Pregnant woman from southern Peru with rabies infection who delivered a healthy baby.

Rabies in pregnancy is rare with a high mortality. We report a pregnant woman who developed urban rabies from the bite of an infected dog. An emergency Cesarean section was performed at 31 weeks of gestation, and a premature baby was delivered who survived and did not develop rabies. The mother, however, suffered a rapid clinical deterioration and was admitted to intensive care where a Milwaukee protocol was followed. The patient survived 19 months but developed severe neurological sequelae secondary to rabies encephalitis and finally died of respiratory failure.

Placental Proinflammatory State and Maternal Endothelial Dysfunction in Preeclampsia.

OBJECTIVE: To evaluate the placental and decidual gene expression and maternal and umbilical serum concentrations of tumor necrosis factor alpha, interleukin 6 (IL-6), IL-8, IL-10, IL-1 receptor antagonist (IL-1RA), intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 (VCAM-1), along with the proinflammatory/anti-inflammatory cytokine ratios in women with preeclampsia (PE) vs. women with normal pregnancy (NP), and to analyze PE classified as early- (EO) and late-onset (LO). METHODS: This cross-sectional study was performed with 50 women with PE (EO n = 30, LO n = 20) and 50 women with NP. Tissue gene expression levels were measured by real-time RT-PCR. Cytokines and adhesion molecules serum concentrations were measured by immunoassays. RESULTS: In PE, placental expression of IL-10 and IL-1RA was lower, while placental IL-8/IL-1RA ratio and maternal concentrations of VCAM-1 were higher vs. NP. In EO, placental expression of IL-10 was lower, while placental IL-8/IL-10 and IL-8/IL-1RA ratios were higher than LO and NP. Maternal concentrations of IL-6 were higher in LO than EO and NP. Throughout PE, maternal VCAM-1 concentrations were higher vs. NP. No significant differences were observed in the decidual expression and umbilical concentrations of the markers between the groups. CONCLUSION: PE associates with a proinflammatory placental state; however, EO associates with a proinflammatory placental state, while LO associates with systemic maternal inflammation. Both subtypes associated with maternal endothelial dysfunction.

Similar to Adiponectin, Serum Levels of Osteocalcin are Associated with Mammographic Breast Density in Postmenopausal Women.

OBJECTIVE: Breast cancer is the most common type of cancer in Canadian women and worldwide. Mammographic density is a well-established breast cancer risk. Recent evidence suggested inverse correlations among adiponectin, osteocalcin, and the risk developing breast cancer. The objective of the study was to evaluate the relationship between breast density and adiponectin and osteocalcin concentrations. METHODS: A cross-sectional study was performed in 239 women, age range 40 to 60. Mammographic density, serum adiponectin, and osteocalcin levels were measured. According to the Wolfe method, participants were divided into those with low-risk and high-risk pattern mammograms. RESULTS: The study population included 107 premenopausal and 132 postmenopausal women. Parameters were no different between women with low-risk and high-risk patterns. In obese postmenopausal women, the high-risk pattern mammogram group had significantly higher values of adiponectin and osteocalcin compared with the low-risk pattern group. Multiple linear regression analyses showed that adiponectin and osteocalcin levels were associated with high-risk pattern mammograms. CONCLUSION: Adiponectin and osteocalcin levels were directly associated with high-risk pattern mammograms in obese postmenopausal women. These results do not support the use of adipokines as biomarkers; nevertheless, the most important factor is to assess the risk through breast density.

[Dienogest usefulness in pelvic pain due to endometriosis. A meta-analysis of its effectiveness]. / Evaluación de dienogest en el tratamiento del dolor pélvico asociado a la endometriosis. Un metaanálisis de su efectividad.

