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1.
Rev Saude Publica ; 53: 100, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31800911

RESUMO

OBJECTIVE: To evaluate the clinical factors, as well as weight gain, in a group of pregnant women, associating them with fetal macrosomia in a public institution in Antioquia, Colombia, from 2010-2017. METHODS: A case-control study, using secondary information registries. Cases were defined using newborn weight of ≥ 4000g, while controls were defined as newborn weight between 3000-3999g. A proportion ratio (PR) was established to evaluate factors associated with macrosomia, and a generalized linear model (GLM) of Poisson regression with robust variance was used to evaluate the aspects that best explained macrosomia in the neonate. RESULTS: 122 pregnant women participated in the study, of which 611 were cases and 61 were controls. Of the participants, 44.3% had pre-pregnancy overweight and 48.4% had excess gestational weight gain. Statistically significant differences were found between the groups in the following variables: pre-pregnancy BMI (p = 0.004), gestational weight gain (p = 0.000), gestational diabetes (p = 0.000), and type of delivery (p = 0.004). According to the regression model, a macrosomic newborn is 3.5 times more likely in women with excessive gestational weight gain (95%CI 1.78-7.18) and twice more likely in women who have gestational diabetes (95%CI 1.51-2.76). Of women with pre-pregnancy excess weight, 63% had excess gestational weight gain. CONCLUSIONS: Within this cohort, pre-pregnancy BMI, excess weight gain in pregnancy, and the presence of gestational diabetes were associated with an increased risk of neonatal macrosomia. pre-pregnancy BMI and weight gain in pregnancy are modifiable risk factors that are responsive to nutrition interventions, which can minimize adverse perinatal outcomes.


Assuntos
Macrossomia Fetal/etiologia , Ganho de Peso na Gestação/fisiologia , /complicações , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Colômbia , Estudos Transversais , Diabetes Gestacional/fisiopatologia , Feminino , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
2.
PLoS Med ; 16(12): e1003009, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31887140

RESUMO

BACKGROUND: Suboptimal weight gain during pregnancy is a potentially modifiable risk factor. We aimed to investigate the association between suboptimal gestational weight gain and severe adverse birth outcomes by pre-pregnancy body mass index (BMI) categories, including obesity class I to III. METHODS AND FINDINGS: We conducted a population-based study of pregnant women with singleton hospital births in Washington State, US, between 2004 and 2013. Optimal, low, and excess weight gain in each BMI category was calculated based on weight gain by gestational age as recommended by the American College of Obstetricians and Gynecologists and the Institute of Medicine. Primary composite outcomes were (1) maternal death and/or severe maternal morbidity (SMM) and (2) perinatal death and/or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios (AORs) and 95% confidence intervals. Overall, 722,839 women with information on pre-pregnancy BMI were included. Of these, 3.1% of women were underweight, 48.1% had normal pre-pregnancy BMI, 25.8% were overweight, and 23.0% were obese. Only 31.5% of women achieved optimal gestational weight gain. Women who had low weight gain were more likely to be African American and have Medicaid health insurance, while women with excess weight gain were more likely to be non-Hispanic white and younger than women with optimal weight gain in each pre-pregnancy BMI category. Compared with women who had optimal weight gain, those with low gestational weight gain had a higher rate of maternal death, 7.97 versus 2.63 per 100,000 (p = 0.027). In addition, low weight gain was associated with the composite adverse maternal outcome (death/SMM) in women with normal pre-pregnancy BMI and in overweight women (AOR 1.12, 95% CI 1.04-1.21, p = 0.004, and AOR 1.17, 95% CI 1.04-1.32, p = 0.009, respectively) compared to women in the same pre-pregnancy BMI category who had optimal weight gain. Similarly, excess gestational weight gain was associated with increased rates of death/SMM among women with normal pre-pregnancy BMI (AOR 1.20, 95% CI 1.12-1.28, p < 0.001) and obese women (AOR 1.12, 95% CI 1.01-1.23, p = 0.019). Low gestational weight gain was associated with perinatal death and severe neonatal morbidity regardless of pre-pregnancy BMI, including obesity classes I, II, and III, while excess weight gain was associated with severe neonatal morbidity only in women who were underweight or had normal BMI prior to pregnancy. Study limitations include the ascertainment of pre-pregnancy BMI using self-report, and lack of data availability for the most recent years. CONCLUSIONS: In this study, we found that most women do not achieve optimal weight gain during pregnancy. Low weight gain was associated with increased risk of severe adverse birth outcomes, and in particular with maternal death and perinatal death. Excess gestational weight gain was associated with severe adverse birth outcomes, except for women who were overweight prior to pregnancy. Weight gain recommendations for this group may need to be reassessed. It is important to counsel women during pregnancy about specific risks associated with both low and excess weight gain.


