The delay of motherhood: Reasons, determinants, time used to achieve pregnancy, and maternal anxiety level.

BACKGROUND: Fertility in recent decades in European countries such as Norway, Spain or United Kingdom has declined, while in others such as Portugal, it has remained relatively constant, and in others such as Germany fertility rated have risen. The determinants of this change in reproductive pattern can be explained by the cultural, social, and economic changes that took place in our society. Objective: to identify the principal reasons and independent determinants associated with the postponement of motherhood and document any association between the time taken to achieve successful pregnancy and maternal age, as well as the level of anxiety of these women. METHODS: An observational study, including 326 women, was conducted in Spain with primiparous women, in which data was collected on sociodemographic, health, and pregnancy-related factors. Comparison of means (t-test or analysis of variance) and the analysis of covariance was used to estimate adjusted means for potential confounders. RESULTS: Women in stable relationships became mothers at older ages (31.83±0.29) than those who were not (28.75±0.78) (p<0.001). Women who delayed motherhood for medical reasons had a mean age of 34.15 ± 0.88 years, compared to a mean of 30.52±0.36 years for personal reasons, and 27.51±1.39 years for other reasons. Mothers with an older age had a higher level of anxiety (p<0.05). The average time required to achieve pregnancy increased as maternal age increased, with an average time of 24 months for women with a mean age of 35.23±0.71 years compared to <3 months for women with a mean age of 29.44±0.39 years. Women ≥ 35 years were more likely to need medical assistance to achieve pregnancy (aOR = 12.07, 95% CI: 1.50-97.05; p = 0.019). CONCLUSIONS: Medical reasons were among those cited for delaying motherhood. The postponement of motherhood was associated with difficulty to achieve a successful pregnancy and a higher level of anxiety.

Evaluación de la ingesta de pescado en población gestante en relación a la exposición al metilmercurio / Assesment of fish intake in pregnant population in relation to exposure to methylmercury

Introducción: El pescado es fuente importante de ácidos grasos poliinsaturados, fundamentales para el neurodesarrollo. Sin embargo, la contaminación con metilmercurio de algunas especies puede actuar en sentido contrario. Objetivo: Conocer la ingesta de pescado en las mujeres gestantes, así como el consumo de especies restringidas por los organismos internacionales por su contenido en metilmercurio y obtener información acerca de la educación sanitaria que reciben sobre las recomendaciones de ingesta de pescado y sus riesgos. Material y método: Se llevó a cabo un estudio descriptivo transversal de evaluación nutricional sobre la ingesta de pescado y marisco en 56 mujeres gestantes, mediante un cuestionario semicuantitativo de frecuencia de consumo. Asimismo, se evaluó el seguimiento de las recomendaciones de consumo de pescado. Resultados: Se obtuvo un consumo medio de pescado y marisco de 101g/día y una frecuencia de consumo medio de 5.53 raciones/semana. Un 91% de las mujeres cumplían las recomendaciones de la SECN, sin embargo un 25% excedían el consumo de especies no recomendadas por su contenido en metilmercurio según las recomendaciones de la AESAN y un 21.4% según recomendaciones de la Comisión Europea. Conclusiones: Las mujeres gestantes en este estudio, consumen pescado de forma adecuada en cantidad pero no siempre del tipo adecuado, excediendo el consumo de pescado azul con alto contenido en mercurio. Destaca la falta de conocimientos en relación al consumo recomendado de pescado y riesgos consecuencia de un déficit de educación sanitaria (AU)

Introduction: Fish is an important source of polyunsaturated fatty acids, which are essential for infant neurodevelopment. Nevertheless, the contamination of some species with methylmercury may act in opposite sense. Objective: To determine fish intake in pregnant population, as well as consumption of species restricted by international organisations because of their content in methylmercury, and to gather information about health education that women receive regarding fish intake recommendations and its possible risks. Materials and méthods: A cross-sectional study about nutritional evaluation of seafood intake was carried out in a sample of 56 pregnant women. Fish intake was assessed using a semiquantitative food frequency questionnaire. In addition, the meeting of the recommendations for fish consumption was analysed. Results: The average consumption of seafood was 101g/day, with a main frequency of 5,53 servings/week. 91% of the women met the recommendations given by the SECN. However, 25% and 21, 4% of pregnant women exceed the consumption of fish species with high methylmercury content in accordance with the AESAN and European Commission recommendations, respectively. Conclusions: Pregnant women in this study consumed fish frequently, but not always the correct kind, exceeding the consumption of oily fish high in mercury. It is important to note the lack of knowledge regarding the recommended fish consumption and its risks, due to a lack of health education (AU)

¿Es perjudicial el ayuno del ramadán durante el embarazo? / Is it harmful Ramadan fasting during pregnancy?

