Biometrías fetales y variables maternas como predictores de desviaciones de la condición trófica al nacer

Introducción: Durante el embarazo varios factores pueden interactuar sobre el organismo en formación. Parte de los cuidados prenatales se centran en detectar desviaciones del crecimiento fetal. Objetivo: Describir las variables biométricas fetales primarias y la asociación de las enfermedades maternas con la condición trófica del recién nacido. Método: Se realizó un estudio cuantitativo, observacional, analítico y retrospectivo, con una población de 5432 y una muestra de 4131 gestantes, seleccionada por muestreo no probabilístico, intencional, por criterios. Los datos fueron obtenidos del registro de consultas de genética desde enero de 2013 hasta octubre de 2018. Para el análisis estadístico se utilizó el test de Kruskal Wallis, la prueba post hoc de Dunn-Bonferroni, ji cuadrado y V de Cramer. Resultados: Prevaleció el incremento de las medianas de las variables biométricas, según la condición trófica y semana gestacional, predominó la significación estadística, al igual que las diferencias significativas en todos los contrastes dos a dos realizados. Las gestantes de peso adecuado preponderaron en cada condición al nacer, los recién nacidos pequeños se relacionaron con los trastornos hipertensivos durante el embarazo, la sepsis vaginal y la diabetes mellitus mientras que los recién nacidos grandes predominaron en madres con la glucemia alterada y anemia. Conclusiones: Las mediciones biométricas y las fórmulas de estimación del peso fetal pueden advertir las desviaciones del crecimiento fetal y la condición trófica al nacer. Las variables maternas se relacionaron con la condición trófica del recién nacido.

Introduction: During pregnancy several factors can interact on the developing organism. Part of prenatal care focuses on detecting deviations in fetal growth. Objective: Describe the primary fetal biometric variables and the association of maternal diseases with the trophic condition of the newborn. Method: A quantitative, observational, analytical and retrospective study was carried out, with a population of 5432 and a sample of 4131 pregnant women, selected by non-probabilistic, intentional sampling, by criteria. The data were obtained from the registry of genetic consultations from January 2013 to October 2018. For statistical analysis, the Kruskal Wallis test, the Dunn-Bonferroni post hoc test, chi-square and Cramer's V were used. Results: The increase in the medians of the biometric variables prevailed, according to the trophic condition and gestational week, the statistical significance predominated, as did the significant differences in all the two-to-two contrasts carried out. Pregnant women of adequate weight predominated in each condition at birth, small newborns were related to hypertensive disorders during pregnancy, vaginal sepsis and diabetes mellitus, while large newborns predominated in mothers with altered glycemia and anemia. Conclusions: Biometric measurements and fetal weight estimation formulas can warn of deviations in fetal growth and trophic condition at birth. Maternal variables were related to the trophic condition of the newborn.

Effect of laser-assisted hatching on birth weight in blastocyst cultureof low-grade cleavage embryos / 预防医学

Objective@#To examine the impact of laser-assisted hatching (LAH) technique on perinatal outcomes in blastocyst culture of low-grade cleavage embryos, so as to provide insights into improving the utilization of low-grade cleavage embryos and embryo quality.@*Methods@#A total of 369 single live births after transfer of thawed blastocysts following in vitro fertilization or intracytoplasmic sperm injection at Zhejiang Provincial People's Hospital were selected as subjects, and they were divided into 51 conventional culture blastocysts and 318 LAH blastocysts based on whether LAH was performed on day 4 of blastocyst culture. Gestational age, birth weight, birth defects and maternal perinatal information were collected, and the prevalence of premature birth, birth weight and birth defects were analyzed after propensity score matching (PSM).@*Results@#After PSM, 98 matched cases were included in the study. There were no statistically significant differences in maternal age, body mass index, type of infertility and blastocyst age (P>0.05), indicating effective matching. The birth weight of offspring in the LAH group was lower than that in the conventional culture group [(3 261.08±432.24) g vs. (3 464.18±444.46) g; P<0.05].@*Conclusion@#The birth weight of offspring can be reduced by using LAH during blastocyst culture of low-grade cleavage embryos.

Impact of anthro-metabolic indices and gestational weight gain on maternal and neonatal outcomes: a prospective observational study

SUMMARY OBJECTIVE: The aim of this study was to examine the relationship of anthro-metabolic indices on maternal and neonatal outcomes. METHODS: This prospective observational study was conducted on healthy mother-baby pairs between January 1, 2023 and July 1, 2023. Detailed sociodemographic information was collected through an interview with the mother. Clinical, biochemical, obstetric, fetal, and neonatal outcomes were abstracted from hospital medical records. Anthropometric measurements were obtained from the examination of mother-baby pairs. RESULTS: A total of 336 healthy mothers-children pairs were included. Mothers of newborn ≥4000 g had higher gestational age (p=0.003), body mass index (p=0.003), gestational weight gain (p=0.016), waist circumferences (p=0.002), and hip circumferences (p=0.001). gestational weight gain was associated with the mode of delivery (p=0.023). waist-to-hip ratio (p=0.005), gestational weight gain (p=0.013), and a body shape ındex (p<0.001) were associated with longer length of hospital stay. Age (p<0.001) and inter-pregnancy interval (p=0.004) were higher in pre-pregnancy underweight/obese mothers. Receiver operating characteristic analysis revealed that maternal waist circumferences (AUC: 0.708, p=0.005), maternal weight (AUC: 0.690, p=0.010), and hip circumferences (AUC: 0.680, p=0.015) were sufficient to predict macrosomia (p<0.05). CONCLUSION: The study demonstrated a significant association between gestational weight gain and cesarean delivery, prolonged hospital stay, and macrosomia. It was also found that maternal body mass index, waist circumferences, and hip circumferences during pregnancy were associated with macrosomia. On the contrary, no significant relationship was found between maternal anthro-metabolic characteristics and maternal-fetal and birth outcomes.

