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Resumen Antecedentes Alrededor del 45% de las embarazadas aquejan lumbalgia o dolor pelvico posterior (LBPGP, low back pain and/or pelvic girdle pain ). Este estudio tiene como objetivo evaluar el efecto de la acupuntura auricular en LBPGP comparado con acupuntura auricular placebo y cuidados obstetricos habituales en el ambito de atencion primaria de salud. Metodos y diseno Se trata de un estudio de cuatro brazos, multicentrico, aleatorizado, y controlado con placebo. Un total de 212 embarazadas (entre 24 y 36 semanas de gestacion), de al menos 17 anos, con LBPGP, se asignaran de forma aleatoria a uno de los siguientes cuatro grupos: acupuntura auricular verdadera asociada a los cuidados obstetricos habituales (AcAV), acupuntura auricular en puntos no especificos asociada a los cuidados obstetricos habituales (AcANE), acupuntura auricular placebo en puntos no especificos asociada a los cuidados obstetricos habituales (AcAP), o exclusivamente a cuidados obstetricos habituales (COH). Los grupos AcAV, AcANE y AcAP recibiran tratamiento en tres puntos auriculares (especificos en el grupo AcAV, y no especificos en los grupos AcANE y AcAP) una vez por semana durante dos semanas; el grupo COH solo recibio cuidados obstetricos habituales durante el mismo periodo. La variable principal de resultado sera la reduccion en la intensidad del dolor segun escala visual analogica (iEVA), a las 2 semanas del inicio del tratamiento. Las variables secundarias seran los cambios en el estado funcional en relacion con LBPGP (segun cuestionario de discapacidad de Roland-Morris), la calidad de vida relacionada con la salud (SF-12) a las 2 semanas del inicio del tratamiento, y la iEVA a las 12 y 48 semanas despues del parto. Discusion Este ensayo implementara una metodologia de alta calidad y proporcionara evidencia sobre la eficacia, la seguridad y la especificidad de la acupuntura auricular como tratamiento para las mujeres embarazadas con LBPGP.

Fundamentos: El tabaquismo durante la gestación constituye el principal problema prevenible de salud perinatal. El objetivo es establecer la prevalencia de tabaquismo de las mujeres gestantes en distintos momentos del embarazo así como explorar factores asociados al mismo. Métodos: Estudio transversal. La población diana fueron las mujeres cuyo control de embarazo se realizaba en centros de salud públicos. Muestra aleatoria representativa de 40 centros estratificados según número de embarazos. Participaron 1.813 mujeres seleccionadas en 3 muestras independientes (inicio y final del embarazo y posparto). La exposición se midió mediante cotinina en orina, autodeclaración y monóxido de carbono. Se registraron variables sociodemográficas, de tabaquismo y clínico-obstétricas. Se realizó una regresión logística para identificar los factores asociados al tabaquismo. Resultados: La prevalencia media fue 21,6%, menor al final del embarazo (15,6%) y en el puerperio (16,7%) y mayor en el principio del embarazo (30,3%). Las mujeres fumadoras diarias pasaron del 56,3% antes del embarazo al 14% al final (autodeclaración). El 21,8% de los abandonos se produjo antes del embarazo y el 23,6% cuando las mujeres supieron que estaban embarazadas. La ocultación del consumo fue 19,6% . Fueron factores asociados ser joven (OR: 0,956; IC: 0,92-0,99), estar expuesta al tabaco en el hogar (OR: 3,48; IC: 2,6-4,7), consumo pregestacional alto (6-10 OR: 13,1 IC: 3-56,9; >10 OR: 25,1 IC: 5,8-109,6), mayor edad gestacional en la medición (al final OR: 0,5 IC: 0,4-0,8; posparto inmediato OR: 0,4 IC: 0,3-0,6) y menor nivel de estudios (sin estudios y primer grado comparadas con universitarias OR: 1,98; IC: 1,22-3,22). Conclusiones: El perfil de la mujer gestante fumadora es el de una mujer joven con bajo nivel educativo, expuesta al humo de tabaco en el hogar y con alto consumo pregestacional. Background: Smoking during pregnancy is the most important preventable perinatal health problem. The aim of this research is to determine smoking prevalence in pregnant women at different times of pregnancy in Andalucía, using biochemical validation methods and to explore factors associated with it. Methods: Cross-sectional study. The study population was pregnant women followed in andalusian public health centers. A random sample of 40 health centers, stratified by number of pregnancies was collected, with 1813 pregnant enrolled in 3 independent samples (beginning and end of pregnancy, postpartum). The smoke exposure was measured by urinary cotinine, self-report and carbon monoxide in exhaled air. Control variables were socio-demographic, obstetric and related to smoking habit. A logistic regression was performed to explore factors associated with pregnancy smoking. Results: The mean prevalence in the whole sample was 21.6%, which was lower at the end of pregnancy (15.6%) and postpartum (16.7%) than at the beginning (30.3%). Daily smokers fell from 56.3% before pregnancy to 14% at the end (according to selfreport). Most of the quitters gave up before pregnancy (21.8%) or when they noticed they were pregnant (23.6%). Deception rate was 19.6%, varying according to gestational age and the amount of tobacco consumed. Younger age (OR: 0.956, CI 0.92-0.99), be exposed to second hand smoke at home (OR: 3.48, CI 2.6 to 4.7), a higher level of consumption before pregnancy (6-10 OR 13.1 CI 3 to 56.9,> 10 OR 25.1 CI 5.8 to 109.6), greater gestational age at measurement (end OR: 0.5 CI: 0.4-0.8; immediate postpartum OR 0.4 CI 0.3-0.6) and lower educational level (no education and first grade compared to university OR: 1.98, CI 1.22 to 3.22) were identified as factors associated. Conclusion: Consumption variations with gestational age compel to indicate the time of measurement in prevalence studies. The profile of the pregnant smoker was being young, poorly educated, exposed to tobacco smoke at home and with a previous history of heavy smoking. Proyecto financiado por la Consejería de Salud de la Junta de Andalucía: Subvenciones para la financiación de proyectos de investigación en Ciencias de la Salud en el ámbito de la Comunidad Autónoma de Andalucía según resolución de 27 de diciembre de 2004. Expediente 284/04.

