La obesidad materna como factor de riesgo para defectos congénitos / Maternal obesity as a risk factor for birth defects

RESUMEN

Objetivos: La prevalencia mundial de la obesidad se ha incrementado significativamente en las últimas décadas. Los cambios en los factores socioeconómicos y el estilo de vida influyen en el deterioro de los hábitos alimentarios de las mujeres en edad reproductiva. El objetivo del presente estudio fue estimar el riesgo de defectos congénitos (DC) asociados a sobrepeso y obesidad materna preconcepcional. Material y métodos: Diseño observacional y analítico, retrospectivo, tipo caso-control. Población Los registros del Sistema Informático Perinatal y en la base de datos del sector de Genética Médica de la Maternidad Sardá entre 1995-2000. Criterios de inclusión Todos los recién nacidos (RN) vivos, de más de 25 semanas de edad gestacional y más de 500 g de peso al nacer. Criterios de exclusión Fetos muertos, ausencia de datos del IMC materno y del registro de DC. Factor de riesgo sobrepeso materno (S, IMC 25,0-29,9 kg/m2), obesidad materna (O, IMC materno ≥30 kg/m2) y la combinación de ambos (SO, IMC ≥25,0 kg/m2) (presente/ausente). Resultados: Se incluyeron 18.098 pares madre-recién nacido (RN), 64,5% (IC 95% 63,9-65,0) de la base original. La prevalencia de S fue del 25,6% (24,9-26,2) y la de O 10,2% (9,7-10). La prevalencia global de DC fue 2,57% (2,35-2,82); para peso normal (≤25,0 kg/m2) fue de 2,61% (2,33-2,91), para S 2,31% (1,92-2,78) y para O 3,04% (2,34-3,92) (chi2 p= 0,377; p= 0,692). La distribución de las características demográficas, obstétricas y neonatales entre casos y controles, fueron similares. En comparación con mujeres de PN los riesgos no ajustados de DC asociados a sobrepeso y obesidad materna fueron 0,88 (IC 95% 0,70-1,11) y 1,17 (0,87-1,58) respectivamente; tampoco hubo diferencias según la gravedad de DC. Luego del ajuste por covariados estos resultados no se modificaron... (TRUNCADO)

ABSTRACT

Objective: To estimate the risk for birth defects associated with prepregnancy maternal obesity. We have also examined the relationship between maternal prepregnancy obesity and overweight and several birth defects and have compared our findings with those of previous studies. Methods: A case-control study of several birth defects was performed with data of the Perinatal Informatic System of Sardá Maternity Hospital (Buenos Aires) between 1995-2000. Mothers who delivered a live infant with and without birth defects were included. Registers without anthropometric measures of the mother were excluded. Maternal body mass index (BMI) was calculated from weight and height. Women with known pre-existing or gestational diabetes were included. The risks for overweight women (BMI 25.0-29.9 kg/m2) and obese women (BMI≥30) were compared with those for average-weight women (BMI <25.0). Results: 18,098 mothers were included. Overall prevalence of birth defects was 2.57% (95% CI 2.35-2.82). Prevalence for average-weight women was 2.61% (2.33-2.91), for overweight women 2.31% (1.92-2.78) and for obese women 3.04% (2.34-3.92) (chi2 p = 0.377; chi2 for lineal trend p = 0.692). Demographic, obstetric and neonatal characteristics were similar between cases and controls. When compared with average-weight women, the crude risks for birth defects were 0.88 (I 95% CI 0.70-1.11) and 1.17 (0.87-1.58) for overweight and obese women, respectively. No differences were found after adjusting for potential confounders. A higher risk for some birth defects were observed. Maternal age and maternal diabetes showed a slight increase in the risk, whereas maternal education and gestational age were associated with a statistically significant protective effect. Conclusions: Our study did not confirm the previously established association between birth defects and prepregnancy maternal obesity... (TRUNCADO)