Estudo dos fatores de risco para macrossomia em recém-nascidos de uma maternidade pública do Distrito Federal e desenvolvimento de guia orientador para detecção precoce

Abstract

INTRODUCTION: Macrosomia is defined as birth weight above 4000g. The identification of environmental, epidemiological, clinical, and gestational factors that may influence the weight of newborns is essential for implementing preventive and therapeutic measures during prenatal care, aiming to prevent outcomes such as birth macrosomia and its negative repercussions for maternal-fetal health. This dissertation follows the line of action of the Quality in Women's Health Care program, and the research problem originated from obstetric medical practice within the scope of the Health Department of the Federal District, where fetal macrosomia is mostly diagnosed at birth but rarely have its risk factors addressed and managed during prenatal care to be avoided. This proposal was developed in partnership with the professional team of the Gynecology and Obstetrics Unit of the Maternity and Child Hospital of Brasília. OBJECTIVE: To study the risk factors for macrosomia in newborns in a public maternity hospital in the federal district and develop a guide for early detection. METHOD: A case-control study was conducted at Joint Accommodation System/Maternity of the Maternity and Child Hospital of Brasília, reference in high-risk pregnancies, based on interviews using a standardized questionnaire developed by the researcher herself, with postpartum women up to the fifth day after delivery, who had macrosomic newborns, between November 2019 and January 2020. The groups consisted of mother-child dyads, with the case group comprising all newborns weighing 4000g or more and the control group comprising newborns weighing between 2500g and 3999g, in a 1:1 ratio. Descriptive analysis of sociodemographic variables related to lifestyle, family history, and gestational health-disease-care, regarding delivery and the newborn, was performed. For continuous variables, measures of central tendency and dispersion were verified. Absolute and relative frequencies were estimated for categorical variables, as well as chi-square or Fisher's exact tests with a significance level of 5%. Unconditional logistic regression was employed to measure the crude and adjusted Odds Ratios with their respective 95%. RESULTS: Ninety-six women participated in the study. Maternal height (≥1.65m), excessive maternal weight gain, postdatism (gestational age at birth ≥ 41 weeks), macrosomia in first-degree family members, late initiation of prenatal care (from the second trimester onwards), cesarean delivery, indication of cesarean section due to large fetus for gestational age, complications with the newborn, newborn hypoglycemia, and newborn weight at the last gestational ultrasound were considered predictive factors for fetal macrosomia. Furthermore, as a result of this dissertation, a technical product was developed, divided into 4 stages: identification of risk factors in the original study on the presented theme in product 1, evaluation of predictors for macrosomia in the literature, proposal of a practical guide with a checklist by expert qualification, and dissemination of information to the Health Department of the Federal District. The method used is appropriate, applicable, and innovative as it enables the identification of risk factors for macrosomia during prenatal consultations and the use of proposed flowcharts for guidance and orientation of pregnant women in the health network that did not exist until then. The developed technical production has the potential to generate impact on public health by intervening early in the care and management of pregnant women with risk factors, through preventive measures, to reduce the number of macrosomic newborns and their negative consequences for maternal-fetal health. This work presents originality and relevance for scientific, technological, cultural, social, and innovation development in women's health. PRODUCTS: Two products were developed for this dissertation: 1) Original Article - "Predictors for macrosomia in newborns from a public maternity hospital in the Federal District" - to be submitted to the Brazilian Journal of Gynecology and Obstetrics (RBGO); 2) Technical Product - "Guiding guide for early detection and management direction of pregnant women with risk factors for fetal macrosomia". CONCLUSION: Considering the predictive factors for macrosomia identified in this study, it is essential that these determinants and trends of this condition are systematically monitored to minimize it, implementing preventive and therapeutic measures, given that macrosomia constitutes an important obstetric and public health problem associated with significant maternal and perinatal morbidity and consequences. The results of this study have the potential to influence public health policies and good obstetric practices and women's health, bringing innovation and impact to the training of health professionals who work with pregnant women in prenatal care and obstetric emergencies. For this purpose, a guiding guide for early detection and management direction of pregnant women with risk factors for fetal macrosomia was developed, aiming to guide medical professionals and patients on preventive measures, as well as appropriate interventions to reduce the risks associated with this condition and standardize clinical practices to ensure a consistent approach in different health units.