Introduction: Epidemiological studies have shown associations between placental measurements and perinatal and later life outcomes. Objectives: To report placental measurements and evaluate their association with birth weight in a Brazilian birth cohort. Methods: Retrospective cohort study with 958 mothers, placentas, and newborns delivered at the Ribeirão Preto Medical School Hospital, Universidade de São Paulo, Brazil, in 2010 and 2011. The information was collected from interviews, medical records, and pathology reports. The placental measurements were: weight, largest and smallest diameters, eccentricity, thickness, shape, area, and birth weight/placental weight and placental weight/birth weight ratios. We analyzed the associations between birth weight and placental measurements using multiple linear regression. Results: Placental weight alone accounted for 48% of birth weight variability (p < 0.001), whereas placental measurements combined (placental weight, largest and smallest diameters, and thickness) were responsible for 50% (p < 0.001). When adjusted for maternal and neonatal characteristics, placental measurements explained 74% of birth weight variability (p < 0.001). Conclusion: Placental measurements are powerful independent predictors of birth weight. Placental weight is the most predictive of them, followed by the smallest diameter.
. Resumen:Antecedentes: Se ha observado que el aumento de nacimientos prematuros fue acompañado por una disminución en la mortalidad fetal. Objetivo: Evaluar la relación entre la mortalidad fetal y la prematurez en Argentina. Material y Métodos: Diseño ecológico; la población incluyó a todos los nacidos vivos y muertos de Argentina entre 2003 y 2013. Variables Resultado: tasa de mortalidad fetal total (TMFT), tasa de mortalidad fetal por peso, razón de mortalidad fetal, tasa de mortalidad neonatal, tasa de mortalidad perinatal, tendencias de las tasas de mortalidad fetal específicas por edad gestacional (EG), y Prematurez (PP,<37 +0 semanas). Variables independientes: edad (<19 y > 35 años), educación <8 años, con pareja, paridad 1 y > 4, embarazo múltiple y tasa de natalidad. Análisis estadístico: análisis de regresión lineal ajustado para covariados. Resultados: La TMFT mostró una reducción anual del 0,18 por mil y disminución con el aumento de la EG, siendo la mayor reducción en menores a 28 +0 semanas (68%), mientras que el parto prematuro aumentó 0,07% por año, siendo el mayor incremento (0,75%) entre la 32 +0 y 36 +6 semanas. La regresión lineal mostró un R 2 ajustado de 0,76 (p = 0,010) y la mayor relación inversa entre la TMFT y el PP se observó en prematuros entre 32 +0 a 36 +6 semanas (R 2 = 0,98, p = <0,001). Conclusiones: La reducción de la mortalidad fetal se asoció con el incremento observado de los nacimientos vivos prematuros en la Argentina.Palabras clave: mortalidad fetal; prematuro; mortalidad neonatal; tendencias; diseño ecológico. Abstract:Background: It has been observed that the increase in preterm births was accompanied by a decrease in fetal mortality. Objective: To evaluate the relationship between fetal mortality and prematurity in Argentina. Methods: Ecological design. The population included all live births and fetal demise in Argentina between 2003 and 2013. Outcomes: total fetal mortality rate (TFMR), fetal mortality rate by birth weight, fetal mortality rate, neonatal mortality rate, perinatal mortality rate, trends in fetal mortality rates specific for gestational age (GA), and prematurity (<37+ 0 weeks). Independent variables: age (<19 and > 35 years), education <8 years, with partner, parity 1 and > 4, multiple pregnancy and birth rate. Statistical analysis: linear regression analysis adjusted for covariates. Results: TFMR showed an annual reduction of 0.18 per thousand births that decreased with the increase of GA, being the largest reduction below 28 +0 weeks (68%), while prematurity increased 0.07% per year, being the largest increase (0.75%) between 32 +0 and 36 +6 weeks. Linear regression model showed an inverse relationship between TFMR and prematurity (adjusted R 2 0.76, p = 0.010), being the highest between 32 +0 and 36 +6 weeks (adjusted R 2 = 0.98, p < 0.001). Conclusions: The reduction in fetal mortality was associated with the observed increase in preterm births in Argentina.
. Resumen:Antecedentes: Se ha observado que el aumento de nacimientos prematuros fue acompañado por una disminución en la mortalidad fetal. Objetivo: Evaluar la relación entre la mortalidad fetal y la prematurez en Argentina. Material y Métodos: Diseño ecológico; la población incluyó a todos los nacidos vivos y muertos de Argentina entre 2003 y 2013. Variables Resultado: tasa de mortalidad fetal total (TMFT), tasa de mortalidad fetal por peso, razón de mortalidad fetal, tasa de mortalidad neonatal, tasa de mortalidad perinatal, tendencias de las tasas de mortalidad fetal específicas por edad gestacional (EG), y Prematurez (PP,<37 +0 semanas). Variables independientes: edad (<19 y > 35 años), educación <8 años, con pareja, paridad 1 y > 4, embarazo múltiple y tasa de natalidad. Análisis estadístico: análisis de regresión lineal ajustado para covariados. Resultados: La TMFT mostró una reducción anual del 0,18 por mil y disminución con el aumento de la EG, siendo la mayor reducción en menores a 28 +0 semanas (68%), mientras que el parto prematuro aumentó 0,07% por año, siendo el mayor incremento (0,75%) entre la 32 +0 y 36 +6 semanas. La regresión lineal mostró un R 2 ajustado de 0,76 (p = 0,010) y la mayor relación inversa entre la TMFT y el PP se observó en prematuros entre 32 +0 a 36 +6 semanas (R 2 = 0,98, p = <0,001). Conclusiones: La reducción de la mortalidad fetal se asoció con el incremento observado de los nacimientos vivos prematuros en la Argentina.Palabras clave: mortalidad fetal; prematuro; mortalidad neonatal; tendencias; diseño ecológico. Abstract:Background: It has been observed that the increase in preterm births was accompanied by a decrease in fetal mortality. Objective: To evaluate the relationship between fetal mortality and prematurity in Argentina. Methods: Ecological design. The population included all live births and fetal demise in Argentina between 2003 and 2013. Outcomes: total fetal mortality rate (TFMR), fetal mortality rate by birth weight, fetal mortality rate, neonatal mortality rate, perinatal mortality rate, trends in fetal mortality rates specific for gestational age (GA), and prematurity (<37+ 0 weeks). Independent variables: age (<19 and > 35 years), education <8 years, with partner, parity 1 and > 4, multiple pregnancy and birth rate. Statistical analysis: linear regression analysis adjusted for covariates. Results: TFMR showed an annual reduction of 0.18 per thousand births that decreased with the increase of GA, being the largest reduction below 28 +0 weeks (68%), while prematurity increased 0.07% per year, being the largest increase (0.75%) between 32 +0 and 36 +6 weeks. Linear regression model showed an inverse relationship between TFMR and prematurity (adjusted R 2 0.76, p = 0.010), being the highest between 32 +0 and 36 +6 weeks (adjusted R 2 = 0.98, p < 0.001). Conclusions: The reduction in fetal mortality was associated with the observed increase in preterm births in Argentina.
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