Percentilos del peso de la placenta y su relación con el peso fetal según la edad gestacional en el área urbana de Buenos Aires
DOI:
https://doi.org/10.31053/1853.0605.v72.n2.11946Palabras clave:
Placental weight, Fetal to placental weight ratio, Placental to birth weight ratio, Percentile, Gestational ageResumen
RESUMEN
Antecedentes: El peso placentario (PP) y los índices de su relación con el peso al nacer (PN) (PN/PP, PP/PN) predicen morbi-mortalidad perinatal y resultados alejados de la salud.
Objetivos: Calcular percentilos del PP e índices por sexo y edad gestacional correspondientes a 867 RNV de la Maternidad Sardá de Buenos Aires, Argentina y compararlos con referencias internacionales.
Material y métodos: Se excluyeron feto muerto, embarazo múltiple, edad gestacional <22 y >42 semanas y PP<100g y >2500g. Características maternas y fetales: edad, educación, tabaco, paridad, diabetes, preeclampsia, corioamnionitis, restricción del crecimiento, malformación congénita y prematurez. Se calcularon estadísticos de resumen y percentilos con el método LMS. Las comparaciones se realizaron con test t-Student, ANOVA y referencias internacionales.
Resultados: Edad materna media 24 años, educación 10.1 años, 24.5% primíparas, 12.6% fumadoras, 4.9% presentaron diabetes, 8.7% preeclampsia, 7.9% corioamnionitis y 13.0% restricción del crecimiento fetal. El 55.3% de los RN fueron varones, 51.6% prematuros, 18.9% PEG y 7.1% malformados. El PN y EG promedio fue de 2581g y 35.6 semanas respectivamente. Elevada correlación positiva de la EG con PP y PN/PP y negativa con PP/PN (p<0.001); el peso de la placenta e índices fueron mayores en varones. Se presentan los percentiles de PP, PN/PP y PP/PN. Las diferencias con las referencias oscilaron de 0.46% -13%, 4.91% -12.1% y 5.81% -14% para el PP, PN/PP y PP/PN respectivamente.
Conclusiones: los percentilos generados son aplicables en investigaciones sobre la relación de la placenta con resultados perinatales y la salud durante el ciclo vital.
Palabras claves: placenta, índices placentarios, peso al nacer, edad gestacional, percentilos
ABSTRACT
Background: The placental weight (PW) and the rates of their relationship with birth weight (BW) (BW / PW, PW / BW) predict perinatal morbidity and mortality and future health outcomes.
Objectives: Estimate percentiles of PW and indices by sex and gestational age (GA) corresponding to 867 live born from Sardá Maternity of Buenos Aires and compare with international references.
Methods: Stillbirth, multiple pregnancy, gestational age <22 and > 42 weeks and PW <100g and > 2500g were excluded. Maternal and fetal characteristics were: age, education, smoking, parity, diabetes, preeclampsia, chorioamnionitis, growth restriction, prematurity and congenital anomalies. Summary statistics and percentiles with the LMS method were calculated. The comparisons were performed using Student t-test, ANOVA and international references.
Results: Average maternal age 24 years , education 10.1 years, 24.5% primiparous, 12.6% smokers, 4.9% had diabetes, 8.7% preeclampsia, 7.9% chorioamnionitis and 13.0% fetal growth restriction; 55.3% of newborns were male, 51.6% preterm, 18.9% small for gestational age and 7.1% malformed. On average BW and GA were 2581g and 35.6 weeks, respectively. High positive correlation between GA with PW and BW/PW, and negative with PW/BW was observed (p <0.001); placental weight and indices were higher in males. Percentiles of PW, BW / PW and PW / BW are depicted. Differences with references ranged from 0.46% -13%, 4.91% -12.1% and 5.81% -14% for PW, BW / PW and PW / BW, respectively.
Conclusions: Percentiles generated are applicable in research on the relationship of the placenta with perinatal outcomes and health throughout the life cycle.
Key words: Placental weight, Fetal to placental weight ratio, Placental to birth weight ratio Percentiles, Gestational age
Descargas
Citas
Cardoso V, Mazzitelli N, Veiga MA, Grandi C et al. Medidas del crecimiento placentario y su relación con el peso de nacimiento y la edad gestacional. Revision bibliográfica. Rev Hosp Mat Inf Ramón Sardá 2012; 31: 69-74.
Macdonald EM, Koval JJ, Natale R, Regnault T, et al. Population-based placental weight ratio distributions. Int J Pediatr 2014; 291: 84-6.
Wallace JM, Bhattacharya S, Horgan GW. Gestational age, gender and parity specific centile charts for placental weight for singleton deliveries in Aberdeen, UK. Placenta 2013; 34:269-374.
Hutcheon JA, McNamara H, Platt RW, Benjamin A, et al. Placental weight for gestational age and adverse perinatal outcomes. Obstet Gynecol 2012; 119:1251-58.
Moore VM, Miller AG, Boulton TJ, Cockington RA, et al. Placental weight, birth measurements, and blood pressure at age 8 years. Arch Dis Child 1996; 74: 538-41.
Barker DJ, Thornburg KL, Osmond C, Kajantie E, et al. Beyond birthweight: the maternal and placental origins of chronic disease. J Dev Orig Health Dis 2010; 1:360-4.
