Lumbreras-Márquez, Mario Isaac

Main Affiliation

Preferred name

Official Name

Lumbreras Márquez, Mario Isaac

ORCID

0000-0002-5378-5724

Researcher ID

AAZ-5337-2021

Scopus Author ID

55938270900

Now showing 1 - 10 of 17

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Prediction of preeclampsia before 11th week of gestation: a secondary analysis of the ASPIRIN trial
(Elsevier BV, 2025-08)
Gabriela Capdeville
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Andrea Godinez-Medina
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Diana Y. Copado-Mendoza
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Sandra Acevedo-Gallegos
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Mario R. Rodriguez-Bosch
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Maternal, fetal, and neonatal serious adverse events associated with low-dose aspirin during the first trimester of pregnancy: A secondary analysis of the Aspirin Supplmentation for Pregnancy Indicated Risk Reduction In Nulliparas (ASPIRIN) trial
(Elsevier BV, 2025)
Rodriguez-Sibaja, Maria J.
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Gálvez Rubalcava, Natalia
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Hagerman-Sucar, Gonzalo
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Alcocer González-Camarena, Paulina
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Gómez Woodworth, Juan Ramón
Background: Low-dose aspirin (LDA) has been shown to reduce the risk of preterm preeclampsia, particularly when initiated early in pregnancy. However, the safety of starting LDA before 11 0/7 weeks of gestation remains unclear. Objective: To assess whether initiating LDA before 11 0/7 weeks of gestation is associated with increased maternal, fetal, or neonatal serious adverse events compared to later initiation. Study Design: This secondary analysis of the ASPIRIN (Aspirin Supplmentation for Pregnancy Indicated Risk Reduction In Nulliparas) trial included 11,879 nulliparous women with singleton pregnancies randomized to receive LDA (81 mg/d) or placebo between 6 0/7–13 6/7 weeks of gestation. Severe adverse events (ie, maternal death, antepartum hemorrhage, postpartum hemorrhage, anemia, preeclampsia or eclampsia, preterm labor, hypertension admission, fever or infection, fetal loss, neonatal death up to 28 days, miscarriage, abortion, or medical termination of pregnancy, and congenital anomalies) were analyzed based on gestational age at LDA initiation (<11 0/7 vs ≥11 0/7 weeks). Furthermore, congenital anomalies were assessed for therapy initiated during the embryonic (ie, <9 0/7 weeks) or fetal period. Interaction tests were performed via logistic regression models on the ASPIRIN trial safety population (ie, participants who received at least one dose of LDA or placebo) and on the subset of participants who had an adherence to the exposure of ≥90%. Results: Among the 11,879 eligible participants for this secondary analysis, 62% (n=7324) initiated the allocated exposure before 11 0/7 weeks vs 38% (n=4555) that initiated LDA or placebo at a later gestational age. Furthermore, in this population, 84.4% (n=10,030) had an adherence to the intervention of 90% or more. Moreover, the proportion of adherence of ≥90% to LDA or placebo was similar between strata (84.6% [n=6195] for <11 0/7 vs 84.2% [n=3835] ≥11 0/7 weeks, P=.570). No significant differences were observed in the maternal, fetal, or neonatal adverse events described above based on the timing of LDA initiation (P>.05 for all interactions). Likewise, congenital anomalies did not significantly differ between embryonic and fetal exposure periods (interaction P-value = .095). Results remained consistent in participants who had an adherence to the exposure of ≥90%. Conclusions: LDA (81 mg/d) initiated before 11 0/7 weeks of gestation may not increase the risk of maternal, fetal, or neonatal serious adverse events or congenital anomalies. These findings provide reassuring evidence of the safety of LDA exposure during early pregnancy. ©The authors ©American Journal of Obstetrics & Gynecology MFM © Elsevier BV.
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Reply: Enhancing diagnostic approaches for placental dysfunction in fetal growth restriction
(Elsevier BV, 2025)
Rodriguez-Sibaja, Maria J.
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Lopez-Diaz, Jimena
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We appreciate Dr Carbillon's insightful commentary on our study comparing the performance of the International Society of Ultrasound in Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine definitions of fetal growth restriction (FGR) in identifying maternal vascular malperfusion (MVM) lesions and adverse neonatal outcomes.1 His insights into the role of Doppler studies and angiogenic biomarkers in placental dysfunction diagnostics highlight important considerations for advancing FGR assessment. However, our study focused on the histopathological confirmation of MVM lesions associated with the FGR definitions mentioned above. We agree with Dr Carbillon that integrating uterine artery Doppler and angiogenic biomarkers, such as placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1–to–PlGF ratio, into the diagnostic framework for FGR could enhance the diagnostic precision of FGR and placental dysfunction, as supported by recent research and international guidelines. ©The authors ©American Journal of Obstetrics & Gynecology MFM ©Elsevier.
