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Pregnancy prevention programme; Prescribing medicinal products; Valproate Programa de prevenció de l'embaràs; Prescripció de medicaments; Valproat Programa de prevención de embarazo; Prescripción de medicamentos; Valproato Introduction Due to established teratogenicity of valproates, the EU risk minimisation measures (RMMs) with a pregnancy prevention programme (PPP) for valproate were updated in March 2018. Objectives To investigate the effectiveness of the 2018 EU RMMs on valproate utilisation in five European countries/regions. Methods A multi-database, times series study of females of childbearing potential (12–55 years) was conducted using electronic medical records from five countries/regions (01.01.2010–31.12.2020): Denmark, Tuscany (Italy), Spain, the Netherlands, and the UK. Clinical and demographic information from each database was transformed to the ConcePTION Common Data Model, quality checks were conducted and a distributed analysis was performed using common scripts. Incident and prevalent use of valproate, proportion of discontinuers and switchers to alternative medicine, frequency of contraception coverage during valproate use, and occurrence of pregnancies during valproate exposure were estimated per month. Interrupted time series analyses were conducted to estimate the level or trend change in the outcome measures. Results We included 69,533 valproate users from 9,699,371 females of childbearing potential from the five participating centres. A significant decline in prevalent use of valproates was observed in Tuscany, Italy (mean difference post-intervention −7.7%), Spain (−11.3%), and UK (−5.9%) and a non-significant decline in the Netherlands (−3.3%), but no decline in incident use after the 2018 RMMs compared to the period before. The monthly proportion of compliant valproate prescriptions/dispensings with a contraceptive coverage was low (

Maternal infections during pregnancy, as cytomegalovirus and zika, have been consistently associated with severe newborn neurodevelopmental conditions, mainly related to vertical transmission and congenital infection. However, little is known about the neurodevelopmental consequences of maternal respiratory viral infections, which are the most prevalent infections during pregnancy. The recent COVID-19 pandemic has increased the interest in understanding the consequences of infections in offspring's development. This systematic review explores whether maternal gestational viral respiratory infections are associated with neurodevelopmental deviations in children below 10 years-old. The search was conducted in Pubmed, PsychInfo and Web of Science databases. 12 articles were revised, including information about maternal infection (Influenza, SARS-CoV-2 and unspecified respiratory infections) and offspring's neurodevelopment (global development, specific functions, temperament and behavioral/emotional aspects). Controversial results were reported regarding maternal respiratory infections during pregnancy and infants' neurodevelopment. Maternal infections seem to be associated with subtle alterations in some offspring's developmental subdomains, as early motor development, and attentional, behavioral/emotional minor problems. Further studies are needed to determine the impact of other psychosocial confounding factors.

Segons el Dossier Estadístic de Violències Masclistes publicat per l'Observatori de la Igualtat de Gènere de Catalunya el novembre de l'any passat, des de fa una dècada hi ha més de 12.000 denúncies anuals per violència en l'àmbit familiar i de parella. No obstant això, segons constaten tots els estudis, aquesta dada representa només la punta de l'iceberg d'una realitat que, per diversos motius, sovint és silenciada des del mateix àmbit familiar on es produeix. Segons el Protocol per a l'Abordatge de la Violència Masclista en l'Àmbit de la Salut a Catalunya, publicat pel departament de Salut, aquest greu problema social afecta al voltant del 9% de les dones a Catalunya. En nombroses ocasions, a més, els maltractaments i l'assetjament es produeixen també en dones gestants, i, fins i tot, en un nombre significatiu de casos, l'embaràs és el moment en què s'inicien. Més enllà de l'abordatge social imprescindible que es fa sobre les conseqüències personals i per a la salut general que els maltractaments, tant físics com psicològics, provoquen en les persones afectades, també s'han dut a terme nombrosos estudis neurocientífics sobre els efectes que tenen en la construcció del cervell de les dones que en són víctimes. El cervell és un òrgan plàstic i mal·leable, que es va construint i reconstruint constantment mitjançant la creació de connexions neuronals noves en interacció amb múltiples factors ambientals, motiu pel qual aquestes situacions traumàtiques hi deixen una empremta clara. La psicòloga Lucy Hiscox i els seus col·laboradors, de diverses universitats i centres de recerca anglesos, nord-americans i sud-africans, han fet un pas més en aquestes recerques: han analitzat de quina manera els maltractaments que reben algunes dones gestants afecten la construcció del cervell del nadó, i han fet un seguiment de quines conseqüències impliquen fins que els infants fan nou anys. Segons han publicat a la revista Developmental Cognitive Neuroscience, hi ha diverses estructures del cervell que es veuen molt afectades per la violència que van patir les mares quan els gestaven, i que influeixen en la seva funció mental durant, com a mínim, tota la infantesa.

Food is fundamental in the decision making of pregnant and breastfeeding women to care for their own health and that of their child. In this paper, we explore some common food classification systems and certain attributes assigned to these categories, represented by values of trust and distrust. This study is based on an interdisciplinary research project in which we analysed discourses and practices regarding the dietary intake of pregnant and breastfeeding women in relation to the presence of chemical substances in foods. The results presented are part of the second phase of this research where we explored the results of our analysis of the pile sort technique based on an analysis of cultural domains in order to explore the categories and semantic relations among terms regarding trust and distrust in food. This technique was applied to the 62 pregnant and breastfeeding women of Catalonia and Andalusia. These women also participated in eight focus groups that provided information and narratives enabling us to analyse the meanings of the associative subdomains obtained in the pile sorts. They classified different foods and assigned certain attributes to them according to the level of trust and mistrust, providing a social representation of food risks. The mothers expressed great concern about the quality of the food they consume and about its possible effects on their own health and on that of their child. They perceive that an adequate diet is one based on the consumption of fruits and vegetables, preferably fresh. Fish and meat generate serious concern, as their properties are considered ambivalent depending on the food’s origin and mode of production. These criteria are perceived by women as relevant to their food decisions and, therefore, emic knowledge should be taken into account when developing food safety programmes and planning actions aimed at pregnant and breastfeeding women.

[spa] INTRODUCCIÓN: La obesidad durante el embarazo es un problema de salud pública en nuestra sociedad. Las gestantes con obesidad y ganancia excesiva de peso gestacional tienen mayor riesgo de presentar complicaciones maternas y perinatales. El uso de Apps móviles y pulsera durante el embarazo puede contribuir a promover estilos de vida saludables y, por tanto, mejorar la salud materna y neonatal. OBJETIVOS: Evaluar la efectividad de una intervención digital compleja, en gestantes con obesidad, con el uso de una pulsera de actividad física y la provisión de consejos de salud y soporte virtual de una matrona a través de una APP, respecto a la ganancia ponderal gestacional, la actividad física, los hábitos alimentarios; así como analizar su impacto en los resultados maternos y perinatales. Además, se estudió la frecuencia de uso, la usabilidad y la satisfacción con las Apps móviles utilizadas por las mujeres del grupo de intervención. MÉTODOS: Se realizó un ensayo clínico paralelo aleatorizado con dos brazos 1:1 con grupo intervención (GI) y grupo control (GC). Se incluyeron 150 gestantes con obesidad preconcepcional. El grupo de intervención recibió una intervención digital compleja “Pas & Pes” que consistía en el uso de una pulsera de actividad (Mi band 2© y Mi Fit©) y la recepción de consejos de salud mediante una App, y el soporte virtual de una matrona (Hangouts©), además del control prenatal habitual. El grupo control recibió solo el control prenatal habitual. Se utilizaron las versiones validadas en español del “International Physical Activity Questionnaire Short Form”, la “System Usability Scale” y el “Cuestionario de hábitos alimentarios para pacientes con sobrepeso y obesidad”. La satisfacción se midió en una escala tipo Likert de 1 a 5 puntos. Las pruebas estadísticas fueron bilaterales y se evaluaron a un nivel α de 0,05. Los análisis se realizaron con SPSS v. 25 y SAS v. 9,4. RESULTADOS: Se analizaron un total de 137 gestantes (91,3% del total). La ganancia ponderal gestacional mediana en el grupo de intervención fue de 7,0 kg (Q1=3,8-Q3=11) frente a 9,5 kg (Q1=6-Q3=14) en el grupo control, (p=0,014). La ganancia ponderal gestacional media ajustada por semana fue de 0,5 kg/semana [intervalo de confianza (IC) del 95 %=-0,2 a -0,05] en el grupo de control y de 0,3 kg/semana (IC 95 %=0,2 a 0,4) en el grupo intervención (p=0,002). En el tiempo 1 (35-37 semanas de gestación), las mujeres del grupo de intervención tuvieron una mediana más alta de actividad física que las mujeres del grupo de control, 1.950 frente a 1.386 múltiplo de la tasa de gasto metabólico-min/semana (MET-min/sem) (p=0,007), respectivamente. En el grupo intervención la puntuación media de los hábitos alimentarios fue mayor que en el grupo control [(3,51 ± 0,37) versus (3,33 ± 0,40) puntos; (p=0,009)]. No se observaron diferencias entre los grupos de estudio en la incidencia de resultados maternos y perinatales. Respecto a la intervención digital, el 61% (36) de las gestantes utilizó la pulsera de actividad a diario y la usabilidad de la App Mi Fit© fue valorada como excelente por el 74,6% (44). Todas las mujeres del grupo de intervención utilizaban la aplicación Hangouts© al menos una vez a la semana. La media de la escala de satisfacción con la App de consejos de salud y el apoyo de la matrona virtual fue de 4,8 ± 0,6 sobre 5 puntos. CONCLUSIONES: El uso de una intervención digital compleja mostró ser efectiva en una menor ganancia ponderal gestacional, en un aumento de la actividad física y en la mejora de los hábitos alimentarios. No se hallaron diferencias en las complicaciones perinatales maternas entre ambos grupos. La satisfacción con la intervención y la usabilidad de la App fue muy elevada., [eng] BACKGROUND: Obesity during pregnancy is a public health problem in our society. Pregnant women with obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile Apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. OBJECTIVE: To evaluate the effectiveness of a complex digital intervention, using a smartband and an App for health advice with virtual midwife’ counselling, on gestational weight gain, physical activity and eating habits. The secondary objectives are to assess the impact of these interventions on maternal and perinatal outcomes and identify the frequency of use, usability and satisfaction with the mobile Apps used by the women in the intervention group. METHODS: A randomized parallel clinical trial with two arms in a 1:1 ratio with intervention group (IG) and control group (CG) was conducted. 150 pregnant women with pre-pregnancy obesity were included. The intervention group received a complex digital intervention called Pas & Pes. The intervention was delivered with a smartband (Mi band 2© and Mi Fit©) linked to an App with the virtual midwife to provide personal health information (Hangouts©), and also the standard prenatal care. The control group only received standard control prenatal care. The validated Spanish versions of the International Physical Activity Questionnaire Short Form, the System Usability Scale and the Questionnaire of eating habits for patients with overweight and obesity were used. Satisfaction was measured on a 1-5 points Likert scale. Statistical tests were two-sided and evaluated at an α level of 0.05. Analyzes were performed using SPSS v. 25 and SAS v. 9.4. RESULTS: 137 (91.3% of the total) women were analyzed. The mean gestational weight gain in the intervention group was 7.0 kg (Q1=3.8-Q3=11) versus 9.5 kg (Q1=6-Q3=14) in the control group, p=0.014. The adjusted mean gestational weight gain per week was 0.5 kg/week (95% confidence interval [CI]=-0.2 to -0.05) in the control group and 0.3 kg/week (95% CI=0.2 to 0.4) in the intervention group (p= 0.002). In time 1 (35-37 gestational weeks), women in the intervention group had a higher mean physical activity than women in the control group (1,950 metabolic equivalent of tasks [METs]-min/week vs. 1,386 METs/min-week (p=0.007), respectively. The mean score for eating habits was higher in the IG than in the CG [(3.51 ± 0.37) versus (3.33 ± 0.40) points; p=0.009]. No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36) of the pregnant women used the smartband daily, and 74.6% (44) evaluated the usability of the Mi Fit© App as excellent. All women in the intervention group used the Hangouts© App at least once a week. The mean of the satisfaction scale with the health counselling App and virtual midwife support was 4.8 ± 0.6/5 points. CONCLUSIONS: The use of a complex digital intervention was effective in a lower gestational weight gain, in an increase in physical activity and in the improvement of eating habits. No differences were found in maternal perinatal complications between study groups. Satisfaction with the intervention and the usability of the App was very high.

