[Effect of high altitude on birth weight and adverse perinatal outcomes in two Argentine populations]. / Efecto de la altitud sobre el peso al nacer y eventos perinatales adversos en dos poblaciones argentinas.

INTRODUCTION: Depending on the geographical altitude the purpose of this work was to analyze in two argentine populations the variation of birth weight (BW) and adverse perinatal outcomes, adjusting for maternal and obstetric factors. MATERIAL AND METHODS: Data from 4000 births in the provinces of Jujuy and 4000 in Buenos Aires (Sarda Maternity Hospital) (1996-2000) recruited and randomized from the Perinatal Information System was used. The data were grouped according to an altitudinal gradient composed by Sarda Maternity (20 masl) and the geographic regions of Jujuy province: Ramal (500 masl), Valle (1200 masl), Quebrada (2500 masl) and Puna (3500 masl). Outcome variables were BW > 3000 g, BW <2500 g, ponderal index (PI), prematurity, small for gestational age (SGA) and intrauterine growth restriction (FGR), while potentially confounding variables were: age, type of partner, education, overweight, obesity, smoking, hypertension, preeclampsia, urinary infection, growth restriction and cesarean section. RESULTS: An increasing altitudinal gradient for adolescent mothers (<19 years) and decreasing for the rest of the maternal obstetric variables was observed. The BW, BW>3000 g, BW<2500 g and PI were negatively associated with altitude (p <0.001). Prematurity, SGA and FGR showed an opposite trend (p <0.001). Adjusted for confounding variables BW <3000 g, SGA, FGR<0.90 and PI <2.53 showed an increased risk with geographical altitude (p <0.05). CONCLUSIONS: Altitude was independently associated with BW restriction and adverse perinatal outcomes. Given the impact of BW reduction in the risk of chronic no communicable diseases this relationship in other populations, regardless of their location altitude, should be assess.

Introducción: existe poca información sobre la relación entre tamaño al nacer y altura geográfica ajustada para factores maternos y obstétricos potencialmente confusores. Objetivo: analizar la variación, en función de la altitud geográfica, del Peso al Nacimiento (PN) y resultados perinatales adversos, en dos poblaciones argentinas. Material y Métodos: 4000 registros de recién nacidos (RN) de Jujuy y 4000 de Buenos Aires (Maternidad Sardá) (1996-2000), seleccionados y aleatorizados del Sistema Informático Perinatal. Los datos provenían de la Maternidad Sarda (20 msnm) y las regiones jujeñas: Ramal (500 msnm), Valle (1200 msnm), Quebrada (2500 msnm) y Puna (3500 msnm). Variables resultado: PN >3000 g, PN <2500 g, Índice Ponderal (IP), prematurez, pequeño para edad gestacional (PEG) y restricción del crecimiento intrauterino (FGR). Variables confusoras: edad, tipo de pareja, educación, sobrepeso-obesidad, tabaquismo, hipertensión arterial, preeclampsia, infección urinaria, restricción del crecimiento y terminación cesárea. Resultados: Se observó un gradiente altitudinal creciente para madres adolescentes y decreciente para las variables obstétrico-maternas. El PN, PN >3000 g, PN <2500 g e Índice Ponderal se asociaron negativamente con altitud (p<0.001). La prevalencia de prematurez, PEG y FGR mostraron un comportamiento opuesto (p<0.001). Ajustados para variables confusoras el PN<3000 g, PEG, FGR < 0.90 e IP<2.53 mostraron mayor riesgo con la altitud geográfica (p<0.05). Conclusiones: La altitud se asoció independientemente con restricción del PN y resultados perinatales adversos. Dado el impacto de la reducción del PN en el riesgo de enfermedades crónicas no transmisibles, se debería evaluar esta relación en otras poblaciones, independientemente de su localización altitudinal.

Efecto de la altitud sobre el peso al nacer y eventos perinatales adversos en dos poblaciones argentinas / [Effect of high altitude on birth weight and adverse perinatal outcomes in two Argentine populations].

