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Introduction: Objective: the aim of our study was to assess the effect of bariatric surgery on obstetric outcomes. Material and methods: a retrospective cohort study was conducted, including 54 pregnancies post-bariatric surgery and 219 pregnancies in non-operated obese women, from December 2018 to January 2023. Various maternal and obstetric characteristics were evaluated, ranging from baseline data to antepartum, intrapartum, postpartum, and neonatal outcomes. Results: bariatric surgery showed a significant 69 % reduction in the risk of gestational diabetes (GDM) (p = 0.045) and a 63.1 % reduction in cesarean sections (p = 0.014), but also a notable increase in the risk of miscarriage (3.5 times more, p = 0.046) and intrauterine growth restriction (35 times more, p = 0.009). Bariatric surgery was associated with a significant prolongation of postpartum hospital stay (7.5 times more, p = 0.001) and a decrease in the average weight of the newborn (213.71 g, p = 0.006). Conclusion: pregnancy after bariatric surgery presents benefits, such as a reduced risk of gestational diabetes (GDM) and cesarean section, but also presents challenges, such as an increased risk of miscarriage and intrauterine growth restriction (IUGR). These results highlight the importance of specialized obstetric care to optimize maternal-fetal outcomes in pregnant women with a history of bariatric surgery.

Introduction: To identify the association between maternal obesity and perinatal adverse outcomes in a population from the Colombian northeast., Patients and Method: Multicenter, prospective, transverse study with patients who consulted and completed their pregnancy at the Clinica Materno Infantil San Luis and Hospital Universitario de Santander, between January 2019 and March 2020. The nutritional status of the patients was classified according to the Rosso-Mardones curve and obese and normal- weight pregnant women were included. The main outcome was prematurity, and the secondary ones were intrauterine growth restriction, large for gestational age, and early neonatal hypoglycemia. The analysis was made in subgroups of pregnant women without comorbidities. The strength of associa tion was estimated through binomial regression (RR), and a confidence interval of 95%, adjusted by maternal age as a confounding variable according to a counterfactual model. A p- < 0.05 value was considered statistically significant., Results: 283 obese pregnant women and 276 normal body mass index pregnant women were included. There was a significant association between maternal obesity and prematurity (RR 2.5; CI95% 1.4-4.2), early neonatal hypoglycemia (RR 7.1; CI95% 2.1-23.7), and large for gestational age (RR 6.6; CI95% 3,3-13,1). These findings were similar in pregnant wo men without maternal hypertension or diabetes., Conclusion: Maternal obesity is associated with prematurity, large for gestational age, and early neonatal hypoglycemia; even in patients without maternal hypertension and diabetes.

Introducción: El bajo peso neonatal (< 2.5 kg o < percentil 10) se atribuye a causas constitucionales (pequeño para la edad gestacional [PEG]) o a la restricción en el crecimiento intrauterino (RCIU), con riesgos posnatales diferentes. En ausencia de una valoración fetal-placentaria prenatal adecuada, resulta difícil establecerlo. El conocer los antecedentes maternos de enfermedades gestacionales (AMEG): hipertensión arterial (HTA), hipotiroidismo, Diabetes Mellitus (DM) gestacional y otra; pudiera orientar a la diferenciación y el manejo. El objetivo de este trabajo fue determinar si la presencia de AMEG se asocia a complicaciones neonatales en productos de bajo peso neonatal., Métodos: Se realizó un estudio de cohorte retrospectivo en un grupo de 349 recién nacidos vivos de término (≥ 37 semanas de edad gestacional [SEG]), PEG, en cunero fisiológico y agrupados según los AMEG. Se determinó la frecuencia de dificultad respiratoria (DR), hipoglucemia (HG) e hiperbilirrubinemia (HBr)., Resultados: El 16.6% (58/349) presentó AMEG (58.6% HTA y 41.3% hipotiroidismo, solos o combinados). Los neonatos con AMEG fueron más limítrofes (37 SEG, 55.2% vs. 35.1%; p = 0.037). Los de 37 SEG con menor peso (diferencia de ≈100 g; p = 0.028), más riesgo de HG (13.6%; intervalo de confianza al 95% [IC 95%]: -4.08-31.2) pero menos DR (diferencia de -4.7%; IC 95%: -20.6-11.05). La HG en los de 39 SEG solo se presentó en neonatos sin AMEG (diferencia 12.7%; IC 95%: 3.9 a 31.5) igual que la HBr (tres casos)., Conclusiones: Indagar sobre los AMEG en un producto PEG parece ser útil en la inferencia de RCIU. Sin embargo, es insuficiente, por lo que en conjunto con otras herramientas nos ayuda a estimar posibles complicaciones y acciones preventivas., Background: Low-birth-weight (LWB < 2.5 kg or <10 percentile) could be caused by constitutional matters or by intrauterine growth restriction (IUGR), both with different neonatal complications. Without an adequate prenatal evaluation is hard to stablish those conditions. Knowing the maternal history for gestational diseases (MHGD) such as hypertension (HTA), hypothyroidism or diabetes, among others could help clarify that difference. The aim of this work was to determine if having a MHGD is associated to neonatal complications in newborns with LWB., Methods: Retrospective cohort study, which included 349 with LWB at term (≥ 37 weeks of gestation [WG]) grouped into those with or without MHGD at a hospital nursery. The frequency of respiratory distress, hypoglycemia, and hyperbilirubinemia was determined., Results: 16.6% (58/349) had MHGD (58.6% for HTA and 41.3% hypothyroidism alone or combined). The neonate with MHGD were more borderline term (37 WGA, 55.2% vs. 35.1%; p = 0.037), and had lower weight (difference of ≈100 g; p = 0.028), had more cases with hypoglycemia (13.6%; CI 95%: −4.08 to 31.2%) but developed less respiratory distress (RD) (difference of −4.7%; CI 95%: −20.6 to 11.05%). Hypoglycemia in 39 WGA was only seen among neonates without MHGD (difference 12.7%; CI95%: 3.9 to 31.5%) just as for the hyperbilirubinemia cases (three)., Conclusions: Inquiring about the MHGD on LBW term babies could be useful in the inference of IUGR, although we need other tools so that altogether can help to predict possible complications and to plan preventive actions., (Copyright: © 2018 SecretarÍa de Salud.)

