Elisabete Alves

Prevalence of self-reported cardiovascular risk factors in Portuguese women: a survey after delivery

ObjectivesTo estimate the pre-pregnancy prevalence of overweight/obesity, smoking, hypertension, dyslipidemia and diabetes mellitus, in women who delivered a live born.MethodsIn a birth cohort study, puerperae were consecutively recruited at five public maternities of Porto, Portugal (2005–2006). We included 7,381 women with complete data for the current analysis. Socioeconomic characteristics, smoking habits, pre-pregnancy weight and chronic diseases diagnosis were self-reported and height was measured.ResultsBefore pregnancy, 21.3% of women were overweight and 8.8% were obese, 26.6% smoked and 11.2% were former smokers. The prevalence of hypertension, dyslipidemia and diabetes mellitus was 1.7, 1.7 and 0.6%, respectively, with an evident tendency to cluster. The prevalence of all cardiovascular risk factors, except smoking, increased with age and body mass index. Education and income were inversely associated with excessive weight. Current smokers were younger, thinner and in a lower socioeconomic position, whereas former smokers were older and in a higher socioeconomic position.ConclusionDespite the low prevalence of hypertension, dyslipidemia and diabetes, their tendency to cluster and the increased prevalence among overweight/obese women highlight the high level of risk of this young female population.

Medical record review to recover missing data in a Portuguese birth cohort: agreement with self-reported data collected by questionnaire and inter-rater variability

OBJECTIVES To assess the yield of medical record review to recover missing data originally collected by questionnaire, to analyze the agreement between these two data sources and to determine interobserver variability in clinical record review. METHODS We analyzed data from a birth cohort of 8,127 women who were consecutively recruited after giving birth from 2005-2006. Recruitment was conducted at all public maternity units of Porto, Portugal. We reviewed the medical records of 3,657 women with missing data in the baseline questionnaire and assessed agreement between these two sources by using information from participants with data from both sources. Interobserver variability was assessed by using 400 randomly selected clinical records. RESULTS Data on pregnancy complications and maternal anthropometric parameters were successfully recovered. Agreement between the questionnaire and records in family history data was fair, particularly for cardiovascular disease [k=0.27; 95% confidence interval (95%CI): 0.23-0.32]. The highest agreement was observed for personal history of diabetes (k=0.82; 95%CI 0.70-0.93), while agreement for hypertension was moderate (k=0.60; 95%CI 0.50-0.69). Discrepancies in prepregnancy body mass index classes were observed in 10.3% women. Data were highly consistent between the two reviewers, with the highest agreement found for gestational diabetes (k=1.00) and birth weight (99.5% concordance). CONCLUSION Data from the medical records and questionnaire were concordant with regard to pregnancy and well-known risk factors. The low interobserver variability did not threaten the precision of our data.

Parents’ views on factors that help or hinder breast milk supply in neonatal care units: systematic review

Objective To synthesise what is known about the parents’ views on factors that help or hinder breast milk supply during their infants’ hospitalisation in neonatal intensive care units (NICU). Methods A systematic search of PubMed, ISI WoK, PsycINFO and SciELO, targeting studies presenting original empirical data that examined parents’ perspectives regarding breast milk supply experiences in NICU, was performed. Based on content analysis, three independent researchers synthesised the findings of seven studies. Categories of facilitators and barriers were identified using quotations stated in the studies: parents’ breast milk supply experience; parents–professionals relationships; characteristics of the NICU; and parents’ social background and expectations. Results The studies, five qualitative and two mixed methods, were published between 1994 and 2011. With heterogeneous study designs, fathers’ perspectives were analysed in one article. Only one study defined breastfeeding. According to parents’ perspectives, successful breast milk supply in NICU depends on coherent and accurate knowledge about its techniques and benefits, reinforcement of mothers’ motivation and alignment between NICUs routines and parents’ needs. Parents perceived issues related to their own current breast milk supply experience, simultaneously, as main facilitators and barriers. Parents–professionals relationship constituted the second group of facilitators, but the fourth of barriers. The characteristics of the NICU were more relevant as a barrier than as a facilitator. Conclusions Although parents’ perspectives are grounded on individual child-focused experiences, their emphasis on learning and motivation guided by short-term goals opens room to the collective intervention of experts. This may facilitate the engagement of mothers, fathers and health professionals on family-centred care.

Impact of risk factors on hypertensive disorders in pregnancy, in primiparae and multiparae.

