The association between maternal infant feeding practices and child weight at 11-17 months in first-time Australian mothers

Introduction: Emerging evidence reveals that early feeding practices are associated with child food intake, eating behaviour and weight status. This cross-sectional analysis examined the association between maternal infant feeding practices/beliefs and child weight in Australian infants aged 11-17 months. Methods: Participants were 293 first-time mothers of healthy term infants (144 boys, mean age 14±1 months) enrolled in the NOURISH RCT. Mothers self-reported infant feeding practices and beliefs using the Infant Feeding Questionnaire (Baughcum, 2001). Anthropometric data were also measured at baseline (infants aged 4 months). Multiple regression analysis was used, adjusting for infant age, gender, birth weight, infant feeding mode (breast vs. formula), maternal perceptions of infant weight status, pre-pregnancy weight, weight concern, age and education. Results: The average child weight-for-age z-score (WAZ) was 0.62±0.83 (range:-1.56 to 2.94) and the mean change in WAZ (WAZ change) from 4 to 14 months was 0.62±0.69 (range:-1.50 to 2.76). Feeding practices/beliefs partly explained child WAZ (R2=0.28) and WAZ change (R2=0.13) in the adjusted models. While child weight status at 14 months was inversely associated with responsive feeding (e.g. baby feeds whenever she wants, feeding to stop baby being unsettled) (β=-0.104, p=0.06) and maternal concern about the child becoming underweight (β=-0.224, p<0.001), it was positively associated with mother’s concern about child overweight (β=0.197, p<0.05). Birth weight, infant’s age, maternal weight concern and perceiving her child as overweight were significant covariates. WAZ change was only significantly associated with responsive feeding (β=-0.147, p<0.05). Conclusion: Responsive feeding may be an important strategy to promote healthy child weight.

Associations between parenting behaviours and feeding beliefs of first-time Australian mothers in the NOURISH obesity prevention trial

Purpose: Parenting style and early feeding practices have been linked to child intake, eating behaviour and weight status. The purpose of this study was to examine associations between general maternal parenting behaviours and feeding beliefs in Australian mothers of 11-17 month-old children. Methods: This cross-sectional analysis included 223 first-time mothers and their children (49% male, mean age 14 [sd 1] months) enrolled in the control group of the NOURISH trial. Mothers self-reported their feeding beliefs and parenting behaviours (overprotection, irritability, warmth, autonomy-encouraging) using modified questions from the Infant Feeding Questionnaire (Baughcum, 2001) and the Longitudinal Study of Australian Children. Multiple regression analyses were conducted, using feeding beliefs (four factors) as dependent and parenting behaviours as independent variables while adjusting for child gender, age, weight-for-age z-score and maternal age, education level, feeding mode (breast vs. non-breast), and perception of own pre-pregnancy and child weight status. Results/Findings: Two of four parenting behaviours were significantly associated with feeding beliefs. Maternal warmth was inversely associated with concerns that the child would become underweight (β=-0.156, p=0.022) and positively associated with mothers’ awareness of child’s hunger/satiety cues (β=0.303, p<0.001). Mothers’ overprotection was positively associated with concerns that the child would become underweight (β=0.213, p=0.001); become overweight (β=0.174, p=0.005); and mother’s responsive feeding (β=0.135, p=0.057). Weight-for-age z-score, mothers’ perception of their child and own weight status, education, feeding mode, and child’s age were significant covariates. Conclusions: Feeding occurs within the broader parenting context. Improving early feeding beliefs and practices may require addressing mother’s approaches to parenting, especially warmth and overprotection.