Introduction: Wolf-Hirschhorn syndrome (WHS) is a contiguous gene syndrome that gives rise to multiple congenital anomalies, caused by the loss of a distal portion of the short arm of chromosome 4 (4p16.3). It is characterised by its own peculiar facial phenotype, associated to growth problems, psychomotor retardation and epilepsy., Aims: To establish a register of patients with WHS in Spain, describe their characteristics, determine the prevalence of epilepsy, estimate the degree of psychomotor retardation and perform a review of the literature in order to compare these data with those published to date., Patients and Methods: In collaboration with the Spanish Wolf-Hirschhorn Syndrome Association, we contacted the families affected and collected data via forms endorsed by medical reports., Results: The characteristics of 51 patients are described. Psychomotor retardation was considered the most severe in 37% of cases. Of the total sample, 88% presented epilepsy, and nearly all of them showed growth problems. The mean size of the deletion was 8.4 Mb, and the phenotype is displayed in photographs. Other clinical features reported were sensory alterations and nephrourological and cardiological pathologies., Conclusions: This study reports on the second largest cohort of patients with WHS with a genetic characterisation published to date. Many of the characteristics coincide with those described previously, with several exceptions, such as the degree of psychomotor retardation, which appears to be lower in the sample studied here.

Introduction: The use of greater amounts of protein and energy during the first week of life is associated with hypophosphataemia in extreme preterm babies. The lowest phosphorus levels are described in intrauterine growth restricted (IUGR) babies., Objectives: To describe biochemistry levels in cord blood plasma in extreme premature, adequate and small for gestational age babies (AGA/SGA) and their relationship with plasma calcium and phosphorus levels during the first week of life., Patients and Method: A descriptive clinical study was performed in the Neonatology Service at Hospital Dr. Sótero del Río during 2013 and 2014. A biochemical analysis of cord blood was performed on 43 premature babies, as well as plasma calcium and phosphorus levels during the first week. The adequacy for gestational age was obtained using Alarcón- Pittaluga growth curves. Statistical significance was P<.05., Results: Cholesterol, transaminases, albumin and creatinine levels were similar for both AGA and SGA babies. Levels of pH, phosphorus, calcium and alkaline phosphatase were significantly lower in SGA babies. Urea nitrogen, uric acid and triglycerides levels were higher in SGA. The analysis during the first week showed a strong reduction in phosphorus levels, as well as an increase in calcium levels in proportion to the decrease in phosphorus in the SGA sub- group., Conclusions: Intrauterine malnutrition in preterm babies is expressed in the modulation of plasma levels of calcium, phosphorus, alkaline phosphatase, urea nitrogen, uric acid and triglycerides. During post-natal life, when nutritional intake begins, a decrease in phosphorus and an increase in calcium levels appear, consistent with insufficient phosphorus intake during this period., (Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objective: since 1976, the term low birth weight (LBW) has been applied to all infants weighing less than 2 500 g and it constitutes the most important factor affecting neonatal mortality, morbidity in childhood. The aim of this study is to identify associations between biological, socioeconomic and health factors and underweight newborns in the Canary Islands., Materials and Methods: a cross-sectional epidemiological study was conducted, with the files belonging to pregnant women in 2011 and 2012 (n = 11.768) at the Hospital Universitario Insular Materno of Gran Canaria, which accounted for 66.3% of all births in the province for those years, excluding from the analysis the data pertaining to multiple births (393) (3.3%). The distribution and frequency of weight by sociodemographic characteristic were analyzed. Percentages were compared using the χ2 test, means with the t-test and medians with the Wilcoxon test for independent data. Those variables that were associated with low birth weight in the univariate analysis were entered into a logistic multidimensional analysis., Results: the distribution of birth weight revealed an of excess underweight children (9.3%), of which (62.1%) were pretermature. Mothers of children with LBW are thinner, of a smaller size and BMI (< 18.5 kg/m2), and an average age of 31.5. It was also noted that there is an increase between the age of the mothers