Normal pregnancy Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):691-695
DOI 10.1590/S0100-72032004000900003
PURPOSE: to evaluate the importance of circulating maternal and fetal leptin in the healthy gestation, using its association with maternal, placental and fetal anthropometric variables, obtained at birth, and the relationship between the evaluated compartments. METHODS: in a transversal study a population of 33 single, healthy and term gestations was studied. The evaluated variables were maternal age, maternal weight, body mass index (BMF), weight of the newborn, placental weight, and placental index. Samples of maternal blood were immediately obtained before birth and from fetal umbilical cord blood at birth. Determination of serum leptin was performed using conventional radioimmunoassay. The relationships between serum leptin concentrations in maternal blood, umbilical artery and vein and the studied variables were assessed through linear regression. RESULTS: leptin levels were detected in the blood of all 33 pregnant women and their respective newborns, with maternal blood concentration (17.1±1.77 ng/mL) higher than that of umbilical vessels (vein: 9.0±1.16 ng/mL; artery: 8.23±1.02 ng/mL), p<0.0001. Leptin concentrations in the maternal blood were correlated with leptin concentrations in fetal blood (artery: coef. 0.63, p=0.037; vein: coef. 0.72, p=0.006). Regarding the anthropometric variables, leptin measured in the maternal blood was associated with initial and final maternal BMF (coef. 1.13; p=0.002; coef. 1,18, p=0.001) and cord leptin levels were correlated with the fetal weight at birth (vein: coef. 0.007, p=0.02; artery: coef. 0.006, p=0.02). CONCLUSION: there was a correlation between maternal and fetal leptin production and probably by the action of similar stimuli during gestation. Serum leptin was associated with the weight of the compartment where it circulates.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):691-695
DOI 10.1590/S0100-72032004000900003
PURPOSE: to evaluate the importance of circulating maternal and fetal leptin in the healthy gestation, using its association with maternal, placental and fetal anthropometric variables, obtained at birth, and the relationship between the evaluated compartments. METHODS: in a transversal study a population of 33 single, healthy and term gestations was studied. The evaluated variables were maternal age, maternal weight, body mass index (BMF), weight of the newborn, placental weight, and placental index. Samples of maternal blood were immediately obtained before birth and from fetal umbilical cord blood at birth. Determination of serum leptin was performed using conventional radioimmunoassay. The relationships between serum leptin concentrations in maternal blood, umbilical artery and vein and the studied variables were assessed through linear regression. RESULTS: leptin levels were detected in the blood of all 33 pregnant women and their respective newborns, with maternal blood concentration (17.1±1.77 ng/mL) higher than that of umbilical vessels (vein: 9.0±1.16 ng/mL; artery: 8.23±1.02 ng/mL), p<0.0001. Leptin concentrations in the maternal blood were correlated with leptin concentrations in fetal blood (artery: coef. 0.63, p=0.037; vein: coef. 0.72, p=0.006). Regarding the anthropometric variables, leptin measured in the maternal blood was associated with initial and final maternal BMF (coef. 1.13; p=0.002; coef. 1,18, p=0.001) and cord leptin levels were correlated with the fetal weight at birth (vein: coef. 0.007, p=0.02; artery: coef. 0.006, p=0.02). CONCLUSION: there was a correlation between maternal and fetal leptin production and probably by the action of similar stimuli during gestation. Serum leptin was associated with the weight of the compartment where it circulates.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):703-707
DOI 10.1590/S0100-72032004000900005
PURPOSE: to analyze the association between modes of consecutive deliveries of 714 adolescents attended at the Maternity sector of the Hospital das Clínicas da Universidade Federal de Pernambuco (Federal University of Pernambuco), from January to December 2001. PATIENTS AND METHODS: according to a prospective, analytic, transversal, and incidence type study, the sequence of delivery modes was analyzed from the first to the fourth parturition of 714 pregnant adolescents, aged from 13 to 19 years (mean17.2±1.5 years). Every day, after identifying the adolescents who delivered, by the parturition room register, they were invited to participate in this study. Those who agreed, after signing a free informed consent answered a structured questionnaire with 65 direct questions with precodified closed options, among which were delivery mode and number of gestations. RESULTS: it was found that 527 (73.8%) adolescents had only one delivery, 149 (20.9%) two deliveries, 35 (4.9%) three deliveries, and 3 (0.4%) had had four deliveries. Among the 273 cesarean sections, 207 (75.8%) occurred in primiparae, 65 (23.8%) in secundiparae and one (0.4%) in a multipara. There was a statistically significant association between the first and the second deliveries for 83 (55.7%) adolescents who had transvaginal delivery, as well as for 41 (27.5%) by cesarean section. There was also coincidence about the second and third deliveries, regarding transvaginal delivery of 23 (65.7%) adolescents, as well as cesarean section of 10 (28.6%) adolescents. CONCLUSION: a tendency to coincidence of subsequent delivery modes was identified for adolescents until the third parturition.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):703-707
