Teses e Dissertações


Aluno:Alicia Matijasevich Manitto

Título: Fatores de risco maternos para morte fetal: Um estudo de casos e controles de base populacional


Área de concentração:-

Orientador:Fernando Celso Barros

Banca examinadora:Aluísio J. D. de Barros, Denise Petrucci Gigante. Elaine Albernaz e Maria Helena Benício

Data defesa:19/04/2005

Palavras-chave:Morte fetal, fatores de risco, epidemiologia

Maternal caffeine consumption and fetal death: a case-control study in Uruguay.

The objective of this study was to examine the association between caffeine intake during pregnancy and fetal mortality in Montevideo, the capital city of Uruguay, taking into account several potential confounders factors. A population-based casecontrol study was conducted between August 1st 2002 and December 31st 2003. A total of 382 cases and 792 controls were recruited. Cases consisted of women hospitalized with a medically confirmed diagnosis of spontaneous antepartum fetal death in all maternity hospitals during the study period. Antepartum fetal death was defined as a fetal death in which the attending doctor certified that the death occurred prior to the onset of labor. Fetal deaths were included if they had at least 20 weeks of gestational age or weighed more than 350 grams. Controls were women who had a live, vigorous and term adequate-for-gestational-age newborn. Multiple gestations and fetuses/newborns with evident congenital malformations were excluded. Only a small proportion of the mothers did not consume caffeine during pregnancy - 8.1% of the cases and 9.5% of the controls. Among consumers, mate drinking was the most frequent source of caffeine both in cases and controls. After controlling for mother’s and her partner’s education, previous history of abortions and/or fetal deaths, vomiting/nausea during the first trimester of gestation and attendance to prenatal care, compared with no caffeine consumption during pregnancy, the category of mean caffeine intake of =300 mg/day showed a significantly increased risk of fetal death (OR 2.33 [1.23; 4.41]). The study also found that less-educated women, mothers who did not attend to prenatal care and women with previous history of abortions and fetal death were at increased risk of fetal death. As mate drinking is highly consumed among pregnant women in this country, the association found with fetal death makes it a preventable risk factor.

Does caffeine consumption during pregnancy increase the risk of fetal mortality? A literature review.

The aim of this study was to evaluate the available epidemiological evidence of the effect of caffeine consumption during pregnancy on fetal mortality. A systematic qualitative review of observational studies that referred to any source of exposure to caffeine from food in pregnancy and to fetal mortality as the outcome was conducted at the electronic databases Medline and Lilacs. Studies published between January 1966 and September 2004 were searched. The following descriptors were used: ‚Äúcaffeine‚ÄĚ, ‚Äúcoffee‚ÄĚ, ‚Äútea‚ÄĚ, ‚Äúcola‚ÄĚ and ‚Äúcacao‚ÄĚ to define the exposure and ‚Äúfetal death‚ÄĚ, ‚Äústillbirth‚ÄĚ, ‚Äúfetal demise‚ÄĚ and ‚Äúfetal loss‚ÄĚ to define the outcome. A total of four publications were found. The small number of publications addressing this subject, methodological limitations, inaccurate exposure assessment in all the studies, overall risks only marginally significant in most cases and the possibility of publication bias prevent to state with certainty that caffeine consumption is actually associated with fetal death. Well-designed future research with further assessment of caffeine intake is needed to define the role of caffeine in fetal mortality.Keywords: Caffeine; Fetal death; Pregnancy;

O objetivo desse estudo foi avaliar a evid√™ncia epidemiol√≥gica existente a respeito do efeito do consumo de cafe√≠na durante a gravidez sobre a mortalidade fetal. Foi realizada uma revis√£o qualitativa sistem√°tica dos estudos observacionais que utilizaram como exposi√ß√£o qualquer fonte alimentar de cafe√≠na durante a gesta√ß√£o e como desfecho, mortalidade fetal. A revis√£o foi conduzida nas bases eletr√īnicas Medline, Lilacs para estudos publicados entre janeiro de 1966 e setembro de 2004. Foram usados os seguintes descritores: ‚Äúcaffeine‚ÄĚ, ‚Äúcoffee‚ÄĚ, ‚Äútea‚ÄĚ, ‚Äúcola‚ÄĚ and ‚Äúcacao‚ÄĚ para definir a exposi√ß√£o e ‚Äúfetal death‚ÄĚ, ‚Äústillbirth‚ÄĚ, ‚Äúfetal demise‚ÄĚ e ‚Äúfetal loss‚ÄĚ para definir o desfecho. Um total de quatro publica√ß√Ķes foram localizadas. O pequeno n√ļmero de artigos abordando o tema, as limita√ß√Ķes metodol√≥gicas e a avalia√ß√£o inacurada da exposi√ß√£o em todos os estudos, os riscos marginalmente significativos na maioria dos casos e a possibilidade de vi√©s de publica√ß√£o impedem que se afirme que o consumo de cafe√≠na esteja associado a morte fetal. Estudos bem delineados e com uma melhor avalia√ß√£o do consumo de cafe√≠na s√£o necess√°rios para definir o papel da cafe√≠na na mortalidade fetal. Palavras chave: Cafe√≠na; Mortalidade fetal; gravidez

Maternal obesity and antepartum fetal death: a population-based study in Uruguay.

Background This study examined the influence of maternal pre-pregnancy obesity, height and weight gain during pregnancy on antepartum fetal death (APFD) in Uruguay, South America, taking into account several potential confounding factors. In this country there is a high prevalence of overweight/obesity among women at reproductive age.Method This population-based, historical cohort study included 2814 fetal deaths -1786 APFD, 263 intrapartum fetal deaths and 765 deaths with unknown timing of death- and 326 080 live births of the public and private maternity hospitals of Uruguay from 1992 to 2001. The analysis excluded multiple births and fetal deaths with less than 20 completed weeks of gestational age. The denominator for the analysis of APFDs included intrapartum fetal deaths at 20 or more weeks of gestation, live births and those with unknown timing of death. Multiple imputation was used to deal with missing information in the data set.Results In the adjusted analysis obese women (pre-pregnancy body mass index, BMI, =30 kg/m2) showed an increased risk of antepartum fetal death relative to women with BMI 18.5-<25 kg/m2 (OR 1.40, CI 95% 1.16, 1.68, P<0.001). Women with low weight gain rate during pregnancy (<0.18 kg/week) showed increased risk of APFD relative to those gaining 0.25-<0.35 kg/week, and maternal height did not show an association with APFD. When women with chronic hypertension and pregnancyrelated complications such us preeclampsia, eclampsia and gestational diabetes mellitus were excluded from the analysis, pre-pregnancy obesity continued to be associated with APFD showing that the risk of APFD among obese women was independent on the presence or not of such complications.Conclusions The high prevalence of obesity in women of reproductive age in Uruguay, and the association found with APFD is a cause for concern. Pre-pregnancy obesity is one of the most important preventable factors for APFD in this population.

Programa de Pós-Graduação em Epidemiologia - Centro de Pesquisas Epidemiológicas