Variación del perfil lipídico durante el embarazo y su relación con las enfermedades metabólicas / Changes in lipid profile during pregnancy and their association with metabolic disorders

Introducción: En el embarazo se producen numerosos cambios fisiológicos en las gestantes los cuales pueden llegar a desencadenar potenciales complicaciones y enfermedades cardiovasculares o metabólicas tales como hipertensión gestacional, hiperlipidemia y diabetes mellitus gestacional.Objetivo: Realizar una revisión sistemática de la literatura con objeto de evaluar la relación entre las variaciones del perfil lipídico durante el embarazo y el riesgo de padecer enfermedades metabólicas y cardiovasculares.Métodos: Se ha llevado a cabo una revisión sistemática siguiendo las directrices del modelo PRISMA en la que se incluyeron 22 artículos. Los descriptores empleados incluyeron marcadores del perfil lipídico (HDL, LDL, TG y CT) y las principales patologías metabólicas y cardiovasculares. El idioma se restringió a español e inglés. La revisión fue llevada a cabo durante el año 2019.Resultados: Niveles elevados de colesterol total, LDL y triglicéridos durante el embarazo se asocian con un mayor riesgo de padecer preeclampsia y diabetes mellitus gestacional. Un mayor índice de masa corporal pre gestacional y una mayor ganancia ponderal se relacionan con mayor tasa hiperlipidemia lo cual conlleva a su vez alteraciones vasculares.Conclusiones: Se hace patente la necesidad de reforzar el control preventivo del peso materno trimestral y del perfil lipídico durante la gestación con objeto de prevenir complicaciones del embarazo. Son necesarios estudios centrados en determinados resultados adversos perinatales tales como la macrosomía del recién nacido.(AU)

Background: Various changes occur during pregnancy that, when exacerbated, could progress to metabolic and cardiovascular disorders such as gestational hypertension, hyperlipidemia, and gestational diabetes mellitus.Objective: To conduct a systematic review of the literature that evaluates the association between changes in lipid profile during pregnancy and the risk of developing metabolic and cardiovascular disorders.Methods: We conducted a PRISMA systematic review of scientific databases. A total of 22 articles were finally included. Used search terms consisted of lipid profile biomarkers (HDL, LDL, triglycerides, total cholesterol) in combination with the most important metabolic and cardiovascular disorders. Language was restricted to Spanish and English. The review was conducted during 2019.Results: High levels of total cholesterol, LDL and triglycerides during pregnancy were found to be associated with increased risk of developing preeclampsia and gestational diabetes mellitus. Higher pre-gestational BMI and elevated gestational weight gain were associated with increase rates of hyperlipidemia which is closely related to vascular pathologies.Conclusions: Fostering routine control of maternal weight during all trimesters of gestation and monitoring the lipid profile throughout pregnancy is necessary to prevent pregnancy adverse outcomes. New studies focused on specific perinatal outcomes such as neonatal macrosomia are required.(AU)

Effects of physical activity on quality of life in overweight and obese children / Efectos de la actividad física sobre la calidad de vida en niños con sobrepeso y obesidad

Background: in recent years the prevalence of obesity in infants, children, and adolescents has increased alarmingly, which may affect their health, educational level, and quality of life. Objectives: the aim of this study was to determine whether a program with physical activity and nutritional recommendations may improve health-related quality of life (HRQL) in overweight and obese children. Material and methods: the design of this study was that of a randomized clinical trial (RCT). The sample consisted of 54 children with a median age of 10.65 years, all of them overweight or obese. They were divided into a study (SG) and a control (CG) group, with 27 children each. The study group received physical activity and nutritional advice, while the control group only received theoretical-practical sessions on nutrition during 9 months. Families participated in the workshops on nutritional recommendations in both groups. Results: there was a significant difference in fat percentage before and after the intervention in the study group compared to the children who did not engage in sports activity. In the SF-10 quality-of-life perception questionnaire, statistically significant differences in both the physical and mental components may be seen at the end of the study between both groups (p < 0.001). Conclusions: an educational intervention with physical activity based on play and nutritional advice improved quality of life in overweight and obese children. Family involvement is vital for children to improve their life habits, and achieve favorable results in the reduction of overweight and obesity. (AU)

Introducción: en los últimos años, la prevalencia de la obesidad en los bebés, niños y adolescentes ha aumentado de forma alarmante, lo que podría afectar a su salud, nivel educativo y calidad de vida. Objetivos: el objetivo de este estudio fue determinar si un programa con actividad física y recomendaciones nutricionales puede mejorar la calidad de vida relacionada con la salud (CVRS) en niños con sobrepeso y obesidad. Material y métodos: el diseño de este estudio fue el de un ensayo clínico aleatorizado (ECA). La muestra consistió en 54 niños de 10,65 años de edad mediana con sobrepeso u obesidad. Se dividieron en grupos de estudio (SG) y de control (CG), ambos con 27 niños. El grupo de estudio recibió actividad física y asesoramiento nutricional mientras que el grupo de control solo recibió las sesiones de nutrición teórico-prácticas durante 9 meses. Las familias participaron en los talleres sobre recomendaciones nutricionales en ambos grupos. Resultados: hubo una diferencia significativa en el porcentaje de grasa antes y después de la intervención en el grupo de estudio en comparación con los niños que no participaron en la actividad deportiva. En el cuestionario de calidad de vida SF-10 se puede observar que existen diferencias estadísticamente significativas en los componentes físicos y mentales al final del estudio entre ambos grupos (p < 0,001). Conclusiones: una intervención educativa con actividad física basada en el juego y asesoramiento nutricional mejoró la calidad de vida de estos niños obesos y con sobrepeso. La participación familiar es vital para que los niños mejoren sus hábitos de vida y logren resultados favorables en la reducción del sobrepeso y la obesidad. (AU)

Effects of physical activity on quality of life in overweight and obese children.

