Hallazgos citogenéticos y edad materna en pacientes con síndrome down en un hospital de referencia pediátrico en el Perú

Introducción: El síndrome Down es un trastorno congénito originado por una trisomía total o parcial del cromosoma 21 y es considerada la causa genética más común de malformaciones congénitas y discapacidad intelectual. El objetivo de este estudio fue describir las alteraciones citogenéticas de pacientes con Síndrome Down y su relación con la edad materna. Métodos: Estudio transversal, descriptivo-analítico. Se incluyó 436 pacientes con Síndrome Down admitidos en el Instituto Nacional de Salud del Niño durante el período 2017-2019. Se analizaron las variables: alteración citogenética y edad materna. Resultados: Se encontró que el 99,3% (n=433) de pacientes presentaron algún tipo de alteración citogenética y tres pacientes presentaron cariotipo normal. La edad de los pacientes al momento de la toma de muestra estuvo comprendida entre los 0,03 y 17 años, la relación masculino/femenino fue de 1.2:1. La alteración citogenética más frecuente fue la trisomía 21 libre (94,7%), seguida por la translocación Robertsoniana (n=16) y el mosaicismo (n=6). En el caso de la edad materna se encontró una mediana de 37 años (rango: 13-47). Conclusiones: La trisomía 21 libre es la alteración citogenética más común en Síndrome Down; sin embargo, la translocación Robertsoniana y los mosaicismos fueron más frecuentes en edad materna menor de 35 años, sugiriendo que existe otros factores de riesgo diferentes a la edad materna avanzada en este grupo etario.

Introduction: Down syndrome is a congenital disorder caused by a total or partial trisomy of chromosome 21 and is considered the most common genetic cause of congenital malformations and intellectual disability. The objective of this study was to describe the cytogenetic alterations of patients with Down syndrome and their relationship with maternal age. Methods: Cross-sectional, descriptive-analytical study. 436 patients with Down syndrome admitted to the Instituto Nacional de Salud del Niño during the 2017-2019 period were included. The variables analyzed were: cytogenetic diagnosis and maternal age. Results: It was found that 99,3% (n=433) of patients presented some type of cytogenetic alteration and three patients presented a normal karyotype. The age of the patients at the time of sampling was between 0,03 and 17 years, the male/female ratio was 1.2:1. The most frequent cytogenetic alteration was free trisomy 21 (94,7%), followed by Robertsonian translocation (n=16) and mosaicism (n=6). In the case of maternal age, a median of 37 years was found (range: 13-47). Conclusions: Free trisomy 21 is the most common cytogenetic condition in Down syndrome; however, the Robertsonian translocation and mosaicisms were more frequent in patients whose mothers were les than 35 years old, suggesting that there are other risk factors than advanced maternal age in this group.

Complicaciones obstétricas y edad materna avanzada

La edad materna avanzada guarda relación directamente proporcional con el riesgo de complicaciones obstétricas y no obstétricas durante la gestación, tanto para la gestante como para el feto. Esto es particularmente importante debido a que a las tasas de fecundidad de las mujeres de mayor edad han aumentado. En Estados Unidos, el 10% del primer nacimiento y el 20% de todos los nacimientos ocurren en mujeres con 35 años o más. Históricamente la edad materna avanzada se ha definido como una edad mayor o igual a 35 años, punto de corte que sustentado en la disminución de la fecundidad y el mayor riesgo de anomalías genéticas en la descendencia de las mujeres mayores a esta edad. Sin embargo, los efectos relacionados al aumento de edad son continuos y el riesgo es mayor mientras mayor sea la edad al momento de la concepción más que como efecto de pasar el umbral de los 35 años. Diferentes investigaciones han mostrado que las gestantes añosas tienen mayor riesgo de complicaciones tempranas de la gestación como aborto espontáneo, embarazo ectópico, anomalías cromosómicas y malformaciones congénitas, así como, preeclampsia, diabetes gestacional, patología placentaria, parto pretérmino, peso bajo al nacer, mortalidad perinatal, embarazo múltiple, parto distócico, parto por cesárea y mortalidad materna. En este artículo se revisa publicaciones recientes sobre el tema y se incluye estadística de un importante hospital de Lima, Perú, y de la Encuesta Nacional de Demografía y Salud Familiar - ENDES 2022.

Advanced maternal age is directly proportional to the risk of obstetric and nonobstetric complications during gestation, both for the pregnant woman and the fetus. This is particularly important because the fertility rates of older women have increased. In the US, 10% of first births and 20% of all births occur to women 35 years of age or older. Historically, advanced maternal age has been defined as an age greater than or equal to 35 years, a cutoff point that is supported by declining fertility and the increased risk of genetic abnormalities in the offspring of women older than this age. However, the effects related to increasing age are continuous and the risk is greater the older the age at conception rather than as an effect of passing the 35 years threshold. Research has shown that older pregnant women are at increased risk of early pregnancy complications such as miscarriage, ectopic pregnancy, chromosomal abnormalities and congenital malformations, as well as, preeclampsia, gestational diabetes, placental pathology, preterm delivery, low birth weight, perinatal mortality, multiple pregnancy, dystocic delivery, cesarean delivery and maternal mortality. This article reviews recent publications on the subject and includes statistics from a major hospital in Lima, Peru, and from the National Demographic and Family Health Survey - ENDES, 2022.

Child mortality remains a serious public health problem / Mortalidade infantil continua sendo um grave problema de saúde pública

The identification of factors related to infant deaths can help in the planning of public health actions for the restructuring and improvement of maternal and child care, with a view to reducing infant mortality. The variables related to infant mortality continue to be incident in males, in those of brown color, with birth weight below normal and children of young mothers. Furthermore, the infant mortality rate in the first year of life among the Yanomami population reached 114.3 per thousand births in 2020, ten times the infant mortality rate recorded in other corners of Brazil. Actions with technical and financial investment throughout prenatal care with a complete care network and strengthening childcare services for children by the Primary Care network at municipal level are necessary and urgent strategies to reduce the drama of preventable deaths of children in the first year of life.

