Correction to: Calcium and vitamin D supplementation and/or periodontal therapy in the treatment of periodontitis among Brazilian pregnant women: protocol of a feasibility randomised controlled trial (the IMPROVE trial).

An amendment to this paper has been published and can be accessed via the original article.

Vitamin D and Calcium Milk Fortification in Pregnant Women with Periodontitis: A Feasibility Trial.

This study aims to assess the acceptability, adherence, and retention of a feasibility trial on milk fortification with calcium and vitamin D (Ca+VitD) and periodontal therapy (PT) among low income Brazilian pregnant women with periodontitis (IMPROVE trial). This 2 × 2 factorial feasibility trial used a mixed-methods evaluation. In total, 69 pregnant women were randomly allocated to four groups: 1. fortified sachet with Ca+VitD and milk plus early PT (throughout gestation); 2. placebo and milk plus early PT; 3. fortified sachet with Ca+VitD and milk plus late PT after childbirth; 4. placebo and milk plus late PT. Data were collected via questionnaires, field notes, participant flow logs, treatment diary, and focal group discussions. Quantitative and qualitative data were analysed using appropriate descriptive statistics and content analysis, respectively. Eligibility rate (12%) was below the target of 15%, but participation (76.1%) and recruitment rate (2 women/week) exceeded the targets. Retention rate (78.6%) was slightly below the target (80%). Adherence to the PT was significantly higher in the early treatment groups (98.8%) compared to the late treatment groups (29%). All women accepted the random allocation, and baseline groups were balanced. There was no report of adverse events. This multi-component intervention is acceptable, well-tolerated, and feasible among low-risk pregnant women in Brazil.

Calcium and vitamin D supplementation and/or periodontal therapy in the treatment of periodontitis among Brazilian pregnant women: protocol of a feasibility randomised controlled trial (the IMPROVE trial).

BACKGROUND: Periodontitis is a common oral inflammation, which is a risk factor for adverse pregnancy outcomes. Intakes of vitamin D and calcium are inversely associated with occurrence and progression of periodontitis. This study aims to assess the feasibility of a multi-component intervention, including provision of milk powder supplemented with calcium and vitamin D and periodontal therapy (PT), for improving maternal periodontal health and metabolic and inflammatory profiles of low-income Brazilian pregnant women with periodontitis. METHODS: The IMPROVE trial is a feasibility randomised controlled trial (RCT) with a 2 × 2 factorial design with a parallel process evaluation. Pregnant women with periodontitis, aged 18-40 years and with < 20 gestational weeks (n = 120) were recruited and randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus PT during pregnancy, (2) placebo sachet and powdered milk plus PT during pregnancy, (3) fortified sachet (vitamin D and calcium) and powdered milk plus PT after delivery and (4) placebo sachet and powdered milk plus PT after delivery. Dentists and participants are blinded to fortification. Acceptability of study design, recruitment strategy, random allocation, data collection procedures, recruitment rate, adherence and attrition rate will be evaluated. Data on serum levels of vitamin D, calcium and inflammatory biomarkers; clinical periodontal measurements; anthropometric measurements; and socio-demographic questionnaires are collected at baseline, third trimester and 6-8 weeks postpartum. Qualitative data are collected using focus group, for analysis of favourable factors and barriers related to study adherence. DISCUSSION: Oral health and mineral/vitamin supplementation are much overlooked in the public prenatal assistance in Brazil and of scarcity of clinical trials addressing these issues in low and middle-income countries,. To fill this gap the present study was designed to assess the feasibility of a RCT on acceptability of a multi-component intervention combining conventional periodontal treatment and consumption of milk fortified with calcium-vitamin D for improving periodontal conditions and maternal metabolic and inflammation status, among Brazilian low-income pregnant women with periodontitis. Thus, we hope that this relatively low-cost and safe multicomponent intervention can help reduce inflammation, improve maternal periodontal health and metabolic profile and consequently prevent negative gestational outcomes. TRIAL REGISTRATION: NCT, NCT03148483. Registered on May 11, 2017.

Blood Pressure Variation Throughout Pregnancy According to Early Gestational BMI: A Brazilian Cohort.

