German national consensus recommendations on nutrition and lifestyle in pregnancy by the 'Healthy Start - Young Family Network'.

Diet and physical activity before and during pregnancy affect short- and long-term health of mother and child. The energy needs at the end of pregnancy increase only by about 10% compared to nonpregnant women. An excessive energy intake is undesirable since maternal overweight and excessive weight gain can increase the risks for a high birth weight and later child overweight and diabetes. Maternal weight at the beginning of pregnancy is especially important for pregnancy outcome and child health. Women should strive to achieve normal weight already before pregnancy. Regular physical activity can contribute to a healthy weight and to the health of pregnant women. The need for certain nutrients increases more than energy requirements. Before and during pregnancy, foods with a high content of essential nutrients should be preferentially selected. Supplements should include folic acid and iodine, iron (in case of suboptimal iron stores), the ω-3 fatty acid docosahexaenoic acid (in case of infrequent consumption of ocean fish) and vitamin D (in case of decreased sun exposure and decreased endogenous vitamin D synthesis). Pregnant women should not smoke and not stay in rooms where others smoke or have smoked before (passive smoking). Alcohol consumption should be avoided, since alcohol can harm unborn children.

Exercise in gestational diabetes. An optional therapeutic approach?

Forty-one patients with gestational diabetes requiring insulin were enrolled in a randomized study to investigate the efficacy of an exercise program in normalizing glucose tolerance. Seventeen of 21 patients completed the exercise program while maintaining normoglycemia and obviating insulin therapy. Maternal and neonatal complications did not differ between the study and control groups. The type of program described appears to be safe and can serve as a model for exercise prescription for pregnant diabetic women to attain improved glucose tolerance.

Gestational diabetes and exercise: a survey.

Exercise has long been accepted as an adjunctive nonmedical intervention in the management of diabetes in nonpregnant subjects. It is universally accepted that pregnancy is a diabetogenic event which could develop into gestational diabetes mellitus (GDM) in up to 12% of pregnant women. GDM, a carbohydrate intolerance of variable severity with onset or first recognition during pregnancy, involves a relative resistance to insulin. Exercise becomes thus a logical intervention, only recently offered as an adjunctive therapy to pregnant diabetics. This article reviews our current understanding of the role of exercise in the management of GDM.

Maternal and fetal heart rate patterns: a pregnant athlete during training and laboratory exercise tests; a case report.

Maternal and fetal heart rates in a professional athlete were monitored during exercise in pregnancy. No changes were observed in the fetal heart rate following submaximal maternal exertion; however, following strenuous exercise bradycardia was noticed.

[Nutrition in pregnancy - Practice recommendations of the Network "Healthy Start - Young Family Network"]. / Ernährung in der Schwangerschaft - Teil 1.

Nutrition, physical activity and lifestyle in pregnancy influence maternal and child health. The "Healthy start - Young Family Network" supported by the German Government with the national action plan IN FORM developed recommendations on nutrition in pregnancy. Energy needs increase by only ≈10 % by the end of pregnancy whereas micronutrient needs increase much more. Normal weight should preferably be achieved before pregnancy. Dietary recommendations follow those for the general population. Folic acid supplements (400 µg/day) should be started before pregnancy and continue for at least the first trimester. Iodine rich foods and salt and an iodine supplement (100-150 µg/day) are recommended. Long-chain omega-3 fatty acids should be provided with ≥ 1 weekly portion of oily sea fish, or a DHA-supplement if regular fish consumption is avoided. Vitamin D supplementation is advisable unless there is regular exposure to sunlight. Health care professions should lead parents to health-promoting lifestyles. Subjects of part 2 of the article are practice recommendations on nutrition in pregnancy, especially vegetarian diets, recommendations on micronutrient supplementation, risk reduction of listeriosis and toxoplasmosis, alcohol, tobacco, caffeine and physical activity in pregnancy.

[Nutrition in pregnancy - Practice recommendations of the Network "Healthy Start - Young Family Network"]. / Ernährung in der Schwangerschaft - Teil 2. Handlungsempfehlungen des Netzwerks "Gesund ins Leben - Netzwerk Junge Familie".

