Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial

BackgroundHealthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM.AimsThis unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care.MethodsPopulation: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada’s Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10–14, 24–26, and 34–36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval.DiscussionThis RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT05299502, NCT0529950

Comportements alimentaires et alimentation intuitive durant la grossesseh[ressource électronique] : association avec le gain de poids gestationnel

La grossesse est reconnue comme une période déterminante dans la vie d’une femme durant laquelle de nombreux changements physiologiques et métaboliques se produisent. La prise pondérale représente l’un des changements les plus importants. En Amérique du Nord, une majorité de femmes gagnent du poids en dehors des intervalles recommandés, ce qui peut avoir des impacts négatifs sur la santé de la mère et de l’enfant à naître. Le gain de poids gestationnel représente une problématique complexe et multifactorielle qui demeure partiellement comprise. De nombreux facteurs biologiques, psychosociaux et alimentaires influencent la prise pondérale de la femme enceinte. Notamment, les comportements et attitudes envers l’alimentation peuvent avoir un impact non négligeable sur cette prise pondérale. Cependant, jusqu’à présent, aucune étude n’a évalué de façon prospective les comportements alimentaires durant la grossesse en association avec la prise pondérale. Ainsi, l’objectif général du présent mémoire est d’examiner l’association auprès des femmes enceintes entre les comportements alimentaires, dont l’alimentation intuitive, et le gain de poids gestationnel. Les principaux résultats de ce mémoire démontrent que la plupart des comportements alimentaires demeurent stables durant la grossesse et que l’alimentation intuitive représente une approche prometteuse pour promouvoir une prise pondérale saine. Les travaux de cette maîtrise contribueront à enrichir la littérature sur les multiples facteurs contribuant au gain de poids durant la grossesse. Éventuellement, l’identification précise de ces éléments permettra la création d’études d’interventions qui aideront l’optimisation du gain de poids gestationnel.Pregnancy has long been recognized as a decisive period in a woman’s life where numerous physiological and metabolic changes occur. Weight gain represents one of the most important changes. In North America, most women gain weight outside of the recommended range, which can impact both the mother and child health. Gestational weight gain represents a complex and multifactorial problem, which is still only partially understood. Numerous physiological, psychosocial and dietary factors influence the weight gained during the course of pregnancy. In particular, behaviours and attitudes toward diet can have a substantial impact on weight gain. Up to now, no study has prospectively evaluated eating behaviours in association with weight gain during pregnancy. Hence, the general aim of this study is to examine the association between eating behaviours, which include intuitive eating, and gestational weight gain during pregnancy. The main results show that most eating behaviours remained stable over the course of pregnancy and that intuitive eating may represent a promising approach to promote healthy weight gain. This master’s thesis contributes to the existing literature on the multiple factors associated with gestational weight gain. Eventually, the precise identification of all these elements will help elaborate intervention studies designed to optimize gestational weight gain

Description des médicaments utilisés pour induire et maintenir une sédation palliative au CHU de Québec–Université Laval et à la Maison Michel-Sarrazin

Objectifs : Le premier objectif est de décrire les médicaments utilisés pour induire et maintenir une sédation palliative chez des patients hospitalisés au Centre hospitalier universitaire de Québec–Université Laval et à la Maison Michel-Sarrazin. Le deuxième objectif est de détailler les doses sédatives employées selon les doses reçues avant la sédation et certaines caractéristiques des patients. Méthode : Il s’agit d’une étude descriptive longitudinale et rétrospective menée chez 154 patients ayant reçu une sédation palliative entre le 10 décembre 2015 et le 30 septembre 2017. Résultats : En moyenne, la durée de la sédation palliative était de 38,5 ± 35,6 heures. Les sédatifs les plus utilisés étaient le midazolam (79,2 %) et la méthotriméprazine (76,6 %). Les doses moyennes (mg/24 heures) au décès étaient supérieures aux doses initiales, tant pour les benzodiazépines (87,0 vs 44,8 en équivalent de midazolam) que pour la méthotriméprazine (134,1 vs 98,5). L’augmentation était statistiquement significative dès les 24 premières heures, où plus de 50 % des patients ont eu besoin minimalement d’un changement de dose. Le sous-groupe présédation en équivalent de midazolam inférieur à 7,5 mg/24 heures a subi la hausse la plus marquée. L’utilisation de doses présédation égales ou supérieures à 30 mg/24 heures en équivalent de midazolam entraînait significativement des doses de benzodiazépines supérieures au moment du décès. Les patients de moins de 75 ans avaient besoin de doses plus élevées tandis que ceux atteints d’un cancer recevaient plus de sédatifs. Conclusion : Une optimisation des doses sédatives initiales semble indiquée, mais il faut envisager l’influence de certains facteurs (âge, dose sédative présédation). Un outil guidant la prescription, qui comprend une échelle d’évaluation de l’efficacité, s’avère essentiel. Abstract Objective: The primary objective is to describe the drugs used to induce and maintain palliative sedation in patients hospitalized at the Centre hospitalier universitaire de Québec−Université Laval and at the Maison Michel-Sarrazin. The secondary objective is to detail the sedative doses used according to the doses received before sedation and certain patient characteristics. Method: This was a longitudinal, retrospective, descriptive study of 154 patients who received palliative sedation between December 10, 2015 and September 30, 2017. Results: On average, the duration of palliative sedation was 38.5 ± 35.6 hours. The most commonly used sedatives were midazolam (79.2%) and methotrimeprazine (76.6%). The mean doses (mg/24 hours) at the time of death were higher than the initial doses for both benzodiazepines (87.0 vs. 44.8 in midazolam equivalent) and methotrimeprazine (134.1 vs. 98.5). The increase was statistically significant as early as the first 24 hours, when more than 50% of the patients required at least one dose change. The subgroup with presedation in midazolam equivalent less than 7.5 mg/24 hours had the largest increase. The use of presedation doses greater than or equal to 30 mg/24 hours in midazolam equivalent resulted in significantly higher benzodiazepine doses at the time of death. Patients under 75 years of age required higher doses, while those with cancer received more sedatives. Conclusion: Optimizing initial sedative doses appears to be indicated, but the influence of certain factors (age, presedation sedative dose) should be considered. A prescribing guidance tool that includes an efficacy rating scale is essential