Assuntos
Idade Gestacional , Ganho de Peso na Gestação/fisiologia , Complicações na Gravidez/etiologia , Resultado da Gravidez/epidemiologia , Adulto , Peso ao Nascer/fisiologia , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Obesidade/complicações , Sobrepeso/complicações , Gravidez , Estudos Retrospectivos , Fatores de Risco , Washington , Adulto Jovem
3.
Diabetes Res Clin Pract ; 158: 107912, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31682880

RESUMO

AIMS: To compare the abilities of Intergrowth-21st standards, Institute of Medicine (IOM) recommendations and a Chinese reference on gestational weight gain (GWG) to identify women at risk of gestational diabetes (GDM) and GDM-related adverse outcomes. METHODS: A retrospective cohort study was conducted on 13,366 women delivering live singleton infants between 2013 and 2017 in Tongzhou district of Beijing, China. Poisson regression with robust error estimates was used to estimate risk ratios (RRs) of GDM in different GWG groups according to three standards. RESULTS: There were 39.97%, 46.31% and 30.03% of women gaining weight above Intergrowth-21st standards, IOM recommendations and the Chinese reference respectively. Women with GWG above Intergrowth-21st standards and the Chinese reference had 27% (aRR, 1.27 95% CI, 1.18-1.37) and 30% (aRR, 1.30; 95% CI, 1.21-1.40) increased risks of GDM respectively, as compared to 22% (aRR, 1.22; 95% CI, 1.13-1.32) for IOM recommendations. GWG above either of these three standards was associated with macrosomia and cesarean delivery (P < 0.05). CONCLUSION: Compared with IOM recommendations, GWG above Intergrowth-21st standards or the Chinese reference was associated with higher risks of GDM and GDM-related adverse outcomes. Furthermore, these two prospective standards could additionally assess the severity of abnormal GWG and are feasible for dynamic monitoring.


Assuntos
Diabetes Gestacional/etiologia , Ganho de Peso na Gestação/fisiologia , Adulto , Feminino , Humanos , Gravidez , Complicações na Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Estados Unidos
4.
J Med Life ; 12(2): 178-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31406521

RESUMO

Weight gain during pregnancy can be a real risk factor for long-term obesity which has implications in all areas of medicine. This study is designed to assess pregnancy-related weight gain and postpartum weight loss, to identify a possible correlation between weight gain during pregnancy and the risk of obesity in the late postpartum period. The batch comprised 306 women, hospitalized in the Obstetrics and Gynecology Section of the "Nicolae Malaxa" Clinical Hospital between June - November 2017. During this study, we assessed the weight status using the Weight, Body Mass Index, Height, and Abdominal Circumference. These parameters were clinically assessed in three periods pre-pregnancy, early postpartum period, late postpartum period. We also collected data on the evolution of the pregnancy using the anamnesis and the personal pregnancy monitoring sheet. Pregnancy and postpartum period represent a key moment in women's lives in which the risk of obesity is real. Understanding women experiences with weight changes during pregnancy and postpartum period can improve the management of losing weight following pregnancy, avoid long-term weight gain and so reduce the risk for obesity. Also, the correct management of obesity should include the assessment of somatic disorders that may cause major dysfunction, requiring complex rehabilitation programs.


Assuntos
Ganho de Peso na Gestação/fisiologia , Obesidade/complicações , Período Pós-Parto/fisiologia , Perda de Peso , Adolescente , Adulto , Índice de Massa Corporal , Parto Obstétrico , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
6.
Nutr. hosp ; 36(4): 854-861, jul.-ago. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184711

RESUMO

Background: postpartum weight retention (PWR) strongly predicts obesity, the major nutritional concern of this century; however, there is a gap in nutritional care for postpartum women in Brazil. Objective: to evaluate the effect of nutritional counselling provided at primary health care on the reduction of PWR. Method: pilot study carried out in a low-income community in southeastern Brazil, involving postpartum women with PWR, who were provided with individual monthly appointments with a nutritionist over three months of follow-up. Nutritional counselling was based on the Dietary Approach to Stop Hypertension (DASH diet) aiming at healthy and gradual weight loss. Anthropometric evaluation included measurement of weight, height, waist circumference and percentage of body fat. Dietary intake was assessed using a food frequency questionnaire and adherence to diet was evaluated using a DASH score. Results: women who participated in the study (n = 26) showed a reduction in PWR (median -1.80 kg, p = 0.004), body mass index (-0.57 kg/m², p = 0.004), and waist circumference (-2.50 cm, p = 0.024), as well as 91.67% of them presented good adherence to diet. Conclusion: nutritional counselling provided to low-income postpartum women at primary health care contributed to the reduction of PWR, body mass index and waist circumference, as the study participants presented good adherence to a healthy dietary pattern


