Direct standardization method according to Robson classification for comparison of cesarean rates.

BACKGROUND: Compare cesarean section rates between populations or within a population over time using the crude measure is biased mainly due to differences in the characteristics of the obstetric population. The Robson Ten Group Classification (RTGC) is being widely used all over the world based on a few basic obstetrics variables. OBJECTIVES: Propose a method of direct standardization according to RTGC to make the overall rates of cesarean sections comparable between different populations or within the same population over time. METHODS: We used data from the WHO Global Maternal and Perinatal Health Survey (WHOGS) conducted between 2004 and 2008 and data from the WHO Multinational Survey on Maternal and Neonatal Health (WHOMCS) conducted between 2010 and 2011, covering information from obstetric population of 21 countries. The standard population was based in the average size of Robson Groups in WHOMCS. The crude and standardized rates, their differences intra and inter populations, and its respective confidence intervals were calculated. RESULTS: The impact and importance of the method were demonstrated. The five leading countries list on cesarean rates was completely modified and changes of cesarean rates over time in the same country varied in both directions by the standardization. CONCLUSION: This method is useful to compare overall rates as an additional information when RTGC Report Table is been used or, for some type of studies as analytical ecologic studies with multiple groups, where leading with the report tables are laborious and hard to interpret. The use of Robson Ten Group Classification for direct standardization of cesarean rates is easy to apply and interpret.

Obesity and diet contents of protein and fat are associated with underreport of energy at pregnancy / Obesidade e conteúdo de proteína e gordura na dieta estão associados ao sub-relato do consumo energético na gravidez

Abstract Objectives: to evaluate the association of pre-pregnancy and current body mass index and the density of dietary macronutrients on underreporting of energy intake at pregnancy. Methods: cross-sectional analysis of 327 postpartum women from the city of Mesquita, in Rio de Janeiro. A food frequency questionnaire was administered at maternity ward having the last six months of the pregnancy as the time frame. Energy balance was considered as the outcome, and it was calculated as the division of energy intake by basal metabolic rate (underreport <1.35). Multivariate logistic regression was applied to test the associations between body mass index (pre-gestational and postpartum) on energy balance (underreport or not). Dietary density of protein (4th quartile), carbohydrate (1st quartile) and fat intake (1st quartile) were tested. Results: mean energy intake was 2,894 kcal and near of 25% of the women were considered as underreported during pregnancy. Obese women had higher chance (OR=1.90; CI95%=1.09-3.33) of being underreported at pregnancy. Underreported women presented greater chance of report dietary intake with higher contents of protein (OR=2.37; CI95%=1.37-4.09) and lower density of fat (OR= .81; CI95%=1.04-3.15). Conclusion: underreported pregnant women had higher chance of report great and lower amounts of protein and fat dietary densities.

Resumo Objetivos: avaliar a associação entre o índice de massa corporal pré-gestacional e pós-parto e a densidade de macronutrientes da dieta com o sub-relato de energia da dieta na gestação. Métodos: análise transversal com 327 puérperas da cidade de Mesquita, no Rio de Janeiro. Aplicou-se o questionário de frequência alimentar na primeira semana após o parto tendo como base o consumo dos dois últimos trimestres gestacionais. O balanço energético foi calculado a partir da divisão da ingestão de energia pela taxa metabólica basal (sub-relato<1,35). Adotou-se a regressão logística multivariada para analisar as associações entre os índices de massa corporal e a densidade dos macronutrientes da dieta (proteína, carboidratos e lipídios) com o balanço energético (sub-relato ou não). Resultados: a ingestão média de energia foi de 2.894 kcal e 25% das mulheres foram classificadas com sub-relato. Mulheres obesas no pós-parto tiveram maiores chances (OR=1,90; IC95%=1,09-3,33) de sub-relato de energia na gravidez e gestantes com balanço energético <1,35 apresentaram dieta com maior densidade de proteína (OR=2,37; IC95%=1,37-4,09) e menor densidade de gordura (OR=1,81; IC95%=1,04-3,15). Conclusão: a obesidade no pós-parto foi associada ao sub-relato de energia na gravidez e o balanço energético associou-se a densidade dos macronutrientes da dieta

Longitudinal association of 25-hydroxyvitamin D with adipokines and markers of glucose metabolism among Brazilian pregnant women.

