Possible interplay between vitamin C deficiency and prolactin in pregnant women with premature rupture of membranes: facts and hypothesis.

The precise etiologic mechanisms involved in the premature rupture of membranes (PROM) during pregnancy, the main cause of preterm delivery worldwide, are unknown. Previous studies have shown that: (a) the rupture of chorioamniotic membranes is related to an imbalance between synthesis and degradation of collagen induced by the overexpression/activity of various matrix metalloproteinases (MMP); (b) during human labor and delivery the expression of prolactin receptors (PRL-R) increases in chorioamniotic membranes, decidua and placenta; (c) prolactin (PRL) can influence the synthesis of prostaglandins, the expression of some MMP (MMP-2, MMP-9 and decysin) and tissue inhibitors of MMP in general; (d) vitamin C deficiency induces the expression/activity of extracellular MMP and is considered a risk factor for PROM; and (e) vitamin C potentiates the dopamine-mediated inhibition of PRL in rats. The present hypothesis proposes that a decreased hypothalamic dopaminergic tone-and thus an increased synthesis/release of pituitary PRL - is induced by vitamin C deficiency below a critical threshold (<18 microg/10(8) leukocytes) and that both factors, in turn, would cause upregulation of the expression/activity of several MMP. The increased PRL concentrations (acting like a Th1-type cytokine) along with the overexpression of other proinflammatory cytokines would induce a premature switch from a favorable Th2-type immune response to a noxious Th1-type immune response in the intrauterine environment. This change, in conjunction with the upregulation of MMP-2 and MMP-9, would cause a premature imbalance between synthesis/degradation of collagen in chorioamniotic membranes (an "anticipation" of the normal parturition cascade?), which favors extracellular matrix degradation, proposed as the most relevant event in the genesis of PROM. This hypothesis represents a new dimension in the study of the etiology of PROM.

Embarazo en la adolescencia y su relación con la deserción escolar / The relationship between teenage pregnancy and school desertion

Background: In Chile, the prevalence of teenage pregnancy is 17 percent. Aim: To assess relationship between adolescent pregnancy and school desertion. Patients and methods: At the Hospital Guillermo Grant Benavente's Departament of Obstetrics and Gynecology, in Concepción, Chile, 2001 a comparative, cross sectional and correlational study was conducted. The study group were pregnant adolescents who deserted from school system, divided in two subgroups: 86 adolescents who deserted before pregnancy and 130 who deserted during pregnancy. Results: Twenty percent of teenagers that deserted from school before pregnancy belonged to a sublevel of poverty, compared with 5 percent of those who deserted during pregnancy. Flunk was frequent in both but higher in girls that deserted before pregnancy (46.5 and 36.9 percent respectively, (p <0.001). Economic problems were the main cause of desertion before pregnancy (27.6 percent). Shame (41.6 percent) and obstetric complications (31.7 percent) were the main reasons for deserting during pregnancy. Seventy percent of adolescents who deserted before pregnancy had no educational, working or recreational activities. The parental educational level of both groups was low. Conclusions: There is a relationship between teenage pregnancy and school desertion. Adolescents who deserted from school before pregnancy are more vulnerable (Rev Méd Chile 2004; 132: 65-70).

Collagen synthesis during pregnancy, vitamin C availability, and risk of premature rupture of fetal membranes.

OBJECTIVE: To examine the relationship between plasma and leukocyte concentration of ascorbic acid and collagen type I propeptide C during pregnancy and subsequent premature rupture of membranes (PROM). METHODS: Fifteen women with PROM and 26 controls were compared for plasma and leukocyte concentration of vitamin C and for Pro-C during pregnancy. RESULTS: A statistically significant difference in maternal leukocyte ascorbic acid concentration was found between the two groups at week 28 of gestation (P50 was 16.90 for PROM group vs. 21.46 for control group; P>0.05). Increased risk for PROM (odds ratio, 10.99; 95% confidence interval, 2.40-49.91) was found with elevated concentrations of Pro-C at week 16 of gestation. CONCLUSIONS: A higher rate of collagen synthesis early in pregnancy was demonstrated in PROM cases. However, no correlation with ascorbic acid availability was found. This study supports the findings of others that collagen metabolism disturbances are associated with PROM.

