Association of DNA Methylation with Infant Birth Weight in Women with Gestational Diabetes.

Offspring exposed to gestational diabetes mellitus (GDM) exhibit greater adiposity at birth. This early-life phenotype may increase offspring risk of developing obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease later in life. Infants born to women with GDM have a dysregulation of several hormones, cytokines, and growth factors related to fetal fat mass growth. One of the molecular mechanisms of GDM influencing these factors is epigenetic alterations, such as DNA methylation (DNAm). This review will examine the role of DNAm as a potential biomarker for monitoring fetal growth during pregnancy in women with GDM. This information is relevant since it may provide useful new biomarkers for the diagnosis, prognosis, and treatment of fetal growth and its later-life health consequences.

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

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.

Effect of transgenerational diabetes via maternal lineage in female rats.

Aim: To investigate the transgenerational effect of maternal hyperglycemia on oxidative stress markers, lipid profile, glycemia, pancreatic beta (ß)-cells, and reproductive outcomes in the F2 adult generation. Additionally, to expand the knowledge on transgenerational diabetes the F3 generation at birth will be evaluated. Methods: On day 5 of postnatal life female Sprague-Dawley rat newborns (F0 generation) were distributed into two groups: Diabetic (Streptozotocin-STZ, 70 mg/kg body weight, subcutaneous route) and Control rats. Adult female rats from the F0 generation and subsequently the F1 generation were mated to obtain the F2 generation, which was distributed into F2 generation (granddaughters) from control (F2_C) and diabetic (F2_D) rats. Oral Glucose Tolerance Test (OGTT), the area under the curve (AUC), blood biochemical analyses, and pancreatic morphology were analyzed before pregnancy. Reproductive outcomes were performed at the end of pregnancy. At birth, the glycemia and body weight of F3_C and F3_D rats were determined. p < 0.05 was considered significant. Results: F2_D had higher body weight, triglyceride levels, and percentage of insulin-immunostained cells, contributing to glucose intolerance, and insulin resistance before pregnancy. At day 21 of pregnancy, the F2_D showed increased embryonic losses before and after implantation (84.33 and 83.74 %, respectively). At birth, F3_D presented hyperglycemia, and 16.3 % of newborns were large for pregnancy age (LGA). Conclusion: Diabetes induction since the neonatal period in the first generation (F0) led to transgenerational (F2 and F3 generations) changes via the maternal lineage of female rats, confirming the relevance of control strictly the glycemia all the time.

Gestational Diabetes Mellitus Subtypes Classified by Oral Glucose Tolerance Test and Maternal and Perinatal Outcomes: Results of a Mexican Multicenter Prospective Cohort Study "Cuido Mi Embarazo".

Purpose: This study explores the impact of gestational diabetes mellitus (GDM) subtypes classified by oral glucose tolerance test (OGTT) values on maternal and perinatal outcomes. Patients and Methods: This multicenter prospective cohort study (May 2019-December 2022) included participants from the Mexican multicenter cohort study Cuido mi Embarazo (CME). Women were classified into four groups per 75-g 2-h OGTT: 1) normal glucose tolerance (normal OGTT), 2) GDM-Sensitivity (isolated abnormal fasting or abnormal fasting in combination with 1-h or 2-h abnormal results), 3) GDM-Secretion (isolated abnormal values at 1-h or 2-h or their combination), and 4) GDM-Mixed (three abnormal values). Cesarean delivery, neonates large for gestational age (LGA), and pre-term birth rates were among the outcomes compared. Between-group comparisons were analyzed using either the t-test, chi-square test, or Fisher's exact test. Results: Of 2,056 Mexican pregnant women in the CME cohort, 294 (14.3%) had GDM; 53.7%, 34.4%, and 11.9% were classified as GDM-Sensitivity, GDM-Secretion, and GDM-Mixed subtypes, respectively. Women with GDM were older (p = 0.0001) and more often multiparous (p = 0.119) vs without GDM. Cesarean delivery (63.3%; p = 0.02) and neonate LGA (10.7%; p = 0.078) were higher in the GDM-Mixed group than the overall GDM group (55.6% and 8.4%, respectively). Pre-term birth was more common in the GDM-Sensitivity group than in the overall GDM group (10.2% vs 8.5%, respectively; p=0.022). At 6 months postpartum, prediabetes was more frequent in the GDM-Sensitivity group than in the overall GDM group (31.6% vs 25.5%). Type 2 diabetes was more common in the GDM-Mixed group than in the overall GDM group (10.0% vs 3.3%). Conclusion: GDM subtypes effectively stratified maternal and perinatal risks. GDM-Mixed subtype increased the risk of cesarean delivery, LGA, and type 2 diabetes postpartum. GDM subtypes may help personalize clinical interventions and optimize maternal and perinatal outcomes.

