Saime YETİS, Atakan TANACAN, Esra KARATAS, Namık DEMİR, Mehmet Sinan BEKSAÇ

Düşük Riskli Bir Gebe Populasyonunda Gebelik Haftasına Göre İri Fetusların Tahmin Edilmesi Amacıyla Gestasyonel Kilo Alımı İçin Bir Eşik Değer

Amaç: Doğum haftasına göre iri bebekleri (LGA) tahmin etmek amacıyla gestasyonel kilo alımı için bir eşik değer belirlemek. Gereç ve Yöntemler: Bu retrospektif kohort çalışması, 1 Ocak 2018 ile 31 Aralık 2018 tarihleri arasında İzmir'deki bir özel hastaneye başvuran 103 hamile kadın üzerinde gerçekleştirildi. Hastalar neonatal doğum ağırlığı persantilleri açısından iki gruba ayrıldı: 1) LGA grubu (≥90 persentil)(n=11) ve 2) LGA olmayan grup (n=92). Demografik özellikler ve klinik karakteristikler gruplar arasında karşılaştırıldı. Ayrıca, LGA fetüslerinin tahmini amacıyla hamilelik sırasında maternal kilo alımı için bir eşik değeri belirlendi. Bulgular: LGA grubunda diğer gruba göre belirgin olarak daha yüksek gestasyonel kilo alımı ve sezaryen oranı gözlendi (p değerleri sırasıyla 0.01 ve 0.03). LGA bebekleri tahmin etmek amacıyla gestasyonel kilo alımı için eşik değer olarak 16.1 kg belirlendi (% 72.7 duyarlılık,% 60.9 özgüllük). Sonuç: Hamilelik sırasında aşırı kilo alımı konusunda dikkatli olunmalıdır.

Anahtar Kelimeler:

doğum kilosu, gestasyonel kilo alımı, doğum haftasına göre iri bebek, gebelik

A Cut-off Value for Gestational Weight Gain to Predict Large for Gestational Age Fetuses in a Low-risk Pregnant Population

Objective: To determine a cut-off value for gestational weight gain for the prediction of large for gestational age (LGA) fetuses Materials and Methods: This retrospective cohort study was conducted among 103 pregnant women who delivered at private hospitals in Izmir between January, 1, 2018 and December, 31, 2018. Patients were divided into two groups in terms of neonatal birth weight percentiles: 1) LGA group (≥90 percentile) (n=11), 2) Non-LGA Group (n=92). Demographic features and clinical characteristics were compared between the groups. Additionally, a cut-off value for maternal weight gain during pregnancy was determined for the prediction of LGA fetuses. Results: Significantly higher total weight gain during pregnancy and higher cesarean rates were observed in LGA group compared to non-LGA group (p values were 0.01 and 0.03, respectively). The cut-off value of 16.1 kg for gestational weight gain (72.7% sensitivity, 60.9% specificity) was determined for the prediction of LGA fetuses. Conclusion: Physicians should be cautious about excess weight gain during pregnancy.

Keywords:

birth weight, gestational weight gain, large for gestational age, pregnancy,

PDF

___

[1] N. Alavi, S. Haley, K. Chow, and S. D. McDonald, "Comparison of national gestational weight gain guidelines and energy intake recommendations," (in eng), Obes Rev, vol. 14, no. 1, pp. 68-85, Jan 2013.
[2] J. G. Chung et al., "Gestational weight gain and adverse pregnancy outcomes in a nulliparous cohort," (in eng), Eur J Obstet Gynecol Reprod Biol, vol. 167, no. 2, pp. 149-53, Apr 2013.
[3] D. O. Daemers, H. A. Wijnen, E. B. van Limbeek, L. M. Bude, and R. G. de Vries, "Patterns of gestational weight gain in healthy, low-risk pregnant women without co-morbidities," (in eng), Midwifery, vol. 29, no. 5, pp. 535-41, May 2013.
[4] Z. M. Ferraro et al., "Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index," (in eng), J Matern Fetal Neonatal Med, vol. 25, no. 5, pp. 538-42, May 2012.
[5] M. A. Kominiarek and A. M. Peaceman, "Gestational weight gain," American journal of obstetrics and gynecology, vol. 217, no. 6, pp. 642-651, 2017.
[6] R. F. Goldstein et al., "Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis," (in eng), Jama, vol. 317, no. 21, pp. 2207-2225, Jun 6 2017.
[7] N. E. Stotland, L. M. Hopkins, and A. B. Caughey, "Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas," Obstetrics & Gynecology, vol. 104, no. 4, pp. 671-677, 2004.
[8] P. M. Dietz, W. M. Callaghan, and A. J. Sharma, "High pregnancy weight gain and risk of excessive fetal growth," American journal of obstetrics and gynecology, vol. 201, no. 1, pp. 51. e1-51. e6, 2009.
[9] C. Tian et al., "Excessive weight gain during pregnancy and risk of macrosomia: a meta-analysis," Archives of gynecology and obstetrics, vol. 293, no. 1, pp. 29-35, 2016.
[10] B. Seçkin, G. Özakşit, G. Biteker, K. Yüksel, and E. Ayarcan, "Maternal Body Mass Index and the course of the labor," Gynecology Obstetrics & Reproductive Medicine, vol. 17, no. 1, pp. 12-15, 2011.
[11] E. Voerman et al., "Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes," (in eng), Jama, vol. 321, no. 17, pp. 1702-1715, May 7 2019.
[12] E. L. Duryea, J. S. Hawkins, D. D. McIntire, B. M. Casey, and K. J. Leveno, "A revised birth weight reference for the United States," (in eng), Obstet Gynecol, vol. 124, no. 1, pp. 16-22, Jul 2014.
[13] "2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019," (in eng), Diabetes Care, vol. 42, no. Suppl 1, pp. S13-s28, Jan 2019.
[14] R. Fluss, D. Faraggi, and B. Reiser, "Estimation of the Youden Index and its associated cutoff point," Biometrical Journal: Journal of Mathematical Methods in Biosciences, vol. 47, no. 4, pp. 458-472, 2005.
[15] L. A. Gilmore and L. M. Redman, "Weight gain in pregnancy and application of the 2009 IOM guidelines: toward a uniform approach," Obesity, vol. 23, no. 3, pp. 507-511, 2015.
[16] P. Institute of Medicine Committee on Nutritional Status During and Lactation, in Nutrition During Pregnancy: Part I Weight Gain: Part II Nutrient SupplementsWashington (DC): National Academies Press (US) Copyright (c) 1990 by the National Academy of Sciences., 1990.
[17] M. S. Beksac, A. Tanacan, D. A. Hakli, and O. Ozyuncu, "Use of the 50‐g glucose challenge test to predict excess delivery weight," International Journal of Gynecology & Obstetrics, vol. 142, no. 1, pp. 61-65, 2018.
[18] E. Fadiloglu, A. Tanacan, C. Unal, D. A. Hakli, and M. S. Beksac, "Clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large for gestational age (LGA) fetuses in non-diabetic pregnancies," Journal of perinatal medicine, 2019.
[19] N. Aka, S. E. Sayharman, Y. Yaşlak, G. Köse, and C. Tüfekçi, "Evaluation of perinatal and maternal complications type of deliveries and neonatal outcomes in macrosomic and normal weighed newborns in our clinic between 2000 and 2010 years," Gynecology Obstetrics & Reproductive Medicine, vol. 17, no. 1, pp. 16-19, 2011.