This study aimed to evaluate the longitudinal association of vitamin D status with glycaemia, insulin, homoeostatic model assessment of insulin resistance, adiponectin and leptin. A prospective cohort with 181 healthy, pregnant Brazilian women was followed at the 5th-13th, 20th-26th and 30th-36th gestational weeks. In this cohort, 25-hydroxyvitamin D (25(OH)D) plasma concentrations were analysed using liquid chromatography-tandem MS. Vitamin D status was categorised as sufficient or insufficient using the Endocrine Society Practice Guidelines (≥75/<75 nmol/l) and the Institute of Medicine (≥50/<50 nmol/l) thresholds. Linear mixed-effect regression models were employed to evaluate the association between vitamin D status and each outcome, considering interaction terms between vitamin D status and gestational age (P<0·1). At baseline, 70·7 % of pregnant women had 25(OH)D levels <75 nmol/l and 16 % had levels <50 nmol/l. Women with sufficient vitamin D status at baseline, using both thresholds, presented lower glycaemia than those with insufficient 25(OH)D. Pregnant women with 25(OH)D concentrations <75 nmol/l showed lower insulin (ß=-0·12; 95 % CI -0·251, 0·009; P=0·069) and adiponectin (ß=-0·070; 95 % CI -0·150, 0·010; P=0·085) concentrations throughout pregnancy than those with 25(OH)D levels ≥75 nmol/l. Pregnant women with 25(OH)D <50 nmol/l at baseline presented significantly higher leptin concentrations than those with 25(OH)D levels ≥50 nmol/l (ß=-0·253; 95 % CI -0·044, 0·550; P=0·095). The baseline status of vitamin D influences the biomarkers involved in glucose metabolism. Vitamin D-sufficient women at baseline had higher increases in insulin and adiponectin changes throughout gestation than those who were insufficient.

Sleep duration of 24 h is associated with birth weight in nulli- but not multiparous women.

OBJECTIVES: This study aimed to evaluate the association between nightly, napping, and 24-h sleep duration throughout pregnancy and birth weight z-score among nulli- and multiparous women. METHODS: Nightly,napping, and 24-h sleep duration and birth weight z-score (calculated on thebasis of the International Fetal and Newborn Growth Consortium for the 21st century standards) were studied in a cohort of 176 pregnant women from Brazil. Linear mixed-effect analyses were performed to assess the longitudinal evolution of sleep duration and the best unbiased linear predictors of the random coefficients were estimated. The best unbiased linear predictor estimates of sleep duration intercept and slope were included in the linear regression models with birth weight z-score as the outcome. RESULTS: The mean hours of nightly sleep decreased during pregnancy in nulliparous women (ß = -0.55; 95% confidence interval [CI], -0.83 to -0.27) but the decrease was not statistically significant in multiparous women (ß = -0.19; 95% CI, -0.30 to 0.01). Twenty-four hour sleep duration decreased during pregnancy in both multiparous (ß = -0.50; 95% CI, -0.76 to -0.25) and nulliparous women (ß = 0.77; 95% CI, -1.06 to -0.48). Napping sleep duration did not change in either group. Among the nulliparous women, both first-trimester 24-h sleep duration and its change throughout pregnancy were inversely associated with birth weight (ß = -0.44; 95% CI, -0.68 to -0.21; ß = -1.75; 95% CI, -3.17 to -0.30, respectively). No associations were detected in multiparous women for nightly and napping sleep duration. CONCLUSIONS: Nulliparous women with greater decreases in sleep duration throughout their pregnancy gave birth to newborns with lower birth weight z-scores.

Changes in plasma concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D during pregnancy: a Brazilian cohort.