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Fetal cardiac rhabdomyomas susceptible to prenatal treatment with mTOR inhibitors: literature review and proposal of a prenatal management algorithm
(Frontiers Media SA, 2025-12-08)
Alfonso Martinez-Garcia
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Omar A. Tirado-Aguilar
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Sandra Acevedo-Gallegos
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Juan M. Gallardo-Gaona
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Berenice Velazquez-Torres
<jats:p>Certain types of fetal cardiac rhabdomyomas can lead to severe complications, including intrauterine death, yet no specific criteria have been established for the prenatal use of pharmacological therapies to mitigate the impact of rhabdomyomas. We conducted a narrative review of case reports and case series published between January 1, 2000, and February 28, 2025, identified through PubMed, Scopus, Web of Science, and Google Scholar, describing the prenatal use of mammalian target of rapamycin inhibitors in this context. Thirteen studies reporting on 15 fetuses were included. Five fetuses (33.3%) had a single rhabdomyoma, and 10 (66.6%) had multiple lesions. Prenatal genetic testing for Tuberous Sclerosis Complex was performed in 9 cases (60%): 1 with a TSC1 mutation, 7 with TSC2 mutations, and 1 negative. Sirolimus was the most frequently used inhibitor (86.6%), while everolimus was used in 2 cases (13.3%). The main indication for treatment was progressive tumor growth causing outflow obstruction and/or hemodynamic compromise, including reduced cardiac output, arrhythmias, and fetal hydrops. Therapy was initiated at a median of 30.0 weeks (IQR 26.7–33.1) and completed at 38.0 weeks (IQR 36–39). All reports documented tumor reduction and improved cardiac function, though regrowth occurred in 5 cases (33.3%) after discontinuation. No fetal or neonatal deaths were reported, and none required postnatal cardiac surgery before discharge. Based on these findings, we proposed echocardiographic criteria to identify suitable candidates, including inflow/outflow tract obstruction, severe atrioventricular valve insufficiency, tachyarrhythmia, impaired cardiac function, or hydrops, and developed a structured prenatal management algorithm. Prenatal therapy with mTOR inhibitors, therefore, appears to improve fetal cardiac function by reducing tumor burden and may contribute to better perinatal outcomes, although validation in future studies is required. TSC1: urn:lsid:hgnc.org: HGNC:12362</jats:p> <jats:p>TSC2: urn:lsid:hgnc.org: HGNC:12363 Sirolimus: urn:lsid:ebi.ac.uk:chebi:9168 Everolimus: urn:lsid:ebi.ac.uk:chebi:68478.</jats:p>
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Survival assessment in extremely preterm neonates in a middle-income setting
(Frontiers Media SA, 2025-05-30)
Maria J. Rodriguez-Sibaja
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Olivo Herrera-Ortega
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Deneb Morales-Barquet
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Sandra Acevedo-Gallegos
<jats:sec><jats:title>Introduction</jats:title><jats:p>Globally, an estimated 15.1 million preterm neonates are born annually, with 1% classified as extremely preterm (i.e., &lt;28.0 weeks of gestation). The survival and outcomes of this vulnerable population are influenced by multiple factors, particularly gestational age, birth weight, and available medical resources. This study aimed to describe the hospital discharge survival of extremely preterm infants born in a middle-income setting. As a secondary objective, we assessed the neonatal morbidity associated with this group.</jats:p></jats:sec><jats:sec><jats:title>Material and methods</jats:title><jats:p>In this cross-sectional study of singleton pregnancies<jats:bold>,</jats:bold> neonatal survival following extremely preterm birth was determined using three different denominators and expressed as prevalence (i.e., percentages): (1) the total number of extremely preterm births, including intrapartum fetal deaths; (2) the total number of all live births, including neonatal deaths in the delivery room, and (3) the total number of preterm neonates admitted to the neonatal intensive care unit (<jats:italic>N</jats:italic>ICU). Neonatal morbidity was assessed as a secondary outcome.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There were no live births between 22.0 and 23.6 weeks of gestation. Overall mortality decreased with increasing gestational age, from 100% (22/22) at &lt;24.0 weeks of gestation to 87% (14/16), 42% (16/38), and 21% (11/52) at a gestational age of 25, 26, and 27 weeks, respectively. The survival rate to NICU discharge among extremely preterm infants was 49% (65/132), 67% (65/97), and 69% (65/93), depending on whether survival was calculated based on all births, all live births, or NICU admissions, respectively. None of the neonates born before 24.6 weeks of gestation survived to discharge. Notably, 97.0% of NICU survivors were diagnosed with major morbidity.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The survival rate at NICU discharge exceeds 50% from 26 weeks onwards in a middle-income setting. Importantly, survival rates varied significantly depending on the denominator used, highlighting the need to carefully select inclusion criteria in neonatal survival analyses. Notably, survival after extremely preterm birth was associated with significant morbidity.</jats:p></jats:sec>