Barker DJ, Eriksson JG, Kajantie E, Alwasel SH, et al. The maternal and placental origins of chronic disease. In: Burton GJ, Barker DJP, Moffett A, Thornburg K, eds. The placenta and human developmental programming. Cambridge, United Kingdom: Cambridge University Press; 2010; 5–16.
Godfrey KM. The role of the placenta in fetal programming-a review. Placenta 2002; 23 Suppl A:S20-7.
Dy C, Chari RS, Russell LJ. Updating reference values for placental weights in Northern Alberta. Am J Obstet Gynecol 2004; 190:1458-60.
Risnes KR, Romundstad PR, Nilsen TI, Eskild A, et al. Placental weight relative to birth weight and long-term cardiovascular mortality: findings from a cohort of 31,307 men and women. Am J Epidemiol 2009; 170:622-31.
Zhao Y, Zhang H, Li C, Wua T, et al. Selecting placental measures that have clinical implications in child development and diseases. Placenta 2014; 35:178-87.
Barker DJP. Maternal Nutrition, Fetal Nutrition, and Disease in Later Life. Nutrition 1997; 13:807-13.
Thame M, Osmond C, Bennett F, Wilks R, et al. Fetal growth is directly related to maternal anthropometry and placental volume. Eur J Clin Nutr 2004; 58:894-900.
Stieve H. Feto-placental weight ratio. Anay Anz 1940; 90: 225-42.
Moore K, Persaud T. The placenta and fetal membranes. In: The Developing Human: Clinically Oriented Embryology. Philadelphia, PA: W.B. Saunders; 1993:113–40.
Thompson JM, Irgens LM, Skjaerven R, Rasmussen S. Placenta weight percentile curves for singleton deliveries. BJOG 2007; 114:715-20.
Salafia C, Zhang J, Charles A, Bresnahan M, et al. Placental characteristics and birthweight. Paediatric and Perinatal Epidemiology 2008, 22: 229–39.
Coall D, Charles A, Salafia C. Gross Placental Structure in a Low-Risk Population of Singleton, Term, First-Born Infants. Pediatr Dev Pathol 2009; 12: 200-10.
Effendi M, Demers S, Giguère Y, Forest J, et al. Association between first-trimester placental volume and birth weight. Placenta 2014; 35:99-102.
Villar J, Cheikh Ismail L, Victora CG, Ohuma EO, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet 2014; 384(9946):857-68.
Urquia ML, Alazraqui M, Spinelli HG, Frank JW. Reference birthweights for the Argentine population by multiplicity of birth, sex, and gestational age. Rev Panam Salud Publica 2011; 29:108-19.
San Pedro M, Grandi C, Larguia M, Solana C. Estándar de peso para la edad gestacional en 55706 recién nacidos sanos de una maternidad pública de Buenos Aires. Medicina (Buenos Aires) 2001; 61:15–22.
Burkhardt T, Schäffer L, Schneider C, Zimmermann R, et al. Reference values for the weight of freshly delivered term placentas and for placental weight-birth weight ratios. Eur J Obstet Gynecol Reprod 2006; 128:248-52.
Almog B, Shehata F, Aljabri S, Levin I, et al. Placenta weight percentile curves for singleton and twins deliveries. Placenta 2011; 32:58-62.
Leary S, Godfrey K, Greenaway L, Davill V, et al. Contribution of the umbilical cord and membranes to untrimmed placental weight. Placenta 2003; 24:276–8
Cole TJ. Fitting smoothed centile curves to reference data. J R Statist Soc 1988; 151: 385-418.
Cole TJ. Using the LMS method to measure skewness in the NCHS and Dutch National height standards. Ann Hum Biol 1989; 16:407-19.
Windera NR, Krishnavenib GV, Veenab SR, Hilla JC, et al. Mother’s lifetime nutrition and the size, shape and efficiency of the placenta. Placenta 2011; 32: 806-10.
Hernandorena C, García JS, Cavoti Sadonio V, Grandi C. Lesiones placentarias en embarazos de madre adolescente en una maternidad pública de la argentina. Rev Fac Cien Med Univ Nac Cordoba 2012; 69:7-14.
Uriburu G, Mercer R, Romero M, Zamberlin N, et al. El modelo de maternidad centrada en la familia: experiencia del Hospital Materno Infantil Ramón Sardá: estudio de buenas practicas. Organización Panamericana de la Salud. Buenos Aires. 2008.
División Estadística, Sistema Informático Perinatal. Departamento Técnico. HMIRS. Estadísticas Sardá 2010. Comparación con los años 2008-2009. Rev Hos Mat Inf Ramón Sardá 2011; 30: 127-42.
Pinar H, Sung J, Oyer E. References values for singleton and twin placental weights. Pediatric Pathology& Laboratory Medicine 1996; 16: 901-7.
Heinonen S, Taipale P, Saarikoski S. Weights of placentae from small- for-gestational age infants revisited. Placenta 2001; 22:399–404
Araujo Júnior E, Nardozza L, Nowak P, Rolo L, et al. Three-dimensional power Doppler placental vascularisation indices in early pregnancy: a pilot study. J Obstet Gynaecol 2011; 31: 283-85.
Avni R, Neeman M, Garbow J. Functional MRI of the placenta. From rodents to humans. Placenta 2015; 36: 615-22.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2015 Universidad Nacional de Córdoba
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
La Revista de la Facultad de Ciencias Médicas de Córdoba (RFCM) adhiere a la política de Acceso Abierto y no cobra cargos a los autores para publicar, ni tampoco a lectores para acceder a los artículos publicados.
