Edgar Kestler

The effect of maternal work on fetal growth and duration of pregnancy: a prospective study

Summary. The effect on birth outcome of work requiring different degrees of physical exertion was examined among 15 786 pregnant women who were followed through the Guatemalan Social Security Institutes hospital. Work inside and outside the home was ascertained through a questionnaire administered to each woman before delivery. Odds ratios were adjusted for household income, maternal height and age, and birthweight of previous infant. Women with three or more children and no household help were at increased risk for small‐for‐gestational‐age (SGA) births compared with women with family (odds ratio (OR) 1.79; 95% confidence interval (CI) 1.31, 2.47) or hired help (OR 2.0; 95% CI 1‐16 to 3‐33). Compared with office work, manual work increased the risk for an SGA (OR 1.32 95% CI 1.12 to 1.56) and SGA/preterm birth (OR 2.56; 95% CI 1.10 to 5.96). Work in a standing compared with sitting position significantly increased the risk for a preterm birth (OR l.56; 95% CI l.04 to 2.60). There was a significant positive trend in frequency of SGA and SGA/preterm birth with an increase in the physical demands at work, as measured by an activity score. These data suggest that interventions to reduce physical exertion among pregnant women could improve birth outcome.

Impact of a low-technology simulation-based obstetric and newborn care training scheme on non-emergency delivery practices in Guatemala

To assess the effect of a low‐technology simulation‐based training scheme for obstetric and perinatal emergency management (PRONTO; Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) on non‐emergency delivery practices at primary level clinics in Guatemala.

Epidemiological differences among birth weight and gestational age subgroups of newborns

For a sample of 16,113 women who received prenatal care from the Guatemalan Social Security Institute Hospital, we described the distribution of birth weight and gestational age subgroups and the association between known epidemiologic risk factors and the odds for 1) an appropriate‐weight‐for‐gestational‐age preterm vs. a small‐for‐gestational‐age term infant, 2) a small‐for‐gestational‐age preterm vs. a small‐for‐gestational‐age term infant, and 3) a normal ponderal index vs. a low ponderal index term small‐for‐gestational‐age infant. We found that low maternal income, education, height (3147 cm), prepregnancy weight (347.8 kg), and weight gain during pregnancy (30.72 kg) were associated with a greater odds for birth of a term small‐for‐gestational‐age infant (particularly those with a normal ponderal index) than for the birth of a preterm appropriate‐weight‐for‐gestational‐age infant. Conversely, medical and pregnancy‐related complications were associated with greater odds for a preterm birth of an appropriate‐ or a small‐for‐gestational‐age infant. Implications of these findings for interventions and research are discussed.

Perfil situacional y estrategias de intervención en la región mesoamericana en el área de salud materna, reproductiva y neonatal

Presentar los principales resultados del diagnostico situacional y plan regional de intervenciones en salud materna, reproductiva y neonatal elaborado como parte de los trabajos del Sistema Mesoamericano de Salud por el grupo de salud materna, reproductiva y neonatal (SMRN) en 2010. Se conformo un grupo de expertos y de representantes de los paises de la region (que incluye Centroamerica y nueve estados del sur de Mexico). Se hizo una revision documental para conformar un diagnostico situacional, una revision de practicas efectivas y se conformo un plan regional de accion. El diagnostico situacional indica que las tasas de mortalidad materna y neonatal se mantienen inaceptablemente altas en la region. Se propuso como meta regional reducir la mortalidad materna y neonatal de acuerdo a los Objetivos de Desarrollo del Milenio. Se conformo un plan regional que identifica intervenciones especificas en SMRN con enfasis en la atencion adecuada a las emergencias obstetricas y neonatales, atencion calificada al nacimiento, y en planificacion familiar. Se sugiere asimismo un plan de implementacion a cinco anos y una estrategia de evaluacion y de capacitacion. El plan regional en SMRN puede tener exito siempre y cuando los aspectos de implementacion sean atendidos debidamente.

The differential neonatal morbidity of the intrauterine growth retardation syndrome

Objective. To study the effect of intrauterine growth and maternal physique on blood pressure in adult life. Design. A follow up study of infants born 50 years previously whose measurements at birth were recorded in detail. Setting. Preston, Lancashire. Subjects. 449 Men and women born in hospital in Preston during 193543 and still living in Lancashire. Main outcome measures. Placental weight, birth weight, and blood pressure at age 46 to 54 years. Results. In both sexes systolic and diastolic pressures were strongly related to placental weight and birth weight. Mean systolic pressure rose by 15 mm Hg as placental weight increased from c I lb (0.45 kg) to > 1.5 lb and fell by II mm Hg as birth weight increased from 5 5.5 lb to > 7.5 lb. These relations were independent so that the highest blood pressures occurred in people who had been small babies with large placentas. Higher body mass index and alcohol consumption were also associated with higher blood pressure. but the relations of placental weight and birth weight to blood pressure and hypertension were independent of these influences. Conclusions. These findings show for the first time that the intrauterine environment has an important effect on blood pressure acd hypertension in adults. The highest blood pressures occurred in men and women who had been small babies with large placentas. Such discordance between placental and fetal size may lead to circulatory adaptation in the fetus. altered arterial structure in the child, and hypertension in the adult. Prevention of hypertension may depend on improving the nutrition and health of mothers.