Walking in pregnancy and prevention of insomnia in third trimester using pedometers: study protocol of Walking_Preg project (WPP). A randomized controlled trial.

BACKGROUND: Previous studies in pregnancy have not focused in evaluating the effect of walking during pregnancy and prevention of insomnia. Our general objective is to determine the effect of a walking program in preventing the appearance of insomnia in the third trimester of pregnancy, increasing sleep quality and improving quality of life throughout pregnancy. METHODS: Randomized Controlled trial in parallel in healthy sedentary pregnant women (n = 265), Walking_Preg Project (WPP), from university hospital in Granada, Spain. At 12th gestational week (GW), they will be invited to participate and randomly assigned to one of the three arms of study: the intervention group I1 (pedometer, goal of 11,000 steps/day), intervention group I2 (pedometer, no goal) and control (no pedometer). Duration of intervention: 13-32 GW. At 12th, 19th and 31st GW the average steps/day will be measured in groups I1 and I2. At 13th, 20th and 32nd GW, Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), Adherence to Mediterranean Diet (AMD), physical activity (short IPAQ), quality of life (PSI), and consumption of toxic substances (caffeine, illegal drugs, alcohol and tobacco) will be collected. Student t test or Mann-Whitney U will be used to compare 19th and 31st GW mean of daily steps between I1 and I2 groups. To compare differences between groups in terms of frequency of insomnia/quality of life for each trimester of pregnancy, Pearson's Chi-square test or Fisher's exact test will be used. To determine differences in hours of sleep and quality of sleep throughout each trimester of pregnancy, analysis of variance or Friedman test will be used. McNemar-Bowker test will be used to assess differences in life quality in pre-post analyses in the 3 arms. We will use Stata 15 statistical software. DISCUSSION: promoting walking in second half of pregnancy through use of pedometer and health pre-registration of a goal to be achieved -'10,000-11,000 steps a day'- should prevent appearance of insomnia in third trimester, will increase sleep quality and quality of life in pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03735381 . Registered 8th November, 2018.

Alcohol consumption during pregnancy and risk of small-for-gestational-age newborn.

BACKGROUND: Contradictory results have been published on the association of alcohol consumption during pregnancy with perinatal outcomes, including the risk of small for gestational age newborn. AIM: To determine whether alcohol consumption during pregnancy is associated with the risk of small for gestational age newborn. METHOD: A case-control study with 518 pairs of pregnant Spanish women in five hospitals was conducted; cases were women with small for gestational age newborn and age-matched (±2years) controls were women with non-small for gestational age newborn. Data were gathered on demographic characteristics, socioeconomic status, toxic habits, and diet. Alcohol intake was recorded with a self-administered 137 food frequency questionnaire and with a personal interview, Alcohol intake was categorized -. Agreement in alcohol intake results between direct interview and frequency food questionnaire was evaluated with the Kappa index. Crude and adjusted odds ratios and their 95% confidence intervals were estimated by conditional logistic regression. FINDINGS: Poor agreement was observed between food frequency questionnaire and personal interview results for both cases (κ=0.23) and controls (κ=0.14). A food frequency questionnaire-recorded intake of less than 4g/day was associated with a significantly lower odds ratios for small for gestational age newborn (odds ratios=0.62, 95% confidence intervals, 0.43-0.88), whereas an interview-recorded intake of <4g/day was not related to small for gestational age newborn (odds ratios=0.86, 95% confidence intervals, 0.49-1.54). CONCLUSIONS: A very moderate alcohol intake during pregnancy may have a negative association with the risk of having a small for gestational age newborn.

Factors associated with insomnia in pregnancy: A prospective Cohort Study.