INTRODUCTION: Background: in recent years the prevalence of obesity in infants, children, and adolescents has increased alarmingly, which may affect their health, educational level, and quality of life. Objectives: the aim of this study was to determine whether a program with physical activity and nutritional recommendations may improve health-related quality of life (HRQL) in overweight and obese children. Material and methods: the design of this study was that of a randomized clinical trial (RCT). The sample consisted of 54 children with a median age of 10.65 years, all of them overweight or obese. They were divided into a study (SG) and a control (CG) group, with 27 children each. The study group received physical activity and nutritional advice, while the control group only received theoretical-practical sessions on nutrition during 9 months. Families participated in the workshops on nutritional recommendations in both groups. Results: there was a significant difference in fat percentage before and after the intervention in the study group compared to the children who did not engage in sports activity. In the SF-10 quality-of-life perception questionnaire, statistically significant differences in both the physical and mental components may be seen at the end of the study between both groups (p < 0.001). Conclusions: an educational intervention with physical activity based on play and nutritional advice improved quality of life in overweight and obese children. Family involvement is vital for children to improve their life habits, and achieve favorable results in the reduction of overweight and obesity.

INTRODUCCIÓN: Introducción: en los últimos años, la prevalencia de la obesidad en los bebés, niños y adolescentes ha aumentado de forma alarmante, lo que podría afectar a su salud, nivel educativo y calidad de vida. Objetivos: el objetivo de este estudio fue determinar si un programa con actividad física y recomendaciones nutricionales puede mejorar la calidad de vida relacionada con la salud (CVRS) en niños con sobrepeso y obesidad. Material y métodos: el diseño de este estudio fue el de un ensayo clínico aleatorizado (ECA). La muestra consistió en 54 niños de 10,65 años de edad mediana con sobrepeso u obesidad. Se dividieron en grupos de estudio (SG) y de control (CG), ambos con 27 niños. El grupo de estudio recibió actividad física y asesoramiento nutricional mientras que el grupo de control solo recibió las sesiones de nutrición teórico-prácticas durante 9 meses. Las familias participaron en los talleres sobre recomendaciones nutricionales en ambos grupos. Resultados: hubo una diferencia significativa en el porcentaje de grasa antes y después de la intervención en el grupo de estudio en comparación con los niños que no participaron en la actividad deportiva. En el cuestionario de calidad de vida SF-10 se puede observar que existen diferencias estadísticamente significativas en los componentes físicos y mentales al final del estudio entre ambos grupos (p < 0,001). Conclusiones: una intervención educativa con actividad física basada en el juego y asesoramiento nutricional mejoró la calidad de vida de estos niños obesos y con sobrepeso. La participación familiar es vital para que los niños mejoren sus hábitos de vida y logren resultados favorables en la reducción del sobrepeso y la obesidad.

Childhood Obesity and its Influence on Sleep Disorders: Kids-Play Study.

Background: Sleep disorders are associated with overweight and obese children, and could decrease life quality with limitations to normal daily activities. The purpose of the study is to describe the prevalence of sleep disorders in a cohort of overweight/obese children using respiratory polygraphy. Methods: A descriptive cross-sectional study was conducted in Granada (Spain) on a sample of 98 children with overweight or obesity. The presence of sleep disorders was determined by respiratory polygraphy. Results: Regarding apnoea-hypopnea-index (AHI) results, 44% of affected children had severe sleep apnoea-hypopnea syndrome (SAHS), and the remaining 56% had a mild form of the disorder. With respect to oxygen-desaturation index, 56% of the same group had severe SAHS, 32% had mild SAHS, and the remaining 12% did not suffer from SAHS. Among participants, average scores of 13.8 obstructive apnoea, 7.7 central apnoea, and 13.6 hypopnoea were recorded. Conclusions: Respiratory polygraphy can provide conclusive results in the diagnosis of SAHS in overweight/obese children. Interventional programmes designed and implemented to reduce overweight and obesity can improve quality of sleep and life in children.

Influence of a Water-Based Exercise Program in the Rate of Spontaneous Birth: A Randomized Clinical Trial.

Introduction: Many women change their lifestyles and habits when they become pregnant, to avoid potentially harmful effects to themselves and their babies. This is especially so with respect to physical exercise, which is often greatly reduced due to ignorance of the benefits it provides during pregnancy. Aim: To evaluate the prevalence of spontaneous birth among women who participated in a water-based physical exercise program. Methods: A randomized clinical trial was conducted with a sample of 129 pregnant women (Control Group, CG = 64; Exercise Group, EG = 65). A physical exercise protocol, specifically designed for pregnant women, was created and applied. Those in the EG performed 60 min exercise sessions, three times per week for 17 weeks. The participants in the CG received routine check-ups and advice throughout their pregnancy. Findings: The women in the EG presented better results for the onset of spontaneous birth (OR = 2.060 (0.980-4.332)) and for neonate Apgar score of 10 at five minutes (OR = 8.53 (3.60-20.17)). Those who had normal weight at the start of pregnancy achieved better results for spontaneous delivery (OR = 2.099 (1.017-4.335)) than those with overweight/obesity. The rate of caesarean delivery was higher in the women with overweight/obesity (OR = 3.570 ((1.226-10.397)) than in those with normal weight. Conclusions: In our study, the women who followed the water-based exercise program gained less weight during pregnancy, which facilitated a better rate of spontaneous, non-instrumental childbirth, together with a better Apgar test score at five minutes.

Play as a Method to Reduce Overweight and Obesity in Children: An RCT.

