestación hasta el postparto; adecuación de cuidados al recién nacido; investigación aplicada en Latinoamérica, y evaluación de nuevos protocolos.

INTRODUCTION AND OBJECTIVE A new disease, COVID-19, is dramatically affecting the world. Knowing the risks for the reproductive health is an imperative for the obstetric and gynecological practice. This research analyzes the maternal and perinatal risks associated with COVID-19, with the aim of identifying challenges that the disease poses to the practice of midwifery. METHODS Narrative review. Scientific articles from primary sources indexed in Scielo, Pubmed, Scope, and WOS, are consulted by using the following search terms: "pregnancy" "vertical transmission" "maternal and perinatal health", "maternal and perinatal risks" "breastfeeding", COVID-19", "Coronavirus". Three selection phases were carried out. The topics of analysis were vertical transmission, maternal and perinatal risk, breastfeeding. RESULTS In pregnant women severe forms of COVID-19 occur in the presence of chronic diseases. At the perinatal level, the biggest risk is premature delivery, generally for medical indications and by cesarean section. Although there is no evidence of vertical transmission, it cannot be ruled out either. Neonatal risks are related to transmission by proximity and restrictive measures that may affect breastfeeding and mother-child interaction. CONCLUSIONS COVID-19 brings several challenges to the practice of midwifery: implementation of methods to prevent infection of the pregnant woman and her close environment; adaptation of birth preparation in case of positivity; prevention of maternal stress and emotional distress from the beginning of pregnancy to postpartum; adequacy of care for the newborn; research in Latin America, and evaluation of new protocols.

Forecasting the possibility of neonatal early onset sepsis based on perinatal risk factors

Background: Neonatal sepsis remains a leading cause of neonatal mortality and morbidity, diagnosis of which remains difficult due to variable presentations. With the increasing threat of antimicrobial resistance, it is important to identify perinatal risk factors which are associated with higher incidence of definite sepsis, to initiate empirical antibiotics, while awaiting blood culture reports.Methods: This was hospital based cross-sectional study done in SVPPGIP, Cuttack, Odisha during January 2019 to April 2019, enrolling all neonates  ≥37 weeks gestation and aged less than 72 hours, with suspected early onset sepsis. Neonates with TORCH infections, congenital anomalies, syndromic baby or with surgical conditions were excluded. After obtaining informed consent, blood culture was sent for all and their perinatal risk factors noted. Blood culture positive newborns were considered to have definite sepsis. Data was analysed with Chi-square test and percentages, using SPSS 18.Results: Among the 200 cases, incidence of definite sepsis was 26%. The most common risk factor was low birth weight and birth asphyxia. Majority (67%) had single or lesser risk factor and number of risk factors was significantly associated with definite sepsis. A significant association was seen between blood culture positivity with low birth weight (p=0.003), foul smelling liquor (p= 0.025), birth asphyxia (p 0.018) and premature rupture of membranes (p= 0.016). The combination of maternal fever and unclean vaginal examination was also significantly associated with the same.Conclusions: Protocols for initiating empiric antibiotics need to be formulated, taking into account the significant risk factors, in resource limited settings, to avoid resource and time wastage.

Anthropometric outcome of extremely low birth weight and very low birth weight newborn at 12 months of corrected age associated with prenatal risk factors

Background: Advancement of skill, technology and perinatal medicine has led to improve survival of low birth weight babies during the last few decades but they have reported high incidence of growth failure during infancy and early childhood. The objective of the study was to find out the influence of perinatal risk factors on anthropometric outcome.Methods: A prospective cohort study conducted on 143 ELBW and VLBW babies admitted in Sick Newborn Care Unit (SNCU and PICU) of North Bengal Medical College and Hospital (NBMC), Darjeeling, West Bengal from 2016 to 2017 and discharged babies were followed up.Results: Total 143 neonates were studied at NBMC among male 82(57.3%) and female 61(42.7%), 95 were AGA and 48 were SGA babies. Significant positive correlations were found among birth weight, gestational age, perinatal infection (p<0.001). The mean weight for age (Mean'SD) was 7.615'1.1092 kg with median 7.8 kg. The mean length for age (Mean'SD) was 72.6'3.74 cm with median 73 cm. The mean head circumference for age (Mean'SD) was 42.5'2.12 cm median 43 cm. Adverse neonatal outcome associated with CRIB II score ?10. Total CRIB II score with parameters of growth (<-2 Z score) like weight for age, length for age, weight for length and head circumference for age shows significant correlation (p<0.001).Conclusions: Perinatal risk factors are important determinant for future anthropometric outcome in very low and extremely low birth weight babies. They should be identified, and appropriate measures should be taken to achieve good outcome.