BACKGROUND: The maternal cardiovascular system undergoes progressive adaptations throughout pregnancy, causing blood pressure fluctuations. However, no consensus has been established on its normal variation in uncomplicated pregnancies. OBJECTIVE: To describe the variation in systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels during pregnancy according to early pregnancy body mass index (BMI). METHODS: SBP and DBP were measured during the first, second and third trimesters and at 30-45 days postpartum in a prospective cohort of 189 women aged 20-40 years. BMI (kg/m2) was measured up to the 13th gestational week and classified as normal-weight (<25.0) or excessive weight (≥ 25.0). Longitudinal linear mixed-effects models were used for statistical analysis. RESULTS: A decrease in SBP and DBP was observed from the first to the second trimester (ßSBP=-0.394; 95%CI: -0.600- -0.188 and ßDBP=-0.617; 95%CI: -0.780- -0.454), as was an increase in SBP and DBP up to 30-45 postpartum days (ßSBP=0.010; 95%CI: 0.006-0.014 and ßDBP=0.015; 95%CI: 0.012-0.018). Women with excessive weight at early pregnancy showed higher mean SBP in all gestational trimesters, and higher mean DBP in the first and third trimesters. Excessive early pregnancy BMI was positively associated with prospective changes in SBP (ßSBP=7.055; 95%CI: 4.499-9.610) and in DBP (ßDBP=3.201; 95%CI: 1.136-5.266). CONCLUSION: SBP and DBP decreased from the first to the second trimester and then increased up to the postpartum period. Women with excessive early pregnancy BMI had higher SBP and DBP than their normal-weight counterparts throughout pregnancy, but not in the postpartum period.

Blood Pressure Variation Throughout Pregnancy According to Early Gestational BMI: A Brazilian Cohort / Variação da Pressão Arterial na Gestação Segundo o IMC no Início da Gravidez: Uma Coorte Brasileira

Background: The maternal cardiovascular system undergoes progressive adaptations throughout pregnancy, causing blood pressure fluctuations. However, no consensus has been established on its normal variation in uncomplicated pregnancies. Objective: To describe the variation in systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels during pregnancy according to early pregnancy body mass index (BMI). Methods: SBP and DBP were measured during the first, second and third trimesters and at 30-45 days postpartum in a prospective cohort of 189 women aged 20-40 years. BMI (kg/m2) was measured up to the 13th gestational week and classified as normal-weight (<25.0) or excessive weight (≥25.0). Longitudinal linear mixed-effects models were used for statistical analysis. Results: A decrease in SBP and DBP was observed from the first to the second trimester (βSBP=-0.394; 95%CI: -0.600- -0.188 and βDBP=-0.617; 95%CI: -0.780- -0.454), as was an increase in SBP and DBP up to 30-45 postpartum days (βSBP=0.010; 95%CI: 0.006-0.014 and βDBP=0.015; 95%CI: 0.012-0.018). Women with excessive weight at early pregnancy showed higher mean SBP in all gestational trimesters, and higher mean DBP in the first and third trimesters. Excessive early pregnancy BMI was positively associated with prospective changes in SBP (βSBP=7.055; 95%CI: 4.499-9.610) and in DBP (βDBP=3.201; 95%CI: 1.136-5.266). Conclusion: SBP and DBP decreased from the first to the second trimester and then increased up to the postpartum period. Women with excessive early pregnancy BMI had higher SBP and DBP than their normal-weight counterparts throughout pregnancy, but not in the postpartum period. .

Fundamento: O sistema cardiovascular materno sofre adaptações progressivas durante a gestação, acarretando flutuações da pressão arterial. Entretanto, não há consenso sobre a variação pressórica normal na gravidez saudável. Objetivo: Descrever a variação da pressão arterial sistólica (PAS) e diastólica (PAD) durante a gravidez e no pós-parto imediato segundo o índice de massa corporal (IMC) no início da gravidez. Métodos: A PAS e a PAD foram medidas no 1º, 2º e 3º trimestres gestacionais e aos 30-45 dias pós-parto em uma coorte prospectiva de 189 mulheres com idade entre 20 e 40 anos. O IMC (kg/m2) foi aferido até a 13a semana e classificado como normal (< 25,0) ou excessivo (≥ 25,0). Modelos longitudinais de efeitos mistos foram utilizados para a análise estatística. Resultados: Observou-se diminuição da PAS e da PAD do primeiro para o segundo trimestre (βPAS=-0,394; IC95%:-0,600- -0,188 e βPAD=-0,617; IC95%:-0,780- -0,454) e subsequente aumento de ambas até 30-45 dias após o parto (βPAS=0,010; IC95%:0,006-0,014 e βPAD=0,015; IC95%:0,012-0,018). As mulheres com IMC excessivo apresentaram média de PAS maior em todos os trimestres, e de PAD maior no primeiro e no terceiro trimestres. O IMC excessivo no início da gestação esteve positivamente associado com mudanças na PAS (βPAS=7,055; IC95%:4,499-9,610) e na PAD (βPAD=3,201; IC95%:1,136-5,266). Conclusão: A PAS e a PAD diminuíram do primeiro para o segundo trimestre e aumentaram do segundo trimestre até o pósparto. Mulheres com IMC excessivo no início da gestação apresentaram valores mais elevados de PAS e PAD ao longo da gravidez, mas não no pós-parto, quando comparadas às de IMC normal. .

