Diseases during pregnancy in a large unselected South American sample

Our aim was to describe the prevalence of diseases during pregnancy and the association between fetal exposure to the most frequent maternal diseases and the risk of preterm (PTB) and/or small for gestational age (SGA) newborns in an unselected sample of women who gave birth in South American countries.

Methods:

We conducted a descriptive, cross-sectional study including 56,232 mothers of non-malformed infants born between 2002 and 2016, using data from the Latin American Collaborative Study of Congenital Malformations (ECLAMC). Diseases with higher- than-expected PTB/SGA frequencies were identified. Odds ratios of confounding variables for diseases and birth outcomes were calculated with a multivariable logistic regression.

Results:

Of the 14 most reported diseases, hypertension, genitourinary infection, epilepsy, hypothyroidism, diabetes, and HIV/AIDS showed higher PTB and/or SGA frequencies. Advanced and low maternal age, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with PTB, while advanced maternal age, primigravidity, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with SGA. After adjusting for the associated variables, the identified illnesses maintained their association with PTB and all, except epilepsy, with SGA.

Conclusion:

The description of an unselected population of mothers allowed identifying the most frequent diseases occurring during gestation and their impact on pregnancy outcomes. Six diseases were associated with PTB and two with SGA newborns. To the best of our knowledge, there are no similar reports about women not intentionally selected by specific diseases during pregnancy in South American populations.

Keywords:
Pregnancy; Disease; Pregnancy complications, infectious; Chronic disease; Infant, small for gestational age; Infant, premature

Disease	n	%	95%CI
No disease	40,056	71.2	70.9–71.6
Urinary infection	7,292	13.0	12.7–13.3
Influenza	2,102	3.7	3.6–3.9
Hypertension	1,766	3.1	3.0–3.3
Diabetes	903	1.6	1.5–1.7
Anemia	880	1.6	1.5–1.7
Asthma	842	1.5	1.4–1.6
Vaginal infection	657	1.2	1.1–1.3
Hypothyroidism	544	1.0	0.9–1.1
Toxoplasmosis	223	0.4	0.3–0.5
HIV/AIDS	206	0.4	0.3–0.4
Syphilis	190	0.3	0.3–0.4
Chagas disease	155	0.3	0.2–0.3
Epilepsy	154	0.3	0.2–0.3
Obesity	138	0.3	0.2–0.3

	Total	PTB				SGA
	n	n	% (95%CI)	E	O/E (95%CI)	n	% (95%CI)	E	O/E (95%CI)
No disease	40,056	2,498	6.2 (6.0–6.5)	--	--	2,338	5.8 (5.6–6.1)	--	--
Urinary infection	7,292	601	8.2 (7.6–8.9)	454.7	1.3 (1.2–1.4)	461	6.3 (5.8–6.9)	425.6	1.1 (1.0–1.2)
Influenza	2,102	141	6.7 (5.8–7.9)	131.1	1.1 (0.9–1.3)	94	4.5 (3.6–5.4)	122.7	0.8 (0.6–0.9)
Hypertension^* * Hypertension includes preeclampsia, and gestational and chronic hypertension.	1,766	230	13.0 (11.4–14.7)	110.1	2.1 (1.8–2.4)	236	13.4 (11.8–15.0)	103.1	2.3 (2.0–2.6)
Diabetes	903	83	9.2 (7.4–11.3)	56.3	1.5 (1.2–1.8)	29	3.2 (2.2–4.6)	52.7	0.6 (0.4–0.8)
Anemia	880	46	5.2 (3.9–6.9)	54.9	0.8 (0.6–1.1)	42	4.8 (3.5–6.4)	51.4	0.8 (0.6–1.1)
Asthma	842	58	6.9 (5.3–8.8)	52.5	1.1 (0.8–1.4)	47	5.6 (4.1–7.4)	49.1	1.0 (0.7–1.3)
Vaginal infection	657	71	10.8 (8.5–13.4)	41.0	1.7 (1.4–2.2)	42	6.4 (4.6–8.5)	38.3	1.1 (0.8–1.5)
Hypothyroidism	544	53	9.7 (7.4–12.5)	33.9	1.6 (1.2–2.0)	27	5.0 (3.3–7.1)	31.8	0.9 (0.6–1.2)
Toxoplasmosis	223	10	4.5 (2.2–8.1)	13.9	0.7 (0.3–1.3)	12	5.4 (2.8–9.2)	13.0	0.9 (0.5–1.6)
HIV/AIDS	206	19	9.2 (5.6–14.0)	12.8	1.5 (0.9–2.3)	25	12.1 (8.0–17.4)	12.0	2.1 (1.4–3.1)
Syphilis	190	12	6.3 (3.3–10.8)	11.8	1.0 (0.5–1.8)	9	4.7 (2.2–8.8)	11.1	0.8 (0.4–1.5)
Chagas disease	155	2	1.3 (0.2–4.5)	9.7	0.2 (0.0–0.7)	5	3.2 (1.1–7.4)	9.0	0.6 (0.2–1.3)
Epilepsy	154	16	10.4 (6.1–16.3)	9.6	1.7 (1.0–2.7)	15	9.7 (5.6–15.6)	9.0	1.7 (1.0–2.8)
Obesity	138	12	8.7 (4.6–14.7)	8.6	1.4 (0.7–2.4)	10	7.2 (3.5–12.9)	8.1	1.2 (0.6–2.3)

