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Prognosis for patients diagnosed with pregnancy-associated breast cancer: a paired case-control study

Moreira,Wagner Brant; Brandão,Eduardo Carvalho; Soares,Aleida Nazareth; Lucena,Clécio Enio Murta de; Antunes,Carlos Maurício Figueiredo
Fonte: Associação Paulista de Medicina - APM Publicador: Associação Paulista de Medicina - APM
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/05/2010 EN
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CONTEXT AND OBJECTIVE: Previous studies have suggested that the occurrence of pregnancy concomitantly with a diagnosis of breast cancer may affect the evolution of the neoplasia. The present study aimed to compare pregnancy-associated breast cancer (PABC) patients with non-pregnant cancer patients (controls) in relation to the time taken to diagnose the disease, tumor characteristics and mortality. DESIGN AND SETTING: A retrospective, paired case-control study was conducted at the Hospital da Santa Casa de Misericórdia and Centro de Quimioterapia Antiblástica e Imunoterapia in Belo Horizonte, Brazil. METHODS: The study involved 87 PABC and 252 control patients. The influence of covariables (interval between first symptoms and diagnosis, tumor histology, size of primary tumor, distant metastasis, grade of malignancy, hormone receptor status and axillary lymph node involvement) and the pregnancy variable on overall survival was investigated using univariate and multivariate analyses. RESULTS: The median overall survival for PABC patients of 30.1 months (95% confidence interval, CI: 19.4-40.9 months) was significantly different (P = 0.005) from that of the control group (53.1 months; 95% CI: 35.1-71.0 months). The cumulative overall survivals after five and ten years were...

Can the delivery method influence lower urinary tract symptoms triggered by the first pregnancy?

Botelho,Simone; Silva,Joseane Marques da; Palma,Paulo; Herrmann,Viviane; Riccetto,Cassio
Fonte: Sociedade Brasileira de Urologia Publicador: Sociedade Brasileira de Urologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2012 EN
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INTRODUCTION AND OBJECTIVES: The increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin. There are also controversies whether the etiology of lower urinary tract symptoms during pregnancy is the same as postpartum and whether the method of delivery could influence the risk of onset of urinary symptoms. This study aimed to evaluate the urinary symptoms triggered during pregnancy and its evolution in the late puerperium, correlating them with the delivery method. MATERIALS AND METHODS: A longitudinal study was conducted, which included 75 primigravidae women, classified according to method of delivery as: (VD) vaginal delivery with right mediolateral episiotomy (n = 28); (CS) elective caesarean section (n = 26); and (EC) emergency caesarean section (n = 21). Urinary symptoms were assessed in the last trimester of pregnancy and at 45 days (± 10) of puerperium with validated versions for Portuguese language of the following questionnaires: International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). RESULTS: It was observed that frequency...

Maternal cardiac metabolism in pregnancy

Liu, Laura X.; Arany, Zolt
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
EN
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Pregnancy causes dramatic physiological changes in the expectant mother. The placenta, mostly foetal in origin, invades maternal uterine tissue early in pregnancy and unleashes a barrage of hormones and other factors. This foetal ‘invasion’ profoundly reprogrammes maternal physiology, affecting nearly every organ, including the heart and its metabolism. We briefly review here maternal systemic metabolic changes during pregnancy and cardiac metabolism in general. We then discuss changes in cardiac haemodynamic during pregnancy and review what is known about maternal cardiac metabolism during pregnancy. Lastly, we discuss cardiac diseases during pregnancy, including peripartum cardiomyopathy, and the potential contribution of aberrant cardiac metabolism to disease aetiology.