BACKGROUND: Overweight and obesity are the result of a complex interaction between genetic and environmental factors, which begins prenatally. AIM: To analyse an intervention based on play as a means of improving the body composition of children who are overweight or obese. METHODS: The Kids-Play study is a randomized clinical trial (RCT) consisting of 49 children aged 8-12 years on a nine-month intervention programme based on physical activity, play and nutritional advice. Controls had another 49 children, who received only nutritional advice. RESULTS: The play-based intervention achieved a moderate-vigorous level of physical activity in the study group of 81.18 min per day, while the corresponding level for the control group was only 37.34 min. At the start of the intervention, the children in the study group had an average body fat content of 41.66%, a level that decreased to 38.85% by the end of the programme. Among the control group, body fat increased from 38.83% to 41.4% during the same period. CONCLUSIONS: The intervention programme considered, based on both play and nutritional recommendations, produced a decrease in body fat among children aged 8-12 years. However, the control group, which received only nutritional recommendations, experienced an increase in body weight.

Feasibility and reliability of a physical fitness tests battery for adults with intellectual disabilities: The SAMU DIS-FIT battery.

BACKGROUND: People with intellectual disability (ID) have lower performances in physical fitness (PF) tests than people without ID, a situation that exists during all the life stages. However, the assessment of the FP of persons with ID often uses instruments that were designed for non-disabled people. AIM: To check the reliability and feasibility of 8 PF tests in adults with mild to moderate ID. METHODS: A cross-sectional study was carried out with a test-retest design in a maximum interval of 2 weeks with 240 adults (160 men and 80 women) with mild to moderate ID in order to assess the feasibility and reliability of the following 8 tests: body mass index (BMI), waist circumference (WC), the timed up & go test (TUG), the deep trunk flexion test (DTF), the hand grip test (HG), the timed stand test (TST), the 30-s sit-up (SUP) test, and the 6-min walk test (6MWT). The complete battery was called the SAMU-Disability Fitness Battery (SAMU-DISFIT). The psychometric properties of the battery, feasibility, reliability, the standard error of the measurement (SEM) and the minimal detectable change (MDC) were calculated. RESULTS: The TUG, DTF, HG, TST, and 6MWT showed an intraclass correlation coefficient (ICC) from fair to high reliability. Only the SUP test in men had an ICC lower than 0.7 and high SEM values. CONCLUSION: The psychometric properties provide robust data on the use of the SAMU-DISFIT battery in people with ID and can be considered a useful tool for assessing PF in adults with mild to moderate ID in future research.

Influence of Physical Activity on Blood Pressure in Children With Overweight/Obesity: A Randomized Clinical Trial.

BACKGROUND: The prevalence of childhood hypertension (HT) is growing exponentially, influenced by environmental factors such as foods with high salt content, sedentary lifestyles, and poor-quality food. The incidence of HT is about 10.4% in well-nourished children, but when associated with obesity or overweight, this can rise to 38% and 68%, respectively. To assess the influence of physical activity on the blood pressure (BP) of children who are overweight or obese. METHODS: This randomized clinical trial was carried out in Granada (Spain), from October 2015 to June 2016. The sample consisted of 98 children, all of whom were overweight or obese. The intervention group (IG) (n = 49) practised physical activity and received nutritional advice, while the control group (n = 49) only received theoretical-practical sessions on nutrition. Body composition was measured, a nutritional assessment was made and BP was determined (in percentiles, to avoid the misclassification of children who are located at the extremes of normal growth). RESULTS: Before the physical activity intervention, 85.7% of the children in the IG (with overweight/obesity) were in the 95th or higher percentile for BP, a situation representative of high BP (HT). However, by the end of the study period, this value had decreased significantly (P = 0.001), to 16.13%. CONCLUSIONS: Childhood obesity is a risk factor for HT. Physical activity, together with nutritional advice, effectively reduces BP in children who are overweight or obese. The use of percentiles, according to age, weight, and height, is an effective means of measuring BP. CLINICAL TRIALS REGISTRATION: This study is registered at https://www.clinicaltrials.gov (identifier NCT02779647).

Physical Exercise and Grip Strength in Patients Intervened through Bariatric Surgery / Ejercicio físico y fuerza de agarre en pacientes intervenidos de cirugía bariátrica / Exercício físico e força muscular em pacientes submetidos à cirurgia bariátrica

ABSTRACT Objective: This work sought to evaluate a physical exercise program of moderate intensity in patients operated of bariatric surgery and its influence on muscle strength. Method: Randomized clinical trial, with an intervention group and a control group. Forty three patients were operated of bariatric surgery. The intervention group was applied a program of moderate physical activity during six months. Grip strength and bioimpedance were measured at their baseline form, at one month, and six months after surgery. A bivariate study was conducted to observe variable changes. Results: Upon conducting Student´s t for independent samples in all the variables (weight, body mass index, grip strength, lean mass, fat mass, and metabolism), the result is that no significant differences exist between the intervention group and the control group with p > 0.05. Conclusion: A program of moderate physical activity lasting six months in patients intervened of bariatric surgery has no significant result in the development of muscle mass evaluated through manual dynamometry and bioimpedance.

RESUMEN Objetivo: evaluar un programa de ejercicio físico de intensidad moderada en pacientes operados de cirugía bariátrica y su influencia en la fuerza muscular. Método: ensayo clínico aleatorizado, con un grupo de intervención y un grupo control. Cuarenta y tres pacientes fueron operados de cirugía bariátrica. Al grupo de intervención se le aplicó un programa de actividad física moderada durante seis meses. La fuerza de agarre y la bioimpedancia se midieron en su forma basal, al mes y a los seis meses después de la cirugía. Se realizó un estudio de bivariante para observar los cambios de las variables. Resultados: al realizar la prueba de t de student para muestras independientes en todas las variables (peso, índice de masa corporal, fuerza de agarre, masa magra, masa grasa y metabolismo), el resultado es que no hay diferencias significativas entre el grupo de intervención y el grupo control con p>0,05. Conclusión: un programa de actividad física moderado de seis meses de duración en pacientes intervenidos de cirugía bariátrica no tiene resultados significantes en el desarrollo de la masa muscular evaluada a través de la dinamometría manual y la bioimpedancia.