Environments For Healthy Living (EFHL) Griffith birth cohort study : characteristics of sample and profile of antenatal exposures

Background The Environments for Healthy Living (EFHL) study is a repeated sample, longitudinal birth cohort in South East Queensland, Australia. We describe the sample characteristics and profile of maternal, household, and antenatal exposures. Variation and data stability over recruitment years were examined. Methods Four months each year from 2006, pregnant women were recruited to EFHL at routine antenatal visits on or after 24 weeks gestation, from three public maternity hospitals. Participating mothers completed a baseline questionnaire on individual, familial, social and community exposure factors. Perinatal data were extracted from hospital birth records. Descriptive statistics and measures of association were calculated comparing the EFHL birth sample with regional and national reference populations. Data stability of antenatal exposure factors was assessed across five recruitment years (2006–2010 inclusive) using the Gamma statistic for ordinal data and chi-squared for nominal data. Results Across five recruitment years 2,879 pregnant women were recruited which resulted in 2904 live births with 29 sets of twins. EFHL has a lower representation of early gestational babies, fewer still births and a lower percentage of low birth weight babies, when compared to regional data. The majority of women (65%) took a multivitamin supplement during pregnancy, 47% consumed alcohol, and 26% reported having smoked cigarettes. There were no differences in rates of a range of antenatal exposures across five years of recruitment, with the exception of increasing maternal pre-pregnancy weight (p=0.0349), decreasing rates of high maternal distress (p=0.0191) and decreasing alcohol consumption (p<0.0001). Conclusions The study sample is broadly representative of births in the region and almost all factors showed data stability over time. This study, with repeated sampling of birth cohorts over multiple years, has the potential to make important contributions to population health through evaluating longitudinal follow-up and within cohort temporal effects.

Early life predictors of preschool overweight and obesity : a case–control study in Sri Lanka

Background Childhood obesity increases the risk of obesity in adulthood and is associated with cardiovascular disease risk factors. Our aim was to assess the early life risk factors associated with overweight and obesity among preschool children. Methods In this case–control study, from the 1087 preschool children measured, age, sex and ethnicity matched 71 cases and 71 controls were recruited. Cases and controls were defined according to the WHO 2006 growth standards. The birth and growth characteristics were extracted from the child health development records. Infant feeding practices and maternal factors were obtained from the mother. Rapid weight gain was defined as an increase in weight-for-age Z score (WHO standards) above 0.67 SD from birth to 2 years. The magnitude and significant difference in mean values of the variables associated with overweight and obesity were evaluated using logistic regressions and paired t-test, respectively. Results Cases had significantly shorter duration (months) of breastfeeding (19.4, 24.6, p = 0.003), and smaller duration (months) of exclusive breastfeeding (3.7, 5.1, p = 0.001) compared to controls. Rapid weight gain (OR = 6.3, 95% CI = 2.04–19.49), first born status (OR = 3.6, 95% CI = 1.17-10.91) and pre-pregnancy obesity (OR = 4.0, 95% CI = 1.46-10.76) were positively associated with overweight and obesity. Breastfeeding more than 2 years (OR = 0.2, 95% CI = 0.06-0.57) was negatively associated with overweight and obesity. Conclusion Rapid weight gain within first two years, first–born status and pre-pregnancy obesity of the mother contributed for preschool obesity. Our results suggest that intervention may be indicated earlier in infancy and during the toddler and preschool years to tackle the increasing prevalence of obesity.

Weight-related risk perception among healthy and overweight pregnant women: A cross-sectional study

Objective The objective of this study was to evaluate weight-related risk perception in early pregnancy and to compare this perception between women commencing pregnancy healthy weight and overweight. Study design Pregnant women (n=664) aged 29±5 (mean±s.d.) years were recruited from a metropolitan teaching hospital in Australia. A self-administered questionnaire was completed at around 16 weeks of gestation. Height measured at baseline and self-reported pre-pregnancy weight were used to calculate body mass index. Cross-sectional analysis was conducted. Differences between groups were assessed using chi-squared tests for categorical variables and t-tests or Mann–Whitney U tests for continuous variables depending on distribution. Result Excess gestational weight gain (GWG) during pregnancy was more important in leading to health problems for women or their child compared with pre-pregnancy weight. Personal risk perception for complications was low for all women, although overweight women had slightly higher scores than healthy-weight women (2.4±1.0 vs 2.9±1.0; P<0.001). All women perceived their risk for complications to be below that of an average pregnant woman. Conclusion Women should be informed of the risk associated with their pre-pregnancy weight (in the case of maternal overweight) and excess GWG. If efforts to raise risk awareness are to result in preventative action, this information needs to be accompanied by advice and appropriate support on how to reduce risk.