OBJECTIVE: To quantify insomnia and their components in a longitudinal cohort of pregnant women and factors associated with insomnia. STUDY DESIGN: A prospective cohort of 486 healthy singleton pregnancies assembled before the 14th gestational week (February 2013 to March 2016). Insomnia data were collected pre-gestationally, in each trimester and six months post-partum, analysing five different moments. Multiple logistic regression analysis was performed to generate adjusted Odds Ratios (aOR) with 95% confidence intervals (CI) of determinants of insomnia in each trimester, defined using Athens Insomnia Scale (AIS) as score ≥8. RESULTS: Insomnia prevalence was 6.1% (3.9-8.9) pre-gestational, 44.2% (39.3-49.6) in first trimester (T1), 46.3% (41.9-51.3) in second (T2) and 63.7% (57.7-67.8) in third trimester (T3). Post-gestational insomnia was 33.2% (28.2-37.9) (p < 0.001 pre-gestational vs T1, T2 vs T3 and T3 vs after pregnancy). There was worsening mean AIS score, from: 2.34 before pregnancy to 9.87 in T3 because the deterioration of nighttime sleep, in absolute terms, but daytime impact was higher in T1. Previous trimester insomnia was associated with insomnia in T2 (aOR = 4.21, 95% CI 2.78-6.37) and T3 (aOR = 4.43, 95% CI 2.77-7.08). Pre-gestational insomnia was determinant of insomnia in T1 (aOR 12.50, 95% CI 3.58-43.60) and obesity was associated with insomnia in T3 (aOR = 2.30, 95% CI 0.99-5.32). On the contrary, moderate physical activity reduced the odds of insomnia in T3 (aOR 0.65, 95% CI 0.40-1.03). CONCLUSIONS: Insomnia prevalence was high from the beginning of pregnancy, associated with pre-gestational insomnia. In late pregnancy, two out of three pregnant women suffering insomnia. Insomnia prevention should be targeted particularly to those with high body mass index and pre-gestational insomnia.

Partner smoking influences whether mothers quit smoking during pregnancy: a prospective cohort study.

OBJECTIVE: To analyse the prevalence and intensity of smoking among pregnant women and their partners, and factors associated with quitting smoking among pregnant women. DESIGN: A prospective cohort study, starting in 2013. SETTING: Andalusia, the south of Spain. SAMPLE: A cohort of 486 healthy pregnant women followed-up on three occasions during pregnancy. METHODS: Estimation of the proportions of women and partners who quit smoking at each trimester. MAIN OUTCOME MEASURES: To determine factors associated in a multivariable model, considering sociodemographic, obstetric, anthropometric, lifestyle variables, and the smoking habits of their partners. RESULTS: A high proportion of women quit smoking during pregnancy (61.08%; 95% confidence interval, 95% CI 53.61-68.55%). The smoking rate amongst mothers decreased from 36.06% (n = 167) before pregnancy to 14.08% (n = 65), 12.39% (n = 54), and 11.92% (n = 51) during the three pregnancy trimesters (P < 0.001), and consumption decreased from 8.71 cigarettes/day in the first trimester to 5.51 cigarettes/day in the second trimester (P < 0.001) and 5.96 cigarettes/day in third trimester (P = 0.0002 first versus third trimester). There was only a minimal decrease in the frequency of smoking among the partners, however: 38.44% (n = 178) before pregnancy, and 36.07% (n = 167), 32.72% (n = 143), and 31.85% (n = 136) during the three trimesters of pregnancy. The consumption of cigarettes did not decrease among partners: 11.75, 11.67, and 12.09 cigarettes/day (P = 0.4299 first versus second trimester; P = 0.654 first versus third trimester). Women whose partner smoked were less likely to quit (adjusted odds ratio, aOR 0.26; 95% CI 0.12-0.55). CONCLUSIONS: About one in ten pregnant women smoked and one in four was a passive smoker. Strategies to reduce tobacco exposure in pregnancy should include a focus on partner smoking. TWEETABLE ABSTRACT: Pregnant women quit smoking cigarettes in pregnancy. What about their partners?

