A Pilot Study of Dietetic, Phenotypic, and Genotypic Features Influencing Hypertensive Disorders of Pregnancy in Women with Pregestational Diabetes Mellitus.

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal morbimortality. Dietetic, phenotypic, and genotypic factors influencing HDP were analyzed during a nutrigenetic trial in Rio de Janeiro, Brazil (2016-2020). Pregnant women with pregestational diabetes mellitus (n = 70) were randomly assigned to a traditional or DASH diet group. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured during prenatal visits and HDP were diagnosed using international criteria. Phenotypic data were obtained from medical records and personal interviews. Genotyping for FTO and ADRB2 polymorphisms used RT-PCR. Linear mixed-effect models and time-to-event analyses were performed. The variables with significant effect on the risk for progression to HDP were: black skin color (adjusted hazard ratio [aHR] 8.63, p = 0.01), preeclampsia in previous pregnancy (aHR 11.66, p < 0.01), SBP ≥ 114 mmHg in the third trimester (aHR 5.56, p 0.04), DBP ≥ 70 mmHg in the first trimester (aHR 70.15, p = 0.03), mean blood pressure > 100 mmHg (aHR 18.42, p = 0.03), and HbA1c ≥ 6.41% in the third trimester (aHR 4.76, p = 0.03). Dietetic and genotypic features had no significant effect on the outcome, although there was limited statistical power to test both.

FTO and ADRB2 Genetic Polymorphisms Are Risk Factors for Earlier Excessive Gestational Weight Gain in Pregnant Women with Pregestational Diabetes Mellitus: Results of a Randomized Nutrigenetic Trial.

Excessive gestational weight gain (GWG) is associated with increased risk of maternal and neonatal complications. We investigated obesity-related polymorphisms in the FTO gene (rs9939609, rs17817449) and ADRB2 (rs1042713, rs1042714) as candidate risk factors concerning excessive GWG in pregnant women with pregestational diabetes. This nutrigenetic trial, conducted in Brazil, randomly assigned 70 pregnant women to one of the groups: traditional diet (n = 41) or DASH diet (n = 29). Excessive GWG was the total weight gain above the upper limit of the recommendation, according to the Institute of Medicine guidelines. Genotyping was performed using real-time PCR. Time-to-event analysis was performed to investigate risk factors for progression to excessive GWG. Regardless the type of diet, AT carriers of rs9939609 (FTO) and AA carriers of rs1042713 (ADRB2) had higher risk of earlier exceeding GWG compared to TT (aHR 2.44; CI 95% 1.03-5.78; p = 0.04) and GG (aHR 3.91; CI 95% 1.12-13.70; p = 0.03) genotypes, respectively, as the AG carriers for FTO haplotype rs9939609:rs17817449 compared to TT carriers (aHR 1.79; CI 95% 1.04-3.06; p = 0.02).

Determinants of gestational night blindness in pregnant women from Rio de Janeiro, Brazil.

OBJECTIVE: To describe the prevalence and determinants of gestational night blindness in pregnant women receiving care in a hospital in Rio de Janeiro, Brazil. DESIGN: Cross-sectional study of pregnant and postpartum women receiving care in a public hospital in Rio de Janeiro from 1999 to 2001 (group I; n 225) or from 2005 to 2008 (group II; n 381). Night blindness was identified through a standardized and validated interview (WHO, 1996). The determinants of gestational night blindness were identified through a hierarchical logistic regression model. SETTING: Public maternity hospital in Rio de Janeiro, RJ, Brazil. SUBJECTS: Adult pregnant and postpartum women (n 606), aged ≥20 years. RESULTS: The prevalence of gestational night blindness was 9·9 %. The final model revealed that not living in the South Zone of Rio de Janeiro (distal level: adjusted OR=1·846; 95 % CI 1·002, 3·401), belonging to group I (intermediate level: adjusted OR=2·183; 95 % CI 1·066, 4·471) and for the proximal level, having a history of abortion (adjusted OR=2·840; 95 % CI 1·134, 7·115) and having anaemia during the first and second trimesters of pregnancy (adjusted OR=3·776; 95 % CI 1·579, 9·029) were determinants of gestational night blindness. CONCLUSION: Gestational night blindness should be assessed for during the prenatal care of all pregnant women, especially those living in deprived areas of the city and/or who have a history of abortion or anaemia. Nutritional monitoring is recommended during pregnancy to control gestational night blindness.

