Lívia Costa de Oliveira

Determinant factors of insufficient and excessive gestational weight gain and maternal–child adverse outcomes

OBJECTIVE To estimate the magnitude and determinant factors of insufficient and excessive gestational weight gain (GWG) and its relation with maternal-child adverse outcomes. METHODS This was a prospective study with 173 pregnant women and their newborns monitored at a primary health care facility in Rio de Janeiro. Multinomial regression models were employed, having as the outcome the adequacy of GWG (insufficient, adequate, or excessive). Covariables were classified as biological, socioeconomic, reproductive, behavioral, and nutritional. RESULTS Forty-one percent of pregnant women had insufficient GWG and 22.0% had excessive GWG. Pregestational overweight was associated with insufficient GWG (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.05-0.78), and pregestational obesity was associated with excessive GWG (OR 4.66, 95% CI 1.34-19.08). Also associated with insufficient GWG were a stature <157 cm (OR 2.25, 95% CI 1.03-4.93) and ages 25-29 y (OR 3.70, 95% CI 1.26-10.84) and >or=30 y (OR 2.88, 95% CI 1.13-7.35) compared with the reference group (18-24 y). Age <12 y at menarche (OR 4.97, 95% CI 1.51-16.30) and being a former smoker (OR 5.18, 95% CI 1.62-16.52) demonstrated an association with excessive GWG compared with non-smokers (reference group). Sixty percent of pregnant women with excessive GWG delivered by cesarean section compared with 39.8% with adequate or insufficient GWG (P < 0.05). Prevalence of macrosomia in the excessive GWG group was 23.5% compared with 4.5% for pregnant women with insufficient GWG (P < 0.001). CONCLUSION Different determinant factors related to insufficient and excessive GWG were observed, which can be identified in the beginning of pregnancy, thus predicting unfavorable gestational outcomes. An increased percentage of women presented GWGs outside recommended levels.

Fatores associados à ocorrência de cesárea e aborto em mulheres selecionadas em um centro de saúde no município do Rio de Janeiro, Brasil

OBJETIVOS: investigar fatores potencialmente associados a ocorrencia de cesarea e aborto. METODOS: foram analisados dados de uma coorte no pos-parto com 352 mulheres entre 15-45 anos. Os seguintes desfechos foram estudados: ocorrencia de cesarea no ultimo parto e ocorrencia de aborto anterior a ultima gravidez. A analise estatistica foi feita por meio de modelos de regressao logistica multivariados e hierarquizados. RESULTADOS: as prevalencias de cesarea e aborto foram de 36,3% e 34,0%, respectivamente. O modelo final revelou que as seguintes variaveis permaneceram estatisticamente associadas a ocorrencia de cesarea: nivel 1: cor de pele branca (OR=2,02; IC95%: 1,29-3,16); nivel 2: ligadura (OR=19,68; IC95%: 5,77-67,15). As seguintes variaveis permane-ceram associadas a ocorrencia de aborto: nivel 1: idade >29 anos (OR=6,11; IC95%: 2,94-12,72), estado marital: vive em uniao (OR=4,22; IC95%: 2,03-8,78); solteira: (OR=3,70; IC95%: 1,59-8,61). CONCLUSOES: a cor de pele branca e a pratica de ligadura foram co-variaveis potencialmente associadas a ocorrencia de cesarea, enquanto o estado marital em uniao ou solteira e a idade materna estiveram associadas a ocorrencia de aborto, sendo maior a probabilidade para mulheres acima de 29 anos.

Factors associated with prospective leptin concentrations throughout pregnancy in pregestational normal weight, overweight and obese women

Leptin concentrations increase throughout pregnancy but little is known about factors that influence this physiological change and whether they differ according to pregestational body mass index (BMI).

Fatores relacionados à prevalência de morbidades psiquiátricas menores em mulheres selecionadas em um Centro de Saúde no Rio de Janeiro, Brasil

The aim was to investigate factors potentially associated with minor psychiatric disorders, including maternal nutritional status variables. A cohort was studied with 479 women 15-45 years of age. The reduced General Health Questionnaire (GHQ-12 items) was applied at nine months post-partum with the 312 women who had completed follow-up. Minor psychiatric disorder was defined as a GHQ score of > or = 4 points and was treated as the response variable. Statistical analysis used hierarchical multivariate logistic regression models. The prevalence of minor psychiatric morbidity was 54.2% (95%CI: 48.6-59.7). According to the final model, the following variables remained statistically associated with minor psychiatric morbidity: level 1: total family income (1st quartile: OR = 2.71, 95%CI: 1.42-5.19; 2nd quartile: OR = 2.13; 95%CI: 1.13-4.04); level 3: body fat > or = 30% (OR = 1.66; 95%CI: 1.03-2.65). In conclusion, low income and obesity were the only factors potentially associated with minor psychiatric disorders, even after adjusting for confounding variables, while there are few studies relating maternal nutritional status and minor psychiatric morbidity.