Pregnancy outcomes; Vaccine effectiveness; Omicron Resultados del embarazo; Efectividad de la vacuna; Omicron Resultats de l'embaràs; Eficàcia de la vacuna; Omicron Background In 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern. Methods INTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile. Findings We enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0–38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03–1·31]) and SPMMI (RR 1·21 [95% CI 1·00–1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88–1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12–1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84–3·43]), perinatal complications (RR 1·84 [95% CI 1·02–3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67–20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02–4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44–41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22–65) and 76% (47–89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48–87) and 91% (65–98) after a booster dose. Interpretation COVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority.

Introduction: Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Grouphas prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. Development: This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. Conclusions: We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients., Introducción: La cefalea es uno de los motivos de consulta más comunes en neurología, siendo más frecuente durante la edad reproductiva. Por ello, es habitual encontrar en nuestras consultas pacientes embarazadas o en periodo de lactancia con dicha queja. Es importante conocer las opciones farmacológicas más seguras, cuáles no se deben emplear, así como cuándo sospechar cefaleas secundarias. Por este motivo, el Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología ha elaborado una guía con las recomendaciones consensuadas acerca de los algoritmos diagnósticos y terapéuticos que se deben emplear durante el embarazo y la lactancia

The COVID-19 pandemic represents a valuable opportunity to carry out cohort studies that allow us to advance our knowledge on pathophysiological mechanisms of neuropsychiatric diseases. One of these opportunities is the study of the relationships between inflammation, brain development and an increased risk of suffering neuropsychiatric disorders. Based on the hypothesis that neuroinflammation during early stages of life is associated with neurodevelopmental disorders and confers a greater risk of developing neuropsychiatric disorders, we propose a cohort study of SARS-CoV-2-infected pregnant women and their newborns. The main objective of SIGNATURE project is to explore how the presence of prenatal SARS-CoV-2 infection and other non-infectious stressors generates an abnormal inflammatory activity in the newborn. The cohort of women during the COVID-19 pandemic will be psychological and biological monitored during their pregnancy, delivery, childbirth and postpartum. The biological information of the umbilical cord (foetus blood) and peripheral blood from the mother will be obtained after childbirth. These samples and the clinical characterisation of the cohort of mothers and newborns, are tremendously valuable at this time. This is a protocol report and no analyses have been conducted yet, being currently at, our study is in the recruitment process step. At the time of this publication, we have identified 1,060 SARS-CoV-2 infected mothers and all have already given birth. From the total of identified mothers, we have recruited 537 SARS-COV-2 infected women and all of them have completed the mental health assessment during pregnancy. We have collected biological samples from 119 mothers and babies. Additionally, we have recruited 390 non-infected pregnant women., This work has received support from the Fundación Alicia Koplowitz to realize the epigenetic wide association study and to the clinical assessment to the children. This work has also received public support from the Consejería de Salud y Familias para la financiación de la investigación, desarrollo e innovación (i + d + i) biomédica y en ciencias de la salud en Andalucía (CSyF 2021 - FEDER). Grant Grant number PECOVID- 0195-2020. Convocatoria financiada con Fondo Europeo de Desarrollo Regional (FEDER) al 80% dentro del Programa Operativo de Andalucía FEDER 2014-2020. Andalucía se mueve con Europa. NG-T received payment under Rio Hortega contract CM20-00015 with the Carlos III Health Institute.

The World Health Organization (WHO) identified vaccine hesitancy as one of the top 10 threats to global health in 2019. Health promotion and education have been seen to improve knowledge and uptake of vaccinations in pregnancy. This qualitative study was conducted based on phenomenology, a methodological approach to understand first-hand experiences, and grounded theory, an inductive approach to analyse data, where theoretical generalisations emerge. Data were collected through semi-structured interviews with pregnant women attending antenatal care services and healthcare workers (HCWs) in Barcelona, Spain. Interviews were audio-recorded, transcribed, and coded, and notes were taken. Inductive thematic analysis was performed, and data were manually coded. Pertussis was reported as the most trusted vaccine among pregnant women due to its long-standing background as a recommended vaccine in pregnancy. The influenza vaccine was regarded as less important since it was perceived to cause mild disease. The COVID-19 vaccine was the least trustworthy for pregnant women due to uncertainties about effectiveness, health effects in the mid- and long-term, the fast development of the vaccine mRNA technology, and the perceptions of limited data on vaccine safety. However, the necessity to be vaccinated was justified by pregnant women due to the exceptional circumstances of the COVID-19 pandemic. The recommendations provided by HCW and the established relationship between the HCW, particularly midwives, and pregnant women were the main factors affecting decision-making. The role of mass media was perceived as key to helping provide reliable messages about the need for vaccines during pregnancy. Overall, vaccines administered during pregnancy were perceived as great tools associated with better health and improved quality of life. Pregnancy was envisioned as a vulnerable period in women’s lives that required risk–benefits assessments for decision-making about maternal vaccinations. A holistic approach involving the community and society was considered crucial for health education regarding maternal vaccines in support of the work conducted by HCWs.

COVID-19 is associated with poor maternal and pregnancy outcomes. COVID-19 vaccination is recommended in Spain, yet vaccination rates in pregnancy are suboptimal. This study investigates the perceptions of pregnant women and healthcare workers (HCW) regarding COVID-19 vaccination. A web-based cross-sectional quantitative study was conducted in 2021–2022 among 302 pregnant women and 309 HCWs in the Catalan public health system. Most pregnant women (83%) and HCWs (86%) were aware of COVID-19 maternal vaccines. The recommendation of the COVID-19 vaccination by an HCW was identified as the greatest facilitator for maternal vaccine uptake, while the fear of harming the foetus was the most significant barrier reported for rejecting vaccination. HCWs recognised they received limited information and training about COVID-19 vaccination in pregnancy, which hindered them from providing informed recommendations. This study highlights that information and education on COVID-19 vaccines to pregnant women and health professionals are pivotal to ensuring informed decision-making and increasing vaccine uptake.

Treball Final de Grau de Podologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, curs: 2021-2022, Tutor: Carles Vergés Salas, Durant el procés de l’embaràs es produeixen canvis fisiològics a nivell psicològic, hormonal i físic. L’augment de pes és un dels esdeveniments que pot fer variar les pressions plantars i provocar compensacions donant lloc a les patologies més freqüents: lumbàlgies i podàlgies. Per mesurar l’evolució de les pressions al llarg de l’embaràs existeixen diferents sistemes com les plataformes de pressions i les plantilles instrumentades. Aquest estudi pretén analitzar la informació publicada sobre la variació de les pressions plantars en dones embarassades i comparar així els seus resultats. S’ha dut a terme una recerca bibliogràfica consultant sis bases de dades i es varen obtenir un total de 12 articles finals segons els criteris d’inclusió i exclusió elegits. Les pressions plantars varien a mesura que avança l’embaràs però no de la mateixa forma entre els diferents estudis. La majoria dels autors defensen que es produeix un augment del PPM al mig peu fruit de l’augment de pes i laxitud dels lligaments, així com l’anteriorització del CdP. Altres autors reporten un augment en l’avantpeu com a estratègia d’absorció d’impacte o al retropeu amb canvis en la morfologia del peu. Els resultats de la magnitud del PPM són molt variats degut a la diferent metodologia dels estudis. Les podàlgies són més freqüents en les dones embarassades però no està relacionat exclusivament amb les variacions de les pressions plantars, sinó que influeixen el CdP, canvis hormonals o l’augment de l’ús d’estructures múscul esquelètiques. Com a conseqüència cada dona embarassada adopta compensacions úniques per garantir una marxa estable.

Treball de fi de grau d'Infermeria Tutora: Montserrat Sanclemente Dalmau Introducció: Al llarg del període de gestació es duen a terme una sèrie de canvis hormonals, fisiològics i psicològics en les persones gestants. Aquesta és una etapa complexa en la que les persones gestants poden arribar a experimentar grans variacions en l’estat anímic i emocional. Les respostes emocionals més freqüents durant aquest període de gestació solen ser l'estrès i l’ansietat, entre d’altres. Per altra banda, una de les preocupacions a destacar, que solen tenir les persones gestants al llarg del seu embaràs, és si el seu estat d’ànim, si l’estrès i l’ansietat que pateixen, pot arribar a influir en l’estat de salut del fetus. És cert que aquesta és una creença que es porta arrossegant des de l'antiguitat, tot i que actualment diversos estudis defensen que els efectes de l'estrès i l’ansietat de la persona gestant al llarg del període de gestació poden comportar greus i prolongats problemes de salut en el recent nascut. Objectius: Estudiar la correlació entre el nivell d’estrès i ansietat experimentats per part de les persones gestants al llarg del primer trimestre del període de gestació i l'aparició d'alteracions congènites en els recent nascuts a la ciutat de Barcelona durant els anys 2023 i 2024. Metodologia: Es realitzarà un estudi descriptiu correlacional en el qual s'inclouran 410 participants dels diferents districtes de la ciutat de Barcelona mitjançant un tipus de mostreig aleatori estratificat. Es realitzarà una primera entrevista a les persones participants, entre les setmanes 12 i 14 de gestació, en la qual s'avaluaran els nivells d’estrès i ansietat percebuts, mitjançant les escales Perceived Stress Scale i State-Trait Anxiety Inventory, respectivament. Posteriorment al part, es realitzarà una segona entrevista amb les persones participants en la qual s’identificaràn els recent nascuts que hagin presentat algun tipus d’alteració congènita. Resultats esperats: Amb la investigació proposada s’espera demostrar una associació positiva entre estrès i ansietat de la persona gestant durant la etapa prenatal i l’aparició d’alteracions congènites en el recent nascut per promoure una millor atenció a la salut mental i emocional de la persona gestant. Introduction: During the gestation period, a series of hormonal, physiological and psychological changes take place in pregnant women. This is a complex stage in which pregnant women can experience great variations in mood and emotional state. The most common emotional responses during this gestation period are stress and anxiety, among others. On the other hand, one of the concerns that pregnant women often have throughout their pregnancy is whether their mood, whether the stress and anxiety they suffer, can influence the pregnancy. fetal health status. It is true that this is a belief that has been dragging on since antiquity, although currently several studies argue that the effects of stress and anxiety on the pregnant woman during the gestation period can lead to severe and prolonged health problems in the newborn. Objectives: Study the correlation between the level of stress and anxiety experienced by pregnant women during the first trimester of the gestation period and the appearance of congenital alterations in newborns in the city of Barcelona during the years 2023 and 2024 . Methodology: A correlational descriptive study will be carried out which will include 410 participants from the different districts of the city of Barcelona using a stratified type of random sampling. Participants will be interviewed for the first time between 12 and 14 weeks of gestation, and their perceived levels of stress and anxiety will be assessed using the Perceived Stress Scale and State-Trait Anxiety Inventory, respectively. After the birth, a second interview will be held with the participants in which the newborns who have presented some type of congenital disorder will be identified. Expected results: The proposed research is expected to show a positive association between stress and anxiety of the pregnant woman during the prenatal stage and the appearance of congenital disorders in the newborn to promote better attention to the mental and emotional health of the pregnant woman.