BACKGROUND: Endometriosis is the presence of functional endometrial tissue in the pelvic peritoneum and it affects several age groups. That is why the impact of endometriosis in quality of life is considerable. The objective of this study was to evaluate the effectiveness of dienogest in patients with pelvic pain associated to endometriosis (PPAE). METHODS: The evaluation of the effectiveness was carried out through a systematic review using the Cochrane methodology. It was used Markov model, which considers two states of health (with and without PPAE), with the possibility of weekly transition. Women between 18 and 45 years with PPAE were included, in a temporary horizon of 26 weeks. A level of statistical significance of 95% was used for a p < 0.05, with a multivariate probabilistic analysis of sensibility, as well as a univariate analysis of sensibility in several scenarios. RESULTS: The probability that the female patient did not experience PPAE with the initial treatment was 87.91% with dienogest, 80.07% with danazol, 84.93% with medroxyprogesterone (injectable and oral) and 89.17% with gosereline. The probability that the female patient abandoned her initial treatment was 9% with dienogest, 12.07% with danazol, 9.6 and 6.75% with medroxyprogesterone injectable and oral, respectively, and 10.8 and 3.6% 3-monthly and monthly with gosereline. CONCLUSION: Compared to danazol, medroxiprogesterone and gosereline, dienogest is the most efficient alternative to treat PPAE.

Introducción: La endometriosis es la presencia de tejido endometrial funcional en el peritoneo pélvico y afecta a varios grupos de edad, por lo que su impacto en la calidad de vida es considerable. El objetivo fue evaluar la efectividad del dienogest en pacientes con dolor pélvico asociado a endometriosis (DPAE), al compararlo con danazol, medroxiprogesterona y goserelina. Métodos: se hizo una revisión sistemática de la literatura con la metodología Cochrane. Se usó el modelo de Markov, que considera dos estados de salud: con y sin DPAE, con posibilidad de transición semanal. Se consideraron mujeres entre 18 y 45 años con DPAE, en un horizonte de 26 semanas; se utilizó un nivel de significación estadística de 95% (p < 0.05), con un análisis probabilístico multivariante de sensibilidad y uno univariante de sensibilidad en varios escenarios. Resultados: la probabilidad de que la mujer se encontrara sin DPAE con el tratamiento inicial fue de 87.91% para dienogest, 80.07% para danazol, 84.93% para medroxiprogesterona inyectable y oral y 89.17% para goserelina; la probabilidad de que la mujer abandonara su tratamiento inicial fue de 9% para dienogest, 12.07% para danazol, 9.6 y 6.75% para medroxiprogesterona inyectable y oral, respectivamente, y 10.8 y 3.6% para goserelina trimestral y mensual, respectivamente. Conclusiones: Comparado con el danazol, la medroxiprogesterona y la goserelina, el dienogest es la alternativa más eficiente para el DPAE.

[Persists the controversy concerning the rutinary use of diagnostic tests in asymptomatic persons]. / Persiste la controversia acerca del uso rutinario de pruebas de detección en personas asintomáticas.

Currently, in medicine there is an environment replete with controversy and debate, partially due to the popular concept Evidence-Based Medicine, and to the development of technological advances and, apparently, better therapeutic resources. This has led to the establishment of an over-diagnosis epidemic and to an excess of therapeutic interventions, which do not necessarily lead to a longer life expectancy. Some medical controversies, which have called the attention of physicians and even of common people are those related with dislipoproteinemias, pre-diabetes and detection of cancer in asymptomatic persons. The debate and the controversy will surely continue and that is why it is very important to emphasize that clinical practice should be personalized, taking into account risks and implied benefits.

En la actualidad existe en medicina un ambiente repleto de controversias y debates, en parte generado por la popularidad del concepto de medicina basada en evidencia y por la aparición de avances tecnológicos y aparentemente mejores recursos terapéuticos. Esto ha llevado a la instalación de una epidemia diagnóstica y a una excesiva politerapéutica que no se traducen en una más larga expectativa de vida. Algunas controversias médicas que han llamado la atención de los médicos e incluso del público en general son las relacionadas con los tópicos de dislipoproteinemia, prediabetes y detección de cáncer en personas asintomáticas. El debate y la controversia seguramente continuarán y por ello resalta la importancia de la práctica médica en la individualidad, tomando en cuenta los riesgos y los beneficios implicados.

