Ana Amélia Freitas Vilela

Prevalence of psychiatric disorders in the first trimester of pregnancy and factors associated with current suicide risk

This study aimed to describe the prevalence of psychiatric disorders and to identify the factors associated with Current Suicide Risk (CSR) in the first trimester of pregnancy. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was employed to diagnose mental disorders in 239 women enrolled in a prospective cohort in Rio de Janeiro, Brazil. Serum lipids, leptin and socio-economic status were the independent variables. CSR, the dependent variable, was entered as binary (yes/no) variable into crude and adjusted Poisson regression models with robust variances. CSR was found to be the main psychiatric syndrome (18.4%), followed by agoraphobia (17.2%), major depressive disorder (15.1%) and generalized anxiety disorder (10.5%). Women with CSR showed higher mean levels of cholesterol (169.2 vs. 159.2; p=0.017), high density lipoprotein (50.4 vs. 47.7; p=0.031) and low density lipoprotein (102.8 vs. 95.6; p=0.022) when compared to women without CSR. The adjusted regression model showed a higher prevalence ratio (PR) of CSR among pregnant women with generalized anxiety disorder (PR=2.70, 95% CI: 1.36-5.37), with ≥ two parturitions (PR=2.46, 95% CI: 1.22-4.93), and with major depressive disorder (PR=2.11, 95% CI: 1.08-4.12). We have shown that generalized anxiety disorder, major depressive disorder and higher parity are associated with CSR in the first trimester of pregnancy.

Prepregnancy Healthy Dietary Pattern Is Inversely Associated with Depressive Symptoms among Pregnant Brazilian Women

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

Dietary patterns associated with anthropometric indicators of abdominal fat in adults

This study aimed to identify dietary patterns and assess their association with abdominal fat. A cross-sectional study was conducted in the Central West Region of Brazil with a probabilistic sample of 208 adults of both sexes. Data on food intake was obtained using a food frequency questionnaire and factor analysis (principal components) was conducted to identify dietary patterns. Waist circumference (WC) and waist-to-hip ratio (WHR) were used to assess abdominal fat. The association between dietary patterns and body fat distribution was examined using multiple linear regression analysis adjusted for confounders. Three dietary patterns were identified: Western, regional traditional, and prudent. A positive association was found between the Western pattern and WC (p = 0.04) and WHR (p = 0.001) and between the regional traditional pattern and WHR (p = 0.05) among women. A slight association was also found between the latter pattern and WC (p = 0.07) also among women. An association was found between the Western and regional traditional dietary patterns and a larger concentration of abdominal fat among women.Este estudo teve o objetivo identificar padroes alimentares e analisar a associacao com a adiposidade abdominal. Estudo transversal, realizado na Regiao Centro-Oeste do Brasil, com amostra probabilistica de 208 adultos, de ambos os sexos. O consumo alimentar foi obtido por questionario de frequencia alimentar e aplicada analise fatorial (componentes principais) para identificar padroes alimentares. A circunferencia da cintura (CC) e a relacao cintura quadril (RCQ) foram indicadores de adiposidade abdominal. A associacao dos padroes alimentares com adiposidade abdominal foi analisada em modelos de regressao linear multipla ajustados por fatores de confusao. Identificaram-se tres padroes alimentares: ocidental, tradicional regional e prudente. O padrao ocidental associou-se positivamente com CC (p = 0,04) e RCQ (p = 0,001) e o padrao tradicional regional associou-se tambem com RCQ (p = 0,05), e marginal a associacao com a CC (p = 0,07) somente em mulheres. Os padroes ocidental e tradicional regional associaram a maior adiposidade abdominal em mulheres.

