Ticona-Rendón M, Pacora-Portella P, Huanco-Apaza D, Ticona-Vildoso M

Language: Spanish
References: 25
Page: 725-736
PDF size: 499.13 Kb.

ABSTRACT

Objective: To determine the incidence, stressors and perinatal outcomes of intrauterine growth retardation in the hospitals of the Ministry of Health of Peru.
Material and Methods: Cross-sectional, analytical, case-control study of 9777 infants with intrauterine growth retardation (IUGR) in 29 hospitals of the Ministry of Health of Peru in 2010. The Peruvian intrauterine growth curve was used for the diagnosis of IUGR. IUGR newborns (cases) and newborns appropriate for gestational age (controls) were compared using the odds ratio (OR) with a confidence interval of 95%.
Results: The incidence of IUGR was 10,1 %. The incidence by region was: 8,1% Coast, 11,8% Selva and Sierra 14,6%. The frequency of stress factors of IUGR were: nutrition (92%), psychological (84,8% ), social (53%), anatomical (63,6%), toxic/ environmental (52,9%), vascular (29,8%), infection (14,1%) and metabolic (0,3%). The newborn with IUGR had higher perinatal morbidity (OR=2,1) and mortality (OR=3,5).
Conclusion: The healthy fetus is the result of a balance between stress factors and the adaptive response of the mother and fetus. When the response of physiological adaptation is overcome by stress factors, IUGR occurs. The political, psychological, nutritional and medical intervention before 12 weeks of gestation has the potential to change the harmful effects of all human stress factors that affect fetal growth.

REFERENCES

1. Baschat AA, Galan HL, Gabbe S. Intrauterine Growth Restriction. Chapter 31 in Obstetrics: Normal and Pregnancy problems. 6a ed. Gabbe S, Niebyl J, Simpson J, Landon M, Galan H, Jauniax E, Driscoll D, editors., Philadelphia: Elsevier Saunders, 2012;706-741.

2. Vedmedovska N, Rezeberga D, Teibe U, Melderis I, Donders GG. Placental pathology in fetal growth restriction. Eur J Obstet Gynecol Reprod Biol 2011;155:36-40.

3. Yamada H, Sata F, Saijo Y, Kishi R, Minakami H. Genetic factors in fetal growth restriction and miscarriage. Semin Thromb Hemost 2005;31:334-45.

4. Van Den Hooven EH, Pierik FH, de Kluizenaar Y, Willemsen SP, Hofman A, Van Ratingen SW, et al. Air pollution exposure during pregnancy, ultrasound measures of fetal growth, and adverse birth outcomes: a prospective cohort study. Environ Health Perspect 2012;120:150-6.

5. Pinto SM, Dodd S, Walkinshaw SA, Siney C, Kakkar P, Mousa HA. Substance abuse during pregnancy: effect on pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol 2010;150:137-41.

6. Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. Obstet Gynecol 1989;73:576-82.

7. Luewan S, Chakkabut P, Tongsong T. Outcomes of pregnancy complicated with hyperthyroidism: a cohort study. Arch Gynecol Obstet 2011;283:243-7.

8. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 2010;67:1012-24.

9. CLAP-OPS-OMS. Retardo del crecimiento intrauterino: un grave problema de los países en desarrollo. Rev Hosp Mat Inf Ramón Sardá 2001;20:24-27.

10. Belkacemi L, Nelson DM, Desai M, Ross MG. Maternal undernutrition influences placental-fetal development. Biol Reprod 2010;83:325-31.

11. Varvarigou AA. Intrauterine growth restriction as a potential risk factor for disease onset in adulthood. J Pediatr Endocrinol Metab 2010; 23:215-24.

12. Ticona M, Huanco D. Curvas de crecimiento fetal de niños peruanos. Ginecol Obstet Mex 2008; 76:476-82.

13. INEI. Encuesta Demográfica y de Salud Familiar (ENDES Continua) 2011. Disponible en: http://proyectos.inei.gob. pe/endes/2011/

14. De Onis N, Blosner N, Villar J. Levels and Patterns of intrauterine growth retardation in developing countries. European Journal of Clinical Nutrition 1998;52:S5-S15.

15. Kozuki N, Lee AC, Katz J; Child Health Epidemiology Reference Group. Moderate to severe, but not mild, maternal anemia is associated with increased risk of small-forgestational- age outcomes. J Nutr 2012;142:358-62.

16. Gonzales GF, Tapia V, Fort AL. Maternal and perinatal outcomes in second hemoglobin measurement in nonanemic women at first booking: effect of altitude of residence in Peru. ISRN Obstet Gynecol 2012;2012:368571.

17. Eidelman AI, Kamar R, Schimmel MS, Bar-On E. The grand multipara: is she still a risk? Am J Obstet Gynecol 1988;158:389-92.

18. Mandruzzato G, Alfirevic Z, Chervenak F, Gruenebaum A, Heimstad R, Heinonen S, et al. World Association of Perinatal Medicine. Guidelines for the management of postterm pregnancy. J Perinat Med 2010;38:111-9.

19. Nahum GG, Stanislaw H. Hemoglobin, altitude and birth weight: does maternal anemia during pregnancy influence fetal growth? J Reprod Med 2004; 49:297-305.

20. Gonzales GF. Impacto de la altura en el embarazo y en el producto de la Gestación. Rev Perú Med Exp Salud Pública 2012;29:242-9.

21. Núñez P, Pacora P. Diabetes mellitus y gestación. En: Ginecología, Obstetricia y Reproducción Humana. Editor José Pacheco Romero. 2ª ed. Lima, Perú 2007;1169-1187.

22. Bonamy AK, Parikh NI, Cnattingius S, Ludvigsson JF, Ingelsson E. Birth characteristics and subsequent risks of maternal cardiovascular disease: effects of gestational age and fetal growth. Circulation 2011;124:2839-46.

23. Lykke JA, Paidas MJ, Triche EW, Langhoff-Roos J. Fetal growth and later maternal death, cardiovascular disease and diabetes. Acta Obstet Gynecol Scand 2012;91:503-10.

24. Walker MG, Fitzgerald B, Keating S, Ray JG, Windrim R, Kingdom JC. Sex-specific basis of severe placental dysfunction leading to extreme preterm delivery. Placenta 2012; 33:568-71.

25. Ramakrishnan U, Grant F, Goldenberg T, Zongrone A, Martorell R. Effect of Women’s Nutrition before and during Early Pregnancy on Maternal and infant outcomes: A Systematic Review. Paediatr Perinat Epidemiol 2012; 26 Suppl 1:285-301.