Association between maternal plasma one-carbon biomarkers during pregnancy and fetal growth in twin pregnancies / 中华妇产科杂志

Objective: To characterize the relationship between the levels of plasma methyl donor and related metabolites (including choline, betaine, methionine, dimethylglycine and homocysteine) and fetal growth in twin pregnancies. Methods: A hospital-based cohort study was used to collect clinical data of 92 pregnant women with twin pregnancies and their fetuses who were admitted to Peking University Third Hospital from March 2017 to January 2018. Fasting blood was collected from the pregnant women with twin pregnancies (median gestational age: 18.9 weeks). The levels of methyl donors and related metabolites in plasma were quantitatively analyzed by high-performance liquid chromatography combined with mass spectrometry. The generalized estimation equation was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and neonatal outcomes of twins, and the generalized additive mixed model was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and fetal growth ultrasound indicators. Results: (1) General clinical data: of the 92 women with twin pregnancies, 66 cases (72%) were dichorionic diamniotic (DCDA) twin pregnancies, and 26 cases (28%) were monochorionic diamniotic (MCDA) twin pregnancies. The comparison of the levels of five plasma methyl donors and related metabolites in twin pregnancies with different basic characteristics showed that the median levels of plasma choline and betaine in pregnant women ≥35 years old were higher than those in pregnant women <35 years old, and the differences were statistically significant (all P<0.05). (2) Correlation between plasma methyl donor and related metabolites levels and neonatal growth indicators: after adjusting for confounding factors, plasma homocysteine level in pregnant women with twins was significantly negatively correlated with neonatal birth weight (β=-47.9, 95%CI:-94.3- -1.6; P=0.043). Elevated methionine level was significantly associated with decreased risks of small for gestational age infants (SGA; OR=0.5, 95%CI: 0.3-0.9; P=0.021) and low birth weight infants (OR=0.6, 95%CI: 0.4-0.9; P=0.020). Increased homocysteine level was associated with increased risks of SGA (OR=1.5, 95%CI: 1.0-2.2; P=0.029) and inconsistent growth in twin fetuses (OR=1.9, 95%CI: 1.0-3.7; P=0.049). (3) Correlation between the levels of plasma methyl donors and related metabolites and intrauterine growth indicators of twins pregnancies: for every 1 standard deviation increase in plasma choline level in pregnant women with twin pregnancies, fetal head circumference, abdominal circumference, femoral length and estimated fetal weight in the second trimester increased by 1.9 mm, 2.6 mm, 0.5 mm and 20.1 g, respectively, and biparietal diameter, abdominal circumference and estimated fetal weight increased by 0.7 mm, 3.0 mm and 38.4 g in the third trimester, respectively, and the differences were statistically significant (all P<0.05). (4) Relationship between plasma methyl donor and related metabolites levels in pregnant women with different chorionicity and neonatal birth weight and length: the negative correlation between plasma homocysteine level and neonatal birth weight was mainly found in DCDA twin pregnancy (β=-65.9, 95%CI:-110.6- -21.1; P=0.004). The levels of choline, betaine and dimethylglycine in plasma of MCDA twin pregnancy were significantly correlated with the birth weight and length of newborns (all P<0.05). Conclusion: Homocysteine level is associated with low birth weight in twins, methionine is associated with decreased risk of SGA, and choline is associated with fetal growth in the second and third trimesters of pregnancy.

Prevalence of physical activity and associated factors among pregnant women: a cross-sectional population-based study in southern Brazil / Prevalência de atividade física e fatores associados entre gestantes: estudo transversal de base populacional no sul do Brasil

Abstract Objectives: to describe the prevalence of sufficient leisure-time physical activity (LPA) in the trimesters of pregnancy and to test its association with sociodemographic and contextual characteristics. Methods: cross-sectional study that in 2019 analyzed data from 3580 pregnant women residing in Santa Catarina, Brazil. LPA was categorized as "active" (150 minutes or more of LPA/week) and "inactive" (less than 150 minutes). Results: the prevalence for the recommended level of LPA was 15.3% (CI95%= 14.1-16.4) before pregnancy, gradually declining to 7.8% (CI95%= 7.3-8.7), 7.3% (CI95%= 6.58.2), and 5.8% (CI95%= 5.1-6.7) in the following trimesters of pregnancy. Higher level of education was associated with the four outcomes, increasing the chance of being active by 79% in the third trimester of pregnancy. In the second trimester, living in a neighborhood that stimulates physical activity increased the chance of being active by 39%. In the third trimester, having received guidance from a health professional was associated with an increase of 60% in the chance of practicing LPA. Conclusion: the prevalence of recommended LPA is low among pregnant women and living in a neighborhood favorable to outdoor practices, greater education level and receiving guidance from health professionals increased the chance of pregnant women to be active.