PURPOSE: To characterize the physiological changes in 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] throughout pregnancy. METHODS: Prospective cohort of 229 apparently healthy pregnant women followed at 5th-13th, 20th-26th, and 30th-36th gestational weeks. 25(OH)D and 1,25(OH)2D concentrations were measured by LC-MS/MS. Statistical analyses included longitudinal linear mixed-effects models adjusted for parity, season, education, self-reported skin color, and pre-pregnancy BMI. Vitamin D status was defined based on 25(OH)D concentrations according to the Endocrine Society Practice Guideline and Institute of Medicine (IOM) for adults. RESULTS: The prevalence of 25(OH)D <75 nmol/L was 70.4, 41.0, and 33.9%; the prevalence of 25(OH)D <50 nmol/L was 16.1, 11.2, and 10.2%; and the prevalence of 25(OH)D <30 nmol/L was 2, 0, and 0.6%, at the first, second, and third trimesters, respectively. Unadjusted analysis showed an increase in 25(OH)D (ß = 0.869; 95% CI 0.723-1.014; P < 0.001) and 1,25(OH)2D (ß = 3.878; 95% CI 3.136-4.620; P < 0.001) throughout pregnancy. Multiple adjusted analyses showed that women who started the study in winter (P < 0.001), spring (P < 0.001), or autumn (P = 0.028) presented a longitudinal increase in 25(OH)D concentrations, while women that started during summer did not. Increase of 1,25(OH)2D concentrations over time in women with insufficient vitamin D (50-75 nmol/L) at baseline was higher compared to women with sufficient vitamin D (≥75 nmol/L) (P = 0.006). CONCLUSIONS: The prevalence of vitamin D inadequacy varied significantly according to the adopted criteria. There was a seasonal variation of 25(OH)D during pregnancy. The women with insufficient vitamin D status present greater longitudinal increases in the concentrations of 1,25(OH)2D in comparison to women with sufficiency.

Association between plasma concentrations of vitamin D metabolites and depressive symptoms throughout pregnancy in a prospective cohort of Brazilian women.

Plasma concentrations of vitamin D metabolites can be inversely associated with depressive symptoms. However, few longitudinal studies have investigated this association, especially during pregnancy. The aim of this study was to investigate the association between concentrations of 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxivitamin D [1,25(OH)2D] with the occurrence of depressive symptoms throughout pregnancy. A prospective cohort of 179 women was followed at 5th-13th, 20th-26th and 30th-36th gestational weeks. At each trimester of pregnancy, the plasma concentrations of 25(OH)D and 1,25(OH)2D were analyzed by liquid chromatography tandem mass spectroscopy. Vitamin D status was categorized according to the Endocrine Society Practice Guidelines and the Institute of Medicine. Depressive symptoms were measured at each trimester using the Edinburgh Postnatal Depressive Scale (cutoff ≥13). Statistical analyses included random intercept logistic regression models for longitudinal analyses. In the first trimester, the prevalence of 25(OH)D <75, <50 and <30 nmol/L were 69.3%, 14.0% and 1.7%, respectively. Prevalence of depressive symptoms were 20.1%, 14.7% and 7.8% for the first, second and third trimesters, respectively. The probability of occurrence of depressive symptoms decreased throughout pregnancy (p-value = 0.005). Women with higher concentrations of 25(OH)D in the first trimester presented a lower odds ratio (OR) for the development of depressive symptoms during pregnancy (OR = 0.98; 95%CI: 0.96 to 0.99, p-value = 0.047) in the adjusted model. In conclusion, there was a higher prevalence of vitamin D inadequacy and depressive symptoms during the first trimester. Higher 25(OH)D concentrations in the first trimester were associated with a decrease of 2% in the odds for presenting depressive symptoms throughout pregnancy.

Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study.

The change in maternal lipid, leptin and adiponectin concentrations during pregnancy and infant birth weight (BW) is still poorly characterized. Thus, the aim of the study was to evaluate the association of maternal lipids, leptin and adiponectin throughout pregnancy with large-for-gestational-age (LGA) births and BW z-score. A prospective cohort of 199 mothers was followed during pregnancy in Rio de Janeiro, Brazil. The statistical analyses comprised multiple logistic and linear regression. Women delivered 36 LGA and 11 small-for-gestational-age newborns. HDL-c rate of change throughout pregnancy was negatively associated with BW z-score (ß = -1.99; p = 0.003) and the delivery of a LGA newborn (OR = 0.02; p = 0.043). Pregnancy baseline concentration of log leptin was positively associated (OR = 3.92; p = 0.025) with LGA births. LDL-c rate of change throughout pregnancy was positively associated with BW z-score (ß = 0.31; p = 0.004). Log triglycerides and log adiponectin were not significantly associated with BW z-score or LGA birth. In conclusion, a higher log leptin pregnancy baseline concentration and a lower HDL-c rate of change during pregnancy were associated with higher odds of having a LGA newborn. These maternal biomarkers are important to foetal growth and could be used in prenatal care as an additional strategy to screen women at risk of inadequate BW.