Prevalence of nutritional deficiencies in Mexican adolescent women with early and late prenatal care

The objective was to evaluate the prevalence of specific nutritional deficiencies in a group of pregnant adolescents according to the gestational age when they started to receive prenatal care. A group of 163 pregnant adolescents that attended the Instituto Nacional de Perinatología (Mexico City) for the first time to receive prenatal care was evaluated. An anthropometrical evaluation was performed and a blood sample taken to determine hemoglobin, ferritin, erythrocyte folate and plasma zinc to all cases. The mean age was 15 years (11 to 17 years). The mean gestational age when starting prenatal care was 27 +/- 7 gestation weeks and most of them tended to have low weight (97 +/- 12 per cent expected weight for height and gestational age). Eight of every ten adolescents had anemia and iron deficiency. Late prenatal care (> or = 25 weeks) was associated with the risk of presenting anemia OR 5.11 (CI 95 per cent 2.4-10.7) iron deficiency (OR 3.5; CI 95 per cent 1.7 to 7.1) and zinc deficiency (OR 2.9; CI 95 per cent 1.1 a 7.6). In relation to folate deficiency, the opposite effect was observed (OR 0.10; CI 95 per cent 0.02 a 0.48). Lack of opportune prenatal care was associated with the presence of iron and zinc depletion. Probably iron deficiency contributes to an erythrocyte folate accumulation.

Violencia y riesgos asociados en adolescentes / Violence and associated risks in adolescents

Introducción: El fenómeno de la violencia en los centros urbanos es entendido como un proceso social que comprende las más variadas formas de agresión que tiene un efecto multiplicador y expansivo que no solo afecta a las víctimas sino a la sociedad en pleno por lo cual su aumento es motivo de preocupación. Objetivo: Determinar las características de los adolescentes violentos y su asociación con antecedentes personales, familiares y del entorno en adolescentes relacionados al Consejo Nacional del Menor y la Familia en 1997 Material y Métodos: Se definió como adolescente violento aquel que participó en peleas (agresión física) en el ultimo año. Población: Fueron estudiados 522 adolescentes de ambos sexos y de 10 a 21 años de edad, asistidos en dependencias del Consejo Nacional del Menor y la Familia. Instrumento Utilizado: Dos fichas epidemiológicas, que incluyeron el Present State Examination, registrando el estado psíquico actual y los antecedentes personales, familiares y del entorno. Análisis Estadístico: Se estableció la frecuencia de adolescentes violentos y se analizaron las asociaciones posibles con ciertas variables, utilizando el Chi Cuadrado y el Riesgo Relativo. Resultados: El 21,3 por ciento de la población había tenido conductas violentas. En los varones se encontró una asociación significativa con el diagnóstico de trastornos de conductas disociales y el consumo de tabaco, marihuana, cocaína y sedantes. En las mujeres se asoció significativamente con los diagnósticos de depresión leve, distimia, trastorno de conducta desafiantes, antecedentes de acoso sexual y consumo de tabaco.Actuar tempranamente sobre los factores de riesgo genéricos detectados, es una forma de prevenir la violencia

Violencia y riesgos asociados en adolescentes / Violence and associated risks in adolescents