Prevalence of macrosomic newborn and maternal and neonatal complications in a high-risk maternity

Abstract Objective Evaluate the prevalence of macrosomic newborns (birth weight above 4000 grams) in a high-risk maternity from 2014 to 2019, as well as the maternal characteristics involved, risk factors, mode of delivery and associated outcomes, comparing newborns weighing 4000-4500 grams and those weighing above 4500 grams. Methods This is an observational study, case-control type, carried out by searching for data in hospital's own system and clinical records. The criteria for inclusion in the study were all patients monitored at the service who had newborns with birth weight equal than or greater than 4000 grams in the period from January 2014 to December 2019, being subsequently divided into two subgroups (newborns with 4000 to 4500 grams and newborns above 4500 grams). After being collected, the variables were transcribed into a database, arranged in frequency tables. For treatment and statistical analysis of the data, Excel and R software were used. This tool was used to create graphs and tables that helped in the interpretation of the results. The statistical analysis of the variables collected included both simple descriptive analyzes as well as inferential statistics, with univariate, bivariate and multivariate analysis. Results From 2014 to 2019, 3.3% of deliveries were macrosomic newborns. The average gestational age in the birth was 39.4 weeks. The most common mode of delivery (65%) was cesarean section. Diabetes mellitus was present in 30% of the deliveries studied and glycemic control was absent in most patients. Among the vaginal deliveries, only 6% were instrumented and there was shoulder dystocia in 21% of the cases. The majority (62%) of newborns had some complication, with jaundice (35%) being the most common. Conclusion Birth weight above 4000 grams had a statistically significant impact on the occurrence of neonatal complications, such as hypoglycemia, respiratory distress and 5th minute APGAR less than 7, especially if birth weight was above 4500 grams. Gestational age was also shown to be statistically significant associated with neonatal complications, the lower, the greater the risk. Thus, macrosomia is strongly linked to complications, especially neonatal complications.

Third trimester HbA1c as a prognostic indicator in the prediction of large-for-gestational age babies in South Indian women with gestational diabetes mellitus: A cross-sectional study

Background: The prevalence of hyperglycemia first detected during pregnancy is showing an escalating increase in recent years contributed by the increasing obesity prevalence, advanced maternal age at delivery, and the universal screening protocol during the first antenatal visit. There exists a very little data on the role of HbA1c in pregnancy and the results remain inconsistent. There is a need to define diagnostic criteria to predict the adverse perinatal outcomes in gestational diabetes mellitus (GDM). Aims and Objectives: This study was aimed to assess the role of HbA1c as a prognostic indicator of third trimester mean blood glucose in GDM pregnancies and in predicting the birth of large for gestational age (LGA) babies. Materials and Methods: 200 pregnant women with GDM and 200 pregnant women without GDM and their neonates participated in this analytical cross-sectional study. Maternal age, height, weight, BMI, and neonatal birth weight were recorded. Third trimester maternal HbA1c level was analyzed by high-performance liquid chromatography. The association between HbA1c and LGA births was analyzed. Results: The mean HbA1c levels and percentage of LGA births were high in GDM group. Multiple logistic regression analysis showed association between high HbA1c values and LGA births in GDM. A Receiver operating characteristic curve was drawn to derive the optimal cut-off value, sensitivity, and specificity of HbA1c in predicting birth of LGA neonates in GDM. Conclusion: This study shows that high third trimester HbA1c levels in GDM increase the risk of LGA births. Further studies are needed to define standard cut-off values of glycated Hb in each trimester of pregnancy.

Impacts of pre-pregnancy body mass index, gestational diabetes mellitus and gestational weight gain on perinatal outcomes and mode of delivery / 中国新生儿科杂志

Objective:To study the impacts of pre-pregnancy body mass index (BMI), gestational diabetes mellitus (GDM) and gestational weight gain (GWG) on perinatal outcomes and mode of delivery.Methods:From November 2016 to December 2017, single-pregnancy women in early pregnancy (<13 weeks) regularly checked-up at our hospital were enrolled in this prospective cohort study and followed up until delivery. They were assigned into four groups according to pre-pregnancy BMI: obese group (≥28.0 kg/m 2), overweight group(24.0-<28.0 kg/m 2), normal group (18.5-<24.0 kg/m 2) and underweight group(<18.5 kg/m 2). A 75-g oral glucose tolerance test was performed at 24-28 weeks of pregnancy to screen for GDM. The optimal GWG was 11.0-16.0 kg for underweight group, 8.0-14.0 kg for normal group, 7.0-11.0 kg for overweight group and 5.0-9.0 kg for obesity group. The effects of pre-pregnancy BMI, GDM and GWG on perinatal outcomes and delivery mode were evaluated using multivariate logistic regression methods. Results:A total of 802 pregnant women were included. The incidences of pre-pregnancy overweight and obesity were 21.8% and 8.9%, respectively. The incidence of GDM was 14.1%. 57.2% of the participants experienced excessive GWG. The incidences of macrosomia, low birth weight and premature birth were 7.1%, 2.7% and 2.2%, respectively. The incidence of Cesarean delivery (C-section) was 37.7%. Pre-pregnancy obesity [adjusted odds ratio ( AOR)=4.355, 95% confidence interval ( CI) 1.900-9.980] and excessive GWG ( AOR=3.799, 95% CI 1.796-8.034) were independent risk factors for macrosomia. Excessive GWG was a protective factor for low birth weight ( AOR=0.279, 95% CI 0.084-0.928) and inadequate GWG was a risk factor for low birth weight ( AOR=10.954, 95% CI 3.594-33.382) and premature birth ( AOR=8.796, 95% CI 2.628-29.438). Compared with the normal group, overweight group had an increased risk of C-section ( AOR=1.817, 95% CI 1.119-2.949). Compared with pregnant women without pre-pregnancy overweight/obesity, GDM nor excessive GWG, any combination of two of the above-mentioned three factors increased the risks of macrosomia ( AOR=3.908, 95% CI 1.630-9.370) and C-section ( AOR=2.269, 95% CI 1.325-3.886). The risks of macrosomia and C-section were the highest when all three factors existed. Conclusions:Pre-pregnancy obesity and excessive GWG are independent risk factors for macrosomia and pre-pregnancy overweight is a risk factor of C-section. Exposure to any two of the three factors (pre-pregnancy overweight/obesity, GDM and excessive GWG) increases risks of macrosomia and C-section and the highest risk is observed when all three factors are present.