Nutrition, physical activity and lifestyle in pregnancy influence maternal and child health. The "Healthy start - Young Family Network" supported by the German Government with the national action plan IN FORM developed recommendations on nutrition in pregnancy. Folic acid supplements (400 µg/day) should be started before pregnancy and continue for at least the first trimester. Iodine rich foods and salt and an iodine supplement (100-150 µg/day) are recommended. Long-chain omega-3 fatty acids should be provided with ≥ 1 weekly portion of oily sea fish, or a DHA-supplement if regular fish consumption is avoided. Vitamin D supplementation is advisable unless there is regular exposure to sunlight. Iron supplements should be used based on medical history and blood testing. Vegetarian diets with nutritional supplements can provide adequate nutrition, but counselling is recommended. In contrast, a vegan diet is inadequate and requires additional micronutrient supplementation. For risk reduction of listeriosis and toxoplasmosis, raw animal foods, soft cheeses and packed fresh salads should be avoided; fresh fruit, vegetables and salad should be washed well and consumed promptly. Pregnant women should remain physically active and perform sports with moderate intensity. They should avoid alcohol, active and passive smoking. Up to 3 daily cups of coffee are considered harmless, but energy drinks should be avoided. Childhood allergy is not reduced by avoiding certain foods in pregnancy whereas oily sea fish is recommended. Health care professions should lead parents to health-promoting lifestyles. Subjects of part 1 of the article are practice recommendations on nutrition, on energy needs, micronutrient needs and body weight/weight gain in pregnancy.

[The analgesic effect of exercise during labor]. / Der analgetische Effekt von körperlicher Aktivität auf Wehen unter der Geburt.

OBJECTIVE: The aim of this study was to test for an analgesic effect of exercise during labor. PATIENTS AND METHODS: 50 women in labor exercised continuously with moderate intensity on a bicycle ergometer for 20 minutes. During rest and exercise, they rated their pain on a visual analogue scale (VAS). Venous blood was sampled for beta-endorphin, cortisol and catecholamines during rest and directly after exercise. RESULTS: 84 percent of the women perceived uterine contractions during exercise as less painful than at rest. 76.2 percent objectified the pain relief by a reduction in VAS units 1.67 +/- 1.01. Beta-endorphin levels were much higher after exercise than at rest (P < 0.001). During exercise the fetal heart rate rose slightly within the reference range. Uterine contractions were more frequent during and after exercise than at rest (P < 0.05). CONCLUSION: Exercising on a bicycle ergometer during labor seems to be safe for the fetus, a stimulus to uterine contractions, and a source of analgesia, possibly due to the release of beta-endorphin.

[Pregnancy and sports--physiologic considerations and practical examples]. / Schwangerschaft und Sport--physiologische Uberlegungen und praktische Beispiele.

Mothers-to-be expect practical and competent consulting from their obstetricians rather than orders or interdictions regarding their way of living. Particularly answering questions concerning physical activity and sports during pregnancy require profound knowledge on the physiological adaptations of the cardiopulmonary system and the anatomical structures and-on the other hand-on performance and sports' physiology. Resuming these alterations through pregnancy there result practical examples and proposals of physical activities in gestation as therapeutic and preventive measures. Moreover risks and contraindications are worked out.

Pregnancy and postpartum after kidney transplantation and cyclosporin therapy--review of the literature adding a new case.

The number of pregnancies after renal transplantation and immunosuppression is relative low. Since the introduction of a most effective medication, Cyclosporin A, there is not only an increasing improvement of the transplantation results, but there are also more reports on successfully concluded pregnancies. This report pertains to a 26-year old primigravida, whose pregnancy progressed without severe complications until the 33rd week of gestation. Then a sudden and rapidly worsening preeclampsia led to admission and delivery. The postoperative period was complicated by a severe septical shock. The literature is reviewed. Problems following pregnancy after kidney transplantation and triple immunotherapy with Cyclosporin A treatment are pointed out.

Physical exercise during pregnancy--physiological considerations and recommendations.