Resumo Objetivos: descrever a prevalência de atividade física no lazer (AFL) suficiente nos trimestres da gravidez e testar sua associação com características sociodemográficas e contextuais. Métodos: estudo transversal que analisou em 2019 dados de 3.580 gestantes residentes em Santa Catarina, Brasil. AFL foi categorizada como "ativa" (150 minutos ou mais de LPA / semana) e "inativa" (menos de 150 minutos por semana). Resultados: a prevalência para o nível recomendado de AFL foi de 15,3% (IC95%= 14,116,4) antes da gravidez, diminuindo gradualmente para 7,8% (IC95%= 7,3-8,7), 7,3% (IC95%= 6,5-8,2), e 5,8% (IC95%= 5,1-6,7) nos trimestres seguintes da gravidez. Maior escolaridade foi associada aos quatro desfechos, aumentando a chance de ser ativa em 79% no terceiro trimestre da gravidez. No segundo trimestre, morar em um bairro que estimula a atividade física aumentou em 39% a chance de ser ativa. Já no terceiro trimestre, ter recebido orientação de profissional de saúde esteve associado a um aumento de 60% na chance de praticar AFL. Conclusão: a prevalência de AFL recomendada é baixa entre gestantes e morar em bairro favorável a atividades ao ar livre, maior escolaridade e receber orientação de profissionais de saúde aumentam a chance de gestantes serem ativas.

Revisión de la literatura: composición salival y su relación con caries dental en embarazadas / Review of the literature: salivary composition and its relationship with dental caries in pregnant women

La saliva es un fluido complejo muy importante en las funciones de la cavidad bucal. El embarazo es un estado normal en el que el embrión se forma y evoluciona durante nueve meses. En este proceso la mujer sufre una serie de cambios fisiológicos y psicológicos. Entre ellos, tiene modificaciones en la saliva y, por consiguiente, en el flujo, pH y concentración de proteínas salivales, que desempeñan un papel importante en la protección contra la infección en los seres humanos. Su nivel en la cavidad oral está sujeto a constantes fluctuaciones que dependen de numerosos factores. El embarazo genera adaptaciones en la fisiología femenina que pueden repercutir en la salud bucal de la gestante. Las afecciones bucales más frecuentes son la caries dental y la gingivitis. Si estas afecciones no son tratadas a tiempo, pueden repercutir en la salud del futuro bebé. Se realizó una revisión bibliográfica con el objetivo de conocer acerca de los componentes de la saliva y su relación con caries dental en las embarazadas, considerando los tres trimestres de gestación (AU)

Saliva is a complex fluid very important in the functions of the oral cavity. Pregnancy is a normal state in which the embryo forms and evolves for nine months. In this process, women undergo a series of physiological and psychological changes. Among them, it has modifications in saliva and, consequently, in the flow, pH and concentration of salivary proteins, which play an important role in protecting against infection in humans. Its level in the oral cavity is subject to constant fluctuations that depend on numerous factors. Pregnancy generates adaptations in female physiology that can affect the oral health of the pregnant woman. The most common oral conditions are dental caries and gingivitis. If these conditions are not treated in time, they can affect the health of the future baby. A bibliographic review was carried out with the objective of knowing about the components of saliva and its relationship with dental caries in pregnant women, considering the three trimesters of gestation (AU)

Blood Pressure Variation Throughout Pregnancy According to Early Gestational BMI: A Brazilian Cohort / Variação da Pressão Arterial na Gestação Segundo o IMC no Início da Gravidez: Uma Coorte Brasileira

