[Effect of weight gain on the development of gestational diabetes]. / Efecto de la ganancia ponderal en el desarrollo de diabetes gestacional.

Background: Gestational diabetes mellitus (GDM) refers to diabetes diagnosed in the second or third trimester of pregnancy. Assessing the weight gain in each pregnant women's appointment is a common task of primary care during their visit. However, the implications of this increase in weight for the development of GDM are unknown. Objective: Evaluate if the greater than expected weight gain (HEWG) in pregnancy is a risk factor for the development of GDM. Methods: Analytical, observational, longitudinal, retrolective study, which included pregnant women between 15 and 40 years of age with complete follow-up of the preg-nancy with > 2 prenatal check-ups, somatometry and complete medical history was made. During follow-up, the GPME was determined. Odds ratio (OR) and 95% confi-dence intervals (95% CI) were calculated. Variables with significance were entered into a multiple logistic regression model (MLR), where the dependent variable was DMG. The sample size calculation was for convenience. Results: 1000 pregnant women with a median age of 28 years were included. In the MLR The pre-gestational body mass index (BMI) with overweight had an RM of 1.3 (95% CI 0.86-1.98), BMI with obesity an OR of 2.57 (95% CI 1.6-4.14), the HEWG during pregnancy had an OR 1.14 95% CI (0.71-1.81), Age> 30 years shows an RM of 2.24 (95% CI 1.55-3.25). Conclusions: HEWG during pregnancy is not an independent risk factor for the devel-opment of GDM. The main ones are age> 30 years and pre-gestational obesity.

Introducción: la diabetes mellitus gestacional (DMG) se refiere a la diabetes diagnosti-cada a partir del segundo trimestre del embarazo. Evaluar el incremento de peso de mu-jeres embarazadas es una labor habitual en la consulta del primer nivel de atención. Sin embargo, se desconocen las implicaciones que tiene este incremento ponderal para el desarrollo de DMG. Objetivo: evaluar si la ganancia ponderal mayor a la esperada (GPME) en el embarazo es factor de riesgo para el desarrollo de DMG. Métodos: estudio analítico, observacional, longitudinal, retrolectivo, que incluyó a em-barazadas de 15 a 40 años con seguimiento completo del embarazo con más de dos consultas de control prenatal, somatometría e historia clínica completa. Durante el se-guimiento se determinó la GPME. Se calculó razón de momios (RM) e intervalos de confianza del 95% (IC95%). Las variables con significancia se ingresaron a un modelo de regresión logística múltiple (RLM), en donde la variable de desenlace fue DMG. Resultados: se incluyeron a 1000 embarazadas con mediana de edad de 28 años. En la RLM el índice de masa corporal (IMC) pre-gestacional con sobrepeso tuvo una RM de 1.3 (IC95%: 0.86-1.98), IMC con obesidad una RM de 2.57 (IC95%: 1.6-4.14), la GPME durante el embarazo tuvo una RM de 1.14 (IC95%: 0.71-1.81) y la edad > 30 años una RM de 2.24 (IC95%: 1.55-3.25). Conclusiones: la GPME durante el embarazo no es un factor de riesgo independiente para el desarrollo de DMG. Los principales son la edad >30 años y la obesidad preges-tacional.

Influencia de la obesidad, los factores sociodemográficos y las características del parto en la aparición de la hemorragia posparto / Influence of obesity, sociodemograpgical factors and characteristitcs of delivery on the development of post-partum hemorrhage

Objetivo: analizar la asociación de las características sociodemográficas, la obesidad pregestacional, la ganancia ponderal excesiva durante la gestación y las características del parto, con el riesgo de sufrir una hemorragia posparto (HPP).Método: estudio descriptivo, transversal, retrospectivo realizado con mujeres cuyos partos acontecieron en el año 2018 en un hospital de segundo nivel. Se incluyeron mujeres gestantes con parto único, con un recién nacido vivo, a término, con parto vaginal y con un completo control gestacional en el hospital. Se recogió información de la historia clínica acerca de la edad y el origen de la mujer, el índice de masa corporal pregestacional, la ganancia ponderal durante la gestación y diferentes variables relacionadas con el parto. La variable resultado fue la HPP (> 500mL).Resultados: se incluyeron N= 831 mujeres. La edad media fue de 31,8 años (DE:5,38), el 62,7% era española; el 64,6%, multípara; el 41,7% presentaba sobrepeso/obesidad pregestacional; el 26,2%, una ganancia ponderal excesiva durante la gestación; el 89,3% tuvo un parto eutócico y el 70,4% de los alumbramientos fue dirigido. Veinte mujeres presentaron HPP (2,4%). No se halló asociación con ninguna característica de las estudiadas a excepción del tipo de alumbramiento (p= 0,039). Las pacientes con alumbramiento no-espontáneo presentaron mayor riesgo de sufrir HPP: 5,39 veces más (1,13-25,75; p= 0,022) cuando el alumbramiento era dirigido y 5,29 (1,3-21,69; p= 0,013) cuando era manual.Conclusiones: ni los factores sociodemográficos ni las características antropométricas pre y posgestacionales influyen en la aparición de HPP. Un alumbramiento no-espontáneo aumenta el riesgo de HPP hasta cinco veces más. Estos datos deben ser interpretados con cautela.(AU)

Objective: to analyse the association of sociodemographic characteristics, pre-pregnancy obesity, excessive weight gain during pregnancy and characteristics of delivery with the risk of suffering a post-partum haemorrhage (PPH).Method: a retrospective, cross-sectional, descriptive study conducted with women who gave birth during 2018 in a second level hospital. The study included pregnant women with single birth of a live newborn at term, with vaginal delivery and complete pregnancy monitoring at hospital. The following information was collected from the clinical record: age and origin of the mother, pre-pregnancy body mass index, weight gain during pregnancy, and different variables associated with delivery. The outcome variable was PPH (> 500mL).Results: the study included N= 831 women; their mean age was 31.8 years (SD:5.38), 62.7% were Spanish; 64.6% were multiparous; 41.7% presented pre-pregnancy overweight / obesity; 26.2% had an excessive weight gain during pregnancy; 89,3% had natural deliveries and 70,4% of deliveries were directed. Twenty women presented PPH (2.4%). No association was found with any of the characteristics studied, except for type of delivery (p= 0.039). Patients with non-spontaneous delivery presented higher risk of suffering PPH; 5.39 times more (1.13-25.75; p= 0.022) when delivery was directed and 5.29 (1.3-21.69; p= 0.013) when it was manual.Conclusions: neither sociodemographic factors nor pre and post-pregnancy anthropometric characteristics have influence on the development of PPH. Non-spontaneous delivery increases the risk of PPH up to five times more. These data must be interpreted cautiously.(AU)

Environmental factors associated with excessive gestational weight gain: a meta-analysis and systematic review / Fatores ambientais associados ao ganho de peso gestacional excessivo: uma meta-análise e revisão sistemática

Abstract The aim is, systematically examine the scientific evidences that associated environmental factors (environment, social environment, environmental planning and spatial population distribution) with the excessive gestational weight gain. A meta-analysis and systematic review carried out as per the Cochrane Handbook recommendations and following the steps recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. The inclusion studies were done with the following PECO criteria: P-pregnant women, E-environmental factors, O-weight gain. The search procedure was conducted on the databases EMBASE, Web of Science, Cinahl, LILACS and MEDLINE (PubMed). The relationship between the socioeconomic factors of the micro-region of residence and gestational weight gain was evidenced by the linkage between residing in high-poverty neighborhoods and inadequate gestational weight gain. This study revealed the higher prevalence of excessive gestational weight gain in pregnant women those lives in urban areas. Environmental factors of the pregnant women's residence area implicated in the excessive gestational weight gain. Our findings can therefore contribute to the development of public policies to prevent inadequate gestational weight gain.