[spa] ANTECEDENTES. El plan de nacimiento es un documento escrito en el que la mujer gestante expresa a los profesionales de la salud sus preferencias sobre el parto y tiene como objetivo facilitar la toma de decisiones de la mujer embarazada. El asesoramiento de las matronas a las mujeres durante el desarrollo de este es fundamental. Se desconoce el grado de la actividad educativa sobre el plan de nacimiento que reciben las mujeres por parte de las matronas, la entrega del plan de nacimiento que realizan las mujeres en el hospital y si un asesoramiento basado en la toma de decisiones compartida (TDC) del plan de nacimiento es efectivo. OBJETIVOS. Determinar la prevalencia de la actividad educativa sobre el plan de nacimiento que realizan las matronas, en el control prenatal de las mujeres e identificar la prevalencia de la entrega del plan de nacimiento que realizan las mujeres en el hospital y sus factores relacionados. Evaluar la efectividad de una actividad de asesoramiento, basado en la TDC, en la entrega del plan de nacimiento, información suficiente recibida, la satisfacción con la experiencia del parto y las preferencias sobre el parto y recién nacido. METODOLOGÍA. Se diseñaron dos estudios multicéntricos observacionales descriptivos de asociación cruzada en 5 unidades de Atención a la Salud Sexual y Reproductiva (ASSIR) y un ensayo clínico multicéntrico por clústeres y paralelo en 4 ASSIR del Institut de Català de la Salut (ICS) de Cataluña durante los años 2016 al 2019. En el ensayo clínico, 247 las mujeres del grupo experimental (GE) recibieron por parte de las matronas un asesoramiento del plan de nacimiento basado en la toma de decisiones compartida junto con un díptico con las recomendaciones basadas en la evidencia sobre el parto y recién nacido. Las 214 mujeres del grupo control (GC) recibieron el asesoramiento habitual de las matronas. La satisfacción con la experiencia del parto fue evaluada con la Escala Mackey de Satisfacción (MCSRS). El análisis de los datos se realizó con el programa SPSS 24.0 y se consideró para todas las variables un valor de p, [eng] BACKGROUND. The birth plan is a written document in which the pregnant woman expresses her preferences about childbirth to health professionals and it has as objective to facilitate the decision-making of the pregnant woman. The advice of midwives to pregnant women during the development of this birth plan is essential. It is unknown the degree of educational activity that women receive from midwives about the birth plan, the presentation of the birth plans those women carried out to the hospital, and whether counselling based on shared decision making of the birth plan is effective. OBJECTIVES. To determine the prevalence of educational activity on the birth plan carried out by midwives, in the women prenatal control and to identify the prevalence of the presentation of the birth plan carried out by women in the hospital and its related factors. To evaluate the effectiveness of a counselling activity based on the shared decision making with the presentation of the birth plan to the hospital, sufficient information received, the satisfaction with the childbirth experience and preferences about childbirth and the newborn. METHODOLOGY. Two observational descriptive cross-association multicenter studies were designed in 5 Sexual and Reproductive Healthcare Services (ASSIR) units and a multicenter clinical trial by clusters and parallel in 4 ASSIR of the Catalan Health Institute (Institut Català de la Salut) of Catalonia during the years 2016 to 2019. In the clinical trial, 247 women in the experimental group (EG) received counselling from their midwives about the birth plan based on the shared decision making together with a leaflet with the evidence-based recommendations on childbirth and the newborn. The 214 women in the control group (CG) received the usual counselling from midwives. Satisfaction with the birth experience was assessed with the Mackey Childbirth Satisfaction Rating Scale (MCSRS). Data analysis was performed with the SPSS 24.0 program and a value of p

Background Fetal growth restriction (FGR) affects 7–10% of all pregnancies resulting in a higher risk of perinatal morbidity and mortality, long-term disabilities, and cognitive impairment. Due to its multifactorial etiology, changes in maternal lifestyle, including suboptimal maternal diet and stress, have increasingly been associated with its prevalence. We present a protocol for the Improving Mothers for a better PrenAtal Care Trial Barcelona (IMPACT BCN), which evaluates two different maternal lifestyle strategies (improved nutrition by promoting Mediterranean diet and stress reduction program based on mindfulness techniques) on perinatal outcomes. The primary objective is to reduce the prevalence of FGR. Secondary aims are to reduce adverse perinatal outcomes and to improve neurodevelopment and cardiovascular profile in children at 2 years of age. Methods A randomized parallel, open-blind, single-center trial following a 1:1:1 ratio will select and randomize high-risk singleton pregnancies for FGR (N=1218), according to the criteria of the Royal College of Obstetricians and Gynaecologists (19.0–23.6 weeks’ gestation), into three arms: Mediterranean diet, mindfulness-based stress reduction program, and usual care without any intervention. Compliance to the interventions will be randomly tested in 30% of participants with specific biomarkers. Maternal socio-demographic, clinical data, biological samples, and lifestyle questionnaires will be collected at enrollment and at the end of the interventions (34.0–36.6 weeks’ gestation), together with a fetoplacental ultrasound and magnetic resonance. Fetoplacental biological samples and perinatal outcomes will be recorded at delivery. Postnatal follow-up is planned up to 2 years of corrected age including neurodevelopmental tests and cardiovascular assessment. Intention-to-treat and population per-protocol analysis will be performed. Discussion This is the first randomized study evaluating the impact of maternal lifestyle interventions during pregnancy on perinatal outcomes. The maternal lifestyle interventions (Mediterranean diet and mindfulness-based stress reduction program) are supported by scientific evidence, and their compliance will be evaluated with several biomarkers. Trial registration ClinicalTrials.govNCT03166332. Registered on April 19, 2017

Coronavirus disease 2019; First trimester; Preeclampsia Coronavirus 2019; Primer trimestre; Preeclàmpsia Coronavirus 2019; Primer trimestre; Preeclampsia Introduction: The association between preeclampsia and coronavirus disease 2019 (COVID-19) is under study. Previous publications have hypothesized the existence of shared risk factors for both conditions or a deficient trophoblastic invasion as possible explanations for this association. The primary aim of this study was to examine baseline risk factors measured in the first-trimester combined screening for preeclampsia in pregnant women with COVID-19 compared with the general population. A secondary aim of this study was to compare risk factors among patients with mild and severe COVID-19. Material and methods: This was an observational retrospective study conducted at Vall d'Hebron Hospital Campus (Catalonia, Spain). Study patients were 231 pregnant women undergoing the first-trimester screening for preeclampsia and positive for severe acute respiratory syndrome coronavirus 2 between February 2020 and September 2021. The reference cohort were 13 033 women of the general population from six centers across Catalonia from May 2019 to June 2021. Based on the need for hospitalization, patients were classified in two groups: mild and severe COVID-19. First-trimester screening for preeclampsia included maternal history, mean arterial blood pressure, mean uterine artery pulsatility index (UtAPI), placental growth factor (PlGF), and pregnancy-associated plasma protein-A (PAPP-A). Results: The proportion of cases at high risk for preeclampsia was significantly higher among the COVID-19 group compared with the general population (19.0% and 13.2%, respectively; p = 0.012). When analyzing risk factors for preeclampsia individually, women with COVID-19 had higher median body mass index (25.2 vs 24.5, p = 0.041), higher UtAPI multiple of the median (MoM) (1.08 vs 1.00, p < 0.001), higher incidence of chronic hypertension (2.8% vs 0.9%, p = 0.015), and there were fewer smokers (5.7% vs 11.6%, p = 0.007). The MoMs of PlGF and PAPP-A did not differ significantly between both groups (0.96 vs 0.97, p = 0.760 and 1.00 vs 1.01, p = 0.432; respectively). Conclusions: In patients with COVID-19, there was a higher proportion of women at high risk for preeclampsia at the first-trimester screening than in the general population, mainly because of maternal risk factors, rather than placental signs of a deficient trophoblastic invasion.

Maternal body mass index; Newborn weight; Obesity Índice de masa corporal materno; Peso del neonato; Obesidad Índex de massa corporal matern; Pes del nounat; Obesitat Background: Obesity and thinness are serious diseases, but cases with abnormal maternal weight have not been excluded from the calculations in the construction of customized fetal growth curves (CCs). Method: To determine if the new CCs, built excluding mothers with an abnormal weight, are better than standard CCs at identifying SGA. A total of 16,122 neonates were identified as SGA, LGA, or AGA, using the two models. Logistic regression and analysis of covariance were used to calculate the OR and CI for adverse outcomes by group. Gestational age was considered as a covariable. Results: The SGA rates by the new CCs and by the standard CCs were 11.8% and 9.7%, respectively. The SGA rate only by the new CCs was 18% and the SGA rate only by the standard CCs was 0.01%. Compared to AGA by both models, SGA by the new CCs had increased rates of cesarean section, (OR 1.53 (95% CI 1.19, 1.96)), prematurity (OR 2.84 (95% CI 2.09, 3.85)), NICU admission (OR 5.41 (95% CI 3.47, 8.43), and adverse outcomes (OR 1.76 (95% CI 1.06, 2.60). The strength of these associations decreased with gestational age. Conclusion: The use of the new CCs allowed for a more accurate identification of SGA at risk of adverse perinatal outcomes as compared to the standard CCs.

COVID-19; Preeclampsia; Pregnancy COVID-19; Preeclampsia; Embarazo COVID-19; Preeclampsia; Embaràs BACKGROUND Since the outbreak of the COVID-19 pandemic, some studies have reported an increased preeclampsia incidence in pregnant women with SARS-CoV-2 infection. Several explanations for this association have been proposed, including a preeclampsia-like syndrome induced by severe COVID-19. This syndrome was described in a small case series and has not been confirmed in larger studies, and its effect on perinatal outcomes has not been studied. OBJECTIVE This study aimed to confirm the preeclampsia-like syndrome because of COVID-19 and to investigate its implications on pregnancy outcomes and prognosis. STUDY DESIGN This was a prospective, observational study conducted in a tertiary referral hospital. The inclusion criteria were pregnant women admitted to the intensive care unit for severe pneumonia because of COVID-19. They were classified into 3 groups based on clinical and laboratory findings: preeclampsia, preeclampsia-like syndrome, and women without preeclampsia features. The 3 cohorts were analyzed and compared at 3 different times: before, during, and after severe pneumonia. The main outcomes were incidence of adverse perinatal outcomes and signs and symptoms of PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, and increased angiogenic factors (soluble fms-like tyrosine kinase 1–to–placental growth factor ratio). RESULTS A total of 106 women were admitted to the intensive care unit because of severe pneumonia, and 68 women were included in the study. Of those, 53 (50.0%) did not meet the diagnostic criteria for preeclampsia and remained pregnant after pneumonia (non-preeclampsia); 7 (6.6%) met the diagnostic criteria for preeclampsia, had abnormal (>38) soluble fms-like tyrosine kinase 1–to–placental growth factor ratio (preeclampsia), and delivered during severe pneumonia, and 8 (7.5%) met the diagnostic criteria for preeclampsia, had normal (≤38) soluble fms-like tyrosine kinase 1–to–placental growth factor ratio (preeclampsia like), and did not deliver during pneumonia. Despite not having delivered, most preeclampsia-related features improved after severe pneumonia in women with preeclampsia-like syndrome. Women with preeclampsia had significantly poorer outcomes than women with preeclampsia-like syndrome or without preeclampsia. CONCLUSION More than 50% of women with severe COVID-19 and diagnostic criteria for preeclampsia may not be preeclampsia but a preeclampsia-like syndrome, which may affect up to 7.5% of women with severe COVID-19. Preeclampsia-like syndrome might have similar perinatal outcomes to those of normotensive women with severe pneumonia because of COVID-19. For these reasons, preeclampsia-like syndrome should be excluded by using soluble fms-like tyrosine kinase 1–to–placental growth factor ratio in future research and before making clinical decisions.

Pregnancy care; Rheumatic diseases Cuidado del embarazo; Enfermedades reumáticas Cura de l'embaràs; Malalties reumàtiques Objectives: To describe different models of multidisciplinary pregnancy care for patients with inflammatory and autoimmune rheumatic diseases, and the steps to follow concerning their implementation. Methods: A qualitative study was conducted including: (1) a comprehensive literature search in PUBMED focused on multidisciplinary care models; (2) structured interviews with seven rheumatologists from multidisciplinary pregnancy clinics for patients with inflammatory and autoimmune rheumatic diseases. Data were collected related to the hospitals, medical departments, populations cared for, and multidisciplinary care models (type, material, and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision-making, research and educational activities, multidisciplinary clinical sessions, initiation/start, planning, advantages/disadvantages, and barriers/facilitators for implementation); (3) a nominal meeting group in which the results of searches and interviews were analyzed and the recommendations for the implementation of the multidisciplinary care models defined. Results: We analyzed seven models of multidisciplinary care in pregnancy, implemented 3-10 years ago, which can all be summarized by two different subtypes: parallel (patients are assessed the same day in the involved medical services) and preferential (patients are assessed on different days in the involved medical services) circuits. The implementation of a specific model results rather from an adaptation to the hospital’s and professionals’ circumstances. Correct planning and good harmony among professionals are key points to implementing a model. Conclusion: Different multidisciplinary care models have been implemented for patients with inflammatory and autoimmune rheumatic diseases during pregnancy. They pretend to improve care, system efficiency, and collaboration among specialists and should be carefully implemented. The project was supported by UCB Pharma.

