Gestational Diabetes and Metabolic Outcomes

Women with gestational diabetes mellitus (GDM) have increased weight and higher glucose levels during pregnancy and in the postpartum period compared to women without GDM. It is therefore recommended to prevent excess gestational weight gain (GWG) and also return to pre-pregnancy weight at 1-year postpartum. This is essential as higher postpartum weight retention (PPWR) at 1-year postpartum is a significant risk factor for long-term weight gain and the most important predictor of future diabetes in women with GDM. To tackle weight and subsequent metabolic health problems such as weight and glucose control in these women, there is a need to comprehend their risk and to investigate different lifestyle approaches. This thesis provides a better understanding of the novel concept of intuitive eating during and after pregnancy and its associations with metabolic health. It also investigates the predictors and consequences of PPWR in a cohort of women with GDM. This thesis utilized data from the Lausanne University Hospital (CHUV) GDM longitudinal cohort. We assessed the cross-sectional and longitudinal associations between intuitive eating and metabolic health outcomes during pregnancy and in the postpartum period in women with GDM. We also investigated the predictors and consequences of weight retention in this cohort. The cross-sectional analysis showed that intuitive eating during and after pregnancy was significantly associated with metabolic health outcomes, both with weight and with glucose control. The longitudinal analyses revealed that intuitive eating during pregnancy was also related to later metabolic health outcomes, at the end of pregnancy, but also in the early (6-8 weeks) and late (1-year) postpartum period. Regarding the predictors and consequences of PPWR, GWG predicted higher PPWR, both in the early and late postpartum period. Women with PPWR had worsened glucose control at 1 year postpartum that was not observed in the early postpartum period. These results suggest that intuitive eating could represent a novel approach to weight and glucose management in women with GDM. Our data regarding the consequences of PPWR also suggest that clinical care with a strong focus on lifestyle interventions in order to improve weight and glucose control should be essential up to the late postpartum

Maternal dietary diversity and pattern during pregnancy is associated with low infant birth weight in the Cape Coast metropolitan hospital, Ghana: A hospital based cross-sectional study

Background: This study investigated the associations between mother's dietary diversity score and dietary patterns during pregnancy and the odds of low birth weight at the Cape Coast Metropolitan Hospital in Ghana. Methods: Mothers attending the postnatal clinic from January to August 2016 at the Cape Coast Metropolitan Hospital were included. Dietary information during pregnancy was assessed with a food frequency questionnaire. In reference to the women's dietary diversity score, women were categorized into low, medium or high dietary diversity score groups. The primary outcome was low birth weight and was defined as weight <2500 g at birth. Factor analysis was conducted to identify maternal dietary patterns and a multivariable logistic regression analysis was used to determine the associations between dietary diversity score and dietary patterns with low birth weight. Results: The prevalence of low birth weight in infants was 43.8% (95% CI = 39%–49%). After adjusting for covariates, the odds of low birth weight was four times higher in the low dietary diversity score group compared to the high dietary diversity score group (odds ratio [OR] = 4.29, 95% confidence interval [CI], 1.24–6.48). Three dietary patterns namely "Western", “Traditional” and "Healthy", which explained 58.23% of the total variance in food intake were identified. The subjects in the highest quartiles of “healthy” and “traditional” dietary pattern scores had significantly lower odds of low birth weight (healthy: OR = 0.23, 95% CI, 0.19–0.39, P trend <0.0001; traditional: OR = 0.14, 95% CI, 0.06–0.35, P trend <0.0001, respectively) compared to those in the lowest quartiles of dietary pattern score. Conclusion: Low dietary diversity score during pregnancy was associated with higher odds of infant low birth weight whereas dietary patterns considered as “healthy” and “traditional” during pregnancy were associated with lower odds of infant low birth weight. Findings of this study suggests that higher dietary diversity and “healthy” and “traditional” dietary patterns during pregnancy may be protective of LBW in the study area

Prevalence and knowledge of hypertension among people living in rural communities in Ghana: a mixed method study