Resumo O objetivo é examinar sistematicamente as evidências científicas que associam fatores ambientais (meio ambiente, meio ambiente social, planejamento ambiental e distribuição espacial da população) com o excessivo ganho de peso gestacional. Trata-se de uma revisão sistemática e meta-análise realizada seguindo os passos recomendados pelo Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. Os estudos de incluídos basearam-se nos seguintes critérios PECO: P-gestantes, E-fatores ambientais, O-ganho de peso gestacional. O procedimento de pesquisa foi conduzido nas bases de dados EMBASE, Web of Science, Cinahl, LILACS e MEDLINE (PubMed). A relação entre os fatores socioeconômicos da microrregião de residência e o ganho de peso gestacional foi evidenciada pela ligação entre a residência em bairros de alta pobreza e o ganho de peso gestacional inadequado. Este estudo revelou a maior prevalência de ganho de peso gestacional excessivo em gestantes que vivem em áreas urbanas. Fatores ambientais da área de residência das gestantes implicados no ganho de peso gestacional excessivo. As descobertas desse estudo podem, portanto, contribuir para o desenvolvimento de políticas públicas para evitar o ganho de peso gestacional inadequado.

Gestational weight gain influences neonatal outcomes in women with obesity and gestational diabetes.

INTRODUCTION: Obesity and gestational diabetes mellitus (GDM) are associated with an increased risk of perinatal complications and obesity in the offspring. However, the impact of gestational weight gain (GWG) on maternal and foetal outcomes is controversial. PATIENTS AND METHODS: Retrospective study of 220 women with GDM and pre-pregnancy body mass index (BMI)>30kg/m2. Pregnant women were classified according to the Institute of Medicine (IOM) recommendations regarding their prior BMI and GWG. We evaluated the impact of GWG on perinatal and obstetric outcomes. RESULTS: Mean maternal age was 34.7±5.3 years. Pre-pregnancy obesity was classified as class I in 55.3% of the cases, class II in 32.0% and class III in 12.7%. GWG was adequate (5-9kg) in 24.2%, insufficient (<5kg) in 41.8% and excessive (>9kg) in 34.2%. Birth weight was within normal range in 81.9%, 3.6% were small for gestational age (microsomia) and 14.4% were large for gestational age (macrosomia). Insufficient GWG was associated with a higher rate of microsomal offspring, excessive GWG was associated to macrosomia and adequate GWG with normal birth weight. CONCLUSION: GWG in women with pre-pregnancy obesity and GDM impacts neonatal birthweight. Insufficient GWG is associated with microsomia and excessive GWG is associated with macrosomia. Women with adequate GWG according to the IOM guidelines obtained better perinatal outcomes.

TSH neonatal como marcador del estado de nutrición de yodo. Influencia de la yoduria y la función tiroidea maternas sobre la TSH neonatal / Neonatal TSH as a marker of iodine nutrition status. Effect of maternal ioduria and thyroid function on neonatal TSH

Introducción: La TSH neonatal (TSHn) es un marcador de nutrición de yodo en la población. La OMS relaciona una prevalencia<3% de TSHn>5mUI/L, obtenida a partir de las 72h del nacimiento, con un adecuado estado nutricional de yodo. El objetivo de este estudio es conocer la prevalencia de TSHn>5mUI/L en una población yodosuficiente y su relación con factores maternos, neonatales y obstétricos. Materiales y métodos: Se reclutaron 243 gestantes entre mayo-junio de 2017 en nuestra área sanitaria. Se realizó un cuestionario sobre consumo de yodo y determinación de yoduria, función y autoinmunidad tiroideas en el primer trimestre de gestación. Se analizó la TSHn entre 48-72h del nacimiento, así como otros factores obstétricos y neonatales. Resultados: La TSHn media fue 2,43±1,68mUI/L, con un 7,8% de neonatos con TSHn>5mUI/L. La TSHn más elevada pertenecía a los neonatos de madres con yodurias insuficientes (p=0,021) o con TSH>2,5mUI/L, tanto en autoinmunidad tiroidea negativa (p=0,049) como positiva (p=0,006). La yoduria materna<150μg/L fue un factor de riesgo de TSHn>5mUI/L (3,70 [1,06-14,60], p=0,046), mientras que el peso neonatal ≥2500g fue un factor protector (0,14 [0,02-1,00], p=0,038). Conclusiones: La prevalencia de TSHn>5mUI/L en nuestra área sanitaria fue elevada, según las recomendaciones de la OMS. Se asoció el déficit de yodo materno con mayor riesgo de TSHn>5mUI/L. Dado que en la actualidad la determinación de la TSHn se realiza antes de las 72h del nacimiento, precisamos de nuevos puntos de corte para continuar empleando la TSHn como marcador de nutrición de yodo. (AU)

Introduction: Neonatal thyroid stimulating hormone (nTSH) is a marker of iodine nutrition status in the population. The WHO considers a prevalence of less than 3% of nTSH levels greater than 5mIU/L in samples obtained within 72h from birth indicative of iodine sufficiency. The aim of this study was to determine the prevalence of nTSH levels greater than 5mIU/L in an iodine-sufficient population and its association with maternal, neonatal and obstetric factors. Materials and methods: A total of 243 pregnant women were recruited between May and June 2017 in our health area. A questionnaire of iodine intake was administered, in addition to determination of ioduria, thyroid function and autoimmunity in the first trimester of gestation. We analysed nTSH levels in samples collected between 48 and 72h post birth and other obstetric and neonatal factors. Results: The mean nTSH level (standard deviation) was 2.43 (1.68mIU/L), with 7.8% of neonates having levels greater than 5mIU/L. The highest nTSH levels corresponded to neonates of mothers with insufficient ioduria (p=.021) or TSH levels greater than 2.5mIU/L, in both the case of negative (p=0.049) and positive (p=0.006) thyroid autoimmunity results. Maternal ioduria greater than 150μg/L was a risk factor for nTSH levels greater than 5mIU/L (3.70 [1.06–14.60]; p=0.046), while a neonatal weight of 2500g or greater was a protective factor (0.14 [0.02–1.00]; p=0.038). Conclusions: The prevalence of nTSH levels greater than 5mIU/L in our health area was high based on the WHO recommendations. Maternal iodine deficiency was associated with a higher risk of nTSH levels less than 5mIU/L. Given that nTSH is currently measured before 72h post birth, we need new cut-off points to keep on using nTSH as a marker of iodine nutritional status. (AU)

Neonatal TSH as a marker of iodine nutrition status. Effect of maternal ioduria and thyroid function on neonatal TSH.

INTRODUCTION: Neonatal thyroid stimulating hormone (nTSH) is a marker of iodine nutrition status in the population. The WHO considers a prevalence of less than 3% of nTSH levels greater than 5 mIU/L in samples obtained within 72h from birth indicative of iodine sufficiency. The aim of this study was to determine the prevalence of nTSH levels greater than 5 mIU/L in an iodine-sufficient population and its association with maternal, neonatal and obstetric factors. MATERIALS AND METHODS: A total of 243 pregnant women were recruited between May and June 2017 in our health area. A questionnaire of iodine intake was administered, in addition to determination of ioduria, thyroid function and autoimmunity in the first trimester of gestation. We analysed nTSH levels in samples collected between 48 and 72h post birth and other obstetric and neonatal factors. RESULTS: The mean nTSH level (standard deviation) was 2.43 (1.68 mIU/L), with 7.8% of neonates having levels greater than 5 mIU/L. The highest nTSH levels corresponded to neonates of mothers with insufficient ioduria (P = 0.021) or TSH levels greater than 2.5 mIU/L, in both the case of negative (P = 0.049) and positive (P = 0.006) thyroid autoimmunity results. Maternal ioduria less than 150 µg/L was a risk factor for nTSH levels greater than 5 mIU/L (3.70 [1.06-14.60]; P = 0.046), while a neonatal weight of 2500 g or greater was a protective factor (0.14 [0.02-1.00]; P = 0.038). CONCLUSIONS: The prevalence of nTSH levels greater than 5 mIU/L in our health area was high based on the WHO recommendations. Maternal iodine deficiency was associated with a higher risk of nTSH levels greater than 5 mIU/L. Given that nTSH is currently measured before 72h post birth, we need new cut-off points to keep on using nTSH as a marker of iodine nutritional status.

Pre-pregnancy body mass index and gestational weight-gain predict maternal hemoglobin levels and are jointly associated with neonatal outcomes in a Mexican birth cohort.