A identificação de fatores relacionados aos óbitos infantis pode auxiliar no planejamento de ações de saúde pública para a reestruturação e a melhoria da assistência materno-infantil, visando à redução da mortalidade infantil. As variáveis relacionadas à mortalidade infantil continua sendo incidente no sexo masculino, naqueles de cor parda, com peso ao nascer abaixo do normal e filhos de mães jovens. Ações com investimento técnico e financeiro ao longo do pré-natal com rede assistencial completa e fortalecimento no atendimento de puericultura das crianças pela rede de Atenção Básica em nível municipal são estratégias necessárias e urgentes para reduzir a dramaticidade das mortes evitáveis de crianças no primeiro ano de vida.

Casamiento infantil y salud perinatal en Ecuador, 2015-2020 / Child marriage and perinatal health in Ecuador, 2015-2020

RESUMEN Este estudio buscó estimar la prevalencia y distribución de nacidos vivos de madres menores de 18 años en Ecuador y la asociación entre indicadores perinatales y estado marital materno. A partir de los registros de nacidos vivos obtenidos del Instituto Nacional de Estadísticas y Censos de Ecuador para el período 2015-2020, se estimó la asociación conjunta entre grupos de edad (10-15, 16-17, 18-19 y 20-24 años) y la situación conyugal materna (casada, unión estable y soltera), con bajo peso al nacer, parto pretérmino e inadecuada atención prenatal. La prevalencia de partos de madres menores de 18 años fue del 9,3% y declinó en el periodo de estudio, drásticamente entre las mujeres casadas. La asociación entre estado marital y las variables explicativas dependió de la edad materna. Los resultados más favorables de salud observados entre las madres casadas de 20-24 años, en comparación con las madres solteras, se debilitan o desaparecen entre las menores de edad. Las madres en uniones de hecho experimentaron resultados intermedios entre las mujeres casadas y las solteras.

ABSTRACT This study sought to estimate the prevalence and distribution of newborns to mothers under age 18 in Ecuador and the association between perinatal indicators and maternal marital status. Newborn records obtained from Ecuador's Instituto Nacional de Estadísticas y Censos (INEC) between 2015 and 2020 were used to assess the joint association between maternal age groups (10-15, 16-17, 18-19, and 20-24 years) and marital status (married, common-law, and single) with low birthweight, preterm birth, and inadequate prenatal care. The prevalence of newborns to mothers under age 18 was 9.3% overall, but declined over the study period, drastically among married mothers. The association between marital status and perinatal indicators depended on maternal age. The more favorable outcomes observed among married mothers aged 20-24 years (compared to their single counterparts) weaken or disappear among mothers under age 18. Mothers in stable unions exhibited outcomes in between those of married and single mothers.

Tendencia temporal y factores asociados al parto prematuro en Chile, 1992-2018 / Temporal trends and factors associated with preterm birth in Chile, 1992-2018

RESUMEN Se realizó un estudio analítico con base en los registros poblacionales de nacimientos en Chile, obtenidos del Departamento de Estadística e Información en Salud (DEIS), con el objetivo de evaluar la tendencia temporal de los partos prematuros en Chile en el periodo 1990-2018, asociado a la edad de la madre. Los resultados muestran que, para el año 1992, la tasa de parto prematuro fue del 5,0%, aumentando a 7,2% en 2018. El promedio del porcentaje del cambio anual (PPCA) fue de 1,44. Los grupos etarios extremos -menor o igual de 19 años y 35 y más años- fueron los que presentaron las tasas de parto prematuro más altas, tanto al inicio y como al término del periodo, siendo este último grupo el que mostró una menor disminución al inicio del periodo (1992-1995), con porcentaje de cambio anual (PCA) de -3,00. Para ambos grupos, la probabilidad de un parto prematuro fue mayor respecto del grupo de 20 a 34 años. Chile, presenta uno de los mejores indicadores de salud materna e infantil para la región; no obstante, dada la actual postergación de la maternidad, deben vigilarse las repercusiones asociadas, dentro de ellas un nacimiento prematuro.

ABSTRACT An analytical study based on Chilean birth records obtained from the Department of Statistics and Health Information (DEIS) was conducted. This study aimed to evaluate temporal trends in preterm births by maternal age in Chile from 1990 to 2018. Results show that the preterm birth rate in 1992 was 5.0% and increased to 7.2% in 2018. The average annual percent change (AAPC) was 1.44. Age groups at the extremes (19 and under and 35 and over) presented the highest rates of preterm birth, both at the beginning and at the end of the study period. The latter group showed a smaller decrease at the beginning (1992 to 1995), with an annual percentage change (APC) of -3.00. The probability of preterm birth in both groups was higher compared to the 20-34 year old group. Although Chile boasts some of the best maternal and child health indicators in the region, repercussions associated with the current postponement of maternity - including preterm birth - must be monitored.