Abstract Background: Hypertensive disorders complicating pregnancy increase the risk of adverse obstetric and perinatal outcomes. Aim: To assess the impact of age, education, family history of cardiovascular disease, pre-pregnancy overweight/obesity and weight gain during pregnancy on hypertensive disorders, among primiparae and multiparae. Subjects and methods: In a birth cohort study, puerperae were consecutively recruited at public maternity units of Porto, Portugal (2005–2006). The study included 6952 women with singleton births and complete data. Hypertensive disorders included chronic hypertension, gestational hypertension or pre-eclampsia/eclampsia. Results: Overall, hypertensive disorders affected 4.6% of single pregnancies and were associated with older age, lower education, family history of cardiovascular disease and excessive weight before and during pregnancy, similarly in primiparae and multiparae. Approximately 50% of cases among primiparae and 70% among multiparae were attributable to the joint effect of pregnancies after 34 years of age, education below 12 years, family history of cardiovascular disease and excessive weight before and during pregnancy. Conclusion: The risk factors explained a high proportion of hypertensive disorders during pregnancy. Excessive weight before and during pregnancy had a very large contribution. The substantial joint effect of the risk factors suggests that interventions focusing on these risk factors should be part of pre-conceptional and pre-natal care.

Parenting roles and knowledge in neonatal intensive care units: protocol of a mixed methods study

Introduction There is a strong focus on the translation of scientific knowledge into evidence-based practice when dealing with very preterm births. The aim is to standardise and rationalise healthcare. The incorporation of parents’ perspectives with respect to the organisation of care and technical interventions in neonatal intensive care units (NICUs) is needed. This study aims to analyse the repertoire of meanings, knowledge and emotions actualised by the parents of very preterm infants hospitalised in NICUs in the decision process regarding parental care, treatment options and uses of information sources. Methods and analysis This is a mixed-methods, observational study. The methodological strategy will rely on: (1) Ethnographic observation, carried out in a level III NICU located in the North of Portugal, during 6 months; (2) NICU-based surveys of mothers and fathers of very preterm infants born between July 2013 and June 2014 and admitted at the seven public level III NICUs of the Northern Health Region of Portugal; (3) Single and couple semistructured interviews to a subsample of mothers and fathers of very preterm infants, 4 months after birth. Inferential statistics will be used to analyse the quantitative data and content analysis, with an iterative and reflexive process and will be implemented to assess qualitative data. Ethics and dissemination The study protocol was approved by the National Data Protection Commission and the Ethics Committee of all the hospitals involved. The current project will contribute to develop resources for enriched good medical practices in the context of neonatal services through integrating insights from social sciences, public health, epidemiology and ethics. The expected dissemination actions are effective tools in designing strategies that aim to develop family-centred care and to improve medical practices in the context of neonatal services.

Long-Term Maintenance of Smoking Cessation in Pregnancy: An Analysis of the Birth Cohort Generation XXI

INTRODUCTION Pregnancy affords opportunities for health promotion and disease prevention. We worked with a population-based cohort of women who gave birth in Portugal to quantify the proportion of women who quit smoking during pregnancy, the proportion of these women who continued to abstain 4 years after delivery, and the determinants of these outcomes. METHODS A birth cohort was assembled in public maternity units of Porto, Portugal, in 2005-2006, and all women were reevaluated at an average of 4 years after delivery. A total of 5,420 mothers were included in the analysis. Smoking status at baseline and at follow-up was ascertained by interview. Adjusted prevalence ratios and 95% CIs were computed using robust Poisson regression. RESULTS Overall, 47.4% of women who smoked ceased smoking and 41.7% reduced cigarette consumption during pregnancy. Four years after delivery, 32.1% of those who stopped smoking during pregnancy continued to abstain. Older women, first-time mothers, light smokers, those who were living with a partner at the time of follow-up, those who became pregnant again after the index pregnancy, those who breast fed for more than 52 weeks, and those with a child diagnosed with asthma and/or rhinitis were more likely to abstain from smoking. CONCLUSIONS Approximately half of all women stopped smoking during pregnancy and, among these, approximately one third continued to abstain 4 years after delivery. The high proportion of relapse may be attributable to poor awareness or skepticism regarding the adverse effects of secondhand smoke on children or physiological and psychological dependence on nicotine.

Long-term survival, autonomy, and quality of life of elderly patients undergoing aortic valve replacement.

