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Abstract(s)
Introdução: A restrição do crescimento intrauterino refere-se à perda de oportunidade de o
feto atingir o respetivo potencial de crescimento. Os critérios de definição utilizados são um
dos seguintes: peso fetal estimado (PFE) ou o perímetro abdominal (PA) inferior ao percentil
3, PFE ou PA inferior ao percentil 10 com alteração do fluxo cérebro-placentar ou das artérias
uterinas ou ausência de crescimento fetal em pelo menos 2 avaliações com intervalo mínimo
de 2 a 4 semanas. Estas condicionantes pré-natais traduzem-se frequentemente em recémnascidos
com menos peso que o esperado para a sua idade. Recém-nascido leve para a idade
gestacional (LIG) é aquele que tem peso inferior ao correspondente ao percentil 10 para a
respetiva idade gestacional, numa curva representativa da população. Vários fatores
influenciam este crescimento, sendo o tabagismo considerado um dos mais importantes
fatores de risco modificáveis durante a gravidez. Segundo estudos recentes, a cessação
tabágica durante as primeiras doze semanas de gestação está associada a uma diminuição das
diferenças do crescimento fetal em comparação com recém-nascidos de mães não fumadoras
e, desta forma, a uma melhoria do crescimento intrauterino.
Materiais e Métodos: Estudo retrospetivo de uma amostra de 482 recém–nascidos do Hospital
do Alto Ave, entre 1 de janeiro de 2011 e 31 de dezembro de 2012, tendo por base a análise
dos processos clínicos. As variáveis estudadas incidiram sobre as características maternas,
onde se incluiu idade materna, fumadora ou não fumadora e o perfil de carga tabágica nos
diferentes trimestres da gravidez; características do período gestacional materno (idade
gestacional em semanas completas) e características dos recém-nascidos, entre os quais, data
de nascimento, género, peso, comprimento, perímetro cefálico e restrição do crescimento
uterino documentada. A análise estatística foi efetuada usando o software IBM SPSS Statistics
Versão 19.0 com aplicação do Teste Shapiro-Wilk, Teste de Fisher, Teste t para duas amostras
independentes e para duas amostras emparelhadas.
Resultados: Da amostra formada por 482 recém-nascidos, 52 tinham mães fumadoras e 430
não fumadoras. Relativamente às mães fumadoras, 71% têm entre 18 e 35 anos e 29% mais de
35 anos. Destas, 53,8% diminuíram os hábitos tabágicos, sendo que 82% o fez no 1º trimestre
de gestação; 25% cessou o tabagismo, tendo-o feito no 1º trimestre 69,2% das grávidas
fumadoras; e 21,2% manteve a carga tabágica durante toda a gravidez. A redução do número
de cigarros fumados ao longo da gestação foi de 7,0±5,73 cigarros. Os percentis do peso em
recém-nascidos de mães não fumadoras foram estatisticamente superiores aos de mães
fumadoras; no que diz respeito ao comprimento e perímetro cefálico estas alterações não
foram significativas. Também relativamente aos valores corretos e absolutos existem
diferenças significativas no peso e comprimento, sendo estes mais baixos em mães que
fumaram durante a gravidez. Estas alterações já não são significativas quando se compara os
recém-nascidos de mães fumadoras com os de mães que cessaram o tabagismo no 1º trimestre de gestação. Relativamente ao recém-nascido apresentar restrição de crescimento
intrauterino, houve uma relação significativa com o facto de a mãe fumar durante a gravidez;
contudo, não existe relação significativa entre cessar os hábitos tabágicos no 1º trimestre e os
recém-nascidos apresentarem restrição de crescimento intrauterino.
Conclusão: Os recém-nascidos de mães fumadoras durante a gravidez têm associado maior
risco de restrição de crescimento intrauterino comparado com recém-nascidos de mães não
fumadoras, sem que haja uma diferença estatisticamente significativa entre cessar o
tabagismo no 1º trimestre e fumar durante toda a gravidez. Isto demonstra a necessidade de
implementação de programas clínicos para a cessação tabágica num período pré-concecional
ou pelo menos numa fase inicial da gravidez. Uma breve sessão de cessação tabágica através
de cinco etapas é uma medida custo-efetiva e facilmente integrada numa prática de
consultório médico. Esta terá um melhor resultado caso seja efetuada pelos médicos que
acompanham a mulher numa fase pré-concecional e durante a gravidez, ou seja, os médicos
de medicina geral e familiar e os obstetras.