Cannabis consumption during pregnancy increases the risk of pregnancy and neonatal complications. Since the underlying mechanism is unknown, the purpose of this study is to evaluate the changes in maternal and fetal blood flow in pregnancies exposed to cannabis, Δ9-tetrahydrocannabinol (THC). A case-control study between 2013 and 2020, included women with continued cannabis exposure during the pregnancies, defined by qualitative detection of THC in urine (Cannabis Group), and low-risk pregnancy women divided into tobacco smokers (Tobacco Group), and non-tobacco smokers (Control Group). We evaluated the association between cannabis consumption and maternal and fetal blood flow parameters measured by Doppler ultrasound: uterine artery at 11-14, 20-22 and 33-35 weeks, umbilical artery and middle cerebral artery at 33-35 weeks. Cerebral-placental ratio was calculated. Overall, 275 participants were included, 60 in the Cannabis Group, 17 in the Tobacco Group and 198 in the Control Group. At 33-35 weeks, differences were found in the umbilical artery pulsatility index (PI) (1.05 ± 0.23, 1.06 ± 0.19, 0.93 ± 0.15, P < 0.01), middle cerebral artery PI (1.75 ± 0.35, 1.90 ± 0.45, 1.88 ± 0.34, P < 0.05), cerebral-placental ratio (1.69 ± 0.40, 1.85 ± 0.53, 2.07 ± 0.47, P < 0.05) and mean uterine artery PI (0.89 ± 0.26, 0.73 ± 0.19, 0.74 ± 0.20, P < 0.01), respectively. On logistic regression analysis, adjusted for maternal age, maternal body mass index, maternal weight and white ethnicity, both cannabis and tobacco were predictors for increased umbilical artery PI, but only cannabis was a predictor for a decreased cerebral-placental ratio and an increased uterine artery PI at 33-35 weeks. Data from a large cohort of continuous cannabis exposure pregnancies show that cannabis is associated with maternal and fetal blood flow changes. However, it is not possible to disentangle the association of the tobacco and cannabis. Continuous cannabis exposure pregnancies showed that cannabis is associated with maternal and fetal blood flow changes. Nevertheless, it is not possible to disentangle the association of the tobacco and cannabis

In Bos. taurus cattle, follicular deviation to dominance begins when the selected ovulatory follicle reaches a mean diameter of 8.5 mm. The dominant follicle acquires the capacity to ovulate when it reaches a diameter of about 10 mm. In this study, data derived from 148 cows in estrus with one follicle of ovulatory size and another of 7–9 mm, reveal that the small follicle has the capacity to ovulate alone or with the dominant follicle; thus, giving rise to a single or twin pregnancy. This indicates that a follicle of deviation size may ovulate in the presence of a follicle of ovulatory size.

Background The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain. Methods Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB). Results The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1. Conclusions In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.

Knowing maternal satisfaction linked to interventionism is essential to improve care processes. The aim of this research is to analyze women satisfaction according to the sociodemographic variables, clinical variables related to childbirth assistance and interventionism, in order to identify those predictors. A descriptive and cross-sectional study was carried out with the participation of 301 women assisted in an obstetric unit in Girona. It was concluded that the women assisted by midwives, with a lobour at term, started spontaneously and without administration of oxytocin showed greater satisfaction, personal capacity, participation and security. Instrumental delivery, inductions of labour, and admissions at the neonatal unit were identified as barriers to maternal satisfaction, as well as low participation, low perception of safety and personal capability, manifesting that interventionism is also a barrier to maternal satisfaction Conèixer la satisfacció materna lligada a l’intervencionisme és essencial per millorar els processos assistencials. L’objectiu de la investigació és analitzar la satisfacció de les dones segons les variables sociodemogràfiques, les variables clíniques relacionades amb l’assistència i l’intervencionisme al part, i identificar els factors predictors d’aquesta satisfacció. Es va realitzar un estudi descriptiu i transversal on van participar 301 dones ateses a una unitat obstètrica de Girona. Es va concloure que les dones ateses per la llevadora, en un part a terme, d’inici espontani i sense administració d’oxitocina manifesten major satisfacció, capacitat personal, participació i seguretat. Es va identificar com a barreres de la satisfacció materna, la manca de participació, la baixa sensació de seguretat i capacitat personal, els parts distòcics, induïts i amb ingrés del nadó a la unitat de nounats, posant de manifest que l’intervencionisme també és una barrera per la satisfacció matern Programa de Doctorat en Biologia Molecular, Biomedicina i Salut

Apolipoprotein E; Genetic modifiers; Neurodevelopment Apolipoproteïna E; Modificadors genètics; Neurodesenvolupament Apolipoproteína E; Modificadores genéticos; Neurodesarrollo Background Air pollution exposure is associated with impaired neurodevelopment, altered structural brain morphology in children, and neurodegenerative disorders. Differential susceptibility to air pollution may be influenced by genetic features. Objectives To evaluate whether the apolipoprotein E (APOE) genotype or the polygenic risk score (PRS) for Alzheimer's Disease (AD) modify the association between air pollution exposure during pregnancy and childhood and structural brain morphology in preadolescents. Methods We included 1186 children from the Generation R Study. Concentrations of fourteen air pollutants were calculated at participants’ home addresses during pregnancy and childhood using land-use-regression models. Structural brain images were collected at age 9–12 years to assess cortical and subcortical brain volumes. APOE status and PRS for AD were examined as genetic modifiers. Linear regression models were used to conduct single-pollutant and multi-pollutant (using the Deletion/Substitution/Addition algorithm) analyses with a two-way interaction between air pollution and each genetic modifier. Results Higher pregnancy coarse particulate matter (PMcoarse) and childhood polycyclic aromatic hydrocarbons exposure was differentially associated with larger cerebral white matter volume in APOE ε4 carriers compared to non-carriers (29,485 mm3 (95% CI 6,189; 52,781) and 18,663 mm3 (469; 36,856), respectively). Higher pregnancy PMcoarse exposure was differentially associated with larger cortical grey matter volume in children with higher compared to lower PRS for AD (19436 mm3 (825, 38,046)). Discussion APOE status and PRS for AD possibly modify the association between air pollution exposure and brain structural morphology in preadolescents. Higher air pollution exposure is associated with larger cortical volumes in APOE ε4 carriers and children with a high PRS for AD. This is in line with typical brain development, suggesting an antagonistic pleiotropic effect of these genetic features (i.e., protective effect in early-life, but neurodegenerative effect in adulthood). However, we cannot discard chance findings. Future studies should evaluate trajectorial brain development using a longitudinal design. The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, Rotterdam, the Rotterdam Homecare Foundation, Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. We gratefully acknowledge the contribution of children and parents, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. The general design of the Generation R Study is made possible by financial support from the Erasmus Medical Center, Rotterdam; the Erasmus University Rotterdam; the Netherlands Organization for Health Research and Development (ZonMw); the Netherlands Organization for Scientific Research (NWO); and the Ministry of Health, Welfare and Sport. A.N. was supported by a grant of the Dutch Ministry of Education, Culture, and Science and the Netherlands Organization for Scientific Research (024.001.003, Consortium on Individual Development), a grant of the Canadian Institutes of Health Research team, and by the Research Foundation Flanders (FWO). S.A. was supported by the Programa Talen_UAB-Banc de Santander. The geocodification of the addresses of the study participants and the air pollution estimations were done within the framework of a project funded by the Health Effects Institute (HEI) (Assistance Award No. R-82811201). We received funding from the Spanish Institute of Health Carlos III (CPII18/00018), the EU Commission (733,206, 824,989), and the Agence Nationale de Securite Sanitaire de l’Alimentation de l’Environnement et du Travail (EST-18 RF-25). We acknowledge support from the Spanish Ministry of Science and Innovation and State Research Agency through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program”.

El mes de març de l’any 2020 la pandèmia global provocada per la COVID-19 va generar una crisi sanitària i de cures a nivell internacional. A Catalunya, com a molts altres indrets de l’Estat espanyol, d’Europa i del món, els serveis sanitaris es van veure desbordats i van entrar en risc de col·lapse, no només per donar resposta als estralls causats per la nova malaltia sinó per atendre altres situacions, com ara l’atenció a les dones embarassades abans, durant i després del part. En aquest context, les mesures adoptades en els serveis de salut per fer front a l’escenari d’emergència van resultar en alteracions importants dels processos d’atenció a la maternitat tal i com es venien realitzant fins el moment i, fins i tot, algunes veus van denunciar que els drets sexuals i reproductius de les dones en situació d’embaràs, part o postpart s’estaven veient subordinats a les exigències de la gestió de la pandèmia i, en algunes ocasions, vulnerats. Partint de l’interès en entendre la mesura i la manera en què es va veure afectada l’atenció sanitària a les dones en un moment tan fonamental de les seves vides, des del Grup de Recerca Societats, Polítiques i Comunitats Inclusives (SopCI) i la Càtedra UNESCO Dones, Desenvolupament i Cultures de la Universitat de Vic-Universitat Central de Catalunya vam impulsar el projecte de recerca Drets sexuals i reproductius en temps de pandèmia: maternitat i COVID-19 a Catalunya. El projecte va rebre inicialment el finançament del Ministeri d’Igualtat (Secretaria d’Estat d’Igualtat i contra la Violència de Gènere/Pacto de Estado contra la Violencia de Género). Posteriorment també ha rebut suport de la Secretaria d’Universitats i Recerca del Departament d’Empresa i Coneixement de la Generalitat de Catalunya (2017SGR0657). L’estudi va estar aprovat pel Comitè d’Ètica per a la Recerca de la Universitat de Vic-Universitat Central de Catalunya. Més enllà de les publicacions i altres resultats científics que es puguin derivar del projecte, des de l’equip d’investigació considerem que les dades que se n’han generat són de gran rellevància per, en primer lloc, visibilitzar situacions, no sempre positives, que milers de dones a Catalunya van haver de viure en un moment de les seves vides de màxima vulnerabilitat i necessitat de cura i acompanyament. D’altra banda, també ens sembla important publicar els principals resultats de la investigació en aquest format divulgatiu d’informe breu per fer-los fer accessibles a diferents públics. 2017SGR0657