Glycemic Control in Diabetic Pregnancies: Effects on Fetal and Maternal Outcome

Background: Both maternal and fetal complications are increased in diabetic pregnancies. Although hypertensive complications are increased in pregnant women with pregestational diabetes, reports on hypertensive complications in women with gestational diabetes mellitus (GDM) have been contradictory. Congenital malformations and macrosomia are the main fetal complications in Type 1 diabetic pregnancies, whereas fetal macrosomia and birth trauma but not congenital malformations are increased in GDM pregnancies. Aims: To study the frequency of hypertensive disorders in gestational diabetes mellitus. To evaluate the risk of macrosomia and brachial plexus injury (Erb’s palsy) and the ability of the 2-hour glucose tolerance test (OGTT) combined with the 24-hour glucose profile to distinguish between low and high risks of fetal macrosomia among women with GDM. To evaluate the relationship between glycemic control and the risk of fetal malformations in pregnancies complicated by Type 1 diabetes mellitus. To assess the effect of glycemic control on the occurrence of preeclampsia and pregnancy-induced hypertension in Type 1 diabetic pregnancies. Subjects: A total of 986 women with GDM and 203 women with borderline glucose intolerance (one abnormal value in the OGTT) with a singleton pregancy, 488 pregnant women with Type 1 diabetes (691 pregnancies and 709 offspring), and 1154 pregnant non-diabetic women (1181 pregnancies and 1187 offspring) were investigated. Results: In a prospective study on 81 GDM patients the combined frequency of preeclampsia and PIH was higher than in 327 non-diabetic controls (19.8% vs 6.1%, p<0.001). On the other hand, in 203 women with only one abnormal value in the OGTT, the rate of hypertensive complications did not differ from that of the controls. Both GDM women and those with only one abnormal value in the OGTT had higher pre-pregnancy weights and BMIs than the controls. In a retrospective study involving 385 insulin-treated and 520 diet-treated GDM patients, and 805 non-diabetic control pregnant women, fetal macrosomia occurred more often in the insulin-treated GDM pregnancies (18.2%, p<0.001) than in the diet-treated GDM pregnancies (4.4%), or the control pregnancies (2.2%). The rate of Erb’s palsy in vaginally delivered infants was 2.7% in the insulin-treated group of women and 2.4% in the diet-treated women compared with 0.3% in the controls (p<0.001). The cesarean section rate was more than twice as high (42.3% vs 18.6%) in the insulin-treated GDM patients as in the controls. A major fetal malformation was observed in 30 (4.2%) of the 709 newborn infants in Type 1 diabetic pregnancies and in 10 (1.4%) of the 735 controls (RR 3.1, 95% CI 1.6–6.2). Even women whose levels of HbA1c (normal values less than 5.6%) were only slightly increased in early pregnancy (between 5.6 and 6.8%) had a relative risk of fetal malformation of 3.0 (95% CI 1.2–7.5). Only diabetic patients with a normal HbA1c level (<5.6%) in early pregnancy had the same low risk of fetal malformations as the controls. Preeclampsia was diagnosed in 12.8% and PIH in 11.4% of the 616 Type 1 diabetic women without diabetic nephropathy. The corresponding frequencies among the 854 control women were 2.7% (OR 5.2; 95% CI 3.3–8.4) for preeclampsia and 5.6% (OR 2.2, 95% CI 1.5–3.1) for PIH. Multiple logistic regression analysis indicated that glycemic control, nulliparity, diabetic retinopathy and duration of diabetes were statistically significant independent predictors of preeclampsia. The adjusted odds ratios for preeclampsia were 1.6 (95% CI 1.3–2.0) for each 1%-unit increment in the HbA1c value during the first trimester and 0.6 (95% CI 0.5–0.8) for each 1%-unit decrement during the first half of pregnancy. In contrast, changes in glycemic control during the second half of pregnancy did not alter the risk of preeclampsia. Conclusions: In type 1 diabetic pregnancies it is extremely important to achieve optimal glycemic control before pregnancy and maintain it throughout pregnancy in order to decrease the complication rates both in the mother and in her offspring. The rate of fetal macrosomia and birth trauma in GDM pregnancies, especially in the group of insulin-treated women, is still relatively high. New strategies for screening, diagnosing, and treatment of GDM must be developed in order to decrease fetal and neonatal complications.