Introduction: Intrauterine growth restriction refers to the loss of opportunity of the fetus to reach its growth potential. The defining criteria are one of the following: estimated fetal weight or waist circumference below the 3rd percentile, estimated fetal weight or waist circumference below the 10th percentile with abnormal brain-placental or uterine artery flow or absence of fetal growth in, at least, 2 reviews with an interval 2-4 weeks. These prenatal conditions translate often in newborns with less weight than expected for their age. Newborn small for gestational age is one that has less weight than the corresponding to the 10th percentile for the respective gestational age, in a representative curve of the population. Several factors influence this growth, and smoking is considered one of the most important modifiable risk factors during pregnancy. According to recent studies, smoking cessation during the first twelve weeks of gestation is associated with a decrease on the differences in fetal growth compared to newborns of non-smoking mothers and thus to an improvement of intrauterine growth. Materials and methods: Retrospective study of a sample of 482 newborns of Alto Ave Hospital between January 1st 2011 and December 31st 2012, based on the analysis of clinical processes. The variables focused on maternal characteristics, which included maternal age, smoking or non-smoking and smoking history profile in the different trimesters of pregnancy; characteristics of maternal pregnancy (gestational age in completed weeks) and newborn characteristics among which birth date, gender, weight, length and head circumference. The statistical analysis was performed in SPSS Statistics software version 19.0 with application of Shapiro-Wilk test, Fisher test, t test for two independent samples and two paired samples. Results: Of the sample composed by 482 newborns, 52 had smoking and 430 non-smoking mothers. With regard to smoking mothers, 71% are between 18 and 35 years and 29% over 35 years. Of these, 53.8% decreased their smoking habits, wherein 82% did in the 1st trimester of pregnancy; 25% stopped smoking, having it done in the 1st trimester 69.2 % of pregnant smokers; and 21.2% maintained the level of smoking throughout pregnancy. The reduction in the number of cigarettes smoked during gestation was 7.0 ± 5.73 cigarettes. Percentiles of weight in newborns of non-smoking mothers were statistically higher than in those of smoking mothers, with regard to length and head circumference the changes were not statistically significant. Concerning the correct and absolute values there are also significant differences in weight and length, which are lower in mothers who smoked during pregnancy. These changes are no longer significant when comparing the newborns of smoking mothers with mothers who ceased smoking in the 1st trimester of pregnancy. Regarding the fact that the newborn has restricted intrauterine growth, there was a significant relationship with the mother smoking during pregnancy; however, there is no significant relationship between ceasing smoking habits in the 1st trimester and newborns presenting restriction intrauterine growth. Conclusions: The newborns of smoking mothers during pregnancy are associated with increased risk of restricted intrauterine growth compared to newborns of non-smoking mothers, without a statistically significant difference between smoking cessation in 1st trimester and smoking throughout pregnancy. This demonstrates the need for implementation of clinical programs for smoking cessation in a preconception period or at least at an early stage of pregnancy. A brief 5-step smoking cessation session is a cost-effective and easily integrated measure in a practicing doctor. This will have a better outcome if performed by doctors who treat the woman in a preconception period and during pregnancy, like general practitioners and obstetricians.
Introduction: Intrauterine growth restriction refers to the loss of opportunity of the fetus to reach its growth potential. The defining criteria are one of the following: estimated fetal weight or waist circumference below the 3rd percentile, estimated fetal weight or waist circumference below the 10th percentile with abnormal brain-placental or uterine artery flow or absence of fetal growth in, at least, 2 reviews with an interval 2-4 weeks. These prenatal conditions translate often in newborns with less weight than expected for their age. Newborn small for gestational age is one that has less weight than the corresponding to the 10th percentile for the respective gestational age, in a representative curve of the population. Several factors influence this growth, and smoking is considered one of the most important modifiable risk factors during pregnancy. According to recent studies, smoking cessation during the first twelve weeks of gestation is associated with a decrease on the differences in fetal growth compared to newborns of non-smoking mothers and thus to an improvement of intrauterine growth. Materials and methods: Retrospective study of a sample of 482 newborns of Alto Ave Hospital between January 1st 2011 and December 31st 2012, based on the analysis of clinical processes. The variables focused on maternal characteristics, which included maternal age, smoking or non-smoking and smoking history profile in the different trimesters of pregnancy; characteristics of maternal pregnancy (gestational age in completed weeks) and newborn characteristics among which birth date, gender, weight, length and head circumference. The statistical analysis was performed in SPSS Statistics software version 19.0 with application of Shapiro-Wilk test, Fisher test, t test for two independent samples and two paired samples. Results: Of the sample composed by 482 newborns, 52 had smoking and 430 non-smoking mothers. With regard to smoking mothers, 71% are between 18 and 35 years and 29% over 35 years. Of these, 53.8% decreased their smoking habits, wherein 82% did in the 1st trimester of pregnancy; 25% stopped smoking, having it done in the 1st trimester 69.2 % of pregnant smokers; and 21.2% maintained the level of smoking throughout pregnancy. The reduction in the number of cigarettes smoked during gestation was 7.0 ± 5.73 cigarettes. Percentiles of weight in newborns of non-smoking mothers were statistically higher than in those of smoking mothers, with regard to length and head circumference the changes were not statistically significant. Concerning the correct and absolute values there are also significant differences in weight and length, which are lower in mothers who smoked during pregnancy. These changes are no longer significant when comparing the newborns of smoking mothers with mothers who ceased smoking in the 1st trimester of pregnancy. Regarding the fact that the newborn has restricted intrauterine growth, there was a significant relationship with the mother smoking during pregnancy; however, there is no significant relationship between ceasing smoking habits in the 1st trimester and newborns presenting restriction intrauterine growth. Conclusions: The newborns of smoking mothers during pregnancy are associated with increased risk of restricted intrauterine growth compared to newborns of non-smoking mothers, without a statistically significant difference between smoking cessation in 1st trimester and smoking throughout pregnancy. This demonstrates the need for implementation of clinical programs for smoking cessation in a preconception period or at least at an early stage of pregnancy. A brief 5-step smoking cessation session is a cost-effective and easily integrated measure in a practicing doctor. This will have a better outcome if performed by doctors who treat the woman in a preconception period and during pregnancy, like general practitioners and obstetricians.
Description
Keywords
Cessação do Tabagismo Curvas de Crescimento Fetal Gravidez Restrição do Crescimento Intrauterino