and low weight although the effect is not linear; in fact, the increases in the risk of LBW accelerate as age increases. When maternal BMI decreases, to approximately below 25, the risk of low birth weight increases linearly. The highest OR correspond to fetal intrauterine growth retardation (CIR) (OR = 6.3; 95% CI = 5.3, 7.4), hypertension/eclampsia (OR = 3.2; 95% CI = 2.1; 5.1), in gestations of less than 37 weeks (OR = 2.5; 95% CI = 2.0; 3.3) and the consumption of tobacco by the mother (OR = 1.9; 95% CI = 1.6, 2.3)., Conclusions: smoking during pregnancy appears to be the most important mediating factor in IUGR mediating factor. An overweight or obese mother did not appear to constitute a risk factor for a child's low birth weight. Intrauterine growth restriction (IGR) is the variable health that most affects low weight and high blood pressure in the mother, also associated with fetal growth retardation. While it is true that lack of antenatal care cannot be considered as a causal factor of underweight babies, 47.1% of pregnant women in the Canaries had insufficient controls (< 3 controls) with an increase of said controls would make it possible to reduce the frequency of the low weight in newborns., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objective: To report our experience in maternal-fetal outcome in women with RA in a national medical referral center., Methods: A retrospective analysis of the records of pregnant women with rheumatoid arthritis attending at a Pregnancy and Autoimmune Rheumatic Diseases Clinic was performed. Maternal-fetal outcomes such as disease activity, preclampsia/eclampsia, rate of live births, abortions, stillbirths, preterm birth, weeks of gestation, birth weight, congenital malformations and use of anti-rheumatic drugs were studied., Results: We included 73 pregnancies in 72 patients. Disease activity was documented in 47.2% of patients during pregnancy and/or postpartum and 87.7% of patients received some antirheumatic drug. Preclampsia developed in 8.2% of cases. The live birth rate was 98.6%, with preterm delivery in 15.9% and low weight at term in 17.6% of cases. Cesarean section was performed in 77.1% of cases. The disease activity was not associated with a higher percentage of maternal-fetal complications., Conclusions: Our study showed that most patients do not experience significant activity of RA during pregnancy, fetal outcome is satisfactory and disease activity did not appear to influence significantly the obstetric outcome.

Objective: To determine the incidence, stressors and perinatal outcomes of intrauterine growth retardation in the hospitals of the Ministry of Health of Peru., Material and Methods: Cross-sectional, analytical, case-control study of 9777 infants with intrauterine growth retardation (IUGR) in 29 hospitals of the Ministry of Health of Peru in 2010. The Peruvian intrauterine growth curve was used for the diagnosis of IUGR. IUGR newborns (cases) and newborns appropriate for gestational age (controls) were compared using the odds ratio (OR) with a confidence interval of 95%., Results: The incidence of IUGR was 10.1%. The incidence by region was: 8.1% Coast, 11.8% Selva and Sierra 14.6%. The frequency of stress factors of IUGR were: nutrition (92%), psychological (84.8%), social (53%), anatomical (63.6%), toxic/environmental (52.9%), vascular (29,8%), infection (14.1%) and metabolic (0.3%). The newborn with IUGR had higher perinatal morbidity (OR=2,1) and mortality (OR=3.5)., Conclusion: The healthy fetus is the result of a balance between stress factors and the adaptive response of the mother and fetus. When the response of physiological adaptation is overcome by stress factors, IUGR occurs.The political, psychological, nutritional and medical intervention before 12 weeks of gestation has the potential to change the harmful effects of all human stress factors that affect fetal growth.

This article advances theoretical and conceptual arguments to justify efforts to reduce chronic malnutrition as a basic component of any strategy for promoting health and development in countries with a high malnutrition prevalence. The arguments rest on four cardinal principles of contemporary social epidemiology, in whose framework reducing chronic malnutrition would be a key strategic component: the social determinants approach, the life course as the clinical-epidemiological paradigm, the concept of heredity and population health, and recognition of the family as a social determinant. Added to these are the close association between nutrition, health, and development, on the one hand, and the political significance of any strategy that makes the fight against chronic malnutrition the most visible focus of programmatic action.