Parental smoking during pregnancy and risk of overweight and obesity in the daughter

Harris, Holly R.; Willett, Walter C.; Michels, Karin B.
Fonte: Harvard University Publicador: Harvard University
Tipo: Artigo de Revista Científica
EN_US
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Objective: Emerging evidence suggests that prenatal exposures may affect long-term health outcomes. In utero exposure to smoking is associated with an increased risk of overweight and obesity in children and adolescents. However, few studies have examined how prenatal exposure to parental smoking influences risk of obesity in adulthood and whether these associations are independent of childhood and adolescent adiposity. The aim of the current study was to investigate whether prenatal exposure to parental smoking influences body size in adulthood and whether any association may be mediated by childhood and adolescent body size. Methods: We investigated the association between parental smoking during pregnancy and risk of overweight and obesity in adulthood and at age 18, and adiposity during childhood among 35,370 participants in the Nurses’ Health Study II. Data on smoking during pregnancy and socioeconomic variables were provided by the mothers, and anthropometric data and adult risk factors were reported by participants. Results: After adjustment for socioeconomic and behavioral variables, maternal smoking during pregnancy was associated with adiposity at ages 5–10, age 18, and during adulthood. For age 18 overweight the ORs (95% CIs) for 1–14...

A Population-Based Study of Pregnancy and Delivery Characteristics Among Women with Vulvodynia

Nguyen, Ruby H. N.; Stewart, Elizabeth G.; Harlow, Bernard L.
Fonte: Springer Healthcare Communications Publicador: Springer Healthcare Communications
Tipo: Artigo de Revista Científica
EN_US
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Introduction: To examine pregnancy and delivery characteristics of women with and without vulvodynia. Methods: The authors analyzed 227 vulvodynia cases that were less than 45 years old at pain onset; controls were age matched 1:1 to cases and had no history of vulvar pain. Pregnancy and delivery events were assessed after age at first vulvar pain onset (the reference age) in cases and a matched age in controls. Results: The authors observed no significant difference between cases and controls in achieving pregnancy after reference age. Also, no difference in pregnancy outcome was observed between cases and controls (P = 0.87). There was an indication that cases were more likely to receive a Cesarean section delivery (P = 0.07). In addition, 37.1% of cases who had vaginal delivery versus 11.3% of controls (P < 0.01) reported pain at 2 months postpartum. Comparing only women with vulvodynia, women who had intermittent pain versus constant pain were more than twice as likely to have a pregnancy (adjusted odds ratio 2.26, 95% CI 1.10–4.60). Conclusions: Women with vulvodynia may be as likely as other women to carry their pregnancy to birth; however, they may experience higher rates of Cesarean section delivery and could reflect a selection towards those women with vulvodynia who have inconsistent pain.

Depression During Pregnancy and the Postpartum Among HIV-Infected Women on Antiretroviral Therapy in Uganda

Kaida, Angela; Matthews, Lynn T.; Ashaba, Scholastic; Tsai, Alexander C.; Kanters, Steve; Robak, Magdalena; Psaros, Christina; Kabakyenga, Jerome; Boum, Yap; Haberer, Jessica E.; Martin, Jeffrey N.; Hunt, Peter W.; Bangsberg, David R.
Fonte: JAIDS Journal of Acquired Immune Deficiency Syndromes Publicador: JAIDS Journal of Acquired Immune Deficiency Syndromes
Tipo: Artigo de Revista Científica
EN_US
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Background: Among HIV-infected women, perinatal depression compromises clinical, maternal, and child health outcomes. Antiretroviral therapy (ART) is associated with lower depression symptom severity but the uniformity of effect through pregnancy and postpartum periods is unknown. Methods: We analyzed prospective data from 447 HIV-infected women (18–49 years) initiating ART in rural Uganda (2005–2012). Participants completed blood work and comprehensive questionnaires quarterly. Pregnancy status was assessed by self-report. Analysis time periods were defined as currently pregnant, postpartum (0–12 months post-pregnancy outcome), or non–pregnancy-related. Depression symptom severity was measured using a modified Hopkins Symptom Checklist 15, with scores ranging from 1 to 4. Probable depression was defined as >1.75. Linear regression with generalized estimating equations was used to compare mean depression scores over the 3 periods. Results: At enrollment, median age was 32 years (interquartile range: 27–37), median CD4 count was 160 cells per cubic millimeter (interquartile range: 95–245), and mean depression score was 1.75 (s = 0.58) (39% with probable depression). Over 4.1 median years of follow-up, 104 women experienced 151 pregnancies. Mean depression scores did not differ across the time periods (P = 0.75). Multivariable models yielded similar findings. Increasing time on ART...