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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)
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Asimina Lazaridou
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Diego Villela-Franyutti
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Kara G Fields
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Michaela K Farber
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Importance</jats:title> <jats:p>Labor epidural placement can cause significant procedural anxiety for patients. Behavioral interventions, such as mindful meditation, can effectively reduce anxiety, including during pregnancy.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This study aimed to assess the impact of a 10-minute mindful meditation session on anxiety and pain during labor epidural placement.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, Setting, Participants, Intervention, and Outcome Measures</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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 &gt; .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).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions and Relevance</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Clinical Trial Number and Registry URL</jats:title> <jats:p>ClinicalTrials.gov Identifier: NCT04687085 (https://clinicaltrials.gov/ct2/show/NCT04687085).</jats:p> </jats:sec>
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Fetal and Neonatal Outcomes in Fetuses with an Estimated Fetal Weight Percentile of 10–20 in the Early Third Trimester: A Retrospective Cohort Study
(MDPI AG, 2025)
Mendez-Piña, Miguel A.
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Acevedo-Gallegos, Sandra
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Velázquez-Torres, Berenice
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Rodriguez-Sibaja, Maria J.
first_pagesettingsOrder Article Reprints Open AccessArticle Fetal and Neonatal Outcomes in Fetuses with an Estimated Fetal Weight Percentile of 10–20 in the Early Third Trimester: A Retrospective Cohort Study by Miguel A. Mendez-Piña 1ORCID,Mario I. Lumbreras-Marquez 1,2,Sandra Acevedo-Gallegos 1,Berenice Velazquez-Torres 1ORCID,Maria J. Rodriguez-Sibaja 1,Dulce M. Camarena-Cabrera 1 andJuan M. Gallardo-Gaona 1,*ORCID 1 Maternal-Fetal Medicine Department, Instituto Nacional de Perinatologia, Mexico City 11000, Mexico 2 Department of Epidemiology and Public Health, Universidad Panamericana School of Medicine, Mexico City 03920, Mexico * Author to whom correspondence should be addressed. Diagnostics 2025, 15(17), 2251; https://doi.org/10.3390/diagnostics15172251 Submission received: 12 June 2025 / Revised: 1 August 2025 / Accepted: 1 August 2025 / Published: 5 September 2025 (This article belongs to the Special Issue Diagnosis and Management of Contemporary Issues in Maternal-Fetal Medicine) Downloadkeyboard_arrow_down Browse Figures Review Reports Versions Notes Abstract Background: Fetal size is often dichotomized as normal or abnormal using the 10th percentile of estimated fetal weight (EFW) or abdominal circumference as a cutoff. While the risk of adverse perinatal outcomes decreases with increasing fetal weight percentile, no percentile completely eliminates that risk. Objective: The aim of this study was to compare perinatal outcomes between fetuses with an EFW between the 10th and 20th percentiles and those with an EFW between the 20th and 90th percentiles (i.e., >20 and <90) at the beginning of the accelerated growth stage (28.0–30.0 weeks’ gestation). Methods: We conducted a retrospective cohort study of singleton pregnancies managed at a quaternary center in Mexico City (2017–2024). Outcomes were compared based on EFW percentiles at 28.0–30.0 weeks. The primary outcome was adverse neonatal outcome (ANeO), defined as the presence of at least one of the following: umbilical artery pH ≤ 7.1, 5 min Apgar ≤ 7, NICU admission, early neonatal hypoglycemia, non-reassuring fetal status, respiratory distress syndrome, intraventricular hemorrhage, hypoxic–ischemic encephalopathy, or perinatal death. Secondary outcomes included progression to fetal growth restriction (FGR) and low birth weight. Modified Poisson regression was used to estimate adjusted risk ratios (aRRs) with 95% confidence intervals (CIs). Results: Among 650 cases, ANeO occurred in 45.8% of fetuses in the 10th–20th percentile group vs. 29.4% in the 20th–90th percentile group (aRR: 1.51, 95% CI: 1.22–1.86; p < 0.001). FGR and low birth weight were also more frequent in the 10th–20th percentile group (21.1% and 27.6% vs. 6.4% and 5.8%, respectively; p < 0.001). Conclusions: Fetuses between the 10th and 20th percentiles at 28–30 weeks have increased risks of neonatal morbidity, FGR, and low birth weight. ©The authors ©Diagnostics © MDPI AG.
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Second-Line Uterotonics for Uterine Atony
(Lippincott, Williams & Wilkins, 2024)
