{"id":116146,"date":"2018-03-11T10:45:07","date_gmt":"2018-03-11T10:45:07","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/influencia-de-la-diabetes-gestacional-en-el-desarrollo-psicomotor-y-la-regulacion-de-los-ritmos-circadianos-durante-el-primer-ano-de-vida\/"},"modified":"2018-03-11T10:45:07","modified_gmt":"2018-03-11T10:45:07","slug":"influencia-de-la-diabetes-gestacional-en-el-desarrollo-psicomotor-y-la-regulacion-de-los-ritmos-circadianos-durante-el-primer-ano-de-vida","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ginecologia\/influencia-de-la-diabetes-gestacional-en-el-desarrollo-psicomotor-y-la-regulacion-de-los-ritmos-circadianos-durante-el-primer-ano-de-vida\/","title":{"rendered":"Influencia de la diabetes gestacional en el desarrollo psicomotor y la regulaci\u00f3n de los ritmos circadianos durante el primer a\u00f1o de vida"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Matilde Zornoza Moreno <\/strong><\/h2>\n<p>Objetivos  el objetivo general se centr\u00f3 en conocer si el neurodesarrollo y la regulaci\u00f3n de los ritmos circadianos de los ni\u00f1os pueden estar influidos por la presencia de diabetes gestacional materna (gdm). Se plantearon como objetivos secundarios: evaluar si los sensores utilizados en adultos para el registro de temperatura perif\u00e9rica y actividad son \u00fatiles en la medici\u00f3n de los estos mismos ritmos circadianos durante el primer a\u00f1o de vida y determinar si existe relaci\u00f3n entre la maduraci\u00f3n de \u00e9stos y el neurodesarrollo evaluado con la escala de bayley de desarrollo infantil 2\u00aa edici\u00f3n (bsid ii) a los 6 y 12 meses.  metodolog\u00eda  se reclutaron 63 mujeres embarazadas en el servicio de ginecolog\u00eda y obstetricia del hospital cl\u00ednico universitario virgen de la arrixaca de murcia, 23 controles sanas, 21 mujeres con gdm tratadas con dieta y 19 mujeres diagnosticadas de gdm que precisaron insulina. En el reclutamiento y el parto se tomaron muestras de sangre materna, as\u00ed como de cord\u00f3n en el parto, extray\u00e9ndose y analiz\u00e1ndose los \u00e1cidos grasos de acuerdo a los m\u00e9todos descritos previamente (folch et al., 1957; larqu\u00e9 et al., 2003). Los hijos fueron clasificados de acuerdo al grupo materno; 34 varones y 29 mujeres, nacidos a t\u00e9rmino, con una puntuaci\u00f3n normal de apgar y par\u00e1metros antropom\u00e9tricos acordes a los de ni\u00f1os sanos espa\u00f1oles (carrascosa et al., 2008). Se realiz\u00f3 un estudio longitudinal prospectivo, monitorizando la temperatura cut\u00e1nea y la actividad, durante 3 d\u00edas consecutivos a los 15 d\u00edas, 1, 3 y 6 meses de edad, con la rutina normal de sue\u00f1o-vigilia. Para ello se proporcion\u00f3 a los padres un par de calcetines que inclu\u00edan ambos sensores. El sensor de temperatura registr\u00f3 la misma cada 10 minutos; mientras que el de actividad se program\u00f3 para integrar, cada 2 minutos, el desplazamiento del sensor. A partir de los datos obtenidos se estimaron distintos \u00edndices para evaluar la evoluci\u00f3n de los ritmos circadianos. La evaluaci\u00f3n del desarrollo neurol\u00f3gico de los ni\u00f1os se realiz\u00f3 a los 6 y 12 meses usando la escala bsid ii, que se compone de un \u00edndice de desarrollo mental (mdi) y otro de desarrollo motor (pdi).  para analizar un ritmo circadiano, la funci\u00f3n sinusoidal es un modelo matem\u00e1tico capaz de explicar un per\u00edodo de 24 horas, para lo que se utilizaron los m\u00e9todos param\u00e9tricos, obteniendo variables como mesor, acrofase o amplitud del cosinor, el vector de rayleigh o el ratio p1\/pultradiano de fourier. Ya que muchos ritmos circadianos no son estrictamente sinusoidales, se han propuesto las t\u00e9cnicas no param\u00e9tricas (carvalho-bos et al., 2007; portaluppi et al., 2008), que demuestran una mayor sensibilidad para definir los ritmos circadianos en ni\u00f1os (zornoza moreno et al., 2011). De ellos se obtienen la estabilidad interdiaria, la variabilidad intradiaria, la amplitud relativa, el \u00edndice dicot\u00f3mico i&lt;o o el \u00edndice de funci\u00f3n circadiana (cfi) de la variable integrada temperatura-actividad.   conclusiones  los sensores utilizados en adultos para la medici\u00f3n de temperatura y actividad son \u00fatiles para esta medici\u00f3n de manera domiciliaria en menores de un a\u00f1o. Los tests m\u00e1s adecuados para su estudio son los no param\u00e9tricos. La aparici\u00f3n de los ritmos circadianos de temperatura perif\u00e9rica, actividad motora y sue\u00f1o, estimado a partir la integraci\u00f3n de ambas variables, se produce a los 3 y 6 meses. Los valores medios de los ritmos circadianos en los ni\u00f1os no se afectaron por la presencia de gdm en sus madres. Sin embargo, la fragmentaci\u00f3n del ritmo de temperatura y sue\u00f1o, as\u00ed como el \u00edndice de funci\u00f3n circadiana (cfi) fueron significativamente menores a los 6 meses en hijos de madre con gdm con insulina. La adiposidad fetal, estimada por ecograf\u00eda materna, se correlacion\u00f3 con una peor regulaci\u00f3n de ritmos circadianos en los 6 primeros meses. Existe una influencia de la gdm en el neurodesarrollo durante el primer a\u00f1o, pues los hijos de madre con gdm presentaron puntuaciones significativamente menores a los 6 meses en ambos scores del bsid ii, con igual tendencia a los 12 meses. Existen correlaciones entre el pdi y par\u00e1metros de actividad, como la media, y el cfi a los 3 y 6 meses, lo que hace afirmar que la actividad es un buen marcador precoz de neurodesarrollo. Los hijos de madre con gdm presentaron un menor contenido de dha en cord\u00f3n, a pesar de mayores niveles maternos. El nivel de dha en sangre de cord\u00f3n se correlacion\u00f3 con el pdi y par\u00e1metros de fragmentaci\u00f3n del ritmo de actividad.     