Healthy habits in pregnancy, body composition and weight variation after childbirth

Orientador: Fernanda Garanhani de Castro SuritaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: Os hábitos saudáveis (HS) praticados durante a gestação são de extrema importância para a manutenção do bem-estar e qualidade de vida, não só durante gestação como no período pós-parto. Além disso a composição corporal, variação de peso, aspectos psicossociais sofrem modificações de acordo com a prática dos hábitos de vida saudáveis. Objetivos: O objetivo geral desta tese foi avaliar o conhecimento das gestantes acerca dos hábitos de vida saudáveis, assim como a composição corporal, estado nutricional e variação de peso no pós-parto. Métodos: Foram realizadas duas pesquisas de campo: a primeira um corte transversal realizado no Hospital da Mulher com 61 gestantes, aplicando questionários sobre conhecimento de hábitos saudáveis (HS) durante a gestação, para a qual dados sobre HS, sociodemográficos e antecedentes obstétricos foram coletados prospectivamente e um guia educacional sobre HS durante a gravidez e período pós-parto foi oferecido. A segunda um corte transversal realizado com 131 mulheres no puerpério imediato, com avaliação da composição corporal através de bioimpedância elétrica (BIA) e pregas cutâneas, cálculo do índice de massa corpórea, circunferência abdominal e quadril, medida abdominal sagital, foram também coletados dados da retenção ponderal e prática de exercício físico, assim como o conhecimento das puérperas sobre os HS durante a gravidez. Foi realizada também uma revisão sistemática com as palavras chaves "postpartum period¿¿ e "body composition¿¿, nas bases de dados PubMed, MEDLINE, Web of Science e SciELO, com estudos publicados entre 2007-2017 no idioma Inglês e que avaliassem a composição corporal materna até 10 anos após o parto. Resultados: A idade média das mulheres do primeiro estudo foi de 28,7 ± 6,23 anos, sendo 85% casadas e 68% multíparas. O índice de massa corporal (IMC) médio antes da gestação foi de 25,4 ± 9,8 kg/m². Apenas 61% haviam recebido informações prévias sobre o GPG durante o pré-natal e sabiam quantos quilos deveriam ganhar durante a gravidez. A maioria (85%) sabia que não precisavam "comer por dois" e 99% sabia que o EF tinha benefícios para seu corpo e era seguro para seu bebê. Metade das mulheres praticava EF antes da gravidez, mas apenas 31% continuaram praticando durante a gravidez. No segundo estudo a idade média das mulheres foi de 27.63±5.68 anos, escolaridade 11.03±3.44 anos de estudo. Com relação ao estado nutricional das puérperas, o peso pré-gestacional médio foi de 68.63±15.42 kg, IMC pré-gestacional 26.34±5.85 kg/m² e peso na última consulta 79.77±14.33 kg, IMC na última consulta do pré-natal 30.62±5.42 kg/m², ganho de peso médio total na gestação 11.14±6.49 kg, peso e IMC no puerpério imediato respectivamente, 77.82±14.36 kg e 29.94±5.45 kg/m². A média de retenção de peso no pós-parto imediato foi de 9.13±6.82 kg. Na Revisão sistemática 19 artigos foram incluídos, sendo destes 9 incluídos na metanálise. As mulheres apresentaram significativa redução do IMC, até 6 meses e após 6 meses do parto com relação ao peso pré-gestacional. (IMC: G1= -0,89 kg/m2 e G2= -0,56 kg/m2, p<0,01; peso corporal: G1= -2.71 kg e G2= -1.61 kg, p<0,01). Quanto à composição corporal avaliada à partir do percentual de gordura, não houve mudança ao longo dos primeiros seis meses com relação a porcentagem de gordura pré-gestacional (MD -0.67, IC -1.46, +0.12, p=0.1), entretanto houve uma redução sustentada do percentual de gordura do sexto mês de pós parto em diante (MD -2.05, IC -2.35, -1.74, p<0.01). Conclusões: Apesar de compreender a necessidade de HS durante a gravidez, as mulheres ainda precisam de incentivo para praticar EF nesse período. A maioria das mulheres começou a gestação com excesso de peso e imediatamente pós-parto tinha critérios de obesidade de acordo com BIA e IMC. Diferentes métodos podem ser utilizados para avaliação da composição corporal; há uma sustentada redução do peso e do IMC nos anos que se seguem ao parto, entretanto, para o percentual de gordura, este efeito só é significativo 6 meses após o parto. Estratégias apropriadas, com a introdução de hábitos saudáveis na gravidez e no puerpério podem ser