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.

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.

Influence of the DASH Diet on Gestational Weight Gain and Perinatal Outcomes in Women with Pre-Existing Diabetes Mellitus: A Randomized, Single-Blind, Controlled Clinical Trial.

BACKGROUND: This study aimed to investigate the influence of the dietary approaches to stop hypertension (DASH) diet on gestational weight gain and perinatal outcomes in pregnant women with pre-existing diabetes mellitus (PDM). METHODS: A randomized, single-blind, controlled clinical trial was conducted with 68 pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital in Rio de Janeiro, Brazil (2016-2020). The standard diet adopted by the control group (standard diet group-SDG) contained 45-55% carbohydrates, 15-20% protein, and 25-30% lipids of the total energy intake. An adapted DASH diet, with a similar macronutrient composition, but with higher calcium, potassium, magnesium, fiber, and reduced saturated fat, was prescribed for the intervention group (DASH diet group-DDG). Student's t- or Mann-Whitney U tests were used to compare outcomes between groups. To assess the trajectory of gestational weight gain throughout the intervention between the study groups, linear mixed-effects regression models were used. RESULTS: The DDG had lower gestational weight gain at the fifth (p = 0.03) and seventh appointment (p = 0.04), with no difference in average total gestational weight gain (SDG: 10 kg [SD = 4]; DDG: 9 kg [SD = 5], p = 0.23). There was a trend for a lower length of stay of the newborns (p = 0.08) in the DDG without differences for other perinatal outcomes. CONCLUSIONS: The DASH diet promoted less variation in gestational weight gain without promoting a difference in total gestational weight gain, and there was no difference between the study groups for perinatal outcomes.

Neonatal mortality risk of large-for-gestational-age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000-2020.

OBJECTIVE: We aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020. DESIGN: Population-based, multi-country study. SETTING: National healthcare systems. POPULATION: Liveborn infants. METHODS: We used individual-level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th-90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500-3999 g. INTERGROWTH 21st served as the reference population. MAIN OUTCOME MEASURES: Prevalence and neonatal mortality risks. RESULTS: Large for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%-22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77-0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%-13.3%), with 1.2% (IQR 0.7%-2.0%) ≥4500 g and with 0.2% (IQR 0.1%-0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69-0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10-2.11) and ≥5000 g (RR 4.54, 95% CI 2.58-7.99), compared with birthweights of 2500-3999 g, with the highest risk observed in the first 7 days of life. CONCLUSIONS: In this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.

The burden of inappropriate birth weight on neonatal survival in term newborns: a population-based study in a middle-income setting.

Introduction: Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births. Methods: This is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0-27 days). Survival functions were calculated using the Kaplan-Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs). Results: The neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89-4.65), independent of sex, 1-min Apgar score, and five maternal factors. Discussion: The risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil.

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.

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.

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.

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.

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.

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 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.

Factores de riesgo materno perinatal asociados a macrosomía en recién nacidos en los hospitales EsSalud Juliaca-Puno

Introducción: La geografía en el que se desenvuelve los inicios de la maternidad, juegan un rol determinante en la región sur del Perú, dado que, existen diversas causas para la presencia y desarrollo de riesgo materno perinatal asociados a macrosomía. El estudio tuvo como objetivo determinar los factores de riesgo materno perinatal asociados a la macrosomía en recién nacidos en los hospitales EsSalud de Puno y Juliaca. Metodología: La investigación se efectuó bajo el enfoque cuantitativo con diseño transversal y los sujetos de la muestra fueron asignados por el método no-probabilístico, aplicándose la ficha clínica para registrar la información sobre las variables de estudio. Resultados: El abordaje se desarrolló en tres niveles: (i) en el Hospital EsSalud Puno predominan nacimientos macrosómicos de grado 1 con 85,7 % y de grado 2 con 14,3 %, a su vez en Juliaca, se aprecia que es más frecuente la macrosomía de grado1 con 87,0 % y macrosomía de grado 2 con 13,0 %. (ii) el 32,1 % de recién nacidos macrosómicos de grado 1 en el Hospital de Puno nacieron de madres en edad de 25 a 29 años, 53,6 % de madres con talla 1,51 a 1,59 cm; 39,3 % de madres con peso normal, 42,9 % de multíparas; 85,7 % sin antecedente de macrosomía; 53,6 % de sexo masculino y 50,0 % entre 40 a 41 semanas de gestación. (iii) en el Hospital de Juliaca, 39,1 % de neonatos macrosómicos nacieron de madres en edades mayores de 35 años, 56,5 % de madres con talla de 1,51 a 1,59 cm, 34,8 % de madres obesas, 39,1 % de gran multípara, 87,0 % sin antecedente de macrosomía, 62,5 % de sexo masculino y 56,5 % de edad gestacional entre 40 a 41 semanas. Conclusión: Los factores maternos como la edad materna, peso pregestacional, paridad y el factor perinatal antecedente de macrosomía, se asocian significativamente (p<0,05) al nacimiento macrosómico.