Repeated adolescent pregnancy in Brazil from 2015 to 2019

SUMMARY OBJECTIVE: The aim of this study was to assess the rate of repeated pregnancy in adolescence and its association with early marriage and education level. METHODS: This is a cross-sectional study conducted by searching the Live Births Data System. The study included all adolescents in the age group 10-19 years with live births from 2015 to 2019 (n=2,405,248), divided into three groups: G1: primiparas; G2: with 1 previous pregnancy; and G3: with two or more previous pregnancies. RESULTS: Total repeated pregnancies remained stable, along the years. In the age group 10-14 years, the decrease in the period was from 5.0 to 4.7%, whereas in the age group 15-19 years, it was from 27.8 to 27.3%. Being married or in a stable union increases by 96% the chance of repeated pregnancy in the age group 10-14 years (p<0.001; OR=1.96; 95% confidence interval [CI] 1.85-2.09). In the age group 15-19 years, the chance of repeated pregnancy among the married or in stable union increased 40% (p<0.001; OR=1.40; 95%CI 1.39-1.41)). Girls aged 10-14 years with an education level of<8 years had a 64% higher chance of repeated pregnancy (p<0.001; OR=1.64; 95%CI 1.53-1.75), and among those aged 15-19 years, there was a 137% higher chance of repeated pregnancy (p<0.001; OR=2.37; 95%CI 2.35-2.38). CONCLUSION: Repeated pregnancy in adolescence in Brazil remains very high over the years. There is an association between low education level and early marriage with repeated pregnancies in adolescence.

Association between interpregnancy interval and pregnancy complications in multiparas / 中华围产医学杂志

Objective:To explore the influence of interpregnancy interval (IPI) on pregnancy complications in multiparas.Methods:This was a retrospective cohort study involving 7 669 singleton parturients who delivered at ≥28 gestational weeks in the Affiliated Hospital of Southwest Medical University between December 2015 and December 2020 and had given birth in the third trimester before. Clinical data were collected, including the baseline characteristics, pregnancy complications, gestational weeks at delivery, and neonatal birth weight. According to the IPI, these women were divided into five groups: <12 months ( n=350), 12-<24 months ( n=945), 24-<60 months ( n=2 544), 60-<120 months ( n=2 478), and ≥120 months ( n=1 352). Based on the recommendation of the World Health Organization, pregnant women with an IPI of 24-<60 months were the control group. A multivariate logistic model was used to adjust for confounders and calculate the risks of pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). The influences of maternal age and previous delivery mode on the associations between IPI and maternal complications were analyzed. Analysis of variance (ANOVA), Chi-square test, and Cochran-Mantel-Haenszel Chi-square test were used for statistical analysis. Results:Compared with the control group, the incidence of GDM and HDP increased in the 60-<120 months group ( OR=1.23, 95% CI: 1.01-1.48 and OR=1.47, 95% CI: 1.13-1.92) and ≥120 months group ( OR=1.37, 95% CI:1.07-1.78 and OR=1.92, 95% CI: 1.39-2.64); the risks of uterine rupture/postpartum hemorrhage and placental abruption increased in the <12 months group ( OR=1.54, 95% CI: 1.01-2.34) and 12-<24 months group ( OR=2.38 95% CI: 1.13-5.02), respectively. In the 60-<120 months group, the risk of GDM increased only in non-elderly women (adjusted OR=1.71, 95% CI: 1.36-2.14), so did the risks of GDM and HDP in the ≥120 months group (adjusted OR=3.11, 95% CI: 2.10-4.62 and adjusted OR=1.81, 95% CI: 1.12-2.91). Among women who had undergone a previous cesarean section, the risk of GDM increased in the ≥120 months group (adjusted OR=1.35, 95% CI: 1.00-1.81). In the 60-<120 months group and ≥120 months group, the risk of HDP increased in postpartum women (adjusted OR=1.79, 95% CI: 1.08-2.95 and adjusted OR=3.32, 95% CI: 1.91-5.77). Conclusion:IPI≥60 months is a risk factor for GDM and HDP, and the associations between IPI and maternal complications are influenced by maternal age.

Prevention and Treatment of Age-related Ovarian Hypofunction with Traditional Chinese Medicine： A Review / 中国实验方剂学杂志

Age-related ovarian hypofunction includes a decrease in follicle quantity and quality as well as alterations in the ovarian microenvironment，the mechanisms of which are mainly related to mitochondrial dysfunction，free radical and antioxidant systems，telomere and telomerase alterations，and apoptosis，and is one of the major factors contributing to infertility in advanced maternal age （AMA）. Despite the tremendous progress in assisted reproductive technology in recent decades，few breakthroughs have been made in alleviating age-related ovarian hypofunction and improving reproductive outcomes for AMA. In recent years，there has been an increasing number of studies on the multi-level and multi-targeted mechanisms of traditional Chinese medicine （TCM） to improve age-related ovarian hypofunction by modulating mitochondrial homeostasis，alleviating oxidative stress，and inhibiting apoptosis，while more high-quality randomized controlled trials have demonstrated the clinical efficacy of TCM in assisted reproductive technology. Given this，this article presented a systematic review of recent research and randomized controlled trials on the mechanism of Chinese medicine active ingredients，single Chinese medicine， and Chinese medicine compounds in delaying age-related ovarian hypofunction，to clarify the current status and shortcomings of the research. This paper provides medication management of TCM for effectively alleviating age-related ovarian hypofunction and improving reproductive outcomes for AMA.

Perinatal outcomes of adolescent and adult mothers: a systematic review / Resultados perinatais de mães adolescentes e adultas: uma revisão sistemática / Resultados perinatales de madres adolescentes y adultas: una revisión sistemática

Objective: To identify and analyze studies published in the literature that researched adverse perinatal outcomes in live births to adolescent and adult mothers. Methods: The electronic databases PubMed and VHL (LILACS and MEDLINE) were consulted, using the MeSH descriptors with Boolean operators were used, which were grouped as follows: ("maternal age") AND ("risk factors") AND ("Pregnancy Complica- tions OR "Adverse Birth Outcomes" OR "Perinatal outcome"). This analysis resulted in eight articles published between 2018 and 2022. Results: Studies presented a strong as- sociation between young maternal age (<20 years) and unfavorable neonatal outcomes, such as low birth weight, premature delivery, need for oxygen therapy and admission to the Neonatal Intensive Care Unit. No significant data were found on adverse outcomes in pregnancies in the optimum age range (20>35 years). Conclusion: The analyzed studies point to a strong association between young maternal age and some clinical-obstetric complications.