Weekly gestational weight gain in women with obesity and its association with risk of macrosomia / 中华围产医学杂志

Objective:To explore the characteristics of weekly gestational weight gain (GWG) in women with obesity and its correlation with the risk of macrosomia.Methods:Clinical data of women with singleton pregnancy and pre-pregnancy body mass index (PPBMI) ≥28 kg/m 2 were retrospectively analyzed, from January 2014 to December 2019, in Beijing Obstetrics and Gynecology Hospital, Capital Medical University (Beijing Maternal and Child Health Care Hospital). The participants were divided into three groups based on their PPBMI: group A (28-<30 kg/m 2), group B (30-<32 kg/m 2), and group C (≥32 kg/m 2). The study compared the characteristics of GWG among the three groups, explored the correlation between the weekly weight gain during each gestational stage and the risk of macrosomia, and discussed the impacts of the GWG pattern in women with different PPBMI on the risk of macrosomia. Chi-square (or Fisher's exact), Kruskal-Wallis, and Mann-Whitney U tests were performed for statistical analysis. Multivariate logistic regression was used to analyze the impact of weekly weight gain in specific gestational stages on macrosomia. Results:(1) A total of 2 046 participants were included in the study, with 982 in group A, 588 in group B, and 476 in group C. For all of the 2 046 cases, the median PPBMI was 30.1 kg/m 2 (29.0-31.9 kg/m 2), GWG was 10.5 kg (7.3-14.0 kg), and neonatal birth weight was 3 520 g (3 215-3 816 g) with 60 (2.9%) ≥4 500 g, and the biggest baby weighed 5 580 g. Out of the births analyzed, macrosomia occurred in 318 cases (15.5%). (2) Among the three groups (A, B and C), the differences in maternal age [32.0 years (29.0-35.0 years), 32.0 years (29.0-35.0 years) and 32.0 years (29.0-34.0 years), H=6.58] and women with a history of type 2 diabetes mellitus [0.9% (9/982), 0.3% (2/588) and 1.9% (9/476), χ2=6.61] were statistically significant (all P<0.05). (3) The weekly weight gain in each group exhibited a gradual upward trend before 20-24 weeks, reached a plateau at 24-32 weeks, peaked at 32-36 weeks, and subsequently declined. The weekly weight gain of group A in the pre-pregnancy to 14 weeks [0.14 kg/week (0.00-0.25 kg/week)], 14 to 20 weeks [0.25 kg/week (0.17-0.42 kg/week)], and 20 to 24 weeks [0.38 kg/week (0.25-0.63 kg/week)] were higher than those of group B [0.07 kg/week (－0.03-0.21 kg/week), 0.25 kg/week (0.10-0.42 kg/week), and 0.38 kg/week (0.22-0.60 kg/week)], respectively ( Z value was－3.73,－2.16, and－2.01, all P<0.05). Likewise, the weekly weight gain of group B in the above three stages were all higher than those of group C [0.07 kg/week (－0.10-0.21 kg/week), 0.17 kg/week (0.05-0.33 kg/week), and 0.25 kg/week (0.08-0.50 kg/week)], respectively ( Z value was－2.55,－3.28, and－3.25, all P<0.05). (4) The risk of macrosomia increased with the weekly weight gain in specific gestational stages in different PPBMI groups. In group A, the stages correlated with increased risk were 14-20 weeks [adjusted odd ratio ( aOR)=2.669, 95% CI: 1.378-5.169] and 20-24 weeks ( aOR=1.764, 95% CI: 1.143-2.723), while the stages were 20-24 weeks ( aOR=2.149, 95% CI: 1.156-3.996) and 36 weeks until delivery ( aOR=1.888, 95% CI: 1.268-2.810) in group B, and pre-pregnancy to 14 weeks ( aOR=3.515, 95% CI: 1.158-10.665) and 14-20 weeks ( aOR=3.021, 95% CI: 1.058-8.628) in group C (all P<0.05). The risk of macrosomia increased when the weekly weight gain of both risk-related stages in group A ( aOR=2.255, 95% CI: 1.029-4.940) ≥50th percentile, and group B ( aOR=4.399, 95% CI: 1.017-19.023) ≥75th percentile, and for group C ( aOR=3.404, 95% CI: 1.004-11.543) when the weekly weight gain above 25th percentile (all P<0.05). Conclusions:Weekly GWG demonstrates an observable gradual acceleration pattern in women with obesity. Therefore, clinical attention should be directed towards monitoring fluctuations in the weekly weight gain in this population, as excessive weekly weight gain before 24 gestational weeks is associated with an elevated risk of macrosomia.

Influence of blood donation before pregnancy on neonatal birth weight / 中国输血杂志

【Objective】 To explore the influence of maternal blood donation before pregnancy on neonatal birth weight. 【Methods】 A total of 6 428 full-term (gestational age ≥37 weeks) singleton pregnant women in Ningbo Medical Center Lihuili Hospital and Ningbo Women and Children′s Hospital from January 2020 to October 2020 were enrolled in this study. The cumulative whole blood donations before pregnancy were obtained through Alipay software. The relevant data of parturients and their fetuses were collected from electronic medical records. 【Results】 The maternal blood donation rate in Zhejiang Province before pregnancy was 14.69%. The average age of women was 29 (27-32), and the median of cumulative blood donation (except 0 mL) before pregnancy was 300 mL. Univariate analysis showed that there was no significant difference in neonatal gender, neonatal birth weight, proportion of low birth weight infants and proportion of macrosomia among non blood donation group, low blood donation group and high blood donation group (P>0.05). After multiple linear regression analysis, it was found that there was no correlation between blood donation before pregnancy and the neonatal birth weight (B=0.123, 95%CI: -1.013-8.461, P>0.05). Multivariate Logistic regression analysis showed that, compared with the non blood donation group, the occurrence of macrosomia was higher in both the low blood donation group and the total blood donation group (OR=1.366, 95%CI: 1.007-1.766, P<0.05; OR=1.369, 95%CI: 1.019-1.851, P<0.05). 【Conclusion】 Maternal blood donation before pregnancy may not be related to neonatal birth weight, but may be related to the probability of macrosomia in their offspring.