Diagnosis and treatment of cervical cancer during pregnancy

Gon??alves, Carla Vitola; Duarte, Geraldo; Costa, Juvenal Soares Dias da; Marcolin, Alessandra Cristina; Bianchi, M??nia Steigleder; Dias, Daison Nelson Ferreira; Lima, Luis Cl??udio de Velleca e
Fonte: Universidade Federal do Rio Grande Publicador: Universidade Federal do Rio Grande
Tipo: Artigo de Revista Científica
ENG
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CONTEXT AND OBJECTIVE: One third of all cervical carcinomas occur during the reproductive period. Cervical carcinoma is the second greatest cause of death due to cancer during this phase. The estimated frequency of cervical cancer during pregnancy is one case for every 1,000 to 5,000 pregnancies. The aim here was to provide information about the difficulties in diagnosing and managing cervical neoplasia during pregnancy. MATERIALS: A systematic review of the literature was undertaken through the PubMed, Cochrane, Excerpta Medica (Embase), Literatura Latino Americana e do Caribe em Ci??ncias da Sa??de (Lilacs) and Scientific Electronic Library Online (SciELO) databases, using the following words: pregnancy, cervical cancer, diagnosis and management. RESULTS: There was a consensus in the literature regarding diagnosis of cervical carcinoma and management of preneoplastic lesions during pregnancy. However, for management of invasive carcinoma, there was great divergence regarding the gestational age taken as the limit for observation rather than immediate treatment. CONCLUSION: All patients with cytological abnormalities should undergo colposcopy, which will indicate and guide biopsy. Conization is reserved for patients with suspected invasion. High-grade lesions should be monitored during pregnancy and reevaluated after delivery. In cases of invasive carcinoma detected up to the 12th week of pregnancy...

The influence of environmental contaminants on time to pregnancy

Velez Gomez, Maria del Pilar
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
EN
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Cette thèse porte sur l’évaluation de l’impact de certains composés environnementaux sur la fécondité féminine, tel que mesuré par le délai de conception (« time to pregnancy » en anglais, ou TTP). Cette recherche a été réalisée dans le cadre de l’Étude mère-enfant sur les composés chimiques de l’environnement (MIREC), une cohorte de grossesse de 2001 femmes recrutées durant le premier trimestre dans dix villes canadiennes de 2008 à 2011. Les données des questionnaires et les échantillons biologiques ont servi à évaluer l’effet de deux groupes de composés : les persistants [composés perfluorés – perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA) et perfluorohexane sulfonate (PFHxS)] et les non persistants (bisphénol A, triclosan et phtalates). Cette thèse comprend également une analyse du potentiel du ratio index-annulaire (2D:4D) comme mesure de sensibilité endocrinienne. À ce jour, des mesures anthropométriques ont été collectées sur environ 800 mères-enfants dans le cadre de l’Étude mère-enfant sur les composés chimiques de l’environnement : biomonitoring et neurodéveloppement à la petite enfance (MIREC CD Plus), un suivi de la cohorte MIREC portant sur la croissance et le développement des enfants jusqu’à 5 ans. Sur l’ensemble...

The prevalence of recalled low back pain during and after pregnancy: a South Australian population survey