a chave para as mulheres evitarem ganho excessivo na gravidez e retenção de peso após o parto e assim reduzirem o risco de doenças associadas à obesidadeAbstract: Introduction: The healthy habits (HS) practiced during pregnancy are extremely important for the maintenance of well-being and quality of life, not only during pregnancy but also in the postpartum period. In addition the body composition, weight variation, psychosocial aspects undergo modifications according to the practice of healthy lifestyle habits. Objectives: The general objective of this thesis was to evaluate the knowledge of pregnant women about healthy life habits, as well as body composition, nutritional status and postpartum weight variation. METHODS: Two field surveys were carried out: the first was a cross-sectional study conducted at the Women's Hospital with 61 pregnant women, applying questionnaires on knowledge of healthy habits during pregnancy, for which HS data, sociodemographic data and obstetric history were collected prospectively and an educational guide on HS during pregnancy and postpartum period was offered. The second was a cross-section performed with 131 women in the immediate puerperium, with body bioimpedance (BIA) and skin folds, body mass index, abdominal and hip circumference, and sagittal abdominal measurements. weight retention and practice of physical exercise, as well as the knowledge of puerperal women about HS during pregnancy. A systematic review was also carried out with the key words "postpartum period" and "body composition" in the PubMed, MEDLINE, Web of Science and SciELO databases, with studies published between 2007-2017 in the English language and evaluating the maternal body composition up to 10 years after childbirth. Results: The mean age of the women in the first study was 28.7 ± 6.23 years, 85% of whom were married and 68% were multiparous. The mean body mass index (BMI) before gestation was 25.4 ± 9.8 kg / m². Only 61% had received prior information about GFR during prenatal care and knew how many pounds they should gain during pregnancy. Most (85%) knew they did not have to "eat for two" and 99% knew that EF had benefits for their body and was safe for their baby. Half of the women practiced EF prior to pregnancy, but only 31% continued to practice during pregnancy. In the second study the mean age of women was 27.63 ± 5.68 years, schooling 11.03 ± 3.44 years of study. Regarding the nutritional status of puerperal women, the mean pre-gestational weight was 68.63 ± 15.42 kg, pre-gestational BMI 26.34 ± 5.85 kg / m² and weight at the last visit 79.77 ± 14.33 kg, BMI at the last prenatal visit 30.62 ± 5.42 kg / m², mean total weight gain at gestation 11.14 ± 6.49 kg, weight and BMI in the immediate puerperium respectively, 77.82 ± 14.36 kg and 29.94 ± 5.45 kg / m². The mean postpartum weight retention was 9.13 ± 6.82 kg. In the systematic review, 19 articles were included, of which 9 were included in the meta-analysis. The women presented a significant reduction in BMI up to 6 months and 6 months after delivery in relation to pre-gestational weight. (G1 = -0.89 kg / m2 and G2 = -0.56 kg / m2, p <0.01, body weight: G1 = -2.71 kg and G2 = -1.61 kg, p <0.01) . Regarding the body composition evaluated from the percentage of fat, there was no change during the first six months in relation to the percentage of pre-gestational fat (MD -0.67, CI -1.46, +0.12, p = 0.1). (MD -2.05, CI -2.35, -1.74, p <0.01). The results of this study are presented in Table 2. Conclusions: Despite understanding the need for HS during pregnancy, women still need the incentive to practice PE during this period. Most women began overweight pregnancy and immediately postpartum had obesity criteria according to BIA and BMI. Different methods can be used to evaluate body composition; there is a sustained reduction in body weight and BMI in the years following childbirth. However, for fat percentage, this effect is only significant 6 months after childbirth. Appropriate strategies with the introduction of healthy habits in pregnancy and in the puerperium may be the key for women to avoid excessive gain in pregnancy and postpartum weight retention and thus reduce the risk of obesity-related diseasesDoutoradoSaúde Materna e PerinatalDoutora em Ciências da SaúdeCAPE

Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: A case-control study

OBJECTIVES: The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. METHODS: We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. RESULTS: Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. CONCLUSIONS: Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age

5to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

El V Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2019, realizado del 6 al 8 de febrero de 2019 y organizado por la Universidad Politécnica Salesiana, ofreció a la comunidad académica nacional e internacional una plataforma de comunicación unificada, dirigida a cubrir los problemas teóricos y prácticos de mayor impacto en la sociedad moderna desde la ingeniería. En esta edición, dedicada a los 25 años de vida de la UPS, los ejes temáticos estuvieron relacionados con la aplicación de la ciencia, el desarrollo tecnológico y la innovación en cinco pilares fundamentales de nuestra sociedad: la industria, la movilidad, la sostenibilidad ambiental, la información y las telecomunicaciones. El comité científico estuvo conformado formado por 48 investigadores procedentes de diez países: España, Reino Unido, Italia, Bélgica, México, Venezuela, Colombia, Brasil, Estados Unidos y Ecuador. Fueron recibidas un centenar de contribuciones, de las cuales 39 fueron aprobadas en forma de ponencias y 15 en formato poster. Estas contribuciones fueron presentadas de forma oral ante toda la comunidad académica que se dio cita en el Congreso, quienes desde el aula magna, el auditorio y la sala de usos múltiples de la Universidad Politécnica Salesiana, cumplieron respetuosamente la responsabilidad de representar a toda la sociedad en la revisión, aceptación y validación del conocimiento nuevo que fue presentado en cada exposición por los investigadores. Paralelo a las sesiones técnicas, el Congreso contó con espacios de presentación de posters científicos y cinco workshops en temáticas de vanguardia que cautivaron la atención de nuestros docentes y estudiantes. También en el marco del evento se impartieron un total de ocho conferencias magistrales en temas tan actuales como la gestión del conocimiento en la universidad-ecosistema, los retos y oportunidades de la industria 4.0, los avances de la investigación básica y aplicada en mecatrónica para el estudio de robots de nueva generación, la optimización en ingeniería con técnicas multi-objetivo, el desarrollo de las redes avanzadas en Latinoamérica y los mundos, la contaminación del aire debido al tránsito vehicular, el radón y los riesgos que representa este gas radiactivo para la salud humana, entre otros

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

The misleading choice for safer births in Brazilian's most developed region: a cross-sectional study