Fetal Macrosomia and Postpartum Hemorrhage in Latin American and Caribbean Region: Systematic Review and Meta-analysis / Macrossomia fetal e hemorragia pós-parto na região da América Latina e Caribe: Revisão sistemática e metanálise

Abstract Objective To determine the association between fetal macrosomia (FM) and postpartum hemorrhage (PPH) in Latin American and Caribbean (LAC) women. Data Sources Studies evaluating the association between FM and PPH (≥ 500 ml) and severe PPH (≥ 1,000 ml) until November 4, 2021, indexed in CINHAL, Scopus, Embase, Cochrane Library, MEDLINE, LILACS, and SciELO. Selection of Studies Inclusion criteria were cohort and case-control studies that provided the number of PPH and FM cases. Exclusion criteria were studies lacking information about the number of cases, with a population of women who were not from LAC; published in a language other than English, Spanish, or Portuguese, and with a different design. Data Collection Data extraction was performed independently by two authors, and discrepancies were resolved with a third author. Data regarding FM and PPH cases were retrieved. Data Synthesis Of the 1,044 articles evaluated, 5 studies were included, from 6 different countries: Argentina and Uruguay (multi-country), West Indies, Antigua and Barbuda, French Guyana, and Suriname. The pooled odds ratio (OR) for FM and PPH in the meta-analysis (five studies) was 2.10 (95% confidence interval [CI]: 1.79-2.47; I2: 0%), with estimates within this 95% CI in the sensitivity analysis. The combined OR for severe PPH (3 studies) was 1.61 (95% CI: 0.40-6.48; I2: 91.89%), showing high heterogeneity. Conclusion There was a positive association between FM and PPH in the LAC, increasing the risk of the presence of this event 2-fold. The high heterogeneity of the studies that measured severe PPH does not allow drawing conclusions about the estimates obtained.

Resumo Objetivo Determinar a associação entre macrossomia fetal (FM) e hemorragia pós-parto (HPP) em mulheres da América Latina e Caribe (ALC). Fontes de dados Estudos avaliando a associação entre FM e HPP (≥ 500 ml) e HPP grave (≥ 1.000 ml) até 4 de novembro de 2021, indexados no CINHAL, Scopus, Embase, Biblioteca Cochrane, MEDLINE, LILACS e SciELO. Seleção de estudos Os critérios de inclusão foram estudos de corte e caso-controle que forneceram o número de casos de HPP e FM. Os critérios de exclusão foram estudos sem informação sobre o número de casos, com uma população de mulheres que não eram da ALC; publicado em um idioma diferente do inglês, espanhol ou português e com um design diferente. Coleta de dados A extração de dados foi realizada independentemente por dois autores, as discrepâncias foram resolvidas com um terceiro autor. Os dados relativos aos casos de FM e HPP foram recuperados. Síntese dos dados Dos 1.044 artigos avaliados, foram incluídos 5 estudos, de 6 países diferentes: Argentina e Uruguai (multipaíses), Índias Ocidentais, Antígua e Barbuda, Guiana Francesa e Suriname. O odds ratio agrupado (OR) para FM e HPP na meta-análise (cinco estudos) foi de 2,10 (intervalo de confiança de 95% [IC]: 1,79-2,47; I2: 0%), com estimativas dentro deste IC de 95% no análise sensitiva. O OR combinado para HPP grave (3 estudos) foi de 1,61 (95% CI: 0.40-6.48; I2: 91.89%), mostrando alta heterogeneidade. Conclusão Houve associação positiva entre FM e HPP na ALC, aumentando em 2 vezes o risco da presença desse evento. A alta heterogeneidade dos estudos que mediram a HPP grave não permite tirar conclusões sobre as estimativas obtidas.

Prontidão para via oral, aleitamento materno e diabetes mellitus gestacional: estudo caso-controle / Readiness for way oral, breastfeeding and gestational diabetes mellitus: a case-control study

RESUMO Objetivo verificar a prontidão para via oral e aleitamento materno em recém-nascidos de mães diagnosticadas com diabetes mellitus gestacional (DMG). Métodos estudo observacional, analítico, quantitativo, do tipo caso-controle. Para avaliação da sucção não nutritiva, foi utilizado o Protocolo de Prontidão do Prematuro para Início da Alimentação por Via Oral - POFRAS e, para avaliação do desempenho em seio materno, o Protocolo de Acompanhamento Fonoaudiológico - Aleitamento Materno. A amostra foi estratificada em dois grupos, sendo o grupo experimental composto por recém-nascidos de mães diagnosticadas com DMG e o grupo-controle, por recém-nascidos de mães hígidas. Para a análise estatística, foram utilizados os testes Mann-Whitney, Shapiro Wilk e t de Student. Resultados a amostra total foi composta por 46 recém-nascidos, sendo 21 do grupo experimental e 25 do grupo-controle. Observou-se p<0,05 na comparação entre os grupos nas seguintes variáveis: oscilação do estado de consciência, hipotonia global, reflexo de procura débil, menos de cinco sucções por pausa na avaliação da sucção não nutritiva, pega em seio, adormecimento após iniciar sucção e posicionamento mãe-bebê. Conclusão recém-nascidos de mães diagnosticadas com DMG apresentaram maior dificuldade na prontidão para via oral e na prática do aleitamento materno nas primeiras 72 horas de vida, comparados aos filhos de mães hígidas.