Background: Knowledge and understanding of hypertension and its associated health risks remain inadequate despite increasing trend of hypertension prevalence. This study was conducted to assess the prevalence, knowledge and perceptions of hypertension in rural communities in Ghana.Methods: A mixed method study involving 534 subjects was employed. Data was collected in six communities from May to December 2014 with structured questionnaires and interview guides. A logistic regression analysis was conducted to estimate the influence of the socio-demographic factors on knowledge of hypertension. Qualitative data was thematically analyzed.Results: The mean systolic blood pressure (BP) was higher in men than women (127.42mmHg versus 124.42mmHg). The proportion of hypertensives was 21.4% and was higher among men in all age categories. Knowledge on some risk factors of hypertension was extremely low. Having formal education was associated with higher odds of knowledge of hypertension (Adjusted odds ratio [AOR]; 95% confidence interval [CI]=2.28; 1.25-4.16). Several misconceptions such as the use of agro-chemicals, fertilizers and excess vitamins  were identified as causes of hypertension.Conclusion: This study demonstrates an increased prevalence of hypertension, knowledge gaps and misconceptions surrounding hypertension in rural communities in Ghana. This evidence is useful in streamlining interventional programmes aimed at improving knowledge and prevention of hypertension.Keywords: Hypertension, knowledge, prevalence, rural communities, Ghana, blood pressure

Prevalence and knowledge of hypertension among people living in rural communities in Ghana: a mixed method study

Background: Knowledge and understanding of hypertension and its associated health risks remain inadequate despite increasing trend of hypertension prevalence. This study was conducted to assess the prevalence, knowledge and perceptions of hypertension in rural communities in Ghana. Methods: A mixed method study involving 534 subjects was employed. Data was collected in six communities from May to December 2014 with structured questionnaires and interview guides. A logistic regression analysis was conducted to estimate the influence of the socio-demographic factors on knowledge of hypertension. Qualitative data was thematically analyzed. Results: The mean systolic blood pressure (BP) was higher in men than women (127.42mmHg versus 124.42mmHg). The proportion of hypertensives was 21.4% and was higher among men in all age categories. Knowledge on some risk factors of hypertension was extremely low. Having formal education was associated with higher odds of knowledge of hypertension (Adjusted odds ratio [AOR]; 95% confidence interval [CI]=2.28; 1.25-4.16). Several misconceptions such as the use of agro-chemicals, fertilizers and excess vitamins were identified as causes of hypertension. Conclusion: This study demonstrates an increased prevalence of hypertension, knowledge gaps and misconceptions surrounding hypertension in rural communities in Ghana. This evidence is useful in streamlining interventional programmes aimed at improving knowledge and prevention of hypertension

Dietary Diversity Score during Pregnancy is Associated with Neonatal Low Apgar Score : A Hospital-Based Cross-Sectional Study

Background: Apgar score is an established index of neonatal well-being and development. Nutrition during pregnancy is an accepted risk factor for neonatal low Apgar score. Objective: To investigate the association between dietary diversity score and low Apgar score. Methods: This was a hospital based cross-sectional study. The study participants were 420 mothers who delivered and were attending the postnatal clinic at the Cape Coast Metropolitan Hospital. Mothers' dietary information during pregnancy was assessed with a food frequency questionnaire. In reference to the FAOs women's Dietary Diversity Score (DDS), the subjects were categorized into low, medium or high DDS. The primary outcome was Apgar score. Apgar scores <5 were classified as low. Results: The mean age (+/- standard deviation, SD) of subjects was 26.7 +/- 5.7 years with a range of 17 to 45 years. The prevalence of low Apgar score among the study population was 16.9%. Majority of the study participants had a low DDS in relation to low Apgar score whereas 7.5% had high DDS. After adjusting for potential confounding factors, the odds of low Apgar score in the low DDS group was three times higher than those who had high DDS (Adjusted odds ratio, AOR= 3.10, 95% confidence interval, CI=1.23-4.48). Conclusion: Dietary diversity score during pregnancy was associated with a low Apgar score in the study area. The results of this study reinforce the significance of adequate nutrition during pregnancy in the study area.Peer reviewe

Intuitive Eating Behavior, Diet Quality and Metabolic Health in the Postpartum in Women with Gestational Diabetes

Little is known regarding intuitive eating (IE), diet quality and adherence. We investigated the associations between IE, diet quality and metabolic health after gestational diabetes (GDM), who have an increased diabetes risk. Data from 179 women with GDM from MySweetheart trial (NCT02872974) were analyzed. IE was assessed using the eating for physical rather than emotional reasons (EPR) and reliance on hunger and satiety cues (RHSC) subscales of the French Intuitive Eating Scale-2. Metabolic outcomes included weight, central body fat and insulin resistance. Diet quality was calculated using the Alternative Health Eating Index (AHEI) and compliance with national recommendations was evaluated. Both IE subscales were associated with lower BMI and fat mass (BIA) at 1-year postpartum (all p &le; 0.034). The EPR subscale inversely correlated with fat mass (DXA) and visceral adipose tissue (both p &le; 0.028), whereas RHSC with higher insulin sensitivity (Matsuda, p = 0.034). RHSC during pregnancy predicted increased AHEI (p = 0.043) at 1-year postpartum, whilst EPR predicted lower fat mass and insulin resistance (HOMA-IR) (all p &le; 0.04). In longitudinal analyses, both subscales were associated with increased adherence to dairy and fiber intake recommendations (both p &le; 0.023). These data suggest IE may be an interesting approach to improve diet quality and metabolic outcomes in women with GDM