Factors associated with maternal serum C-reactive protein throughout pregnancy: A longitudinal study in women of Rio de Janeiro, Brazil.

OBJECTIVES The aim of this study was to evaluate the longitudinal changes of C-reactive protein (CRP) concentrations during pregnancy and to assess whether socioeconomic, anthropometric, dietary, behavioral, and biochemical factors are associated with these changes. METHODS This was a prospective cohort study of 115 adult pregnant women, followed at gestational weeks 5 to 13, 20 to 26, and 30 to 36. Serum concentrations of CRP (mg/L) were measured by the immunoturbidimetric method with ultrasensitive kits (sensitivity 0.05 mg/dL). The statistics included descriptive analysis (mean + SD) and longitudinal linear mixed-effects models, reporting the β coefficient and 95% confidence intervals (CI). RESULTS Serum CRP concentrations progressively increased throughout pregnancy (β = 0.121; 95% CI, 0.071-0.171). Parity (β = 1.579; 95% CI, 0.731-2.427) and prepregnancy body mass index (BMI) (β = 0.316; 95% CI, 0.053-0.587) were positively associated and dietary glycemic load was negatively associated (β = -0.203; 95% CI, -0.380 to -0.026) with CRP concentrations in the multiple model. Prepregnancy obese women presented a more pronounced increase of CRP concentrations compared with normal weight women (β = 0.210; 95% CI, 0.059-0.360 versus 0.115, respectively; 95% CI, 0.049-0.181). A statistically significant interaction was observed between parity and gestational age (β = -0.045; 95% CI, -0.084 to -0.005), indicating that the variation of CRP throughout pregnancy differed according to parity categories. CONCLUSION CRP concentrations increased throughout pregnancy. Parity and prepregnancy BMI were positively associated and dietary glycemic load was negatively associated with concentrations of CRP.

Fatores associados à prática de atividade física no lazer em mulheres no pós-parto

INTRODUCAO: Sao escassos os estudos brasileiros sobre a pratica de atividade fisica, sobretudo em mulheres no pos-parto. OBJETIVO: Investigar fatores associados as mudancas na pratica de atividade fisica no lazer (AFL) em mulheres no pos-parto. METODOS: Quatrocentos e setenta e oito mulheres entre 15 e 45 anos foram recrutadas e acompanhadas por nove meses pos-parto em um estudo prospectivo com quatro acompanhamentos (15 dias, dois, seis e nove meses). A AFL foi definida como variavel dependente e aferida por meio de um escore. A criacao dos escores baseou-se na aplicacao de um questionario validado, que compreende cinco questoes referentes a atividade fisica no trabalho e seis referentes a AFL. As principais co-variaveis investigadas foram cor de pele, idade, renda familiar total, paridade e tipo de parto. Os dados foram analisados usando-se modelos de regressao linear longitudinal com efeitos mistos. RESULTADOS: Observou-se que 82,4% das mulheres praticavam algum grau de atividade fisica no lazer no pos-parto. As maiores medias de escore para AFL aos nove meses pos-parto foram observadas entre mulheres pardas (2,41), com mais de 30 anos (2,44) e com tres ou mais filhos (2,44). Os fatores que permaneceram associados a maior pratica de AFL no modelo multivariado foram cor de pele preta e parda [(branca/preta s = 0,0925, branca/parda s = 0,1114)], a maior idade (s = 0,0157), a menor renda familiar total (s = -0,0001), a maior paridade (s = 0,1708) e o tipo de parto cesarea (s = -0,1058). CONCLUSOES: Mulheres pretas e pardas, mais velhas e com maior paridade apresentaram maior escore de AFL no periodo pos-parto na amostra estudada.

Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study

The change in maternal lipid, leptin and adiponectin concentrations during pregnancy and infant birth weight (BW) is still poorly characterized. Thus, the aim of the study was to evaluate the association of maternal lipids, leptin and adiponectin throughout pregnancy with large-for-gestational-age (LGA) births and BW z-score. A prospective cohort of 199 mothers was followed during pregnancy in Rio de Janeiro, Brazil. The statistical analyses comprised multiple logistic and linear regression. Women delivered 36 LGA and 11 small-for-gestational-age newborns. HDL-c rate of change throughout pregnancy was negatively associated with BW z-score (β = −1.99; p = 0.003) and the delivery of a LGA newborn (OR = 0.02; p = 0.043). Pregnancy baseline concentration of log leptin was positively associated (OR = 3.92; p = 0.025) with LGA births. LDL-c rate of change throughout pregnancy was positively associated with BW z-score (β = 0.31; p = 0.004). Log triglycerides and log adiponectin were not significantly associated with BW z-score or LGA birth. In conclusion, a higher log leptin pregnancy baseline concentration and a lower HDL-c rate of change during pregnancy were associated with higher odds of having a LGA newborn. These maternal biomarkers are important to foetal growth and could be used in prenatal care as an additional strategy to screen women at risk of inadequate BW.