Background: The maternal cardiovascular system undergoes progressive adaptations throughout pregnancy, causing blood pressure fluctuations. However, no consensus has been established on its normal variation in uncomplicated pregnancies. Objective: To describe the variation in systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels during pregnancy according to early pregnancy body mass index (BMI). Methods: SBP and DBP were measured during the first, second and third trimesters and at 30-45 days postpartum in a prospective cohort of 189 women aged 20-40 years. BMI (kg/m2) was measured up to the 13th gestational week and classified as normal-weight (<25.0) or excessive weight (≥25.0). Longitudinal linear mixed-effects models were used for statistical analysis. Results: A decrease in SBP and DBP was observed from the first to the second trimester (βSBP=-0.394; 95%CI: -0.600- -0.188 and βDBP=-0.617; 95%CI: -0.780- -0.454), as was an increase in SBP and DBP up to 30-45 postpartum days (βSBP=0.010; 95%CI: 0.006-0.014 and βDBP=0.015; 95%CI: 0.012-0.018). Women with excessive weight at early pregnancy showed higher mean SBP in all gestational trimesters, and higher mean DBP in the first and third trimesters. Excessive early pregnancy BMI was positively associated with prospective changes in SBP (βSBP=7.055; 95%CI: 4.499-9.610) and in DBP (βDBP=3.201; 95%CI: 1.136-5.266). Conclusion: SBP and DBP decreased from the first to the second trimester and then increased up to the postpartum period. Women with excessive early pregnancy BMI had higher SBP and DBP than their normal-weight counterparts throughout pregnancy, but not in the postpartum period. .

Fundamento: O sistema cardiovascular materno sofre adaptações progressivas durante a gestação, acarretando flutuações da pressão arterial. Entretanto, não há consenso sobre a variação pressórica normal na gravidez saudável. Objetivo: Descrever a variação da pressão arterial sistólica (PAS) e diastólica (PAD) durante a gravidez e no pós-parto imediato segundo o índice de massa corporal (IMC) no início da gravidez. Métodos: A PAS e a PAD foram medidas no 1º, 2º e 3º trimestres gestacionais e aos 30-45 dias pós-parto em uma coorte prospectiva de 189 mulheres com idade entre 20 e 40 anos. O IMC (kg/m2) foi aferido até a 13a semana e classificado como normal (< 25,0) ou excessivo (≥ 25,0). Modelos longitudinais de efeitos mistos foram utilizados para a análise estatística. Resultados: Observou-se diminuição da PAS e da PAD do primeiro para o segundo trimestre (βPAS=-0,394; IC95%:-0,600- -0,188 e βPAD=-0,617; IC95%:-0,780- -0,454) e subsequente aumento de ambas até 30-45 dias após o parto (βPAS=0,010; IC95%:0,006-0,014 e βPAD=0,015; IC95%:0,012-0,018). As mulheres com IMC excessivo apresentaram média de PAS maior em todos os trimestres, e de PAD maior no primeiro e no terceiro trimestres. O IMC excessivo no início da gestação esteve positivamente associado com mudanças na PAS (βPAS=7,055; IC95%:4,499-9,610) e na PAD (βPAD=3,201; IC95%:1,136-5,266). Conclusão: A PAS e a PAD diminuíram do primeiro para o segundo trimestre e aumentaram do segundo trimestre até o pósparto. Mulheres com IMC excessivo no início da gestação apresentaram valores mais elevados de PAS e PAD ao longo da gravidez, mas não no pós-parto, quando comparadas às de IMC normal. .

Course of migraine during pregnancy among migraine sufferers before pregnancy / Comportamento da enxaqueca durante a gestação em mulheres portadoras de enxaqueca pré-gestacional

OBJECTIVE: To describe the course of migraine without aura and migraine with aura during pregnancy and factors that could influence its course, among migraine sufferers before pregnancy. METHOD: A cross sectional study undertaken at the IMIP, Brazil. Out of 686 consecutively assisted women, at the first postnatal week, 266 were identified as migraine sufferers before pregnancy. RESULTS: There was migraine remission in 35.4 percent, 76.8 percent and 79.3 percent among migraine without aura sufferers and 20.7 percent, 58.6 percent and 65.5 percent among those with migraine with aura, respectively in the first, second and third trimesters. Statistically significant difference was found when the first trimester was compared with the second and third trimesters. The factors associated with the presence of migraine during pregnancy were: multiparity, menstrually related migraine without aura prior to pregnancy and illness during pregnancy. CONCLUSION: The study contributed to elucidate the course of migraine during pregnancy in migraine sufferers prior to pregnancy.

