Preeclampsia is a complication of pregnancy characterized by inadequate placentation,resultant ischemia and failure of several maternal organs. Preeclampsia is one of the mostserious conditions in pregnancy and a leading cause of maternal and perinatal morbidity andmortality. Various risk factors and some protective factors have been reported associated topreeclampsia. Finally, women who develop preeclampsia during pregnancy are at higher riskof future diabetes mellitus, hypertension and cardiovascular complications. In this article anupdate on the epidemiology of preeclampsia is presented.Keywords: Preeclampsia, prevalence, risk factors, protective factors, complications, maternalmortality, perinatal mortality.

Background: Physiological changes during pregnancy are often accompanied by reduced sleep quality, sleep disruptions, and insomnia. Studies conducted among men and non-pregnant women have documented psychiatric disorders as common comorbidities of insomnia and other sleep disorders. However, no previous study has examined the association between stress-related sleep disturbances and psychiatric disorders among pregnant women. Methods: This cross-sectional study included a total of 2051 pregnant women in Peru. The Spanish-language version of the Ford Insomnia Response to Stress Test (FIRST-S) was used to assess sleep disruptions due to stressful situations. Symptoms of antepartum depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD) were examined using the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7 and PTSD Checklist – Civilian Vers...

Objectives To examine the associations of Intimate partner violence (IPV) with stress-related sleep disturbance (measured using the Ford Insomnia Response to Stress Test [FIRST]) and poor sleep quality (measured using the Pittsburgh Sleep Quality Index [PSQI]) during early pregnancy. Methods This cross-sectional study included 634 pregnant Peruvian women. In-person interviews were conducted in early pregnancy to collect information regarding IPV history, and sleep traits. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CIs) were calculated using logistic regression procedures. Results Lifetime IPV was associated with a 1.54-fold increased odds of stress-related sleep disturbance (95% CI: 1.08–2.17) and a 1.93-fold increased odds of poor sleep quality (95% CI: 1.33–2.81). Compared with women experiencing no IPV during lifetime, the aOR (95% CI) for stress-related sleep dis...

Background Preterm birth is a leading cause of perinatal morbidity and mortality worldwide, resulting in a pressing need to identify risk factors leading to effective interventions. Limited evidence suggests potential relationships between maternal sleep or vital exhaustion and preterm birth, yet the literature is generally inconclusive. Methods We examined the relationship between maternal sleep duration and vital exhaustion in the first six months of pregnancy and spontaneous (non-medically indicated) preterm birth among 479 Peruvian women who delivered a preterm singleton infant (<37 weeks gestation) and 480 term controls who delivered a singleton infant at term (≥37 weeks gestation). Maternal nightly sleep and reports of vital exhaustion were ascertained through in-person interviews. Spontaneous preterm birth cases were further categorized as those following either spontaneous pret...

Preeclampsia is a complication of pregnancy characterized by inadequate placentation,resultant ischemia and failure of several maternal organs. Preeclampsia is one of the mostserious conditions in pregnancy and a leading cause of maternal and perinatal morbidity andmortality. Various risk factors and some protective factors have been reported associated topreeclampsia. Finally, women who develop preeclampsia during pregnancy are at higher riskof future diabetes mellitus, hypertension and cardiovascular complications. In this article anupdate on the epidemiology of preeclampsia is presented.Keywords: Preeclampsia, prevalence, risk factors, protective factors, complications, maternalmortality, perinatal mortality.

Background Migraine, a common chronic-intermittent disorder of idiopathic origin characterized by severe debilitating headaches and autonomic nervous system dysfunction, and placental abruption, the premature separation of the placenta, share many common pathophysiological characteristics. Moreover, endothelial dysfunction, platelet activation, hypercoagulation, and inflammation are common to both disorders. We assessed risk of placental abruption in relation to maternal history of migraine before and during pregnancy in Peruvian women. Methods Cases were 375 women with pregnancies complicated by placental abruption, and controls were 368 women without an abruption. During in-person interviews conducted following delivery, women were asked if they had physician-diagnosed migraine, and they were asked questions that allowed headaches and migraine to be classified according to criteria est...

Intimate partner violence (IPV) is increasingly recognized as an important cause of maternal and perinatal morbidity. We assessed the relation between IPV and risk of spontaneous preterm birth (PTB) among Peruvian women. The study was conducted among 479 pregnant women who delivered a preterm singleton infant (<37 weeks gestation) and 480 controls (≥37 weeks gestation). Participants’ exposure to physical and emotional violence during pregnancy was collected during in-person interviews conducted after delivery and while patients were in hospital. Odds ratios (aOR) and 95 % confidence intervals (CI) were estimated from logistic regression models. The prevalence of any IPV during pregnancy was 52.2 % among cases and 34.6 % among controls. Compared with those reporting no exposure to IPV during pregnancy, women reporting any exposure had a 2.1-fold increased risk of PTB (95 % CI 1.59–2...