ABSTRACT Purpose to verify the readiness for oral feeding and breastfeeding in newborns of mothers diagnosed with gestational diabetes mellitus (GDM). Methods observational, analytical, quantitative case-control study. For the evaluation of non-nutritive sucking, the PROFAS protocol was used and for the evaluation of performance at the mother's breast, the protocol of Speech Therapy - Breastfeeding. The sample was stratified into two groups, the experimental group, composed of newborns of mothers diagnosed with GDM, and the control group, with newborns of healthy mothers. For statistical analysis, the Mann-Whitney, Shapiro Wilk and Student's t tests were used. Results the total sample consisted of 46 newborns, 21 from the experimental group and 25 from the control group. P<0.05 was observed in the comparison between the groups in the variables: oscillation in the state of consciousness, global hypotonia, weak search reflex, less than five suctions per pause in the assessment of non-nutritive sucking, holding on to the breast, falling asleep after starting suction and mother-infant positioning. Conclusion newborns of mothers diagnosed with GDM had greater difficulty in readiness for oral feeding and in the practice of breastfeeding in the first 72 hours of life, compared to children of healthy mothers.

Effect of anesthesia type on outcome measures in cesarean section in the presence of fetal macrosomia

SUMMARY OBJECTIVE: The aim of this study was to compare the effects of general and spinal anesthesia on maternal and neonatal outcomes during cesarean section in pregnancies with macrosomia. METHODS: This retrospective cohort study included 1043 patients who delivered by cesarean section between May 2018 and December 2021 and had a baby born with a birth weight of 4000 g or greater. Maternal and neonatal outcomes were compared according to the type of anesthesia performed in the spinal anesthesia group (n=903; 86.6%) and general anesthesia group (n=140; 13.4%). The Apgar score was categorized into <7 and ≥7. RESULTS: Neonates with an Apgar score of <7 at the first minute (11.4 vs. 0.4%; p<0.001) and the fifth minute (2.9 vs. 0.3%; p=0.004) were significantly higher in the general anesthesia group. The preoperative and postoperative hematocrit difference was significantly lower in patients who received spinal anesthesia than those who received general anesthesia [2 (1.1-3.1) vs. 4.05 (2.8-5.35); p<0.001]. The number of patients transfused was higher in the general anesthesia group (9.3 vs. 2.7%; p<0.001). In the regression model, general anesthesia, birth weight, and emergency conditions were significant independent factors related to the preoperative and postoperative hematocrit decrease (p<0.001, p=0.005, and p=0.034, respectively). CONCLUSIONS: Apgar scores of <7 at the first and fifth minutes are higher in macrosomic neonates who received general anesthesia than in neonates who received spinal anesthesia. Performing cesarean section under general anesthesia in mothers of macrosomic neonates results in a greater decrease in hematocrit value and a greater need for blood transfusion than under spinal anesthesia.

Incidencia de recién nacidos grandes para la edad gestacional y su asociación con diabetes mellitus gestacional y obesidad maternas. Estudio de cohorte en un hospital de Buenos Aires / Incidence of large-for-gestational-age newborns and its association with maternal gestational diabetes mellitus and obesity. Cohort study in a hospital in Buenos Aires

Resumen Introducción: existen dos términos para describir el crecimiento fetal excesivo: "grande para la edad gestacional" (GEG) y "macrosomía". GEG generalmente implica un peso al nacer superior al percentil 90 para una edad gestacional determinada. Objetivos: estimar la incidencia de recién nacidos GEG, y evaluar si la obesidad y la diabetes mellitus gestacional (DMG) son factores asociados. Materiales y métodos: estudio de cohorte retrospectivo de embarazadas -con y sin DMG- y sus recién nacidos vivos entre 2015 y 2018, evaluadas en el Hospital Italiano de la Ciudad Autónoma de Buenos Aires. La incidencia de recién nacidos GEG y de macrosomía se presentó como porcentajes e intervalos de confianza del 95% (IC 95%), así como sus complicaciones. Se utilizó regresión logística múltiple para evaluar si la DMG y la obesidad eran factores asociados a recién nacidos GEG. Resultados: la incidencia de GEG fue del 15,9% (IC 95%; 14,117,9) y de macrosomía del 6,7% (IC 95%; 5,5-8,1). La incidencia de recién nacidos GEG fue mayor en las mujeres con DMG y obesidad. La obesidad representó per se un mayor riesgo con y sin asociación con DMG. La obesidad, en presencia de DMG, incrementa la chance de recién nacidos GEG comparada con las mujeres sin DMG y sin obesidad (OR 2,41; p<0,001). Conclusiones: la DM y la obesidad materna incrementan el riesgo de GEG. Es importante implementar medidas preventivas e intervenciones en las mujeres en edad fértil con el objetivo de promover la salud de la madre y de su descendencia.

Abstract Introduction:two terms are used to describe excessive fetal growth: "large for gestational age" (LGA) and "macrosomia". LGA generally implies a birth weight greater than the 90th percentile for a given gestational age. Objectives: to estimate the incidence of LGA newborns and to assess whether obesity and gestational diabetes mellitus (GDM) are associated factors. Materials and methods: retrospective cohort study of pregnant women with and without GDM and their live newborns between 2015-2018 evaluated at the Italian Hospital in the City of Buenos Aires, Argentina. The incidence of LGA and macrosomia newborns is presented as percentages and 95% confidence intervals (95% CI), as well as their complications. Multiple logistic regression was used to assess whether GDM and obesity are factors associated with LGA newborns. Results: the incidence of LGA was 15.9% (IC 95%; 14.1-17.9) and of macrosomia 6.7% (IC 95%; 5.5-8.1). The incidence of LGA newborns was higher in women with GDM and obesity. Obesity represented a higher risk per se with and without association with GDM. Obesity, in the presence of GDM, increases the chance of LGA newborns compared to women with GDM and without obesity (OR 2.41; p<0.001). Conclusions:diabetes and maternal obesity increase the risk of LGA. It is important to implement preventive measures and interventions on women of childbearing age with the aim of promoting the health of the mother and her offspring.