Objetivo: Identificar e analisar estudos publicados na literatura que pesquisaram desfechos perinatais adversos em nascidos vivos de mães adolescentes e adultas. Métodos: Foram consultadas as bases de dados eletrônicas PubMed e BVS (LILACS e MEDLINE), utilizando-se os MeSH descritores com operadores booleanos, os quais foram agrupados da seguinte forma: ("maternal age") AND ("risk factors") AND ("Pregnancy Complications OU "Resultados adversos do parto" OU "Resultados perinatais"). Essa análise resultou em oito artigos publicados entre 2018 e 2022. Resultados: Os estudos apresentaram forte associação entre a idade materna jovem (<20 anos) e os desfechos neonatais desfavoráveis, como baixo peso ao nascer, parto prematuro, necessidade de oxigenoterapia e internação na UTI neonatal. Não foram encontrados dados significativos sobre resultados adversos em gestações na faixa etária ideal (20>35 anos). Conclusão: Os estudos analisados apontam para uma forte associação entre idade materna jovem e algumas complicações clínico-obstétricas.

Objetivo: Identificar y analizar estudios publicados en la literatura que investigaran resultados perinatales adversos en nacidos vivos de madres adolescentes y adultas. Métodos: Se realizaron búsquedas en las bases de datos electrónicas PubMed y BVS (LILACS y MEDLINE) utilizando los descriptores MeSH con operadores booleanos, que se agruparon de la siguiente manera: ("edad materna") AND ("factores de riesgo") AND ("complicaciones del embarazo OR "resultados adversos del parto" OR "resultados perinatales"). Este análisis dio como resultado ocho artículos publicados entre 2018 y 2022. Resultados: Los estudios mostraron una fuerte asociación entre la edad materna joven (<20 años) y los resultados neonatales desfavorables, como bajo peso al nacer, parto prematuro, necesidad de oxigenoterapia e ingreso en la UCI neonatal. No se encontraron datos significativos sobre resultados adversos en embarazos en el grupo de edad ideal (20>35 años). Conclusión: Los estudios analizados apuntan a una fuerte asociación entre la edad materna joven y algunas complicaciones clínico-obstétricas.

Influencia de la edad de la madre en los desenlaces perinatales y maternos / Influence of maternal age on perinatal and maternal outcomes

Resumen OBJETIVOS: Describir y comparar la influencia de la edad materna en los desenlaces maternos y perinatales. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo y unicéntrico en el que se reunieron todos los partos ocurridos en el año 2020 en un hospital español. La edad de la mujer se categorizó en tres tramos (1: menores de 35 años; 2: más o menos mayores de 35 años y menores de 40 años; 3: mayores de 40 años). RESULTADOS: Se reunió una población de estudio de 1700 mujeres y encontró una clara correlación entre la edad materna avanzada y el riesgo de cesárea y una tendencia no significativa hacia una mayor cantidad de partos instrumentados. La edad materna avanzada es un factor de riesgo de sufrir distintas enfermedades relacionadas con el embarazo y con malos desenlaces perinatales. Puesto que la tendencia actual marca un aumento de este tipo de embarazos es indispensable conocer los riesgos obstétricos a fin de informar y asesorar correctamente a las embarazadas y llevar a cabo las actuaciones pertinentes que eviten las complicaciones más frecuentes. CONCLUSIONES: Existe mayor tasa de cesárea en embarazos en edad avanzada después de ajustar los factores de confusión. Los desenlaces fetales no se ven afectados por la edad materna ni con otros eventos perinatales.

Abstract OBJETIVE: To describe and compare the influence of maternal age on maternal and perinatal outcomes. MATERIALS AND METHODS: Observational, retrospective, single-center, retrospective study in which all deliveries that occurred in the year 2020 in a Spanish hospital were collected. The age of the women was categorized into three groups (1: under 35 years; 2: more or less older than 35 years and younger than 40 years; 3: older than 40 years). RESULTS: A study population of 1700 women was assembled and found a clear correlation between advanced maternal age and risk of cesarean section and a nonsignificant trend toward a higher number of instrumented deliveries. Advanced maternal age is a risk factor for various pregnancy-related diseases and poor perinatal outcomes. Since the current trend shows an increase in this type of pregnancies, it is essential to know the obstetric risks in order to correctly inform and advise pregnant women and to carry out the pertinent actions to avoid the most frequent complications. CONCLUSIONS: There is a higher rate of caesarean section in advanced age pregnancies after the confounding factors were adjusted. Fetal outcomes are not affected by maternal age, as well as other perinatal events.

Desfechos maternos e neonatais em servidoras públicas estaduais de São Paulo com idade materna avançada / Maternal and neonatal outcomes in state public servants of São Paulo with advanced maternal age

Objetivo: Caracterizar a população das gestantes em diferentes faixas etárias; avaliar desfechos maternos e neonatais em pacientes com idade materna avançada; determinar a faixa etária a partir da qual os desfechos adversos foram mais prevalentes. Métodos: Parturientes atendidas no Hospital do Servidor Público Estadual de São Paulo entre junho/2019 e maio/2020 foram divididas em três grupos ­ 20 a 34 anos; 35 a 39 anos; 40 anos ou mais ­ e analisadas quanto a diversas variáveis. Resultados: Entre as gestantes do Serviço, 44,2% tinham idade materna avançada. A amostra foi composta por 927 pacientes, a maioria com relacionamento conjugal estável (75,2%) e ensino de nível superior (74,7%). Independentemente do grupo etário, foram observados elevados índices de obesidade (25,9%), sobrepeso (39,7%) e cesariana (76,4%). A frequência de iteratividade, diabetes gestacional e doença hipertensiva específica da gestação foi maior a partir dos 35 anos, e a frequência de hipertensão arterial crônica foi maior a partir dos 40 anos. Neonatos de pacientes com 40 anos ou mais tiveram maiores índices de baixo peso ao nascer, óbito neonatal, Apgar de quinto minuto < 7 e necessidade de reanimação neonatal. Conclusão: Pacientes com idade materna avançada representaram porcentagem expressiva da população e tiveram maior frequência de desfechos adversos. Complicações obstétricas foram mais prevalentes a partir dos 35 anos, com destaque para diabetes gestacional e distúrbios hipertensivos. Resultados neonatais desfavoráveis, como baixo peso ao nascer e óbito neonatal, foram mais prevalentes a partir de 40 anos.

