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Early Initiation of Low-Dose Aspirin in Pregnancy: Clarifying Safety Analyses from the ASPIRIN Trial
(Elsevier BV, 2026)
Rodriguez-Sibaja, Maria J.
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Lumbreras-Márquez, Mario Isaac
No abstract available.
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Mindful meditation for epidural catheter placement during labor: a single-center randomized controlled trial
(Oxford University Press (OUP), 2025-06-16)
Lumbreras-Márquez, Mario Isaac
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Lazaridou, Asimina
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Villela-Franyutti, Diego
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Fields, Kara G.
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Farber, Michaela K.
Importance: Labor epidural placement can cause significant procedural anxiety for patients. Behavioral interventions, such as mindful meditation, can effectively reduce anxiety, including during pregnancy. Objective: This study aimed to assess the impact of a 10-minute mindful meditation session on anxiety and pain during labor epidural placement. Design, Setting, Participants, Intervention, and Outcome Measures: Pregnant women were recruited and randomized into 2 groups: A 10-minute guided mindful meditation, or a neutral content recording, both delivered via headphones before the epidural procedure as a recording. After the procedure, participants reported their levels of anxiety, pain, and satisfaction. Linear regression analyses were used to evaluate the main effects of the intervention on anxiety, pain, and satisfaction. Additionally, an exploratory post hoc moderation analysis assessed the role of baseline pain catastrophizing and its interaction with the intervention. Results: A total of 100 participants were included (50 per group). There were no overall main effect of mindful meditation on primary outcomes of anxiety and pain, or secondary outcome of procedural satisfaction, compared to the neutral content recording (P’s > .05). Exploratory post hoc analysis indicated a moderation of treatment effect, such that participants with higher baseline pain catastrophizing experienced greater benefits from mindful meditation compared to neutral content on anxiety (b = −0.18, P = .01) and pain (b = −0.14, P = .03). Conclusions and Relevance: While no overall group-level effects of mindful meditation were found, exploratory analysis suggested that the intervention may be more beneficial for participants with high baseline pain catastrophizing. Future studies enrolling a larger sample, or enriching for patients with these characteristics are needed to confirm these results. ©The authors ©Oxford University Press.
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Entidades de la gestación imitadoras de preeclampsia: revisión narrativa
(Sociedad de Obstetricia y Ginecología de Venezuela, 2025)
Santiago-Sanabria, Leopoldo
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Gal Or , Ory
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Sanabria-Villegas, Luz del Carmen
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Paz-Carranza, Julio César
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Hernández-Angulo, Gerlin Eduardo
Los desórdenes hipertensivos del embarazo continúan siendo un problema de salud pública a nivel global, causando secuelas a largo plazo, tanto en la madre como en el recién nacido. Sin embargo, existe un grupo de entidades que pueden imitar preeclampsia, eclampsia y síndrome HELLP (hemólisis, enzimas hepáticas elevadas, trombocitopenia), dado que comparten similitudes en su fisiopatología, como la presencia de vasoespasmo, activación o destrucción plaquetaria, trombosis microvascular, disfunción endotelial o perfusión tisular disminuida. La mayoría de estas son consideradas potencialmente emergencias obstétricas que pueden desarrollarse o exacerbarse durante la gestación o en el periodo posparto. El objetivo de la presente revisión es describir estos desórdenes, haciendo énfasis en las características clínicas que permitan realizar un adecuado diagnóstico diferencial con la preeclampsia, síndrome HELLP y eclampsia, ya que es imprescindible para brindar un tratamiento oportuno y dirigido del cual se obtenga un impacto positivo para la madre y el recién nacido. ©Los autores © Revista de Obstetricia y Ginecología de Venezuela © Sociedad de Obstetricia y Ginecología de Venezuela. Hypertensive disorders of pregnancy continue to be a global public health problem, causing long-term consequences for both mother and newborn. However, there are a group of conditions that can mimic preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, thrombocytopenia) syndrome, given that they share similarities in their pathophysiology, such as vasospasm, platelet activation or destruction, microvascular thrombosis, endothelial dysfunction, or decreased tissue perfusion. Most of these are considered potential obstetric emergencies that can develop or exacerbate during pregnancy or in the postpartum period. The objective of this review is to describe these disorders, emphasizing the clinical characteristics that allow for an adequate differential diagnosis with preeclampsia, HELLP syndrome, and eclampsia, as this is essential for providing timely and targeted treatment that has a positive impact on the mother and newborn. ©The authors © Revista de Obstetricia y Ginecología de Venezuela © Sociedad de Obstetricia y Ginecología de Venezuela.