Gene variants in the FTO gene are associated with adiponectin and TNF-alpha levels in gestational diabetes mellitus.

BACKGROUND: Obesity may have a role in the development of gestational diabetes mellitus (GDM). Single-nucleotide-polymorphisms (SNPs) of the FTO (fat mass and obesity associated) gene have been associated with obesity. The aim of this study was to investigate SNPs rs8050136, rs9939609, and rs1421085 of the FTO gene in women with GDM and their associations with maternal pre-pregnancy weight and body mass index, gestational weight gain and mediators of insulin resistance in GDM like leptin, adiponectin, ghrelin and tumor necrosis factor-alpha (TNF-alpha), compared with healthy pregnant controls. METHODS: 80 women with GDM and 80 women with normal pregnancy were considered for the present study. Genotyping of selected SNPs in all study subjects was done using the Taq-Man assay and the adipokines and ghrelin were measured by immunoassays. Chi square test, odds ratios (OR) and their respective 95% confidence intervals were used to measure the strength of association between FTO SNPs and GDM. RESULTS: There was no association among FTO SNPs and GDM. Interestingly, in GDM group, women carrying the risk alleles of the three SNPs had increased TNF-alpha, and decreased adiponectin levels; these associations remained significant after adjusting for pre-gestational body weight and age. Moreover, the risk allele of rs1421085 was also associated with increased weight gain during pregnancy. CONCLUSIONS: The FTP SNPs rs8050136, rs9939609, and rs1421085 are not a major genetic regulator in the etiology of GDM in the studied ethnic group. However, these SNPs were associated with adiponectin and TNF-alpha concentrations in GDM subjects.

[Debate persists over the use of mammogram in the detection of breast cancer in asymptomatic women]. / Persiste el debate del uso rutinario de la mamografía en la detección de cáncer de mama en mujeres asintomáticas.

In this opinion article, it is discussed the importance of questioning the use of mammogram in the detection of breast cancer in asymptomatic women.

En el presente artículo de opinión se discute acerca de la necesidad de cuestionar la práctica rutinaria del empleo de la mamografía para detectar cáncer de mama en mujeres asíntomáticas.

Colesterol y aterosclerosis. Consideraciones históricas y tratamiento / Cholesterol and atherosclerosis. Historical considerations and treatment

Resumen El colesterol es un esteroide precursor de hormonas, componente esencial de la membrana celular, sin embargo, alteraciones en la regulación de la síntesis, absorción y excreción del colesterol predisponen al desarrollo de enfermedades cardiovasculares de origen aterosclerótico. De esta manera, reconociendo los acontecimientos históricos desde hace 200 años, con Michel Chevreul que le dio el nombre "colesterina", más tarde Lobstein que acuñó el término aterosclerosis y Marchand que lo introduce, Anichkov que identifica el colesterol en las placas de ateroma, y el descubrimiento del receptor LDL por Brown y Goldstein; además de la aparición de los diferentes fármacos que han surgido desde los fibratos, las estatinas y en esta década cetrapibs, muy prometedores para aumentar el HDL, en forma más reciente, ezetimibe y anti-PCSK9 para inhibir el proceso de degradación del receptor LDL; no obstante, estos avances no han sido suficientes para disminuir la morbilidad en enfermedades cardiovasculares.

Abstract Cholesterol is a precursor of steroid hormones and an essential component of the cell membrane, however, altered regulation of the synthesis, absorption and excretion of cholesterol predispose to cardiovascular diseases of atherosclerotic origin. Despite, the recognition of historical events for 200 years, starting with Michel Chevreul naming "cholesterol"; later on, Lobstein coining the term atherosclerosis and Marchand introducing it, Anichkov identifying cholesterol in atheromatous plaque, and Brown and Goldstein discovering LDL receptor; as well as the emerging of different drugs, such as fibrates, statins and cetrapibs this decade, promising to increase HDL and the most recent ezetimibe and anti-PCSK9 to inhibit the degradation of LDL receptor, however morbidity has not been reduced in cardiovascular disease.