OBJETIVO: Descrever o comportamento da enxaqueca com e sem aura durante a gestação e fatores que possam influenciar o seu curso, em mulheres com enxaqueca antes da gestação. MÉTODO: Estudo transversal realizado no IMIP, Brasil. De 686 mulheres consecutivamente assistidas na primeira semana pós-parto, 266 foram identificadas como portadoras de enxaqueca antes da gestação. RESULTADOS: Houve desaparecimento das crises de enxaqueca, tanto na enxaqueca sem aura em 35,4 por cento, 76,8 por cento e 79,3 por cento, como na enxaqueca com aura em 20,7 por cento, 58,6 por cento e 65,5 por cento, respectivamente no primeiro, segundo e terceiro trimestres de gestação, com diferença estatisticamente significante quando se comparou o primeiro, com o segundo e terceiro trimestres. Os fatores associados à presença de crises de enxaqueca foram: multiparidade, enxaqueca sem aura relacionada à menstruação antes de gestação e doença durante a gestação. CONCLUSÃO: O estudo contribuiu para elucidar o comportamento da enxaqueca durante a gestação em mulheres com enxaqueca antes da gestação.

Desenvolvimento de um Questionário Quantitativo de Freqüência Alimentar (QQFA) para gestantes usuárias de Unidades Básicas de Saúde de Ribeirão Preto, São Paulo, Brasil / Development of a quantitative food frequency questionnaire for pregnant women attending primary care in Ribeirão Preto, São Paulo State, Brazil

The aim of this study was to design a food frequency questionnaire for pregnant women attending primary care under the Unified National Health System in Ribeirão Preto, São Paulo State, Brazil. A 24-hour food recall was obtained from 150 pregnant women, 50 in each trimester of pregnancy (age 18-35 years). A second food recall was obtained from 90 women, 30 in each trimester of pregnancy, from 7 to 15 days after the first dietary assessment. An 85-item questionnaire was developed with stepwise multiple linear regression models, based on the contribution of each food to inter-individual variation of energy and 28 target nutrients, which accounted for 74.2 to 98.8 percent of the selected nutrients. Portion sizes were determined according to percentiles 25, 50, 75, and 100 for each food item intake. To our knowledge, this is the first food frequency questionnaire designed for Brazilian pregnant women.

O objetivo do presente estudo foi desenvolver um questionário quantitativo de freqüência alimentar para gestantes adultas usuárias do Sistema Único de Saúde de Ribeirão Preto, São Paulo, Brasil. Um inquérito recordatório de 24 horas (IR24h) foi obtido de 150 gestantes, 50 em cada trimestre gestacional, com idade entre 18 e 35 anos. Um segundo IR24h foi obtido de 90 gestantes, 30 em cada trimestre gestacional, entre 7 e 15 dias após o primeiro inquérito. Uma lista de 85 alimentos foi estabelecida por regressão linear múltipla stepwise, estimando-se a contribuição percentual para a variabilidade interindividual da estimativa de energia e 28 nutrientes de interesse, com contribuição de 74,2 a 98,8 por cento para os nutrientes de interesse selecionados. As porções alimentares foram determinadas de acordo com a distribuição percentual dos pesos relatados e descritas nos percentis 25, 50, 75 e 100. Desconhecemos a existência de questionário quantitativo de freqüência alimentar desenvolvido para gestantes no Brasil.

Hierro, oxígeno y desarrollo placentario en la génesis de la preeclampsia: Efectos de la altura en Ecuador / Iron, oxygen and placental development in the etiology of preeclampsia: Effects of high altitude in Ecuador

Preeclampsia is the second cause of maternal death in Ecuador. The etiology of this condition is probably a placental alteration, although the details are not well known. The development of the placenta is closely related to the availability of oxygen. A defect in the differentiation of trophoblastic cells due to a faulty sensitization to changes in oxygen pressure, could be the cause of the alteration in placental development. The role of iron and local environmental conditions of a susceptible population, should be considered in the study of the etiology of preeclampsia. In the Andrean area of Ecuador, the high incidence of preeclampsia could be explained by the high prevalence of anemia and high altitude. However more studies are required to establish a close link between the environmental conditions of this area and the imperfect placental development.