Introducción: El fenómeno de la violencia en los centros urbanos es entendido como un proceso social que comprende las más variadas formas de agresión que tiene un efecto multiplicador y expansivo que no solo afecta a las víctimas sino a la sociedad en pleno por lo cual su aumento es motivo de preocupación. Objetivo: Determinar las características de los adolescentes violentos y su asociación con antecedentes personales, familiares y del entorno en adolescentes relacionados al Consejo Nacional del Menor y la Familia en 1997 Material y Métodos: Se definió como adolescente violento aquel que participó en peleas (agresión física) en el ultimo año. Población: Fueron estudiados 522 adolescentes de ambos sexos y de 10 a 21 años de edad, asistidos en dependencias del Consejo Nacional del Menor y la Familia. Instrumento Utilizado: Dos fichas epidemiológicas, que incluyeron el Present State Examination, registrando el estado psíquico actual y los antecedentes personales, familiares y del entorno. Análisis Estadístico: Se estableció la frecuencia de adolescentes violentos y se analizaron las asociaciones posibles con ciertas variables, utilizando el Chi Cuadrado y el Riesgo Relativo. Resultados: El 21,3 por ciento de la población había tenido conductas violentas. En los varones se encontró una asociación significativa con el diagnóstico de trastornos de conductas disociales y el consumo de tabaco, marihuana, cocaína y sedantes. En las mujeres se asoció significativamente con los diagnósticos de depresión leve, distimia, trastorno de conducta desafiantes, antecedentes de acoso sexual y consumo de tabaco.Actuar tempranamente sobre los factores de riesgo genéricos detectados, es una forma de prevenir la violencia (AU)

[HIV-1 virus transmission through maternal milk]. / Transmisión del HIV-1 a través de la leche materna.

Human immunodeficiency virus type 1 (HIV-1) may be vertically transmitted during the pre, peri or postpartum period. Postnatal transmission as well as an increased risk of vertical transmission with breastfeeding has been shown for HIV-1 in several reports. Breastfeeding was here analyzed as a risk of HIV-1 transmission in a group of infants born to HIV-1 infected mothers. Among the 215 children studied in our population a significant difference was detected between those who were breastfed vs those who were bottle fed and finally became infected (p < 0.000000, R.R. = 4.29). We also report the case of a postnatal infection in a baby born to an HIV-1 seropositive father and a seronegative mother. Due to the risk of infection of the mother she had been thoroughly controlled when pregnant and after delivery. Mother and child were negative when retested at delivery, and at 10 months post-partum. At the age of 32 months the child attended the outpatient clinic with generalized lymphadenopathy and right parotitis. HIV-1 infection was then confirmed in both mother and child. At that time it was discovered that the baby had been breastfed up to the age of 24 months. This is the first reported child in Argentina whose infection may undoubtedly be attributed to breastfeeding.

Perfíl lipídico en recién nacidos con retardo del crecimiento intrauterino / Serum lipids in newborns with intrauterine growth retardation

Background: The X syndrome, related to coronary disease in adults, could be possibly programmed priory to delivery, in children with intrauterine growth retardation. Aim: To measure serum lipids in newborns with symmetrical or asymmetrical intrauterine growth retardation. Patients and methods: One hundred thirty five newborns with intrauterine growth retardation and 116 normal term newborns, with 38 to 41 gestational weeks, were studied. Total, HDL, and LDL cholesterol, triglycerides and apoproteins. A1 and B were measured in imbilical cord blood samples. Results: No differences in total, HDL, LDL cholesterol, apoproteins A1 and B were observed between the study groups. Triglycerides were higher in newborns with intrauterine growth retardation, compared to normal term newborns (45 ñ 27 and 36 ñ 19 mg/dl respectively, p<0,001). Differences in serum triglyceride levels respect to controls were observed in both male and female newborns with asymmetrical growth retardation. Likewise the differences respect to controls were observed in newborns with mild or severe but not with moderate growth retardation. Conclusions: Newborns with intrauterine growth retardation have higher triglyceride levels than normal term newborns

Depression and body fat deposition in Mexican pregnant adolescents.