Avaliação do consumo alimentar no período reprodutivo e variação de peso no pós-parto

O presente estudo tem como tema central o ganho de peso e o consumo alimentar no período reprodutivo. A tese está dividida em três partes: i) revisão da literatura científica sobre os fatores de risco para o ganho de peso excessivo na gestação e para a sua retenção no pós-parto; ii) análise quantitativa e qualitativa do consumo alimentar (energia, nutrientes e alimentos) do período gestacional para o pós-parto; e iii) avaliação prospectiva da associação entre a dieta hiperproteica (≥ 1.2 g/kg) e a variação de peso pós-gestacional. A revisão da literatura apontou como principais determinantes da variação de peso no pós-parto os seguintes fatores: ganho de peso gestacional, peso pré-gestacional, dieta, atividade física, lactação, idade, escolaridade, renda, paridade e raça. As partes ii e iii correspondem a dois artigos, sendo que a população do estudo empregada nas duas análises foi baseada em uma coorte de mulheres no pós-parto atendidas no Centro Municipal de Saúde (CMS) Marcolino Candau, localizado no Município do Rio de Janeiro. Dentre as 709 mulheres convidadas para participar da pesquisa, 479 ingressaram na coorte. As mulheres foram recrutadas através dos serviços de pré-natal e na rotina pediátrica de imunização do BCG, oferecidos pelo CMS, e imediatamente após o parto, na maternidade central de referência. A coleta de dados ocorreu entre maio de 1999 e abril de 2001, sendo 15 meses de recrutamento e 9 meses de seguimento. As mulheres foram entrevistadas aos 15 dias, 2, 6 e 9 meses do pós-parto. Foram consideradas elegíveis para as duas analises as mulheres com idade entre 18 e 45 anos de idade, entrevistadas até 30 dias do pós-parto, sem doenças crônicas pré-existentes, com gravidez de 35 ou mais semanas gestacionais e sem gestação gemelar. O estudo sobre a composição da dieta do período gestacional para o pós-parto contou com 276 mulheres que responderam aos dois questionários de freqüência de consumo alimentar (QFCA) aplicados aos 15 dias e aos 6 meses do seguimento. Os resultados mostraram que as mulheres consumiram dietas mais energéticas na gravidez e aquelas que mais restringiram o consumo de energia no pós-parto, apresentaram um incremento na densidade de proteínas da dieta. As análises das medidas repetidos do peso foram realizadas para avaliar o efeito da dieta hiperproteica (≥ 1.2 g/kg) sobre a variação de peso no pós-parto, para as quais haviam dados de uma amostra de 430 mulheres. Os resultados mostraram que as mulheres com dieta hiperproteica perderam mais peso do que as mulheres com dieta normo ou hipoproteica (< 1.2 g/kg) (226 g/mês versus 123 g/mês). As duas analises indicam que um pequeno incremento no consumo de proteínas promove maior perda de peso. Estudos longitudinais futuros devem incluir avaliação relativa a segurança das dietas hiperproteicas no pós-parto.