INTRODUCTION: Depending on the geographical altitude the purpose of this work was to analyze in two argentine populations the variation of birth weight (BW) and adverse perinatal outcomes, adjusting for maternal and obstetric factors. MATERIAL AND METHODS: Data from 4000 births in the provinces of Jujuy and 4000 in Buenos Aires (Sarda Maternity Hospital) (1996-2000) recruited and randomized from the Perinatal Information System was used. The data were grouped according to an altitudinal gradient composed by Sarda Maternity (20 masl) and the geographic regions of Jujuy province: Ramal (500 masl), Valle (1200 masl), Quebrada (2500 masl) and Puna (3500 masl). Outcome variables were BW > 3000 g, BW 3000 g, BW<2500 g and PI were negatively associated with altitude (p <0.001). Prematurity, SGA and FGR showed an opposite trend (p <0.001). Adjusted for confounding variables BW <3000 g, SGA, FGR<0.90 and PI <2.53 showed an increased risk with geographical altitude (p <0.05). CONCLUSIONS: Altitude was independently associated with BW restriction and adverse perinatal outcomes. Given the impact of BW reduction in the risk of chronic no communicable diseases this relationship in other populations, regardless of their location altitude, should be assess.

Efecto de la altitud sobre el peso al nacer y eventos perinatales adversos en dos poblaciones argentinas. / [Effect of high altitude on birth weight and adverse perinatal outcomes in two Argentine populations].

INTRODUCTION: Depending on the geographical altitude the purpose of this work was to analyze in two argentine populations the variation of birth weight (BW) and adverse perinatal outcomes, adjusting for maternal and obstetric factors. MATERIAL AND METHODS: Data from 4000 births in the provinces of Jujuy and 4000 in Buenos Aires (Sarda Maternity Hospital) (1996-2000) recruited and randomized from the Perinatal Information System was used. The data were grouped according to an altitudinal gradient composed by Sarda Maternity (20 masl) and the geographic regions of Jujuy province: Ramal (500 masl), Valle (1200 masl), Quebrada (2500 masl) and Puna (3500 masl). Outcome variables were BW > 3000 g, BW <2500 g, ponderal index (PI), prematurity, small for gestational age (SGA) and intrauterine growth restriction (FGR), while potentially confounding variables were: age, type of partner, education, overweight, obesity, smoking, hypertension, preeclampsia, urinary infection, growth restriction and cesarean section. RESULTS: An increasing altitudinal gradient for adolescent mothers (<19 years) and decreasing for the rest of the maternal obstetric variables was observed. The BW, BW>3000 g, BW<2500 g and PI were negatively associated with altitude (p <0.001). Prematurity, SGA and FGR showed an opposite trend (p <0.001). Adjusted for confounding variables BW <3000 g, SGA, FGR<0.90 and PI <2.53 showed an increased risk with geographical altitude (p <0.05). CONCLUSIONS: Altitude was independently associated with BW restriction and adverse perinatal outcomes. Given the impact of BW reduction in the risk of chronic no communicable diseases this relationship in other populations, regardless of their location altitude, should be assess.

Mortality and morbidity of very low birth weight newborn infants assisted in Buenos Aires public hospitals.

INTRODUCTION: The Neonatal Network of Public Hospitals in the city of Buenos Aires closely monitors the progress of newborn infants with a birth weight less than 1500 g (very low birth weight, VLBW) because it largely contributes to neonatal morbidity and mortality. OBJECTIVE: To analyze the morbidity and mortality of VLBW infants and determine their riskadjusted mortality using the score of the South American Neonatal Network (Red Neonatal de los países del Conosur de América, NEOCOSUR). MATERIAL AND METHODS: Live infants born in the network hospitals with a birth weight of 500-1499 g between 2008 and 2010 were included in the study. Data was recorded prospectively using a standardized methodology. Mortality, morbidity and risk-adjusted mortality rates according to the NEOCOSUR score were estimated. Results. There were 92,698 infants born during the study period. Of them, 1.26% weighed less than 1500 g at birth. Only 40.4% of these received a full course of antenatal corticosteroids. A total of 62.7% of these developed respiratory distress syndrome, 5.4% enterocolitis, 10.1% intracranial hemorrhage, and 13.4% severe retinopathy. Early sepsis was observed in 5.6%, and late sepsis in 9.6%. Bronchopulmonary dysplasia was present in 10.7% of the cases. Neonatal mortality was 29.2%, and the adjusted mortality with no major malformations was 25.4%. Survival of infants with a birth weight of =750 g and a gestational age of =26 weeks was 50%. The observed/expected mortality ratio was 1.04, with a large variability. CONCLUSIONS: The percentage of VLBW infants who received antenatal corticosteroids was low. The incidence of sepsis and the rate of infants with severe retinopathy of prematurity are high. The risk-adjusted mortality is higher than expected.

