Prevalencia del exceso de peso en la gestación en Andalucía. Implicación del exceso de peso en la gestación como factor relacionado con la aparición de complicaciones cardiovasculares a largo plazo

Abstract

OBJECTIVES: The main objectives of the study are to determine the prevalence of excess weight in pregnancy in Andalusia and to determine the possible difference in incidences of cardiovascular and / or metabolic events based on weight at the beginning of pregnancy. Secondary objectives are to analyze the clinical profile of pregnant women, describe the obstetric and maternal-fetal complications that they present as well as determine the factors related to excess weight and inadequate weight gain during pregnancy. It is also intended to analyze the incidence of cardiovascular events and other long-term pathologies. Finally, it is intended to analyze from a qualitative point of view the beliefs, feelings, self perception and perceived social support of pregnant women during the process of pregnancy and childbirth, analyzing whether there are differences based on their weight. MATERIAL AND METHODS: To respond to these objectives, a mixed design has been proposed that combines three types of study: prevalence study, historical cohort study, and qualitative study; all of them carried out in the field of primary care. The study population is made up of all the Andalusian pregnant women treated in the Andalusian health system throughout 2018, with a record of the first pregnancy visit before the 12th week of gestation. For the study of historical cohorts, the same inclusion criteria were followed, but analyzing pregnant women from the province of Huelva who were seen in 2009 (to guarantee a follow-up of at least 10 years). The fundamental variables in the prevalence study are BMI, weight categorized by BMI, and weight gain during pregnancy. Other variables are age, province of residence, evolution of pregnancy, smoking, parity, personal history and pathologies during pregnancy, prematurity, macrosomia, type of delivery and complications. In the cohort study, the variables are cardiovascular and / or metabolic events (arterial hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, vascular pathology, ischemic heart disease and thyroid disorders), and other pathologies (cancer and death). All of them analyzed in two population groups defined by the excess weight exposure factor: normal weight and excess weight (based on the BMI of the first pregnancy visit). The qualitative study was carried out through semi-structured interviews, with open questions with a pre-established script. The data collection has been carried out through the single health history. A descriptive analysis of the data has been carried out, using descriptive measures such as mean, standard deviation and percentages. For statistical inference, the relevant tests have been used: Chi square, ANOVA of polynomial contrasts or linear regression. Incidences and RR were calculated. The application conditions have been verified and the 95% CIs have been constructed. The limitations of the study are, on the one hand, the study of the population cared for in public health centers, with part of the pregnant population that opting for follow-up in private medicine being left out of the study and, on the other, the possible lack of information on the collection of information from the single health history. In addition, the follow-up carried out (10 years) may be too short considering that the population is young at the time of the start of the study. The ethical and legal precepts of research in human beings have been complied with. Approval was obtained by the ethics committee. RESULTS: The prevalence of excess weight in the pregnant population of Andalusia is 45% (95% CI 44.6-45.4), of which 27.6% (95% CI 27.2-27.9) corresponds to overweight and 17.4% (95% CI 17.1-17.7) corresponds to obesity (sample size 56,990 pregnant women). Weight is related to age (p <0.001), finding a mean age of 32.1 years, SD 5.71, 95% CI (32.02-32.15) and with the province of residence (p <0.001 ), with more unfavorable data in the provinces of Huelva, Cádiz and Almería. The incidence of arterial hypertension at 10 years of pregnancy is 9% in pregnant women with excess weight and 3% in pregnant women with normal weight. The RR is 3.25 (95% CI 1.09-9.73), p 0.021. The incidence of other cardiovascular and / or metabolic events in the overweight group is as follows: 1% diabetes mellitus, 2% dyslipidaemia, 1% chronic kidney disease, 2% vascular events and 9% thyroid disorders, with no statistically significant differences. significant with respect to the normal weight group (p 0.5, 0.124, 0.5, 0.311, 0.183 respectively). Regarding other pathologies, the incidence of tumor pathology was 2% and death rate 1%, not finding statistically significant differences (p 0.5 in both cases). Ischemic heart disease was not recorded in any group. The sample corresponds to 288 pregnant women (144 in each group). A relationship has been found between BMI and adequate weight gain during pregnancy (p 0.002), as well as between BMI and type of delivery (vaginal vs. cesarean section) (p 0.004) in a random sample of 381 patients. No relationship has been found with the rest of the variables (previous pathologies, pathologies during pregnancy, type of delivery, complications ...) From a qualitative point of view, in general the experience of pregnancy is good in all pregnant women and they try to improve their lifestyle during it. In general, the experience of weight gain and self-perception is quite good during pregnancy, although it seems that pregnant women with more weight make more criticism of their initial weight. It seems that there are differences in terms of self-perception after delivery, this being negative more frequently in the overweight population and in the feeling of perceived social support, being worse also in this group. CONCLUSIONS: There is a high prevalence of overweight and obesity at the beginning of pregnancy in Andalusia. The most unfavorable data are found in the provinces of Huelva, Cádiz and Almería. This prevalence is related to age, with a higher BMI being found at an older age. Excess weight is related to the type of delivery, being the most frequent caesarean sections in pregnant women with excess weight. It has not been possible to demonstrate a relationship with other important variables such as the development of pathologies during pregnancy, prematurity or macrosomia or complications, although it seems that the tendency of the sample is for excess weight to be related to the appearance of complications. The risk of developing high blood pressure at 10 years of pregnancy is three times higher in pregnant women with excess weight than in pregnant women with normal weight. The tendency of the sample is to present a higher incidence of other cardiovascular diseases and events in pregnant women with excess weight, although it has not been possible to demonstrate the difference with the normal weight group. It would be advisable, on the one hand, to propose a follow-up of the present study to analyze the incidents after a longer observation period, and on the other hand, to propose intervention proposals in relation to health promotion and the promotion of healthy lifestyles in the population in childbearing age, in the pregnant population and in the general population.