Variables maternas relacionadas con la condición trófica al nacer / Maternal variables related to the trophic condition at birth

RESUMEN Introducción: El crecimiento y desarrollo prenatal tiene su expresión en el peso al nacer, que adquiere gran importancia por su relación con la morbilidad y mortalidad en cualquier etapa de la vida. Objetivo: Identificar las asociaciones de variables maternas con la condición trófica del recién nacido. Métodos: Se realizó un estudio descriptivo, en tres áreas de salud del municipio Santa Clara, en el periodo comprendido de enero 2013 a diciembre 2020. De una población de 6035 recién nacidos se seleccionó una muestra aleatoria de 2454. De los libros de genética se obtuvo la información de variables maternas y del neonato. Se aplicaron las pruebas no paramétricas de independencia basada en la distribución chi cuadrado y Kruskal Wallis en el análisis estadístico. Resultados: A excepción de la edad, las variables estudiadas mostraron relación con la condición trófica al nacer. El estado nutricional deficiente fue más frecuente en nacimientos pequeños y el obeso en los grandes. En nacimientos grandes se observó mayores porcentajes de gestantes con riesgo de diabetes gestacional. Los trastornos hipertensivos, la anemia, la infección del tracto urinario, la sepsis vaginal y el hábito de fumar se presentaron en mayores porcentajes en gestantes cuyos recién nacidos fueron pequeños. Conclusiones: De las variables estudiadas el riesgo de diabetes gestacional y los trastornos hipertensivos mostraron la mayor fuerza de asociación con la condición trófica al nacer.

ABSTRACT Introduction: prenatal growth and development have their expression in birth weight, which acquires great importance due to its relationship with morbidity and mortality at any stage of life. Objective: to identify the associations of maternal variables with the trophic condition of the newborn. Methods: a descriptive study was carried out in three health areas from Santa Clara municipality between January 2013 and December 2020. A random sample of 2,454 was selected from a population of 6,035 newborns. Information on maternal and newborn variables was obtained. Non-parametric tests of independence based on the Chi-square distribution and Kruskal Wallis were applied in the statistical analysis. Results: the variables studied showed a relationship with the trophic condition at birth, except for age. Poor nutritional status was more frequent in small births and obesity in large ones. In large births, higher percentages of pregnant women at risk of gestational diabetes were observed. Hypertensive disorders, anemia, urinary tract infection, vaginal sepsis and smoking were present in higher percentages in pregnant women whose newborns were small. Conclusions: from the studied variables, the risk of gestational diabetes and hypertensive disorders showed the strongest association with the trophic status at birth.

Resultados maternos perinatales vinculados a la macrosomía fetal / Perinatal maternal outcomes linked to fetal macrosomia

RESUMEN Introducción: la macrosomía fetal ha estado asociada a una alta tasa de morbilidad y mortalidad materna y perinatal. Objetivo: identificar las peculiaridades maternas asociadas a un feto macrosómico en el Hospital Abel Santamaría, entre el 2018 y 2020. Métodos: se realizó un estudio observacional, transversal y retrospectivo en el Hospital Abel Santamaría, entre el 2018 y 2020. El universo estuvo conformado por todos los neonatos nacidos en el período antedicho, mientras que la muestra se formó por un grupo de fetos macrosómicos escogidos según la fórmula muestral y dos neonatos con peso entre 3 000 y 3 500 gramos (grupo control); los resultados se analizaron por diferentes métodos estadísticos, además se utilizó el Chi cuadrado con nivel de significación de p < 0,05 y el Odds Ratio. Resultados: se obtuvo que los fetos macrosómicos tuvieron relación altamente significativa con la edad gestacional de 40 a 41,6 semanas, y la cesárea; asimismo, el sexo masculino, el Apgar bajo al minuto y los cinco minutos se asociaron al macrofeto. Hubo mayor número de complicaciones maternas y neonatales en el grupo estudio. Conclusiones: la macrosomía fetal es un evento obstétrico que se asocia altamente con resultados maternos y perinatales desfavorables.

ABSTRACT Introduction: fetal macrosomia has been associated with a high rate of maternal and perinatal morbidity and mortality. Objective: to identify the maternal peculiarities that associated with a macrosomic fetus in the Abel Santamaría Hospital, between 2018 and 2020. Methods: an observational, cross-sectional and retrospective study was conducted at the Abel Santamaría Hospital, between 2018 and 2020; the universe was made up of all the neonates born in the aforementioned period, while the sample was formed by a group of macrosomic fetuses chosen according to the sample formula and two neonates weighing between 3000 and 3500 grams (control group); the results were analyzed by different statistical methods, in addition Chi-square with significance level of p < 0,05 and Odds Ratio were used. Results: macrosomic fetuses had a highly significant relationship with gestational age from 40 to 41,6 weeks, and cesarean section; likewise, male sex, low Apgar at one minute and five minutes were associated with macrosomia. There were more maternal and neonatal complications in the study group. Conclusions: fetal macrosomia is an obstetric event that is highly associated with unfavorable maternal and perinatal outcomes.

Relación entre el índice de masa corporal y el nivel de los ácidos grasos circulantes maternos como predictores de la presencia de la macrosomía fetal / Relationship between body mass index and maternal circulating fatty acid levels as predictors of the presence of fetal macrosomia

Introducción: los recién nacidos con peso elevado al nacer presentan mayor riesgo de complicaciones en el parto y problemas de salud a largo plazo. Un factor poco explorado durante la gestación es el nivel de los ácidos grasos circulantes. Materiales y métodos: estudio prospectivo donde se estudiaron mujeres durante el embarazo hasta el parto. Se analizaron las variables antropométricas y la medición de ácidos grasos libres entre las semanas 24-28 de gestación. Resultados: se incluyeron 27 pacientes, de las cuales cuatro (13,8%) dieron a luz a recién nacidos macrosómicos. Las pacientes se agruparon según el índice de masa corporal (IMC) preembarazo en normopeso y sobrepeso u obesidad. Los bebés macrosómicos correspondieron al grupo de madres con sobrepeso y obesidad que, además, tuvieron un incremento significativo de los niveles de ácidos grasos libres (2067 uM, ICC: 947,5-1590 vs 1212 uM, ICC: 13367-2247; p<0,05) en el grupo obesidad y sobrepeso. Los valores de glucemia basal y posteriores a la prueba de tolerancia oral a la glucosa no mostraron diferencias. El análisis multivariado reveló que tener obesidad o sobrepeso al inicio del embarazo resulta en un odds ratio (OR) de ácidos grasos libres de 1,0023 (IC9 5%:1,0000-1,0046), mientras que la prueba de tolerancia oral a la glucosa presentó un OR: 1,0186 (IC 95%: 0,9645-1,0756). Conclusiones: los resultados muestran el rol del IMC pregestacional sobre el riesgo de tener hijos macrosómicos, lo que confirma la necesidad de mejorar el estado nutricional de las mujeres antes y durante el embarazo.