Morbimortalidad de recién nacidos con menos de 1500 gramos asistidos en hospitales públicos de la ciudad de Buenos Aires / Mortality and morbidity of very low birth weight newborn infants assisted in Buenos Aires public hospitals

Introducción. La red neonatal de los hospitales públicos porteños desarrolla una estrecha vigilancia de la evolución de los neonatos con menos de 1500 g (RNMBPN), pues contribuyen en gran medida a la morbimortalidad neonatal. Objetivo. Analizar la morbimortalidad de los RNMBPN y determinar la mortalidad ajustada por riesgo utilizando el puntaje de la Red Neonatal de los países del cono sur de América (NEOCOSUR). Material y métodos. Se incluyeron todos los recién nacidos vivos en hospitales de la red con peso de 500-1500 g desde 2008 a 2010. Los datos se registraron prospectivamente con metodología estandarizada. Se calcularon las tasas de mortalidad, morbilidad y la mortalidad ajustada por riesgo según puntaje de NEOCOSUR. Resultados. En el período del estudio nacieron 92 698 niños de los cuales 1,26% pesó menos de 1500 g. Sólo 40,4% recibió corticoides antenatales completos. Un 62,7% desarrolló síndrome de difcultad respiratoria, 5,4% enterocolitis, 10,1% hemorragia endocraneana y 13,4% retinopatía grave. La sepsis precoz fue del 5,6%, la tardía de 9,6%. Un 10,7% presentó displasia broncopulmonar. La mortalidad neonatal fue del 29,2% y la ajustada sin malformados graves, 25,4%. La supervivencia de niños con peso =750 g y edad gestacional =26 semanas fue de 50%. El cociente mortalidad observada/esperada fue de 1,04, con gran variabilidad. Conclusiones. El porcentaje de RNMBP que recibió corticoides antenatales es bajo. La incidencia de sepsis y la proporción de niños con ROP grave son elevadas. La mortalidad ajustada por riesgo es superior a la esperada.

Introduction. The Neonatal Network of Public Hospitals in the city of Buenos Aires closely monitors the progress of newborn infants with a birth weight less than 1500 g (very low birth weight, VLBW) because it largely contributes to neonatal morbidity and mortality. Objective. To analyze the morbidity and mortality of VLBW infants and determine their riskadjusted mortality using the score of the South American Neonatal Network (Red Neonatal de los países del Conosur de América, NEOCOSUR). Material and Methods. Live infants born in the network hospitals with a birth weight of 500-1499 g between 2008 and 2010 were included in the study. Data was recorded prospectively using a standardized methodology. Mortality, morbidity and risk-adjusted mortality rates according to the NEOCOSUR score were estimated. Results. There were 92,698 infants born during the study period. Of them, 1.26% weighed less than 1500 g at birth. Only 40.4% of these received a full course of antenatal corticosteroids. A total of 62.7% of these developed respiratory distress syndrome, 5.4% enterocolitis, 10.1% intracranial hemorrhage, and 13.4% severe retinopathy. Early sepsis was observed in 5.6%, and late sepsis in 9.6%. Bronchopulmonary dysplasia was present in 10.7% of the cases. Neonatal mortality was 29.2%, and the adjusted mortality with no major malformations was 25.4%. Survival of infants with a birth weight of =750 g and a gestational age of =26 weeks was 50%. The observed/expected mortality ratio was 1.04, with a large variability. Conclusions. The percentage of VLBW infants who received antenatal corticosteroids was low. The incidence of sepsis and the rate of infants with severe retinopathy of prematurity are high. The risk-adjusted mortality is higher than expected.

Morbimortalidad de recién nacidos con menos de 1500 gramos asistidos en hospitales públicos de la ciudad de Buenos Aires / Mortality and morbidity of very low birth weight newborn infants assisted in Buenos Aires public hospitals

