Long-Term Cardiovascular Morbidity in Children Born Following Fertility Treatment.

OBJECTIVE: To determine the risk of long-term cardiovascular disease (CVD) among children born following in vitro fertilization (IVF) and compared with spontaneous pregnancies. STUDY DESIGN: A population-based cohort study including all singleton deliveries occurring between 1991and 2014 at a tertiary medical center was performed. Hospitalizations up to the age of 18 years involving CVD were evaluated in children delivered following IVF, ovulation induction, and spontaneous pregnancies. CVD included valvular disorders, hypertension, arrhythmias, rheumatic disease, cardiomyopathy, ischemic heart disease, and heart failure. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence, and a Cox regression model controlled for confounders. RESULTS: During the study period, 242 187 singleton deliveries met the inclusion criteria; 1.1% following IVF (n = 2603), and 0.7% following ovulation induction (n = 1721). Hospitalizations up to the age of 18 years involving CVD (n = 1503) were comparable in children delivered following IVF (0.6%), ovulation induction (0.7%), and spontaneous pregnancies (0.6%; P = .884). No significant difference in the cumulative incidence of CVD was noted between the groups (log rank P = .781). Controlling for maternal age, gestational age, birthweight, maternal diabetes, and hypertensive disorders in pregnancy, fertility treatment was not noted as a risk factor for long-term pediatric CVD (IVF adjusted hazard ratio 1.05, 95% CI 0.63-1.74, P = .86; ovulation induction adjusted hazard ratio 0.97, CI 95% 0.55-1.71, P = .92). CONCLUSIONS: Singletons conceived via fertility treatments do not appear to be at an increased risk of long-term pediatric CVD.

Cesarean Delivery and Childhood Malignancies: A Single-Center, Population-Based Cohort Study.

Rising rates of cesarean deliveries worldwide prompt the evaluation of long-term morbidity to the offspring. In this retrospective cohort study, we evaluated whether cesarean delivery influences the development of childhood malignancies. We identified an association of cesarean delivery with acute lymphoblastic leukemia in children, suggesting prudence in the recommendation of cesarean delivery for nonmedically indicated cases.

Pediatric Cardiovascular Morbidity of the Early Term Newborn.

OBJECTIVE: To determine whether early term delivery (at 370/7-386/7 weeks of gestation) is associated with long-term pediatric cardiovascular morbidity of the offspring. STUDY DESIGN: A population-based cohort analysis was performed including all term deliveries occurring between 1991 and 2014 at a single tertiary medical center. Gestational age at delivery was subdivided into early term (370/7-386/7), full term (390/7-406/7), late term (410/7-416/7) and post term (≥420/7) delivery. Hospitalizations of children up to the age of 18 years involving cardiovascular morbidity were evaluated, including structural valvular disease, hypertension, arrhythmias, rheumatic fever, ischemic heart disease, pulmonary heart disease, perimyoendocarditis, congestive heart failure, and others. Kaplan-Meier survival curves were used to compare cumulative hospitalization incidence between groups. A multivariable Weibull parametric model was used to control for confounders. RESULTS: During the study period, 223 242 term singleton deliveries met the inclusion criteria. Of them, 24% (n = 53 501) occurred at early term. Hospitalizations involving cardiovascular morbidity were significantly more common in children delivered at early term (0.7%) as compared with those born at full (0.6%), late (0.6%), or post term (0.5%; P = .01). The survival curve demonstrated a significantly higher cumulative incidence of cardiovascular-related hospitalizations in the early term group (log-rank P <.001). In the Weibull model, early term delivery was found to be an independent risk factor for cardiovascular-related hospitalization as compared with full term delivery (adjusted HR, 1.16; 95% CI, 1.01-1.32; P = .02). CONCLUSION: Early term delivery is independently associated with pediatric cardiovascular morbidity of the offspring as compared with offspring born at full term.

The Association between Sex and Long-Term Pediatric Cardiovascular Morbidity.