HDL-cholesterol concentrations are inversely associated with Edinburgh Postnatal Depression Scale scores during pregnancy: Results from a Brazilian cohort study *

Serum lipids have been associated with depression in the adult population; however, this association during pregnancy remains unclear. The aim of this study was to evaluate the association between serum lipids and depressive symptom scores during pregnancy. A prospective cohort of 238 pregnant women was followed at the 5th-13th, 20th-26th and 30th-36th weeks of gestation. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Serum concentrations (mg/dL) of triglycerides, total cholesterol, and low- and high-density lipoproteins (LDL-c; HDL-c) were the main exposures. Marital status (married/single), physical activity (active or very active/low or very low active), unplanned pregnancy (no/yes), pre-pregnancy BMI (<25/≥ 25 kg/m(2)), generalized anxiety disorder (no/yes) and current suicidal ideation (no/yes) were considered as potential confounders. Analyses were performed using linear mixed-effects models. The results showed that the EPDS mean score (95%CI) decreased with time during pregnancy trimesters [1st: 8.89 (95%CI = 8.28-9.51), 2nd: 7.32 (95%CI = 6.67-7.97) and 3rd: 7.08 (95%CI = 6.41-7.74)]. Suicidal ideation frequency at baseline was 18%. HDL-c concentrations were inversely associated with changes in EPDS score (β = -0.080, 95%CI = -0.157 to -0.002), while low or very low active women (β = 1.288, 95%CI = 0.630-1.946), with single marital status (β = 1.348, 95%CI = 0.163-2.534), unplanned pregnancy (β = 1.922, 95%CI = 0.714-3.131), generalized anxiety disorder (β = 2.139, 95%CI = 0.410-3.868) and current suicidal ideation (β = 1.927, 95%CI = 0.596-3.258) tended to have higher EPDS scores. No relationship was observed between other lipids and EPDS scores. HDL-c concentration was inversely associated with changes in depressive symptom scores during pregnancy after adjusting for socio-economic, demographic, behavioral, nutritional, biochemical and mental health disorders.

Association of Prepregnancy Dietary Patterns and Anxiety Symptoms from Midpregnancy to Early Postpartum in a Prospective Cohort of Brazilian Women

BACKGROUND Adherence to unhealthy dietary patterns may alter the risk of mental disorders during pregnancy and the postpartum period. OBJECTIVE To analyze the association between prepregnancy dietary patterns and prospective variations on anxiety symptoms from midpregnancy to early postpartum. METHODS A prospective cohort of 207 healthy pregnant women was followed at 5 to 13, 20 to 26, and 30 to 36 gestational weeks, and once at 30 to 45 days postpartum. The State-Trait Anxiety Inventory was used to evaluate anxiety symptoms at the second and third gestational trimesters and during the postpartum period. Dietary intake was assessed using a food frequency questionnaire administered during the first trimester of pregnancy that referred to the 6 months before pregnancy. Principal components analysis was used to identify dietary patterns and three prepregnancy dietary patterns were identified: common-Brazilian, healthy, and processed. Three longitudinal mixed-effect models were estimated to verify the association between dietary patterns and anxiety symptoms, adjusted for confounding variables. RESULTS The mean anxiety symptom scores were 40.4, 40.5, and 37.2 for the second trimester, third trimester, and postpartum, respectively. The rate of variation of the State-Trait Anxiety Inventory score was 0.535 (95% CI -0.035 to 1.107; P=0.066) and -0.010 (95% CI -0.018 to -0.002; P=0.019) when accounting for gestational age and quadratic gestational age, respectively. The common-Brazilian pattern, comprised mainly of rice and beans (β=-1.200, 95% CI -2.220 to -0.181; P=0.021), and the healthy pattern comprised mostly of vegetables, fruits, fish, and tea (β=-1.290, 95% CI -2.438 to -0.134; P=0.029), were negatively associated with prospective changes in anxiety symptoms. CONCLUSIONS High adherence to the common-Brazilian or healthy patterns was negatively associated with higher anxiety symptom scores from mid-pregnancy to early postpartum in this group of Brazilian women.