Introducció i Objectius. L´atenció al part en el medi hospitalari y la violència institucional que al seu interior s´exerceix, en alguns casos, constituïa ja un tema d´interès abans de la Pandèmia. No obstant, la irrupció de la Pandèmia de Covid-19 ha constituït un factor fonamental de vulnerabilitat per a les persones, donant un nou sentit bioètic a l´atenció a l´embaràs, part i naixement. L’objectiu d’aquest treball és avaluar una proposta formativa pilot sobre bioètica en la atenció al naixement desprès de la pandèmia COVID-19. Material i mètode. Després de la realització d’un grup focal amb experts i entrevistes semiestructurades a llavadores i dones en el formació comprès entre març i desembre del 20200 es van formació les necessitats formatives i es va dissenyar una proposta pilot de programa formatiu. En aquest treball es presenten els objectius, formació, continguts i avaluació de la dita activitat formativa, dirigida professionals sanitaris, que es va dur a terme el maig de 2022. Resultats. Els resultats de l’avaluació de l’activitat mostren altes xifres de satisfacció amb la formació procurada i informen favorablement de la repetició. Així mateix, les dades recollides apunten la necessitat que tenen els professionals sanitaris de més activitats d'aplicació de continguts i ampliació de la formació en bioètica en l'atenció al naixement i en atenció a la procreació. Discussió i Conclusions. La implementació de la formació en bioètica a professionals sanitaris i l'anàlisi dels resultats de la formació pilot conclou que promoure accions formatives en aquesta temàtica i sotmetre-les a avaluació és una de les vies per promoure la bioètica i el respecte al dret a la salut sexual i reproductiva dels usuaris/es del sistema de salut. Així mateix, l'anàlisi dels resultats mostra que els professionals reclamen necessitats formatives en matèria de bioètica., Introduction and Aims. Childbirth care in the hospital environment and the institutional violence that is exercised within it, in some cases, it was already a topic of interest before the Pandemic. Nevertheless, the emergence of the pandemic of Covid-19 has been a fundamental factor of vulnerability for people, giving a new bioethical sense to the attention to pregnancy, childbirth and birth. The objective of this work is to evaluate a pilot training proposal on bioethics in birth care after the COVID-19 pandemic. Material and Methods. After conducting a focus group with experts and semi-structured interviews to midwives and women in the period from March to December 2020 the training needs were analyzed and a pilot proposal for a training program was designed. This paper presents the objectives, methodology, contents and evaluation of this training activity, directed healthcare professionals, which was carried out in May 2022. Results. The results of the evaluation of the activity show high figures of satisfaction with the training provided, and report favorably on its repetition. Likewise, the data collected point to the need for health professionals to carry out more content application activities and expansion of training in bioethics in birth care and procreation care. Discussion and Conclusions. The implementation of bioethics training for healthcare professionals and the analysis of the results of the pilot training concludes that promoting training actions in this area and submitting them to evaluation is one of the ways to promote bioethics and respect for the right to sexual health and reproductive health system users. Likewise, the analysis of the results shows that professionals claim training needs in bioethics., Introducción y Objetivos. La atención al parto en el medio hospitalario y la violencia institucional que en su interior se ejerce, en algunos casos, constituía ya un tema de interés antes de la Pandemia. No obstante, la irrupción de la pandemia de Covid-19 ha constituido un factor fundamental de vulnerabilidad para las personas, dando un nuevo sentido bioético a la atención al embarazo, parto y nacimiento. El objetivo del presente trabajo es evaluar una propuesta formativa piloto sobre bioética en la atención al nacimiento tras la pandemia COVID-19. Material y Métodos. Tras la realización de un grupo focal con expertos y entrevistas semiestructuradas a matronas y mujeres en el periodo comprendido entre marzo y diciembre de 2020 se analizaron las necesidades formativas y se diseñó una propuesta piloto de programa formativo. En este trabajo se presentan los objetivos, metodología, contenidos y evaluación de dicha actividad formativa, dirigida profesionales sanitarios, que se llevó a cabo en mayo de 2022. Resultados. Los resultados de la evaluación de la actividad muestran altas cifras de satisfacción con la formación procurada, e informan favorablemente de su repetición. Asimismo, los datos recogidos apuntan la necesidad que tienen los profesionales sanitarios de más actividades de aplicación de contenidos y ampliación de la formación en bioética en la atención al nacimiento y en atención a la procreación. Discusión y Conclusiones. La implementación de la formación en bioética a profesionales sanitarios y el análisis de los resultados de la formación piloto concluye que promover acciones formativas en dicha temática y someterlas a evaluación es una de las vías para promover la bioética y el respeto al derecho a la salud sexual y reproductiva de los usuarios/as del sistema de salud. Asimismo, el análisis de los resultados muestra que los profesionales reclaman necesidades formativas en materia de bioética.

Background Seronegative antiphospholipid syndrome (SN-APS) is often defined as the presence of APS criteria manifestations, negative antiphospholipid antibodies (aPL), and coexistence of APS non-criteria manifestations. Nevertheless, the impact of these non-criteria features is still unclear. On a different note, the relevance of one single aPL positive determination in patients with APS manifestations is another domain with limited evidence. We aim to compare the course of SN-APS and single-positive aPL (SP-aPL) patients with that of individuals with APS manifestations without non-criteria features/aPL positivity (controls). Methods Retrospective analysis of patients with thrombosis/obstetric morbidity assessed in two European hospitals between 2005 and 2020. Patients were divided into SN-APS, SP-aPL, and control groups. Clinical characteristics, comorbidities, and therapies were compared. Results A total of 82 patients were included in the SN-APS group, 88 in the SP-aPL group, and 185 in the control group. In Cox regression model, SN-APS displayed more thrombosis recurrence than controls (HR 3.8, 95% CI 2.2–6.5, p p = 0.078). Indefinite anticoagulation (p p = 0.008, respectively) and vitamin K antagonist (VKA) use (p Conclusion SN-APS displayed more thrombosis recurrence, indefinite anticoagulation, and VKA use than controls without non-criteria manifestations. The presence of such features in patients with thrombosis and negative aPL may negatively impact their clinical course.

Aquest és el segon d’una sèrie d’informes resultants del projecte d’investigació Drets sexuals i reproductius en temps de pandèmia: maternitat i COVID-19 a Catalunya. Se centra en les experiències d’acompanyament al part per la persona d’elecció de la mare durant la pandèmia. Aquesta persona sol associar-se amb l’altre progenitor, tot i que pot ser un familiar o persona propera a la mare i, també, una doula. L’evidència científica assenyala la presència de la persona acompanyat durant el part com un important suport físic i emocional a la dona (López-Villar, 2011) i imprescindible per garantir una experiència de part satisfactòria (Macpherson, Roqué-Sánchez, Legget, Fuertes & Segarra, 2016; Waldenström, Hildingsson, Rubertsson, & Rådestad, 2004). Al seu torn, l’Organització Mundial de la Salut inclou entre les seves recomanacions: “L’accés a tenir un suport continu d’elecció és imprescindible per actuar de manera respectuosa amb la dona i mantenir una bona atenció en la maternitat, satisfent les necessitats de la família” (Oladapo et al., 2018). Així, és enormement rellevant comprendre la mesura i la manera en què aquest suport ha estat restringit durant la pandèmia. Hem triat aquesta temàtica per continuar aquesta col·lecció d’informes sobre els impactes de la pandèmia en l’atenció sanitària a la maternitat a Catalunya amb la voluntat de contribuir a la reflexió sobre les tensions que durant aquesta crisi s’han generat entre una atenció humanitzada i centrada en la persona -i de manera específica, respecte de la possibilitat d’estar acompanyada en tot moment per la persona d’elecció de la mare-, i les mesures de seguretat que es van decidir adoptar en un context de risc de contagi, mesures que sovint es van materialitzar en protocols i decisions que contradeien les expectatives, els desitjos i les necessitats de les dones. Les polítiques sanitàries i els serveis d’atenció a la maternitat no només s’haurien de centrar en protegir la seguretat de les dones i dels i les 6 professionals sanitàries que les atenen sinó en promoure els sentiments de les dones de control i seguretat en el seu espai de part (Mollard & Wittmaack, 2021).

L’embaràs a l’Artritis Reumatoide (AR) proporciona un model únic per l’estudi dels mecanismes biològics de la malaltia. Durant l’embaràs, generalment, es produeix una interrupció transitòria de l’activitat de l’AR que es reprèn després del part. En conseqüència, l’estudi dels patrons moleculars associats als canvis en l’activitat de la malaltia durant l’embaràs podria proporcionar una informació essencial sobre les principals vies biològiques de la malaltia. Aquí perfilem els transcriptomes de 8.604 cèl·lules mononuclears de sang perifèrica d’alta qualitat (CMSP) amb sc-RNAseq de dues dones amb AR a la setmana 30 de gestació i la setmana 8 del postpart. Es van estudiar les CMSP després de cultiu in vitro durant 48 hores amb i sense estimulació de cèl·lules T. El present estudi és el primer atles amb single cell de CMSP a AR durant l’embaràs i el postpart. L’anàlisi inicial agrupat de les cèl·lules va dividir-les en cèl·lules Natural Killer i T no estimulades, cèl·lules T estimulades, cèl·lules mieloides i cèl·lules B. Aquests clústers es van subdividir en 35 clústers més específics. Hem detectat un gradient d’activitat efectora al compartiment de cèl·lules T no estimulades. Al postpart, l’anàlisi de la composició cel·lular va revelar, en les cèl·lules no estimulades, un augment de les cèl·lules T naïf en repòs i de les cèl·lules T CD8+ que produeixen GZMA+ GNLY+. En les cèl·lules estimulades, l’anàlisi va revelar un augment de cèl·lules de memòria central T activades amb alt contingut ribosòmic i les cèl·lules T naïf activades recentment. A les cèl·lules de l’embaràs, hem trobat una resistència immune a l’estimulació cel·lular en els monòcits CD14+ i NK CD16+ CD56dim. Finalment, l'expressió gènica diferencial en els diferents tipus cel·lulars va revelar gens potencialment relacionats amb la modulació de la malaltia durant l'embaràs. També gens que podrien estar implicats en l’embaràs i l’oncogènesi i, gens implicats en RA i preeclàmpsia. El embarazo en la Artritis Reumatoide (AR) proporciona un modelo único para el estudio de los mecanismos biológicos de la enfermedad. Durante el embarazo, generalmente, se produce una interrupción transitoria de la actividad de la AR que se retoma después del parto. En consecuencia, el estudio de los patrones moleculares asociados a los cambios en la actividad de la enfermedad durante el embarazo podría proporcionar una información esencial sobre las principales vías biológicas de la enfermedad. Aquí perfilamos los transcriptomas de 8.604 células mononucleares de sangre periférica de alta calidad (CMSP) con sc-RNAseq de dos mujeres con AR en la semana 30 de gestación y en la semana 8 del postparto. Se van a estudiar las CMSP después de cultivo in vitro durante 48 horas con y sin estimulación de células T. El presente estudio es el primer atlas con single cell de CMSP en AR durante el embarazo y el postparto. El análisis inicial agrupado de las células las divide en células Natural Killer y T no estimuladas, células T estimuladas, células mieloides y células B. Estos clústeres se subdividieron en 35 clústeres más específicos. Hemos detectado un gradiente de actividad efectora en el compartimento de células T no estimuladas. En el postparto, el análisis de la composición celular reveló, en las células no estimuladas, un aumento de las células T naïf en reposo y de las células T CD8+ que producen GZMA+ GNLY+. En las células estimuladas, el análisis reveló un aumento de células de memoria central T activadas con alto contenido ribosómico y las células T naïf activadas recientemente. En las células del embarazo, hemos encontrado una resistencia inmune a la estimulación celular en los monocitos CD14+ y NK CD16+ CD56dim. Finalmente, la expresión génica diferencial en los diferentes tipos celulares reveló genes potencialmente relacionados con la modulación de la enfermedad durante el embarazo. También genes que podrían estar implicados en el embarazo y la oncogénesis y, genes implicados en RA y preeclampsia. Pregnancy in Rheumatoid Arthritis (RA) provides a unique model to study the biological mechanisms of the disease. In RA pregnancy, there is generally a transitory interruption of disease activity that is resumed after delivery. Consequently, the study of the molecular patterns associated with changes in disease activity during pregnancy could provide essential information on the main biologic pathways in the disease. Here we profile the transcriptomes of 8,604 high quality peripheral blood mononuclear cells (PBMCs) with sc-RNAseq from two RA women at the 30th week of gestation and at the 8th week of postpartum. PBMCs were studied after in vitro culture for 48 hours with and without T cell stimulation. The present study is the first single-cell atlas of PBMCs of RA during pregnancy and postpartum. An initial cell clustering analysis divided the cells into NK and unstimulated T cells, stimulated T cells, myeloid cells and B cells. These clusters could be further subdivided into 35 highly specific clusters. We detected an effectorness gradient in the unstimulated T cell compartment. In postpartum, cell composition analysis revealed an increase in unstimulated resting naïve T cells and GZMA+ GNLY+ producing CD8+ T cells. In stimulated cells, the analysis revealed an increase in activated T central memory cells with high ribosomal content and recently activated naïve T cells. In cells from pregnancy, we found an immune resistance to cell stimulation in CD14+ monocytes and CD16+ CD56dim NKs. Finally, differential gene expression between the different cell clusters revealed genes related possibly associated to modulation of disease during pregnancy. Also, genes that could be involved in pregnancy and oncogenesis and genes involved in RA and preeclampsia. Universitat Autònoma de Barcelona. Programa de Doctorat en Medicina

Pregnant women constitute a promising sentinel group for continuous monitoring of malaria transmission. To identify antibody signatures of recent Plasmodium falciparum exposure during pregnancy, we dissected IgG responses against VAR2CSA, the parasite antigen that mediates placental sequestration. We used a multiplex peptide-based suspension array in 2,354 samples from pregnant women from Mozambique, Benin, Kenya, Gabon, Tanzania, and Spain. Two VAR2CSA peptides of limited polymorphism were immunogenic and targeted by IgG responses readily boosted during infection and with estimated half-lives of