DOI 10.1590/S0100-72032004000900005
PURPOSE: to analyze the association between modes of consecutive deliveries of 714 adolescents attended at the Maternity sector of the Hospital das Clínicas da Universidade Federal de Pernambuco (Federal University of Pernambuco), from January to December 2001. PATIENTS AND METHODS: according to a prospective, analytic, transversal, and incidence type study, the sequence of delivery modes was analyzed from the first to the fourth parturition of 714 pregnant adolescents, aged from 13 to 19 years (mean17.2±1.5 years). Every day, after identifying the adolescents who delivered, by the parturition room register, they were invited to participate in this study. Those who agreed, after signing a free informed consent answered a structured questionnaire with 65 direct questions with precodified closed options, among which were delivery mode and number of gestations. RESULTS: it was found that 527 (73.8%) adolescents had only one delivery, 149 (20.9%) two deliveries, 35 (4.9%) three deliveries, and 3 (0.4%) had had four deliveries. Among the 273 cesarean sections, 207 (75.8%) occurred in primiparae, 65 (23.8%) in secundiparae and one (0.4%) in a multipara. There was a statistically significant association between the first and the second deliveries for 83 (55.7%) adolescents who had transvaginal delivery, as well as for 41 (27.5%) by cesarean section. There was also coincidence about the second and third deliveries, regarding transvaginal delivery of 23 (65.7%) adolescents, as well as cesarean section of 10 (28.6%) adolescents. CONCLUSION: a tendency to coincidence of subsequent delivery modes was identified for adolescents until the third parturition.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):685-690
DOI 10.1590/S0100-72032004000900002
PURPOSE: to identify the responses of heart rate (HR), blood pressure (BP), and hydrostatic weight (HW) in pregnant women immersed up to different anatomic points as far as the xiphoid process. METHODS: eleven pregnant women underwent the following experimental procedure: 10 minutes in recumbent position for evaluation of HR and BP at rest; 2 minutes in standing position for evaluation of initial measures of HR, BP and mass, and one minute for each immersion depth. HR, BP and HW were measured after immersion up to the level of the ankle, knee, hip, navel, and xiphoid process, respectively. Descriptive statistics, test of normality (Shapiro-Wilks), homogeneity of variance test (Levene), one-way ANOVA and the Bonferroni test (SPSS version 8.0) were used, with significance at p<0.05. RESULTS: significant differences were found for HR, diastolic BP and mean BP starting from the xiphoid process (79.1±5.1 bpm; 53.3±6.7 mmHg and 63.9±6.2 mmHg, respectively) and for the systolic BP starting from the navel (92.7±11.1 mmHg). Significant differences were seen in all measurements of percent HW reduction, as in previous studies carried out with non-pregnant women. CONCLUSION: the obtained results showed a decrease in HR and BP on water immersion when compared non-immersion, as well as decreases in HW, which were proportional to the depth of immersion. The decrease in HW was found to influence the decrease in mechanical load imposed on the lower limb joints, since the mechanical load depends on both the vertical force (hydrostatic weight) and on the acceleration with which the body touches the ground. As a result, it is concluded that water is a healthy environment for the population under study, and may be adequate for the practice of physical activities.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):685-690
DOI 10.1590/S0100-72032004000900002