Maternal C-reactive protein concentrations during pregnancy and birth weight in a prospective cohort in Rio de Janeiro, Brazil

Abstract Objective: To evaluate the association between maternal C-reactive protein (CRP) concentrations during pregnancy and birth weight (BW) Z-score. Methods: A prospective cohort of pregnant women were followed at 5–13 (n = 203), 20–26 (n = 181), and 30–36 (n = 181) gestational weeks and at 30–45 d postpartum. Maternal CRP concentrations were assessed three times during pregnancy using immunoturbidimetric methods (ultra-sensitive kits). BW Z-score and newborns classified as small for gestational age (SGA) were evaluated according to Intergrowth-21st curves. Statistical analyses included SGA rates, BW Z-score means (SD) and a two-stage procedure: (1) a linear mixed-effect model (LME) to predict CRP intercept (mean exposure level) and slope (trend of change during pregnancy); and (2) a multiple linear regression model with BW Z-score as the outcome and CRP intercept and slope exposures. Results: A total of 4.4% (n = 9) women delivered SGA newborns. The mean BW was 3282.0 (37.3) g, and the mean gestational age at delivery was 38.8 (0.1) weeks. Women in the third tertile of the CRP rate of change gave birth to infants with a mean BW Z-score that was lower than those in the first/second tertiles (0.226 versus 0.381; p = 0.324). For the adjusted baseline CRP (β = 0.08; 95% CI: 0.03–0.14), the CRP trend of change was inversely associated with the BW Z-score (β= −3.77; 95% CI: −5.45 to −2.10). Conclusions: The maternal CRP trend of change during pregnancy was negatively associated with BW Z-score.

The Prognostic Role of Phase Angle in Advanced Cancer Patients: A Systematic Review

Phase angle (PA) is a ratio between the reactance and resistance obtained by bioelectric impedance analysis and has been interpreted as a cell membrane integrity indicator and a predictor of total body cell mass. A low PA may suggest deterioration of the cell membrane, which in advanced cancer patients may result in a reduced overall survival (OS). This systematic review sought to investigate the current evidence regarding whether there is an association between PA and OS in patients with advanced cancer (ie, metastatic disease). The search was conducted on electronic databases in August 2017. A total of 34 articles were identified in the initial literature search. Nine studies reporting on 1496 patients were deemed eligible according to our inclusion criteria. PA data were analyzed as continuous variables or according to different cutoffs, under a frequency of 50 Khz. Low PA was associated with worse nutrition status evaluated by body mass index, serum albumin level, transferrin, and fat-free mass. The median OS of the included papers varied from 25.5-330 days, and all studies analyzed showed a significant association between PA and OS, in that patients with low PA had worse OS. Future studies are necessary to justify the use of PA in therapeutic decisions for this population and to evaluate whether nutrition status can influence the association between PA and survival.

Different methods for diagnostic of sarcopenia and its association with nutritional status and survival in patients with advanced cancer in palliative care.

OBJECTIVES The aim of the present study was to evaluate the association between sarcopenia, diagnosed by different muscle mass measurement techniques, with nutritional status and overall survival in patients with advanced cancer under palliative care. AIM To investigate the association of sarcopenia, according to distinct muscle mass measurement methods, with nutritional status and overall survival (OS). METHODS This observational and prospective study, including 334 patients, defined sarcopenia as reduced muscle mass and strength. Muscle mass was evaluated adopting 3 different methods, mid-upper arm muscle area (MUAMA), calf circumference (CC) and appendicular skeletal muscle mass (ASMI) described by Baumgartner (1998) and adjusted for height. Strength was defined using a handgrip dynamometer and OS was established based on a 90 days follow-up after inclusion date. Kaplan-Meier curves were conducted for survival analyzes and the association between sarcopenia and OS was evaluated by Cox regression model RESULTS: Prevalence of sarcopenia varied from 27-65% according to the method used to evaluate muscle mass. Malnutrition assessed by different parameters was significantly higher in patients with sarcopenia. Patients considered sarcopenic by MUAMA (43 versus 67 days, p<0.001), CC (44 versus 77 days, p<0.001) and ASMI (48 versus 75 days, p<0.001) had significantly lower OS compared to non-sarcopenic patients. Sarcopenia evaluated by MUAMA (HR, 1.57; 95% CI, 1.12-2.18) and CC (HR, 2.00; 95% CI, 1.45-2.76) showed a higher risk of mortality. CONCLUSION Sarcopenia diagnosed by MUAMA and CC could predict mortality and CC proved to be the best prognostic method for estimating OS in patients with advanced cancer in palliative care.