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

Mushroom body structure of orientating bees and foragers.

<p><b>(A)</b> Frontal confocal image of the right median MB labelled for synapsin (scale bar = 100μm). Borders of the lip (<i>orange</i>) and dense collar (<i>blue</i>) are highlighted. Boxplots showing the characteristics of the dense collar (<i>blue</i>) and lip (<i>orange</i>) of a sample of orientating bees (<i>O</i>, n = 5) and foragers (<i>F</i>, n = 13): <b>(B)</b> neuropil volume, <b>(C)</b> density of synaptic boutons, <b>(D)</b> number of synaptic boutons per neuropil. * p < 0.05, Mann-Whitney U-Test.</p

Change in reversal learning performance with duration of foraging.

<p>Percentages of individuals displaying PER in response to odours A (<i>red line</i>) and B (<i>orange line</i>) are shown, during the first phase (A+B-) and the reversal phase (A-B+) of the reversal learning task. Results are presented for bees with increasing foraging durations defined by the 1^st quartile (Q₁ = 113.8min), median (Q₂ = 381.3min), and 3^rd quartile (Q₃ = 653.5min) of the total amount of time foraging of the whole sample. The bootstrapped 95% confidence intervals are indicated by the black lines. [<b>(A):</b> n = 21, <b>(B):</b> n = 21, <b>(C):</b> n = 20, <b>(D)</b>: n = 21] *** p < 0.0001, Tukey HSD <i>post hoc</i> analysis.</p

Synaptic bouton density and number and reversal learning performance.

<p>Boxplots showing the characteristics of the dense collar (<i>blue</i>) and lip (<i>orange</i>) of non-learners (<i>NL</i>, IS = -1 or 0) and learners (<i>L</i>, IS = 1) for each of the last two trials of the reversal phase: <b>(A)</b> density of synaptic boutons, <b>(B)</b> number of synaptic boutons per neuropil. [<i>Trial 4</i>: n = 12 NL and 6 L; <i>Trial 5</i>: n = 10 NL and 8 L] * p < 0.05, ** p < 0.005, Mann-Whitney U-Test.</p

Correlations between foraging intensity and structural characteristics of the mushroom bodies.

<p>Individual values (n = 13) for the parameters of the lip <b>(A, B, C)</b> and dense collar <b>(D, E, F)</b> are plotted against foraging intensity: neuropilar volume <b>(A, D)</b>, density of synaptic boutons <b>(B, E),</b> total number of synaptic boutons <b>(C, F)</b>. The volume of the lip and collar, as well as the total number of boutons per lip, correlate positively with foraging intensity (Spearman rank correlations).</p

Modelled consequences of varying MB connectivity on reversal learning performance.

<p>Modelled percentage of individuals displaying PER in response to odours A (<i>red line</i>) and B (<i>orange line</i>) during the reversal learning paradigm. Three different models were run simulating a sparse <b>(A)</b> or dense <b>(B)</b> distribution of excitatory connections onto MB neurons (KC), and <b>(C)</b> sparse with suppressed inhibitory input from the GABAergic PCT. 200 agents (virtual bees) were modelled for each model configuration. The 95% confidence intervals are represented by the black lines.</p

Reversal learning performances of orientating bees and foragers with short or long foraging durations.

<p>The proportions of non-learners (<i>NL</i>: <i>light grey</i>) and learners (<i>L</i>: <i>dark grey</i>) in the last two trials of the reversal phase (trial 4 and 5) are displayed. For each trial, bees were defined as learners or non-learners according to the value of their individual inversion score (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0196749#sec002" target="_blank">Methods</a>; NL: IS = -1 or 0; L: IS = 1). The IS are compared between orientating bees and foragers, with either short or long foraging durations corresponding respectively to durations within or outside the 1^st quartile of the whole sample (113.8min). [<i>Orientating</i>: n = 11; <i>Foragers-Short</i>: n = 21; <i>Foragers-Long</i>: n = 62] * p < 0.05; ** p < 0.01; *** p < 0.0005, Mann-Whitney U-Test.</p

Reversal learning performance of precocious and normal-age foragers with short or long foraging durations.

<p>The proportions of non-learners (<i>NL</i>: <i>light grey</i>) and learners (<i>L</i>: <i>dark grey</i>) in the last two trials of the reversal phase (trials 4 and 5) are displayed. For each trial, bees were defined as non-learners or learners according to the value of their individual inversion score (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0196749#sec002" target="_blank">Methods</a>; NL: IS = -1 or 0; L: IS = 1). The IS were compared between precocious and normal-age foragers, with either short or long foraging durations corresponding respectively to durations within or greater than the 1^st quartile of the whole sample (113.8min). [<i>Precocious</i>: short: n = 10, long: n = 39; <i>Normal-age</i>: short: n = 11, long: n = 23] * p < 0.01; ** p < 0.005, Mann-Whitney U-test.</p

Centering performance of the model with <i>F</i> = 0.0 and <i>F</i> = 0.25 both agree with experimental data, while performance with <i>F</i> = 0.5 does not.

<p>Experimental data are from Dyhr et al [<a href="http://www.ploscompbiol.org/article/info:doi/10.1371/journal.pcbi.1004887#pcbi.1004887.ref003" target="_blank">3</a>] for real bees. One wall is held at a constant spatial frequency while the other is varied with sinusoidal patterns. Dashed lines indicate the two points where the spatial frequencies of the two walls are equal, one for each of the two lines. The model error bars show the variance of two runs with differing starting positions in the corridor.</p

Layout of the full system showing subregions and AVDU placements.

<p>The input to the full system consists of 32x32 ommatidial locations (blue grid), which are processed by AVDUs in three subregions, left (green), right (red) and centre (orange). AVDUs (yellow circles) exist between the location pairs sharing the edge they are located on. The preferred motion direction of each subregion is shown with an arrow. Note that the 32x32 extent of the locations covers a field of view extending 260 degrees horizontally and 180 degrees vertically.</p