Etude des facteurs de risque du retard de croissance intra-utérin à Lubumbashi

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Abstract

Introduction

Dans notre milieu, il n'existe aucune politique de prévention du Retard de Croissance Intra-Utérin (RCIU) clairement défini. L'objectif de ce travail était d'identifier les facteurs de risque de RCIU afin de proposer une stratégie de lutte contre cette pathologie en agissant surtout sur des facteurs pouvant faire l'objet d'une action préventive.

Méthodes

Une étude cas-témoins a été menée dans 11 centres hospitaliers de Lubumbashi en République Démocratique du Congo, de Janvier 2010 à Juin 2011, dans le but d'identifier les facteurs de risque du retard de croissance intra-utérin (RCIU). Au total 420 gestantes (cas et témoins) avec grossesse monofoetale d'au moins 24 semaines d'aménorrhée ont été inclues dans l'étude. Les cas correspondaient aux gestantes dont le poids du fœtus était resté inférieur au 10 eme percentile des courbes de référence d'Alexander, après 2 échographies successives réalisées à intervalle de 4 semaines. Les témoins correspondaient aux gestantes dont le poids du fœtus était supérieur ou égal au 10 eme percentile de mêmes courbes. A chaque cas a été apparié un témoin de même parité porteur d'une grossesse de même âge.

Résultats

L'analyse univariée a identifié comme facteurs de risque: la taille maternelle.

Conclusion

L'amélioration du niveau socio-économique des populations, la lutte contre le paludisme et les consultations prénatales mieux organisées couplées à une meilleure éducation sanitaire et nutritionnelle peuvent contribuer sensiblement à la réduction de la fréquence du RCIU à Lubumbashi.

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Most cited references 69

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Intrauterine growth restriction increases morbidity and mortality among premature neonates.

Neil R. Clark, J Thorp, T Garite (2004)

Intrauterine growth restriction (IUGR) is an important reason for premature delivery and has been reported to be associated with increased mortality, but in some studies paradoxically, improved morbidities. Data on neonatal outcomes for infants with IUGR at each viable gestational age at birth from large numbers of deliveries are lacking. More particularly, data on perinatal outcome related to an antenatal diagnosis of IUGR compared with a neonatal diagnosis are particularly deficient. Therefore, by using a large contemporary database, we evaluated the outcomes of neonates with IUGR and the gestational age-specific associations between growth restriction, morbidity, and mortality. With the use of a database formed from a computer-assisted tool that generates clinical progress notes and discharge summaries on neonatal intensive care unit (NICU) admissions, we reviewed data on neonates discharged from 124 NICUs between January 1, 1997, and December 31, 2001. We evaluated singleton, inborn neonates who delivered between 23 and 34 weeks, excluding major congenital anomalies. We compared 3 measures of IUGR: antenatally diagnosed IUGR; a birth weight below the 10th percentile (small for gestational age [SGA]), and newborn infants with either or both of these diagnoses against a control group of gestational age-matched infants meeting none of these criteria whose birth weights were no greater than the 90th percentile. Our sample included 29,916 prematurely born neonates; 1,451 (4.8%) with IUGR, 2,936 (9.8%) who were SGA, and 3,708 (12.3%) had at least 1 of these 2 markers. There were 22,798 (76%) normally grown control neonates. Within each gestational age group from 25 to 32 weeks, each marker of IUGR was associated with increased mortality, necrotizing enterocolitis, need for respiratory support at 28 days of age, and retinopathy of the premature. When corrected for gestational age, exposure to antenatal steroids, gender, and mode of delivery, these associations remained significant. IUGR remains a serious problem that is associated with increased morbidity and mortality among prematurely born neonates, regardless of the definition used or whether the diagnosis is made antenatally or after birth. These results are important for obstetric counseling and decision making and for the anticipation and treatment of premature newborn infants.

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Nutrition and low birth weight: from research to practice.

Usha Ramakrishnan (2003)

Low birth weight (LBW) remains a significant public health problem in many developing countries, and poor nutrition both before and during pregnancy is recognized as an important cause. Emerging evidence on the role of intergenerational effects in determining maternal preconceptual nutritional status indicates the need for continued investment in strategies that improve women's nutrition and health throughout the life cycle, especially during the early years. Controlled trials have shown that improving food intakes during pregnancy effectively reduces LBW, but programs have been less successful because these interventions are expensive and difficult to manage. Multivitamin-mineral supplements have been viewed as a simpler solution, but 2 of 3 controlled trials conducted to date failed to show that multivitamin-mineral supplements are more effective than are iron-folate supplements, which are already the standard of care during pregnancy. Emerging evidence indicating the benefits of iron supplements in improving birth weight illustrate the need for increased efforts to reduce iron deficiency by improving coverage of antenatal programs and promoting fortification. Other causes of LBW include environmental factors, such as smoking; indoor air pollution; and infections, such as malaria. However, little is known about the interactions between nutrition and infection. Underlying social factors, such as poverty and women's status, are also important, especially in South Asia, where more than one-half of the world's LBW infants are born. In summary, strategies that combine nutrition-based interventions, such as improving food intakes and micronutrient status, especially iron status, with approaches that improve women's status and reproductive health are needed to reduce LBW.

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The effect of maternal anthropometric characteristics and social factors on gestational age and birth weight in Sudanese newborn infants

Eltahir Elshibly, Gerd Schmalisch (2008)

Background In Africa low birth weight (LBW) ( 12 years of education. Conclusion Birth order and maternal height were found to be the most important maternal parameters which influences birth weight and the risk for LBW. The duration of maternal education and not social class was found to significantly affect the risk for LBW.

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Author and article information

Journal

Journal ID (nlm-ta): Pan Afr Med J

Journal ID (iso-abbrev): Pan Afr Med J

Journal ID (publisher-id): PAMJ

Title: The Pan African Medical Journal

Publisher: The African Field Epidemiology Network

ISSN (Electronic): 1937-8688

Publication date (Electronic): 03 January 2013

Publication date Collection: 2013

Volume: 14

Electronic Location Identifier: 4

Affiliations

[1 ]Département de Gynécologie et Obstétrique, Faculté de médecine de l'Université de Lubumbashi, RD Congo

[2 ]Faculté de médecine, Université Catholique de Louvain, Bruxelles, Belgique

[3 ]Faculté de médecine Vétérinaire, Université de Lubumbashi, RD Congo

Author notes

[& ]Corresponding author: Albert Mwembo Tambwe A Nkoy, Département de Gynécologie et Obstétrique, Faculté de médecine de l'Université de Lubumbashi, RD Congo

Article

Publisher ID: PAMJ-14-4

DOI: 10.11604/pamj.2013.14.4.1798

PMC ID: 3597863

PubMed ID: 23504392

SO-VID: 40df9e5d-5750-4f5c-a795-e2555470e693

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The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Etude des facteurs de risque du retard de croissance intra-utérin à Lubumbashi

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Abstract

Introduction

Méthodes

Résultats

Conclusion

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Pan African Medical Journal

Most cited references 69

Intrauterine growth restriction increases morbidity and mortality among premature neonates.

Nutrition and low birth weight: from research to practice.

The effect of maternal anthropometric characteristics and social factors on gestational age and birth weight in Sudanese newborn infants

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