Introduction: Introduction: there is scarce evidence of the effects of obesity and gestational weight- gain (GWG) on hemoglobin (Hb) levels in pregnancy. Little is known about the implications in offspring when pregnant mothers present with both at delivery. Aim: to identify if pre-pregnancy body mass index (BMI) and GWG are associated with Hb levels at pregnancy third trimester; and identify if the BMI status plus anemia at delivery could influence offspring anthropometry. Methods: in a sub-sample of pregnant women (n = 108) and their offspring (n = 63) from a Mexican birth cohort, information from medical files and questionnaires were used to obtain pre-pregnancy BMI (categorized as normal, overweight, and obese), GWG, and Hb during pregnancy; at delivery and postpartum anthropometric measures were obtained for offspring. Adjusted regression models predicted Hb levels according to pre-pregnancy BMI and GWG; offspring growth trajectories from birth to 3 months old were compared according to mother´s BMI status and anemia combinations at delivery. Results: pre-pregnancy normal (N), overweight (OV), and obesity (OB) were present in 48 %, 40 %, and 12 % of the participants, respectively. Anemia was detected in 22.8 % of the participants at third trimester. Hb levels in the third trimester were significantly lower in those with pre-pregnancy OB-BMI and excessive GWG (12.1 g/dL, 95 % CI: 10.7-13.5) compared to those with pre-pregnancy OB-BMI and insufficient GWG (13.3g/dL, 95 %CI: 11.9-14.8) (p = 0.04). At delivery, 11 % presented with OB-BMI and anemia. Women with OB-BMI and normal Hb levels had children with higher scores in Weight-for-Length-Z score and triceps skinfold. Conclusion: among OB women, excessive GWG was associated with having lower Hb levels in the third trimester. Newborns had higher scores in growth patterns related to adiposity from birth to 3 months old if mothers had normal Hb levels and OB.

Introducción: Introducción: existe escasa evidencia de los efectos de obesidad y ganancia de peso gestacional (GPG) y niveles de hemoglobina (Hb) durante el embarazo. Poco se conoce sobre las implicaciones en la descendencia cuando las embarazadas presentan ambos en el momento del parto. Objetivos: identificar si el índice de masa corporal (IMC) previo al embarazo y el GPG están asociados con los niveles de Hb en el tercer trimestre del embarazo; e identificar si el IMC más la anemia en el momento del parto podrían influir en la antropometría de la descendencia. Metodología: se utilizó información de expedientes médicos y cuestionarios para obtener el IMC antes del embarazo (categorizado como normal, con sobrepeso y obesidad), GPG y Hb durante el embarazo; en el momento del parto y posparto se obtuvieron medidas antropométricas para la descendencia de una submuestra de mujeres embarazadas (n = 108) y su descendencia (n = 63) de una cohorte mexicana. Los modelos de regresión ajustados predijeron los niveles de Hb según IMC y GPG antes del embarazo; se compararon las trayectorias de crecimiento de la descendencia desde el nacimiento hasta los 3 meses de edad según el estado de IMC de la madre y las combinaciones de anemia en el momento del parto. Resultados: peso preembarazo normal (N), sobrepeso (SP) y obesidad (OB) estuvieron presentes en 48 %, 40 % y 12 % de las participantes, respectivamente. Se diagnosticó anemia en el 22,8 % de las participantes en el tercer trimestre. Los niveles de Hb en el tercer trimestre fueron significativamente más bajos en aquellas con IMC-OB antes del embarazo y GPG excesivo (12,1 g/dL, IC del 95 %: 10,7-13,5) en comparación con aquellas con IMC-OB antes del embarazo y GPG insuficiente (13,3 g/dl, IC del 95 %: 11,9-14,8) (p = 0,04). Al momento del parto, el 11 % presentó OB-BMI y anemia. Las mujeres con OB-BMI y niveles normales de Hb tenían hijos con puntuaciones más altas en puntuación Z de peso para longitud y pliegue cutáneo del tríceps. Conclusión: la GPG excesiva entre las mujeres OB se asoció con niveles más bajos de Hb en el tercer trimestre. Los recién nacidos tenían puntajes más altos en los patrones de crecimiento relacionados con la adiposidad desde el nacimiento hasta los 3 meses de edad si las madres tenían niveles normales de Hb y OB.

Pre-pregnancy body mass index and gestational weight-gain predict maternal hemoglobin levels and are jointly associated with neonatal outcomes in a Mexican birth cohort / Índice de masa corporal y ganancia de peso durante el embarazo como predictores de niveles de hemoglobina materna y su asociación con desenlaces neonatales en una cohorte mexicana

Introduction: there is scarce evidence of the effects of obesity and gestational weight- gain (GWG) on hemoglobin (Hb) levels in pregnancy. Little is known about the implications in offspring when pregnant mothers present with both at delivery. Aim: to identify if pre-pregnancy body mass index (BMI) and GWG are associated with Hb levels at pregnancy third trimester; and identify if the BMI status plus anemia at delivery could influence offspring anthropometry. Methods: in a sub-sample of pregnant women (n = 108) and their offspring (n = 63) from a Mexican birth cohort, information from medical files and questionnaires were used to obtain pre-pregnancy BMI (categorized as normal, overweight, and obese), GWG, and Hb during pregnancy; at delivery and postpartum anthropometric measures were obtained for offspring. Adjusted regression models predicted Hb levels according to pre-pregnancy BMI and GWG; offspring growth trajectories from birth to 3 months old were compared according to mother´s BMI status and anemia combinations at delivery. Results: pre-pregnancy normal (N), overweight (OV), and obesity (OB) were present in 48 %, 40 %, and 12 % of the participants, respectively. Anemia was detected in 22.8 % of the participants at third trimester. Hb levels in the third trimester were significantly lower in those with pre-pregnancy OB-BMI and excessive GWG (12.1 g/dL, 95 % CI: 10.7-13.5) compared to those with pre-pregnancy OB-BMI and insufficient GWG (13.3g/dL, 95 %CI: 11.9-14.8) (p = 0.04). At delivery, 11 % presented with OB-BMI and anemia. Women with OB-BMI and normal Hb levels had children with higher scores in Weight-for-Length-Z score and triceps skinfold. Conclusion: among OB women, excessive GWG was associated with having lower Hb levels in the third trimester. Newborns had higher scores in growth patterns related to adiposity from birth to 3 months old if mothers had normal Hb levels and OB (AU)

Introducción: existe escasa evidencia de los efectos de obesidad y ganancia de peso gestacional (GPG) y niveles de hemoglobina (Hb) durante el embarazo. Poco se conoce sobre las implicaciones en la descendencia cuando las embarazadas presentan ambos en el momento del parto. Objetivos: identificar si el índice de masa corporal (IMC) previo al embarazo y el GPG están asociados con los niveles de Hb en el tercer trimestre del embarazo; e identificar si el IMC más la anemia en el momento del parto podrían influir en la antropometría de la descendencia. Metodología: se utilizó información de expedientes médicos y cuestionarios para obtener el IMC antes del embarazo (categorizado como normal, con sobrepeso y obesidad), GPG y Hb durante el embarazo; en el momento del parto y posparto se obtuvieron medidas antropométricas para la descendencia de una submuestra de mujeres embarazadas (n = 108) y su descendencia (n = 63) de una cohorte mexicana. Los modelos de regresión ajustados predijeron los niveles de Hb según IMC y GPG antes del embarazo; se compararon las trayectorias de crecimiento de la descendencia desde el nacimiento hasta los 3 meses de edad según el estado de IMC de la madre y las combinaciones de anemia en el momento del parto. Resultados: peso preembarazo normal (N), sobrepeso (SP) y obesidad (OB) estuvieron presentes en 48 %, 40 % y 12 % de las participantes, respectivamente. Se diagnosticó anemia en el 22,8 % de las participantes en el tercer trimestre. Los niveles de Hb en el tercer trimestre fueron significativamente más bajos en aquellas con IMC-OB antes del embarazo y GPG excesivo (12,1 g/dL, IC del 95 %: 10,7-13,5) en comparación con aquellas con IMC-OB antes del embarazo y GPG insuficiente (13,3 g/dl, IC del 95 %: 11,9-14,8) (p = 0,04). Al momento del parto, el 11 % presentó OB-BMI y anemia. Las mujeres con OB-BMI y niveles normales de Hb tenían hijos con puntuaciones más altas en puntuación Z de peso para longitud y pliegue cutáneo del tríceps (AU)

Malnutrición por exceso en niños de 5 a 10 años y su asociación con el estado nutricional pre y gestacional, lactancia materna y patología materna

