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.

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