Assessment of Preterm Infants Using the Bayley-III Scales in Korea

OBJECTIVE: To assess the well-being of preterm newborns using the Bayley-III scales in a Korean-based population, and to evaluate the perinatal risk factors influencing developmental outcome. METHODS: Using the Bayley-III scales, we assessed 120 preterm infants who were referred for evaluation of neurodevelopmental performance. We subdivided them into an extremely preterm group (n=18) and a very/moderate to late preterm group (n=102). Bayley-III mean scores and the rate of infants showing a delay were compared for both groups. The relationship between perinatal risk factors and Bayley-III scores was analyzed. The risk factors were considered as very low birth weight, history of neonatal medical problems, and abnormal radiologic findings in brain magnetic resonance images (MRIs). RESULTS: Although no significant differences in mean scores were observed between the extremely preterm group and the very/moderate to late preterm group, the rate of babies showing developmental delay in motor composite scores was significantly higher in the extremely preterm group. The proportions of preterm infants with cognitive, language, and motor delays were 38.3%, 26.7%, and 35.0%, respectively. Very low birth weight was a significant risk factor for low cognitive, language, and motor composite scores. Also, abnormal radiologic findings on brain MRI were significant indicators of lower motor composite scores. CONCLUSION: Cognitive development was the most frequently delayed domain in preterm infants and motor development was more frequently delayed in the extremely preterm group. The very low birth weight and abnormal radiologic findings in brain MRI were predictive factors for neurodevelopmental outcome.

Parto Natural. ¿Qué nos dice la evidencia? / Natural birth. What does the evidence tell us?

Introducción: Es deseable que el proceso del parto concluya con una madre y un recién nacido sano, y sea un momento especial e íntimo. El Parto Natural, ha sido propuesto como una opción para mejorar la satisfacción de las mujeres con el proceso del parto. Sin embargo, no existen definiciones serias respecto a qué es el Parto Natural, introduciendo dificultades en la atención de mujeres que solicitan un Parto Natural. Métodos: El objetivo de este artículo es revisar la mejor evidencia disponible para entender cómo debe definirse un Parto Natural y analizar si se asocia a riesgos mayores que los de la atención médica habitual del parto. Resultados: Hemos comprobado que no existen definiciones científicas consensuadas para precisar qué es el Parto Natural, dejando espacio para discusión sobre su verdadero significado. No existen estudios de diseño aleatorizado y controlado que comparen el resultado materno/perinatal del parto natural comparado con la atención habitual del parto. Las intervenciones médicas, usadas en la atención médica del parto, y que podrían ser evitadas en el Parto Natural, producen algunos cambios favorables y otros deletéreos respecto de la salud materna y perinatal. Conclusiones: La decisión de optar por el Parto Natural debe ser discutida con las mujeres que lo solicitan, precisando con ella y su pareja cuál es su concepto de parto natural o qué es lo que desean incluir o evitar, los riesgos y beneficios asociados a cada una de las intervenciones deben ser expuestos por el equipo médico, para adoptar un plan de manejo individualizado.(AU)

Introduction: It is desirable that the birth process concludes with a healthy mother and newborn, while at the same time being a special and intimate moment. Natural childbirth has been proposed as a recent option to improve the satisfaction of women with the process of childbirth. However, there are no serious definitions regarding what is or should be a Natural Childbirth, introducing difficulties in the care of women who request a Natural Birth. Methods: The objective of this article is to review the best available evidence to understand how Natural Childbirth should be defined and to analyze if it is associated with greater maternal or perinatal risks than those of usual medical care at birth. Results: We verified that there are no agreed scientific definition to specify what Natural Childbirth is, leaving space for discussion about its true meaning. There are no randomized, controlled trials comparing the maternal/ perinatal outcome of natural childbirth compared to usual medical care during labor/delivery. Medical interventions used in childbirth are that could be avoided in natural birth produce some favorable changes and some deleterious changes in maternal and perinatal health. Conclusions: The decision to choose Natural Childbirth must be discussed with the women who request it, specifying with her and her partner´s concept of natural childbirth or what they wish to include or avoid, the risks and benefits associated with these interventions must be exposed by the medical team, to adopt an individualized management plan.(AU)

Prenatal, Perinatal and Developmental Risk Factors of Attention-Deficit Hyperactivity Disorder

OBJECTIVES: The purpose of this study was to examine the prenatal, perinatal and developmental risk factors of attention-deficit hyperactivity disorder (ADHD), compared to unaffected siblings (SIB), and typically developing children (TC). METHODS: Subjects with ADHD, their SIB, and TC were recruited from the child psychiatry outpatient clinic of the Asan Medical Center Children's Hospital. The parents of the children completed questionnaires on perinatal and developmental risk factors. RESULTS: Fifty-eight subjects with ADHD (41 boys, 7.7+/-1.3 years), 21 SIB (8 boys, 8.2+/-1.8 years), and 22 TC (8 boys, 8.5+/-2.1 years) were included. The ADHD group showed higher rates of maternal stress during pregnancy than the SIB group (p=.002), and the ADHD group showed higher rates of familial psychiatric history than the TC (odds ratio, 8.76 ; 95% confidence interval, 1.69 to 45.45). CONCLUSION: These findings suggest that among perinatal and developmental factors, maternal stress during pregnancy contribute to the development of ADHD. Future prospective studies will be needed in order to determine the causal relationship between perinatal risk factors and development of ADHD.

