Guía clínica de las modificaciones hipotalamohipofisarias en el embarazo y en el período posparto

Rabinovich, Irene Halperin; Alfonso, Gabriel Obiols; Moreno, Alfonso Manuel Soto; Vela, Enrique; Henzi, Frederic Tortosa; Bauset, Miguel Català; Peral, Alberto Gilsanz; Borràs, Juan Girbés; Esteban, Basilio Moreno; Alfonso, Antonio Miguel Picó; Picó, Carlos del Pozo; Murillo, Ana Zugasti; Morante, Tomás Lucas; Fernández, Concepción Páramo; Sousa, César Varela da; Artero, Carles Villabona

doi:10.1016/s1575-0922(08)70633-8

Cited by 4 publications

(5 citation statements)

References 80 publications

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“…11-beta hydroxysteroid dehydrogenase placental enzyme (HSD-11β) partially protects the foetus by interacting with cortisol; however, studies show that chronic stress can alter the maternal-foetal HPA axis [16,17], meaning that active cortisol could be able to reach the foetal circulation [25]. This, in turn, stimulates the release of CRH from the placenta.…”

Section: Hypothalamic-pituitary-adrenal Axis In Pregnancy and Stressmentioning

confidence: 99%

“…For plasma cortisol testing, it is recommended that plasma cortisol be drawn between 8 and 9 o'clock in order to reduce the variability caused by these circadian changes [13]. There are no established normative daily cortisol values during pregnancy [16], but a normal range is considered to be between 5 and 25 µg/dL until the beginning of the second trimester [17] and 2-3 times higher in the third trimester [18].…”

Section: Introductionmentioning

confidence: 99%

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Prenatal Stress as a Risk Factor for Maternal–Foetal Morbidity: A Longitudinal Study

Palomo-Gómez,

Rúger-Navarrete,

Antúnez-Calvente

et al. 2024

Healthcare

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Pregnancy is one of the most complex periods in a woman’s life, not only because of the biological changes involved but also because of the psychological aspects. Stress during pregnancy refers to the concerns and distress that arise during pregnancy and that can be assessed by means of psychological and physiological scales. The aim of this study was to analyse prenatal stress and to evaluate its consequences on the health of both the mother and the foetus. A descriptive longitudinal study was carried out on a sample of 398 pregnant women being followed up during their entire pregnancy, who gave birth at the Punta de Europa University Hospital in Algeciras (Spain) between September 2021 and August 2023. The Prenatal Distress Questionnaire (PDQ) was used, as well as serum cortisol levels in each trimester of pregnancy and birth experience using the Childbirth Experience Questionnaire in its validated Spanish version, CEQ-E. Demographic and obstetric variables were included. One of the main findings was that experiencing more stress in late pregnancy had a negative impact on obstetric outcomes. Women who had higher levels of prenatal distress had higher blood cortisol levels and increased risk of having a caesarean section at delivery. A significant negative correlation was also found between stress and Apgar test values in the first minute of life. It is concluded that interventions promoted by the health system that provide comprehensive prenatal care contribute to decreased stress as perceived by these pregnant women, thus reducing the risk of maternal and foetal morbidity.

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Section: Hypothalamic-pituitary-adrenal Axis In Pregnancy and Stressmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prenatal Stress as a Risk Factor for Maternal–Foetal Morbidity: A Longitudinal Study

Palomo-Gómez,

Rúger-Navarrete,

Antúnez-Calvente

et al. 2024

Healthcare

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“…Therefore, SDT is not recommended either in patients with partial ACTH deficiency or when the time of start of the deficiency is unknown. 13 , 14 (●●○)…”

Section: Figurementioning

confidence: 99%

“…80% of total cortisol is bound to CBG and variation in CBG significantly affects total cortisol levels, which should be interpreted with caution. 13 (●●○)…”

Section: Figurementioning

confidence: 99%

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The Icet-a Survey on Current Criteria Used by Clinicians for the Assessment of Central Adrenal Insufficiency in Thalassemia: Analysis of Results and Recommendations

Sanctis¹

2016

Mediterr J Hematol Infect Dis

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BackgroundIn March 2015, the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescent Medicine (ICET-A) implemented a two-step survey on central adrenal insufficiency (CAI) assessment in TM patients and after analysis of the collected data, recommendations for the assessment of hypothalamic-pituitary- adrenal (HPA) axis in clinical practice were defined.MethodsTo ascertain the current practice for assessment of CAI in thalassemia, the Coordinator of ICET-A sent two questionnaires by email: i) The first to evaluate the current interpretation of basal serum cortisol level (first step) and ii) The second to assess the current usage of ACTH test and the variability in practice” (second step). Based on the surveys the core ICET-A group prepared the recommendations for the assessment of suspected CAI in thalassemia (third step).ResultsA total of 19 thalassemologists/endocrinologists have participated in the first survey and 35 specialists participated in the second step questionnaire. The study demonstrated a considerable variability in almost all aspects of relevant current criteria used for the diagnosis of CAI. An ROC analysis using peak value > 20 μg/dl (> 550 nmol/L), after ACTH stimulation test, was performed with the aim of identifying the optimal basal serum cortisol cut-off. The optimal threshold that maximizes sensitivity plus specificity for morning basal cortisol against peak post-ACTH value >20 μg/dl (>550 nmol/L) was 10 μg/dl (275 nmol/L). Furthermore, the values associated with the highest negative predictive value (NPV) and highest, positive predictive value (PPV) were 4.20 (115 nmol/L) and 18.45 μg/dl (510 nmol/L), respectively.Surprisingly, 20 specialists in thalassemia working in blood bank, thalassemia centres (day hospital), internal medicine, hematology and onco-hematology had poor knowledge and experience in testing for CAI and stopped filling the questionnaire after the second question. In contrast, 9 endocrinologists (8 pediatricians) and 6 hematologists working in collaboration with endocrinologists completed the questionnaire.ConclusionsWhile waiting for more extensive adequately powered and targeted studies, physicians should adopt an acceptable policy for accurate assessment of HPA in TM patients. Regular surveillance, early diagnosis, treatment and follow-up in a multi-disciplinary specialized setting are also recommended. The ICET-A recommendations are reported in order to facilitate for interested physicians the approach to a successful assessment of adrenal function in thalassemia.

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Multiple, Successful Pregnancies in Pompe Disease

et al. 2015

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Pompe disease is an autosomal recessive lysosomal storage disease characterized in adult patients by slowly progressive limb-girdle muscle weakness and respiratory insufficiency. Data on pregnancy in women with Pompe disease, intrauterine development of the fetus and parturition are rare. Here we describe a twin pregnancy followed by a second pregnancy in a 38-year-old female patient with Pompe disease. We report the impact of pregnancy on muscle and respiratory functions as well as the neurological and endocrine systems and discuss the medical consequences for anaesthetic management at parturition.

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Guía clínica de las modificaciones hipotalamohipofisarias en el embarazo y en el período posparto

Cited by 4 publications

References 80 publications

Prenatal Stress as a Risk Factor for Maternal–Foetal Morbidity: A Longitudinal Study

Prenatal Stress as a Risk Factor for Maternal–Foetal Morbidity: A Longitudinal Study

The Icet-a Survey on Current Criteria Used by Clinicians for the Assessment of Central Adrenal Insufficiency in Thalassemia: Analysis of Results and Recommendations

Multiple, Successful Pregnancies in Pompe Disease

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