Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

O objetivo deste estudo foi verificar o poder de predição da medida da altura uterina para a restrição do crescimento fetal (RCF), por meio da curva de MARTINELLI et al. (2001), tendo como limite o percentil 5 e 10 para a idade gestacional e comparar com a curva de BELIZÁN et al. (1978). Entre julho de 2000 e fevereiro de 2003, 238 gestantes de alto risco foram submetidas a medidas de altura uterina, da 20a à 42a semana de gestação. Todas possuíam idade gestacional confirmada por ultra-sonografia precoce. A confirmação do diagnóstico de RCF foi dada após o nascimento pela curva de RAMOS (1983). Entre as gestantes, 50 (21,0%) tiveram recém-nascidos pequenos para a idade gestacional. O mesmo observador realizou 1617 medidas de altura uterina, com fita métrica, da borda superior da sínfise púbica ao fundo uterino. Para a ocorrência de RCF, considerando um exame positivo se uma medida de altura uterina encontrava-se abaixo do percentil 10 para a idade gestacional na curva de MARTINELLI et al. (2001), a sensibilidade (S) foi de 78%, especificidade (E) de 77,1%, valor preditivo positivo (VPP) de 47,6% e valor preditivo negativo (VPN) de 92,9%. Utilizando como limite o percentil 5, foram obtidos S= 64%, E= 89,9%, VPP= 62,7% e VPN= 90,4%, para o diagnóstico da RCF. Utilizando-se a curva de BELIZÁN et al. (1978) e considerando positivo exame com um valor abaixo do percentil 10 para a idade gestacional, os resultados encontrados foram S= 54%, E= 97,3%, VPP= 84,4% e VPN= 88,8% para a identificação da RCF. Comparada à curva de BELIZÁN et al. (1978), a curva de altura uterina de MARTINELLI et al. (2001) apresentou maior sensibilidade e valor preditivo negativo, consistindo em método de triagem mais adequado para a RCF / The aim of this study was to correlate uterine height measurements below the 5th and 10th percentiles using MARTINELLI et al. (2001) curve to fetal growth restriction (FGR) and to compare with the BELIZÁN et al. (1978) curve. During the period of July 2000 and February 2003, 238 pregnant women of high risk were submitted to uterine height measurements between the 20th and 42nd weeks of gestation. The whole group had well-known gestational age, confirmed by early ultrasound. The diagnosis of FGR was confirmed after birth according to RAMOS (1983). Among these women, 50 (21,0%) gave birth to light for gestational age infants. The same observer, using tape measure, performed 1617 uterine height measurements, from the upper border of the symphysis pubis to the fundus uteri. For the diagnosis of FGR, being considered as positive the exam with measurements below the 10th percentile according to MARTINELLI et al. (2001) curve, the sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were 78,0%, 77,1%, 47,6% and 92,9%, respectively. For the 5th percentile, this curve showed SE= 64,0%, SP= 89,9%, PPV= 62,7% and NPV= 90,4% for the detection of FGR. The BELIZÁN et al. (1978) curve, having the 10th percentile as the limit, yielded SE= 54,0%, SP= 97,3%, PPV= 84,4% and NPV= 88,8% for the identification of FGR. We conclude that, when used for screening FGR, the MARTINELLI et al. (2001) curve showed greater sensitivity and negative predictive value, and presents better results than that of Belizán et al. (1978)

O objetivo deste estudo foi verificar o poder de predição da medida da altura uterina para a restrição do crescimento fetal (RCF), por meio da curva de MARTINELLI et al. (2001), tendo como limite o percentil 5 e 10 para a idade gestacional e comparar com a curva de BELIZÁN et al. (1978). Entre julho de 2000 e fevereiro de 2003, 238 gestantes de alto risco foram submetidas a medidas de altura uterina, da 20a à 42a semana de gestação. Todas possuíam idade gestacional confirmada por ultra-sonografia precoce. A confirmação do diagnóstico de RCF foi dada após o nascimento pela curva de RAMOS (1983). Entre as gestantes, 50 (21,0%) tiveram recém-nascidos pequenos para a idade gestacional. O mesmo observador realizou 1617 medidas de altura uterina, com fita métrica, da borda superior da sínfise púbica ao fundo uterino. Para a ocorrência de RCF, considerando um exame positivo se uma medida de altura uterina encontrava-se abaixo do percentil 10 para a idade gestacional na curva de MARTINELLI et al. (2001), a sensibilidade (S) foi de 78%, especificidade (E) de 77,1%, valor preditivo positivo (VPP) de 47,6% e valor preditivo negativo (VPN) de 92,9%. Utilizando como limite o percentil 5, foram obtidos S= 64%, E= 89,9%, VPP= 62,7% e VPN= 90,4%, para o diagnóstico da RCF. Utilizando-se a curva de BELIZÁN et al. (1978) e considerando positivo exame com um valor abaixo do percentil 10 para a idade gestacional, os resultados encontrados foram S= 54%, E= 97,3%, VPP= 84,4% e VPN= 88,8% para a identificação da RCF. Comparada à curva de BELIZÁN et al. (1978), a curva de altura uterina de MARTINELLI et al. (2001) apresentou maior sensibilidade e valor preditivo negativo, consistindo em método de triagem mais adequado para a RCF / The aim of this study was to correlate uterine height measurements below the 5th and 10th percentiles using MARTINELLI et al. (2001) curve to fetal growth restriction (FGR) and to compare with the BELIZÁN et al. (1978) curve. During the period of July 2000 and February 2003, 238 pregnant women of high risk were submitted to uterine height measurements between the 20th and 42nd weeks of gestation. The whole group had well-known gestational age, confirmed by early ultrasound. The diagnosis of FGR was confirmed after birth according to RAMOS (1983). Among these women, 50 (21,0%) gave birth to light for gestational age infants. The same observer, using tape measure, performed 1617 uterine height measurements, from the upper border of the symphysis pubis to the fundus uteri. For the diagnosis of FGR, being considered as positive the exam with measurements below the 10th percentile according to MARTINELLI et al. (2001) curve, the sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were 78,0%, 77,1%, 47,6% and 92,9%, respectively. For the 5th percentile, this curve showed SE= 64,0%, SP= 89,9%, PPV= 62,7% and NPV= 90,4% for the detection of FGR. The BELIZÁN et al. (1978) curve, having the 10th percentile as the limit, yielded SE= 54,0%, SP= 97,3%, PPV= 84,4% and NPV= 88,8% for the identification of FGR. We conclude that, when used for screening FGR, the MARTINELLI et al. (2001) curve showed greater sensitivity and negative predictive value, and presents better results than that of Belizán et al. (1978)