La malnutrición por exceso es un problema de salud pública relevante, con origen multifactorial y factores asociados como el estado nutricional pregestacional (ENP), durante y post gestación, ganancia excesiva de peso (EGP) gestacional y duración de la lactancia materna. El objetivo del estudio fue evaluar la malnutrición por exceso en niños de 5 a 10 años y su asociación con el estado nutricional pre y gestacional, lactancia materna exclusiva (LME) y patologías maternas. Se realizó un estudio con 213 niños y niñas estudiantes de 5 a 10 años. Los datos biosociodemográficos se obtuvieron mediante entrevistas con las madres y datos maternos previos y el embarazo con el carné de control. El estimó estado nutricional se estimó con z-score del peso para la talla e IMC/E, según sexo. Para los análisis estadísticos se usó el software STATA 15.0. El 56% de los estudiantes tuvo malnutrición por exceso. Un 53,1% de las madres presentó malnutrición por exceso previo al embarazo que aumentó a 74,6% post gestación. El 71,4% de los niños tuvo una LME ≥6 meses. Se relacionó estadísticamente la edad materna ≥35 años (p= 0,044) y la malnutrición por exceso pregestacional (p= 0,014). La edad materna ≥35 años aumentó el riesgo de malnutrición por exceso casi dos veces (OR= 1,78; IC: 1,029-3,046), al igual que el ENP (OR= 2,11; IC: 1,193-3,693) y en patologías maternas (OR= 1,41; IC: 1, 073-2,694). En conclusión, los niños preescolares de 5 a 10 años con factores de edad materna ≥35, ENP y patologías maternas tuvieron entre 1,4 y 2,11 veces más riesgo de presentar malnutrición por exceso comparado con aquellos niños sin estos factores.

Overnutrition is a relevant public health problem with a multifactorial origin. Associated factors include maternal nutritional status before, during, and after gestation, excessive gestational weight gain, and breastfeeding duration. The objective of the study was to evaluate the association between overnutrition in children aged 5-10 years and pre- and gestational nutritional status, exclusive breastfeeding, and maternal pathologies. The study consisted of 213 schoolchildren aged 5-10 years. Bio-socio-demographic data were obtained through interviews with mothers, previous maternal data and pregnancy follow-up records. Nutritional status was measured using weight-for-height and BMI z-score by age and sex. The STATA 15.0 software was used for statistical analysis. A total of 56% of the schoolchildren had overnutrition. Meanwhile, 53.1% of the mothers demonstrated pre-pregnancy overnutrition, which increased to 74.6% post-pregnancy. It was found that 71.4% of schoolchildren had experienced exclusive breastfeeding ≥6 months. Maternal age ≥35 years (p= 0.044) and pre-gestational nutritional status (p= 0.014) were statistically related. Maternal age ≥35 years increased overnutrition by almost two-fold (OR= 1.78; IC: 1.029-3.046), as did pre-gestational nutritional status (OR= 2.11; IC: 1.193-3.693) and maternal pathologies (OR= 1.41; IC: 1.073-2.694). In conclusion, schoolchildren aged 5-10 years with mothers ≥35 years of age, who had overnutrition in the pre-gestational period, and a pathology were 1.4 to 2.44 times more at risk of developing overnutrition than children without these factors.

Atividade física na gravidez e seu efeito sobre os parâmetros relacionados ao peso: um estudo piloto randomizado e controlado / Physical activity in pregnancy and its effect on weight-related parameters: a pilot randomized controlled trial

INTRODUÇÃO: O declínio no nível de atividade física durante a gravidez está relacionado a várias complicações relacionadas à gravidez. Portanto, a atividade física regular durante a gravidez tem um papel importante na manutenção da boa saúde reprodutiva e de um estilo de vida saudável. OBJETIVOS: Avaliar o efeito de exercícios supervisionados, mensagens de texto e intervenções de atividade física baseadas em pedômetros durante a gravidez sobre os níveis de atividade física e parâmetros relacionados ao peso. MATERIAIS E MÉTODOS: Estudo piloto de grupo paralelo controlado e aleatório. Sessenta mulheres grávidas foram aleatorizadas em cinco grupos (N=12 em cada grupo): Grupo A: Exercício supervisionado; Grupo B: Pedômetro; Grupo C: Pedômetro mais mensagem de texto; Grupo D: Mensagem de texto e Grupo E: Controle. Mulheres grávidas de 20 a 30 anos de idade com uma gravidez de um botão e idade gestacional inferior a 16 semanas na inclusão, um IMC ≥ 18,5 kg /m2, uma disponibilidade de telefone celular e capacidade de falar e ler hindi e inglês foram selecionadas para participação no estudo. Mulheres com gestações gêmeas ou múltiplas, IMC >30kg/m2, gravidez de alto risco conforme decisão do ginecologista, quaisquer complicações relacionadas à gravidez, tais como hipertensão pré-gestacional, diabetes pré-gestacional e outras condições de saúde importantes que restringem sua atividade física no momento do recrutamento e mulheres grávidas analfabetas foram excluídas do estudo. O Grupo A recebeu um exercício supervisionado de luz a moderada intensidade de 45-60 minutos uma vez por semana a partir da 15ª semana até o parto. Os grupos B e C foram encorajados a melhorar o nível de atividade física, concentrando-se em uma contagem de passos de pelo menos 5000-7500 passos por dia avaliados por pedômetro em sete dias consecutivos por mês. O grupo C, além do pedômetro e o grupo D receberam SMS padrão relacionados aos cuidados da gravidez (atividade física, dieta, motivacional e educacional específica). Foi utilizada a ANOVA de uma via para estimar as diferenças entre os grupos e foi utilizado o teste t pareado para estimar a diferença dentro do grupo nas variáveis de resultado (p=0,05). RESULTADOS: O resultado do estudo mostrou estatisticamente significativo entre as diferenças de peso dos grupos no 9º mês (p=0,029) e a retenção de peso nos 2 meses pós-parto (p=0,005). O grupo de exercício supervisionado reteve menos peso durante o período pós-parto em comparação com o grupo de controle (Exercício supervisionado vs Controle, MD = 2,79kg, p=0,002). Entretanto, não houve melhora estatística significativa no ganho de peso gestacional, IMC, circunferência da cintura, circunferência do quadril e relação cintura/quadril em comparação com os grupos. CONCLUSÃO: Pode-se concluir que os exercícios supervisionados são eficazes para aumentar a atividade física, reduzir os parâmetros relacionados ao peso e ajudar na adoção de um estilo de vida saudável durante a gravidez.

INTRODUCTION: The decline in the level of physical activity during pregnancy is related to various pregnancy related complications. Therefore, regular physical activity during pregnancy plays an important role in maintaining good reproductive health and healthy lifestyle. OBJECTIVES: was to assess the effect of supervised exercises, text messages, and pedometer-based physical activity interventions during pregnancy on physical activity levels and weight-related parameters. MATERIALS AND METHODS: Controlled, randomized, parallel-group pilot study. Sixty pregnant women were randomized into five groups (N= 12 in each group): Group A: Supervised exercise; Group B: Pedometer; Group C: Pedometer plus text message; Group D: Text message and Group E: Control. Pregnant women aged 20-30 years with a singleton pregnancy and gestational age of less than 16 weeks at inclusion, a BMI ≥ 18.5 kg /m2, an availability of mobile phone and ability to speak and read Hindi and English languages were selected for participation in the study. Women with twin or multiple pregnancies, BMI >30kg/m2, high-risk pregnancy as decided by the gynecologist, any pregnancy related complications such as pre-gestational hypertension, pre-gestational diabetes, and other major health conditions restricting their physical activity at the time of recruitment and illiterate pregnant women were excluded from the study. Group A received supervised light to moderate intensity exercise of 45-60 minutes once weekly from the 15th week till delivery. Groups B and C were encouraged to improve physical activity level, focusing at a steps count of at least 5000-7500 steps per day assessed by pedometer on seven consecutive days per month. Group C in addition to pedometer and group D received standard SMS related to pregnancy care (physical activity, diet, motivational, and educational specific. One-way ANOVA was used to estimate the between-group differences and Paired t-test was used to estimate the within-group difference in the outcome variables (p=0.05). RESULTS: The result of the study showed statistically significant between groups differences in the weight at 9th month (p=0.029) and weight retention at 2months post-partum (p=0.005). The supervised exercise group retained less weight during post-partum period as compared to control group (Supervised exercise vs Control, MD = 2.79kg, p=0.002). However, there was no statistical significant improvement in gestational weight gain, BMI, waist circumference, hip circumference and waist to hip ratio as compared to groups. CONCLUSIONS: It can be concluded that supervised exercises are effective in increasing physical activity, reducing weight-related parameters, and help in adopting a healthy lifestyle during pregnancy.