Introduction: neonates with high birth weight are at increased risk of birth complications and long term health problems. An unexplored factor during gestation is the level of circulating fatty acids. Materials and methods: prospective study where women were studied during pregnancy until delivery. Anthropometric variables and free fatty acid measurements were analyzed between 24-28 weeks of gestation. Results: we included 27 patients, of whom 4 (13.8%) gave birth to macrosomic newborns. Patients were grouped according to pre-pregnancy mass index (BMI) into normal weight and overweight or obese. Macrosomic neonates corresponded to the group of overweight and obese mothers, who also presented a significant increase in free fatty acid levels (2067 uM, ICC: 947,5-1590 vs 1212 uM, ICC: 13367-2247; p<0.05) was found in the obese and overweight group. Basal and post oral glucose tolerance test showed no differences, Multivariate analysis showed that being obese or overweight at the beginning of pregnancy results in an OR of free fatty acids 1,0023 (95%CI: 1,0000-1,0046), while oral glucose tolerance test presented an OR: 1,0186 (95%CI: 0,9645-1,0756). Conclusions: the results show the role of pre-gestational BMI on the risk of having macrosomic children, confirming the need to improve the nutritional status of women before and during pregnancy

Resultados neonatales adversos según grados de obesidad pregestacional en un hospital público del sur de Perú, 2010 a 2019

Introducción: La obesidad materna, creciente problema de salud pública mundial, se relaciona con morbimortalidad neonatal. El objetivo fue determinar los resultados neonatales adversos según los grados de obesidad pregestacional. Material y método: Estudio analítico, de cohorte retrospectiva, en gestantes de embarazo único, de parto atendido en el hospital Hipólito Unanue de Tacna Perú, durante 2010 a 2019, con recién nacido vivo, los casos fueron 5935 madres con índice de masa corporal pregestacional de 30 Kg/m2 a más, agrupadas en grado I (IMC 30-34,9 Kg/m2), II (IMC 35-39,9 Kg/m2) y III (IMC>40 Kg/m2), los controles madres con IMC de 18-24,9 Kg/m2. Se excluyeron gestantes con diabetes mellitus, preeclampsia, eclampsia y anomalías congénitas. Se utilizó Riesgo Relativo (RR) crudo y ajustado por edad materna, escolaridad y paridad, con intervalo de confianza al 95%. Resultados: La frecuencia de obesidad pregestacional fue 14,3% grado I, 3,8% grado II y 1% grado III. Los resultados neonatales que se asociaron fueron: peso al nacer >4000 gramos, para obesidad grado I (RRa: 1,9; IC95%:1,7-2,0), grado II (RRa: 2,0; IC95%:1,8-2,3) y grado III (RRa: 2,1; IC95%:1,7-2,5); grande para la edad gestacional para grado I (RRa: 1,6; IC95%: 1,4-1,7), grado II (RRa: 1,7; IC95%: 1,6-1,9) y grado III (RRa: 1,8; IC95%: 1,4-2,1). Conclusiones: Existe mayor riesgo de macrosomía fetal y grande para la edad gestacional a mayor grado de obesidad pregestacional materna.

Background: Maternal obesity, a growing global public health problem, is related to neonatal morbidity and mortality. The objective was to determine adverse neonatal outcomes according to degrees of pregestational obesity. Material and method: Analytical study, retrospective cohort, in pregnant women with a single pregnancy, delivery attended at the Hipolito Unanue hospital in Tacna, Peru, during 2010 to 2019, with live newborns, the cases were 5935 mothers with pre-pregnancy body mass index from 30 Kg/m2 to more, grouped in grade I (BMI 30-34.9 Kg/m2), II (BMI 35-39.9 Kg/m2) and III (BMI>40 Kg/m2), the control mothers with a BMI of 18-24.9 Kg/m2. Pregnant women with diabetes mellitus, preeclampsia, eclampsia and congenital anomalies were excluded. Crude Relative Risk (RR) was used, adjusted for maternal age, schooling and parity, with a 95% confidence interval. Results: The frequency of pre-pregnancy obesity was 14.3% grade I, 3.8% grade II and 1% grade III. The associated neonatal outcomes were: birth weight >4000 grams, for grade I obesity (RRa: 1.9; 95% CI: 1.7-2.0), grade II (RRa: 2.0; 95% CI: 1.8-2.3) and grade III (RRa: 2.1; CI95%: 1.7-2.5); large for gestational age for grade I (RRa: 1.6; 95% CI: 1.4-1.7), grade II (RRa: 1.7; 95% CI: 1.6-1.9) and grade III (RRa: 1.8; CI95%: 1.4-2.1). Conclusions: There is an increased risk of fetal macrosomia and large for gestational age with a higher degree of maternal pregestational obesity.

Altura uterina versus ecografía obstétrica para detectar macrosomía fetal. Hospital San Juan de Kimbiri, Perú

RESUMEN Fundamento Aunque la ecografía obstétrica es ampliamente utilizada en los niveles primario y secundario de salud para la detección de macrosomía fetal, la altura uterina también puede resultar útil, sobre todo, en contextos sanitarios desprovistos de equipamiento tecnológico. Objetivo determinar la correlación entre altura uterina versus ecografía obstétrica y el diagnóstico de macrosomía fetal. Métodos estudio descriptivo, correlacional, en madres no diabéticas de partos a término con neonatos macrosómicos, realizado en un hospital público del Valle de los ríos Apurímac, Ene y Mantaro, Perú. Las variables del estudio: edad materna, índice de masa corporal pregestacional, número de embarazos, edad gestacional al parto, y vía del parto. Se emplearon los coeficientes de correlación Rho de Spearman, y Pearson, ambos con intervalos de confianza al 95 % y error del 5 %. Resultados la estimación del peso fetal y la macrosomía se correlacionaron con la altura uterina (R Pearson 0,05). Entre las características maternas asociadas a neonatos macrosómicos, se hallaron la obesidad pregestacional (Rho = 0,009) y la condición de multigesta (Rho = 0,04). La estimación del peso fetal mayor a 4000 g tuvo mayor porcentaje de acierto (26,3 %) por ecografía obstétrica. Conclusión la ecografía obstétrica mostró mayor correlación que la altura uterina con el diagnóstico de macrosomía fetal.