[Temporal evolution of anemia prevalence in pregnant adolescents of a public maternity of Rio de Janeiro]. / Evolução temporal da prevalência de anemia em adolescentes grávidas de uma maternidade pública do Rio de Janeiro.

PURPOSE: To describe the evolution of the prevalence of anemia in pregnant adolescents attended at a public maternity in the city of Rio de Janeiro from 2004 to 2013. METHODS: A retrospective cross-sectional study with 628 pregnant/postpartum women divided into 3 groups: Group A (2004-2006), Group B (2007-2010) and Group C (2013). Information about anthropometric, clinical, sociodemographic data and obstetric and prenatal care of adolescents was obtained from medical records of the pregnant women. A hemoglobin concentration n<11 g/dL was considered to be anemia. Data were analyzed statistically by the chi-square test, Student's t-test and ANOVA, and the post hoc Tukey test. RESULTS: The prevalence of gestational anemia over the years was 43% (GA=138), 36% (GB=80) and 47.1% (GC=40) and the overall prevalence for the 2004-2013 period was 41.1% (n=258). The occurrence of anemic pregnant women increased with the progression of pregnancy; however, in the 3rd quarter there was a decrease in the prevalence of anemia in GB (29.3%) compared to GA (38.7%; p=0.04). Factors associated with anemia were number of prenatal visits and prenatal nutritional assistance, place of residence, pre-pregnancy BMI, and gestational weight gain. CONCLUSION: The results showed that the prevalence of anemia among pregnant adolescents seen at a public maternity is high. There was no reduction of anemia during the study period and other factors in addition to iron deficiency were involved in the genesis of anemia in this population.

Association between maternal glucose levels during pregnancy and gestational diabetes mellitus: an analytical cross-sectional study.

BACKGROUND: To evaluate the association between fasting glucose levels in women throughout pregnancy and the occurrence of gestational diabetes mellitus (GDM) and other pregnancy complications, macrosomia, and cesarean delivery. METHODS: An analytical cross-sectional study with 829 healthy pregnant women receiving health care at a public maternity unit in Rio de Janeiro between 1999 and 2008. The dependent variables assessed in the study were: GDM (was confirmed when two or more values were above the glucose curve using 100 g glucose), complications, mode of delivery and birth weight. Macrosomia was defined as a birth weight of >4000 g. The independent variables assessed were: maternal fasting glucose per trimester as a continuous variable, divided into three categories, socio-demographic data on the mothers. The level of statistical significance was set at 5%. RESULTS: The mean fasting glucose levels of the women who had GDM were higher in the second trimester than for those who had no pregnancy complications (90.5 mg/dL vs. 78.5 mg/dL, p = 0.000). Higher mean fasting glucose levels were also found in the third trimester for women who developed GDM than for those with no pregnancy complications (90 mg/dL vs. 77.8 mg/dL, p = 0.016). Women who had a cesarean delivery had higher fasting glucose levels in the second (80.4 mg/dL vs. 78 mg/dL, post hoc = 0.034) and third (80.4 mg/dL and 77.1 mg/dL; post hoc = 0.005) trimesters than women who had a normal delivery. Also, higher fasting glucose levels were found in the second semester for women whose infants had macrosomia than for women whose newborns were normal weight (86.2 mg/dL and 78.8 mg/dL; post hoc = 0.003). The chance of develop GDM was higher for the women with glucose levels in the 90-94 mg/dL range in the second trimester (OR = 7.2; 95% CI = 2.33-22.24) than for the women whose glucose levels were in the <80 mg/dL and 80-90 mg/dL ranges. CONCLUSION: Second and third trimester fasting glucose levels below the cut-off values for the diagnosis of GDM are associated with an increased risk of pregnancy complications. The dependent variables assessed in the study were: GDM (present/absent), complications, mode of delivery (normal, forceps, cesarean), and birth weight.