[Diabetes and pregnancy in Mexico]. / Diabetes y embarazo en México.

OBJECTIVE: To review the Mexican studies published in the last 15 years on diabetes mellitus (DM) and pregnancy. MATERIAL AND METHODS: We found five descriptive studies on DM and pregnancy and six on the detection of gestational diabetes (GDM) in normal pregnant women using the oral glucose tolerance test (OGTT). RESULTS: The first group of studies comprised 689 patients: 331 with pregestational DM type 2 and 32 type 1; the other 326 patients (47%) had GDM established by clinical symptoms and hyperglycemia, or by fasting hyperglycemia (> 140 mg/dL) in at least two ocassions. The distribution of types 1 and 2 was similar in the five studies. Maternal complications were toxemia in 18%, polyhydramnios is 10% and urinary infection in 6%. Perinatal mortality was 7%, congenital malformations in 6%, macrosomia in 25% and prematurity in 8%. In the puerperium 71 women with GDM were reevaluated: 48 (68%) were type 2, one (1%) type 1, three (4%) glucose intolerance (GI) and 19 (27%) were normal to an OGTT test. The six studies on GMD in normal pregnants were done using the OGTT. Three studies were done in the city of Monterrey, state of Nuevo Leon and show a prevalence of 4.3 to 6%, mean 5.3%. The other three studies show a prevalence of 10.5 to 11%. In the puerperium, 26 women were reevaluated: only three were type 2 (12%), five GI (19%) and 18 (69%) had a normal response to the OGTT. CONCLUSIONS: Type 2 DM is the more frequent type of diabetes associated to pregnancy in Mexican groups; the systematic screening for GDM in normal pregnant women yields 4 to 11% of positivity.

Infection of pregnant women with hepatitis B and C viruses and risks for vertical transmission.

Pregnant women infected with hepatitis B and C viruses pose a risk for infecting their newborn infants by vertical transmission. We studied 6,253 pregnant women aged 12-49 years for infection with hepatitis B (HBV) and C (HCV) viruses. Infection was diagnosed by measuring IgG antibodies against HBc, HBs, HBe, as well as IgM-HBc and HCV viral antigens with commercially available immunoassay kits. HBV infection was detected in 113 cases (1.8%), and prevalence was significantly higher (2.4%) in a group of women with a high-risk pregnancy who were attending a perinatology hospital than in healthy pregnant women (1.67%, p < 0.05). Infection with HBV was significantly higher in women older than 30 years old (p < 0.05). HBsAg was found in blood, colostrum and vaginal exudate of two pregnant women; HBsAg was detected in the gastric aspirate but not in the blood of the two newborn infants. HBeAg and IgM-HBc were not detected in any of the samples. DNA-HBV was detected in serum of seven women, and DNA-HBV was detected in the gastric aspirate of only one of the newborns. HCV infection was diagnosed in three out of 111 women with markers for HBV infection (2.7%), and in 6 out of 1,000 women without these markers (0.6%). Anti-HCV antibodies were found in the serum of six of their infants during up to six months of age. Infants were monitored for one year and none of them developed any sign of hepatic disease. These results suggest that special attention should be paid to women older than 30 years and with a high-risk pregnancy, as they are at a higher risk of HBV and HCV infections.

Comparison of five methods for the detection of measles specific immunoglobulin G antibody.

In this work we compare the sensitivity, specificity and predictive values of hemagglutination inhibition (HI), immunofluorescent assay (IFA), biotin-streptavidin immunofluorescent assay (B/SA-IFA), enzyme-linked immunosorbent assay (EIA) and plaque neutralization test (PN). This study includes serum samples from children taken before and after vaccination, children with clinically diagnosed measles and household contacts. EIA were the most specific and better serological diagnostic test. HI and IFA had high sensitivity but low specificity. An alternative to EIA is B/SAIFA, which is cheaper than EIA and can be used in the study of small outbreaks or in isolated cases.

Prevalencia de marcadores serológicos para los virus B y C de la hepatitis en una cohorte de mujeres embarazadas del Valle de México / Prevalence of serologic markers for virus B and C hepatitis in a cohort of pregnant women from the valley of Mexico

Introducción. Una de las vías de trasmisión de los virus B (HVB) y C (HVC) de la hepatitis es la vertical o perinatal a través de una madre portadora de estos agentes. Material y métodos. En este estudio se investigaron por ELISA marcadores serológicos para HVB y HVC en 6254 gestantes sanas del Valle de México, con edades de 12 a 54 años. Resultados. Se detectó infección previa por HVB (anti-HBc+) en 114 casos (1.82 por ciento), con una P= 0.01 (1.35 vs 2.50 por ciento) entre gestantes de Ciudad Netzahualcóyotl y las del Intituto Nacional de Perinatología. De 6254 muestras, 0.03 por ciento (dos casos) fueron portadores de HVB (HBsAg+). Encontramos 2.7 por ciento (tres casos) positivos para anti HVC en 111 gestantes positivas para anti-HBc. Solamente seis casos (0.6 por ciento de 1000 embarazadas negativas para HVB presentaron anticuerpos contra HVC. Conclusiones. Se observó transmisión transplacentaria de anticuerpos contra virus B o C sin evidencia de infección en nueve de diez recién nacidos estudiados. La transmisión vertical o perinatal no es el principal mecanismo de diseminación de HVB y/o HVC en los grupos familiares analizados

Noninsulin dependent diabetes mellitus and pregnancy in Mexico.

We analyzed 215 consecutive patients with diabetes mellitus and pregnancy, 118 (54.83%) with noninsulin dependent diabetes mellitus (NIDDM), 90 (41.86%) with gestational diabetes mellitus (GDM) and 7 (3.26%) with insulin dependent diabetes mellitus (IDDM). NIDDM and GDM patients had no significant difference in age and body mass index. There were no maternal deaths, nor episodes of ketoacidosis. Maternal and neonatal complications occurred with a similar frequency in NIDDM and GDM. We concluded that in our population, diabetes associated with insulin-resistance occurred in over 96% of our pregnant diabetic patients and was associated with an increased prevalence of maternal and neonatal complications. Earlier perinatal care has to be established in NIDDM patients, and obese young women should be screened to detect GDM from early gestation and advised to reduce weight before pregnancy ensues.

[Mercury poisoning in pregnancy. A case report and review of the literature]. / Intoxicación con mercurio durante el embarazo. Presentación de un caso y revisión de la literatura.

The case of a 28 year old woman with pregnancy of 32 weeks, exposed to mercury vapors at home, without clinical manifestations or mercurial intoxication, but with toxic urinary levels. A review of medical literature about mercury intoxication during pregnancy and its obstetrical and fetal consequences, was carried out. Abruptio placentae was described as a manifestation not previously described.

[Sinusoid pattern. Perinatal consequences]. / Patrón sinusoidal. Repercusión perinatal.

This is a review of 7,203 antepartum fetal heart rate recordings. It was found that the sinusoidal pattern is rare for fetal heart rate, which is seen more frequently in patients with severe Rh isoimmunization, that is easily identified, and it may lead to interruption; in its incomplete form will allow to evaluate the cases totally, as it'bit a severe fetal condition.