Transmisión vertical en una población de gestantes infectada por el virus de la inmunodeficiencia humana

Consultable des del TDXTítol obtingut de la portada digitalitzadaIntroducción: Según estimaciones de la OMS en Diciembre del 2002, existían en el mundo un total de 42 millones de personas infectadas por el virus de la inmunodeficiencia humana. En nuestro país, las cifras no son menos halagüeñas, habiéndose producido un incremento de la prevalencia de la infección en gestantes del 54% desde el año 1995 al 1998, estabilizándose hasta la actualidad en una prevalencia del 1,4 por mil en el año 2001. La prevalencia actual en Cataluña es del 0,2%. En la actualidad hemos conseguido disminuir la tasa de transmisión vertical hasta cifras alrededor del 2%, gracias a la introducción del tratamiento antirretroviral durante la gestación, el parto y su administración al recién nacido, y a la utilización de una serie de medidas que han contribuido a la disminución de esta tasa. Objetivos: Principal: Evolución de la tasa de transmisión vertical en nuestro colectivo de gestantes infectadas Secundarios: Cambios epidemiológicos acaecidos; importancia del control gestacional; prevalencia de patología obstétrica; incidencia de patología cervical; papel del tratamiento antirretroviral y de la cesárea electiva. Pacientes y método: El estudio está formado por 306 gestantes infectadas por el VIH, que fueron atendidas en nuestro centro (Hospital del Mar de Barcelona)desde Enero de 1986 hasta Diciembre del 2001. Las pacientes están divididas a su vez en dos grupos, el primero es un grupo de referencia histórico que comprende desde 1986 a 1994, y el segundo grupo es prospectivo, subdividido en dos grupos, 1995-98 y 1999-2001, según la pauta de antirretrovirales utilizada. Las variables analizadas han sido, entre otras, la tasa de transmisión vertical, el modo de adquisición de la infección, el control gestacional, la patología obstétrica, la patología cervical, la vía de parto y el tratamiento antirretroviral. Resultados: Disminución de la tasa de transmisión vertical a la mitad (12% al 6%). Se ha producido un cambio en las características del tipo de contagio del VIH, con aumento de la transmisión heterosexual y estabilización de la parenteral (advp). Actualmente la mayoría de las pacientes conocen su seropositividad en el momento del embarazo, encontrándose un 29,4% en estadios avanzados de la enfermedad. Asistimos a una mejoría ostensible del control gestacional, pero manteniendo un 25% de pacientes no controladas. El hecho de ser ex - advp, haber adquirido recientemente la infección y por vía distinta a la sexual, demostraron ser factores de riesgo de mal control gestacional. Mayor prevalencia de patología obstétrica. La prematuridad y el bajo peso al nacer se han asociado directamente con la advp y el escaso control prenatal, pero no con la inmunodepresión. Elevada prevalencia de patología cervical (28,2%), lo que advierte sobre la necesidad de campañas de cribaje de esta población. Buena implementación del protocolo 076 y de la terapia combinada. El tratamiento antirretroviral disminuye la carga viral en el momento del partoIntroduction: According to the valuation of WHO, in December 2002 there were 42 million people in the entire world infected by HIV. In our country, the numbers are less hopeful, because it has been a 54% increase of the prevalence of the infection in pregnant women from year 1995 to 1998. Actually the prevalence is stable in 1.4 per thousand in year 2001. The present prevalence in Catalonia is 0.2%. Nowadays we have achieved the diminution of vertical transmission of HIV infection until numbers around 2% thank to the introduction of antiretroviral treatment during pregnancy, delivery and early children life, and to the use of different measures that took to a diminution of this transmission. Objectives: Main objective: Evolution of vertical transmission rate in our infected pregnant women population. Secondary objectives: Epidemiologic changes happened; importance of pregnancy control; prevalence of obstetric pathology; cervical pathology incidence; paper of antiretroviral treatment and elective caesarean section. Patients and method: Our study includes 306 pregnant women infected by HIV who were attended in our hospital (Hospital del Mar de Barcelona) from January 1986 to December 2001. The patients are divided simultaneously in two groups, the first one is an historic reference group from 1986 to 1994, and the second one is a prospective group subdivided in two, depending on antiretroviral treatment used, from 1995 to 1998 and from 1999 to 2001. Analyzed variable were, among others, vertical transmission rate, way of acquiring the infection, pregnancy control, obstetric pathology, way of delivery and antiretroviral treatment. Results: Diminution to the half of vertical transmission rate (from 12% to 6%). It has happened a change in the way of acquiring the HIV infection; it has increased heterosexual transmission and stable parenteral transmission. Actually the majority of patients know their positivity, finding a 29.4% of illness advanced stages. We attend to an ostensible improvement of pregnancy control, but keeping a 25% of non-controlled patients. The fact of being ex drug addicted, have acquired recently the infection and from other than sexual way, demonstrated to be risk factors for bad pregnancy control. Major prevalence of obstetric pathology. Prematurity and low weight at birth have been directly associated with drug addiction and scarce prenatal control, but not with immunosupression. High prevalence of cervical pathology (28.2%), this advises about necessity of screening programs for this population. Good establishing of 076 protocols and combined antiretroviral therapy. Antiretroviral therapy diminishes viral charge during delivery

Trends in Prevalence of Diabetes among Twin Pregnancies and Perinatal Outcomes in Catalonia between 2006 and 2015 : the DIAGESTCAT Study

The aims of our study were to evaluate the trends in the prevalence of diabetes among twin pregnancies in Catalonia, Spain between 2006 and 2015, to assess the influence of diabetes on perinatal outcomes of twin gestations and to ascertain the interaction between twin pregnancies and glycaemic status. A population-based study was conducted using the Spanish Minimum Basic Data Set. Cases of gestational diabetes mellitus (GDM) and pre-existing diabetes were identified using ICD-9-CM codes. Data from 743,762 singleton and 15,956 twin deliveries between 2006 and 2015 in Catalonia was analysed. Among twin pregnancies, 1088 (6.82%) were diagnosed with GDM and 83 (0.52%) had pre-existing diabetes. The prevalence of GDM among twin pregnancies increased from 6.01% in 2006 to 8.48% in 2015 (p < 0.001) and the prevalence of pre-existing diabetes remained stable (from 0.46% to 0.27%, p = 0.416). The risk of pre-eclampsia was higher in pre-existing diabetes (15.66%, p = 0.015) and GDM (11.39%, p < 0.001) than in normoglycaemic twin pregnancies (7.55%). Pre-existing diabetes increased the risk of prematurity (69.62% vs. 51.84%, p = 0.002) and large-for-gestational-age (LGA) infants (20.9% vs. 11.6%, p = 0.001) in twin gestations. An attenuating effect on several adverse perinatal outcomes was found between twin pregnancies and the presence of GDM and pre-existing diabetes. As a result, unlike in singleton pregnancies, diabetes did not increase the risk of all perinatal outcomes in twins and the effect of pre-existing diabetes on pre-eclampsia and LGA appeared to be attenuated. In conclusion, prevalence of GDM among twin pregnancies increased over the study period. Diabetes was associated with a higher risk of pre-eclampsia, prematurity and LGA in twin gestations. However, the impact of both, pre-existing diabetes and GDM, on twin pregnancy outcomes was attenuated when compared with its impact on singleton gestations