RESUMO Objetivo: avaliar um programa de exercício físico de intensidade moderada em pacientes submetidos à cirurgia bariátrica e sua influência na força muscular. Materiais e método: ensaio clínico randomizado, com um grupo de intervenção e um grupo controle. Quarenta e três pacientes foram operados de cirurgia bariátrica. Ao grupo de intervenção, foi aplicado um programa de atividade física moderada durante seis meses. A força muscular e a bioimpedância foram medidas em sua forma basal em um mês e aos seis meses depois da cirurgia. Foi realizado um estudo de bivariante para observar as mudanças das variáveis. Resultados: ao realizar o teste t de Student para amostras independentes em todas as variáveis (peso, índice de massa corporal, força muscular, massa magra, massa gordurosa e metabolismo), não se verificam diferenças significativas entre o grupo de intervenção e o grupo controle com p > 0,05. Conclusão: um programa de atividade física moderada de seis meses de duração em pacientes submetidos à cirurgia bariátrica não apresenta resultados significantes no desenvolvimento da massa muscular avaliada por meio da dinamometria manual e da bioimpedância.

Feasibility and Reliability of a Physical Fitness Test Battery in Individuals with Down Syndrome.

BACKGROUND: Down syndrome (DS) is a genetic disorder that occurs because of an abnormal division between cells that results in an extra copy of chromosome 21. Some studies show that physical exercise in people with DS increases some cognitive capacities, such as memory, and improves the quality of life. AIM: The main aim of this study was to perform an analysis of the reliability and feasibility of the SAMU-Disability Fitness (DISFIT) battery in adults with DS. METHODS: A cross-sectional study with a test-retest design was performed in a maximum interval of 2 weeks in 37 subjects (11 women and 26 men) aged between 21 and 58 years old with DS. Eight field-based fitness tests were proposed to assess the physical fitness (PF) of adults with DS: Body Mass Index (BMI), Waist Circumference (WC), the Timed Up and Go test (TUG), the Deep Trunk Flexibility test (DTF), the Hand Grip test (HG), the Timed Stand Test (TST), the 30-s Sit-Up (SUP) and the 6-Min Walk Test (6MWT). RESULTS: The intra-class correlation coefficient (ICC) in all the tests was good and high (>0.80), except for the 6MWT, whose reliability was fair. CONCLUSION: The SAMU-DISFIT battery is a reliable and feasible physical fitness battery which has been created with the purpose of establishing tests which measure the four basic components of PF (flexibility, cardiorespiratory fitness, musculoskeletal fitness and motor fitness) in adults with DS.

Randomized Clinical Trial of an Aquatic Physical Exercise Program During Pregnancy.

OBJECTIVE: To determine the effect of an aquatic physical exercise program performed during pregnancy on rate of intact perineum after childbirth. DESIGN: Randomized clinical trial. SETTING: Health centers in the metropolitan health district of Granada, Spain. PARTICIPANTS: A total of 129 pregnant women (control group [CG] = 64; aquatic exercise group [EG] = 65). METHODS: The intervention was an aquatic physical exercise program specifically designed for pregnant women (Study of Water Exercise During Pregnancy [SWEP] method). Participants were randomly assigned to the CG or EG by simple random sampling. Participants in the EG performed three sessions per week of physical exercises, which were led by the principal investigator. All participants received routine prenatal care. We evaluated status of the perineum after birth, including laceration and episiotomy rates. We also evaluated participants' weight, body mass index (BMI) in the first and third trimesters, parity, the administration of anesthesia, and birth weight of the neonate as potential confounding variables. RESULTS: The women in the EG had a greater rate of intact perineum than those in the CG (odds ratio [OR] = 13.54, 95% confidence interval [CI] [2.75, 66.56]). After adjusting for infant birth weight, the effect of the intervention on intact perineum was an OR of 8.57 (95% CI [1.85, 39.68]. Maternal weight gain did not influence the odds of intact perineum (OR = 1.072, 95% CI [0.896, 1.283]). Women who previously gave birth and followed the SWEP method had an OR of 10.197 (95% CI [2.190, 47.476] for an intact perineum. The administration of anesthesia and previous pregnancy also were associated with intact perineum (OR = 6.68, 95% CI [1.21, 36.84] and OR = 5.42, 95% CI [1.64, 17.89] respectively. CONCLUSION: The women who followed the SWEP method were significantly more likely to have intact perinea after childbirth.

Physical activity during pregnancy and its influence on delivery time: a randomized clinical trial.

INTRODUCTION: During pregnancy, women often change their lifestyle for fear of harmful effects on the child or themselves. In this respect, many women reduce the amount of physical exercise they take, despite its beneficial effects. OBJECTIVE: To determine the duration of labor in pregnant women who completed a program of moderate physical exercise in water and subsequently presented eutocic birth. METHODS: A randomized trial was performed with 140 healthy pregnant women, divided into an exercise group (EG) (n = 70) and a control group (CG) (n = 70). The women who composed the study population were recruited at 12 weeks of gestation. The intervention program, termed SWEP (Study of Water Exercise during Pregnancy) began in week 20 of gestation and ended in week 37. Perinatal outcomes were determined by examining the corresponding partographs, recorded by the Maternity Service at the Granada University Hospital Complex. RESULTS: The intervention phase of the study took place from June through October 2016, with the 120 women finally included in EG and CG (60 in each group). At term, 63% of the women in EG and 56% of those in CG had a eutocic birth. The average total duration of labor was 389.33 ± 216.18 min for the women in EG and 561.30 ± 199.94 min for those in CG, a difference of approximately three hours (p < 0.001). CONCLUSIONS: The women who exercised in water during their pregnancy presented a shorter duration of labor than those who did not. The difference was especially marked with respect to the duration of the first and second stages of labor.

