The Effects of Breastfeeding and Gestational Diabetes Mellitus on Body Mass Composition and the Levels of Selected Hormones after Childbirth.

Breastfeeding may have a positive effect on glucose metabolism and insulin sensitivity, which may reduce the risk of developing diabetes following gestational diabetes mellitus (GDM). This study aimed to evaluate the effect of breastfeeding and GDM on the body mass composition of the studied women, the levels of leptin, ghrelin, adiponectin, resistin, and insulin, and weight loss during the 6-8-week postpartum period and 1 year after childbirth. MATERIALS AND METHODS: The study group included 42 women with a singleton pregnancy, diagnosed with GDM between the 24th and 28th week of gestation. The control group consisted of 28 non-diabetic women with a singleton pregnancy. This study was carried out at 6-8 weeks as well as at 1 year postpartum. The women were subjected to body weight measurements and body composition analysis performed using a professional body composition analyzer TANITA DC-430 S MA. Waist circumference and subcutaneous fat was measured. Blood for laboratory tests was taken in the morning, on an empty stomach. RESULTS: It was shown that, regardless of diabetes, exclusive breastfeeding had a significant impact on weight loss at 6-8 weeks postpartum (p = 0.014785) and lower insulin levels (p = 0.047). However, there was no effect of breastfeeding on the women's anthropometric measurements or hormone levels one year after delivery, except for the thickness of subcutaneous adipose tissue, which was significantly lower in breastfeeding women (p = 0.03). One year after delivery, breastfeeding women had a lower BMI (p = 0.0014), less-thick subcutaneous adipose tissue (p < 0.001), and a lower risk of obesity (p = 0.016). There were also higher insulin and ghrelin levels in both breastfeeding and non-breastfeeding women (p < 0.001), and lower resistin levels in non-breastfeeding women (p = 0.004). Women who had diabetes during pregnancy had a significantly reduced waist circumference and subcutaneous fat thickness after one year (p < 0.001 and p = 0.05, respectively). CONCLUSIONS: Having diabetes during pregnancy did not significantly affect the results of anthropometric measurements and hormone levels noted at 6-8 weeks after delivery (the only exception was the thickness of subcutaneous fat tissue, which was greater in women without GDM). This may indicate normalization of carbohydrate metabolism after childbirth; however, the observation period is too short to elucidate long-term metabolic effects. This suggests the need for further research related to GDM and breastfeeding.

Assessment of Fatty Acid Content in the Milk of Women from the West Pomeranian Region of Poland with Regard to Supplementation and the Amount of Adipose Tissue.

The total amount of fat in the milk of nursing mothers depends on maternal reserves, as well as food intake and its synthesis in the mammary glands. The aim of this study was to assess the contents of fatty acids in the milk of women from the West Pomeranian region of Poland with regards to supplementation and the amount of adipose tissue. We also wanted to find out whether these women, who have direct access to the sea and potential access to fresh marine fish, have higher levels of DHA. METHODS: We analyzed milk samples obtained 6-7 weeks postpartum from 60 women. The content of fatty acid methyl esters (FAME) in lipids was determined by gas chromatography-mass spectrometry (GC/MS) using a Clarus 600 device (PerkinElmer). RESULTS: Women using dietary supplements had significantly higher levels of docosahexaenoic acid (DHA) (C22:6 n-3) (p = 0.000) and eicosapentaenoic acid (EPA) (20:5 n-3) (p = 0.000). The levels of eicosatrienoic acid (ETA) (C20:3 n-3) and γ-linolenic acid (GLA) increased with the amount of body fat, and the level of DHA was lowest in subjects where body fat exceeded 40% (p = 0.036). CONCLUSIONS: The contents of fatty acids in the milk of women from the West Pomeranian region of Poland were similar to that reported by other authors. The levels of DHA in women using dietary supplements was also comparable to the values reported worldwide. BMI had an effect on the levels of ETE and GLA acids.