Impact of the change of the Atalah standard cut-off point to classify underweight nutritional status during pregnancy

ABSTRACT Chile, and several Latin American countries, use the Atalah standard to assess nutritional status during pregnancy. However, this standard (underweight: pre-pregnancy body mass index (BMI)<20 kg/m2 and normal weight: pre-pregnancy BMI= 20-24.9 kg/m2) differ from those recommended by the US Institute of Medicine (IOM2009) (underweight: BMI<18.5 kg/m2 and normal weight: 18.5-24.9 kg/m2). Using a large population database from a Chilean public hospital, we compared the prevalence of underweight and normal weight at the beginning of pregnancy with Atalah and IOM2009 standards. Additionally, we evaluated the performance of both standards in detecting adverse neonatal outcomes and gestational weight gain. Methods: Data from clinical records of single birth pregnancies (n= 59,476) at the Sótero del Río Hospital, between 2003-2012 were collected. We compared 1. nutritional status, 2. proportion of excessive gestational weight gain, 3. association between nutritional status and neonatal outcomes (large/small for gestational age, low birth weight, preterm birth and macrosomia), using logistic regression models, and 4. Sensitivity, specificity, and predictive values to predict adverse neonatal outcomes per nutritional status. Results: Pre-pregnancy underweight decreased from 8.6% to 2.5% and women with BMI between 18.5-19.9kg/m2, who exceeded the recommended gestational weight gain increased from 32.7% to 49.2% when using IOM2009 instead of Atalah. Both standards showed low sensitivity, but the IOM2009 cut-off points showed better specificity for identifying healthy newborns. Conclusion: The cut-off points recommended by the IOM2009 better identify the prevalence of underweight and normal weight during pregnancy without increasing neonatal risk. This study supports the recent change of the Ministry of Health in adopting the WHO cut-off points during pregnancy.

RESUMEN Chile y diversos países Latinoaméricanos utilizan el estándar de Atalah para evaluar el estado nutricional (EN) durante el embarazo. Sin embargo, los puntos de corte de este estándar (bajo peso, BP: índice de masa corporal pre-gestacional (IMC)<20 kg/m2 y normal, NP: IMC pregestacional= 20-24,9 kg/m2) difieren de los recomendados por el Instituto de Medicina de EE.UU. (IOM2009) (BP: BMI<18.5kg/m2 and NP: 18,5-24,9 kg/m2). Con datos obtenidos desde el Hospital Sótero del Río, nosotros evaluamos la prevalencia de BP y NP al comienzo del embarazo con los estándares de Atalah e IOM2009. Adicionalmente, nosotros comparamos el comportamiento de ambos estándares en detectar resultados neonatales (RN) adversos y en la clasificación de la ganancia de peso gestacional (GPG). Métodos: Se obtuvieron datos de embarazos simples entre 2003-2012, (n= 59.476). Nosotros comparamos: 1. Prevalencia de EN, 2. Proporción de excesiva GPG, 3. Asociación entre EN y RN, usando modelos de regresión logística, y 4. Sensibilidad, especificidad y valores predictivos para predecir RN según EN. Resultados: La prevalencia de BP pregestacional disminuyó de 8,6% a 2,5% y las mujeres con IMC entre 18,5-19,9 kg/m2 que excedieron la GPG recomendada, incrementaron desde 33% a 50% cuando se utilizó el estándar IOM2009 en vez de Atalah. Ambos estándares mostraron baja sensibilidad, pero IOM2009 mostró mejor especificidad para identificar recién nacidos saludables. Conclusión: Estandar IOM2009 identifica con mayor precisión la prevalencia de BP y NP durante la gestación sin incrementar el riesgo neonatal. Este estudio respalda el reciente cambio del MINSAL al adoptar los puntos de corte de la OMS durante el embarazo.

Impacto del tabaquismo, ganancia de peso y talla materna en la antropometría del recién nacido / Impact of smoking, weight gain and maternal height on the anthropometry of the newborn

Objetivo: Determinar la influencia del consumo de tabaco, el índice de masa corporal (IMC) y la talla materna en el peso y la talla del recién nacido (RN). Material y métodos: Se llevó a cabo un estudio descriptivo, observacional y retrospectivo analizando los datos de todas las gestantes y sus RN, atendidos/as en el Hospital de Verín (Ourense) entre enero de 2014 y abril de 2017. Tras comprobar que 131 de ellas cumplían los criterios de inclusión, y una vez obtenido su consentimiento por escrito, se procedió a la revisión de las historias clínicas informatizadas. Se analizaron diversas variables, como el IMC, el consumo de tabaco y la ganancia de peso materno, así como el peso y talla del RN. Se consideró estadísticamente significativo un valor de p <0,05. Resultados: La muestra estaba formada por un total de 131 mujeres y sus RN. La prevalencia de sobrepeso y/u obesidad pregrávida alcanzó el 35,9% (n= 47). El porcentaje de mujeres que aumentaron de peso por encima de las recomendaciones del Food and Nutrition Board del National Institute of Medicine fue del 41,9% (n= 55). Las fumadoras y exfumadoras fueron las que más peso aumentaron, respectivamente (p= 0,043). Con respecto al consumo de tabaco, no hubo diferencias significativas entre las fumadoras y las no fumadoras en el peso, la talla y la edad gestacional de sus RN, si bien el grupo de niños cuyas madres fumaron durante la gestación tuvo un peso promedio ≤100 g. Los hijos de madres fumadoras con ganancia excesiva de peso e hipotiroidismo en el primer trimestre tuvieron una talla menor (p= 0,022). Se demostró una fuerte correlación entre la talla, el peso de la madre y el previo al embarazo con la talla y el peso del RN. Conclusiones: La talla materna es una variable no modificable que debemos tener muy en cuenta como predictor del tamaño fetal. El hábito tabáquico muestra una asociación con la ganancia de peso excesiva durante la gestación y con una reducción del tamaño del neonato. (AU)

Objective: Determine the influence of tobacco consumption, body mass index (BMI) and maternal height on the weight and height of the newborn (NB). Material and methods: A descriptive, observational and retrospective study was carried out analyzing the data of all pregnant women and their newborns, who were cared for at the Hospital de Verín (Ourense) between January 2014 and April 2017. After verifying that 131 of them met the inclusion criteria and once their written consent has been obtained, the computerized medical records were reviewed. Variables such as BMI, tobacco consumption and maternal weight gain, as well as the weight and height of the newborn were analyzed. A p-value <0.05 was considered statistically significant. Results: The sample consisted of a total of 131 women and their newborns. The prevalence of overweight and/or pre-life obesity reached 35.9% (n= 47). The percentage of women who gained weight above the recommendations of the Food and Nutrition Board of the National Institute of Medicine was 41.9% (n= 55). The smokers and ex-smokers were the ones that gained the most weight, respectively (p= 0.043). Regarding tobacco consumption, there were no significant differences between smokers and non-smokers in weight, height and gestational age of their newborns. However, the group of children whose mothers smoked during gestation had a lower average weight of ≤100 g. The children of mothers who smoke, with excessive weight gain and with hypothyroidism in the first trimester had a lower height (p= 0.022). A strong correlation was demonstrated between the height and weight of the mother and the one before pregnancy with the height and weight of the newborn. Conclusions: Maternal size is a non-modifiable variable that we must take into account as a predictor of fetal size. Smoking habit shows association with inadequate weight gain during pregnancy and with a reduction in the size of the newborn. (AU)

Estado ponderal pregestacional, ganancia de peso y resultados obstétricos en embarazadas atendidas en el Hospital de la Mujer de Sevilla / Prepregnancy weight status, weight gain, and obstetrical outcomes in pregnant women managed at the Hospital de la Mujer in Seville