PURPOSE: to identify the responses of heart rate (HR), blood pressure (BP), and hydrostatic weight (HW) in pregnant women immersed up to different anatomic points as far as the xiphoid process. METHODS: eleven pregnant women underwent the following experimental procedure: 10 minutes in recumbent position for evaluation of HR and BP at rest; 2 minutes in standing position for evaluation of initial measures of HR, BP and mass, and one minute for each immersion depth. HR, BP and HW were measured after immersion up to the level of the ankle, knee, hip, navel, and xiphoid process, respectively. Descriptive statistics, test of normality (Shapiro-Wilks), homogeneity of variance test (Levene), one-way ANOVA and the Bonferroni test (SPSS version 8.0) were used, with significance at p<0.05. RESULTS: significant differences were found for HR, diastolic BP and mean BP starting from the xiphoid process (79.1±5.1 bpm; 53.3±6.7 mmHg and 63.9±6.2 mmHg, respectively) and for the systolic BP starting from the navel (92.7±11.1 mmHg). Significant differences were seen in all measurements of percent HW reduction, as in previous studies carried out with non-pregnant women. CONCLUSION: the obtained results showed a decrease in HR and BP on water immersion when compared non-immersion, as well as decreases in HW, which were proportional to the depth of immersion. The decrease in HW was found to influence the decrease in mechanical load imposed on the lower limb joints, since the mechanical load depends on both the vertical force (hydrostatic weight) and on the acceleration with which the body touches the ground. As a result, it is concluded that water is a healthy environment for the population under study, and may be adequate for the practice of physical activities.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):477-482
DOI 10.1590/S0100-72032004000600009
OBJECTIVE: to evaluate the neonatal morbidity and mortality related to mothers at the age of 35 or older than that. METHODS: in 2377 births in a year, 316 newborns (13.26%) from mothers at the age of 35 or more were selected for the study. These women were compared to pregnant controls aged 20 to 29, randomly selected among the 1170 women in the same age group (49,2%). For the inclusion criteria, pregnancies should have been over 22 weeks and the newborns should have weighted 500g or more at birth. Fourteen twin cases were excluded. To evaluate mortality and morbidity the following variables were considered: Apgar Index, birth weight, newborn health conditions, fetal malformations and neonatal mortality until hospital discharge. RESULTS: when analyzed as a whole, nulliparous and multiparous women showed significantly less favorable perinatal results for the selected group of women at 35 or more years old as compared with pregnant controls, what was not sustained when the nulliparous were excluded. Multiparous at the age of 35 or over presented a higher rate of low Apgar index in the 1st minute: 21.3 and 13.1%: (p<0,0033); small NB for the gestational age: 15.2% and 6.7% (p<0,02); big NB for the gestational age: 5.7 and 0.0% (p<0,02); low weight at birth: 23.8 and 14,5% (p<0,01), and prematurity, 16,7 and 6,7%, (p<0,005). Significant differences were not found for the Apgar index in the 5th minute, fetal malformations, newborn health conditions at hospital discharge and neonatal mortality. CONCLUSIONS: Neonatal morbidity increased among pregnant women at the age of 35 and older, but not the neonatal mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):477-482
DOI 10.1590/S0100-72032004000600009
OBJECTIVE: to evaluate the neonatal morbidity and mortality related to mothers at the age of 35 or older than that. METHODS: in 2377 births in a year, 316 newborns (13.26%) from mothers at the age of 35 or more were selected for the study. These women were compared to pregnant controls aged 20 to 29, randomly selected among the 1170 women in the same age group (49,2%). For the inclusion criteria, pregnancies should have been over 22 weeks and the newborns should have weighted 500g or more at birth. Fourteen twin cases were excluded. To evaluate mortality and morbidity the following variables were considered: Apgar Index, birth weight, newborn health conditions, fetal malformations and neonatal mortality until hospital discharge. RESULTS: when analyzed as a whole, nulliparous and multiparous women showed significantly less favorable perinatal results for the selected group of women at 35 or more years old as compared with pregnant controls, what was not sustained when the nulliparous were excluded. Multiparous at the age of 35 or over presented a higher rate of low Apgar index in the 1st minute: 21.3 and 13.1%: (p<0,0033); small NB for the gestational age: 15.2% and 6.7% (p<0,02); big NB for the gestational age: 5.7 and 0.0% (p<0,02); low weight at birth: 23.8 and 14,5% (p<0,01), and prematurity, 16,7 and 6,7%, (p<0,005). Significant differences were not found for the Apgar index in the 5th minute, fetal malformations, newborn health conditions at hospital discharge and neonatal mortality. CONCLUSIONS: Neonatal morbidity increased among pregnant women at the age of 35 and older, but not the neonatal mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(1):15-20
DOI 10.1590/S0100-72032004000100003
