Evaluación de un programa de intervención prenatal en embarazadas con fetos pequeños para la edad gestacional

La prematuridad y el retraso de crecimiento intrauterino constituyen actualmente los problemas más importantes de la Medicina Fetal y de la Neonatología y son las causas más frecuentes de la morbilidad y mortalidad perinatal en los países desarrollados. OBJETIVO. Valorar la eficacia de un programa de intervención de apoyo prenatal (creado ex-novo) dirigido a madres gestantes de fetos Pequeños para la Edad Gestacional (PEG): detectar si este procedimiento mejora el desarrollo físico y neuroconductual del neonato, el estado emocional de la madre y el vínculo entre ambos. METODOLOGÍA. Estudio quasiexperimental tipo ensayo clínico controlado y sin asignación aleatoria de la intervención realizado en el área Materno-fetal de BCNatal (corporación del Servicio de Medicina Maternofetal del Hospital Clínic y el Hospital Sant Joan de Déu de Barcelona). El tamaño final de la muestra fue de 158 embarazadas, de las cuales 65 formaron parte del grupo intervención y 93 formaron parte del grupo control. RESULTADOS. Al finalizar el programa se observa que el feto y el neonato muestran una mayor ganancia de peso y mayor perímetro craneal en el grupo intervención. En cuanto a las capacidades y competencias del neonato, valoradas con la Escala de Brazelton, los del grupo intervención obtienen unos resultados discretamente superiores en casi todos los parámetros estudiados, destacando una mayor capacidad de habituación ante los estímulos auditivos. En relación a la embarazada, los resultados más relevantes al finalizar el programa son una disminución de la ansiedad (valorada con el cuestionario STAI) y una mayor vinculación afectiva materno-filial (valorada con la escala EVAP). CONCLUSIONES. Para las madres gestantes de fetos PEG, el hecho de haber participado en un programa de intervención de apoyo prenatal tiene un resultado beneficioso para ambos, madre e hijo, presentando menos ansiedad materna, mejores condiciones para establecer el vínculo así como una mejora en el desarrollo físico e indicios de mejores capacidades neuroconductuales en el neonato.Prematurity and intrauterine growth restriction are currently the most important problems in Fetal Medicine and Neonatology and also are the most frequent causes of perinatal morbidity and mortality in developed countries.The Objectives were to evaluate the effectiveness of a prenatal support program (created ex-novo) aimed at pregnant mothers of small fetuses for Gestational Age (PEG): to detect if this procedure improves the physical and neurobehavioral development of the neonate, the emotional state of the mother and the bond between them. This was a quasiexperimental study of a controlled clinical trial and without random assignment of the intervention performed in the Maternal-fetal area of BCNatal (Hospital of the Maternal-Fetal Medicine Service of Hospital Clínic and Sant Joan de Déu Hospital in Barcelona). The final sample size was 158 pregnant women, of whom 65 were part of the intervention group and 93 were part of the control group. At the end of the program, it is observed that the fetus and the neonate show a greater weight gain and greater cranial perimeter in the intervention group. As for the abilities and competences of the newborn, evaluated with the Brazelton Scale, those in the intervention group obtained slightly better results in almost all the studied parameters, emphasizing a greater capacity of habituation before the auditory stimuli. In relation to the pregnant woman, the most relevant results at the end of the program are a reduction of anxiety (valued with the STAI questionnaire) and a greater maternal-filial affective attachment (valued with the EVAP scale). In conclusion, for pregnant mothers of PEG fetuses, having participated in a prenatal support intervention program has a beneficial outcome for both mother and child, with less maternal anxiety, better bonding conditions, and improved development physical and signs of better neurobehavioral abilities in the neonate

Amount of biogenic amines in whole brains of bees following acute or repeated cocaine treatment.

<p>A. Biogenic amine content of brains frozen two hours after being treated with sham, vehicle control, 10 µg or 20 µg cocaine. There were no significant differences between the groups (MANOVA: F_6,74 = 0.2859, p = 0.9419). B. Biogenic amine content of brains treated seven times with sham, vehicle control, or 3 µg cocaine. No significant differences were seen between the groups (MANOVA: F_6,72 = 0.3549, p = 0.905). C. Biogenic amine content of brains of bees frozen one hour after treatment with 0, 5, 25, 50, 100, or 200 µg of volatilised cocaine. There were no significant differences between the treatment groups (MANOVA: F_15,93 = 0.9069, p = 0.5561, Fig. 3C).</p

Survival plot of time to loss of righting reflex, and barplot of amount of locomotion for bees acutely and repeatedly treated with cocaine.