Prepregnancy Dietary Patterns Are Associated with Blood Lipid Level Changes During Pregnancy: A Prospective Cohort Study in Rio de Janeiro, Brazil.

BACKGROUND: Physiologic adaptations lead to an increase in blood lipid levels during pregnancy, yet little is known about the influence of prepregnancy dietary patterns. AIM: To identify whether prepregnancy dietary patterns that explain the consumption of fiber, energy, and saturated fat are associated with blood lipid levels throughout pregnancy. DESIGN: Prospective cohort study, with data collection at gestational weeks 5 to 13, 20 to 26, and 30 to 36. A food frequency questionnaire was administered at baseline (gestational week 5 to 13). PARTICIPANTS/SETTING: Women with singleton pregnancy (N=299) aged 20 to 40 years, without infectious/chronic disease (except obesity) were enrolled in the study. One hundred ninety-nine women were included in the final analysis. The study took place at a prenatal service of a public health care center in Rio de Janeiro, Brazil, during the period from 2009 to 2012. MAIN OUTCOME MEASURES: Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and triglyceride levels, measured at all trimesters. STATISTICAL ANALYSES PERFORMED: Dietary patterns were derived by reduced rank regression. Fiber density, dietary energy density, and percent energy from saturated fat were response variables. Crude and adjusted longitudinal linear mixed-effects regression models were performed to account for confounders and mediators. Interaction terms between dietary pattern and gestational week were tested. RESULTS: Fast Food and Candies; Vegetables and Dairy; and Beans, Bread, and Fat patterns were derived. Our Fast Food and Candies pattern was positively associated with triglyceride level (ß=4.961, 95% CI 0.945 to 8.977; P=0.015). In the HDL-C rate of change prediction, significant interactions were observed between both the Fast Food and Candies and Vegetables and Dairy patterns and gestational week (ß=-.053, 95% CI -0.101 to -0.004; P=0.035 and ß=.055, 95% CI -0.002 to 0.112; P=0.060, respectively). The Beans, Bread, and Fat pattern was not associated with blood lipid levels. CONCLUSIONS: Prepregnancy dietary patterns were associated with gestational blood lipid levels; that is, higher scores for the Fast Food and Candies pattern were associated with higher triglyceride and slower HDL-C rates of change during pregnancy, whereas higher scores for the Vegetables and Dairy dietary patterns were associated with faster HDL-C rates of change over gestational weeks.

Maternal C-reactive protein concentrations during pregnancy and birth weight in a prospective cohort in Rio de Janeiro, Brazil.

OBJECTIVE: To evaluate the association between maternal C-reactive protein (CRP) concentrations during pregnancy and birth weight (BW) Z-score. METHODS: A prospective cohort of pregnant women were followed at 5-13 (n = 203), 20-26 (n = 181), and 30-36 (n = 181) gestational weeks and at 30-45 d postpartum. Maternal CRP concentrations were assessed three times during pregnancy using immunoturbidimetric methods (ultra-sensitive kits). BW Z-score and newborns classified as small for gestational age (SGA) were evaluated according to Intergrowth-21st curves. Statistical analyses included SGA rates, BW Z-score means (SD) and a two-stage procedure: (1) a linear mixed-effect model (LME) to predict CRP intercept (mean exposure level) and slope (trend of change during pregnancy); and (2) a multiple linear regression model with BW Z-score as the outcome and CRP intercept and slope exposures. RESULTS: A total of 4.4% (n = 9) women delivered SGA newborns. The mean BW was 3282.0 (37.3) g, and the mean gestational age at delivery was 38.8 (0.1) weeks. Women in the third tertile of the CRP rate of change gave birth to infants with a mean BW Z-score that was lower than those in the first/second tertiles (0.226 versus 0.381; p = 0.324). For the adjusted baseline CRP (ß = 0.08; 95% CI: 0.03-0.14), the CRP trend of change was inversely associated with the BW Z-score (ß= -3.77; 95% CI: -5.45 to -2.10). CONCLUSIONS: The maternal CRP trend of change during pregnancy was negatively associated with BW Z-score.

