Conocimiento de las puérperas sobre los efectos perinatales del tabaquismo materno y factores sociodemográficos asociados al consumo / Knowledge of puerperal women about the effects rates of maternal smoking and factors sociodemographics associated with consumption

Objetivo. El tabaquismo materno es un factor de riesgo conductual, evitable y cuyos efectos perjudiciales alcanzan todo el ciclo vital del niño. El objetivo es valorar el conocimiento de una población de puérperas atendidas en el Hospital de la Línea de la Concepción, sobre los efectos perinatales del tabaquismo materno. Material y métodos. Estudio exploratorio, transversal (septiembre a noviembre de 2022). Muestreo consecutivo y aplicación de encuesta a 151 puérperas/ expedientes de neonatos, para recolectar información sociodemográfica, clínica obstétrica y del neonato, de consumo de tabaco y de conocimiento sobre efectos perinatales del tabaquismo materno con preguntas cerradas. Estadísticas descriptivas y comparación de grupos independientes con las pruebas t de Student y chi-cuadrado. Resultados. El consumo de tabaco previo al embarazo distinguió un 32% (48/151) de fumadoras. Se obtuvo un nivel global de aciertos entre el 45% y el 76,8%; mayor proporción de aciertos entre no fumadoras (rango 45,6-79,6%) que entre fumadoras (rango 37,5-72,9%). Para cada enunciado, el nivel de aciertos resultó sin diferencias (p>0,05) entre ambos grupos. Conclusiones. El nivel de conocimientos registrado no mostró diferencias entre fumadoras y no fumadoras. Se discuten alternativas para profundizar en la investigación y acciones integrales orientadas a reducir y eliminar el consumo de tabaco por la población femenina general y las mujeres embarazadas. (AU)

Objective. Maternal smoking is an avoidable behavioral risk factor whose harmful effects reach the entire life cycle of the child. The objective is to evaluate the knowledge of a population of puerperal women treated at the Hospital de la Linea de la Concepción (Cádiz, Spain), about the perinatal effects of maternal smoking. Material and methods. Exploratory, cross-sectional study –September to November 2022. Consecutive sampling and survey application to 151 puerperal women/newborn records, to collect sociodemographic, obstetric, and neonatal clinic information on tobacco use and knowledge about the perinatal effects of maternal smoking with closed questions. Descriptive statistics and comparison of independent groups with Student’s t and chi-square tests. Results . Tobacco use prior to pregnancy distinguished 32% (48/151) smokers. A level global of hits between45% and 76.8% was obtained; higher proportion of correct answers among non-smokers (range 45.6%-79.6%) than among smokers (range 37.5%-72.9%). For each statement, the level of correct answers was not different between both groups (p>0.05). Conclusions. The level of knowledge registered did not show differences between smokers and non-smokers. Alternatives are discussed to deepen the research and integral actions aimed at reducing and eliminating tobacco use by the general female population and pregnant women. (AU)

New frontiers of developmental endocrinology opened by researchers connecting irreversible effects of sex hormones on developing organs.

In the early 1960's, at Professor Bern's laboratory, University of California, Berkeley) in the US, Takasugi discovered ovary-independent, persistent vaginal changes in mice exposed neonatally to estrogen, which resulted in vaginal cancer later in life. Reproductive abnormalities in rodents were reported as a result of perinatal exposure to various estrogenic chemicals. Ten years later, vaginal cancers were reported in young women exposed in utero to the synthetic estrogen diethylstilbestrol (DES) and this has been called the "DES syndrome". The developing organism is particularly sensitive to developmental exposure to estrogens inducing long-term changes in various organs including the reproductive organs. The molecular mechanism underlying the persistent vaginal changes induced by perinatal estrogen exposure was partly demonstrated. Persistent phosphorylation and sustained expression of EGF-like growth factors, lead to estrogen receptor α (ESR1) activation, and then persistent vaginal epithelial cell proliferation. Agents which are weakly estrogenic by postnatal criteria may have major developmental effects, especially during a critical perinatal period. The present review outlines various studies conducted by four generations of investigators all under the influence of Prof. Bern. The studies include reports of persistent changes induced by neonatal androgen exposure, analyses of estrogen responsive genes, factors determining epithelial differentiation in the Müllerian duct, ESR and growth factor signaling, and polyovular follicles in mammals. This review is then expanded to the studies on the effects of environmental estrogens on wildlife and endocrine disruption in Daphnids.

Immunoendocrinology: faulty hormonal imprinting in the immune system.

Hormonal imprinting is an epigenetic process which is taking place perinatally at the first encounter between the developing hormone receptors and their target hormones. The hormonal imprinting influences the binding capacity of receptors, the hormone synthesis of the cells, and other hormonally regulated functions, as sexual behavior, aggressivity, empathy, etc. However, during the critical period, when the window for imprinting is open, molecules similar to the physiological imprinters as synthetic hormone analogs, other members of the hormone families, environmental pollutants, etc. can cause faulty imprinting with life-long consequences. The developing immune system, the cells of which also have receptors for hormones, is very sensitive to faulty imprinting, which causes alterations in the antibody and cytokine production, in the ratio of immune cells, in the defense against bacterial and viral infections as well as against malignant tumors. Immune cells (lymphocytes, monocytes, granulocytes and mast cells) are also producing hormones which are secreted into the blood circulation as well as are transported locally (packed transport). This process is also disturbed by faulty imprinting. As immune cells are differentiating during the whole life, faulty imprinting could develop any time, however, the most decisive is the perinatal imprinting. The faulty imprinting is inherited to the progenies in general and especially in the case of immune system. In our modern world the number and amount of artificial imprinters (e.g. endocrine disruptors and drugs) are enormously increasing. The effects of the faulty imprinters most dangerous to the immune system are shown in the paper. The present and future consequences of the flood of faulty imprintings are unpredictable however, it is discussed.

Enfermedad de Chagas y embarazo / Chagas disease and pregnancy

Objetivo: Analizar la situación actual de la Enfermedad de Chagas (EC) en relación con la gestación en el Hospital Universitario La Paz (HULP). Método: Estudio retrospectivo de gestantes diagnosticadas de EC en el HULP y seguimiento de sus hijos. Resultados: En el HULP hay descritos cinco casos de recién nacidos de madres con EC en seguimiento sin que se haya demostrado transmisión vertical. Discusión: El diagnóstico de la enfermedad en el neonato es complicado debido a la dificultad de detectar parásitos en sangre y a la presencia de anticuerpos maternos. El tratamiento únicamente tiene buenos resultados cuando se administra en los primeros meses de vida. Conclusiones: Debido al aumento de población inmigrante procedente de áreas endémicas, el tamizaje de EC en gestantes procedentes de dichas áreas y el seguimiento de los neonatos es fundamental para facilitar la detección de la infección congénita y su tratamiento.

Objective: Analyze the current situation of Chagas' disease in relation with gestation in The University Hospital La Paz (HULP). Methods: Retrospective study of pregnant women diagnosed of Chagas' disease in HULP and the clinical tracking of their children. Results: In the HULP, five cases of new borns with mothers affected of Chagas' disease have been reported without a vertical transmission being detected. Discussion: The diagnosis of Chagas' disease in the new born is complicated because of the difficulty for detecting parasites in blood and the presence of maternal antibodies. Treatment is only effective if it is administered during the first months of life. Conclusions: Due to the increment of immigrant population from endemic areas, the screening of Chagas' disease is really important to detect this congenital infection and its treatment.