<p>Numbers indicate sample size per group. A. Survival plot of time to loss of righting reflex after acute treatment with vehicle control, 10 µg of cocaine, or 20 µg cocaine. The loss of righting reflex to cocaine administration occurred significantly earlier in cocaine treated groups than controls (Survival analysis: Kaplan-meier log-rank test: χ² = 32.2, p<0.001, n = 10 per cocaine group; n = 30 for vehicle control). Pair-wise comparison showed that all groups differed from each another (10 µg vs DMF: χ² = 10.5, p = 0.0012; 20 µg vs DMF: χ² = 30.1, p<0.0001; 10 µg vs 20 µg: χ² = 4.9, p = 0.0262). B. Survival plot of time to loss of righting reflex after being treated with 10 µg of cocaine following seven pretreatments with either 3 µg of cocaine, vehicle- or sham control. Time to loss of the righting reflex after administration of 10 µg cocaine was delayed in bees repeatedly pretreated with 3 µg of cocaine, compared to controls never treated with cocaine prior to the challenge dose (Survival analysis: Kaplain-meier log-rank test: χ² = 18.4, p = 0.0001, n = 26 per group). Pair-wise comparison showed that both controls differed from cocaine treated bees (Sham: χ² = 7.5, p = 0.0060; DMF: χ² = 18.9, p<0.0001). Control groups did not differ from each other (Sham vs DMF: χ² = 2.5, p = 0.1110). C. Amount of locomotion twenty mins after administration of vehicle control or 10 µg cocaine. Locomotion is reduced by a large cocaine dose (Mann-Whitney test: U = 22, p = 0.037). D. Amount of locomotion twenty min after administration of 10 µg cocaine after seven repeated treatments with 3 µg cocaine, or sham or vehicle control. The bees pretreated with 3 µg moved significantly after treatment with a 10 µg cocaine dose than the controls never treated with cocaine (ANOVA: F_2,85 = 4.834, p = 0.011; Tukey’s multiple comparison between controls and cocaine: p = 0.012, between controls: p = 0.969).</p

The dependence of the colony population at equilibrium on the death rate of foragers.

<p>For this set of parameter values, when the death rate <i>m</i> exceeds 0.355, the only stable equilibrium population is zero. Parameter values are the same as <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0018491#pone-0018491-g003" target="_blank">Figure 3</a>.</p

Honey bee social dynamics represented in the model.

<p>The dash-dot lines represent consumption of food. The class “capped brood” appears in a box with a dashed border because it is not explicitly modeled although the period that brood spends as capped pupae is accounted for by the delay in the equations.</p

Plot of the eclosion function <i>E(h,F) = LN/(w+N)</i> where <i>N = H+F</i> for different values of <i>w</i>.

<p>The solid line has <i>w</i> = 4000; the dashed line, <i>w</i> = 10 000 and the dash-dot line, <i>w</i> = 27 000.</p

Elements of honey bee social dynamics considered by our model.

<p>Eggs laid by the queen are reared as brood that eclose three weeks later as adult bees. Adult bees work in the hive initially before becoming foragers. Our model considers the death rate of adult bees within the hive to be negligible, but forager death rate is a parameter varied in our simulations. We assume the amount of brood reared is influenced by the size of the colony (number of hive and forager bees) and that the rate at which bees transition from hive bees to forager bees is influenced by the number of foragers to represent the effect of social inhibition.</p

Locomotion over time in bees following volatilsed cocaine treatment.

<p>Locomotion was significantly reduced in bees treated with 100 µg of volatilised cocaine compared to controls (Repeated measures ANOVA: F_1,34 = 23.998, p<0.001, Fig. 4), but was the same at all time intervals measured (Repeated measures ANOVA: F_1,34 = 0.007, p = 0.934, Fig. 4).</p

Treatment schedule and survival for repeatedly treated foragers.

<p>A. Survival curves for repeated treatment groups. Cocaine, vehicle control, and sham treated groups contained 51, 57, and 58 bees, respectively. Bees disappearing between marking and first treatment have not been included. Cocaine treated bees did not differ from vehicle (Kaplan-meier log-rank test: χ² = 0.1, p = 0.750) nor sham control (Kaplan-meier log-rank test: χ² = 3.4, p = 0.064), but there was a significant difference between the two control groups (Kaplan-meier log-rank test: χ² = 5.4, p = 0.02). B. The schedule of treatments used in the repeated treatment experiments.</p

JEBbeedyadlikelihood

data for bee dyadic interaction