PURPOSE: to analyze the values of Doppler ultrasound for blood flow velocity in the ductus venosus between the 10th and the 14th week of gestation, during the different phases of the cardiac cycle: ventricular systole (wave S), ventricular diastole (wave D), atrial systole (wave a), and angle-independent indexes. METHODS: Doppler was used in this prospective cross-sectional study to examine 276 single pregnancies. Fetus malformations, abnormal nuchal translucency, and women with clinical pathologies were excluded. A Toshiba SSH-140 ultrasound equipment was used. The derivation of Doppler frequency spectra was carried out according to standardized measurement procedures: less than 30ºinsonation angle and 50-70 Hz high-pass filter. The ductus venosus was identified in a median sagittal and ventral plane with the presence of color aliasing due to increase in blood flow velocity. The sample volume (1-2 mm³) was placed immediately at the origin of the ductus venosus. At least three clearly and subsequent waves were available for measurement of standard values. The Levene test and the Bonferroni method were used for statistical analysis. RESULTS: increase in blood flow velocity from 29 cm/s to 37 cm/s (p=0.013) was observed during ventricular systole between the 10th and the 14th week of gestation. Similarly, increase in blood flow velocity was recorded during the ventricular diastole (from 25 cm/s to 32 cm/s, p=0.026). There were no changes in wave a, pulsatility index, and S/a ratio in this period. CONCLUSION: the reference ranges established by this study may serve as the basis for Doppler ultrasound follow-up in a normal patient population. Further studies are required to determine the validity of these parameters and, in particular, for the fetus at risk.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(1):15-20
DOI 10.1590/S0100-72032004000100003
PURPOSE: to analyze the values of Doppler ultrasound for blood flow velocity in the ductus venosus between the 10th and the 14th week of gestation, during the different phases of the cardiac cycle: ventricular systole (wave S), ventricular diastole (wave D), atrial systole (wave a), and angle-independent indexes. METHODS: Doppler was used in this prospective cross-sectional study to examine 276 single pregnancies. Fetus malformations, abnormal nuchal translucency, and women with clinical pathologies were excluded. A Toshiba SSH-140 ultrasound equipment was used. The derivation of Doppler frequency spectra was carried out according to standardized measurement procedures: less than 30ºinsonation angle and 50-70 Hz high-pass filter. The ductus venosus was identified in a median sagittal and ventral plane with the presence of color aliasing due to increase in blood flow velocity. The sample volume (1-2 mm³) was placed immediately at the origin of the ductus venosus. At least three clearly and subsequent waves were available for measurement of standard values. The Levene test and the Bonferroni method were used for statistical analysis. RESULTS: increase in blood flow velocity from 29 cm/s to 37 cm/s (p=0.013) was observed during ventricular systole between the 10th and the 14th week of gestation. Similarly, increase in blood flow velocity was recorded during the ventricular diastole (from 25 cm/s to 32 cm/s, p=0.026). There were no changes in wave a, pulsatility index, and S/a ratio in this period. CONCLUSION: the reference ranges established by this study may serve as the basis for Doppler ultrasound follow-up in a normal patient population. Further studies are required to determine the validity of these parameters and, in particular, for the fetus at risk.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):731-738
DOI 10.1590/S0100-72032003001000006
PURPOSE: to evaluate, in pregnant adolescents, the incidence of iron deficiency, using the following blood tests: hemoglobin, ferritin, serum iron, transferrin saturation rate and serum transferrin receptor, and their relationships. METHODS: a total of 56 adolescents were included at the first prenatal evaluation between the 12th and the 20th week of gestation. The normal values for each test were: above 11 mg/dL for hemoglobin, 12 µg/dL for ferritin, 50 mg/L for serum iron, 16% for transferrin saturation rate and below 28.1 nmol/L for serum transferrin receptor. Each result was evaluated using percentages and the McNemar test was used to compare the results. RESULTS: incidence of anemia using the hemoglobin concentration test was 21.4%. All pregnant women presented mild anemia. In the present study, 21.4% of the patients had iron deficiency with a ferritin concentration <12 mug/dL. Serum iron concentration was reduced in 3.6% of the adolescents and transferrin saturation rate in 26.8% of the sample. The value obtained by the transferrin receptor test was unclear, due to the lack of international standardization regarding measure unit. Comparing the hemoglobin concentration test to the other iron deficiency tests, it was found that the latter do not show a better evaluation than the hemoglobin concentration test in patients with hypoferremia. CONCLUSIONS: the hemoglobin concentration test in patients with mild anemia was effective to identify iron deficiency.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):731-738
