Term gebelerde plasenta ağırlığını etkileyen antenatal faktörlerin değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı, vajinal doğum yapmış miadında gebelerde çeşitli antenatal faktörlerin plasenta ağırlığını etkileyip etkilemediğini değerlendirmektir. Gereç ve Yöntemler: Bu gözlemsel çalışma Ocak-Ağustos 2022 tarihleri arasında Karaman Eğitim ve Araştırma Hastanesi'nde yapılmıştır. Otuz yedinci gebelik haftasını tamamlayarak vajinal doğum yapan 630 gebe bu çalışmaya alındı. anne yaşı, paritesi, vücut kitle indeksi, kronik hastalıkları, plasenta ağırlığı, yenidoğanların da doğum ağırlığı, boyu ve cinsiyeti kaydedildi.Bu çalışmanın birincil sonucu, plasenta kitlesini etkileyebilecek anne yaşı, vücut kitle indeksi, parite, anemi ve kronik hastalık ve yenidoğan ağırlığı gibi faktörleri değerlendirmektir. Hamilelik sırasında tütün kullanımının yanı sıra cinsiyetin etkisinin değerlendirilmesi bu çalışmanın ikincil bir sonucuydu. Plasenta ağırlığını etkileyen faktörler değerlendirilirken Enter yöntemi ile lineer regresyon analizleri uygulandı. Bulgular: Çalışmanın bulgularını değerlendirdiğimizde, doğum ağırlığının ve paritenin plasenta ağırlığı üzerinde istatistiksel olarak anlamlı bir etkiye sahip olduğunu gözlemledik (sırasıyla, p>0,001 ve p=0,024). Primipar gebelerde ortalama plasenta ağırlığı 580 gram iken, multiparlarda 600 gram (p=0,008). 13 hastalık kategorisi incelendiğinde sadece gestasyonel diyabetin plasenta ağırlığı üzerine anlamlı etkisi olduğu gösterildi (p=0,024). Annelerin vücut kitle indeksi , hemoglobin düzeyi ≤11 gr/dL olan annedeki anemi ve sigara alışkanlığının plasenta ağırlığı üzerinde etkisi bulunmamıştır. Sonuç: Bu çalışmanın sonuçları, parite, yenidoğanın doğum ağırlığı ve annede gestasyonel diyabet varlığının plasenta ağırlığını etkileyen kritik faktörler olduğunu desteklemektedir

Anahtar Kelimeler

• doğum ağırlığı
• kronik hastalık
• cinsiyet
• gebe

Evaluation of antenatal factors affecting placental weight in term pregnancies

Öz

ABSTRACT: Objective: The aim of this study was to evaluate whether various antenatal factors affect placental weight in term pregnant women who gave birth vaginally. Materials and Methods: This observational study was conducted between January and August 2022 in Karaman Training and Research Hospital. Six hundred and thirty parturients after thirtyseventh gestational week with vaginal delivery were enrolled to this study. The maternal age, parity, body mass index, chronic diseases, and placental weight, weight, length and gender of he newborns were documented. Primary outcome of this study was to evaluate the factors such as age, body mass index, parity, anemia and chronic disesase of mothers and weight of the newborns that may affect placental mass. Assessment of the influence of gender as well as tobacco usage during pregnancy was a secondary outcome of this study. Linear regression analyses with Enter methos was applied while evaluating the factors affecting placental weight. Results: As we evaluated the findings of the study, we found that birth weight and parity had a statistically significant influence on placental weight (p>0,001 and p=0,024 ,respectively). In primipar pregnants , the average weight of the placenta was 580 grams, whereas it was 600 grams in multiparas (p=0,008). Only gestational diabetes was shown to have a significant effect on placental weight when 13 disease categories were investigated (p=0,024).Body mass index of mothers , maternal anemia with hemoglobin level ≤11 gr/dL and smoking habitus had no effect on placental weight. Conclusion: The results of this study support , parity , birthweight of the newborn and gestational diabetes mellitus are critical factors affecting placental weight.