Weight Gain during and after Pregnancy in Women with Gestational Diabetes Mellitus-A Preliminary Study.

Appropriate gestational weight gain (GWG) favors fewer complications related to pregnancy, delivery, puerperium, and the condition of the fetus and newborn baby. The aim of this study was to evaluate weight gain in women during and after pregnancy, including both women with and without gestational diabetes mellitus (GDM). MATERIALS AND METHODS: The study involved 42 singleton pregnant women diagnosed with GDM between the 24th and 28th week of pregnancy. The control group consisted of 28 nondiabetic women with a singleton pregnancy. The pre-pregnancy BMI, intra-pregnancy weight gain, and postpartum body weight were assessed in the participants. RESULTS: There were no statistically significant differences in the values of intra-pregnancy weight gain. Only diabetic women who were also overweight or obese had a significantly higher percentage of weight gain during pregnancy. The analysis of the percentage of weight gain during the entire pregnancy showed differences only in the group of women with pre-pregnancy BMI over 30. CONCLUSIONS: There were no significant differences in total pregnancy or mid-pregnancy weight gain between women with and without GDM. Most of the women had too high or too low total-pregnancy and mid-pregnancy weight gain. Therefore it is necessary to control GWG and educate pregnant women about it.

Analysis of the impact of selected hospital practices on exclusive breastfeeding.

Introduction: Breastfeeding is the optimal method of feeding children during the first period of their life. The correct management of lactation is essential for proper breastfeeding initiation which would be continued long enough. Many factors have a huge impact on lactation, among others mode of delivery, parturition, hospital procedures and practices, such as suctioning the airway, 'skin to skin' contact, feeding the baby, and the competent support of the staff. The aim of the study was to analyze the impact of selected procedures related to childbirth and post-natal care, as well as hospital practices on lactation. Materials and methods: The study involved 145 women who gave birth in the Department of Foetal Medicine and Gynaecology Pomeranian Medical University in Szczecin located in Police, West Pomeranian Province in Poland. The research was carried out by a diagnostic survey with a self-authorship questionnaire. Conclusions: 1. Some hospital practices, such as suctioning the airway, short 'skin to skin' contact after cesarean delivery, and complementary feeding of a newborn baby with a bottle had negative impact on maintaining lactation. 2. Complementary feeding of an infant with a bottle was a frequent hospital practice. As the procedure has an adverse impact on lactation, breastfeeding should be replaced by complementary feeding in an alternative way only in justified cases. 3. Most of the patients who obtained support during lactation were breastfeeding exclusively. Competent assistance in initiating and maintaining lactation is the responsibility of the medical personnel, thus there is a necessity for their permanent development, and a constant need to modify hospital practices to ones that affect lactation favourably.

[Views and expectations of women regarding gynaecological examinations].

Introduction: It has long been known that gynaecological examination causes a lot of negative emotions for most women. The aim of the study was to learn the views of women on the issue of gynaecological examination. Materials and methods: The study involved 1200 women from the West Pomeranian and Lódz provinces in Poland. Results: The majority of non-pregnant women considered gynaecological examination to be embarrassing. The most embarrassing moment of the visit for the respondents from both groups was lying down on the gynaecological chair, and the most unpleasant stage of examination was palpation through the vagina. The greatest sense of security and mental comfort during the examination was provided by the presence of only the gynaecologist. Most pregnant respondents prefer to be examined by a male gynaecologist. Respondents would most willingly have examinations with a doctor who is nice, talkative, calm, smiling and mature. Most of the pregnant surveyed women claimed that the gynaecological examination is very necessary, while only 49% would appear for it once every 6 months. Conclusions: 1. Gynaecological examination was significantly more embarrassing and stressful for women who were not pregnant. 2. In the opinion of pregnant women, breast examination is the least embarrassing stage of the examination. 3. Pregnant women significantly more often chose a man as their gynaecologist. 4. The frequency of having a gynaecological examination depended significantly on the status of pregnancy. 5. The expectations of the surveyed women to a gynaecologist focused mainly on him/her maintaining a sense of intimacy and security, on informing the women on the procedures taken, as well as on a nice and individual approach.

