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Figueras-Aloy J, Izquierdo Renau M, Herranz Barbero A, Urquía Martí L, García-Muñoz Rodrigo F, Iriondo-Sanz M, García Algar Ó. Comparative analysis of foetal and neonatal growth curves. An Pediatr (Barc) 2024; 100:333-341. [PMID: 38653671 DOI: 10.1016/j.anpede.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/22/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Our aim was to determine which foetal or neonatal growth curves discriminate the probability of dying of newborns with low birth weight for their gestational age (small for gestational age, SGA) and sex (weight < 10th percentile) and to establish the curves that are presumably most useful for monitoring growth through age 10 years. MATERIAL AND METHODS The analysis included every neonate (15 122) managed in our hospital (2013-2022) and all neonates born preterm before 32 weeks (6913) registered in the SEN1500 database (2019-2022). We considered most useful those curves with the highest likelihood ratio (LR) for dying with or without a history of SGA in each subgroup of gestational ages. Theoretically, the optimal curves for monitoring growth would be those with a higher R2 in the quantile regression formulas for the 50th percentile. RESULTS The growth curves exhibiting the strongest association between SGA and hospital mortality are the Intergrowth fetal curves and the Fenton neonatal curves in infants born preterm before 32 weeks. However, the optimal curves for premature babies and neonates overall were those of Olsen and Intergrowth. The most useful curves to monitor anthropometric values alone until age 10 years of age are the longitudinal Intergrowth curves followed by the WHO standards, but if a single reference is desired from birth through age 10 years, the best option is the Fenton curves followed by the WHO standards. CONCLUSIONS The Intergrowth reference provides the most discriminating foetal growth curves. In neonatal clinical practice, the optimal references are the Fenton followed by the WHO charts.
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Affiliation(s)
- Josep Figueras-Aloy
- Servicio de Neonatología, ICGON, IDIBAPS, Hospital Clínic-Maternitat, BCNatal, Barcelona, Spain.
| | | | - Ana Herranz Barbero
- Servicio de Neonatología, ICGON, IDIBAPS, Hospital Clínic-Maternitat, BCNatal, Barcelona, Spain
| | - Lourdes Urquía Martí
- Servicio de Neonatología, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Fermín García-Muñoz Rodrigo
- Servicio de Neonatología, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Martín Iriondo-Sanz
- Servicio de Neonatología, Hospital Sant Joan de Déu, BCNatal, Esplugues de Llobregat, Barcelona, Spain
| | - Óscar García Algar
- Servicio de Neonatología, ICGON, IDIBAPS, Hospital Clínic-Maternitat, BCNatal, Barcelona, Spain
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González González NL, González Dávila E, González Martín A, Padrón E, García Hernández JÁ. Maternal Thinness and Obesity and Customized Fetal Weight Charts. Fetal Diagn Ther 2021; 48:551-559. [PMID: 34407539 DOI: 10.1159/000515251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 02/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to determine if customized fetal growth charts developed excluding obese and underweight mothers (CC(18.5-25)) are better than customized curves (CC) at identifying pregnancies at risk of perinatal morbidity. MATERIAL AND METHODS Data from 20,331 infants were used to construct CC and from 11,604 for CC(18.5-25), after excluding the cases with abnormal maternal BMI. The 2 models were applied to 27,507 newborns and the perinatal outcomes were compared between large for gestational age (LGA) or small for gestational age (SGA) according to each model. Logistic regression was used to calculate the OR of outcomes by the group, with gestational age (GA) as covariable. The confidence intervals of pH were calculated by analysis of covariance. RESULTS The rate of cesarean and cephalopelvic disproportion (CPD) were higher in LGAonly by CC(18.5-25) than in LGAonly by CC. In SGAonly by CC(18.5-25), neonatal intensive care unit (NICU) and perinatal mortality rates were higher than in SGAonly by CC. Adverse outcomes rate was higher in LGAonly by CC(18.5-25) than in LGAonly by CC (21.6%; OR = 1.61, [1.34-193]) vs. (13.5%; OR = 0.84, [0.66-1.07]), and in SGA only by CC(18.5-25) than in SGAonly by CC (9.6%; OR = 1.62, [1.25-2.10] vs. 6.3%; OR = 1.18, [0.85-1.66]). CONCLUSION The use of CC(18.5-25) allows a more accurate identification of LGA and SGA infants at risk of perinatal morbidity than conventional CC. This benefit increase and decrease, respectively, with GA.