Efeitos da ingestão materna de sorbitol na lactação sobre o perfil nutricional, bioquímico e toxicológico das proles amamentadas

Sorbitol é um poliol encontrado em produtos para fins especiais, como diet e light, Dentro deste contexto, incluem-se as lactantes como grandes consumidoras, almejando o retorno mais rápido ao peso pré-gestacional. Devido à grande carência em dados referentes às consequências metabólicas do consumo excessivo destes tipos de produtos, o objetivo deste trabalho foi avaliar os possíveis efeitos da ingestão materna de sorbitol na lactação sobre os perfis nutricional, bioquímico e toxicológico nas proles amamentadas. O teste da Salmonella/microssoma foi utilizado, inicialmente, na avaliação mutagênica e citotóxica com linhagens de S. enterica sorovar Typhimurium (TA97, TA98, TA100, TA102, TA104 e TA1535). Verificamos a capacidade de reversão da mutação (I.M.) e sobrevivência (%), em diferentes concentrações (0,4; 4; 40; 400; 4000 e 5000 μg/placa). Os resultados foram considerados positivos para valores de I.M. ≥ 2,0. Ratas wistar lactantes (6 por grupo experimental), cada uma com 6 filhotes, receberam sorbitol (0,00015 mg/g/dia; 0,0015 mg/g/dia e 0,15 mg/g/dia), nos primeiros 14 dias da lactação. Neste período, avaliamos a biometria das mães e proles, consumo de ração e ingestão hídrica das mães. Após a lactação, as ratas mães foram ordenhadas, e, junto com as proles, sacrificadas por punção cardíaca, para coleta de sangue total. Os fígados das proles foram submetidos ao método de perfusão, para obtenção de hepatócitos em cultura primária, ao final dos 14 dias de lactação. Os fêmures das proles foram retirados, para obtenção da medula óssea. A bioquímica de sangue das proles (glicose, triglicerídeo, colesterol total, LDL, proteínas totais, albumina, ALT, AST, cálcio total e ionizado) foi analisada, assim como a bioquímica do leite ordenhado (triglicerídeos). Os testes do micronúcleo em medual óssea e hepatócitos, assim como o teste Cometa em sangue total, foram utilizados para avaliação genotóxica e citotóxica, de acordo com as diretrizes da OECD. Os resultados mostraram que, em concentrações mais baixas (0,00015 e 0,0015 mg/g), o sorbitol induziu o ganho de peso, principalmente na menor concentração (0,00015 mg/g), e alterações no perfil lipídico do sangue em todas as concentrações. As quantidades de triglicerídeo no leite variaram em função da dose ingerida, reduzida na maior concentração (0,15 mg/g) e aumentada na menor (0,00015 mg/g). A maior concentração (0,15 mg/g) resultou em perda de peso das mães e proles, diminuição de proteínas viscerais totais, albumina e aumento de enzimas hepáticas (ALT e AST) nas proles. Os resultados do teste da Salmonella/microssoma não indicaram mutagenicidade, entretanto, uma relação de dependência entre dose e Índice de Mutagenicidade (I.M.). Ambos os testes, micronúcleos de medula óssea e hepatócitos, apresentaram uma citotoxicidade dose dependente, estatisticamente significativa em relação ao grupo controle, corroborando com a genotoxicidade do teste Cometa e dependência de dose encontrada no teste da Salmonella/microssoma. Em concentrações mais baixas, parece existir modulação das vias lipogênicas, em contrapartida, nas mais altas a toxicidade parece dificultar tais alterações, induzindo o efeito contrário. Concluimos que o consumo excessivo de sorbitol resulta em alterações metabólicas e toxicológicas em lactentes, mesmo sendo considerado seguro pelo FDA e ANVISA.

Efeitos intergeracionais da obesidade materna sobre o pâncreas endócrino de camundongos C57BL/6