Objective: Featuring the population of pregnant women in different age groups; assessing maternal and neonatal outcomes in patients at advanced maternal age; determining the threshold age for the potential prevalence of adverse outcomes. Methods: Women in labor assisted at Hospital do Servidor Público Estadual de São Paulo between June/2019 and May/2020 were divided into three age groups ­ 20 to 34 years; 35 to 39 years; over 40 years ­, who were assessed for several variables. Results: 44.2% of pregnant women in this Service were at advanced maternal age. The sample counted on 927 patients, most of them declared stable marital relationships (75.2%) and College degree (74,7%). High obesity levels (25.9%), overweight (39.7%) and cesarean delivery (76.4%) were observed, regardless of age group. Maternal request was the main indication for cesarean surgery. Iteration frequency, gestational diabetes and pregnancy-specific hypertensive disease was higher from the age of 35 years, on. Chronical high blood pressure was higher in the age group over 40 years. Newborns from patients older than over 40 years presented higher low weight at birth index, neonatal death, 5th minute Apgar score < 7 and the need of neonatal resuscitation. Conclusion: Patients at advanced maternal age recorded higher obstetric adversity frequency in the age group over 35 years, with emphasis on gestational diabetes and high blood pressure. Unfavorable neonatal outcomes related to low weight at birth and neonatal death were more prevalent in the age group over 40 years.

Malnutrición por exceso en niños de 5 a 10 años y su asociación con el estado nutricional pre y gestacional, lactancia materna y patología materna

La malnutrición por exceso es un problema de salud pública relevante, con origen multifactorial y factores asociados como el estado nutricional pregestacional (ENP), durante y post gestación, ganancia excesiva de peso (EGP) gestacional y duración de la lactancia materna. El objetivo del estudio fue evaluar la malnutrición por exceso en niños de 5 a 10 años y su asociación con el estado nutricional pre y gestacional, lactancia materna exclusiva (LME) y patologías maternas. Se realizó un estudio con 213 niños y niñas estudiantes de 5 a 10 años. Los datos biosociodemográficos se obtuvieron mediante entrevistas con las madres y datos maternos previos y el embarazo con el carné de control. El estimó estado nutricional se estimó con z-score del peso para la talla e IMC/E, según sexo. Para los análisis estadísticos se usó el software STATA 15.0. El 56% de los estudiantes tuvo malnutrición por exceso. Un 53,1% de las madres presentó malnutrición por exceso previo al embarazo que aumentó a 74,6% post gestación. El 71,4% de los niños tuvo una LME ≥6 meses. Se relacionó estadísticamente la edad materna ≥35 años (p= 0,044) y la malnutrición por exceso pregestacional (p= 0,014). La edad materna ≥35 años aumentó el riesgo de malnutrición por exceso casi dos veces (OR= 1,78; IC: 1,029-3,046), al igual que el ENP (OR= 2,11; IC: 1,193-3,693) y en patologías maternas (OR= 1,41; IC: 1, 073-2,694). En conclusión, los niños preescolares de 5 a 10 años con factores de edad materna ≥35, ENP y patologías maternas tuvieron entre 1,4 y 2,11 veces más riesgo de presentar malnutrición por exceso comparado con aquellos niños sin estos factores.

Overnutrition is a relevant public health problem with a multifactorial origin. Associated factors include maternal nutritional status before, during, and after gestation, excessive gestational weight gain, and breastfeeding duration. The objective of the study was to evaluate the association between overnutrition in children aged 5-10 years and pre- and gestational nutritional status, exclusive breastfeeding, and maternal pathologies. The study consisted of 213 schoolchildren aged 5-10 years. Bio-socio-demographic data were obtained through interviews with mothers, previous maternal data and pregnancy follow-up records. Nutritional status was measured using weight-for-height and BMI z-score by age and sex. The STATA 15.0 software was used for statistical analysis. A total of 56% of the schoolchildren had overnutrition. Meanwhile, 53.1% of the mothers demonstrated pre-pregnancy overnutrition, which increased to 74.6% post-pregnancy. It was found that 71.4% of schoolchildren had experienced exclusive breastfeeding ≥6 months. Maternal age ≥35 years (p= 0.044) and pre-gestational nutritional status (p= 0.014) were statistically related. Maternal age ≥35 years increased overnutrition by almost two-fold (OR= 1.78; IC: 1.029-3.046), as did pre-gestational nutritional status (OR= 2.11; IC: 1.193-3.693) and maternal pathologies (OR= 1.41; IC: 1.073-2.694). In conclusion, schoolchildren aged 5-10 years with mothers ≥35 years of age, who had overnutrition in the pre-gestational period, and a pathology were 1.4 to 2.44 times more at risk of developing overnutrition than children without these factors.