Moderate Physical Activity in an Aquatic Environment During Pregnancy (SWEP Study) and Its Influence in Preventing Postpartum Depression.

INTRODUCTION: Postpartum depression (PPD) can begin within 6 weeks postpartum (International Classification of Diseases, 10th Revision) and represents a significant health problem for mothers. AIM: To determine whether physical activity during pregnancy alleviates PPD. METHOD: Randomized controlled trial in which the exercise group practiced moderate physical exercise in an aquatic environment (1-hour sessions, 3 days a week), following the recommendations of the SWEP method. RESULTS: The results observed in the Edinburgh Postnatal Depression Scale were significant between the exercise group and the control group ( p < .001). In addition, significant differences were observed according in body mass index between the exercise group and control group in the overweight and obesity categories ( p < .05). CONCLUSION: Women who perform moderate physical exercise in an aquatic environment are at lower risk of PPD than sedentary women. Overweight and obesity among sedentary women during pregnancy are closely associated with positive screening for PPD.

[Influence of physical exercise during pregnancy on newborn weight: a randomized clinical trial]. / Influencia del ejercicio físico durante el embarazo sobre el peso del recién nacido: un ensayo clínico aleatorizado.

INTRODUCTION: Recent studies have proved that physical activity of the pregnant woman brings benefits not only for the mother but also for the fetus, given that it decreases the number of macrosomic newborns and their negative consequences in both of them. OBJECTIVE: To analyze in pregnant women the influence of a moderate physical activity program in the aquatic environment on the weight of the newborn. MATERIAL AND METHODS: A randomized clinical trial with 140 healthy pregnant women, aged between 21 and 43 years, divided into two groups, study (GE, n = 70) and control (GC, n = 70). The women were attracted at 12 weeks of gestation in the first trimester ultrasound control carried out in the different obstetrical services in Granada. They joined the program at week 20 of gestation and ended in week 37. The perinatal results were obtained from the partograph of each woman, included in the Delivery Room Services of the Complejo Hospitalario Universitario de Granada. RESULTS: The median weight of the babies of the pregnant women who participated in the intervention was 3,250 g, compared to the babies of the control group, with a median of 3,460 g. There were statistically significant differences between the two groups (p = 0.011). Among newborns, 86.8% of both groups had weights within clinical normality, that is between 2,500 and 4,000 g. Women who followed the SWEP (Study Water Exercise Pregnant) method during pregnancy had a weight gain of 8.28 kg, compared to sedentary women, who presented a 11.17 kg weight gain. However, the rate of macrosomic infants was similar, so there were no significant differences between the two groups (GC n = 7, GE n = 6). There were no significant differences in gestation time between the two groups, with an average of 279.70 days (GC) and 280.09 days (SG) (p-value > 0.05). CONCLUSION: Moderate physical activity in the aquatic environment, following the SWEP methodology, does not present risks of preterm birth and does not alter the gestation time with regard to the sedentary women during pregnancy. Physical exercise has achieved a significant decrease in the weight of the newborn and a less profit ponderal during pregnancy. These two results have not been instrumental in reducing the rate of macrosomies in our study.

INTRODUCCIÓN: los últimos estudios han demostrado que la actividad física de la mujer embarazada aporta beneficios no solo para la madre sino también para el feto, puesto que disminuye el número de recién nacidos macrosómicos y sus consecuencias negativas para los dos. OBJETIVO: analizar la influencia de un programa de actividad física de carácter moderado para la mujer gestante en el medio acuático sobre el peso del recién nacido. MATERIAL Y MÉTODOS: ensayo clínico aleatorizado con 140 mujeres gestantes sanas, con edades entre 21 y 43 años y divididas en dos grupos, estudio (GE, n = 70) y control (GC, n = 70). Las mujeres fueron captadas a las 12 semanas de gestación en el control ecográfico del primer trimestre, en los distintos servicios de obstetricia de Granada. Se incorporaron al programa en la semana 20 de gestación y terminaron en la semana 37. Los resultados perinatales se obtuvieron del partograma de cada mujer, registrado en los Servicios de Paritorio del Complejo Hospitalario Universitario de Granada. RESULTADOS: la mediana del peso de los bebes de las gestantes que participaron en la intervención fue de 3.250 g, frente a la de los bebes del grupo control, que fue de 3.460 g; existen diferencias estadísticamente significativas entre ambos grupos (p = 0,011). El 86,8% de los dos grupos presentaba pesos dentro de la normalidad clínica, esto es, entre 2.500 y 4.000 g. Las mujeres que siguieron el método SWEP (Study Water Exercise Pregnant)durante el embarazo tuvieron una ganancia ponderal de 8,28 kg, frente a las mujeres sedentarias, en las cuales fue de 11,17 kg (p < 0,001). Sin embargo, la tasa de bebés macrosómicos fue similar, por lo que no se presentan diferencias significativas entre los dos grupos (GC n = 7, GE n = 6). No hubo diferencias significativas en el tiempo de gestación entre ambos grupos, con una media de 279,70 días (GC) y 280,09 días (GE) (p-valor > 0,05). CONCLUSIÓN: La actividad física de carácter moderado en el medio acuático siguiendo la metodología SWEP no presenta riesgos de parto prematuro y no se altera el tiempo de gestación con respecto a las mujeres sedentarias durante el embarazo. El ejercicio físico ha logrado una disminución significativa del peso del recién nacido y una menor ganancia ponderal durante el embarazo. Estos dos resultados no han sido determinantes para reducir la tasa de macrosomías en nuestro estudio.