DOI 10.1590/S0100-72032003001000006
PURPOSE: to evaluate, in pregnant adolescents, the incidence of iron deficiency, using the following blood tests: hemoglobin, ferritin, serum iron, transferrin saturation rate and serum transferrin receptor, and their relationships. METHODS: a total of 56 adolescents were included at the first prenatal evaluation between the 12th and the 20th week of gestation. The normal values for each test were: above 11 mg/dL for hemoglobin, 12 µg/dL for ferritin, 50 mg/L for serum iron, 16% for transferrin saturation rate and below 28.1 nmol/L for serum transferrin receptor. Each result was evaluated using percentages and the McNemar test was used to compare the results. RESULTS: incidence of anemia using the hemoglobin concentration test was 21.4%. All pregnant women presented mild anemia. In the present study, 21.4% of the patients had iron deficiency with a ferritin concentration <12 mug/dL. Serum iron concentration was reduced in 3.6% of the adolescents and transferrin saturation rate in 26.8% of the sample. The value obtained by the transferrin receptor test was unclear, due to the lack of international standardization regarding measure unit. Comparing the hemoglobin concentration test to the other iron deficiency tests, it was found that the latter do not show a better evaluation than the hemoglobin concentration test in patients with hypoferremia. CONCLUSIONS: the hemoglobin concentration test in patients with mild anemia was effective to identify iron deficiency.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):717-724
DOI 10.1590/S0100-72032003001000004
PURPOSE: to evaluate the adequacy of the prenatal care process offered to users of the Unified Health Care System (SUS) in Juiz de Fora-MG and to compare the municipal services. METHODS: a transversal study with auditing was carried out on the records of 370 pregnant women, selected by systematic sampling among women who carried their pregnancies to term and gave birth using SUS services in the first semester of 2002, with prenatal care given in Juiz de Fora. For statistical analysis the c² test was used to compare the municipal services (level of significance: 5%). The evaluation followed a three-tiered complementary sequence, using: the utilization of prenatal care (Kessner index: beginning and frequency of care) at level 1; the utilization of prenatal care and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (ABO-Rh, hemoglobin/hematocrit, VDRL, glycemia and urinalysis), at level 2; and the utilization of prenatal care, the basic laboratory tests and the obligatory clinical-obstetric procedures during a prenatal visit (assessment of blood pressure, weight, edema, uterine fundal height, gestational age, fetal heart rate and fetal presentation), at level 3. RESULTS: the observed adequacy of the process was only 26.7% (level 1), 1.9% (level 2) and 1.1% (level 3). We also observed a prenatal coverage of 99.04%, an average of 6.4 visits per pregnant woman, and an average gestational age of 17.4 weeks at the time of the first prenatal visit. There were no significant differences between the municipal services. CONCLUSIONS: prenatal care offered to SUS users in Juiz de Fora should be reviewed from a qualitative standpoint, and periodic evaluations as necessary instruments of improvement are recommendable. Managers and professionals should undertake actions aimed at increasing compliance with norms/routines of the program - principally the request/recording of basic complementary tests - and which guarantee increased utilization of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):717-724
DOI 10.1590/S0100-72032003001000004
PURPOSE: to evaluate the adequacy of the prenatal care process offered to users of the Unified Health Care System (SUS) in Juiz de Fora-MG and to compare the municipal services. METHODS: a transversal study with auditing was carried out on the records of 370 pregnant women, selected by systematic sampling among women who carried their pregnancies to term and gave birth using SUS services in the first semester of 2002, with prenatal care given in Juiz de Fora. For statistical analysis the c² test was used to compare the municipal services (level of significance: 5%). The evaluation followed a three-tiered complementary sequence, using: the utilization of prenatal care (Kessner index: beginning and frequency of care) at level 1; the utilization of prenatal care and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (ABO-Rh, hemoglobin/hematocrit, VDRL, glycemia and urinalysis), at level 2; and the utilization of prenatal care, the basic laboratory tests and the obligatory clinical-obstetric procedures during a prenatal visit (assessment of blood pressure, weight, edema, uterine fundal height, gestational age, fetal heart rate and fetal presentation), at level 3. RESULTS: the observed adequacy of the process was only 26.7% (level 1), 1.9% (level 2) and 1.1% (level 3). We also observed a prenatal coverage of 99.04%, an average of 6.4 visits per pregnant woman, and an average gestational age of 17.4 weeks at the time of the first prenatal visit. There were no significant differences between the municipal services. CONCLUSIONS: prenatal care offered to SUS users in Juiz de Fora should be reviewed from a qualitative standpoint, and periodic evaluations as necessary instruments of improvement are recommendable. Managers and professionals should undertake actions aimed at increasing compliance with norms/routines of the program - principally the request/recording of basic complementary tests - and which guarantee increased utilization of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):625-630