Stapleton, D.; MacLennan, A.; Kristiansson, P.
Fonte: Australian NZ J Obstet Gynaec Publicador: Australian NZ J Obstet Gynaec
Tipo: Artigo de Revista Científica
Publicado em //2002 EN
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Objective To determine the prevalence of low back pain during pregnancy (LBPP) in an Australian Results population. Design A representative population-based survey of women aged 15 years and older. Setting and sample Four thousand four hundred randomly selected South Australian households were visited by trained surveyors who interviewed 1531 women (69.7% response rate) using pre-tested questions. Methods The South Australian Health Omnibus survey was utilised. Main outcome measures Demographic data were collected along with details of previous pregnancies, and degree of back pain during pregnancy, treatment regimens, and persistence of back pain. Results Thirty-five and a half per cent of women recall having at least moderately severe back pain during pregnancy. Women who reported such back pain were younger, were more likely to report ill health and be unemployed. Increasing parity was not associated with current back pain. The most commonly used treatments were bed rest, pain killing medication, physiotherapy, and chiropractic treatment. Half of those with symptoms were untreated. Sixtyeight per cent of women who experienced moderate or worse low back pain during pregnancy continued to experience recurring low back pain with a self reported reduction in their health. Conclusions Chronic low back pain is commonly associated with an onset in pregnancy subjectively contributing to long-term morbidity. The high prevalence may be an underestimate in view of the potential for recall bias in older women.; David B Stapleton...

A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy

Smith, C.; Crowther, C.; Willson, K.; Hotham, N.; McMillian, V.
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Artigo de Revista Científica
Publicado em //2004 EN
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Objectives: To estimate whether the use of ginger to treat nausea or vomiting in pregnancy is equivalent to pyridoxine hydrochloride (vitamin B6). Methods: A randomized, controlled equivalence trial involving 291 women less than 16 weeks pregnant was undertaken at a teaching hospital in Australia. Women took 1.05 g of ginger or 75 mg of vitamin B6 daily for 3 weeks. Differences from baseline in nausea and vomiting scores were estimated for both groups at days 7, 14, and 21. Results: Ginger was equivalent to vitamin B6 in reducing nausea (mean difference 0.2, 90% confidence interval [CI] -0.3, 0.8), retching (mean difference 0.3; 90% CI -0.0, 0.6) and vomiting (mean difference 0.5; 90% CI 0.0, 0.9), averaged over time, with no evidence of different effects at the 3 time points. Conclusion: For women looking for relief from their nausea, dry retching, and vomiting, the use of ginger in early pregnancy will reduce their symptoms to an equivalent extent as vitamin B6.; http://www.greenjournal.org/cgi/content/abstract/103/4/639; Smith, Caroline; Crowther, Caroline; Willson, Kristyn; Hotham, Neil; McMillian, Vicki; © 2004 The American College of Obstetricians and Gynecologists

Longitudinal analysis of heart rate variability in chronic hypertensive pregnancy

Walther, T.; Wessel, N.; Baumert, M.; Stepan, H.; Voss, A.; Faber, R.
Fonte: Japanese Soc Hypertension Cent Academic Soc Publicador: Japanese Soc Hypertension Cent Academic Soc
Tipo: Artigo de Revista Científica
Publicado em //2005 EN
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36.48%
In the US, it is currently estimated that 3% of pregnant women have chronic hypertension, or more than 100,000 pregnant women each year. The aim of our study was to investigate the adaptation of autonomic control during pregnancy based on heart rate variability analysis and to determine whether chronic hypertension during pregnancy has an impact on this adaptation. Sixteen pregnant women with chronic hypertension (CH group; mean age, 30 years; range, 25-33 years) and 35 healthy pregnant women serving as controls (CON group; mean age, 28 years; range, 24-30 years) were recruited for this longitudinal study. Beginning at the 20th week of pregnancy, the women were monitored every 4th week until delivery. For the analysis of heart rate variability, Portapres signals (200 Hz) were recorded for 30 min under resting conditions. Women in the CH group had significantly elevated blood pressure compared to controls (CON, 111 mmHg [105-132]; CH, 140 mmHg [132-148]; p<0.001). An increased heart rate was found in both groups during the second half of pregnancy. Consequently, decreased heart rate variability was observed, but was more pronounced in the CON group. There was a shift in the frequency bands indicated by an elevation of the low-to-high frequency ratio (LF/HF) in both groups due to a decrease in HF...