Introducción. La red neonatal de los hospitales públicos porteños desarrolla una estrecha vigilancia de la evolución de los neonatos con menos de 1500 g (RNMBPN), pues contribuyen en gran medida a la morbimortalidad neonatal. Objetivo. Analizar la morbimortalidad de los RNMBPN y determinar la mortalidad ajustada por riesgo utilizando el puntaje de la Red Neonatal de los países del cono sur de América (NEOCOSUR). Material y métodos. Se incluyeron todos los recién nacidos vivos en hospitales de la red con peso de 500-1500 g desde 2008 a 2010. Los datos se registraron prospectivamente con metodología estandarizada. Se calcularon las tasas de mortalidad, morbilidad y la mortalidad ajustada por riesgo según puntaje de NEOCOSUR. Resultados. En el período del estudio nacieron 92 698 niños de los cuales 1,26% pesó menos de 1500 g. Sólo 40,4% recibió corticoides antenatales completos. Un 62,7% desarrolló síndrome de difcultad respiratoria, 5,4% enterocolitis, 10,1% hemorragia endocraneana y 13,4% retinopatía grave. La sepsis precoz fue del 5,6%, la tardía de 9,6%. Un 10,7% presentó displasia broncopulmonar. La mortalidad neonatal fue del 29,2% y la ajustada sin malformados graves, 25,4%. La supervivencia de niños con peso =750 g y edad gestacional =26 semanas fue de 50%. El cociente mortalidad observada/esperada fue de 1,04, con gran variabilidad. Conclusiones. El porcentaje de RNMBP que recibió corticoides antenatales es bajo. La incidencia de sepsis y la proporción de niños con ROP grave son elevadas. La mortalidad ajustada por riesgo es superior a la esperada.(AU)

Introduction. The Neonatal Network of Public Hospitals in the city of Buenos Aires closely monitors the progress of newborn infants with a birth weight less than 1500 g (very low birth weight, VLBW) because it largely contributes to neonatal morbidity and mortality. Objective. To analyze the morbidity and mortality of VLBW infants and determine their riskadjusted mortality using the score of the South American Neonatal Network (Red Neonatal de los países del Conosur de América, NEOCOSUR). Material and Methods. Live infants born in the network hospitals with a birth weight of 500-1499 g between 2008 and 2010 were included in the study. Data was recorded prospectively using a standardized methodology. Mortality, morbidity and risk-adjusted mortality rates according to the NEOCOSUR score were estimated. Results. There were 92,698 infants born during the study period. Of them, 1.26% weighed less than 1500 g at birth. Only 40.4% of these received a full course of antenatal corticosteroids. A total of 62.7% of these developed respiratory distress syndrome, 5.4% enterocolitis, 10.1% intracranial hemorrhage, and 13.4% severe retinopathy. Early sepsis was observed in 5.6%, and late sepsis in 9.6%. Bronchopulmonary dysplasia was present in 10.7% of the cases. Neonatal mortality was 29.2%, and the adjusted mortality with no major malformations was 25.4%. Survival of infants with a birth weight of =750 g and a gestational age of =26 weeks was 50%. The observed/expected mortality ratio was 1.04, with a large variability. Conclusions. The percentage of VLBW infants who received antenatal corticosteroids was low. The incidence of sepsis and the rate of infants with severe retinopathy of prematurity are high. The risk-adjusted mortality is higher than expected.(AU)

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

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)

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)

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

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) (AU)

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) (AU)

Evaluación nutricional durante el embarazo: Nuevo estándar / Nutrition assessment during pregnancy: A new weight chart

Los límites para el aumento de peso ideal de una mujer embarazada y el patrón de ganancia de peso han sido poco estudiados en nuestra región. Los objetivos fueron: 1) construir una nueva curva de distancia del índice de masa corporal (IMC) para evaluación nutricional de la embarazada; 2) calcular la ganancia media de peso semanal y total por trimestres, y 3) comparar la nueva curva con un estándar propuesto como referente. Se incluyeron 326 embarazadas antes de la 16ª semana en el Hospital Sardá (Buenos Aires) entre 2001 y 2002. Se midieron peso, talla, perímetro braquial y pliegue tricipital. Se calcularon media, desviación estándar y coeficiente de variación (CV). Los percentilos reales 3 al 97 del peso y del IMC materno para la edad gestacional entre la 12ª y 42ª semana se calcularon mediante interpolación polinómica. El CV alcanzó un valor máximo del 18.4% después de la 28ª semana. El promedio del IMC preconcepcional fue de 24.2 kg/m² ± 4.5 y el 96% de los recién nacidos fueron de término con un índice ponderal de 2.7 ± 0.2 g/cm³. Los incrementos de peso fueron 0.600 kg ± 0.473, 6.476 kg ± 3.739 y 5.388kg ± 4.233 para el 1°, 2° y 3° trimestres respectivamente. Se observó concordancia entre la media de la nueva curva y el límite superior de la categoría "normal" de la curva actualmente recomendada. Los nuevos estándares de la ganancia de peso según peso e IMC permitirán lograr un adecuado control del incremento de peso gestacional.