Changes in Maternal Plasma Adiponectin from Late Pregnancy to the Postpartum Period According to the Mode of Delivery: Results from a Prospective Cohort in Rio de Janeiro, Brazil.

INTRODUCTION: Maternal plasma adiponectin is inversely related to insulin resistance, atherosclerosis and child health. However, little is known about its concentrations in the perinatal period, especially according to mode of delivery. Our aim is to evaluate the association between mode of delivery and changes in maternal plasma adiponectin from 3rd trimester of pregnancy to 30-45 days postpartum. METHODS: A cohort was recruited in Rio de Janeiro, Brazil, with four waves of follow-up: 5-13th, 22-26th, 30-36th gestational weeks and 30-45 days postpartum. Eligible subjects should be between 20-40 years of age, be free of chronic and infectious diseases and presenting with a singleton pregnancy. The mode of delivery was classified as vaginal (VD) or cesarean (CS). Plasma adiponectin concentration (µg/mL) was measured using commercial ELISA kits. Statistical analyses included the Wilcoxon rank-sum test and the multiple linear mixed effects model. RESULTS: A total of 159 participated in the study. Median adiponectin concentrations were higher for the VD group (n = 99; 8.25, IQR: 5.85-11.90) than for the CS group (n = 60; 7.34, IQR: 4.36-9.76; p = 0.040) in the postpartum samples but were not different between the two groups in the 3rd trimester. Women who underwent CS had a lower rate of increase in adiponectin concentration from the 3rd trimester to 30-45 days postpartum compared to those who underwent VD (ß = -.15, 95% CI: -.28-.02, p = 0.030). CONCLUSION: The CS procedure was associated with lower maternal circulating concentrations of adiponectin at 30-45 days postpartum, compared to the VD.

Dietary intake variations from pre-conception to gestational period according to the degree of industrial processing: A Brazilian cohort.

OBJECTIVE: To estimate food intake changes from pre-conception to gestational period according to the degree of food processing. METHODS: Prospective cohort conducted in a public health care center in Rio de Janeiro with Brazilian pregnant women (n = 189). A food frequency questionnaire was applied at the first (5(th)-13(th)) and third (30(th)-36(th)) gestational trimesters. The food items were classified according to characteristics of food processing in four groups: unprocessed/minimally processed foods; sugar/fat; processed foods and ultra-processed foods. The variation of food intake according to the degree of processing between the pre-conception and gestational period was compared using paired Student's t-test. Linear regression models were performed to estimate the association of mother's characteristics on the variation of food group contribution to the total energy intake between periods. RESULTS: Total energy intake was 2415 (SD = 813) in the pre-conception and 2379 (750) kcal in the gestational period. We excluded women who had implausible total energy intake (<600 and >6000 kcal/day). The contribution of unprocessed/minimally processed food group to total energy intake during pregnancy when compared to the pre-conception period was higher [50.5 (14.1) vs. 48.8 (12.4), p-value = 0.048], while the caloric share of ultra-processed food group was lower [41.3 (14.6) vs. 43.1 (12.5), p-value = 0.032]. We observed a negative association of age (p-value = 0.009) and a positive association of pre-pregnancy BMI (p-value = 0.060) with the variation of ultra-processed food intake. CONCLUSIONS: Ultra-processed food intake decreased, while minimally/unprocessed food intake slightly increased from the pre-conception to gestational period. These results indicate potential for a larger improvement in the women's diet quality and that nutritional counseling interventions in pregnant women are still needed.

Factors associated with maternal serum C-reactive protein throughout pregnancy: A longitudinal study in women of Rio de Janeiro, Brazil.