Asthma during pregnancy: Mechanisms and treatment implications

Murphy, V.; Gibson, P.; Smith, R.; Clifton, V.
Fonte: European Respiratory Soc Journals Ltd Publicador: European Respiratory Soc Journals Ltd
Tipo: Artigo de Revista Científica
Publicado em //2005 EN
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Asthma is becoming increasingly prevalent worldwide. Numerous historical and prospective cohort studies have investigated the effects of maternal asthma on pregnancy outcome; however, the data has been conflicting and many studies have not used standard classifications for asthma severity. Overall, the literature suggests that asthmatic females are more at risk of low birth weight neonates, pre-term delivery and complications such as pre-eclampsia, especially in the absence of actively managed asthma treated with inhaled corticosteroids. Pregnancy with a female foetus may particularly increase the risk of these outcomes. In addition, pregnancy has an effect on the course of asthma. The risk of an exacerbation requiring medical intervention may be as high as 50% in females with severe asthma and this may further increase the risk of poor outcomes, particularly low birth weight and pre-term delivery. The mechanisms responsible for changes in asthma with pregnancy, or alterations in pregnancy outcomes due to asthma have not been thoroughly explored. Maternal inflammatory pathways may contribute to reduced foetal growth through alterations in placental function. Asthma treatment, by reducing maternal inflammation and preventing exacerbations...

Dietary zinc supplementation during pregnancy prevents spatial and object recognition memory impairments caused by early prenatal ethanol exposure

Pearce, B.; Henry, C.; Rofe, A.; Coyle, P.
Fonte: Elsevier Science BV Publicador: Elsevier Science BV
Tipo: Artigo de Revista Científica
Publicado em //2008 EN
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Alcohol-induced zinc (Zn) deficiency is one of the mechanisms proposed as a cause of ethanol teratogenicity. Subcutaneous Zn treatment with ethanol in early pregnancy has been shown to prevent birth abnormalities and memory impairments in mice. This study examined whether dietary Zn supplementation throughout pregnancy can prevent cognitive impairments caused by early ethanol exposure. Pregnant C57BL/6J mice were fed either a control (35 microg Zn/g) or Zn-supplemented (200 microg Zn/g) diet throughout pregnancy. On gestational day (GD) 8, mice received two intraperitoneal injections (4h apart) of either saline or 25% ethanol (0.015 mL/g). All offspring were screened for physical and behavioural defects (e.g. growth, visual, exploratory, anxiety, motor deficits). Twenty-four phenotypically-normal offspring were randomly selected from each of the four treatment groups (saline +/- Zn-supplementation, ethanol +/- Zn-supplementation) and tested at 60 d of age using a cross-maze escape task for spatial learning and memory impairments, and an object recognition task. While no differences were observed between treatments for spatial learning, offspring exposed to ethanol demonstrated spatial memory impairments at both 12 and 28 d after learning an escape task...

Ethanol-related teratogenicity and neurobehavioural impairments: influence of dietary zinc supplementation during pregnancy.

Summers, Brooke Lee
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2009
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Ethanol consumption during pregnancy can result in wide range of negative outcomes, including pre-and post-natal mortality, growth retardation, physical abnormalities and brain deficits, manifested as behavioural impairments. These outcomes can result from “binge-drinking” (generally defined as >5 standard drinks on a single occasion) or chronic ethanol consumption. Ethanol-induced zinc (Zn) deficiency is one of the mechanisms proposed as a cause of ethanol teratogenicity. We have previously demonstrated in mice that ethanol exposure on gestational day (GD)8 (during organogenesis) can alter Zn homeostasis by inducing the Zn-binding protein metallothionein (MT) in the maternal liver. This causes plasma Zn concentrations to decrease as Zn redistributes into the liver, and consequently decreases the fetal Zn supply and increases the risk of teratogenicity. Subcutaneous Zn treatment with ethanol on GD8 can prevent the deleterious effects of ethanol on the fetus (i.e. physical abnormalities and spatial memory impairments). The main objective of this thesis was to investigate whether a less invasive approach of giving dietary Zn supplementation throughout pregnancy could provide similar protective benefits against a range of adverse outcomes caused by prenatal binge or chronic ethanol exposure. Binge ethanol exposure in early pregnancy (i.e. where mice are injected with 25% ethanol (0.015 ml/g) intraperitoneally at 0 and 4 hours on GD8) significantly increased the incidence of birth abnormalities measured on GD18. These included craniofacial abnormalities (microphthalmia...