Weight charts and patterns of weight gain for pregnant women in Argentina are scarce. The aims of the study were:1) to design a new reference weight gain chart to asses the nutritional status of pregnant women using the body mass index (BMI); 2) to estimate weight gain patterns, and 3) to compare it with a proposed reference chart. In 326 pregnant women before 16th week gestation at enrollment during 2001-2002 at the Sarda' Maternity Hospital (Buenos Aires), weight, height, mid arm circumference and skinfold were measured and body mass index was calculated. Mean, standard deviation, coefficient of variation and polynomial percentiles 3rd through 97th were generated for each gestational age between 12th to 42nd weeks. Maximum variability was 18.4% after 28th week, mean preconcepcional BMI was 24.2 ± 4.5 kg/m² and 96% of newborns were at term with a mean Ponderal Index of 2.7 ± 0.2 g/cm³. Trimesters weight increments were 0.600 kg ± 0.473, 6.476 kg ± 3.739 and 5.388kg ± 4.233 for the 1st, 2nd and 3rd, respectively. Total weight gain achieved was 12.46 Kg ± 3.13. Compared with the reference curve, the new one showed concordance at the 50th percentile with the upper limit of the normal range. The new reference charts of weight gain for pregnant women using maternal weight and BMI may be useful in prenatal care to asses nutritional status during pregnancy.

The contribution of birth defects to spontaneous preterm birth.

The purpose of this study was to determine if and which birth defects (BDs) are risk factors for spontaneous preterm delivery, and to quantify that risk. A case-control study of spontaneously delivered term (n = 21,093) and preterm (n = 2937; 12.2%) liveborn neonates, between 1996 and 2000, at Ramón Sardá Maternity Hospital of Buenos Aires, was performed. Selected risk factors were compared between term and preterm neonates, and risks of preterm birth in the presence of BDs were evaluated, using stratified and logistic regression analyses. Preterm versus term neonates showed higher rates of most of the selected maternal and neonatal risk factors. The prevalence of BDs among preterm and term neonates was 4.1 and 2.0%, respectively (p < 0.001). Newborns with BDs showed a higher adjusted risk for preterm birth than those without BDs (odds ratio, 2.16; 95% confidence interval, 1.92 to 2.40), with the highest risks for skeletal dysplasias, abdominal wall defects, chromosome, multiple, and minor anomalies. That neonates with BDs are at risk for spontaneous preterm birth, regardless of other factors, should lead to a readjustment of health policies aimed at the reduction of preterm delivery.

[Nutrition assessment during pregnancy. A new weight chart]. / Evaluación nutricional durante el embarazo. Nuevo estándar.

Weight charts and patterns of weight gain for pregnant women in Argentina are scarce. The aims of the study were: 1) to design a new reference weight gain chart to asses the nutritional status of pregnant women using the body mass index (BMI); 2) to estimate weight gain patterns, and 3) to compare it with a proposed reference chart. In 326 pregnant women before 16th week gestation at enrollment during 2001-2002 at the Sarda' Maternity Hospital (Buenos Aires), weight, height, mid arm circumference and skinfold were measured and body mass index was calculated. Mean, standard deviation, coefficient of variation and polynomial percentiles 3rd through 97th were generated for each gestational age between 12th to 42nd weeks. Maximum variability was 18.4% after 28th week, mean preconcepcional BMI was 24.2 +/- 4.5 kg/m2 and 96% of newborns were at term with a mean Ponderal Index of 2.7 +/- 0.2 g/cm3. Trimesters weight increments were 0.600 kg +/- 0.473, 6.476 kg +/- 3.739 and 5.388kg +/- 4.233 for the 1st, 2nd and 3rd, respectively. Total weight gain achieved was 12.46 Kg +/- 3.13. Compared with the reference curve, the new one showed concordance at the 50th percentile with the upper limit of the normal range. The new reference charts of weight gain for pregnant women using maternal weight and BMI may be useful in prenatal care to asses nutritional status during pregnancy.