Antiphospholipid antibodies; Obstetric antiphospholipid syndrome; Thrombotic antiphospholipid syndrome Anticuerpos antifosfolípidos; Síndrome antifosfolípido obstétrico; Síndrome antifosfolípido trombótico Anticossos antifosfolípids; Síndrome antifosfolípid obstètric; Síndrome antifosfolípid trombòtic Antiphospholipid syndrome (APS) is a systemic autoimmune condition characterised by the presence of antiphospholipid antibodies (aPL) associated with vascular thrombosis and/or pregnancy complications. In a cohort of 74 yet diagnosed APS individuals fulfilling Sydney laboratory criteria (twice positive for lupus anticoagulant, anticardiolipin, aCL, and/or anti-β2glycoprotein I, aβ2GPI), 33 out of 74 were obstetric APS (OAPS) and 41 thrombotic APS (TAPS) patients. 39% of TAPS patients were women. Although aPL detection was persistent, we observed an oscillatory aPL positivity in 56.7% and a transient seroconversion in 32.4% of APS patients at enrolment. Thus, we tested their sera in a line immunoassay that simultaneously detected IgG or IgM for criteria (aCL and aβ2GPI) and non-criteria (anti-phosphatidylserine, aPS; anti-phosphatidic acid, aPA; anti-phosphatidylinositol, aPI; anti-annexin 5, aA5; anti-prothrombin, aPT; anti-phosphatidylethanolamine; anti-phosphatidylglycerol, and anti-phosphatidylcholine) aPL. OAPS and TAPS patients displayed different but overlapping clusters based on their aPL reactivities. Specifically, while OAPS patients showed higher aPA, aPS, aA5, aβ2GPI and aPT IgM levels than TAPS patients, the latter displayed higher reactivity in aCL, aPI and aA5 IgG. Eventually, with a cut-off of the 99th percentile established from a population of 79 healthy donors, TAPS patients significantly tested more positive for aCL and aA5 IgG than OAPS patients, who tested more positive for aPA, aPS and aβ2GPI IgM. Transiently seronegative APS patients showed non-criteria aPL positivity twice in sera obtained 3 months apart. Overall, our data show that APS patients presented clusters of aPL that define different profiles between OAPS and TAPS, and persistent non-criteria aPL positivity was observed in those who are transiently seronegative. This research was funded by Fundació Ona Futura (ONA-JAR-2021; Port d’Alcudia, Balearic Islands, Spain); and Gravida Fertilitat Avançada (GRA-JAR-2021; Barcelona, Spain).

Background: Premenopausal women with early hormone-receptor positive (HR+) breast cancer receive 5–10 years of adjuvant endocrine therapy (ET) during which pregnancy is contraindicated and fertility may wane. The POSITIVE study investigates the impact of temporary ET interruption to allow pregnancy. Methods: POSITIVE enrolled women with stage I-III HR + early breast cancer, ≤42 years, who had received 18–30 months of adjuvant ET and wished to interrupt ET for pregnancy. Treatment interruption for up to 2 years was permitted to allow pregnancy, delivery and breastfeeding, followed by ET resumption to complete the planned duration. Findings: From 12/2014 to 12/2019, 518 women were enrolled at 116 institutions/20 countries/4 continents. At enrolment, the median age was 37 years and 74.9 % were nulliparous. Fertility preservation was used by 51.5 % of women. 93.2 % of patients had stage I/II disease, 66.0 % were node-negative, 54.7 % had breast conserving surgery, 61.9 % had received neo/adjuvant chemotherapy. Tamoxifen alone was the most prescribed ET (41.8 %), followed by tamoxifen + ovarian function suppression (OFS) (35.4 %). A greater proportion of North American women were, SCOPUS: ar.j, info:eu-repo/semantics/published

Preeclampsia (PE) and fetal growth restriction (FGR) are both placenta-mediated disorders with unclear pathogenesis. Metabolomics of maternal and fetal pairs might help in understanding these disorders. We recruited prospectively pregnancies with normotensive FGR, PE without FGR, PE + FGR and uncomplicated pregnancies as controls. Nuclear magnetic resonance metabolomics were applied on plasma samples collected at delivery. Advanced lipoprotein, glycoprotein and choline profiling was performed using the Liposcale test. The software package Dolphin was used to quantify 24 low-molecular-weight metabolites. Statistical analysis comprised the comparison between each group of complicated pregnancies versus controls, considering 5% false discovery rate correction. Lipid profiles were altered in accordance with the clinical presentation of these disorders. Specifically, PE mothers and FGR fetuses (with or without FGR or PE, respectively) exhibited a pro-atherogenic and pro-inflammatory profile, with higher concentrations of triglycerides, remnant cholesterol (VLDL, IDL) and Glc/GalNAc-linked and lipid-associated glycoproteins compared to controls. Low-molecular-weight metabolites were extensively disturbed in preeclamptic mothers, with or without FGR. Growth restricted fetuses in the presence of PE showed changes in low-molecular-weight metabolites similar to their mothers (increased creatine and creatinine), while normotensive FGR fetuses presented scarce differences, consistent with undernutrition (lower isoleucine). Further research is warranted to clarify maternal and fetal adaptations to PE and FGR.

Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries.A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis.Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage.WLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.ANTECEDENTES: Las mujeres que viven con el VIH (MVV) carecen de información basada en evidencias sobre las opciones reproductivas mientras son presionadas por la familia, los profesionales de la salud y los miembros de la comunidad para renunciar a la idea de tener hijos. Como las intenciones reproductivas de las MVV no son comprendidas, las conductas estigmatizantes las obligan a ocultar su enfermedad para evitar el rechazo de su familia, pareja y grupos sociales. El cumplimiento de las normas sociales, el miedo al estigma y la discriminación influyen en su experiencia. La presente investigación está compuesta por estudios cualitativos que de forma individual carecen de la perspectiva de síntesis necesaria para guiar el desarrollo de las intervenciones. El propósito de este estudio fue sintetizar la evidencia para explicar el proceso de toma de decisiones reproductivas para las MVV en los países desarrollados. MéTODOS: Se realizó una revisión sistemática con síntesis de investigación cualitativa mediante búsquedas en 10 bases de datos electrónicas (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo y SciELO). Los estudios publicados en revistas de entre 1995 y 2019 que contuvieran datos cualitativos sobre la toma de decisiones reproductivas entre las MVV en países desarrollados fueron elegibles para su inclusión. Se consideraron países desarrollados aquellos que pertenecieran a la OCDE con el objetivo de comparar condiciones de bienestar social y estabilidad económica. Las listas de verificación CASP y JBI para la investigación cualitativa se utilizaron para evaluar la calidad del estudio y la integridad metodológica. Para la síntesis se utilizaron técnicas de análisis temático y metanálisis cualitativo.En la síntesis se incluyeron veinte estudios de 12 países desarrollados. Los hallazgos se organizaron en 3 metatemas de 15 temas y 45 subtemas, incluyendo: (1) Identidad fragmentada, (2) Barreras, inequidades y desinformación, (3) Afrontamiento, resiliencia y apoyo. La toma de decisiones reproductivas se percibió como un proceso complejo influenciado por factores facilitadores y barrera. Los facilitadores ayudaron a las MVV a afrontar su nueva realidad para volverse más resilientes, mientras que las barreras hicieron que su situación fuera más difícil de manejar. CONCLUSIóN: Las MVV enfrentan la toma de decisiones reproductivas con déficits de conocimiento y apoyo social limitado. Es necesario adoptar un enfoque holístico de atención integral con asesoramiento multidisciplinario para acompañar a las MVV. Los clínicos podrían beneficiarse del desarrollo profesional para aprender a estar verdaderamente presentes para las MVV, participando en reflexiones, demostrando compasión y comprendiendo sus situaciones. Las guías de práctica clínica basadas en la evidencia deben adaptarse a las necesidades de planificación familiar y salud sexual y reproductiva de las MVV. Plain Language Summary Women living with HIV can become pregnant and deliver a healthy baby due to advances in medicine. Being a mother is an important role that gives meaning to life for most women. For women living with HIV thinking about having a baby is difficult because HIV complicates many areas of daily living. When women living with HIV try to speak with physicians and nurses about having a baby, they often do not feel supported and report feeling stigmatized. This review of the scientific literature summarizes the experiences of women living with HIV in developed countries as they considered having a baby. Ten electronic databases were searched for studies published between 1995 and 2019 reporting interviews with women living with HIV about becoming pregnant and having a baby. From the 4519 articles identified, 20 were included for review with 1395 participants from 12 developed countries. After abstracting and analyzing the interviews, three themes were developed to summarize the process described by women living with HIV as they considered pregnancy and the possibility of having a baby, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, and (3) Coping, resiliency, and support. When women living with HIV consider having a baby, they need to feel comfortable and safe speaking with physicians and nurses about family planning. They also need more support from their partner, as well as family and friends. Strategies need to be implemented to improve the family planning process for women living with HIV, including education health care providers about speaking to women about pregnancy and having a healthy baby.

Background A birth plan (BP) is a written document in which the pregnant woman explains her wishes and expectations about childbirth to the health professionals and aims to facilitate her decision-making. Midwives’ support to women during the development of the BP is essential, but it’s unknown if shared decision making (SDM) is effective in birth plan counselling. We hypothesized that women who receive counselling based on SDM during their pregnancy are more likely to present their BP to the hospital, more satisfied with the childbirth experience, and have better obstetric outcomes than women who receive standard counselling. We also aimed to identify if women who presented BP to the hospital have better obstetric outcomes and more satisfied with the childbirth experience. Methods This was a randomised cluster trial involving four Primary Care Units. Midwives provided BP counselling based on SDM to the women in the intervention group (IG) during their pregnancy, along with a leaflet with evidence-based recommendations. Women in the control group (CG) only received the standard birth plan counselling from midwives. The primary outcomes were birth plan presentation to the hospital, obstetrics outcomes and satisfaction with childbirth experience. The Mackey Satisfaction with Childbirth Scale (MCSRS) was used to measure childbirth satisfaction. Results A total of 461 (95.5%) pregnant women received BP counselling (IG n = 214 and CG n = 247). Fewer women in the intervention group presented their BP to the hospital compared to those in the control group (57.8% vs 75.1%; p Conclusion This counselling intervention was not effective to increase the presentation of the BP to the hospital and women’s satisfaction with childbirth; however, it was related to a lower usage of analgesia epidural, a higher combination of pharmacological and non-pharmacological methods for pain relief and the initiation of breastfeeding in the delivery room. Presenting the BP to the hospital increased the likelihood of using pharmacological and non-pharmacological methods for pain relief, and early skin-to-skin contact.