Buprenorphine and Methadone in pregnancy: effects on the mother, fetus and neonate.

Gordon, Andrea Louise
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2006
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The current study aimed to assess the efficacy and safety of buprenorphine maintenance for the treatment of illicit opioid dependence during pregnancy. Parameters investigated assessed pregnancy progression and Neonatal Abstinence Syndrome (NAS) compared to methadone maintenance and non-opioid exposed control pregnancies. This is the first study to present results comparing the two treatment groups to a control population. The trial was a prospective, non-randomised, open-label, flexible dosing study (n=25 for each group). Women were recruited up to a gestational age of 28 weeks and their infants observed postnatally for 4 weeks. Methadone and buprenorphine doses did not change significantly from recruitment to delivery and were 48.40±5.95 mg.day⁻¹ and 7.46±O.84 mg.day⁻¹ respectively at delivery. Both subjective and objective measures of maternal withdrawal were significantly lower for buprenorphine compared to the methadone group (p

IFPA Award in Placentology Lecture: Complicated interactions between genes and the environment in placentation, pregnancy outcome and long term health

Roberts, C.
Fonte: W B Saunders Co Ltd Publicador: W B Saunders Co Ltd
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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36.48%
Most research on the developmental origins of health and disease has implicated poor nutrition in the fetus, most often conferred by deficiencies in maternal nutrition, as an important causal factor that programmes offspring physiology for adult disease. Emerging evidence implicates interactions between genes and the environment that may help to explain why poor growth before birth is associated with a variety of adult onset diseases that appear in different individuals of the same birthweight. However, it is underappreciated that the placenta, particularly trophoblast invasion, is key to health of both the mother and child in both the short and long term and that the role of the father is more important than perhaps ever expected. Intrauterine growth restriction (IUGR) is but one of a continuum of several pregnancy complications that may be related and that may reflect the long term health of both parents and offspring. These include preeclampsia, pre-term birth and gestational diabetes, as well as IUGR. Polymorphisms in genes that regulate how the placenta invades maternal tissues, differentiates and functions and how the mother adapts to pregnancy have been identified as candidates that confer risk to pregnancy success. Potentially...

Altered interactions of heart rate and blood pressure during normal and abnormal pregnancy

Voss, A.; Seeck, A.; Baumert, M.
Fonte: IEEE; CD Publicador: IEEE; CD
Tipo: Conference paper
Publicado em //2010 EN
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The assessment of the autonomic cardiovascular regulation provides important diagnostic and prognostic information. The aim of this study was to investigate the alterations of this autonomic regulation in the progress of a normal pregnancy and in several pregnancy disorders associated with hypertension, especially pre-eclampsia, applying the method of Joint Symbolic Dynamics (JSD). The JSD reveals nonlinear interactions/ coupling between two time series. Continuous, non-invasive 30 min blood pressure recordings from women with normal pregnancies (CON), with chronic hypertension (CH), with pregnancy-induced hypertension (PIH) and with pre-eclampsia (PE) were analyzed. It could be shown that the cardiovascular regulation system was changed considerably between a first and a second part of gestation in normal pregnancy. These changes were revealed by the analysis of the interactions of heart rate and blood pressure applying the bivariate method JSD. Further on, significant changes of these interactions led to a significant differentiation between normal pregnancy and pre-eclampsia and between chronic or pregnancy-induced hypertension and pre-eclampsia. The JSD provides new information about interaction and coupling between heart rate and blood pressure...