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Affiliation(s)
- Nieves L González González
- Obstetrics and Gynecology Department, University of La Laguna, Canary Islands, University Hospital of Canary Islands., La Laguna, Spain
| | - Enrique González Dávila
- Mathematics, Statistics and Operations Research Department, University of La Laguna, La Laguna, Spain
| | - Agustina González Martín
- Obstetrics and Gynecology Department, University of La Laguna, Canary Islands, University Hospital of Canary Islands., La Laguna, Spain
| | - Erika Padrón
- Obstetrics and Gynecology Department, University of La Laguna, Canary Islands, University Hospital of Canary Islands., La Laguna, Spain
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González-González NL, González Dávila E, Padrón E, Armas Gonzalez M, Plasencia W. Value of Placental Volume and Vascular Flow Indices as Predictors of Early and Late Preeclampsia at First Trimester. Fetal Diagn Ther 2018; 44:256-263. [PMID: 29393218 DOI: 10.1159/000481433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/07/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION We evaluated the utility of placental volume and three-dimensional (3D) vascular flow indices to predict early and late preeclampsia. MATERIAL AND METHODS In 1,004 pregnancies attending routine care, we recorded first-trimester screening program for aneuploidy (FTSA) parameter and measured uterine artery pulsatility index (uterine-a PI). Placental volume and vascular flow indices were obtained using 3D power Doppler and VOCAL techniques. RESULTS Placental volume was lower and uterine-a PI was higher in both early and late preeclampsia groups versus nonaffected pregnancies. The prediction rate of placental volume in late preeclampsia was higher than that of uterine-a PI (AUROC 0.707 vs. 0.581, p < 0.011). The inclusion of placental volume improved significantly the prediction rate of total and late preeclampsia in the models constructed with maternal characteristics, FTSA, and uterine-a PI (AUROC 0.745 vs. 0.818, p < 0.004, and 0.740 vs. 0.812, p < 0.012, respectively). The inclusion of vascular indices did not improve the predictive value of these models. DISCUSSION Placental volume was an independent predictor of total, early, and late preeclampsia and its inclusion in combined predictive models significantly improved prediction rates. Reduced placental volume observed at first trimester in women with early and late preeclampsia suggests that these entities are the clinical expression of a similar pathophysiological process.
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Affiliation(s)
- Nieves L González-González
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, La Laguna,
| | - Enrique González Dávila
- Departamento de Matemáticas, Estadística e Investigación Operativa, Universidad de La Laguna, La Laguna, Spain
| | - Erika Padrón
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Marina Armas Gonzalez
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, La Laguna, Spain
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Terán JM, Varea C, Bernis C, Bogin B, González-González A. New birthweight charts according to parity and type of delivery for the Spanish population. GACETA SANITARIA 2017; 31:116-122. [PMID: 28160963 DOI: 10.1016/j.gaceta.2016.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Birthweight by gestational age charts enable fetal growth to be evaluated in a specific population. Given that maternal profile and obstetric practice have undergone a remarkable change over the past few decades in Spain, this paper presents new Spanish reference percentile charts stratified by gender, parity and type of delivery. They have been prepared with data from the 2010-2014 period of the Spanish Birth Statistics Bulletin. METHODS Reference charts have been prepared using the LMS method, corresponding to 1,428,769 single, live births born to Spanish mothers. Percentile values and mean birth weight are compared among newborns according to gender, parity and type of delivery. RESULTS Newborns to primiparous mothers show significantly lower birthweight than those born to multiparous mothers (p<0.036). Caesarean section was associated with a substantially lower birthweight in preterm births (p<0.048), and with a substantially higher birthweight for full-term deliveries (p<0.030). Prevalence of small for gestational age is significantly higher in newborns born by Caesarean section, both in primiparous (p<0.08) and multiparous mothers (p<0.027) and, conversely, the prevalence of large for gestational age among full-term births is again greater both in primiparous (p<0.035) and in multiparous mothers (p<0.007). CONCLUSIONS Results support the consideration of establishing parity and type of delivery-specific birthweight references. These new charts enable a better evaluation of the impact of the demographic, reproductive and obstetric trends currently in Spain on fetal growth.