Introducción: la retención de peso después del parto (RPDP) predice firmemente la obesidad, que es la principal preocupación nutricional de este siglo; sin embargo, existe una brecha en la atención nutricional para las mujeres después del parto en Brasil. Objetivo: evaluar el efecto del asesoramiento nutricional brindado en Atención Primaria sanitaria sobre la reducción de RPDP. Método: estudio piloto realizado en una comunidad de bajos ingresos en el sureste de Brasil, en el que participaron mujeres postparto con RPDP, que recibieron citas mensuales individuales con un nutricionista durante tres meses de seguimiento. El asesoramiento nutricional se basó en la dieta Dietary Approach to Stop Hypertension (DASH) y apuntó a una pérdida de peso saludable y gradual. La evaluación antropométrica incluyó la medición del peso, la altura, la circunferencia de la cintura y el porcentaje de grasa corporal. La ingesta dietética se evaluó mediante un cuestionario de frecuencia alimentaria y la adherencia a la dieta se evaluó mediante un score DASH. Resultados: las mujeres que participaron en el estudio (n = 26) mostraron una reducción en la RPDP (mediana de -1,80 kg, p = 0,004), índice de masa corporal (-0,57 kg/m², p = 0,004) y circunferencia de la cintura (-2,50 cm, p = 0,024); el 91.67% de ellas presentaron buena adherencia a la dieta. Conclusión: el asesoramiento nutricional brindado a las mujeres de bajos ingresos después del parto en Atención Primaria sanitaria contribuyó a la reducción de la RPDP, el índice de masa corporal y la circunferencia de la cintura, ya que los participantes del estudio presentaron una buena adherencia a un patrón de dieta saludable


Assuntos
Humanos , Feminino , Ganho de Peso na Gestação/fisiologia , Atenção Primária à Saúde , Antropometria , Avaliação Nutricional , Projetos Piloto , Peso Corporal/fisiologia , Relação Cintura-Quadril , Índice de Massa Corporal , Brasil
7.
Nutr. hosp ; 36(4): 931-938, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184721

RESUMO

Introducción: el ejercicio físico es una buena forma de mantener un estilo de vida saludable y su práctica regular es recomendable durante el periodo gestacional, favoreciendo, entre otros, una adecuada ganancia ponderal durante la gestación y una mejor recuperación del peso pregestacional. Objetivo: analizar la evolución del peso, gestacional y posparto, en mujeres embarazadas que realizan un programa de ejercicio físico moderado en el medio acuático. Material y métodos: se realizó una intervención mediante un programa de ejercicio físico acuático diseñado específicamente para mujeres embarazadas. Los participantes fueron asignados al azar al grupo de ejercicios (GE; n = 65) o al grupo de control (GC; n = 64). Los participantes en el GE realizaron tres sesiones por semana de ejercicios físicos, que fueron dirigidos por el investigador principal. Las participantes del GC recibieron atención prenatal de rutina. El peso materno se midió durante la gestación en las semanas 20 y 35 y en el posparto en las semanas 16 y 28 del mismo. Resultados: la ganancia ponderal durante la gestación presenta diferencias significativas entre grupos (p < 0,001). Las retenciones de peso a los cuatro meses y a los siete meses fueron significativas entre GE y GC (p < 0,001). El peso del recién nacido se mantuvo en el rango de peso normal para recién nacidos a término en ambos grupos, aunque con diferencias significativas (p = 0,011). Conclusión: la metodología Study of Water Exercise Pregnancy (SWEP) durante el embarazo ayuda al control de la ganancia de peso gestacional y a la recuperación del peso pregestacional


Introduction: physical exercise is a good way to maintain a healthy lifestyle and its regular practice is recommended during the gestational period, favoring, among others, an adequate weight gain during pregnancy and a better recovery of pre-pregnancy weight. Objective: to analyze the evolution of weight, gestational and postpartum, in pregnant women who perform a program of moderate physical exercise in the aquatic environment. Material and methods: an intervention was carried out through a program of aquatic physical exercise designed specifically for pregnant women. The participants were randomly assigned to the exercise group (EG; n = 65) or to the control group (CG; n = 64). Participants in the EG performed three sessions per week of physical exercises, which were led by the principal investigator. CG participants received routine prenatal care. Maternal weight was measured during pregnancy at weeks 20 and 35, and postpartum at weeks 16 and 28 of the same. Results: weight gain during pregnancy shows significant differences between groups (p < 0.001). Weight retention at four months and at seven months were significant between EG and GC (p < 0.001). The weight of the newborn remained in the range of normal weight for term newborns in both groups, although with significant differences (p = 0.011). Conclusion: the Study of Water Exercise Pregnancy (SWEP) methodology during pregnancy helps control the gain of gestational weight and the recovery of pre-pregnancy weight


Assuntos
Humanos , Feminino , Gravidez , Adulto , Peso Corporal/fisiologia , Ganho de Peso na Gestação/fisiologia , Exercício , Esportes Aquáticos/fisiologia , Período Pós-Parto/fisiologia , Inquéritos e Questionários , Frequência Cardíaca
8.
Nutr Hosp ; 36(4): 931-938, 2019 Aug 26.
Artigo em Espanhol | MEDLINE | ID: mdl-31282169

