E. Valdes

Assessment of pregestational insulin resistance as a risk factor of preeclampsia.

Aim: To assess the impact that pregestational insulin resistance (PIR) has as a risk factor for preeclampsia (PE). Methods: Nested case-control study that included patients with PIR and a control group that was randomly selected from pregnancies admitted to the Fetal Medicine Unit between January 2005 and May 2011. Clinical and hemodynamic variables were analyzed by a multiple logistic regression analysis. Results: Of the 13,124 patients admitted during the study period, 119 had a diagnosis of PIR (0.9%). Patients with PIR were older and had a higher body mass index (BMI). PIR was also related to a significantly higher frequency of chronic hypertension (CrHT; 10.1 vs. 2.2%, p < 0.05) and hypothyroidism (5.0 vs. 1.6%, p < 0.05) than in the control group. Moreover, women with PIR were more likely to develop PE (8.4 vs. 4.2%, p < 0.05) and gestational diabetes mellitus (9.2 vs. 2.9%) than the control group. Multivariate analysis showed that maternal age, CrHT and altered uterine artery Doppler sonography during the first and second trimesters were good predictors of PE and that PIR was not. Conclusion: Although PIR correlates with PE, conditions related to the latter (CrHT, higher maternal age and increased BMI) may be predominant as risk factors for PE.

Is there a role for cervical assessment and uterine artery Doppler in the first trimester of pregnancy as a screening test for spontaneous preterm delivery

To evaluate the role of cervical length (CL) and uterine artery pulsatility index (UtA‐PI) at 11 + 0 to 13 + 6 weeks as predictors of spontaneous preterm delivery (sPTD) in a Chilean population.

Nifedipine versus fenoterol in the management of preterm labor: a randomized, multicenter clinical study.

Purpose: To compare the efficacy of nifedipine and fenoterol in the management of threatened preterm labor (TPL). Methods: A randomized and multicenter study assessing the tocolytic effect of nifedipine versus fenoterol in patients admitted to the participating maternity units with a diagnosis of TPL and a cost-savings study for economic assessment. For a power of 80% and an α error equal to 0.05, 132 consecutive patients were recruited during the study period; 66 patients were assigned to each group. A χ2 analysis and a mean differences test were performed according to variable types and survival curves per intention-to-treat. Results: Demographics were similar in both groups. The latency period was similar in both groups (26.7 vs. 25.6; p = 0.3). There were no differences in the results obtained. Nifedipine failed more frequently to obtain tocolysis when used as a first-line agent (80 vs. 90%, p = 0.0001). The group treated with fenoterol showed more drug adverse events (57.8 vs. 19.0%, p = 0.0001). The economic assessment did not evidence a significant difference in terms of cost savings between groups treated with either drug. Conclusion: The present study failed to demonstrate either clinical or economic superiority of any of the two drugs used in TPL management. The highest failure percentage of nifedipine when used as a first-line agent should encourage further research.

First-Trimester Adiponectin and Subsequent Development of Preeclampsia or Fetal Growth Restriction

Background/Aims: The evidence regarding the utility of assessing first-trimester adiponectin (ApN) serum levels in early prediction of preeclampsia (PE) and fetal growth restriction (FGR) is contradictory. This study aims to determine the role of maternal serum ApN levels as an early predictor of PE and FGR. Methods: A prospective case-control study among a pregnant population who attended their 11- to 14-week ultrasound scan at the University of Chile’s Clinical Hospital’s Fetal Medicine Unit. We included patients who developed PE or FGR (10 cases per group) and 35 healthy controls. We determined ApN levels in blood samples from these 55 patients using a commercial ELISA kit and assessed the relationship of ApN levels with variables like development of PE, FGR, weight at birth and maternal BMI. Results: There were no significant differences among first-trimester ApN serum levels in the groups. Average concentrations were 8, 6.8 and 10.8 ng/ml for the control, PE and FGR groups, respectively. Conclusion: In our study, maternal serum ApN levels were not useful in predicting subsequent development of PE and FGR. However, maternal serum ApN concentration adjusted by BMI was significantly higher during the first trimester in women who later developed FGR.