Prevalencia de los factores de riesgo perinatales en los Trastornos Generalizados del Desarrollo / Prevalence of Perinatal Risk Factors in the Pervasive Developmental Disorders

Los Trastornos Generalizados del Desarrollo (TGD) son perturbaciones graves y generalizadas que afectan áreas centrales del desarrollo (DSM-IV-TR). Se propone que el período perigestacional aglutina una serie de factores de riesgo que influyen y condicionan el desarrollo normal del feto. El objetivo de este artículo fue estudiar la presencia de riesgos durante el desarrollo perinatal, considerando las respuestas de 93 madres con hijos que presentan un Trastorno Generalizado del Desarrollo a un autoinforme estructurado, tal como es el caso del trastorno autista, trastorno de Asperger y TGD-no especificado. Del análisis de las respuestas al autoinforme se han encontrado diferencias significativas entre los grupos de TGD en la dimensión pregestacional -malnutrición/anorexia e hipertensión-, en la perigestacional -malnutrición/anorexia y problemas con el líquido amniótico- y en la psicosocial -género no deseado del bebé-.

Pervasive Developmental Disorders (PDDs) are severe and pervasive disturbances affecting central areas of development (DSM-IV-TR). It is proponed that the perigestational period encompasses a number of risk factors that influence and affect normal fetal development. The aim of this paper was to study the presence of risks during the perinatal development, considering the responses of 93 mothers of children with a pervasive developmental disorder -autistic disorder, Asperger disorder and PDD-NOS- to a structured self-report. We found significant differences among the PDD groups in the pregestational -malnutrition/anorexia and hypertension- , in the perigestational - malnutrition/anorexia and problems with the amniotic fluid-, and in the psychosocial -unwanted gender baby- dimensions from the analysis of the responses.

Perinatal and Developmental Risk Factors of ADHD Children Diagnosed with a Structured Interview

OBJECTIVES: The objective of this study was to examine the perinatal and developmental risk factors of attention-deficit hyperactivity disorder (ADHD) diagnosed with a structured interview among Korean children. METHODS: The current study included 924 children (6-15 years) recruited from schools in five Korean cities or a child psychiatry outpatient clinic of Seoul National University Children's Hospital. The parents of the children completed the structured diagnostic interview for attention-deficit hyperactivity disorder, as well as questionnaires on perinatal and developmental risk factors. RESULTS: Preterm delivery, severe maternal stress during pregnancy, change in primary care taker during the first three years, postpartum depression, and delayed first sentence showed a significant association with ADHD diagnosis. CONCLUSION: These findings suggest that perinatal and developmental factors contribute to development of ADHD in Korean children. Conduct of future research using a prospective design is needed in order to identify the causal relationship between observed risk factors and development of ADHD.

Frecuencia y repercusiones maternas y perinatales del embarazo en adolescentes atendidas en hospitales del Ministerio de Salud del Perú, año 2008 / Frequency and maternal-perinatal consequences of the adolescent pregnancy in 23 hospitals of the Ministry of Health of Peru

Objetivo: Conocer frecuencia y repercusiones maternas y perinatales del embarazo en adolescentes en 23 hospitales del Ministerio de Salud del Perú. Métodos: Estudio de casos y controles que compara el riesgo materno-perinatal entre adolescentes (10 a 19 años) y adultas (20 a 29 años). Se analizaron las variables desde la base de datos del Sistema Informático Perinatal. Para el análisis se usó frecuencias y Odds Ratio con 95 por ciento de intervalo de confianza. Resultados: Las adolescentes representan 19,2 por ciento de los partos, con diferencias significativas entre regiones naturales (17,6 por ciento sierra, 18,1 por ciento costa y 29 por ciento selva). Se asoció al embarazo adolescente una menor escolaridad, alta dependencia económica, situación conyugal inestable, región selva y mal estado nutricional. Las repercusiones maternas negativas fueron: control prenatal Inadecuado (OR=1,2) y tardío (OR=1,56), morbilidad materna (OR=1,18), anemia (OR=1,24), infección del tracto urinario (OR=1,3), enfermedad hipertensiva del embarazo (OR=1,3) e infección puerperal (OR=1,44). Las repercusiones perinatales negativas fueron: bajo peso al nacer (OR=1,36), prematuridad (OR=1,29), desnutrición fetal (OR=1,34), depresión a minuto de nacer (OR=1,17), morbilidad neonatal (OR=1,1), traumatismos al nacer (OR=1,36) y mortalidad neonatal (OR=1,49). Conclusión: Las adolescentes tienen condiciones socio demográficas desfavorables, mal estado nutricional, alto riesgo de morbilidad materna y morbi mortalidad neonatal comparadas con embarazadas adultas.