Objetivo: describir las características del estado y control ponderal de las mujeres embarazadas atendidas en el Hospital de la Mujer de Sevilla y evaluar la asociación de estos factores con los resultados obstétricos en este contexto.Material y método: se realizó un estudio descriptivo transversal. Se incluyó a mujeres adultas, con seguimiento desde el primer trimestre y parto a término que dieron a luz entre septiembre de 2017 y febrero de 2018. Se excluyó a las no hispanohablantes, sin datos de peso iniciales, embarazos gemelares, diabetes o hipertensión arterial pregestacional. Se recogieron datos del Documento de Salud de la Embarazada: variables independientes (edad, nivel de estudios, nacionalidad, IMC pregestacional, adecuación de la ganancia de peso gestacional a las recomendaciones, paridad) y dependientes (comienzo de parto, motivo de inducción y tipo de parto). Se realizaron análisis descriptivos y bivariantes.Resultados: participaron 221 mujeres [edad media 30,7 (DE 5,5)]. El índice de masa corporal (IMC) pregestacional superó el límite normal en el 44,8% y la ganancia de peso durante el embarazo fue mayor a la recomendada en el 29,9%. El IMC pregestacional óptimo y la adherencia a las recomendaciones de ganancia de peso se asociaron con mayor proporción de inicio de parto espontáneo (p= 0,022 y p= 0,029, respectivamente). No se encontró esta relación con el tipo de parto (p> 0,05), pero se aproximó a la significación con mayor proporción de cesáreas cuando se excedió la recomendación.Conclusión: los resultados sugieren la importancia del papel de la matrona en mujeres con sobrepeso u obesidad que deseen gestar y en la educación para una adecuada ganancia de peso durante la gestación.(AU)

Objective: to describe the characteristics of weight status and control in pregnant women managed at the Hospital de la Mujer in Seville, and evaluate the association between these factors and the obstetrical outcomes in this setting.Materials and method: a cross-sectional descriptive study was conducted, including adult women, with follow-up since the first trimester and delivery at term, who gave birth between September, 2017 and February, 2018. Non-Spanish-speaking women were excluded, as well as those without initial weight data, twin pregnancies, or prepregnancy diabetes or hypertension. Data were collected from the Pregnancy Medical Record: independent variables (age, education level, nationality, prepregnancy BMI, whether gestational weight gain was adequate according to recommendations, parity) and dependent variables (onset of labor, reason for induction, and type of delivery). Descriptive and bivariate analyses were conducted.Results: the study included 221 women [mean age: 30.7 (SD 5.5)]. The prepregnancy body mass index (BMI) exceeded the normal level in 44.8% and the weight gain during pregnancy was higher than recommended in 29.9%. An optimal pregestational BMI and adherence to weight gain recommendations were associated with a higher rate of spontaneous onset of labor (p= 0.022 and p= 0.029, respectively). This association was not found with type of delivery (p> 0.05), but it was close to significant values with Caesarean deliveries when the recommendation was exceeded.Conclusion: these outcomes point at the importance of the midwife role for overweight or obese women who want to have children, and education for an adequate weight gain during pregnancy.(AU)

Factores maternos y ganancia de peso en un grupo de gestantes con recién nacidos macrosómicos / Maternal Factors and Weight Gain in a Group of Pregnant Women with Macrosomic Newborns

Resumen Antecedentes: la excesiva ganancia de peso contribuye al riesgo de diabetes gestacional y sobrecrecimiento fetal. Objetivo: explorar el efecto de algunos factores sociodemográficos, gestacionales y antropométricos sobre la ganancia de peso durante la gestación en un grupo de mujeres con recién nacidos macrosómicos, atendidas en una institución de segundo nivel del departamento de Antioquia, Colombia, entre 2010 y 2017. Materiales y métodos: se realizó un estudio transversal retrospectivo con historias clínicas prenatales de 61 mujeres que tuvieron recién nacidos macrosómicos. La variable de interés fue la ganancia de peso. Para la asociación de los aspectos sociodemográficos y gestacionales con la ganancia de peso, se aplicó la prueba t de Student y la magnitud del efecto con la medida g de Hedges. Se aplicó un modelo de regresión lineal múltiple ajustado para el análisis multivariado. Resultados: se hallaron diferencias estadísticamente significativas según edad materna, IMC pregestacional, estatura materna e interconsulta a nutrición. El tamaño del efecto sobre el aumento de peso en el embarazo para cada una de estas variables fue significativo. El IMC pregestacional (p<0,001; IC95 % -7,28; -2,67) y la estatura materna (p<0,05 IC95 % 0,88; 5,87) explican el 27 % de la variabilidad de la ganancia de peso. Conclusión: factores como edad materna menor a 35 años, IMC pregestacional, estatura materna y ausencia de atención nutricional pueden repercutir en ganancias de peso por encima de lo recomendado.

Abstract Background: Excessive weight gain contributes to the risk of gestational diabetes and fetal overgrowth. Objective: to explore the effect of some sociodemographic, gestational and anthropometric factors on weight gain during pregnancy, in a group of women with macrosomic newborns, treated at a second-level institution in the department of Antioquia, between 2010 and 2017. Materials and Methods: A descriptive cross-sectional study was conducted with prenatal medical records of 61 women with macrosomic newborns. The variable of interest was weight gain. For the relationship of the sociodemographic and gestational aspects with the weight gain, the t-Student test was applied and the magnitude of the effect with the Hedges g measure. A multiple linear regression model adjusted was applied for multivariate analysis. Results: Statistically significant differences were found in maternal age, pregestational body mass index, maternal height, and nutrition consultation. The effect size on weight gain in pregnancy for each of these variables was significant. Pregestational body mass index (p<0.001, 95% CI -7.28; -2.67) and maternal height (P<0.05 95% CI 0.88; 5.87) explain 27% of the variability of weight gain. Conclusion: factors such as maternal age less than 35 years, pregestational body mass index, maternal height and lack of nutritional care, can have an impact on weight gains above the recommendations.

Gestational Weight Gain Among Pregnant Women in the Mexico–US Border City of Tijuana, Mexico / Ganancia Excesiva de Peso Gestacional entre Mujeres Embarazadas en la Ciudad Fronteriza de Tijuana, México

Background: Excess of gestational weight gain is a risk factor for short and long term health implications for women and their offspring. The aim of this study was to assess the prevalence of excess of gestational weight gain (EGWG) among pregnant women attending the social security system, and to assess the factors associated with it. Methods: The inclusion criteria for this study were women attending immediate puerperium, older than 18yo with a single delivery, and delivery of a live, single birth, mothers who sought prenatal visits at or before the 20th week of gestation with a minimum of 8 total visits, and who had a baseline weight measure before pregnancy. Categorization of BMI was done according to WHO classification and EGWG was assessed by using the Institute of Medicine guidelines. Associations between EGWG and maternal and new- born variables were assessed by odds ratio and Chi-squared test. Results: A total of 438 women were included. The overall prevalence of EGWG was 43%, and a higher prevalence was observed in higher BMI subgroups. Significant dependence was found between EGWG and new-born weight categories and after stratification of macrosomic vs non-macrosomic delivery (OR=2.2 (CI95%=1.2-4.2). Further, an association was found between EGWG and threatened abortion (7.7%). Conclusions: A very high prevalence (43%) of EGWG with a higher likelihood of having macrocosmic new-borns was found. Additionally, an association was found between EGWG and threatened abortion.(AU)

Antecedentes: La ganancia excesiva de peso gestacional es un factor de riesgo a corto y a largo término con implicaciones para las mujeres y sus hijos. El objetivo de este estudio fue valorar la prevalencia de la ganancia excesiva de peso gestacional (GEPG) entre mujeres que se atienden en el sistema de seguridad social y valorar los factores asociados. Métodos: Los criterios de inclusión fueron mujeres que se atendieron en el puerperio inmediato, mayores de 18 años, con parto único, producto vivo, y que antes de la semana 20 de embarazo tuvieron atención pre-natal un mínimo de ocho visitas, y a quienes tenían la medición del peso previo al embarazo. Las categorías del índice de masa corporal fueron de acuerdo a los criterios de la OMS y la GEPG se estimó de acuerdo a las guías del Instituto de Medicina de los EEUU. Las asociaciones entre la GEPG y las variables maternas y las del recién nacido se realizaron por medio de la Chi cuadrada y el Odds Ratio. Resultados: Se incluyeron un total de 438 mujeres. La prevalencia de GEPG fue de 43% y se observó una mayor prevalencia en los grupos de IMC más altos. Se observó asociación significativa entre GEPG y las categorías de peso al nacimiento y después de la estratificación de producto macrosómico vs no macrosómico (OR=2.2 (CI95%=1.2-4.2). Además se observó asociación entre GEPG y amenaza de aborto (7.7%). Conclusión: Se observó una muy alta prevalencia de GEPG (43%), y una mayor probabilidad de productos macrosómicos. Asimismo, se observó una asociación entre la GEPG y la amenaza de aborto.(AU)

[Standard international recommendations for gestational weight gain: suitability for our population]. / Recomendaciones internacionales estándar sobre la ganancia de peso gestacional: adecuación a nuestra población.