	PTB		SGA
	OR	95%CI	OR	95%CI
Maternal age <20	1.3	1.1–1.6	1.1	0.9–1.3
Maternal age ≥30	1.1	0.9–1.4	1.2	1.0–1.4
Primigravidity	1.1	0.9–1.3	1.5	1.3–1.8
Multigravidity	1.0	0.9–1.1	1.0	0.8–1.2
Previous fetal loss	1.4	1.2–1.7	1.4	1.2–1.7
Low socioeconomic level	1.2	1.0–1.4	1.3	1.1–1.6
High socioeconomic level	1.2	0.9–1.5	1.0	0.8–1.3
Few prenatal visits	1.1	0.9–1.3	1.1	0.9–1.3
African-American ancestry	1.6	1.2–2.3	1.7	1.3–2.2
Native ancestry	0.9	0.7–1.2	0.9	0.6–1.3
Latin-European ancestry	1.0	0.7–1.4	1.1	0.7–1.7

Disease	n	Confounding variables	OR	95%CI
Urinary infection	7,292	Primigravidity	1.2	1.0–1.3
		Previous fetal loss	1.3	1.1–1.5
		African-American ancestry	1.6	1.3–2.2
Influenza	2,102	Previous fetal loss	1.4	1.0–1.0
Hypertension^* * Hypertension includes preeclampsia, and gestational and chronic hypertension.	1,766	Maternal age ≥30	2.4	2.0–2.9
	1,766	Low socioeconomic level	1.4	1.1–1.7
Diabetes	903	Maternal age ≥30	3.8	2.6–5.4
Anemia	880	Maternal age <20	1.6	1.1–2.5
Asthma	842	Latin-European ancestry	1.8	1.1–3.1
Vaginal infection	657	Native ancestry	1.7	1.0–2.9
Hypothyroidism	544	Maternal age ≥30	2.7	1.6–4.6
		Primigravidity	1.5	1.1–2.1
		High socioeconomic level	1.8	1.3–2.5
		Previous fetal loss	1.4	1.0–2.0
Toxoplasmosis	223	Multigravidity	2.2	1.6–3.0
Toxoplasmosis	223	Low socioeconomic level	1.5	1.2–1.9
HIV/AIDS	206	Multigravidity	2.0	1.4–2.8
		Low socioeconomic level	1.5	1.0–2.3
		Few prenatal visits	2.0	1.3–2.9
		African-American ancestry	5.0	1.9–13.4
Syphilis	190	Low socioeconomic level	1.5	1.0–2.2
Chagas disease	155	Maternal age ≥30	1.8	1.2–2.7
		Low socioeconomic level	1.7	1.2–2.7
		Few prenatal visits	2.2	1.5–3.4
		Native ancestry	4.5	1.6–12.6
Epilepsy	154	Maternal age ≥30	1.9	1.3–2.9
Epilepsy	154	Previous fetal loss	2.3	1.5–3.5
Obesity	138	Maternal age ≥30	2.5	1.9–3.4

		OR	95%CI	ORadj	95%CI
PTB
	Hypertension^* * Hypertension includes preeclampsia, and gestational and chronic hypertension.	2.0	1.8–2.3	2.1	1.8–2.4
	Vaginal infection	1.7	1.4–2.2	1.7	1.4–2.2
	Epilepsy	1.7	1.1–2.7	1.7	1.0–3.0
	Hypothyroidism	1.6	1.2–2.0	1.5	1.1. 2.0
	Diabetes	1.5	1.2–1.8	1.4	1.1–1.8
	Urinary infection	1.3	1.2–1.5	1.3	1.2–1.5
SGA
	Hypertension^* * Hypertension includes preeclampsia, and gestational and chronic hypertension.	2.3	2.0–2.6	2.4	2.1–2.8
	HIV/AIDS	2.1	1.4–3.0	1.8	1.2–2.6
	Epilepsy	1.7	1.0–2.7	1.4	0.7–2.8

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[1] CORRESPONDING AUTHOR: Jorge López Camelo. Hospital Universitario CEMIC, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas. Galván 4102, 1431, Buenos Aires, Argentina. E-mail: jslc@eclamc.org