Purpose: To analyze the Cesarean Section (CS) rate in Brazilian women according to category of health insurance and individual characteristics associated with the mode of delivery. Materials and methods: A cross-sectional study was performed in three maternity services (one public tertiary referral center, one maternity service for both public and private care, and one private maternity service) in Campinas city, Brazil. Eligibility criteria were: inpatient during the immediate postpartum period, hospital birth, single pregnancy, and live newborn. Sociodemographic and anthropometric data, reproductive history, pregnancy planning, and prenatal care information was obtained from participants. Comorbidities, type of birth, and newborn data were collected from medical records. The mode of delivery was categorized as either CS or vaginal delivery. Results: A total of 1276 women were included in this study. The overall CS rate was 57.5%. CS rates were 41.6, 54.8, and 90.1% for public, mixed (public and private), and private maternity services, respectively. Mean age was higher in women who had a CS (28.0 +/- 6.0 years versus 25.9 +/- 6.5 years, p < .0001) as was the mean Body Mass Index (25.2 +/- 5.3 kg/m(2) versus 23.8 +/- 4.5 kg/m(2), p < .0001). CS was related to higher education, employment, white skin color, planned pregnancy, antenatal care in a private service, and primiparity. Conclusions: The overall CS rate was high (greater than 50%); in the private service, almost all participants had a CS delivery (90.1%). Better socioeconomic conditions and primiparity were associated with higher CS rates in Brazil. Political pressure for the management of unnecessary CSs is vital in Brazil. Together with the provision of real incentives for normal deliveries in public and, most importantly, private services.32571872

Colocando conhecimento em prática: o desafio de adquirir hábitos saudáveis durante a gravidez

Objective: The aim of this study was to investigate the knowledge concerning gestational weight gain (GWG), nutrition, and physical exercise (PE) in pregnant women, and how to put them into practice. Methods: A cross-sectional study with 61 pregnant women above 26 weeks of gestation, at the Woman's Hospital, CAISM, University of Campinas. Questionnaires regarding the knowledge of healthy habits (HH) during pregnancy, sociodemographic data, and previous obstetric outcomes were applied. An educational guide with advice on HH during pregnancy and in the postpartum period was offered. Results: The average age of women was 28.7 +/- 6.23 years, with 85% of them being married; 32% nulliparous; the average body mass index (BMI) before pregnancy was 25.4 +/- 9.8 kg/m(2), and the mean number of years of schooling was 11.2 +/- 3.8. Only 61% of the subjects had received any previous information about GWG during their antenatal care and were aware as to how many pounds they should gain during pregnancy. Among the 61 women, 85% understood that they did not need to "eat for 2" and 99% knew that PE had benefits for their body and was safe for their baby. Half of the women practiced PE prior to pregnancy; however, only 31% continued the practice of PE during the pregnancy. Conclusion: Despite understanding the need for HH during pregnancy, women still need encouragement to practice PE during pregnancy, as well as more information about GWG.418469475Objetivo: O objetivo deste estudo foi investigar os conhecimentos sobre ganho de peso gestacional (GPG), nutrição, e exercício físico (EF) em gestantes e o quanto elas os colocam em prática. Métodos: Estudo transversal realizado no Hospital da Mulher, CAISM, Unicamp, com 61 gestantes acima das 26 semanas gestacionais. Questionários sobre conhecimento de hábitos saudáveis (HS) durante a gestação, dados sociodemográficos, e antecedentes obstétricos foram aplicados. Um guia educacional com conselhos sobre HS durante a gravidez e período pós-parto foi oferecido. Resultados: A idade média das mulheres foi de 28,7 ± 6,23 anos, sendo 85% casadas, 32% nulíparas, o índice de massa corporal (IMC) médio antes da gestação foi de 25,4 ± 9,8 kg/m2, e a média de anos de escolaridade foi de 11,2 ± 3,8. Apenas 61% das mulheres entrevistadas haviam recebido informações prévias sobre o GPG durante o pré-natal e sabiam quantos quilos deveriam ganhar durante a gravidez. Entre as mulheres, 85% sabiam que não precisavam “comer por dois,” e 99% sabiam que o EF tinha benefícios para seu corpo e era seguro para seu bebê. Metade das mulheres praticava EF antes da gravidez, mas apenas 31% continuaram praticando durante a gravidez. Conclusão: Apesar de compreender a necessidade de HS durante a gravidez, as mulheres ainda precisam de incentivo para praticar EF durante a gravidez, bem como mais informações sobre o GPG

Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: A case-control study

OBJECTIVES: The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. METHODS: We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. RESULTS: Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. CONCLUSIONS: Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age