Controversial findings in numerous studies involving physiological and endocrinological parameters indicate that physical exercise during pregnancy is complex and somewhat poorly understood. But despite this reservation, it is safe to say that on the basis of the current state of scientific research in this area, physical exercise is to be recommended during pregnancy so long as women are aware of potential dangers and contraindications. Due to thermoregulatory advantages, the beneficials effects of immersion and its joint protective character "aquatic exercise" can be highly recommended during pregnancy. Psychologically speaking, physical exercise offers a variety of benefits such as the encouragement of cooperation and competition which can be experienced as fun and gratifying. The physiological and psychological benefits of physical exercise are not only available to healthy women, but have also proven to be valuable for the prevention and treatment of illnesses such as gestational diabetes. The activation of large groups of muscles allow for an improved glucose utilization by simultaneously increasing insulin sensitivity.

[Regular exercise therapy in disorders of carbohydrate metabolism in pregnancy--results of a prospective, randomized longitudinal study]. / Regelmässige Bewegungstherapie bei Kohlehydratstoffwechselstörungen in der Schwangerschaft--Ergebnisse einer prospektiven, randomisierten Longitudinalstudie.

Regular exercise has long been known as an adjunct in the therapy of diabetes mellitus. There are, however, only few reports on the impact of this therapy during pregnancy. This study aims at presenting an exercise programme for patients with insulin-requiring gestational diabetes (GDM) and its short-term and long-term effects on carbohydrate metabolism, on the foetus and on the course of pregnancy. Between the 26th and 32nd week of gestation, 41 pregnant subjects were randomised into either an exercise and diet group (EXE) or an Insulin and diet group (INS). The EXE patients (N = 21) trained three times per week at 50% VO2max. For 3 x 15 minutes on a recumbent bicycle ergometer throughout pregnancy with blood glucose monitoring before and after exercise). Blood glucose metabolism was followed by daily home monitoring and weekly fasting blood glucose sampling (FBG). The FBG results were comparable in the study and the control group (< 105 mg/dl); the maternal and foetal complications did not differ significantly between the two groups. The glycaemic parameters indicate a persistent decrease in blood glucose and an increase in insulin sensitivity induced by regular physical activity. We conclude, that such a medically supervised exercise programme can be safely conducted in women with GDM resulting in normoglycaemia for the mother and thus preventing insulin therapy.

[Pregnancy, labor and postpartum development after kidney transplantation and triple therapy with cyclosporin A--follow-up in relation to literature review]. / Schwangerschaft, Entbindung und postpartale Entwicklung nach Nierentransplantation und Triple-Therapie mit Cyclosporin A--Eine Verlaufsbeschreibung im Spiegel der Literatur.

This report pertains to a 26-year old primigravida three years after kidney transplantation and still on immunotherapy. Her pregnancy progressed without severe complications until the 33rd week of gestation. Then a sudden and rapidly worsening pre-eclampsia led to admission and delivery. The postoperative period was complicated by an episode of severe septic shock. Reported is a review of the literature. Problems following pregnancy after kidney transplantation and triple therapy including Cyclosporin A are pointed out.

[Is Indian version a successful method for decreasing the incidence of breech presentation?]. / Ist die indische Wendung eine erfolgreiche Methode zur Senkung der Beckenendlagefrequenz?

In a prospective randomized study involving 30 gravidae with breech presentation the efficacy of a maternal positioning exercise--raising of the pelvis, abduction of the thighs, relaxed abdominal breathing--for the purpose of spontaneous version of the fetus into vertex presentation was investigated. The results were compared with the rate of uninfluenced, spontaneous version in a further 31 gravidae with the same initial conditions. In view of the low numbers involved no statistical statements can be made; however, version in 21 out of 30 positioned subjects (70%) as opposed to 17 out of 31 spontaneous versions indicates some degree of success. Considering the risks of breech presentation during pregnancy and at birth on the one hand and the absence of risk and good acceptance of the positioning exercise on the other, the method can be recommended.

[Performance training in pregnancy. Report of respiratory and cardiovascular physiologic changes in a pregnant high-performance athlete in comparison with a sample of normal pregnant patients]. / Leistungstraining in der Schwangerschaft. Bericht über die atem- und kreislaufphysiologischen Veränderungen einer schwangeren Hochleistungssportlerin im Vergleich zu einem Normalkollektiv Schwangerer.

