RESUMO
Resumen INTRODUCCIÓN: En Estados Unidos, las cardiopatías periparto se registran en 1 de cada 4000 pacientes. Se consideran idiopáticas y se asocian con enfermedades genéticas, problemas inmunológicos y malformaciones cardiacas, sin que se tenga certeza del origen real de este tipo de enfermedades. La miocardiopatía periparto se asocia con el embarazo y el puerperio; los criterios diagnósticos incluyen: a) insuficiencia cardiaca en las últimas cuatro semanas del embarazo o en los cinco meses siguientes al parto, b) ausencia de causas identificables de insuficiencia cardiaca, c) ausencia de enfermedad cardiaca demostrable antes de las últimas cuatro semanas del embarazo y alteración de la función del ventrículo izquierdo (fracción de eyección del ventrículo izquierdo, menor del 45%). La presentación del caso ayudará a que se tenga conocimiento de este problema. CASO CLINICO: Paciente de 26 años, en curso de las 35.4 semanas de embarazo, con inicio abrupto de signos de cardiopatía congestiva: tos, edema, taquicardia e hipertensión arterial. El embarazo finalizó por cesárea, con traslado inmediato a la unidad de cuidados intensivos. La ecocardiografía reportó una valvulopatía no conocida, insuficiencia ventricular izquierda y disminución de la fracción de eyección del ventrículo izquierdo; con lo anterior se integró el diagnóstico de miocardiopatía periparto. CONCLUSIONES: Las cardiopatías periperiparto son alteraciones excepcionales, con cuadros clínicos debidamente definidos y diagnóstico complejo. Las valvulopatías son el último diagnóstico diferencial de cardiopatía congestiva peripuerperal y se han descrito pocos casos asociados con miocardiopatía periparto.
Abstract BACKGROUND: Peripartum heart disease occurs in 1 out of 4000 cases in the United States; currently, its exact origin is unknown, which is why they are called idiopathic. Genetic diseases, immunological problems and heart malformations have been associated, without being certain about the real origin of these pathologies. Peripartum cardiomyopathy is a rare pathology associated with pregnancy and the puerperium, the diagnosis criteria includes: a) Development of heart failure in the last month of pregnancy or in the 5 months after delivery, b) absence of identifiable causes of heart failure, c) absence of demonstrable heart disease prior to the last month of pregnancy and impaired left ventricular function (FEVI less than 45%). The presentation of the case will help to raise awareness about this problem. CLINICAL CASE: A 26-year-old female patient coursing second gestation in the 35.4 pregnancy week, who debuts abruptly with signs of congestive heart disease such as cough, edema, tachycardia and arterial hypertension. The pregnancy was solved by cesarean section with a subsequent stay in Intensive Care Unit, an unknown valvular disease was identified by echocardiography, as well as left ventricular failure and decreased FEVI. Finally, a definitive diagnosis of peripartum cardiomyopathy was integrated. CONCLUSIONS: Peripartum heart disease is a rare occurrence, with well-defined clinical pictures, but difficult to approach and diagnose. Where valvular heart disease is the last differential diagnosis for peripuerperal congestive heart disease, and few cases associated with peripartum cardiomyopathy have been described.
RESUMO
BACKGROUND: Obesity and pregnancy increase levels of maternal oxidative stress (OS). However, little is known about the maternal, placental, and neonatal OS status. OBJECTIVE: To analyze the relation between prepregnancy obesity and the expression of OS markers and antioxidant capacity in the fetomaternal unit and their association with dietary intake. METHODS: This cross-sectional study included 33 women with singleton, noncomplicated pregnancies. Two groups were formed: women with prepregnancy body mass index (pBMI) within normal range (18.5-24.9 kg/m2, n = 18) and women with pBMI ≥ 30 kg/m2, suggestive of obesity (n = 15). Dietary and clinical information was obtained by questionnaire and from clinical records. Total antioxidant capacity (TAC) and malondialdehyde (MDA) concentration were measured on maternal and cord serum by colorimetric techniques, and placental expression of glutathione peroxidase 4 (GPx4) was measured by immunohistochemistry. RESULTS: Placental GPx4 expression was lower in the group with pBMI suggestive of obesity than in the normal weight group (ß = -0.08, p = 0.03, adjusted for gestational age and magnesium intake). Concentrations of TAC and MDA in maternal and cord blood were not statistically different between groups (p>0.05). Cord MDA concentration was related to maternal MDA concentration (ß = 0.40, p < 0.01), vitamin A intake (tertile 2: ß = -0.04, p = 0.40, tertile 3: ß = 0.13, p = 0.03, vs tertile 1), and placental GPx4 expression (ß = -0.09, p = 0.02). CONCLUSION: Prepregnancy obesity is associated with a decrease in GPx4 expression in the placenta, which is related to OS in the newborn. The influence of micronutrient intake on OS biomarkers highlights the importance of nutritional assessment during pregnancy and adequate prenatal care.