RESUMEN: INTRODUCCIÓN: La violencia de género es un delito que afecta a un tercio de todas las mujeres a nivel mundial y es un problema difícil de abordar por el personal de enfermería, causado por el desconocimiento de las acciones a realizar. OBJETIVOS: se ha propuesto elaborar una guía de actuación de enfermería de Urgencias sobre violencia de género en etapa gestacional e identificar cuál es el rol de enfermería en esos circuitos asistenciales, entendiendo que se trata de un abordaje multidisciplinar e interdisciplinar entre varios profesionales. METODOLOGÍA: Se ha buscado las guías de actuación y protocolos de violencia machista para poder crear nuestra versión de una guía de actuación rápida para enfermería de Urgencias teniendo en cuenta cuestiones de embarazo. Toda la información se ha filtrado a 5 años de antigüedad con finalidad de asegurar que los datos tengan relevancia en el momento de la elaboración de esta guía de actuación. RESULTADOS: Se ha realizado un diagrama de flujo y un prototipo de aplicación de móvil en formato PDF interactivo, como que se ha llegado a la conclusión que los protocolos son genéricos y no dejan claro cuáles son los profesionales sanitarios que intervienen y que papel tiene cada uno. El trabajo realizado sería una herramienta de apoyo más accesible. PALABRAS CLAVE: Violencia de género, violencia machista, etapa gestacional, embarazo, circuitos asistenciales, abordaje multidisciplinar, guía de actuación, protocolos. ABSTRACT: INTRODUCTION: Gender violence is a crime that affects a third of all women worldwide and is a difficult problem for nursing personnel to address, due to not knowing what actions need to be taken. 3 OBJECTIVES: It has been proposed to develop an action guide for Emergency nurses on gender violence in the gestational stage and to identify the role of nursing in these healthcare circuits, understanding that it is a multidisciplinary and interdisciplinary approach between several professionals. METHODOLOGY: Action guides and protocols for sexist violence have been used as a reference in order to create our version of a fast action guide for Emergency nurses taking into account pregnancy issues. All information has been filtered to 5 years of antiquity to ensure that the data is relevant at the time of preparing this action guide. RESULTS: A flow chart and a mobile application prototype have been made in interactive PDF format, as it has been concluded that the protocols are generic and do not make it clear about which are the health professionals involved and what role each one plays. This work would be a more accessible support tool. KEYWORDS: Gender violence, sexist violence, gestational stage, pregnancy, healthcare circuits, multidisciplinary approach, action guide, protocols. Grau en Infermeria

Background: In recent years, higher than the recommended rate of oxytocin use has been observed among low-risk women. This study examines the relationship between oxytocin administration and birth outcomes in women and neonates. Methods: A retrospective analysis of birth and neonatal outcomes for women who received oxytocin versus those who did not. The sample included 322 women with a low-risk pregnancy. Results: Oxytocin administration was associated with cesarean section (aOR 4.81, 95% CI: 1.80–12.81), instrumental birth (aOR 3.34, 95% CI: 1.45–7.67), episiotomy (aOR 3.79, 95% CI: 2.20–6.52) and length of the second stage (aOR 00:18, 95% CI: 00:04–00:31). In neonatal outcomes, oxytocin in labor was associated with umbilical artery pH ≤ 7.20 (OR 3.29, 95% CI: 1.33–8.14). Admission to neonatal intensive care unit (OR 0.56, 95% CI: 0.22–1.42), neonatal resuscitation (OR 1.04, 95% CI: 0.22–1.42), and Apgar score &lt, 7 (OR 0.48, 95% CI: 0.17–1.33) were not associated with oxytocin administration during labor. Conclusions: Oxytocin administration during labor for low-risk women may lead to worse birth outcomes with an increased risk of instrumental birth and cesarean, episiotomy and the use of epidural analgesia for pain relief. Neonatal results may be also worse with an increased proportion of neonates displaying an umbilical arterial pH ≤ 7.20.

A 43-year-old woman with an associated history of gynecological pathology and breast cancer with only one cryopreserved embryo wished to be a mother. Several factors that influenced the success of the pregnancy in this case were analyzed. Favorable factors included: triple positive breast cancer [positive hormone receptors and positive human epidermal growth factor receptor 2], which is more hormosensitive and chemosensitive; absence of metastasis; correct endometrium preparation; and the patient's optimistic attitude and strict health habits. In contrast, the factors against success were: breast cancer; adjuvant breast cancer therapy gonadotoxicity; the age of the patient (> 40-year-old); endometriosis; ovarian cyst; hydrosalpinx; submucosal fibroids and the respective associated surgery done for the above-mentioned pathology (all resolved prior to the embryo transfer); and a low quantity of ovules (low ovarian reserve) after ovarian stimulation. This is a very special clinical case of a patient with theoretically low pregnancy success probability due to the consecutive accumulation of gynecological and oncological pathologies, who nonetheless became pregnant and delivered a full-term infant and was able to provide adequate breastfeeding.

En aquest treball, em centro en l'estudi de les relacions socials de gènere a través de la corporalitat. Mitjançant una metodologia qualitativa i abductiva, que consta d'una cerca documental, set entrevistes semiestructurades i una etnografia digital exploratòria, tracto d'aproximar-me a l'autopercepció del cos les dones embarassades i que han donat a llum recentment a Espanya. Una autopercepció que es troba travessada pel discurs i la moralitat neoliberal tan present a les societats de consum contemporànies, la qual té grans efectes en les pràctiques i concepcions del nostre dia a dia. En este trabajo, me centro en el estudio de las relaciones sociales de género a través de la corporalidad. Mediante una metodología cualitativa i abductiva, que consta de una búsqueda documental, siete entrevistas semiestructuradas y una etnografía digital exploratoria, trato de acercarme a la autopercepción del cuerpo de las mujeres embarazadas y que han dado a luz recientemente en España. Una autopercepción que está atravesada por el discurso y la moralidad neoliberal tan presente en las sociedades de consumo contemporáneas, la cual tiene grandes efectos en las practicas i concepciones de nuestro día a día. In this research, I focus on the study of gender relations through corporality. By means of a qualitative and abductive methodology, that consists of a documental research, seven semi structured interviews and an exploratory digital ethnography, I try to approach to the corporal auto perception of pregnant women and women who have recently given birth in Spain. The auto perception that is influenced by a neoliberal discourse and morality, the one that is so present in contemporary consume societies, that has huge effects in our daily practices and conceptions.

Objective: To identify the prevalence of pre-pregnancy overweight/obesity in pregnant women and its relationship with socio-demographic factors and to describe the maternal and perinatal outcomes in a Barcelona hospital (Spain). Method: A descriptive cross-association study, with retrospective data collection, was performed Barcelona Hospital. The data of 5447 pregnant women who delivered at >=23 weeks of gestation were included. Body Mass Index (BMI) data were categorised into World Health Organization classifications. p values

Objetivo: Evaluar si la exposición a la violencia de género durante la gestación se relaciona con la interrupción voluntaria del embarazo y las complicaciones de salud neonatales que conlleven el ingreso en una Unidad de Cuidados Neonatales. Metodología: Estudio observacional, descriptivo y prospectivo, llevado a cabo en los dos centros de Atención a la Salud Sexual y eproductiva de L'Hospitalet de Llobregat (Barcelona). Cumplimentaron el cuestionario validado de detección de violencia de género Index of Spouse Abuse las mujeres gestantes asistidas por matronas de los centros participantes. Conjuntamente, se recogieron variables sociodemográficas y obstétricas. Se realizó un análisis descriptivo, bivariante y multivariante de los datos. Resultados: Se obtuvo una muestra de 120 mujeres que solicitaron una interrupción voluntaria del embarazo y 381 que continuaron con la gestación. La prevalencia de violencia de género en el último año fue significativamente mayor (p

Resumen En los últimos años, se ha mostrado un creciente interés por dar a luz en entornos seguros, aunque menos medicalizados, como son las salas de atención al "parto natural" que ya funcionan en algunos hospitales. Sin embargo, la opción de parir en casa, en caso de embarazo de bajo riesgo, no está contemplada en el sistema sanitario público de salud. A raíz de la pandemia del Covid, ha aumentado la demanda de parto en casa y en Cataluña se ha triplicado. Con la intención de profundizar en la decisión del lugar donde dar a luz, se entrevista en profundidad a una mujer primípara durante el confinamiento. El relato sigue un hilo conductor: inicio de la gestación, vivencias durante el embarazo, aparición de la pandemia y el final del parto. Conclusión: la elección de parir en casa, en el caso que nos ocupa, se forja a partir de constatar la imposibilidad de cumplir con su deseo de un parto natural dada la situación generada por la Pandemia de COVID-19. La información facilitada por las matronas ha sido clave en el empoderamiento para la toma de esta decisión.