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Affiliation(s)
- José Manuel Terán
- Department of Biology, Faculty of Sciences, Madrid Autonomous University, Madrid, Spain; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom.
| | - Carlos Varea
- Department of Biology, Faculty of Sciences, Madrid Autonomous University, Madrid, Spain; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Cristina Bernis
- Department of Biology, Faculty of Sciences, Madrid Autonomous University, Madrid, Spain; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Barry Bogin
- Department of Biology, Faculty of Sciences, Madrid Autonomous University, Madrid, Spain; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Antonio González-González
- Departments of Obstetrics and Gynaecology, Faculty of Medicine, Madrid Autonomous University, Madrid, Spain; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
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Association Between Low Dairy Intake During Pregnancy and Risk of Small-for-Gestational-Age Infants. Matern Child Health J 2016; 20:1296-304. [DOI: 10.1007/s10995-016-1931-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Martínez MC, Martínez AV, Reyes EA, Hernández AS, Jaimez MDF. Manejo obstétrico de la deficiencia hereditaria de antitrombina durante el embarazo y puerperio. Dos casos clínicos. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2015. [DOI: 10.1590/s1519-38292015000400008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumen Introducción: la deficiencia de antitrombina III hereditaria es una rara enfermedad que afecta al 0.02-0.2% de la población. Puede presentar mayor frecuencia de complicaciones y resultados adversos tanto en la madre como en el feto. Se presenta el manejo obstétrico de dos gestaciones consecutivas en una mujer con deficiencia de antitrombina III. Descripción: en ambos embarazos la madre realiza profilaxis de la enfermedad tromboembólica con heparina de bajo peso molecular para evitar la aparición de esta patología tanto en el embarazo como en el puerperio y mejorar el flujo útero-placen-tario. Con respecto a las complicaciones obstétricas, sólo existe un enlentecimiento del crecimiento fetal que obliga a un control obstétrico estricto. En ambas gestaciones los estudios eco-Doppler están dentro de la normalidad lo que permite una conducta expectante, consiguiendo llegar a término. Discusión: la profilaxis con heparina de bajo peso molecular en las gestantes con esta trombofilia y las intervenciones preventivas de factores de riesgo de enfermedad tromboembólica, junto con un control obstétrico adecuado, ha conseguido evitar la apari-ción de complicaciones derivadas de esta patología en el embarazo y en el puerperio. Por otra parte, el control del crecimiento fetal y el estudio Eco-Doppler han permitido asegurar el bienestar fetal no adelan-tando el parto, consiguiendo partos a término.
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González González NL, González Dávila E, Goya M, Vega B, Hernández Suarez M, Bartha JL. Twin pregnancy among women with pregestational type 1 or type 2 diabetes mellitus. Int J Gynaecol Obstet 2014; 126:83-7. [PMID: 24797150 DOI: 10.1016/j.ijgo.2014.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/17/2014] [Accepted: 03/28/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the impact of twin versus singleton pregnancy on obstetric and perinatal outcomes among women with pregestational diabetes mellitus (DM). METHODS Multicenter retrospective cohort study of women with pregestational DM and twin or singleton pregnancy, conducted in Spain during 2005-2010. Each group included 63 women (type 1 DM, n=39; type 2 DM, n=24). RESULTS Of 269 565 deliveries, 68 (0.025%) were twins of mothers with pregestational DM, with 28/63 (44.4%) conceptions achieved with assisted reproduction technology. Among women with type 1 DM, hypertensive complications were more common among those with twins than among controls (13% versus 3%, P=0.02); the rate of preterm birth was higher (69% versus 15%, P<0.001); and the rate of admission to the neonatal intensive care unit was higher (51% versus 21%, P=0.005). Twin pregnancy was an independent risk factor for adverse perinatal outcomes regardless of the type of diabetes. CONCLUSION Twin pregnancy in women with either type of DM dramatically increased the risk of perinatal morbidity. In mothers with type 1 DM, twin pregnancy was more often associated with hypertensive complications than singleton pregnancy. Transfer of more than one embryo should be avoided if ART is needed in a woman with DM.
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Affiliation(s)
| | | | - Maria Goya
- Departamento de Obstetricia y Ginecología, Hospital Vall'de Hebrón, Barcelona, Spain
| | - Begoña Vega
- Departamento de Obstetricia y Ginecología, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | | | - Jose L Bartha
- Departamento de Obstetricia y Ginecología, Hospital Universitario La Paz, Madrid, Spain
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