Objective: To determine frequency and maternal-perinatal consequences of the adolescent pregnancy in 23 hospitals of the Ministry of Health of Peru. Methods: Case-control study who compared maternal and perinatal risk between pregnant teenagers (10 to 19 years) and pregnant adults (20 to 29 years). Variables were obtained and analyzed from the Perinatal Data System. For the analysis, were used frequencies and odds ratio with 95 percent of confidence interval. Results: Adolescents represent 19.2 percent of births, with significant differences between natural regions (17.6 percent highland, 18.1 percent coast and 29 percent jungle). Low education, high economic dependence, unstable marital status, jungle region and poor nutritional status, were associated with adolescent pregnancies. The negative maternal effects were: inadequate (OR=1.2) and late prenatal care (OR=1.56), morbidity (OR=1.18), anemia (OR=1.24), urinary tract infection (OR=1.3), hypertensive disease of pregnancy (OR=1.3) and puerperal infection (OR=1.44). The negative perinatal effects were: low birth weight (OR=1.36), prematurity (OR=1.29), fetal malnutrition (OR=1.34), depression at 1 minute of live (OR=1.17), neonatal morbidity (OR=1.1), birth trauma (OR=1.36) and neonatal mortality (OR=1.49). Conclusion: The adolescents pregnant have unfavorable sociodemographic conditions, poor nutrition, high risk of maternal and neonatal morbidity and mortality compared with adults pregnant.

Morbilidad y mortalidad neonatal asociada a la diabetes gestacional / Neonatal morbidity and mortality asociated with gestational diabetes

Objetivo: Determinar la asociación de la morbilidad y mortalidad neonatal con la diabetes gestacional. Método: Estudio tipo cohortes. Se realizó un estudio en embarazadas desde diciembre de 2007 a noviembre de 2008 en el servicio de tococirugía del Hospital General Regional No. 1 de Querétaro, México, se formaron dos grupos de 71 pacientes, uno con diabetes gestacional y otro sin ella. El muestreo fue por cuota pareado por edad. En ambos grupos se midieron variables sociodemográficas, antecedentes obstétricos, vía de interrupción del embarazo, morbilidad y mortalidad neonatal. Los resultados se analizaron con Chi cuadrado y riesgo relativo con un poder alfa de 0,05. Resultados: La tasa de morbilidad en el grupo expuesto fue de 60 por ciento. Las variables que tuvieron significancia estadística fueron: la obesidad pregestacional (RR: 2,7), cesßrea (RR: 3,3), complicaciones metabólicas (RR: 10), morbilidad respiratoria (RR: 6,7), macrosomía (RR: 4,1), hipoglucemia (RR: 14,2) y taquipnea transitoria del recién nacido (RR: 7,7). La edad materna, sobrepeso gestacional, nivel socioeconómico, escolaridad, antecedentes de macrosómicos, de cesáreas y de malformaciones congénitas; malformaciones congénitas, bajo peso neonatal, prematurez, enfermedad de membrana hialina, hiperbilirru-binemia, hipocalcemia, mortalidad neonatal y la asfixia no tuvieron asociación significativa. La complicación metabólica más frecuente fue: hipoglucemia (17,2 por ciento). No hubo muertes perinatales. Conclusiones: El grupo expuesto estudiado mostró mayor morbilidad asociada a la diabetes gestacional que el grupo no expuesto, es necesario el diagnóstico temprano en mujeres con factores de riesgo para esta entidad y establecer un programa de tratamiento con vigilancia estrecha.

Objectives: To determine the association of neonatal morbidity and mortality with gestational diabetes. Methods: Study cohort. A study of pregnant women from December 2007 to November 2008 in the service of ginecology and obstetrics HGR No. 1 Querétaro, were divided into two groups of 71 patients, one gestational diabetic and one without it. The quota sampling was matched by age. In both groups were measured sociodemographic, obstetric history, via interruption of birth, neonatal morbidity and mortality. The results were analyzed with Chi square and relative risk with a power alpha of 0.05. Results: The morbidity rate in the exposed group was 60 percent. Variables that were statistically significant were: pregestational obesity (RR: 2.7), cesarean (RR 3.3), metabolic complications (RR 10), respiratory illness (RR: 6.7), macrosomia (RR: 4.1), hypoglycemia (RR: 14.2) and transient tachypnea of the newborn (RR: 7.7). Maternal age, gestational overweight, socioeconomic status, education, history of macrosomic, and cesarean birth defects, congenital malformations, low birth weight, prematurity, hyaline membrane disease, hyperbilirubinemia, hypocalcemia, and neonatal asphyxia had no significant association. The most common metabolic complication was hypoglycemia (17.2 percent). There were no perinatal deaths. Conclusions: The exposed group showed higher morbidity associated with gestational diabetes that the unexposed group, early screening is necessary in women with risk factors for this disease and establish a treatment program with close monitoring.