Antecedents: L’ Streptococcus agalactiae (SGB) és la primera causa d’infecció bacteriana perinatal de transmissió vertical al món occidental. Existeix controvèrsia respecte al protocol de cribratge i tractament amb un augment de les resistències als antimicrobians en enterobacteriaes, així com cada vegada més, reaccions al·lèrgiques als antibiòtics. Es qüestionen, els estudis en què es basen les guies actuals seguides a casa nostra i la dubtosa efectivitat del cribratge. Malgrat totes les mesures preventives i de tractament, es continuen enregistrant infeccions neonatals per aquest microorganisme. Hipòtesi: Existeix variabilitat en resultat del cultiu per SGB entre la setmana 35-37 de gestació i el part. Objectiu: Investigar la variabilitat de el resultat dels cultius per SGB vaginal i rectal entre el tercer trimestre de gestació (35-37w) i el part en gestants de l’Hospital Universitari Germans Trias i Pujol de Badalona. Metodologia: Estudi observacional, descriptiu, transversal de sèrie de casos en 304 gestants. Tècnica de mostreig no probabilística accidental i una anàlisi descriptiva i inferencial. Resultats: La variabilitat de resultats es va donar en 22 mostres (7,2%). Un 4% (9) va canviar de positiu a negatiu i un 26% (14) de negatiu a positiu. L’edat i el pes van influir en el canvi de resultat. Un antecedent de positiu en anteriors gestacions (p: 0,021) o una infecció de transmissió sexual (risc x3,8) es va relacionar amb un canvi de resultat. Ni la paritat, l’ètnia, la raça, l’antiguitat dels cultius o diabetis gestacional / pregestacional van influir en un canvi de resultat. La prevalença de SGB va ser d’entre el 15,1% i el 15,6%. El percentatge de canvis de resultat entre els positius del primer cultiu, va ser 7 vegades superior que entre els negatius, i el percentatge de canvis de resultat entre els positius en el segon cultiu va quadruplicar el percentatge de canvis entre els negatius. Un de cada quatre cultius va arribar a el part amb una antiguitat superior a les 5 setmanes, dada que no va influir en la modificació del resultat. Pel que fa a l’associació entre SGB i les variables estudiades, es va trobar una correlació amb la paritat (a major paritat major nombre de SGB positius). La diabetis (més del doble entre els resultats positius que entre els negatius). El sobrepès (risc x 2,7 vegades). Generalment, les dones amb resultat positiu tendien a l’obesitat. L’antecedent de positivitat en una gestació anterior(risc i odds ratio x4) i d’infecció de transmissió sexual (risc i odds ratio x3,8) també van resultar factors d’augment de risc per a la positivitat. No obstant això, el risc de ser positiva es va reduir un 67% en les dones de raça blanca pel que fa a dones d’altres races (indo-pakistanesa, negra i oriental). Conclusions: En un 7% de les mostres, va existir una variabilitat entre el resultat del cultiu per SGB vaginal i rectal de l tercer trimestre al part. Aquest fet s’ha de considerar una dada clínicament rellevant per a la pràctica assistencial. Es van crear dos models predictius de regressió logística (LOGIT), models probabilístics en els quals es detectaran els factors de risc entre els paràmetres contemplats, i amb els quals es podrà calcular la probabilitat de ser positiu i de modificar el cultiu, però no es podrà predir ni classificar. Aquest estudi va observar que, el cribratge en el tercer trimestre de gestació per SGB, es podria revalorar i / o individualitzar en funció del benefici aportat a la gestant, donada la naturalesa canviant i pràcticament impredictible d’aquest bacteri, atenent a la controvèrsia de les dades obtinguts i acceptant el potencial risc d’efectes adversos versus el potencial benefici per al binomi mare-nounat. Antecedentes: El Streptococcus agalactiae (SGB) es la primera causa de infección bacteriana perinatal de transmisión vertical en el mundo occidental. Existe controversia respecto al protocolo de cribaje y tratamiento con un aumento de las resistencias a los antimicrobianos en enterobacterias, así como cada vez más, reacciones alérgicas a los antibióticos. Se cuestionan los estudios en los que se basan las guías actuales seguidas en nuestro país y la dudosa efectividad del cribaje. Pese a todas las medidas preventivas y de tratamiento, continúan registrándose infecciones neonatales por este microorganismo. Hipótesis: Existe variabilidad en resultado del cultivo para SGB entre la semana 35-37 de gestación y el día de parto. Objetivo: Investigar la variabilidad del resultado de los cultivos para SGB vaginal y rectal entre el tercer trimestre de gestación (35-37w) y el parto en gestantes del Hospital Universitari Germans Trias i Pujol de Badalona. Metodología: Estudio observacional, descriptivo, transversal de serie de casos en 304 gestantes. Técnica de muestreo no probabilística accidental y un análisis descriptivo e inferencial. Resultados: La variabilidad de resultados se dió en 22 muestras (7,2%). Un 4% (9) cambió de positivo a negativo y un 26% (14) de negativo a positivo. La edad y el peso influyeron en el cambio de resultado. Un antecedente de positivo en anteriores gestaciones (p:0,021) o una infección de transmisión sexual (riesgo x3,8) se relacionó con un cambio de resultado. Ni la paridad, la etnia, la raza, la antigüedad de los cultivos o diabetes gestacional/pregestacional influyeron en un cambio de resultado. La prevalencia de SGB fue de entre el 15,1% y el 15,6 %. El porcentaje de cambios de resultado entre los positivos del primer cultivo fue 7 veces superior que entre los negativos y el porcentaje de cambios de resultado entre los positivos en el segundo cultivo cuadruplicó el porcentaje de cambios entre los negativos. Uno de cada cuatro cultivos llegó al parto con una antigüedad superior a las 5 semanas, dato que no influyó en la modificación de su resultado. En referencia a la asociación entre SGB y las variables estudiadas, se halló una correlación con la paridad (a mayor paridad mayor número de SGB positivos). La diabetes (más del doble entre los resultados positivos que entre los negativos). El sobrepeso (riesgo x 2,7 veces). Generalmente, las mujeres con resultado positivo fueron más obesas. El antecedente de positividad en una gestación anterior (riesgo y odds ratio x4). o de infección de transmisión sexual (riesgo y odds ratio x3,8)., también resultaron factores de aumento de riesgo para la positividad. Sin embargo, el riesgo de ser positiva se redujo un 67% en las mujeres de raza blanca con respecto a mujeres de otras razas (indo-pakistaní, negra y oriental). Conclusiones: La prevalencia de gestantes con Streptococcus agalactiae vaginal y/o rectal se halló entre el 15,1-15,6%. En un 7% de las muestras, existió una variabilidad entre el resultado del cultivo para Streptococcus agalactiae vaginal y rectal del tercer trimestre al parto. Este hecho debe considerarse un dato clínicamente relevante para la práctica asistencial. Se crearon dos modelos predictivos de regresión logística (LOGIT), modelos probabilísticos en los que se detectarán los factores de riesgo entre los parámetros contemplados, y con el que se podrá calcular la probabilidad de ser positivo y de modificar el cultivo, pero no se podrá predecir ni clasificar. Este estudio observó que, el cribaje en el tercer trimestre de gestación para SGB, se podría revalorar y/o individualizar en función del beneficio aportado a la gestante, dada la naturaleza cambiante y prácticamente impredecible de esta bacteria, atendiendo a la controversia de los datos obtenidos y aceptando el potencial riesgo de efectos adversos versus el potencial beneficio para el binomio madre-neonato. Background: Streptococcus agalactiae (GBS) is the leading cause of vertically transmitted perinatal bacterial infection in the western world. There is controversy regarding the screening and treatment protocol with an increase in antimicrobial resistance in Enterobacteriaceae, as well as, increasingly, allergic reactions to antibiotics. The studies on which the current guidelines followed in our country are based and the doubtful effectiveness of the screening are questioned. Despite all preventive and treatment measures, neonatal infections with this microorganism continue to be recorded. Hypothesis: There is variability in the result of the culture for GBS between the 35-37 week of gestation and the day of delivery. Objective: To investigate the variability of the result of the cultures for vaginal and rectal GBS between the third trimester of gestation (35-37w) and delivery in pregnant women at the Germans Trias i Pujol University Hospital in Badalona. Methodology: Observational, descriptive, cross-sectional study of a series of cases in 304 pregnant women. Accidental non-probability sampling technique and a descriptive and inferential analysis. Results: The variability of results occurred in 22 samples (7.2%). 4% (9) changed from positive to negative and 26% (14) from negative to positive. Age and weight influenced the change in outcome. A history of positive in previous pregnancies (p: 0.021) or a sexually transmitted infection (risk x3.8) was related to a change in outcome. Neither parity, ethnicity, race, age of crops, or gestational / pregestational diabetes influenced a change in outcome. The prevalence of GBS was between 15.1% and 15.6%. The percentage of result changes among the positives of the first culture was 7 times higher than that of the negatives and the percentage of result changes among the positives in the second culture quadrupled the percentage of changes among the negatives. One out of every four cultures arrived at delivery older than 5 weeks, a fact that did not influence the modification of their result. Regarding the association between GBS and the variables studied, a correlation with parity was found (the higher the parity, the greater the number of positive GBS). Diabetes (more than double the positive results than the negative ones). Being overweight (risk x 2.7 times). Generally, women with a positive result were more obese. A history of positivity in a previous pregnancy and a sexually transmitted infection also resulted in increased risk factors for positivity. However, the risk of being positive was reduced 67% in white women compared to women of other races (Indo-Pakistani, Black and Oriental). Conclusions: The prevalence of pregnant women with positive vaginal and / or rectal Streptococcus agalactiae was found between 15.1-15.6%. In 7% of the samples, there was a variability between the culture results for vaginal and rectal Streptococcus agalactiae from the third trimester to delivery. This fact should be considered clinically relevant data for healthcare practice. Two predictive logistic regression models (LOGIT) were created, probabilistic models in which the risk factors will be detected among the parameters contemplated, and with which the probability of being positive and of modifying the culture can be calculated, but it will not be possible to predict or classify. This study observed that screening in the third trimester of pregnancy for GBS could be reassessed and / or individualized based on the benefit provided to the pregnant woman, given the changing and practically unpredictable nature of this bacterium, taking into account the controversy of the data. obtained and accepting the potential risk of adverse effects versus the potential benefit for the mother-neonate binomial. Universitat Autònoma de Barcelona. Programa de Doctorat en Pediatria, Obstetrícia i Ginecologia

Introduction: Cannabis is a drug with increasing consumption in many countries around the world in the reproductive age of women. This illegal substance in Spain is involved in all stages of pregnancy and can affect both the pregnant women and her future baby. Thus, sociodemographic differences and exposure to different risk factors will lead to more or less cannabis use during pregnancy. In addition, it is very important to determine the pattern of cannabis use in women of childbearing potential in order to provide health education and prevent the use of this drug during pregnancy. Objectives: To know the sociodemographic characteristics, the consumption pattern and the main risk factors of women cannabis users during pregnancy, as well as the preventive intervention carried out by health professionals to prevent the use of this drug during pregnancy Introducció: El cànnabis és una droga amb creixent consumició en molts països d’arreu del món a l’edat reproductiva de la dona. Aquesta substància il·legal en l’àmbit espanyol, intervé en totes les etapes de l’embaràs podent afectar tant a la gestant com el seu futur nadó. Així doncs, les diferències sociodemogràfiques i l’exposició a diferents factors de risc propiciarà a consumir més o menys cànnabis durant la gestació. A més a més, és molt important determinar el patró de consum de cànnabis en dones en edat fèrtil per així oferir educació per a la salut i evitar el consum d’aquesta droga durant la gestació. Objectius: Conèixer les característiques sociodemogràfiques, el patró de consum i els factors de risc principals de les dones consumidores de cànnabis durant l’embaràs, així com la intervenció preventiva que porten a terme els professionals sanitaris per evitar l’ús d’aquesta droga durant la gestació

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM, Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations, Background The Coronavirus Disease 2019 (COVID-19) is a novel disease which has been having a worldwide affect since December 2019. Evidence regarding the effects of SARS-CoV-2 during pregnancy is conflicting. The presence of SARS-CoV-2 has been demonstrated in biological samples during pregnancy (placenta, umbilical cord or amniotic fluid); however, maternal and fetal effects of the virus are not well known. Methods Descriptive, multicentre, longitudinal, observational study in eight tertiary care hospitals throughout Spain, that are referral centres for pregnant women with COVID-19. All pregnant women with positive SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction during their pregnancy or 14 days preconception and newborns born to mothers infected with SARS-CoV-2 will be included. They will continue to be followed up until 4 weeks after delivery. The aim of the study is to investigate both the effect of COVID-19 on the pregnancy, and the effect of the pregnancy status with the evolution of the SARS-CoV-2 disease. Other samples (faeces, urine, serum, amniotic fluid, cord and peripheral blood, placenta and breastmilk) will be collected in order to analyse whether or not there is a risk of vertical transmission and to describe the behaviour of the virus in other fluids. Neonates will be followed until 6 months after delivery to establish the rate of neonatal transmission. We aim to include 150 pregnant women and their babies. Ethics approval will be obtained from all the participating centres. Discussion There is little information known about COVID-19 and its unknown effects on pregnancy. This study will collect a large number of samples in pregnant women which will allow us to demonstrate the behaviour of the virus in pregnancy and postpartum in a representative cohort of the Spanish population, The study has been awarded with a Spanish Government grant (Instituto de Salud Carlos III: COV20/00188). It covers the expenses for transporting, processing and analyzing samples, database creation and maintenance, and hiring support staff

Durante el embarazo y el posparto ocurren numerosas y complejas adaptaciones en el cerebro femenino, las cuales permiten el desarrollo de las conductas de cuidado y protección para la supervivencia de la descendencia. Hasta hace poco la investigación sobre la neuroplasticidad neuronal en relación con la reproducción estaba basada en estudios animales. No obstante, un limitado número de estudios de neuroimagen recientes llevados a cabo en madres humanas revelan que la maternidad produce drásticos y dinámicos cambios estructurales y funcionales en su cerebro. Estas transformaciones se han asociado con la transición de la mujer hacia la maternidad. En este trabajo se revisan los cambios en la estructura y función del cerebro materno inherentes al embarazo y el período posparto, así como la relación de estas alteraciones con el comportamiento maternal. Complex and numerous adaptations take place in the female brain during pregnancy and the postpartum period. These cerebral changes allow the development of care and protection behaviours for the survival of the offspring. Until recently, the majority of research on maternal neuroplasticity was based on animal studies. However, a limited number of recent neuroimaging studies on human mothers reveal that maternity causes dramatic and dynamic structural and functional changes in the brain. These transformations have been associated with the transition of women towards motherhood. This work reviews the changes in human brain structure and function during pregnancy and postpartum, as well as the relationship of these alterations with maternal behaviour. Durant l'embaràs i el postpart ocorren nombroses i complexes adaptacions en el cervell femení, les quals permeten el desenvolupament de les conductes de cura i protecció per a la supervivència de la descendència. Fins fa poc la recerca sobre la neuroplasticidad neuronal en relació amb la reproducció estava basada en estudis animals. No obstant això, un limitat nombre d'estudis de neuroimagen recents duts a terme en mares humanes revelen que la maternitat produeix dràstics i dinàmics canvis estructurals i funcionals en el seu cervell. Aquestes transformacions s'han associat amb la transició de la dona cap a la maternitat. En aquest treball es revisen els canvis en l'estructura i funció del cervell matern inherents a l'embaràs i el període postpart, així com la relació d'aquestes alteracions amb el comportament maternal.

Artículo con numerosos autores. Sólo destacamos el primero. el de la UAM y el Grupo colectivo, Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13–3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms, This project was supported by public funds obtained in competitive calls: Grant COV20/00021 (EUR 43,000 from the Instituto de Salud Carlos III—Spanish Ministry of Health and co-financed with Fondo Europeo de Desarrollo Regional (FEDER) funds. Dr Cruz-Lemini is supported by a Juan Rodés contract JR19/00047, Instituto de Salud Carlos III—Spanish Ministry of Health

Aim To investigate microbial profiles in placentas from a population of East African mothers with and without adverse pregnancy outcomes and with regard to their periodontal status. Material and methods Thirty-six placentas from pregnant women from Tanzania were classified into three groups according to both pregnancy outcome and the mother's periodontal health. The microbial composition in each group was then compared using 16S rRNA metagenomics. Additionally, placenta specimens were analyzed histologically for chorioamnionitis by a single pathologist blinded to the clinical data. Results The greatest differences were observed in the group of mothers with periodontitis. The microbial load was low in all three groups of mothers. Periodontitis had a notable influence on the structure of the placental microbiota. Three phyla and 44 genera were associated with periodontitis, whereas only the Tenericutes phylum was associated with the adverse pregnancy variable. Streptococcaceae and Mycoplasmataceae families were associated with both periodontitis and adverse pregnancy outcomes. Finally, although the differences for chorioamnionitis were not significant, this intra-amniotic infection was more frequent in the placentas from mothers with periodontitis. Conclusions Our findings suggest that bacteria from the oral cavity may involve the feto-placental unit, and that periodontitis may be a modulating factor of the microbial community present in this niche.