¿Es adecuado el uso de curvas de peso neonatales para el diagnóstico de retardo del crecimiento en recién nacidos prematuros? / Is the neonatal grouwth curves for the diagnosis of intrauterine growth retardation apropiate for prematures

Introducción. Las curvas estandarizadas derivadas del peso de nacimiento a diferentes edades gestacionales (curvas neonatales) probablemente subestiman la prevalencia del "bajo peso para la edad gestacional" (percentilo 10) en comparación con estándares ecográficos fetales. El objetivo del presente estudio observacional fue comparar el estándar de peso neonatal local con los pesos estimados sobre la base de diferentes modelos a similares edades gestacionales. Población, material y métodos. Se incluyeron 55.706 recién nacidos vivos entre la 25ª y la 42ª semanas de edad gestacional del período 1988-1999 del Hospital Materno-Infantil "Ramón Sardá" de Buenos Aires (pretérminos, de 25ª a 36ª semanas, n= 3.745). Mediante la fórmula de Mongelli se construyó la "curva fraccional de crecimiento" que, para cualquier edad gestacional, estima el peso fetal como un porcentaje del feto a término. Se calcularon las diferencias porcentuales al nivel de los percentilos 10 y 50 entre los pesos observados (curva neonatal y los pesos estimados (curva fraccional) y se compararon estas diferencias con el intervalo de confianza al 95% (error medio absoluto del peso estimado). Se contrastó la curva fracciona! del Hospital Materno-Infantil "Ramón Sardá" con una similar de Nottingham (Reino Unido) y con el estándar fetal por ecografía de Hadlock. Resultados. Los pesos neonatales fueron significativamente menores que los derivados de la curva fraccional hasta la 36ª semana tanto para el percentilo 10 como para el 50. A nivel del percentilo 10, los pesos derivados de estándares neonatales en el período de la prematurez fueron significativamente menores a los estimados por ecografía, mientras que la curva fraccional del Hospital Materno-Infantil "Ramón Sardá" fue ligeramente superior a la de Nottingham. Las diferencias porcentuales entre el peso al nacer y los pesos previstos fueron estadísticamente muy significativas durante el período de la prematurez, siendo constantemente mayores para el percentilo 10 (p=0,009). A nivel del percentilo 10, las diferencias entre la curva fraccional y la neonatal fueron sistemáticamente mayores al límite superior del intervalo de confianza al 95%. Conclusiones. A nivel del percentilo 10, los pesos derivados de estándares neonatales en el período de la prematurez (27ª a 34ª semanas) fueron significativamente menores a los derivados de la curva fraccional-estimador del peso normal-así como a los estimados por ecografía (Hadlock) y ligeramente superiores al compararlos con una curva similar pero de otro país (Nottingham).

Introduction. Growth standards derived from birth weight at different gestational ages (neonatal curves) probably underestimate the small-forgestational-age (<10th percentile) prevalence, when compared with ultrasonographically determined fetal growth standards. The aim of this observational study was to compare local neonatal standards with estimated fetal weight, using different models, at similar gestational ages. Population, material and methods. 55.706 singleton births between 25th and 42th gestational weeks, born at Hospital Materno-Infantil "Ramón Sardá" in Buenos Aires between 1988 and 1999. were included (preterms -25th to 36th weeks-, n= 3.745). A fractional growth curve was designed, using Mongelli's formula, showing the fetal weight at any gestational age, as a percentage of the final, term weight. Percentage differences were calculated at the 10th and 50th percentile levels, between observed weight (neonatal curve) and estimated weight (fractional curve). These differences were then compared with the 95% confidence interval (estimated absolute median error). The fractional curve of Hospital Materno-Infantil "Ramón Sarda" was compared with a similar one from Nottingham (UK) and with the Hadlock's fetal ultrasonographic standards. Results. Neonatal weights were significantly lower than those derived from the fractional curve, for the JOth as well as for the 50th percentile. At the 10th percentile level, weights from neonatal standards for the premature period were significantly lower than those estimated ultrasonographically, while the Sardá fractioual curve was slightly above that ofNottingham. The percentage differences between neonatal and predicted weights were highly significant for the premature period, being consistently higher for the 10th percentile (p= 0.009). Differences at 10th percentile systematically fell above the upper limit of the 95% confidence interval. Conclusions. Al the 10th percentile level, neonatal derived fetal growth standards of the preterm period (27th-34th weeks) were significantly lower than the estimated fractional and the published ultrasoundderived fetal growth curves, while the local fractional curve fel! slightly above that of Nottingham.