Anahtar Kelimeler

• birth weight
• chronic disease
• gender
• placenta

Kaynakça

1. Redline RW. Placental pathology: a systematic approach with clinical correlations. Placenta 29 (Suppl A), 2008; S86–S91. https://doi.org/10.1016/j.placenta.2007.09.003
2. Hayward CE, Lean S, Sibley CP, Jones RL, Wareing M, Greenwood SL, Dilworth MR. Placental adaptation: what can we learn from birthweight: placental weight ratio? Front Physiol, 2016;7-28. https://doi.org/10.3389/fphys.2016.00028
3. Hutcheon JA, McNamara H, Platt RW, Benjamin A, and Kramer MS. Placental weight for gestational age and adverse perinatal outcomes. Obstet Gynecol, 2012; 119(6)1251–1258, https://doi.org/10.1097/aog.0b013e318253d3df
4. Haavaldsen C, Samuelsen SO, Eskild A, Fetal death and placental weight/ birthweight ratio: a population study. Acta Obstet Gynecol Scand, 2013; 92(5):583–590. https://doi.org/10.1111/aogs.12105
5. Wallace JM, Bhattacharya S, Horgan GW. Gestational age, gender and parity specific centile charts for placental weight for singleton deliveries in Aberdeen. Placenta, 2013 ; 34(3):269–274. https://doi.org/10.1016/j.placenta.2012.12.007
6. Kharkova OA, Krettek A, Grjibovski AM, Nieboer E, Odland JØ. Prevalence of smoking before and during pregnancy and changes in this habit during pregnancy in Northwest Russia: a Murmansk county birth registry study. Reproductive health, 2016; 13(1): 18. https://doi.org/10.1186/s12978-016-0144-x
7. World Health Organization. The prevelance of anemia in women: A tabulation of avaliable information. 2nded. Geneva, Switzerland, WHO, 1992.
8. Brown ZA, Schalekamp-Timmermans S, Tiemeier HW, Hofman A, Jaddoe VWV, Steegers EAP. Fetal sex specific differences in human placentation: a prospective cohort study. Placenta, 2014; 35(6): 359–364. https://doi.org/10.1016/j.placenta.2014.03.014

9. Goldman-Wohl D, Gamliel M, Mandelboim O, Yagel S. Learning from experience: cellular and molecular bases for improved outcome in subsequent pregnancies. Am J Obstet Gynecol, 2019; 221(3):183-193.https://doi.org/10.1016/j. ajog.2019.02.037
10. Khong TY, Adema ED, Erwich JJHM. On an anatomical basis for the increase in birth weight in second and subsequent born children. Placenta, 2003;24(4): 348–353. https://doi.org/10.1053/plac.2002.0922
11. Ballering G, Leijnse J, Eijkelkamp N, Peeters L, de Heus R. First-trimester placental vascular development in multiparous women differs from that in nulliparous women. J Matern Fetal Neonatal Med, 2018;209–215. https://doi.org/10.1080/14767058.2017.1280020
12. Ogawa M, Matsuda Y, Nakai A, Hayashi M, Sato S, Matsubara S. Standard curves of placental weight and fetal/placental weight ratio in Japanese population: difference according to the delivery mode, fetal sex, or maternal parity. Eur. J. Obstet. Gynecol. Reprod Biol 2016 Nov; 206:225–231. https://doi.org/10.1016/j.ejogrb.2016.09.004
13. Tekgül N, Yamazhan M. The effects of maternal anemia in pregnant women with respect to the newborn weight and the placental weight in the Delivery room. J Pediatr Res, 2019; 6(4):342-346. : doi:10.4274/jpr.galenos.2019.22599
14. Munir SI, Frarooqı SS, Gondal M. Effect of maternal iron deficiency anemia on placental weight to birth weight ratio in term infant. Pak Postgrad Med J, 2021; 32(2):62-66. https://doi.org/10.51642/ppmj.v32i02.448
15. Wallace JM, Horgan GW, Bhattacharya S. Placental weight and efficiency in relation to maternal body mass index and the risk of pregnancy complications in women delivering singleton babies. Placenta, 2012; 33(8): 611–618. https://doi.org/10.1016/j.placenta.2012.05.006
16. Strom-Roum EM, Haavaldsen C, Tanbo TG, Eskild A. Placental weight relative to birthweight in pregnancies with maternal diabetes mellitus. Acta Obstet Gynecol Scand, 2013; 92: 783–789. https://doi.org/10.1111/aogs.12104
17. Huang SH et all. The effects of maternal smoking exposure during pregnancy on postnatal outcomes: A cross sectional study. J Chin Med Assoc, 2017;80(12):796-802. https://doi.org/10.1016/j.jcma.2017.01.007