[Cholesterol and atherosclerosis. Historical considerations and treatment]. / Colesterol y aterosclerosis. Consideraciones históricas y tratamiento.

Cholesterol is a precursor of steroid hormones and an essential component of the cell membrane, however, altered regulation of the synthesis, absorption and excretion of cholesterol predispose to cardiovascular diseases of atherosclerotic origin. Despite, the recognition of historical events for 200 years, starting with Michel Chevreul naming «cholesterol¼; later on, Lobstein coining the term atherosclerosis and Marchand introducing it, Anichkov identifying cholesterol in atheromatous plaque, and Brown and Goldstein discovering LDL receptor; as well as the emerging of different drugs, such as fibrates, statins and cetrapibs this decade, promising to increase HDL and the most recent ezetimibe and anti-PCSK9 to inhibit the degradation of LDL receptor, however morbidity has not been reduced in cardiovascular disease.

[Scientific contributions of Jules Hirsch regarding the physiopathogenesis of obesity]. / Contribuciones científicas de Jules Hirsch sobre la fisiopatogenia de la obesidad.

Jules Hirsch was born in New York City and died at age 88 after a long illness. He was considered notorious leader in the study of human metabolism mainly in the area of lipids and obesity. His research at The Rockefeller University helps establish the mechanism of obesity and lipids metabolism. Hirsch joined Rockefeller´s faculty in 1954 and remained there for the rest of his career. Hirsch´s research helped to support the idea of dynamic interactions among diet, physical activity, general metabolism and obesity. At that time most scientific considered adipose tissue to be biologically inert such as a passive insulator in which the body reserved energy in the form of triglycerides. Hirsch had a natural characteristic of showing a nice smile and greeting for everyone he worked with at the university. Another important contribution was there relationship between diet and cardiovascular ailments as well as metabolism disturbance.

Jules Hirsch nació en la ciudad de Nueva York y murió en Julio 23 de 2015, a la edad de 88 años. Es considerado como un notable y eminente líder en el estudio del metabolismo; particularmente centró su interés en la obesidad ocasionada por un acumulo excesivo de grasa por exceso de alimento y falta de actividad física. Hirsch ingresó a la facultad como profesor en la Universidad Rockefeller en 1954 y permaneció por el resto de su carrera como investigador clínico hasta su jubilación como emérito. Los estudios de Hirsch apoyaron la idea de que existía una interrelación entre la dieta, la actividad física, el metabolismo y la obesidad. En ese tiempo la mayor parte de los científicos pensaba que el tejido adiposo era simplemente una reserva inerte en donde se almacenaba la grasa en forma de triglicéridos para proporcionar energía al organismo. Una de las características personales de Hirsch era una agradable sonrisa y el buen trato a todas las personas que trabajaban en la universidad. Hirsh también advirtió, y esta es otra contribución importante, que la obesidad, la falta de actividad física y el exceso de lípidos contribuyen al desarrollo de trastornos metabólicos y enfermedad cardiovascular.

[Clinical implications of basic research in preeclampsia: immunological tolerance]. / Implicaciones clínicas de la investigación básica de la preeclampsia: tolerancia inmunológica.

Preeclampsia is one of the main causes of maternal and perinatal mortality in the world; however, the pathophysiologic pathways haven't been clearly elucidated. It is thought to result from a breakdown of maternal tolerance to paternal antigens in placenta that start an immune response against the trophoblast inducing a defective placentation and a hipoxic/isquemic environment which in turn triggers a systemic inflamatory response. This review gives an overview of the mechanims involved in maternal tolerance, how these are disrupted in preeclampsia, and how they contribute to the inflamatory response.

Morphological changes of red blood cells in peripheral blood smear of patients with pregnancy-related hypertensive disorders.