RESUMO

Introduction: Introduction: physical exercise is a good way to maintain a healthy lifestyle and its regular practice is recommended during the gestational period, favoring, among others, an adequate weight gain during pregnancy and a better recovery of pre-pregnancy weight. Objective: to analyze the evolution of weight, gestational and postpartum, in pregnant women who perform a program of moderate physical exercise in the aquatic environment. Material and methods: an intervention was carried out through a program of aquatic physical exercise designed specifically for pregnant women. The participants were randomly assigned to the exercise group (EG; n = 65) or to the control group (CG; n = 64). Participants in the EG performed three sessions per week of physical exercises, which were led by the principal investigator. CG participants received routine prenatal care. Maternal weight was measured during pregnancy at weeks 20 and 35, and postpartum at weeks 16 and 28 of the same. Results: weight gain during pregnancy shows significant differences between groups (p < 0.001). Weight retention at four months and at seven months were significant between EG and GC (p < 0.001). The weight of the newborn remained in the range of normal weight for term newborns in both groups, although with significant differences (p = 0.011). Conclusion: the Study of Water Exercise Pregnancy (SWEP) methodology during pregnancy helps control the gain of gestational weight and the recovery of pre-pregnancy weight.


Assuntos
Exercício/fisiologia , Ganho de Peso na Gestação/fisiologia , Adulto , Peso ao Nascer , Feminino , Humanos , Recém-Nascido , Esforço Físico , Período Pós-Parto , Gravidez , Avaliação de Programas e Projetos de Saúde , Água , Adulto Jovem
9.
Medicine (Baltimore) ; 98(27): e16199, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277127

RESUMO

BACKGROUND: Clinical evidence indicates that women will benefit from regular physical activity during pregnancy. This study aimed to summarize and update the evidence on the effect of exercise on maternal gestational weight gain (GWG). METHODS: We conducted a systematic literature search of Pubmed, Embase, and Cochrane Library from inception until July, 2018 for randomized controlled trials (RCTs) that investigate the effect of physical exercises on the maternal GWG compared with that of no physical exercises or conventional medical care. We extracted data from eligible trials for study characteristics, interventions, patients' baseline characteristics and outcomes for the study populations of interest. We conducted meta-analyses using random effects models. RESULTS: From 844 citations, 23 RCTs including 4462 pregnant women met the inclusion criteria. Meta-analysis indicated that compared with that in women having conventional medical care, GWG was significantly decreased in pregnant women with physical exercise [weighted mean difference (WMD) -1.02, 95% CI -1.35 to -0.70; P < .01; I = 48.4%]. Women appeared to benefit more for gestational weight control for exercise frequency of 3 times per week (WMD -1.22, 95% CI -1.55 to -0.90; I = 40.3%) and exercise duration of 30 to 45 minutes each time (WMD -1.32, 95% CI -1.79 to -0.85; I = 1.5%). CONCLUSION: This meta-analysis provides indications that exercise intervention can reduce maternal GWG for pregnant women, especially for those with exercise frequency of 3 times per week and duration of 30 to 45 minutes each time.


Assuntos
Terapia por Exercício/métodos , Exercício/fisiologia , Ganho de Peso na Gestação/fisiologia , Sobrepeso/prevenção & controle , Complicações na Gravidez/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Feminino , Humanos , Sobrepeso/fisiopatologia , Gravidez , Complicações na Gravidez/fisiopatologia
10.
Rev Epidemiol Sante Publique ; 67(4): 253-260, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31255432

RESUMO

OBJECTIVES: Study weight gain in pregnant women according to the recommendations of the American Institute of Medicine (IOM 2009) and identify the associated factors with inadequate weight gain in pregnant women in Constantine (Algeria). MATERIALS AND METHODS: A prospective and longitudinal study of a cohort of 217 pregnant women aged 19 to 43 years was carried out during the entire period of pregnancy at antenatal consultation and monitoring centers in Constantine (Algeria) from December 2013 to July 2016. Their weight was measured in the first, second and third trimester. Gestational weight gain was classified as lower or meeting the IOM recommendations. Factors associated with gestational weight gain (GWG), such as pre-gestational body mass index, women's knowledge of GWG, sympathetic signs, eating habits and consumption, and maternal stress were studied. Statistics were performed using Statview™ and SPSS software. RESULTS: The majority of women (65.4 %) had inadequate total GWG and only 34.6 % of them had GWG consistent with IOM recommendations. Inadequate weight gain was more frequent in women obese before pregnancy (p<0.0001), women who reported not knowing the ideal GWG (p=0.01), had sympathetic signs (p=0.01), food aversions (p=0.0086), and insufficient vitamin, and mineral intakes (p<0.01). Inadequate GWG was also common among women with insufficient duration of sleep and living in a stressful environment. CONCLUSION: GWG is associated with a number of factors and variable relationships for each trimester of pregnancy.