INTRODUCTION: Background: gestational weight gain (GWG) is one of the most commonly used indicators in prenatal care, and probably the most influential factor in perinatal outcomes. Objective: to determine the extent to which the GWG of pregnant women from the Ribera Health Department (Valencia) meets GWG international standards as recommended by the U.S. Institute of Medicine (IOM). Methods: a retrospective observational study of a sample of 4,361 women who gave birth at Hospital Universitario de la Ribera between January 1, 2010 and December 31, 2015. Pregnant women were classified according to GWG international recommendations: adequate weight gain, above and below. Results: a higher GWG increases the risk of cesarean delivery or instrumental delivery (OR = 1.454, p < 0.001; OR = 1.442, p < 0.001, respectively), and of having a macrosomic or larger newborn for gestational age (OR = 3.851, p = 0.008; OR = 1.749, p < 0.001, respectively) as compared to an appropriate GWG. GWG is related to birth weight (p < 0.001). Conclusions: the GPG recommendations issued by the IOM are generally well adapted to pregnant women in our environment. It has been found that a GPG other than these recommendations increases the probability of obtaining poor perinatal outcomes. Nevertheless, a more personalized approach is needed, adapting international recommendations to prenatal control for each of the pre-pregnancy BMI categories.

INTRODUCCIÓN: Introducción: la ganancia de peso gestacional (GPG) es uno de los indicadores que más se utilizan en el control prenatal y quizás sea el factor que más influya en los resultados perinatales. Objetivo: determinar hasta qué punto se ajusta la GPG de las gestantes del Departamento de Salud de la Ribera (Valencia) a los estándares internacionales de GPG recomendados por el Institute of Medicine (IOM) de EE. UU. Métodos: estudio observacional retrospectivo sobre una muestra de 4361 mujeres cuyo parto tuvo lugar en el Hospital Universitario de la Ribera entre el 1 enero de 2010 y el 31 de diciembre de 2015. Las gestantes se clasificaron en función de la GPG según las recomendaciones internacionales: incremento de peso adecuado, superior e inferior. Resultados: una mayor GPG recomendada aumenta el riesgo de terminar el parto en cesárea o en parto instrumentado (OR = 1,454, p < 0,001; OR = 1,442, p < 0,001, respectivamente), y de obtener un recién nacido macrosómico o grande para la edad gestacional (OR = 3,851, p = 0,008; OR = 1,749, p < 0,001, respectivamente) con respecto a obtener una GPG adecuada. La GPG está relacionada con el peso al nacer (p < 0,001). Conclusiones: las recomendaciones de GPG emitidas por el IOM se adaptan en general a las gestantes de nuestro entorno. Se ha constatado que una GPG distinta a dichas recomendaciones aumenta la probabilidad de tener resultados perinatales desfavorables. Sin embargo, es necesaria una aproximación más personalizada, adaptando las recomendaciones internacionales al control prenatal en cada una de las categorías de IMC pregestacional.

Retenção de peso pós-parto em mulheres assistidas no serviço público de saúde: estudo de coorte / Retención de peso posparto en mujeres asistidas en el servicio de salud pública: estudio de cohorte / Postpartum weight retention in women assisted in the public health service: cohort study

Objetivo analisar a retenção de peso pós-parto em mulheres assistidas no serviço público de saúde em um município do Sul do Brasil. Método estudo de coorte realizado com 85 puérperas. Dados socioeconômicos, obstétricos, antropométricos, hábitos alimentares, atividade física, amamentação e fatores emocionais foram coletados mediante entrevista em dois momentos: no hospital, no puerpério imediato; e no domicílio, seis meses após o parto. Na análise, utilizou-se estatística descritiva e inferencial. Resultados a incidência da retenção de peso pós-parto maior que 1 kg foi de 54,1%, associada ao ganho de peso gestacional excessivo (68,4%), estado nutricional eutrófico/baixo peso no início da gestação (65,8%) e excesso de peso seis meses pós-parto (61,8%). Mulheres que não amamentaram exclusivamente até seis meses retiveram mais peso. A prevalência de insatisfação corporal foi alta (82,4%). Conclusão os fatores de risco para retenção de peso pós-parto foram estado nutricional eutrófico pré-gestacional e ganho de peso excessivo na gestação

Objetivo analizar la retención de peso posparto en mujeres atendidas en el servicio público de salud en un municipio del sur de Brasil. Método estudio de cohorte realizado con 85 puérperas. Los datos socioeconómicos, obstétricos, antropométricos, hábitos alimenticios, actividad física, lactancia materna y factores emocionales fueron recolectados a través de entrevistas en dos momentos: en el hospital, en el puerperio inmediato; y en casa, seis meses después del parto. En el análisis se utilizó estadística descriptiva e inferencial Resultados la incidencia de retención de peso posparto mayor de 1 kg fue de 54,1%, asociada a aumento excesivo de peso gestacional (68,4%), estado nutricional eutrófico/bajo peso al inicio del embarazo (65,8%) y sobrepeso seis meses postparto (61,8%). Las mujeres que no amamantaron exclusivamente hasta seis meses retuvieron más peso. La prevalencia de insatisfacción corporal fue alta (82,4%). Conclusión los factores de riesgo para la retención de peso posparto fueron el estado nutricional eutrófico pre-gestacional y el aumento de peso excesivo durante el embarazo.

Objective to analyze postpartum weight retention in women assisted in the public health service in a municipality in southern Brazil. Method cohort study conducted with 85 puerperal women. Socioeconomic, obstetric, anthropometric data, eating habits, physical activity, breastfeeding and emotional factors were collected through interviews in two moments: in the hospital, in the immediate puerperium; and at home, six months after delivery. Descriptive and inferential statistics were used in the analysis. Results the incidence of postpartum weight retention greater than 1 kg was 54.1%, associated with excessive gestational weight gain (68.4%), eutrophic nutritional status/low weight at the beginning of pregnancy (65.8%) and overweight six months postpartum (61.8%). Women who did not breastfeed exclusively up to six months retained more weight. The prevalence of body dissatisfaction was high (82.4%). Conclusion the risk factors for postpartum weight retention were pre-gestational eutrophic nutritional status and excessive weight gain during pregnancy.

Factores associados ao ganho de peso gestacional e aos resultados da gravidez das puérperas atendidas na consulta pós-parto do hospital distrital da manhiça, 2019 / Factors associated with gestational weight gain and pregnancy outcomes of puerperal women seen in the postpartum consultation at manhiça dstrict hospital, 2019

O ganho de peso gestacional excessivo ou insuficiente é considerado como um factor de risco para a gestante e ao feto podendo ser influenciado por vários factores dentre eles: sócio-demográficos, clínicos, estilos de vida e obstétricos. Este estudo tinha como objectivo principal determinar o ganho de peso gestacional e analisar os factores associados a si e sua associação com os resultados da gravidez. Metodologia: Realizou-se um estudo descritivo transversal retrospectivo, envolvendo 222 puérperas com idade igual ou superior a 18 anos e com idade gestacional na primeira consulta pré-natal entre 14 a 28 semanas de gestação. O estudo decorreu na maternidade do Hospital Distrital da Manhiça, Província de Maputo, de Fevereiro a Abril de 2019. Os dados foram recolhidos com recurso a um questionário, revisão da caderneta da mulher, entrevista as puérperas e a análise foi feita usando o teste qui-quadrado da independência para estimar a relação entre as variáveis. O índice de massa corporal inicial foi classificado de acordo com os critérios de Atalah (1997). Resultados: Na amostra selecionada as puérperas na sua maioria eram adolescentes jovens na faixa etária de 18 a 25 anos, casadas, multíparas, baixo nível de escolaridade, domésticas e camponesas. No início da gravidez 18,5% tinham baixo peso, 56.3% peso adequado, 18.9% sobrepeso e 6.3% eram obesas. As taxas médias de ganho de peso gestacional semanal em todas as categorias iniciais foram maiores no 3º trimestre do que no 2º. A maioria das puérperas tiveram um ganho de peso fora dos parâmetros recomendados pelo IOM durante a gravidez 70.3% e 75.7% no segundo e terceiro trimestre respectivamente. Em quanto aos factores associados, as variáveis sócio-demográficos que apresentaram associação estatisticamente significativa com o ganho de peso gestacional semanal foram a idade e a profissão apenas no terceiro trimestre e das variáveis clínicas como a anemia, resultado de HIV, tratamento antirretroviral e estado nutricional inicial, no segundo e terceiro trimestres. Não foi encontrada associação entre os resultados da gravidez e ganho de peso semanal em ambos os trimestres. Conclusão: Compreender as características associadas ao ganho de peso insuficiente ou excessivo pode identificar as mulheres potencialmente em risco de forma atempada permitindo a realização de intervenções adequadas de modo a prevenir complicações da mãe e do filho.