Perfil de parturientes correlacionado com o pré-natal e as características dos recém-nascidos em hospital da região metropolitana de Porto Alegre / Profile of parturient women correlated with prenatal care and characteristics of newborns at a hospital in the Porto Alegre metropolitan area

Introdução: A assistência à gestante no período que antecede o parto é determinante nos indicadores de saúde. O objetivo principal do estudo foi verificar o perfil das parturientes do Hospital Universitário de Canoas/RS e correlacionar com o número de consulta de pré-natal. Métodos: Desenvolvido um estudo transversal pela análise de prontuários do Alojamento Conjunto do Hospital Universitário de Canoas, com total de 413 parturientes e seus recém-nascidos. Resultados: A frequência de consultas de pré-natal não teve diferença significativa entre as faixas etárias e com a escolaridade. Em contrapartida, as pacientes que afirmaram ter companheiro tiveram mais consultas. As pacientes com mais de um filho frequentaram, na maior parte, menos de seis consultas de pré-natal. Discussão: Os parceiros se fazem necessários para a qualidade do pré-natal ­ benefícios para o casal e para cuidados com o filho. As mulheres que já deram a luz podem se considerar mais experientes; questiona-se a realização de exames e demais necessidades de cada gestação. A idade materna e a escolaridade não tiveram diferença significativa para o número de consultas, ao contrário do resultado de outros grandes estudos brasileiros. Além disso, existem locais na cidade que carecem de maior incentivo de continuidade do cuidado pré-natal. Conclusão: No presente estudo, a menor frequência de pré-natal estava associada a multíparas e sem companheiro. A detecção de sífilis sobressaiu-se, com média superior à do Rio Grande do Sul. Em vista dos expostos, a assistência pré-natal deve alcançar melhorias na cobertura de determinados grupos de parturientes.

Introduction: Pregnancy care in the period preceding delivery is a determinant of health indicators. The main objective of this study was to verify the profile of parturient women at Hospital Universitário de Canoas and to correlate it with the number of prenatal visits. Methods: This is a cross-sectional study performed through the analysis of medical records of the rooming-in unit of Hospital Universitário de Canoas, totaling 413 parturient women and their newborns. Results: The frequency or prenatal visits did not significantly differ between age groups and level of education. On the other hand, patients who reported having a partner had more prenatal visits. Most of the patients with more than one child attended less than 6 prenatal visits. Discussion: Support partners are necessary to the quality of prenatal care ­ providing benefits to the couple and childcare. Women who have given birth may consider themselves more experienced; examinations and other requirements of each pregnancy are questioned. Maternal age and education did not show significant differences regarding the number of visits, as opposed to results observed in other large Brazilian studies. Moreover, some areas of the city lack incentives to Estrepthe continuity of prenatal care. Conclusions: In this study, a lower frequency of prenatal visits was associated with multiparous women without a partner. The detection of syphilis was noteworthy, with a higher average than that of the state of Rio Grande do Sul. In view of these results, prenatal care should reach better coverage among certain groups of parturient women.

Análisis descriptivo poblacional respecto a tasa de natalidad y edad materna en Chile entre 2015-2020 / Descriptive population analysis of the birth rate and maternal age in Chile between 2015 -2020

Introducción: A nivel mundial la tasa de natalidad desde las últimas décadas ha venido en declive, por lo que adquiere relevancia investigar sus cambios. Objetivos: Cuantificar la tendencia de nacimientos en Chile según rango etario de la madre y sexo biológico del recién nacido en el periodo 2015-2020. Metodología: Se realizó un estudio observacional y ecológico, con los datos obtenidos del banco mundial y DEIS, para la población y nacimientos respectivamente. Los datos se dividieron según las edades maternas en tres grupos: <18 años, 18-34 años y ≥ 35 años. No se requirió comité de ética debido a que no se interviene con personas. Los autores no presentan conflicto de interés. Resultados: Se observó una disminución de los nacimientos del 22,6%, pasando de 244.626 el 2015 a 189.250 el 2020. Los nacimientos en el grupo etario de madres menores a 18 años disminuyeron un 82,13%, reduciéndose de 17.505 a 3.129, el rango de edad materna correspondiente al segundo grupo de 18 a 34 años, ubicó la mayor cantidad de nacimientos, manteniéndose alrededor de un 77,75% (neto), el rango ≥ 35 años, presentó un alza de un 17%, aumentando de 34.648 nacimientos a 40.539. Discusión: En Chile hay un descenso en los nacimientos dado a que la maternidad se está postergando, lo cual puede deberse a la educación sexual implementada en el país y la mayor participación de mujeres en ámbito laboral, esto sugiere una transición de una demografía estable a una regresiva.

Introduction: The birth rate has been declining worldwide since the last decades, so it is important to investigate its changes. Objectives: To quantify the trend of births in Chile according to age range of the mother and biological sex of the newborn in the period 2015-2020. Methodology: An observational and ecological study was conducted, with data obtained from the World Bank and DEIS, for population and births respectively. Data were divided according to maternal ages into three groups: <18 years, 18-34 years and ≥ 35 years. No ethics committee was required due to the fact that we did not intervene with individuals. The authors have no conflict of interest. Results: A decrease in births of 22.6% was observed, from 244,626 in 2015 to 189,250 in 2020. Births in the age group of mothers under 18 years decreased by 82.13%, decreasing from 17,505 to 3,129, the maternal age range corresponding to the second group from 18 to 34 years, located the highest number of births, remaining around 77.75% (net), the range ≥ 35 years, presented a rise of 17%, increasing from 34. Discussion: In Chile there is a decrease in births due to the fact that motherhood is being postponed, which may be due to the sexual education implemented in the country and the greater participation of women in the labor market, suggesting a transition from a stable demography to a regressive one.