Perinatal and Familial Risk Factors Are Associated with Full Syndrome and Subthreshold Attention-Deficit Hyperactivity Disorder in a Korean Community Sample

OBJECTIVE: The objective of this study was to examine the effect of perinatal and familial risk factors on full syndrome and subthreshold attention-deficit/hyperactivity disorder (ADHD) among Korean children and adolescents. METHODS: A sample of 2,673 students was randomly selected from 19 representative schools in Seoul, Korea. The parents of the students completed the Diagnostic Interview Schedule for Children-version IV (DISC-IV), as well as questionnaires on perinatal and familial risk factors. RESULTS: Maternal stress and alcohol use during pregnancy, parental marital discord, parental separation or divorce, changes in primary caregivers, and notbreastfeeding were significantly associated with full syndrome ADHD; however, maternal stress during pregnancy was the only variable that differentiated subthreshold ADHD from non-ADHD. CONCLUSION: Our results provide evidence the perinatal and familial risk factors contribute to the development of ADHD in Korea children and adolescents, and suggest that these perinatal and familial risk factors are more closely related to full syndrome than to subthreshold ADHD.

Perinatal and Familial Risk Factors Are Associated with Full Syndrome and Subthreshold Attention-Deficit Hyperactivity Disorder in a Korean Community Sample

OBJECTIVE: The objective of this study was to examine the effect of perinatal and familial risk factors on full syndrome and subthreshold attention-deficit/hyperactivity disorder (ADHD) among Korean children and adolescents. METHODS: A sample of 2,673 students was randomly selected from 19 representative schools in Seoul, Korea. The parents of the students completed the Diagnostic Interview Schedule for Children-version IV (DISC-IV), as well as questionnaires on perinatal and familial risk factors. RESULTS: Maternal stress and alcohol use during pregnancy, parental marital discord, parental separation or divorce, changes in primary caregivers, and notbreastfeeding were significantly associated with full syndrome ADHD; however, maternal stress during pregnancy was the only variable that differentiated subthreshold ADHD from non-ADHD. CONCLUSION: Our results provide evidence the perinatal and familial risk factors contribute to the development of ADHD in Korea children and adolescents, and suggest that these perinatal and familial risk factors are more closely related to full syndrome than to subthreshold ADHD.

Riesgo obstétrico y perinatal en embarazadas mayores de 35 años / Perinatal risk in pregnant women of 35 years and older

Antecedentes: El embarazo en edades tardías es una condición que ha aumentado en los últimos años. Objetivo: Evaluar el riesgo materno y perinatal en embarazadas mayores de 35 años. Método: Estudio de cohorte retrospectiva de todos los embarazos atendidos en el hospital Dr. Gustavo Fricke de Viña del Mar, entre enero de 2001 y diciembre de 2006. Se excluyeron menores de 20 años. Se analizaron variables maternas y perinatales. Resultados: En el período hubo 16.338 partos, 10,9 por ciento fueron en mujeres entre 35 y 39 años y 3,6 por ciento en embarazadas de 40 años o más. Un 27,2 por ciento de los embarazos fue en primigestas. La comparación entre embarazadas de 20-34 años y de 35-39 años mostró mayor frecuencia de hipertensión arterial crónica, hospitalización durante el embarazo, diabetes, preeclampsia, hemorragia del tercer trimestre, parto cesárea, hemorragia puerperal, menor peso del recién nacido, y defectos congénitos, entre otros. Hubo mayor frecuencia de rotura prematura de membranas al analizar las mayores de 40 años. Las primigestas tuvieron mayor frecuencia de obesidad, preeclampsia, diabetes, hospitalización del recién nacido, y hemorragia puerperal. Al realizar una regresión logística para determinar influencia de la edad, se apreció que el riesgo de comorbilidades y eventos adversos maternos y fetales aumentaba proporcionalmente con la edad. Conclusión: La edad materna se asoció significativamente en forma independiente con resultados maternos y perinatales adversos. Hubo mayor riesgo para la mayoría de las variables analizadas en embarazadas de 35 años o más.

Background: Pregnancy in elderly ages is a condition that has been rising in the last years. Objective: To evaluate the maternal and perinatal risk of pregnant over the 35 years-old. Methods: Retrospective cohort study of all pregnant women attended in Dr. Gustavo Fricke Hospital, Viña del Mar, from January 2001 to December 2006. Patients under 20 years were excluded. Maternal and perinatal variables were analyzed. Results: 16,338 childbirths were analyzed, 10.9 percent were in women between 35 and 39 years, and 3.6 percent in women of 40 years or more. A 27.2 percent of the pregnancy was the first gestation. A greater frequency of chronic hypertension, hospitalization during pregnancy, diabetes, preeclampsia, third trimester hemorrhage, cesarean section, postpartum hemorrhage, low birth weight, and congenital defects, among others, were found when comparing pregnant of 20-34 years-old with pregnant of 35-39 years-old. Elevated frequencies of premature rupture of fetal membranes were found in women over 40 years. First gestation women had higher frequency of obesity, preeclampsia, and hospitalization during pregnancy, diabetes and postpartum hemorrhage. Using logistic regression to determinate the influence of age, we determine that the risk of co morbidity and maternal and fetal adverse events, increase according to age. Conclusion: Maternal age was associated independently and significantly with adverse maternal and perinatal results. Major risk was observed for the majority of the variables analyzed in pregnant of 35 years or more.