BACKGROUND: The objective of this study was to assess the effect of maternal depressive symptomatology on fat deposition in a group of pregnant adolescents. METHODS: A case-control study was performed with 85 pregnant women (45 adolescents and 40 adults) who attended a prenatal care course at a teaching hospital in Mexico City. During the second and third trimesters of gestation, a test proposed by Zung was applied to measure depressive symptoms. Weight and skinfolds (i.e., triceps, biceps, suprailiac, subscapular, and thigh) were measured in all women beginning at week 20 of gestation through 4 weeks postpartum. Monthly evaluations were performed. RESULTS: At the 28th week of gestation, nearly 40% of pregnant adolescents showed scores above the cut-off points in the depression test, while among the adults this proportion corresponded to 15%. In the adolescents, depression status was related to self-esteem. Percentage of body fat in adult women tended to be relatively constant, while in adolescents a tendency toward increased body fat was found. In adolescents, depressive symptomatology and especially lack of self-esteem and weight gain during pregnancy were the variables that better predicted the fat-increment pattern during gestation, while in adults no variable was found that predicted fat deposition. CONCLUSIONS: Depression status is a risk factor for excessive fat deposition during pregnancy in Mexican adolescents.

Transmisión del HIV-1 a través de la leche materna. / [HIV-1 virus transmission through maternal milk]

Human immunodeficiency virus type 1 (HIV-1) may be vertically transmitted during the pre, peri or postpartum period. Postnatal transmission as well as an increased risk of vertical transmission with breastfeeding has been shown for HIV-1 in several reports. Breastfeeding was here analyzed as a risk of HIV-1 transmission in a group of infants born to HIV-1 infected mothers. Among the 215 children studied in our population a significant difference was detected between those who were breastfed vs those who were bottle fed and finally became infected (p < 0.000000, R.R. = 4.29). We also report the case of a postnatal infection in a baby born to an HIV-1 seropositive father and a seronegative mother. Due to the risk of infection of the mother she had been thoroughly controlled when pregnant and after delivery. Mother and child were negative when retested at delivery, and at 10 months post-partum. At the age of 32 months the child attended the outpatient clinic with generalized lymphadenopathy and right parotitis. HIV-1 infection was then confirmed in both mother and child. At that time it was discovered that the baby had been breastfed up to the age of 24 months. This is the first reported child in Argentina whose infection may undoubtedly be attributed to breastfeeding.

[Development and evaluation of food supplements for the education, health, and nutrition program]. / Desarrollo y evaluación de suplementos alimenticios para el programa de educación, salud y alimentación.

OBJECTIVE: To develop and evaluate nutritional supplements destined to a program of social assistance. MATERIAL AND METHODS: In the design of the nutritional supplements a series of criteria were considered including nutrient composition, physicochemical properties and feasibility of production and utilization. Final products were initially evaluated to determine the level of acceptance in 40 children, 52 pregnant women and 62 lactating women in Mexico City. A community trial was also carried out to determine acceptance and consumption in 108 children and 128 women from a rural community in the state of Morelos. RESULTS: The specific formulation and technical processes of production of the nutritional supplements are presented. Products proved to be widely accepted, with average scores of 4.11-4.29 for the children's beverage, and 3.98-4.15 for a more viscous pap (range of scores was 1 to 5). Products for women received average scores from 4.75 to 5.70 in pregnant and from 4.8 to 5.4 in lactating women (range of scores from 1 to 7). In the community trial, supplements were very well accepted. Average consumption was > 75% among children and > 98% among women. Mean energy intake from supplements was 244 Kcal/day for women, and for children, 168 Kcal/day with the pap and 147 Kcal/day with the beverage. Consumption was consistent in all cases along the study. CONCLUSIONS: Nine nutritional supplements were developed and evaluated which comply with the necessary nutritional, physicochemical and hygienic characteristics for the target population, besides being relatively simple to prepare, and widely well accepted and consumed.

[Serum retinol in urban Mexican women during the perinatal period]. / Retinol sérico en mujeres mexicanas urbanas durante el periodo perinatal.

