Avaliação do impacto da suplementação alimentar a gestantes no cotrole do baixo peso ao nascer no município de São Paulo, SP (Brasil)

A partir de estudo realizado em oito grandes maternidades do Município de São Paulo, SP (Brasil) que atendem clientela predominantemente de baixo nível sócio-econômico, objetivou-se analisar o impacto da suplementação alimentar durante a assistência pré-natal sobre a incidência de recém-nascidos de baixo peso ao nascer (peso < 2.500 g). Foram envolvidos no estudo 1.060 recém-nascidos de mães que receberam suplementação e 664 recém-nascidos de mães que não a receberam. Ã incidência de baixo peso ao nascer foi de cerca de 11%, considerada elevada e semelhante em ambos os grupos de recém-nascidos. A análise multivariada, realizada para controlar eventuais diferenças entre os grupos, que não a condição de suplementação, descartou qualquer associação significativa entre suplementação e peso ao nascer e revelou, por outro lado, que tabagismo e morbidade na gestação e determinadas características antropométricas e reprodutivas da mãe, prévias à gestação, são importantes fatores de risco para o baixo peso ao nascer. A aparente explicação para a ausência de impacto da suplementação alimentar na população estudada parece residir não na quantidade insuficiente da suplementação alimentar oferecida (370 Kcal/dia), mas no predomínio de fatores não alimentares na determinação do baixo peso ao nascer. São formuladas recomendações quanto ao controle do baixo peso ao nascer no contexto estudado

Evaluation of echocardiography and cardiac biomarker concentrations in dogs with gastric dilatation volvulus

Objective To assess abnormalities in concentrations of cardiac troponin I (cTnI), lactate, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in relation to arrhythmias, echocardiographic measurements, and survival in dogs with gastric dilatation volvulus (GDV). Design Prospective observational study. Setting University hospital. Animals Twenty-two dogs with naturally occurring GDV. Samples Concentrations of cTnI, plasma lactate, and NT-proBNP were recorded at presentation to the emergency room, the time closest to echocardiography, and the highest recorded concentrations during hospitalization. Interventions None. Measurements and Main Results Cardiac rhythms were categorized on a 0–4 scale (0 = no ventricular premature complexes [VPCs], 1 = single VPCs, 2 = bigeminy or trigeminy, 3 = couplets or triplets, and 4 = R-on-T phenomenon or ventricular tachycardia). Echocardiography was performed 6–18 hours postoperatively. Fifteen dogs had ventricular arrhythmias during hospitalization (Grade 1 [n = 9], Grade 4 [n = 6]). The highest recorded cTnI concentration was significantly higher in the dogs with Grade 4 (P = 0.002) or Grade 1 (P = 0.001) arrhythmias compared to dogs without arrhythmias. Plasma lactate was significantly correlated with left ventricular internal diameter in diastole (r = −0.52, P = 0.01) and systole (r = −0.57, P = 0.006), left ventricular free wall in diastole (LWDd, r = 0.59, P = 0.004), and interventricular septal thickness in diastole (IVDs, r = 0.65, P = 0.001). Dogs that did not survive to 1 week postdischarge (3/22) had a significantly thicker LVWd (P = 0.04) and IVSd (P = 0.05), and received significantly less fluids in the first 24 (P = 0.02) and 48 hours (P = 0.03) of hospitalization. Conclusions Concentrations of cTnI and NT-proBNP increased during hospitalization, but only cTnI concentrations were significantly higher in dogs with a higher arrhythmia grade. Additional research on the potential role of serial measurement of biomarkers in dogs with GDV is warranted

Effect of antenatal dietary interventions in maternal obesity on pregnancy weight-gain and birthweight: Healthy Mums and Babies (HUMBA) randomized trial

Background: Pregnancy interventions that improve maternal and infant outcomes are urgently needed in populations with high rates of obesity. We undertook the Healthy Mums and Babies (HUMBA) randomized controlled trial to assess the effect of dietary interventions and or probiotics in a multiethnic population of pregnant women with obesity, living in an area of high deprivation. Objectives: To determine whether a culturally tailored dietary intervention and or daily probiotic capsules in pregnant women with obesity reduces the co-primary outcomes of (1) excessive gestational weight gain (mean >0.27 kg/week) and (2) birthweight. Study Design: We conducted a 2 × 2 factorial, randomized controlled trial in women without diabetes at pregnancy booking, body mass index ≥30 kg/m2, and a singleton pregnancy. At 12+0 to 17+6 weeks' gestation, eligible women were randomized to a dietary intervention (4 tailored educational sessions at ≤28 weeks' gestation by a community health worker trained in key aspects of pregnancy nutrition plus text messaging until birth) or to routine dietary advice; and to daily capsules containing either (Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12, minimum 6.5 × 109 colony forming units), or placebo, until birth. Analysis was by intention to treat with adjustment for maternal baseline body mass index. Infant outcomes were additionally adjusted for ethnicity, sex, and gestational age at birth. Results: In total, 230 women were recruited between April 2015 and June 2017 (dietary intervention N = 116 vs routine dietary advice N = 114; probiotics N = 115 vs placebo N = 115). Baseline characteristics and demographic variables were similar across all groups. There was no significant difference between intervention groups, for the co-primary outcomes of (1) proportion of women with excessive gestational weight gain (dietary intervention vs routine advice: 79/107 [73.8%] vs 90/110 [81.8%], adjusted relative risk [relative risk, 0.92; 95% confidence interval, 0.80-1.05]; probiotics versus placebo: 89/108 [82.4%] and 80/109 [73.4%], relative risk, 1.14, 95% confidence interval, 0.99-1.31) or (2) birthweight (dietary intervention vs routine advice: 3575 vs 3612 g, adjusted mean difference, -24 g, 95% confidence interval, -146 to 97; probiotics vs placebo: 3685 vs 3504 g, adjusted mean difference, 107 g, 95% confidence interval, -14 to 228). Total maternal weight gain, a secondary outcome, was lower with dietary intervention compared with routine dietary advice (9.7 vs 11.4 kg, adjusted mean difference, -1.76, 95% confidence interval, -3.55 to 0.03). There were no significant differences between intervention groups in other secondary maternal or neonatal outcomes. Conclusion: Although dietary education and or probiotics did not alter rates of excessive gestational weight gain or birthweight in this multiethnic, high-deprivation population of pregnant women with obesity, dietary education was associated with a modest reduction in total weight gain with potential future benefit for the health of mothers and their offspring if sustained.Karaponi A.M. Okesene-Gafa, Minglan Li, Christopher J.D. McKinlay, Rennae S. Taylor, Elaine C. Rush, Clare R. Wall, Jess Wilson, Rinki Murphy, Rachael Taylor, John M.D. Thompson, Caroline A. Crowther, Lesley M.E. McCowa