ABSTRACT Background Although obstetric ultrasound is widely used at primary and secondary health levels for the detection of fetal macrosomia, uterine height can also be useful, especially in health contexts lacking technological equipment. Objective to determine the correlation between uterine height versus obstetric ultrasound and the diagnosis of fetal macrosomia. Methods descriptive, correlational study in non-diabetic mothers of full-term deliveries with macrosomic neonates, carried out in a public hospital in the Valley of the Apurímac, Ene and Mantaro rivers, Peru. The study variables: maternal age, pre-pregnancy body mass index, number of pregnancies, gestational age at delivery, and route of delivery. Spearman's Rho and Pearson's correlation coefficients were used, both with 95% confidence intervals and 5% error. Results Fetal weight estimation and macrosomia correlated with uterine height (Pearson's R 0.05). Among the maternal characteristics associated with macrosomic neonates, pregestational obesity (Rho = 0.009) and multigestational condition (Rho = 0.04) were found. The estimation of fetal weight greater than 4000 g had a higher percentage of success (26.3%) by obstetric ultrasound. Conclusion obstetric ultrasound showed a higher correlation than uterine height with the diagnosis of fetal macrosomia.

Nursing care of a child with Beckwith-Wiedemann Syndrome frequent hypoglycemia / 中国实用护理杂志

Objective:To summarize the experience of blood glucose management and nursing for a newborn with repeated hypoglycemia in Beckwith-Wiedemann syndrome.Method:A multidisciplinary team was formed, and formulated an individualized care plan for a large infant with Beckwith-Wiedemann syndrome. A dynamic blood glucose monitoring system was used to closely monitor blood glucose fluctuations for this children, dynamically adjusted the amount of infusion and milk according to the blood sugar situation, detected and dealed with hypoglycemia in time, strengthened the skin care of child and implemented psychological care for the family.Results:After refined treatment and care, the child′s vital signs were stable, and his blood sugar could maintain within a normal range before being discharged from the hospital.Conclusions:The use of dynamic blood glucose monitoring system under the guidance of a multidisciplinary team can effectively monitor and control the blood glucose fluctuations of children with BWS syndrome, which can provide a basis for further treatment of children.

Application of random forest algorithm and logistic regression in predicting the risk of macrosomia / 公共卫生与预防医学

Objective To establish macrosomia risk prediction models based on a cohort study, and to analyze and compare the results. Methods The research subjects were the pregnant women of the Chinese Pregnant Women Cohort Study. The general demographic information and clinical data of pregnant women were collected through the questionnaire and physical examination, and the related outcomes of newborns were obtained by follow-up. The dataset was divided into training set and test set by a 3:1 ratio. Multivariate logistic regression analysis (LR) and random forest algorithm (RF) were used to construct macrosomia risk prediction models in the training set, and the models were verified in the test set. The prediction efficiency of the models was evaluated by Kappa and the area under the receiver operating characteristic curve (ROC). Results Among 5544 pregnant women, 397 women delivered macrosomia, and the incidence of macrosomia was 7.16%. Among the pregnant women who delivered macrosomia, 10.08% (40/397) were over 35 years old, 27.46% (109/397) were overweight or obese, and 60.96% (242/397) were excessive gestational weight gain (GWG). LR was used to establish a macrosomia risk prediction model to predict the test set, with the accuracy of 0.716, the sensitivity of 0.719, the specificity of 0.715, the Kappa value of 0.428, the Yoden index of 0.393, and the AUC of 0.796 (95% CI: 0.777-0.815). RF was used to construct a risk prediction model to predict the test set, with the accuracy of 0.819, the sensitivity of 0.782, the specificity of 0.846, the Kappa value of 0.629, the Yoden index of 0.439, and the AUC of 0.897 (95% CI: 0.883-0.910). Conclusion The prediction effect of the two models is satisfactory. The random forest algorithm has a higher predictive effect on the risk of macrosomia in this cohort, but the multivariate logistic regression analysis can directly explain the influencing factors of the macrosomia. It is suggested to integrate the advantages of the two models in the future, so that they can play a more important role in macrosomia risk prediction.

A retrospective identification of risk factors associated with fetal macrosomia

Despite extensive work on macrosomia, it is impossible to predict women at risk. Current prediction strategies which include clinical examination and ultrasound are imprecise. This study aims to determine the risk factors associated with macrosomia. It was a descriptive, retrospective chart review of women delivered of macrosomic neonates over a two-year period from 2015-2016. Detailed clinical and demographic information was recorded. Statistical analysis was carried out using SPSS (version 25.0 IBM, Armonk, New York, USA). Of 22 244 singleton deliveries, 415 were macrosomic infants (1.9%). The mean birth weight for macrosomic infants was 4.39 ± 0.43 (range 4-5.15) kg and males were more in number and weight. Macrosomic infants occurred more in age groups 25-29 years and peaked with BMI ≥30 kg/m2 . Majority were cesarean sections compared to vaginal deliveries (56.6% vs 43.4%; p=0.006) respectively. Vaginal delivery of macrosomic infants was associated with complications. Significant differences were found between fetal macrosomia and clinical characteristics such as body mass index, parity, advanced maternal age, and male fetal sex. Hypoglycaemia was most frequent in infants born to non-diabetic mothers (98.1%). Antenatal risk factors are important in the prediction of macrosomia, but fetal and maternal outcome depends on labour management. (Afr J Reprod Health 2022; 26[7]: 127-134).