BACKGROUND AND AIMS: Pregnancy-related hypertensive disorders are complications in which risk factors are identified such as nulliparity, age, malnutrition, obesity and social issues. Those statements are explained by theories of abnormal placentation, immunological inadequacy, genetics and oxidative stress, but all theories converge in endothelial damage, which is able to mechanically deform and hemolyze erythrocytes as they pass through the capillaries. Given the effects of endothelial damage, the aim of the study was to determine erythrocyte alterations in peripheral blood smear of patients with hypertensive disorders of pregnancy that could be used as prognostic condition. METHODS: We performed a prospective, descriptive and observational study where all patients with hypertensive disorders admitted to the obstetrics and gynecology service of a specialty hospital were recruited. Patients who provided signed informed consent underwent peripheral blood smear. Results were tabulated in percentage graphics and analyzed with Cramer's V based on χ(2). The peripheral blood smear consisted of an extended drop of peripheral blood from the patient with subsequent hematological staining done with Romanowsky stain. RESULTS: A total of 119 samples were analyzed; 74% showed abnormal morphology of erythrocytes and the most frequent abnormality was the presence of schistocytes in up to 39% of samples. Descriptive analysis showed a degree of association to independent variables with Cramer's V = 0.41 value (p <0.05). CONCLUSIONS: A high percentage of patients with hypertensive disorders of pregnancy show some morphologic alterations of erythrocytes in peripheral blood smear.

[Commentary on the Nobel Prize that has been granted in Medicine-Physiology, Chemistry and Physics to noteable investigators]. / Comentario sobre los Premios Nobel de Medicina-Fisiología, Química y Física otorgados a investigadoras notables.

The Nobel Prize was established by Alfred Nobel in 1901 to award people who have made outstanding achievements in physics, chemistry and medicine. So far, from 852 laureates, 45 have been female. Marie Curie was the first woman to receive the Nobel Prize in 1903 for physics and eight years later also for chemistry It is remarkable that her daughter Irene and her husband also received the Nobel Prize for chemistry in 1935. Other two married couples, Cori and Moser, have also been awarded the Nobel Prize. The present commentary attempts to show the female participation in the progress of scientific activities.

[A tribute to Carl Djerassi]. / Tributo a Carl Djerassi.

On January 15, 2015, Carl Djerassi, an extraordinary personality, died at the age of 91 years. He was born in Vienna, Austria, on October 29, 1923. His parents were physicians and probably he wanted to be also a physician, but sooner than later he chose to be a chemist. In 1939 he arrived to live to New York with his mother. In 1945 he became American citizen. Part of his work is the first commercial antihistamine, pyribenzamine, and the first successful combined oral contraceptive pill. With this editorial we make a tribute to this steroid pioneer.

El 30 de enero de 2015 falleció, a la edad de 91 años, Carl Djerassi, un personaje extraordinario. Nació en Viena, Austria, el 29 de octubre de 1923. Sus padres eran médicos y quizás por esa razón él también quería serlo, pero pronto escogió la química. En 1939 llegó con su madre a vivir a Nueva York y en 1945 se naturalizó estadounidense. Son obra suya el primer antihistamínico comercial (la piribenzamina) y el compuesto farmacológico de la píldora anticonceptiva. Sirva el presente editorial como un homenaje a este pionero de los esteroides sintéticos.

[Usefulness and risks of routine mammography for the detection of breast cancer]. / Utilidad y riesgos de la mamografía rutinaria para detectar cáncer de mama.

It has been accepted that preclinicall detection of breast cancer by means of the routine practice of mammography could discover the disease at its initial stage; therefore, practicing a mammography annually became widespread as a preventive health measure to diagnose the disease and prevent death due to breast cancer. Over time, the benefit of detection tests has been questioned and demonstration of their benefit, as well as that of the undesirable effects they might cause, has been demanded. There is recent information with regard to an absence of difference in terms of breast cancer mortality as final index between women with or without routine mammography. Additionally, a 20 % frequency has been observed in false-positive diagnoses, with high numbers of women undergoing unnecessary diagnostic procedures due to suspicion of a non-clinically apparent presumed cancer. In Mexico, from 2004 on, the popularity of mammography to detect and effectively cure cancer has increased. Acceptance can be attributted to how easily detection campaigns can be promoted, since most women accept that mastography can offer the opportunity of receiving an early treatment that reduces dissemination and prevents early mortality. The age at which it is convenient to perform the first mammography, how frequently it should be repeated and even the age for its discontinuation is still under debate and no consensus has been reached.