El Institute 2009 de Medicina (IOM) recomendaciones de peso gestacional se adaptan a índice de masa corporal previo al embarazo de las mujeres (IMC). Las pruebas limitadas existe en métodos para la estimación pre-embarazo índice de masa corporal de las mujeres, especialmente para las mujeres que viven en países de bajos y medianos ingresos. Utilizando los datos de recogida entre las mujeres embarazadas peruanas, se comparó la concordancia entre la percepción subjetiva de IMC antes del embarazo con el IMC medido en la visita de estudio prenatal temprana.Los datos fueron de la Embarazo resultados maternos y neonatales Estudio (Promis), una cohorte de mujeres embarazadas en el Instituto Nacional Materno Perinatal (INMP) en Lima, Perú. 2605 mujeres de 18 a 49 años (media ± desviación estándar de edad gestacional = 10,9 ± 3,3 semanas) fueron incluidos en el estudio. Auto-reporte ...

STUDY OBJECTIVES: We sought to evaluate the construct validity and factor structure of the Spanish-language version of the Pittsburgh Sleep Quality Index (PSQI) among pregnant Peruvian women. METHODS: A cohort of 642 women were interviewed at ≤ 16 weeks of gestation. During interview, we ascertained information about lifestyles, demographics, sleep characteristics, and mood symptoms. Stress induced sleep disturbance, depressive symptoms, and anxiety symptoms were evaluated using the Ford Insomnia Response to Stress Test (FIRST), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) assessment scales, respectively. Consistency indices, exploratory and confirmatory factor analyses, correlations, and logistic regressions were used. RESULTS: Both exploratory and confirmatory factor analyses indicated a three-factor solution: sleep quality, sleep efficiency, and...

This small-scale pilot study studied the potential benefit of taking a concentrated dose of anthocyanin 300 mg once a day for 3 weeks (purple corn extract) on blood pressure among untreated Peruvian adults with mild-to-moderate hypertension. A double-blind placebo-controlled randomized crossover trial using intention-to-treat analysis was conducted on 30 healthy men and women who received care at the Dos de Mayo Hospital (Lima, Peru) between September 2010 and August 2011. The 4-phase study compared blood pressure readings on placebo and on purple corn extract. Blood pressure readings decreased from baseline levels to end of study, especially after taking a purple corn extract capsule for 3 weeks, regardless of age, gender, body mass index level, or initial average blood pressure reading. Individuals who had higher blood pressure readings at baseline showed the most marked reduction in s...

Purpose Preterm birth (PTB) is a major cause of neonatal mortality. The vaginal microbiome is associated with PTB, but results vary across racial/ethnic populations. Some evidence suggests gestational age affects this association. We investigated these associations in a novel population, conducting a post hoc analysis assessing if associations differed between women swabbed at different gestational ages. Methods We compared vaginal microbiomes from women with PTB (n = 25) to a random sample of women with term births (n = 100) among participants in the Pregnancy Outcomes, Maternal and Infant Study, conducted in Lima, Peru. Using DADA2, we identified taxa from 16S DNA sequencing and used Dirichlet multinomial mixture models to group into community state types (CSTs). Results If gestational age at sampling was not considered, no CST (diverse, Lactobacillus-dominated or Lactobacillus inersâ€...

Purpose Experiencing childhood abuse (CA) or intimate partner violence (IPV) has been linked to adverse pregnancy outcomes. We examined whether CA history and current IPV are independently and jointly associated with placental abruption (PA). Methods We recruited 662 PA cases and 665 controls in Lima, Peru. We used multivariate logistic regression to calculate odds ratios (OR), adjusting for age, education, and parity. Results Approximately 42% of cases and controls reported CA; 50% of cases and 49% of controls reported IPV. History of any CA was not associated with PA, but history of severe CA was associated with 38% increased odds of PA (adjusted OR [aOR], 1.38; 95% confidence interval (CI), 1.07–1.80), adjusting for IPV. There was a statistically nonsignificant association between severe IPV and odds of PA (aOR, 1.22; 95% CI, 0.92–1.62), adjusting for CA. Women who experienced sev...

Background: : Few investigators have evaluated the association between early pregnancy social support and depression; however, increased social support may improve mental health during pregnancy. Our objective is to examine whether in early pregnancy there is an association between social support and maternal depression among women in Peru. Methods: : 2,062 pregnant women participated in structured interviews. Early pregnancy social support was measured using the Social Support Questionnaire (SSQ-6). We evaluated the number of individuals that participants could turn to in different situations (Social Support Number Score; SSQN) and their satisfaction with support received (Social Support Satisfaction Score; SSQS). Median SSQN and SSQS characterized participants according to high and low levels of support. SSQN family vs. non-family support were also evaluated separately. Antepartum depr...