Detección de los riesgos maternos perinatales en los trastornos generalizados del desarrollo / Detection of the perinatal maternal risks in the pervasive developmental disorders

Pervasive Developmental Disorders (PDD) refer to a group of severe neuropsychologic alterations. Symptoms affect three development components: social-interaction skills, language and communication skills and a set of behaviours and activities that become restricted and stereotyped. PDDs include the following disorders: Autistic, Rett's, Infantile Disintegrative, Asperger's and Generalized Non-specific Development Disorder. Regarding to its unknown causes, several explanations have been gathered as a challenging task. They highlight the idea of generalised alterations in the Central Nervous System (CNS). However, the strongest thesis defines a multicausal etiology, with different factors associated to PDDs. Never the less, over the past few years, the review of problems associated with pregnancy and labour have been stressed. This perspective is complemented by other elements that point towards genetic alterations and CNS deficits as causes behind PDD. It has been suggested that pregnancy, labour and even neonatal complications can act on different fronts: increasing the risk of autism or any other PDD, or interacting along with genetic determinants to increase the potential risk at a critical moment in the perinatal development process. The goal of this paper is to study the presence of perinatal risk in mothers of children with and without PDD. A total of 259 mothers took part in the study; 95 were used as an experimental group: they all had a PDD-diagnosed child, according to DSM-IV-TR criteria (68 had autistic disorder, six had Asperger's disorder, one had Rett's disorder and 19 had non-specific PDD). The remaining 165 women had children with a normal evolutive development and were selected as a control group. In order to collect information about perinatal risk, a Maternal Perinatal Risk Questionnaire (MPRQ) was used. This is a structured and specifically-designed autoreport that evaluates the presence or absence of 40 pregestational and perigestational risk factors annalysed from six perspectives: pregestational, perigestational, intrapartum, neonatal, psychosocial and sociodemographic. For every factor evaluated in the MPRQ, an analysis of the average scores and typical deviations was made, along with a frequency and percentage study. Furthermore, a comparative of the frequencies in the control and experimental groups was carried out for every MPRQ item. By means of descriptive analysis, both groups were classified according to the children's age and birth order, the mother's age during pregnancy, current parent's age and their educational and professional levels. When comparing the experimental group's frequencies to those of the control group in the pregestational stage, two significative items were found in Chi-square: the number of previous spontaneous abortions and the use of contraceptive methods. As a result, the control group had fewer spontaneous abortions than the experimental group (10.9% and 22.4% respectively). The use of contraceptive methods previous to pregnancy described the control group's superiority both for hormonal methods and intrauterine devices (IUD). The experimental group was defined by the absence of IUD and the scarce use of hormonal contraceptives (4.3%). In the perigestational dimension, the three significative items in Chi-square were: pharmacological consumption and presence of edema during pregnancy, and premature rupture of amniotic sac. Pharmacological consumption during pregnancy stresses the consumption of medicine or vitamines and iron in control group (81.2%), compared to the group of mothers of children with PDD (60.6%). The presence of gestational edema has been conclusively linked to the control group. As for the premature rupture of waters, a significantly higher presence of amniotic rupture was found in the experimental group compared to the control group. In the intrapartum dimension, the experimental group confirmed higher frequencies in situations that imply a higher perinatal risk such as: a very quick labour or one lasting over 12 hours. In the neonatal dimension, the control group showed with higher percentages (87.9%), the absence of blue coloration -which would be indicative of cyanosis-, when compared to the experimental group (79.8%). The psycho-social dimension included two significant items: the desired gender for the newborn and the desired pregnancy. The desired gender item confirmed that situations of happiness about finding out the baby's gender were higher in the control group (68.4%) than in the experimental group. The desired pregnancy item proved that situations of desired pregnancy were higher in the control group (91.5%) compared to the experimental group (84.0%). Finally, in the socio-demographic dimension, two siginificative items were identified when comparing both groups: the mother's profession and the baby's gender. In one hand, regarding the mother's profession, it was observed that mothers of PDD children were mainly found within home enviroment (37.2%) or unqualfied worker categories (18.1%). On the other hand, in the control group, the mothers who adscribed to the qualified professional category was notably higher (33.3%). Regarding the child's gender, a higher risk is detected in males, at a proportion of 1 to 3. The results of this study showed that there are significative differences between PDD children who developed perinatal risks, compared to children who have a regular evolutive development. Children with PDD will thus show significant differences compared to non-PDD children: they have an unequal perinatal development and developed perinatal risks. Therefore, many risks are present in a higher measure in PDD children when compared to the control group. An innovative contribution is also made, by strongly suggesting that physical risks define the presence of perinatal risks in PDD. However, the psychosocial and sociodemographic dimensions must also be taken into account.