Objetivo: Avaliar os efeitos da obesidade materna sobre a estrutura do pâncreas e metabolismo de carboidratos no início da vida adulta, com foco na prole da primeira geração (F1) e segunda geração (F2) de progenitoras F0 alimentadas com dieta rica em gordura nos períodos pré-gestacional, durante a gestação e lactação. Métodos: Camundongos C57BL/6 do gênero feminino (F0) foram alimentadas com dieta padrão (SC) ou dieta rica em gordura (HF) durante as oito semanas que antecederam o acasalamento, durante a gestação e lactação para gerar a F1 (F1-SC e F1-HF). As proles geradas receberam dieta SC até o terceiro mês de vida. Aos três meses de idade, fêmeas F1 foram acasaladas para gerar a F2 (F2-SC e F2-HF). Apenas os machos das geração F1 e F2 foram avaliados aos 3 meses de idade. As características metabólicas foram avaliadas pela massa corporal (MC), glicemia de jejum, área sob a curva no teste oral de tolerância a glicose; análise plasmática de insulina, leptina e adiponectina; distribuição e análise morfológica do pâncreas através da imunohistoquímica e imunofluorescência. Resultados: A prole F1-HF teve aumento significativo na massa corporal e glicemia quando comparado à F1-SC. Por outro lado, as proles F2-HF e F2-SC tiveram massas corporais semelhantes. A prole F1-HF e F2-HF mostrou aumento da ingestão de energia, intolerância à glicose, hiperinsulinemia, hiperleptinemia, hipoadiponectinemia, resistência à insulina, aumento da massa pancreática, o aumento da densidade de volume de ilhotas com elevada massa de células alfa e beta, ilhotas hipertrofiadas caracterizadas por uma distribuição alterada de células alfa e beta, e fraca imunoreatividade do pâncreas homeobox duodeno-1 (PDx1). Conclusões: Uma dieta HF materna consumida durante o período pré-concepção e durante toda a gestação e lactação em camundongos promoveu programação metabólica do pâncreas endócrino com pré-disposição ao diabetes mellitus tipo 2 precoce nas proles F1 e F2 do gênero masculino, sugerindo que essas mudanças são intergeracionais.

Saúde Mental Materna e Retenção de Peso no Pós-parto

O objetivo do presente estudo foi investigar a associação entre a depressão pós-parto e a retenção de peso no pós-parto. Trata-se de um estudo longitudinal, com 563 mulheres no baseline acolhidas em unidades de saúde do município do Rio de Janeiro entre 2005 e 2009, acompanhadas até o 6 mês pós-parto, com dados sobre peso e estatura aos 15 dias pós-parto e peso pré-gestacional. O peso retido após o parto foi calculado a partir da diferença entre o peso aferido nas ondas de seguimento (15 dias, 1, 2, 4 e 6 mês) e o peso pré-gestacional. O estado nutricional pré-gestacional foi classificado de acordo com a OMS. A presença de depressão pós-parto foi avaliada a partir da versão em português da Escala de Depressão Pós-parto de Edimburgo (EPDS) aos 15 dias e no 2 mês após o parto, utilizando-se 11/12 da EPDS como ponto de corte. Considerou-se depressão recorrente quando houve presença de depressão nos dois momentos. Inicialmente analisaram-se características da população. Para as análises estatísticas do efeito do estado nutricional pré-gestacional e do efeito da depressão pós-parto sobre a retenção de peso pós-parto empregou-se o proc mixed do pacote estatístico SAS. Dentre os principais achados, destaca-se que 22,7% (IC 95% 19,3-26,4) das mulheres iniciaram a gravidez com sobrepeso e 10,9% (IC 95% 7,0-15,7) apresentaram depressão recorrente. A retenção média de peso foi de 5,6 kg (IC 95% 5,1-6,1) aos 15 dias pós-parto. Na análise das trajetórias no tempo do peso pós-parto por estado nutricional pré-gestacional ajustadas por idade, escolaridade, número de filhos, aleitamento materno e ganho de peso gestacional, observou-se diminuição da retenção de peso pós-parto para os grupos de baixo peso e sobrepeso pré-gestacional e aumento da retenção de peso pós-parto para o grupo de obesidade pré-gestacional. Na análise das trajetórias no tempo do peso pós-parto por depressão pós-parto verifica-se que o efeito entre o tempo e a retenção de peso pós-parto se modifica para mulheres com depressão pós-parto recorrente nas análises bruta e ajustadas por idade, escolaridade, estado nutricional pré-gestacional, número de filhos, ganho de peso gestacional, aleitamento materno e rede social, nas quais observa-se que as mulheres com depressão pós-parto recorrente perdem menos peso. Os resultados permitem identificar que há no pós-parto perda e ganho de peso, apesar de ser esperada perda de peso almejando o retorno ao peso pré-gestacional. Ressalta-se o impacto da depressão pós-parto observado nesta dinâmica de peso, uma vez que mulheres com depressão pós-parto recorrente apresentaram menor perda de peso. Destaca-se a relevância dos resultados deste estudo para o desenvolvimento da promoção da saúde e da segurança alimentar e nutricional, visando um monitoramento do estado nutricional pós-parto e avaliação da saúde mental materna de forma a contribuir para a prevenção da obesidade feminina e comorbidades