Cole, Naida M.
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Kim, Jimin J.
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Fields, Kara G.
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Mendez-Pino, Laura
Objective: To evaluate the comparative efficacy of two of the most commonly used second-line uterotonics—methylergonovine maleate and carboprost tromethamine. Methods: We conducted a double-blind randomized trial at two large academic perinatal centers in patients undergoing nonemergency cesarean delivery with uterine atony refractory to oxytocin, as diagnosed by the operating obstetrician. The intervention included administration of a single dose of intramuscular methylergonovine or carboprost intraoperatively at diagnosis. The primary outcome, uterine tone on a 0–10 numeric rating scale 10 minutes after study drug administration, was rated by operating obstetricians blinded to the drug administered. Secondary outcomes included uterine tone score at 5 minutes, administration of additional uterotonic agents, other interventions for uterine atony or hemorrhage, quantitative blood loss, urine output, postpartum change in serum hematocrit, transfusion, length of hospital stay, adverse drug or transfusion reactions, and postpartum hemorrhage complications. A sample size of 50 participants per group was planned to detect a 1-point difference (with estimated within-group SD of 1.5) in the mean primary outcome with 80% power at a two-sided α level of 0.05 while accounting for potential protocol violations. © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
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Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine
(2023)
Ayumi Maeda
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Diego Villela-Franyutti
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Anarghya Murthy
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Kara G. Fields
The dural puncture epidural (DPE) technique has a faster onset, better sacral spread, and improved bilateral coverage when compared to the conventional epidural (EPL) technique. Whether these qualities translate into a lower bupivacaine dose to provide initial analgesia is unknown. We sought to determine the effective dose of bupivacaine to achieve initial (first 30 minutes) labor analgesia in 90% of patients (ED90) with the DPE and EPL techniques, using a biased-coin, sequential allocation method. A total of 100 women of mixed parity with term, singleton gestation at ≤5 cm dilation with no major comorbidities were randomized to receive a DPE or an EPL technique. An experienced anesthesiologist performed these techniques and administered an allocated dose of plain bupivacaine diluted with isotonic sterile 0.9% saline to a total volume of 20 mL via the EPL catheter. Bupivacaine doses for each subject were determined by the response of the previous subject, using a biased-coin sequential allocation method, with success defined by a numeric rating scale (NRS) < 3 at 30 minutes. Outcome assessments were performed by an investigator blinded to the technique and bupivacaine dose. Sensory and motor blockade and maternal or fetal side effects were recorded every 5 minutes for the first 30 minutes. The ED90 of bupivacaine with each technique was estimated using centered isotonic regression. A total of 95 women were included in the final analysis. The ED90 of bupivacaine was estimated at 29.30 mg (90% confidence interval [CI], 28.55–31.56) with a DPE technique and 45.25 mg (90% CI, 42.80–52.03) with an EPL technique. Using a biased-coin, sequential allocation method, the DPE technique requires less bupivacaine to achieve effective initial analgesia (ED90) when compared to the EPL technique.
Scopus© Citations 5 22
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Abdominal circumference growth velocity as a predictor of adverse perinatal outcomes in small-for-gestational-age fetuses
(2023)
Rodriguez-Sibaja, Maria J.
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Villa-Cueva, Alejandra
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Ochoa-Padilla, Maria
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Rodriguez-Montenegro, Maria S.
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Objective: To assess the predictive value of abdominal circumference growth velocity (ACGV) between the second and third trimesters to predict adverse perinatal outcomes in a cohort of small-for-gestational-age fetuses without evidence of placental insufficiency (i.e. fetal growth restriction). Material and methods: This is a single-center retrospective cohort study of all singleton pregnancies with small-for-gestational-age fetuses diagnosed and delivered at a quaternary institution. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between abnormal ACGV (i.e. ≤10th centile) and adverse perinatal outcomes defined as a composite outcome (i.e. umbilical artery pH <7.1, 5-min Apgar score <7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). Furthermore, the area under the receiver-operating characteristic curve (AUC) of three logistic regression models based on estimated fetal weight and ACGV for predicting the composite outcome is also reported.
Scopus© Citations 2 17 1

Lumbreras-Márquez, Mario Isaac

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