Efficacy of regular exercise during pregnancy on the prevention of postpartum depression: The PAMELA randomized clinical trial

Importance Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited. Objective To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression. Design, Setting, and Participants This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018. Interventions Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week. Main Outcomes and Measures Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained). Results A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, −0.6; 95% CI, −1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis. Conclusions and Relevance Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken

Efficacy of regular exercise during pregnancy on the prevention of postpartum depression: The PAMELA randomized clinical trial

Importance Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited. Objective To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression. Design, Setting, and Participants This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018. Interventions Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week. Main Outcomes and Measures Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained). Results A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, −0.6; 95% CI, −1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis. Conclusions and Relevance Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken

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Amino acid requirements can be studied maintaining or not the ratio of the amino acids to lysine and changing or not dietary crude protein level. A third alternative was studied in this study conducted to evaluate broiler performance and weight gain of carcass parts, in response to increasing dietary digestible lysine (dig Lys) levels (0.70, 0.80, 0.90, 1.00, 1.055, 1.11, 1.165, and 1.22%). Two basal diets were formulated to contain 19.0% (diet A) and 20.5% (diet B) crude protein, and Met, Arg and Thr levels were formulated to maintain their ideal ratio to Lys. Three hundred and twenty CobbXCobb500 broilers, from 19 to 40 days of age, were used. Basal diet A was set for the 4 lowest levels of dig Lys, and diet B for the other four levels. Body weight (BW), weight gain (WG), feed intake, Lys intake, feed conversion (FC), carcass part weights and carcass, breast, leg, and thigh protein and fat were evaluated. Body weight, WG and Lys intake linearly increased with increasing dietary dig Lys, independently of basal diet CP content. A multiple regression effect was observed for FC, with the best estimated levels of dig Lys of 0.96% and 1.18% for diet A and B, respectively. Breast and carcass weight gain and breast protein and water gain showed multiple regression and split curves as a function of basal diet. The best responses were obtained with the highest crude protein level in the basal diet. Therefore, we concluded that high levels of crude protein in basal diets are recommended to study amino acid requirements for broilers

Effect of different dietary concentrations of Amino Acids on the performance of two different Broiler Strains

Four Nutritional Programs (NP) used in the Brazilian poultry industry were tested in two broiler strains (Cobb 500 and Ross 308). NP varied in the concentrations of their main essential amino acids (AA) and were classified as Low, Regular, High and Mixed (high AA concentrations up to 21 days and regular concentrations after that). Minimum digestible Met+Cys/Lys, Thr/Lys, Arg/Lys, Ile/Lys, and Val/Lys ratios were 0.74, 0.64, 1.05, 0.65 and 0.75, respectively, in all NP, and no minimum amount of CP was fixed. There were no interactions between strain and NP for any of the evaluated responses. From 1 to 47 days of age, birds fed the Low NP presented lower average body weight and body weight gain (BWG). The high NP allowed for better feed conversion ratio (FCR), followed by the Regular and the Mixed NP. Ross 308 broilers were heavier, presenting worse FCR due to higher FI. Birds fed the High NP had lower carcass yield than those fed the Low NP. The Low and Regular NP had lower costs per WG when compared with the High NP. Low and Regular NP presented higher gross margin returns compared with the High NP. The Regular and Mixed NP are the most recommended, presenting intermediate performance and higher economic returns

The impact of organic and inorganic selenium on the immune system of growing broilers submitted to immune stimulation and heat stress

One to 42-d-old (432) female broilers were fed different levels of inorganic selenium (ISe) and organic selenium (OSe), according to the following treatments: (1) 0.3 mg ISe; (2) 0.3 mg ISe + 0.2 mg OSe; (3) 0.5 mg ISe and (4) 0.3 mg OSe/ kg of feed. All birds were vaccinated against infectious bursal disease (IBD) at 19d of age and three birds/replicate (R) were inoculated with sheep red blood cells (SRBC) at 32d. Three other birds/R received Freund's adjuvant at 37d and avian tuberculin (AT) in the wattle at 47d of age. All birds were submitted to heat stress after 21d. Performance parameters, bursa and spleen weights, lymphocyte bursa depletion, antibody (Ab) production against IBD and SRBC, hematocrit, leukocytes, heterophil/lymphocyte ratio (H/L), and cellular reaction to AT were evaluated. The contrast analysis showed that OSe has improved feed intake (FI) between day 1 and 42 (p<0.10). Birds fed ISe presented worse H/L ratio (p<0.10), but higher Ab titers against IBD (p<0.04) and SRBC (p<0.05) than birds fed OSe, but OSe supplemented birds showed lower lymphocyte depletion scores in the bursa. The higher FI promoted by OSe may be beneficial when rearing broilers in hot weather. The use of ISe induced higher humoral immune respons