[Women's expectations towards gynaecological examination ]. / Oczekiwania kobiet wobec badan ginekologicznych.

INTRODUCTION: It is commonly known that gynaecologi- cal examinations cause a lot of negative emotions in the majority of women. The aim of my work was: 1. Getting to know women's views on the nature of a pelvic examination and their expectations regarding gynaecologists. 2. To determine the correlation between the examined views and independent variables such as the age of the respondents, residence, and place of examination. MATERIAL AND METHODS: The research material consisted of 1200 women living in the region of Western Pomerania and in Lódz. The measurement tool was a survey of my own authorship. CONCLUSIONS: 1. In the opinion of most women, gynaecological examination is embarrassing and stressful. It has not been proven that this opinion was related to age, residence or place of examination. 2. According to women, the most embarrassing moment of a visit to the gynaecologist is lying down on the gynaecological chair, and the gynecological examination. The most unpleasant aspect is palpation through the vagina and rectum. These feelings differ depending on age, residence and place of taking the examination. 3. The choice of the gynaecologist's gender is dependent on women's age. 4. The frequency of reporting for the gynaecological examination decreases with women's age, and is dependent on their place of residence. 5. A sense of safety and mental comfort during the gynaecological examination is provided by the lack of third parties, except for the presence of a midwife. It is also dependent on the patient's age, her place of residence, as well as the examination site. 6. Women's expectations of a gynaecologist are focused mainly on maintaining a sense of intimacy and safety, getting information about the procedures, as well as a pleasant and individual approach.

[Women's opinions regarding gynaecological examination in a hospital]. / Opinie kobiet na temat badania ginekologicznego w szpitalu.

A visit to the gynaecologist is connected with considerable embarrassment and stress for most women. AIM OF THE RESEARCH: To ascertain patients' opinions about gynaecological examination, frequency of visits, and doctors' attitudes towards patients. MATERIAL AND METHODS: A hundred women from Western-Pomeranian region underwent an anonymous examination. The women were divided into three age groups: 20-40, 41-60 and 61+. The study was carried out in two hospital clinics of the Pomeranian Medical University: the Clinic of Procreation and Gynaecology and the Clinic of Obstetric and Gynaecology, between 2006-2007. RESULTS: 70% of the respondents find the gynaecological examination embarrassing and stressful. According to patients, the most unpleasant moment during their visit to the gynaecologist is time spent in the gynaecological chair (47%) and preparation for the examination (30%), whereas the least embarrassing moment is the gynaecological examination itself (21%). However, the most embarrassing moment of the examination is vaginal examination (40%), rectal examination (33%), colposcopy (27%), and breast examination (2%). All the women stated that gynaecological examination is necessary; with 40% of them having examinations once every twelve months, 32% once every six months, 9% once every twenty-four months and 19% even more seldom. Sense of safety and psychical comfort during the examination is ensured by the presence of a qualified midwife (46%), presence of another doctor (9%), privacy (only the doctor and the patient are present) (36%). 53% of the respondents stated that the doctor ensures intimacy during the examination and 47% gave negative answer. Analysis of the doctor's gender indicated that 56% women prefer to be examined by a woman, 37% by a man, and 7% find the gender to be of no importance. The respondents would prefer if the doctor were nice, good-tempered and communicative. CONCLUSIONS: (1) Gynaecological examination is embarrassing and stressful for women and that is why patients expect the gynaecologist to ensure intimacy and sense of safety during the examination, as well as a pleasant individual approach to a patient, and presence of a midwife. (2) The most embarrassing moment is climbing to the gynaecological chair and the most unpleasant moment is the vaginal examination. (3) The fact that women go to the gynaecologist so rarely is particularly worrisome.