Mães obesas, filhotes obesos: estudo experimental

O aumento da obesidade materna pode refletir em efeitos deletérios na prole adulta, manifestos diferentemente de acordo com o gênero do indivíduo. Este trabalho teve como objetivo verificar a hipótese de que a obesidade materna provoca alterações metabólicas, na estrutura do tecido adiposo e hepático e mudanças de perfil inflamatório nas proles adultas de machos e fêmeas. Fêmeas C57BL/ 6 receberam dieta padrão (SC, 17% da energia proveniente do lipídeo) ou dieta hiperlipídica (HF; 49% da energia proveniente do lipídeo) durante oito semanas pré-gestacionais até a lactação. Após o desmame, os filhotes foram divididos nos grupos: SCM (machos), SCF (fêmeas), HFM (machos) e HFF (fêmeas). As características metabólicas foram avaliadas pela massa corporal (MC), glicemia de jejum, área sob a curva no teste oral de tolerância a glicose; concentrações de triglicerídes (TG) hepáticos e estimativa da esteatose hepática; análise plasmática de insulina, colesterol total (CT), triglicerídes (TG) e adipocinas; distribuição e análise morfológica do tecido adiposo e estado pró-inflamatório dos filhotes. Diferenças entre os grupos foram analisadas pelo Teste T não pareado (dados entre progenitoras e pares de grupos nas proles); one-way ANOVA com pós-teste de Tukey (para proles) e two-way ANOVA (efeito da dieta materna e gênero). O nível de significância adotado foi de P≤0,05. Progenitoras HF tiveram maior MC (+20%), glicemia elevada (+22%) e intolerância à glicose em comparação ao grupo SC. A partir da quarta semana, a MC mostrou-se maior nas proles HF, em ambos os gêneros, quando comparados às proles SC. Na 12 semana, a MC foi 20% maior no grupo HF macho e 30% maior no grupo HF fêmea do que seus controles (p<0,0001, ambos os gêneros). Intolerância à glicose foi observada em machos e fêmeas HF em relação aos seus contrapares SC (+20%, p<0,05). Proles HF demonstraram hepatomegalia com maior acúmulo de TG hepático, resultando em maior percentual de esteatose em machos (27%) e fêmeas HF (25%). Proles HF apresentaram incremento na adiposidade (+20%) e nos níveis de CT e TG do que seus congêneres SC. Níveis plasmáticos de leptina e insulina foram maiores, enquanto houve diminuição da adiponectina no grupo HF macho em relação ao grupo SC macho. Hipertrofia de adipócitos foi observada nas proles HF. TNF-alfa, IL-6 e leptina foram mais expressos em proles HF, porém diminuição na expressão de adiponectina foi evidenciada nas proles geradas por mães obesas. A luz do exposto, a dieta HF administrada em mães antes e durante períodos de gestação e lactação leva à obesidade materna que tem consequências na prole, tais como remodelamento do tecido adiposo, juntamente com alterações bioquímicas e metabólicas dos adipócitos, intensificando o estado pró-inflamatório da prole, em ambos os gêneros, na idade adulta.

Predictors and dynamics of postpartum relapses in women with multiple sclerosis

Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.

Preconception counselling for women with diabetes: An online resource

Pre-pregnancy care impacts positively on pregnancy outcome, yet the majority of women continue to receive suboptimal support in this area owing to a lack of awareness about the importance of pregnancy planning. An innovative preconception counselling resource has been developed in Northern Ireland (originally as a DVD and later in an online format), in collaboration with end users to raise awareness of planning for pregnancy. This educational resource is now embedded in routine care in the region as a preconception counselling tool, being adopted by all diabetes care teams and many GP practices. It also recently received national recognition, winning the “Best improvement programme for pregnancy and maternity” category at the 2013 Quality in Care Diabetes awards. This article presents the background to the resource’s development, as well as experiences from its production and roll-out.

