Ernesto González-Mesa

Oxytocin administered during labor and breast-feeding: a retrospective cohort study

Abstract Objective: The relationship between labor physiology and the onset of lactation leads to assess the potential correlation between oxytocin administration during labor and duration of breast-feeding. Methods: This study was designed as a retrospective cohort study where patients given synthetic oxytocin during labor induction were considered as the exposed cohort, and patients not given oxytocin formed the non-exposed cohort. Four hundred of the 7465 children born at our maternity during 2006 were randomly selected. Information about breast-feeding was available for 316 of these children. Eventual confounding or adjustment factors were analyzed using stratified and multivariate analysis. Results: Oxytocin was used for delivery of 189 (59.8%) newborns, multiplying the risk of bottle-feeding by 1.451 (95% CI 1.28–1.63). The best-fit regression model of oxytocin use effect on bottle-feeding included sex and gestational age of the newborn. The use of oxytocin also multiplies the risk of breast-feeding withdrawal at 3 months by 2.29 (95% CI 1.41–3.74). This effect is confounded by maternal age, being higher for mothers under 27 years. Conclusion: Oxytocin administration during labor had some impact on both onset and duration of breast-feeding, particularly in mothers under 27 years of age and newborns delivered at term. Clinical Study registered at U.S. NIH, ID: NCT01951040.

Effects of oxytocin used during delivery on development: A retrospective cohort study

Objective: The objective was to evaluate the potential influence of oxytocin administered during delivery on children’s development at the age of 5. Method: This study was designed as a retrospective cohort study where children from patients given synthetic oxytocin during delivery were considered as the exposed cohort and children from patients not given oxytocin as the nonexposed cohort. From a total of 7465 births attended at our maternity ward in 2006, an initial sample of 400 was randomly selected. A total of 148 children were evaluated using the Battelle Developmental Inventory. Potential confounding and adjustment factors were analyzed using stratified analysis and multivariate analysis (logistic regression). Results: Oxytocin use did not significantly affect the overall risk of developmental delay in the study sample (relative risk, RR, 1.46; 95% confidence interval, CI [0.79–2.71]). The best fit regression model included twin delivery, type of delivery, and maternal age. In the group of vaginal noninstrumental deliveries, oxytocin administration increased the risk of poor Battelle Developmental Inventory outcome, particularly when maternal age was under 28 or over 35 years of age (odds ratio, OR, 67.14; 95% CI [5.46–824.86]). When delivery was instrumental or through cesarean section in mothers aged 28–35 years, oxytocin administration decreased the risk of developmental disorders (OR 0.16; 95% CI [0.04–0.66]). Conclusion: Although oxytocin administration during delivery did not affect the overall risk of low Battelle Developmental Inventory scores in the study sample, some effects were seen according to maternal age and type of birth.

Exposure to synthetic oxytocin during delivery and its effect on psychomotor development

The main objective is to examine the influence of oxytocin administration during delivery on psychomotor development at age five years. This was a retrospective cohort study involving two groups: children of mothers exposed vs. not exposed to oxytocin during labor. Of the 7,465 newborns registered in our maternity service during 2006 we randomly selected an initial sample of 400 children. Of these, 146 children were assessed using the motor scale of the Battelle Developmental Inventory. Other predictor variables that could potentially act as confounders and/or interact with the main relationship were also examined. The data were subjected to bivariate analysis, estimates of measures of strength of association, stratified analysis and multivariate binary logistic regression. The results indicate that exposure to synthetic oxytocin during delivery is an independent risk factor for a delay in gross and fine motor development. This was the case after controlling for the variables duration of labor and sex of the newborn, none of which modified the effect of oxytocin on gross and fine motor development. However, sex of the newborn were shown to be confounding gross motor development. In light of these results, and with the aim of preventing possible psychomotor alterations, further studies are now needed to analyze the effect that the oxytocin dose and the duration of perfusion may have on childrens subsequent development.

The influence of obstetric variables on school achievement, intelligence and neuropsychological development in a sample of Spanish twins at the age of six: a retrospective study

Abstract Objectives: The increasing number of multiple pregnancies in recent years has raised a particular concern about the problems associated to these pregnancies. It still remains unclear whether twin deliveries, as currently conceived, provide the same future health chances to both fetuses. In this regard, it is worth mentioning that the effects of obstetric and neonatal care beyond the perinatal period have not often been evaluated. The main objective of this research was to analyze the impact of obstetric and perinatal variables on postnatal neuropsychological development, intelligence and school achievement of twin children. Methods: We conducted a cross-sectional and observational study on 62 pairs of 6-year-old twins, who were on their first year of primary education. All 124 children and their mother were individually assessed and perinatal clinical data were collected. A stratified multivariate analysis was performed using multiple linear regressions. Results: The type of birth was the best predicting variable, so that the best results were achieved in children born in spontaneous vaginal deliveries. Comparatively, however, poorer scores were seen in males second twins born by the vaginal route in spatial structuring, non-verbal development and total development areas, especially in case of delivery before 37 weeks. Conclusions: Our study confirms the impact of some obstetric variables on school achievement and psychological development of twins.