OBJECTIVES: The aim of this study was to evaluate the longitudinal changes of C-reactive protein (CRP) concentrations during pregnancy and to assess whether socioeconomic, anthropometric, dietary, behavioral, and biochemical factors are associated with these changes. METHODS: This was a prospective cohort study of 115 adult pregnant women, followed at gestational weeks 5 to 13, 20 to 26, and 30 to 36. Serum concentrations of CRP (mg/L) were measured by the immunoturbidimetric method with ultrasensitive kits (sensitivity 0.05 mg/dL). The statistics included descriptive analysis (mean + SD) and longitudinal linear mixed-effects models, reporting the ß coefficient and 95% confidence intervals (CI). RESULTS: Serum CRP concentrations progressively increased throughout pregnancy (ß = 0.121; 95% CI, 0.071-0.171). Parity (ß = 1.579; 95% CI, 0.731-2.427) and prepregnancy body mass index (BMI) (ß = 0.316; 95% CI, 0.053-0.587) were positively associated and dietary glycemic load was negatively associated (ß = -0.203; 95% CI, -0.380 to -0.026) with CRP concentrations in the multiple model. Prepregnancy obese women presented a more pronounced increase of CRP concentrations compared with normal weight women (ß = 0.210; 95% CI, 0.059-0.360 versus 0.115, respectively; 95% CI, 0.049-0.181). A statistically significant interaction was observed between parity and gestational age (ß = -0.045; 95% CI, -0.084 to -0.005), indicating that the variation of CRP throughout pregnancy differed according to parity categories. CONCLUSION: CRP concentrations increased throughout pregnancy. Parity and prepregnancy BMI were positively associated and dietary glycemic load was negatively associated with concentrations of CRP.

Blood pressure in healthy pregnancy and factors associated with no mid-trimester blood pressure drop: a prospective cohort study.

BACKGROUND: The well-known mid-trimester drop in blood pressure (BP) during normal pregnancy was recently questioned. OBJECTIVE: To describe longitudinal changes in BP during healthy pregnancies and to investigate factors associated with no mid-trimester drop in BP. METHODS: A prospective cohort with 158 healthy pregnant women was followed up in a public health care center in Rio de Janeiro, Brazil. We used linear mixed-effects models to estimate longitudinal changes in systolic BP (SBP) and diastolic BP (DBP) during pregnancy. Poisson regression models were performed to identify factors associated with no mid-trimester drop in BP. RESULTS: Significant mid-trimester increase in SBP (5.6 mm Hg; 95% confidence interval (CI) = 4.6-6.7) and DBP (4.4 mm Hg; 95% CI = 3.4-5.3) was observed in 44.3% and 39.9% of the sample, respectively. Women (37.1%) who had not a mid-trimester SBP drop still had a DBP drop. White skin color (incidence ratio (IR): 1.71; 95% CI = 1.22-2.39), family history of hypertension (IR: 1.93; 95% CI = 1.29-2.89), early pregnancy obesity (IR: 2.29; 95% CI = 1.27-4.11), outside temperature variation (IR: 1.45; 95% CI = 1.00-2.10), and gestational weight gain from the first to second trimester (IR: 1.71; 95% CI = 1.01-2.88 and IR: 2.32; 95% CI = 1.39-3.89 for second and third tertiles) were characteristics associated with no mid-trimester drop in SBP. The same characteristics were associated with no mid-trimester drop in DBP, except family history of hypertension and outside temperature variation. CONCLUSIONS: Some women without a mid-trimester SBP drop still present a DBP drop. The different patterns of mid-trimester change in BP seem to be determined by preexisting and pregnancy-related factors.

Factors associated with prospective leptin concentrations throughout pregnancy in pregestational normal weight, overweight and obese women.