Preconception counselling resource for women with diabetes

Women with diabetes need to plan for pregnancy if they are to reduce their risk of poor pregnancy outcome. While care providers have focused on setting up specialist pre-pregnancy planning clinics to help women prepare for pregnancy, the majority of women do not attend, entering pregnancy unprepared. A major barrier to accessing this care, and a consequence of poor preconception counselling, is a lack of knowledge as to the need to plan and the reasons why. This project addressed an urgent need to raise awareness of the importance of planning for pregnancy among women with diabetes and among the healthcare professionals (HCPs) caring for them. Focus groups with the target groups informed the development of a preconception counselling resource for women with diabetes. Originally produced as a DVD (Diabetes UK funding), this resource has been embedded in routine care in Northern Ireland (NI) since 2010. A subsequent service evaluation of pregnancy planning indicators undertaken across all five antenatal-metabolic clinics in NI indicated that women who viewed the resource were better prepared for pregnancy. In order to increase the positive impact of the resource and to ensure longer term sustainability the DVD was converted to a website, http://www.womenwithdiabetes.net (Public Health Agency NI funding). The evaluation also highlighted that women with type 2 diabetes were a hard to reach group. As these women are often cared for outside of specialist clinics, it is pertinent that all HCPs caring for women with diabetes are aware of the importance of preconception counselling. Funding also supported the development of an e-learning continuing professional development (CPD) resource within the website. The e-learning resource has since been embedded into existing CPD programmes and is an important tool to ensure that all HCPs caring for women with diabetes are empowered to provide preconception counselling at every opportunity.

The effectiveness of a health versus appearance message on pregnant women's intentions to exercise postpartum : the moderating role of self-monitoring

Despite the confimied health benefits of exercise during the postpartum period, many new mothers are not sufficiently active. The present research aimed to examine the effectiveness of 2 types of messages on intention to exercise after giving birth on 2 groups of pregnant women (low and high self-monitors) using the Theory of Planned Behavior as a theoretical basis. Participants were 2 1 8 pregnant women 1 8 years of age and older (Mean age = 27.9 years, SD = 5.47), and in their second or third trimester. Women completed a demographics questionnaire, a self-monitoring (SM) scale and the Godin Leisure Time Exercise Questionnaire for current and pre-pregnancy exercise levels. They then read one of two brochures, describing either the health or appearance benefits of exercise for postpartum women. Women's attitudes, social norms, perceived behavioral control, and intentions to exercise postpartum were then assessed to determine whether one type of message (health or appearance) was more effective for each group. A MANOVA found no significant effect (p>0.05) for message type, SM, or their interaction. Possible reasons include the fact that the two messages may have been too similar, reading any message about exercise may result in intentions to exercise, or lack of attention given to the brochure. Given the lack of research in this area, more studies are necessary to confirm the present results. Two additional exploratory analyses were conducted. Pearson correlations found higher levels of pre-pregnancy exercise and current exercise to be associated with more positive attitudes, more positive subjective norms, higher perceived behavioral control, and higher intention to exercise postpartum. A hierarchical regression was conducted to determine the predictive utility of attitudes, subjective norms, and perceived behavioral control on intention for each self-monitoring group. Results of the analysis demonstrated the three independent variables significantly predicted intention (p < .001) in both groups, accounting for 58-62% of the variance in intention. For low self-monitors, attitude was the strongest predictor of intention, followed by perceived behavioral control and subjective norm. For high self-monitors, perceived behavioral control was the strongest predictors, followed by attitudes and subjective norm. The present study has practical and real world implications by contributing to our understanding of what types of messages, in a brochure format, are most effective in changing pregnant women's attitudes, subjective norm, perceived behavioral control and intention to exercise postpartum and provides ftirther support for the use of the Theory of Planned Behavior with this population.