Background: happens in the womb when the death of one of the twins, it is necessary to consider the factors that influence the perinatal outcome of surviving fetus., Objective: To review the outcome of twin pregnancies complicated by single fetal intrauterine death and how it can increase morbidity to its co-twin and its mother., Material and Methods: A retrospective analysis of the fifty one twin pregnancies complicated by single fetal intrauterine death in the second or third trimester in our centre from December 1999 to December 2010., Results: Of the total amount of 1996 twin pregnancies attended in our centre, 51 were complicated by single fetal intrauterine death (2.5%). In 68.7% of the cases we found several maternal complications, such as 12.2% of preeclampsia and 12% of coagulopathies. As for the dead foetus, there was a 47% of malformations, a 19.6% of intrauterine fetal growth restriction and there was a 9.8% of cases complicated by twin-twin transfusion syndrome. In the group of the surviving co-twin, 9.8% developed intrauterine growth restriction, 9.8% oligohydramnios and 9.8% Doppler alterations. There was a high risk of prematurity with 43.1% of the births under 34 weeks and 13.7% under 30 weeks of pregnancy. The percentage of caesarean was 64.7%. There was 3 cases of co-twin died intra-uterus, and one more died postpartum. A 10% of the newborns had some kind of neurological disability., Conclusions: It seems that surviving co-twin prognosis is mainly compromised by prematurity and its consequences. There should be more prospective research to inform decision-making and evaluate and control the potential maternal and fetal risks.

Background: intrauterine growth restriction (IUGR) is related with neonatal morbidity and mortality. The detection and prenatal monitoring are necessary for an early intervention. The objective was to establish the prevalence and risk factors associated with intrauterine growth restriction in the university hospital Dr. José Eleuterio González., Methods: we performed an observational, cross-sectional study, during the period from May 2009 to April 2010. The sample was divided into two groups, asymmetrical and symmetrical IUGR., Results: the global prevalence of IUGR was 13.5 %. We included 464 patients, 324 (70 %) with asymmetric IUGR and 140 (30 %) with symmetric IUGR. The maternal variables were not statistically significant (p = ns) between groups. We found a mean weight at birth higher (2548 ± 437.33) in the symmetric IUGR group (p < 0.01), as well as a higher vaginal delivery rate (p < 0.05) as compared with the asymmetrical IUGR group. The overall mortality rate was higher in the asymmetric IUGR group (p < 0.01)., Conclusions: prevalence of IUGR in our population is higher than that reported in the literature; there were more preterm infants and higher mortality in the asymmetric group.

Introduction and Objective: Population standards of intrauterine growth are necessary to evaluate if the newborn has grown well, if their nutritional conditions are appropriate and to identify groups at risk as those small for gestational age (SGA). Differences in the number of SGA newborns identified, depending on the standard applied, have been analyzed in this study., Material and Methods: Cross-sectional study conducted in 4,486 Caucasian newborns (2,361 boys and 2,125 girls), born between 35 and 41 weeks. Weight and length valuation was performed following the standard methodology. Percentage of children under the 10(th) percentile for weight and length was calculated depending on the standard used (Olsen et al. 2010, Lubchenco et al. 1966, Delgado et al. 1996, Carrascosa et al. 2008), being diagnosed of SGA., Results: Weight and length were significantly higher in boys than in girls at all ages. 10(th) percentile values defined for every gestational age are globally similar among the different standards and our population, with the clear exception of Lubchenco curves whose 10(th) percentile values are even 300 g. lower for the newborns at the highest gestational ages. Lubchenco charts do not fit the pattern of intrauterine growth of our population and identify a smaller number of SGA. The percentage of SGA of our sample ranged between 1.7% and 14% in depending on the standard, sex and gestational age considered., Conclusion: The number of children classified as SGA is different according to each standard used. Lubchenco charts identify a smaller number of SGA than the others. The rest of curves show similar values and seem to be well adapted for our population. The correct identification of SGA will allow a better assessment of short and long-term risks of these newborns.

Background: Monochorionic biamniotic (MC/BA) twin pregnancies are at higher risk for twin-to-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR) and structural defects., Material and Method: During an 18 months period all MC/BA twins referred to our unit for clinical surveillance were evaluated. Chorionicity was assessed based on the characteristics of the intertwin amniotic membrane. MC complicated cases were labeled either as, TTTS or sIUGR and classified according to severity. All cases were closely evaluated for structural defects., Results: There were 34 MC/BA pregnancies, from them 20 presented TTTS, 6 in a moderate stage of severity, and 14 severely affected. Four cases had sIUGR, all severely affected. Four pregnancies showed a structural defect, 2 cardiac, 1 urological, and 1 open neural tube defect. Six twin MC/BA pregnancies underwent gestation without complications., Conclusion: The presence of a MC/BA twin pregnancy warrants close monitoring, including a detailed anatomical review and hemodynamic assessment of the umbilical arteries and ductus venosus of both twins.