Se ha aceptado que la detección preclínica del cáncer de mama mediante la práctica rutinaria de mamografía podría descubrir el cáncer en su etapa inicial, por lo que se generalizó hacer anualmente una mamografía como medida de salud preventiva para diagnosticar e impedir la muerte por cáncer mamario. Con el tiempo se ha cuestionado el beneficio de las pruebas de detección y se exige que se demuestre el beneficio y los efectos indeseables que pudieran causar. Existe información reciente respecto a que no hay diferencia en cuanto a la mortalidad por cáncer de mama como índice final entre las mujeres con o sin mamografía rutinaria. También se ha observado 20 % de frecuencia de diagnósticos falso-positivos, por los cuales numerosas mujeres han sido sometidas a procedimientos diagnósticos innecesarios por la sospecha de un supuesto cáncer que no es clínicamente aparente. En México, a partir de 2004 se incrementó la popularidad de la mamografía para detectar y curar efectivamente el cáncer, sin embargo, la mortalidad por cáncer de mama no ha variado. La aceptación se puede atribuir a la facilidad para promover las campañas de detección, ya que la mayoría de las mujeres acepta que la mamografía puede ofrecer la oportunidad de recibir oportunamente un tratamiento que reduzca la propagación e impida una pronta mortalidad. Aún se discute y no se ha alcanzado un consenso en cuanto a la edad en la que es conveniente realizar la primera mamografía, la frecuencia de repetirla e, incluso, la edad para suspenderla.

El desarrollo de la endocrinología ginecobstétrica en el Instituto Mexicano del Seguro Social / The development of gynecobstetric endocrinology at the Instituto Mexicano del Seguro Social

El Dr. Luis Castelazo Ayala había conseguido que la Maternidad de Gabriel Mancera se convirtiera en el Hospital de Ginecobstetricia Núm. 1 (HGO 1), pero quería que fuera considerado como un centro de excelencia científica con un prestigio tanto nacional como extranjero, así que era indispensable agregar la medicina científica para obtener el crédito académico. Por ello, se intentó implementar un laboratorio para algunas pruebas hormonales en orina, que posteriormente sustentó la investigación médica científica de endocrinología ginecológica y la implementación de las determinaciones hormonales con la novedosa técnica del radioinmunoanálisis. Además, se hicieron pruebas de laboratorio rudimentarias para determinar el grado de desarrollo del feto que complementaran las usadas tradicionalmente. Las mediciones de estriol y fosfolípidos fueron las más comunes; además, contribuían a decidir el uso de glucocorticoides para mejorar la inmadurez pulmonar. Se reubicó el HGO 1 al sur de la ciudad, lo cual contribuyó a modernizar y mejorar los laboratorios de alta especialidad y crear el Departamento de Perinatología, resultando en un impulso a la investigación en las áreas de perinatología y endocrinología postparto, la cual incluía la fisiología y manipulación farmacológica de la lactancia y del eje hipotálamo-adenohipófisis-ovario. Así, resultaron varias publicaciones relacionadas con las áreas de diagnóstico y terapéutica de los trastornos hormonales en las etapas fisiológicas de la pubertad, gestación y puerperio.

Dr. Luis Castelazo Ayala had succeeded in turning the Gabriel Mancera Maternity Hospital into the Hospital of Obstetrics and Gynecology No. 1 (HGO 1), but he wanted it to be regarded as a center of scientific excellence with both domestic and international prestige, so it became essential to add scientific medicine to obtain academic credit. Thus, a laboratory was implemented to do some hormonal tests on urine, which later sustained the scientific medical research of gynecological endocrinology and the implementation of hormonal determinations with the novel technique of radioimmunoassay. Rudimentary laboratory tests that supplemented those traditionally used were also made to determine the degree of fetal development. Estriol and phospholipids measurements were the most common; they also helped to decide upon the use of glucocorticoids to improve lung immaturity. The HGO 1 was relocated to the south of the city, which contributed to modernize and improve the high specialty laboratories and to create the Department of Perinatology, which resulted in a boost to the research in the areas of perinatology and postpartum endocrinology. This included the physiology and pharmacological manipulation of breastfeeding and of the hypothalamus-adenohypophysis-ovary axis. This resulted in several publications related to the areas of diagnosis and therapy of hormonal dysfunctions in the physiological stages of puberty, gestation and puerperium.