Limiting weight gain in overweight and obese women during pregnancy to improve health outcomes: the LIMIT randomised controlled trial

Dodd, J.; Turnbull, D.; McPhee, A.; Wittert, G.; Crowther, C.; Robinson, J.
Fonte: BioMed Central Ltd. Publicador: BioMed Central Ltd.
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
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Background: Obesity is a significant global health problem, with the proportion of women entering pregnancy with a body mass index greater than or equal to 25 kg/m2 approaching 50%. Obesity during pregnancy is associated with a well-recognised increased risk of adverse health outcomes both for the woman and her infant, however there is more limited information available regarding effective interventions to improve health outcomes. The aims of this randomised controlled trial are to assess whether the implementation of a package of dietary and lifestyle advice to overweight and obese women during pregnancy to limit gestational weight gain is effective in improving maternal, fetal and infant health outcomes. Methods/Design: Design: Multicentred randomised, controlled trial. Inclusion Criteria: Women with a singleton, live gestation between 10+0-20+0 weeks who are obese or overweight (defined as body mass index greater than or equal to 25 kg/m2), at the first antenatal visit. Trial Entry & Randomisation: Eligible, consenting women will be randomised between 10+0 and 20+0 weeks gestation using a central telephone randomisation service, and randomisation schedule prepared by non-clinical research staff with balanced variable blocks. Stratification will be according to maternal BMI at trial entry...

A longitudinal study of plasma and urinary cortisol in pregnancy and postpartum

Jung, C.; Ho, J.; Torpy, D.; Rogers, A.; Doogue, M.; Lewis, J.; Czajko, R.; Inder, W.
Fonte: Endocrine Society Publicador: Endocrine Society
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
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CONTEXT: There is a paucity of longitudinal data on plasma and urinary cortisol levels during pregnancy using modern assays. Furthermore, conflicting data exist as to the effect of the low-dose oral contraceptive pill (OCP) on cortisol. DESIGN, SUBJECTS, AND MEASUREMENTS: We conducted a prospective longitudinal study on morning plasma cortisol (total and free), corticosteroid-binding globulin (CBG), and 24-h urinary free cortisol (UFC) levels in 20 pregnant women during the first, second, and third trimesters and 2–3 months postpartum compared with 12 subjects on low-dose OCP and 15 nonpregnant subjects not taking the OCP (control group). RESULTS: A progressive rise in total plasma cortisol, CBG, and 24-h UFC was demonstrated during pregnancy, peaking during the third trimester (mean 3-fold rise compared with controls). Plasma free cortisol increased 1.6-fold by the third trimester. In the OCP group, total plasma cortisol and CBG were 2.9- and 2.6-fold elevated, respectively, whereas 24-h UFC and plasma free cortisol were not significantly different from controls. Compared with liquid chromatography-mass spectrometry, a commercial immunoassay underestimated mean total plasma cortisol concentrations by 30% during second and third trimesters and in OCP users and overestimated UFC levels by 30–35% during pregnancy. CONCLUSIONS: Our study demonstrated elevations in total plasma cortisol and CBG concentrations during pregnancy and with low-dose OCP use. Pregnancy was also associated with significant increases in plasma free cortisol and UFC...

A decrease in diet quality occurs during pregnancy in overweight and obese women which is maintained post-partum

Moran, L.; Sui, Z.; Cramp, C.; Dodd, J.
Fonte: Nature Publishing Group Publicador: Nature Publishing Group
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
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BACKGROUND: Ensuring adequate dietary intake during pregnancy has important implications for optimising maternal and fetal health. It is not known whether diet quality is altered over pregnancy and the post-partum period. OBJECTIVE: The aim of this study was to perform a comprehensive assessment of diet quality in overweight and obese women during pregnancy and early post-partum. DESIGN: In a prospective cohort study, n=301 overweight or obese pregnant women completed a food frequency questionnaire at study entry (10–20 weeks gestation), 28 weeks gestation, 36 weeks gestation and 4 months post-partum for assessment of macronutrient and micronutrient intake and diet quality by the Healthy Eating Index (HEI). RESULTS: Energy, macronutrient and dietary sources of micronutrients did not alter across pregnancy or post-partum. The HEI was of below average quality in 31.0% of women at baseline. This decreased from week 28 (P<0.001) and was maintained at a lower level post-partum such that HEI levels were lower compared with study entry (53.3±12.7 versus 56.7±10.1, P<0.001). The HEI decrease occurred in association with decreases in the milk, meat and unsaturated oil components, and increases in the proportion of energy from solid fats...