Objective: To identify the risk factors implicated in the intrauterine growth retardation (IUGR) of neonates born in a social security institution., Methods: Case controls design study in 376 neonates: 188 with IUGR (weight < 10 percentile) and 188 without IUGR. When they born, information about 30 variables of risk for IUGR were obtained from mothers. Risk analysis and logistical regression (stepwise) were used., Results: Odds ratios were significant for 12 of the variables. The model obtains by stepwise regression included: weight gain at pregnancy, prenatal care attendance, toxemia, chocolate ingestion, father's weight, and the environmental house., Conclusions: Must of the variables included in the model are related to socioeconomic disadvantages related to the risk of RCIU in the population.

Introduction: The term intrauterine growth delay (IGD) is used to refer a fetus with weight at birth lower than the 10th percentile for their gestational age., Objective: to determine the prevalence and to identify risk factors associated with intrauterine growth delay in patients with normal fetal growth curves., Material and Methods: This study was made at General Hospital in Queretaro, Queretaro. There were included 70 obstetric patients with newborn with intrauterine growth delay (cases) and it was compared with 70 control patients with newborn without intrauterine growth delay., Results: There were studied 70 cases of a total of 192 registered during the period of this study. There was a prevalence of 2.5. Of all the newborn with intrauterine growth delay, 40 (47.2%) were female and 30 (42.8%) were male, relating with age, mothers below 20 and above 30 were not show significant differences The risk factors associated were mainly inadequate pregnant women weight (OR 4.84, CI 95%=1.56 to 16.1) and less than five medical appointments for medical control during prenatal period (OR 6.0, CI 95%=2048 to 14.81) , hypertensive disease during pregnancy (OR 5.09, CI 95%=1.4 to 20.21) and cervicovaginal infections (OR 5.09. CI 95%=1.52 to 21.56)., Conclusions: It is necessary to pay more attention to pregnant teenagers and also to general pregnant women to receive an adequate prenatal control in order to detect patients with risk of IGD and of this way to diminish morbidity and mortality in the newborn.

Objective: To describe the proportion of preterm delivery at pregnant adolescents clinic and their maternal, obstetric and fetal conditions other than spontaneous labor., Patients and Method: Descriptive inside a cohort of consecutive cases. Preterm was defined from 20 to 36 full weeks. Maternal, obstetric and fetal conditions were defined if directly caused preterm labor or elective interruption; it was differentiated from spontaneous preterm labor., Results: Preterm delivery rate was 10.8% (252/2326): 0.8% from 20 to 27 weeks (19/2326), 3.3% from 28 to 33 weeks (77/2326) and 6.7% from 34 to 36 weeks (156/2326). Spontaneous preterm labor presented in 39.3% (99/252); main conditions found were: rupture of the membranes 18.7% (47/252), preeclampsia-eclampsia 10.3% (26/252), twin pregnancy 10.3% (26/252), intrauterine growth restriction 5.6% (14/252) and congenital defects 5.6% (14/252). They were classified as: obstetric-type 34.9% (887252), fetal 25.4% (64/252) and maternal 0.4% (1/252). There was a 40.5% rate of vaginal delivery (102/252), with the use of forceps in 1 out of 5., Conclusions: At purpose-built clinics using evidence-based and problem oriented interventions, that are individually adapted and continuously up-dated, a non-risk comparable preterm delivery rate can be achieved at gestational ages with better neonatal prognosis.

Objectives: To evaluate the clinical severity and proportionality of small for gestational age, very low birth weight neonates (< 1,500 g) and to estimate the neonatal mortality risk associated with the condition of being small for gestational age according to the degree of severity and proportionality., Methods: Observational design. All of the NEOCOSUR Collaborative Group's very low birth weight infants (25-36 weeks' gestation) were included (n = 1,518). Anthropometric indices: birth weight < 3rd and 10th percentile. Severity (fetal growth ratio = observed weight/mean birth weight for gestational age); no growth restriction: fetal growth ratio 0.90-1.10, mild: fetal growth ratio 0.80-0.89, moderate: fetal growth ratio 0.75-0.79 and severe: fetal growth ratio < 0.75. Proportionality: coefficient of bimodality and z score for ponderal index (PI = g/cm3 x 100). Neonatal mortality until discharge., Results: < 3rd percentile: 13.5% (p < 0.001); < 10th percentile: 31% (p < 0.001); fetal growth ratio: 0.90-/+0.21 (p < 0.001), mild restriction: 20.8%, moderate restriction: 8.7% and severe restriction: 32.6%. Coefficient of bimodality: 0.53; PI z score < -1: 8%. Maternal hypertensive disease was systematically associated with being small for gestational age (aOR 1.20, 95% CI 0.86-1.67), fetal growth ratio < or = 0.89 (aOR 1.71, 1.24-2.36) and PI z score < -1 (aOR 1.60, 1.03-2.41). Adjusted odds ratios for neonatal mortality were: 2.64 (95% CI 1.71-3.92) for being small for gestational age, 2.76 (95% CI 1.85-4.10) for fetal growth ratio < or = 0.89, and 1.37 (95% CI 0.80-2.32) for z score PI < -1., Conclusions: Small for gestational age, mostly symmetric and severe restriction is a frequent condition in < 1,500 g neonates and is associated with higher mortality rates.