Ganancia de peso gestacional como factor de riesgo para desarrollar complicaciones obstétricas / Gestational weight gain as a risk factor for developing obstetric complications

La ganancia de peso gestacional es un fenómeno complejo influenciado no sólo por cambios fisiológicos y metabólicos maternos, sino también por el metabolismo placentario. Las mujeres que durante el embarazo tienen un índice de masa corporal (IMC) normal y una ganancia de peso adecuada, presentan una mejor evolución gestacional y del parto. Las mujeres con una ganancia de peso gestacional mayor a la recomendada presentan un incremento en el riesgo de tener hipertensión, diabetes mellitus, varices, coledocolitiasis, embarazos prolongados, retardo en el crecimiento intrauterino, mayor porcentaje de complicaciones al nacimiento, complicaciones trombóticas, anemia, infecciones urinarias y desórdenes en la lactancia. Por una parte, existe una relación entre el peso de la placenta y el volumen del líquido amniótico y, por la otra, el peso del recién nacido, probablemente también exista una relación con el tamaño del útero. Existen diferentes factores que dificultan que la ganancia de peso sea la adecuada, entre los que se encuentra una edad mayor o igual a 40 años. La ganancia excesiva de peso que se puede mantener, e incluso aumentar después del embarazo, dificulta que la mujer regrese a su peso ideal. En el primer trimestre, en la dieta (1,800 calorías) se debe incluir ingredientes saludables. En el segundo trimestre, el feto dobla su talla (a 2,500 calorías), al inicio del cuarto mes, hay que ir aumentando progresivamente las calorías hasta llegar a las 2,500 recomendadas por la OMS. Durante el tercer trimestre (2,750 calorías), en los últimos meses de gestación, se debe aportar a la dieta unas 2,750 calorías diarias y contener sólo unos 100 gramos de proteínas. La comprensión de los determinantes de la ganancia de peso durante el embarazo es esencial para el diseño de las intervenciones clínicas y de la salud de la madre y el bebé.

Gain of gestational weight is a complex phenomenon, not only influenced by maternal physiologic and metabolic changes, but also for the placental metabolism. The women that have a normal body weight index (BWI) and a gain of weight adapted during the gestation to the moment to be pregnancy present a better evolution in pregnancy and childbirth that those women with a gain of more weight to the one recommended. The women with a gain of gestational weight bigger than the increase the risk of having obstetric complications like hypertension, diabetes, coledocolitiasis, prolonged pregnancy, intra-uterine low growth, bigger percentage of complications to the birth, infections before and after the childbirth, thrombotic complications, anemia, bladder infections and disorder in the nursing. A relationship exists between the weight of the placenta and the volume the amniotic liquid, on one hand and the weight of the newly born one for other and that it probably exists also a relationship among the size of the uterus. Different types of complications exist when the gain of weight is not the appropriate one, among those that are the oldest age or similar to 40 years where a bigger risk of obstetric complications exists, this way the excessive gain of weight that can stay and even to increase after the pregnancy being therefore very difficult so that the woman to return to its ideal weight. In the first trimester (1,800 calories) should begin to include healthy ingredients. Second trimester, the fetus bends its size, to the beginning of the fourth month it is necessary to go increasing the calories intake progressively until arriving at the 2,500. Third trimester recommends an intake of 2,750 calories and to contain about 100 grams of proteins. The understanding of the determinant of the gain of weight during the pregnancy is essential for the design of the clinical interventions and of the mother's health and the baby.