DOI 10.1590/S0100-72032003000900002
PURPOSE: to evaluate the nutritional condition of pregnant adolescents using the pregestational body mass index (BMI) and the BMI at the end of pregnancy and to establish a possible association with the type of delivery and weight of the newborn child. METHODS: in a descriptive retrospective observational study 558 pregnant teenagers as well as their newborns were evaluated in the Obstetrics outpatient clinic of the Universidade Federal de São Paulo, Brazil (UNIFESP-EPM), from January 1998 to December 2000. The sample consisted of pregnant girls who were between 10 and 19 years old at the time of the first prenatal examination, excluding the teenagers who had preexistent disease and those with incomplete data in their records. Thus, the sample consisted of 300 pregnant teenagers. Qualitative variables are presented as absolute and relative frequency and quantitative variables as mean, standard deviation and range. The correlation between maternal variables (pre-pregnancy BMI and final BMI) and parameters of the newborn (type of delivery and weight) was determined by the c² test and the differences were identified by partitioning of the c² values, with the level of significance set at p < 0.05 (a = 0.05). RESULTS: nutritional deviation was detected in 34.7% of the girls, at the beginning of pregnancy. Of these adolescents, 27.7% presented malnutrition, 4% were overweight and 3% were obese. By the end of the gestational period, BMI of 54.3% of them was normal, 1.3% correponded to malnutrition, 27% to overweight and 17.3% to obesity. The mother's nutritional condition (malnutrition, normal, overweight and obesity) did not affect the method of delivery, either vaginal (80.3%) or cesarean section (19.7%). The patients who reached end of pregnancy with BMI corresponding to malnutrition had 75% of neonates under 2.500 g. CONCLUSIONS: the mother's nutritional status was not related to the type of delivery. BMI corresponding to malnutrition at the end of pregnancy was significantly related to more cases of newborn babies under 2.500 g.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):625-630
DOI 10.1590/S0100-72032003000900002
PURPOSE: to evaluate the nutritional condition of pregnant adolescents using the pregestational body mass index (BMI) and the BMI at the end of pregnancy and to establish a possible association with the type of delivery and weight of the newborn child. METHODS: in a descriptive retrospective observational study 558 pregnant teenagers as well as their newborns were evaluated in the Obstetrics outpatient clinic of the Universidade Federal de São Paulo, Brazil (UNIFESP-EPM), from January 1998 to December 2000. The sample consisted of pregnant girls who were between 10 and 19 years old at the time of the first prenatal examination, excluding the teenagers who had preexistent disease and those with incomplete data in their records. Thus, the sample consisted of 300 pregnant teenagers. Qualitative variables are presented as absolute and relative frequency and quantitative variables as mean, standard deviation and range. The correlation between maternal variables (pre-pregnancy BMI and final BMI) and parameters of the newborn (type of delivery and weight) was determined by the c² test and the differences were identified by partitioning of the c² values, with the level of significance set at p < 0.05 (a = 0.05). RESULTS: nutritional deviation was detected in 34.7% of the girls, at the beginning of pregnancy. Of these adolescents, 27.7% presented malnutrition, 4% were overweight and 3% were obese. By the end of the gestational period, BMI of 54.3% of them was normal, 1.3% correponded to malnutrition, 27% to overweight and 17.3% to obesity. The mother's nutritional condition (malnutrition, normal, overweight and obesity) did not affect the method of delivery, either vaginal (80.3%) or cesarean section (19.7%). The patients who reached end of pregnancy with BMI corresponding to malnutrition had 75% of neonates under 2.500 g. CONCLUSIONS: the mother's nutritional status was not related to the type of delivery. BMI corresponding to malnutrition at the end of pregnancy was significantly related to more cases of newborn babies under 2.500 g.