To explore the association between low caloric intake during pregnancy and intrauterine growth retardation (IUGR), a case-control study with 264 cases and 892 controls was conducted in three maternity hospitals in Mexico City from January to August 1995. Nutritional information on pregnancy was recorded using a previously validated food frequency questionnaire. After adjusting for other known maternal risk factors in the non-conditional logistic regression analysis, for the total sample, caloric intake did not present a direct effect on IUGR (OR: 0.99; CI 95%: 0.99-1.00). However the odds ratios were as follows for women: with low pre-gestational weight (OR: 2.31; CI 95%: 1.59-3.36), in first gestation (OR: 1.72; CI 95%: 1.18-2.51), with low birth weight infants (OR: 3.54; CI 95%: 1.93-6.46), and presenting hypertension during pregnancy (OR: 1.61; CI 95%: 1.00-2.59).

Unlabelled: Body mass index (BMI) has been employed as an epidemiologic predictor of fetal growth. But most of the studies are focused on BMI values for non pregnancy women, while BMI varies according to gestational age. On the other hand, adolescence has been considered as a risk factor for intrauterine growth retardation (IUGR: birthweight for gestational age < 10th. centile). The aims of this study were: 1) to identify the distribution for weight, height and BMI in adolescent and adult pregnancies, 2) to measure the association between maternal BMI and fetal growth and 3) to evaluate the relative risk to have an intrauterine growth retardation (IUGR) according to maternal BMI. 2409 pregnancies and their newborns were studied. Maternal height and weight were measured and BMI by gestational age was calculated by trimesters of gestation. Birthweight, recumbent length, cephalic perimeter, BMI and weight by gestational age were determined in the newborns. Z score by gestational age were calculated in each pregnant woman taken into account the cut of point of BMI of -1 standard deviation. There were highly statistically significants differences in both body size and body composition between adolescent and adult mothers and in their newborns. The newborns from mothers with BMI under -1 standard deviation were smaller and the relative risk to have an IUGR was double for newborns whose mothers had BMI under -1 standard deviation., Conclusions: 1--Both body size and composition values differs between newborns from mothers under or above the cut off point of -1SD of BMI and 2--The risk to have an IUGR was double in pregnancies under -1 SD of BMI, independently to the age of the mother.

Background: Intrauterine growth retardation, associated to hypertensive disease of pregnancy, is responsible for a higher perinatal mortality and morbidity., Aim: To assess obstetrical, perinatal and neonatal features of intrauterine growth retardation associated to hypertensive disease of pregnancy., Patients and Methods: One hundred thirty seven newborns with intrauterine growth retardation, whose mothers had hypertensive disease of pregnancy, were compared to 165 similar newborns but whose mothers did not have the disease., Results: The incidence of intrauterine growth retardation associated to hypertensive disease of pregnancy was 45.4%. Maternal obesity at the start and end of pregnancy, a pregestational weight over 65 kg and a weight increment of more than 20 kg during pregnancy were risk factors for hypertensive disease of pregnancy with relative risks of 1.76, 1.62, 1.62 and 2.09 respectively. Relative risks for cesarean section and prematurity were also higher among women with hypertensive disease of pregnancy. Intrauterine growth retardation associated to maternal hypertension was symmetrical and severe in 37.9% of newborns. All seven neonatal deaths occurred in newborns with severe retardation., Conclusions: Neonatal and perinatal morbidity and mortality are higher in newborns with intrauterine growth retardation. Hypertensive disease of pregnancy was associated with a twice higher incidence of asymmetrical intrauterine growth retardation.