Influencia del ejercicio físico durante el embarazo sobre el peso del recién nacido: un ensayo clínico aleatorizado / Influence of physical exercise during pregnancy on newborn weight: a randomized clinical trial

Introducción: los últimos estudios han demostrado que la actividad física de la mujer embarazada aporta beneficios no solo para la madre sino también para el feto, puesto que disminuye el número de recién nacidos macrosómicos y sus consecuencias negativas para los dos. Objetivo: analizar la influencia de un programa de actividad física de carácter moderado para la mujer gestante en el medio acuático sobre el peso del recién nacido. Material y métodos: ensayo clínico aleatorizado con 140 mujeres gestantes sanas, con edades entre 21 y 43 años y divididas en dos grupos, estudio (GE, n = 70) y control (GC, n = 70). Las mujeres fueron captadas a las 12 semanas de gestación en el control ecográfico del primer trimestre, en los distintos servicios de obstetricia de Granada. Se incorporaron al programa en la semana 20 de gestación y terminaron en la semana 37. Los resultados perinatales se obtuvieron del partograma de cada mujer, registrado en los Servicios de Paritorio del Complejo Hospitalario Universitario de Granada. Resultados: la mediana del peso de los bebes de las gestantes que participaron en la intervención fue de 3.250 g, frente a la de los bebes del grupo control, que fue de 3.460 g; existen diferencias estadísticamente significativas entre ambos grupos (p = 0,011). El 86,8% de los dos grupos presentaba pesos dentro de la normalidad clínica, esto es, entre 2.500 y 4.000 g. Las mujeres que siguieron el método SWEP (Study Water Exercise Pregnant) durante el embarazo tuvieron una ganancia ponderal de 8,28 kg, frente a las mujeres sedentarias, en las cuales fue de 11,17 kg (p < 0,001). Sin embargo, la tasa de bebés macrosómicos fue similar, por lo que no se presentan diferencias significativas entre los dos grupos (GC n = 7, GE n = 6). No hubo diferencias significativas en el tiempo de gestación entre ambos grupos, con una media de 279,70 días (GC) y 280,09 días (GE) (p-valor > 0,05). Conclusión: La actividad física de carácter moderado en el medio acuático siguiendo la metodología SWEP no presenta riesgos de parto prematuro y no se altera el tiempo de gestación con respecto a las mujeres sedentarias durante el embarazo. El ejercicio físico ha logrado una disminución significativa del peso del recién nacido y una menor ganancia ponderal durante el embarazo. Estos dos resultados no han sido determinantes para reducir la tasa de macrosomías en nuestro estudio (AU)

Introduction: Recent studies have proved that physical activity of the pregnant woman brings benefits not only for the mother but also for the fetus, given that it decreases the number of macrosomic newborns and their negative consequences in both of them. Objective: To analyze in pregnant women the influence of a moderate physical activity program in the aquatic environment on the weight of the newborn. Material and methods: A randomized clinical trial with 140 healthy pregnant women, aged between 21 and 43 years, divided into two groups, study (GE, n = 70) and control (GC, n = 70). The women were attracted at 12 weeks of gestation in the first trimester ultrasound control carried out in the different obstetrical services in Granada. They joined the program at week 20 of gestation and ended in week 37. The perinatal results were obtained from the partograph of each woman, included in the Delivery Room Services of the Complejo Hospitalario Universitario de Granada. Results: The median weight of the babies of the pregnant women who participated in the intervention was 3,250 g, compared to the babies of the control group, with a median of 3,460 g. There were statistically significant differences between the two groups (p = 0.011). Among newborns, 86.8% of both groups had weights within clinical normality, that is between 2,500 and 4,000 g. Women who followed the SWEP (Study Water Exercise Pregnant) method during pregnancy had a weight gain of 8.28 kg, compared to sedentary women, who presented a 11.17 kg weight gain. However, the rate of macrosomic infants was similar, so there were no significant differences between the two groups (GC n = 7, GE n = 6). There were no significant differences in gestation time between the two groups, with an average of 279.70 days (GC) and 280.09 days (SG) (p-value > 0.05). Conclusion: Moderate physical activity in the aquatic environment, following the SWEP methodology, does not present risks of preterm birth and does not alter the gestation time with regard to the sedentary women during pregnancy. Physical exercise has achieved a significant decrease in the weight of the newborn and a less profit ponderal during pregnancy. These two results have not been instrumental in reducing the rate of macrosomies in our study (AU)

Beneficios inmunológicos de la leche humana para la madre y el niño. Revisión sistemática / Immunological benefits of human milk for the mother and child. Systematic review

Introducción: la leche es un fluido cambiante formado por lípidos, proteínas, minerales y moléculas inmunes. Las tasas de lactancia materna (LM) exclusiva se encuentran por debajo de los objetivos fijados por la Organización Mundial de la Salud (OMS), que establece que las madres deben dar el pecho de forma exclusiva durante 6 meses y suplementarla con otros alimentos durante los dos primeros años. Si se llevan a cabo esas recomendaciones, las madres y sus bebés se verían beneficiados. La leche materna modifica su composición en función de la edad del bebé, el momento del día, la dieta materna o el grado de plenitud de la glándula mamaria. Estudios recientes apuntan que existe una relación dinámica entre el estado de salud del niño y la composición de la leche de la madre, ya que, incluso, aumenta la producción de anticuerpos ante una infección activa del lactante. Objetivo: efectuar una revisión sistemática de la literatura científica a base de reunir los conocimientos actuales relacionados con las propiedades inmunológicas de la lactancia materna y de sus efectos en la salud de la madre y el niño. Métodos: se lleva a cabo una búsqueda sistemática y se seleccionan 21 artículos específicos sobre el tema, siguiendo las directrices PRISMA. Resultados: los estudios analizados muestran que la leche materna tiene gran cantidad de componentes inmunológicos que aumentan ante las necesidades del bebé. También ofrece beneficios físicos y psicológicos para la madre y el niño y supone, igualmente, un ahorro económico al disminuir los ingresos hospitalarios de los bebés, puesto que disminuye su morbilidad. Conclusiones: los bebés alimentados con leche materna tienen menos probabilidades de padecer enfermedades gastrointestinales, respiratorias, alérgicas o asma, y también previene la obesidad infantil. Además, la LM tiene efectos beneficiosos para la madre, pues disminuye el riesgo de padecer cáncer de mama, enfermedades cardiovasculares y el síndrome metabólico. Se deben aumentar las tasas de lactancia materna exclusiva, al menos hasta los 6 meses de vida (AU)