Assuntos
Ganho de Peso na Gestação/fisiologia , Complicações na Gravidez/epidemiologia , Adulto , Argélia/epidemiologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Ganho de Peso/fisiologia , Adulto Jovem
11.
Obes Facts ; 12(4): 407-415, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31261149

RESUMO

OBJECTIVE: Timing of gestational weight gain (GWG) may influence perinatal outcomes differently. This study aimed to find associations of latent GWG patterns with risk of large for gestational age (LGA) in women with overweight or obesity. METHODS: A total of 4,438 women with overweight or obesity were included in the analyses. Latent trajectories of GWG associated with LGA were identified by trajectory analysis. GWG, risk of LGA and early pregnancy factors were compared between these identified groups. RESULTS: This study identified four distinct GWG trajectory groups associated with LGA, each group including, respectively, 78.6, 19.0, 1.4, and 0.9% of the participants. Group 1 presented a typical curve with lower GWG in early pregnancy and relatively higher GWG in mid- and late pregnancy. Women in group 2 showed sustained high GWG and high LGA prevalence than women in group 1 (48.24 vs. 21.56%, p < 0.0001). A catch-up in GWG after low weight gain did not result in significantly higher risk of LGA in group 3 compared to group 1. On the other hand, a rapid GWG in the first two-thirds of pregnancy followed by a strict weight control was associated with elevated risk of LGA in group 4 than group 1 (62.50 vs. 21.56%, p < 0.0001). CONCLUSIONS: Women affected by overweight or obesity combined with high GWG in early mid-pregnancy were at elevated risk of LGA. Early clinical recognition of a poor GWG trajectory will enable early intervention in high-risk groups.


Assuntos
Macrossomia Fetal/etiologia , Ganho de Peso na Gestação/fisiologia , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Complicações na Gravidez/fisiopatologia , Adulto , Peso ao Nascer/fisiologia , Índice de Massa Corporal , Estudos de Coortes , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Obesidade/complicações , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Fatores de Risco , Ganho de Peso/fisiologia , Adulto Jovem
12.
Eat Behav ; 34: 101311, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31330479

RESUMO

This observational study was designed to establish whether there is a relationship between intuitive eating and gestational weight gain. Intuitive eating involves eating according to hunger and satiety cues, rather than following diet rules or eating in response to external triggers or emotions. Higher levels of intuitive eating are associated with bodyweight in the normal range in women during young and middle adulthood. Excess gestational weight gain is associated with an increased incidence of adverse health outcomes for mothers and children, including many pregnancy related conditions and, following pregnancy, an increased likelihood of obesity among mothers and children. Pregnant women were recruited at their nuchal translucency scan (11-14 weeks gestation), in Dunedin, New Zealand, between 2013 and 2015. A cohort of 218 women completed questionnaires at four times during their pregnancies. Intuitive eating was measured using a version of the Intuitive Eating Scale (IES) adapted for pregnant women and revalidated with this population. Gestational weight gain was calculated at the term visit (>35 weeks gestation) and babies' birth weight was established from the electronic maternity system. Mean total IES scores (and all IES subscales) increased across pregnancy. For every one point greater total IES score at baseline, there was a 1.7 (0.5, 2.9) kg lower gestational weight gain. There was no association between babies' birth weight and intuitive eating. Intuitive eating appears to be associated with lower gestational weight gain but not babies' birth weight. It remains to be seen whether intuitive eating can be increased by educational interventions during pregnancy and thus have an impact on gestational weight gain.


Assuntos
Ingestão de Alimentos/psicologia , Comportamento Alimentar/psicologia , Ganho de Peso na Gestação/fisiologia , Fome/fisiologia , Saciação/fisiologia , Adulto , Estudos de Coortes , Dieta/psicologia , Feminino , Humanos , Nova Zelândia , Gravidez , Inquéritos e Questionários , Adulto Jovem
13.
Med Sci Sports Exerc ; 51(6): 1292-1302, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31095086

RESUMO

PURPOSE: This study aimed to summarize the evidence from the 2018 Physical Activity Guidelines Advisory Committee Scientific Report, including new evidence from an updated search of the effects of physical activity on maternal health during pregnancy and postpartum. METHODS: An initial search was undertaken to identify systematic reviews and meta-analyses published between 2006 and 2016. An updated search then identified additional systematic reviews and meta-analyses published between January 2017 and February 2018. The searches were conducted in PubMed®, CINAHL, and Cochrane Library and supplemented through hand searches of reference lists of included articles and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: The original and updated searches yielded a total of 76 systematic reviews and meta-analyses. Strong evidence demonstrated that moderate-intensity physical activity reduced the risk of excessive gestational weight gain, gestational diabetes, and symptoms of postpartum depression. Limited evidence suggested an inverse relationship between physical activity and risk of preeclampsia, gestational hypertension, and antenatal anxiety and depressive symptomology. Insufficient evidence was available to determine the effect of physical activity on postpartum weight loss, postpartum anxiety, and affect during both pregnancy and postpartum. For all health outcomes, there was insufficient evidence to determine whether the relationships varied by age, race/ethnicity, socioeconomic status, or prepregnancy weight status. CONCLUSIONS: The gestational period is an opportunity to promote positive health behaviors that can have both short- and long-term benefits for the mother. Given the low prevalence of physical activity in young women in general, and the high prevalence of obesity and cardiometabolic diseases among the U.S. population, the public health importance of increasing physical activity in women of childbearing age before, during, and after pregnancy is substantial.