Television viewing and abdominal obesity in women according to smoking status: results from a large cross-sectional population-based study in Brazil.

OBJECTIVE: To investigate the associations between television viewing and abdominal obesity (AO) in Brazilian women, according to smoking status. METHODS: Data of 13,262 adult women (18-49 years) from the 2006's Demographic Health Survey, a cross-sectional household study with complex probabilistic sample and national representativeness, were analyzed. AO, defined as waist circumference ≥ 80.0 cm, was the outcome. Television viewing frequency (≥ 5 times/week, 1-4 times/week, < 1 time/week) was the main exposure variable, and smoking status (yes or no) the main co-variable. Prevalence ratios were estimated using Poisson regression models separately for smokers and non-smokers. RESULTS: A statistically significant interaction term was observed between smoking status and television viewing (p < 0.05). Prevalence of AO among smokers who reported television viewing ≥ 5 times/week amounted to 59.0%, higher than the 35.0% for those with < 1 time/week television viewing (p-value = 0.020). The values for non-smokers were 55.2% and 55.7%, respectively. Smokers with television viewing ≥ 5 times/week were 1.7 times (95% CI: 1.1 - 2.5) more likely to pre-sent AO, compared to those who reported a frequency < 1 time/week. There was no significant association among non-smokers. CONCLUSIONS: Television viewing ≥ 5 times/week may increase the prevalence of AO among women who smoke. More detailed information on media use, as hours per day, may offer better estimates.

Household food insecurity and excess weight/obesity among Brazilian women and children: a life-course approach.

Household food insecurity (HFI) may increase obesity risk, but results are not consistent across the life course or between developed/underdeveloped settings. The objective of this paper is to review findings from previous analyses in Brazil among adult women, female adolescents, and children up to five. Data were derived from the 2006 Brazilian Demographic and Health Survey. Associations between HFI (measured with the Brazilian Food Insecurity Scale) and excess weight/obesity were investigated through Poisson regression models. While severe HFI was associated with obesity risk among adult women (PR: 1.49; 95%CI: 1.17-1.90), moderate HFI was associated with excess weight among female adolescents (PR: 1.96; 95%CI: 1.18-3.27). There was no association between HFI and obesity among children (either boys or girls). The nutrition transition in Brazil may be shaping the differential deleterious effect of HFI on body fat accumulation across the life course; the association is already evident among female adolescents and adult women but still not among children.

Television viewing and abdominal obesity in women according to smoking status: results from a large cross-sectional population-based study in Brazil / Hábito de assistir televisão e obesidade abdominal entre mulheres fumantes: resultados de um estudo transversal de base populacional no Brasil

OBJECTIVE: To investigate the associations between television viewing and abdominal obesity (AO) in Brazilian women, according to smoking status. METHODS: Data of 13,262 adult women (18-49 years) from the 2006's Demographic Health Survey, a cross-sectional household study with complex probabilistic sample and national representativeness, were analyzed. AO, defined as waist circumference ≥ 80.0 cm, was the outcome. Television viewing frequency (≥ 5 times/week, 1-4 times/week, < 1 time/week) was the main exposure variable, and smoking status (yes or no) the main co-variable. Prevalence ratios were estimated using Poisson regression models separately for smokers and non-smokers. RESULTS: A statistically significant interaction term was observed between smoking status and television viewing (p < 0.05). Prevalence of AO among smokers who reported television viewing ≥ 5 times/week amounted to 59.0%, higher than the 35.0% for those with < 1 time/week television viewing (p-value = 0.020). The values for non-smokers were 55.2% and 55.7%, respectively. Smokers with television viewing ≥ 5 times/week were 1.7 times (95% CI: 1.1 - 2.5) more likely to pre-sent AO, compared to those who reported a frequency < 1 time/week. There was no significant association among non-smokers. CONCLUSIONS: Television viewing ≥ 5 times/week may increase the prevalence of AO among women who smoke. More detailed information on media use, as hours per day, may offer better estimates. .