Resultados perinatales en función de 3 criterios diagnósticos de diabetes gestacional / Perinatal outcomes according to 3 diagnostic criteria for gestational diabetes

Objetivo: Comparar la frecuencia de efectos perinatales adversos en función de 3 criterios diagnósticos de diabetes gestacional (DG). Material y métodos: Estudio prospectivo. Las gestantes se clasificaron en 3 categorías: DG según los criterios del NDDG (tratadas), criterios de Carpenter y Coustan e Hyperglycemia and Adverse Pregnancy Outcomes (no tratadas). Se comparó el riesgo de recién nacidos prematuros, macrosomías, grandes para edad gestacional y el tipo de parto entre los grupos. Resultados: Las gestantes con DG presentan mayor frecuencia de resultados perinatales adversos. Las gestantes con criterios Hyperglycemia and Adverse Pregnancy Outcomes no se diferencian significativamente de la población no diabética, mientras que aquellas con criterios de Carpenter y Coustan muestran mayor riesgo de macrosomías y grandes para edad gestacional; OR de 7,14 (1,76-29,96) y 5,84 (1,75-19,52) respectivamente. Sin embargo, no se encuentran diferencias en otras variables obstétricas como la prematuridad o el tipo de parto

Objective: To compare the frequency of adverse perinatal effects according to 3 diagnostic criteria for gestational diabetes (GD). Material and methods: We conducted a prospective study in which pregnant women were categorized according to the following criteria: NDDG (treated), Carpenter-Coustan and Hyperglycemia and Adverse Pregnancy Outcomes (untreated). We compared the risk of preterm infants, fetal macrosomia, large for gestational age infants and type of delivery among the study groups. Results: Women with GD showed a higher frequency of adverse perinatal outcomes. Women with Hyperglycemia and Adverse Pregnancy Outcomes criteria showed no significant difference with non-diabetics. Women with Carpenter-Coustan criteria showed an increased frequency of fetal macrosomia and large for gestational age infants, OR 7.14 (1.76-29.96) and 5.84 (1.75-19.52), respectively. There were no differences among the study groups in other obstetric variables such as prematurity or type of delivery

[Association of age and sex with intensity of exposure to bicycle use in Spain, 1993-2009]. / Asociación de la edad y el sexo con la intensidad de la exposición al uso de la bicicleta en España, 1993-2009.

BACKGROUND: To estimate the association of age and sex with the intensity of exposure of cyclists in Spain, between 1993 and 2009, in a global way and for subtypes of use. METHODS: From the distribution of cyclists passively involved in collisions with other vehicles included in the register of the Spanish General Traffic Directorate between 1993 and 2009, we have estimated the increase in intensity of exposure by age groups and sex, for global exposure and for subtypes of exposure (e.g. riding with or without a helmet, or riding on an open road or in urban areas), using males aged 45-49 as a reference. RESULTS: Males have a greater exposure than females and this difference increases with age, although it has tended to decrease in recent years. In both sexes the exposure is greater in young people and goes down with age, while in males the excess in young people has disappeared in recent years. Regarding subtypes of use, female underexposure riding on an open road should be highlighted, as well as overexposure in both women and extreme age groups among non-helmet users. CONCLUSION: There is a close association of age and sex with the intensity of bicycle use, which changes depending on the type of use and the time period considered. Consequently, estimations of the effect of factors affecting the accident rate and the morbidity and mortality of cyclists in Spain have to be adjusted by the age and sex of the cyclist.

Asociación de la edad y el sexo con la intensidad de la exposición al uso de la bicicleta en España, 1993-2009 / Association of age and sex with intensity of exposure to bicycle use in Spain, 1993-2009