Assuntos
Exercício , Período Pós-Parto/fisiologia , Gravidez/fisiologia , Pesquisa Biomédica , Depressão Pós-Parto/prevenção & controle , Feminino , Ganho de Peso na Gestação/fisiologia , Humanos , Saúde Materna , Guias de Prática Clínica como Assunto , Complicações na Gravidez/prevenção & controle , Fatores Socioeconômicos , Perda de Peso/fisiologia
14.
Medicine (Baltimore) ; 98(20): e15470, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096442

RESUMO

BACKGROUND: Growing evidence suggests that interpregnancy weight change (IPWC) is a risk factor for perinatal outcomes, since it may increase the probability of gestational complications including gestational diabetes or cesarean delivery. Additionally, IPWC may affect neonatal outcomes increasing the prevalence of newborns small for gestational age or preterm birth. However, the association between IPWC and perinatal outcomes has not systematically synthesized thus far. This study protocol aims to provide a clear, transparent and standardized procedure for systematically reviewing the association between IPWC and perinatal outcomes. METHODS AND ANALYSIS: This systematic review and meta-analyses protocol is based on the preferred reporting items for systematic review and meta-analysis protocols and the Cochrane Collaboration Handbook. MEDLINE, EMBASE, the Cochrane Library, and Web of Science will be systematically searched from their inception. No limits will be defined by study design, as such different tools to assess risk of bias will be used:Odd ratios and their corresponding 95% confidence intervals will be reported to evaluate associations between IPWC and perinatal outcomes. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This systematic review and meta-analysis will systematically synthesize the evidence regarding the association between IPWC and perinatal outcomes. Data will be extracted from published articles and findings will be published in peer-reviewed journals. Ethical approval and informed consent will not be required due to the nature of the study. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018100449.


Assuntos
Peso Corporal/fisiologia , Ganho de Peso na Gestação/fisiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Estudos Observacionais como Assunto , Mortalidade Perinatal , Gravidez , Complicações na Gravidez/fisiopatologia , Fatores de Risco
15.
Reprod Health ; 16(1): 31, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30866980

RESUMO

BACKGROUND: Pregnancy as one of the critical stages of life carries a high risk to the health of pregnant women. The amount of weight gained during pregnancy can affect the woman and her infant health immediately or in the future. The present study is conducted to design and explore the effectiveness of an educational intervention based on health belief model (HBM) to preventing excessive gestational weight gain (GWG). METHODS: This research-based planning is designed in three phases and will be conducted on pregnant women in first trimester. In the first phase of this randomized controlled trial study, body mass index (BMI), the level of knowledge and the level of the HBM constructs will be measured using a questionnaire. The HBM questionnaire is designed based on a literature review and experts opinions. In the next phase the educational program content will be designed based on the results of the first phase of the study on the level of women's knowledge, and HBM constructs as well as a literature review and experts opinions. The intervention will be designed in four training sessions about the importance of behaviors, especially physical activity and nutrition, in the prevention of excessive weight gain during pregnancy. The tired phase includes the implementation of educational intervention with two intervention and control groups. The efficacy of the program will be evaluated by measuring the level of the knowledge, HBM constructs and women's weight gain during pregnancy in the second and third trimesters. Appreciate weight gain will be considered according to the BMI in first trimester. DISCUSSION: The present study will provide strong information regarding the effetiness of the HBM and appropriate framework to develop educational interventions together with enhancing pregnant women's knowledge and belief toward weight management behaviors. TRIAL REGISTRATION: Registration of this randomized control trial has been completed with the Iranian Registry of Clinical Trials, IRCT20180703040325N1 . Date of registration: 2018-08-20.


Assuntos
Ganho de Peso na Gestação/fisiologia , Sobrepeso/prevenção & controle , Complicações na Gravidez/prevenção & controle , Adulto , Feminino , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Educação de Pacientes como Assunto , Gravidez , Gestantes , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Artigo em Inglês | MEDLINE | ID: mdl-30925697

RESUMO

BACKGROUND: The association of maternal parity, pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with childhood weight status has been well studied; however, little is known about these factors with respect to the rate of weight changes in early childhood. METHODS: This study was based on a prospective longitudinal study. The follow-up surveys were conducted at the ages of 1, 3, 6, 8, 12, and 18 months. Child weight was investigated twice at each wave. Data on maternal parity, pre-pregnancy weight and height were collected at baseline. The latent growth curve model was used to examine the effects of interested predictors on the trajectory of weight in early childhood. RESULTS: Finally, 893 eligible mother-child pairs were drawn from the cohort. In adjusted models, multiparas were associated with higher birth weight (ß = 0.103) and slower weight change rate of children (ß = -0.028). Pre-conception BMI (ß = 0.034) and GWG (ß = 0.014) played important roles in the initial status of child weight but did not have effects on the rate of weight changes of the child. CONCLUSIONS: Multiparous pregnancy is associated with both higher mean birth weight and slower weight-growth velocity in early childhood, while pregravid maternal BMI and GWG are only related to the birth weight.