Objective To compare the effectiveness of additional moxibustion at point BL67 with moxibustion at a non-specific acupuncture point and with usual care alone to correct non-vertex presentation. Methods This was a multicentre randomised controlled trial in which 406 low-risk pregnant women with a fetus in ultrasound breech presentation, with a gestational age of 33–35 weeks, were assigned to (1) true moxibustion at point BL67 plus usual care; (2) moxibustion at SP1, a non-specific acupuncture point (sham moxibustion) plus usual care; or (3) usual care alone. The primary outcome was cephalic presentation at birth. Women were recruited at health centres in primary healthcare. Results In the true moxibustion group, 58.1% of the full-term presentations were cephalic compared with 43.4% in the sham moxibustion group (RR 1.34, 95% CI 1.05 to 1.70) and 44.8% of those in the usual care group (RR 1.29, 95% CI 1.02 to 1.64). The reduction in RR of the primary outcome in women allocated to the true moxibustion group compared with the usual care group was 29.7% (95% CI 3.1% to 55.2%) and the number needed to treat was 8 (95% CI 4 to 72). There were no severe adverse effects during the treatment. Conclusions Moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. We believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus. Trial Registration Current Controlled Trials ISRCTN10634508.

Background: About 45% of all pregnant women suffer low back pain and/or pelvic girdle pain (LBPGP). This study seeks to evaluate the effect of auricular acupuncture on LBPGP compared with placebo auricular acupuncture and with standard obstetric care in the field of primary health care. Methods and design: This study will be a four-parallel-arm, multicentre, randomised, placebo-controlled trial. A total of 212 pregnant women (24 to 36 weeks' gestation), aged at least 17 years, with LBPGP, will be randomly assigned to the verum auricular acupuncture plus standard obstetric care group (VAAc), to the non-specific auricular acupuncture plus standard obstetric care group (NSAAc), to the non-specific placebo auricular acupuncture plus standard obstetric care group (PAAc), or the standard obstetric care group (SOC). The VAAc, NSAAc, and PAAc groups will receive treatment at three auricular acupuncture points (specific points for the VAAc group or non-specific ones for the NSAAc and PAAc groups), once a week for 2 weeks; the SOC group will receive only standard obstetric care during the same period. The primary outcome will be the reduction in pain intensity, according to the visual analogue scale (iVAS), at 2 weeks after the start of treatment. The secondary outcomes will be functional status with respect to LBPGP (according to the Roland-Morris disability questionnaire), health-related quality of life (SF12) at 2 weeks after the start of treatment, and iVAS at 12 and 48 weeks postpartum. Discussion: This trial will implement a high-quality methodology and may provide evidence for the efficacy, safety, and specificity of auricular acupuncture as a treatment for pregnant women with LBPGP., This study has been awarded a grant (No. PI13/00010) in a competitive application process of the programme for the promotion of biomedical research and health sciences for the performance of clinical research projects of a non-commercial nature, from the Spanish Ministry of Health and Consumer Affairs (Carlos III Health Institute).