<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0390</journal-id>
<journal-title><![CDATA[Revista Médica del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. Urug.]]></abbrev-journal-title>
<issn>1688-0390</issn>
<publisher>
<publisher-name><![CDATA[Sindicato Médico del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-03902020000100216</article-id>
<article-id pub-id-type="doi">10.29193/rmu.36.1.9</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Abordaje obstétrico integral de la prematurez y restricción del crecimiento fetal y su relación con las enfermedades crónicas del adulto]]></article-title>
<article-title xml:lang="en"><![CDATA[Obstetric comprehensive approach to pre-term birth and growth restriction and its relationship with chronic adult diseases]]></article-title>
<article-title xml:lang="pt"><![CDATA[Abordagem obstétrica integral da prematuridade e restrição do crecimiento fetal e sua relação com as doenças crônicas do adulto]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Briozzo]]></surname>
<given-names><![CDATA[Leonel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Viroga]]></surname>
<given-names><![CDATA[Stephanie]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de la República Facultad de Medicina Clínica Ginecotocológica A, Centro Hospitalario Pereira Rossell]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de la República Facultad de Medicina Clínica Ginecotocológica A, Centro Hospitalario Pereira Rossell]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2020</year>
</pub-date>
<volume>36</volume>
<numero>1</numero>
<fpage>216</fpage>
<lpage>234</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-03902020000100216&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-03902020000100216&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-03902020000100216&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: Los síndromes obstétricos de parto de pretérmino (PP) y restricción de crecimiento fetal (RCIU) comparten mecanismos etiopatogénicos y fisiopatológicos que muchas veces interactúan y se retroalimentan. Desde el punto de vista etiológico, las condiciones específicas que los generan esquemáticamente se pueden clasificar en inflamación, estrés materno, déficit en las condiciones socioeconómicas y vulnerabilidad de derechos, actuación de disruptores endocrinos, alteraciones de la dieta y de la microbiota y afecciones vasculares. Estas condiciones, actuando aislada o más frecuentemente combinadamente, generan un entorno materno desfavorable para el desarrollo del embarazo provocando efectos específicos como son la reacción inmune materna, mediada o no por la presencia de infecciones, la activación del eje hipotálamo-hipófiso-adrenal, la disminución de la acción de la progesterona, las disbiosis, tanto intestinales como vaginales, y la disfunción por envejecimiento placentario. El entorno desfavorable así generado impactará en la unidad útero-placento-fetal, produciendo, bien el PP o bien el RCIU, de acuerdo a la primacía de diferentes respuestas; independientemente de cuál de las respuestas sindromáticas predomine, ambos, el PP y el RCIU, tienen en común el desarrollo del feno-genotipo ahorrador, imprescindible para la sobrevida fetal. El costo de esta modulación epigenética es el aumento de las enfermedades crónicas del adulto, que conceptualmente son enfermedades transmisibles por la vulnerabilidad social donde se desarrolla el ciclo de vida de esas personas.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary: Preterm birth and growth restriction are obstetric syndromes which share etiopathogenic and pathophysiological mechanisms that often interact and feed from each other. Etiologically, they may be classified into inflammation, maternal stress, low socio-economic background and vulnerability of rights, endocrine disruptors, diet and microbiota alterations and vascular conditions, depending on specific conditions. These conditions, either in isolation or more often combined, create an unfavorable environment for the development of pregnancy, causing specific effects such as maternal immune response that may be mediated by infections, the activation of the hypothalamic-pituitary-adrenal (HPA) axis, drop in progesterone levels, dysbiosis, both intestinal and vaginal, and placental dysfunction caused by ageing. The unfavorable environment has an impact on the utero-feto-placental unit resulting in either preterm birth of growth restriction, depending on the predominance of the different responses. Regardless of the prevailing syndromic response, both preterm birth and growth restriction share the development of the thrifty pheno-genotype, essential for fetal survival. The cost of this epigenetic modulation is an increase in chronic adult diseases, which, conceptually, are transmissible diseases due to social vulnerability where these people live.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: As síndromes obstétricas de parto de pré-termo (PP) e de restrição do crescimento fetal (RCIU) compartem mecanismos etiopatogênicos e fisiopatológicos, que muitas vezes interagem e se retroalimentam. Do ponto de vista da etiologia, as condições específicas que as geram podem ser classificadas esquematicamente em inflamação, estresse materno, déficit nas condições socio econômicas e vulnerabilidade de direitos, ação de disruptores endócrinos, alterações da dieta e da microbiota e afecções vasculares. Estas condições, agindo de forma isolada ou mais frequentemente combinada, geram um ambiente materno desfavorável para o desenvolvimento da gravidez provocando efeitos específicos como a reação imune materna, mediada ou não pela presença de infecções, a ativação do eixo hipotálamo - hipófiso - adrenal, a diminuição da ação da progesterona, as disbioses, tanto intestinais como vaginais e a disfunção por envelhecimento placentário. Esse ambiente desfavorável impactará na unidade útero-placento-fetal, produzindo PP ou RCIU, de acordo com a preferência de diferentes respostas. Independentemente de qual das respostas sindromáticas predomine, ambos PP e RCIU, têm em comum o desenvolvimento do feno-genótipo poupador, imprescindível para a sobrevida fetal. O custo desta modulação epigenética é o aumento das doenças crônicas do adulto, que conceitualmente, são patologias transmissíveis pela vulnerabilidade social na qual o ciclo de vida dessas pessoas se desenvolve.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Retardo del crecimiento fetal]]></kwd>
<kwd lng="es"><![CDATA[Nacimiento prematuro]]></kwd>
<kwd lng="es"><![CDATA[Enfermedades crónicas]]></kwd>
<kwd lng="es"><![CDATA[Epigenómica]]></kwd>
<kwd lng="en"><![CDATA[Fetal growth retardation]]></kwd>
<kwd lng="en"><![CDATA[Premature birth]]></kwd>
<kwd lng="en"><![CDATA[Chronic diseases]]></kwd>
<kwd lng="en"><![CDATA[Epigenomics]]></kwd>
<kwd lng="pt"><![CDATA[Retardo do crecimento fetal]]></kwd>
<kwd lng="pt"><![CDATA[Nascimento prematuro]]></kwd>
<kwd lng="pt"><![CDATA[Doenças crônicas]]></kwd>
<kwd lng="pt"><![CDATA[Epigenômica]]></kwd>
</kwd-group>
</article-meta>
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