OBJETIVO: Investigar a associação entre a frequência assistindo televisão e obesidade abdominal (OA) entre mulheres brasileiras, segundo o hábito de fumar. MÉTODOS: Foram analisados os dados de 13.262 mulheres adultas (18-49 anos) estudadas na Pesquisa Nacional de Demografia e Saúde (PNDS-2006), um estudo transversal, com amostragem probabilística complexa, de representatividade nacional. OA, definida como circunferência da cintura ≥ 80.0 cm, foi considerada como desfecho. A frequência assistindo televisão (≥ 5 vezes/semana, 1-4 vezes/semana, < 1 vez/semana) foi a principal variável de exposição e o hábito de fumar (sim ou não) a principal covariável. Foram estimadas razões de prevalência por meio de modelos de regressão de Poisson, para fumantes e não fumantes separadamente. RESULTADOS: Observou-se interação estatisticamente significante entre frequência assistindo televisão e hábito de fumar (p < 0,05). A prevalência de OA entre mulheres fumantes que assistiam televisão ≥ 5 vezes/semana foi de 59,0%, e maior do que 35,0% entre aquelas que assistiam televisão < 1 vez/semana (p-valor = 0,02). Os valores de OA para não fumantes foram 55,2% e 55,7%, respectivamente. Fumantes que assistiam televisão ≥ 5 vezes/semana apresentaram chance 1,7 (1,1 - 2,5) vezes maior de ter OA, comparadas aquelas que relataram assistir televisão < 1 vez/semana. Não se observou associação significante para não fumantes. CONCLUSÃO: Assistir televisão ≥ 5 vezes/semana pode aumentar a prevalência de OA entre as mulheres fumantes. Informações mais detalhadas sobre a frequência de assistir televisão, como o número de horas por dia, ...

Waist circumference and waist circumference to height ratios of Kaingáng indigenous adolescents from the State of Rio Grande do Sul, Brazil.

The aim of this study was to describe the distribution of waist circumference (WC) and WC to height (WCTH) values among Kaingáng indigenous adolescents in order to estimate the prevalence of high WCTH values and evaluate the correlation between WC and WCTH and body mass index (BMI)-for-age. A total of 1,803 indigenous adolescents were evaluated using a school-based cross-sectional study. WCTH values > 0.5 were considered high. Higher mean WC and WCTH values were observed for girls in all age categories. WCTH values > 0.5 were observed in 25.68% of the overall sample of adolescents. Mean WC and WCTH values were significantly higher for adolescents with BMI/age z-scores > 2 than for those with normal z-scores. The correlation coefficients of WC and WCTH for BMI/age were r = 0.68 and 0.76, respectively, for boys, and r = 0.79 and 0.80, respectively, for girls. This study highlights elevated mean WC and WCTH values and high prevalence of abdominal obesity among Kaingáng indigenous adolescents.

Waist circumference and waist circumference to height ratios of Kaingáng indigenous adolescents from the State of Rio Grande do Sul, Brazil / Circunferência da cintura e circunferência da cintura/estatura entre adolescentes indígenas Kaingáng do Rio Grande do Sul, Brasil

The aim of this study was to describe the distribution of waist circumference (WC) and WC to height (WCTH) values among Kaingáng indigenous adolescents in order to estimate the prevalence of high WCTH values and evaluate the correlation between WC and WCTH and body mass index (BMI)-for-age. A total of 1,803 indigenous adolescents were evaluated using a school-based cross-sectional study. WCTH values > 0.5 were considered high. Higher mean WC and WCTH values were observed for girls in all age categories. WCTH values > 0.5 were observed in 25.68% of the overall sample of adolescents. Mean WC and WCTH values were significantly higher for adolescents with BMI/age z-scores > 2 than for those with normal z-scores. The correlation coefficients of WC and WCTH for BMI/age were r = 0.68 and 0.76, respectively, for boys, and r = 0.79 and 0.80, respectively, for girls. This study highlights elevated mean WC and WCTH values and high prevalence of abdominal obesity among Kaingáng indigenous adolescents.