BACKGROUND: Leptin concentrations increase throughout pregnancy but little is known about factors that influence this physiological change and whether they differ according to pregestational body mass index (BMI). OBJECTIVE: To assess whether longitudinal trends of leptin in pregnancy are influenced by biochemical, anthropometric and lifestyle factors in women with normal weight (NW), overweight (OW) or obese (OB) pregestational BMI. DESIGN AND METHODS: Prospective cohort of 232 pregnant women followed at 5-13th, 20-26th and 30-36th gestational weeks. The effect of selected variables on longitudinal behaviour of plasma leptin concentrations, stratifying for NW (18·5-24·9 kg/m(2) ), OW (25-29·9 kg/m(2) ) and OB (≥30·0 kg/m(2) ) pregestational BMI was assessed through longitudinal linear mixed-effects models. RESULTS: The multiple regression model for women with NW revealed associations of maternal body weight (ß = 0·714, CI = 0·491 to 0·937), serum HDL-cholesterol (ß = 0·239, CI =0·089 to 0·388) and C-reactive protein (CRP) (ß = -0·138, CI = -0·272 to -0·004) with plasma leptin concentrations. Maternal body weight (ß = -0·871, CI = 0·475 to 1·267) and serum HDL-cholesterol concentrations (ß = 0·315, CI = -0·022 to 0·651) were also associated with leptin in OW women. In OB women, serum HDL-cholesterol (ß = 0·722, CI = 0·219 to 1·226), maternal body weight (ß = 0·666, CI = 0·187 to 1·145), triglycerides concentrations (ß = -0·130, CI = -0·241 to -0·020) and dietary carbohydrate (ß = 0·075, CI = 0·023 to 0·126) were significantly associated with plasma leptin. CONCLUSION: Maternal body weight and serum concentrations of HDL-cholesterol were associated with leptin changes independent of pregestational BMI. Serum CRP concentrations were associated with leptin only in NW women and serum triglycerides concentrations and dietary carbohydrate only in OB. These results indicate that factors that influence leptin concentrations differ according to pregestational BMI.

Plasma adiponectin is inversely associated with antenatal anxiety: Results from a Brazilian cohort.

Antenatal anxiety may increase the risk of undesirable birth outcomes. Studies have demonstrated an association between adiponectin and anxiety, but this issue has not been investigated during pregnancy. This study aimed to evaluate the association between plasma adiponectin, measured throughout gestation, and the occurrence of anxiety at late pregnancy (30-36th weeks). A prospective cohort was investigated in Rio de Janeiro, Brazil. Healthy pregnant women, aged 20-40 years, were evaluated between gestational weeks 5-13, 22-26 and 30-36. State anxiety was measured using a validated version of the State-Trait Anxiety Inventory, and women were categorized as high (score≥50, n=30) or low anxiety (score<50, n=129). Plasma samples for all trimesters were analyzed using commercial ELISA kits to determine adiponectin concentrations (U/mL). Statistical analysis involved student's t-tests, chi-square, Pearson correlation, multiple logistic regression and linear mixed effects (LME) regression to model longitudinal trends of adiponectin, stratified for anxiety categories. Women with higher anxiety scores had lower mean concentrations of 3rd trimester adiponectin compared with those with lower scores (7.9; 95% CI: 7.0-8.9 vs. 9.9; 95% CI: 9.1-10.7). Women with 3rd trimester adiponectin values within the third tertile (10.47-26.57U/mL) were less likely to have high antenatal anxiety (adjusted OR=0.30; 95% CI: 0.09-0.98) compared with those within the first tertile (2.25-7.08U/mL). Unlike women with low levels of anxiety, those with high levels had a significant decrease of plasma adiponectin throughout pregnancy (ß=-0.07; 95% CI: -0.13-[-0.01] vs. ß=-0.01; 95% CI: -0.05 to 0.03). Multiple LME model indicated higher adiponectin throughout pregnancy for women with low anxiety (ß=-1.57; 95% CI: -2.78-[-0.37]). In conclusion, plasma adiponectin throughout pregnancy was inversely associated with antenatal anxiety.

Prepregnancy healthy dietary pattern is inversely associated with depressive symptoms among pregnant Brazilian women.

