Factors associated with Intra-Uterine Growth Retardation newborns in public maternity in Salvador. / Fatores associados ao retardo de crescimento intra-uterino em recém nascidos em maternidades públicas da cidade de Salvador-Bahia.

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Factors associated with Intra-Uterine Growth Retardation have not been fully clarified. Small newborns for gestational age have shown different hematological parameters compared appropriate newborns for gestational and preterm newborns. There are also methodological limitations concerning accuracy to determine gestational age. Objectives: To determine factors associated with Intra-Uterine Growth Retardation, the hematological characteristics of newborns bearing IUGR, and to examine the accuracy of gestational age evaluation methods in diagnosing anthropometric conditions of these newborns. Methodology: Study involving mothers and 564 newborns in 2 public maternity hospitals, in Salvador Brazil. It has been classified appropriate for gestational age for term, newborns with weight ranging >= 10th and =<90th and >=37 gestational weeks, while small for gestational age newborn for term shows weight <10th and >=37 gestational weeks, evaluated by Williams curve. Preterm newborn was those newborns with <37 gestational weeks. The data was gathered using standardized questionnaires. It was collected` anthropometric measures of both infant and mother, and umbilical cord blood of newborn. The gestational age was computed by last menstrual period (LMP), ultrasonography (USG), and Capurro physical method. Study 1 case control design. Study 2 and 3 - cross sectional design. Statistical analysis: Study1 A non-conditional logistic regression was performed to test association between IUGR as dependent variable and maternal risk factors as independent variables. And Odds ratio was adopted as association measure. Study2- The mean and standard deviation, both maximum and minimum values were used to describe hematological values of umbilical cord. Study3- The difference between gestational age medians was calculated using a non-parametric test Wilcoxon Signed Rank Test. The correlation between gestational ages estimated by LPM, USG and Capurro methods, and between methods and birth weight were performed using Pearson correlation coefficient. K-statistic was used to evaluate methods agreement in estimating anthropometric state of the newborn. The validity of methods was evaluated using sensitivity, specificity, both positive and negative predictive values, and ROC curve. SPSS 11.0 and Stata 8 were used for data processing and analysis, accepting 5% of significance. Results: Study 1- the study has identified the primiparous mothers (OR: 2,85 ; 1,73-4,71); smoking habit (OR: 2,65; 1,35-5,19) and previous unfavorable pregnancy (OR: 2,10 ; 1,21-3,64) as potential risk factors for IGUR. Study 2- the study has identified SGA newborn having the highest values of RBC (×1012/l): 4,460,49, Hemoglobin (g/dl) 15,071,26; Hct (%) 45,333,73; RDW (%): 13,560,70; ferritin (g/l): 190,89144,79, and leucocytes count (109/l) 13,036,29 relative to AGA both term and preterm newborn. The AGA preterm has also shown the highest values of MCV and MCH. AGA newborn for term has shown higher platelets average values. Study3 The Capurro method has increased gestational age estimation in intervals below 39 weeks and USG has decreased in intervals above this gestational age, relative to LMP. The USG method has shown better correlation with LMP in all newborns (r=0,668) and in AGA newborns (r=0,685). The last menstrual period method has shown the best correlation coefficient with the birth weight in SGA infants. (r=0,609). For the diagnostic of SGA infants the highest sensibility was noticed for USG (96,6%) and the highest specificity was noticed for Capurro (75.5%). It was also noticed the highest accuracy in the gestational age estimation for USG at 41st gestational week, taking LMP method as a standard (ROC Curve =77%). Conclusion: The findings suggest that IUGR has associated with primiparous, smokers and mothers with previous unfavorable pregnancy. IUGR newborn has shown the highest hematological values relatively to AGA newborns both term and preterm. It has also been noticed that physical Capurro method has the poorest performance in identifying IUGR.

ASSUNTO(S)

umbilical cord blood gestational age risk factor saude materno-infantil newborn intra-uterine growth retardation fator de risco idade gestacional sangue do cordão umbilical retardo do crescimento intra-uterino recém-nascido

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