Background: Most published papers on women with a bicornuate uterus analyze their fertility problems, as well as certain pregnancy complications. We have not found any epidemiological study on the infants of mothers with this uterine malformation. Only in some papers a reference is made about the relationship of maternal bicornuate uterus with congenital deformations and disruptions in their infants., Patients and Methods: Using data from the Spanish Collaborative Study of Congenital Malformations (ECEMC), which has a case-control methodology, some characteristics in a series of 26,945 malformed infants, such as birth weight, sex, gestational age, umbilical cord length, placental weight and maternal age, were analyzed by separating infants of mothers with normal uterus and those of mothers with a bicornuate uterus., Results: Results showed that women with a bicornuate uterus have more daughters than sons and an increased risk for intrauterine growth retardation and prematurity with respect to infants of mothers with a normal uterus. On the other hand, the risk of having an infant with congenital defects is higher for women with a bicornuate uterus than for those with a normal uterus., Conclusions: Pregnancies of women with a bicornuate uterus have to be considered at risk since they have more risk for complications and for having an infant with congenital defects, premature birth and with intrauterine growth retardation.

Objective: This study aimed at two purposes: 1) To become aware, in our environment, of some epidemiological factors of fetal growth retardation in its harmonious, non-harmonious and semiharmonious variants. 2) To obtain fetal growth curves, from the 31st to the 43rd weeks of pregnancy, of the three types of deficiencies and compare them with the intrauterine growth of normal newborns., Patients and Methods: We have studied the last 249 growth retarded fetuses admitted to the Neonatology Service. The statistical study was carried out in comparison to 7,720 cases of fetuses with normal growth., Results: The main results were the following: 1) An unquestionable influence of a deficient educational, laboral and economical level of the mother in the genesis of fetal growth retardation. 2) Fetuses with harmonious retardation reached the highest gestational ages. 3) The obstetric procedure is conditioned by the fetal growth retardation. 4) There was higher morbility in the studied group. 5) The increased weekly anthropometry tendency was similar in the three groups of growth retarded fetuses.

An epidemiologic case-control study to ascertain the determinants of low birthweight was carried out in Santiago, Chile, from January to December 1989. The cases were defined as livebirths < 2500 g. The controls were livebirths > or = 2500 g of birthweight. All cases and a random sample (1:1) of controls were selected among 8,254 singleton births occurring at the El Salvador Hospital in the Eastern area of Santiago. These deliveries represented 50% of institutional deliveries in the area. Home deliveries (2%) and private hospital deliveries were not included in the study. Information was obtained from hospital medical records by six trained medical students. Some information could not be obtained from the hospital medical records. Thus the second step in data collection was the tracking of all the selected subjects to their referring neighborhood health centers. For the analysis, the data were divided into 3 case (outcome) categories: 453 subjects were the total case group. From these, 153 were the IUGR case group and 300 were the LBW preterm case group. The general control group consisted of 605 normal birthweight infants. 565 were the IUGR control group and 40 were the preterm control group. A total of 25 risk factors showed a significant crude odds ratio for at least one of the groups. In the multivariate logistic regression analysis eight variables: No. of pregnancies, previous adverse outcomes, previous LBW, pregnancy maternal weight, No. of visits, month of first prenatal care visit, maternal smoking and intrahepatic cholestasis of pregnancy, were significantly associated with LBW after adjustment by confounding. Eight risk factors: IUGR in previous pregnancies, Previous adverse outcome, Maternal smoking, intrahepatic cholestasis, maternal pregnancy weight, maternal height, month first prenatal visit, No. of visit, were significant to IUGR. Only two variables: pregnancy weight, divorced mother, were significantly associated with low birth weight in the preterm group. The most relevant risk factors were included in stepwise logistic regression models carried out for the outcome LBW for the general group, term group and preterm group, in order to adjust by confounding. Adjusted odds ratios were then obtained. Prenatal care related factors and maternal adverse obstetric factors were at higher significance for LBW in the general and IUGR groups. Only nutritional factors were related to LBW in preterm group. Women who delivered a LBW or IUGR infant were more likely to have fewer pregnancies, a history of previous LBW, lower prepregnancy weight and lower gestational weight gain. ICP was associated with an elevated risk of LBW that was independent of gestational age.

The objective of this study was to confirm the risk factors (RF) for low birth-weight (LBW) and suggest new risk factors, which were analyzed separately and together, in order to define a program to be coordinated by family doctors to reduce the frequency of this problem. For this purpose, a retrospective cross-sectional survey was carried out with 57 cases (mothers who had had LBW babies) and 58 controls (mothers who had not had LBW babies). In addition, data were obtained from the prenatal records of mothers who received care at family doctors' offices and at the clinica in the Plaza de la Habana Area. Estimates were made of the relative risk and the percentage attributable risk of 107 hypothetical RF for LBW from a clinical-epidemiological and social standpoint. One-way analysis of variance, the chi-square test, multiple linear regression, and logistic regression were used to analyze the results, which suggested the following RF for LBW: family dysfunction, family crisis, lack of spousal support, extended family, failure to attend prenatal group sessions for pregnant women, and failure to receive education on how to prevent LBW. The multifactorial risk profile was the following: risk of [corrected] intrauterine growth retardation, family dysfunction, threat of preterm delivery, coffee-drinking, attendance at fewer than 11 prenatal checkups, and failure to attend prenatal group sessions for pregnant women. The variables excluded from the model were: low weight-for-height, lack of spousal support, smoking more than 10 cigarettes a day, and family history of LBW. The findings confirmed 10 of the suspected risk factors for LBW in Cuba and nine of those described in the international literature. Maternal age, spontaneous abortion, and alcohol consumption were not confirmed. Six RF for LBW preventable by the family doctor through his/her actions at the family and community level are identified, as is a multifactorial profile of six RF for LBW. On the basis of these results, proposals are made in regard to programming priorities and the implementation of strategies aimed at preventing LBW, and it is recommended that the study be continued with a larger sample.