Introduction: Milk is a changing fluid composed of lipids, proteins, minerals and immune molecules. The exclusive breastfeeding (BF) rates are below the targets set by the World Health Organization (WHO) who states that mothers should breastfeed exclusively for 6 months and supplement it with other foods during the first two years. If these recommendations are carried out, they would benefit mothers and their babies. Breast milk changes its composition depending on the baby’s age, the time of day, the mother’s diet or the degree of fullness of the breast. Recent studies suggest that there is a dynamic relationship between the health of children and the composition of breast milk because it increases the production of antibodies against an active infection of the infant. Objective: Perform a systematic review of the scientific literature, grouping current knowledge gathering related to the immunological properties of breast-feeding and its effects on the health of the mother and child. Methods: We conducted a systematic search and 21 specific articles on the subject are selected, following the PRISMA guidelines. Results: The studies analyzed concluded that breast milk has a lot of immune components which increase according to the baby’s needs. It also has physical and psychological benefits for mother and child and it also assumed a cost savings by reducing hospital admissions of infants, because it reduces morbidity. Conclusions: Breast-fed babies have less gastrointestinal, respiratory, allergic diseases or asthma and human milk prevents childhood obesity. In addition, the BF has beneficial effects for the mother; it decreases the risk of breast cancer, cardiovascular disease and metabolic syndrome. Mothers should increase rates of exclusive breastfeeding until at least 6 months (AU)

[Not Available]. / Influencia del programa SWEP (Study Water Exercise Pregnant) en los resultados perinatales: protocolo de estudio

Introduction: Moderate exercise training during the pregnancy benefits both the pregnant woman and the fetus. The research papers consulted have linked physical activity with the reduction of the number of cesareans, instrumental delivery and with a more physiological delivery. It also prevents excessive weight gain in women and decreases the risk of gestational diabetes and high blood pressure. Aim: The aim of this research is to know if an exercise program of moderate character with Water Study Exercise Pregnant (SWEP) method, performed in an aquatic environment, contributes to have more favorable results in the perinatal period, both for women and baby. Material and methods: The design is a randomized clinical trial. The sample will consist of 364 pregnant women, with a total universe of 6,579 births occurred in Granada (Spain) during 2014. The sample was divided into two groups, intervention group and control group. The activity will be carried out in the water sporting facilities of the Faculty of Sports Science of the University of Granada, which have two pools suitable for our purposes: a 25-meter polyvalent pool and a 12.5-meter pool for training. Results: The exercise program designed specifically for the project called SWEP is performed from 20 to 37 weeks of gestation (SG), and it consists of three weekly sessions, with duration of 60 minutes each. Sessions will include three phases: warm-up phase, the main phase in which the exercise is divided into an aerobic phase and strength training and endurance training phase and a final phase of stretching and relaxation. The variables that will be studied are: a) Maternal: weight, BMI, blood pressure, O'Sullivan test, postpartum depression, level of self-rated health, sleep quality and perceived exertion during physical activity; b) fetal: weight, Apgar scores, head circumference and GA (Gestational age); c) peripartum: time dilation, expulsion and delivery, type of delivery, episiotomy, type of feed received by the RN and time of exclusive breastfeeding; and d) descriptive: age, occupation, education level, type of exercise done before and OF (obstetric formula). Conclusion: With aquatic moderate physical activity during pregnancy (method SWEP), we intended to improve the variables above.

Introducción: El entrenamiento mediante ejercicio físico moderado durante el periodo de gestación aporta beneficios tanto a la mujer embarazada como al feto. Los trabajos de investigación consultados vinculan la actividad física con una reducción del número de cesáreas, de partos instrumentados y con un parto más fisiológico. Previene igualmente la ganancia excesiva de peso de la mujer, disminuye el riesgo de diabetes gestacional y de hipertensión arterial. Objetivo: El objetivo de esta investigación es conocer si un programa de ejercicio físico de carácter moderado con el método Study Water Exercise Pregnant (SWEP), realizado en un medio acuático, contribuye a obtener unos resultados más favorables en la etapa perinatal, tanto para la mujer como para el bebé. Material y métodos: El diseño que se llevará a cabo es un ensayo clínico aleatorizado. La muestra estará constituida por 364 gestantes, obtenida de un universo total de 6.579 partos acontecidos en Granada (España) durante el año 2014. Dicha muestra se ha dividido en dos grupos, uno de intervención y otro de control. La actividad se realizará en las instalaciones deportivas acuáticas de la Facultad de Ciencias del Deporte de la Universidad de Granada, que cuentan con dos vasos adecuados a nuestros objetivos, uno polivalente de 25 metros y otro de enseñanza de 12,5 metros. Resultados: El programa de ejercicios diseñado específicamente para el proyecto denominado SWEP, abarca desde la 20 hasta la 37 semana de gestación (SG) y consta de tres sesiones semanales, con una duración de 60 minutos cada una. Las sesiones incluirán tres fases: fase de calentamiento, fase principal en la que el ejercicio se divide en una parte aeróbica y otra de ejercicios de fuerza y resistencia y una final con estiramientos y relajación. Las variables que se van a estudiar son las siguientes: a) maternas: peso, IMC, tensión arterial, test de O´Sullivan, aparición de depresión postparto, nivel de autopercepción de salud, calidad del sueño y esfuerzo percibido durante la actividad física; b) fetales: peso, test de Apgar, perímetro cefálico y SG (semana de gestación al nacimiento); c) periparto: tiempos de dilatación, expulsivo y alumbramiento, tipo de parto, presencia de episiotomía, tipo de alimentación que recibe el RN y tiempo de lactancia materna exclusiva; y d) descriptivas: edad, profesión, nivel de estudios, tipo de ejercicio físico realizado previamente y FO (fórmula obstétrica). Conclusión: Con la actividad física acuática moderada, por parte de la embarazada (método SWEP), se pretenden mejorar las variables arriba indicadas.