Os objetivos do estudo foram descrever a distribuição das medidas de circunferência de cintura (CC) e CC/estatura (CC/E) para adolescentes indígenas Kaingáng; estimar a prevalência de valores elevados para CC/E; e avaliar a correlação entre CC e CC/E com o IMC/idade. Um total de 1.803 adolescentes indígenas foi avaliado no estudo seccional de base escolar. Foram considerados elevados valores de CC/E superiores a 0,5. Observaram-se maiores valores médios de CC e CC/E para meninas, em todas as faixas etárias. Valores de CC/E > 0,5 foram encontrados em 25,6% dos adolescentes. Valores médios de CC e CC/E foram significativamente maiores para os adolescentes com IMC/idade > 2 z-scores, em comparação aos eutróficos. Os coeficientes de correlações entre CC e CC/E com o IMC/idade foram: meninos: r = 0,68 e 0,76, respectivamente, e meninas: r = 0,79 e 0,80, respectivamente. Destaca-se proeminência de valores médios elevados de CC e CC/E e prevalências expressivas de obesidade abdominal.

C-reactive protein and hormones but not IL-6 are associated to body mass index in first trimester of pregnancy.

OBJECTIVE: To investigate if body mass index (BMI) is related to inflammatory markers and hormones in early pregnancy. METHODS: A prospective study with 190 pregnant women evaluated at 10 weeks when leptin, insulin, homeostatic model assessment-insulin resistance (HOMA-IR), C-reactive protein (CRP) and interleukin-6 (IL-6) were measured. Median and inter-quartile values of hormones and inflammatory markers are presented according to BMI quintiles. Spearman correlations and Kruskal-Wallis analysis of variance were implemented followed by Mann-Whitney post hoc pair-wise tests. RESULTS: Leptin (P < 0.001), insulin (P = 0.005), HOMA-IR (P = 0.015), and CRP (P = 0.026) assumed higher and significantly median values as BMI quintiles increases, but no differences were observed for IL-6 (P = 0.859). Pair-wise comparisons among quintiles (Q) of BMI were significant for leptin (Q1 × Q3, Q1 × Q4, Q1 × Q5, Q2 × Q4, Q2 × Q5, Q3 × Q5), insulin (Q1 × Q5, Q2 × Q5, Q3 × Q5, Q4 × Q5) and for CRP (Q1 × Q4, Q1 × Q5, Q2 × Q5). Spearman correlation coefficients between BMI showed significant results for leptin (r (s) = 0.58, P < 0.001), insulin (r (s) = 0.19, P = 0.018), HOMA-IR (r (s) = 0.22, P = 0.007), CRP (r (s) = 0.26, P < 0.001), but not for IL-6 (r (s) = -0.06, P = 0.526). Median (mg/L) values of CRP were higher in overweight (35.26) than in normal weight women (21.28, P = 0.051). CONCLUSIONS: The present investigation provides evidences on the positive relationship between BMI, leptin, insulin, HOMA-IR and CRP in early pregnancy. CRP but not IL-6 demonstrated a strong relation with overweight in pregnant women, as early as the tenth week.

Birth weight and bone mass in young adults from Brazil.

BACKGROUND: Birth weight is positively associated with adult bone mass. However, it is not clear if its effect is already evident in early adulthood. OBJECTIVE: To investigate the association between birth weight, adult body size, the interaction between them and bone mass in young adults. METHODS: Bone densitometry by DXA was performed on 496 individuals (240 men) aged 23-24 years from the 1978/79 Ribeirão Preto (southern Brazil) birth cohort, who were born and still residing in the city in 2002. Birth weight and length as well as adult weight and height were directly measured and converted to z-scores. The influence of birth weight and length, and adult weight and height on bone area (BA), bone mineral content (BMC) and bone mineral density (BMD) at the lumbar spine, proximal femur and femoral neck were investigated through simple and multiple linear regression models. Adjustments were made for sex, skin color, gestational age, physical activity level, smoking status and dietary consumption of protein, calcium and alcohol. Interaction terms between birth weight and adult weight, and birth length and adult height were tested. RESULTS: Men in the highest tertile of birth weight distribution had greater BA and BMC at all three bone sites when compared with their counterparts in the lowest tertiles (p<0.008). For BMD, this trend was observed only in the lumbar spine. Adult weight and height were positively associated with BA and BMC at all three bone sites (p<0.05). For BMD, these associations were seen for adult weight, but for adult height an association was observed only in the lumbar spine. Birth weight retained positive associations with proximal femur BA and BMC after adjustments for current weight and height. No interaction was observed between variables measuring prenatal growth and adult body size. CONCLUSION: Birth weight and postnatal growth are independent determinants of adult bone mass in a sample of Brazilian adults. This effect is already evident in early adulthood.

[Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil]. / Fatores determinantes da incidência de macrossomia em um estudo com mães e filhos atendidos em uma Unidade Básica de Saúde no município do Rio de Janeiro.

PURPOSE: to investigate factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. METHODS: a prospective study, with 195 pairs of mothers and progeny, in which the dependent variable was macrosomia (weight at delivery > or =4,000 g -- independent of the gestational age or of other demographic variables), and socioeconomic, previous pregnancies/gestation course, biochemical, behavioral and anthropometric, the independent variables. Statistical analysis has been done by multiple logistic regression. Relative risk (RR) values have been estimated, based on the simple form: RR=OR/ (1 - I0) + (I0 versus OR), in which I0 is the macrosomia incidence in non-exposed people. RESULTS: Macrosomia incidence was 6.7%, the highest value being found in the progeny of women > or =30 years old (12.8%), white (10.4%), with two or more children (16.7%), with male newborns (9.6%), with height > or =1.6 m (12.5%), with overweight or obesity as a nutritional pre-gestational state (13.6%), and with excessive gestational gain of weight (12.7%). The final model has shown that having two or more children (RR=3.7; CI95%=1.1-9.9), and having a male newborn (RR=7.5; CI95%=1.0-37.6) were the variables linked to the macrosomia occurrence. CONCLUSIONS: macrosomia incidence was higher than the one observed in Brazil as a whole, but inferior to the one reported in studies from developed countries. Having two or more children and a newborn male were the factors accountable for the occurrence of macrosomia.

Determinants of weight gain in pregnant women attending a public prenatal care facility in Rio de Janeiro, Brazil: a prospective study, 2005-2007.

The objective of this study was to evaluate the determinants of weight gain during pregnancy. The study adopted a prospective cohort design with four follow-up waves and included a sample of 255 pregnant women that received prenatal care at a public health care facility in Rio de Janeiro, Brazil. A mixed-effects linear longitudinal regression model was used, having as the dependent variable the weight assessed in four follow-up waves, and as independent variables: demographic, socioeconomic, reproductive, behavioral, and nutritional data. Mean weight gain was 0.413kg per gestational week, consistent with recommendations by the Institute of Medicine. Per capita family income and smoking were associated with total weight gain during gestation. According to the longitudinal multiple linear regression model, age (beta = 0.6315), menarche (beta = -2.3861), triglycerides (beta = 0.0437), blood glucose (beta = 0.1544), and adequacy of energy consumption (beta = -0.0642) were associated with gestational weight gain. Special attention should be given to these sub-groups, due to increased risk of excessive weight gain.

Physical activity during pregnancy and maternal-child health outcomes: a systematic literature review.

A systematic literature review was conducted to investigate the effects of physical activity during pregnancy on selected maternal-child health outcomes. The search included articles published from 1980 to 2005 in the MEDLINE and LILACS databases using key words such as physical activity, physical exercise, pregnancy, and gestation. The methodological quality of 37 selected articles was evaluated. It appears to be a consensus that some light-to-moderate physical activity is not a risk factor and may even be considered a protective factor for some outcomes. However, some studies found an association between specific activities (e.g., climbing stairs or standing for long periods) and inadequate birth weight, prematurity, and miscarriage. Few studies found an association between physical activity and maternal weight gain, mode of delivery, or fetal development. Further research is needed to fill these gaps and provide guidelines on the intensity, duration, and frequency of physical activity during pregnancy.

Reference values of handgrip dynamometry of healthy adults: a population-based study.

BACKGROUND & AIMS: Although maximal voluntary handgrip strength (HGS) is considered a reliable tool in nutritional assessment there are few reference data available. This paper presents reference values for handgrip strength of healthy adults (age > or = 20 years) from a household survey. METHODS: Data were obtained from a representative sample of adults (1122 males and 1928 females) living in Niterói, Rio de Janeiro, Brazil. HGS was measured three times with a Jamar mechanical dynamometer in both hands and the highest value used in the analysis. The percentile distribution of HGS was calculated according to sex and age categories. RESULTS: Mean values of right and left HGS were 42.8 and 40.9 kg for males, and 25.3 and 24.0 kg for females, respectively. HGS increased with age and significantly decreased after 40 and 50 year-olds for women and men, respectively. Body mass index (BMI) was associated with HGS in both sexes but only underweight male subjects had significantly lower HGS values. CONCLUSIONS: The highest HGS values are observed at the 4th decade of life with significant declines thereafter. HGS is significantly associated with BMI. The reference values of HGS may be useful in assessing the nutritional status of similar adult urban population.