objectives  the general aim was to discern whether neurodevelopment and circadian rhythms regulation in children can be influenced by the presence of maternal gestational diabetes (gdm). The secondary objectives were to: evaluate if sensors used in adults for the recording of temperature and activity are useful for the evaluation of circadian rhythms of peripheral temperature and motor activity during the first year of life. In addition, we determined the relationship between the maturation of these rhythms and neurodevelopment evaluated by the 2nd bayley scale of infant development (bsid ii) at 6 and 12 months of life.   methodology  63 pregnant women were recruited in the gynaecology and obstetrics service of the clinical universitary virgen de la arrixaca hospital in murcia, 23 healthy controls, 21 women with gdm controlled with diet and 19 women diagnosed with gdm and treated with insulin. At the recruitment and delivery maternal blood samples were collected, as well as cord blood at delivery, extracting and analyzing fatty acids according to methods previously described (folch et al., 1957; larqu\u00e9 et al., 2003). The offsprings were classified according to maternal group; they were 34 boys and 29 girls, born at term, with normal score by the apgar test and somathometric parameters according to healthy spanish children (carrascosa et al., 2008). A longitudinal prospective study was performed, recording skin temperature and activity in the children, for 3 consecutive days at 15 days, 1, 3 and 6 months of age, with their normal routine of sleep-wake periods. For that, parents received a pair of shocks, with both sensors. The skin temperature sensor recorded it every 10 minutes; while motor activity sensor was programmed to integrate, every 2 minutes, the sensor displacement. From these data it was estimated several indexes to define the circadian rhythms in children. The evaluation of psychomotor development was performed in the children at 6 and 12 months using the bsid ii, which provides information on the mental development index (mdi) and the psychomotor development index (pdi). to analyze a circadian rhythm, the mathematic model able to explain a 24-hour period is a sinusoidal function. For that the parametric methods were used as adjustment model, obtaining variables as cosinor mesor, acrophase and amplitude, rayleigh vector or p1\/pultradiano ratio of the fourier analysis. Since some circadian rhythms are not strictly sinusoidal, the non-parametric techniques are also proposed (carvalho-bos et al., 2007; portaluppi et al., 2008), and in some cases they have shown higher sensibility to define the circadian rhythm in children (zornoza moreno et al., 2011). By non-parametric tests we obtain some indexes as interdaily stability of the rhythm, intradaily variability, relative amplitude, dichotomous index i&lt;o or circadian function index (cfi) of the integrated variable temperature-activity.   conclusions  the sensors, used in adults for the measurement of temperature and activity, were suitable for these measurements at home in children during the first year of life. The most appropriate tests for measuring circadian rhythms in the children were the non-parametric ones. Circadian rhythms of peripheral temperature, motor activity and sleep, estimated form the integration of both variables, occurs between 3 and 6 months. Mean values of the three circadian rhythms in children weren&apos;t affected by the existence of gdm in their mothers. However, the fragmentation of both temperature and sleep rhythms as well as the circadian function index (cfi) were significantly lower at 6 months in children from mothers with gdm under insulin treatment. The foetal adiposity, estimated by maternal ecography, was also correlated with a worse regulation of circadian rhythms during the first 6 months of life. There is an influence of gdm in neurodevelopment of these children during the first year of life, and babies of mothers with gdm had significantly lower scores at 6 months in both scores from bsid ii, and the same trend was observed at 12 months. There are correlations between pdi and motor activity parameters, mainly mean activity, and cfi at 3 and 6 months, which let us assert that motor activity is a good early marker of psychomotor development. Offsprings of mothers with gdm had a lower content of dha in cord blood, despite higher maternal levels. Cord blood dha is correlated with pdi and activity parameters that reflect more mature circadian rhythms at 6 months.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Influencia de la diabetes gestacional en el desarrollo psicomotor y la regulaci\u00f3n de los ritmos circadianos durante el primer a\u00f1o de vida<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Influencia de la diabetes gestacional en el desarrollo psicomotor y la regulaci\u00f3n de los ritmos circadianos durante el primer a\u00f1o de vida <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Matilde Zornoza Moreno <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 18\/07\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Elvira Larque Daza<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: julio Ardura fern\u00e1ndez <\/li>\n<li>Fernando Romero braquehais (vocal)<\/li>\n<li>mercedes Juste ruiz (vocal)<\/li>\n<li>cristina Campoy folgoso (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Matilde Zornoza Moreno Objetivos el objetivo general se centr\u00f3 en conocer si el neurodesarrollo y la regulaci\u00f3n 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