Bilateral renal agenesis (BRA) is an uniformly lethal malformation occurring in 0.1-0.3/1000 births. This condition is associated with severe oligohydramnios, intrauterine growth retardation (IUGR), extra-renal anomalies, and malpresentation. The aim of this study was to present our experience with 10 cases of BRA seen in a 10-year period. In only one case the prenatal diagnosis was made. Therefore, the clinician was faced with a high-risk pregnancy: 70% of cases presented with malpresentation, oligohydramnios, and severe IUGR. This explain the high rate of cesarean section (40%) and the neonatal intensive care offered to these neonates. The principal methods to improve the prenatal diagnosis of this condition are discussed.

Forty-four pregnancies with clinical and sonographic diagnosis of intrauterine growth retardation (IUGR) were prospectively studied. A Doppler examination of arcuate and umbilical arteries, fetal descending aorta and medial cerebral artery was done. The results of the Doppler interrogation determined three groups. The first with normal Doppler had the higher birth weight the lesser ponderal deficit and the lesser percent of newborns below the fifth centile. No morbimortality was found in this group. The second group with a mild abnormal Doppler, had a morbidity of 18.8%, and no mortality was found. The third group had the most abnormal Doppler and, showed a perinatal morbidity rate of 28.6% and mortality 42.9%. In our series, the Doppler examination was able to identify among the pregnancies with clinical and sonographic diagnosis of IUGR those with the highest risk of morbimortality (sensibility 100%, specificity 77.8%, positive examination predictive value 50% and negative examination predictive value 100%).

In order to determine the relationship between nutritional, sociodemographic, and obstetrical variables and fetal malnutrition, a study was done on a group of mothers of nonpremature neonates born in a hospital in the central mountainous region of Guatemala. Of the 306 neonates, 105 (34%) presented fetal malnutrition (intrauterine growth retardation, IUGR), which in 77% of the cases was chronic (fetal atrophy, or IUGR type I) and in 23% of the cases was acute (fetal emaciation, or IUGR type II). The maternal factors related to fetal atrophy were puerperal nutritional indicators (weight, height, skinfold thickness, and arm circumference) and sociodemographic indicators (schooling, literacy, and socioeconomic level). Fetal emaciation was found to be related to obstetrical characteristics such as number of previous deliveries and birth interval. The results suggest that poverty, malnutrition, and precarious living conditions over prolonged periods of time are related to chronic fetal malnutrition (fetal atrophy), which is very frequent in this population.

Using a national curve of fetal growth development, clinical and laboratory characteristics of 100 term neonates small for dates and 130 term adequate for gestational age newborns are studied. A 91% of the small for dates were classified by the ponderal index as having symmetrical growth retardation. At the same time in the 230 mothers we look for clinical features that have been mentioned to produce intrauterine growth retardation. Results showed marked differences (with statistic significance) between both groups of women in relation to: nutritional factors, maternal height, labor activity and presence of oligoamnios. The newborns of both groups didn't show differences, with exception of congenital malformation. The incidence of the classical morbidity of small for dates (asphyxia, hypoglycemia, polycythemia) was no different in both groups. We believe the explanation is that the national curve is more exigent and neonates with higher weight fall under the 10th percentile. We think that in the study group a high percentage of small for dates, are constitutional small and not really growth retarded. We suggest the possibility to use the 5th percentile for better sensibility.

Birth weight and gestational age data from 5,418 infants born in the Maternal Hospital "Valle de Hebrón" during 1984, were retrospectively reviewed. 295 infants (5.4%) were excluded for different reasons. Tabulated data of the 5,123 remaining cases were used to design a representative chart of this population of infants. Simultaneous inclusion in the chart of +/- 2 SD curves and 10th and 90th percentile curves, allows us to establish an easy distinction between the low birthweight infants with moderate intrauterine growth retardation and those with a severe delay. This distinction may be clinically important. Data collecting methods for designing intrauterine growth charts are also discussed.