OBJECTIVE: To establish the prevalence of vitamin A deficiency during pregnancy and lactation in a group of urban Mexican women. MATERIAL AND METHODS: A group of pregnant women who attended a prenatal care program were invited to participate. Subjects had no added pathologies and were less than 20 weeks pregnant. Evaluations were performed 3 times during pregnancy until 24 weeks post-partum. Vitamin A levels were determined in serum by high performance liquid chromatography (HPLC). The cut-off point to consider retinol deficiency was < 1.05 mumol/L. RESULTS: During the 3 gestational evaluations, vitamin A levels were 2.34 +/- 0.70, 2.41 +/- 1.03 and 1.86 +/- 0.66 mumol/L, respectively, which shows a significant decrease. However, only 1/30 was situated below the accepted cut-off point to consider risk of deficiency, and none for deficiency. During post-partum, concentrations remained relatively constant, approximately 2.10 mumol/L. Lactation had no impact on serum retinol levels, while weight loss did. CONCLUSIONS: No cases of vitamin A deficiency were found in the studied population during the perinatal period. Maternal weight loss affects post-partum retinol levels.

[Non-pregnant women's nutrition and its impact in life quality]. / Nutrición de la mujer no embarazada y su impacto en la calidad de vida.

Emphasis is made in the nutrition aspects related to women at reproductive age that are not pregnant or lactating and that includes the variations that happen throughout the menstrual cycle, fluctuations in energy expenditure, body composition and mood. Nutrition role in some premenstrual syndrome alterations as premenstrual stress (serotonin, magnesium, calcium and vitamin E), anemia, gynecological cancers (antioxidants, alcohol, folic acid, lipids, fiber and phytosterols) and osteoporosis (exercise and diet) are also described, as well as the impact on nutrition of the use of contraceptive methods (hormonal and intrauterine devices). Practical recommendations directed toward the evaluation and management of the main nutrition needs of adult women are included.

Modulation of 72-kilodalton type IV collagenase (Matrix metalloproteinase-2) by ascorbic acid in cultured human amnion-derived cells.

Extensive research has been done to investigate the effects of nutrients on placental and fetal development. It is now evident that environmental factors such as diet may exert a profound effect on gene expression during pregnancy. A low intake of vitamin C during pregnancy has been linked to a higher risk of premature rupture of the membranes (PROM) because of its well-known role in collagen biosynthesis. Here we report a new effect of ascorbic acid acting as a modulator of the 72-kDa type IV collagenase (matrix metalloproteinase-2; MMP-2). MMP-2 expression/activity is down-regulated by vitamin C in human amnion cultured cells. The regulatory effect is exerted at the transcriptional level and is specific for MMP-2. Matrix metalloproteinases are implicated in tissue remodeling, and our results allow us to suggest a molecular mechanism that relates poor availability of vitamin C during pregnancy and the development of PROM.

Impacto del sindrome hipertensivo del embarazao en el retardo del crecimiento intrauterino / Impact of hypertensive disease of pregnancy on intrauterine growth retardation

Background: Intrauterine growth retardation, associated to hypertensive disease of pregnancy, is responsible for a higher perinatal mortality and morbidity. Aim: To assess obstetrical, perinatal and neonatal features of intrauterine growth retardation associated to hypertensive disease of pregnancy. Patients and methods: One hundred thirty seven newborns with intrauterine growth retardation, whose mothers had hypertensive disease of pregnancy, were compared to 165 similar newborns but whose mothers did not have the disease. Results: The incidence of intrauterine growth retardation associated to hypertensive disease of pregnancy was 45.4 percent. Maternal obesity at the start and end of pregnancy, a pregestational weight over 65 kg and a weight increment of more than 20 kg during pregnancy were risk factors for hypertensive disease of pregnancy with relative risks of 1.76, 1.62, 1.62 and 2.09 respectively. Relative risks for cesarean section and prematurity were also higher among women with hypertensive disease of pregnancy. Intrauterine growth retardation associated to maternal hypertension was symmetrical and severe in 37.9 percent of newborns. All seven neonatal deaths occurred in newborns with severe retardation. Conclusions: Neonatal and perinatal morbidity and mortality are higher in newborns with intrauterine growth retardation. Hypertensive disease of pregnancy was associated with a twice higher incidence of asymmetrical intrauterine growth retardation