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Prediction of preeclampsia before 11th week of gestation: a secondary analysis of the ASPIRIN trial
(Elsevier BV, 2025)
Capdeville, Gabriela
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Godinez-Medina, Andrea
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Copado-Mendoza, Diana Y.
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Acevedo-Gallegos, Sandra
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Rodriguez-Bosch, Mario R.
Background: Early screening for preeclampsia is crucial for preventing adverse maternal and fetal events. Current first-trimester algorithms for predicting preeclampsia are designed to evaluate individual risk between 11.0 and 13.6 weeks of gestation based on various maternal characteristics while integrating biophysical and biochemical features. However, there is limited information regarding risk assessment during earlier stages of pregnancy (i.e., <11.0 weeks gestation). Objective: To develop a prediction model for preeclampsia/eclampsia before 11.0 weeks of gestation as a proof-of-concept in a secondary analysis of the ASPIRIN trial. Study design: This study is a secondary analysis of the ASPIRIN trial, a multinational, randomized, double-blind, placebo-controlled trial. The ASPIRIN trial database, obtained from NICHD DASH, included 11,976 nulliparous pregnant women aged 18–40 with gestational ages of 6.0–13.6 weeks at randomization. Participants were assigned to receive either aspirin (81 mg/day) or placebo until 36.0 weeks or delivery. This secondary analysis included pregnancies delivered at ≥20.0 weeks, excluding those in the aspirin group or with gestational ages ≥11.0 weeks at enrollment. The composite outcome was preeclampsia/eclampsia, as reported in the ASPIRIN trial. Predictor variables available in the dataset included maternal age, education (4 levels), body mass index (BMI kg/m2), gravidity, baseline hemoglobin, baseline systolic blood pressure, and baseline diastolic blood pressure. Logistic regression, with logarithmic transformation for continuous variables, was used to develop the model. The area under the ROC curve with a 95% confidence interval (CI) estimated via bootstrap resampling (1,000 iterations) and the P-value of the Hosmer-Lemeshow statistical test are reported as discrimination and calibration measures. This study used the entire available sample using a complete case approach. Results: A total of 3421 participants met the inclusion criteria, with a cumulative incidence of preeclampsia/eclampsia of 2.9% (99/3,421). Maternal age (21.96 ± 4.13 vs 20.86 ± 3.21, P<.001) and BMI (22.49 ± 4.77 vs 20.79 ± 3.55, P<.001) were significantly higher in the preeclampsia/eclampsia group. Gravidity was lower (P=.023), and hemoglobin levels were slightly elevated (11.88 ± 1.52 g/dL vs 11.50 ± 1.61 g/dL, P=.019) in the preeclampsia/eclampsia group. Educational level (P=.070), systolic blood pressure (P=.720), and diastolic blood pressure (P=.390) showed no significant differences between groups. The logistic regression model yielded an AUC of 0.69 (95% CI 0.63–0.74), and the Hosmer-Lemeshow test P-value was 0.094, indicating acceptable discrimination and calibration. Conclusions: This proof-of-concept logistic regression model using first-trimester maternal characteristics demonstrated acceptable predictive performance for preeclampsia/eclampsia before 11.0 weeks of gestation. During this critical period, several interventions could be proposed to reduce preeclampsia risk, including medication adjustments, lifestyle changes, and appropriate referral if needed. Further studies are required to validate these findings and assess their clinical utility in different settings. © The authors © Elsevier.