Against the background of dramatic changes that took place in the history of sports during the past one hundred years, we are today discussing with regard to the compatibility of sport and pregnancy whether the extent of sports activities before pregnancy contributes to the amount of stress tolerated during pregnancy. Animal experimental studies on the effect of physical stress on the foetus cannot always be transferred to man, and hence recommendations made to pregnant women are often purely empirical. The article reports on the results of an examination of a professional woman athlete during pregnancy: Various maternal circulatory and respiratory parameters were recorded in this primigravida of 25 years of age, who had been regularly active as a competitive runner for 12 years, during the 24th week of pregnancy and from the 28th week of pregnancy onwards, at intervals of 14 days and post partum, at rest and during steady-state load on a bicycle ergometer (6 minutes each at 40 and 70 watts load, respectively) and a step-by-step load increasing every minute by 15 watts until attainment of a maternal heart rate of 150 beats per minute. The results were compared with those in a group of pregnant women who had not been competitive sportswomen. During continued training as per schedule up to the 36th week of pregnancy of the athlete, there was hardly any change in performance, and there was a marked difference against the other women. The pulse at rest was lower by a mean of 30 beats in the athlete during pregnancy, clearly indicating maintenance of the economic cardiac mechanism known to occur in trained persons, which produces a greater cardiac output via an increased stroke volume at a lower heart rate. This difference was impressively demonstrated under different loads. Another example of more economic management of an identical load is also seen, for instance, in the lower oxygen uptake and lower respiratory rate. Even at a maternal heart rate of 150 beats per minute the foetus of the athlete did not show any signs of stress under test conditions. In a measurement "at site" during the 38th week of pregnancy under routine and training conditions with relevant sprints and a maternal heart rate increase to more than 170 beats per minute, however, foetal behaviour displaying bradycardia clearly showed the existence of tolerance limits for foetal supply.(ABSTRACT TRUNCATED AT 400 WORDS)

[Ileus in late pregnancy--sequela of follicle puncture within the scope of in vitro fertilization?]. / Ileus in der Spätschwangerschaft--Folge der Follikelpunktion im Rahmen der In-vitro-Fertilisation?

Complications in connection with the puncture in in-vitro fertilisation (IVF) occur normally relatively soon after the operation. This is a report on a patient in her 28th week of gestation, operated on by laparotomy for ileus. Retrospectively this acute event must be seen as a very rare late complication connected with the puncture. It must be stressed that patients should be informed about this eventually.

Micronutrients during pregnancy: the nutritive situation in Germany.

During pregnancy the demands for energy and nutrients are increased. Despite increasing awareness about nutrition in the population of a western country like Germany, there is a discrepancy between actual food intake and recommended quantities of certain nutrients, particularly during pregnancy. There are correlations between deficiencies in micro-nutrients such as iodine, iron and folic acid and the course and outcome of pregnancy. The consequences of an insufficient supply of these micronutrients during pregnancy are described and high-risk-groups for an inadequate supply are defined. Recommendations for nutrition counselling during this period of life are given.

Therapeutic exercise for insulin-requiring gestational diabetics: effects on the fetus--results of a randomized prospective longitudinal study.

Regular physical activity is an established therapeutic adjunct in diabetes, but has not been offered to pregnant diabetics in the past; for sports might induce significant cardiovascular and hormonal changes that are able to reduce blood flow to the uterus and thus limit oxygen transfer to the fetus. Studying the impact of a medically supervised exercise program on gestational diabetes mellitus [GDM) in a randomised prospective longitudinal study, this paper aims to assess the effects of maternal moderate and strenuous exercise on the fetus. By evaluating shortterm fetal responses as reflected in heart rate patterns (FHR) and longterm-pregnancy complications and neonatal outcome, our results suggest that--in absence of ominous FHR changes or significant changes in uterine activity following the exercise sessions or increased diabetes-related peri- and neonatal morbidity--regular physical activity seems to be a safe therapeutic option for the fetus of GDM mothers.