Gezond beginnen aan zwangerschap essentieel*
Vrouwen die een kind willen, kunnen hun ongezonde gewoontes beter afleren, voordat zij zwanger worden.
De gezondheid van de moeder speelt in de eerste weken van de zwangerschap namelijk een veel belangrijkere rol dan tot dusver werd gedacht.
Dat blijkt uit onderzoek van het Erasmus Medisch Centrum in Rotterdam. De resultaten zijn dinsdag gepubliceerd in het gezaghebbende Amerikaanse geneeskundige tijdschrift Journal of the American Medical
Association.
Uit de studie blijkt dat zaken als roken, een tekort aan foliumzuur of een hoge bloeddruk ook in de beginfase van de zwangerschap een nadelige invloed hebben op de ontwikkeling van het kind in de baarmoeder.
Tot dusver werd gedacht dat dergelijke factoren pas in een later stadium een rol gaan spelen.
Groeiachterstand
Moeders die tijdens de zwangerschap ongezond leven, lopen twee tot drie keer zoveel risico dat hun kind een groeiachterstand oploopt en daardoor te vroeg of te klein geboren wordt, twee belangrijke oorzaken van babysterfte.
Ook lopen hun kinderen op latere leeftijd meer risico op hart- en vaatziekten, overgewicht en diabetes.
De onderzoekers pleiten voor betere voorlichting voor aanstaande moeders. Dat kan volgens hen helpen de babysterfte, die in Nederland opvallend hoog is vergeleken met de meeste andere Europese landen, terug te dringen.
Risk Factors and Outcomes Associated With First-Trimester Fetal Growth Restriction
Dennis O. Mook-Kanamori, MD, MSc; Eric A. P. Steegers, MD, PhD; Paul H. Eilers, PhD; Hein Raat, MD, PhD; Albert Hofman, MD, PhD; Vincent W. V. Jaddoe, MD, PhD
JAMA. 2010;303(6):527-534.
Context Adverse environmental exposures lead to developmental adaptations in fetal life. The influences of maternal physical characteristics and lifestyle habits on first-trimester fetal adaptations and the postnatal consequences are not known.
Objective To determine the risk factors and outcomes associated with first-trimester growth restriction.
Design, Setting, and Participants Prospective evaluation of the associations of maternal physical characteristics and lifestyle habits with first-trimester fetal crown to rump length in 1631 mothers with a known and reliable first day of their last menstrual period and a regular menstrual cycle. Subsequently, we assessed the associations of first-trimester fetal growth restriction with the risks of adverse birth outcomes and postnatal growth acceleration until the age of 2 years. The study was based in Rotterdam, the Netherlands. Mothers were enrolled between 2001 and 2005.
Main Outcome Measures First-trimester fetal growth was measured as fetal crown to rump length by ultrasound between the gestational age of 10 weeks 0 days and 13 weeks 6 days. Main birth outcomes were preterm birth (gestational age <37 weeks), low birth weight (<2500 g), and small size for gestational age (lowest fifth birth centile). Postnatal growth was measured until the age of 2 years.
Results In the multivariate analysis, maternal age was positively associated with first-trimester fetal crown to rump length (difference per maternal year of age, 0.79 mm; 95% confidence interval [CI], 0.41 to 1.18 per standard deviation score increase). Higher diastolic blood pressure and higher hematocrit levels were associated with a shorter crown to rump length (differences, –0.40 mm; 95% CI, –0.74 to –0.06 and –0.52 mm; 95% CI, –0.90 to –0.14 per standard deviation increase, respectively). Compared with mothers who were nonsmokers and optimal users of folic acid supplements, those who both smoked and did not use folic acid supplements had shorter fetal crown to rump lengths (difference, –3.84 mm; 95% CI, –5.71 to –1.98). Compared with normal first-trimester fetal growth, first-trimester growth restriction was associated with increased risks of preterm birth (4.0% vs 7.2%; adjusted odds ratio [OR], 2.12; 95% CI, 1.24 to 3.61), low birth weight (3.5% vs 7.5%; adjusted OR, 2.42; 95% CI, 1.41 to 4.16), and small size for gestational age at birth (4.0% vs 10.6%; adjusted OR, 2.64; 95% CI, 1.64 to 4.25). Each standard deviation decrease in first-trimester fetal crown to rump length was associated with a postnatal growth acceleration until the age of 2 years (standard deviation score increase, 0.139 per 2 years; 95% CI, 0.097 to 0.181).
Conclusions Maternal physical characteristics and lifestyle habits were independently associated with early fetal growth. First-trimester fetal growth restriction was associated with an increased risk of adverse birth outcomes and growth acceleration in early childhood.
Author Affiliations: The Generation R Study Group (Drs Mook-Kanamori and Jaddoe); Departments of Epidemiology (Drs Mook-Kanamori, Hofman, and Jaddoe), Pediatrics (Drs Mook-Kanamori and Jaddoe), Obstetrics & Gynecology (Dr Steegers), Biostatistics (Dr Eilers), and Public Health (Dr Raat), Erasmus Medical Center, Rotterdam, the
Netherlands. (Februari 2010)