Although the association between high maternal alcohol consumption and adverse reproductive outcomes is well established, the effect of lower levels of consumption during pregnancy is unclear; few studies have investigated this exposure. A hospital-based case-control study of small-for-gestational age (SGA) newborns (birth weight below the 10th percentile, according national standards for gestational age and sex) was conducted in Montreal between 1998 and 2000. Controls were born at the same hospital and during the same period with birth weight at or above the 10th percentile. This analysis aims at investigating the effect of low alcohol consumption (0.25 to 3 alcoholic drinks weekly) during pregnancy on the risk of small-for-gestational-age (SGA) birth. Independent effects of wine, beer and spirits and of paternal alcohol consumption before conception were also assessed. The logistic regression analysis showed no significant effect of light maternal drinking during pregnancy on the risk of SGA birth. The association was also studied separately for consumption of wine, beer and spirits, and likewise for paternal alcohol consumption, with similarly negative results.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2667. Advisers: Kim Waller; Steven Kelder. Includes bibliographical references.

Objetivos: identificar los principales factores de riesgo para recién nacidos a término pequeños para edad gestacional (PEG).Materiales y métodos: cohorte retrospectiva que utilizó los datos del Sistema Informático Materno Perinatal del Hospital María Auxiliadora de Lima, Perú, durante el período 2000-2010. Se evaluó la edad materna, la paridad, el nivel educativo, el estado civil, el índice de masa corporal pregestacional, el número de controles prenatales (CPN), la presencia de patologías como preeclampsia, eclampsia, infección urinaria y diabetes gestacional como factores de riesgo para PEG. El peso para la edad gestacional fue calculado en base a percentiles peruanos. Se calculó los riesgos relativos crudos (RR) y ajustados (RRa) con sus respectivos intervalos de confianza al 95% para cada variable con respecto a la condición de PEG usando modelos lineales generalizados log binomial. Resultados: se incluyó a un total de 64 670 gestantes. La incidencia de PEG fue de 7,2%. La preeclampsia (RRa 2,0; IC 95% 1,86-2,15), la eclampsia (RRa 3,22; IC 95% 2,38-4,35), el bajo peso materno (RRa 1,38; IC 95%: 1,23- 1,54), la nuliparidad (RRa 1,32; IC 95%: 1,23-1,42) y la edad ≥35 años (RRa 1,16; IC 95% 1,04- 1,29) se encontraron asociados con un riesgo mayor de recién nacido PEG. Asimismo, un número de 0-2 CPN (RRa 1,43; IC95%: 1,32-1,55), y 3-5 CPN (RRa 1,22; IC 95%: 1,14-1,32) también se encontraron asociados con un riesgo mayor de recién nacido PEG, comparado con 6-8 CPN. Un número de ≥9 CPN (RRa 0,74; IC 95%: 0,69-0,80) fue factor protector. Conclusiones: es necesario identificar a las gestantes con factores de riesgo como los encontrados en este estudio, para disminuir la condición de PEG. Se debe actuar rigurosamente, poniendo especial énfasis en factores modificables, tales como la frecuencia de sus controles prenatales. / Objective: to identify the main risk factors for term infants small for gestational age (SGA). Materials and methods: we conducted a retrospective cohort study using the database of Hospital María Auxiliadora, Lima, Peru, with information of all pregnant women during the period 2000-2010. We analyzed maternal age, parity, educational level, marital status, pre-pregnancy body mass index, number of prenatal visits (PNV), the presence of diseases such as preeclampsia, eclampsia, urinary tract infection and gestational diabetes as risk factors for SGA. The weight for gestational age was calculated on Peruvian percentiles. Crude relative risks (RR) and adjusted relative risk (aRR) with their respective confidence intervals at 95% for each variable was calculated using log binomial generalized linear models. Results: A total of 64 670 pregnant were included. The incidence of SGA was 7.2%. Preeclampsia (aRR 2.0, 95% CI: 1.86 to 2.15), eclampsia (aRR 3.22, 95% CI: 2.38 to 4.35), low maternal weight (aRR 1.38; 95% CI: 1.23 to 1.54), nulliparity (aRR 1.32; 95% CI: 1.23 to 1.42) and age ≥35 years (aRR 1.16, 95% CI: 1.04 to 1.29) were associated with an increased risk for newborn SGA. Also, a number of 0-2 PNV (aRR 1.43, 95% CI: 1.32 to 1.55), and 3-5 PNV (aRR 1.22; 95% CI: 1.14 to 1.32) were also found associated with an increased risk of newborn SGA, compared with 6-8 PNV. A number of ≥9 PNV (aRR 0.74; 95% CI: 0.69 to 0.80) was a protector factor. Conclusions: it is necessary to identify pregnant women with risk factors such as those found in this study, in order to reduce SGA. Particular emphasis on modifiable factors, such as the frequency of antenatal care visits, must be taken. / Tesis

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