Association between sociodemographics factors and dietary patterns during pregnancy

OBJECTIVE:To investigate the association between socio-demographic factors and dietary patterns in pregnancy.METHODS:Cross-sectional study with baseline data from a cohort of 421 postpartum women aged 18 and 45 years resident in Rio de Janeiro,Brazil. Dietary intake was evaluated with a validated food frequency questionnaire at 15 days following delivery, having as time frame the second and third pregnancy trimesters. Dietary patterns were identified using factor analysis for principal components analysis. The association between socio-demographic factors and the identified dietary patterns was assessed with multiple linear regression analysis.RESULTS:Two dietary patterns were identified: i) healthy: fruits; green vegetables; vegetables; fish; roots, corn and potato; milk and dairy and herbal tea mate, and negatively loadings for alcohol and coffee and ii) mixed: rice; bean; flour and pasta; breads; cake and cookies; soda and juice; sugar and sweets; fatty foods; meats; chicken; and eggs. The linear regression showed that the income (β=0.0002; 95%CI: 0.0002-0.0004) and schooling (β=0.0491; 95%CI: 0.0264-0.0718) were positively associated with healthy pattern, and parity (β=-0.1044; 95%CI: -0.1665- -0.0423) and skin color (β=-0.3102; 95%CI: -0.5256- -0.0947) were negatively associated. Skin color (β=0.1647; 95%CI: 0.0378- 0.2916) and marital status (β=0.1065; 95%CI: 0.0062- 0.2067) were positively associated with mixed pattern and income (β=-0.0001; 95%CI:-0.0002- -0.0001) and schooling (β=-0.0281; 95%CI: -0.0417- -0.0146) were negatively associated.CONCLUSION:Socio-demographic factors such as income, schooling, skin color, marital status and parity were associated with dietary patterns in this sample of postpartum women residents in Rio de Janeiro.

Hepatic, renal and inflammatory biomarkers are positively associated with blood pressure changes in healthy pregnant women: a prospective cohort.

AbstractThis article evaluates the association of hepatic, renal, and inflammatory biomarkers with changes in systolic (SBP) and diastolic (DBP) blood pressure (BP) during healthy pregnancies.A prospective cohort study with 225 healthy pregnant women was conducted in Rio de Janeiro, Brazil. SBP and DBP were evaluated throughout pregnancy (5th–13th, 20th–26th, and 30th–36th gestational weeks) and were the outcomes. The following biomarkers were measured at the first trimester and analyzed according to tertiles of the sample distribution and were considered the main independent predictors: alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA), creatinine (Cr), and C-reactive protein (CRP) concentrations. The statistical analysis included 3 stages of modeling with the longitudinal linear mixed-effects procedures: Model 1 was adjusted for gestational age and quadratic gestational age; Model 2 included interactions between the biomarkers and gestational age; and Model 3 was adjusted for self-reported skin color, education, parity, early-pregnancy body mass index (BMI) (under/normal <25; overweight/obese ≥25 kg/m2), smoking habit, and leisure-time physical activity. Additional models were performed for CRP and UA with the inclusion of interaction terms between the biomarkers and BMI.Women classified in the third tertile of the ALP (≥61.1 U/L; &bgr;SBP = 3.474; 95% confidence interval [CI]: 0.955–5.992; &bgr;DBP = 3.291; 95% CI: 1.098–5.485), ALT (≥14.3 U/L; &bgr;SBP = 2.232; 95% CI: 0.221–4.242; &bgr;DBP = 2.355; 95% CI: 0.721–3.989), and Cr values (≥48.6 &mgr;mol/L; &bgr;DBP = 1.927; 95% CI: 0.347–3.508) presented higher BP levels during pregnancy compared to those in the first and second tertiles. Women in the highest tertile of the ALP concentration distribution presented a lower rate of change in SBP and DBP during pregnancy (interaction term with gestational age &bgr;SBP = −0.004; 95% CI: −0.007 to −0.001; P = 0.02; &bgr;DBP = −0.003; 95% CI: −0.006 to −0.001; P = 0.01). Higher UA concentrations were associated with higher SBP levels only in overweight/obese women (&bgr; = 3.878; 95% CI: 0.687–7.068), whereas higher CRP concentrations (≥2.6 mg/L) were associated with higher DBP in under/normal weight women (&bgr; =2.252; 95% CI: 0.267–4.236).ALP, ALT, and Cr concentrations were positively associated with BP levels, whereas ALP was associated with a lower rate of change in BP. The associations of UA and CRP with BP differ according to the early-pregnancy BMI.