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The Emotional Experience of Mexican Women with SARS-CoV-2 during Pregnancy―A Qualitative Study
(MDPI, 2023)
Gómez-López, María Eugenia
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Aldrete Cortez, Vania Rocío
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González-Carpinteiro, Aline
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Mendizábal-Espinosa, Rosa
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Bobadilla, Liliana
Pregnant women have been considered a high-risk group for SARS-CoV-2 infection; the impact of the disease on the health of a mother and her child is still being studied. The emotional impact of the pandemic on pregnant women has been extensively studied. Emotional distress is proposed as a perspective to explain the emotional manifestations in women during this stage as something common rather than pathological. The objective of this study was to explore the emotional experience of women who tested positive for SARS-CoV-2 towards the end of their pregnancy, during the first and second waves of COVID-19 in Mexico. A qualitative study was carried out: 18 pregnant women with COVID-19 were interviewed. A thematic analysis of the data was performed, resulting in 3 main themes and 14 subthemes. The COVID-19-infected mothers-to-be experienced mild to moderate emotional distress. It was more intense for those with comorbidities. This distress was aggravated during obstetrical complications and comorbidities, as well as during COVID-19 and postpartum. The emotional distress was appeased by both the perception of medical care and social support. The emotional distress of pregnant women with COVID-19 requires emotional support to reduce its impact.
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Nephrology in Mexico
(2021)
García-García, Guillermo
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Chávez-Iñiguez, Jonathan Samuel
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Vázquez-Rangel, Armando
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Cervantes-Sánchez, Cynthia Gabriela
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Paniagua, Ramón
Nephrology in Mexico started in 1955 with the opening of the nephrology department at Mexico’s National Heart Institute, where the first nephrology training program began in 1958. Pediatric nephrology care was first offered at Mexico’s Federico Gomez Children’s Hospital in 1953, among the first pediatric nephrology programs in the world. Kidney transplantation began in 1963 at the IMSS General Hospital. The Sociedad Mexicana de Nefrologia, the first Mexican nephrology society, was established in 1967, followed by the publication of Nefrologia Mexicana, its official journal, in 1980. Chronic kidney disease has emerged as a public health problem in Mexico. However, the fragmentation of the health system has resulted in unequal access to renal replacement therapy. Seguro Popular, a public health-care insurance for the poor, does not cover renal replacement therapy. As a consequence, many uninsured patients refuse dialysis, eventually abandon their treatment, or lose their kidney grafts because sustaining dialysis or immunosuppression becomes unaffordable. The lack of a national dialysis registry results in a vacuum of information on the burden of treated end-stage renal disease and its outcomes. In addition to the high burden of traditional risk factors (i.e., diabetes mellitus), a number of “hotspots” of chronic kidney disease of unknown origin have been recently described in the country. Despite the increased burden of chronic kidney disease, strategies to prevent chronic kidney disease have not been part of the nation’s noncommunicable disease health policies. Chronic kidney disease screening is not part of the National Health Surveys. Peritoneal dialysis continues to be the dialysis modality of choice, although a significant shift to hemodialysis has been observed over the last two decades. The number of nephrologists (9.1 per million population) is insufficient to match the demand imposed by the burden of chronic kidney disease. In conclusion, after 65 years of the beginning of nephrology in Mexico, kidney disease care remains unjust, unequal, and below the quality of international standards. The current infrastructure and resources are insufficient to satisfy the demand of renal care in our society. Therefore, it is important to consider it as a public health priority and to implement a comprehensive program for the prevention and control of this illness. The establishment of a national public policy for the prevention and treatment of chronic kidney disease is urgently needed. © Springer Nature
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