OBJECTIVE: To evaluate the association between sex and long-term pediatric cardiovascular morbidity. STUDY DESIGN: A population-based cohort study was performed that compared the risk of long-term cardiovascular morbidity (up to the age of 18 years) of children according to sex. Deliveries occurred between the years 1991 and 2013 in a tertiary medical center. Multiple pregnancies and fetal congenital malformations were excluded. Kaplan-Meier survival curves were constructed to compare cumulative cardiovascular morbidity incidence. A Cox proportional hazards model was used to control for confounders, including gestational age at birth, birth weight, and maternal factors. RESULTS: During the study period, 240 953 newborns met the inclusion criteria and were included in the long-term analysis. Of them, 51.0% (n = 122 840) were male and 49.0% (n = 118 113) female. Cardiovascular morbidity up to the age of 18 years was significantly more common in male as compared with female newborns (0.3% vs 0.2%, OR 1.33, 95% CI 1.12-1.57, P = .001). In the Cox regression model, male sex exhibited an independent association with long-term cardiovascular morbidity with an adjusted hazard ratio of 1.37 (95% CI 1.16-1.63, P <.001). CONCLUSION: Male newborns are at an increased risk for pediatric cardiovascular morbidity independent of gestational age at birth and birth weight.

Cómo eliminar el círculo vicioso de la obesidad: [revisión] / Could the viscous cycle of obesity be restricted?: [review]

Las preocupaciones mundiales más tradicionales de la salud pública, es decir la desnutrición y las enfermedades infecciosas, han sido reemplazadas por el sobrepeso y la obesidad como principal factor de mala salud. En efecto, el sobrepeso y la obesidad son prevalentes y están en aumento en todo el mundo. Cerca de un tercio de las mujeres en edad reproductiva son clasificadas como obesas, y otro 25% de las mujeres de este grupo de edad tienen sobrepeso. Las tasas de resultados adversos perinatales y comorbilidades también se encuentran en aumento. La obesidad materna previa al embarazo es un factor de riesgo importante de los resultados perinatales adversos. Se sabe que la obesidad se asocia con complicaciones obstétricas graves en la madre y el feto. La obesidad es un factor de riesgo para macrosomía, al igual que la diabetes pregestacional y gestacional, que también son más frecuentes entre las pacientes con sobrepeso y obesas. El tratamiento quirúrgico de la obesidad, es decir, la cirugía bariátrica, es un área de rápido crecimiento de la práctica quirúrgica actual. Esto refleja tanto la capacidad de los procedimientos de cirugía bariátrica para proporcionar una solución a un problema que de otro modo es irresoluble como la evolución de procedimientos más seguros y menos invasores...

Evaluación del embarazo luego de la cirugía bariátrica de la obesidad / Pregnancy outcome after bariatric surgery for obesity

Obesity, generally defined as body mass index (BMI) of 30 kg/m2 and above, is a universal growing epidemic. From a public health perspective, it represents an important modifiable risk factor for adverse health and pregnancy outcome. There is a significant association between obesity and diabetes mellitus, hypertensive disorders, ischemic heart disease and sleep apnea. During pregnancy, obesity is associated with fertility treatments, recurrent abortions, preeclampsia, gestational hypertension, gestational diabetes mellitus and other complications such as labor dystocia, mal-presentations, fetal macrosomia, and higher rates of cesarean deliveries. Bariatric surgery is the only effective treatment for morbidly obese patients, and these operations are performed predominantly among women. Few studies have addressed pregnancy outcome after obesity surgery. Basically, pregnancy outcome is comparable to controls of normal BMI. This review aims to present updates on the relationship between obesity and pregnancy outcomes, and the outcome of patients following bariatric surgeries.

La obesidad, generalmente definida como el índice de masa corporal (IMC) igual o mayor de 30 kg/m2, es una epidemia mundial en progresión. Enfocada desde la perspectiva de la salud pública, representa un importante pero modificable factor adverso que condiciona los resultados de la salud y el embarazo. Existe una asociación significativa entre obesidad, por una parte, y diabetes, hipertensión, cardiopatía isquémica y apnea del sueño por la otra. Durante el embarazo, la obesidad se asocia con los tratamientos para fertilidad, abortos recurrentes, preeclampsia, hipertensión inducida por embarazo, diabetes gestacional y otras complicaciones tales como distocia del trabajo de parto, presentaciones distócicas, macrosomía fetal y altas tasas de cesárea. La cirugía bariátrica es el único tratamiento efectivo para pacientes con obesidad mórbida. Estas operaciones se hacen predominantemente entre mujeres jóvenes. Pocos estudios se dedicaron especialmente a la evolución del embarazo luego de la cirugía bariátrica. Básicamente, la evolución del embarazo es comparable a los controles con IMC normal. Esta revisión pretende actualizar la relación entre obesidad y evolución del embarazo, y los resultados obtenidos por las operaciones bariátricas

Significado clínico del líquido amniótico teñido de meconio / Clinical significance of the fluid meconium stained amniotic

La amnioinfusión es un método seguro y efectivo para mejorar el resultado perinatal en los casos en los cuales el líquido amniótico meconial es espeso.