Excessive or insufficient gestational weight gain is considered a risk factor for the pregnant woman and the fetus and can be influenced by several factors, including: sociodemographic, clinical, lifestyle and obstetric. This study had as main objective to determine the gestational weight gain and to analyze the factors associated with you and its association with the pregnancy results. Methodology: A retrospective cross-sectional descriptive study was carried out, involving 222 puerperal women aged 18 years or older and with gestational age at the first prenatal consultation between 14 to 28 weeks of gestation. The study took place at the maternity ward of the District Hospital of Manhiça, Maputo Province, from February to April 2019. Data were collected using a questionnaire, revision of the woman's handbook, interviewing the mothers and the analysis was carried out using the chi test. -dependence square to estimate the relationship between variables. The initial body mass index was classified according to the criteria of Atalah (1997). Results: In the sample selected, the puerperal women were mostly young adolescents aged 18 to 25 years old, married, multiparous, with a low level of education, domestic workers and peasants. In early pregnancy 18.5% were underweight, 56.3% were overweight, 18.9% were overweight and 6.3% were obese. The average rates of weekly gestational weight gain in all initial categories were higher in the 3rd trimester than in the 2nd. Most puerperal women had a weight gain outside the parameters recommended by the IOM during pregnancy, 70.3% and 75.7% in the second and third trimesters, respectively. Regarding the associated factors, the socio-demographic variables that showed a statistically significant association with weekly gestational weight gain were age and occupation only in the third trimester and anemia clinics, result of HIV, antiretroviral treatment and initial nutritional status, in the second and third quarters.No association was found between pregnancy results and weekly weight gain in both trimesters. Conclusion: Understanding the characteristics associated with insufficient or excessive weight gain can identify women potentially at risk in a timely manner, allowing appropriate interventions to be carried out to prevent complications for the mother and child.

Ganancia de peso gestacional como predictor de macrosomía y bajo peso al nacer: revisión sistemática / Gestational weight gain as a predictor of macrosomia and low birth weight: a systematic review

RESUMEN Objetivos: Evaluar la capacidad predictiva de las recomendaciones de ganancia de peso gestacional respecto del bajo peso al nacer (BPN) y la macrosomía neonatal, propuestas por el Institute of Medicine (IOM) y el Centro Latinoamericano de Perinatología (CLAP). Materiales y métodos: La búsqueda bibliográfica se realizó en PubMed, Embase (vía Ovid), Cochrane Library, EBSCO host, Scopus, LILACS y SciELO. La calidad metodológica se evaluó utilizando QUADAS 2. Resultados: Se obtuvieron 1192 artícu los, cinco cumplieron los criterios de inclusión, ningún estudio evaluó las recomendaciones CLAP. La sensibilidad y especificidad para predecir el BPN y la macrosomía variaron largamente según el país de realización del estudio. En las cohortes de América Latina, la sensibilidad para predecir el BPN varió entre 62,8% y 74%, y la especificidad, entre 61,7% y 68%, mientras que la sensi bilidad para predecir macrosomía fue 28,8%, y la especificidad, 43,8%. En la mayoría de estudios el valor predictivo positivo fue inferior al 25%, y el valor predictivo negativo, superior al 90%. La mayoría de los estudios tuvo alto riesgo de sesgo y problemas de aplicabilidad en la selección de pacientes. Conclusiones: La limitada calidad metodológica y representatividad de las cohortes estudiadas, probables factores de confusión no ajustados y modestos valores de sensibilidad y especificidad sugieren la necesidad de desarrollar estudios para establecer recomendaciones que se ajusten a las características epidemiológicas de la población peruana.

ABSTRACT Objectives: To evaluate the predictive capacity of gestational weight gain recommendations regarding low birth weight (LBW) and neonatal macrosomia, proposed by the Institute of Medicine (IOM) and the Latin American Center of Perinatology (CLAP). Mate rials and methods: The bibliographic search was performed in PubMed, Embase (via Ovid), Cochrane Library, EBSCOhost, Sco pus, LILACS and SciELO. Methodological quality was evaluated using QUADAS 2. Results: A total of 1,192 articles were identified, only 5 articles met the inclusion criteria, no study evluated the CLAP recomendations. Sensitivity and specificity to predict LBW and macrosomia varied widely depending on which country the study took place. In the Latin American cohorts, the sensitivity for predicting LBW ranged from 62.8% to 74% and the specificity from 61.7% to 68%, while the sensitivity for predicting macrosomia was 28.8% and the specificity 43.8%. In most studies the positive predictive value was less than 25%, and the negative predictive va lue was more than 90%. Most studies had high risk of bias and applicability problems in patient selection. Conclusions: The limited methodological quality and representativeness of the studied cohorts, probable unadjusted confounding factors and modest values of sensitivity and specificity suggest the need to develop studies aimed at providing recommendations that fit the epidemiological characteristics of the Peruvian population.

Association between gestational weight gain and birth weight: NISAMI Cohort / Associação entre ganho ponderal na gestação e peso ao nascer: Coorte NISAMI

Abstract Objectives: this study aims to evaluate the association between gestational weight gain and the weight of newborns from one municipality in Recôncavo Baiano region. Methods: this is a prospective cohort (NISAMI Cohort), conducted with 185 pregnant women living in the urban area of the municipality of Santo Antônio de Jesus, using the prenatal service of the Family Health Units, between April 2012 and June 2013. The pregestationalBMI and the third trimester of pregnancy were used to assess maternal anthropometric status.Birth weight data were collected from the Epidemiological Surveillance of the municipality. Stata 12.0 software was used for statistical analysis. Logistic regression analysis was used to evaluate to assess the association. Results: among the 185 women evaluated, 33.5% presented inadequate weight gain during pregnancy. The prevalence of inadequate birth weight was 20% (birth weight ≤ 2.999g and ≥ 4.000 g). It was observed that inadequate weight gain during pregnancy is considered an embarrassing factor for birth weight (OR= 2.6; CI95%= 1.5-3.5); adjusted for the following variables: alcohol consumption, duration of pregnancy, and gestational complications. Conclusion: the research results suggest that weight gain throughout pregnancy influences the weight of the conceptus, indicating the need for nutritional interventions in all trimesters of pregnancy, promoting a healthy weight gain throughout the gestational cycle.

Resumo Objetivos: avaliar a associação entre ganho ponderal na gestação e o peso de recém-nascidos em um município do Recôncavo Baiano. Métodos: trata-se de uma coorte prospectiva (Coorte NISAMI), conduzida com 185 gestantes residentes na zona urbana do município de Santo Antônio de Jesus, captadas no serviço de pré-natal das Unidades de Saúde da Família, entre abril de 2012 a junho de 2013. O IMC pré-gestacional e do terceiro trimestre da gestação foram utilizados para avaliar o estado antropométrico materno. Os dados de peso ao nascer foram coletados da Vigilância Epidemiológica do município. Utilizou-se o software Stata 12.0 para as análises estatísticas. Empregou-se análise de regressão logística para avaliar a associação. Resultados: das 185 mulheres, 33,5% apresentaram ganho ponderal inadequado ao longo da gestação. A prevalência de peso inadequado ao nascer foi de 20% (peso ao nascer ≤2.999g e ≥ 4.000 g). Observou-se que o ganho de peso inadequado no período gestacional é considerado fator constrangedor do peso ao nascer (OR= 2,6; IC95%= 1,5-3,5; ajustado pelas variáveis: consumo de bebida alcoólica, duração da gestação e intercorrências gestacionais. Conclusão: o resultado desta investigação sugere que o ganho de peso ao longo da gestação exerce influência no peso do concepto indicando necessidade de intervenções nutricionais em todos os trimestres da gestação, promovendo um ganho ponderal saudável em todo ciclo gestacional.