Dietary patterns before pregnancy may be associated with depressive symptomatology during pregnancy. The aim of this study was to identify dietary patterns before pregnancy and to examine the association between these dietary patterns and depressive symptoms during pregnancy. A prospective cohort of 248 healthy pregnant women were followed at 5-13, 20-26, and 30-36 gestational weeks. Dietary intake was obtained by using a food-frequency questionnaire administered between 5 and 13 gestational weeks, which referred to the 6 mo preceding gestation, and factor analysis (principal components) was applied to identify dietary patterns. The Edinburgh Postnatal Depressive Scale (EPDS) was used to evaluate depressive symptoms during 3 follow-up pregnancy points. A multiple linear mixed-effects model was applied to verify the association between dietary patterns and depressive symptoms adjusted for obstetric factors, socioeconomic status, and energy intake. Three prepregnancy dietary patterns were identified: common-Brazilian, healthy, and processed. Together, these patterns explained 36.1% of the total percentage of variance; the eigenvalues were 2.88, 2.12, and 1.86, respectively. Mean depressive symptom scores were 9.0 (95% CI: 8.4, 9.6), 7.2 (95% CI: 6.5, 7.8), and 7.0 (95% CI: 6.4, 7.7) for trimesters 1, 2, and 3, respectively. The rate of decrease in depressive symptoms was -0.088/wk (95% CI: -0.115, -0.061; P < 0.001). In the multiple longitudinal linear regression model, the healthy dietary pattern before pregnancy was inversely associated with depressive symptoms (ß:-0.723; 95% CI: -1.277, -0.169; P = 0.011). High adherence to the healthy pattern before pregnancy was associated with lower EPDS scores during pregnancy in women from Rio de Janeiro, Brazil.

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.

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, ...

C-reactive protein and later preeclampsia: systematic review and meta-analysis taking into account the weight status.

OBJECTIVES: This study aims to determine whether high C-reactive protein (CRP) concentration during pregnancy is associated with later preeclampsia and whether weight status (BMI) is a potential modifier of the relation between CRP and preeclampsia. METHODS: Twenty-three studies were included in a systematic literature review and a subset of 18 in a meta-analysis. Weighted mean difference (WMD) [with their 95% confidence intervals (CI)] of CRP in preeclampsia and control groups was the estimator. A quality assessment was carried out using a scale specifically developed for this study. Meta-regression with estimates for study characteristics and inter-arm differences and sensitivity and subgroup analysis was employed. Statistical heterogeneity was investigated using I(2) statistic. RESULTS: The pooled estimated CRP between 727 women, who developed preeclampsia and 3538 controls was 2.30 mg/l (95% CI: 1.27-3.34). The heterogeneity among studies was high (I(2) = 92.8). The WMD was found to be lower in studies comprising preeclampsia and control groups with similar BMI [WMD = 0.85 (95% CI: 0.10-1.61); I(2) = 25.3%] compared with studies among which BMI was significantly elevated in the preeclampsia group [2.01 (95% CI: 1.23-2.78); I(2) = 0.0%], which may explain the high heterogeneity of pooled data. Meta-regression results confirmed that difference in BMI between groups modifies the association of CRP and preeclampsia. High quality studies represented 30%. CONCLUSION: The pooled WMD suggest that women with higher levels of CRP may have an increased risk of developing preeclampsia. This association seems to be modified by confounders, such as BMI. Further studies of high methodological quality are needed.

Low leptin concentration in the first gestational trimester is associated with being born small for gestational age: prospective study in Rio de Janeiro, Brazil.

BACKGROUND: Being born small for gestational age (SGA) is a known risk factor for greater neonatal mortality and disease in later life. Some determinants of the incidence of SGA newborns have been studied but little is known about the role of leptin in the beginning of pregnancy. OBJECTIVES: To investigate the effect of serum leptin concentration in the 1st gestational trimester on the incidence of SGA newborns and to identify other determining factors in the occurrence of SGA. METHODS: Prospective study with 195 pairs of mothers and their children monitored in Rio de Janeiro, Brazil. The dependent variable was SGA newborns, while the independent variables were sociodemographic, reproductive, anthropometric and biochemical variables. Statistical analysis was performed by means of logistic regression. RESULTS: The incidence of SGA was 11.3% (CI 95%: 7.31-16.46). The results showed that low concentrations (lowest tertile compared to 2nd and 3rd tertiles) of leptin (RR = 5.26; CI 95%: 1.91-9.56), insufficient gestational weight gain (RR = 3.16; CI 95%: 0.98-7.38), low stature (RR = 3.94; CI 95%: 1.22-8.57) and alcohol consumption during gestation (RR = 5.92; CI 95%: 1.44-12.92) were risk factors for SGA. CONCLUSIONS: Lower leptin concentrations were associated with a significant risk for SGA after adjusting for confounding variables. Maternal serum leptin at the beginning of gestation can be used as a marker for the early detection of SGA.