Correlation of Four Toxic Elements Concentrations in Hair and Follicular FluidCollected from Women Undergoing in vitro Fertilization

We assess the correlation between four trace elements concentrations (As, Cd, Hg, Pb) in hair and follicular fluid (FF) specimens collected from 205 women undergoing in vitro fertilization (IVF), and analysed using high resolution inductively coupled plasma-mass spectrometer. We find that hair arsenic concentration was positively correlated with FF arsenic, mercury and lead concentrations. We conclude that trace element determination in hair specimens would be of interest to clarify their effect on outcomes of women undergoing IVF in a prospective cohort study.

Toxic elements in hair and in vitro fertilization outcomes: A prospective cohort study

We analysed the association between the concentration of four toxic elements (As, Cd, Hg and Pb) and diverse reproductive outcomes in a cohort of 194 women with fertility disorders undergoing IVF in a public hospital. Concentration in hair specimens was explored as biomarker of exposure during the three months prior to oocyte retrieval. The proportion of negative results, especially regarding pregnancy and birth outcomes, is remarkable. However, we found that the probability of mature oocytes was inversely associated with the concentration of Hg in hair (RR = 0.81, 95% CI: 0.70-0.95) and directly associated with that of Pb (RR = 1.18, 95% CI: 1.03-1.35). These findings provide insights for future research on the links between heavy metal concentrations and IVF outcomes.

Mood state at the beginning of the pregnancy and its influence on obstetric and perinatal outcomes

Abstract Aim: We designed this study to ascertain the prevalence of depressive disorders and anxiety at the beginning of the pregnancy, studying possible associated factors and assessing the influence of mood disorders on perinatal outcomes. Methods: A representative sample of 191 pregnant women at first trimester of their pregnancies completed a questionnaire that included the Whooley´s questions, the Spanish version of the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory and a series of questions related to health status, general mood and sociodemographic variables. Later, we prospectively evaluated the influence of anxiety and depression on the perinatal and obstetric results in 145 of them. Results: More than 20% of pregnant women presented high levels of anxiety. The mean values of the state and trait anxiety scores were 38.7 (SD 9.8) and 34.5 (SD 9.5). The mean BDI score was 5.97 (SD 4.9), with 9.5% of participants achieving scores compatible with depression, (61% mild in, 22.2% moderate, and 16.6% severe). BDI scores were significantly lower in women who became pregnant after assisted reproductive techniques. We observed an association between depression and trait anxiety scores with an infant’s low birth weight. The multivariate analysis showed that the feeling of happiness at the beginning of pregnancy was the best predictor of foetal weight. Conclusion: The prevalence of emotional disorders in the first trimester of pregnancy is high, with more than 20% of pregnant women presenting high levels of anxiety, and more than 9.5% presenting depression. During the first trimester, depression and anxiety were associated with low birth weight.

Cultural factors influencing antenatal depression: A cross-sectional study in a cohort of Turkish and Spanish women at the beginning of the pregnancy

BACKGROUND Depression is the most frequent mental disorder during pregnancy, and its prevalence is at least as high as that of postnatal depression. Differences between Western and Eastern countries may exist according to cultural and educational factors. OBJECTIVE to determine the influence of social and cultural factors on the mood state of a multicultural sample of 514 Turkish and Spanish pregnant women at the beginning of the pregnancy. METHODS Between October and December 2017 250 Turkish and 264 Spanish pregnant women attending their first pregnancy medical check-up between 10 and 12 weeks of pregnancy were recruited (264 in Málaga, 102 in Istanbul and 148 in Antalya). These women completed a questionnaire that included the Turkish or Spanish validated versions of the Edinburg Postnatal Depression Scale (EDS) and a series of questions related to health status, general mood, and sociodemographic variables. RESULTS Turkish women scored significantly higher with a mean value of 12.1 (SD 4.2) against 7.6 (SD 4.3) of Spanish women. Coping strategies and matters of women´s concern were also different. A total of 9.1% of Spanish and 30% of Turkish scored over cut-off point of 13. We found differences in EDS scores regarding the type of work, working status, and educational level. Family structure and perceived support were identified as specific risk factors for antenatal depression (AD). The multivariate regression model showed that best predictor variables for EDS score in the global sample were the country of recruitment, the number of living children, the pregnancy planning and the perceived partner´s support. CONCLUSIONS Our results confirm the existence of important differences in AD prevalence between Turkish (30.0%) and Spanish (9.9%) pregnant women. Some sociocultural features like having more children, unplanned pregnancies, or perceiving poor support from the partner, become important vulnerability factors.

High levels of alcohol consumption in pregnant women from a touristic area of Southern Spain

The prevalence of alcohol intake in women who become pregnant is similar to that found in the general population, especially in cases of unplanned pregnancies. Consequently, foetal exposure is high during the period of maximum vulnerability. The present study was carried out to determine the prenatal level of exposure to alcohol in Málaga, a Mediterranean region whose economy is based on the touristic sector (Costa del Sol). A cross-sectional, observational design was used to investigate the consumption of alcohol during pregnancy, based on a self-reporting questionnaire. A total of 451 women in the first, second or third trimesters of pregnancy were recruited. Consumption prevalences in each trimester were 40.7%, 25.5% and 17.1%. A higher educational level was associated with greater exposure to alcohol (risk ratio, 1.87 [1.30–2.69]). These results should alert the providers of obstetric care in touristic areas to the need for the adoption of adequate preventive measures.