Factores asociados a morbilidad materna y perinatal en gestantes con edad materna avanzada

Resumen

Objetivo

Evaluar los factores asociados a morbilidad materna y perinatal en gestantes con edad materna avanzada (EMA), atendidas en el Instituto Nacional Materno Perinatal de Perú durante el periodo de enero a diciembre 2018.

Materiales y métodos

Estudio observacional de corte transversal, realizado en el Instituto Nacional Materno Perinatal de Perú durante el año 2018. Los criterios de inclusión fueron gestantes de 35 a más años de edad que culminaron en parto vaginal o cesárea. Las variables estudiadas fueron factores sociodemográficos, obstétricos y perinatales. Se usó el método de regresión logística multivariada y análisis de curvas ROC.

Resultados

Participaron 325 gestantes, con edad media 38,01 ± 2,66 años. Estado civil conviviente 70,8%; control prenatal inadecuado 47,7%; sobrepeso pregestacional 38,6%; primíparas 11,7% y grandes multíparas 18,5%. Periodo intergenésico largo 62,8% y corto 15,4%. El 56,3% presentó cesárea y el 28% desgarro vaginal I°. Aplicando regresión logística el IMC ≥ 25 kg/m² presentó un odds ratio (OR) de 1,02 para preeclampsia severa; OR: 2,35 para desgarro vaginal I°; y OR: 2,91 para macrosomía fetal. Control prenatal inadecuado representa OR: 1,31 para parto pretérmino y un OR: 1,48 para preeclampsia severa. Antecedente de preeclampsia previa OR: 3,03 para parto pretérmino y OR: 10,90 para preeclampsia severa. Curva ROC para el desarrollo de preeclampsia severa fue 69,74%; complicaciones en parto vaginal 85,44% y macrosomía fetal 72,78%.

Conclusiones

Sobrepeso pregestacional en EMA están asociados a desarrollar preeclampsia severa, desgarro vaginal y macrosomía fetal y la preeclampsia previa, está fuertemente asociada al desarrollo de parto pretérmino y preeclampsia severa; las cuales deberían indagarse a detalle durante la atención prenatal.

Abstract

Objective

To evaluate the factors associated with maternal and perinatal morbidity in pregnant women with advanced maternal age (AMA) attending the National Maternal and Perinatal Institute of Peru during the period January to December 2018.

Materials and methods

An observational cross-sectional study was carried out at the National Maternal and Perinatal Institute of Peru during the 2018 period. Inclusion criteria were pregnant women aged 35 years and over that culminated in vaginal delivery or caesarean section. The variables studied were sociodemographic, obstetric, and perinatal factors. The multivariate logistic regression method and ROC curve analysis were used.

Results

The study included a total of 325 pregnant women with a mean age of 38.01 ± 2.66 years. Cohabiting civil status was 70.8%, primiparous 11.7%, and large multiparous 18.5%. Inadequate prenatal care was 47.7%, and intergenesic period- long 62.8%, and short 15.4%. Pre-pregnancy overweight was 38.6%, with caesarean 56.3%, and vaginal tear I°, 28%. Applying logistic regression, BMI ≥25 Kg/m² gave an odds ratio (OR): 1.02 for severe pre-eclampsia; OR: 2.35 vaginal tear I°; and OR: 2.91 for foetal macrosomia. Inadequate prenatal control had an OR: 1. 31 for preterm delivery; and an OR: 1.48 for severe pre-eclampsia. Having a history of pre-eclampsia gave an OR: 3.03 for preterm delivery, and an OR: 10.90 for severe pre-eclampsia. ROC curve for the development of severe preeclampsia was 69.74%, complications in vaginal delivery 85.44%, and foetal macrosomia 72.78%.

Conclusions

Pre-gestational overweight in AMA is associated with developing severe pre-eclampsia, vaginal tear, and foetal macrosomia. Previous pre-eclampsia is strongly associated with developing preterm birth and severe pre-eclampsia, which should be thoroughly investigated during prenatal care.