Assuntos
Peso ao Nascer/fisiologia , Índice de Massa Corporal , Desenvolvimento Infantil/fisiologia , Ganho de Peso na Gestação/fisiologia , Paridade/fisiologia , Adulto , Estudos de Coortes , Família , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Gravidez , Estudos Prospectivos , Ganho de Peso
17.
J Gynecol Obstet Hum Reprod ; 48(6): 401-405, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30902762

RESUMO

BACKGROUND: Recommendations by the Institute of Medicine (IOM) on gestational weight gain (GWG) for women with histories of bariatric surgery have yet to be studied. OBJECTIVES: To describe GWG in women with histories of bariatric surgery and to investigate the relationship between GWG and maternal and neonatal outcomes. STUDY DESIGN: A bicentric retrospective study on the medical charts of pregnant women with histories of bariatric surgery who delivered between 2003 and 2017 in two level III maternity units. In accordance with IOM guidelines, GWG was classified as insufficient, adapted, or excessive. RESULTS: At least 337 pregnancies from 264 patients were included in this study. Of these pregnancies, 154 (45.7%) occurred after gastric banding, 135 (40.1%) after Roux-en-Y gastric bypass, and 48 (14.2%) after sleeve gastrectomy. GWG was adapted in 90 of the pregnancies (26.7%), insufficient in 11 of the pregnancies (35%), and excessive in 129 of pregnancies (38.3%). Gestational age at birth was significantly lower when GWG was insufficient (37.7 ± 4.2 weeks vs. 38.8 ± 2.9 weeks for adequate GWG and 39.4 ± 1.8 weeks for excessive GWG). When compared to normal GWG, insufficient GWG was indicated to be a risk factor for preterm labor (adjusted OR, 3.05, 95% CI 1.30-7.17). When compared to excessive GWG, insufficient GWG increased the rates of small for gestational age (SGA) newborns (OR, 1.96, 95% CI 1.04-3.68), preterm labor (OR, 4.13, 95% CI 1.84-9.24), and preterm delivery (OR, 6.40, 95% CI 2.41-17.0). CONCLUSION: In our study, adequate GWG was associated with better obstetrical outcomes, resulting in the conclusion that IOM recommendations applied to pregnant women who had undergone bariatric surgery. Our findings suggest that the large proportion of women with insufficient GWG may account for increased rates of SGA and preterm birth.


Assuntos
Cirurgia Bariátrica , Ganho de Peso na Gestação/fisiologia , Resultado da Gravidez , Feminino , Gastrectomia , Derivação Gástrica , Gastroplastia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Obesidade/cirurgia , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco
18.
Medicina (Kaunas) ; 55(3)2019 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-30909620

RESUMO

Background and objectives: Data concerning vaspin in obstetric aspects are limited and conflicting. The aim of the study was to evaluate vaspin concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) in the early post-partum period (i.e., 48 h after delivery), when placental function no longer influences the results. Materials and Methods: The study subjects were divided into two groups of 28 healthy controls and 38 mothers with EGWG. Maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. Concentrations of vaspin, fatty acid-binding protein 4 (FABP4), leptin, and ghrelin were determined via enzyme-linked immunosorbent assay (ELISA). Results: Serum vaspin levels were lower in the EGWG group, whereas no significant differences were noted between the groups, with regard to the urine vaspin concentrations. In both studied groups, the serum vaspin concentrations correlated positively with the urine FABP4 levels and negatively with gestational weight gain, body mass index gain in the period from pre-pregnancy to 48 h after delivery (ΔBMI), and fat tissue index (FTI). In the multiple linear regression models, the serum vaspin concentrations were positively dependent on the serum FABP4 levels, as well as negatively dependent on triglycerides, FTI, and ΔBMI. Conclusions: Our study revealed that the EGWG mothers were characterized by significantly lower serum vaspin concentrations in the early post-partum period compared with the subjects that had appropriate gestational weight gain. Our observation supports previous hypotheses that vaspin might be used as a marker of lipid metabolism in pregnancy and maternal adipose tissue. Considering the fact that FABP4 is widely referred to as a pro-inflammatory adipokine, further research on the protective role of vaspin seems crucial, especially in the context of its relationship to FABP4.


Assuntos
Biomarcadores/metabolismo , Ganho de Peso na Gestação/fisiologia , Período Pós-Parto/sangue , Período Pós-Parto/urina , Serpinas/sangue , Serpinas/urina , Adulto , Índice de Massa Corporal , LDL-Colesterol/análise , Proteínas de Ligação a Ácido Graxo/sangue , Proteínas de Ligação a Ácido Graxo/urina , Feminino , Grelina/sangue , Grelina/urina , Hemoglobina A Glicada/análise , Hospitais Universitários , Humanos , Leptina/sangue , Leptina/urina , Modelos Lineares , Metabolismo dos Lipídeos , Polônia , Gravidez , Triglicerídeos/sangue , Adulto Jovem
19.
Int J Mol Sci ; 20(3)2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30704061