A pesar de no considerarse obligatorio para la embarazada, el ayuno del ramadán es una práctica común entre las gestantes musulmanas. El objetivo de esta revisión es conocer el impacto de esta práctica religiosa en la salud materno-infantil y establecer recomendaciones al respecto. Con este fin, se ha llevado a cabo una revisión de la bibliografía publicada en los últimos 25 anos. Los resultados muestran que el ayuno del ramadán puede producir cambios metabólicos en la madre, principalmente hipoglucemia y cetosis, y se asocia a un menor tamaño de la placenta al nacer. Sin embargo, en la actualidad no existe evidencia sobre resultados perinatales negativos. Debemos informar correctamente a la mujer para que tome una decisión considerando los posibles efectos del ayuno, y establecer una serie de recomendaciones para aquellas gestantes que deciden ayunar

Although Ramadan fasting is not considered mandatory during pregnancy, it is a common practice among muslim pregnant women. The objective of this review is to determine the impact of this religious practice on maternal and child health and to establish recommendations. With this aim, we carried out a review of the literature published in the last25 years. The results show that Ramadan fasting produces metabolic changes in the mother, mainly hypoglycemia and ketosis, and it has been associated with placental reduced size at birth. However, there is no current evidence of adverse perinatal outcomes. We should properly advise the woman to take a decision taking into account the possible effects of fasting and set some recommendations in case of fasting

El jengibre como método alternativo para paliar las náuseas y vómitos durante el embarazo / Ginger as an alternative method to alleviate nausea and vomiting during pregnancy

Las náuseas y los vómitos durante la gestación (NVG) son un trastorno común durante las primeras semanas de embarazo y en ocasiones se prolongan más allá de la semana 20. Normalmente no revisten gravedad para la salud de la embarazada y su futuro hijo/a, pero supone un trastorno angustiante que puede interferir en su vida cotidiana. Cada vez son más las embarazadas que recurren al uso de los “remedios naturales” para evitar los posibles efectos secundarios delos medicamentos habituales. El jengibre ha demostrado ser una alternativa segura y eficaz para paliarlas náuseas y vómitos en la embarazada, siempre y cuando se utilice en las dosis recomendadas y teniendo en cuenta el historial médico particular de cada mujer, a fin de evitar posibles interacciones medicamentosas y efectos secundarios que pudieran influir en otras patologías presentes en la gestante. Se debe fomentar la realización de estudios acerca de la seguridad y efectividad de dichos tratamientos en mujeres embarazadas, ya que en numerosas ocasiones la ingesta de las plantas medicinales se hace sin la información necesaria para que sea efectivo y seguro (AU)

Nausea and vomiting during gestation (NVG) are a common disorder during the first weeks of pregnancy, and sometimes continue beyond week 20. Typically they don’t entail any severe health problems for the pregnant woman and her future child, but they represent a distressing disorder which may interfere in her daily life. There is an increasing trend for pregnant women to use “natural remedies “in order to avoid possible side effects by usual medications. Ginger has proven to be a safe and effective alternative to alleviate nausea and vomiting in pregnant women, as long as it is used in recommended doses, and taking into account the specific medical record of each woman, in order to avoid possible drug interactions and side effects which may have an impact on other conditions suffered by the pregnant woman. It is necessary to encourage studies about safety and efficacy of said treatments in pregnant women, because these medicinal plants are often ingested without the information required for their efficacy and safety (AU)

Implicaciones obstétricas, perinatalesy maternas de los pujos espontáneosfrente a los pujos dirigidos / Obstetrical, perinatal and maternal implications of spontaneous pushing and directed pushing

Existen dos maneras de conducir la segunda fase del parto: pujos espontáneosy pujos dirigidos. Los pujos espontáneos constituyen la maneranatural de conducir la segunda etapa del parto, sin embargo, últimamente,como consecuencia del uso de la analgesia epidural, losprofesionales recurren con frecuencia al manejo dirigido, sin considerarsus repercusiones negativas.El objetivo de este trabajo ha sido analizar comparativamente la evidenciadisponible sobre el efecto obstétrico, perinatal y materno de lospujos espontáneos frente a los pujos dirigidos.Metodología: revisión bibliográfica de las bases de datos Pubmed, CINAHLy Cochrane, entre los años 1995 y 2008, con las siguientes palabras clave:pushing, second stage labor, delayed pushing, passive fetal descent.Se recogieron datos sobre duración del expulsivo, tiempo de pujo, partosinstrumentales, alteraciones del patrón cardiaco fetal, desaturaciones,valores de PO2, PCO2 y pH fetales, test de Apgar, resultados perineales,fatiga y satisfacción materna en ambos tipos de pujo.Resultados: según las investigaciones realizadas, los pujos espontáneosque permiten el descenso pasivo fetal conllevan menos efectos adversos anivel materno y fetal. El pujo espontáneo es un método seguro para madree hijo en el manejo del período expulsivo. Aunque se observa un aumentodel tiempo de la segunda fase del parto, se reduce el tiempo de pujo,siendo éste el parámetro que realmente conlleva repercusiones negativas (AU)

There are two ways of directing the second stage of labour: spontaneouspushing and directed pushing. Spontaneous pushing represent a naturalway of managing the second stage of labour; however, lately, and as aresult of epidural analgesia, healthcare professionals frequently resortto directed pushing without taking into account the negative repercussionsit has on the patient.The aim of this work was to perform a comparative analysis of theavailable evidence on the obstetrical, perinatal and maternal effects ofspontaneous vs directed pushing.Methodology: bibliographic review of the Pubmed, CINAHL andCochrane databases, between the years 1995 and 2008, under thefollowing tag words: “pushing”, “second stage labour”, “delayed pu -shing”, “passive foetal descent”.Data were collected on the duration of the expulsion stage, pushing time,instrumental deliveries, alterations of the foetal cardiac pattern, disa -turations, PO2, PCO2 and pH foetal values, Apgar score, perineal outcome,fatigue and tiredness and maternal satisfaction with both types of pushing.Results: according to research, spontaneous pushing permits the passivedescend of the foetus and results in fewer maternal and foetal adverseeffects. Spontaneous pushing is a safe method for mother and baby in themanagement of the expulsion stage. Even though, an increase in the durationof the second stage of labour is observed, the pushing time is reduced,this being the parameter that really entails negative repercussions (AU)