Fundamento: Estimar la asociación de la edad y el sexo con la intensidad de exposición de los ciclistas en España, entre 1993 y 2009, globalmente y para subtipos de uso. Métodos: A partir de la distribución de los ciclistas pasivamente implicados en colisiones con otros vehículos, incluidos en el registro de la Dirección General de Tráfic oentre 1993 y 2009, se ha estimado el incremento en la intensidad de exposición por grupos de edad y sexo para la exposición global y para subtipos de exposición (conducción con o sin casco, en carretera o en zona urbana), tomando como referencia los varones de 45-49 años. Resultados. Los varones presentan una mayor exposición que las mujeres, diferencias que aumentan con la edad, aunque tienden a reducirse en años más recientes. En ambos sexos la exposición es mayor en jóvenes y desciende con la edad, si bien en los varones el exceso en los jóvenes desaparece en los últimos años. Por subtipos de uso, destaca la menor exposición de las mujeres en la conducción en carretera, así como la mayor exposición, en las mujeres y en los grupos de edad extremos, entre los no usuarios de casco. Conclusión: Existe una estrecha asociación entre el sexo y la edad con la intensidad de uso de la bicicleta, que cambia en función del tipo de uso y del período considerado. En consecuencia, las estimaciones del efecto de los factores que inciden sobre la accidentalidad y la morbi-mortalidad de los ciclistas en España deben ser ajustadas por la edad y el sexo del ciclista (AU)

Background: To estimate the association of age and sex with the intensity of exposure of cyclists in Spain, between 1993 and 2009, in a global way and for subtypes of use. Methods: From the distribution of cyclists passively involved in collisions with other vehicles included in the register of the Spanish General Traffic Directorate between 1993 and 2009, we have estimated the increase in intensity of exposure by age groups and sex, for global exposure and for subtypes of exposure (e.g. riding with or without a helmet, or riding on an open road or in urban areas), using males aged 45-49 as a reference. Results: Males have a greater exposure than females and this difference increases with age, although it has tended to decrease in recent years. In both sexes the exposure is greater in young people and goes down with age, while in males the excess in young people has disappeared in recent years. Regarding subtypes of use, female underexposure riding on an open road should be highlighted, as well as overexposure in both women and extreme age groups among non-helmet users. Conclusion: There is a close association of age and sex with the intensity of bicycle use, which changes depending on the type of use and the time period considered. Consequently, estimations of the effect of factors affecting the accident rate and the morbidity and mortality of cyclists in Spain have to be adjusted by the age and sex of the cyclist (AU)

Modificación del consumo de tabaco durante el embarazo: incidencia y factores asociados / No disponible

Objetivo: Determinar la incidencia de abandono y reducción del hábito tabáquico durante la gestación, así como los factores asociados con ésta. Métodos: Estudio retrospectivo de una cohorte de445 embarazadas sanas, fumadoras al inicio del embarazo, atendidas en el Hospital Materno-Infantil Virgen de las Nieves de Granada. Se recogió información acerca del consumo de tabaco, antecedentes obstétricos y variables sociodemográficas. Para el análisis de los datos se utilizaron modelos de regresiónmúltiple. Resultados: El 51,5% de las fumadoras continuó fumando durante el embarazo. La frecuencia de abandono fue menor en mujeres que fumaban más de1 paquete al día (odds ratio [OR] = 0,02, intervalo de confianza [IC] del 95%, 0,01-0,04) y en las mujeres con 1 hijo (OR = 0,49; IC del 95%, 0,28-0,86) o más hijos anteriores (OR = 0,34; IC del 95%, 0,16-0,73).Conclusión: Es posible identificar grupos de embarazadas con menor probabilidad de abandono o reducción del hábito tabáquico en las que se deberían intensificar las estrategias de intervención en este sentido (AU)

Objective: To determine the incidence of smoking cessation and reduced smoking during pregnancy and to identify associated factors. Methods: A cohort of 445 healthy, pregnant women smokers at the beginning of their pregnancies and followed-up at the maternity hospital Virgen de las Nieves(Granada, Spain) was retrospectively studied. Data on their use of tobacco and alcohol before and during pregnancy, as well as obstetric and sociodemographic variables, were collected. Data were evaluated through multiple regression models. Results: A total of 51.5% of all women smoking at the beginning of pregnancy continued to smoke. Smoking cessation was lower among women who smoked more than on pack per day before conceiving (OR =0.02; 95% CI, 0.01-0.04) and in those with one previous child (OR = 0.49; 95% CI, 0.28-0.86) or more(OR = 0.34; 95% CI, 0.16-0.73).Conclusion: Groups of expectant mothers with a lower probability of smoking cessation or reduction can be identified. In these women, intervention strategies should be intensified (AU)