RESUMO

Among the new adipokines, secreted frizzled-related protein 5 (SFRP5) is considered to prevent obesity and insulin resistance. The umbilical cord SFRP5 levels have not yet been investigated. The main aim of the study was to investigate whether the umbilical cord SFRP5 concentrations are altered in term neonates born to mothers with excessive gestational weight gain (EGWG). Two groups of subjects were selected depending on their gestational weight gain, i.e. 28 controls and 38 patients with EGWG. Umbilical cord and maternal serum SFRP5 levels were lower in the EGWG group. Umbilical cord SFRP5 concentrations were directly associated with the maternal serum SFRP5, hemoglobin A1c and lean tissue index, umbilical cord leptin levels, as well as newborns' anthropometric measurements in the EGWG subjects. In multiple linear regression models performed in all the study participants, umbilical cord SFRP5 concentrations depended positively on the maternal serum SFRP5, ghrelin, and leptin levels and negatively on the umbilical cord ghrelin levels, low-density lipoprotein cholesterol, pre-pregnancy body mass index, and gestational weight gain. EGWG is associated with disturbances in SFRP5 concentrations. Obstetricians and midwives should pay attention to nutrition and weight management during pregnancy.


Assuntos
Proteínas do Olho/sangue , Ganho de Peso na Gestação/fisiologia , Proteínas de Membrana/sangue , Cordão Umbilical/metabolismo , Adulto , Índice de Massa Corporal , Feminino , Idade Gestacional , Grelina/sangue , Hemoglobina A Glicada/metabolismo , Humanos , Leptina/sangue , Modelos Lineares , Gravidez , Adulto Jovem
20.
PLoS Med ; 16(2): e1002744, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30742624

RESUMO

BACKGROUND: Maternal obesity and excessive gestational weight gain may have persistent effects on offspring fat development. However, it remains unclear whether these effects differ by severity of obesity, and whether these effects are restricted to the extremes of maternal body mass index (BMI) and gestational weight gain. We aimed to assess the separate and combined associations of maternal BMI and gestational weight gain with the risk of overweight/obesity throughout childhood, and their population impact. METHODS AND FINDINGS: We conducted an individual participant data meta-analysis of data from 162,129 mothers and their children from 37 pregnancy and birth cohort studies from Europe, North America, and Australia. We assessed the individual and combined associations of maternal pre-pregnancy BMI and gestational weight gain, both in clinical categories and across their full ranges, with the risks of overweight/obesity in early (2.0-5.0 years), mid (5.0-10.0 years) and late childhood (10.0-18.0 years), using multilevel binary logistic regression models with a random intercept at cohort level adjusted for maternal sociodemographic and lifestyle-related characteristics. We observed that higher maternal pre-pregnancy BMI and gestational weight gain both in clinical categories and across their full ranges were associated with higher risks of childhood overweight/obesity, with the strongest effects in late childhood (odds ratios [ORs] for overweight/obesity in early, mid, and late childhood, respectively: OR 1.66 [95% CI: 1.56, 1.78], OR 1.91 [95% CI: 1.85, 1.98], and OR 2.28 [95% CI: 2.08, 2.50] for maternal overweight; OR 2.43 [95% CI: 2.24, 2.64], OR 3.12 [95% CI: 2.98, 3.27], and OR 4.47 [95% CI: 3.99, 5.23] for maternal obesity; and OR 1.39 [95% CI: 1.30, 1.49], OR 1.55 [95% CI: 1.49, 1.60], and OR 1.72 [95% CI: 1.56, 1.91] for excessive gestational weight gain). The proportions of childhood overweight/obesity prevalence attributable to maternal overweight, maternal obesity, and excessive gestational weight gain ranged from 10.2% to 21.6%. Relative to the effect of maternal BMI, excessive gestational weight gain only slightly increased the risk of childhood overweight/obesity within each clinical BMI category (p-values for interactions of maternal BMI with gestational weight gain: p = 0.038, p < 0.001, and p = 0.637 in early, mid, and late childhood, respectively). Limitations of this study include the self-report of maternal BMI and gestational weight gain for some of the cohorts, and the potential of residual confounding. Also, as this study only included participants from Europe, North America, and Australia, results need to be interpreted with caution with respect to other populations. CONCLUSIONS: In this study, higher maternal pre-pregnancy BMI and gestational weight gain were associated with an increased risk of childhood overweight/obesity, with the strongest effects at later ages. The additional effect of gestational weight gain in women who are overweight or obese before pregnancy is small. Given the large population impact, future intervention trials aiming to reduce the prevalence of childhood overweight and obesity should focus on maternal weight status before pregnancy, in addition to weight gain during pregnancy.


Assuntos
Índice de Massa Corporal , Análise de Dados , Ganho de Peso na Gestação/fisiologia , Obesidade Pediátrica/epidemiologia , Austrália/epidemiologia , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Humanos , América do Norte/epidemiologia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Obesidade Pediátrica/diagnóstico , Gravidez , Fatores de Risco
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