Los trastornos generalizados del desarrollo (TGD), hacen referencia a un conjunto de alteraciones neuropsicológicas graves. Sus síntomas afectan a tres componentes del desarrollo: interacción social, lenguaje y comunicación e intereses, comportamientos y actividades restringidas y estereotipadas. Los TGD incluyen los siguientes trastornos: autismo, Rett, desintegrativo infantil, Asperger y el Trastorno generalizado del desarrollo no especificado. Su etiología resulta poco conocida y es un reto para la investigación actual. En los últimos años se ha acentuado la revisión de los problemas asociados con el embarazo y el parto. Diversas hipótesis sugieren que el embarazo, el parto e incluso las complicaciones neonatales, pueden actuar desde diversos frentes e incrementar el riesgo de autismo y de los demás TGD. El objetivo de esta investigación es estudiar la presencia de riesgos perinatales entre madres de hijos con TGD y madres de hijos sin TGD. En la investigación participaron un total de 259 madres. De ellas, 94 participaron como grupo experimental: todas tenían un hijo con un diagnóstico de TGD, según criterios del DSM-IV-TR (68 con trastorno autista, seis con trastorno de Asperger, uno con trastorno de Rett y 19 con TGD no especificado). Las mujeres restantes (165) fueron seleccionadas como grupo control y eran madres de infantes/niños con un desarrollo evolutivo normal. Para recoger la información sobre la presencia de riesgos perinatales, se utilizó el Cuestionario Materno de Riesgo Perinatal (CMRP). Este cuestionario es un autoinforme estructurado diseñado ad hoc que contempla, desde seis dimensiones -pregestacional, perigestacional, intraparto, neonatal, psicosocial y sociodemo-gráfica-la presencia o ausencia de 40 factores de riesgo pregestacionales y perigestacionales. Para cada factor valorado con el CMRP, se realizó un análisis de las puntuaciones medias y las desviaciones típicas, junto con un estudio de las frecuencias y los porcentajes resultantes. Asimismo, se efectuó una comparativa de las frecuencias y se utilizó el estadístico Chi-cuadrado de Pearson (χ²), de los grupos experimental y control en cada uno de los reactivos del CMRP. En la dimensión pregestacional, se encontraron dos reactivos significativos en Chi-cuadrado: el número de abortos espontáneos anteriores y el uso de métodos anticonceptivos. En la dimensión perigestacional tres reactivos resultaron significativos: el consumo de fármacos y la presencia de edema durante el embarazo, así como también la ruptura prematura de la fuente. En la dimensión intraparto el grupo experimental mostró frecuencias más altas en aquellas situaciones que implican un mayor riesgo perinatal; un parto muy rápido o la tardanza de más de 12 horas en el mismo. En la dimensión neonatal la coloración azulada del neonato, indicativa de cianosis, fue superior en el grupo experimental. Por otra parte, la dimensión psicosocial ofreció dos reactivos significativos: el sexo deseado del bebé y el embarazo deseado. Por último, en la dimensión sociodemográfica, se identificaron dos reactivos importantes al comparar el grupo experimental con el grupo control, que fueron: la profesión de la madre y el sexo del bebé. Los resultados de esta investigación indican que existen diferencias significativas en niños con TGD que presentaron riesgos perinatales frente a otros con desarrollo evolutivo sin dificultades. Los niños con TGD muestran diferencias significativas comparados con otros niños sin TGD: tienen un desarrollo perinatal desigual, con una presencia significativamente distinta de riesgos perinatales. De esta forma, los riesgos físicos definen la presencia de riesgos perinatales en los TGD. Ahora bien, las dimensiones psicosocial y sociodemográfica deben también ser tomadas en cuenta.

Clinical characteristics of cerebral palsy following preterm or term birth; 10 years' experience / 대한산부인과학회지

OBJECTIVE: To investigate the perinatal and clinical characteristics of cerebral palsy (CP) following preterm or term birth. METHODS: A total of 75 infants born and diagnosed as CP in our hospital from October 1994 to December 2004 were recruited retrospectively. Their maternal and perinatal outcomes and the type, involved lesion and severity of CP were analyzed. RESULTS: The incidence of CP was 0.23%, which showed decreasing pattern according to advancing gestational age at birth. CP was more frequent (6.7-times) in multifetal pregnancy. Male to female ratio was 1.5: 1. After excluding five infants with major congenital anomalies, 55 (79%) infants were born before 37 weeks' gestation (preterm CP) and 15 (21%) infants were born beyond 37 weeks' gestation (term CP). Eighty-six percent of preterm CP had significant neonatal morbidities, but only 6 out of 15 infants in term CP had significant perinatal events including hypoxic ischemic encephalopathy, meconium aspiration syndrome, and seizure of unknown origin. The most common type of preterm CP was spastic (95%), whereas the types of term CP were more diverse; spastic in 67%, athetoid in 20%, dystonic in 7%, and hypotonic in 7%. Regarding the involved lesions, the most common type was diplegic in preterm CP and quadriplegic in term CP. CONCLUSION: In contrast to preterm CP, term CP had significantly less perinatal risk factors, and their type and involved lesion showed more diverse patterns. These findings may implicate that more heterogenous etiologies are involved in pathogenesis of term CP.