Influencia del programa SWEP (Study Water Exercise Pregnant) en los resultados perinatales: protocolo de estudio / Influence of SWEP (Study Pregnant Water Exercise) program in perinatal outcomes: Study protocol

Introducción: el entrenamiento mediante ejercicio físico moderado durante el periodo de gestación aporta beneficios tanto a la mujer embarazada como al feto. Los trabajos de investigación consultados vinculan la actividad física con una reducción del número de cesáreas, de partos instrumentados y con un parto más fisiológico. Previene igualmente la ganancia excesiva de peso de la mujer, disminuye el riesgo de diabetes gestacional y de hipertensión arterial. Objetivo: el objetivo de esta investigación es conocer si un programa de ejercicio físico de carácter moderado con el método Study Water Exercise Pregnant (SWEP), realizado en un medio acuático, contribuye a obtener unos resultados más favorables en la etapa perinatal, tanto para la mujer como para el bebé. Material y métodos: el diseño que se llevará a cabo es un ensayo clínico aleatorizado. La muestra estará constituida por 364 gestantes, obtenida de un universo total de 6.579 partos acontecidos en Granada (España) durante el año 2014. Dicha muestra se ha dividido en dos grupos, uno de intervención y otro de control. La actividad se realizará en las instalaciones deportivas acuáticas de la Facultad de Ciencias del Deporte de la Universidad de Granada, que cuentan con dos vasos adecuados a nuestros objetivos, uno polivalente de 25 metros y otro de enseñanza de 12,5 metros. Resultados: el programa de ejercicios diseñado específicamente para el proyecto denominado SWEP, abarca desde la 20 hasta la 37 semana de gestación (SG) y consta de tres sesiones semanales, con una duración de 60 minutos cada una. Las sesiones incluirán tres fases: fase de calentamiento, fase principal en la que el ejercicio se divide en una parte aeróbica y otra de ejercicios de fuerza y resistencia y una final con estiramientos y relajación. Las variables que se van a estudiar son las siguientes: a) maternas: peso, IMC, tensión arterial, test de O´Sullivan, aparición de depresión postparto, nivel de autopercepción de salud, calidad del sueño y esfuerzo percibido durante la actividad física; b) fetales: peso, test de Apgar, perímetro cefálico y SG (semana de gestación al nacimiento); c) periparto: tiempos de dilatación, expulsivo y alumbramiento, tipo de parto, presencia de episiotomía, tipo de alimentación que recibe el RN y tiempo de lactancia materna exclusiva; y d) descriptivas: edad, profesión, nivel de estudios, tipo de ejercicio físico realizado previamente y FO (fórmula obstétrica). Conclusión: con la actividad física acuática moderada, por parte de la embarazada (método SWEP), se pretenden mejorar las variables arriba indicadas (AU)

Introduction: Moderate exercise training during the pregnancy benefits both the pregnant woman and the fetus. The research papers consulted have linked physical activity with the reduction of the number of cesareans, instrumental delivery and with a more physiological delivery. It also prevents excessive weight gain in women and decreases the risk of gestational diabetes and high blood pressure. Aims: The aim of this research is to know if an exercise program of moderate character with Water Study Exercise Pregnant (SWEP) method, performed in an aquatic environment, contributes to have more favorable results in the perinatal period, both for women and baby. Material and methods: The design is a randomized clinical trial. The sample will consist of 364 pregnant women, with a total universe of 6,579 births occurred in Granada (Spain) during 2014. The sample was divided into two groups, intervention group and control group. The activity will be carried out in the water sporting facilities of the Faculty of Sports Science of the University of Granada, which have two pools suitable for our purposes: a 25-meter polyvalent pool and a 12.5-meter pool for training. Results: The exercise program designed specifically for the project called SWEP is performed from 20 to 37 weeks of gestation (SG), and it consists of three weekly sessions, with duration of 60 minutes each. Sessions will include three phases: warm-up phase, the main phase in which the exercise is divided into an aerobic phase and strength training and endurance training phase and a final phase of stretching and relaxation. The variables that will be studied are: a) Maternal: weight, BMI, blood pressure, O’Sullivan test, postpartum depression, level of self-rated health, sleep quality and perceived exertion during physical activity; b) fetal: weight, Apgar scores, head circumference and GA (Gestational age); c) peripartum: time dilation, expulsion and delivery, type of delivery, episiotomy, type of feed received by the RN and time of exclusive breastfeeding; and d) descriptive: age, occupation, education level, type of exercise done before and OF (obstetric formula). Conclusion: With aquatic moderate physical activity during pregnancy (method SWEP), we intended to improve the variables above (AU)