Maternal age and miscarriage: A unique association curve in Sudan

This study's aim was to estimate the prevalence and maternal age and other risk factors of miscarriage among Sudanese women. Across-sectional study was conducted at the Saad Abuelela Tertiary Hospital in Khartoum, Sudan, from February to December 2019. Sociodemographic, obstetric and clinical data were collected. A multivariate logistic regression analysis was performed. Four hundred thirteen (20.5%) women reported experiencing a miscarriage. Risk factors included older age, high parity, histories of caesarean delivery, and obesity. Logistic regression showed that the lowest risk for women aged less than 20 years (adjusted odds ratio [AOR], 0.33) or 20 to 24 years (AOR, 0.57), primiparas (AOR, 0.42) and women educated below the secondary level (AOR, 0.78). Unlike the global age-associated risk of miscarriage, the risk of miscarriage among Sudanese women follows a unique curve in relation to maternal age. Interestingly, the curve showed a lower risk for women less than 20 years and at 40 years. (Afr J Reprod Health 2022; 26 [7]: 15-21).

Gestação em idade avançada e aconselhamento genético: um estudo em torno das concepções de risco / Advanced maternal age pregnancy and genetic counseling: a study on the concept of risk

Resumo As inovações científicas em torno do estudo de cromossomos humanos surgidas após a segunda metade do século XX consolidaram a inserção da genética na assistência em saúde, no que tange ao diagnóstico pré-natal. A associação entre idade materna e síndromes genéticas, proposta por pesquisadores da biomedicina, produziu determinações sobre risco, referidas a gestantes a partir de determinada idade. O artigo apresenta as concepções de risco em torno do que a biomedicina considera ser idade materna avançada de modo a configurar o que é classificado como gestação de risco. A análise documental em manuais médicos brasileiros e estrangeiros das especialidades obstetrícia e genética evidenciou diferentes concepções de risco em relação ao fator etário reprodutivo. A idade materna é um aspecto presente na obstetrícia enquanto fator de risco de doenças. Para a especialidade genética, a idade materna não é um fator central de risco reprodutivo. A pesquisa constatou que a classificação de uma idade materna ideal para gestar é relativa e suscetível a alterações, segundo o contexto sócio-histórico de cada sociedade.

Abstract Scientific innovations around the study of human chromosomes, which emerged after the mid 20th century, consolidated the incorporation of genetics in prenatal diagnosis. The link between maternal age and genetic syndromes, proposed by biomedical researchers, produced resolutions about risks to pregnant women of a certain age. The article presents biomedicine concepts for advanced maternal age classified as a risk pregnancy. The review of Brazilian and foreign medical manuals in obstetrics and genetics showed different conceptions of risk concerning the reproductive age factor. Maternal age is an aspect in obstetrics related to the risk of diseases. For genetic expertise, advanced maternal age is not a central factor of risk for reproduction. The research found that the classification of an ideal maternal age for pregnancy is relative and susceptible to changes according to the socio-historical context of each society.

Efectos demográficos, clínicos y biológicos de la postergación de la maternidad / Demographic, clinical, and biological effects of delayed maternity

En el presente artículo se analizan los efectos de la postergación de la maternidad en tres ámbitos: i) demográfico, ii) clínico y iii) biológico. Desde luego, la literatura demográfica existente procede fundamentalmente de países con un buen grado de desarrollo, pero se ha realizado un esfuerzo por reunir la mayor cantidad de datos de países en desarrollo. Así se analiza la situación en Europa, EE.UU. y Latinoamérica para finalizar esta sección con la realidad específica en Chile. Desde el punto de vista clínico, se pone especial interés en los cambios que experimenta la probabilidad de embarazo por ciclo (definida como fecundabilidad) y la fertilidad en general. En los aspectos perinatológicos se enfatiza el incremento de frecuencia de la muerte fetal in útero temprana (aborto espontáneo) y tardía con especial mención de algunas patologías (frecuencia del síndrome de Down y otros). Se establece además la frecuencia significativamente mayor de bajo y muy bajo peso de nacimiento, necesidad de hospitalización del recién nacido (morbilidad perinatal) así como el efecto sobre la mortalidad neonatal.Biológicamente la postergación de la maternidad tiene su correlato en la pérdida de reserva ovárica y la disminución de la calidad ovocitaria que involucra un aumento en la incidencia de fallas de fecundación y embriones con bajo potencial de desarrollo y aneuploidías dependientes fundamentalmente de la edad materna. También se hace mención a algunos aspectos del envejecimiento uterino y sus consecuencias en el desarrollo y función placentaria. El enfoque se centra fundamentalmente en la mujer, pero incluye aspectos de la contribución masculina a esta temática.

This article analyzes the effects of the postponement of maternity in three areas: i) demographic, ii) clinical and perinatological and iii) biological. Of course, the existing demographic literature comes primarily from well-developed countries, but an effort has been made to collect as much data from developing countries. The situation in Europe, the U.S. and Latin America is analyzed to end this section with the specific reality in Chile. From the clinical point of view, special interest is placed on changes in the probability of pregnancy by cycle (defined as fecundability) and fertility in general. In the perinatological aspects, the increased frequency of early fetal death (spontaneous abortion) and stillbirth is emphasized, with special mention of some pathologies (frequency of Down syndrome and others). It is also stressed the significant higher frequency of low and very low birth weight, the need newborn hospitalization (perinatal morbidity), as well as the effects on neonatal mortality. Biologically, the postponement of maternity has its correlation in the loss of ovarian reserve and the decrease in oocyte quality that involves an increased incidence of fertilization failure and embryos with low potential for development and aneuploidies, mainly dependent on maternal age. Some aspects of uterine aging and its consequences on placental development and function are also mentioned. The discussion is mainly focused on women, but includes some aspects of the male contribution to this issue

Assistência ao parto de adolescentes e mulheres em idade materna avançada em maternidades vinculadas à Rede Cegonha / Childbirth care for adolescents and advanced maternal age in maternities linked to Rede Cegonha

