RESUMO
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.
RESUMO
Background: The prevalence of gestational diabetes (GDM) is increasing along with obesity and gestational age. This prevalence varies in populations and with different guidelines used for the diagnoses. Aim: To estimate the change in prevalence of GDM and obesity in a period 11 years. Material and Methods: Analysis of pregnancies attended at an obstetrics ward of a general hospital between 2001 and 2018. Those women who were diabetic prior to their pregnancy were excluded from the analysis. Annual crude and adjusted prevalence using direct standardization by age were estimated. Results: We analyzed 33,985 pregnancies. GDM screening was performed in 20,139 (59%), and 1,466 (7%) had GDM. In 2007 the crude and adjusted prevalence of GDM were 4.9 and 5.2%, respectively. The figures in 2018 were 8.8 and 8.5%, respectively, with an annual percentage of change (APC) of 6.9% (p < 0.001). The frequency of obesity also increased with an APC of 4.1% (p < 0.001). In women with GDM the APC of obesity was 4.6% (p < 0.001). There was also an increase in the frequency of screening, with a joinpoint in 2011. The APC of screening in the periods 2007-2011 and 2011-2018 were 16.6 and 2.9%, respectively (p < 0.001). Conclusions: The prevalence of GDM increased in this period of eleven years along with the prevalence of obesity.