We sought to evaluate the psychometric properties of two resilience scales; the Resilience Inventory (IRES) and the 14-item Resilience Scale (RS-14) among Peruvian postpartum adolescent mothers. This cross-sectional study included 785 adolescent mothers who delivered at a maternity hospital in Lima, Peru. The Spanish versions of IRES and RS-14 were used to evaluate the properties of the measures. We examined reliability using Cronbach’s alpha. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the construct validity and factor structures of the two scales. Both scales had good internal consistency (Cronbach’s alpha > 0.7). Correlation between IRES and RS-14 scores was fair (r = 0.53). The EFA results of both scales yielded a three-factor structure. EFA including all items from IRES and RS-14 yielded a six-factor structure. CFA results corrobora...

Background Mitochondrial biogenesis and adequate energy production are important for embryogenesis and placentation. Previous studies documented alterations in maternal blood mitochondrial DNA (mtDNA) copy number—a marker of mitochondrial dysfunction—in pregnancies complicated by placental abruption. To further understand the role of mitochondrial dysfunction in the pathogenesis of placental abruption, we conducted a pilot study using placental specimen collected from 103 placental abruption cases and 102 non-abruption controls. Real-time quantitative polymerase chain reaction (PCR) was used to assess the relative copy number of mtDNA in DNA extracted from placental samples collected immediately after delivery. Logistic regression procedures were used to estimate adjusted odds ratios (OR) and 95 % confidence intervals (CI). Results Higher odds of placental abruption was observed with...

Objective We sought to evaluate the validity of the Spanish language version of the patient health questionnaire-9 (PHQ-9) depression scale in a large sample of pregnant Peruvian women using Rasch item response theory (IRT) approaches. We further sought to examine the appropriateness of the response formats, reliability and potential differential item functioning (DIF) by maternal age, educational attainment and employment status. Methods This cross-sectional study was conducted among 1520 pregnant women in Lima, Peru. A structured interview was used to collect information on demographic characteristics and PHQ-9 items. Data from the PHQ-9 were fitted to the Rasch IRT model and tested for appropriate category ordering, the assumptions of unidimensionality and local independence, item fit, reliability and presence of DIF. Results The Spanish language version of PHQ-9 demonstrated unidimen...

OBJECTIVE: To examine the association between the levels of Papanicolaou (Pap) test and cervical cancer knowledge with fear, stress, or shame related to these. DESIGN: A simple random sample of all households within the community was conducted. MATERIAL AND METHODS: A survery was administered to women in a low socioeconomic community of Lima, Peru. Chisquare analysis, odds ratios and 95% confidence intervals were used to measure association of the variables studied with fear, stress, or shame. Logistic regression was used to control for confounding variables. RESULTS: From 300 women interviewed ages between 18 and 50, 20% had their last Pap test over two years and another 20% had never had a Pap smear. Nineteen percent (57) of women reported a high level of lear, stress or shame to the Pap test and cervical cancer, all associated to adolescence (OR 5,5 CI95% 1,8 16,9), living in Lima 5 y...

Objective We examined the ability of anthropometric measures to predict the risk of metabolic syndrome (MetS) and its components in Peruvian adults. Methods Participants were 1,815 Peruvian adults. Body mass index (BMI), waist circumference (WC), A Body Shape Index (ABSI), Body Roundness Index (BRI) and Visceral Adiposity Index were examined. MetS components were defined using the National Cholesterol Education Program’s Adult Treatment Panel III. Logistic regression was used to calculate odds ratios of MetS and MetS components in relation to increases in anthropometric measures. Receiver operating characteristic curves (and area under the curve) were calculated to compare each measure’s power to predict MetS and MetS components. Results BRI performed similar to or better than BMI and WC at predicting MetS and MetS components. ABSI underperformed other measures. In men, the odds of M...

OBJECTIVE: To examine the association between the levels of Papanicolaou (Pap) test and cervical cancer knowledge with fear, stress, or shame related to these. DESIGN: A simple random sample of all households within the community was conducted. MATERIAL AND METHODS: A survery was administered to women in a low socioeconomic community of Lima, Peru. Chisquare analysis, odds ratios and 95% confidence intervals were used to measure association of the variables studied with fear, stress, or shame. Logistic regression was used to control for confounding variables. RESULTS: From 300 women interviewed ages between 18 and 50, 20% had their last Pap test over two years and another 20% had never had a Pap smear. Nineteen percent (57) of women reported a high level of lear, stress or shame to the Pap test and cervical cancer, all associated to adolescence (OR 5,5 CI95% 1,8 16,9), living in Lima 5 y...

Oxidative stress and impaired placental function – pathways implicated in the pathogenesis of placental abruption – have their origins extending to mitochondrial dysfunction. To the best of our knowledge, there are no published reports of associations of placental abruption with circulating mitochondrial DNA (mtDNA) copy number – a novel biomarker of systemic mitochondrial dysfunction. This pilot case-control study was comprised of 233 placental abruption cases and 238 non-abruption controls. Real-time quantitative polymerase chain reaction (PCR) was used to assess the relative copy number of mtDNA in maternal whole blood samples collected at delivery. Logistic regression procedures were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). There was some evidence of an increased odds of placental abruption with the highest quartile of mtDNA copy number (P f...