Abstract  Aims: We reviewed the long‐term survival, autonomy, and quality of life (QoL) of elderly patients undergoing aortic valve replacement (AVR). Methods: Records of patients ≥75 years old that underwent AVR from 2002 to 2006 were retrospectively analyzed. Functional status was classified with Barthel Index (BI). QoL was presumed as the self‐perception of well‐being after AVR. Independent predictors of mortality were identified using the Cox proportional hazards model. Results: We included 114 patients, with a mean age of 78.5 ± 2.5 years. Seventy (59.8%) patients were females. Mean additive and logistic EuroSCORE were 7 ± 2 and 9 ± 7, respectively. Follow‐up on vital status was achieved for 113 (99.1%) patients after a mean period of 47.2 ± 23.4 months. Twenty‐seven (23.7%) patients died (including three operative deaths). Survival up to one, three, and five years of follow‐up was 94.4%, 86.7%, and 76.1%, respectively. Multivariate analysis showed that pulmonary hypertension and diabetes were independent predictors of all‐cause mortality. Information on BI score and QoL was obtained for 77 (89.5%) and patients. Among those, 69 (89.6%) were autonomous according to BI and 72 (93.5%) considered having had an improvement in QoL. Conclusion: Patients ≥75 years old undergoing AVR presented good medium‐term survival. Predictors of an adverse outcome were significant pulmonary hypertension and diabetes. At follow‐up, most achieved improvement of QoL and remained autonomous. These results stress that excellent long‐term outcomes with AVR can be achieved in appropriately selected elderly patients. (J Card Surg 2012;27:20–23)

Awareness and motives for use and non-use of preimplantation genetic diagnosis in familial amyloid polyneuropathy mutation carriers.

To assess awareness of preimplantation genetic diagnosis (PGD) and to identify the reasons surrounding its use and non‐use by familial amyloidotic polyneuropathy (FAP) carriers.

Factors Influencing Parent Reports of Facilitators and Barriers to Human Milk Supply in Neonatal Intensive Care Units

Background: Successful human milk supply in neonatal intensive care units (NICUs) requires the development of family-centered services. Objective: This study aimed to assess parent perceptions of factors that help or hinder providing human milk to very preterm infants (VPI) in the NICU according to sociodemographic, reproductive, and obstetric characteristics. Methods: This cross-sectional quantitative study included 120 mothers and 91 fathers of VPI hospitalized in a level 3 NICU located in the Northern Health Region of Portugal (July 2013-June 2014). Interviewers administered structured questionnaires regarding parent characteristics and the provision and perception of factors that help or hinder human milk supply in the NICU, 15 to 22 days after birth. Results: The main facilitators of human milk supply were its contribution to infant growth and well-being (51.4%) and parents’ knowledge of breastfeeding benefits (27.6%). The main barriers were worries related to inadequate milk supply (35.7%), difficulties with expressing breast milk (24.8%), and physical separation from infants (24.3%). Fathers referred less frequently to the contribution of human milk to infant growth and well-being (odds ratio [OR] = 0.57; 95% confidence interval [CI], 0.32-1.00) but more frequently to knowledge of breastfeeding benefits as facilitators (OR = 2.31; 95% CI, 1.23-4.32). Participants with > 12 years of education (OR = 1.91; 95% CI, 1.05-3.47) and those with an extremely low birth weight infant (OR = 1.90; 95% CI, 1.02-3.54) highlighted worries related to inadequate milk supply. Fathers (OR = 2.16; 95% CI, 1.11-4.19) and participants with ≤ 12 years of education (OR = 0.25; 95% CI, 0.11-0.57) more frequently reported difficulties with expressing as the main barrier. Conclusion: The parent’s gender and education and the infant’s birth weight are crucial considerations for establishing optimal practices for supporting breastfeeding.

Women’s Satisfaction with Body Image before Pregnancy and Body Mass Index 4 Years after Delivery in the Mothers of Generation XXI

Background Body image satisfaction (BIS) influences body weight regulation and may contribute to long-term healthier lifestyle after pregnancy. Thus, we aimed to assess the association between BIS before pregnancy and body mass index (BMI) 4 years after the index pregnancy. Methods As part of the follow-up of a birth cohort, 3612 women with prepregnancy BMI >18.5 kg/m2 were reevaluated 4 years after the birth of a child. BIS was defined as the difference between perceived and ideal body size before pregnancy, assessed by Stunkard Silhouettes after birth. The associations of BIS with BMI change (continuous) and BMI classes at 4 years, based on measured weight and height, were estimated using linear and multinomial regression, respectively. Results Among women with normal prepregnancy BMI, those who felt too small, regarding their ideal, had a 0.25 kg/m2 smaller increase in BMI within 4 years and a lower likelihood of becoming overweight or obese [multivariate-adjusted odds ratio (OR) = 0.63; 95% confidence interval (95%CI): 0.44–0.91 and OR = 0.21; 95%CI: 0.05–0.91, respectively) than those satisfied with body image. Feeling too large was associated with a 0.41 kg/m2 larger increase in BMI and a higher risk of becoming overweight or obese (OR = 2.12; 95%CI:1.73–2.59 and OR = 3.42; 95%CI:2.02–5.79, respectively). A similar, non-significant, trend was observed for overweight women. Obese women who felt too large had a non-significant decrease in BMI. Conclusions BIS plays a role in maternal body weight after delivery. Realistic body size goals may promote the motivation to lose weight and contribute to higher success in attaining them.