Longitudinal changes in circulating concentrations of inflammatory markers throughout pregnancy: are there associations with diet and weight status?

The natural inflammation occurring during pregnancy can, under certain conditions, be associated with adverse pregnancy outcomes. This study aimed to: 1) quantify changes in circulating concentrations of leptin, adiponectin, interleukin-6 (IL-6) and C-reactive protein (CRP) across trimesters of pregnancy, according to pre-pregnancy body mass index (ppBMI); and 2) examine the trimester-specific associations between the inflammatory markers’ concentrations, a Mediterranean diet score (MDS) and the dietary inflammatory index (DII). We measured leptin, adiponectin and IL-6 by ELISA, and CRP by high-sensitivity immunonephelometry, in blood samples from 79 pregnant women (age: 32.1 3.7 years; ppBMI: 25.7 5.8 kg/m2). Three web-based 24h recalls were completed at each trimester and used to compute the MDS and the DII. CRP concentrations remained stable across trimesters, whereas concentrations of leptin and IL-6 increased, and adiponectin concentrations decreased (pThe accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Trimester-Specific Serum Fructosamine in Association with Abdominal Adiposity, Insulin Resistance, and Inflammation in Healthy Pregnant Individuals

This study aimed to (1) characterize the variations in serum fructosamine across trimesters and according to pre-pregnancy BMI (ppBMI), and (2) examine associations between fructosamine and adiposity/metabolic markers (ppBMI, first-trimester adiposity, leptin, glucose homeostasis, and inflammation measurements) during pregnancy. Serum fructosamine, albumin, fasting glucose and insulin, leptin, adiponectin, interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations were measured at each trimester. In the first trimester, subcutaneous (SAT) and visceral (VAT) adipose tissue thicknesses were estimated by ultrasound. In the 101 healthy pregnant individuals included (age: 32.2 ± 3.5 y.o.; ppBMI: 25.5 ± 5.5 kg/m2), fructosamine concentrations decreased during pregnancy whereas albumin-corrected fructosamine concentrations increased (p p p p p < 0.05 for both). In conclusion, serum fructosamine is inversely associated with adiposity before and during pregnancy, with markers of glucose homeostasis and inflammation, but the latter associations are partially influenced by albumin concentrations and ppBMI

First-trimester diet quality in association with maternal subcutaneous and visceral adipose tissue thicknesses and glucose homeostasis during pregnancy

We aimed to characterise the associations between first-trimester diet quality, adiposity, and glucose homeostasis measurements throughout pregnancy in a sample of 104 healthy pregnant women. Three Web-based 24-h recalls were completed, from which the Alternate Healthy Eating Index (AHEI) was calculated. At each trimester (12.5 ± 0.7, 22.8 ± 1.0, and 33.6 ± 1.3 weeks of gestation), fasting glucose and insulin were measured to compute an insulin resistance index (HOMA-IR). Subcutaneous and visceral adipose tissue thicknesses were estimated by ultrasound at the end of the first trimester. Inverse associations were observed between the first-trimester AHEI and first-trimester fasting insulin (r = 0.24; p r = −0.22; p r = −0.20; p r = −0.17; p < 0.1). Pre- and early-pregnancy adiposity measurements were identified as high predictors fasting insulin concentrations throughout pregnancy. Higher early-pregnancy diet quality is associated with more favourable metabolic measurements during pregnancy.</p

The Potential Impacts of Urban and Transit Planning Scenarios for 2031 on Car Use and Active Transportation in a Metropolitan Area

Land use and transportation scenarios can help evaluate the potential impacts of urban compact or transit-oriented development (TOD). Future scenarios have been based on hypothetical developments or strategic planning but both have rarely been compared. We developed scenarios for an entire metropolitan area (Montreal, Canada) based on current strategic planning documents and contrasted their potential impacts on car use and active transportation with those of hypothetical scenarios. We collected and analyzed available urban planning documents and obtained key stakeholders&rsquo; appreciation of transportation projects on their likelihood of implementation. We allocated 2006&ndash;2031 population growth according to recent trends (Business As Usual, BAU) or alternative scenarios (current planning; all in TOD areas; all in central zone). A large-scale and representative Origin-Destination Household Travel Survey was used to measure travel behavior. To estimate distances travelled by mode, in 2031, we used a mode choice model and a simpler method based on the 2008 modal share across population strata. Compared to the BAU, the scenario that allocated all the new population in already dense areas and that also included numerous public transit projects (unlikely to be implemented in 2031), was associated with greatest impacts. Nonetheless such major changes had relatively minor impacts, inducing at most a 15% reduction in distances travel by car and a 28% increase in distances walked, compared to a BAU. Strategies that directly target the reduction of car use, not considered in the scenarios assessed, may be necessary to induce substantial changes in a metropolitan area