Second-Trimester Anterior Cervical Angle in a Low-Risk Population as a Marker for Spontaneous Preterm Delivery

Objective: The aim of this article is to assess the use of the anterior cervical angle (ACA) as a predictor of spontaneous preterm delivery (sPTD) at 20+0-24+6 weeks of gestation in an unselected population. Methods: We conducted a nested case-control study that included 93 women who later delivered spontaneously <34 weeks of gestation and 225 controls. The ACA was assessed retrospectively on all selected images using ImageJ® software. The concordance correlation coefficient was determined for the assessment of interobserver variability. Continuous variables were adjusted by maternal characteristics and expressed as the z-score or multiples of the expected normal median (MoM) of the unaffected group. Logistic regression analysis was used to evaluate whether any maternal characteristics and ultrasound variables were significantly associated with sPTD <34 weeks. Results: ACA z-score values were significantly greater in women who later delivered <34 weeks compared to controls (ACA z-score = 1.32 ± 0.57 vs. -0.09 ± 0.35; p = 0.035). The best prediction of sPTD <34 weeks was provided by a model that combined cervical length (CL) MoM, ACA z-score and maternal characteristics. For a fixed false-positive rate of 10%, the detection rate for this model was 37.6%. Conclusion: A model combining maternal history, CL and ACA at 20+0-24+6 weeks of gestation can predict approximately 40% of the severe preterm births.

OC23.04: A risk model for pre-eclampsia based on maternal characteristics and uterine artery Doppler during the first trimester of pregnancy

for significant physiological and pathological variables affecting fetal growth were derived using backward stepwise multiple regression for singletons (Cust Singlechart). The same process was repeated including only twin births (1893 pairs) in the regression models and adjusting for chorionicity (cust Twinchart). The association between SGA <10th percentile defined using the twin versus singleton customized charts and IUFD were compared. Statistical analyses including OR, 95% confidence interval (CI), and screening accuracy using each chart was performed. Results: The derived coefficients for fetal growth for cust Twinchart are different from those for cust Singlechart; with lower constants and R2 (2744 and 279 in twins; versus 3244 and 416 in singletons, respectively). Among 3786 twin infants, IUFD was seen in 123 (3.2%). The numbers of pregnancies identified as SGA were: 972 (25.7%), and 371 (9.8%) by the cust Singlechart and cust Twinchart, respectively. The association between SGA and IUFD and screening efficiency using both customized charts are shown in the table. Conclusions: Customized charts designed specifically for twins are more efficient at identifying twin pregnancies at risk for IUFD compared with those derived using singleton birth data.

Role of the glucose tolerance test as a predictor of preeclampsia.

Objective: To determine whether oral glucose tolerance tests (OGTT) play a role as predictors of preeclampsia (PET) in pregnant women. Methods: A retrospective case-control study was conducted in 2,002 singleton pregnancies that had a uterine artery (UtA) Doppler at 22-25 weeks and an OGTT. The UtA Doppler and OGTT were adjusted based on maternal characteristics, and the results were expressed as multiples of the expected normal median and compared between groups. Logistic regression analysis was used to determine whether maternal characteristics, OGTT, and UtA Doppler significantly contribute to the prediction of early- (<34 weeks), intermediate- (34-37 weeks), or late-onset (>37 weeks) PET. The performance of the screening was determined by ROC curves. Results: Women who developed PET were characterized by an older maternal age, an increased body mass index, and an altered UtA Doppler. The group with intermediate-onset PET was the only one associated with higher 2-hour OGTT levels compared to controls. Combined models were developed via logistic regression analysis using maternal characteristics, UtA Doppler, and OGTT to predict PET. These combined models were able to detect around 74, 42, and 21% of women who later developed early-, intermediate-, or late-onset PET, respectively, with only a 5% false-positive rate. Conclusions: This study shows that the combination of maternal characteristics, second-trimester UtA Doppler, and OGTT is a predictor of the development of PET in healthy pregnant women.

Metformin as a prophylactic treatment of gestational diabetes in pregnant patients with pregestational insulin resistance: A randomized study

We aimed to assess the use of metformin (MTF) in the prevention of gestational diabetes mellitus (GDM) in patients with pregestational insulin resistance (PIR).

Hepatitis aguda por alfa-metildopa durante el embarazo

Resumen La alfa-metildopa (AMD) es un farmaco de uso comun durante en el tratamiento del sindrome hipertensivo cronico del embarazo. La hepatotoxicidad de este medicamento esta descrita en forma excepcional en las gestantes. Se presenta el primer caso clinico reportado en Chile de hepatitis secundaria al uso de AMD durante el segundo trimestre del embarazo. Se propone una aproximacion a su diagnostico y tratamiento.

First trimester screening for preterm and term pre-eclampsia by maternal characteristics and biophysical markers in a low-risk population: First trimester prediction of preterm pre-eclampsia

To develop a combined predictive model for preterm and term pre‐eclampsia (PE) during the first trimester of pregnancy.