Summary Introduction: The geography in which the beginnings of motherhood unfold play a determining role in the southern region of Peru, given that there are various causes for the presence and development of perinatal maternal risk associated with macrosomia. The study aimed to determine the perinatal maternal risk factors associated with macrosomia in newborns at EsSalud hospitals in Puno and Juliaca. Methodology: The research was carried out under the quantitative approach with a cross-sectional design and the subjects of the sample were assigned by the non-probabilistic method, applying the clinical record to record the information on the study variables. Results: The approach was developed at three levels: (i) in the Hospital EsSalud Puno macrosomic births of grade 1 predominate with 85.7% and grade 2 with 14.3%, in turn in Juliaca, it is appreciated that it is more grade 1 macrosomia is frequent with 87.0% and grade 2 macrosomia with 13.0%. (ii) 32.1% of grade 1 macrosomic newborns in the Puno Hospital were born to mothers aged 25 to 29 years, 53.6% to mothers with a height of 1.51 to 1.59 cm; 39.3% normal weight mothers, 42.9% multiparous; 85.7% without a history of macrosomia; 53.6% were male and 50.0% between 40 and 41 weeks of gestation. (iii) in the Juliaca Hospital, 39.1% of macrosomic neonates were born to mothers over 35 years of age, 56.5% of mothers with a height of 1.51 to 1.59 cm, 34.8% of mothers obese, 39.1% highly multiparous, 87.0% without a history of macrosomia, 62.5% male, and 56.5% gestational age between 40 and 41 weeks. Conclusion: Maternal factors such as maternal age, pre-pregnancy weight, parity and perinatal factor, history of macrosomia, are significantly associated (p<0.05) with macrosomic birth.

Introdução: A geografia em que se desenrola o início da maternidade desempenha um papel determinante na região sul do Peru, visto que existem várias causas para a presença e desenvolvimento de risco materno perinatal associado à macrossomia. O estudo teve como objetivo determinar os fatores de risco maternos perinatais associados à macrossomia em recém-nascidos nos hospitais EsSalud em Puno e Juliaca. Metodologia: A pesquisa foi realizada sob a abordagem quantitativa com delineamento transversal e os sujeitos da amostra foram alocados pelo método não probabilístico, aplicando-se a ficha clínica para registro das informações sobre as variáveis ​​do estudo. Resultados: A abordagem foi desenvolvida em três níveis: (i) no Hospital EsSalud Puno os nascimentos macrossômicos de grau 1 predominam com 85,7% e grau 2 com 14,3%, no que lhe concerne em Juliaca, avalia-se que é mais macrossomia de grau 1 é frequente com 87,0% e macrossomia grau 2 com 13,0%. (ii) 32,1% dos recém-nascidos macrossômicos grau 1 no Hospital Puno nasceram de mães de 25 a 29 anos, 53,6% de mães com altura de 1,51 a 1,59 cm; 39,3% mães com peso normal, 42,9% multíparas; 85,7% sem histórico de macrossomia; 53,6% eram do sexo masculino e 50,0% entre 40 e 41 semanas de gestação. (iii) no Hospital Juliaca, 39,1% dos neonatos macrossômicos nasceram de mães com mais de 35 anos, 56,5% de mães com altura de 1,51 a 1,59 cm, 34,8% de mães obesas, 39,1% altamente, multíparas, 87,0% sem história de macrossomia, 62,5% do sexo masculino e 56,5% de idade gestacional entre 40 e 41 semanas. Conclusão: Fatores maternos como idade materna, peso pré-gestacional, paridade e fator perinatal, história de macrossomia, estão significativamente associados (p<0,05) ao nascimento macrossômico.

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.