Effect of the MySweetheart randomized controlled trial on birth, anthropometric and psychobehavioral outcomes in offspring of women with GDM

IntroductionGestational diabetes mellitus (GDM) may negatively affect offspring outcomes. A lifestyle intervention may therefore not only improve maternal, but also offspring outcomes. The effects of lifestyle interventions on birth, anthropometric, and psychobehavioral outcomes in offspring of women with GDM need further evidence.DesignThe MySweetheart trial is a monocentric single-blind randomized controlled trial in 211 women with GDM. It tested the effect of a pre- and postpartum multidimensional interdisciplinary lifestyle and psychosocial intervention focusing on both the mothers and their infants and its effects on maternal (primary outcomes) and offspring (secondary outcomes) metabolic and psychobehavioral outcomes compared with guidelines-based usual-care. This paper focuses on offspring’s birth, anthropometric, and maternal report of psychobehavioral outcomes at singular timepoints.MethodsWomen with GDM aged ≥18 years, between 24-32 weeks of gestation, speaking French or English were included and randomly allocated to either the intervention or to an active guidelines-based usual-care group using a 1:1 allocation ratio. The intervention lasted from pregnancy until 1 year postpartum and focused on improving diet, physical activity, and mental health in the mother. For the offspring it focused on supporting breastfeeding, delaying the timing of introduction of solid foods, reducing the consumption of sweetened beverages, increasing physical activity of the family, and improving parental responsiveness to infant distress, hunger, satiety and sleeping cues, and difficult behavior.ResultsAdverse birth and neonatal outcomes rarely occurred overall. There were no differences between groups in offspring birth, neonatal, anthropometric, or psychobehavioral outcomes up to one year. After adjustments for maternal age and the offspring’s sex and age, there was a borderline significant between-group difference in birth length (β:-0.64, CI:-1.27; -0.01, p: 0.05), i.e., offspring of mothers in the intervention group were born 0.64 cm shorter compared to those in the usual-care group.ConclusionThis is the first pre- and postpartum multidimensional interdisciplinary lifestyle and psychosocial intervention in GDM focusing on both the mother and the offspring. It did not lead to a significant improvement in most birth, anthropometric, and psychobehavioral outcomes in offspring of women with GDM. ClinicalTrials.gov Identifier: NCT0289069

Integrating herbal medicine into mainstream healthcare in Ghana: clients’ acceptability, perceptions and disclosure of use

Abstract Background Although there are current efforts to integrate herbal medicine (HM) into mainstream healthcare in Ghana, there is paucity of empirical evidence on the acceptability and concurrent use of HM, in the formal health facilities in Ghana. This study sought to determine client perception, disclosure and acceptability of integrating herbal medicine in mainstream healthcare in Kumasi, Ghana. Methods A cross-sectional study was conducted from May to August, 2015. Five hundred patients presenting at the outpatient departments of Kumasi South, Suntreso and Tafo Government Hospitals in Kumasi were randomly selected. Interviews were conducted with the use of structured questionnaires. A logistic regression analysis, using backward selection, was conducted to determine the influence of socio-demographic and facility related factors on the odds of using HM at the facility. All statistical tests were two-sided and considered significant at a p-value of <0.05. Results Majority of the study respondents were females (64.8%) and the median age was 36 years. Less than half, 42.2%, of the respondents utilized HM services when they visited the health facility. Reasons for using HM at the facility level included ‘being effective’ (24.4%), ‘easy to access’ (25.3%) and ‘being comparatively cheaper’ (16%). About 86% never disclosed previous use of HM to their health care providers. Socio-economic status and perception of service provision influenced use of herbal medicines. Respondents who rated themselves wealthy had increased odds of using herbal medicines at the health facility as compared to those who rated themselves poor (OR = 4.9; 95%CI = 1.6–15.3). Conclusion This study shows that integration of herbal medicine is feasible and herbal medicines may be generally accepted as a formal source of healthcare in Ghana. The results of this study might serve as a basis for improvement and upscale of the herbal medicine integration programme in Ghana