Incidence, Timing of Screening Examinations and Perinatal Risk Factors for Retinopathy of Prematurity in Very Low Birth Weight Infants / 대한주산의학회잡지

OBJECTIVE: This study was conducted to evaluate the incidence, the optimal timing of screening examinations for retinopathy of prematurity(ROP) and to analyze perinatal risk factors associated with cryotherapy or lasertherapy(CT/LT) in ROP. METHODS: Medical records of 130 very low birth weight(VLBW) infants who admitted to the NICU of Wonkwang University Hospital from July 1997 to June 2002 were reviewed retrospectively. We evaluated the incidence and severity of ROP by gestational age(GA) and birth weight(BW). And the comparisons of perinatal risk factors between ROP with and without CT/LT have been made. RESULTS: Incidence of ROP was 36.9% and mean GA and BW were 29.1+/-1.99 weeks, 1,153+/-209 gm in VLBW infants respectively. ROP Stage II or greater was 15.4% of VLBW infants, 41.7% of ROP infants, and 27.1% of ROP infants were treated with CT/LT. All infants with BW <750gm or GA <26 weeks were developed ROP with stage II or greater and treated with CT/LT. First detection of ROP was performed at chronologic age(CA) 3 weeks, postconceptional age(PCA) 30 weeks, and first identification of threshold ROP needed with CT/LT were at CA 5 weeks and PCA 33 weeks. The perinatal risk factors with CT/LT for ROP were significant in GA, BW, Apgar score at 1 and 5 minutes and number of blood transfusion. The mean time of spontaneous regression is 13.4+/-8.8 weeks in the mild ROP infants without CT/LT. CONCLUSION: The incidence of ROP is 36.9% and the optimal timing of screening for ROP should be selected by earlier time in 2 guidelines of at 5 weeks of CA and 33 weeks of PCA in VLBW infants. And the related risk factors with CT/LT for threshold ROP were GA, BW and Apgar score at 1 and 5 minutes and number of blood transfusions.

Pregnancy, Delivery and Perinatal Risk Factors Associated with Symptoms of Attention Deficit/Hyperactivity Disorder: Community Study / 신경정신의학

OBJECTIVE: This community based study was conducted to evaluate the association between pre- and perinatal factors and symptoms of ADHD. METHOD: 1800 children from 10 elementary schools in an urban community were recruited by randomized sampling method. We evaluated the symptoms of ADHD by Child Behavior Check List, Disruptive behavior disorder scale from 2 sources (parent & teacher). A thorough evaluation of perinatal problems was carried out. Data were analyzed by appropriate statistical method using SPSS 10.0 window version. RESULT: In the pre- & peri-natal events, boy, low SES, use of forceps, emotional stress, prolonged labor time and postpartum depression were significantly more frequent in attention deficit group compared to normal group. After controlling sex and SES, further analyses we revealed emotional stress, prolonged labor, and postpartum depression as risk factors of ADHD symptoms. CONCLUSION: These findings implied that pre- & perinatal biological and environmental risk factors could be symptom risk factors of the attention deficit hyperactivity disorder. Further research should prove the etiological association of these factors.

Risk Factors of Threshold Retinopathy of Prematurity in Preterm Infants with Bronchopulmonary Dysplasia

PURPOSE: We tried to clarify perinatal risk factors that are related to the occurrence of threshold retinopathy of prematurity in preterm infants with bronchopulmonary dysplasia. METHODS: We enrolled 40 infants with bronchopulmonary dysplasia who had received ophthalmologic examination between April 1995 and May 2001. The patients were categorized into two groups; "threshold retinopathy of prematurity" group as study (n=18), and "no retinopathy of prematurity" and "prethreshold retinopathy of prematurity" group as control population (n=22), and we compared the perinatal risk factors between the two. RESULTS: Out of total 40 preterm infants with bronchopulmonary dysplasia, only prethreshold retinopathy of prematurity occurred in 6 infants (15%) and threshold retinopathy of prematurity developed in 18 infants(45%). The incidence of threshold retinopathy of prematurity decreased with longer gestation and higher birth weight. Mean gestational age was 26.3 weeks in the study group vs 29.4 weeks in control group, and mean birth weight was 868 g and 1,413 g, respectively. An increased risk of reaching threshold retinopathy of prematurity was found associated with apnea, longer use of aminophylline, hyperglycemia, and higher SNAP scores during the first 24 hours from admission to the NICU. The incidence of threshold retinopathy of prematurity was not influenced by duration of oxygen therapy, ventilator therapy, total parenteral nutrition, phototherapy, hospitalization, intraventricular hemorrhage, pneumonia, pulmonary hemorrhage, sepsis, patent ductus arteriosus, air leak syndrome, necrotizing enterocolitis, frequency of transfusion, and longer use of dexamethasone. CONCLUSION: An increased risk of reaching threshold retinopathy of prematurity in preterm infants with bronchopulmonary dysplasia was found associated with lower birth weight, younger gestational age, apnea, longer use of aminophylline, hyperglycemia, and higher SNAP scores during the first 24 hours from admission to the NICU.