Padrões alimentares associados a indicadores antropométricos de adiposidade abdominal em adultos

This study aimed to identify dietary patterns and assess their association with abdominal fat. A cross-sectional study was conducted in the Central West Region of Brazil with a probabilistic sample of 208 adults of both sexes. Data on food intake was obtained using a food frequency questionnaire and factor analysis (principal components) was conducted to identify dietary patterns. Waist circumference (WC) and waist-to-hip ratio (WHR) were used to assess abdominal fat. The association between dietary patterns and body fat distribution was examined using multiple linear regression analysis adjusted for confounders. Three dietary patterns were identified: Western, regional traditional, and prudent. A positive association was found between the Western pattern and WC (p = 0.04) and WHR (p = 0.001) and between the regional traditional pattern and WHR (p = 0.05) among women. A slight association was also found between the latter pattern and WC (p = 0.07) also among women. An association was found between the Western and regional traditional dietary patterns and a larger concentration of abdominal fat among women.Este estudo teve o objetivo identificar padroes alimentares e analisar a associacao com a adiposidade abdominal. Estudo transversal, realizado na Regiao Centro-Oeste do Brasil, com amostra probabilistica de 208 adultos, de ambos os sexos. O consumo alimentar foi obtido por questionario de frequencia alimentar e aplicada analise fatorial (componentes principais) para identificar padroes alimentares. A circunferencia da cintura (CC) e a relacao cintura quadril (RCQ) foram indicadores de adiposidade abdominal. A associacao dos padroes alimentares com adiposidade abdominal foi analisada em modelos de regressao linear multipla ajustados por fatores de confusao. Identificaram-se tres padroes alimentares: ocidental, tradicional regional e prudente. O padrao ocidental associou-se positivamente com CC (p = 0,04) e RCQ (p = 0,001) e o padrao tradicional regional associou-se tambem com RCQ (p = 0,05), e marginal a associacao com a CC (p = 0,07) somente em mulheres. Os padroes ocidental e tradicional regional associaram a maior adiposidade abdominal em mulheres.

Patrones alimentarios asociados a los indicadores antropométricos de adiposidad abdominal en adultos

This study aimed to identify dietary patterns and assess their association with abdominal fat. A cross-sectional study was conducted in the Central West Region of Brazil with a probabilistic sample of 208 adults of both sexes. Data on food intake was obtained using a food frequency questionnaire and factor analysis (principal components) was conducted to identify dietary patterns. Waist circumference (WC) and waist-to-hip ratio (WHR) were used to assess abdominal fat. The association between dietary patterns and body fat distribution was examined using multiple linear regression analysis adjusted for confounders. Three dietary patterns were identified: Western, regional traditional, and prudent. A positive association was found between the Western pattern and WC (p = 0.04) and WHR (p = 0.001) and between the regional traditional pattern and WHR (p = 0.05) among women. A slight association was also found between the latter pattern and WC (p = 0.07) also among women. An association was found between the Western and regional traditional dietary patterns and a larger concentration of abdominal fat among women.Este estudo teve o objetivo identificar padroes alimentares e analisar a associacao com a adiposidade abdominal. Estudo transversal, realizado na Regiao Centro-Oeste do Brasil, com amostra probabilistica de 208 adultos, de ambos os sexos. O consumo alimentar foi obtido por questionario de frequencia alimentar e aplicada analise fatorial (componentes principais) para identificar padroes alimentares. A circunferencia da cintura (CC) e a relacao cintura quadril (RCQ) foram indicadores de adiposidade abdominal. A associacao dos padroes alimentares com adiposidade abdominal foi analisada em modelos de regressao linear multipla ajustados por fatores de confusao. Identificaram-se tres padroes alimentares: ocidental, tradicional regional e prudente. O padrao ocidental associou-se positivamente com CC (p = 0,04) e RCQ (p = 0,001) e o padrao tradicional regional associou-se tambem com RCQ (p = 0,05), e marginal a associacao com a CC (p = 0,07) somente em mulheres. Os padroes ocidental e tradicional regional associaram a maior adiposidade abdominal em mulheres.