Resumo Com base nas diretrizes da Rede Cegonha, que propõem fortalecimento dos direitos sexuais e dos direitos reprodutivos das mulheres, buscou-se apresentar um breve panorama de questões relacionadas ao planejamento reprodutivo e analisar as práticas obstétricas na atenção ao parto de adolescentes e mulheres em idade avançada, em maternidades vinculadas a Rede Cegonha. Os dados foram extraídos da avaliação conduzida em 2017, com base nas informações da entrevista com as puérperas e do prontuário hospitalar. Para os extremos etários, a alta proporção de gravidez não planejada e a baixa utilização de meios de contracepção indicam problemas no acesso aos programas de planejamento familiar. As adolescentes estão mais expostas à presença de acompanhante e menos ao uso de analgesia no trabalho de parto. As mulheres em idade avançada apresentaram maior chance de uso de analgesia no trabalho de parto e de parir na posição de litotomia, estando menos expostas a prática de amniotomia. Apesar da Rede Cegonha ser uma excelente estratégia para melhoria da assistência ao trabalho de parto e ao parto, ainda é preciso atenção ao uso de intervenções potencialmente desnecessárias ou não recomendadas, com maior incentivo às boas práticas obstétricas.

Abstract Based on the Rede Cegonha guidelines that propose the strengthening of women's sexual and reproductive rights, we sought to present a brief overview of issues related to reproductive planning and to analyze obstetric practices in childbirth care for adolescents and women of advanced age in maternity hospitals linked to Rede Cegonha. Data were extracted from an assessment conducted in 2017, based on information from the interview with puerperal women and from the hospital record. For age extremes, the high proportion of unplanned pregnancies and low use of contraception means problems in accessing family planning programs. Adolescents are more exposed to the presence of a companion and less to the use of analgesia in labor. Advanced maternal age were more likely to use analgesia in labor and to give birth in the lithotomy position, being less exposed to amniotomy. Although Rede Cegonha is an excellent strategy for improving assistance to childbirth, attention is still needed to the use of potentially unnecessary or not recommended interventions, with greater incentive to good obstetric practices.

The role of parity in the mode of delivery in advanced maternal age women / O papel da paridade no tipo de parto em mulheres com idade materna avançada

Abstract Objectives: to describe the profile of Brazilian Advanced Maternal Age (AMA) women (> 35 years) according to parity, as well as to analyze the role of parity in the relationship between AMA and mode of delivery. Methods: this is a cross-sectional study, based on the "Nascer no Brasil" (Born in Brazil) survey. The data were collected in 2011/2012. The chi-square test was performed to verify the association between parity and maternal, prenatal and delivery characteristics, maternal habits, pre-pregnancy diseases, maternal complications and obstetric history. Results: of the 2,510 puerperal AMA women, 20.2% were nulliparous, 54.4% had one or two previous births and 25.4% had three or more previous births. The nulliparous women had higher schooling, higher economic class and adequate BMI, were white; and had better maternal habits when compared to multiparous. However, they were also more submitted to cesarean section, although without reported complications. Conclusions: one cannot speak of AMA pregnant women as a homogeneous group in Brazil. There are inequalities that can be revealed via parity, since nulliparous women have maternal characteristics, habits and access to prenatal care and childbirth that are more advantageous than multiparous women.

Resumo Objetivos: descrever o perfil das mulheres brasileiras com IMA (> 35 anos) segundo a paridade, além de analisar o papel da paridade na relação entre IMA e tipo de parto. Métodos: trata-se de um estudo transversal, baseado no inquérito "Nascer no Brasil". Os dados foram coletados em 2011/2012. Executou-se o teste qui-quadrado para verificar a associação entre paridade e características maternas, do pré-natal, parto, hábitos maternos, doenças pré-gestacionais, complicações maternas e antecedentes obstétricos. Resultados: das 2.510puérperas com IMA, 20,2% eram primíparas, 54,4% tinham um ou dois partos anteriores e 25,4%o três ou mais partos anteriores. As primíparas apresentaram maior escolaridade, classe econômica mais elevada e IMC adequado, eram brancas; e possuíam melhores hábitos maternos quando comparadas às multíparas. Entretanto, também foram mais submetidas à cesariana, ainda que sem intercorrências relatadas. Conclusão: não se pode falar em gestantes com IMA como um grupo homogêneo no Brasil. Existem desigualdades que podem ser reveladas via paridade, uma vez que as primíparas apresentam características maternas, hábitos e acesso ao pré-natal e parto mais vantajosas que as multíparas.

Desfechos perinatais relacionados a idade materna e comorbidades gestacionais nos nascimentos prematuros / Perinatal outcomes related to maternal age and gestational comorbidities in premature births

Objetivo: descrever os desfechos perinatais do binômio no nascimento prematuro, de acordo com a idade materna e as principais comorbidades gestacionais. Métodos: estudo descritivo e retrospectivo, com inclusão de todos os nascimentos prematuros de 2015. As mães foram divididas em grupos de acordo com idade e presença ou não de doença hipertensiva e diabetes. Foi analisado o tempo de internação e o desfecho clínico materno­infantil. Resultados: doença hipertensiva foi a principal indicação de internação materna de UTI; poucos casos de diabetes. Conclusão: idade materna elevada e síndrome hipertensiva gestacional apresentaram maior tempo de internação e maior porcentagem de óbitos neonatais.

Objective: to describe the perinatal outcomes of the binomial in preterm birth, according to the maternal age and the main gestational comorbidities.Methods: descriptive and retrospective study, including all premature births in 2015. Mothers were divided into groups according to age and the presence or absence of hypertensive disease and diabetes. The leng­th of stay and the maternal and child clinical outcome were analyzed. Results: hypertensive disease was the main indication for maternal ICU admission; few cases of diabetes.Conclusion: high maternal age and gestational hypertensive syndrome had a longer hospital stay and a higher percentage of neonatal deaths.